Application of herbal rectal suppositories beyond intestinal disorders in Persian medicine

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doi: 10.12032/TMR20190414115
TMR | May 2019 | vol. 4 | no. 3 |
Persian Medicine
Application of herbal rectal suppositories beyond intestinal disorders
in Persian medicine
Fatemeh Ebrahimi1
, Mohammadali Torbati2
, Zoleikha Khoshbakht1
, Laleh Khodaie1, 3
*
1
Department of Phytopharmacy, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz,
Iran. 2
Department of Food Science and Technology, Faculty of nutrition, Tabriz University of Medical Sciences,
tabriz, Iran. 3
Medical Philosophy and History Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
*Corresponding to: Laleh Khodaie, Medical Philosophy and History Research Centre, Tabriz University of
Medical Sciences, Tabriz, Iran. E-mail: khodaiel@gmail.com.
Highlights
This review provides a new insights of the application of herbal rectal suppositories beyond anorectic and
intestinal disorders in traditional Persian medicine, such as sciatic, lower back pain and joint aches, fever
and ascites.
Traditionality
The first application of rectal suppositories was recorded in Egyptian civilization (3150 B.C.). Other
literatres in traditional Chinese, Persian, and Ayurveda medicines showed its prevalence as a dosage form.

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Abstract
Background: Herbal rectal suppositories (RSs) were prescribed not only as a drug delivery system but also as a
storing method in Persian medicine. According to the record of ancient references, RSs were clinically
administered for diarrhea, constipation, colitis, ascites, dysentery and intestinal parasites, sciatic, lower back pain
and joint aches, fever, kidney disease and as an aphrodisiac. Objectives: The aim of this study is to categorize and
review different types of RSs, their main herbal components and to find evidence to elucidate their clinical
administration. Results: In this study, 7 manuscripts were studied to extract and categorize 11 types of herbal
rectal suppositorie (RS) formulations, their ingredients and therapeutic indications. Furthermore, the Persian and
scientific names of 43 herbs and their temperaments were mentioned in this study. Hence, ancient therapeutic
indications of herbs used in RS formulations as well as their proven effects have been studied, which makes it
possible to compare ancient and proven indications of medicinal plants used as ingredients of RSs. Conclusions:
In modern medicine, RSs are mostly used for anorectic disorders. However in traditional Persian medicine, they
were commonly used not only for anorectic and intestinal diseases, but also as an aphrodisiac, an agent for healing
joint, sciatic pain and lumbago, an anti-fever, and an anti-ascites. Other implications of this study could be
producing new insights of utilizing herbal RSs in diseases and disorders beyond anorectic and intestinal disorders.
Keywords: Rectal suppositories, Traditional medicine, Herbs, Medicinal plants, Persia
Concepts:
Earth, Water, Air, and Fire: Earth, Water, Air, and Fire are the four elements that are described by natural
philosophy, each of which has its own specific quality, Air is hot and moist, Fire is hot and dry, Water is
cold and moist, and Earth is cold and dry. Amood: The most important component of the medicament.
Abbreviations:
APIs, Active pharmaceutical ingredients; PM, Persian medicine; RS, Rectal suppositorie; RSs, Rectal
suppositories.
Acknowledgments:
We thank our colleagues who provided insight and expertise that greatly assisted the research.
Competing interests:
No conflict of interest exists with any person or organization.
Citation:
Fatemeh Ebrahimi, Mohammadali Torbati, Zoleikha Khoshbakht, et al. Application of Herbal rectal
suppositories beyond intestinal disorders in Persian medicine. Traditional Medicine Research, 2019, 4(3):
160-172.
Executive Editor: Cui-Hong Zhu, Submitted: 7 February 2019, Accepted: 10 April 2019, Online: 18 April 2018.

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Background
According to description of the United States
Pharmacopeia (USP37 NF32), suppositories are solid
dosage forms in which one or more APIs (active
pharmaceutical ingredients) are dispersed in a suitable
base and molded or formed into suitable shapes for
insertion into the rectum to provide both systemic and
local effects. They usually melt, soften or dissolve at
body temperature. Moreover, they are considered as an
appropriate route of administration for drugs which are
sensitive to pH, enzymes of stomach or to the
environmental conditions. Also, the other reasons to
substitute this administration route instead of oral one
are: first, not to bypass portal circulation; second, risk
of vomiting; third, their usage before surgery; and forth,
in uncooperative patients (who makes swallowing
impossible) [1, 2]. Suppository bases typically include
cocoa butter, glycerinated gelatin, hydrogenated
vegetable oils, mixtures of polyethylene glycols of
various molecular weights, and fatty acid esters of
polyethylene glycol. The suppository base can have a
notable influence on the release of the APIs [3]. The
first use of RSs has been reported in Egyptian
civilization (3150 B.C.) [1, 4]. Other documents
showed its prevalence as a dosage form in traditional
Chinese, Persian, and Ayurveda medicines [5-7].
