http://informahealthcare.com/phb ISSN 1388-0209 print/ISSN 1744-5116 online Editor-in-Chief: John M. Pezzuto Pharm Biol, Early Online: 1–9 ! 2014 Informa Healthcare USA, Inc. DOI: 10.3109/13880209.2014.928330

REVIEW ARTICLE

Medicinal plants contain mucilage used in traditional Persian medicine (TPM) Ahmad Ameri1, Ghazaleh Heydarirad2, Jamileh Mahdavi Jafari2, Ali Ghobadi3, Hossein Rezaeizadeh4, and Rasool Choopani2

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Department of Radiation Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 3Department of Traditional Pharmacy, Faculty of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran, and 4Persian Medicine & Pharmacy Research Center, Department of Traditional Medicine, Faculty of Traditional Medicine, Tehran University of Medical Science, Tehran, Iran Abstract

Keywords

Context: Conventional therapies using mucilage plants greatly used by practitioners in Iran. The usage of mucilages is rooted in traditional knowledge with a history of more than 4000 years. Scientific assessment of these historical documents could be valuable for finding new potential usage in the current medicine. Objective: This study assembled an inventory of mucilage plants considered important therapeutic aids for alleviating the ailments in ancient Persian medicine and compared therapeutic applications of ancient times with current findings of medicinal mucilages in the same plant species. Methods: A literature search compiled some main traditional manuscripts of Persian medicine, including the book of AlHavi, Canon of Medicine, Zakhireh-iKharazmshahi, Qarabadine-kabir, Tohfat ol Moemenin, and Makhzan-ol-advieh, and select mucilage plants used in treating the mouth and respiratory system disorders. Also, current investigations on related subjects were considered through a search of the Pub Med and Google Scholar databases. Results: In Iran, the application of medicinal plants contains mucilage date back to ancient times. In mentioned medieval Persian books, 20 medicinal plants containing mucilage were identified. Mucilages have been traditionally used via oral or topical routes for a variety of disorders. According to this study, most of the cited medicinal plant species were used for their mucilaginous, anti-inflammatory, and anti-oxidant effects. Conclusions: A scientific evaluation of these historical documents can give an insight into the ideas of the past and be valuable in finding new data on clinical use of the mucilages that should lead to future opportunities to investigate their potential medicinal use.

Mouth disease, mucilage, respiratory disorders, traditional medicine

Introduction Ever since the beginning of civilization, herbal, mineral, and animal medicaments have been used to treat illnesses (Rezaeizadeh et al., 2009). Iranian traditional medicine dates back thousands of years. It has been combined with diverse medical traditions from Greece, Egypt, China, and India for more than 4000 years (Gorji &Khaleghi Ghadiri, 2001). Most remedies in traditional medicinal systems have focused on medicinal herbs (Gurav et al., 2011). Despite the emergence of new chemical drugs in contemporary medicine, the application of herbal remedies has not yet been declined (Zargaran et al., 2012a). Recently, interest in traditional medicine was revived by the WHO recommendations for the Correspondence: Rasool Choopani, M.D., Ph.D., Assistant Professor of Iranian Traditional Medicine, Department of Traditional Medicine, The School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box 1516745811, Tehran, Iran. Tel/Fax: +98 21 8877 60271. Mobile: +98 9123790148. E-mail: [email protected]

History Received 17 December 2013 Revised 1 April 2014 Accepted 7 May 2014 Published online 9 December 2014

development of native knowledge and the use of alternative national medicine. Although the use of medicinal herbs is not the only therapeutic method in traditional medicine, it is the basis of medical treatments (Dabaghian et al., 2012). Nearly 80% of the population of developing countries still uses traditional medicine for health care. Modern pharmacopoeias contain a minimum 25% of drugs derived from plants (Kim, 2005). The history of ancient Persia from prehistoric times to 637 AD goes back to about 10 000 years ago, and the development of pharmaceutical science and practice was particularly notable (Zarshenas et al., 2013a). Medical sciences including pharmacy flourished in Persia throughout medieval times (Zargaran et al., 2012c). Prominent medieval scholars such as Rhazes (ninth and tenth centuries CE), Avicenna (tenth and eleventh centuries CE), Jorjani (eleventh century CE), Tonkaboni (seventeenth century CE), and Aghili Khorasani (eighteenth century CE) significantly influenced the development of Persian medical science (Heydari et al., 2013; Zargaran et al., 2012b; Zarshenas et al., 2012, 2013b)

