{ "slug": "lemon-hemorrhoid", "question": "Is lemon good for hemorrhoids?", "shortTitle": "Lemon for Hemorrhoids", "clinicalQuestion": "In adults with symptomatic hemorrhoids, does drinking lemon juice or lemon water, or using lemon topically, reduce symptoms such as pain, itching, or bleeding, or shrink hemorrhoids, compared with no treatment or usual care?", "pico": { "population": "Adults with symptomatic hemorrhoids (internal or external)", "intervention": "Lemon juice, lemon water, or topical lemon application (alone or with honey)", "comparator": "No treatment, placebo, or usual care (e.g., fiber, sitz baths, topical corticosteroid)", "outcomes": [ "Change in hemorrhoid symptom score (pain, itching, bleeding)", "Rectal bleeding frequency or severity", "Hemorrhoid size or grade on examination", "Time to symptom resolution", "Need for further medical or surgical treatment", "Recurrence of symptoms at 3–12 months" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "No study has tested whether lemon helps hemorrhoids.", "detail": "The related research found tests purified flavonoid drugs (like diosmin and hesperidin, which are extracted and concentrated from citrus fruits) in people who already had hemorrhoids or had hemorrhoid surgery — not lemon juice, lemon water, or lemon applied to the skin. None of the 5 randomized trials or 25 total studies gave anyone plain lemon, so this evidence cannot say whether lemon itself affects pain, bleeding, or hemorrhoid size.", "studyIds": [ "pmid:16736537", "pmid:38847122", "pmid:25893991", "pmid:29934701", "pmid:34057643", "pmid:32953352" ] }, "strength": { "level": "very-low", "why": "The 10 human studies found measure a related question rather than this one, so they can only be read indirectly.", "override": null }, "direction": { "level": "not-studied", "why": "No study has measured this outcome in people with this condition.", "override": null }, "counts": { "recordsRetrieved": 209, "recordsScreened": 200, "included": 25, "rcts": 5, "systematicReviews": 4, "observational": 0, "participants": 2659, "yearFrom": 1997, "yearTo": 2024, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Symptom score (pain, itching, bleeding combined)", "status": "not-studied", "note": "No study measured a symptom score after giving people lemon. Trials measuring symptom scores used purified flavonoid drugs, not lemon.", "studyIds": [ "pmid:25893991", "pmid:16736537" ] }, { "name": "Rectal bleeding frequency or severity", "status": "not-studied", "note": "Bleeding was tracked in trials of flavonoid drugs, with some showing less bleeding, but none of these treatments was lemon itself.", "studyIds": [ "pmid:32953352", "pmid:29934701", "pmid:25893991", "pmid:16736537" ] }, { "name": "Hemorrhoid size or grade on exam", "status": "not-studied", "note": "One trial measured hemorrhoid size after a flavonoid drug, not lemon. No study has examined whether lemon shrinks hemorrhoids.", "studyIds": [ "pmid:32953352" ] }, { "name": "Time to symptom resolution", "status": "not-studied", "note": "One flavonoid drug trial reported improvement after 12 days of treatment, but that treatment was not lemon.", "studyIds": [ "pmid:25893991" ] }, { "name": "Need for further medical or surgical treatment", "status": "not-studied", "note": "No study in this search reported whether using lemon changed the chance of needing further treatment.", "studyIds": [] }, { "name": "Recurrence of symptoms at 3-12 months", "status": "not-studied", "note": "No study followed people for 3 to 12 months after using lemon, or after any citrus-based treatment, to check for symptoms coming back.", "studyIds": [] } ], "benefits": [], "limitations": [ { "text": "Every human trial here tested a purified, concentrated flavonoid drug (such as diosmin or hesperidin) rather than whole lemon, lemon juice, or lemon water, so the results don't describe what eating or applying lemon would do.", "studyIds": [ "pmid:16736537", "pmid:25893991", "pmid:29934701", "pmid:32953352", "pmid:34057643", "pmid:38847122" ] }, { "text": "Several of the 25 studies are animal experiments, lab dish experiments, or computer simulations, not tests in people with hemorrhoids at all.", "studyIds": [ "pmid:39649264", "pmid:38078787", "pmid:37979821", "pmid:37478119", "pmid:27069720" ] }, { "text": "These review articles do not provide direct