Herbal remedies and their adverse effects in Tem tribe traditional medicine in Togo

Potential Emergence of Plasmodium Resistance to Artemisinin Induced by the Use of Artemisia annua for Malaria and COVID-19 Prevention in Sub-African Region

Plasmodium resistance to antimalarial drugs is an obstacle to the elimination of malaria in endemic areas. This situation is particularly dramatic for Africa, which accounts for nearly 92% of malaria cases worldwide. Drug pressure has been identified as a key factor in the emergence of antimalarial drug resistance. Indeed, this pressure is favoured by several factors, including the use of counterfeit forms of antimalarials, inadequate prescription controls, poor adherence to treatment regimens, dosing errors, and the increasing use of other forms of unapproved antimalarials. This resistance has led to the replacement of chloroquine (CQ) by artemisinin-based combination therapies (ACTs) which are likely to become ineffective in the coming years due to the uncontrolled use of Artemisia annua in the sub-Saharan African region for malaria prevention and COVID-19. The use of Artemisia annua for the prevention of malaria and COVID-19 could be an important factor in the emergence of resistance to Artemisinin-based combination therapies.

Evaluation of antiplasmodial activity of extracts from endemic medicinal plants used to treat malaria in Côte d'Ivoire

Introduction:Plasmodium falciparum strains had been increasingly resistant to commonly used molecules including artemisinin. It is therefore urges to find new therapeutic alternatives.

Methods: In this study, the antiplasmodial activity of 21 extracts obtained from seven plants of the Anthocleista djalonensis, Cochlospermum planchonii, Harungana madagascariensis, Hoslundia opposita, Mangifera indica, Margaritaria discoidea and Pericopsis laxiflora of the Ivorian pharmacopoeia was evaluated on the chloroquine sensitive (NF54) and multi-resistant (K1) reference strains and on clinical isolates as well. The technique used was the microtiter method based on fluorescence reading with SYBR Green.

Results: The aqueous extract of the bark of H. madagascariensis and methanolic extracts of P. laxiflora showed the best antiplasmodial activity with IC₅₀ values of 6.16 µg/mL and 7.44 µg/mL, respectively. On the other hand, extracts of M. indica showed a very moderate activity with IC₅₀ values between 15 µg/mL and 50 µg/mL (5<IC₅₀<50 µg/mL) on the same strains of P. falciparum. Only the aqueous extract of A. djalonensis had IC₅₀ values greater than 50 µg/mL. The phytochemical analysis showed a strong presence of polyphenols and alkaloids in extracts with a cumulative rate of 90.47% and 95.23%, respectively.

Conclusion: The results obtained were also justified by the composition of these plants, which have several secondary metabolites involved in the treatment of malaria. The antiplasmodial properties of these plants could partially justify their use in malaria treatment. Further studies on these extracts are needed to manufacture a stable galenic formulation for the development of an improved traditional medicine.

Etiologies of diarrhea and drug susceptibility patterns of bacterial isolates among under-five year children in refugee camps in Gambella Region, Ethiopia: a case control study

Background

Despite substantial global effort and updated clinical management guidelines, diarrhea continues to be among leading worldwide causes of morbidity and mortality in children. Infectious diarrhea, the most common form of diarrhea causes substantial morbidity and mortality among children in developing countries, and the muddled use of antibiotics needs caution due to potential problems of drug-resistance. The aim of this study is to identify etiologies of diarrhea and drug susceptibility patterns of bacterial isolates in under-five children in refugee camps in Gambella Region, Ethiopia.

Methods

An institution- based matched case control study was conducted using a questionnaire-based interview from June to December 2017 in Pugnido and Teirkidi refugee camps. Stool samples were collected and parasites causing diarrhea were identified by wet mount microscopy. Conventional culture supplemented with API 20E identification kit was used to identify Salmonella and Shigella species. Antibiotic susceptibility of bacterial isolates was investigated by using the disk diffusion method. The association between etiologies and diarrhea was analyzed using McNemar test or Fisher exact test with 95% confidence interval at a level of significance of P < 0.05.