In preceding decades, traditional systems of
medicine have attained great popularity among the
patients. Success of this system in the treatment of
disease owes to consideration, particularly in cases for
which conventional medicine has been insufficient [8].
The principles of PM (Persian medicine) are based on
quadratic elements; four elements that are described by
natural philosophy are Air, Fire, Water, and Earth,
each of which has its own specific quality, Air is hot
and moist, Fire is hot and dry, Water is cold and moist,
and Earth is cold and dry. So, each object in the world
has its own specific quality based on its dominant
element(s). Beliefs in temperament existed not only in
PM but also in many other traditional medical theories.
Medicinal plants also adhere to this rule and have their
own temperaments. Persian herbal pharmacopeias
described the pharmacological effects of the herbs by
the aid of their temperaments [9].
The origin of PM dated back before Islamic era
(before 637 A.D.) and rose during 9th
to 12th
centuries
(called as Islamic Golden Age) and continued to the
18th
century, and after this time it was replaced by the
molecular (conventional) paradigm of medicine.
During Islamic Golden Age, many manuscripts and
books including Qarabadins (Persian pharmacopeias)
and medical encyclopedias like Canon of medicine
(written by Avicenna in 1025 A.D.) were written
[10-12]. When searching these ancient references, we
notice that suppositories were described as one of the
important dosage forms, not only as a drug delivery
system, but also as a method of storing components of
medicines. In contrast with modern medicine, which
describes suppositories as the rectal ones, in the
mentioned manuscripts, suppositories consisted of a
variety of types-nasal, vaginal, urethral, rectal (as drug
delivery dosage forms) and ophthalmic (as a storing
method) suppositories [7, 13, 14].
To the best of our knowledge, there was not any
previous study about RSs, addressed in the Persian
manuscripts. Also, due to the emphasis of mentioned
manuscripts on the mentioned kind of dosage form, the
aims of this study are: first, to review the indications
and major herbal components of RSs; second, to
investigate the differences between the modern
suppositories and the RSs; and third, to search the
major herbal components of RSs and their recently
confirmed pharmacological evidence to reconcile the
effects of the mentioned medicinal plants from the
both modern and ancient point of view.
Experimental materials
In this study, some of the most important Persian
manuscripts related to the pharmaceutical sciences
which were defined as Qarabadines, as well as
Tohfat-ol-Momenin and Makhzan-ol-Advieh were used.
Qarabadines discussed types of the ancient dosage
forms used by ancient physicians, their ingredients,
procedures of their preparation, administered dosage,
their indications and maintenance procedures as well
as the best time of their usage and other related issues
(Table 1) [13-18]. Also, the Persian and scientific
names, the used parts of the herbs as well as ancient
and confirmed pharmacological evidence of the most
used herbs which were frequently utilized in RSs
formulations were derived from mentioned ancient
manuscripts as well as from electronic databases
including Science Direct, PubMed, Scopus and Google
Scholar, from September 2016 to May 2017, to accord
traditional indications and pharmacological effects of
the herbs. The related articles were selected from the
mentioned data bases by the aid of key words chosen
from mesh: herb, medicinal plants as well as
pharmacology and toxicology. To authenticate the
scientific names of herbs, botanical textbooks
including “A dictionary of Iranian plant names”,
“Popular medicinal plants of Iran” and “Identification
of medicinal and aromatic plants of Iran” were used
[19-21].
Results
Manufacturing process of suppositories
Generally, in order to make applicable suppositories,
the first step was making a fine powder from dry
ingredients including dried herbs, the animal’s material
and the minerals. Then, the ingredients were sieved to

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achieve suitable particle sizes. As an important point,
gums and resins were dissolved in the appropriate
solvents. After mixing all ingredients, a binder such as
plant extracts, mucilage, honey, oils and tar were
needed to stick all particles together. Finally, the
products were severely dried and stored in the closed
door glass containers to increase their shelf lives as
much as possible. The RSs shelf life was claimed to be
5-6 years in cold and up to 1 year in hot regions,
respectively [13].
The RSs were described as solid dosage forms in
shapes of a little chestnut or a date kernel, which
means they had variable sizes. In this case, the size of
RSs was dependent on the purpose of their application.
The RSs applied to the aphrodisiac purposes were
medium sized. Small sized ones were applied in opium
containing suppositories to reduce the risk of addiction
by the patient. The large sized ones were used in colon
targeted types to ensure their maximum efficacy on the
site of action [13, 14]. This part is in contrast with the
modern suppositories not exceeding 2-3 centimeters
and usually weigh about 2 g each [3].
