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Background and objective: Endometriosis is a common and complex gynecological condition. (Cymbopogon citratus (DC.) Stapf (lemongrass) has been mentioned in Iranian traditional medicine references for uterus disorders. This study aimed to assess the effects of a lemongrass oil vaginal cream on pain levels, mass size, and overall health profiles in endometriosis patients. Methods: In this single-arm, before-and-after clinical trial, participants with endometrial cysts larger than 2 cm and experiencing dysmenorrhea were treated with lemongrass oil vaginal cream for two months. Their pain and health status were assessed using the Visual Analogue Scale (VAS) and the Endometriosis Health Profile Questionnaire (EHP-30) before and after the treatment. Transvaginal ultrasounds were also performed to measure the size of the cysts before and after the intervention. Results: The intervention led to a significant reduction in pain scores (p

Background and objectives: Ajuga genus is used as wound healing in traditional Persian medicine. This study aimed to evaluate the effectiveness of Ajuga chamaecistus ssp. tomentella ointment on healing pressure ulcers in patients admitted to the intensive care unit. Methods: In this randomized, double-blind, placebo-controlled clinical trial, 131 patients with grade 1 or 2 pressure ulcers were randomly assigned into one of two groups through simple randomization. The study group received 3% Ajuga ointment, containing 17.26 µg/mL of 20-hydroxyecdysone (ecdysterone) as the main compound, while the control group received placebo twice a day for 14 days in addition to the standard care for pressure ulcers Changes in the degree and size of wounds were considered as the primary outcomes of the study based on the 2-digit Stirling scale. Results: Forty patients in each group completed the research. Mean (95% confidence interval) difference values, for wound degree, between two groups on day 7 vs. day 0 was -0.88 (-1.01 to -0.76, p

Background and objectives: Paeonia daurica ssp. macrophylla (PD) (Paeoniaceae) is a perennial plant, growing in Iran. In Persian medicine, another species, Paeonia officinalis “Oode-saleeb” has been used especially for treating epilepsy and brain disorders. This study aimed to evaluate the sedative and hypnotic activity and the acute toxicity of P. daurica root extracts in mice. Methods: Sedative and hypnotic effects of the aqueous extract, total hydro alcoholic 80% extract, and its fractions, hexane, chloroform, and methanol were examined by the righting reflex method. Plant samples (50, 100, and 200 mg/kg) and vehicle (10 mL/kg) were injected intraperitoneally (i.p.) 30 minutes before sodium thiopental injection (40 mg/kg, i.p.) in groups of seven mice. The time taken before losing the righting reflex and the time taken to regain the righting reflex were recorded as the onset of sleep and sleep duration, respectively. The findings of the study indicated that, with the exception of the chloroform fraction and the total hydroalcoholic extract administered at the dose of 50 mg/kg, all the samples demonstrated a reduction in sleep onset time produced by sodium thiopental. Furthermore, chloroform (200 mg/kg) was the most effective sample on sleep duration compared to diazepam (3 mg/kg) (p

Background and objectives: Vaginitis is one of the most common diseases in women. Oak gall and ajwain have been used in traditional Persian medicine for treatment of vaginitis. The purpose of this study was to formulate a vaginal preparation containing oak gall and ajwain and evaluate its effectiveness on the recovery and recurrence of vaginitis. Methods: The present pilot study is a randomized, double-blind clinical trial performed on 24 women with mixed vaginitis, including bacterial vaginitis and trichomoniasis in a gynecology center. Subjects were divided into two groups receiving herbal vaginal tablets or metronidazole vaginal tablets for 7 days. The vaginal tablets were prepared using dried extract of oak gall and essential oil from ajwain by direct compression method. Clinical signs and laboratory tests were assessed after treatment. The symptoms were evaluated on day 10, and also 4 and 12 weeks after intervention. Results: There was a statistically significant difference in sexual function, and characteristics of secretions including amount, pH, odor, leukocyte count and parasite content in both groups of herbal (oak gall and ajwain) and metronidazole vaginal tablets before and after treatment (p

