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Plant Part Extract/phytochemical Activity Tested cell line/assay Result Reference
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Sambucus nigra Fruits Ethanol (80%) extract Anti-IBV Vero cells Inhibition of viral r eplication; ↓ viral
Chen etal.
(2014)
titer dose-dependently
Syzygium
aromaticum
Synon ym:
Eugenia
uds Ethanol and methanol
Flower b
extracts/eugenol
Anti-HSV,
anti-influenza
A virus,
anti-Ebola
caryophyllus Flower buds Essential oil/eugenol Anti-HSV GMK cells Crude extract: anti-HSV; ED50 =
– Viral inhibition Vicidomini etal.
(2021)
Tragoolpua and
72.8 μg/ml (HSV-1) and 74.4 μg/
ml (HSV-2); eugenol more potent
J
atisatienr
(2007)
than crude extract
Vitis vinifera Leaves Polyphenol extract Anti HSV-1,
anti-SARSCoV-2
ADV, adenovirus; Cox-B3, coxsackievirus B type 3; Cox-B4, coxsackievirus B type 4; CPE, cytopathic effect; ED50, median effective dose; ECV-11, echovirus type 11; GMK, green
monkey kidney; HAV, hepatitis A virus; HBsAg, hepatitis B surface antigen; HCMV, human cytomegalovirus; HCV, hepatitis C virus; HCV-LP, hepatitis C virus-like particle; HHV-3, human
herpes virus-3; HIV, human immunodeficiency virus; HRSV; human respiratory syncytial virus; HTLV, human T-lymphotropic virus; IBV, infectious bronchitis virus; IC
inhibitory concentration; IL, interleukin; IFN-γ, interferon-γ; MDCK, Madin–Darby canine kidney; MTC, minimum toxic concentration; NO, nitric oxide; PBMC, peripheral blood mononuclear cell; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TI, therapeutic index; TNF-α, tumor necrosis factor-α.
Vero, HCT-116, A549,
MCF7, H9c2, HepG2,
and Hacat cells
Inhibition of viral replication at early
stages (concentration = 10 μg/ml)
Zannella etal.
(2021)
, half-maximal
50
346 Zahra Boghrati etal.
Table 10.3. In vivo studies on medicinal plants mentioned in Canon of Medicine for treatment of viral diseases.
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Extract/
Plant Part
Allium sativum Cloves Aqueous extract Anti-NDV Time-of-addition assay
Chelidonium majus Aerial parts Aqueous extract
Glycyrrhiza glabra Leaves Aqueous, methanol,
Nigella sativa Seeds Seed oil Anti-SARS-CoV-2 Murine (BALB/c)
AIDS, acquired immunodeficiency syndrome; NDV, Newcastle disease virus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
phytochemical Activity Study design Result Reference
↓ Virus infectivity and titer
(purified active
substance)
and ethanol
extracts
in embryonated
chicken eggs
Antiretroviral C57B1/6 murine AIDS
model
Anti-NDV 9-day-old
embryonated
chicken eggs
cytomegalovirus
model
(especially in pretreatment trial)
Prevention of splenomegaly and
the enlargement of cervical
lymph nodes
↑ Survival rate and virus control
by all extracts; strong antiviral
activity: methanol extract at
300 μg/ml
↓ Virus load in spleen and liver Khazdair etal. (2021)
Doostmohammadian
etal. (2020)
Gerencer etal. (2006)
Ashraf etal. (2017)
Application of Certain Medicinal Herbs 347
Extract/
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Plant Part
Nigella sativa Seeds Seed oil in capsule
Seeds Oil Anti-COVID-19 Prospective, two-arm, parallel-
Allium sativum Bulbs Ethanol extract Anti-HPV (genital
Myrtus communis Leaves – Anti-HPV Quantitative randomized
Descurainia
sophia
Adianthum
capillus-veneris
Glycyrrhiza glabra
Ziziphus jujube
Nigella sativa
Allium sativum
Artemisia
absinthium
Leaves – Anti-HPV Quantitative randomized
Aerial parts
Roots
Fruits
Seed oil
Bulbs
Whole plant Decoction Anti-HBV Prospective, single-arm, pilot
phytochemical Activity Study design/no. of patients Result Reference
Anti-HCV Prospective, single-armed,
(450 mg)
Herbal mixture
(with other
medicinal herbs)
Herbal mixture
(with other
medicinal herbs)
warts)
Anti-asthma
symptoms in
viral respiratory
infections
Anti-rhinovirus
infections
self-controlled pilot study/30
patients
group, randomized, controlled,
open-label, phase II clinical
trial/173 patients
Double-blind, randomized,
placebo-controlled clinical
trial/35 male patients
controlled clinical trial/100
patients
controlled clinical trial/100
patients
Randomized, double-blind,
placebo-controlled clinical
trial/46 patients
Prospective, double-blind,
randomized controlled
manner in an outpatient
setting/62 patients
clinical trial/30 patients
↓ Viral load, improving
oxidative stress and
clinical condition
↑ Symptom recovery Koshak etal. (2021)
Use of 10% garlic extract
for 2 months has similar
effects to cryotherapy
↓ Size and number of
warts; more effective
than SA
↑ Excretion of wart-
inducing materials
↓ Cough and nighttime
awakening
↓ Severity and duration of
symptoms
↓ HBV DNA, HBeAg, and
HBsAg,normalizing ALT
Barakat etal. (2013)
Mousavi etal. (2018)
Yazdi etal. (2014)
Yazdi etal. (2014)
Javid etal. (2019)
Yakoot and Salem
(2011)
Ansari etal. (2018)
