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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5578_Библиотеки_им_академика_М_И_Перельмана
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296 Motahare Nayebzadeh etal.
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Study design
Double-blind
randomized,
placebo-controlled
clinical trial
Triple-blind
randomized,
placebo-controlled
clinical trial
Randomized, single-
blind, controlled,
crossover feeding
study
Double-blind,
randomized
controlled trial
Randomized single-
blind, placebocontrolled trial
No. of
patients Disease Plant(s) Part(s) Control group
46 Asthma Adiantum capillus-
Flower
Placebo 5 days ↓ Nighttime awakening
veneris
60 Moderate to
severe
Matricaria chamomilla
Hyssopus officinalis
Glycyrrhiza glabra
Althaea officinalis
Malva sylvestris
Ziziphus jujuba
Drimia maritima (L.)
Stearn
Aerial part
Aerial part
Root
Flower
Flower
Fruit
Bulb Placebo 6 weeks The syrup significantly
persistent
asthma
25 CHD risk
factors such
as
inflammation
and
D.A. Webb
Nut Cholesterol-
lowering
control diet
without
nuts
hemostasis
128 Intermittent
Viola odorata L. Flower Placebo 5 days The syrup enhanced
asthma
400 Recurrent
tonsillitis and
peritonsillar
abscess
Viola odorata L. Flower Co-amoxiclav
(625 mg)
and
fexofenadine
(60 mg)
twice daily
Treatment
duration Results
and severity of
cough
improved FEV
1
6 weeks High-almond diet
significantly
decreased serum
E-selectin and
almond diets can
reduce CRP
In control and
high-almond diets,
tPA antigen was
significantly lower
cough suppression
with short-acting
β-agonist
7 days Decoction of V. odorata
flower (1 mg/150 ml
water) can decrease
the frequency of these
abscesses in one year
Reference
Javid etal. (2019)
Nejatbakhsh etal.
(2017)
Rajaram etal.
(2010)
Qasemzadeh etal.
(2015)
Ali etal. (2013)
CHD, coronary heart disease; tPA, tissue plasminogen activator.
Cough Management 297
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important flavonoid compounds in A. capillusveneris are quercetin, quercetin-3-O-rutinoside,
and quercetin-3-O-glycoside in the ethyl
acetate fraction (Singh et al., 2008; Ibraheim
et al., 2011; Gaikwad-Samdani, 2012; Ishaq
et al., 2014; Al-Snafi, 2015; Dehdari and Ha-
jimehdipoor, 2018; Khan et al., 2018; Nazim
etal., 2018; Zhang etal., 2019). In a study, the
antibacterial effect of the methanol fraction of
A. capillus-veneris fronds against MDR bacterial
strains was investigated, and the maximum
zone of inhibition (ZI) against Klebsiella pneu-
moniae, Providencia, Shigella, Staphylococcus aureus, Vibrio cholerae, Salmonella typhi, and Proteus
vulgaris was determined by the disk diffusion
method (Hussain eta l., 2014). In another study,
the anti-inflammatory effect of ethanolic extract of A. capillus-veneris in vitro using HEK293
and HepG2 cell lines and in vivo was investigated experimentally on 32 mice. The results
showed that this extract could normalize p38
and nuclear factor-κB (NF-κB) activation in
mice as well as the increase in spleen index by
lipopolysaccharide (LPS) induction (Yuan etal.,
2013). In an in vivo study that aimed to compare
the anti-asthmatic effect of the ethanolic extract of A. capillus-veneris fronds with that of
Sargassum wightii on 24 guinea pigs with acute
asthma induced by histamine aerosol, it was
found that A. capillus-veneris was more effective
than the other plant (Kumar et al., 2012). Twenty-seven healthy rats were examined in hypoxia
condition to investigate the Bcl2-associated-X
protein (Bax)/B-cell lymphoma 2 (Bcl-2) apoptotic index ratio and remodeling of pulmonary
epithelial cells in the control group compared to
the group supplemented with a A. capillus-
veneris ethanol extract obtained using the
Soxhlet method. The result showed this extract
could significantly modulate the apoptotic ratio
(Yadegari etal., 2019). In another in vivo study,
the anti-inflammatory activity of an alcoholic
extraction of A. capillus-veneris was evaluated by
inducing paw edema with formalin in 66 mice
and nine rats. The results showed that this fraction could significantly inhibit the release of
nitric oxide (NO) and tumor necrosis factor-α
(TNF-α) (Haider et al., 2011). Another study
examined the efficacy of aqueous and hydroalcoholic extracts of A. capillus-veneris in the
prevention of inflammation and incidence of
colitis. During this examination, 60 Wistar rats
were induced with colitis by rectal injection of
acetic acid 3% w/w and the efficacy of two extracts of A. capillus-veneris was compared to that
of prednisolone and mesalazine. Results showed
that these extracts have beneficial, dosedependent, ulcer healing, anti-inflammatory,
and antioxidant activities by suppressing interleukin-6 (IL-6), NO, and TNF-α release as well
as inhibiting NF-κB activation (Khoramian
etal., 2020).