Herbal components and clinical indications
As mentioned before, the RSs were used both in the
local and systemic diseases. Hemorrhoids, anorectic
inflammation and lesions, anal fissures, and accidental
bowel leakage were some of the important local
conditions treated by this kind of dosage form. Also,
they were notified as the most beneficial treatment in
some of the lower abdominal diseases such as diarrhea,
constipation, colitis, ascites, dysentery and intestinal
parasites. Further prescription conditions of
suppositories were disorders such as sciatic, lower
back and joint aches and fever. They were used as an
aphrodisiac as well [13-15]. Furthermore, RSs were
considered as the urgent dosage forms when colorectal
system needed a little stimulation to unload its contents
and to relieve the existing obstruction. Moreover, they
were the first priority in patients who had low physical
strength and could not tolerate using enema for the
treatment based on PM perspective [13, 14].
Table 1 Related pharmaceutical manuscripts in Persian medicine
No Name Author Date
1 Qarabadin-e-azam Hakim Azamkhan 1853 A.D.
2 Qarabadin-e-ghaderi Ahmadshah Arzani 1714 A.D.
3 Qarabadin-e-kabir Seyyed Mohammad Hossein Aghili Khorasani Shirazi 1772 A.D.
4 Qarabadin-e-salehi Mohammad Saleh Ghaeni Heravi 1766 A.D.
5 Tohfat-ol-momenin Mohammad Momen Tonecabeni 1460 A.D.
6 Makhzan-ol-advieh Seyyed Mohammad Hossein Aghili Khorasani Shirazi 1772 A.D.
Table 2 Some RSs formulations derived from Persian medicine
Name Active ingredients (amood) Indications
Shyaf -e afyon Papaver somniferum L., Boswellia carterii Birdw., Crucus sativus
L., Acacia nilotica (L.) Delile., Lycium L.
Anti-dysentery
Shyaf -e khiar shanbar Viola odorata L., Althae officinalis L., Cassia senna L., salt, Honey,
Cassia fistula L., Saccharum officinarum L.
Relieving colitis
Shyaf-e tagviate baah Ferula Assa foetida L., Euphorbia helioscopia L. Aphrodisiac
Shyaf -e layeneh Althae officinalis L., Saccharum officinarum L., Borax. Laxative
Shyaf -e momsek Acacia nilotica Del., Punica granatum L., Quercus infectoria oliv.,
Aqueous extract of Myrtus communis L., Zea mays L., Tamarix
dioica Roth.
Anti-diarrhea
Shyaf -e saboon Soap, Decoction of Ipomoea turpethum L., Rosa damascena oil. Laxative
Shyaf -e ergonnesa Colchicum L., Borax, Citrullus colocynthis (L.) Schrad.,
Convolvulus scammonia L., Sacharrum officinarum L.
Relieving sciatic pain
Shyaf -e bavasir Aloe vera L., Peganum harmala L., Commiphora myrrha (Nees)
Engl., Hedera helix L. extract.
Anti-hemorrhoids
Shyaf -e tab Viola odorata L., salt, Althae officinalis L., Sacharrum officinarum
L., Honey, Cassia fistula L.
Anti-fever, laxative
Shyaf-e estesgaye tabli Ruta graveolens L., Peganum harmala L., Ipomoea turpethum L.,
Apium graveolens L., Sacharrum officinarum L., Pimpinella anisum
L., Borax.
Anti-ascites
Shyaf -e kerm kosh Citrullus colocynthis (L.) Schrad., Artemisia absinthium L., Olive
oil, Loranthus europaeus Jacq., Tar.
Anthelmintic
RSs, Rectal suppositories.

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Ancient Persian pharmacists used several natural
resources for their medicaments. To prepare RSs,
natural resources including different parts of herbs,
their gums and resins, mineral substances such as salt,
borax, clay, ferrus sulfate, ferrus oxide and tar, as well
as some parts of animal material for instance animal
fats and castoreum were applied. However, in most
cases, the active ingredients of rectal suppositorie (RS)
were herbal components.
Some important and commonly used RSs
formulations, their ingredients and indications are
represented in Table 2. Moreover, in PM related
manuscripts, the term active ingredient was known as
Amood, meaning the most important component of the
medicament, so other ingredients were mostly added as
the excipients to stabilize, maintain and enhance the
therapeutic effects of RSs and to deliver them to the
xxx
site of action [13, 14]. As it is apparent in Table 3,
Amood herbs in RS formulations are selected.
Furthermore, ancient indications as well as confirmed
effects of Amood herbs are shown in Table 3.