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Persian traditional medicine was based on four humors (in Persian language named khelt) comprising balgham or phlegm (with cold and wet qualities), dam or blood (with hot and wet qualities), safra or yellow bile (with hot and dry qualities), and sauda or black bile (with cold and dry qualities). Every humor is a substance made from digestion and permutation of foodstuffs in the GI. Health is due to the balance of these humors and abnormality in humors can lead to sickness (Emtiazy et al., 2013). Reviews of historical manuscripts on medical science authored by medieval Persian scholars provide valuable information in the field of medicinal herbs application (Zargaran et al., 2013). In ancient Persian manuscripts, mucilage is one of the most cited applications of medicinal herbs for therapeutic purposes (Ibn-Sina, 1993). Mucilages have been traditionally used via oral or topical routes for gastrointestinal, musculoskeletal, respiratory, urinary, and genital systems as well as skin disorders (Avicenna, 1998; Khorasani, 2001; Rhazes, 2001; Tonkaboni, 2007). The herbs used in ancient Persian medicine produce mucilage, known as ‘‘loab’’ and defined in a series of ancient Persian pharmaceutical manuscripts, namely ‘‘qarabadin’’ (pharmacopeia), which contains medical texts on drug compounds, indications, and formulas (Hamedi et al., 2013). In current medicine, mucilage as a production of many various plant species (Deng et al., 2012), regularly used adjuvant in pharmaceutical preparations (Sabale et al., 2012) and contains sugar and uronic acid units (Sabale et al., 2012). Plant mucilages have evoked much interest due to their various applications in pharmacy. They are pharmaceutically important polysaccharides and have an extensive range of applications, including as water retention agents, thickeners, binding agents, emulsion stabilizers, disintegrates, suspending agents, gelling agents, and film formers (Nayak et al., 2010). Mucilages have been used effectively for several years in the food and pharmaceutical industries (Majmudar, 2013). The therapeutic value of mucilages extends to diabetes, wound healing, immunity stimulation, cancer, and angiotensin converting enzyme inhibition; furthermore, they have antioxidant properties. Based on their sustaining capacities, binding properties, and gelling, mucilages have been proposed as materials most valuable to modulating drug delivery (Wadhwa et al., 2013). In this paper, we investigated medicinal mucilage plants used in TPM for an overview of traditional knowledge compared with recent concepts.

Methods This study is literature research, investigating some important Persian medical and pharmaceutical manuscripts from the ninth to the eighteenth century CE. The manuscripts were composed of the book of Al-Havi (The Liber Continens, written by Rhazes in the tenth century CE) (Rhazes, 2001), Al-Qanoon fi al-Tibb (The Canon of Medicine, written by Avicenna in 1025 CE) (Avicenna, 1998), Zakhireh Kharazmshahi (Treasures of the Khwarazm Shah, written by Sayed Isamail Jorjani in the eleventh century CE) (Jorjani, 1976), Qarabadine-kabir (the largest pharmaceutical manuscript of Persian medicine, written by Aghili Khorasani in 1772 CE) (Khorasani, 1855), the book of Tohfat ol Moemenin