Althaea officinalis L.
The secondary metabolites of Althaea officinalis include alkaloids, glycosides, flavonoids
(like isoscutellarein, kaempferol, hypolaetin,
and luteolin), coumarines (like scopoletin),
phenolic acids, terpenes, tannins, and saponins (Table 8.5). Mucilage of A. officinalis
contains rhamnogalacturonan, glucans, arabinans, and arabinoglucans (Gautam et al.,
2015; Mahboubi, 2020).
In an in vitro study, the antibacterial activity of the essential oil and the petroleum
ether, acetone, methanol, and aqueous extracts of A. officinalis seeds was evaluated
against various respiratory pathogens such
as Haemophilus influenzae, Pseudomonas
aeruginosa, S. aureus, Streptococcus pneumoniae, and Streptococcus pyogenes by the agar
diffusion method. The results showed that
both the essential oil and the seed extracts
possess antimicrobial activity. In particular,
the 200 mg/ml concentration of the essential oil was more effective against S. pyogenes
and H. influenza, and the methanol extract
showed high antimicrobial activity against
P. aeruginosa (Gautam etal., 2015).
Table 8.5. Major phytochemicals of Althaea
officinalis seeds. (From Gautam etal., 2015.)
Extract Compounds
Methanol Alkaloids, flavonoids, glycosides,
terpenes, saponin, tannins
Petroleum ether Alkaloids, steroids
Acetone Alkaloids, terpenes, saponins,
tannins
Aqueous Alkaloids, flavonoids, glycosides,
terpenes, saponins, tannins
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Cordia myxa L.
Major compounds of the extract obtained
from Assyrian plum fruit include the essential
oil, flavonoids, glycosides, sterols, carbohydrat es,
terpenoids, saponins, alkaloids, coumarins,
phenolic acids, mucilages, resins, tannins, and
gums (Al-Snafi, 2016a; Shwaish and Imarah,
2017). Cordia myxa fruit extract contains high
amounts of phenolic compounds, and the
antitumor and antioxidant activities of this
plant are related to the individual concentrations of these substances including gallic acid,
catechin, caffeic acid, p-coumaric acid, rutin,
quercetin, and kaempferol (El-Massry et al.,
2021). A study evaluated the mechanism of
tracheal relaxation activity of alcoholic extracts
obtained from C. myxa fruits in sheep tracheal
muscle and showed this extract can induce the
expression of NO synthesis, which is related to
the cytosolic calcium ions (Ca
2+
) originating
from extracellular space (Al-Bayati, 2008).
The anti-inflammatory activity of the
aqueous alcoholic extract of C. myxa fruit
was evaluated by acetic acid and formalin
assay in 72 mice. Tramadol and indomethacin administered intraperitoneally and orally, respectively, were compared with this
fruit extract. The study showed that hydroalcoholic extracts of this fruit possess
significant anti-inflammatory activity in
both chronic and acute phases (Ranjbar
etal., 2013). In another in vivo study, colitis
was induced in 48 rats by intrarectal administration of acetic acid to show the antiinflammatory effect of the suspension of the
section surrounding the seeds of C. myxa fruit,
which have the largest amount of mucilage
in the whole fruit. The results showed that
this effect of C. myxa is related to the fixation of zinc (Zn), manganese (Mn), copper
(Cu), and selenium (Se) in the destroyed tissue (Al-Awadi etal., 2001).
The immunomodulatory activity of C.
myxa fruit was evaluated in 40 BALB/c (albino, laboratory-bred) mice through comparison between immunization by hydatid
cyst fluid antigens (HCFAg) and treatment
by aqueous extract of the fruit in four mice
groups, which revealed that this extract
could stimulate the immune responses in
mice and cell-mediated cases (Rashid Ali
etal., 2015). In another study, the anticancer and anti-inflammatory activity of hydroalcoholic extracts of C. myxa fruit was
investigated through inhibition of cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX)
enzymes with the molecular docking of
α-amyrins as a triterpenoid of C. myxa and
both enzymes. These enzymes are related to
occurrence of cancer, so this extract can inhibit
cancer pathways in the lung, breast, and
colon neoplasm (Ranjbar etal., 2016).
Commiphora myrrha (Nees) Engl.