348 Zahra Boghrati etal.
ALT, alanine transaminase; HBV, hepatitis B virus; HBeAg, hepatitis B e-antigen; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus.
Application of Certain Medicinal Herbs 349
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11 Treatment of Various Skin Diseases,
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Including Psoriasis, Skin Cancer,
Ultraviolet Protection, Skin Dryness, and
Allergic Reactions
Maryam Nikoosokhan*
Science and Technology Park of University of Tehran, College of Agriculture &
Natural Resources, University of Tehran, Karaj, Iran
Abstract
e skin is the largest body organ and acts as a physical barrier established in the epidermis, it is exposed to uctuating external factors and shows remarkable functional and structural diversity. Over
the last two decades, understanding the complex phenotype and mechanisms of dermal diseases has
led to a variety of new biologic targets and strategies for pharmacologic intervention and signicant
potential for a medical approach to the management of skin disorders. Atopic dermatitis, eczema,
psoriasis, and abscesses are common acute or chronic skin diseases increasing dramatically due to industrialization and unhealthy lifestyle habits. e comparatively high failure rate in treatment of skin
diseases makes alternative treatments urgently needed. Fast approaches to drug discovery through
traditional medical therapies reduce process time and costs. Traditional Persian Medicne has unique
therapeutic methods in the treatment of skin disorders. ese traditional treatments and the latest
research ndings in this eld are presented in this chapter.
The skin is the largest body organ and acts as
a physical barrier established in the epidermis, it is exposed to fluctuating external factors and shows remarkable functional and
structural diversity. The outermost layer or
epidermis has powerful metabolic and endocrine capabilities with squamous cells or keratinocytes as principal cells. The dermis is the
inner layer composed of the fibrillar structural protein collagen (Arnold etal., 1990).
Better understanding of the complex phenotype and mechanisms of dermal disease over
the past two decades offers a variety of new
biologic targets and strategies for pharmacologic intervention and significant potential
*Email: maryam.nikoosokhan@gmail.com
Introduction
© CAB International 2023. Medicinal Plants Used in Traditional Persian Medicine
for a medical approach to the management of
skin disorders. Atopic dermatitis, eczema,
psoriasis, and abscesses are common acute or
chronic skin diseases that have increased
dramatically due to industrialization and
unhealthy lifestyle habits. Many cellular activ
ities of the nervous, immune, and endocrine
systems carry on towards the skin (O’Sullivan
et al., 1988) and several metabolic events
contribute to the rapid restoration of barrier
function caused by adverse mental and emo
tional conditions (Altemus etal., 2001). The
high treatment failure rate in skin diseases
requires urgent alternative treatment
methods. Fast approaches to drug discovery
through traditional medical therapies reduce
process time and costs (Bieber, 2022).
(eds. H. Schulz, Seyed Ahmad Emami and Farsad Nadjafi)
DOI: 10.1079/9781800621671.0011 352
-
-
Treatment of Various Skin Diseases 353
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Skin in View of Canon
Avicenna considered that skin and hair diseases are temperamental illnesses and that
the skin covers the whole body, creating cohesive capillary and nervous networks and a
sensitive barrier for protection of internal
organs. Many sensors, early awareness of receiving a slight dystemperament, engaging
negative stimuli from inside or outside the
body, and expelling waste products out of its
pores as an incense vapor are the duties of
the skin as a large organ. Humors from the
diet and environmental conditions will de
termine the intrinsic body temperament
(mezadj), the transformation of ileus into
blood takes place in the liver and the form of
food is destroyed and becomes humor, the
result of the second or liver digestion is the
preliminary moisture of the four humors
(Sepehrikia etal., 2022). The skin has a moderate temperament in the body and like the
other organs, proper nutrition with appropriate quality and quantity is one of the
most important factors in skin health. Avicenna’s views on dermatology were transferred to Europe in the 13th century upon
translating the Canon of Medicine into Latin,
which had a considerable effect on medieval
European medicine (Atarzadeh etal., 2016).
