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Natural remedies for impotence in medieval Persia

Abstract

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.

Main

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 Qanoon-fel-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.1,2,3,4 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.5,6,7

Erectile dysfunction (ED) represents a highly prevalent social problem; approximately 5–20% of the general mail population suffer from moderate-to-severe ED.8 The United Nations estimated the worldwide prevalence of ED among men aged 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.10,11,12,13 ED has been defined as the partial or total inability to achieve or maintain an erection for satisfying sexual intercourse.9,10,11,12 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), 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

Figure 1
figure1

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.

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 … 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.10,11,12,13

Table 1 Natural impotence remedies in medieval Persian medicine

Among the medicinal herbs advised for treatment of ED, Ebn-e-sina believed that the root of spotted-orchis (Orchis maculata), terebinth (Pistacia terebenths) 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 assa-foetida) 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.10,11,12,13

This review presents the clinical approaches that practitioners in medieval Persia used to deal with impotence. In recent years, research into medieval 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.

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Correspondence to A Gorji.

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Khaleghi Ghadiri, M., Gorji, A. Natural remedies for impotence in medieval Persia. Int J Impot Res 16, 80–83 (2004). https://doi.org/10.1038/sj.ijir.3901153

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Keywords

  • medieval literature
  • Persian history
  • erectile dysfunction
  • traditional medicine

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