Citrullus colocynthis: the Most Suggested Herb in Persian Medicine for Management of Low-Back Pain

Document Type : Review

Authors

1 Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

3 Department of Orthopedics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Low-back pain is a common disease and a considerable economic burden in modern societies. Complementary and alternative therapies for assisting management of pain and disability are sought by a large number of patients. In the present work, the most common herbs used to manage Low-back pain in Iranian traditional medicine (Persian medicine) and current literature has been investigated.Chapters about low-back pain (“Vaja-e Zahr”), and radiculopathy (“Erghonnasa”) and sciatica from Liber Continens (Alhavi) and Canon of Medicine were reviewed. All types of plant usage mentioned in the books including oral, rectal, and topical administration, either alone or in combination were recorded. Descriptive statistics (frequency distributions) were used to report the findings. The current literature were searched with “herbal medicine” and “low-back pain” medical subject heading (MeSH) terms in PubMed, EMBASE, ScienceDirect, Scientific Information Database (in Persian), and Google Scholar databases, to investigate medicinal usage of the most suggested plants.Citrullus colocynthis L. Schrad was the most common plant that Rhazesused in compounds and a significant herb used by Avicenna for management of low-back pain and sciatica. Fruit was the main part and rectal route was the main type of administration of colocynth for low-back pain management.In conclusion, we have proposed a new use of Citrullus colocynthis for management of low-back pain and sciatica according to the evidences from Persian medicine. According to current literature survey, no study has yet investigated or suggested the usage of Citrullus colocynthis for low-back pain management. Further laboratory and clinical studies are required to confirm the safety and efficacy of this plant or its components in low-back pain and sciatica management.