Background and objectives: Depression is a chronic mental disorder that influences people’s lives and functionality. The available medications do not give full guaranty of effectiveness and are not devoid of unwanted side effects. Cuscuta chinensis has been recommended for the treatment of depression in traditional medicine. In this study, the antidepressant-like activity of C. chinensis has been evaluated by using forced swimming test (FST) in mice. Methods: Cuscuta chinensis extract was provided by boiling in water. The antidepressant effect was evaluated by forced swimming test (FST) in mice with daily gavage of 270, 360 and 430 mg/kg of the treatments for four weeks. The immobility time and behavioral activity and also the blood levels of 5-HT and norepinephrine were measured. Results: The FST confirmed antidepressant effect of the extract with decreased time of immobility and increased swimming time alongside increase in serum 5-HT in all groups (p

Background and objectives: Psoriasis is a prevalent, chronic, and inflammatory disorder with good response rates using novel treatment strategies. However, side effects are a limiting factor in long-time treatment. Recent studies have demonstrated that many natural remedies have fewer side effects, and are thus safer options. The aim of this study was to evaluate the efficacy of a novel topical herbal preparation in patients with plaque psoriasis. Methods: This randomized, triple-blind, vehicle-controlled, two-arm parallel trial was conducted in patients with mild-to-moderate plaque psoriasis (psoriasis area & severity index= PASI score< 12). We randomized 108 patients in 1:1 ratio to receive Boswellia-based cream (containing Boswellia spp. ethanolic extract, Boswellia spp. oil, Glycyrrhiza glabra extract, Cucurbita pepo pulp oil) or vehicle cream, both applied as a thin layer on skin lesions twice daily for four weeks. Results: Compared with vehicle, the Boswellia-based cream group showed greater reduction in mean PASI score from baseline to week two and from week two to week four (both p

Background and objectives: Ulcerative colitis (UC) is a chronic inflammatory bowel disease. Herbal medicines such as Persicaria bistorta, Pistacia lentiscus, Punica granatum, and Myrtus communis manifesting a variety of pharmacological properties and effects, have been widely implicated in the treatment of UC. We report a case of UC in a 42-year-old male patient. Methods: The patient presented frequent passage of bloody stool, severe cramping, and abdominal pain. This was accompanied by fatigue, excessive mucus, and pus in the stool. He had a 12 years prehistoric diagnosis of ulcerative colitis and received conventional therapy, which yielded no improvement in the symptoms. His regimen was then switched to the Persian traditional treatment employing the “Sahj” formula (including Persicaria bistorta, Pistacia lentiscus, Boswellia frereana, Punica granatum, and Myrtus communis) for 4 months. Results: After 18 days of traditional therapy with “Sahj” tablet, there was a significant improvement in his UC symptoms as evidenced in the increased frequency of his bowel movements (twice daily), absence of bloating, cramping, or abdominal pain and a normal bloodless stool. A colonoscopy report and digital rectal examination 4 months post-treatment, revealed a normal perianal area, cecum, and terminal ileum. Conclusion: The results suggest that the Persian traditional “Sahj” medicine possesses pharmacological properties that render it effective in the treatment of UC and mucosal diseases. However, further clinical trials are needed to evaluate and confirm the efficacy and safety of “Sahj” therapy.

