Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

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Pharmacological Research - Modern Chinese Medicine

journal homepage: www.elsevier.com/locate/prmcm

Medicinal herbs from Western Himalayas for hemorrhoids treatment: A

review correlating traditional knowledge with modern therapeutics
Sakshi Dhiman, Rohit Kumar Nadda, Prerna Bhardwaj *
School of Biological and Environmental Sciences, Shoolini University, Solan, Himachal Pradesh, 173229, India

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Hemorrhoid or piles is a highly prevalent anorectal disease. In this review we aimed for systematic
Hemorrhoids correlation of traditional claims of Himalayan medicinal plants with scientific investigation for Hemorrhoids.
Medicinal plants Methods: Detailed data on medicinal plants used for hemorrhoids, treatment options and traditional & scientific
Ayurveda
information on hemorrhoids are collected from research articles, review articles, books and pharmacopoeia.
Western Himalaya
Traditional Chinese medicines (TCM)
Literature survey was conducted using keywords hemorrhoids, Himalayan medicinal plants, medicine systems
Phytoconstituents and hemorrhoids, traditional plants for hemorrhoids etc. The information is compiled from various sources such
as PubMed, Hinari, science direct, google, google scholar, survey, and literature available on these plants and
different books.
Result: According to the traditional medicine knowledge, indigenous peoples of Western Himalayas and Chinese
provinces are employing Terminalia chebula, Aristolochia contorta and Holarrhena antidysenterica for the treatment
of piles. The Ayurvedic literature and TCM suggested some anti-hemorrhoidal formulations Diyu Huaijiao,
Mayinglong Shexiang Zhichuang Gao (ointment), Kutajarishta. Among all the plants mentioned in formulations,
Emblica officinalis, Terminalia chebula and Azadirachta indica were found promising in scientific investigations on
piles and its pathological conditions. Phytoconstituents gallic acid, ferulic acid and steroidal alkaloids also
revealed their efficacy against hemorrhoids and associated pathologies.
Conclusion: By doing so, we discovered several valuable leads and gaps in the available literature. The identified
medicinal plants and bioactive constituents may be evaluated against a standardized hemorrhoids model using a
target-based approach.

Introduction vascular tone, perivascular amorphous substrate microcirculation,

connective tissue strength, and capillary flow.
Hemorrhoids are the most prevalent gastrointestinal condition Himachal Pradesh (H.P.) is a hilly state of India, with an area of
which is characterized by swelling, enlarged veins in the anus and 55,673 sq. km. State is situated in the mountain range of Western
rectum areas or frequently accompanied by pain, discomfort, and Himalayas (33◦ − 12′ north latitudes and 75◦ − 47′ east longitudes) where
bleeding that get worse with time [1]. Hemorrhoids are unusual in altitudes vary from 350 m to 6975 m above sea level [4]. H.P. contains a
children, but their prevalence in the elderly is a big concern for future huge variety of medicinal and odoriferous plants, making it the actual
generations [2]. After or during the treatment of hemorrhoids by using emporium of the Western Himalayas. This region contains a diverse flora
surgical and non-surgical procedures, patients have faced a variety of and is appropriate for ethnobotanical investigation, yet it is home to a
problems, including recurrence of symptoms. In comparison to surgical range of plants used to treat several diseases, such as jaundice, anemia,
and non-surgical procedures, medicinal plant products and nutritional diarrhea, dysentery, malaria, leprosy and many more [5]. In this review,
therapies are a key element of safe and effective hemorrhoid treatment we are mostly focused on those plants which are used to treat hemor­
[3]. Herbal-based medications have been demonstrated to increase rhoids (piles). Traditional, ayurvedic and herbal remedies have gained

Abbreviations: TCM, traditional Chinese medicines; DPPH, 2,2-diphenylpicrylhydrazyl; ABTS, 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid); NO, nitric
oxide; FRAP, Ferric reducing ability of plasma; SOD, superoxide dismutase; IRC, Infrared photocoagulation; RBL, Rubber band ligation; WHO, World Health Or­
ganization; H.P., Himachal Pradesh; VEGF, vascular endothelial growth factor; ROS, Reactive oxygen species; HUVECs, human umbilical vein endothelial cells.
* Corresponding author.
E-mail address: [email protected] (P. Bhardwaj).

https://doi.org/10.1016/j.prmcm.2023.100334
Received 3 September 2023; Received in revised form 9 November 2023; Accepted 17 November 2023
Available online 25 November 2023
2667-1425/© 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

Fig. 1. Types of hemorrhoids.

popularity for treating hemorrhoids due to cultural or historical factors, investigate ethnomedicinal plants used to treat hemorrhoids with their
as well as the expensive price and side effects of allopathic medicines pharmacological potential and according to the literature few directions
[6]. People from many different tribes and cultures have used a variety related plant-based medicines to cure and management of the disease
of ethnomedicinal plants to treat hemorrhoids based on their indigenous may be speculated.
knowledge.
Traditional medicines and herbal-based medications are indispens­ Methods
able components of alternative medical systems. In India, indigenous
people use several herbs to effectively a variety of disorders. According Detailed data on medicinal plants used for hemorrhoids, treatment
to the World Health Organization (WHO), 80 % of the world’s popula­ options and traditional & scientific information on hemorrhoids are
tion relies on traditional medicines, the majority of which are derived collected from research articles, review articles, books and pharmaco­
from plants, as they are primary source of health care [7]. India is a great poeia. Literature survey was conducted using keywords hemorrhoids,
treasure of well-documented and historically rehearsed herbal health Himalayan medicinal plants, medicine systems and hemorrhoids,
records. Traditionally, in Ayurvedic, Unani and other western medicinal traditional plants for hemorrhoids etc. The information is compiled from
systems, curative/remedial herbs constitute an integral component of various sources such as PubMed, Hinari, science direct, google, google
primary health care particularly in developed nations [8]. Herbal scholar, survey, and literature available on these plants and different
medicine remains the cornerstone for health care for around 75–80 % of books. Plant data collected from traditional literature and books was
the world’s population, particularly in poor countries, due to greater correlated to formulations in Chinese and ayurvedic pharmacopoeia to
cultural acceptability, better compliance with the human body and filter the data. In the end, data from pharmacological studies for hem­
fewer side effects [6]. In rural areas, herbal medicine plays an important orrhoids was collected for scientific evidences of medicinal plants.
role where numerous homemade medicines still to be used as natural Plants were identified using an internet database to verify the botanical
treatments for a variety of diseases [6]. Tribal people live in harmony names of plant species (www.theplantlist.org).
with nature and have a strong relation with it. There are approximately
7500 plants known for their medicinal properties out of which 4691 are Hemorrhoids
reported in various medicine systems and homeopathy leaving around
2800 plants unknown or forgotten to the community [9]. Although, Hemorrhoids or bleeding piles is commonly known as Bavasir. It is a
there is currently no approved medicine to treat hemorrhoids, sub­ most common anorectal disorder with a high prevalence and is char­
stantial studis are being conducted in the field of natural products to acterized as vascular structures that extend from the subcutaneous
explore the potential ofmedicinal plants to cure hemorrhoids [10,11]. anterior venous vascular plexus in the anal region to the smooth anal
Pilex is one of the polyherbal formulation approved by the Government sphincter muscle through the conjoined longitudinal muscle [1]. Hem­
of India’s Drug Regulation Authority [10]. Pilex in found in both tablet orrhoid has a reported prevalence of 4.4 %− 86 % of the general popu­
and ointment forms and is a mixture of various plant extracts: Bauhinia lation worldwide and 36.9 % of the those aged 45–65 [2]. Hemorrhoids
aristata, B. variegata, Cassia fistula, Emblica officinalis, Melia ferrea, M. are caused due to pathological abnormalities in the structural compo­
azadirachta, Terminalia bellirica, T. chebula [11]. Clinical and pre-clinical nent of the anal canal. Thickened cushions of mucosa and submucosa are
studies have shown Pilex to be potent in the treatment of hemorrhoids. arranged in the anal canal and are implicated in facilitating stool
[12,13]. Himachal Pradesh is one of the hilly states with a strong legacy evacuation and maintaining anal continence [15]. As a result of these
of ethnobotanical flora and natural blessings. The Indian subcontinent is degenerative alterations, the connective tissue inside the cushions rup­
home to over 53.8 million tribal people living in 5000 vegetational tribal tures, resulting to enlargement of the vascular plexus and hemorrhoidal
group communities, covering 15 % of the total geographical area of cushions, which produce a range of symptoms, including bleeding,
Indian land masses and representing one of the largest emporia of swelling, prolapse, itching, leaking and irritation of the perianal
ethnobotanical resources [14]. As a result, this study is an effort to epidermis. Along with that, thrombosis is a another highly problematic

