1. Introduction: The Burden of Haemorrhoids in Nigeria

Haemorrhoids, also known as piles, are a common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. This condition, characterised by inflamed and swollen veins in the lower rectum or anus, represents a significant global health burden, with profound impacts in regions with limited healthcare access, such as Nigeria and sub-Saharan Africa. Globally, the prevalence of haemorrhoids is estimated at 4.4–38.9%, with higher rates in developed nations due to sedentary lifestyles and low-fibre diets. In Nigeria, the condition affects an estimated 10–25% of the population, posing significant healthcare challenges, particularly in resource-limited settings.

The predisposition to haemorrhoids is influenced by multiple factors including heredity, age, prolonged straining during defecation, anal sex, prolonged labour during pregnancy, and the intake of a low-fibre diet, which puts extra pressure on the internal lining of the small intestine. The condition ranges from being acute to a complicated state and affects several millions of people worldwide. More than half of men and women aged 50 years and older will develop haemorrhoid symptoms during their lifetime.

The challenges of managing haemorrhoids in Nigeria are compounded by limited healthcare infrastructure, high treatment costs, and the cultural preference for traditional remedies. The widespread use of herbal remedies for haemorrhoid management reflects both the deep-rooted cultural heritage of Nigerian peoples and the practical realities facing individuals living with this condition. As the World Health Organization (WHO) reported that more than 85% of the emerging world population depends on traditional medicine for the treatment or management of their ailments, the integration of evidence-based traditional practices with modern healthcare offers a promising path forward.

2. Ethnobotanical Surveys: Documenting Nigeria’s Antihaemorrhoid Flora

2.1 North-Central Nigeria Survey

An ethnobotanical survey conducted in North-Central Nigeria identified and documented 48 plant species from 27 families used in the treatment of haemorrhoids. The survey consulted 300 respondents, including herb sellers, herbalists, and traditional medicinal practitioners, using structured questionnaires to collect data.

Key Findings:

Parameter	Finding
Total plant species	48
Plant families	27
Most prominent family	Euphorbiaceae (4 species)
Other prominent families	Amaranthaceae, Compositae, Fabaceae, Meliaceae (3 species each)
Most commonly used plant part	Leaves (43.80%)
Other parts used	Root (8.30%), whole plants (8.30%), stem bark (4.24%), bark (10.43%), stem (6.25%), fruits, young leaves, bulb, fruit cob, juice, shaft of seeds (2.08% each)

The predominance of the family Euphorbiaceae indicates the utmost importance of this family in the treatment of haemorrhoids in the study area. The study revealed that traditional medicinal practices were widely accepted among the people, probably because they believed in their effectiveness.

2.2 Osun State Forest Reserve Survey

An ethnobotanical survey in selected villages around Ago-Owu Forest Reserve, Osun State, documented 20 medicinal plants used for curing haemorrhoids . The survey was conducted across five villages: Arinkinkin, Okodowo, Alaadura, Agbaogun, and Alaguntan, with respondents including hunters, farmers, herbalists, civil servants, and other professionals .

Plants Investigated and Phytochemical Composition:

Plant	Alkaloids (%)	Tannins (%)	Saponins (%)	Flavonoids (%)	Polyphenols (%)
Ficus exasperata	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Ageratum conyzoidea	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Paullinia pinnata	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Momordica charantia	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Senna alata	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Newbouldia laevis	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Phyllanthus amarus	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Sphenocentrum jollyanum	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Cissampelos owariensis	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85
Ocimum gratissimum	0.0075-0.02	0.02-0.44	0.001-0.002	0.02-0.57	0.11-1.85

The nutritional analysis revealed that the plants are highly nutritious, containing crude protein (14.57% to 29.37%), moisture content (14.40% to 58.09%), crude fibre (4.54% to 29.05%), ash (6.65% to 22.08%), and carbohydrate (2.04% to 43.60%). The study concluded that these plants possess anti-viral, anti-microbial, anti-bacterial, anti-parasitic, anti-inflammatory, expectorant, and immune-boosting properties.

2.3 Ibadan, Oyo State Survey

Researchers at the Forestry Research Institute of Nigeria (FRIN) identified 25 different medicinal plants believed to be effective treatments for piles in eight villages in Akinyele Local Government Area, Ibadan, Oyo State. The study documented the indigenous knowledge and curative plants used in the treatment of piles, relying on questionnaires to obtain information from local herb sellers, hunters, herbalists, and elderly people.

