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Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

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Open Access   Full Text Article                                                                                                                                                                             Review Article 

Therapeutic potential of Murmakki (Commiphora myrrha) in gynaecological disorder: A Unani review

Shazamani S,¹  Begum Wajeeha,²  Sumaiya Syeda ³*

1. PG Scholar, Dept of Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine, Bengaluru, Karnataka, India 

2. Professor & HoD, Dept. of Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine, Bengaluru, Karnataka, India 

3*. PG Scholar, Dept of Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine, Bengaluru, Karnataka, India

1. Introduction:

The health of women is one of society's most critical issues because women must be physically, mentally and emotionally well before they can devote themselves to serving their families and consider other important social issues. There are many Gynaecological disorders found in women eg. Usr-i-tams (Dysmenorrhoea), Ehtabas-i-tams(Amenorrhea), Sailan-ur-rahem (Leucorrhoea), kasrat-i-tams (menorrhagia), Warm-i-Farj wa Mehbal (Vulvitis and Vaginitis), Marz akyas khusytur rehm (Polycystic ovarian disease),  Quruhal reham (cervical ectopy), sul’ah-ur-Rehm (uterine tumour), isthasqa ur Rahem (hydrometra),  that needs to be timely diagnosed and cured to avoid major health problems.¹ We have several single drugs to treat gynaecological ailments, drug Murmakki (Commiphora myrrha) has tremendous outcomes as per classical Unani literature in gynaecological diseases.

The Commiphora genus belongs to the family Burseraceae and comprises over 200 species, which is a native that belongs to the seasonally dry tropic of Africa, Arabia, and India.² The name Commiphora originates from the Greek words kommi meaning gum and phero meaning to hear. The African name for Commiphora is kanniedood the direct translation cannot die. ³ Myrrh, a yellow fragrant oleo-gum resin, is a famous traditional herb, which is derived from the damaged bark of  Commiphora genus Commiphora myrrha (Nees) is a small tree or a large shrub found in the dry and arid regions of Ethiopia and Somalia (the largest producers and exporters of myrrh) and to some extent in northern Kenya.²

In the Unani system of medicine, various formulations are available in the treatment of Gynaecological diseases, which have been used locally in the form of Humool (pessary), ^4,5 Shiyaf (suppository), Farzaja (tampoon), ⁴ zimad,⁵ Huqna (enema) ⁴  and Abzan (Sitz bath) ⁵ for immediate healing of the wound. Exhibiting the properties of myrhh followed by Mudirr-i-haiz (emmenagogue), ^6,7,8 Usr-i-tams (dysmenorrhea), ⁷ Munaffis-i-balgham (expectorant), ^6,7  Qatil-i-deedan-i-ama(antihelmintic) ^4,8 Muhallil-i-warm (anti-inflammatory), ^7,8 Mudamil-i-qurooh (wound healing),^6,7,8 dafa’e ta’ffun (antiseptic) ^6,7,8 etc. Myrrh causes expulsion of janin o mashima due to its bitter taste. ⁸ Myrrh used as hamool in farj foul smell will disappear. ^4,8 Myrrh act as the best uterus cleanser.⁸ scientific reports have claimed the medicinal values of Commiphora myrhh have Anti Inflammatory, Antipyretic activities, Antimicrobial acidity, and Analgesic activity against zoonotic disease. ³

This review article gives a detailed description of gynaecological diseases as mentioned in classical Unani text, ethnobotanical description, action, therapeutical uses, treatment as well as evidence-based Unani medicine. 

