Scientific Evaluation of the Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications

  • Sahar Dehdari
  • Homa Hajimehdipoor
  • Somayeh Esmaeili
  • Rasool Choopani
Keywords: Herbal medicines, Hypericum perforatum, Portulaca oleracea, Hemorrhoidectomy


Hemorrhoidectomy is an impressive surgery that relieves discomfort in patients who suffer from grade 3 or 4 hemorrhoids. This review is designed to investigate useful herbs for managing post-surgery complications by presenting an overview of Avicenna’s view compared to new scientific evidences. The herbs with anti-inflammatory, analgesic, anti-bleeding, antispasmodic, and wound-healing properties may be important for managing patient discomfort. Avicenna’s most frequently prescribed herbs were selected using Bavasir as a keyword (traditional term for hemorrhoids) from volumes 2 and 5 of the Canon of Medicine textbook, and they were investigated in scientific databases including Scopus, PubMed, Web of Science, Science Direct, and Cochrane Library to obtain researches that confirmed their efficacy. Among the different herbs, Hypericum perforatum and Portulaca oleraceae were the most supported in scientific databases. Other herbs including Anethum graveolens, Cocos nucifera, Ferula assa-foetida, Myrtus communis, Ocimum basilicum, and Plantago major were next in order, while Artemisia absinthium, Solanum melongena, and Trigonella foenum-graecum exhibited few related pharmacological effects. The results established Avicenna’s claims regarding the importance of these herbs in post hemorrhoidectomy complications. Although there were many in vitro and/or in vivo researches on the selected herbal medicines, there were no obtained clinical studies on patients after their hemorrhoidectomy surgeries. So, the aforementioned herbs, especially H. perforatum and P. oleraceae, are recommended for future clinical studies. Among the different classes of compounds, flavonoids were the most responsible phytocomponents for displaying pharmacological effects.[GMJ.2017;6(3):166-184] DOI:10.22086/gmj.v0i0.774


Zampieri N, Castellani R, Andreoli R, Geccherle A. Long-term results and quality of life in patients treated with hemorrhoidectomy using two different techniques: Ligasure versus transanal hemorrhoidal dearterialization. Am J Surg. 2012;204(5):684-8.

Association AG. Technical Review on the Diagnosis and Treatment of Hemorrhoids. Gastroenterology. 2004;5085(4):1463-73.

Fauci A, Brauneald E, Kasper D, Hauser S, Longo D, Jameson J. Harison’s principles of internal medicine. 18 ed. New York: Mc Graw Hillm Health Profession Division; 2008. p. 2507-8.

Pescatori M, Gagliardi G. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol. 2008;12(1):7-19.

Mauricio De la G, Timothy C, Facs F. Complications of hemorrhoid surgery. Semin Colon Rectal Surg. 2013;21(3):96-102.

Roe AM, Bartolo DC, Vellacott KD, Locke-Edmunds J, Mortensen NJ. Submucosal versus ligation excision haemorrhoidectomy: a comparison of anal sensation, anal sphincter manometry and postoperative pain and function. Br J Surg. 1987;74(10):948-51.

Fahimi S, Hajimehdipoor H, Abdollahi M, Mortazavi SA. Burn healing plants in Iranian Traditional Medicine. RJP. 2015;2(1):53-68.

Zargaran A, Mehdizadeh A. Avicenna (980–1037 AD). J Neurol 2012;259(9):389-90.

Ibn Sina AAH. Al Qanun Fi al-Tibb (Canon of medicine) [in Arabic]. Beirut: Alamy Le- Al-Matbooat Institute; 2005. p. 370-85.

Ghahraman A, Okhovvat A. Matching the Old Medicinal Plant Names with Scientific Terminology. Tehran: Tehran University Press; 2004.

Soltani A. Dictionary of Medicinal Plants. Tehran: Arjmand Press; 2004.

Biruni Ar. ketab al-seydana fi-al-tibb. Tehran: Iran academy of persian language and literature; 2004.

Racz-kotilla E. The sedative and antinociceptive effects dill of (Anethum graveolens L.) used in folk medicine. Médicaments et aliments : l'approche ethnopharmacologique1993. p. 303-5.

Rezaee-Asl M, Vahid Nikoui AB. Antinociceptive properties of hydro alcoholic extracts of Anethum graveolens L. (dill) seed and aerial parts in mice. Clin Exp Pharmacol. 2015;03(02):2-5.

