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Safūf-i Aslussūs: A time-tested polyherbal formulation for the management of Premature Ejaculation- A comprehensive review

Waish Ahmad ¹, Javed Inam Siddiqui ², Mohammed Abdul Rasheed Naikodi ³, Qamrul Islam Usmani⁴*

¹Assistant Professor, Department of Ilmul Advia (Pharmacology), Yunus Fazlani Unani Medical College & Al-Fazlani Unani Hospital, Aurangabad, Maharashtra, India

²Professor, Department of Ilmul Advia (Pharmacology), National Research Institute of Unani Medicine for Skin Disorders, Hyderabad, Telangana, India

³Research Assistant (Chemistry), National Research Institute of Unani Medicine for Skin Disorder, Hyderabad, Telangana, India

⁴Assistant Professor, Department of Ilmul Advia (Pharmacology), Inamdar Unani Medical College and Hospital, Sedam road, Gulbarga, Karnataka, India

Article Info:

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Article History:

Received 29 March 2024

Reviewed 26 April 2024

Accepted 19 May 2024

Published 15 June 2024

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Cite this article as:

Ahmad W, Siddiqui JI, Naikodi MAR, Usmani QI, Safūf-i Aslussūs: A time-tested polyherbal formulation for the management of Premature Ejaculation- A comprehensive review, Journal of Drug Delivery and Therapeutics. 2024; 14(6):191-199

DOI: http://dx.doi.org/10.22270/jddt.v14i6.6618 ___________________________________________

*Address for Correspondence:

Qamrul Islam Usmani, Assistant Professor, Department of Ilmul Advia (Pharmacology), Inamdar Unani Medical College and Hospital, Sedam road, Kalaburagi, Karnataka, 585105

Abstract

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Premature Ejaculation (PE) is the most prevalent male sexual complaint worldwide. The ability to control the timing of ejaculation is very important to get pleasure and to maintain the couple’s sexual health. PE is believed to have a multifactorial etiology which mainly includes psychogenic and biogenic factors. Currently available conventional drugs are based on mere assumptions and their use in PE is considered off-label as they have not been approved by the regulatory bodies. On the other hand, Unani System of Medicine has a holistic approach to the prevention and treatment of diseases and provides a line of treatment for PE which is mainly focused on the internal and external use of specific drugs for the restoration of lost powers, elimination of morbid humor and strengthening of organs, muscles, and nerves. In classical Unani literature, PE/Surʻat-i-Inzāl are described in detail under the heading of Amrāz-i-Bāh. In the series of drug therapy a polyherbal Unani formulation, Safūf-i Aslussūs mentioned in different Unani Pharmacopoeias for the management of PE, and Spermatorrhoea is widely prescribed and recommended for a long time by Unani physicians and it is a time-tested drug. This manuscript is an attempt to summarize scientific studies in support of the claim made by Unani physicians regarding Safūf-i Aslussūs.

Keywords: Safoof-i Aslussoos, Surʻat-i-Inzāl, Premature ejaculation, Unani System of Medicine

The sexual act is an imperative biological need and an important component of quality of life. It is a kind of intimate expression of love and it cannot be avoided for the propagation of the human race. Human sexuality is believed to be a multidimensional phenomenon that possesses biological, psychological, behavioral, clinical, moral, and cultural aspects¹. One of the defining aspects of human sexuality is to get pleasure, so men need to control ejaculation to enhance their own and their partner’s joy fulfilment. In the evolution of human sexuality, one of the most important features is the ability to control the timing of ejaculation to get pleasure and maintain the couple’s sexual health. Premature Ejaculation (PE) is the most prevalent male sexual complaint². Numerous epidemiological studies suggest that PE has an estimated prevalence of approximately 20% to 30% across all reproductive age groups of the global male population^3,4,5. Male sexual dysfunction leads to psychological stress and loss of self-esteem, which results in significant adverse effects on the quality of life, of both the patient and the partner. International Society of Sexual Medicine defines PE as “a male sexual dysfunction characterized by ejaculation that always or nearly always occurs before or within one minute of vaginal penetration, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy”.⁶ PE can be classified as either a primary/lifelong condition (present since the first sexual experience) or a secondary/ acquired condition that develops later after an interval of normal sexual function⁷.