Commiphora myrrha or true myrrh from the
family Burseraceae has long been used as a
medicinal plant. It is a gum-resin that is extracted from the bark of the trees of Commi-
phora species (Shen et al., 2012). Ethanol
and ether extracts of C. myrrh have been
traditionally used in Greece to treat cough,
wounds, sepsis, and mouth infections. In
Britain, the resin has traditionally been used
to treat cough, gingivitis, tonsillitis, pharyngitis, sinusitis, ulcers, and skin inflammation (Shen et al., 2012). As mentioned in
Chinese culture, the extract of C. myrrha
showed activity against cancer diseases such
as lung cancer. Due to its anti-inflammatory,
antioxidant, antibacterial, and expectorant
properties, C. myrrha it is also used to cure
chest infections and sore throat. Furthermore, furanosesquiterpenoids occurring in
the volatile essential oil have been shown to
have antiseptic and antifungal activities
(Alyafei, 2020). This genus is known to have
anti-inflammatory, antibacterial, antiseptic,
and local anesthetic properties (Latha et al.,
2021). Myrrhterpenes A and B are two cadinane sesquiterpenes that are found in the
resin of this species and showed potent
anti-inflammatory effects by inhibiting NO
production (Bao etal., 2021). A mixture of
C. myrrha oil with vitamin E acetate showed antiviral activity in one study (Madia etal., 2021).
Commiphora gileadensis (L.) C. Chr.
Commiphora gileadensis is from the family
Burseraceae. Its extract has been used tradition ally
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in Arabic medicine to treat headache. The total
extract has shown antiulcerogenic property.
The aerial parts were reported to contain triterpenes such as oleanonic acid, friedelin, and
canophyllal. The ethyl acetate fraction of dry
plant material extraction showed antibacterial
activity against P. aeruginosa, S. aureus, and me-
thicillin-resistant Staphylococcus aureus (MRSA).
Quercetin and mearnsetin are the flavonols
found in this plant that show antioxidant activity. Syringic acid is another compound
that is related to antimycobacterial and antimalarial properties (Abbas etal., 2007). The
essential oil has also antibacterial and antioxidant activity (Al-Massarany etal., 2008).
Cydonia oblonga Mill.
Functional compounds of Cydonia oblonga
include steroids, phenolics, terpenoids, flavonoids, tannins, organic acids, sugars, and
glycosides (Table 8.6). C. oblonga seeds contain sterols, tannins, and triterpenes, with a
high amount of phenolic compounds such as
apigenin, -(–)-quinic acid derivatives, 6-Cpentosyl-8-C-glucosyl chrysoeriol, and stel-
Table 8.6. Major phytochemicals of Cydonia
oblonga seeds. (From Ashraf etal., 2016.)
larin, while the major phenolic component
of C. oblonga fruit is 5-O-caffeoylquinic acid
(Silva etal., 2005).
In another study, the antimicrobial activity
of fruit and seed extracts of C. oblonga was
evaluated by diffusion agar and microdilution
methods. The study showed that the ethanolic
extract of C. oblonga seeds had the most effect
against K. pneumoniae, Escherichia coli, and En-
terobacter aerogenes in comparison with aqueous ones (Alizadeh etal., 2013). In a study, the
antiradical and antioxidant actions of C. oblonga
peel, pulp, jam, and seed were evaluated through
the 2,2-diphenylpicrylhydrazyl (DPPH)
method, showing that the methanolic extract of
freeze-dried seeds is the most powerful antioxidant in this plant (Silva et al., 2004). A study
evaluated the antispasmodic activity of C. oblon-
ga in the tracheal tissues of rabbits. Results
showed that this action was related to the antagonist Ca
2+
activity, which relaxes the trachea
in bronchitis and asthma patients; however,
this extract can cause mild spasm because of
stimulation of the muscarine receptors (Janbaz
et al., 2013). An in vitro study evaluated the
anti-inflammatory effect of the C. oblonga seed
extract on the human cell line THP-1 that was
polluted by LPS. Results showed that the extract of the seeds had an antiproliferative activity against renal cancer cells in the 500 μg/ml
concentration (Al-Snafi, 2016b).
Compound Components
Mucilages
Phenolics 3-, 4- and 5-O-Caffeoyl quinic
Flavones Isoschaftoside, 5-O-caffeoylquinic
Amino acids L-Aspartic acid, L-asparagine,
Fatty acids Palmitic acid, stearic acid, linoleic
L-Arabinose, aldobionic acids,
D-xylose, 4-O-methyl glucose,
2,3,4-tri-O-methyl-D-xylose,
D-glucose, 2,3-di-O-methyl-D-
xylose, 3-O-methyl-D-xylose
acids, apigenin derivatives,
3,5-dicaffeoyl quinic acid,
leucenin-2, 6-C-pentosyl-8-Cglucosyl chrysoeriol, stellarin-2,
6-C-glucosyl-8-C-pentosyl
chrysoeriol
acid, caffeoylquinic acids
L-glutamic acid, L-glycine,
L-isoleucine, L-valine, L-proline,
L-alanine, L-leucine
acid, eicosanoic acid, oleic acid
Cucurbita pepo L.