Results

The overall prevalence of enteric pathogens were 55 (41.0%) in diarrhea cases and 18 (13.4%) in healthy controls. The detected etiologies include Giardia lambia (28), Shigella spp. (16), E. hystolyotica/dispar (13), Ascaris lumbricoides (10), Salmonella spp. (6), Cryptosporidium parvum (6), Hymenolepis nana (4) and Isospora belli (3). All isolates were sensitive to kanamycine and ceftazidime. The high resistance rate was observed against ampicillin (100%), amoxicillin (100%), erythromycin (52%), chloramphenicol (47.5%), tetracycline (40.5%), cotrimoxazole (34.8%) and amoxicillin-clavulanic acid (33%). The majorities of the isolates had a low rate of resistance to ciprofloxacin (8.7%), naldxic acid (8.7%) and amikacin (13%).

Conclusions

Giardia lamblia, E. Hystolytica/dispar, and Shigella spp are the common etiologies of diarrhea in children in the studied refugee camps. The study also showed that significant numbers of bacterial isolates were resistant to the commonly used antimicrobial drugs. Therefore, improving clinical laboratory services and promoting evidence-based drug prescription may reinforce proper use of antibiotics and reduce the emergence of microbial resistance.

Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review

Background

The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region.

Methods

We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken.

Results

Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers.

Conclusion

TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.

Review on medicinal plants and natural compounds as anti-Onchocerca agents

Onchocerciasis is a filarial vector borne disease which affects several million people mostly in Africa. The therapeutic approach of its control was based on a succession of drugs which always showed limits. The last one: ivermectin is not the least. It was shown to be only microfilaricidal and induced resistance to the human parasite Onchocerca volvulus. The approach using medicinal plants used in traditional medicine is a possible alternative method to cure onchocerciasis. Onchocerca ochengi and Onchocerca gutturosa are the parasite models used to assess anthelmintic activity of potentially anthelmintic plants. Numerous studies assessed the in vitro and/or in vivo anthelmintic activity of medicinal plants. Online electronic databases were consulted to gather publications on in vitro and in vivo studies of anti-Onchocerca activity of plants from 1990 to 2017. Globally, 13 plant families were investigated for anti-Onchocerca activity in 13 studies. The most active species were Anacardium occidentale, Euphorbia hirta and Acacia nilotica each with an LC₅₀ value of 2.76, 6.25 and 1.2 μg/mL, respectively. Polycarpol, voacamine, voacangine, ellagic acid, gallic acid, gentisic acid, 3-O-acetyl aleuritolic acid and (-)-epigallocatechin 3-O-gallate were the isolated plant compounds with anti-Onchocerca activity. Most of the assessed extract/compounds showed a good safety after in vivo acute toxicity assays and/or in vitro cytotoxicity test. The exception was the ethanol extract of Trichilia emetica, which killed completely and drastically mice at a dose of 3000 mg/kg. Several plant groups of compounds were shown active against Onchocerca sp. such as tannins, alkaloids, triterpenoids and essential oils. Nevertheless, none of the active compounds was subjected to clinical trial, to assessment of its diffusibility through nodular wall or its capability to induce genetic resistance of Onchocerca sp.

Ethnobotanical Study of Medicinal Plants Used for the Treatment of Malaria in the Plateau Region, Togo

BACKGROUND

In Togo, malaria constitutes a major public health problem but, until now, the population still mostly relies on herbal medicine for healing. This study aimed to document medicinal plants used for malaria therapy in the Plateau region of the country.

METHODOLOGY

Semi-structured questionnaire interviews were used to gather ethnobotanical and sociodemographic data from traditional healers of the study area.

RESULTS

A total of 61 plants species belonging to 33 families were found to be in use for malaria therapy in the Plateau region. Caesalpiniaceae were the most represented family with 7 species, followed by Euphorbiaceae and Poaceae with 4 species each. According to the relative frequency of citation (RFC), Newbouldia laevis Seem. (RFC =0.52), Sarcocephalus latifolius (Sm.) E.A. Bruce (RFC =0.48), Acanthospermum hispidum DC. (RFC =0.43), and Senna siamea (Lam.) H.S. Irwin and Barneby (RFC =0.40) were the most cited in the treatment of malaria in the traditional medicine in the Plateau region. The parts of plants used could either be the barks, roots, leaves, or whole plants. The recipes also could be a combination of various species of plants or plant parts.