As it can be seen in Figure 1, the usage percent of
herbs as RS ingredients for each ailment is shown;
among the ailments cured by commonly used herbs to
make RSs, joint, sciatic pains and lumbago, obstructive
and flatulent colic and hemorrhoid are mostly treated
by the listed herbs in Table 3, respectively. Besides,
Figure 2 indicates the percentage of the temperaments
of the herbs as RS ingredients. Among the commonly
used herbs as RSs ingredients, mostly used medicinal
plants have hot and dry temperaments (65.11%). The
temperaments of the commonly used herbs are hot and
dry (65.11%), cold and dry (23.25%), cold and moist
(6.97%) and hot and moist (4.65%), successively.
Figure 1 The usage percent of herbs as RS ingredients for each ailment
RS, Rectal suppositorie.
Figure 2 The percent of the temperaments of the herbs as RS ingredients
RS, Rectal suppositorie.

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Table 3 Commonly used medicinal plants in RSs formulations with their Persian and scientific names,
temperaments, used parts, ethno medicinal and approved indications
No. Persian
name
Scientific
name
Temperament Used part Ethno medicinal
indications
Approved
indications
1 Anzaroot Astragalus
fasciculifolius
Boiss
Hot and dry Gum-resin Healing wound Healing wound [45]
2 Oshogg Dorema
ammoniacum
D.Don
Hot and dry Oleo-gum-r
esin
Healing sciatic, joint
pains and lumbago,
anthelmintic effect
-
3 Barzad
(Barijeh)
Ferula
gummosa
Boiss
Hot and dry Gum-resin Anti-hemorrhoids,
healing wound,
relieving lumbago
Anti-inflammatory
effect [54]
4 Zanjabil Zingiber
officinale
Roscoe
Hot and dry Rhizome Relieving flatulent colic,
sciatic and joint pains,
anthelmintic and
aphrodisiac effects
Relieving
rheumatoid arthritis,
anti-inflammation,
relieving intestinal
spasms, laxative and
anthelmintic effects,
increasing sperm
percent and serum
total testosterone
[27]
5 Karafs Apium
graveolense
L.
Hot and dry Seed Carminative and
laxative effects, healing
sciatic pains and
lumbago
Anti-inflammatory
and analgesic
effects [63]
6 Zaranbad Zingiber
zerumbet (L.)
smith
Hot and dry Root Healing cold pains,
aphrodisiac effect
Anti-inflammatory
effect and
pain-mediated
diseases [55]
7 So’d (Oyar
salam)
Cyperus
longus L.
Hot and dry Root Anti-hemorrhoids,
aphrodisiac effect
-
8 Farfioun Euphorbia
helioscopia L.
Hot and dry Gum Anthelminthic effect,
relieving colic, sciatic,
joint pain and lumbago
Anthelmintic effect
[28]
9 Caphour Cinnamomum
camphora L.
Cold and dry Wood Anti-fever -
10 Panirak
(khobbazi)
Malva
rotundifolia L.
Cold and wet Aerial parts Anti-dysentery, laxative
effect
-
11 Holbeh Trigonella
foenum-graec
um L.
Hot and dry Seeds and
leaves
Relieving lumbago,
anti-ascites, laxative and
aphrodisiac effects
Enhancing
testosterone level
and sexual function
[46, 47],
anti-inflammatory
and anti-arthritic
effects [33, 56]
12 Katan
(Bazrak)
Linum
usitatissimum
L.
Cold and dry Seed Anti-hemorrhoids,
relieving sciatic and
joint pains
Anti-inflammatory
and analgesic
effects, anti-
diarrhea and
anti-constipation
[32]
13 Kherva
(Karchak)
Ricinus
communis L.
Hot and dry Seed Laxative effect,
relieving colic, lumbago
and anti-ascites
Antiulcer and
anti-inflammation,
healing wound [58]

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14
Irsa Iris
pseudoacorus
L.
Hot and dry Rhizomes Anti-hemorrhoids,
relieving sciatic pains,
anti-ascites, laxative
effect
-
15 Afsantin Artemisia
absinthium L.
Hot and dry Root Anthelmintic effect,
relieving obstructive
colic, anti-hemorrhoids,
healing joint pains
Anti-inflammatory
effect [59]
anti-parasites [30]
16 Shooniz Nigella sativa
L.
Hot and dry Seed Relieving flatulent
colic, anti-hemorrhoids,
healing joint pains,
anthelmintic effect
Anti-inflammatory,
analgesic and
anti-parasitic
actions [34]
17 Zenian
(Nankhah)
Trachyspermu
m ammi (L.)
