Constipation

Massimo Chiaretti et al. (2020) · Scientific reports

This randomized clinical trial with 199 adults at an Italian university proctology clinic compared two plant-based venotonic products, called phlebotonics, with routine care for hemorrhoidal disease (swollen anal cushions that cause bleeding, itching or irritation, and pain) and for recovery after hemorrhoid surgery. One product was a flavonoid preparation containing rutin, borage, horse chestnut and witch hazel. The other was a Centella asiatica (gotu kola) preparation containing triterpenic acids, asiaticoside, arnica and aloe. Flavonoids are plant antioxidants reported to improve venous tone and reduce inflammation, while Centella is reported to stimulate collagen and repair connective tissue. Participants aged 18 to 85 were randomized to three groups. Group A (73 people) took 300 mg flavonoid tablets twice daily for 15 days and applied a 3 g ointment inside the anus once daily. Group B (66 people) took 60 mg Centella tablets twice daily for 15 days and used a 3 g Centella-based ointment. Group C (60 people) received routine care only. Everyone followed a water- and vegetable-rich diet and used a medicated soap for 42 days. Time until bleeding stopped was tracked, and irritation or pain was rated on a visual analogue scale. Among 130 people with hemorrhoidal disease, bleeding stopped after a median of 2 weeks with flavonoids and 3 weeks with Centella or routine care (flavonoids versus routine care p < 0.001, meaning a clear difference; Centella versus routine care p = 0.152, meaning no significant difference). Irritation scores were lower than routine care for both products (flavonoids p = 0.007; Centella p = 0.041), and the two products did not differ (p = 0.782). After hemorrhoidectomy (31 people), bleeding time did not differ significantly between groups, and pain differed only for flavonoids versus routine care (p = 0.045). In 34 people with thrombosed hemorrhoids, pain fell faster with either product (all p < 0.001). Tissue examination linked flavonoids to fibrosis, a fibrous tissue change in the excised piles (p = 0.008). No adverse reactions were reported except burning from the Centella ointment in one person, which led to suspension of that ointment. The authors interpret the results as favouring flavonoids for bleeding and irritation, with Centella comparable on irritation. Limitations are stated plainly: a single centre, only 42 days of follow-up, small surgical and thrombosis subgroups added after the original protocol, no described blinding of participants, and multi-ingredient products that prevent attributing effects to individual plants. A medicated soap containing Centella was also given to every group. The authors suggest longer trials to test whether the benefits last.

Monika Kujawska et al. (2019) · Journal of ethnobiology and ethnomedicine

This historical review examined Bryonia alba (white bryony), a vine in the cucumber family, tracing its use across northern and central-eastern Europe from antiquity through the twentieth century. The authors, an ethnobiologist and an ethnologist, worked from written and oral sources rather than a clinical study, covering Sweden, Denmark, Germany, Poland, Belarus, Ukraine, Romania and the Balkans. White bryony's root closely resembles the root of mandrake (Mandragora officinarum), a plant with an extensive European magical and medicinal reputation; the paper's central finding is that this resemblance let bryony function as mandrake's cheaper stand-in, inheriting much of its folklore in the process. Rather than enrolling participants, the authors searched historical floras, pharmacopoeias, ethnographic monographs, and travel accounts for every mention of the plant, then sorted findings into categories: ritual and folk-belief use, food, folk and historical medicine, ethnoveterinary practice, and ornamental planting. They cross-checked, where sources allowed, whether a given account referred to B. alba or its close relative B. dioica, and separated practices documented only in printed herbals ("booklore") from those recorded as living oral tradition passed between households. Across independent sources, root preparations were repeatedly recorded for oedema (fluid swelling, called dropsy at the time), convulsions and epilepsy, intestinal worms, wounds, and rheumatic pain — a 1792 Swedish account describes juice collected from a hollowed-out root curing oedema and treating worms, convulsions and headache, while twentieth- and twenty-first-century accounts from Serbia and Kosovo describe the same root used as a purgative, diuretic and topical anti-rheumatic agent. The authors cite phytochemical literature attributing these effects to cucurbitacins (bitter plant compounds), also linked elsewhere to antitumor activity, while stating plainly that historical claims for epilepsy specifically lack sufficient supporting study. Toxicity is dose- and season-dependent: freshly harvested summer root contains the more toxic cucurbitacin I, and the berries carry a cited lethal dose of roughly 15 for a child and 40 for an adult. The authors report that medicinal use had become obsolete across Scandinavia, Germany and western Slavic regions by the twentieth century, surviving only in isolated Balkan communities in Serbia and Kosovo. The authors present this decline as an unusual case: a plant of substantial historical medicinal and magical importance that today survives mainly as an ornamental garden relic or, in North America, as an unrelated invasive weed. Because the review synthesizes historical and ethnographic records rather than testing the plant directly, it offers no controlled data on safety or effectiveness, and the authors themselves flag some recorded folklore as possibly the invention of root sellers rather than genuine tradition. Future work, the authors suggest, could extend this same source-based method to B. dioica across German-, Latin- and Celtic-speaking Europe.