Background and objectives: Sleep disorders are among the most common complaints in childhood. Considering the pitfalls regarding safety and efficacy of conventional treatments for sleep disorders in children and based on the Persian medicine literature and results of recent animal and clinical investigations, this study was conducted to evaluate the effect of topical lettuce seed oil in these patients. Methods: The study was a double-blind randomized controlled trial in 3-6 years old children with sleep disorders. They were randomly assigned to receive either topical placebo oil and clonidine capsule or lettuce seed oil and placebo capsule for three weeks. Lettuce seed oil was prepared using cold press method. Persian version of “BEARS” pediatric sleep questionnaire was used before and after the intervention. Data analysis was performed using SPSS software (version 20) and pResults: At the end of study, 67 patients out of 72 completed the study. Similar to control group, children in intervention group significantly improved regarding bedtime issues (pConclusions: Topical use of lettuce seed oil on forehead and temporal areas of children could be considered as a safe and effective treatment for sleep disorders. However, further studies with larger sample size, longer duration of follow-up, and with the use of objective outcome measures are warranted.

Background and objectives: Depression is a common and costly public-health disease. It has been considered in Iranian traditional medicine and many herbal combinations have been used for healing depressive-like disorders. Traditional herbal medicines should be converted into common dosage forms for patient acceptance and easier usage. Methods: In the present research, a poly herbal syrup containing Echium amoenum, Lavandula angustifolia, Melissa officinalis, Cuscuta chinensis, Vitis sp., Prunus domestica and Alhagi camelorum was formulated and its physicochemical characteristics including physical appearance, pH, viscosity, density, dried residue, physical stability and microbiological levels were evaluated. Furthermore, the antidepressant activity was determined by tail suspension test (TST) and also the effect of the formulation on the serum levels of dopamine and adrenaline was assessed in mice. Results: The syrup showed to be stable regarding physical changes and microbiological quality control tests. It significantly reduced the time of immobility in TST (pConclusion: Regarding the modern evidences about the plants used in the poly herbal syrup and physiochemical stability and the considerable results of the in vivo experiments, it could be suggested as a suitable antidepressant agent.

Low-back pain is a common disease and a considerable economic burden in modern societies. Complementary and alternative therapies for assisting management of pain and disability are sought by a large number of patients. In the present work, the most common herbs used to manage Low-back pain in Iranian traditional medicine (Persian medicine) and current literature has been investigated.Chapters about low-back pain (“Vaja-e Zahr”), and radiculopathy (“Erghonnasa”) and sciatica from Liber Continens (Alhavi) and Canon of Medicine were reviewed. All types of plant usage mentioned in the books including oral, rectal, and topical administration, either alone or in combination were recorded. Descriptive statistics (frequency distributions) were used to report the findings. The current literature were searched with “herbal medicine” and “low-back pain” medical subject heading (MeSH) terms in PubMed, EMBASE, ScienceDirect, Scientific Information Database (in Persian), and Google Scholar databases, to investigate medicinal usage of the most suggested plants.Citrullus colocynthis L. Schrad was the most common plant that Rhazesused in compounds and a significant herb used by Avicenna for management of low-back pain and sciatica. Fruit was the main part and rectal route was the main type of administration of colocynth for low-back pain management.In conclusion, we have proposed a new use of Citrullus colocynthis for management of low-back pain and sciatica according to the evidences from Persian medicine. According to current literature survey, no study has yet investigated or suggested the usage of Citrullus colocynthis for low-back pain management. Further laboratory and clinical studies are required to confirm the safety and efficacy of this plant or its components in low-back pain and sciatica management.

Background and objectives: Traditional medicine could provide a hopeful area of research to mitigate the suffering of patients. “Qust” is one of the medicinal plants that are mentioned in Persian Medicine (PM) for treatment of neurological diseases. There is diversity within the scientific name of “Qust” in different references. Some have introduced Saussurea costus (Falc.) Lipsch. (Asteraceae), while others have presented Costus speciosus (J. Koenig) Sm. (Costaceae) as “Qust”. Since “Qust” is not endemic in Iran, there is difficulty to access to the whole plant for its identification. Hence, this study has aimed to identify available bitter “Qust” which is composed of roots of the plant in the Iranian market. Methods: Macroscopic characters and microscopic properties of powders and transverse sections of specimens with essential oil analysis of the Indian and one of the Iran herbal market samples using chromatography-mass spectrometry (GC-MS) were investigated for identification of bitter “Qust”. Results: Microscopic evaluation showed presence of secretory cavities and their specific size, narrow radial rows of conducting tissue alternating with broad medullary rays in the secondary phloem and xylem, presence of inulin, absence of starch and calcium oxalate crystals in the bitter “Qust” particles. Further, positive response was observed to S. costus identifying test. In the analysis of essential oils, active components of S. costus, such as dehydrocostus lactone, were identified in the examined essential oils. Conclusion: According to the results, it could be concluded that bitter “Qust” in Iran herbal market most probably is S. costus.