Sprague
Hot and dry Seed Relieving flatulent
colic, anthelminthic and
aphrodisiac effects,
anti-ascites
Antispasmodic
activity,
anti-inflammatory,
nematicidal and
anthelmintic
activities [29]
18 Sabr Aloe vera L. Hot and dry Latex Anthelmintic and
laxative effects
Laxative effect [65]
19 Khiar
chanbar
Cassia fistula
L.
Hot and wet Fruit Relieving obstructive
colic, laxative effect
20 Golnar Punica
granatum L.
Cold and dry Flowers Anti-diarrhea -
21 Kondor Boswellia
sacra Flueck.
Hot and dry Gum- resin Anti-dysentery, healing
wound,
anti-hemorrhoids and
anti-diarrhea
Analgesic effect
[35]
22 Gall
(Mazoo)
Quercus spp. Cold and dry Fruit & Gall Anti-hemorrhoids,
anti-diarrhea
Anti-inflammation
[36]
23 Halileh Terminalia
chebula L.
Cold and dry Fruit Anti-ascites,
anti-hemorrhoids,
anti-diarrhea
Anti-diarrheal and
anti-inflammatory
activities [37, 38,
50]
24 Balileh Terminalia
bellerica L.
Cold and dry Fruit Anti-diarrhea Anti-diarrhea [51]
25 Amoleh Phylantus
emblica L.
Cold and dry Fruit Aphrodisiac effect,
anti-hemorrhoids,
anti-diarrhea
Anti-diarrhea,
anti-dysentery,
anti-inflammation
[39]
26 Khatmi Althaea
officinalis L.
Cold and wet Flowers Anti-fever, relieving
obstructive colic,
laxative effect
-
27 Za’faran Crocus
sativus L.
Hot and dry Flowers Anti-dysentery,
colic, healing wound
Relaxant activity
[49]
28 Sorenjan Colchicum L. Hot and dry Root Relieving flatulent
colic, sciatic & joint
pain
Anti-arthritic
activity [60]
29 Heltit
(Anghouze
h)
Ferula asa
foetida L.
Hot and dry Oleo-gum-res
in
Carminative,
anthelmintic and
aphrodisiac effects,
anti-hemorrhoids
Antispasmodic,
anthelmintic,
anti-ulcerogenic,
and anti-
inflammatory
activities [31]
30 Banafsheh Viola odorata
L.
Cold and wet Aerial parts Anti-fever, relieving
obstructive colic
-

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31 Faniz Sacharrum
officinarum L.
Hot and wet Stem
extract
Purgative aphrodisiac
effect
-
32 Hanzal Citrullus
colocynthis (L.)
Schrad.
Hot and dry Fruit &
Seed
Anthelmintic and
purgative effects,
relieving flatulent
colic, sciatic and joint
pains,
anti-hemorrhoids
Purgative activity
and anti-ulcer [43]
33 Afyoun Papaver
somniferum L.
Cold and dry Latex Anti-dysentery,
colic, anti-diarrhea
Analgesic effect,
anti-diarrhea,
anti-dysentery [40,
52, 53]
34 Moord Myrtus
communis L.
Cold and dry Fruit Anti-diarrhea,
anti-hemorrhoids
Anti-inflammatory,
analgesic and
anti-parasitic effects
[41]
35 Morr-e-
makkii
Commiphora
myrrha (Nees)
Engl.
Hot and dry Oleo-gum-
resin
Relieving obstructive
colic, anti-dysentery,
healing wound
-
36 Barhangh Plantago major
L.
Cold and dry Seeds and
Leaves
Anti-hemorrhoids,
anti-dysentery and
anti-diarrhea
Anti-ulcerogenic,
Anti-inflammatory
and analgesic
activities [42]
37 Shaghagh
ol
Polygonatum
orientale Desf.
Hot and dry Rhizome Relieving sciatic and
joint pain
-
38 Moghl Commiphora
mukul Engl.
Hot and dry Oleo-gum
resin
Relieving sciatic and
joint pain, carminative
effect
Anti‐inflammation
[62]
39 sakbinaj Ferula persica
Willd.
Hot and dry Gum-resin Anti-dysentery,
relieving flatulent
colic, sciatic and joint
pain
Anti-inflammation
[64]
40 Senna Senna
alexandrina
Mill.
Hot and dry Leaves
and fruits
Relieving obstructive
colic, laxative effect
41 Saghmuni
a
Convolvulus
scammonia L.
Hot and dry Oleo gum
resin
Relieving flatulent
colic and sciatic pain,
purgative effect
-
42 Agharghar
ha
Anacyclus
pyrethrum (L.)
Lag.