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S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

and painful symptom of hemorrhoids [16]. Hemorrhoids are generally Healer’s Piles Treatment Cream®, Hemorrhoids No More®, and Pilex
of two types: internal (inside the anus-internal) or external (under the ointment®, are available for topical treatment of hemorrhoids [25].
skin around the anus-external), which may protrude externally or Other poly herbal drugs are also well-studied for the treatment of the
internally (Fig. 1). Utilization or incorporation of antioxidant, hemorrhoids such as Daflon 500®, Soft gel Capsules®, and Pilex ®
anti-healing, anti-inflammatory, analgesic and anti-astringent proper­ tablets [17].
ties in a product may provide enhanced treatment for the disease [17].
In contrast, external hemorrhoids are truly symptomatic only when Sclerotherapy
they become thrombosed and occur near the anus or may be externally It is a non-surgical method in which chemicals are inserted into the
in the anus cavity [18]. Primarily, external hemorrhoids originate hemorrhoids to weaken their blood vessels and cause them to shrink. For
embryonically from ectoderm and are located below the dentate line grades I and II, this approach is suggested. It includes the injection of
[19]. They are surrounded by anoderm, which is made up of squamous various chemicals or sclerosants into the submucosal space or apex of
epithelium and vascularized by somatic neurons that feed the perianal the hemorrhoid to be repaired [26,27].
skin and leads to pain.
Internal hemorrhoids are that type of hemorrhoids which occur near Rubber band ligation (RBL)
the rectum. They are derived from the endoderm and are situated above It is a another commonly used non-surgical method in the case of
the dentate line. They are insulated by columnar epithelium and vas­ type I, II, and III hemorrhoids. In the RBL method, an endoscope is
cularized by visceral nerve fibers, so they do not cause any harm [20]. inserted in the anal region. A rubber band is then stretched around the
Internal hemorrhoids are further classified according to how much the affected area to cut off the blood flow and reduce the hemorrhoids. This
tissue descends via the anal canal i.e. First degree (always remains in the is a very efficient, affordable and easy method that is put up for grades I
rectum), Second degree (tends to come out of the rectum during a bowel and II, as well as in some cases of grade III. During treatment of the first
movement), Third degree (extends outside of the rectum during a bowel three grades of hemorrhoids (I, II, and III) RBL was found to be the best
movement and they need to be pushed back into the rectum after the method other than infrared coagulation (IRC) or injection sclerotherapy
bowel movement) and fourth degree (always remains outside the anus) [28,29].
[21].
Cryotherapy
Causes of hemorrhoids In the United States, it is a very famous non-surgical method used for
hemorrhoids. But due to certain drawbacks such as foul-smelling
Even with some medical achievements in haemorrhoid therapy, the emitted, and discomfort with a high incidence of recurrent hemor­
actual causes of hemorrhoids are not fully understood. Body habits, rhoidal tissues, this procedure is rarely used [30].
tight-fitting clothing, customs, passions, temperature, sedentary life,
atmosphere, blood vessel wall vulnerability, heredity and hereditary Infrared photocoagulation (IRC)
predisposition are some of the intimated causes of hemorrhoids [22]. In 1979, Neiger was the first to notice this technique. In this tech­
Patients with spinal cord injuries, constipation, frequent diarrhoea, bad nique, the blood flow to the hemorrhoids is limited by scar tissue
bathroom habits, postponing bowel movements, sitting on defecation (infrared radiations can cause scar tissue), causing them to shrink in the
for a long time and a low-fiber diet are often at risk. Increased case of type I and II. A tungsten-halogen lamp is required to provide a
intra-abdominal pressure can be caused by many factors, including controlled amount of infrared radiation (transformed into heat) to the
Valsalva defecation with a lot of force, venous occlusion due to preg­ colony. This procedure is quick and painless, but it does not work on
nancy and constipated stool in the rectal area ampulla. Cirrhosis due to massive or prolapsed hemorrhoids [26].
alcoholism or other causes of portal obstruction may result in serious
consequences [17]. Direct-current electrotherapy and bipolar diathermy
The direct current probe in this method is a non-thermal technique
Treatments for hemorrhoids that employs NaOH ions at the negative electrode to get the desired
tissue results. The significant amount of time required to treat the
As the true causes of hemorrhoids are unspecified, the cornerstone of injured tissue (up to 14 min per second) prevents direct current tech­
conservative medical treatment for hemorrhoids are changes in lifestyle nology from being employed to cure hemorrhoids. [17,31]. In another
and nutrition. Surgical or non-surgical methods are the basis of con­ study, it was determined that mucosal ulceration occurred in 24 % of
servative medical therapy for hemorrhoid disorders [20]. In patients, and in 8 % of cases, there was significant bleeding.
non-surgical methods, it does not include anaesthesia and surgical ex­ Low-wattage bipolar diathermy results in tissue coagulation. In ran­
cisions for the treatment of hemorrhoid disease. Non-surgical methods domized clinical trials, the success rate of bipolar surgical excision
are of various types such as Rubber band ligation (RBL), Cryotherapy, ranges from 88 to 100 percent, although the incidence of complications
Sclerotherapy, Direct-Current electrotherapy, Infrared photocoagula­ is still rather high. The operation might take up to 30 s, and many ap­
tion (IRC), and Bipolar Diathermy [17]. Non-surgical methods are used plications are frequently submitted to the same site [26,32]. On the
only in the case of first and second-degree hemorrhoids. other hand, patients who have external hemorrhoids that have been
strangulated, choose for surgical treatment. It may also be necessary for
Medicinal therapy patients with symptomatic grade III hemorrhoids as well as those who
Hemorrhoids tend to worsen over time; thus, they should be treated have experienced thrombosed hemorrhoids. [17,20].
as soon as they appear. Always the best effective treatment is preven­
tion. Botanical is a term that is increasingly used to describe a wide Traditional herbal-based approaches for hemorrhoids
range of plant-based products. About 70–80 % of people worldwide rely
on traditional, primarily herbal medicine for their primary healthcare The current treatment and surgery of hemorrhoids have many other
issues [23]. In the initial stages of hemorrhoids, herbal and allopathic adverse effects such as burning sensations, discomfort, bleeding, itching,
therapies are effective (Oral and Topical) [24]. A variety of modern and and so on, whereas herbal/natural therapy takes a slightly longer time to
traditional medications are progressively being employed like Psyllium cure but has no side effects as discussed above in 3.2.1. Since ancient
husk, corticosteroid creams, nitro-glycerine ointment, calcium domi­ times, Ayurveda has been the backbone of a long and healthy life in
ciliate, and nifedipine in the treatment of hemorrhoids. Some of the India. Herbal medicines are derived from plants and their extracts as
marketed cream-based ointments with essential oils, such as Neo well as, the ayurvedic remedies are also derived from numerous

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Table 1
Plant drugs utilized in Traditional Chinese medicines for hemorrhoids.
S. No Plant Name Part used Dosage Indications

1. Aristolochia contorta Bunge Dried/riped fruit 3–9 g Clear intestine and eliminate hemorrhoids
2. Polygonum bistorta L. Dried rhizome 5–10 g Bleeding hemorrhoids
3. Bombax ceiba L. Flower 6–9 g Diarrhea, dysentery, Bleeding hemorrhoids
4. Momordica cochinchinensis (Lour.) Spreng. Seeds 0.9–1.2 g Hemorrhoids
5. Nelumbo nucifera Gaertn. Dried receptacle 5–10 g Bleeding hemorrhoids
6. Potentilla chinensis Ser. Dried herb 9–15 g Bleeding hemorrhoids

medicinal plants and their components serve as the foundation for the intravenous medicines. Hemorrhoids are a common condition. Surveys
development of multiple treatments for treating various diseases. Vai­ performed in China indicate that up to 70 % of individuals suffer from
dya, Ayurvedacharya, older people and tribals have a wealth of this disorder. Third-degree internal hemorrhoids and mixed hemor­
knowledge that can be used to make medicines and other drugs. The use rhoids are normally treated clinically by surgical excision; nevertheless,
of medicinal herbs to treat piles has proven to be more effective and has in many such situations, patients commonly feel embarrassed and
fewer side effects. Herbal and natural remedies are available to all. discomfort as a result of post-operative complications and side effects
Typically, it is significantly less expensive than purchasing standard [36,37]. To treat hemorrhoids, diarrhoea, and other gastrointestinal
medications. diseases, the TCM system also employed some herbal plant medicines
such Aristolochia contorta, Bombax ceiba, Nelumbo nucifera, etc. (Table 1).
Different plant parts were used in various forms such as, dried or riped
Treatment of hemorrhoids with natural flavonoids
fruit of Aristolochia contorta was used to clear intestine and hemorrhoids.
The dried rhizome of Polygonium bistorta, flower of Bombax ceiba, seeds
Flavonoids are plant-derived naturally occurring substances in a
of Momordica cochinchinensis, dried receptacles of Nelumbo nucifera and
variety of plants, fruits and vegetables that are taken on a daily basis.
dried herb of Potentilla chinensis were used against hemorrhoids, diar­
Numerous studies have been established that the flavonoids’ importance
rhea and dysentery. In addition, various Chinese formulations are
as an analgesic, anti-inflammatory and antioxidants, even though their
offered, including: Sanqi Xueshangning Jiasnang (capsules), Gangtai
methods of action remain unclear. Many preparations for the treatment
Ruangas (ointment), Zanglian Wan (pills), and Diyu Huaijiao Pills.
of hemorrhoids are made from distilled or crude extracts of flavonoids,
These remedies can be used to treat a variety of disorders including
which have been confirmed to have anti-inflammatory effects and
diarrhoea, dysentery, hemorrhoids, constipation, and many more as
improve blood vessels, venous insufficiency, and other gastrointestinal
shown in Table 2.
disorders. Drug therapy plays a significant role in the diagnosis of
venous insufficiency and hemorrhoids. The most prevalent phleboton­
ists’ medications are flavonoids such as diosmin, hesperidin, rutin, Treatments in alternative systems of medicine
quercetin and outsides it appears that these, diosmin in conjunction with
diosmetin, hesperidin, and linarin in distilled micronized fraction One more suitable and best method for the treatment of hemorrhoids
(PMFF), can achieve better results in recent literature [33]. Phlebotonics is herbal formulations, prepared from various plant parts which are used
are used to cure hemorrhoids, strengthen blood vessel walls, increase internally or topically in the form of oral, ointment, lotion, decoction or
venous flow, control acute bleeding, congestion, thrombosis of anal oil [29]. Based on human research on the treatment categories for
cushions, lymphatic drainage and give anti-inflammatory effects [34]. hemorrhoids, many ayurvedic medicinal herbs are used to treat a variety
Flavonoids can improve vein flexibility and vascular tone as measured of intestinal disorders. These herbal preparations can be used to treat
by plethysmography in humans, in addition to a number of other sub­ hemorrhoids in the early stages and as an alternative method to cure in
stantial improvements in chronic venous insufficiency. Low water sol­ the later stages. Herbal medicine is recommended above other therapies
ubility is the most challenging problem to overcome in flavonoids, as it for treating varying degrees of hemorrhoidal disease. It is regarded as
reduces oral bioavailability. In contrast, topical formulations are a one of the most effective home remedies since it describes how to cure
viable therapeutic alternative for providing a site of the medication with hemorrhoids with daily household products. Plants have numerous
beneficial pharmacological uses, such as lowering local inflammation, well-known pharmacological properties, including antioxidant, astrin­
pain, stress, and other oxidative actions [35]. gent, anti-inflammatory, anti-edema, hepatoprotective, and various
other bioactive compounds, which makes them very effective and con­
tributes to increasing venous tone, which is a step forward in the
Treatments in traditional Chinese medicines (TCM)
treatment of hemorrhoids [17]. In Ayurveda, Triphlaguggulu is an Ay­
urvedic medicine that includes Piper longum, Terminalia chebula, Emblica
Early in the 1970s, Chinese medicine began to gain popularity,
officinalis, Comiphora mukul, and Terminalia billerica. It is one of the most
which has continued to this day. A survey conducted in Japan in 1982
effective hemorrhoid treatment due to its inflammatory, antioxidant and
revealed that over forty percent of Western-trained physicians practiced
astringent properties. The plants which are commonly used by local
Kampo, a Japanese version of Chinese medicine, with an additional
people, in Ayurveda, and in herbal medicines which have the properties
twenty percent predicting they would in the future. Since 1977, the
to cure hemorrhoids are discussed below (Table 3).
World Health Organization (WHO) has promoted Chinese alternative
medicines in a number of countries and has created six TCM medicine
partnership centres in China. In Guangzhou, it sponsored a regional Medicinal plants from the Western Himalayan region for hemorrhoids
conference on the implementation of TCM in primary healthcare last
year [36]. By administering the medication through the skin, TCM seeks The Himalayan Centre of plant diversity is a small biodiversity hot­
to increase the patient’s ability to adapt to it and prevent any adverse spot on the southern edge of the Himalayas and the world’s largest
effects on the liver, gastrointestinal tract, or other organs. It can mountain range, with heights exceeding 8000 m. H.P. is a Himalayan
simultaneously maintain consistent blood concentration and provide state in India and an important source of medical knowledge. This
long-term therapy. mountainous state is the home to an extensive variety of world’s most
Most importantly, the TCM method of external therapy considerably important medicinal plants. The state has over 3000 plant species, but
enhances safety by minimizing the risk associated with oral or only 500 have been confirmed to have medicinal properties. A total of

