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306 Motahare Nayebzadeh etal.
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citronella, salicylaldehyde, and linalool (Akhbari etal., 2012; Feyzabadi etal., 2017; Habibi
et al., 2019). A study investigated the antiinflammatory activity of V. odorata flower on
six rats before and after inducing lung damage
by formalin, in comparison to hydrocortisone.
The results showed that the V. odorata prepar-
ation prevented lung injury equal to the efficacy of hydrocortisone (Koochek etal., 2002).
An in vivo study experimented with the antioxidant effect of the ethyl acetate flower and
leaf extracts of V. odorata on Wistar rats with
hepatotoxicity induced by ethanol. By exploring oxidative markers in the liver tissue and
plasma of rats it was shown that both leaf and
flower extracts had a significant antioxidant
activity (Habibi et al., 2019). The anti-asthmatic
efficacy of V. odorata flower in 128 children
(aged 2–12 years) was evaluated in a randomized controlled trial. The flower was formulated as a violet syrup and given to one of the
groups of the study. The results showed that
the anti-asthmatic action of the syrup was
significantly related to the children’s age. As a
result, the violet syrup with a short-acting
β-agonist can increase cough suppression
(Qasemzadeh etal., 2015). In a randomized
clinical trial, the efficacy of V. odorata decoc-
tion in the recurrence of peritonsillar and tonsillitis abscess was evaluated in comparison to
fexofenadine (60 mg) and co-amoxiclav (625
mg). In 400 patients, tonsillitis and peritonsillar abscess recurred two or three times a year.
Decoction of V. odorata flower (1 mg/150 ml
water) can decrease the frequency of these ab
scesses in one year (Ali etal., 2013). A clinical
trial study evaluated the efficacy of V. odorata
decoction on 30 patients suffering from
chronic rhinosinusitis. V. odorata flower (10 g)
in the form of a decoction was given to the patients for 30 days. The results showed that
this decoction improved the symptoms of rhinosinusitis; however, X-ray of the paranasal
sinus revealed that it was not a significant alternative (Mulla etal., 2019).
Conclusion
Acacia senegal mainly consists of polysaccharides and glycoproteins. Apart from being
useful in industries, this gum is antibacterial, antioxidant, and protective in some toxicities. The most important components of
Adiantum capillus-veneris leaf are mucilage,
tannins, quercetin, adiantone, and capillarin
that cause pharmacologic effects such as
modulation of apoptotic ratio and tracheal
tissue remodeling, decreased IL-6, NO, TNF-α,
and NF-κB, and antibacterial effect on pulmonary pathogens. Althaea officinalis seed has
coumarin, tannins, mucilage, and kaempferol that affect respiratory infections and
other diseases. Commiphora gileadensis compounds also show antibacterial and antimycobacterial properties. Commiphora myrrha
has a potent anti-inflammatory effect due to
myrrhterpenes A and B, and the oil has antiviral activity. Cordia myxa fruit has mucilage,
tannins, quercetin, gallic acid, and kaempferol, which cause several pharmacologic effects on pulmonary tissue such as tracheal
relaxation, anti-inflammatory, and immunomodulatory effect by inhibition of COX-2
and 5-LOX enzymes. Cucurbita pepo possesses anticancer activities and is involved
in the prevention and control of many lung
diseases. Cydonia oblonga seed affects asthma
symptoms and cough via antispasmodic
function on the tracheal muscle, bronchial
relaxation, as well as antioxidant and antibacterial activity. This seed has several compounds such as mucilage, tannins, and flavonoids. Drimia maritima bulb contains ph enol ic
compounds and alkaloids that cause anti-asthmatic effects by improving FEV
Both oleogum resin and essential oil of Fer-
.