Currently available conventional therapies for PE are based on mere assumptions and it includes selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and topical anesthetic agents. However, these medications were usually prescribed to treat other medical disorders like depression or erectile dysfunction, and their use in PE is considered off-label as they have not been approved by the regulatory bodies for the treatment of PE⁸. It results in adverse side effects associated with their use, such as decreased libido, impotence, erectile dysfunction, reduced ability to express feelings, dizziness, fatigue, headache, etc.⁹ Hence there is an essential need to search for alternate treatment options which have a high rate of efficacy and should be devoid of side effects. A holistic approach incorporating psychotherapy and pharmacotherapy is considered the best approach for the management of PE.

The literature on Premature ejaculation and Safūf-i Aslussūs was searched from the Urdu translation of the classical books such as Zakhira khwarzam shahi of Ismail Jurjani, Al-mukhtarat fit Tib of Ibn Hubl, Jame Al-Aksir; Qarabadeen Qadri, Qarabadeen Majeedi, Ilajul Amraz and Bayaz Kabeer, Al Jami ul Mufradat Al Advia Wal Aghzia of Ibn al Baitar, Muheet Azam of Hakeem Mohammad Azam Khan, Khazainul Advia of Najmul Ghani, etc., Published works available on PubMed, Science Direct, and Google Scholar were referred to collect all the available information regarding the title using key word ‘Safuf Aslussus’, ‘Premature ejaculation’, ‘Surat-i-inzal’ between 1996 AD to 2023 AD. Standard Unani Medical Terminology published by Central Council for Research in Unani Medicine in collaboration with the World Health Organization was used to write the appropriate Unani terminologies.

The pathophysiology of PE is not well understood and it is believed to have a multifactorial etiology that includes “psychogenic” and “biogenic” factors. Psychogenic causes include anxiety, an unpleasant early sexual experience, infrequent sexual intercourse, and poor ejaculatory control techniques. Biogenic causes include penile hypersensitivity, hyper-excitable ejaculatory reflex, hyper-arousability, endocrinopathy, genetic predisposition, and 5-hydroxy tryptamine (5-HT) receptor dysfunction¹⁰. 5-HT is the major neurotransmitter involved in the process of ejaculation and inhibits the ejaculation reflex. Thus, a low level of 5-HT or the 5-HT receptor hyposensitivity leads to PE.

USM has a holistic approach to the prevention and treatment of diseases that covers the physical, mental, and spiritual dimensions of an individual’s health. In classical Unani texts, Surʻat-i-Inzāl are dealt with in detail under the heading of Amrāz-i-Bāh (sexual disorder). Surʻat-i-Inzāl, an Arabic term is derived from two words; Surʻat means hastiness, and Inzāl means the emission of semen, hence the term Surʻat-i-Inzāl stands for premature ejaculation. USM widely explains the management of sexual disorders including PE. Numerous pathological causes of PE are mentioned viz., hypersensitivity (Zakāwat-i-Ḥiss), debility in retentive power (Ḍuʻf-i-Quwwat-i-Masika), the low viscosity of semen (Riqqat-i-Manī), the acuteness of semen (Ḥiddat-i-Manī), excessive semen volume (Kathrat-i-Manī), debility of vital organs (Ḍuʻf-i-Aʻḍā’ Raʻīsa), dilation of penile vessels and ducts including urethra (Ittisāʹ-i-majārī-i-Qazīb), etc. Other causes may be hot climate, working in hot conditions, inflammations of seminal vessels, etc.^{11, 12, 13}.