Hot and dry Roots Relieving sciatic and
joint pain, aphrodisiac
effect
Improving male
fertility by inducing
spermatogenesis
[48]
43 Samgh e
arabi
Acacia nilotica
(L.) Delile
Hot and dry Gum Anti-dysentery, healing
wound,
anti-hemorrhoids,
anti-diarrhea
Wound dressing
material for
bleeding and
profusely exuding
wounds [42]
RSs, Rectal suppositories; -, Has not been approved.

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Considerations
Due to the risk of addiction and impotence, opium
containing drugs have been restricted to severe pains.
So, when opium is as a component in the combination
of a suppository, a string is placed inside it; thus, as
soon as pain relieves, the patient pulls out the
suppository [22]. Applying the suppositories at
bedtime and then lying on the back are advised to
maximize their effects in the conditions like lower
back, sciatic and joint aches. Laxative suppositories as
well as the ones specified for colon diseases are mostly
made in large sizes, about a middle finger size, for
increasing drug delivery to its action site [22]. Besides,
it is noticed that frequent administration of RSs could
lead to hemorrhoids [13].
Discussion
The rectum is an important route of drug
administration; firstly, for the medicines which have
severe gastrointestinal side effects; secondly, it is
suitable for unconscious patients, old people and
infants who have problem with swallowing medicines;
thirdly, to prevent hepatic enzyme break down;
fourthly, for direct and rapid action on the site; fifthly,
to promote the evacuation of the bowel; sixthly, to
apply as unit dosage forms of the drugs [23]. On the
other hand, studies have indicated some side effects of
non-herbal suppositories; for instance, rectal ulcers
associated with the use of non-steroid anti-
inflammatory drugs caused discontinuation of
suppositories [24]. Furthermore, some of the
suppository bases caused severe mucosal damage
accompanied with irritation, ulceration and
inflammation [25]. Hence, RSs might cause rectal
stricture and stenosis [26]. So, this study set out with
the aim of introducing RSs, their indications in PM and
their proved pharmacologic effects in modern
medicine.
As it is shown in both Table 2 and 3, the most
significant indications of RSs are anthelminthic,
anti-hemorrhoid, aphrodisiac, wound healing,
carminative, relieving obstructive and flatulent colic,
anti-diarrheal, anti-dysentery, healing joint, sciatic pain,
and lumbago, anti-fever, laxative and purgative. As it is
illustrated in Table 3, commonly used medicinal plants
in the RSs formulations, have been shown according to
recent studies.
The herbs, mostly applied in RSs formulations as
anthelmintic agents, are 8 out of 43, including the
seeds and the fruits of Citrullus colocynthis L., the
roots of Artemisia absinthium L., the latex of Aloe vera
L., the seeds of Nigella sativa L., the rhizomes of
Zingiber officinale Roscoe., the gum of Euphorbia
helioscopia L., the seeds of Trachyspermum ammi (L.)
Sprague, the oleo-gum resin of Dorema ammoniacum
D.Don and the oleo-gum-resin of Ferula asa foetida L.
Among the 8 mentioned medicinal plants, the
anthelmintic effects of 3 of them including the latex of
Aloe vera L., the oleo gum resin of Dorema
ammoniacum D.Don, and the fruits of Citrullus
colocynthis L. have not been ascertained yet [27-31].
As it is apparent in Table 3, the herbs which have
been claimed to be utilized as ingredients of
anti-hemorrhoidal RSs in PM manuscripts are 15 out
of 43, covering the oleo-gum resin of Ferula gummosa
Boiss., the roots of Cyperus longus L., the seeds of
Linum usitatissimum L., the rhizomes of Iris
pseudoacorus L., the seeds of Nigella sativa L., the
gum resin of Boswellia sacra Flueck., the fruits and
the gall of Quercus spp., the fruits of Terminalia
chebula L., the fruits of Phylantus emblica L., the
oleo-gum resin of Ferula asa foetida L., the latex of
Papaver somniferum L., the fruits of Myrtus communis
L., the seeds and the leaves of Plantago major L., the
fruits and the seeds of Citrullus colocynthis (L.),
Schrad. and the gum of Acacia nilotica (L.) Delile.
Some of which have been studied for their
anti-inflammatory, analgesic and anti-ulcer activities
[30-44], but the efficacy of them on hemorrhoidal
conditions have not been investigated yet.
As it is presented in Table 3, 3 out of 43 herbs have
been traditionally used as carminative herbs in RS
formulations, that including the seeds of Apium
graveolense L., the oleo gum resin of Ferula asa
foetida L. and the oleo-gum-resin of Commiphora
mukul Engl. In this case, none of them have been
investigated for the aforementioned effect. Hence,
Table 3 presents the herbs which have been
traditionally applied for relieving obstructive and
flatulent colic (17 out of 43), containing the rhizomes
of Zingiber officinale Roscoe., the gum of Euphorbia
helioscopia L., the seeds of Ricinus communis L., the
roots of Artemisia absinthium L., the seeds of Nigella
sativa L., the seeds of Trachyspermum ammi (L.)
