Anticancer Plants in Islamic Traditional Medicine

Islamic Traditional Medicine (ITM) is a holistic and comprehensive medical school that has antecedents over 12 centuries ago. In ITM, cancer was a known disease with many options for treatment. Razi (Razhes; 865-925 AD), Ahwazi (Haly Abbas; 930-994 AD), Avicenna (980-1037AD), Jorjani (1042-1136 AD), and Aqili Khorasani (18th century) are among eminent physicians who discussed different types of cancers and their management in their books. They used a large number of plant species for treatment of different tumors. Although modern medicine has made tremendous advances in cancer control, the effectiveness of its therapeutic approach is often limited by toxic effects on other organs. Moreover, a large number of people in the world have limited or no access to cancer treatment services. Accordingly, benefiting from traditional medicine schools and effective natural medicines to prevent and control cancer would be valuable. In addition, using the teachings of such schools can lead to the discovery of new bioactive compounds and therapeutic methods. In this chapter, a brief history of Islamic medicine and its approach to treat cancer as well as anticancer medicinal plants have been discussed. Out of 107 ITM suggested plant species, 59 plants or their chemical compounds have proven to possess cytotoxic and antitumor activities using pharmacological investigations. These findings show the profound insight of ITM physicians into cancer treatment.


Introduction
Islamic Traditional Medicine (ITM) is a holistic system of medicine which flourished during the Islamic Golden Age (750-1258 AD). It was practiced and taught throughout the Islamic territory. In that era, Muslim and non-Muslim medical scholars, especially Iranian physicians and pharmacists, translated the scientific knowledge which they inherited from ancient Greece and Iran. They endeavored to revive and develop this medical knowledge, remove superstitious ideas and faults from it, and establish an authentic medical school. Although most ITM scientists were not Arabs, the majority of their books are written in Arabic, the lingua franca of the Islamic civilization. Razi (Razhes; 865-925 AD), Ahwazi (Haly Abbas; 930-994 AD), Avicenna (980-1037AD), Jorjani (1042-1136 AD), and Aqili Khorasani (18th century) are eminent Iranian physicians who had the most contributions to ITM promotion.
Although significant progress has been made in cancer control in the last few decades, the effectiveness of modern therapeutic approach is often limited by toxic effects on other organs. Moreover, a large number of people in the world have limited or no access to cancer treatment services. Accordingly, utilizing information from traditional medicine systems to identify alternative methods to prevent and control cancer would be desirable. Furthermore, use of traditional medicine can lead to the discovery of new bioactive compounds as well as available, safe and affordable drugs.
In Islamic medicine, cancer was a known disease with many options for treatment. In the majority of ITM textbooks there is a chapter dedicated to cancer definition, symptoms, etiology, diagnosis, prevention, and management.
In this chapter we will discuss cancer, its etiology and management in the view of Islamic Traditional Medicine. In addition, ITM medicinal plants used to treat different types of cancers and modern pharmacological data confirming their traditional usage will be inserted in tables.

Cancer definition from ITM point of view
ITM is based on the theory of humorism which posits that the human body consists of four basic fluids, namely humors. The four humors are blood, phlegm, yellow bile, and black bile and each one corresponds to paired qualities: blood is hot and wet, phlegm is cold and wet, yellow bile is hot and dry, and black bile is cold and dry. A proper balance between humors is essential to maintaining health. Accordingly, all diseases and disabilities including cancer result from an excess or putridity of these humors.
According to ITM, cancer is a kind of black bile swelling which is accompanied by pain, pulsation, inflammation, and angiogenesis [1]. Blood vessels surrounding a tumor are overfilled and stiff and contain a dark and black blood [2]. The reason for the appellation "cancer" is due to the similarity between the shape of a cancerous tumor affecting an organ and a crab grasping its prey. It may also due to the spherical shape and darkness of tumor and origination of blood vessels from its milieu which resembles crab's feet [3]. Cancer frequently affects soft and porous organs and for this reason, it mainly involves breast and innervated organs (such as uterus) in females, and throat, larynx, testicles and penis in males [1].
its origin and some parts of adjacent nonaffected tissues should be excised as well. In addition, bleeding should be allowed until large blood volumes come out and surrounding tissue should be pressed in order to expel blood mixed with black bile thoroughly. Afterwards, the injured site should be salved or cauterized. However, if the cancerous tumor is located in the vicinity of sensitive and vital organs, surgical procedure and cauterization would be very dangerous and may change the cancer to a nonhealing ulcer [2,4].
Regular venesection is also suggested during the initial phases of cancer, to withdraw black bile blood from body.

Nutrition therapy
In Islamic traditional medicine, dietary recommendations have been proposed to slow the progression of advanced tumors that cannot be manipulated due to metastasis concerns. In these cases, nutritional care would increase the longevity of patients. Food items with wet temperament which produce high-quality blood like beer, almond oil, fresh small fishes, softboiled egg yolk, lamb, bird meat, ripe and sweet apples, sweet plums, bananas, raisin, black gram (Vigna mungo (L.) Hepper), spinach (Spinacia oleracea L.), pumpkin, light wine, and fresh cow's milk and dough are administered [1]. On the other hand, excessive intake of foodstuffs which induce black bile production in the body (such as eggplant (Solanum melongena L.), lentil (Lens esculenta Moench), date (Phoenix dactylifera L.), cabbage (Brassica oleracea L.), beef, black and thick wine, and salt-cured meat) is severely restricted [5].

Pharmacotherapy
As mentioned above, from the Islamic Traditional Medicine point of view, an excess of abnormal black bile in various body sites can lead to cancer formation. In order to treat cancer, black bile should be expelled from the body by using an appropriate purgative, and then preventing the generation and accumulation of black bile in vessels as far as possible [2]. For this purpose, many single and compound medications of herbal, animal, and mineral origin have been recommended.
The essential point in pharmacotherapy of cancers and tumors is avoiding the use of caustic and irritant medications to prevent further stimulation and ulceration [2].

Anticancer plants
One hundred and seven plant species from 53 families have been mentioned to be effective in the management and curing of different types of cancers. Plants Latin and Arabic names, their families, medicinal parts, dosage forms, and routes of administration are given in Table 1. Use

Anticancer and cytotoxic activities of ITM plant species
Many ITM-suggested plants have been shown to exert anticancer activities with different mechanisms such as cytotoxic, antitumor, antiproliferative, cytostatic, and cell-migrationinhibiting effects. Pharmacological data reinterpreting ITM evidence of cancer phytotherapy are given in Table 2.  [115] Citral and essential oil -cytotoxic GBM [116] Myrtus communis L. Phloroglucinols -cytotoxic MT-4 cells, HepG2 and DU145 [117] Narcissus tazetta L.