Kazemi M. Phenolic profile, antioxidant capacity and anti-inflammatory activity of Anethum graveolens L. essential oil. Nat Prod Res. 2015;29(6):551-3.

Naseri M, Mojab F, Khodadoost M, Kamalinejad M. The study of anti-Inflammatory activity of oil-based dill (Anethum graveolens L.) extract used topically in formalin-induced inflammation male rat paw. Iran J Pharm Res. 2012;11(4):1169-74.

Gharib Naseri MK, Heidari A. Antispasmodic effect of Anethum graveolens fruit extract on rat ileum. Int J Pharmacol. 2007;3(3):260-4.

Ahmad F, Khan R, Rasheed S. Study of analgesic and anti-inflammatory activity from plant extracts of Lactuca scariola and Artemisia absinthium. J Islam Acad Sci 1992:111-4.

Hadi A, Hossein N, Shirin P, Najmeh N, Abolfazl M. Anti-inflammatory and analgesic activities of Artemisia absinthium and chemical composition of its essential oil. Int J Pharm Sci Rev Res. 2014;24(2):237-44.

Alviano DS, Rodrigues KF, Leitao SG, Rodrigues ML, Matheus ME, Fernandes PD, et al. Antinociceptive and free radical scavenging activities of Cocos nucifera L. (Palmae) husk fiber aqueous extract. J Ethnopharmacol. 2004;92(2-3):269-73.

Naskar S, Mazumder UK, Pramanik G, Saha P, Haldar PK, Gupta M. Evaluation of antinociceptive and anti-inflammatory activity of hydromethanol extract of Cocos nucifera L. Inflammopharmacolog. 2012;21(1):7-11.

Rinaldi S, Silva DO, Bello F, Alviano CS, Alviano DS, Matheus ME, et al. Characterization of the antinociceptive and anti-inflammatory activities from Cocos nucifera L. (Palmae). J Ethnopharmacol. 2009;122(3):541-6.

Silva RR, Oliveira e Silva D, Fontes HR, Alviano CS, Fernandes PD, Alviano DS. Anti-inflammatory, antioxidant, and antimicrobial activities of Cocos nucifera var. typica. BMC Complement Altern Med. 2013;13(1):107-.

Pallavi S, Durgaprasad S. Burn wound healing property of Cocos nucifera: An appraisal. Indian J Pharmacol. 2008;40(5):144-6.

Bagheri SM, Dashti-R MH, Morshedi A. Antinociceptive effect of Ferula assa-foetida oleo-gum-resin in mice. Res Pharm Sci. 2014;9(3):207-12.

Bagheri SM, Hedesh ST, Mirjalili A, Dashti-R MH. Evaluation of Anti-inflammatory and Some Possible Mechanisms of Antinociceptive Effect of Ferula assa foetida oleo gum resin. J Evid Based Complementary Altern Med. 2015;22(4):1-6.

Bagheri S, Hejazian S, Dashti R M. The relaxant effect of seed’s essential oil and oleo-gum resin of Ferula Assa-foetida on isolated rat’s ileum. Ann Med Health Sci Res. 2014;4(2):4-7.

Kumar V, Singh PN, Bhattacharya SK. Anti-inflammatory and analgesic activity of Indian Hypericum perforatum L. Indian J Exp Biol. 2001;39(4):339-43.

Abdel-Salam OME. Anti-inflammatory, antinociceptive, and gastric effects of Hypericum perforatum in rats. ScientificWorld Journal 2005;5:586-95.

Subhan F, Khan M, Ibrar M. Antagonism of antinociceptive effect of hydro-ethanolic extract of Hypericum perforatum Linn. Pak J Biol Sci. 2007;10(5):792-6.

Raso G, Pacilio M, Carlo G. In-vivo and in-vitro anti-inflammatory effect of Echinacea purpurea and Hypericum perforatum. J Pharm Pharmacol. 2002;54(6):1379-83.

Huang N, Rizshsky L, Hauck C, Nikolau BJ, Murphy PA, Birt DF. Identification of anti-inflammatory constituents in Hypericum perforatum and Hypericum gentianoides extracts using RAW 264.7 mouse macrophages. Phytochemistry. 2011;72(16):2015-23.