The goal of management of PE is to delay ejaculation by achieving voluntary control. The line of treatment/Usool-i-Ilāj for PE consists of internal and external use of specific drugs for restoration of lost powers, correction of deranged temperament, elimination of morbid humor, and strengthening of organs, muscles, and nerves^{12, 13}. There are several single and compound formulations mentioned in the literature for the management of PE. Some of them are Afyun (Papaver somniferum L.), Ajwain Khurasani (Hyoscyamus niger L.), Isapghol (Plantago ovata Forssk.), Kafūr (Cinnamomum camphora L.), Kishneez (Coriandrum sativum L.), Tukhm Kāhū (Lactuca sativa L.), Tukhm Dhatura (seeds of Datura stramonium L.), Roghan Khar Khasak (Tribulus terrestris oil), Sandal safaid (Santalum album L.), etc. In addition to the above-mentioned single drugs, there are some compound formulations used effectively in the treatment of PE like Majun Mughalliz (Majun: a semi-solid dosage form of the compound drug), Majun Piyaz, Majun Jalali, Majun Aspand, Majun Mumsik, Habb Mumsik, Qurṣ Jiryan, Sharbat Khashkhash, Safūf Aslussūs, Safūf Beejband, Safūf Asghand, Safūf Sailan, Safūf Maghz Kanwal Gatta, and Safūf Thalab. Safūf-i Aslussūs, is one of the classical polyherbal Unani formulation that possesses beneficial effects for PE and widely prescribed for a long time by Unani physicians^{11, 12, 13}.

Safūf is the powdered form of medicinal preparations made by powdering and mixing crude ingredients of formulations. Other names for Safūf are Phanki and Churan but Churan is the specific term for the powder which is used for the digestion of foods. The powder is the first polyherbal dosage form used in the history of medicine. Aristotle has been credited for the discovery of this dosage form^{14, 15}. Because of the greater specific surface area of powders, this dosage form disperses and dissolves more readily than compacted dosage forms¹⁶.

Safūf-i Aslussūs is a polyherbal powder preparation mentioned in different Unani Pharmacopoeias (Qarābādīn) for the treatment of PE and spermatorrhoea. In Qarābādīn-i-Majīdī ¹⁴ and Qarābādīn-i-Ḥamdard,¹⁷ Safūf-i Aslussūs is mentioned as comprising six ingredients described in Table 1. In Al-Qarābādīn¹⁸ and Ilaj-ul-Amrāz¹⁹ the same formulation (in the same proportion as in Qarābādīn-i-Majīdī and Qarābādīn-i-Ḥamdard) is mentioned without any specific name of formulation simply written as Safūf-i deegar (other powder) for the treatment of spermatorrhoea and PE. In Al-Qarābādīn another formulation with the title of Safūf-i Aslussūs comprising three ingredients is mentioned for the treatment of respiratory disorders like asthma, cough, etc. In Bayāz-i-Kabīr,²⁰ Safūf-i Aslussūs for the treatment of PE is mentioned with only five ingredients as described in Table 2. This formulation is devoid of Tukhm Kāhū. For the management of spermatorrhoea and PE, a similar formulation but devoid of Tukhm Suddāb as described in Table 1 is mentioned in Qarābādīn-i-Qādrī ²¹.

Table 1: Composition of Safūf-i Aslussūs classified in various Unani Pharmacopoeias ^{14,17,19,20,21}

S. No	Botanical Name	*Qarābādīn-i-Majīdī, Al-Qarābādīn, Ilaj-ul-Amrāz & Qarābādīn-i-Ḥamdard*		*Bayāz-i-Kabīr*		*Qarābādīn-i-Qādrī*		*Al-Qarābādīn*
1	Glycyrrhiza glabra L.	Aslussūs	50 g	Aslussūs	24 g	Aslussūs	7 g	Aslussūs	2 Parts
2	Rosa damascena Herrm.	Gule Surkh	130 g	Gule Surkh	24 g	Gule Surkh	17.5 g	-	-
3	Vitex negundoL.	Tukhm Sambhālu	130 g	Tukhm Sambhālu	24 g	Tukhm Sambhālu	17.5 g	-	-
4	Ruta graveolens L.	Tukhm Suddāb	130 g	Tukhm Suddāb	24 g	-	-	-	-
5	Punica granatum L.	Gule Anār	100 g	Gulnār Fārsi	24 g	Gulnār	14 g	-	-
6	Lactuca sativa L.	Tukhm Kāhū	75 g	-	-	Tukhm Kāhū	10.5 g	-	-
7	Foeniculum vulgare Mill.	-	-	-	-	-	-	Badiyān	1 Part
8	Sugar	-	-	-	-	-	-	Qand Safed	3 Parts
Therapeutic Uses		PE		PE		PE		Respiratory Disorder

According to Unani pharmacopeias, Collect the ingredients of pharmacopoeial quality; dry under shade, remove any physical impurities or foreign matter present in them, and take in the prescribed amount. Ground the main ingredient Aslussūs, after the process of peeling off the external root bark (Aslussūs Muqasshar). Prepare the powder of the remaining ingredient separately. Mix the powder of ingredients to obtain a uniform mixture then sieve through 80 mesh size and store in an airtight glass container^{14, 15}.