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S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

Table 2
Traditional Chinese formulations.
S. Formulations Ingredients Administration and Dosage Indications
No

1. Diyu Huaijiao Pills Sanguisorbae Radix (stir-baked) 72 g, Sophorae Fructus 1 large honey pilled or 5 g water Anal fistula, constipation, Hemorrhoids,
(processed with honey) 108 g, Scutellariae Radix 72 g, (twice a day) Dysentery with blood stool
Rhei Radix et Rhizoma 36 g, Sophorae Flos (stir-baked)
72 g, Rehmanniae Radix 72 g, Paeoniae Radix Rubra 36
g, Angelicae Sinensis Radix 36 g, Carthami Flos 9 g,
Schizonepetae Spica 36 g, Saposhnikoviae Radix 36 g,
Aurantii Fructus (stir baked with bran) 36 g.
2. Gangtai Ruangas Sanguisorbae Radix (carbonized) 72 g, Galla chinesis 7 For anal administration, 1 g per Internal, External, Mixed hemorrhoids, swelling,
(ointment) g, Berberine hydrochloride 36 g, Papaverine time, onces or twice a day before pain, manifested as blood in the stool.
hydrochloride 7 g, Borneolum Syntheticum 7 g. bed time or after defecation
3. Mayinglong Shexiang Moschus Artifactus, Bovis Calculus Artifactus, Apply the paste onto the pars Hemorrhoids, anal fissure or manifested as
Zhichuang Gao Galamina (calcined), Margarita, Borax, Succinum, affecta bleeding during bowel movements, fecal pain or
(ointment) Borneolum Syntheticum bearing-down sensation
4. Sanqi Xueshangning Notoginseng Radix et Rhizome, Paridis Rhizoma, Taken it orally with warm water Static blood obstruction or blood failing to
Jiasnang (capsules) Callicarpae Macrophyllar Folium, Acaniti Kusnezoffii remain within vessels, Hemorrhoids, Menstrual
Radix Cacta, Dioscoreae Rhizoma, Vetatri Japonici, irregularities, bleeding disorders and swelling
Radix et Rhizoma, Borneolum Syntheticum pain due to static blood
5. Xiongdan Zhiling Gao Pulvis Fellis Ursi 1.05 g, Calomina (calcined) 202 g, Apply it around and into the anus Bleeding due to painful swollen hemorrhoids,
(onitment) Borneolum Syntheticum 40 g, Margaritifera Concha after cleaning, twice a day fistula
202 g, Paste 202 g, Bile sugar, Yolk oil 202 g.
6. Xiangdan Zhiling Pulvic Fellis Ursi 1.05 g, Calamina (calcined) 202 g, For rectal administration, 1 pill Bleeding due to painful swollen hemorrhoids,
Shuan (Suppositories) Borneolum Syntheticum 40 g, Margaritifera Concha per time, twice a day anal fistula
202 g, Bile sugar paste 202 g, Yolk oil 202 g
7. Zanglian Wan (pills) Coptidis Rhizoma 25 g, Rehmanniae Radix 75 g, 6–9 g water-honeyed pills, 9 g Bloody stool with intestinal heat, burning
Scutellariae Radix 150 g, Angelicae Sinesis Radix 50 g, honeyed pills, or 1 large honeyed sensation in the anus, pain-full swollen
Sophorae Flos 75 g, Sophorae Fructus 100 g, pill per time, twice a day hemorrhoids
Schizonepetae Spica 50 g, Asini Corii Colla 50 g,
Sanguisorbae Radix (carbonized) 75 g
8. Zhihong Changpi Wan Rehmanniae Radix (charred) 96 g, Scutellariae Radix 6 small pills or 1 large pill per Fecal bleeding in hemorrhoids and dysentery due
(pills) 96 g, Angelicae Sinensis Radix 96 g, Sanguisorbae Radix time, twice a day to blood heat
(charred) 84 g, Paeoniae Radix Alba 72 g, Gardeniae
Fructus 84 g, Asini Corii Colla 64 g, Sophorae Flos 64 g,
Schigonepetae Spica 64 g, Coptidis Rhizoma 24 g,
Platycladi Cacumen (charred) 64 g, Mume Fructus 10 g,
Cimicifuge Rhizoma 5 g
9. Zhichuang Pian Rhei Radix et Rhizoma 323 g, Mahoniae Caulis 645 g, 4–5 tablets per time, three times a Hemorrhoids, constipation, fissure
(tablets) Tribuli Fructus 323 g, Angelicae Dhauricae Radix 323 g, day
Suis Fellis Pulvis 4 g, Syntheticum Borneolum 16 g
10. Zhiyanxiao Keli Cannabis Fructus 150 g, Sophorae Flos 75 g, Perillar 1–2 packs per time, three times a Swelling pain during hemorrhoids, fissure,
(Granules) Folium 150 g, Lonicerae Flos 75 g, Paeoniae Alba Radix day constipation in elderly people
60 g, Sanguisorbae Radix 75 g, Notoginseng Radix et
Rhizoma 5 g, Artemisiae Scopariae Herba 75 g,
Imperatae Rhizom 150 g, Aurantii Fructus 50 g

65 medicinal plants are observed to treat piles traditionally in the Hi­ medicinal plant knowledge used in pile therapy. The most prevalent
malayan region. These different plant species belong to 42 different medicinal plant growth varieties were found to be trees and shrubs, in
families. The detailed data on these plants are given below in Table 3 which leaves and barks being the most used plant parts in the production
that including plant common name, plant botanical name, family, of herbal medicine for the treatment of piles. As analyzed from data in
habitat, mode of use, and plant part used, and references or different Table 1, the above pie-chart (Fig. 2) highlights the various plant parts
sources from where data has been collected. Various types of medicinal widely used for the treatment of piles, among which roots (18 %) are
plants are still used by local or ethnic groups in the Indian Himalayan mostly used followed by leaves (17 %), seeds (14 %), whole plant (12
region. Traditional medicine systems are vital in the daily health care of %), fruits (10 %), flowers (7 %), aerial part (4 %) and (1 %) of stem,
poor people in Himachal Pradesh, where various plant species are grains and other parts are shown. The greatest number of ethno­
employed in sufficient dosages or volumes to treat hemorrhoids. The medicinal plants were recorded from the family Fabaceae and subfamily
usage of various plant components by people and herbalists for the which includes Caesalpinioideae, Mimosoideae, and Papilionoideae
treatment of piles is detailed in Table 1. In district Hamirpur, Terminalia contributed the most plant species. Hence, it is concluded that the leaves
chebula and Terminalia bellirica are the most widely utilized medicinal of the medicinal plants along with the family Fabaceae are highly
plants in the treatment of piles. The dried fruit of both plants is crushed effective than other plant parts, and other families, and this may be due
into powder, mixed with salt, and then given orally to treat piles [38]. to high phytochemical accumulation in the plants belongs to family
One another example is from district Kullu, where many of the plants fabaceae. Further, having five plant species followed by Brassicaceae
used by the native people have been recorded and are employed in having four plant species. The other three families namely Amar­
various medicine systems such as Unani and Ayurveda. Aconitum het­ anthaceae, Rutaceae, and Solanaceae have three plant species each. The
erophyllum and Holarrhena antidysenterica are mentioned in Ayurveda for remaining other belongs to 9 other families as described in Table 4. The
treatment of stomach ache, fever, and piles. These plants are the primary graphical representation of the plants from different families is given
or key components of Ayurvedic and Unani formulations: namely, Ati­ below in Fig. 3.
vishadichurna, Chandraprabhavati, Amritarishta, and Sufufhabib in
which are used to cure hemorrhoids [39].
Herbalists, hunters, and elderly users are the guardians of traditional

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S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

Table 3
Traditional/ ayurvedic formulations to cure hemorrhoids.
S. Formulations Plants Mode of use References
No.