Osteoarthritis (OA) of the knee is one of the important medical complications in elderly peoples. Various pharmacological and non-pharmacological therapies are described for treatment of knee OA, but considerable side effects especially in old populations are the limiting factors. Traditional, complementary and integrative medicines have a long history in treatment of chronic diseases such as OA. Many different oral and topical drugs have been introduced for curing of OA in Persian medicine (PM) as one of the most important and historical systems of medicine. The aim of this survey was to review the clinical trials related to pharmacological treatment of knee OA with medicinal methods of PM. The main databases including PubMed, Scopus and ISI Web of Knowledge were searched and consequently eight clinical trials were achieved. Some of common dosage forms such as gel and oil and some of traditional ones like “Marham” and “Dohn” were used for treatment of OA in these studies. The investigated plants were suppressors for different pathways of inflammatory responses. Antioxidant capacity and analgesic effects were other recognized effects for some of these herbs. In clinical aspect, seven of eight papers that were presented in this study, showed a significant effect in the treatment of OA; however, more researches are required to judge these traditional therapies. eatinine and urea as compared to the untreated diabetic mice. Multipledoses of GTAE and G10 significantly (p≤0.05) decreased the volume and length of renal structures, compared to the diabetic untreated group. Conclusion: According to the obtained results, GTAE groups can regulate the levels of biochemical parameters and inhibit kidney damages in alloxan induced diabetic mice. It appears that GTAE can be suggested for treatment of diabetes as an anti-diabetic supplement or drug.

Jaundice is recognized by increased bilirubin level of blood and yellow appearance in skin, sclera and mucous membrane. Natural products have been used for treatment of jaundice for a long time and Persian Medicine can be a good source of natural drugs for this purpose. This study was done to find the materia medica used for jaundice based on Persian medicine (PM) texts including The Canon of Medicine (al-qanun), Al Hawi Fi Al Tibb, Tuhfat al-Mu’minin, Hedayat al-Motealemin fi Tibb, Zakhireye Khwarazmshahi, Al-Abniah 'an Haqaeq al-Adwia, Makhzan ul-Adwia and Ikhtiyarat Badie. One hundred eleven materia medica belonging to 51 families were identified as herbal remedies for treating jaundice. Apiaceae, Asteraceae, Cucurbitaceae, Fabaceae, Lamiaceae, Rosaceae and Zingiberaceae were the most dominant families. The results of this study may be present sources for pharmacological studies and development of new herbal medicines for jaundice. Asparagus, echium, arnebia, chicory, citron and purgative manna could be good candidate Materia Medica for future studies.

Background and objectives: Urinary incontinence is a public complaint that causes discomfort, embarrassment and costs. Also, there are some limitations and insufficiencies of drug therapy and surgical complications. This study has compared the effect ofSaussurea costus (qost) oil as an Iranian traditional medicine product and other contemporary medicine treatment methods on female urinary incontinence. Methods: A parallel double blinded placebo-controlled study was conducted. Thirty to 70 years old women with urinary incontinence were allocated in placebo and intervention groups, 41 patients in each group.Intervention and placebo groups received qost oil and placebo, respectively by local application twice daily below the navel without massage. The results were evaluated with valid questionnaires (ICIQ-SF and I-QOL). For evaluation, Chi-square test, independent-sample t-test and repeated measure analysis of variance were used. Significant p value was Results: A significant decrease in mean scores of the questionnaires during the study was noted in the qost group compared to the placebo group (p