Hammer KDP, Hillwig M, Solco AKS, Dixon PM. Inhibition of prostaglandin E2 production by anti-inflammatory Hypericum perforatum extracts and constituents in RAW264.7 mouse macrophage cells. J Agric Food Chem. 2008;55(18):520-9.

Sosa S, Pace R, Bornancin A, Morazzoni P, Riva A, Tubaro A, et al. Topical anti-inflammatory activity of extracts and compounds from Hypericum perforatum L. J Pharm Pharmacol 2007;59(5):703-9.

Prisacaru AI, Andriţoiu CV, Andriescu C, Havarneanu EC, Popa M, Motoc AGM, et al. Evaluation of the wound-healing effect of a novel Hypericum perforatum ointment in skin injury. Rom J Morphol Embryol. 2013;54(4):1053-9.

Dikmen M, Ozturk Y, Sagratini G, Ricciutelli M, Vittori S, Maggi F. Evaluation of the wound healing potentials of two subspecies of Hypericum perforatum on cultured NIH3T3 fibroblasts. Phytother Res. 2011;25(2):208-14.

Suntar IP, Akkol EK, Yilmazer D, Baykal T, Kirmizibekmez H, Alper M, et al. Investigations on the in vivo wound healing potential of Hypericum perforatum L. J Ethnopharmacol. 2010;127(3):468-77.

Ozturk N, Korkmaz S, Ozturk Y. Wound-healing activity of St. John's Wort (Hypericum perforatum L.) on chicken embryonic fibroblasts. J Ethnopharmacol. 2007;111(1):33-9.

Capasso R, Borrelli F, Capasso F, Mascolo N, Izzo AA. Inhibitory effect of the antidepressant St. John's Wort (Hypericum perforatum) on rat bladder contractility in vitro. Urology. 2004;64(1):168-72.

Khan A-u, Gilani A-h. Pharmacological studies on Hypericum perforatum fractions and constituents. Pharm Biol. 2011;49(1):46-56.

Tugrul I, Demirci B, Demir O, Dost T, Birincioglu M. The effect of Hypericum perforatum on isolated rat aorta. Pharm Biol. 2011;49(8):879-83.

Hosseinzadeh H, Khoshdel M, Ghorbani M. Antinociceptive, anti-inflammatory effects and acute toxicity of aqueous and ethanolic extracts of Myrtus communis L. aerial parts in mice. J Acupunct Meridian Stud. 2011;4(2):242-7.

Mubarak SS, Ibrar M, Barkatullah, Muhammad N, Ehsan M. Evaluation of essential oil of Myrtus communis leaves for analgesic and gistrointestinal motility profile. Pharmacologyonline. 2012;2(7):41-5.

Rossi A, Di Paola R, Mazzon E, Genovese T, Caminiti R, Bramanti P, et al. Myrtucommulone from Myrtus communis exhibits potent anti-inflammatory effectiveness in vivo. J Pharmacol Exp Ther. 2009;329(1):76-86.

Feisst C, Franke L, Appendino G, Werz O. Identification of molecular targets of the oligomeric nonprenylated acylphloroglucinols from Myrtus communis and their implication as anti-inflammatory compounds. J Pharmacol Exp Ther. 2005;315(1):389-96.

Janbaz KH, Nisa F, Imran I, Zia-ul-haq M. Bronchodilator , vasodilator and spasmolytic activities of methanolic extract of Myrtus communis L. J Physiol Pharmacol. 2013;64(4):2016.

Venancio AM, Onofre AS, Lira AF, Alves PB, Blank AF, Antoniolli AR, et al. Chemical composition, acute toxicity, and antinociceptive activity of the essential oil of a plant breeding cultivar of basil (Ocimum basilicum L.). Planta Med. 2011;77(8):825-9.

Sabib Al-ghurabi SE. Study the analgesic and sedative effect of Ocimum basilicum alcoholic extract in male rats. Diyal Agr Sci J. 2014;6:9-22.

Raina P, Deepak M, Chandrasekaran CV, Agarwal A, Wagh N, Kaul-ghanekar R. Comparative analysis of anti-inflammatory activity of aqueous and methanolic extracts of Ocimum basilicum in RAW264.7, SW1353 and human primary chondrocytes. Perspect Med. 2016.