TAXONOMIC CLASSIFICATION

2. Material and Method

A small tree, branches are often spiny, leaves are usually 3- foliate, the lateral leaflets sometimes small or absent, flowers small fascicled, polygamous, calyx tubular, teeth usually 4, valvate petals usually found inserted on edge if the disk, valvate stamens 8-10  on the disk alternately long and short filaments dilated below, ovary sessile, 2-4 celled: ovules 2 in each cell style short, stigma 3-4 lobed; drupe ovoid resinous, containing a1-3 celled nut or 2-3 nuts.⁶

Ethnobotanical description of Commiphora myrrha :

More than 200 species of Commiphora are native to the seasonally dry tropics about 40 species occur in Arabia and on the African ^3,10 coast of the red sea often cultivated in western India, and South Africa. Yellowish and shedding of leaves occur early in autumn, and the plants are deciduous for most of the year they are brittle and on breaking show a rough and waxy fracture. ³  A small, thorny tree or shrub that can grow to 9 feet tall branches with sharp spine  Leaves are 3- foliate, flowers are small polygamous. Flowers not seen. ¹⁰ A gum resin exudates spontaneously from the bark.⁸  Gum masses are irregularly roundish of various sizes, opaque reddish and when broken exhibits a rough waxy surface ³   it is brittle ⁶  and pleasant. ^{10 ,12}

2.1 Vernacular names:

Eng                    : myrhh ^9,12

Arabic                : mur, ^9,11  makki ³

 Hindi                 : bol, ³ hira bol ^9,11,12

Malayalam        : narumpasamaram ¹²        

Bengali             : gandarsh ^6,12

Persian               : bol, mur  ^3,9,11

Sanskrit              : bolah, rasagandha  ¹²

Kannada             : bola,vola ^{6,9 12}

Tamil                   : velliappa polam  ^6,7,9

Telugu                 : ballintropolum ^6,9  balamitra-polam ¹²

Urdu                    : mur  

Unani                   : murmakki ^6,7

Gujrathi               : bol ^6,9

ayurvedic            : bola,hirabolah,surasa,barbara , gandarasa⁷

2.2. Parts used: Resin from the stem  ^{3,   6 , 9 ,11,12,14}   

2.3 Temperament: Har 3⁰ and Yabis 2^{0    3,6,10,11,14}

2.4. Dosage: ½ gm to2 gm, ¹⁴ 5to15 gms ⁶ 3-5 g, ⁷ 5to15 grains,⁹ 1-2gms ^{3 ,11,13 ,15}

2.5. Form used:  safoof,  ³ shiyaf, ⁴ humool,   ^{4,10,11,13,18}  faraja, ^{4,5, 18} fathila, abzan,  zimad,⁵ huqhna,⁴ joshanda, ¹³ tincture ^9,16  Majoon, ³ qurs ( pills) ^{3, 5}                                    

3. Results

3.1. Af’al (action): 

 Mudir-i-haiz(emmegogue), ^{3,6,7,8,,9,10,11,13,14,} Usr-i-tams (dysmenorrhea),^10,11,13Muhalil-i-awram (anti-inflamatory) ^{3,6,7,8,10,13} Dafa-i-taffun (antiseptic)^{3,6,7,8,10,11,13,14} Mujaffif (siccative), ^3,11 Jali (detergent) ^3,8,10,11,14 Kāsir-i-riyāh (carminative) ^{3,7,8,10,11,14} Muqavvi-e-meda (gastric n intestinal tonic)^10,11 Muhallil (resolvent),^10,11,14 Mufatteh (deobstruent),^3,11 Musakhin (analgesic), ^3,10 Muharrik (stimulant) ^{3,6,7,9,10,11} Munaffis-i-balgham (expectorant), ^{2,3,6,7,9,10,11,13,14} Tiryaq (antidote) ³   qabiz (Astringent), ^{6,7,8,9,10,11,13}, qatil-i-deedan  ama(antihelmintic), ^10,13,11,14  antifungal, cytotoxic ¹⁰ stomachic, hazim (digestive),^9,13 bacteriostatic,⁷ mudir-i- baul (diuretic), ^8,10,13,14 deodorant,¹⁰ ophthalmic ^{8, 10, 13, 14} anti viral, ^7,10,13  Musaffi , (blood purifier), ⁷  arthritis,¹³ Asthma, ¹³ Muqawwi-e-bah (aphrodiasic). ¹⁰

3.2.Uses:

