International Journal of Impotence Research (2004) 16, 80–83 & 2004 Nature Publishing Group All rights reserved 0955-9930/04 $25.00 www.nature.com/ijir

Review of Impotence Natural remedies for impotence in medieval Persia

M Khaleghi Ghadiri1 and A Gorji1*

1Institut fu¨r Physiologie, Universita¨tMu¨nster, Robert-Koch-Strasse, Mu¨nster, Germany

Man’s preoccupation with potency, or the lack thereof, has been present through the ages. Several documents still exist from which the clinical approaches of erectile dysfunction (ED) in medieval Persia can be ascertained. The medieval physicians described definitions and apparent causes of ED. They also noted hygienic and dietary rules as well as long lists of natural substances used in the treatment of ED. Many of the approaches of practitioners in medieval Persia are accurate and accepted even today; however, still more of them could be of use to modern medicine. The present review provides an overview of the knowledge of ED at the time. International Journal of Impotence Research (2004) 16, 80–83. doi:10.1038/sj.ijir.3901153

Keywords: medieval literature; Persian history; erectile dysfunction; traditional medicine

Medieval Persian physicians are well informed 40–70 y at 152 million in 1995, and projected a about the medical traditions of different ancient more than two-fold increase by 2025, to approxi- civilizations. The Persians not only accumulated all mately 322 million men.9 Despite the progress that the existing information on medicine of the time, has taken place in recent years in the development but also added to this knowledge by their own of therapy, there is still a need for more effective ingenious studies based on their empirical find- drugs for the treatment of impotence. It is hoped that ings.1 These practitioners had brought great con- review of clinical approaches to ED used by tributions to pharmaceutical science. They physicians in medieval Persia will inform further categorized medicinal from Africa to research into the clinical benefits of those treat- and studied them in a scientific manner.2 The ments for impotence. medieval medical texts of Persia such as Qanoon- The terms ‘ghovehe baˆee’ and ‘ghovehe mojameat’ fel-teb (The Canon) by Ebn-e-Sina (980–1037), Raˆzi’s have traditionally been used to describe the ability (860–940) Ketab-al-hawi (Continents), and Zakhireh of the male to attain an erection adequate for Kharazmshahi by Esmail Jorjani (1042–1136) be- coitus.10–13 ED has been defined as the partial or came the most widely read literatures in medieval total inability to achieve or maintain an erection for Europe. During renaissance, medieval Persia had a satisfying sexual intercourse.9–12 Medieval Persian significant influence on the contemporary medicine; physicians described a large number of factors that this influence is still felt today.1–4 In recent years, have a negative impact on erectile ability. They some experimental studies have evaluated medieval mentioned that ED might be occurred as a conse- Persian natural therapies using modern scientific quence of a specific illness of penis, testis, and methods. These investigations raised the possibility seminal vessels, or as a cause of the involvement of of revival of traditional treatments.5–7 neighbouring organs such as rectum.10,11 Heart, Erectile dysfunction (ED) represents a highly liver, kidney, stomach, arteries, spinal cord, and prevalent social problem; approximately 5–20% of brain disorders were also known to result in ED. The the general mail population suffer from moderate- association between ED and psychological factors to-severe ED.8 The United Nations estimated the such as depression and rage was recognized by worldwide prevalence of ED among men aged medical clinicians in Persia.10,11,13 Sex with women who failed to rouse up the sexual desire in her mate was mentioned as a possible cause of ED (Figure 1). *Correspondence: A Gorji, Institut fu¨ r Physiologie, Besides the illnesses associated with ED, a number Universita¨tMu¨ nster, Robert-Koch-Strasse 27a, Mu¨ nster of medical interventions such as haemorrhoidect- D-48149, Germany. omy and medicaments like (Cinnamomum E-mail: [email protected] camphora), opium (Papaver somniferum), flea-wort Received 11 August 2003; accepted 5 October 2003 (Plantago psyllium), water-lily (Nymphaea alba), Impotence in medieval Persian medicine M Khaleghi Ghadiri and A Gorji 81 sex in water or bathroom, anxiety, depression, excessive water drinking, sex with fatigue, sex with women during menstruation, and sex with old women).10,11 As fully enjoying sex was believed to be impossible under psychological disorders, it was ordered that the patients suffering from depression or rage ’should not try to have sex until the psychological problems disappear’. Mild to moder- ate exercise, especially riding and swimming, was considered beneficial. Ebn-e-Sina wrote: ’when man is unable to have sex, first he should forget that, read the books contain sexual theme, listen to the experts y talk about erotic stories and watch animal intercourse until sexual arousal and power are appeared’.10 As medieval Persian practitioners believed that proper nutrition played an essential role in sexual activity, they placed special emphasis on and diet in their therapeutic management of ED. Physi- cians recommended abstinence from sour and acrid , (Carum carvi), lentil (Lens culinaris), sweet (Origanum majorana), and wild rue (Peganum narmala). Foods that were thought to help cure ED included almond (Amygdalus com- munis), cocoa-nut (Cocos nucifera), pistachio (Pis- tacia vera), date (Phoenix dactylifera), turnip (Brassica rapa), broad (Faba vulgaris), kidney bean (Phasaeolus vulgaris), pea (Cicer arietinum), Figure 1 Medieval practitioners in Persia believed that sex is a ( cepa), lentisk pistache (Pistachia physiologic expression and extension of love. Sex without love was considered as a factor that may induce sexual dysfunction. lenticus), honey, fish especially sturgeon, moray Many painters and poets described this theme in their works. eel, shark, skink, caviar, diary products, and birds’ ’The girl with her finger in her mouth, with the old man and the egg, especially sparrow and pigeon. Other foods falcon’ is one of these works. Painted by Hossain Behzad. suggested to have aphrodisiac properties were halim Reprinted with the permission of the Saad’abad cultural complex (a kind of dish with wheat groats and meat), lamb or and the Behzad Museum, Tehran, . birds brain, roast meat, kaleh-pacheh (sheep’s head), and pottage. The appropriate beverage included current juice, water from iron-mine’s fountain, and damask rose (Rosa damascena) were noted to juice, juice, camel milk, and fig cause impotence.10 Raˆzi13 laid special stress on the juice. Raˆzi believed that frequent consumption of effect of dress and bed on erectile function, and wine leading to ED.12 Wine, especially old type, was explained how this can induce ED. Malnutrition and also ordered by other practitioners to be avoided, asthenia were also mentioned as the other causes of and if imbibed, it should be fresh.10,11 ED.9 The humour theory of health and mood was a Medieval practitioners in Persia prescribed a long widely held belief in the medieval period. In this series of substances for the treatment of ED. They theory, all diseases result from irregular distribution emphasized the importance of the dose and defined of the four humours––Dam (blood), Balgham a schedule for drug administration. Drugs were (phlegm), Safra (yellow bile), and Sauda (black taken via oral or rectal routes, as well as through bile). Temperament can be viewed as the sum of the the skin of pelvic, genital, and lumbar areas. The proportions of each humour within the body. Both drugs listed in medieval Persian writings include Ebn-e-Sina and Esmail Jorjani noted that impotence and animal products (Table 1). The physi- was usually accompanied with dominating cold cians developed many substances that were sup- temperament, a temperament closely related to posed to have aphrodisiac properties. Some of these black bile humour.10,11 drugs such as dried fig mixed with turnip were also Medieval Persian medical literatures encouraged believed to have fertility-enhancing effects. Based the treatment of ED by tackling the conditions that on the underlying conditions, drug therapy plan was contribute to impotence, nutritional therapy, and individualized, given different single or combined prescription of medicaments. Patients were advised drug therapy in patients suffering from ED.10–13 that they must avoid anything that had a negative Among the medicinal herbs advised for treatment influence on sexual function (e.g., hunger, gluttony, of ED, Ebn-e-sina believed that the root of spotted- having sex immediately following lunch or dinner, orchis (Orchis maculata), terebinth (Pistacia tere-