Cucurbita pepo (pumpkin) belongs to the Cucurbitaceae family. This plant is a good source
of protein, carbohydrate, minerals, and vitamins. It has traditionally been used as an
antioxidant, anti-inflammatory, and antiviral. In Chinese Medicine, the seeds are said
to be good for the lung (Gutierrez, 2016). Regarding Iranian traditional use, Avicenna in
the Canon of Medicine recommends a mixture
of bread-paste and pumpkin for cough. It is
mentioned that pumpkin has a role in preventing lung cancer and controlling its symptoms. Containing high levels of vitamin A, it
is capable of preventing pulmonary emphysema in cigarette smokers (Batool and Dadkhah
Tehrani, 2014). In another study, compounds
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cucurbitacin B and cucurbitacin E had antiproliferative property in lung cancer cells
(A549) and lung cancer cell lines (NCI-H460)
(Gutierrez, 2016). Seeds and seed oil of C.
pepo are a rich source of polyunsaturated
fatty acids, mainly palmitic and palmitoleic
acid, proteins, phytosterols, tocopherols, carotenoids, and antioxidant vitamins. The
phenolic compounds, β- and δ-tocopherol,
and polysaccharides are related to the antioxidant activity. The extract of leaves and
also seed oils have exhibited antibacterial activity (Ratnam etal., 2017).
Ferula gummosa Boiss.
Ferula gummosa is a plant that has been used as
an anti-inflammatory, antiseptic, anti-spasm,
and painkiller. The oleoresin of F. gummosa is
also used in asthma, earache, and as an expectorant in chronic bronchitis. New studies
showed different properties such as spasmolytic, antinociceptive, anti-inflammatory, and
antimicrobial properties. The oleoresin contains
terpenes and terpenoids, arabinogalactan, and
some inorganic substances (Hajifattahi etal.,
2016). The essential oil yield was about 11% in
a study and the major compounds of that determined by one-dimensional gas chromatography–mass spectrometry (1D GC–MS) were
β- and α-pinene and myrcene (Jalali et al.,
2012). Antibacterial activity of F. gummosa was
examined against some Acinetobacter strains.
The experiment showed that both the essential oil and oleogum resin had considerable activity and the alcoholic essential oil had more
effect on the strains of Acinetobacter (Afshar
etal., 2016).
Ferula persica Willd.
Ferula persica is indigenous to Iran and belongs to the family Apiaceae. It has been
traditionally used as antispasmodic and expectorant (Razavi and Janani, 2015) and in
sinusitis (Ahvazi etal., 2012). Chemical constituents of Ferula species are sesquiterpenes,
sesquiterpene coumarins, sesquiterpene
coumarin glycosides, and sulfur-containing
compounds. Compounds auraptene and
umbelliprenin found in Ferula species have
both anti-inflammatory and cancer chemopreventive properties. Chloroform extract
of F. persica’s root showed antifungal activity
related to the compounds persicasulfide A
and persicasulfide B. In addition, the coumarine umbelliprenin at a concentration of 500
μg/ml is responsible for antibacterial activity against Bacillus subtilis, Bacillus cereus, E.
coli, K. pneumoniae, S. typhi, S. aureus, and
Staphylococcus epidermidis. It is also capable
of inhibiting the growth of Leishmania major
(Sattar and Iranshahi, 2017). Another study
showed umbelliprenin to be anti-inflammatory and a lipoxygenase inhibitor, so it can
be used for treating asthma and chronic
obstructive pulmonary disease (COPD)
(Iranshahi etal., 2009).
Drimia maritima (L.) Stearn
Drimia maritima bulb contains several phytochemicals including phenolic compounds
(like pelargonidin 3-monoglucoside and cyanidin 3-monoglucoside), phytosterols (like
β- and γ-sitosterol), cardiac glycosides, and
alkaloids, which significantly have several
pharmacological effects (Bozorgi et al.,
2017). An in vitro study investigated the
cytotoxic and anticancer activity of the
methanolic extract of D. maritima bulb in
MDA-MB-468 and MCF-7 cells. The results
showed that this extract could significantly
activate caspase and also increase ROS, Bax/
Bcl-2 ratio, and mRNA expression of CHOP
(C/EBP homologous protein), TRIB3 (tribbles-related protein 3), GADD34 (growth arrest and DNA damage-inducible 34), and
ATF -4 (activating transcription factor 4) as
stress markers (Hamzeloo-Moghadam et al.,
2018). A randomized clinical trial evaluated
the anti-asthmatic activity of D. maritima
syrup. For this purpose, 10 ml of the syrup
was administrated to the 60 patients taking
anti-asthmatic medicine for 6 weeks, and
then symptoms and spirometry parameters
were evaluated. The results showed that this
syrup could significantly improve forced expiratory volume in the first second (FEV1)
(Nejatbakhsh etal., 2017).
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Glycyrrhiza glabra L.
The main compounds of Glycyrrhiza glabra
root are triterpene saponins like glycyrrhizin, flavonoids like glabridin and isoliquiritigenin, isoflavonoids, chalcones, mucilage,
coumarin-GU-12, phytosterols, and arabinogalactan protein (Table 8.7) (Sharma
etal., 2017).
A study investigated the effect of
isoliquiritigenin, as a flavonoid of G. glabra
root, on tracheal smooth muscle in vivo and in
vitro. To learn the mechanism of tracheal relaxation, the researchers experimented with
isoliquiritigenin in guinea-pig tracheal smooth
muscle cells (TSMCs) pretreated by acetylcholine, potassium chloride (KCl), and histamine.