Qabis (astringent), digestive,  Kāsir-i-riyāh (carminative), ^8,12 Munaffis-i-baigam (expextorant), ^8,9,12,15 muqawwi-i- bah (aphrodiasic), ^8,12Qatil-i- Deedan-i-ama (antihelminthic), ^8,12,15 mudir-i- baul (diuretic), deodorant,^8,10 warm-i-shabatur riyah  (bronchirtis), ^8,12 Waja ul mufassil (rheumatoid  arthritis), ^8,12,15 irqunissa  (sciatica), ^8,12,15 qhuru (ulcers), ^{3, 8} amaraz-i-jild  (skin diseases),^8,12 dafa-i-taffun  (antiseptic) ^12,15  Mudir-i-ḥayḍ (emogongue). ¹²

3.3.Gynaecological Uses;

Ihitibase tams: (Amenorrhea)    Myrhh prepared as decoction used for Emegongue, ¹³ murmakki, marzanjosh, azkhar ,saleeqha, podina, hasha, karanb, shonez, qhust, akleelul mulk ,khurdmana baranjasif each 12 gms to boil in water for the use of  sitz bath.⁵ murmakki, zafran each 7 gms sibr zard 25 gms, namake lahoori 7 gms to grind and add shehad for preparation of pills each pill 2 times a day.⁵ Mur is used with Elwa and iron components to induce menstruation.⁸ 

Cervical stenosis:  shafa of mur is inserted into the introitus for the opening of cervix in cervical stenosis ^[4] Kasrath -i- tams (menorrhagia) : murmakki 1.75 gm along with half boiled egg stops excessive bleeding, ^{4, 8}   Ilthihab-i-rahim:   (PID) application of mur in the form of humool cures the inflammation. Qhatil-i-  janeen   ( Abortifacient); is used as an abortifacient due to its bitter taste. ⁸

Usr-i-tams (Dysmenorrhea):   Mur, satarfarsi, tukhme shapth, qust talaq, tukhme karafs, shaham e Hanzal each 4gms grind with aabe sabz marooqh and add roghan e baid anjeer for application of paste Istharkha ur Rehm: (hydrometra)  humool of murmakki , qharanfil ,narkachor   reduces water accumulation in the uterus. ⁵ Huqna (Enema)of murmakki causes immediate expulsion of fetus and placenta. Huqna (Enema)of murmakki along with methhi (fenugreek) removes the hardness of uterus. ⁴

Humool ( pessary); murmakki grinded with  Aabe aas remove the bad smell of vagina. 

Murmakki along with alcohol inserted into the cervix causes immediate expulsion of  newborn. ⁸

Murmakki acts as a uterine cleanser. ^4,8

Joshanda (Decoction) of murmakki is useful as emmenagogue and diuretics. ¹³

Galactgogue: murmakki along with jaggery increases milk secretion. ⁸

Uterine tumours: Murmakki, sibr, tukhme ulsi, ersa, ajwain desi each 4 gm, tukhme hulba 13 gms, filfil e siya, charaita, gogul, ushkh, furfeoon, qust talqh, zaravand mudarij ,ratinj each 12 gms   grind it a fine powder and mix with Aabe makoo sabz marookh and applied as zimad for uterine tumours. ⁵

3.4.Adverse effect: (Muzir):   Headache, hot temperament (har mizaj). ^3,8,15 Bladder. ¹⁴

3.5.Correctives(Musleh): Shehad, ^6,11,14,15 Kafoor, ^6,8,14 Barid wa ratab drugs.¹³

3.6.Substitute (Badal): Gum of Mukul, Chiraita, ⁶ Black pepper, Gond, Badam Talkh,³ Qust ^{3,11,12,13,14,15} Momiyai,^14,15 Jundbedastar. ^11,14,15

3.7.Compound formula (Murakkabat): Hab-i-Mudir ^{3,6,11,12,13,14,15} Majoon Kundar ^3,6 Majoon Murmakki, Dawaul Kurkum sagheer, Dawaul Kurkum Kabeer ⁶ Tiryaq Arba,^{3,6,11,,13,14,15}Tiryaq-i-Wabayee, ^3,6,13 Qurs, Musalas,^3,15 Tiryaq e nazla, ³Habb-i-Taoon,^11,12,13 tiryaq-i-samania, zimade khanzeer.³