Plants Documented in the Study:

Plant Name	Common Name	Yoruba/Local Name
Momordica charantia	African cucumber, bitter cucumber	Ejinrin-were
Jatropha gossypifolia	Red Physic Nut	Lapalapa pupa
Khaya grandifoliola	African mahogany	Oganwo
Pteleopsis suberosa	Rattan palms	Okuku
Piper guineense	African black pepper, bush pepper	Iyere
Triplochiton scleroxylon	Obeche	Arere
Bridelia micrantha	–	Assas Ira
Acacia nilotica	–	Bonni Booni
Imperata cylindrica	Spear grass	Irekeobo
Angylocalyx oligophyllus	–	Oko-aja
Aristolochia species	Dutchman’s pipe	Akogun
Picralima nitida	–	Abere
Terminalia glaucescens	–	Idi-apata
Anogeissus leiocarpus	African birch, chewstick tree	–
Cassia fistula	Golden tree	Aidantooro
Gongronema latifolium	Swallow apple	Utazi
Lophira lanceolata	Dwarf red, Ironwood	Paran pupa
Allium sativum	Garlic	–
Zingiber officinale	Ginger	–
Ocimum gratissimum	Scent leaf	Efirin
Azadirachta indica	Neem	Dongoyaro
Vernonia amygdalina	Bitter leaf	Ewuro
Aframomum melegueta	Alligator pepper	Atare

The study identified thirteen different herbal recipes (formulations) used in the study area, including:

1. Squeezed fresh leaves of Momordica charantia, Jatropha gossypifolia, and scent leaf in water, filtered, and taken two times daily
2. Bark of Khaya grandifoliola, Ancistrophyllum secundiflorum, and Bridelia micrantha cut into pieces and put inside plastic bottles containing water and kafura
3. Bark of Khaya grandifoliola, Pteleopsis suberosa, Bridelia micrantha, Acacia nilotica, Picralima nitida, garlic, Aristolochia repens, and ginger cut into pieces, placed in plastic bottles with clean water and kafura
4. Boiling tender leaves of Senna alata (asunwon-oyinbo) with a small quantity of water; using the water to prepare amala
5. Root of Spear grass dried and ground with seed of Piper guineense; put in palm kernel oil
6. Bark of Cassia fistula, Aristolochia ringens, and kafura soaked in water for at least three hours
7. Squeezed leaves of Angylocalyx oligophyllus with water
8. Bark of Aristolochia ringens, Khaya grandifoliola, Terminalia glaucescens, Anogeissus leiocarpus, vine of Gongronema latifolium, Lophira lanceolata, and seed of Picralima nitida soaked in water with kafura or soaked in hot drinks without kafura
9. Roots of neem tree with garlic and kafura soaked in water for six hours
10. Squeezed fresh leaves of bitter leaf and red jatropha with water
11. Squeezed leaves of Triplochiton scleroxylon with water

The researchers noted that apart from plant parts, insects such as centipedes and other non-plant materials like water, hot drinks, local gin, schnapps, kafura, and waji’s cloth were also used in preparation of some recipes.

3. Scientifically Validated Nigerian Antihaemorrhoid Plants

3.1 Ocimum gratissimum (Scent Leaf)

Ocimum gratissimum, popularly known as “scent leaf” in Nigeria, is a herbaceous plant belonging to the Lamiaceae family. It is known as Nchanwu in Igbo, Daidoya in Hausa, and Efirin in Yoruba. The plant has been documented to contain a number of phytochemicals such as flavonoids and polyphenols which are responsible for its many pharmacological activities.

A study evaluating the histopathological and anti-haemorrhoid effect of the ethanol leaf extract of Ocimum gratissimum in croton oil-induced haemorrhoids in Wistar rats found significant therapeutic potential.

Key Findings:

Parameter	Result
Body weight	Marked increase in extract-treated groups from day 1 to day 14
Percentage rectal water content (untreated)	76% (significant increase)
Percentage rectal water content (treated)	67% (significant decrease)
Anorectal coefficient	Significant decrease in extract-treated groups
Histopathological changes	Reversal of inflammatory and necrotic conditions in treated animals

The study concluded that the leaf extract of Ocimum gratissimum could help to mitigate anorectal disorders and contribute significantly to improved health.