CONCLUSION

This study highlights the potential sources for the development of new antimalarial drugs from indigenous medicinal plants found in the Plateau region of Togo. Such results could be a starting point for in vitro antimalarial screenings.

SUMMARY

61 plants species from 33 families are use for malaria therapy in the Plateau region of TogoThe main families are Caesalpiniaceae Euphorbiaceae and PoaceaeThe most used species are Newbouldia laevis Seem. (RFC = 0.52), Sarcocephalus latifolius (Sm.) E.A. Bruce (RFC = 0.48), Acanthospermum hispidum DC. (RFC = 0.43), and Senna siamea (Lam.) H.S. Irwin and Barneby (RFC = 0.40) Abbreviations Used: RFC: Relative frequency of citation, FC: Frequency of citation, Dec: Decoction, Orl: Oral route, Mac: Maceration, Jui: Juice, Inf: Infusion, Sau: Sauce, Kne: Kneading, Le: Leaves, Rt: Roots, Wp: Whole plant, St: Stem, Stb: Stem bark, Rh: Rhizome, Fr: Fruits, Pf: Plasmodium falciparum, IC50: Concentration of extract killing 50% parasites.

Ethnobotanical Study of Latex Plants in the Maritime Region of Togo

Background:

In Togo, a little is known about latex plants of the flora used for medicinal purposes.

Objective:

The aim of this study was to identify the latex plant species and their medicinal uses in the Maritime Region of Togo.

Materials and Methods:

The methodology was based on ethnobotanical semi-structural individual interviews of 220 informants. Quantitative ethnobotanical index was used to analyze the data.

Results:

A total of 33 latex plants species were recorded, from 12 botanical families and 24 genera. The most represented families were Euphorbiaceae and Moraceae with eight species each. The relative importance (RI) value of each species and the informant consensus factor (ICF) of the ailments categories showed that Pergularia daemia (Forssk.) Chiov. (RI = 2.00) and Euphorbia hirta L. (RI = 1.91) were the most versatile in relation to their uses, and infectious diseases (ICF = 0.922) were the category with the greatest consensus among 17 categories.

Conclusion:

These latex plants of Togolese flora are variously used in traditional medicine and it would be important to undertake further investigations in phytochemistry, pharmacology, and toxicology to validate their uses.

Abbreviations Used: UV: use value ICF: informant consensus factor RI: relative importance PP: pharmacological properties attributed to a species for a specific ailments AC: ailment categories treated by a given species

Ethnobotanical Study of Medicinal Plants Used for the Treatment of Malaria in the Plateau Region, Togo

BACKGROUND

In Togo, malaria constitutes a major public health problem but, until now, the population still mostly relies on herbal medicine for healing. This study aimed to document medicinal plants used for malaria therapy in the Plateau region of the country.

METHODOLOGY

Semi-structured questionnaire interviews were used to gather ethnobotanical and sociodemographic data from traditional healers of the study area.

RESULTS

A total of 61 plants species belonging to 33 families were found to be in use for malaria therapy in the Plateau region. Caesalpiniaceae were the most represented family with 7 species, followed by Euphorbiaceae and Poaceae with 4 species each. According to the relative frequency of citation (RFC), Newbouldia laevis Seem. (RFC =0.52), Sarcocephalus latifolius (Sm.) E.A. Bruce (RFC =0.48), Acanthospermum hispidum DC. (RFC =0.43), and Senna siamea (Lam.) H.S. Irwin and Barneby (RFC =0.40) were the most cited in the treatment of malaria in the traditional medicine in the Plateau region. The parts of plants used could either be the barks, roots, leaves, or whole plants. The recipes also could be a combination of various species of plants or plant parts.

CONCLUSION

This study highlights the potential sources for the development of new antimalarial drugs from indigenous medicinal plants found in the Plateau region of Togo. Such results could be a starting point for in vitro antimalarial screenings.