Safūf-i Aslussūs have been reported for diverse actions, therapeutic uses, doses, and modes of administration as in Unani pharmacopeias which have been used for a long span for premature ejaculation (Surʻat-i-Inzāl), spermatorrhoea (Jarayān-i-Manī). The dose of the formulation ranges from 5 - 12g as a powder with suitable Badraqa (vehicle) like lukewarm water or milk^14,17-21. The details of Safūf-i Aslussūs is given in Table 2.

The detailed information about the ingredients of Safūf-i Aslussūs and its proven pharmacological studies are summarised in Table 3, which mainly reflects the efficacy of its actions towards various diseases.

Table 2: Details of Safūf-i Aslussūs mentioned in different Unani pharmacopeias

Pharmacopeias	Actions	Therapeutic Uses	Dose	Mode of Administration
Qarābādīn-i-Majīdī ¹⁴	Semen retentive (Mumsik-i-Manī), Semen desicator (Mujaffif-i-Manī) Qāṭiʻ Manī (Anaphrodusiac)	Premature ejaculation (Surʻat-i-Inzāl), Spermatorrhoea (Jarayān-i-Manī), and Hypersensitivity (Zakāwat-i-Ḥiss)	5 g	Orally with 250 ml lukewarm milk or water in the morning
Al-Qarābādīn ¹⁸		Spermatorrhoea	10.5 g	Orally with 250 ml lukewarm milk or water in a divided dose
Ilaj-ul-Amrāz ¹⁹		Spermatorrhoea	10.5 g	Orally with Sharbat-i-Bazoori in a divided dose
Qarābādīn-i-Ḥamdard ¹⁷		Premature ejaculation, Spermatorrhoea, and Hypersensitivity	5 g	Orally with 250 ml lukewarm milk or water in the morning
Bayāz-i-Kabīr ²⁰	Semen desiccator Anaphrodisiac	Premature ejaculation, Spermatorrhoea	12 g	Orally with Sharbat-i-Bazoori in a divided dose
Qarābādīn-i-Qādrī ²¹	Semen Retentive, Semen desiccator, Anaphrodisiac	Premature ejaculation	10.5 g	Orally with 250 ml lukewarm milk or water in a divided dose
Al-Qarābādīn ¹⁸	Expectorant (Mukhrij-i-Balgham), Demulcent (Mulaṭṭif), Deobstruent (Mufattiḥ)	Asthma (Dhīq al-Nafas), Cough (Suʻāl), Coryza (Zukām), and Catarrh (Nazla)	9 g	Orally with 250 ml water in a divided dose

Table 3: Properties of ingredients of Safuf-i Aslussus in Unani medicine and their scientific studies