International Journal of Impotence Research Impotence in medieval Persian medicine M Khaleghi Ghadiri and A Gorji 82 Table 1 Natural impotence remedies in medieval Persian medicine

Origin of drug Latin name Common name Administration

Plant-derived drug Acacia farnesiana Sweet acacia Oral, topical Acanthus mollis Branke ursine Oral Oral Melegueta pepper Oral Amygdalus communis Almond Oral Anacyclus Pyrethrum Pillitory of Spain Oral, topical, rectal officinalis Sparrow grass Oral, rectal Boswellia carterii Oral Brassica oleracea Cabagge Oral Cinnamomum zeylanicum Oral Citrullus colocynthis Colocynth Oral Cucumis melo Melon (seeds) Oral Curcuma longa Oral Daucus carota Carrot (seeds) Oral Ferula Assa-foetida Stinking gum Oral, topical Fraxinus excelsior Common ash Oral Gossypium herbaceum Cotton Rectal, topical Iris florentina Iris Topical sativum Garden cress Oral Linum usitatissimum Flax Oral Luffa aegyptiaca Egyptian towel ground Oral Matthiola incana Common Oral Medicago setiva Lucern Oral Menthapiperata Oral Orchis maculatz Spotted-orchis Oral Pinus silvestris Oral Pistacia Terebenthns Terebinth Oral Polypodium vulgare Polypody Oral Sesamum indicum Oral Syzygium aromaticum Oral Trigonella Foenum-graecum Fenugreck Oral Urtica dioica Nettle (seeds) Oral, topical Vitis vinifera Grape vine Oral Zingiber officinale Oral