1. Kutajghanvati Holarrhena antidysenterica, Aconitum napellus, Aconitum heterophyllum Tablet [1]

2. Kshara karma Achyranthes aspera, Plumbago zeylanica, Gloriosa superba, Acorus calamus Paste [2]
3. Triphalaguggulu Emblica officinalis, Terminalia chebula, Terminalia bellerica, Piper longum, Commiphora mukul Tablet [3]
4. Kutajarishta Madhuca longifolia, Holarrhena antidysenterica, Gmelina arborea, Woodfordia fruticosa, Vitis vinifera Syrup [4]
5. Navayasa churna Cyperus rotundus, Plumbago zeylanica, Phyllanthus emblica, Terminalia chebula, Zingiber officinale, Terminalia Churna [5]
bellerica, Piper nigrum, Piper longum
6. Divya Arshkalp Azadirachta indica, Aloe vera, Berberis aristata, Cinnamomum camphora, Daemonorops draco, Solanum nigrum, Tablet [6]
Vati Terminalia chebula
7. Himalaya Pilex Berberis aristata, Bauhinia variegata, Cassia fistula, Emblica officinalis, Mesua ferrea, Melia azadirachta, Terminalia Tablet and [6]
bellirica, T. chebula ointment

Scientific studies reported on medicinal plants for hemorrhoids melongena on Wistar albino rats. In the experimental hemorrhoid
model, histological and biochemical analysis has been evaluated.
Despite the fact that many chemical compounds have been isolated Furthermore, the extract was screened for anti-inflammatory activity
from different plant parts, only a few have been examined for biological/ which is based on the inhibition of the acetic acid-induced increase in
pharmacological effects. The beneficial therapeutic effects of plant capillary permeability. The healing potential was comparatively
materials are generally due to secondary metabolites contained in assessed with a reference Pilex® tablet and cream. Histological and
plants, and the ability of these phytoconstituents to describe various biochemical analysis demonstrated that S. melongena extract is highly
pharmacological activities such as wound healing, analgesic, antioxi­ effective against hemorrhoids in comparison to the controls and stan­
dant, and anti-bleeding contributing to the treatment of hemorrhoids dard drug as well as showed a significant inhibitory effect on the acetic
and associated complications is summarized in Table 6 [40]. Numerous acid-induced increase in capillary permeability.
phytoconstituents, including terpenoids and flavonoids, used to treat An anti-hemorrhoidal study was conducted by Prasetyo et al. [44],
hemorrhoids primarily demonstrate antioxidant, anti-inflammatory, on the ethanolic Graptophyllum pictum extract determined the parameter
anti-analgesic, and anti-healing activities [1,41]. In clinical studies, of serum COX-2, IL-6, TNF- α, and total Leucocyte count of anal tissues of
they have been shown to increase venous tone and vein flexibility, the wistar rats. Results showed that at 100 mg/kg ethanolic Grapto­
improve discharge, bleeding, edema, and erythema as measured by phyllum pictum extract showed significant anti-hemorrhoidal results by
plethysmography, and decrease blood markers of vascular permeability suppress the levels of COX-2, IL-6, TNF- α, and leucocytes in anal tissues.
[42]. Since only a limited number of plant species have been exposed to Faujdar [12] evaluated the anti-hemorrhoidal activity of the bark of
laboratory testing, this research should emphasize on various plants Acacia ferruginea. The total phenolic, saponins and flavonoid content
extracts that are regularly used for hemorrhoid treatment. Farmers were also determined. The anti-hemorrhoidal potential of bark extract
should also be encouraged to cultivate essential medicinal plants for was determined by levels of inflammatory cytokines such as TNF-α, IL-6,
commercial purposes, with industry and government support. PGE2 and recto-anal coefficient (RAC). The anti-hemorrhoidal activity
of the hydroalcoholic extract of A. ferruginea may attribute due to the
presence of flavonoids (66.6 mg/kg RE).
Anti-hemorrhoidal activity Another study evaluated croton oil-induced hemorrhoids in rats on
methanolic and aqueous extract of Amorphophallus paeoniifolius tuber.
Donmez [43] conducted in-vivo croton-oil-induced The aqueous extract showed a more pronounced effect than the meth­
anti-hemorrhoidal activity of the methanolic extract of Solanum anolic extract. The effects may be attributed to anti-inflammatory and
antioxidant properties. It showed a significant (p<0.001) increase in
plasma exudation of Evans blue in anorectal tissue, macroscopic severity
score and anorectal coefficient as compared to normal rats. Myeloper­
oxidase activity and lipid peroxidation activity were increased in ano­
rectal tissue along with marked histological damage as compared to
normal rats [45].

Clinical study

Pal, Sharma and Mukherjee [46] conducted a clinical study on pa­

tients suffering from hemorrhoids having symptoms like chronic con­
stipation, irregular motions, indigestion and general weakness, etc. They
were treated with Kutajatvakchurna which is made up of stembark
powder of H. antidysenterica for 2 weeks regularly in a dose of 4gms
twice a day. After periods of 2 weeks, the result showed significant ef­
ficacy of the drug to cure bleeding piles. Another clinical trial on patients
with uncomplicated internal grades I and II hemorrhoids with symptoms
like defecation discomfort, constipation, and bleeding intensity. Oleo
gum resins of Commiphora mukul improved numerous hemorrhoid
symptoms, including defecation discomfort, constipation and bleeding
intensity, It shows significant efficacy due to anti-inflammatory action
which is due to the presence of compounds like gugglusteroids and
terpenoids [47].

Fig. 2. Different plant parts used in treatment of hemorrhoids.

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S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

Table 4
Plants used to treat hemorrhoids in Western Himalayas.
S. Botanical Name Family Type Local Name Part Used Mode of Use References
No

1. Acacia catechu Wild Fabaceae T Khayar, Khair Bark Bark powder is useful in the treatment of piles. [7]
2. Acacia nilotica Delile Fabaceae T Kikar, Babul Bark Bark powder is useful in the treatment of piles. [7]
3. Achillea millefolium L. Asteraceae H Biranjasif Whole plant Decoction made of whole plant parts is used to treat bleeding [8,9]
piles.
4. Achyranthes aspera L. Amaranthaceae H Puthkanda, Seeds and Crushed seeds powder is applied to the bleeding piles and root [7,10]
Apamarg Roots powder is mixed with honey given to cure piles.
5. Aconitum Ranunculaceae H Patish Root The root powder is used to cure piles. [9]
heterophyllum Wall.ex
Royle
6. Aegle marmelos (L.) Rutaceae T Beel, Belpatra, Fruits Dried fruit powder is used to cure piles. [11]
Correa Shriphala
7. Aerva glabrata Hook. Amaranthaceae S NA Flowers and Flower and seed powder is taken for piles. [12]
f. Seeds
8. Albizia lebbek Benth. Leguminosae T Siris, Shrinh Seeds Dried seed powder is used to cure piles. [7]
9. Allium cepa L. Amaryllidaceae H Pyaj Bulb The bulb is used to cure piles. [13]
10. Aloe barbadensis Mill. Asphodelaceae H Kabbarya, Aloe Whole plant Aloe vera is used for the treatment of piles. [7]
11. Amaranthus spinosus Amaranthaceae H Spiny pigweed Whole plant Whole plant parts are used to cure piles. [9]
L.
12. Azadirachta indica A. Meliaceae T Neem Fruit Dried fruit powder is used for the treatment of piles. [7]
Juss
13. Bauhinia variegate Fabaceae T Karale Flower and Flower and dried buds are used to cure piles. [10]
Linn. Aerial buds
14. Berberis asiatica Roxb. Berberidaceae T Kashmal Whole plant Bark and root powder (Rasonut) are mixed with honey and given [9]
to the patient twice a day for 5–7 days in the urinary tract and
infection of piles.
15. Blumea lacera (Burm. Asteraceae H Makoragha Leaves Leaves are used to cure piles. [14]
f.) DC.
16. Brassica rapa Brassicaceae H Shalgam Leaves Leaves powder is used to cure piles. [15]
L.
17. Butea monosperma Fabaceae T Dhak, Palash Bark Bark powder is used to cure piles. [7]
(Lamk.) Taub.
18. Cannabis sativa L. Cannabaceae H Bhang Seed, Bark To treat piles, concentrated and dried sap from the leaves is mixed [16]
and Stem with mustard oil and administered both internally and externally.
19. Cassia occidentalis Caesalpinaceae H Kasodi Leaf Leaf extract is used to cure piles. [13]
Linn.
20. Cedrus deodara Pinaceae T Dyar Bark Bark powder is used to cure piles. [7]
21. Coriandum Apiaceae H Dhania Fruit and Fruit and seeds are used to cure piles. [15]
sativum L. Seed
22. Cuscuta reflexa Roxb Convolvulaceae H Akash Bael Whole plant To cure piles, mix 20–35 g of crushed herb, 5–7 seeds of elliachi [7]
(Cardamon), and 25 g of Kuja-misery in a glass of water in the
evening, and drink the decanted solution for eight days in the
morning.
23. Cynodon dactylon Poaceae H Doob-grass Root Decoction of roots can be used to reduce bleeding piles. [7]
(Linn.) Pers.
24. Dioscorea bulbifera L. Discoreaceae S Ratalu Fruits and Fruits and tubers are used to cure piles. [14]
tuber
25. Ficus benghalensis L. Moraceae T Banyan, Indian Roots Make a decoction with tender prop roots and 5 to 6 spoonsful of it [17]
Banyan is given twice a day for 4 months.
26. Ficus racemosa Moraceae T Tarayamblu Roots The root is used for the treatment of piles. [15]
Willd.
27. Hedychium spicatum Zingiberaceae H Banhaldi Rhizome Powder of rhizome is used to cure piles. [13]
Sm.
28. Heracleum Apiaceae H Padiyala Aerial part, Aerial part, stem and root are used to cure piles. [9]
candicansWall. Stem, Root
29. Holarrhena Apocynaceae S Kurchi, Bark Bark powder is combined with honey and taken orally for healing [18]
antidysentrica Wall. Indrajau piles.
ex DC.
30. Kalanchoe Crassulaceae H Lakandru Leaf Leaves are used to cure piles. [15]
pinnata (Lam.)
31. Lens culinaris Leguminosae H Masar Seeds Crushed seed powder is used to treat piles. [15]
Medik.
32. Lepidium sativum Brassicaceae H Hallon Leaves Leaves decoction is used to cure piles. [10]
Linn.
33. Malva verticillate L. Malvaceae H Chiroti Whole Plant Whole plant parts are used to cure piles. [9]
34. Mangifera Anacardiaceae T Aam Seed and Seeds and bark are used to cure piles. [15]
indica L. Bark
35. Momordica Cucerbitaceae H Karela Leaves Leaves are used to cure piles. [15]
charantiaL.
36. Murraya koenigii (L.) Rutaceae S Gandhela, Roots, leaves Roots and leaves are used to treat piles. [14]
Spreng Karripatta
37. Ocimum basilicum L. Lamiaceae H Bhabri Seeds and Seeds and fruits are used to cure piles. [14]
Fruits
(continued on next page)