1
ula gummosa are antibacterial. Ferula persica
from the same genus mostly contains sesquiterpenes. It has anti-inflammatory effect
related to umbelliprenin and auraptene. Gly-
cyrrhiza glabra has glycyrrhizin, mucilage,
coumarins, and flavonoids that cause several effects on the respiratory system such
as tracheal relaxation by increasing cGMP
and decreasing PDE5 activity, suppressing
cough by decreasing citric acid, inhibition of
lung overflow, and having immunomodulatory effect through decreasing IgE as well as
an anti-inflammatory effect by inhibition of
TLR-4/NF-κB. Hyssopus officinalis aerial part
has quercetin, apigenin, and tannins, which
affect cough and asthmatic symptoms by
Cough Management 307
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modulating the immune system, increasing
IgG and ratio of EOS, enhancing mucus secretion, anti-remodeling, antibacterial, and
anti-inflammatory activity. Linum usitatissi-
mum is effective in respiratory disorders.
The essential fatty acids that exist in its
seeds are so beneficial for health and can
prevent some inflammatory diseases. Li-
quidambar orientalis has a potent wound
healing property, and some existing monoterpenes provide the antioxidant activity.
Malva sylvestris stem and seed have mucilage
and flavonoids that cause cough and COVID-19 management by antibacterial and
antioxidant activity. Myrtus communis has
tannins, essential oil, fatty oils, and flavonoids, which cause antioxidant and antiinflammatory effects by decreasing IL-1β,
TNF-α, eNOS, and IL-6. Nymphaea alba
flower has quercetin, apigenin, kaempferol,
tannins, and ellagic acid. It has antiviral and
anticancer effects by decreasing lipid peroxidation, γ-glutamyl transpeptidase, and xan-
thine oxidase. Opopanax chironius is a rich
source of coumarines and is used in asthma
due to the gum and malic acid. Different alkaloids in Papaver somniferum are responsible for the antitussive activity through
suppression of cough reflex. A variety of
unsaturated fatty acids and tocopherols
exist in Pinus gerardiana oil. Pistacia terebin-
thus consists of masticadienonic acid, masticadienolic acid, and morolic acid with
anti-inflammatory effect. Epicatechin and
isoquercetin in Pistacia vera are believed to
be responsible for anti-inflammatory and
antioxidant activity. Prunus dulcis is a rich
source of MUFAs, which seem to be related
to decreased CRP and E-selection levels and
thus anti-inflammatory effect. Plantago ova
-
ta has mucilage and gallic acid components
that cause antibacterial and anti-inflammatory activity by decreasing leukotriene-B4,
NO, and TNF-α. Viola odorata has mucilage,
tannins, saponin, and essential oil, which
can treat the lung injury as well as hydrocortisone; also, it has anti-asthmatic, antioxidant, and anti-rhinosinusitis activity in the
respiratory system.
Acknowledgments
The authors would like to thank Shiraz University of Medical Sciences, Shiraz, Iran and
also Center for Development of Clinical Research of Nemazee Hospital and Dr Nasrin
Shokrpour for editorial assistance.
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9 An Evidence-Based Review of
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Medicinal Plants for Tuberculosis
Management Cited by Avicenna
Seyedeh Mahnaz Karimi*
Department of Traditional Pharmacy, School of Traditional Medicine,Tehran
University of Medical Sciences,Tehran, Iran
Abstract
Tuberculosis (TB) is a potentially serious infectious disease and one of the ten leading causes of death
worldwide. Even today, available treatments are long and dicult, and TB control is complicated by
problems such as inadequate global public health infrastructure, human immunodeciency virus
(HIV) epidemics, and the emergence of drug resistance. In spite of various modern treatments, some
reasons like total cost, ecacy, safety, and drug resistance have caused a global willingness towards
natural remedies. erefore, the aim of this chapter is to focus on medicinal plants mentioned in Avi
cenna’s Canon of Medicine, one of the primary medicinal books. Twenty-eight plants belonging to
22 botanical families have been mentioned for treatment of TB in the Canon. Most of them have a history of use in ethnomedicine and some are used in respiratory products nowadays. Investigating the
literature has shown that anti-inammatory and antibacterial properties are the proposed mechanisms for the treatment of some types of TB. Traditional Persian Medicine (TPM) can give new insights
for the development of multiple natural treatments, the use of which in human medicine has been
tested for thousands of years. By conrming their ecacy and safety, traditional herbal remedies are
appropriate adjuvants and complementary to the chemicals mainly used for treating TB as an infectious agent. In 2018, approximately 1.7 billion people (23% of the world’s population) were estimated
to have latent TB, about 90 % of which live in developing countries.