evidence on lemon: some only list traditional folk uses of other, unrelated plants (such as Sophora japonica, Gmelina arborea, Polygonum, and Rusci aculeati) without hemorrhoid-specific trial data, while others discuss clinical or laboratory research on purified pharmaceutical flavonoid extracts (such as diosmin or MPFF) derived from citrus fruit generally, not lemon itself.", "studyIds": [ "pmid:39554345", "pmid:38893547", "pmid:38638945", "pmid:37759859", "pmid:36432034", "pmid:35883849", "pmid:33217516", "pmid:27085938", "pmid:26465280", "pmid:16245442", "pmid:9454438" ] }, { "text": "The largest and most relevant trials studied people recovering from hemorrhoid surgery, which is a very different situation from someone trying lemon at home for everyday hemorrhoid symptoms.", "studyIds": [ "pmid:38847122", "pmid:34057643", "pmid:25893991" ] } ], "risks": [], "whyPeopleTryIt": [ { "text": "Lemon is cheap, already in most kitchens, and feels like a 'natural' first thing to try before seeing a doctor." }, { "text": "Citrus fruits contain flavonoid compounds, and purified flavonoid drugs are sometimes used for hemorrhoids, so people assume eating or applying lemon has the same effect." }, { "text": "Lemon and vitamin C are often described online as being 'good for veins,' and that idea gets carried over to hemorrhoids." }, { "text": "Lemon juice feels astringent, or tightening, on the skin, which some people mistake for a sign that it is working." } ], "keyStudies": [ "pmid:16736537", "pmid:38847122", "pmid:25893991", "pmid:29934701", "pmid:34057643", "pmid:32953352" ], "studies": [ { "id": "pmid:39649264", "pmid": "39649264", "doi": "10.5114/aoms/183465", "nctId": null, "pmcid": "PMC11623161", "title": "Synergistic therapeutic approach for hemorrhoids: integrating mesenchymal stem cells with diosmin-hesperidin to target tissue edema and inflammation", "firstAuthor": "Kusumo", "multipleAuthors": true, "journal": "Arch Med Sci", "year": 2024, "design": "animal", "n": null, "nField": "not-reported", "population": "mice with hemorrhoids induced by croton oil", "intervention": "mesenchymal stem cells alone or combined with diosmin-hesperidin (MPFF)", "comparator": "", "primaryOutcome": "tissue swelling, inflammation, and molecular markers (TNF-α, TGF-β, collagen ratio, MMP-9 activity)", "result": "treatment significantly reduced tissue edema, inflammation, TNF-α expression, and MMP-9 activity, and increased TGF-β expression and collagen type I/III ratio", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was an animal study using stem cells and a flavonoid drug combination, not lemon, so it offers no direct evidence about lemon for hemorrhoids.", "directness": "indirect", "limitations": "Animal model only, no human data, and the study tested stem cells and a pharmaceutical flavonoid fraction rather than lemon or citrus fruit.", "followUp": "", "plainFinding": "Reduced inflammation in mice, not about lemon", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39649264/", "sourceText": "INTRODUCTION: Mesenchymal stem cells (MSCs) have promising regenerative properties in tissue repair and anti-inflammatory responses. This study aimed to investigate the effects of MSCs and their combination with micronized purified flavonoid fraction (MPFF) in a croton oil-induced hemorrhoids model on tissue edema, inflammation, and underlying molecular mechanisms. MATERIAL AND METHODS: MSCs were isolated and characterized for their adherence, differentiation capacity, and immunophenotyping. Croton oil-induced hemorrhoid mouse models were established to assess tissue edema, inflammation, tumor necrosis factor (TNF-α) expression, transforming growth factor-β (TGF-β) expression, collagen ratio, and MMP-9 activity. The effects of MSCs and their combination with MPFF (diosmin-hesperidin) were evaluated through histological examinations, western blot analysis, and gelatin zymography. RESULTS: Characterization confirmed the MSCs' plastic adherence, osteogenic differentiation potential, and immunophenotype (positive for CD90 and CD29, negative for CD45 and CD31). Treatment with MSCs alone or in combination with MPFF significantly reduced tissue edema, inflammation, TNF-α expression, and MMP-9 activity. Additionally, MSCs increased TGF-β expression, and collagen type I/III ratio, and accelerated wound healing by resolving