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S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

Table 4 (continued )
S. Botanical Name Family Type Local Name Part Used Mode of Use References
No

38. Oroxylum indicum Bignoniaceae T Sonapathha, Root and Root, bark and leaves are used to treat piles. [15]
(L.) Tatpalanga, Bark and
Arlu leaves
39. Oxalis corniculata Oxalidaceae H Tinpatiya Whole plant The juice of entire plant parts is used to cure piles. [13]
Linn.
40. Parthenocissus Vitaceae C Amru bail Roots and To cure piles, the sap is extracted by cutting the plant above [16]
semicordata (Wall.) Aerial parts ground, although it is not suggested for males because it may
cause impotency.
41. Persicaria nepalensis Polygonaceae H Gosumbi Leaves and Ground leaves and flowers are combined with dried whole milk [8]
(Meisn.) Miyabe Flowers (1:1 w/w) to make a paste which is given onces a day to cure piles.
42. Plantago depressa Plantaginaceae H Thram Leaves Leaves powder is used to cure piles. [9]
Willd.
43. Plumbago zeylanica Plumbaginaceae H Chitra Root The root powder is used to treat piles. [7]
Linn.
44. Podophyllum Podophyllaceae H Ban kakri Whole plant Whole plant parts are used to treat piles. [9]
haxandrum Royle
45. Polygonum viviparum Polygonaceae H Chulti Root Extract of roots is given to treat piles. [19]
L.
46. Pongamia pinnata Fabaceae T Karanja, Bark Bark powder is used for the treatment of piles. [7]
(Linn.) Merr. PutiKaranj
47. Punica granatum Lythraceae S Nar Roots, Bark Root and bark are used to treat piles. [15]
L.
48. Raphanus sativus Brassicaceae H Mooli Roots and The juice and flashy portion of the roots are used in the treatment [7,10]
Linn. fleshy of piles.
Part
49. Rhododendron Ericaceae T Burans Bark Bark juice is used to cure piles. [13]
arboretum Sm.
50. Rhus cotinus Linn. Anacardiaceae S Tung Fruit Fruits are used to cure piles. [10]
51. Sedum quadrifidum Crassulaceae H Suru Shoot Juice of shoot is drunk to cure piles. [13]
Pall
52. Sesamum Pedaliaceae H Til Leaves, Seeds Leaves and seeds powder are used to cure piles. [15]
indicum L.
53. Sida cordata Burm. Malvaceae S Pharendbuti Whole Plant 10 g of whole plant powder is heated with water and milk drunk [20]
in the morning to cure piles.
54. Sida rhombifolia L. Malvaceae H Jelly leaf, Whole plant Whole plant part infusion is applied on bleeding piles. [12]
Cuban jute
55. Solanum erianthum Solanaceae S Raada Seeds Seed infusions with butter are administered twice daily until [7]
D.Don bleeding piles are relieved.
56. Solanum melongena L. Solanaceae H Baingan Fruit Fruit ash combined with honey is applied to piles. [7]
57. Solanum nigrum Solanaceae H Makoi Leaves Leaves powder and leaves paste is used to cure piles. [7])
Linn.
58. Terminalia bellirica Combretaceae T Bahera Fruit Mixing dried fruit powder with salt is used to treat piles. [7]
Roxb.
59. Terminalia chebula Combretaceae T Harad Fruit The mixture of salt with dried fruit powder is used to cure piles. [7]
Retz.
60. Viola serpens Violaceae T Banaksha Whole plant Both paste and powder of entire plant parts are used to treat piles. [7]
Wall.
61. Vitex negundo L. Verbenaceae S Nirgundi Leaves Leaves paste or powder form is used to cure piles. [21]
62. Woodfordia fruticose Lythraceae S Dhaun Flowers Dried flower powder is used to cure piles. [10]
(L.) Kurz.
63. Zanthoxylum Rutaceae S Tirmira Leaf and Seed Leaf and seeds powder is used to cure piles. [9]
armatum DC.
64. Zea mays L. Poaceae H Chhali Grains Grains are used to cure piles. [14]
65. Zingiber officinale Zingiberaceae H Adrak Rhizome Powder and juice of rhizome are utilized to cure piles. [7]
Roscoe.

Abbreviations: H- herb, S- shrub, T- tree, C-climber.

Antioxidant activity and ethanol bark extracts have shown substantial DPPH inhibitory ac­
tivity (methanol extract 96 % at 0.1 mg/mL).
The hydroalcoholic bark extract of Acacia ferruginea showed an anti- Chymotrypsin inhibitor isolated from ethanolic seed extract of
hemorrhoidal effect against the croton-oil-induced model in Wistar al­ M. cochinchinensis was tested in-vitro model on hepatic cells. Tert-Butyl
bino rats at a dose of 400 mg/kg due to the presence of powerful anti­ hydroperoxide was used as an inducing agent. It shows significant re­
oxidants. Its compounds such as oxaprozin with proteins were evaluated sults by inducing cell damage and increasing the level of gluthathione
under a docking study for target proteins like prostaglandins, leukotri­ and decreasing the level of lipid peroxidation [48]. The methanolic root
enes, and interleukins under structure-based pharmacophore mapping extract of P. chinensis was assessed for anti-oxidant study using DPPH,
[12]. Zahin et al. (2009) used ferric thiocyanate (FTC), thiobarbituric ABTS, SOD, NO radical scavenging assay and reducing power assay with
acid (TBA), and DPPH radical scavenging methods to study the antiox­ different concentrations (6.25, 12.5, 25, 50 and 100 μg/ml). The results
idant activity of Holarrhena antidysenterica. The FTC and TBA methods show a continuous increase in scavenging activity in a dose-dependent
demonstrated a moderate antioxidant effect, but very low DPPH radical manner [49].
scavenging activity (20 %). H. pubescens bark was tested for antioxidant Alcoholic and hydro-alcoholic extract of seed, leaves and plumule of
properties in another work by Bhusal et al., 2014, and both methanol N. nucifera showed anti-oxidant potential when tested using in-vitro

8
S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

Fig. 3. Families contributing in hemorrhoids treatment.