Mechanism of Action:

Free radical generation is a primary reason for the initiation of many physiological and pathological disorders like haemorrhoids. Antioxidants neutralize free radicals and thus play a major role in the eradication of these free radicals, making them involved in the management of diseases, including haemorrhoids. Herbal extracts rich in phytoantioxidants like polyphenols, flavonoids, tannins, and other related compounds are known to possess positive health effects and eventually reduce the incidence of diseases.

3.2 Mimosa pudica

Mimosa pudica L. is a plant widely used in African traditional medicine for various ailments. A study evaluated the anti-haemorrhoid potential of methanol extract and fractions (n-hexane, ethyl acetate, n-butanol) of Mimosa pudica using a croton oil-induced model in Wistar rats.

Key Findings:

Parameter	Result
Most active fraction	Ethyl acetate fraction at 200 mg/kg
Effect	Significantly reduced recto-anal coefficient (p < 0.05)
Efficacy	Comparable to conventional treatment (Daflon)
Safety concern	Dose-dependent adverse effects observed

The findings validate Mimosa pudica‘s traditional use and its potential as an affordable, plant-based therapy for haemorrhoid management, though dose optimisation and clinical validation are critical for safe application.

3.3 Polyaltha longifolia

A study investigated the ameliorative potential of ethyl acetate fraction of Polyaltha longifolia leaves on croton oil-induced haemorrhoids in albino Wistar rats.

Key Findings:

Parameter	Result
Toxicity	Not toxic even up to 5000 mg/kg body weight
Body weight	Significant increase (200, 400, 600 mg/kg)
Anorectal coefficient	Significant decrease (p < 0.05)
Interleukin levels	Significant reduction (p < 0.05)
TNF-α levels	Significant reduction (p < 0.05)
MDA levels	Significant decrease (p < 0.05)
SOD, CAT, GSH levels	Significant increase (p < 0.05)

Qualitative and quantitative phytochemical analysis revealed the presence of flavonoids, tannins, phenols, alkaloids, terpenoids, glycosides, saponins, steroids, and hydrogen cyanide. The study concluded that the ethyl acetate fraction of Polyaltha longifolia possesses anti-haemorrhoid properties in rats.

3.4 Ficus ingens

Ficus ingens is a medicinal plant used for haemorrhoids in Borno State, Nigeria. A study evaluated the analgesic and anti-inflammatory activities of the methanol leaf extract of Ficus ingens.

Key Findings:

Parameter	Result
Analgesic activity (writhing test)	Significant inhibition (P<0.001) at all doses
Analgesic activity (hot plate)	Significant prolongation of reaction latency (P<0.05)
Anti-inflammatory (paw oedema)	61%, 72%, and 67% inhibition at 75, 150, 300 mg/kg
LD50 (intraperitoneal)	1131.4 mg/kg (relatively non-toxic)
Phytochemicals detected	Alkaloids, flavonoids, glycosides, saponins, tannins

The study concluded that Ficus ingens possesses significant anti-inflammatory and analgesic properties which support the folkloric claim for its use in the management of haemorrhoids.

3.5 Saponin-Rich Plants with Anti-Inflammatory Activity

Crude saponin extracts of five medicinal plants used in the treatment of inflammatory diseases including haemorrhoids were screened for anti-inflammatory activity using the carrageenan-induced rat paw oedema test.

Anti-Inflammatory Activity:

Plant	Plant Part	Saponin Yield (%)	Inhibition at 4 hours (%)	LD50 (mg/kg)
Schwenkia Americana	Whole plant	2.74	61%	471.2
Asparagus africanus	Rhizomes	3.59	55%	1264.9
Dichrostachys cinerea	Leaves	1.62	72%	1264.9
Ficus iteophylla	Stem bark	0.81	66%	118.3
Indigofera pulchra	Leaves	1.57	40%	1264.9
Ketoprofen (standard)	–	–	63%	–

All extracts showed statistically significant (P<0.05) decreases in rat paw-oedema compared to the control, and their inhibition values were comparable to that of ketoprofen (63%). The study demonstrated that the anti-inflammatory properties attributable to these plants may be due to their saponin contents.

