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International Journal of Impotence Research (2004) 16, 80–83
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Review of Impotence
Natural remedies for impotence in medieval Persia
M Khaleghi Ghadiri1 and A Gorji1*
1
Institut für Physiologie, Universität Münster, Robert-Koch-Strasse, Münster, Germany
Man’s preoccupation with potency, or the lack thereof, has been present through the ages. Several
documents still exist from which the clinical approaches of erectile dysfunction (ED) in medieval
Persia can be ascertained. The medieval physicians described definitions and apparent causes of
ED. They also noted hygienic and dietary rules as well as long lists of natural substances used in the
treatment of ED. Many of the approaches of practitioners in medieval Persia are accurate and
accepted even today; however, still more of them could be of use to modern medicine. The present
review provides an overview of the knowledge of ED at the time.
International Journal of Impotence Research (2004) 16, 80–83. doi:10.1038/sj.ijir.3901153
Keywords: medieval literature; Persian history; erectile dysfunction; traditional medicine
Medieval Persian physicians are well informed
about the medical traditions of different ancient
civilizations. The Persians not only accumulated all
the existing information on medicine of the time,
but also added to this knowledge by their own
ingenious studies based on their empirical findings.1 These practitioners had brought great contributions to pharmaceutical science. They
categorized medicinal herbs from Africa to China
and studied them in a scientific manner.2 The
medieval medical texts of Persia such as Qanoonfel-teb (The Canon) by Ebn-e-Sina (980–1037), Râzi’s
(860–940) Ketab-al-hawi (Continents), and Zakhireh
Kharazmshahi by Esmail Jorjani (1042–1136) became the most widely read literatures in medieval
Europe. During renaissance, medieval Persia had a
significant influence on the contemporary medicine;
this influence is still felt today.1–4 In recent years,
some experimental studies have evaluated medieval
Persian natural therapies using modern scientific
methods. These investigations raised the possibility
of revival of traditional treatments.5–7
Erectile dysfunction (ED) represents a highly
prevalent social problem; approximately 5–20% of
the general mail population suffer from moderateto-severe ED.8 The United Nations estimated the
worldwide prevalence of ED among men aged
*Correspondence: A Gorji, Institut für Physiologie,
Universität Münster, Robert-Koch-Strasse 27a, Münster
D-48149, Germany.
E-mail: [email protected]
Received 11 August 2003; accepted 5 October 2003
40–70 y at 152 million in 1995, and projected a
more than two-fold increase by 2025, to approximately 322 million men.9 Despite the progress that
has taken place in recent years in the development
of therapy, there is still a need for more effective
drugs for the treatment of impotence. It is hoped that
review of clinical approaches to ED used by
physicians in medieval Persia will inform further
research into the clinical benefits of those treatments for impotence.
The terms ‘ghovehe bâee’ and ‘ghovehe mojameat’
have traditionally been used to describe the ability
of the male to attain an erection adequate for
coitus.10–13 ED has been defined as the partial or
total inability to achieve or maintain an erection for
satisfying sexual intercourse.9–12 Medieval Persian
physicians described a large number of factors that
have a negative impact on erectile ability. They
mentioned that ED might be occurred as a consequence of a specific illness of penis, testis, and
seminal vessels, or as a cause of the involvement of
neighbouring organs such as rectum.10,11 Heart,
liver, kidney, stomach, arteries, spinal cord, and
brain disorders were also known to result in ED. The
association between ED and psychological factors
such as depression and rage was recognized by
medical clinicians in Persia.10,11,13 Sex with women
who failed to rouse up the sexual desire in her mate
was mentioned as a possible cause of ED (Figure 1).
Besides the illnesses associated with ED, a number
of medical interventions such as haemorrhoidectomy and medicaments like camphor (Cinnamomum
camphora), opium (Papaver somniferum), flea-wort
(Plantago psyllium), water-lily (Nymphaea alba),
Impotence in medieval Persian medicine
M Khaleghi Ghadiri and A Gorji
Figure 1 Medieval practitioners in Persia believed that sex is a
physiologic expression and extension of love. Sex without love
was considered as a factor that may induce sexual dysfunction.
Many painters and poets described this theme in their works.
’The girl with her finger in her mouth, with the old man and the
falcon’ is one of these works. Painted by Hossain Behzad.