SUMMARY

61 plants species from 33 families are use for malaria therapy in the Plateau region of TogoThe main families are Caesalpiniaceae Euphorbiaceae and PoaceaeThe most used species are Newbouldia laevis Seem. (RFC = 0.52), Sarcocephalus latifolius (Sm.) E.A. Bruce (RFC = 0.48), Acanthospermum hispidum DC. (RFC = 0.43), and Senna siamea (Lam.) H.S. Irwin and Barneby (RFC = 0.40) Abbreviations Used: RFC: Relative frequency of citation, FC: Frequency of citation, Dec: Decoction, Orl: Oral route, Mac: Maceration, Jui: Juice, Inf: Infusion, Sau: Sauce, Kne: Kneading, Le: Leaves, Rt: Roots, Wp: Whole plant, St: Stem, Stb: Stem bark, Rh: Rhizome, Fr: Fruits, Pf: Plasmodium falciparum, IC50: Concentration of extract killing 50% parasites.

[Ethnobotanical study of plants used in the treatment of diabetes in the traditional medicine of Maritime Region, Togo]

Introduction

Les plantes constituent une grande source de principes actifs qui peuvent être utilisés pour traiter de nombreuses maladies, dont le diabète. L'objectif de cette étude était de recenser les plantes utilisées en médecine traditionnelle pour traiter le diabète dans la région Maritime du Togo.

Méthodes

De janvier 2013 à juin 2014, une enquête ethnobotanique a été réalisée auprès de 164 guérisseurs traditionnels dans la région Maritime par des interviews directes à l'aide d'un questionnaire semi structuré.

Résultats

Les données recueillies ont permis d'identifier 112 espèces végétales appartenant à 51 familles. Les familles les plus représentées ont été les Caesalpiniaceae / Fabaceae avec 9 espèces, suivie des Euphorbiaceae et des Compositae avec 8 espèces chacune. Les espèces les plus citées ont été Allium sativum, Alium cepa, Guilandina bonduc, Moringa oleifera et de Picralima nitida qui ont eu une valeur usuelle de 0,05. En termes de recettes, 132 recettes sont préparées à partir des 112 espèces de plantes. Les recettes à plantes uniques ont été au nombre de 78, tandis que 54 recettes sont obtenues par des associations de plantes. Les parties de plantes les plus utilisées ont été les feuilles suivies par les racines. La principale méthode de préparation reste la décoction.

Conclusion

La région maritime du Togo dispose d'une biodiversité floristique importante en matière de plantes antidiabétiques. Ces résultats constituent une bonne base de données pour le criblage biologique dans la recherche de molécules antidiabétiques à base des plantes.

Ethno-medicinal study of plants used for treatment of human and livestock ailments by traditional healers in South Omo, Southern Ethiopia

BACKGROUND

Plants have traditionally been used for treatment of human and livestock ailments in Ethiopia by different ethnic and social groups. However, this valuable source of knowledge is not adequately documented, which impedes their widespread use, evaluation and validation. Here, we recorded indigenous knowledge and standard practices for human and livestock disease control, of three ethnic groups (Aari, Maale and Bena-Tsemay) in South Omo Zone of Southern Nations, Nationalities and Peoples Regional State, Ethiopia.

METHODS

A cross-sectional study was carried out using a semi-structured questionnaire to document knowledge of 50 traditional healers (40 male and 10 female) in medicinal plant use for treatment of human and livestock ailments. Descriptive statistics were used to analyze and summarize the ethno-botanical data.

RESULTS

Ninety-one plants, with claimed medicinal properties against a total of 34 human and livestock ailments, were reported and botanically identified as belonging to 57 genera and 33 plant families. Most of the plant species reported belonged to one of seven major families: Lamiaceae, Solanaceae, Menispermiaceae, Fabaceae, Asteraceae, Plumbaginaceae and Geraniaceae. Woody plants (shrubs 21% and trees 29%) were the major growth form used, whilst roots (40%) and leaves (35%) were the major plant parts used in the study areas. Healers mostly practice oral administration of plant preparations (65%). Multiple medicinal plants were cited against particular ailments, and mixing of two or more different medicinal plants (14.3%) against a single ailment was also commonly reported.