Ingredients	Vernacular	*Afaʻal* (Pharmacological actions)	*Dawai* Isteʻmāl (Therapeutic Uses)	Pharmacological Studies
Aslussūs	Arabic- Aslussūs English- Sweet wood Liquorice Hindi- Mulethi Persian- Bekh-e-Mahak Sanskrit- Yashtimadhu Tamil- Atimadhuram Telugu- Yashtimadhukam	Mukhrij-i-Balgham (Expectorant),^{22, 23, 26-29} Mulayyin-i-Amʻā’ (Laxative), ^22,25,27-29 Muqawwī-i-Aʻṣāb (Nervine tonic),^{22, 25, 26, 28, 29} Munḍij-i-Akhlāṭ-i-Ghalizah (Concoctive of viscous humour),^{25, 26, 28, 29} Muqawwī-i-Bāh (Aphrodisiac),^{23, 29} Dāfʻ-i-Khashunat-i-Ḥalaq (Removes throat irritation),^{22, 25, 26} Musakkin-i-ʹAṭash (Relieves thirst),^{23, 25, 26, 28, 29} Kāsir-i-Riyāḥ (Carminative),^25,26,28,29 Mudirr-i-Ḥayḍ (Emmenagogue),^{22, 26-29}Mudirr-i-Bawl (Diuretic),^22,23,26-29 Mulaṭṭif (Demulcent),^22,23,27 Jālī (Detergent)^28,29	Suʻāl (Cough), ^{22-24, 26-29} Khashunat-i-Ḥalaq (Throat irritation),^{22-24, 28,29} Qurūḥ-i-Ḥuḍumī (Peptic ulcer),^{22, 24-29} Buḥḥa al-Ṣawt (Hoarseness of voice) ^{22, 25, 26, 28, 29}, Dhīq al-Nafas (Bronchial asthma),^{22, 24-29} Ḥurqa al-Bawl (Burning micturition),^25-29 Wajaʻ al-Mafāṣil (Polyarthritis),^{24, 27} Amrāḍ-i-Kabid (Liver diseases),^{22, 25-28} Ṣudāʻ (Headache),^{23, 25, 28} Shaqīqa (Migraine),^{25, 26} Wajaʻ al- Aʻṣāb (Neuralgia),^{25, 28} Sozāk (Gonorrhoea),^{25, 28, 29} Zafara (Pterygium),^{25, 28, 29}ʻAraq Muntin (Bromhidrosis),^{25, 26} Intithār al-Sha‘r (Alopecia) ²⁶	Antitussive,³¹ Anti-bacterial,^32,33,34Antiviral,³⁵Memory enhancing,³⁶Antidepressants,³⁷Aphrodisiac,³⁸Estrogenic,³⁹ Antimalarial,⁴⁰Anticonvulsant,⁴¹ Probiotics,⁴²Immunomodulatory,⁴³ Anti-ulcer,⁴⁴Hepatoprotective,⁴⁵Anticancer,⁴⁶Cardioprotective,⁴⁷ Anti-atherosclerotic,⁴⁸ Antioxidant,⁴⁹Hair growth stimulating,⁵⁰Anti-fungal,⁵¹Anxiolytic,⁵²
Tukhm Suddāb	Arabic- Sadab Bangla- Titli English- Garden Rue Hindi, Persian and Sanskrit- Sadapaha Tamil- Arvada Telugu- Sadapaka	Mujaffif (Desiccant),^25,28 Qābiḍ (Astringent),^25,28 Mujaffif-i-Manī (Semen desiccator),^25,26,28-30 Qāṭiʻ-Bāh (Anaphrodisiac),^{22,23,25,26,30} Hāḍim (Digestive),^23,25,26,29Mudirr-i-Ḥayḍ,^22,23,25-30 Mudirr-i-Bawl,^{22,23,24,26-30} Kāsir-i-Riyāḥ,^25,26,28,30 Muḥallil, ^24,25,28,29 Mushtahī (Appetizer),^25,26,28,29	Qūlanj (Colic),^22,23,25-27 Nafkh al-Mi‘da (Flatulence),^22,23,25-30 Tukhma (Indigestion),²³ Iḥtibās al-Ṭamth (Amenorrhoea),^22-24,27 ‘ Irq al-Nasā (Sciatica),^25-30 Niqris (Gout),^25,26,28,29 Wajaʻ al-Mafāṣil (Polyarthritis),^23-30 Jarayān-i-Manī (Spermatorrhoea),^25,30 Surʻat-i-Inzāl (Premature ejaculation),^25,30 Istisqā’ (Edema),^25,26,28-30Raʻsha (Tremor),^25,26,30 Ṣarʻ (Epilepsy),^23,25Fālij (Paralysis),^{22,23,25,26,30}Intithār al-Sha‘r (Alopecia),^25,30	Anti-inflammatory,^53,54 Anti-oxidant,⁵⁵ Anti-tumour,⁵⁶ Anti-androgenic,⁵⁷ Anti-fertility,⁵⁸ Anti-arrhythmic,⁵⁹ Antimicrobial,⁶⁰Antihyperglycemic,⁶¹ Antihyperlipidemic,⁶¹Antinociceptive, Antipyretic,⁶²Contraceptive ⁶³
Tukhm Sambhālu	English- Five leaved chaste tree Hindi- Nirgandi, Sambhalu Persian- Panjkisht Sanskrit- Nirgundi Tamil- Nirkkundi Telugu- Sindhuvaruma	Qābiḍ, ^22,23,27Mulaṭṭif,^28,29,30 Mujaffif-i-Manī,^25,26,28-30Muḥallil,^26-29Mufattiḥ-Sudad,^22,28,29Mudirr-i-Ḥayḍ,^22,26,28,30 Mudirr-i-Bawl,^22,24,26,28Mudirr-i-Laban,^28-30Mujaffif,^28,30Jālī,^28-30 Musakkin-i-Alam (Analgesic),^26-29Dāfʻ-i-Taʻaffun (Antiseptic),^28,29Qāṭiʻ-Bāh ^28-30	Wajaʻ al-Mafāṣil (Polyarthritis),^22-24,26,27 Nafkh al-Mi‘da,^25,28-30 Suʻāl ^23,25,26 Jarayān-i-Manī,^25-30 Dīdān-i-Am‘ā’ (Intestinal Worms),^22,23,25-30Indīmal (Wound healing),^22-30Wajaʻ al-Ḥalaq (Throat pain),^28,29Qulāʻ (Stomatitis),²⁸ Warm al-Raḥim (Metritis and Endometritis),^22,28-30 Waram al-Khuṣyatayn (Orchitis),^22,28-30Iltiḥāb al-shuʻab (Bronchitis),²⁸Niqris (Gout),^26,29Ṣudāʻ (Headache),^{22-26, 29,30}	Anti-inflammatory,⁶⁴ Analgesic,⁶⁴ Anti-oxidant,⁶⁵ Enzyme-inhibitory,⁶⁶Anti-cancer,⁶⁷Anti-bacterial,^68,69Anti-filarial,⁷⁰Anti-fungal,⁷¹Anxiolytic,⁷² Laxative,⁷³Hepatoprotective,⁷⁴Antitussive,⁷⁵Estrogenic,⁷⁶Immunomodulatory⁷⁷