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(written by Mohammad Tonkaboniand in 1670 CE) (Tonkaboni, 2007), and Makhzan-ol-advieh (Storehouse of Medicaments, written by Aghili Khorasani in 1771 CE) (Khorasani, 2001). These books are determined as Persian traditional references in medicine and pharmacy and are now used as references for the Iranian PhD program in traditional pharmacy. The word ‘‘loab’’ in the books mentioned above was searched. Then we selected mucilage plants used in treating the mouth and respiratory system. Also, effects of these mucilage plants on related subjects were considered through a search in Physician’s Desk Reference (PDR) (Gruenwald et al., 2004). The scientific names of the reported mucilages were confirmed using some textbooks such as Popular Medicinal Plants of Iran (Amin, 2005) and Dictionary of Medicinal Plants (Soltani, 2004). In order to make relationships between traditional date and current findings, a search was accomplished on the reported pharmacological effects (experimental, human, and animal studies) related to the mentioned medicinal plants using the Pub Med and Google Scholar databases.

Results and discussion A historical approach could help in the detection of some viewpoints that cannot be paid attention to or signified by a purely medical one (Aciduman et al., 2009). The medical and pharmaceutical usage of mucilages in Persia dates back to ancient times. Medieval Persian scholars and physicians prescribed medicinal mucilages (loab) based on the temperament of plant mucilage. Mucilages are often found in different parts of the plants that are similar to traditional texts (Gruenwald et al., 2004; Tonkaboni, 2007). Mucilages are physiological products and form slimy masses (Jani et al., 2009). Structurally, the extrusion of mucilage subsequent to exposure of dry seed to an aqueous environment is the result of the hydration and expansion of the mucilage, the rupture of the radial fragment of the primary cell wall, and the subsequent formation of a gel (Sabale et al., 2012; Teixeira et al., 2010); the same definition is ‘‘loab’’ in traditional medicine. Some of these ‘‘loab plants’’ such as Ispaghula (Plantago ovate Forsk), Quince (Cydonia oblonga Miller) seed, and marshmallow (Althaea officinalis Linn) had been used most of the time in traditional manuscript and ancient Persian scholars administered them via simple or in compound with other plants for treatment of a variety of diseases, so in this study, a more extensive discussion of these plants is explained. Ispaghulais the most widely used mucilage in Persian medicine texts has been popularly used as a therapeutic agent for the treatment of a large number of diseases. According to most Persian manuscripts, ispaghula is prescribed as a simple or compound medicine (Khorasani, 1855). The uniqueness of the chemical structures and macromolecular configurations of mucilage obtain from the ispaghula has attracted carbohydrate chemists in last decade (Majmudar, 2013). In ancient Persian medicine, quince seed was useful for malignant ulcers, cough, dryness of the throat, and lubricates the trachea (Avicenna, 1998). One study demonstrates that the mild spasmodic property of the quince seed extract is caused

Medicinal mucilage used in traditional Persian medicine

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Table 1. Mucilage plants in TPM and their effects in current investigations.

Persian name Hintah

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Hulbah

Soqutan

Safarjal

Bazr al-Kattan

BazreQatuna

Scientific name Triticum aestivum Linn.

Trigonella foenumgraecum Linn

Symphytum officinalis Linn.

Cydonia oblonga Miller

Linum usitatissimum Linn.

Plantago ovata Forsk (Plantago Psyllium Linn.)

English name Wheat

Fenugreek

Comfrey

Quince seed

Linseed (Flax)

Ispaghula.

Useful effects in current investigations

Type of studies

Antioxidant (Khan et al., 2013; Rao et al., 2013) Anti-nociception (Takahashi et al., 2000) Xerostomia (Singh et al., 2010)

In vivo

Antioxidant (Chaturvedi et al., 2013; Sankar et al., 2012; Suresh et al., 2012), Anti-inflammatory (Sindhu et al., 2012; Suresh et al., 2012) Skin inflammation (Kaviarasan et al., 2007) Laxative (Arfan et al., 2013) Anti-tussive (Kulkarni et al., 2011)