DPPH, ABTS, NO and FRAP free radical scavenging methods [50,51]. showed a significant inhibitory effect at p<0.05 on carrageenan-induced
Whereas, in another study, isoliensinin was isolated from hind paw edema in rats and on the other side, in cotton pellet-induced
hydro-alcoholic seed extract from N. nucifera assessed for inhibitory granuloma model the rats which are treated with prednisolone 5
activity against bleomycin-induced pulmonary fibrosis. A significant mg/kg shows significant results at p<0.05 by reduced the body weight
increasing effect on SOD (antioxidant enzyme) activity and decreasing gain and thymus weight of animals [56].
effect on malondialdehyde level in a concentration-dependent manner The oil of Sesamum indicum seeds has been studied for anti­
were seen and a significant inhibition in over-expression of TNF-α and nociceptive and anti-inflammatory properties in male Wistar rats. The
transforming growth factor- β was also noted [51]. Methanolic extract of oil was found to be effective when tested via paw licking (100, 200, or
B. ceiba also showed antioxidant potential when tested in in-vitro DPPH, 400 mg/kg) and a hot plate latency assay (100, 200, 400 mg/kg) as well
hydroxyl free radical scavenging assay and lipid peroxidation [52]. as carrageenan application on rats. The dose of 200 (p<0.01) and 400
Aside from these studies, Dubey et al. and Faujdar have conducted an mg/kg (p<0.001) show significant results with one of the active chem­
evidence based approach to correlate antioxidant potential with icals sesamin in sesame oil, against antinociceptive and anti-
anti-hemorrhoid activity [40,53]. inflammatory activities [57]. Methanolic rhizome extract of
Oxidative stress is known to play an important role in the progression N. nucifera and isolated compound betulinic acid were evaluated on
and development of hemorrhoids. Out of 71 plants mentioned in ancient carrageenin and serotonin-induced rat paw edema. The rhizome extract
medicine systems for hemorrhoid treatment, only Acacia ferruginea, at doses of 200 and 400 mg/kg, and betulinic acid at doses of 50 and 100
Bombax ceiba, Allium cepa and Holarrhena pubescens have been evaluated mg/kg (administered orally) showed significant anti- inflammatory ac­
for their antioxidant effect using in-vitro and in-vivo models. The bark tivity; the effect was comparable to that of the standard drugs phenyl­
part of A. cepa and H. pubescens is mentioned in traditional medicine butazone and dexamethasone [58]. Another study on hydro-alcoholic
systems for GI disorders and piles whereas preliminary investigations for seed extract of N. nucifera at a dose of 10 mg/kg, inhibited the pro­
the alcoholic and hydroalcoholic extract from the bark were noted. The duction of pro-inflammatory cytokine tumor necrosis factor-a and
efficacy of plant constituents may further be verified using different increased anti-inflammatory cytokine IL-10 in female BALB/c mice with
antioxidant assays which could contribute towards the anti-hemorrhoid systemic inflammation induced by an intraperitoneal injection of lipo­
effect. In TCM, flowers of B. ceiba are used under hemorrhoid treatments polysaccharide. Results show significantly decreased TNF-a levels in the
whereas its bark sample has been employed for pharmacological effect. serum and increased levels of IL-10 [59].
A phytochemical and pharmacological comparative study may give a Ethanolic flower extract and purified fractions (n-hexane, chloro­
newer insight into the efficacy of plant products. A mechanistic study form, ethyl acetate and n butanol) of P. chinesis were subjected to anti-
evaluating the comparative potential of alcoholic and non-alcoholic inflammatory activity using Raw 264.7 macrophagic cell lines. At the
extracts and the bioactive fraction of these plants could be done in doses of 50, 100, 300, and 500 μg/mL the chloroform fraction shows
near future using an in-vivo model of croton oil-induced hemorrhoids significant results by reducing the expression of iNOS and COX-2 gene
evaluating the level of GSH, SOD, CAT, and MDA in anorectal tissue. The [60]. P. bistorta rhizome was extracted with 70 % aqueous ethanol and
rest of the plants also provide an opportunity for researchers as they fractioned with methanol and acetone. Two compounds were isolated
have a strong traditional background for hemorrhoid treatment in Ay­ from methanolic and acetonic fraction, which was possessed for
urveda and TCM. anti-inflammatory activity by carrageenan-induced rat paw edema
model at a single dose level 200 mg/kg shows significant results [61].
Anti-inflammatory activity Momordica saponin and triterpenoid compounds were isolated from the
ethanolic seed extract of M. cochinchinensis and assessed for
In a study, the aqueous leaf extract of Aloe vera was given to Wistar anti-inflammatory activity on the RAW264.7 cell line. It shows signifi­
albino rats at various concentrations (100, 200, 400, and 600 mg/kg) to cant results by regulating an inflammatory signaling pathway; sup­
evaluate the anti-inflammatory effect. Carrageenan and formaldehyde- pressing the activation of inflammatory signaling proteins (such as IκBα,
induced rat paw edema methods were used. Aqueous extract of Aloe Src, and Syk) linked to the activation of NF-κB and inducing expression
vera has been characterized by its potent marker compounds like folic of nitric oxide and IL-6 via the NF-kB pathway [62,63]. Kumar et al. in
acid, β-carotene, α-tocopherol, and vitamins B1, B2, and B6 [54,55]. In a 2011 studied the anti-inflammatory activity of ethyl acetate soluble
study, the efficacy of aqueous extract from the fruit of Phyllanthus fraction of B. ceiba using an HRBC membrane stabilization assay [64].
emblica (150, 300 and 600 mg/kg) was evaluated on Hossain et al. also confirmed the anti-inflammatory potential of meth­
carrageenan-induced hind paw edema and cotton pellet-induced gran­ anolic extract of B. ceiba leaves against carrageenan-induced paw edema
uloma on male Sprague-Dawley rat model. The dose of 600 mg/kg and inflammation. In the study, a dose-dependent inhibition in paw

9
S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

Table 5 Table 5 (continued )

Major active phytoconstituents reported from anti-hemorrhoidal plants. S. Plant Name Phytochemicals References
S. Plant Name Phytochemicals References No
No
17. Coriandum sativum Flavonoids (anthocyanins, vicenin, [38]
1. Acacia catechu Wild Flavonoid (epicatechins, catechin, [22] L. luteolin, apigenin, dihydroquercetin,
catechu, tannic acid and quercetin), catechin, arbutin flavones, isoflavones,
phenolics (tannin and gum) rutin, hesperidin), Polyphenols,
2. Acacia Alkaloids, glycosides, carbohydrates, [23] carotenoids (α- carotene, β-carotene),
niloticaDelile flavonoids (quercetin), phenolic phenol carboxylic acids (ferulic acid,
compounds (tannins), gallic acid, gallic acid, salicylic acid, coumarins
linoleic acid, and beta-amyrin caffeic acid,) р-coumaric acid and
3. Achillea millefolium Phenol (ascorbic acid), flavonoids [24] cinnamic acid
L. (sesquiterpene, lactones, flavanols, 18. Cuscuta reflexa Linoleic acid, palmitic acid, phytol, [39]
apigenin, tocopherols, and quercetin), Roxb stearic acid, oleic acid, stearic acid
camphor, and α-terpineol amide, γ-Tocopherol, campesterol,
4. Achyranthus aspera Saponins A and B (D-Glucuronic Acid), [25] stigmasterol, β-Sitosterol, β-Amyrin,
amino acids, triterpenes, oleanolic a phenolic compounds, α-Tocopherol,
cid and flavonoids (hentriacontane, unsaturated fatty, saturated fatty acid,
β-sitosterol, quercetin). vitamin E and sterols
5. Aconitum Alkaloids (aconitine, hypaconitine), [26] 19. Cynodon dactylon Alkaloids, phytosterols Beta-carotene, [40]
heterophyllum Wall. flavonoids (quercetin), sterols and (Linn.) Pers. palmitic acid, fats, vitamin C, ferulic
ex Royle glycosides acid, carbohydrates, reducing sugar,
6. Aegle marmelos (L.) Steroidal alkaloid, diterpene, [27] tannins, proteins, volatile oils and
Correa flavonoid, some other compounds like flavonoids
vitamin A and tocopherol 20. Dioscorea bulbifera Flavonoids (kaempferol, catechin), [41]
7. Albizia lebbek Saponins, macrocyclic alkaloids, [28] L. palmitic acid, succinic acid, shikimic
Benth. flavonoids, phenolic glycosides, acid, myricetin, kaempferol, quercetin
β-sitosterol, D-catechin, and betulnic and lutein
acid 21. Ficus benghalensis L. Tannins, Vitamin K, saponins, [42]
8. Aloe barbadensis Flavonoids, alkaloids, terpenoids, [29] flavonoids, steroids, terpenoids,
Miller. phenolic compounds, tannins, aloe- lanosterol, tannin, sitosterol,
emodin, campesterol, β-sitosterol, stigmasterol, lupen-3-one, cardiac
chrysophanol, aloenin, emodin, glycosides, saponin, lupeol and
genistein, and naringenin α-amyrin
9. Amaranthus Saponin, tannin, glycoside, protein, [30] 22. Ficus racemose Sterols, alkaloids, tannins, lupeol, [43]
spinosus L. flavonoid, β-sitosterol, carotenoids, Willd. flavonoids, β-sitosterol, hydrocarbons,
linoleic acid, and stigmasterol glucose, phytosterols, triterpenoids
10. Azadirachta indica Saponins, azadirachtin, reducing [31] and histamine
A. Juss sugar, flavonoid, glycosides and 23. Heracleum Flavonoids, lignans, α-Pinene, [44]
alkaloids candicans Wall. myrcene, β-pinene, and coumarin
11. Bauhinia variegate Terpenoids, tannins, saponins, [32] compounds
Linn. reducing sugars, alkaloid (cardiac 24. Holarrhena Alkaloid (Conessine, kurchichine, [45]
glycosides), steroids, flavonoid antidysentrica Wall. holarrhenine), flavonoid, steroid,
(anthraquinones, quercetin, ex DC. terpenoid, glycoside, saponin, tannin
β-sitosterol, kaempferol, and lupeol) and phenol.
12. Berberis asiatica Polyphenolic flavonoids (carotenoids, [33] 25. Kalanchoe pinnata Isocitric acid, malic acid, alkaloids, [46]
Roxb. anthocyanins, quercetin, caffeic acid (Lam.) phenolic, flavonoid (quercetin,
and rutin), chlorogenic acid, lipids, kaempferol, n-henticontane,
vitamins, alkaloids (Protoherberine, sitosterol), gums, Saponins, p-
isoquinoline, bisbenzylisoquinoline) coumaric acid, ferulic acid, caffeic
and phenolic compounds acid, reducing sugars, glycosides,
13. Blumea lacera Glycosides, alkaloids, carbohydrate, [34] steroids and tannins
(Burm.f.) DC. cardiac glycoside, flavonoid, resin, 26. Lepidium sativum Saponin, anthraquinones, sitosterol, [47]
terpenoids and steroids Linn. alkaloids and tannins
14. Brassica rapa L. Glucosinolates and isothiocyanates [35] 27. Malva verticillate L. Polysaccharides, tocopherols, [48]
Amino acids (alanine, phenylalanine, flavonoids (quercetin, rutin,
valine, methionine, leucine, isoleucine, kaempferol, coumarin, luteolin),
tyrosine, tryptophan), flavonoids and phenols (gallic acid, catechic,
phenolic compounds (kaempferol and epicatechin, carotenoids, vanillic
quercetin), phenylpropanoids, phenyl acids), and tannins
glycosides, sesquiterpene, 28. Mangifera indica L. Phenolic acids, α-pinene, α-copaene, [49]
carbohydrate derivatives, sesquiterpenoids, phenolic
diarylheptanoids and phenanthrene compounds, flavonoids, lupeol,
derivative benzophenones, sesquiterpenes,
15. Butea monosperma Flavonoids, Beta-sitosterol, steroids [36] saponins, pinene, α-xanthones,
(Lamk.) Taub. glucosides, aromatic compounds, tannins, terpenoids, alkaloids,
α-Amyrin, medicarpin, tannins (Kino- benzophenones, ascorbic acid,
tannic acid, pyrocatechinic), gallic camphene, γ–cadinene, lupeol,
acid, bucolic acid, allophonic acid, carotenoids and tocopherols
cyanidin, histidine, lupeol, tannins and 29. Momordica Saponins, vanillic acid, ferulic acid, [50]
gums charantia L. caffeic acid, glycosides, tannin,
16. Cedrus dodara Flavonoids (dihydroflavonol, [37] alkaloids, steroids, tannins, p-coumaric
myricetin, quercetin, α-Pinene, acid, saponins, gallic acid, and
β-pinene, sesquiterpene, β-myrcene, flavonoids
limonene, α-bisabol, α-Himachalene) 30. Murraya koenigi (L.) Glycoside, alkaloid, tannin, reducing [51]
and polysaccharides Spreng sugar, saponin, flavonoid (quercetin,
apigenin, kaempferol, catechin,
myricetin, β-sitosterol), phenol,
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Table 5 (continued ) Table 5 (continued )