Animal-derived drugs Stag gall bladder Topical Bull gall bladder Topical Duck suet Rectal Dried bull penis Oral Cock testis Oral He-goat testis Oral rennet obtained from cow or cammel milk Oral

benths) and date soaked in sheep milk, ginger herbal medics is increasing and this field of research (Zingibar officinale), especially its jam, and the seed has become the focus of intense interest and efforts of garden cress (Lepidium sativum) mixed with towards the identification of effective and safe pillitory of Spain (Anacyclus pyrethrum) were very drugs. The efficacy of some traditional Persian effective.10 Furthermore, Esmail Jorjani advised oral treatments for ED, such as the aphrodisiac property administration of rennet obtained from cow or camel of Zingiber officinale,14,15 Amygdalus communis,15 milk as a powerful therapy. It was believed that Aframomum melegueta,16 Brassica spp,15 and Lepi- topical application of stinking gum (Freula assa- dium spp17,18 has been proved by modern medicine; foetida) irritated the genital tract, a feeling that however, most remain largely unexamined. Medie- induced erection.11 Rectal application of cotton val Persian writings provide comprehensive clinical plant (Gossypium herbaceum) was recommended remedies from centuries of experience in the field of as very useful treatment. A mixture of wild carrot ED, which may be helpful for testing their probable (Malabaila secacul) and ginger (Zingibar officinale) benefits for ED. was also described as an effective treatment for ED. When the heart disorders resulted in ED adminis- tration of sweet acacia (Acacia farensica) was References believed to be beneficial.10–13 This review presents the clinical approaches that 1 Elgood C. A medical history of Persia and the eastern caliphate practitioners in medieval Persia used to deal with from the earliest times to the year 1932 A.D. Cambridge impotence. In recent years, research into medieval University Press: London, England, 1951, pp 205–209.

International Journal of Impotence Research Impotence in medieval Persian medicine M Khaleghi Ghadiri and A Gorji 83 2 Najm-Abadi M. The History of Medicine in Iran after Islam. 11 Jorjani E. Zhakhireh Kharazmshahi. Iranian Cultural Organi- Tehran University Press: Tehran, Iran, 1975, pp 425–476. sation Press: Tehran, Iran, 1976. 3 Siraisi NG. Avicenna in Renaissance Italy: the Canon and 12 Hossaini-Tabib MM. Tohfe hakim moemen. Mostafavi Press: Medical Teaching in Italian Universities After 1500. Princeton Tehran and Qum, Iran, 1959. University Press: Princeton, USA, 1987, pp 205–209. 13 Raˆzi M. Al-Hawi. Encyclopedia Press of Ossamania: Dekan, 4 Osler W. Evolution of Modern Medicine: A Series of Lectures India, 1955–1971. Delivered at Yale University on the Silliman Foundation in 14 Shelly TE, McInnis DO. Exposure to ginger root oil enhances April, 1913. Ayer Company Publishers, Incorporated Pub.: mating success of irradiated, mass-reared males of Mediterra- Manchester, USA, 1972, p 243. nean fly (Diptera: Tephritidae). J Econ Entomol 2001; 94: 5 Gorji A, Khaleghi Ghadiri M. History of headache in medieval 1413–1418. Persian medicine. Lancet Neurol 2002; 1: 510–515. 15 Qureshi S, Shah AH, Tariq M, Ageel AM. Studies on herbal 6 Gorji A, Khaleghi Ghadiri M. History of epilepsy in Medieval aphrodisiacs used in Arab system of medicine. Am J Chin Med Iranian medicine. Neurosci Biobehav Rev 2001; 25: 455–461. 1989; 17: 57–63. 7 Gorji A. Pharmacological treatment of headache using 16 Kamtchouing P et al. Effects of Aframomum melegueta and traditional Persian medicine. Trends Pharmacol Sci 2003; guineense on sexual behaviour of male rats. Behav 24: 351–354. Pharmacol 2002; 13: 243–247. 8 Kubin M, Wagner G, Fugl-Meyer AR. Epidemiology of erectile 17 Gonzales GF et al. Effect of (Maca), a root dysfunction. Int J Impot Res 2003; 15: 63–71. with aphrodisiac and fertility-enhancing properties, on serum 9 Ayta IA, McKinlay JB, Krane RJ. The likely worldwide reproductive hormone levels in adult healthy men. J Endocri- increase in erectile dysfunction between 1995 and 2025 and nol 2003; 176: 163–168. some possible policy consequences. BJU Int 1999; 84: 50–56. 18 Zheng BL et al. Effect of a lipidic extract from Lepidium 10 Avicenna A. Qanoon dar Teb. Soroosh Press: Tehran, Iran, meyenii on sexual behavior in mice and rats. Urology 2000; 55: 1988. 598–602.

International Journal of Impotence Research