Selvakkumar C, Gayathri B, Vinaykumar KS, Lakshmi BS, Balakrishnan A. Potential anti-inflammatory properties of crude alcoholic extract of Ocimum basilicum L. in human peripheral blood mononuclear cells. J Health Sci. 2007;53(9):500-5.

Bezerra L, Oliveira A, Pereira B, Martins B, Júnior Q, Anderson B, et al. Anti-inflammatory and antiedematogenic activity of the Ocimum basilicum essential oil and its main compound estragole:In vivo mouse models. Chem Biol Interact. 2016;257(3):14-25.

Boskabady MH, Kiani S, Haghiri B. Relaxant effects of Ocimum basilicum on guinea pig tracheal chains and its possible mechanism (s). DARU. 2005;13:28-33.

Janbaz KH, Hamid I, Gilani AUH, Qadir MI. Spasmolytic, bronchodilator and vasodilator activities of aqueousmethanolic extract of ocimum basilicum. Int J Agric Biol. 2014;16(2):321-7.

Zubair M, Nybom H, Lindholm C, Brandner M, Rumpunen K. Promotion of wound healing by Plantago major L . leaf extracts – ex- vivo experiments confirm experiences from traditional medicine. Nat Prod Res. 2015(5):37-41.

Guillen MEN, Emim ASE, Souccar C, Lapa AJ. Analgesic and antiinflammatory activities of the aqueous extract of Plantago major L. Int J Pharmacog. 1997;35(5):99-104.

Ozbek H, Erten R, Oner A, Cengiz N, Yilmaz O, Turel I. Hepatoprotective and anti-inflammatory activities of Plantago major L. Indian J Pharmacol. 2009;41(3):120-5.

Hussan F, Mansor AS, Hassan SN, Tengku Nor Effendy Kamaruddin TNT, Budin SB, Othman F. Anti-inflammatory property of Plantago major leaf extract reduces the inflammatory reaction in experimental acetaminophen-induced liver injury. Evid Based Complement Alternat Med. 2015(6):1-8.

Chan K, Islam MW, Kamil M, Radhakrishnan R, Zakaria MNM, Habibullah M, et al. The analgesic and anti-inflammatory effects of Portulaca oleracea L. subsp. sativa (Haw.) Celak. J Ethnopharmacol. 2000;73(3):445-51.

Lee AS, Kim JS, Lee YJ, Kang DG, Lee HS. Anti-tnf- α activity of Portulaca oleracea in vascular endothelial cells. Int J Mol Sci. 2012;13(8):5628-44.

Li C, Meng Y, Ying Z, Xu N, Hao D, Gao M, et al. Three novel alkaloids from Portulaca oleracea L. and their anti-inflammatory effects. J Agric Food Chem. 2016;3(9):131-37.

Rashed AN, Afifi FU, Disi AM. Simple evaluation of the wound healing activity of a crude extract of Portulaca oleracea L. (growing in Jordan) in mus musculus JVI-1. J Ethnopharmacol. 2003;88(2-3):131-6.

An OF, Extract A, Muscle ONS, Pressure RATB. Effect of an aqueous extract of Portulaca oleracea leaves on smooth muscle and rat blood pressure. J Ethnopharmacol. 1988;22(9):33-44.

Mutalik S, Paridhavi K, Rao MC, Udupa N. Antipyretic and analgesic effect of leaves of Solanum melongena LINN in rodents. Indian J Pharmacol. 2003:312-5.

Sun J, Gu YF, Su XQ, Li MM, Huo HX, Zhang J, et al. Anti-inflammatory lignanamides from the roots of Solanum melongena L. Fitoterapia. 2014;98(5):110-6.

Maniyar YA. Evaluation of anti-inflammatory activity of aqueous extract of leaves of Solanum melongena linn . in experimental animals. J Clin Diagn Res. 2015;9:1-3.

Javan M, Ahmadiani A, Semnanian S, Kamalinejad M. Antinociceptive effects of Trigonella foenum-graecum leaves. J Ethnopharmacol. 1997;58(3):125-9.

Mandegary A, Pournamdari M, Sharififar F, Pournourmohammadi S, Fardiar R, Shooli S. Alkaloid and flavonoid rich fractions of fenugreek seeds (Trigonella foenum-graecum L.) with antinociceptive and anti-inflammatory effects. Food Chem Toxicol. 2012;50(7):2503-7.