Tukhm Kāhū	Arabic- Khas English- Garden Lettuce Hindi- Kahu, Salad Persian- Kahu Tamil- Salattu Telugu- Kavu	Musakkin (Sedative),^23,26,28,30Munawwim (Hypnotic),^23,26,28,30Mubarrid (Refrigerant),²⁸ Mujaffif-i-Manī,^26,28,30Qāṭiʻ-Bāh,^26,30Muqawwī-i-Miʻda (Stomachic),^23,25,28,30Mudirr-i-Bawl,^{23,25,26,28,30} Mudirr-i-Ḥayḍ,^25,26Muṣaffī-i-Dam (Blood purifier),^23,25,26,28	Sahr (Insomnia),^24,26,28,30Ṣudāʻ ,^23,28,30Dhīq al-Nafas (Bronchial Asthma),^23,24Khafaqān (Palpitation),^24,25Jarayān-i-Manī,^26,28,30Suʻāl,^24,28 Taqṭīr al-Bawl (Dribbling of urine),^24,26-30 Ḥurqa al-Bawl (Burning micturition),²³Yaraqān (Jaundice),^24,28-30Qulāʻ (Stomatitis),^24,26Surʻat-i-Inzāl,^24,26Qurūḥ al-Qarniyya (Corneal Ulcer),^24,26,30	Analgesic,^78,79 Anti-inflammatory,^78,79Anti-depressant,⁷⁹Anticoagulant,⁷⁹Sedative and hypnotic,⁸⁰ Anxiolytic,⁸¹Antioxidant,^82,83 Anti-bacterial,⁸³Antiviral,⁸³Hypolipidemic,⁸⁴Immunomodulatory,⁸⁵Neuroprotective,⁸⁶Diuretic,⁸⁷Anticancer,⁸⁸
Gule Anār	Arabic- Rumman English- Pomegranate Hindi- Anar Persian- Gulnar Sanskrit- Dadimah Tamil- Madalai, Mathulai Telugu- Dadimba	Qābiḍ,^{22,24,25,27-30}Mujaffif,²⁹Dāfʻ-i-Isāhl (Anti diarrhoeal),²⁴Ḥābis-i-Dam (Hemostyptic),^22,23 Muqawwī-i-Jigar (Hepatotonic),²⁵Dāfʻ-i-Isāhl Ṣafrāwī wa Damwī (Anti bilious and bloody diarrhoea),²⁵ Mudammil (Cicatrizant),^25,30 Qatīl-i-Dīdān-i-Amʻā’,^22,23,27Muqawwī-i-Miʻda,^22,25,27 Mubarrid (Refrigerant),^22,27Jālī (Detergent),²⁵	Isāhl (Diarrhoea),^{22-27, 30}Zaḥīr (Dysentery),^22,23,27Jarayān al-Dam,²⁶Jarayān-i-Manī,²⁴Ḥikka (Pruritis),²⁵Saylan al-Raḥim (Leucorrhoea),^{22-25, 28-30}Kathrat-i-Ḥayḍ (Polymenorrhoea),^{28, 29}Litha Dāmiya (Bleeding gums),^24-30Waram al-Litha (Gingivitis),^24-30Nafth al-Dam,^{22, 24 25, 28-30}Ruʻāf (Epistaxis),^{22-24, 26}Khafaqān,^{25, 27, 30}	Anti-inflammatory,⁸⁹ Antimicrobial,⁹⁰Hepatoprotective,⁹¹ Anti-Diabetic,⁹²Antioxidant,⁹²Antifungal,⁹³Antidiarrheal,⁹⁴ Anti-cancer,⁹⁵Cardioprotective,⁹⁶ Wound healing,⁹⁷ Antiplaque and antigingivitic,⁹⁸Immunomodulatory,⁹⁹Antihistaminic,¹⁰⁰
Gule Surkh	Arabic- Ward English-Damask rose Hindi- Gulab Persian- Gul e Surkh Sanskrit- Shatapatri Tamil- Golappu Telugu- Rajapuva	Qābiḍ,^{22-24, 26, 27, 29, 30} Mulayyin (Laxative),^{22-28, 30} Mulaṭṭif, ^25-27Muqawwī-i-Aʻḍā’ Raʻīsa (Tonic for vital organs),^{23, 25, 29}Mufarriḥ (Exhilarant),^{25, 26, 28, 29}Muqawwī-i-Qalb (Cardiac Tonic),^22-27Qāṭiʻ-Bāh ^{26, 30}Mujaffif,²⁸Musakkin-i-Alam (Analgesic),^{25, 28-30} Ḥābis-i-Dam,^{25, 26}Muqawwī-i-Miʻda (Stomachic),^{25, 26, 28-30}	Ṣudāʻ,^{25, 26, 28-30}Wajaʻ al- Miʻda (Gastralgia),^{25, 28} Qarḥa (Ulcers),²⁶Nafth al-Dam,^{25, 26, 28-30}Isāhl,²⁸ Sudad-al-Kabid (Intrahepatic obstruction),³⁰Amrāḍ-i-Ḥalaq (Disease of the throat),^{26, 27, 30}Khafaqān,^{24, 25, 28, 29}Qulāʻ,^{23, 26, 28-30} Khashunat-i Halaq (Sore throat),^22,26,30Āshob-i-Chashm (Conjunctivitis),^26,29,30Wajaʻ al-Udhun (Otalgia),^{28, 29} Wajaʻ al-Asnān (Tooth ache),^{28, 29} ʻAraq Muntin (Bromhidrosis),^{26, 28-30}	Antibacterial,¹⁰¹ Antioxidant,¹⁰²Anticonvulsant,¹⁰³ Neuroprotective,¹⁰³Analgesic,¹⁰⁴Anti-inflammatory,¹⁰⁴Antidepressant,¹⁰⁵ Anti-diabetic,¹⁰⁶Immunomodulatory,¹⁰⁷Antimalarial,¹⁰⁸Antihypertensive,¹⁰⁹Antispasmodic,¹¹⁰ Antitussive,¹¹¹Laxative,¹¹² Cardiac stimulant,¹¹³