Reprinted with the permission of the Saad’abad cultural complex
and the Behzad Museum, Tehran, Iran.
and damask rose (Rosa damascena) were noted to
cause impotence.10 Râzi13 laid special stress on the
effect of dress and bed on erectile function, and
explained how this can induce ED. Malnutrition and
asthenia were also mentioned as the other causes of
ED.9 The humour theory of health and mood was a
widely held belief in the medieval period. In this
theory, all diseases result from irregular distribution
of the four humours––Dam (blood), Balgham
(phlegm), Safra (yellow bile), and Sauda (black
bile). Temperament can be viewed as the sum of the
proportions of each humour within the body. Both
Ebn-e-Sina and Esmail Jorjani noted that impotence
was usually accompanied with dominating cold
temperament, a temperament closely related to
black bile humour.10,11
Medieval Persian medical literatures encouraged
the treatment of ED by tackling the conditions that
contribute to impotence, nutritional therapy, and
prescription of medicaments. Patients were advised
that they must avoid anything that had a negative
influence on sexual function (e.g., hunger, gluttony,
having sex immediately following lunch or dinner,
sex in water or bathroom, anxiety, depression,
excessive water drinking, sex with fatigue, sex with
women during menstruation, and sex with old
women).10,11 As fully enjoying sex was believed to
be impossible under psychological disorders, it was
ordered that the patients suffering from depression
or rage ’should not try to have sex until the
psychological problems disappear’. Mild to moderate exercise, especially riding and swimming, was
considered beneficial. Ebn-e-Sina wrote: ’when man
is unable to have sex, first he should forget that, read
the books contain sexual theme, listen to the experts
y talk about erotic stories and watch animal
intercourse until sexual arousal and power are
appeared’.10
As medieval Persian practitioners believed that
proper nutrition played an essential role in sexual
activity, they placed special emphasis on food and
diet in their therapeutic management of ED. Physicians recommended abstinence from sour and acrid
foods, caraway (Carum carvi), lentil (Lens culinaris),
sweet marjoram (Origanum majorana), and wild rue
(Peganum narmala). Foods that were thought to
help cure ED included almond (Amygdalus communis), cocoa-nut (Cocos nucifera), pistachio (Pistacia vera), date (Phoenix dactylifera), turnip
(Brassica rapa), broad bean (Faba vulgaris), kidney
bean (Phasaeolus vulgaris), pea (Cicer arietinum),
onion (Allium cepa), lentisk pistache (Pistachia
lenticus), honey, fish especially sturgeon, moray
eel, shark, skink, caviar, diary products, and birds’
egg, especially sparrow and pigeon. Other foods
suggested to have aphrodisiac properties were halim
(a kind of dish with wheat groats and meat), lamb or
birds brain, roast meat, kaleh-pacheh (sheep’s head),
and pottage. The appropriate beverage included
current juice, water from iron-mine’s fountain,
carrot juice, garden cress juice, camel milk, and fig
juice. Râzi believed that frequent consumption of
wine leading to ED.12 Wine, especially old type, was
also ordered by other practitioners to be avoided,
and if imbibed, it should be fresh.10,11
Medieval practitioners in Persia prescribed a long
series of substances for the treatment of ED. They
emphasized the importance of the dose and defined
a schedule for drug administration. Drugs were
taken via oral or rectal routes, as well as through
the skin of pelvic, genital, and lumbar areas. The
drugs listed in medieval Persian writings include
plants and animal products (Table 1). The physicians developed many substances that were supposed to have aphrodisiac properties. Some of these
drugs such as dried fig mixed with turnip were also
believed to have fertility-enhancing effects. Based
on the underlying conditions, drug therapy plan was
individualized, given different single or combined
drug therapy in patients suffering from ED.10–13
Among the medicinal herbs advised for treatment
of ED, Ebn-e-sina believed that the root of spottedorchis (Orchis maculata), terebinth (Pistacia tere-
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International Journal of Impotence Research
Impotence in medieval Persian medicine
M Khaleghi Ghadiri and A Gorji
82
Table 1 Natural impotence remedies in medieval Persian medicine
Origin of drug
Latin name
Common name
Administration
Plant-derived drug
Acacia farnesiana
Acanthus mollis
Alpinia officinarum
Aframomum melegueta
Amygdalus communis
Anacyclus Pyrethrum
Asparagus officinalis
Boswellia carterii
Brassica oleracea
Cinnamomum zeylanicum
Citrullus colocynthis
Cucumis melo
Curcuma longa
Daucus carota
Ferula Assa-foetida
Fraxinus excelsior
Gossypium herbaceum
Iris florentina
Lepidium sativum
Linum usitatissimum
Luffa aegyptiaca
Matthiola incana
Medicago setiva
Menthapiperata
Orchis maculatz
Pinus silvestris
Pistacia Terebenthns
Polypodium vulgare
Sesamum indicum
Syzygium aromaticum
Trigonella Foenum-graecum
Urtica dioica
Vitis vinifera
Zingiber officinale
Sweet acacia
Branke ursine
Galangal
Melegueta pepper
Almond
Pillitory of Spain
Sparrow grass
Incense
Cabagge
Cinnamon
Colocynth
Melon (seeds)
Turmeric
Carrot (seeds)
Stinking gum
Common ash
Cotton plant
Iris
Garden cress
Flax
Egyptian towel ground
Common stock
Lucern
Peppermint
Spotted-orchis
Pine
Terebinth
Polypody
Sesame
Clove
Fenugreck
Nettle (seeds)
Grape vine
Ginger
Oral, topical
Oral
Oral
Oral
Oral
Oral, topical, rectal
Oral, rectal
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Oral, topical
Oral
Rectal, topical
Topical
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Oral, topical
Oral
Oral
Animal-derived drugs
Stag gall bladder
Bull gall bladder
Duck suet
Dried bull penis
Cock testis
He-goat testis
rennet obtained from cow or cammel milk
benths) and date soaked in sheep milk, ginger
(Zingibar officinale), especially its jam, and the seed
of garden cress (Lepidium sativum) mixed with
pillitory of Spain (Anacyclus pyrethrum) were very
effective.10 Furthermore, Esmail Jorjani advised oral
administration of rennet obtained from cow or camel
milk as a powerful therapy. It was believed that
topical application of stinking gum (Freula assafoetida) irritated the genital tract, a feeling that
induced erection.11 Rectal application of cotton
plant (Gossypium herbaceum) was recommended
as very useful treatment. A mixture of wild carrot
(Malabaila secacul) and ginger (Zingibar officinale)
was also described as an effective treatment for ED.
