Mediterranean and the Near East

Alexandra senna Senna alexandrina and Tinnevelly senna S. angustifolia / Fabaceae

Both species are of desert origin: Tinnevelly senna, Senna angustifolia, is native to Arabia, West Africa and Asia, as far as Punjab, while Alexandra senna, S. alexandrina, grows naturally in northeastern Africa and it is harvested and cultivated in Sudan, China, and India.

About 1,000 years ago the Arabs introduced the use of dried leaves and especially fruits of senna into Western pharmacopoeias as a laxative. Senna was mentioned in detail by Ibn al-Baytar (1197-1248), one of the most important Arabian scholars of the Middle Ages and the author of the famous medical treatise Jami’ al-mufradat. Over the centuries senna has proved its worth as an herbal drug and today represents one of the most widely used herbal drugs in the classical pharmacy.

Artichoke Cynara cardunculus / Asteraceae

Formerly known as Cynara scolymus, the artichoke is the best example of a food-medicine in the whole of European phytotherapy. Artichokes originated in the Mediterranean region and numerous diverse cultivars were subsequently developed. Many Mediterraneans used artichokes by soaking them in wine, then drinking the liquid as a digestive and a reconstituent for various illnesses. Today the culinary use of the fleshy flower receptacles and the base of the bracts is known worldwide. However, the utilization of the leaves in modern phytotherapy is quite recent and focuses on their cholekinetic (increasing the flow of bile acids), antihyperlipidemic (lowering the level of lipids in the blood), and hepatoprotector ( liver-protecting) properties. Artichoke leaves are the main ingredients of the Italian bitter liqueur Cynar, which has contributed significantly to changes in Italian social habits. During the 1960s and 1970s Cynar was very popular and drinking it after a meal became a “must” in many urban milieus.

Chaste tree Vitex agnus-castus / Lamiaceae

This shrub is native to the Mediterranean and northwestern India. Dried fruits of Vitex agnus-castus seem to be one of the oldest phytomedicines, dating back to the beginning of European civilization. The Greek name of this plant, “lygos” (pliable branch), hints at its usage in viticulture for staking vines and in livestock farming for pasture fences. The other Greek expression, “agonos,”meaning chaste and pure, distinguishes it as a feminine plant of goddesses like Hera, Demeter, and Artemis (Diana), a cult plant of womanliness. Agonos is the source of the medieval name “agnus-castus” (the chaste lamb). The ancient Greek physicians Hippocrates, Theophrastus, and Dioscorides all made reference to it, as did the Greek-Roman historian Pliny The Elder. Both Dioscorides and Pliny reported its use in suppressing the libido. The Greeks’ use closely resembled modern practices: they recommended it as an aid in healing of external wounds and complaints of the spleen, and for use in child birth. The English believed it would suppress the libido, as did the Catholic church, which had it placed in the pockets of novice monks in order to help them in fulfilling their vow of chastity. Adam Lonicer (1679) wrote that the aerial parts of the species were macerated into wine and honey, and early American physicians used the fruits to stimulate lactation and as an emmenagogue.

In the Mediterranean the fruits are sometimes used as a diuretic, to induce production of milk, and as an antirheumatic treatment. Recent studies have confirmed the pharmacological validity of its use in relieving complaints associated with premenstrual syndrome. Specifically, it is effective in relieving insufficiency of the corpus luteum (luteal phase defect). These fruits, and also the aromatic leaves, have been occasionally used as a condiment and pepper substitute in southern Europe and northern Africa, and both are part of the legendary Moroccan spice mixture “ras el hanout.”

Garlic Allium sativum / Alliaceae

Garlic represents one of the oldest medicinal plants in the Mediterranean. Garlic was first discovered in the wild, probably in the Iranian region, and is well documented by textual and archaeological records in Mesopotamia and Egypt from 3000 bc. The early Sumerian diet included garlic as a mainstay, and garlic is mentioned in the Shih Ching (The Book of Songs), a collection of ballads said to have been written by Confucius. Garlic was highly prized in ceremony and ritual, and it is said that lambs offered for sacrifice in China were seasoned with garlic to make them more pleasing to the gods. Herodotus wrote that the Egyptians fed it to slaves building the pyramids in order to increase their stamina. Workers deprived of their ration of garlic went on strike. An Egyptian papyrus from 1500 bc recommended garlic for twenty-two ailments. It represented a kind of combination food-medicine.

In the fourth book of the Bible, it is reported that the Jews returning to Sinai had nostalgia for the eating of garlic, which they had known and appreciated in Egypt. In ancient Greece and Rome, it was claimed to have additional uses, such as repelling scorpions, treating dog bites and bladder infections, and curing leprosy and asthma. By 1000 ad garlic was grown in virtually the entire known Medieval world, and was universally recognized as a valuable plant. Many cultures elevated garlic beyond a dietary staple, and suggested that it had medicinal and even spiritual uses. Philosophers and scholars credited garlic with many virtues. Aristophanes suggested that athletes and those going into battle should eat garlic to enhance their courage. Pliny wrote about garlic’s ability to cure consumption and numerous other ailments. Virgil commented that garlic enhanced and sustained the strength of farm workers. Celsius recommended garlic as a cure for fever. Hippocrates thought it was a good medicine for many health problems, and Mohammed, the prophet, claimed that if garlic was applied directly to a sting or a bite wound, it would ease the pain. For many centuries there was a widely held belief that garlic would keep evil at bay. Wreaths of garlic hung outside a door or dwelling were believed to ward off witches or vampires. Bull fighters may well wear cloves of garlic around their neck during a bullfight in order to protect themselves from the vicious horns. In the Middle Ages it was thought to prevent the plague.