Unani System of Medicine has a rich legacy of efficacious drugs in sexual disorders, which is supported by many preclinical and clinical types of research on scientific parameters. Mostly the drugs have not reported any adverse effects in preclinical and clinical studies. Therefore, Unani medicine can offer the necessary, affordable, and effective management of a wide range of sexual disorders. USM has developed definite practical principles to prepare polyherbal formulations containing multiple ingredients affecting synergistically such as acting on different targets, affecting bioavailability, reducing adverse effects and altering drug metabolism, etc.

The concept of premature ejaculation as a disease was first described by Ismail Jurjani in his book Zakhira Khuwarzam Shahi and mentioned the four causes of PE as excessive semen volume (Kathrat-i-Manī), the low viscosity of semen (Riqqat-i-Manī), debility in retentive power (Ḍuʻf-i-Quwwat-i-Masika) and acuteness of semen (Ḥiddat-i-Manī)¹¹⁴. According to Ibn Hubal, the cause of acquired or secondary PE is Sū’-i-Mizāj Ḥār (hot morbid temperament) of testicles, kidneys, or whole body. He has mentioned that sometimes the cause of PE is a predominance of coldness (burūdat) and wetness (ruṭūbat) which leads to the weakening of reproductive organs. He also mentioned that lifelong or primary PE has no cure¹¹⁵. Unani Scholars of the recent era like Hakim Akbar Arzani, Hakim Azam Khan, and others encouraged the view of Ibn Hubal and Ismail Jurjani and stated a few other causes which include hypersensitivity (Zakāwat-i-Ḥiss), dilation of penile vessels and ducts including urethra (Ittisāʹ-i-Majārī-i-Qazīb), anxiety, excessive sexual thoughts, the guilt associated with masturbation, abnormalities in prepuce, etc.^{11, 13}