Many traditional medical approaches in the
Canon of Medicine can help prevent the incidence and development of illnesses and
treat the cause, not just disease symptoms.
Traditional formulations for skin disorders in
the Canon were prescribed in the form of powder, solid, semisolid, paste, and liquids by local
or systemic route of administration. Both
the brain and the skin may be influenced by
phytochemicals that can activate many biochemical and cellular processes.
Six Necessary Measures of Hygiene
Principles
2. Modication of nutrition that contains
variable amounts of hot-, cold-, dry-, and
wet-nature foods and which, in terms of
quality and quantity, has dierent degrees
of impact on the skin.
3. Movement and rest, in that taking moderate physical exercise and adequate rest
helps in better digestion and absorption.
4. Sleep and wakefulness, and average sleep
time with good quality, make the body tem
perament in the normal state and prevent
skin aging.
5. Relationships, values, life purpose, and
mental condition.
6. Evacuation and retention processes are
good for skin health when they are enough
and typical.
Proper nutrition as the most critical point in
health, humor production with appropriate
quality and quantity, and lifestyle modification are the hallmarks of treatment approaches
in the Canon. Some evidence suggests that
the quality of life in patients with dermatologic conditions is the same or worse than
the quality of life in patients with cancer or
heart diseases (Parvizi etal., 2021).
Holistic Management
in the Modern Era
There are two perspectives at each end of a
spectrum of approaches to disease management: the holistic approach, or considering
the psychological or spiritual condition of
the patient and attention to the whole
patient in their wider environment, at one
end; and the technical or scientific issues, focusing on the hard facts and concentrating
purely on diagnosis and treatment, at the
other. The holistic approach is particularly
pertinent to the discipline of dermatology.
Settehe–Darurieah is a complete concept of
holistic management.
As Avicenna mentioned, six measures of hygiene (Settehe–Darurieah) play a vital role in pre-
venting skin weakness and strengthening it:
1. Healthy air that causes depletion of waste
materials from the body and has a positive
eect on the skin.
Decoding of Humors in Traditional
Persian Medicine
Yellow bile humor is similar to fire, dry and
warm, invisible, and can penetrate into
354 Maryam Nikoosokhan
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every hole of the body, thus acute bacterial
and/or viral infections of the skin are usually related to choleric humor. Blood is warm
and wets like air, increasing the heat and
wetness, thus skin inflammatory disorders
and swellings can result from blood humor.
Melancholic humor is cold and dry, similar
to earth, hard, and tends to stasis, thus cancerous diseases, eczema, and dermatitis are
related to melancholic humor. Phlegmatic
humor is cold and wet, similar to water or
liquid it has a constant movement, thus
phlegmatic humor can be leading to diseases
related to the pathology of water like obesity
(Rafieian Kopaei etal., 2016).
General Treatment Protocols
in Traditional Medicine
Several accepted approach steps are generally considered in the treatment of skin disorders in traditional medicine. The first step
is diagnosing the responsible humor; the second step is general cleansing or blood purification by different traditional processes for
reducing waste toxic materials in the body,
because this is one of the primary ways the
body maintains homeostasis; and finally is
skin healing. According to patient temperament, different dosage forms are prepared in
the Qarabadin or pharmacopeias section of
the Canon, known as “individualized therapy” today. Due to the multiplicity of formulas, only general treatment protocols are
mentioned. The most common herbs used
in various formulas in the Qarabadin are
listed in the tables in this chapter.
Makeup and Beauty in Canon
Specific chapters in Canon of Medicine are allocated to beautification, which deals with
body care. A variety of cosmetic products formulated by different carriers and plants/
minerals for beauty and makeup (zinat), as
well as face, hair, and nail hygienic/cosmetic
products as preventive and healing methods
are found in this preeminent textbook. Hair
curling and straightening methods, depilatories, hair loss, dandruff, hair lice, alopecia,
nail disorders like splitting and pitting, scent
and body aroma, obesity, and emaciation, all
of which affect the appearance, are also discussed in a separate part in Chapter 7 of the
Canon’s fourth volume. Here are to be found
some of the most widely used traditional
dosage forms such as toner/lotion (ghasool),
liniment (tela), ointments (marham), eyeliner (koh l), and hair and nail color (sabgh). In
Avicenna’s Canon, the characterization of
skin diseases is better described for some of
the previously known conditions. The sec
tion on skin diseases discusses different
dermatologic conditions such as psoriasis,
vitiligo, acne, melasma, erysipelas, etc. Also
explained are some cutaneous problems in
the genitalia. The first descriptions of elephantiasis, leprosy, various hair and nail disorders, and pemphigus have been attributed
to Avicenna (Bagherani and Smoller, 2015).