Keywords

Main Subjects


[1] Dalys GBD, Collaborators H, Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015; 386(10009): 2145-2191.
[2] Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999; 354(9178): 581-585.
[3] Papageorgiou AC, Croft PR, Ferry S, Jayson MI, Silman AJ. Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester back pain survey. Spine (Phila Pa 1976). 1995; 20(17): 1889-1894.
[4] Hamaguchi T, Yoshino T, Horiba Y, Watanabe K. Goshajinkigan for low back pain: an observational study. J Altern Complement Med. 2017; 23(3): 208-213.
[5] Al-Snafi AE. Chemical constituents and pharmacological effects of Citrullus colocynthis-a review. IOSR J Pharm. 2016; 6(3): 57-67.
[6] Gagnier JJ, Van Tulder MW, Berman B, Bombardier C. Herbal medicine for low back pain: a Cochrane review. Spine (Phila Pa 1976). 2007; 32(1): 82-92.
[7] Choopani R, Sadr S, Kaveh S, Kaveh N, Dehghan S. Pharmacological treatment of catarrh in Iranian traditional medicine. J Tradit Complement Med. 2015; 5(2): 71-74.
[8] Nikaein F, Zargaran A, Mehdizadeh A. Rhazes’ concepts and manuscripts on nutrition in treatment and health care. Anc Sci Life. 2012; 31(4): 160-163.
[9] Changizi Ashtiyani S, Golestanpour A, Shamsi M, Tabatabaei SM, Ramazani M. Rhazes' prescriptions in treatment of gout. Iran Red Crescent Med J. 2012; 14(2): 108-112.
[10] Razi M. Liber Continens (Alhavi fi-al-teb). Tehran: Shahid Beheshti Medical University, Traditional Medicine and Materia Medica Research Center, 2016.
[11] Ibn-e-Sina. Canon of Medicine (Al-Qanun fi-al-teb). Beirut: Syndicate of Publishers Union in Lebanon, 2005.
[12] Jafari-Dehkordi E, Mokaberinejad R, Minaei B, Sohrabvand F, Nazem E, Hashem Dabaghian F, Aliasl J. A Review of pioneer physicians' work on maternal health in pregnancy in ancient Iran; narrative systematic review. Iran J Public Health. 2013; 42(12): 1340-1346.
[13] Elgood C. A medical history of persia and the eastern caliphate: from the earliest times until the year A.D. 1932. Cambridge: Cambridge University Press, 2010.
[14] Mozaffarian V. A dictionary of Iranian plant names. 7 ed. Tehran: Farhang Moaser, 2013.
[15] Amin G. Popular medicinal plants of Iran. 2ed. Tehran: Tehran University of Medical Sciences, 2008.
[16] Aghili Alavi Shirazi M. Collection of drugs (Makhzan-al-adviah). Tehran: Bavardaran Press, 2001.
[17] Abdalla Elgerwi A, Benzekri Z, ElMagdoub A, El-Mahmoudy A. Qualitative identification of the active principles in Citrullus colocynthis and evaluation of its teratogenic effects in albino rats. J Basic Clin Pharmacol. 2013; 2(4): 438-445.
[18] Qazan W, Almasad MM, Daradka H. Short and long effects of Citrullus colocynthis L. on reproductive system and fertility in female Spague-Dawley rats. Pak J Bio Sci. 2007; 10(16): 2699-2703.
[19] Marzouk B, Marzouk Z, Fenina N, Bouraoui A, Aouni M. Anti-inflammatory and analgesic activities of Tunisian Citrullus colocynthis Schrad. zmmature fruit and seed organic extracts. Eur Rev Med Pharmacol Sci. 2011; 15(6): 665-672.
[20] PDR for herbal medicines. 2nd ed. Montvale: Medical Economics Company, 2000.
[21] Marlowe D. Complementary and alternative medicine treatments for low back pain. Prim Care. 2012; 39(3): 533-546.
[22] Gerayeli Malek V, Abbasian A, Karimi M, Khanlarkhani N, Parvari S. 5 Medicinal plants used in Iranian traditional medicine for low back pain: a quick review. Euro J Exp Bio. 2017; 7(4): 1-4.
[23] Mahdizadeh S, Khaleghi Ghadiri M, Gorji A. Avicenna's canon of medicine: a review of analgesics and anti-inflammatory substances. Avicenna J Phytomed. 2015; 5(3): 182-202.
[24] Gagnier JJ, Oltean H, van Tulder MW, Berman BM, Bombardier C, Robbins CB. Herbal medicine for low back pain: a cochrane review. Spine (Phila Pa 1976). 2016; 41(2): 116-133.
[25] Kalim MD, Bhattacharyya D, Banerjee A, Chattopadhyay S. Oxidative DNA damage preventive activity and antioxidant potential of plants used in Unani system of medicine. BMC Complement Altern Med. 2010; 10: 1-11.
[26] Kim MG, Lee SE, Yang JY, Lee HS. Antimicrobial potentials of active component isolated from Citrullus colocynthis fruits and structure-activity relationships of its analogues against foodborne bacteria. J Sci Food Agric. 2014; 94(12): 2529-2533.
[27] Gurudeeban S, Satyavani K, Ramanathan T. Bitter apple (Citrullus colocynthis): An overview of chemical composition and biomedical potentials. Asian J Plant Sci. 2010; 9(7): 394-401.
[28] Huseini HF, Darvishzadeh F, Heshmat R, Jafariazar Z, Raza M, Larijani B. The clinical investigation of Citrullus colocynthis (L.) schrad fruit in treatment of type II diabetic patients: a randomized, double blind, placebo‐controlled clinical trial. Phytother Res. 2009; 23(8): 1186-1189.
[29] Shi C, Karim S, Wang C, Zhao M, Murtaza G. A review on antidiabetic activity of Citrullus colocynthis Schrad. Acta Pol Pharm. 2014; 71(3): 363-367.
[30] Benariba N, Djaziri R, Hupkens E, Louchami K, Malaisse WJ, Sener A. Insulinotropic action of Citrullus colocynthis seed extracts in rat pancreatic islets. Mol Med Rep. 2013; 7(1): 233-236.
[31] Mehrzadi S, Shojaii A, Pur SA, Motevalian M. Anticonvulsant activity of hydroalcoholic extract of Citrullus colocynthis fruit: involvement of benzodiazepine and opioid receptors. J Evid Based Complement Altern Med. 2016; 21(4): 31-35.
[32] Vakiloddin S, Fuloria N, Fuloria S, Dhanaraj SA, Balaji K, Karupiah S. Evidences of hepatoprotective and antioxidant effect of Citrullus colocynthis fruits in paracetamol induced hepatotoxicity. Pak J Pharm Sci. 2015; 28(3): 951-957.
[33] Tannin-Spitz T, Grossman S, Dovrat S, Gottlieb HE, Bergman M. Growth inhibitory activity of cucurbitacin glucosides isolated from Citrullus colocynthis on human breast cancer cells. Biochem Pharmacol. 2007; 73(1): 56-67.
[34] Dhanotia R, Chauhan NS, Saraf DK, Dixit VK. Effect of Citrullus colocynthis Schrad fruits on testosterone-induced alopecia. Nat Prod Res. 2011; 25(15): 1432-1443.
[35] Rajamanickam E, Gurudeeban S, Ramanathan T, Satyavani K. Evaluation of anti-inflammatory activity of Citrullus colocynthis. Int J Curr Res. 2010; 2: 67-69.
[36] Ramanathan T, Gurudeeban S, Satyavani K. Local anesthetic effect of Citrullus colocynthis on rana hexadactyla. Res J Med Plant. 2011; 5(3): 338-342.
[37] Heydari M, Homayouni K, Hashempur MH, Shams M. Topical Citrullus colocynthis (bitter apple) extract oil in painful diabetic neuropathy: A double‐blind randomized placebo‐controlled clinical trial. J Diabetes. 2016; 8(2): 246-252.