3.6 Paullinia pinnata

Paullinia pinnata (Sapindaceae), commonly called sweet gum, is used traditionally in Nigeria for the management of various diseases, including chronic arthritis and rheumatic pain. The ethyl acetate fraction of P. pinnata leaf was evaluated for analgesic and anti-inflammatory activities.

Key Findings:

Parameter	Result
LD50	1264.9 mg/kg (non-toxic)
Analgesic activity (formalin test)	21.45%, 35.62%, and 92.70% inhibition at 75, 150, 300 mg/kg
Analgesic activity (acetic acid test)	70.03-100% inhibition at 75-300 mg/kg
Anti-inflammatory activity	Maximum activity at 150 mg/kg: 60.0% (1h), 47.47% (2h), 65.38% (3h), 63% (4h)
Ketoprofen (standard) inhibition	28.32% (formalin), 76.60% (acetic acid)

Phytochemical investigation revealed the presence of flavonoids, saponins, anthraquinone, steroidal terpenoids, and carbohydrates . The study concluded that the ethyl acetate fraction of P. pinnata leaf possesses significant analgesic and anti-inflammatory activities .

4. Tokar Sha: A Unique Traditional Formulation

4.1 Description and Preparation

‘Tokar sha’ or ‘sabulun toka’ is a soap concoction widely used as a traditional medicine in the northwest zone of Nigeria, specifically in Sokoto, Kebbi, and Zamfara states. It is a variety of African black soap prepared from millet stalk ash and palm oil, which are mixed to make a paste, heated to boil, and then cooled to solidify.

4.2 Therapeutic Applications

A survey of 200 participants, including Traditional Medical Practitioners (TMPs), actual drug users, and experienced elders across seven Local Government Areas of Sokoto State, documented the medicinal uses of ‘tokar sha’.

Condition	Percentage Reporting Use
Piles (haemorrhoids)	41%
Constipation	20%
Dysentery	15%
Diarrhoea	12%
Skin disease	8%
Malaria	3%
Typhoid	1%

4.3 Mode of Administration

Parameter	Percentage
Preparation	Dissolved in cold water (94%)
Route of administration	Oral (91%), Topical (9%)
Common vehicles	Tamarind (48%), Fura (27%), Lime (17%), Fresh cow milk (8%)
Dosing frequency	Once daily (62%), Twice daily (23%), Three times daily (15%)
Duration of treatment	Days (56%), Weeks (35%), Months (9%)

4.4 Safety Considerations

‘Tokar sha’ is reported to be well tolerated, with only unpleasant taste and allergy reported by 14% of study respondents. Importantly, it was reported to be fatal when taken with honey or any sweetener without a proper time interval. This critical safety warning underscores the importance of proper administration guidance for traditional remedies.

The study concluded that ‘tokar sha’ is strongly claimed to be an effective therapeutic agent in the management of gastrointestinal ailments such as piles, constipation, and dysentery.

5. Summary of Nigerian Antihaemorrhoid Plants

5.1 Plants with Documented Traditional Use

Based on available literature, the following plants are documented for haemorrhoid management across Nigeria:

Plant Name	Common Name	Yoruba/Hausa/Igbo Name	Plant Part Used	Documented Location
Ocimum gratissimum	Scent leaf	Efirin (Yoruba), Nchanwu (Igbo), Daidoya (Hausa)	Leaves	Nationwide
Vernonia amygdalina	Bitter leaf	Ewuro (Yoruba) Onugbu (Igbo)	Leaves	Ibadan
Momordica charantia	Bitter cucumber, African cucumber	Ejinrin-were (Yoruba)	Leaves	Ibadan, Osun
Jatropha gossypifolia	Red Physic Nut	Lapalapa pupa (Yoruba)	Leaves	Ibadan, Osun
Khaya grandifoliola	African mahogany	Oganwo (Yoruba)	Bark	Ibadan
Azadirachta indica	Neem	Dongoyaro (Yoruba)	Roots	Ibadan
Allium sativum	Garlic	–	Bulb	Ibadan
Zingiber officinale	Ginger	–	Rhizome	Ibadan
Ficus ingens	Fig species	–	Leaves	Borno State
Ficus exasperata	Sandpaper leaf	–	Leaves	Osun
Polyaltha longifolia	–	–	Leaves	–
Paullinia pinnata	Sweet gum	–	Leaves	Osun
Mimosa pudica	Touch-me-not	–	Whole plant	–
Picralima nitida	–	Abere (Yoruba)	Seed, bark	Ibadan
Senna alata	–	Asunwon-oyinbo (Yoruba)	Tender leaves	Ibadan
Aristolochia species	Dutchman’s pipe	Akogun (Yoruba)	Bark	Ibadan
Piper guineense	African black pepper	Iyere (Yoruba), Uda (Igbo)	Seed	Ibadan
Gongronema latifolium	Swallow apple	Utazi (Igbo)	Vine	Ibadan