CONCLUSION

This study showed that traditional medicine, mainly involving the use of medicinal plants, is playing a significant role in meeting the primary healthcare needs of the three ethnic groups. Acceptance of traditional medicine and limited access to modern healthcare facilities could be considered as the main factors for the continuation of the practice. Documented knowledge of the traditional healers can be used to support the country's human and livestock health care system and improve lives and livelihoods. Information generated will be used in future studies to validate bioactivity of selected medicinal plants used by traditional healers, so to increase their acceptability in health care systems both nationally and internationally.

Anti-hyperglycemic effects of three medicinal plants in diabetic pregnancy: modulation of T cell proliferation

Background

Populations in Africa mostly rely on herbal concoctions for their primarily health care, but so far scientific studies supporting the use of plants in traditional medicine remain poor. The present study was undertaken to evaluate the anti-hyperglycemic effects of Picralima nitida (seeds), Nauclea latifolia (root and stem) and Oxytenanthera abyssinica (leaves) commonly used, in diabetic pregnancy.

Methods

Pregnant wistar rats, rendered diabetic by multiple low injections of streptozotocin, were treated with selected plant extracts based on their antioxidant activities. Vitamin C concentrations, fatty acid compositions and phytochemical analysis of plants extracts were determined. Effect of selected plant extracts on human T cell proliferation was also analysed.

Results

All analysed plant extracts exhibited substantial antioxidant activities probably related to their content in polyphenols. Picralima nitida exhibited the highest antioxidant capacity. Ethanolic and butanolic extracts of Picralima nitida, butanolic extract of Nauclea latifolia and ethanolic extract of Oxytenanthera abyssinica significantly decreased hyperglycemia in the diabetic pregnant rats. Butanolic extract of Picralima, also appeared to be the most potent immunosuppressor although all of the analysed extracts exerted an immunosuppressive effect on T cell proliferation probably due to their linolenic acid (C18:3n-3) and/or alkaloids content. Nevertheless, all analysed plants seemed to be good source of saturated and monounsaturated fatty acids.

Conclusion

By having antioxidant, anti-hyperglycemic and immunosuppressive activities, these plants could be good candidates in the treatment of diabetes and diabetic pregnancy.

Treatment of diarrhoea in rural African communities: an overview of measures to maximise the medicinal potentials of indigenous plants

Diarrhoea is a major cause of morbidity and mortality in rural communities in Africa, particularly in children under the age of five. This calls for the development of cost effective alternative strategies such as the use of herbal drugs in the treatment of diarrhoea in these communities. Expenses associated with the use of orthodox medicines have generated renewed interest and reliance on indigenous medicinal plants in the treatment and management of diarrhoeal infections in rural communities. The properties of many phenolic constituents of medicinal plants such as their ability to inhibit enteropooling and delay gastrointestinal transit are very useful in the control of diarrhoea, but problems such as scarcity of valuable medicinal plants, lack of standardization of methods of preparation, poor storage conditions and incertitude in some traditional health practitioners are issues that affect the efficacy and the practice of traditional medicine in rural African communities. This review appraises the current strategies used in the treatment of diarrhoea according to the Western orthodox and indigenous African health-care systems and points out major areas that could be targeted by health-promotion efforts as a means to improve management and alleviate suffering associated with diarrhoea in rural areas of the developing world. Community education and research with indigenous knowledge holders on ways to maximise the medicinal potentials in indigenous plants could improve diarrhoea management in African rural communities.

Medicinal plants use in central Togo (Africa) with an emphasis on the timing

Background:

Plant-based remedies continue to play a key role in the health care of people in Togo; however, there is a lack of published data in medicinal plants and medical practices of the people in the country.

Objective:

This study was aimed at documenting the plant utilization in the Tem folk medicine in the central region of Togo.

Materials and Methods:

An ethnobotanical survey was conducted with traditional healers in the central region of Togo using a semi-structured questionnaire.