In vivo

Antimicrobial (Suciu et al., 1988) Anti-inflammatory (Shipochliev et al., 1980) Wound healing (Tunon et al., 1995) Lung cancer (Couet et al., 1996) Mucositis (Oberbaum et al., 2001) Antioxidant (Magalhaes et al., 2009; Pacifico et al., 2012; Silva et al., 2004; Wojdylo et al., 2013) Anti-inflammatory (Essafi-Benkhadir et al., 2012) Anti-allergic (Shinomiya et al., 2009) Antimicrobial (Fattouch et al., 2007) Soreness of throat (Sharma et al., 2011) Xerostomia (Andersson et al., 1995) Antifungal (Abdelillah et al., 2013) Antioxidant (Anwar & Przybylski, 2012) Anti-inflammatory (Kaithwas et al., 2011b) Analgesic (Kaithwas et al., 2011b) Antimicrobial (Kaithwas et al., 2011a) Antipyretic (Kaithwas et al., 2011b) Skin inflammation (O’Neill et al., 2002)

In vitro In vivo

Antioxidant (Matthews et al., 2000) Wound healing (Westerhof et al., 2001)Antiulcer (Singh et al., 2012) Bronchospasm (Hulbert et al., 1995)

In vivo

In vivo Human

In vivo In vivo In vitro In vitro In vitro

In vitro In vitro Human In vitro In vitro In vivo and in vitro In vitro In vitro

Human In vitro In vitro

Useful effects in TPM Inflammations (Avicenna, 1998) Cough (Khorasani, 2001) Lubricates the lung (Khorasani, 2001) Laxative (Avicenna, 1998; Khorasani, 2001) Swellings (Avicenna, 1998; Khorasani, 2001) Hoarseness (Avicenna, 1998) Nourishes the lungs (Avicenna, 1998; Khorasani, 2001) Lubricates the lung, throat (Avicenna, 1998) Cough (Avicenna, 1998; Khorasani, 2001) Asthma (Avicenna, 1998; Khorasani, 2001) Produces saliva (Avicenna, 1998) Dryness of the throat (Avicenna, 1998) Hemoptysis (Avicenna, 1998) Clears the lungs (Avicenna, 1998) Laxative (Avicenna, 1998) Malignant ulcers (Avicenna, 1998) Dryness of the throat (Avicenna, 1998) Lubricates the trachea (Avicenna, 1998) Polydipsia (Jorjani, 1976) Cough (Jorjani, 1976)

Pains (Avicenna, 1998) Swellings (Avicenna, 1998; Tonkaboni, 2007) Cough (Avicenna, 1998; Tonkaboni, 2007)

In vivo and in vitro In vivo In vivo and in vitro In vivo In vivo

In vivo and in vitro In vitro Human

Swellings (Avicenna, 1998; Khorasani, 2001) Lubricates the lung (Avicenna, 1998) Polydipsia (Avicenna, 1998; Khorasani, 2001) Fevers (Avicenna, 1998; Tonkaboni, 2007) (continued )

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Table 1. Continued

Persian name Lisan al-hamal

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Khubbazi

Marw

English name

Scientific name Plantago major Linn.

Malva sylvestris (Malva rotundifolia Linn.)

Great plantain

Jews mallow

Useful effects in current investigations

Type of studies

Antioxidant (Mello et al., 2012) Wound healing (Thome et al., 2012; Zubair et al., 2012) Anti-inflammatory (Turel et al., 2009) Antiviral (Chiang et al., 2002)

In vivo In vitro

Antioxidant (DellaGreca et al., 2009; Samavati & Manoochehrizade, 2013; Marouane et al., 2011) Anti-inflammatory (Prudente et al., 2013) Antiseptic (Razavi et al., 2011) Chemo preventive or chemotherapeutic agent (Razavi et al., 2011) Immunomodulation (El Ghaoui et al., 2008) Wound healing (Pirbalouti et al., 2010) Laxative (Arenas et al., 2013)

In vitro

In vivo In vitro

In vivo In vitro In vitro In vivo

In vitro

Ibrisam

Silkpod

Antiviral (Jin et al., 2008)

In vitro

Hurf

Lepidium sativum Linn.