5.2 Plants with Scientifically Validated Antihaemorrhoid Activity

Plant	Scientific Evidence Level	Key Mechanism	Reference
Ocimum gratissimum	High	Antioxidant, anti-inflammatory, reduction of rectal water content
Mimosa pudica	Moderate	Reduction of recto-anal coefficient
Polyaltha longifolia	Moderate	Reduction of cytokines (IL, TNF-α), oxidative stress markers
Ficus ingens	Moderate	Anti-inflammatory, analgesic
Schwenkia americana	Moderate	Saponin-mediated anti-inflammatory (61% inhibition)
Dichrostachys cinerea	Moderate	Saponin-mediated anti-inflammatory (72% inhibition)
Ficus iteophylla	Moderate	Saponin-mediated anti-inflammatory (66% inhibition)
Paullinia pinnata	Moderate	Analgesic, anti-inflammatory

6. Mechanisms of Action: How Nigerian Herbs Work

6.1 Anti-Inflammatory Action

Inflammation is a key component of haemorrhoid pathophysiology. Many Nigerian antihaemorrhoid plants work by reducing inflammation:

Plant	Mechanism	Evidence
Ocimum gratissimum	Reversal of inflammatory conditions in anorectal tissue	Histopathological studies
Ficus ingens	Inhibition of prostaglandins and lysosomal enzymes	Paw oedema test
Paullinia pinnata	Inhibition of inflammatory mediators	Carrageenan-induced oedema
Saponin-rich plants	Saponin-mediated anti-inflammatory activity	Carrageenan-induced oedema

6.2 Antioxidant Activity

Free radical generation is a primary reason for the initiation of many pathological disorders, including haemorrhoids. Antioxidants neutralize free radicals and thus play a major role in the management of diseases.

Plant	Antioxidant Activity	Markers Affected
Polyaltha longifolia	Significant	Decreased MDA, increased SOD, CAT, GSH
Ocimum gratissimum	Rich in flavonoids and polyphenols	Reduced oxidative stress
Various plants in Osun survey	Phytochemical content	Alkaloids, tannins, saponins, flavonoids, polyphenols

6.3 Analgesic (Pain-Relieving) Action

Plant	Analgesic Mechanism	Test System
Ficus ingens	Central and peripheral mechanisms	Acetic acid writhing, hot plate
Paullinia pinnata	Peripheral mechanism (formalin test)	Formalin test, acetic acid writhing

6.4 Reduction of Anorectal Oedema

Plant	Effect	Measure
Ocimum gratissimum	Reduced rectal water content from 76% to 67%	Percentage rectal water content
Mimosa pudica	Significantly reduced recto-anal coefficient	Recto-anal coefficient
Polyaltha longifolia	Decreased anorectal coefficient	Anorectal coefficient

6.5 Cytokine Modulation

Plant	Cytokine Effect	Target
Polyaltha longifolia	Significant reduction (p < 0.05)	Interleukin levels, TNF-α

7. Holistic and Complementary Therapies

7.1 Lifestyle Modifications

The predisposing factors for haemorrhoids include heredity, age, anal sex, prolonged labour during pregnancy, and the intake of a low-fibre diet, which puts extra pressure on the internal lining of the small intestine. Holistic management should address these modifiable risk factors:

• Dietary modification: Increasing dietary fibre intake, avoiding stony or low-fibre diets
• Hydration: Adequate water intake to prevent constipation and straining
• Regular physical activity: Preventing constipation through enhanced bowel motility
• Avoiding prolonged straining: During defecation
• Weight management: Reducing intra-abdominal pressure

7.2 Traditional Remedies and Formulations

Thirteen different herbal recipes were documented in the Ibadan study, representing the diversity of traditional approaches to haemorrhoid management . These include:

1. Squeezed fresh leaves of Momordica charantia, Jatropha gossypifolia, and scent leaf in water, filtered, and taken two times daily
2. Bark of Khaya grandifoliola, Ancistrophyllum secundiflorum, and Bridelia micrantha cut into pieces and placed in plastic bottles containing water and kafura
3. Boiling tender leaves of Senna alata with water and using the water to prepare amala
4. Root of Spear grass dried and ground with seed of Piper guineense placed in palm kernel oil
5. Roots of neem tree with garlic and kafura soaked in water for six hours

These formulations represent indigenous knowledge that has been refined over generations.