It was found that this compound could relax
the trachea by increasing cyclic guanosine
monophosphate (cGMP) and inhibiting cGMP-specific phosphodiesterase type 5 (PDE5);
also, isoliquiritigenin significantly increased
the latency time of collapse and inhibited the
lung overflow induced by histamine and
acetylcholine (Liu et al., 2008). In an in vivo
study, the activity of G. glabra extract on the
cellular and humoral immune activation and
nonspecific resistance was evaluated in 90
CBA/CaLac mice. The results showed that
G. glabra root extract enhanced the cellular
Table 8.7. Major phytochemicals of Glycyrrhiza
glabra roots. (From Liu etal., 2008; Ng etal., 2013.)
immune response, and this efficacy was
higher than for Echinacea purpurea (Borsuk
etal., 2011). In another study, the antitussive
effect of an aqueous extract of G. glabra was
evaluated in 24 guinea pigs in comparison
with codeine, showing that the polymeric
fraction of G. glabra decreased the amount of
citric acid in the animals, which is the major
cause of cough (Saha etal., 2011).
The anti-inflammatory effect of glabridin was evaluated in an in vivo study through
inducing inflammation and airway hyperresponsiveness in BALB/c mice by intraperitoneal ovalbumin and aluminum hydroxide
(Al(OH)
that glabridin at a dose of 20–30 mg/kg sig-
) administration. The study showed
3
nificantly decreased immunoglobulin (Ig)E
level, leukoctye count, and total protein, so it
can be effective in asthma treatment (Dogan
et al., 2020). The antitussive activity of the
ethanol extract of G. glabra roots and rhizomes was investigated in 36 albino mice
with cough induced by sulfur dioxide (SO2)
gas. The results showed that this extract, in
comparison with codeine sulfate, could significantly inhibit up to 35.62% of coughs in
60 min (Jahan and Siddiqui, 2012). The
anti-inflammatory effect of glycyrrhizin, as a
saponin compound in G. glabra, was evaluated in 36 BALB/c mice with acute lung injury
induced by LPS to assay its mechanism; it was
shown that glycyrrhizin inhibited the toll-like
receptor-4 (TLR-4)/NF-κB pathway and protected the lung tissue (Lee etal., 2019).
Compound Components
Flavonoids Glabridin, isoliquiritigenin,
Phenolics Isoangustone A,
Volatile
components
liquiritin, rhamnoliquirilin,
liquiritigenin, prenyllicoflavone
A, glucoliquiritin apioside,
1-methoxyphaseolin,
shinpterocarpin, shinflavanone,
licopyranocoumarin,
glisoflavone, licoarylcoumarin
semilicoisoflavone B,
licoriphenone,
1-methoxyficifolinol
Pentanol, tetramethyl pyrazine,
hexanol, terpinen-4-ol, linalool
oxide A, linalool oxide B,
geraniol, α-terpineol
Hyssopus officinalis L.
Hyssopus officinalis contains several compounds
such as flavonoids (like quercetin and apigenin7-glucoside), polyphenols (like gallic acid), volatile oil, tannins, terpenoids, and murrain. The
important compounds of hyssop essential oil
are pinocamphone, pinocarvone, β-pinene, terpinene-4-ol, isopinocamphone, p-cymene, myrtenal, and carvacrole. The phenolic compounds
of the alcoholic extract of hyssop comprise caffeic acid, kaempferol, apigenin, cinnamic acid,
naringenin, and cateachin (Süleyman et al.,
2010; Karegar-Borzi etal., 2016; Abdel-Megeed
et al., 2020). An in vitro study examined the
antioxidant and antimicrobial effects of hyssop
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essential oil. To evaluate the antimicrobial activity of this oil, the disk diffusion test was done
for E. coli, P. aeruginosa, S. aureus, and Staphylo-
coccus pyogenes, showing that 5–10 μl of the oil
can inhibit the E. coli, S. aureus, and S. pyogenes.
For assaying the antioxidant activity of this oil,
in comparison with acetic acid and butylated
hydroxytoluene (BHT), the DPPH method was
used, showing that hyssop oil has lower antioxidant action in comparison with BHT and acetic
acid (Süleyman etal., 2010). In an in vivo study,
the anti-remodeling and anti-inflammatory ef
fects of the aqueous extract of hyssop were
evaluated. Asthma was induced in 32 BALB/c
mice by Al(OH)
cacy of this extract in comparison with dexa-
and ovalbumin; then, the effi-
3
methasone was evaluated. The results showed
that hyssop extract decreased the expression of
matrix metalloproteinase (MMP)-9 and tissue
inhibitor of metalloproteinase-1 (TIMP-1) by
collagen deposition, proliferation of smooth
muscle, and mucus secretion (Ma etal., 2014a).