Garden cress

Analgesic (Raval & Ravishankar, 2010) Antioxidant (Stuven & Pflugmacher, 2007; Zia-Ul-Haq et al., 2012) Antibacterial (Oszmian´ski et al., 2013) Anti-asthma (Paranjape & Mehta, 2006) Antioxidant (Ashour et al., 2012) Anti-inflammatory (Al-Awadi et al., 2001; Ficarra et al., 1995) Analgesic (Ficarra et al., 1995) Laxative (Malik et al., 2013) Antioxidant (Narasimhan et al., 2006) Expectorant (Narasimhan et al., 2006) Antipyretic (Narasimhan et al., 2006) Immunostimulant (Verbiscar, 1993) Antiviral (Verbiscar, 1993) Antioxidant (Adiguzel et al., 2009) Antitussive (Sutovska et al., 2007, 2011) Antioxidant (Kardosova & Machova, 2006) Mucositis (Deters et al., 2010) Anti-inflammatory (Hage-Sleiman et al., 2011) Soothing (Al-Snafi, 2013) Immune stimulant (Al-Snafi, 2013) Antimicrobial (Al-Snafi, 2013)

In vivo

Musli

Kathira

Khitmi

Tin

Cordia myxa Linn.

Chlorophytum tuberosum Baker

Astragalus gummifer Lab Althaea officinalis Linn.

Ficus carica Linn

Sage seed gum

Sibestan

Musli

Gum tragacanth

Marsh mallow

Fig

Antiproliferative (Marrelli et al., 2012) Antibacterial (Lazreg-Aref et al., 2012) Anti-inflammatory (Ali et al., 2012)

Swellings (Avicenna, 1998; Khorasani, 2001) Burns (Avicenna, 1998) Ulcers (Avicenna, 1998) Deep wounds (Avicenna, 1998) Hemoptysis (Avicenna, 1998) Asthma (Avicenna, 1998) Laxative (Avicenna, 1998; Khorasani, 2001) Swellings (Avicenna, 1998; Khorasani, 2001) Lubricates, clear the lung (Avicenna, 1998; Khorasani, 2001) Expectorant (Avicenna, 1998) Cough (Avicenna, 1998; Khorasani, 2001)

In vivo

Salvia macrosiphon Boiss Bombyx mori Linn.

Sibistan

Useful effects in TPM

In vitro In vitro Human

In vivo In vivo In vitro In vitro In vitro In vitro

Ulcers (Avicenna, 1998) Swelling (Khorasani, 2001) Weakness of lung (Avicenna, 1998) Laxative (Avicenna, 1998) Abscess (Avicenna, 1998) Swelling (Avicenna, 1998; Khorasani, 2001) Cleanses the lungs (Avicenna, 1998; Khorasani, 2001) Asthma (Avicenna, 1998; Khorasani, 2001) Laxative (Avicenna, 1998; Jorjani, 1976; Rhazes, 2001) Lubricates the throat and the lungs (Avicenna, 1998) Dyspnea (Avicenna, 1998) Catarrh (Avicenna, 1998; Khorasani, 2001)

In vitro In vitro In vitro In vitro In vivo In vitro In vitro In vitro In vitro In vitro In vitro

In vitro In vitro In vitro

Cough (Avicenna, 1998; Jorjani, 1976) Lung ulcers (Avicenna, 1998) Hoarseness (Avicenna, 1998) Laxative (Avicenna, 1998; Khorasani, 2001) Swellings (Avicenna, 1998; Khorasani, 2001) Cough (Avicenna, 1998; Khorasani, 2001) Expectorant (Avicenna, 1998) Hemoptysis (Avicenna, 1998; Khorasani, 2001) Pleurisy (Avicenna, 1998) Pneumonia (Avicenna, 1998, Khorasani, 2001) Lubricates the throat and the lungs (Jorjani, 1976) Swellings (Avicenna, 1998; Khorasani, 2001) Pharyngitis (Avicenna, 1998) Parotitis (Avicenna, 1998) Roughness of thepharynx (Avicenna, 1998) (continued )