S. Plant Name Phytochemicals References S. Plant Name Phytochemicals References
No No

trapezoid, cardiac, anthraquinone, 50. Woodfordia Flavonoids, carbohydrates, [60]

steroid and resins fruticose (L.) Kurz. phytosterols, amino acids, fixed oils,
31. Oroxylum indicum Alkaloids, ellagic acid, phenolic [52] alkaloids, proteins, polyphenols,
(L.) compounds, glycosides and flavonoids glycosides, saponins, gums and resins
32. Persicaria nepalensis Flavonoids, apianen, Sesquiterpenes, [53] 51. Zanthoxylum Flavonoids (Kaempferol, tambulin), [71]
(Meisn.) Miyabe terpenoids, chalcones and armatum DC. alkaloids, phenolics, coumarins,
anthraquinones lignins, glycosides, fatty acids, amino
33. Plumbago Triterpenoids, flavonoids, [54] acids, terpenoids, sterols and Steroids
zeylanicaLinn. carbohydrate, chitanone, plumbagic (β-sitosterol)
acid, zeylanone, alkaloids, 52. Zea mays L. Carotenoids, flavonoids, phenolic [72]
campesterol, reducing sugars, tannins, compounds, coumarins, vitamins,
saponins, sitosterol, stigmasterol and phytosterols and tannins
dihydroflavonol 53. Zingiber officinale Alkaloids, Glycosides, flavonoids, [73]
34. Podophyllum Carbohydrates, alkaloids, tannins, [55] Roscoe. phenols, tannins, saponins, ascorbic
haxandrum Royle glycosides, phenolic compounds, acid, beta carotene, alpha tocopherols,
amino acids, terpenoids, tannins, Monoterpenoids (camphene, cineole,
anthraquinones, flavonoids, saponins terpineol, borneol) and
and sterols sesquiterpenoids
35. Polygonum Quinines (anthraquinone, malonyl [56]
viviparum L. glucosides), terpenoids, terpenoids and
flavonoids (kaempferol, luteolin, edema and inflammation was observed at doses of 100, 200 and 400
quercetin, myricetin, quercetin and mg/kg [65]. Various studies have reported that extracts and phytocon­
isoquercetin), oleanolic acid, and
catechin
stituents like phenols, flavonoids and alkaloids have reported
36. Pongamia pinnata Sterols, karangin, pongamol, [57] anti-inflammatory activities and these phytoconstituents have also been
(Linn.) Merr. pongagalabrone, pongapin, pinnatin, reported for thetreatment of hemorrhoids in some of the in-vitro and
flavones, chalcone, kanjone and in-vivo study models [40,66,67].
flavonoids
Chronic oxidative stress in a particular tissue leads to inflammation
37. Punica granatum L. Glycosides, saponins, tannins, [58]
alkaloids, phenolic compounds, and fibrosis, which is also observed in the case of hemorrhoids. TCM and
phytosterols, carbohydrates, Ayurveda provide a traditional claim for the use of a variety of plants for
terpenoids, and flavonoids the treatment of inflammation associated with hemorrhoids. Out of all
38. Raphanus sativa Terpenoids, saponins, alkaloids, [59] above-mentioned plants, A. berbendis, P. emblica, B. ceiba, P. bistorta, M.
Linn. flavonoids, chalcones, steroids,
phytosterol, reducing sugars,
cochinchinensis, N. nucifera, P. chinensis and S. indicum were tested
anthraquinones, carbohydrates, scientifically for their anti-inflammatory potential. Extracts of these
phlobatannins, cardiac glycosides, plants showed a reduction in inflammation and edema claiming their
amino acids and tannins traditional uses as an anti-inflammatory agent. The flower part of the
39. Rhus cotinus Linn. Carbohydrates, amino acids, [60]
B. ceiba which is mentioned in TCM was nowhere tested for its inflam­
flavonoids (quercetin, caffeic acid,
ferulic acid), glycosides, alkaloids, matory efficacy which may further be evaluated in comparison with
polyphenols, saponins and other parts. Most scientific evaluations were performed on the essential
phytosterols oil, alcoholic and aqueous extracts of Himalayan plants. A comparative
40. Sesamum orientale Alkaloid, flavonoid, tannin, sesamin, [61] study of nonpolar, polar and bioactive fractions is still needed from these
L. saponin, phenols, anthraquinone,
terpenoid and steroid
plants by using in-vitro protocols of albumin denaturation, membrane
41. Sida cordata Burm. Alkaloids, saponins, nonanoic acid, [62] stabilization, NO scavenging and an established model of hemorrhoids
oleic acid, flavonoids (Rutin, morin, to analyse NO and protein denaturation levels in anorectal tissue.
quercetin), vitamins (retinol and
tocopherol) anthocyanins, carotenoids,
polyphenols, flavones (naringenin), Analgesic activity
glycosides and flavanol (catechin)
42. Sida rhombifolia L. Alkaloid, carbohydrates, steroid, [63] Devaraj et al., used Wistar rats to study the analgesic effects of Aloe
coumarins, flavonoid (kaempferol, vera leaf aqueous extract (100, 200, 400, and 600 mg/kg BW) by tail
β-sitosterol), tannin and glycoside
43. Solanum erianthum Flavonoids, tannins, alkaloids, [64]
flick, hot plate, and acetic acid-induced writhing model. The writhing
D.Don saponins, glycosides, carbohydrates, model exhibited a significant analgesic effect as shown by a reduction in
sterols and terpenoids writhes and also a dose-dependent increase in thermal stimulus toler­
44. Solanum melongena Alkaloids, saponins, steroids, tannins, [65] ance [68]. Another similar study by Ghosh et al., showed analgesic
L. flavonoids, proteins and carbohydrates
properties of A. vera aqueous extract in radiant heat, hot plate, and
45. Solanum nigrum Carbohydrates, saponin, fats, [66]
Linn. coumarins, tannins, phytosterols and writhing tests. At a dose of 300 mg/kg, significant analgesic effects were
flavonoids observed in radiant heat and hot plate methods. The same dose showed
46. Terminalia bellirica Alkaloids, flavonoids, phenols, [67] maximum inhibition of 51.17% in writhing test [69]. A study reports the
Roxb. Coumarins, triterpenoids and steroids analgesic effects of the water extracts of the fruit of Phyllanthus emblica
47. Terminalia chebula Gallic acid, punicalagin, ellagic acid, [68]
Retz. anthraquinones, ethaedioic acid,
on ICR mice using a formalin test. The extract showed significant
chebulanin, chebulic acid, gallic acid analgesic properties at doses of 150, 300, and 600 mg/kg in a
and neochebulinic acid dose-dependent manner [70]. Numerous studies have been performed
48. Viola serpens Wall. Flavonoids, saponins, phenols, [69] using Terminalia chebula to show its analgesic properties. A study, using
anthraquinones and tannins
water extract of the fruit of T. chebula in ICR mice using 0.1% formalin,
49. Vitex negundo L. Alkaloids, proteins, tannins, essential [70]
oils, phenolic compounds, saponins, showed a decrease in licking time and therefore concluded that
flavonoids, carbohydrates, terpenoids, T. chebula has analgesic properties [71]. Another similar study used
glycosides and steroids ethanolic extract instead of water extract of T. chebula in swiss albino
mice to study its analgesic effects. It was shown that, at doses of 250 and

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Table 6
Pharmacological and clinical evidences for hemorrhoid pathology and treatment.
S. Plant Name Pharmacological Activity Isolated active compounds/extracts Source References
No.

1. Acacia ferruginea DC Anti-inflammatory Oxaprozin and hydro-alcoholic bark extract Bark [74]

2. Allium ampeloprasum var. Anti-inflammatory Steroidal Saponins Bulb [75]

porrum
3. Aloe vera (L.) Burm.f. Anti-inflammatory and Analgesic Histamine, serotonin, folic acid, β-carotene, α-tocopherol and Leaf and Flesh [76]
Vitamin B1, B2, B6

4. Azadirachta indica A.Juss. Anti-inflammatory and Antioxidant Nimbidin, gallic acid and azadirachtin-A Seed Oil, Bark [77]
and Leaf

(continued on next page)

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Table 6 (continued )
S. Plant Name Pharmacological Activity Isolated active compounds/extracts Source References
No.

5. Commiphora mukul (Hook. Anti-inflammatory, Demulcent Etyhl aceate extract, diterpenoid, triterpenoids and steroids Bark [78]
ex Stocks) Engl. properties and Astringent
6. Emblica officinalis Gaertn. Antioxidant and anti-inflammatory Caffeic acid and gallic acid Fruit and Seed [79,80]

7. Holarrhena pubescens Wall. Anti-inflammatory, Antioxidant and Methanolic and ethanolic bark extracts, Conessine, glycosides, Seeds and Bark [18,81]
ex G. Don Analgesic gallic acid, triterpenoids and steroids
8. Olea europaea L. Anti-inflammatory and Antioxidant Omega-3 fatty acids Fruit [82]
9. Plumbago zeylanica L. Antioxidant Plumbagin and Flavonoid 2-(2,4- Dihydroxy-phenyl)− 3,6,8 Root [83]
trihydroxy chromen-4-one

(continued on next page)

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Table 6 (continued )
S. Plant Name Pharmacological Activity Isolated active compounds/extracts Source References
No.