Thirty-two BALB/c mice were investigated to
determine the effect of aqueous extract of hyssop on asthmatic condition in comparison with
dexamethasone; it was concluded that hyssop
extract decreased the level of IgG and increased
the ratio of eosinophils (EOS). These results
showed that this extract, via modulating the
immune system, had a positive effect on
asthma management (Ma etal., 2014b). A randomized clinical study investigated the antiasthmatic action of a mixed herbal mixture
containing Matricaria chamomilla, A. capillus-
veneris, H. officinalis, G. glabra, A. officinalis, and
Malva sylvestris on 46 children suffering from
asthma. The patients took this herbal mixture
from the first day of starting signs to five days.
The results showed that this herbal mixture
significantly reduced the nighttime awakening
and severity of cough, whereas it did not improve tachypnea, wheezing, and respiratory
distress (Javid etal., 2019).
(Alamgeer etal., 2018). In Iran, it has been
used traditionally to treat respiratory disorders with sticky and thick secretions. It
contains minerals, vitamins, fat, protein,
phenolic, trypsin inhibitor, linatine, lignans
(phytoestrogens), and Se. These compounds
are shown to have roles in affecting cystic fibrosis pulmonary pathogenesis (Tahermohammadi etal., 2021). The seeds are a rich
source of α-linolenic acid (ALA; C18 : 3n-3)
and linoleic acid (LA; C18 : 2n-6), which are
essential fatty acids. n-3 Fatty acids can help
prevent some inflammatory diseases. L. usi-
tatissimum is a rich source of lignan that seems
to have antioxidant property depending on the
presence of specific bacteria. This plant also
contains soluble and insoluble fibers. Mucilage
is the most soluble fiber existing in L. usitatissi-
mum (Jhala and Hall, 2010).
Liquidambar orientalis Mill.
Liquidambar orientalis, known as Asian storax,
is produced when the bark of sweetgum trees
is damaged. It has been used for a long time
to cure cough, skin problems, and wounds.
Major components of L. orientalis are cinnamic derivatives, vanillin, and styrene. Cinnamic
acid presents antibacterial and antioxidant
activities. Oxygenated monoterpenes and
monoterpene ketone groups also account for
considerable antioxidant activity. The sap also
possesses antifungal and immunosuppressant properties (Lingbeck et al., 2015). The
wound healing property was tested on young
Yorkshire pigs with excised wounds on their
back; the results showed that wound healing
was related to cinnamic acid and esters such
as cinnamyl cinnamate and storesinol that
help the proliferation phase to be potent and
increase both granulation and re-epithelialization (Ocsel etal., 2012).
Linum usitatissimum L.
Linum usitatissimum (flax or linseed) from
family Linacaea has been used as a natural
laxative for many years. The seed, bark, leaves,
flower, and oil of this plant have traditionally
been used for cough and asthma in Pakistan
Malva sylvestris L.
Malva sylvestris contains various phytochemicals with several pharmacologic activities;
these compounds include flavonols, tannins,
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mucilage, polyphenols, flavonoids, and folic
acid (Irfan etal., 2021). The antimicrobial activity of the hydroalcoholic extract of M. sylves-
tris was evaluated in an in vitro study by using
disk diffusion and microdilution methods
against Aggregatibacter actinomycetemcomi-
tans. The result showed that M. sylvestris, with
minimum inhibitory concentration of 156.2
μg/ml, had an antimicrobial activity against
periodontal diseases (Vahabi etal., 2019). An
in silico study evaluated the potential of the
methanolic extract of M. sylvestris in the
treatment of COVID-19 by acting on the 6LU7
viral protein. On the other hand, the in vitro
examination of the antioxidant effect of this
plant was evaluated by DPPH and NO bioassay.
The results showed that this plant extract
was significantly effective in the treatment of
SARS-CoV-2 resistance (Irfan etal., 2021).
Myrtus communis L.
Myrtus communis has several important secondary metabolites such as tannins, flavonoids, and essential oils. Studies showed that
M. communis fruit contains 14 fatty acids, its
major ones being oleic acid, palmitic acid,
and stearic acid. Additionally, the pharmacologic effect of M. communis fruit essential
oil is important because of the existence of
1,8-cineole, α-terpineol, and α-pinene
(Serce etal., 2010; Kutlu et al., 2021). An
in vitro study was conducted on the antiinflammatory action of M. communis fruit
through inducing endotoxemia in human
umbilical vein endothelial cells (HUVECs) by
LPS administration. The results showed that
the 1,8-cineole and α-pinene of M. communis
significantly reduced the expression of inflammation markers such as IL-1β, TNF-α,
endothelial nitric oxide synthase (eNOS),
and IL-6 (Kutlu et al., 2021). The antioxidant capacity of the methanol extract of M.
communis fruit was evaluated by DPPH and
β-carotene/LA; the study showed that this
extract was a good antioxidant through
scavenging free radicals and inhibiting lipid
peroxidation (Serce etal., 2010). An in vivo
study compared the effect of black and white
M. communis fruit and leaves on hepatic
ischemia-induced rats. For this purpose, the
researchers used the leaves and fruit extract
15 min before reperfusion and then evaluated the metabolism capacity of the liver.