Medicinal mucilage used in traditional Persian medicine

DOI: 10.3109/13880209.2014.928330

Persian name

Scientific name

English name

Useful effects in current investigations

Type of studies

Antioxidant (Ali et al., 2012) Sore throat (Joseph & Raj, 2011)

In vitro In vivo and in vitro in vitro

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Antitussive (Abdollahi Fard & Shojaii, 2013)

Shahtarj

Fumaria officinalis Linn

Fumitory

Antioxidant (Sengul et al., 2009) Antimicrobial (Sengul et al., 2009) Antiulcer (Cortella & Pochettino, 1999)

In vitro In vitro In vitro

Baqlahamqa

Portulaca oleracea, Linn

Purslane

Antibacterial (Okafor et al., 2014) Antioxidant (Uddin et al., 2012; Zhao et al., 2013) Antitumor (Shen et al., 2013; Zhao et al., 2013) Antipyretic (Shobeiri et al., 2009) Anti-asthma (Shobeiri et al., 2009)

In vivo In vivo and in vitro In vivo and in vitro Human Human

Banafsaj

Viola odorata Linn.

Sweet violet (Garden Violet)

Antimicrobial (Zarrabi et al., 2013) Antitumor (Zarrabi et al., 2013) Antioxidant (Akhbari et al., 2012) Lung damage (Koochek et al., 2003)

In vitro

Basil (Sweet Basil)

Antioxidant (Sakr & Nooh, 2013) Anti-nociceptive (Venancio et al., 2011) Antifungal (Al-Maskri et al., 2011) Antimicrobial (Rattanachaikunsopon & Phumkhachorn, 2010) Antimutagenic (Beric et al., 2008)

In vivo In vitro

Shahsferm

Ocimum basilicum Linn.

by the activation of muscarinic receptors, while a Ca2+ antagonist mechanism is possibly responsible for its antispasmodic actions seen in tracheal and gut tissues. Thus, these data provide a validation for the medicinal use of quince seed in airways (bronchitis and asthma) and gut (diarrhea and constipation) disorders (Janbaz et al., 2013), while traditional Persian texts mention that it is only useful in constipation (Avicenna, 1998). Also, another study on rabbits proved that mucilage extracted from the quince seed heals wounds more rapidly (Hemmati & Mohammadian, 2000), the same effect is known for quince seed in Persian traditional medicine (Avicenna, 1998). Another mucilage plant that has been used since ancient times is marshmallow. Traditionally marshmallows were made from the extract of the mucilaginous root of the

In vitro In vitro In vitro

In vitro In vitro

5

Useful effects in TPM Respiratory system (Khorasani, 2001) Cough (Avicenna, 1998; Khorasani, 2001) Thoracalgia (Avicenna, 1998; Khorasani, 2001) Trachitis (Avicenna, 1998; Khorasani, 2001) Laxative (Avicenna, 1998; Khorasani, 2001) Obstruction (Avicenna, 1998) Gum protective (Avicenna, 1998) Stomatitis (Avicenna, 1998) Cleaning the gums (Avicenna, 1998) Palate (Avicenna, 1998) Tongue lesion (Khorasani, 2001) Clean gums (Khorasani, 2001) Swellings (Avicenna, 1998; Khorasani, 2001) Hemoptysis (Avicenna, 1998) Fever (Avicenna, 1998; Khorasani, 2001) Stomatitis (Avicenna, 1998) Polydipsia (Khorasani, 2001) Cough (Jorjani, 1976; Khorasani, 2001) Inflammations (Avicenna, 1998; Khorasani, 2001) Cough (Avicenna, 1998; Rhazes, 2001) Lubricates the lung (lungs) (Avicenna, 1998) Pleurisy (Avicenna, 1998) Pneumonia (Avicenna, 1998) Polydipsia (Khorasani, 2001) Swellings (Khorasani, 2001) Cough (Khorasani, 2001) Asthma (Khorasani, 2001) Mucositis (Khorasani, 2001)

