Commiphora mukul (Hook. ex Stocks) Engl.: Historical records, application rules, phytochemistry, pharmacology, clinical research, and adverse reaction.

ETHNOPHARMACOLOGICAL RELEVANCE: Commiphora mukul (Hook. ex Stocks) Engl. (also known as Guggulu) is one of the oldest and most prominent herb used in Ayurvedic medicine. Commiphora mukul plants have traditionally been used to treat inflammation, diabetes, rheumatism, arthritis, obesity, and hyperlipidemia. It has long been used in China, India, Greece, and other countries. Commiphora mukul is an over-the-counter dietary supplement in the United States and Western countries. Commiphora mukul has excellent medicinal and commercial value and deserves further investigation. AIM OF THE STUDY: This paper systematically reviews the historical records, application rules, phytochemistry, pharmacokinetics, pharmacology, clinical research, and adverse reactions of C. mukul and provides a reference for its comprehensive application in basic research, new drug development, and clinical treatment. MATERIALS AND METHODS: Literature were collected from databases such as PubMed, CNKI, Web of Science, TBRC, and other sources such as ancient books on traditional medicine, classic books on herbal medicine, and modern monographs. In this study, the application history and modern pharmacological research on C. mukul in the medicine of all ethnic groups were comprehensively and systematically reviewed. RESULTS: According to the vast literature, the varieties, morphological characteristics, distribution, and description of C. mukul used in Unani medicine, Ayurveda, traditional Chinese medicine, Tibetan medicine, Mongolian medicine, and Uygur medicine are highly consistent. Commiphora mukul is mainly used to treat rheumatoid arthritis, heart disease, obesity, hemorrhoids, urinary system diseases, skin diseases, inflammation, diabetes, hyperlipidemia, tumors, and other diseases. The core medicinal material combination in different ethnic medical preparations was C. mukul-Terminalia chebula Retz. (101 times), C. mukul-Moschus (55 times), C. mukul-Aucklandia lappa (Decne.) Decne. (52 times), and C. mukul-Acorus calamus L (27 times). Phytochemical studies confirmed that 150 components with different structures had been isolated and identified. Z-and E-guggulsterone are the main isomers in C. mukul. C. mukul has anti-cancer, anti-inflammatory, antioxidant, hypolipidemic, bone resorption, nervous system protection, myocardial protection, antibacterial, and other pharmacological properties. Clinical studies have only identified the role of C. mukul in treating hemorrhoids and lowering blood lipids. CONCLUSIONS: As an essential traditional medicine, C. mukul is widely used in the national traditional medicine system, and rich in chemical constituents and exhibit pharmacological activities. This study found that current research on C. mukul mainly focuses on its chemical composition and pharmacological properties. However, scientific research on the quality control of medicinal materials, identification of original plants, pharmacokinetics, and toxicology are relatively weak, and research in this area needs to be strengthened.

Analgesic Effect of Ropivacaine Combined with Hydromorphone following Surgery for Mixed Hemorrhoids: A Pilot Study.

BACKGROUND: Postoperative pain is a major adverse effect of surgery for mixed hemorrhoids. We evaluated whether spinal anesthesia with ropivacaine and hydromorphone provided safe and effective analgesia after surgery for mixed hemorrhoids. METHODS: This single-center, double-blind pilot study included patients with mixed hemorrhoids who underwent a procedure for prolapse and hemorrhoids (PPH) and external hemorrhoidectomy under spinal anesthesia at Zhejiang Hospital, China (October 2020 to December 2020). Patients were randomized to a hydromorphone group (spinal anesthesia with 0.5% ropivacaine and 75 µg hydromorphone) or morphine group (spinal anesthesia with 0.5% ropivacaine and 150 µg morphine). Pain scores (numerical rating scale), incidences of vomiting and itching, and length of hospital stay (LoS) were recorded at 6, 12, 18, and 24 hours after surgery. RESULTS: The analysis included 40 patients in each group. Median (interquartile range) pain score in the hydromorphone group was higher than that in the morphine group at 12 hours (1 (0-2] vs. 0 (0-2), p=0.044) but not significantly different between groups at 6 hours (0 (0-1) vs. 0 (0-0) p=0.228), 18 hours (2 (2-3) vs. 2 (1-3) p=0.060) or 24 hours (2 (2-3) vs. 2 (1-3) p=0.081). The hydromorphone group had a lower incidence of pruritus than the morphine group (47.5% vs. 67.5%, p=0.018). There were no significant differences between groups in vomiting incidence or LoS. CONCLUSION: In patients with mixed hemorrhoids, spinal anesthesia with ropivacaine/hydromorphone has a comparable analgesic effect and a lower incidence of pruritus during the first 24 hours after surgery than spinal anesthesia with ropivacaine/morphine.

Histomorphometric study of ethanolic extract of Graptophyllum pictum (L.) Griff. leaves on croton oil-induced hemorrhoid mice: A Javanese traditional anti-hemorrhoid herb.