As there are many factors involved in the etiology of PE, consequently the management of PE is also multimodal. Unani scholars suggested different treatment modalities like Ilāj Bil Ghizā (diet-o-therapy), Ilāj Bil Tadbīr (regimental therapy), and Ilāj Bil Dawā (pharmacotherapy) for the management of PE^11,114,115. For diet therapy aghzia barida ratba and an easily digestible diet are used; cupping. Bloodletting, massage, and irrigation are recommended in regimental therapy¹¹⁶. In pharmacotherapy different single and compound, drugs are recommended according to the causes of PE. If hypersensitivity and acuteness of semen are the cause of PE, anesthetic, febrifuge, and sedative drugs are recommended as the main line of drugs. In Safūf-i Aslussūs, the ingredients like Tukhm Kahu, Aslusoos, Gul Surkh, and Gul Anar decrease the irritation and burning of nerves, prostrate and vas deference, etc. due to their anesthetic, febrifuge, and nervine sedative properties. If the cause is debility in retentive power and low semen viscosity, ingredients like Tukhm Suddab, Tukhm Kahu, Tukhm Sambhalu, Gul Anar, and Gul Surkh obstruct and delay the discharge of semen by their semen desiccator action. If the causative factor is excessive semen volume, ingredients like Tukhm Kahu, Tukhm Sambhalu, and Gul Surkh are beneficial due to their Qāṭiʻ-i-Manī property. In dilation of penile vessels, astringent’s action ingredients viz. Gul Anar, Gul Surkh, Tukhm Suddab, and Tukhm Sambhalu are supportive to overcome the cause ^11,13,25-30. The formulation Safūf-i Aslussūs has poly herbal single drugs in different compositions that cover most of the causes defined by the Unani scholars and exhibit their efficacy synergistically towards the treatment of premature ejaculation. Hence, it is recommended for the management of PE for a long time by Unani physicians.

Safūf-i Aslussūs is one of the Unani pharmacopoeial formulations mentioned in many official Unani Pharmacopoeias. It is widely prescribed and recommended for a long time by Unani physicians for the management of Premature ejaculation and spermatorrhoea, so it is a time-tested drug. However, more scientific studies and clinical trials are needed on this compound formulation to ensure its scientific validation for clinical use in patients. So, the compiled data on the drug in this review can be used to design further scientific studies.

The authors are thankful to the Director General, CCRUM, New Delhi, and Director In charge, NRIUMSD, Hyderabad for providing necessary facilities and their constant encouragement at all stages. The authors are also thankful to the library facilities of the National Research Institute of Unani Medicine for Skin Disorders, Hyderabad for providing the required books and journals.

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