7.3 Tokar Sha: A Unique Approach

‘Tokar sha’ represents a distinctive approach to haemorrhoid management in Nigeria, combining the properties of African black soap with specific vehicles and administration protocols. The oral administration of soap-based formulations is a uniquely Nigerian practice that deserves further scientific investigation.

8. Safety Considerations and Recommendations

8.1 Key Safety Concerns

Concern	Implication
Dose-dependent adverse effects	Observed with Mimosa pudica extracts
Toxicity of some plants	Variable LD50 values; some plants show toxicity at higher doses
Drug interactions	Potential interactions with conventional medications
Lack of standardisation	Variable potency and possible contamination
Potential for serious adverse events	‘Tokar sha’ reported fatal when taken with honey/sweetener without proper timing
Non-plant ingredients	Use of kafura, local gin, schnapps, and other ingredients in formulations

8.2 Toxicity Data

Plant	LD50 (mg/kg)	Toxicity Classification
Schwenkia americana	471.2	Moderate
Asparagus africanus	1264.9	Relatively non-toxic
Dichrostachys cinerea	1264.9	Relatively non-toxic
Ficus iteophylla	118.3	Moderately toxic
Indigofera pulchra	1264.9	Relatively non-toxic
Ficus ingens	1131.4	Relatively non-toxic
Paullinia pinnata	1264.9	Relatively non-toxic
Polyaltha longifolia	>5000	Non-toxic

8.3 Recommendations for Safe Use

For Patients and Families:

1. Consult qualified healthcare practitioners before initiating any herbal regimen
2. Disclose all herbal medicine use to healthcare providers
3. Use products from reputable sources, preferably with NAFDAC registration
4. Follow traditional preparation methods carefully, as incorrect preparation may affect efficacy and safety
5. Avoid using ‘tokar sha’ with honey or sweeteners unless proper time intervals are observed
6. Monitor for adverse effects and report immediately
7. Seek medical attention for severe haemorrhoids (prolapsed, thrombosed, or bleeding heavily)

For Healthcare Providers:

1. Ask about herbal medicine use during consultations
2. Provide evidence-based guidance on complementary therapies
3. Monitor patients for potential interactions and adverse effects
4. Document CAM use in patient records
5. Support research on safety and efficacy of commonly used herbs

For Researchers:

1. Conduct controlled clinical trials on commonly used antihaemorrhoid plants
2. Evaluate safety profiles for chronic use
3. Study drug interactions with conventional medications
4. Identify and characterise active compounds
5. Develop standardised formulations for clinical use

For Policymakers:

1. Strengthen NAFDAC regulation of herbal products
2. Fund research on antihaemorrhoid plants
3. Develop integration guidelines for traditional and orthodox medicine
4. Support conservation of medicinal plant species
5. Promote health education on safe CAM use

9. Research Gaps and Future Directions

9.1 Key Research Needs

Area	Priority
Human clinical trials	Most evidence from animal models; human safety and efficacy data needed
Long-term safety studies	Chronic use effects on liver, kidney, and other organs
Drug interaction studies	Interactions with anti-inflammatory drugs, pain medications
Standardised dosing protocols	Defined dosing for herbal formulations
Pharmacokinetic studies	Understanding absorption, distribution, metabolism, and elimination
Quality control methods	Affordable quality assurance methods
Mechanism of action studies	Cellular and molecular pathways of antihaemorrhoid activity
Tokar sha studies	Scientific validation of this unique formulation
Recipe standardisation	Standardisation of the 13 traditional recipes documented

9.2 Opportunities

• Development of standardised formulations: Moving from traditional decoctions to pharmaceutical-grade products
• Conservation of medicinal plants: Domesticating and conserving plant species at risk of loss
• Documentation of indigenous knowledge: Preserving knowledge before it is lost, as traditional knowledge is passed down through inheritance and apprenticeship
• Integration strategies: Combining the best of traditional and orthodox approaches

10. Conclusion

Haemorrhoids represent a significant health burden in Nigeria, affecting an estimated 10–25% of the population. The condition’s prevalence is driven by low-fibre diets, sedentary lifestyles, and other modifiable risk factors. Against this backdrop, Nigerian traditional medicine offers a rich repository of plant-based remedies for haemorrhoid management, with scientific research increasingly validating the efficacy of these remedies.