Bhalke RD, Anarthe SJ, Sasane KD, Satpute SN, Shinde SN, Sangle VS. Antinociceptive activity of Trigonella foenum-graecum leaves and seeds (Fabaceae). Iranian J Pharmacol Ther. 2009;8(2):57-9.

Vyas S, Agrawal RP, Solanki P, Trivedi P. Analgesic and anti-inflammatory activities of Trigonella foenum-graecum (seed) extract. Acta Pol Pharm. 2008;65(4):473-6.

Prem Kumar N, Abbamalai A, Ram S. (Fenugreek seeds ) in high fat diet-fed / low dose streptozotocin induced diabetic neuropathy in rats. Pharmacologyonline. 2009;2(9):24-36.

Abbas N, Naz M, AlSulaim M. A comparative study of analgesic, antipyretic and anti-inflammatory effect of ethanolic extract of Trigonella foenum-graecum with indomethacin and diclofenac sodium. BJPR. 2016;10(5):1-8.

Kawabata T, Cui MY, Hasegawa T, Takano F, Ohta T. Anti-inflammatory and anti-melanogenic steroidal saponin glycosides from fenugreek (Trigonella foenum-graecum L.) seeds. Planta Med. 2011;77(7):705-10.

Oner AC, Mercan U, Onturk H, Cengiz N, Erten R, Ozbek H. Anti-inflammatory and hepatoprotective activities of Trigonella foenum-graecum L. Pharmacologyonline. 2008;2(9):126-32.

Sindhu G, Ratheesh M, Shyni GL, Nambisan B, Helen A. Anti-inflammatory and antioxidative effects of mucilage of Trigonella foenum graecum (Fenugreek) on adjuvant induced arthritic rats. Int Immunopharmacol. 2012;12(1):205-11.

Subhashini N, Nagarajan G, Kavimani S. Anti-inflammatory and in vitro antioxidant property of Trigonella foenum graecum seeds. J Pharm Toxicol. 2011;6(4):371-80.

Ahmadiani A, Javan M, Semnanian S, Barat E, Kamalinejad M. Anti-inflammatory and antipyretic effects of Trigonella foenum-graecum leaves extract in the rat. J Ethnopharmacol. 2001;75(2-3):283-6.

Thinagaran R, Dharman M. Phytochemical screening and in-vitro anti-inflammatory activity of Trigonella foenum-graecum leaves extracts thinagaran. IJPS. 2014;26(9):157-61.

Yavari M, Rouholamin S, Tansaz M, Esmaeili S. Herbal Treatment of Oligomenorrhea with Sesamum indicum L.: A Randomized ControlledTrial. GMJ 2016;5(3):114-21.

Heydarirad G, Sadeghi S, KHameneh S, KHodadoost M, Kamalinejad M, Jafari S, et al. Effects of Natural Substances on Healing of Long Bone Fractures: A Narrative Review of Traditional Persian Medicine. GMJ. 2016;5(4):165-72.

Mosavat SH, Ghahramani L, Sobhani Z, Haghighi ER, Heydari M. Topical Allium ampeloprasum subsp iranicum (leek) extract cream in patients with symptomatic hemorrhoids: A pilot randomized and controlled clinical trial. J Evid Based Complementary Altern Med. 2015;20(2):132-6.

Mosavat SH, Ghahramani L, Sobhani Z, Haghighi ER, Chaijan MR, Heydari M. The effect of leek (Allium iranicum (Wendelbo) Wendelbo) leaves extract cream on hemorrhoid patients: A double blind randomized controlled clinical trial. Eur J Integr Med. 2015;7(6):669-73.

Yousefi M, Mahdavi MRV, Hosseini SM, Bahrami A, Davati A, Kamalinejad M, et al. Clinical Evaluation of Commiphora Mukul, a Botanical resin, in the Management of Hemorrhoids: A randomized controlled trial. Pharmacogn Mag. 2013;9(36):350-6.

Amini M, Kherad M, Mehrabani D, Azarpira N, Panjehshahin MR, Tanideh N. Effect of Plantago major on burn wound healing in rat. J Appl Anim Res. 2010;37(1):53-6.

How to Cite
Dehdari, S., Hajimehdipoor, H., Esmaeili, S., & Choopani, R. (2017). Scientific Evaluation of the Prescribed Herbs by Avicenna for the Management of Post Hemorrhoidectomy Complications. Galen Medical Journal, 6(3), 166-184.
Review Article