The concentration of total phenols (TP) in
these extracts was different; the TP of white
fruit and black leaves (27 and 94.3 μg/ml, respectively) showed more effectiveness. The
extract of white fruit showed a reduction in
the markers aspartate aminotransferase
(AST), malondialdehyde (MDA), and alanine
aminotransferase (ALT), and an increase in
the concentration of monoethylglycinexyli
dide (MEGX) (Ferchichi, 2012). An open-label randomized clinical trial investigated the
efficacy of M. communis fruit syrup in 18–
65-year-old outpatients with mild to moderate COVID-19; now, this trial is in phase
three of evaluation (Azimi and Hasheminasab, 2020).
Nymphaea alba L.
Nymphaea alba has a high content of several
phytochemicals including flavonoids (quercetin), tannins, tocopheryl esters, phenolic
acids, kaempferol, apigenin, and isokaempferide. Particularly, N. alba conains ellagic
acid and gallic acid such as p-hydroxybenzo-
ic, ferulic, and vanillic acids as methyl and
ethyl esters of them. Among these compounds, the major compounds of N. alba are
quercetin, apigenin, and ellagic acid (Cudalbeanu etal., 2018). The antiviral activity of
the methanolic and acetonic extracts of N.
alba was evaluated in vitro, which was used
to examine the anti-hepatitis C virus (HCV)
effect of these extracts in the Huh-7 cell line.
The result showed that N. alba flower
extract was significantly effective in the
treatment of HCV with or without another
anti-HCV drug (Rehman et al., 2018). The
anticarcinogenic activity of methanolic extract of N. alba flowers was evaluated in Wistar rats with renal oxidative trauma induced
by iron nitrilotriacetate (Fe-NTA) administration. Results showed that administration
of the plant extract at 100–200 mg/kg dose
significantly decreased γ-glutamyl transpeptida se,
xanthine oxidase, lipid peroxidation, and
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hydrogen peroxide (H2O2) generation, which
also recovered the normal level of antioxidant enzymes and glutathione-metabolizing
enzymes (Khan and Sultana, 2005).
Opopanax chironius (L.) W.D.J. Koch
Opopanax chironius is a plant from the family
Apiaceae with deobstruent, antispasmodic,
antipyretic, and expectorant activity that has
also been used in asthma (Maggio etal., 2013;
Önder etal., 2020). This plant is rich in coumarins, especially furanocoumarins and simple prenylated coumarins. Phthalides are another phytochemical observed in O. chironius.
Gum and malic acid are active components for
treating asthma. Imperatorin and heraclenin
are the compounds related to the anticancer
activity of this plant that induces apoptosis in
Jurkat leukemia cells (Önder etal., 2020).
Papaver somniferum L.
Papaver somniferum, with the common name
poppy, belongs to the family Papaveraceae.
More than 40 alkaloids exist in this plant including morphine, codeine, thebaine, and
noscapine as the most important ones. Avicenna ( 980–1037) introduced poppy as the
most powerful analgesic. Morphine reduces
the sensation of pain and suppresses the
cough reflex. Codeine is also a very important
antitussive and is used in many antitussive
products. Other compounds such as ethyl
morphine, phal codeine, hydrocodone, and
oxycodone also have antitussive properties
(Yazdani etal., 2003). The seeds and fruits of
P. somniferum have been used for cough and
the seeds have also been used in Unani Medicine to treat asthma as well (Masihuddin etal.,
2018). In Pakistan, seeds and fruit have been
used as antitussives (Alamgeer etal., 2018).
proteins, and carbohydrates were found to be
relatively abundant. Also, the oil yield on a dry
weight basis was observed to be 49.45% (Thakur, 2015). The kernel and the oil obtained
from P. gerardiana are a rich source of fatty
acids, especially unsaturated fatty acids like LA
(n-6) and oleic acid (n-9) that have many health
benefits (Cai etal., 2013; Sheikhahmadi etal.,
2020). γ-Tocopherol and α-tocopherol are
the most abundant tocopherols in the oil
(Sheikhahmadi etal., 2020). Albumenoids, oil
starch, phytosterol, polyphenols, xanthenes,
carotenoids, tocopherols, catechin, etc. are
also found in P. gerardiana nut. According to
the Ayurvedic Pharmacopoeia, this plant is
used in the treatment of cough and asthma
(Singh etal., 2021).
Pistacia terebinthus L.