In vitro

marshmallow plant; due to the demulcent nature of the extract, it served as a cough suppressant (Ulbricht et al., 2003). Aqueous extracts from the roots of marshmallow are widely used for remedy of irritated mucosa. The clinical proven effects are related to the attendance of bioadhesive and mucilaginous polysaccharides from the rhamnogalacturonan type, leading to the physical formation of mucin like on top of the irritated tissues. One study demonstrated that aqueous extracts of marshmallow stimulated cell vitality of epithelial cells greatly without triggering the cells into higher proliferation status. Neither marshmallow extract nor raw polysaccharides had any effect on fibroblasts. Microarray analysis showed an up-regulation of genes related to cell adhesion proteins, growth regulators, cytokine release, extracellular matrix, and apoptosis. So polysaccharides and aqueous extracts from the roots of marshmallow are effective

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stimulators of cell physiology of epithelial cells that can prove the traditional usage of marshmallow preparations for remedy of irritated mucous membranes within tissue regeneration (Deters et al., 2010). According to the investigated Persian manuscripts, only 20 ‘‘loab plants’’ were mentioned in the books used to treat ailments (Table 1). As studies show that the identified ‘‘loab plants’’ are approved in modern medicine as mucilage plants. It has been established that ‘‘loab plants’’ were used to treat numerous ailments, including respiratory diseases (18 plants), inflammation and swelling (13 plants), throat diseases (5 plants), constipation (7 plants), mouth diseases (4 plants), hoarseness (2 plants), fever (2 plants), ulcer (3 plants), pain (1 plant), and polydipsia (4 plant). Studies have shown that compounds purified from polysaccharides of some mucilage plants have various biological activities, such as antioxidant, anti-inflammatory, immunomodulating, antispasmodic action, or anti-allergic properties, and they often act as cough suppressants (Al-Snafi, 2013; Gasparetto et al., 2012; Nosalova et al., 2013) and protective mucous membranes (Deters et al., 2010). Mucilages have the ability to protect internal mucous membranes, so its use is appropriate for the treatment of irritation of the respiratory (including mouth, throat, larynx, bronchus, etc.) and digestive systems. Constipation is one of the common gastrointestinal problems and mucilage is a type of soluble fiber (Aller et al., 2004) that helps to increase stool by causing increased peristalsis (bowel movement) to bring the stool outside (Gray, 1995). Moreover, in the absence of soluble fiber, stool consistency is frequently too hard, making their expulsion hard. The intake of foods rich in mucilage helps soften stool and facilitates their deletion through defecation (LennardJones, 1993). Most of the effects of mucilage have been confirmed by recent medical research. This shows the depth of knowledge and the validity of the historical concepts. It seems some plants such as musli (Chlorophytum tuberosum Baker), hulbah (Trigonella foenum-graecum Linn), safarjal (Cydonia oblonga Miller), shahtarj (Fumaria officinalis Linn), sibistan (Cordia myxa Linn), soqutan (Symphytum officinalis Linn), kathira (Astragalus gummifer Lab), and bazreqatuna (Plantago ovata Forsk) cited in TPM as helpful in treating polydipsia, constipation, mouth and throat diseases, hoarseness, and respiratory disorders need further study to examine their effects. Whereas Persian scholars were prominent philosophers and scientists, they worked rationally based on the observations and made considerable discoveries in various fields of science; therefore, this study might give us a clear insight into the ideas of the past and may be helpful in future research and clinical trials.

Conclusion As Iranian scholars were prominent philosophers and scientists, they worked rationally based on the observations and made considerable discoveries in various fields of science; therefore, this study give us an insight into the ideas of the past and can be valuable in finding new data on the clinical use of the mucilages that should lead to future opportunities to investigate their potential medicinal use.

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Acknowledgements This research was derived from an ongoing PhD thesis at the School of Traditional Medicine, Shahid Beheshti University of Medical Sciences.

Declaration of interest The authors report no declarations of interest.

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