3.8.Chemical constituents:

Myrrh contains resin (25–40%), gum (57–61%), and volatile oil (7–17%). A large portion of the resin is ether-soluble containing α-, β-, and γ-commiphoric acids, resenes, the esters of another resin, acid and two phenolic compounds. The volatile oil is a mixture of cuminic aldehyde, eugenol, cresol, pinene, limonene, dipentene, and two sesquiterpenes. The disagreeable odour of the oil is due to mainly the disulphide. The gum contains proteins (18%) and carbohydrates (64%) which is a mixture of galactose, arabinose, glucuronic acid, and an oxidase enzyme. ¹⁶

phytochemicals present  in   this plant resulted in a series of metabolites including terpenoids, steroids flavonoids, lignans, and carbohydrates and exhibited  diverse biological activities such as cytotoxic, anaesthetic, anti-inflammatory and antimicrobial effects, anti dysmenorrheic activity.²

3.9.Pharmocological Studies:

Cytotoxic activity: C. myrrha was reported to have cytotoxicity activity on human gynecologic cancer cells in clinical trial due to the presence of two compounds of diterpene resin acid, which significantly inhibit proliferation of human ovarian cancer. ²

Emmenagogue activity: Khatoon et al. reported that Mur is effective in PCOD-related secondary amenorrhea when used in combination with Muqil and Abhal and induced withdrawal bleeding along with menstrual regulation due to the presence of steroids and flavonoids. Moreover, Mur contains phytosterols, saponins, terpenoids, lignans and phenolic compounds; and glycosides and alkaloids in Abhal which exerts hormone-like action in the body and thus withdrawal bleeding and menstrual regulation. ¹⁷

 Anti dysmenorrhic activity: 

Extract of myrrh exhibits significant anti dysmenorrheic activity (Wang et al.2009) and inhibits uterine contraction and aromatase activity. (Su et al.2008) ²

Anti inflammatory activity: 

C. myrrha extract exhibits anti- inflammatory effect as evident by the decrease in volume of paw oedema induced by formalin in rats probably due to an inhibition of release of inflammatory mediator PGs. ¹⁰ anti-inflammatory and antipyretic activities  in mice has been documented for myrhh .³

Analgesic activity: 

C. molmol extract exhibit analgesic activity in rats due to the presence of bioactive compounds that raised the pain threshold by depressing pain receptors centrally in the brain and also by inhibiting the release of prostaglandins (Pgs). Thus C. molmol extract appeared to produce an analgesic effect through both central and peripheral mechanisms ¹⁰ analgesic activity and antihyperlipidemic effect of Commiphora myrhh extract was investigated insprague-Dawley rats. It showed positive significant results by reducing the inflammation and elevated serum levels of triglycerides and total cholesterol.³

3.10. Experimental Studies:

1. Cervical Ectopy in Quru reham:  Murrmakki -half part and each one part of phitkiri, poste anar-, finely powdered and mix with aabe aas and aabe barge saru, later on add equal quantity make as Hamool in fresh ulcers and traumatic oozing wounds.Farzaja - Kundur, anzaroot, damul akhwain, jozsaru, poste anar, shibe yamani, Murrmakki, gule surkh are finely powdered and mixed with aabe bartang or aabe aas or aabe lal   prepared as farazja if the ulcer is associated with blood stained discharge. ¹⁸

2. Trichomoniasis vaginalis infection:  The effectiveness of an oleo resin extract derived from myrhh., commiphora molmol was given to the metronidazole and tinidazole resistant females as two capsules (600mg) for six to eight successive days on an empty stomach two hours before breakfast. All patients were considered cured, In conclusion, the results in the present study support the two safe plant extracts (Commiphora molmol and Punica granatum) proved to be valuable agents in treating T. vaginalis infection. ¹⁹

3. Incomplete Abortion: 

Myrrh used as capsules in incomplete abortion: capsules containing 500 mg of Myrrh oleo-gum-resin three times a day for 2 weeks.   the result of ultrasound examination showed a significant decrease in the size of RPOC after treatment with myrhh and suggested that Myrrh was effective and safe and may be considered as an alternative option in the treatment of patients with RPOC.  ²⁰