Pistacia terebinthus that belongs to the family Anacardiaceae is commonly known as
terebinth. Smoke of the resin has been used
as an air purifier and antiseptic in Iran. In
Greece, it has been considered an expectorant. The fruit in Turkey is known as an antitussive, stimulant, and for cold and flu treatment, while the resin has traditional uses
with anti-inflammatory, antipyretic, and respiratory antiseptic effects and was considered to be good for asthma. The major
compounds in the essential oil of P. terebin-
thus are hydrocarbon and oxygenated monoterpenes such as α-pinene, and the resin
commonly contains triterpenes. Masticadienonic acid, masticadienolic acid, and morolic
acid are compounds with anti-inflammatory
effect. Flavonoids, fatty acids like oleic
acid, and sterols such as β-sitosterol are also
reported in the fruits of P. terebinthus
(Bozorgi etal., 2013).
Pistacia vera L.
Pinus gerardiana Wall. ex D. Don
Pinus gerardiana, also known as chilgoza, is
considered to have carminative, stimulant,
and expectorant activity. In a study, the oils,
Known as pistachio, Pistacia vera is a nut
from the Anacardiaceae family. P. v e r a is an
excellent source of unsaturated fatty acids,
antioxidants, dietary fibers, proteins, and
minerals (Kashaninejad and Tabil, 2011).
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P. v e ra kernels contain 50 to 60% fat which
mostly includes linoleic, linolenic, and oleic
acids (Kashaninejad etal., 2006). In Iran, it
was used traditionally as a food and in Turkey, the resin was used for treating asthma.
New researches show that anti-inflammatory and antimicrobial properties are related
to different terpenoids. Also, antioxidant effects are associated with high levels of flavonoids and phenols (Bozorgi etal., 2013).
Regarding the anti-inflammatory effect, an
experiment showed that a polyphenols-rich
extract of natural raw shelled pistachio
considerably reduced the paw edema and
neutrophilic infiltration in rats. It is also
believed that epicatechin and isoquercetin
concentrations are responsible for antioxi
-
dant and anti-inflammatory properties. A
significant reduction in TNF-α and IL-1β
levels was observed following consumption
of natural raw shelled and roasted salted
pistachios (Paterniti etal., 2017).
Plantago ovata Forssk.
Plantago ovata seeds have several compounds
in the outer coat including mucilage, and compounds in the neutral and acidic polysaccharides fractions from mucilage are -galactose,
-arabinose, -rhamnose, -galacturonic acid,
and -xylose. Gallic acid and rutin are the main
polyphenol compounds of P. ov at a seeds (Talukder etal., 2016; Sarfraz etal., 2017). The antibacterial and anti-inflammatory action of the
aqueous extract of the leaves and seed of P.
ovata was evaluated. For this purpose, the antibacterial activity of these extracts was evaluated
by the tube dilution method against periodontal pathogens including Porphyromonas
gingivalis, A. actinomycetemcomitans, Fusobacterium nucleatum, and Prevotella intermedia.
On the other hand, the anti-inflammatory
effect of P. o v a t a aqueous extract was investigated by zymogen gel electrography against
MMP-2 and MMP-9. The results showed that
these extracts were effective in inflammatory
and bacterial infection of periodontal diseases
(Reddy eta l., 2018). An in vivo study in HL A-B27
rats evaluated the anti-inflammatory effect
of psyllium in the intestinal inflammatory
pathway and its intermediates, which showed
that this plant seed decreased the leukotriene
B4, NO, and TNF-α in inflammatory processes
(Sarfraz etal., 2017).
Prunus dulcis (Mill.) D.A. Webb
Almond (Prunus dulcis) is a good source of vita-
min E, magnesium, manganese, copper, phosphorus, fiber, riboflavin, as well as phenolic
and polyphenolic compounds. Studies show
that the kernels are rich in monounsaturated
fatty acids (MUFAs), which are known to be
beneficial, especially for the cardiovascular
system. The oil contains high amounts of oleic
acid as the major fatty acid, and other compounds such as sterols, tocopherols, and squalene (Čolić etal., 2019). As to treatment, it is
suggested that the paste of soaked almond
with butter helps to relieve cough (Sultana
etal., 2016). The anti-inflammatory property
of almond was investigated in a randomized,
single-blind, crossover, controlled feeding study.
The group receiving a high-almond diet had
lower levels of E-selectin than the control and
low-almond groups. Both groups with almond
diets showed a decrease in the serum level of
C-reactive protein (CRP). MUFAs seem to be
responsible for the decrease in CRP and E-sele ctio n
levels and, as a result, for the anti-inflammatory effect (Rajaram et al., 2010). Another
study shows the role of P. dulcis as the core
drug in treating exogenous cough and acute
bronchitis. The mechanism may involve arachidonic acid metabolism, peroxidase, estrogen metabolism, and tryptophan metabolism
pathways (Sun etal., 2020).
Viola odorata L.
Viola odorata contains several compounds
including alkaloids (like the emetocathartic
alkaloid violine), saponins, glycosides, tannins, mucilage, coumarin, methyl salicylate,
monoterpenes and sesquiterpene terpenoids
(like phenyl butanone, phenyl butanone, and
viridiflorol), vitamin C, and flavonoids (like
gallic acid and quercetin). Additionally, the
essential oil of V. odorata includes geraniol,
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