Results:

This study demonstrated that local specialists in the central region of Togo tend to agree with each other in terms of the plants used to treat diabetes (ICF = 0.38), infertility, and abdominal pains (ICF = 0.33), but cite a much more diverse groups of plants to treat problems related to arterial hypertension, sickle cell disease, and abscess. They use 144 herbal concoctions made of 72 plants, distributed among 36 botanical families. The Euphorbiaceae family with eight species was best represented in terms of the number of species. The species with the highest use value were Khaya senegalensis (Desr.) A. Juss. (Meliaceae) (UV = 0.36), Anthocleista djalonensis A. Chev. (Gentianaceae) (UV = 0.27), Trichilia emetica Vahl (Meliaceae) (UV = 0.25), and Sarcocephalus latifolius (Sm.) E. A. Bruce (Rubiaceae) (UV = 0.21). They also rely on the timing in the plant processing and the administration of herbal remedies.

Conclusion:

All these findings are based on empirical observations; laboratory screenings are needed to check the effectiveness of these plants.

Screening Togolese medicinal plants for few pharmacological properties

Background:

Terminalia macroptera Guill. et Perr. (Combretaceae), Sida alba L. (Malvaceae), Prosopis africana Guill et Perr. Taub. (Mimosaceae), Bridelia ferruginea Benth. (Euphorbiaceae), and Vetiveria nigritana Stapf. (Asteraceae) are traditionally used in Togolese folk medicine to treat several diseases including microbial infections.

Objective:

This study aimed to investigate the antimicrobial, antioxidant, and hemolytic properties of the crude extracts of the above-mentioned plants.

Materials and Methods:

The antimicrobial and the antioxidant activities were assayed using the NCCLS microdilution method and the DPPH free radical scavenging, respectively. Human A+ red blood cells were used to perform the hemolytic assay. Phenolics were further quantified in the extracts using spectrophotometric methods.

Results:

Minimal inhibitory concentrations in the range of 230-1800 μg/ml were recorded in the NCCLS broth microdilution for both bacterial and fungal strains with methanol extracts. The DPPH radical scavenging assay yielded interesting antioxidant activities of the extracts of P. africana and T. macroptera (IC₅₀ values of 0.003 ± 0.00 μg/ml and 0.05 ± 0.03 μg/ml, respectively). These activities were positively correlated with the total phenolic contents and negatively correlated with the proanthocyanidin content of the extracts. The hemolytic assay revealed that great hemolysis occurred with the methanol extracts of T. macroptera, S. longepedunculata, and B. ferruginea.

Conclusion:

These results support in part the use of the selected plants in the treatment of microbial infections. In addition, the plant showed an interesting antioxidant activity that could be useful in the management of oxidative stress.

A randomized, double-blind, placebo-controlled trial of a Chinese herbal Sophora flower formula in patients with symptomatic haemorrhoids: a preliminary study

Dried flowers and buds of Sophora japonica (Huaihua) are used in China, Japan and Korea for treating haematemesis and bleeding haemorrhoids. This study compared the clinical safety and efficacy of a Sophora flower formula with a placebo for the conservative treatment of symptomatic haemorrhoids. The study was a prospective, double-blind, randomized placebo-controlled trial. The clinical effective rate, symptom score and the incidence of important clinical events were used as observation indices to evaluate the effect of the Sophora flower formula. The results showed that after 7 days of treatment, improvement was observed in 87.0% of the patients' major symptoms in the Sophora flower formula group compared with 81.8% of those in the placebo group. After 14 days, 78.2% patients in the Sophora flower formula group were asymptomatic, whereas 40.9% of those in the placebo group exhibited residual symptoms. However, the difference between both groups was not statistically significant. As the bowel habits of the patients improved and as the patients took sitz baths, their symptoms improved drastically, regardless of the use of the Sophora flower formula. These findings indicate that the traditional Chinese Sophora flower formula is clinically safe; however, its effects on haemorrhoids need to be studied in a larger sample size and with different dosages. The present study results may be a potential clinical reference for physicians prescribing medications for patients with symptomatic haemorrhoids.