ETHNOPHARMACOLOGY RELEVANCE: Graptophyllum pictum (L.) Griff., known as "handeuleum" in West Java and "Daun Ungu" in Indonesia, is traditionally used to cure hemorrhoids. AIM OF THE STUDY: The purpose of this study is to prove its effectiveness scientifically using anorectal histological parameters in Croton oil-induced hemorrhoid mice. MATERIALS AND METHODS: In vivo tests were performed by observing histomorphologic changes in mice anorectal tissue induced by croton oil. In addition, in vitro assay was performed for evaluating antioxidant activity, astringency property, and hemostasis-associated activity. The antioxidant activity was measured using a DPPH radical scavenging assay. The total flavonoid and phenolic contents were also determined spectrophotometrically. RESULTS: The in vivo assay showed that the oral-topical combination use of the ethanolic extract of G. pictum leaves demonstrated significant improvement on the croton oil-induced anorectal damage better than the single application by oral or topical application. CONCLUSION: These results showed that G. pictum has potent anti hemorrhoid activity, especially for the combinational use of oral and topical administration.

From nutrition to medicine: Assessing hemorrhoid healing activity of Solanum melongena L. via in vivo experimental models and its major chemicals.

ETHNOPHARMACOLOGICAL RELEVANCE: Solanum melongena L. (eggplant) is used for treatment of rheumatism, beriberi, itching, toothache, bleeding, asthma, bronchitis, cholera, neuralgia and hemorrhoids in traditional medicine (Turkish, Chinese, and Indian). Hemorrhoids from these diseases, are common illness in all over the world, which are treated with various approaches including ethnobotanicals. AIM OF THE STUDY: This study aimed to evaluate the anti-hemorrhoidal activity of eggplant, an edible plant, which is commonly utilized around the world. MATERIALS & METHODS: In vivo anti-hemorrhoidal activity of the methanolic extract prepared from eggplant was evaluated by experimental hemorrhoid model, subsequently histological and biochemical analysis. Hemorrhoid, which was induced by applying croton oil to the anal area of the rats. Furthermore, the extract was screened for anti-inflammatory activity which is based on the inhibition of acetic acid-induced increase in capillary permeability. The healing potential was comparatively assessed with a reference Pilex® tablet and cream. Phytochemical analysis performed by HPLC. The amount of the major phenolic compound (chlorogenic acid) in extract was found by using HPLC method. RESULTS: Histological and biochemical analysis demonstrated that eggplant extract is highly effective against hemorrhoid in comparison to the controls and the commercial preparation. In addition, the methanolic extract demonstrated significant inhibitory effect on acetic acid-induced increase in capillary permeability. The phytochemical studies identified major compound as chlorogenic acid (2.86%) by liquid chromatography. CONCLUSION: The eggplant calyxes, not edible, are easy to reach, by products/vast from the food sources. This is the first scientific evidence revealing that the eggplant extract has significant anti-hemorrhoidal and anti-inflammatory activity.

Curative effect of Amorphophallus paeoniifolius tuber on experimental hemorrhoids in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Amorphophallus paeoniifolius (Dennst.) Nicolson (Family- Araceae) is a crop of south East Asian origin. In India, its tuber is widely used in ethnomedicinal practices by different tribes for the treatment of piles (hemorrhoids). AIM: The present study evaluated the effect of methanolic and aqueous extract of Amorphophallus paeoniifolius tuber on croton oil induced hemorrhoids in rats. MATERIALS AND METHODS: The methanolic extract was standardized with the major phenolic compound, betulinic acid, by HPLC. The hemorrhoids were induced by applying 6% croton oil preparation in the ano-rectal region. Rats were orally administered methanolic and aqueous extract at doses of 250 and 500mg/kg, each for 7 days. Pilex (200mg/kg) was used as reference anti-hemorrhoidal drug. Hemorrhoids were assessed on eighth day by measuring hemorrhoidal and biochemical parameters along with histology of ano-rectal tissue. RESULTS: Croton oil application caused induction of hemorrhoids as indicated by significant (p<0.001) increase in plasma exudation of Evans blue in ano-rectal tissue, macroscopic severity score and ano-rectal coefficient as compared to normal rats. It significantly (p<0.001) elevated lactate dehydrogenase and cytokines (TNF-α and IL-6) levels in serum and increased myeloperoxidase activity and lipid peroxidation in ano-rectal tissue along with marked histological damage as compared to normal rats. Treatment with tuber extracts and pilex significantly (p<0.05-p<0.001) ameliorated Evans blue exudation, hemorrhoidal parameters and other biochemical parameters with attenuation of tissue damage compared to hemorrhoid control rats. The results indicate that tuber extracts exhibited curative action on hemorrhoids. The aqueous extract showed more pronounced effect than methanolic extract. The effects may be attributed to anti-inflammatory and antioxidant properties. CONCLUSION: Results indicate that tuber of Amorphophallus paeoniifolius exhibited curative action on hemorrhoids through anti-inflammatory and antioxidant properties. The study validates the ethnomedicinal use of tuber in hemorrhoids and implicates its therapeutic potential as an anti-hemorrhoidal agent.

Management of anaemia and other treatment complications.