The Food and drug were developed by pharmacists and physicians, in particular Persian scientists throughout medical history. There was an especial view on the subject of nutrition and medications in Persian medicine (PM). Avicenna was one of the main Persian physicians who contributed to this field in the Canon of medicine “Al-qanun-fi-al-tibb”, his main medical and pharmaceutical text book in the 10th century AD. In this paper, different categorizations of foods and drugs and their definitions in the Avicenna’s Canon of medicine were considered and compared with the similar categories in current medicine. These groups of foods and drugs included absolute aliment (Ghidhāol-motlaq), functional foods “Ghidhā od-dawā”, pharconutrient “Dawāol-ghadhā”, absolute medicament or drug “Dawāol-motlaq”, and poisons “Sammol-motlaq”. Also, there were several other classifications for foods and drugs in the Canon of medicine that act without their temperaments (qualities) such as “Dho-l-khāsiyyahis”.These definitions and classifications 1000 years ago and matching with current accepted terminologies are important both historically and also in the field of traditional pharmacy.

Background and objectives: Cervicitis is a common and recurrent gynecologic disease which is usually resistant to treatments. This study was conducted to investigate the effect of Iranian traditional medicine (ITM) product, flixweed- honey, on cervicitis. Methods: A quasi-experimental study was conducted as a clinical trial before and after the intervention at the School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The married women referring to the clinic aged 17-55 years with a diagnosis of cervicitis who were not pregnant and breastfeeding, without any history of cervical polyps and pelvic surgery, and non-concurrent use of herbal or other chemical medicines were included in the study. During this research, 97 patients were treated through the vaginal use of flixweed- honey for two weeks. One week after the treatment, clinical symptoms were examined. Results: Among 97 patients who were evaluated in this study, 72 returned for follow-up. All subjective and objective parameters including vaginal irritation, itching, discharge, bleeding and pain after coitus, tenderness, and cervical wound size and friability improved significantly in comparison to the time before taking the medication. There was no treatment; five patients (0.69%) who took the medication had vulvovaginal itching that was resolved after 3-4 days. Conclusions: Vaginal product of flixweed– honey could be used in the treatment of clinical symptoms of cervicitis regardless of the reason causing cervicitis, without causing severe or serious side effects.

Background and objective: Medicinal oils are one of the most common and special dosage forms in oral and topical therapies of Persian medicine (PM). The oil of Saussurea costus (bitter qust) root is prominent topical oil with different applications in PM. In this study, the oil of bitter qust was prepared according to ancient Persian medical texts. Methods: To prepare traditional qust oil, 100 g of the root was soaked in 600 mL aqueous ethanol 25% overnight. The supernatant was then filtered and boiled in 800 g sesame oil until all water was evaporated. The essential oil of the root and volatile components of its traditional oil were extracted using hydro-distillation method in a Clevenger-type apparatus and were analyzed by gas chromatography-mass spectrometry (GC-MS) method. Total phenolics, flavonoids, tannins and polysaccharides were determined by spectrophotometric methods to evaluate the chemical parameters of traditional bitter qust oil. Results: The content of volatile compounds in both investigated samples was determined (0.5% and 0.1% (v/w), respectively). Dehydrocostus lactone and 1, 3-cyclooctadiene were two similar main compounds in the both analyzed samples. Total phenolics (788.290±0.61 mg/L gallic acid equivalent (GAE)), flavonoids (303.2±2.52 mg/L catechin equivalent (CE)), tannins (23.97±0.52 mg/L GAE) and polysaccharides (9.240±0.13 mg/L dextrose equivalent (DE)) contents were determined. Conclusion: According to the obtained data, dehydrocostus lactone could be used for determination and evaluation of traditional bitter qust oil.