Ethnobotanical surveys have documented substantial diversity in Nigerian antihaemorrhoid flora:

• 48 plant species from 27 families in North-Central Nigeria
• 20 medicinal plants in Osun State
• 25 medicinal plants in Ibadan, Oyo State

Scientific validation of these plants has progressed considerably:

• Ocimum gratissimum demonstrated significant reduction in rectal water content (76% to 67%) and reversal of inflammatory conditions
• Mimosa pudica showed efficacy comparable to the standard drug Daflon
• Polyaltha longifolia showed significant reduction in cytokines and oxidative stress markers
• Ficus ingens demonstrated anti-inflammatory and analgesic activity supporting traditional use
• Saponin-rich plants including Schwenkia americana and Dichrostachys cinerea showed anti-inflammatory activity comparable to ketoprofen
• Paullinia pinnata demonstrated significant analgesic and anti-inflammatory activities

‘Tokar sha’, a soap concoction used in northwestern Nigeria, is reported to be useful for piles management by 41% of surveyed participants, representing a unique traditional formulation that warrants further scientific investigation.

The path forward requires:

1. Acknowledging and respecting traditional knowledge while subjecting it to scientific scrutiny
2. Strengthening regulatory oversight of herbal products through NAFDAC
3. Promoting open communication between patients and healthcare providers about herbal medicine use
4. Investing in research on safety, efficacy, and mechanisms of action
5. Developing integration strategies that combine the best of both systems
6. Preserving and documenting indigenous knowledge before it is lost
7. Promoting conservation of medicinal plant species through domestication and sustainable harvesting
8. Supporting lifestyle modifications including increased dietary fibre and hydration

As Nigeria continues to face the burden of haemorrhoids, the careful integration of evidence-based traditional medicine into the healthcare system offers promising strategies for improving the quality of life for those affected by this common condition.

11. References

• Research on Plant-based Management of Haemorrhoids: Evidence from Extracts of Mimosa pudica L. Scilit.
• Ethnobotanical Survey of Plants used in Treatment of Haemorrhoids in North-Central Nigeria. Temple University.
• Tijjani RG, Adamu A. Traditional applications of ‘tokar sha’ – a soap concoction used as medicine in Sokoto-Nigeria. DUJOPAS. 2025.
• Hassan HS, Sule MI, Musa AM, et al. Anti-inflammatory activity of crude saponin extracts from five Nigerian medicinal plants. Bioline International. 2012.
• Moneme EC, Nwaka AC, Oladejo AA, et al. Histopathological and Anti-hemorrhoid Effect of the Leaf Extract of Ocimum gratissimum in Croton Oil-induced Hemorrhoid. Journal of Complementary and Alternative Medical Research. 2024;25(12):1-10.
• Ethnobotanical Survey of Some Medicinal Plants for Curing Pile or Hemorrhoids in Ago-Owu Forest Reserve, Osun State Nigeria. CORE.
• Tijjani RG, Adamu A. Traditional Applications of ‘Tokar Sha’ – A Soap Concoction Used as Medicine in Sokoto-Nigeria. AJOL. 2025.
• Aiyelero OM, Ibrahim ZG, Yaro AH. Analgesic and anti-inflammatory properties of the methanol leaf extract of Ficus ingens (Moraceae) in rodents. University of Ilorin. 2009.
• Scientists identify 25 herbs for treatment of pile. Tribune Online. 2023.
• Anti-inflammatory activity of crude saponin extracts from five Nigerian medicinal plants. PubMed/National Institutes of Health. 2011.
• Ugwu OC, Umeakuana CD, Ogbonna CG, et al. Phytochemical Screening and Ameliorative Potential of Ethyl Acetate Fraction of Polyaltha longifolia Leaves on Croton Oil-induced Hemorrhoid in Albino Wistar Rats. International Journal of Biochemistry Research & Review. 2025;34(2):1-9.