Antiviral treatment for hepatitis C virus infection has dramatically changed with the advent of triple therapy including telaprevir or boceprevir, which is associated with a new spectrum of adverse events. These may lead to dosage reduction and early discontinuation of therapy. An increase in the frequency and severity of anaemia was reported in clinical trials for both drugs, and skin disorders including rash and pruritus occurred more frequently with the telaprevir-based regimen. The first-line management of anaemia is ribavirin dose reductions. In cirrhotic patients, aggressive ribavirin dosage reductions, erythropoietin alpha and blood transfusions are effective in managing anaemia. Several deaths and cases of severe infections and hepatic decompensation were reported in cirrhotics treated in real-life setting. Patients with platelet count ≤ 100,000/mm(3) and serum albumin < 35 g/L should not be treated with triple therapy as it is related to a high risk of developing severe complications. The management of rashes, if well planned, does not require telaprevir discontinuation. However, approximately 5% of rashes were severe and a few cases were classified as severe cutaneous adverse reactions leading to treatment discontinuation. Successful treatment can be enhanced by a strong patient support network including a multidisciplinary team.

Herbal haemorrhoidal cream for haemorrhoids.

Although hemorrhoids are one of the most common diseases in the world, the exact etiology underlying the development of hemorrhoids is not clear. Many different ointments are currently used to treat hemorrhoids; however, there is little evidence of the efficacy of these treatments to support their use. The aim of this study was to compare different herbal creams used for the treatment of hemorrhoids. Twenty-eight male Wistar albino rats, 6-8 weeks old and weighing 160-180 g, were used in this study as 1-control, 2-croton oil, 3-croton oil+fig leaves+artichoke leaves+walnut husks and 4-croton oil+fig leaves+artichoke leaves+walnut husks+horse chestnut fruit. After 3 days of croton oil application, rats were treated with 0.1 ml of cream or saline twice a day for 15 days by syringe. Tissue and blood samples were collected for histological, immunohistochemical and biochemical studies. Statistical significance was determined using one-way ANOVA followed by Tukey's multiple comparison tests. Croton oil administration resulted in severe inflammation. The third group showed partial improvement in inflammation; however, the greatest degree of improvement was seen in the fourth group, and some recovered areas were observed. Myeloperoxidase immunoreactivity was found to be decreased in the third and fourth groups compared to the second group. Additionally, biochemical analyses (Myeloperoxidase, Malondyaldehyde, nitrate/nitrite and nitrotyrosine levels and Superoxide Dismutase activity) were in agreement with the histological and immunohistochemical results. In conclusion, croton oil causes inflammation in the anal area and results in hemorrhoids. Treatment with our herbal hemorrhoid creams demonstrated anti-inflammatory and anti-oxidant effects in this model.

Red hot chili pepper and hemorrhoids: the explosion of a myth: results of a prospective, randomized, placebo-controlled, crossover trial.

PURPOSE: Spicy foods are appreciated by a large part of the world population but have been blamed for causing hemorrhoids or exacerbating their symptoms, although no epidemiologic studies have been performed supporting this hypothesis. In this double-blind, randomized, placebo-controlled, crossover trial, we have studied the effects of a single dose of red hot chili pepper on the hemorrhoidal symptoms. METHODS: Fifty patients with second-degree and third-degree symptomatic hemorrhoids were randomly assigned to take a capsule containing red hot chili powder or placebo during lunch, scoring five hemorrhoidal symptoms (bleeding, swelling, pain, itching, and burning) on a visual analog scale. After one week, crossover treatment was administered according to the same methodology. Other treatments and foods potentially related with anorectal symptoms were discontinued during the study periods. RESULTS: Patients assigned low scores to their hemorrhoidal symptoms before the study and the scores remained unchanged during the 48 hours after both placebo and chili pepper treatment, the latter showing no statistically significant effects. CONCLUSIONS: There is no scientific evidence that a spicy meal based on red hot chili pepper may worsen hemorrhoidal symptoms and, therefore, there is no reason to prevent these patients from occasionally enjoying a spicy dish if they so wish.

Khat induced hemorrhoidal disease in Yemen.

OBJECTIVE: The aim of this study was to evaluate the potential association between the habit of khat chewing and the development of hemorrhoidal disease METHODS: Four hundred and seventy four individuals (373 men and 101 women) with ages ranging from 17 to 80 years were divided into 2 groups. Group 1 (n=247) chronic khat chewers. Group 2 (n=200) non-khat chewers. Data was collected regarding chewing habits, colorectal symptoms, abdominal, proctoscopic, and operative findings. RESULTS: The key difference between the 2 groups was the incidence of hemorrhoids and hemorrhoidectomy. In the chronic khat chewers group: 169 (62%) had hemorrhoids. Of these 124 (45.4%) underwent hemorrhoidectomy. In the control group there is 8 (4%) had hemorrhoids and one patient underwent hemorrhoidectomy (0.5%). P-value (0.05). CONCLUSION: The study demonstrated a significant association between the habit of khat chewing and the development of hemorrhoidal disease.