Sprague., the fruits of Cassia fistula L., the flowers of
Althaea officinalis L., the flowers of Crocus sativus L.,
the roots of Colchicum L., the aerial parts of Viola
odorata L., the fruits and the seeds of Citrullus
colocynthis (L.) Schrad., the latex of Papaver
somniferum L., the oleo-gum resin of Commiphora
myrrha (Nees) Engl., the gum-resin of Ferula persica
Willd., the leaves and the fruits of Senna alexandrina
Mill., and the oleo-gum resin of Convolvulus
scammonia L. Among the mentioned herbs,
antispasmodic and relaxant activity of the rhizomes of
Zingiber officinale Roscoe., the flowers of Crocus
sativus L., and the seeds of Trachyspermum ammi (L.)
Sprague have been recently revealed [27, 29, 49].
As it is apparent in Table 3, the seeds of Apium
graveolense L., the aerial parts of Malva rotundifolia
L., the seeds and the leaves of Trigonella
foenum-graecum L., the seeds of Ricinus communis L.,
the rhizomes of Iris pseudoacorus L., the latex of Aloe
vera L., the fruits of Cassia fistula L., the flowers of
Althaea officinalis L., the fruits and the seeds of

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doi: 10.12032/TMR20190414115
TMR | May 2019 | vol. 4 | no. 3 |
Citrullus colocynthis (L.) Schrad., the leaves and the
fruits of Senna alexandrina Mill., the stem extract of
Sacharrum officinarum L. and the oleo-gum resin of
Convolvulus scammonia L. (12 out of 43) have been
traditionally used as the laxative and purgative
ingredients in the RS formulations. Likewise the
mentioned effects of the latex of Aloe vera L., the
fruits of Cassia fistula L., the fruits and the seeds of
Citrullus colocynthis (L.) Schrad., and the leaves and
the fruits of Senna alexandrina Mill. have been
ascertained by the recent researches [43, 65-67].
Also, as it is apparent in Table 3, 9 out of 43 herbs
have been traditionally applied as anti-diarrheal agents
by ancient PM pharmacists, including the flowers of
Punica granatum L., the gum resin of Boswellia sacra
Flueck., the fruits and the galls of quercus spp., the
fruits of Terminalia chebula L., Terminalie bellerica L.,
Phylantus emblica L., the latex of Papaver somniferum
L., the fruits of Myrtus communis L., and the seeds and
leaves of Plantago major L. The mentioned effect of
the fruits of Terminalia chebula L., Terminalie
bellerica L., Phylantus emblica L. and the latex of
Papaver somniferum L. have been indicated by recent
researches [39, 50-52]. Moreover, Table 3 presents that
8 out of 43 herbs have been traditionally applied as
anti-dysentery agents in RSs formulations, covering
the aerial parts of Malva rotundifolia L., the flowers of
Crocus sativus L., the gum-resin of Boswellia sacra
Flueck., the latex of Papaver somniferum L., the seeds
and the leaves of Plantago major L., the gum- resin of
Commiphora myrrha (Nees) Engl., the gum-resin of
Ferula persica Willd., and the gum of Acacia nilotica
(L.) Delile. At this point, only anti-dysentery activity
of the latex of Papaver somniferum L. has been proved
by recent investigations [53].
As it is shown in Table 3, the herbs claimed to be
utilized as the ingredients of RSs with the aphrodisiac
effects in the PM manuscripts are 8 out of 43,
including the roots of Zingiber zerumbet (L.) smith, the
roots of Cyperus longus L., the seeds and the leaves of
Trigonella foenum-graecum L., the seeds of
Trachyspermum ammi (L.) Sprague, the fruits of
Phylantus emblica L., the oleo gum resin of Ferula asa
foetida L., the stem extract of Sacharrum officinarum
L., the roots of Anacyclus pyrethrum (L.) Lag.
However, among the 8 mentioned medicinal plants,
two of them with anthelmintic effects have been
indicated by recent researches, including the seeds and
the leaves of Trigonella foenum graecum L. as well as
the roots of Anacyclus pyrethrum (L.) Lag. [46-48].
As it is clear in Table 3, 6 out of 43 herbs have been
traditionally used as wound healing agents in RS
formulations, covering the gum resin of Astragalus
fasciculifolius Boiss., Ferula gummosa Boiss.,
Boswellia sacra Flueck., the flowers of Crocus sativus
L., the oleo- gum-resin of Commiphora myrrha (Nees)
Engl. and the gum of Acacia nilotica (L.) Delile.