Anal fissure is an ischemic ulcer that occurs in anoderm and it has no obvious etiology and pathophysiology in current medicine. Anal fissure has a profound history in Persian and Persian medicine and wallflower (Erysimum cheiri (L.) Crantz) has been a common medication in this case. Traditional oil and/or dilute decoction of wallflower has been introduced as an effective topical medicine for anal fissure in Persian medicine.The aim of this study was to demystify the ancient wisdom in administration of low-dose wallflower for anal fissure, via the view point of modern pharmacological mechanisms. The basic idea and source of information was according to Persian and Arabic medicine manuscripts of the medieval Islamic era. Electronic literature was searched for related phytochemical and pharmacological studies available in Scopus, Google scholar, Pubmed and ScienceDirect databases from 1900 to 2018. The results showed that different parts of wallflower contain several types of cardiotonic steroids, isothiocyanates and flavonoids. Low-dose topical cardiotonic steroids, below their IC50, could have potential effects on the ischemic condition of anal fissure ulcer and collagen synthesis in the local fibroblasts, by stimulation of Na+/K+ ATPase pump. Furthermore, other active compounds in wallflower are isothiocyanates that could be responsible for tissue protective effects by induction of NRf2 expression and activating TRPA1 channels. Also wallflower flavonoids are responsible for anti-inflammatory, analgesic and wound healing properties. To the best of our knowledge, this is the first time that low-dose topical wallflower administration is hypothesized to have anal fissure healing potential in conventional medicine. This study has introduced a novel mechanistic approach for anal fissure treatment.

There were many natural pharmaceutical dosage forms cited by Persian pharmacists and physicians in the historical pharmacopeias (Qarabadins). This work aimed to perform a comprehensive study on “Qarābādin-e-Sālehi” (1765 A.D.), one of the main Persian pharmaceutical manuscripts defining traditional dosage forms. All traditional dosage forms as well as their definitions, descriptions and considerations were extracted by reviewing “Qarābādin-e-Sālehi”. Then, the textbook of “Aulton's Pharmaceutics; the design and manufacture of medicines” was considered to compare the medieval knowledge of pharmaceutics with current ones. Overall, there were 226 different dosage forms which have been cited in traditional Persian pharmacy. Since many of them were related to the preparation method, the final list of dosage form was shortened to nearly 60 items including solid, semisolid, liquid and gaseous forms. On the other hand, almost 40 forms with oral, topical, nasal, parenteral, vaginal and rectal routes of administration are mentioned as current dosage forms. Some of the dosage forms are similar or as the same in traditional and current pharmacy. But, there were too many novel dosage forms in traditional Persian pharmacy. There were 11 types of traditional nasal forms whereas, this route is still known as a novel route of administration. Also 5 different ophthalmic dosage forms have been cited in the textbook. Many of traditional dosage forms were designed according to the medical purposes. Several current dosage forms have roots in the historical definitions and can be found in Persian medicine. However, there are forgotten traditional dosage forms which can be modified and optimized in pharmacy nowadays.

Background and objectives: In recent years, phytomedicine has a main role to support immune system and in preventive medicine to decrease cancer incidence. Traditional medicine has a basic role to introduce herbal drugs to investigate in preventive medicine. Camellia Sinensis has two popular preparations, green (unfermented) and black (fully fermented) tea that among societies is beside water to drink. Methods: In this narrative review study, tea preparation as herbal infusions from traditional Persian available and reliable references beside classic herbal drugs references were studied to show benefits and risks of tea consumption in health. Results: Tea consumption is famous as antioxidative, anti-inflammatory, antimicrobial, anticarcinogenic, antihypertensive, neuroprotective. In traditional Persian medicine point of view its temperament is hot and dry so it can protect brain and stomach. It is sudatory and diuretic and can also increase mood. It is better to drink sweet or with milk to reduce its dryness. Conclusion: Tea preparations have a main role as a protective functional food in the human’s lives.