-
Tuberculosis (TB) is an infectious bacterial
disease caused by Koch’s bacillus Mycobac-
terium tuberculosis (Mtb) that is transmitted
through the respiratory route and mainly affects the lungs and sometimes also other tissues (Bloom etal., 2017). Droplets and small
respiratory particles containing bacilli are
scattered in space by infected people when
*Email: karimi-sm@razi.tums.ac.ir
© CAB International 2023. Medicinal Plants Used in Traditional Persian Medicine
(eds. H. Schulz, Se
DOI: 10.1079/9781800621671.0009
Introduction
yed Ahmad Emami and Farsad Nadjafi)
they cough, sneeze, and talk, and can remain
in space for a long time (Turner and Bothamley, 2011). Although vaccination has
been performed for more than 90 years, TB
is still recognized as the cause of a high number of deaths, with India having the highest
number of TB deaths, followed by Indonesia,
China, Philippines, Pakistan, and Nigeria.
TB treatment involves multiple medications
over several months that force heavy costs
313
314 Seyedeh Mahnaz Karimi
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on individuals and communities, especially
in cases of drug-resistant TB. However,
chemotherapy for tuberculosis is an effective treatment (McKee and Atun, 2006). In
2021 an estimated 10.6 million people fell ill
with TB and 1.6 million deaths from TB were
reported, including 187,000 among people
with human immunodeficiency virus (HIV)
infection (WHO, 2022). The way to diagnose
TB infection is to examine the sputum smear
microscopically, and in some areas more ad
vanced methods like rapid molecular diagnostics to directly monitor the patient’s disease status following the use of drugs have
made great strides in controlling TB over the
past two decades. The prevalence of multidrug-resistant (MDR) TB, especially to the
two main TB drugs, isoniazid (INH) and rifampicin (RMP), is increasing worldwide
and remains a public health crisis.
Another problem is the prevalence of TB
in vulnerable people, such as those having
HIV/acquired immune deficiency syndrome
(AIDS) and TB at the same time. Although
Bacille Calmette–Guérin (BCG) is the most
widely used vaccine in the world, a more effective vaccine is needed in high-prevalence
areas. TB control requires the following three
preconditions: new diagnostic methods;
more effective drug regimens; and the availability of more effective vaccines (Bloom
etal., 2017). Most patients’ concerns about
TB treatments are related to their cost, efficacy, and side effects, thus leading them to
use natural products and herbal medicines
that have been introduced by botanists or
traditional physicians (Welz et al., 2018).
The use of plants with antimicrobial proper
ties along with synthetic antimicrobial
agents can increase the effectiveness of TB
treatments and reduce their side effects
(Iwu etal., 1999). The current positive attitude of society toward the use of medicinal
plants and traditional medicine, as well as
the side effects of existing TB treatments
and the emergence of resistant strains, led
our team to review the types of medicinal
plants mentioned for the treatment of TB in
Canon of Medicine, a book by the great Iranian philosopher and physician, Avicenna
(Ibn Sinā, 2015a).
-
-
In the present chapter, plants effective
against TB were extracted from Avicenna’s
book and their scientific names were identified using reliable sources (Soltani, 2004;
Ibn Sinā, 2015b).
Tuberculosis in View of Avicenna
Brief review on the respiratory system
as described in Canon of Medicine
Avicenna has given a clear description of the
respiratory system and its diseases as well as
some common treatments that can be noteworthy nowadays. According to the Canon,
the lung is a white organ made up of many
interconnected circular shutters, which are
intertwined by tendons and covered by a
membrane. The lung is a porous organ that is
responsible for inhaling, preparing, and storing the suitable air for the heart, and it consists of two parts, right (including three
parts) and left (including two parts). According to Persian medicinal literature, all the
materials in the world exhibit four main
qualities: “warmth”, “coldness”, “wetness”,
and “dryness”, and mizāj (temperament) is a
predominant quality. According to this idea,
the temperament of the lungs may be normal
or out of balance. How a person is breathing
and the type of voice are the clearest indications for the mood of our lungs. Avicenna
studied the causes and treatment of different
types of breathing: dayq alnafas, which means
shortness of breath caused by inflammation
in the lungs or respiratory tract; and rabw,
which means asthma to the state where the
breaths are small, short, and consecutive.