Among the 6 herbs, only the gum resin of Astragalus
fasciculifolius Boiss. and the gum of Acacia nilotica
(L.) Delile have been shown to have wound healing
effects by recent researches [44, 45].
Likewise, as it is apparent in Table 3, the medicinal
plants that have been traditionally used as ingredients
of RSs for healing joint, sciatic pain, and lumbago are
19 out of 43 herbs including the oleo-gum resin of
Dorema ammoniacum D.Don., the gum-resin of Ferula
gummosa Boiss., the rhizomes of Zingiber officinale
Roscoe., the seeds of Apium graveolense L., the
roots of Zingiber zerumbet (L.) smith., the gum of
Euphorbia helioscopia L., the seeds and the leaves of
Trigonella foenum-graecum L., the seeds of Ricinus
communis L. and Linum usitatissimum L., the
rhizomes of Iris pseudoacorus L., the roots of
Artemisia absinthium L., the seeds of Nigella sativa L.,
the roots of Colchicum L., the seeds and the fruits of
Citrullus colocynthis (L.) Schrad., the rhizomes of
Polygonatum orientale Desf., the oleo gum resin of
Commiphora mukul Engl., the gum resin of Ferula
persica Willd., the oleo-gum resin of Convolvulus
scammonia L. and the roots of Anacyclus pyrethrum
(L.) Lag. Among the mentioned herbs, the
oleo-gum-resin of Dorema ammoniacum D.Don., the
gum of Euphorbia helioscopia L., the rhizomes of Iris
pseudoacorus L., the fruits and seeds of Citrullus
colocynthis (L.) Schrad., the rhizomes of Polygonatum
orientale Desf., the oleo-gum-resin of Convolvulus
scammonia L., and the roots of Anacyclus pyrethrum
(L.) Lag. have not been researched for their anti-
arthritic, analgesic or anti-inflammatory effects yet [27,
32, 33, 35, 54-64].
As it is indicated in Table 3, the barks of
Cinnamomum camphora L., the flowers of Althaea
officinalis L. and the aerial parts of Viola odorata L. (3
out of 43) have been traditionally applied as anti-fever
ingredients in RS formulations. None of the aforesaid
herbs have been examined for anti-fever activity by
recent investigations.
As it is shown in Table 3, the seeds and the leaves of
Trigonella foenum-graecum L., the seeds of Ricinus
communis L., the rhizomes of Iris pseudoacorus L., the
seeds of Trachyspermum ammi (L.) Sprague, and the
fruits of Terminalia chebula L. (5 out of 43) have been
traditionally used as anti-ascites by ancient
pharmacists. In this regard, the mentioned
pharmacological activity of none of the aforesaid herbs
has been proved yet.
These facts indicate that, the biological,
pharmacological and medical effects of the aforesaid
herbs not proven yet could create good fields for future
researches. Even though, the RSs might have many
effective properties, some factors for quality control of
the RSs must be considered. Visual inspection, which
could be an evidence of physical or chemical
instability, surface texture or form, color and odor of
this dosage form, disintegration, the uniformity of
mass, and the uniformity of content must be

REVIEW
doi: 10.12032/TMR20190414115
TMR | May 2019 | vol. 4 | no. 3 |
thoroughly considered [3]. Although, scientific studies
have revealed that the herbs of varying potency, when
combined with each other, may theoretically produce a
greater result as compared to the individual use of the
herb, in the mentioned polyherbal suppositories, drug
interactions, side effects, contraindications and
accurate dosage of the herbs must be comprehensively
studied [68, 69]. On the whole, due to the
anti-inflammatory effects of some ingredients of the
RSs as well as unwanted side effects of them, the
introduced RSs and the herbs might represent a new,
promising and effective dosage forms for some
diseases. Moreover, in modern medicine herbal
suppositories are mostly used for anorectal disorders
[70], but in PM manuscripts they were commonly used
not only for anorectal and intestinal diseases but also
as an aphrodisiac, an agent for healing joint, sciatic
pain and lumbago, an anti-fever, and an anti-ascites.
Other implications of this study could be the
possibility of utilizing herbal RSs in diseases and
disorders beyond anorectal and intestinal ones.
Conclusion
The current study shows the impact of RSs in PM
during medieval era. It is important to clarify the
history of pharmacy in this region. Also, our
comparison between traditional knowledge and current
findings indicates that these historical suggestions
could be a good candidate to evaluate and perform
further investigations for finding new drugs based on
old experiences. In fact, herbal RSs have not been
thoroughly investigated; indeed, this manuscript guides
the interested researchers to continue their researches
on this issue. Moreover, validation of the traditional
claims and development of safe and effective botanical
medicine seems to be necessary.
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