Inflammatory Skin Lesions,
Vesicle
Inflammatory dermatoses such as eczema,
psoriasis, and acne have a significant role on
general physical health. However, their impact on psychological and social well-being
is also considerable and needs to be understood. Five characteristic signs of inflammation are redness, heat, pain, swelling, and
loss of function. However, not all signs may
be observed simultaneously in all inflammatory skin lesions.
Redness (rubor) reflects increased blood
flow in arterioles and capillaries and may
also result from stasis without the increased
flow of blood. Inf lammation-induced plasma
extravasation leads to enhanced migration
of leukocytes to the site of inflammation.
Heat (calor) is also a consequence of in
creased blood flow through the skin. In
acute lesions, the skin temperature may increase as a direct result of an elevated local
metabolic rate, pH, and activation of receptors or ion channels by inflammatory mediators or metabolites (Steinhoff, 2016).
Bosur (plural of basarah) is a minor skin
rash, awrām (plural of waram), which can be
produced by the abnormal formation and
the accumulation of waste products in the
Treatment of Various Skin Diseases 355
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subcutaneous tissue are abnormal bulgings
of the external or internal organs that are
equivalent to edema or swelling. Changes in
the quality of humors due to mixing are the
leading cause of skin inflammation, the two
general types of swelling are hot and cold.
The leading cause of hot basareh and hot
oram is blood and yellow bile humor combination divided into “good, unfavorable blood”
and “dense, watery yellow bile humor”, subsequently leading to the creation of a range
of different inflammatory disorders (Table
11.1). Accumulation of abnormal humors in
the skin leads to signs and symptoms; for example, frequent use of hot-nature, thick,
salty, spicy, and sweet foods corrupts the
blood vessels, and the skin as a weak organ
accepts it. According to modern medicine,
skin dystemperament can be due to:
• any gene variation;
• changes in the skin’s external layer like
damage related to pruritis; and
• penetration of microorganisms or envir-
onmental allergens causing skin component interruption (taaroq-e-etes āl).
The main cause of batharah or abnormal
swelling often occurs in the body’s soft organs, although sometimes it is also found in
bone, which thickens bone volume. Avicenna believed that if the skin structure as a
weak organ becomes too weak or if natural
body force sends too much waste material
produced in the body to skin layers, or if the
material quality that spills on the skin has
changed, it will appear as dryness, itching,
burning, scales, crust and vesicles, and
swellings, and sometimes will increase excessively the size of an organ. Abnormal
humor of the body accumulates beneath the
epidermis. These abnormal metabolites not
only act as culture media for pathogenic organisms like jarab or scabies but also change
skin temperament and viscosity and cause
skin diseases (Eghbalian etal., 2017).
Treatment
General treatment protocols for oram and
bosur are both systemic and local drugs. The
systemic treatment is used for blood purification and normalizing the disturbed body
humor, and local remedies with different
dosage forms are used for reducing inflammation, healing properties, and reduction of
invasive behavior action of the disease.
Manual interventions such as venesection
(fasd) and wet cupping (hijamat) are also applied. However, according to the severity of
the disease and the patient’s condition, the
order of treatment may change.
Bosur labanieh (acne)
Acne vulgaris is a prevalent skin condition
that affects 85% of adolescents, often starts
in preadolescence, persists into adulthood,
and is associated with a significant negative
impact on mental health. The mainstay of
acne treatment has remained largely unchanged over recent years. Bosur means
“skin lesions”, “vesicle” and labanieh means
“oily”. Namlah means “wound” or “pustule”
and is red skin lesions with severe itching or
hot swelling. There are different types of
acne in Canon of Medicine due to abnormal
yellow bile humor that natural body force
transmits to the skin to protect internal organs against the danger of its accumulation.
Commonly it may be related to dystemperament of the liver. Characteristics of namlah
and bosur-e-labanieh are similar to acne
(Shirbeigi et al., 2020). According to Table
11.1, there are different types of acneform
lesions in the Canon, such as a mild form
with light yellow bile humor that passes the
layer of the skin and conflicts with subcutaneous tissue, called the “progressive nam-
lah”; akalla or corrosive progressive acne;
and javresiyeh, a moderate form with a less
inflamed skin lesion.
Treatment
Nutrition modification is essential in disease
management, using a wet/heat-lowering temperament diet and oral herbal medicines for
blood purification and excretion of abnormal
mixed humors such as phlegm and black bile
combined with yellow bile or yellow bile alone.
Whey powder is prescribed in the therapy of
acne and scarring often associated with the
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