When the heart disorders resulted in ED administration of sweet acacia (Acacia farensica) was
believed to be beneficial.10–13
This review presents the clinical approaches that
practitioners in medieval Persia used to deal with
impotence. In recent years, research into medieval
International Journal of Impotence Research
Topical
Topical
Rectal
Oral
Oral
Oral
Oral
herbal medics is increasing and this field of research
has become the focus of intense interest and efforts
towards the identification of effective and safe
drugs. The efficacy of some traditional Persian
treatments for ED, such as the aphrodisiac property
of Zingiber officinale,14,15 Amygdalus communis,15
Aframomum melegueta,16 Brassica spp,15 and Lepidium spp17,18 has been proved by modern medicine;
however, most remain largely unexamined. Medieval Persian writings provide comprehensive clinical
remedies from centuries of experience in the field of
ED, which may be helpful for testing their probable
benefits for ED.
References
1 Elgood C. A medical history of Persia and the eastern caliphate
from the earliest times to the year 1932 A.D. Cambridge
University Press: London, England, 1951, pp 205–209.
Impotence in medieval Persian medicine
M Khaleghi Ghadiri and A Gorji
2 Najm-Abadi M. The History of Medicine in Iran after Islam.
Tehran University Press: Tehran, Iran, 1975, pp 425–476.
3 Siraisi NG. Avicenna in Renaissance Italy: the Canon and
Medical Teaching in Italian Universities After 1500. Princeton
University Press: Princeton, USA, 1987, pp 205–209.
4 Osler W. Evolution of Modern Medicine: A Series of Lectures
Delivered at Yale University on the Silliman Foundation in
April, 1913. Ayer Company Publishers, Incorporated Pub.:
Manchester, USA, 1972, p 243.
5 Gorji A, Khaleghi Ghadiri M. History of headache in medieval
Persian medicine. Lancet Neurol 2002; 1: 510–515.
6 Gorji A, Khaleghi Ghadiri M. History of epilepsy in Medieval
Iranian medicine. Neurosci Biobehav Rev 2001; 25: 455–461.
7 Gorji A. Pharmacological treatment of headache using
traditional Persian medicine. Trends Pharmacol Sci 2003;
24: 351–354.
8 Kubin M, Wagner G, Fugl-Meyer AR. Epidemiology of erectile
dysfunction. Int J Impot Res 2003; 15: 63–71.
9 Ayta IA, McKinlay JB, Krane RJ. The likely worldwide
increase in erectile dysfunction between 1995 and 2025 and
some possible policy consequences. BJU Int 1999; 84: 50–56.
10 Avicenna A. Qanoon dar Teb. Soroosh Press: Tehran, Iran,
1988.
11 Jorjani E. Zhakhireh Kharazmshahi. Iranian Cultural Organisation Press: Tehran, Iran, 1976.
12 Hossaini-Tabib MM. Tohfe hakim moemen. Mostafavi Press:
Tehran and Qum, Iran, 1959.
13 Râzi M. Al-Hawi. Encyclopedia Press of Ossamania: Dekan,
India, 1955–1971.
14 Shelly TE, McInnis DO. Exposure to ginger root oil enhances
mating success of irradiated, mass-reared males of Mediterranean fruit fly (Diptera: Tephritidae). J Econ Entomol 2001; 94:
1413–1418.
15 Qureshi S, Shah AH, Tariq M, Ageel AM. Studies on herbal
aphrodisiacs used in Arab system of medicine. Am J Chin Med
1989; 17: 57–63.
16 Kamtchouing P et al. Effects of Aframomum melegueta and
Piper guineense on sexual behaviour of male rats. Behav
Pharmacol 2002; 13: 243–247.
17 Gonzales GF et al. Effect of Lepidium meyenii (Maca), a root
with aphrodisiac and fertility-enhancing properties, on serum
reproductive hormone levels in adult healthy men. J Endocrinol 2003; 176: 163–168.
18 Zheng BL et al. Effect of a lipidic extract from Lepidium
meyenii on sexual behavior in mice and rats. Urology 2000; 55:
598–602.
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