4. PCOS:   All crude drugs (Muqil, Murmakki, Abhal) were taken in equal quantity; cleaned, finely powdered and tablets were prepared; one tablet was approximate 750 mg and three tablets were administered orally thrice daily to fulfil the dose of 6 g/day with water for 7 days in a month for three cycles.   The present study showed that oral administration of Muqil, Murmakki, and Abhal induced withdrawal bleeding in maximum patients (63.33%) of PCOD-associated secondary amenorrhoea in the first treatment cycle and menstrual regulation   (73.33%)  in subsequent cycles of treatment. Hence, it can be inferred that research drugs may be an effective therapeutic option in patients with PCOD-associated secondary amenorrhoea as it has a significant effect on inducing withdrawal bleeding. ¹⁷ 

5. Episiotomy wound healing: 

Women in intervention groups received a 10-min sitz-bath of myrrh extract of frankincense extract twice a day for 1 week. While the women in the control group received the betadine sitz-bath for the same time. The main outcome was the episiotomy wound healing, which was measured using the REEDA scale before the intervention, on the 2nd and 7th postpartum days. 

An improvement in the episiotomy wound healing was significantly in patients receiving myrrh. the total reeda score was significantly improved in patients receiving myrhh than those receiving either frankincense or betadine. This improvement in wound healing by myrhh was mostly contributed by better scores in redness, ecchymosis and approximation. ²¹

6. Usur-E-Tams (Dysmenorrhea):   

During the study, Majoon Murrmakki 3gm and control group mefenamic acid 500mg two times a day was given orally from 1st to 5th days of menstruation for two consecutive cycles, and significant relief was observed in dysmenorrhea and associated symptoms in the patients Hence, Majoon murmakki is a safe, herbal therapeutic option that can provide an alternate management option with no adverse effects and conventional treatments in usr tamth (dysmenorrhea). The findings in the present study  demonstrated that majoon e murmakki is as effective as mefenamic acid in the management of usr tamth .²²

7. Leucorrhea:

 Murmuki  5 gm (Commiphora myrrh) along with boiled egg was given orally early in the morning for 2 months and the follow-up was taken after every 15 days.  After one month the patient got remarkable improvement in the white discharge, backache and itching. At the end of 3 follow up the vaginal discharge was disappeared and the patient gets relief from other signs and symptoms. The Unani medicine is based on the principle of temperament and the medicine Murmuki bears temperament Hot and Dry which is an antagonist to temperament of Sailanur-rehm (Leucorrhea) patient. ²³ 

4. Discussion and Conclusion:                  

The findings from the present review of Murmakki, (Commiphora myrrha), Oleo gum resin used locally in the form of humool, Shiyaf, Farzaja, Zimad, Abzan. Capsules, safoof, Qurs, Joshanda and majoon murmakki is effective in the management of Gynaecological disorders. The effect of murmakki may be at­tributed to its properties like musakkinie-awjāh (analgesic), muhallil-i-awrām (anti-inflammatory), mudirr-i-bole-wa-hayd diuretic and emmenagogue), muffattih-i-sudad (deobstru­ent) among others; also analgesic activity of furanoses­quiterpenes such as furanoelemanes, furanoeudes-manes and furanogermacranes present in the gum resin extract of myrrh. Hence, Murmakki is a safe and effective herbal therapeutic option that can provide an alternate management option with no adverse events as caused by conventional treatments in Gynaecological disorders. Murmakki have greater significance in the treatment and management of various Gynaecological disorder.

Acknowledgment: The authors are extremely thankful to all teachers for their encouragement and the library staff of NIUM for providing all kinds of literature related to this manuscript at the time of writing.

Conflict of interest:  None.

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23 Shabir AB, Suhail F, Paras W, M. Shahabuddin. Effect of Murmuki (Cammiphora Myrrh) With Boiled Egg in Leucorrhea-A Case Study. American Based Research Journal 2015; 08:05-07 DOI: https://doi.org/10.5281/zenodo.3441630