Pulse status, cough, and discharge from the
mouth indicate the health condition the
lungs are in. In cold weather, especially in a
rainy autumn following a dry summer, lung
diseases occur a lot. Avicenna has divided
pulmunary diseases into five categories:
• diseases with similar details;
• instrumental diseases and obstruction
of the arteries and components of the
pulmonary system;
• diseases in the porous mass of the lung;
Tuberculosis Management 315
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• diseases of obstruction of small and
large vessels; and
• participatory lung diseases with other
organs.
Avicenna has given a description of pulmonary diseases and treatments of them, such as
pleurisy (d orat al janb), pneumonia (dat
riah’), pulmonary edema, pimples on the
lungs, plural effusion, pus in the lungs, and
lung ulcers. Ulcers may occur in different
parts of the pulmonary system. Lung ulcers
have the worst prognosis.
In the treatment of respiratory diseases,
Avicenna’s Canon describes single herbs or a
combination of cleansing and expectorant
herbs, such as flaxseed, almonds, caraway,
black cumin, ginger, rhubarb, and squill, to
be taken orally. In this context, especially
lozenges or compresses on the chest are described in detail. In addition, non-medicinal
treatments such as blowing and other special exercises are also used.
Tuberculosis
Ulcers in the lungs are called sel (tuberculosis). According to Persian medicinal literature in the Canon, lung ulcers can have a
variety of causes: corrosive agent (poured
from upper organs into the lungs); infectious agent from nearby organs or distant
organs; infectious agent from the lungs
themselves; untreated pneumonia and
pleurisy; and injury. Avicenna considered
lung ulcers following an infectious agent or
untreated pneumonia to be tuberculosis
(TB). Symptoms listed for TB in the Canon
include:
• Cough and discharge that comes out
of the mouth and has a special color
and smell.
• Fever: Daily fever (deq) that increases
especially after eating and at night (al-
though sometimes deq fever occurs
along with other types of fever).
• Sweating a lot.
• Other symptoms, expressed in the al-
tered appearance of the patient: weak-
ness and wilting, hair loss, stretched
forehead skin, long neck, high thirst, low
appetite, weakness of arms and legs, excretion of wounds or blood with cough,
diarrhea, and shortness of breath.
The longevity of patients with tuberculosis
varies depending on the type of ulcer and its
cause. Children with TB are more treatable
than other ages. People who are more susceptible or at risk for TB are those with curvy
stature, with forward-leaning shoulders, a
long neck, a prominent neck knot, a small
chest, thin hair, white or yellow skin, and a
stiff body. Also, people with cold and wet
temperaments, people between 18 and 30
years of age, and people living in cold regions are more susceptible to infection (Ibn
Sinā, 2015a).
Common treatments for tuberculosis
mentioned in Canon of Medicine
Avicenna has stated two treatments for
TB: real treatment when the disease is curable; and tolerance treatment if there is no
hope of complete cure of the disease, with
the goal to give the patient time and increase longevity. For the tolerance treatment, the disease should be prevented
from getting worse and the wound should
be dried. Lung ulcer drying and cleansing
drugs such as ma olʿsal (honey that is
boiled slightly in water in a special way),
lozenge of squill (Urginea maritima, called
ʿonsol in Arabic), and lozenge of ervil (Vicia
ervilia, called kersannah in Arabic) are re-
commended. Sometimes, narcotics that
prevent cough are used. Milk is not recommended. Common foods such as ervil soup
with chives and chickpea flour and corn
flour are recommended.
In the real treatment, the lungs are
cleansed and new foreign substances are
prevented from falling into the lungs. Preventing the falling of foreign substances
into the lungs is done by the treatment
methods of bloodletting (fasd) or cupping
(alhijama) and using herbal medicines such
as poppy syrup, guggul (Commiphora mukul),
arabic gum, dodder (Cuscuta sp.), and honey.
Then drying, cleansing, emollient drugs
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