In the Middle Ages the use of garlic as a medicine and food was spread to central Europe mainly by the Jews; the Jewish habit of frequently eating garlic became one of the characteristics reviled by the Nazi regime during the 1930s and 1940s. Later, in the 1960s, garlic was spread further by immigration of the southern Europeans. Louis Pasteur first documented that garlic had an anti-bacterial property, in 1858, and nowadays garlic preparations play a primary role in modern phytotherapy as a treatment for high blood pressure and to reduce high levels of lipids in the blood. Some clinical evidence points to garlic’s effectiveness in treating these conditions.

Licorice Glycyrrhiza glabra / Fabaceae

This shrub originated in the semi-arid areas of the Eastern Mediterranean, Near East and Central Asia. The oldest report on the use of the roots of this species comes from a Sumer tablet of Mesopotamia (2000 bc), and shortly thereafter the use of Glycyrrhiza uralensis in China is documented. By then the sweet taste of the licorice root was already known (its botanical name, Glycyrrhiza, sweet root, comes from Greek). Alexander the Great, the Scythian armies, Julius Caesar, and even India’s great prophet, Brahma, were known to have endorsed the benefits of licorice. Arab physicians used licorice to treat coughs and relieve side effects of laxatives.

Licorice began to be cultivated intensively in Syria, southern Italy, France, and Spain, particularly from medieval times onward. The tradition of licorice use then spread to reach central Europe, where St. Hildegard of Bingen first wrote about its use in the 12th century, and England, where the roots were used to aromatize beer in the 14th century. For over 3,000 years, licorice root has been used by Mediterranean and Near Eastern populations as a remedy for sore throats and coughs, and sometimes to heal ulcers. These two medical applications remain the basis on which G. glabra continues to be important in modern evidence-based phytotherapy. Licorice, which is now mainly cultivated in Turkey, the former Soviet Union, and China, is also used in the food industry. A decoction of its washed roots, filtered and concentrated, continues to be one of the favorite snacks for children and adults.

Poppy Papaver somniferum / Papaveraceae

Papaver somniferum has long been popular in the Near East and in the Mediterranean as a remedy and source of pharmaceuticals. It is one of the prime examples of a medicinal plant. Illustrations of the Greek and Roman gods of sleep, Hypnos and Somnos, show them wearing or carrying poppies. Classical Greek physicians either ground the whole plant or used opium extract. Galen lists its medical properties, noting how opium “resists poison and venomous bites, cures chronic headache, vertigo, deafness, epilepsy, apoplexy, dimness of sight, loss of voice.” Dioscorides described both the latex of the capsules (opos) and the extract of the whole plant (mekonion). By the 8th century ad, opium use had spread to Arabia, India, and China. The Arabs both used opium and organized its trade. Thomas Sydenham, 17th-century pioneer of English medicine, wrote, “among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium.” In 1874, English pharmacist Alder Wright had boiled morphine and acetic acid to produce diacetylmorphine, which was synthesised and marketed commercially by the German pharmaceutical giant Bayer. In 1898, Bayer launched the best-selling drug of all time, heroin.

Opium, the latex obtained by making a cut in the unripe capsules of this species, was imported into England from Iran as early as 1870. Today it still represents the industrial source used for isolating the opium alkaloids, which play a central role in the modern pharmaceutical chemistry as analgesics (morphine-derivates) and as a treatment for coughs (codeine-derivates). Today morphine is isolated from opium in large quantities — over 1,000 tons per year — although most commercial opium is converted into codeine by methylation (a simple chemical process which replaces an -OH group by an -0-CH3 group). On the illicit market, opium gum is filtered into morphine base and then synthesized into heroin.

In the popular folk medicine of southern Europe and in the Near East, low doses of P. somniferum fruits, as well as the flowers of P. rhoeas, are still occasionally used as a tranquillizer.

Sage Salvia officinalis / Lamiaceae

Sage is native to the eastern Mediterranean region. The plant was already known in the medical practices of the Greek and Roman period, mainly as a digestive and cough remedy. At that time, its role as a culinary herb had yet to be discovered. In his recipe books, Apicuius refers to the seeds of sage, but not the leaves. Sage became an important medicinal plant for Mediterranean monks of the Middle Ages who dispersed it to central Europe. The medical treatises of the Tuscan physician Pietro Andrea Mattioli (16th century) and the German physician Adam Lonicer from Marburg describe the use of sage leaves as a mouth antiseptic, to heal bronchial diseases, as an appetizer and an emmenagogue (to promote menstrual discharge). The essential oil of sage contains thujon, the compound that makes the dried leaves of sage an important herbal drug today, to heal mild infections of the mouth and upper respiratory tract. It is widely used in over-the-counter phytotherapeuticals.