10. Sesame indicum Anti-inflammatory Vitamin E, Linoleic acid Seed [82]

11. Terminalia chebula Rezt. Anti-inflammatory and Antioxidant Bradykinin and other phenolic compounds Fruit [84,85]
12. Terminalia belerica (Gaertn.) Antioxidant Gallic acid, ferulic acid Fruit [86]
Roxb.

13. Vateria indica L. Anti-inflammatory and Anti-healing Bitter resin Wood [82]
14. Vitis vinifera L. Anti-inflammatory, Antioxidant and Phenolic acids, sugars, sterols, amino acids, flavonoids Fruit [87]
Analgesic (anthocyanins and proanthocyanidins)

500 mg/kg bw using the hot plate method, significant analgesic effects bleeding, severe pain is experienced by the patients in the case of
were observed [72]. Kaur & Jaggi 2010 studied two species of Termi­ hemorrhoids. TCM and Ayurveda suggested some plants to get relief
nalia; T. chebula and T. bellerica and their different extracts (petroleum from hemorrhoidal pain. However, Aloe barbadensis, P. emblica, T.
ether, chloroform, ethanol, and water extracts of fruits) to study their chebula, V. vinifera and P. emblica were found tested for analgesic ac­
analgesic effects. The tail immersion model in swiss albino mice showed tivity. Alcoholic and aqueous extracts of these plants showed a signifi­
that only the ethanolic extracts of both plants at doses of 200, 400, and cant analgesic effect at a dose range of 100–800 mg/kg providing
800 mg/kg were effective in chronic pain and had significant analgesic scientific evidence against pain response. No data was noted for the
effects [73]. A 2012 study reported a standardized ethanolic extract, efficacy of non-polar extracts and purified fractions of the plants which
NDI10218, of T. chebula and evaluated its analgesic effect in ICR mice can be studied in near future using an in-vivo model of hemorrhoids.
using the acetic acid-induced writhing model. Acetic acid, administered Though some semi-solid preparations were mentioned in traditional
intraperitoneally, induced 58.6 ± 7.1 writhes which, at doses of 30, 100, literature.
and 300 mg/kg extract, decreased to 58.4 ± 10.2, 43.7 ± 7.2, and 38.5
± 5.8 times respectively [74]. Another plant, Vitis vinifera, is shown to Wound-healing activity
have analgesic effects. The methanolic extract of the leaves of this plant
at oral doses of 100, 200, and 400 mg/kg BW was tested in swiss albino A study on the wound healing properties of Terminalia chebula was
mice using formalin induced pain and tail flick methods. A dose conducted in vivo and showed its potent effects on wound healing. The
dependent effect in terms of reduction in paw licking response and in­ alcoholic extract (200 µL) of the leaves of the plant was topically applied
crease in latency in thermal stimulus in tail flick test was observed [75]. to the dermal wounds of male albino rats. Faster healing of wounds
The aqueous extract of Phyllanthus emblica had a wound-healing ef­ along with improvement in the rate of contraction and a decrease in
fect at low concentrations but had the opposite effect at high concen­ epithelization was observed [79]. A similar study on T. chebula was
trations. Antineutrophil and antiplatelet activities were observed in the performed using tannin extracts of the plant utilizing its immature fruits.
plant at a concentration of 50 µg/mL, confirming its anti-inflammatory Sprague-Dawley rats were inflicted with dermal wounds and then top­
efficacy in-vitro. Although multiple in-vivo models verified its anti- ically treated with 5 mg tannin extract per wound. The results of the
inflammatory and analgesic properties. Furthermore, the analgesic ef­ paper conclude that wound contraction, granulation formation, collagen
fects are due to direct nociceptor activation as well as an inhibitory organization, and vascular endothelial growth factor (VEGF) expression
influence on the synthesis and release of inflammatory mediators such as was all higher in the treatment groups as compared to the control groups
prostaglandins [76,77]. Ganapathy, Ramachandra and Rai [78] per­ [80].
formed a model of acute inflammation on the methanolic bark extract of A study by Nayak et al., evaluated the wound-healing properties of
H. pubescens at doses of 100 and 200 mg/kg inhibited paw edema in a Vitis vinifera skin powder in Sprague Dawley rats using an excision
dose-dependent manner. At 3 and 4 h, the test and standard medicines wound model. Test group animals were topically treated with grape skin
significantly reduced paw edema as compared to the control (p˂0.001). powder at a dose of 100 mg/kg/day. The assessment of wound healing
Aside from this Mihai et al., [67] also provided evidence of how anal­ was done by performing the content of hydroxyproline, time for
gesic potential of plants can play an important role in the treatment of epithelialization and contraction rate of the wound. There was a sig­
hemorrhoids. nificant enhancement in wound contraction and hydroxyproline content
Pain is a neural response generated at the site of injury or inflam­ and a reduction in epithelialization time [81]. An in vitro study
mation. Due to oxidative stress, swelling, inflammatory injury and providing evidence for wound healing properties of Phyllanthus emblica

14
S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

Fig. 4. Major identified chemical constituents.

was performed by Chularoj montri et al. The study used freeze-dried Wound formation occurs due to rupturing of the epithelial layer,
powder of the fruits of P. emblica on an in vitro model of human um­ which leads to bleeding from anorectal tissue in hemorrhoids. Plants
bilical vein endothelial cells (HUVECs). The wound healing property mentioned in TCM to cure hemorrhoidal bleeding have not been tested
was assessed using scratch wound assay and it was shown that PE was for wound healing activity whereas few references emphasize wound
effective in healing wounds in vitro only at a low concentration of 0.1 healing effect of the plants in Ayurveda such as T. chebula, V. vinifera and
μg/mL and not at higher concentrations (1 μg/mL and 10 μg/mL). P. emblica in in-vitro and in-vivo models were noted. On this account, the
Complete wound healing was observed after 48 h with enhanced wound plants recommended in TCM and Ayurveda may further be evaluated for
confluence, rate of healing, and VEGF [82]. The ethanolic seed extract of healing effects in anal cushion and anal bleeding using the croton oil-
M. cochinchinensis was evaluated in a skin wound closure mouse model induced model of hemorrhoids and wound healing.
with three different doses (50, 100 and 200 μg/mouse). All the doses
showed significant results on the 11th day of the period [62]. Nitulescu, Major phytoconstituents of Himalayan plants
studied the correlation in wound healing and hemorrhoids and provided
evidence that wound healing activities of plant extract and phytocon­ Plants have medicinal properties due to the creation or stimulation of
stituent can also cure hemorrhoids [83]. various organic or chemical compounds known as secondary

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S. Dhiman et al. Pharmacological Research - Modern Chinese Medicine 9 (2023) 100334

metabolites, which exist naturally in plants and are used to cure piles Author’s contributions
and other illnesses. Although botanical and nutritional therapies are
both safe and effective for hemorrhoids, but there has not been much SD formulated the design and layout of article. SD and RN compiled a
research conducted on herbal hemorrhoidal treatments. Various necessary data required for the review and helped on grammar check,
phytochemical constituents, including alkaloids, flavonoids, tannins, language and palagrism check. The final corrections and revision were
vitamins, carbohydrates, terpenoids, saponins, proteins, phenols, and done by PB.
essential oils, are present in different plant components. These phyto­
constituents have been reported to be useful against digestive disorders, Funding
especially in piles. These phytoconstituents have been demonstrated to
increase capillary flow, vascular tone, perivascular amorphous substrate No funding sources.
microcirculation, connective tissue strength and hepatoprotective
properties make them an effective treatment for hemorrhoids. The plant Availability of data and materials
Emblica officinalis is well-known for its anti-inflammatory and astringent
characteristics, which is due to the presence of tannin that is responsible The datasets used and/or analysed during the current study available
for improving venous tone, which is a positive step in making them from the corresponding author on reasonable request.
useful in bleeding hemorrhoidal therapies. The active components of
Centella asiatica like asiaticoside, pentacyclic derivatives asiatic acid and
madecassic acids, have the potential to promote connective tissue Declaration of Competing Interest
integrity, increase antioxidant levels in wound healing and improve
capillary permeability in chronic venous insufficiency and varicose The authors declare that they have no known competing interests or
veins therapies [17]. Terminalia chebula is another plant with saponins, personal relationships that could have appeared to influence the work
glycosides, flavonoids, tannin and volatile oils that have been docu­ reported in this paper.
mented for antibacterial, anti-healing, hypotensive, analgesic, antioxi­
dant, anti-inflammatory and anti-diarrhoeal properties, and all of these Ethics approval and consent to participate
properties are effective against raising venous tone, ROS scavengers and
also as up-regulators of antioxidant enzymes which are helpful in We confirm that all methods were carried out in accordance with
hemorrhoid treatments [17]. Many other different plants, with varied relevant guidelines and regulations.
phytochemical contents are employed in the treatment of hemorrhoids
and some of the most common phytochemicals are included in Table 5.
Consent for publication
Among these phytoconstituents most potent phytochemicals that have
been studied for hemorrhoids are shown below with their chemical
Not applicable.
structures (Fig. 4). Ruscus aculeatus is another plant having
anti-inflammatory and astringent effects which are due to saponin
glycoside, which is useful in boosting venous tone and helps in hemor­ Acknowledgements
rhoid treatment [84]. One of the most persuasive techniques for
discovering new medications against drug-resistant pathogens in the The authors are thankful to Shoolini University, Solan (H.P.) for
modern period or disorders associated with oxidative stress, such as providing research support and facilities.
hemorrhoids, is to integrate ethnomedical data with plant screenings for
a range of biological properties. References

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