inflammation. CONCLUSIONS: These findings suggest that MSCs play a crucial role in modulating TNF-α, TGF-β, collagen remodeling, and MMP-9 activity, highlighting their promising role in hemorrhoid treatment and wound healing processes. Further research is warranted to fully elucidate the intricate mechanisms and optimize MSC-based therapies for clinical applications in hemorrhoidal disease management.", "provenance": [ { "field": "population", "quote": "Croton oil-induced hemorrhoid mouse models were established to assess tissue edema, inflammation" }, { "field": "intervention", "quote": "The effects of MSCs and their combination with MPFF (diosmin-hesperidin) were evaluated" }, { "field": "primaryOutcome", "quote": "tissue edema, inflammation, tumor necrosis factor (TNF-α) expression, transforming growth factor-β (TGF-β) expression, collagen ratio, and MMP-9 activity" }, { "field": "result", "quote": "Treatment with MSCs alone or in combination with MPFF significantly reduced tissue edema, inflammation, TNF-α expression, and MMP-9 activity." }, { "field": "result", "quote": "Additionally, MSCs increased TGF-β expression, and collagen type I/III ratio, and accelerated wound healing by resolving inflammation." } ] }, { "id": "pmid:39554345", "pmid": "39554345", "doi": "10.1002/fsn3.4271", "nctId": null, "pmcid": "PMC11561841", "title": "Diosmin: A promising phytochemical for functional foods, nutraceuticals and cancer therapy", "firstAuthor": "Rahman", "multipleAuthors": true, "journal": "Food Sci Nutr", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic venous insufficiency and hemorrhoids", "intervention": "diosmin, a flavonoid compound derived from citrus fruits", "comparator": "", "primaryOutcome": "management of hemorrhoids and venous insufficiency", "result": "general efficacy in managing hemorrhoids, attributed to anti-inflammatory effects, based on limited research", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review statement citing unspecified 'limited clinical trials' without any details on design, size, or outcomes, so it carries little evidential weight.", "directness": "indirect", "limitations": "The abstract gives no details on the clinical trials it references for hemorrhoids, no numbers, no comparator, and focuses mainly on cancer, not hemorrhoids specifically.", "followUp": "", "plainFinding": "Possible help for hemorrhoid symptoms", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39554345/", "sourceText": "Diosmin, a potent bioflavonoid derived from citrus fruits, has gained significant attention for its anticancer potential, reflecting a critical need in the ongoing battle against cancer. Amidst increasing cancer incidence, the quest for safer and more effective treatments has brought diosmin to the forefront, given its unique pharmacological profile distinct from other flavonoids. Diosmin's anticancer mechanisms are multifaceted, involving apoptosis induction, angiogenesis inhibition, and metastasis prevention. Extensive research encompassing cellular studies, animal models, and limited clinical trials underscores its efficacy not only against cancer but also in managing chronic venous insufficiency and hemorrhoids, attributing to its anti-inflammatory properties. Furthermore, diosmin exhibits low toxicity and complements conventional chemotherapy, proposing its utility as an adjunct therapy in cancer treatment protocols. The review delves into the specific anticancer advantages of diosmin, distinguishing it from the broader flavonoid category. It provides a detailed analysis of its implications in preclinical and clinical settings, advocating for its consideration in the oncological therapeutic arsenal. By juxtaposing diosmin with other herbal medicines, the review offers a nuanced perspective on its role within the wider context of natural anticancer agents, emphasizing the need for further clinical research to substantiate its efficacy and safety in oncology.", "provenance": [ { "field": "intervention", "quote": "Diosmin, a potent bioflavonoid derived from citrus fruits" }, { "field": "population", "quote": "managing chronic venous insufficiency and hemorrhoids" }, { "field": "result", "quote": "Extensive research encompassing cellular studies, animal models, and limited clinical trials underscores its efficacy not only against cancer but also in managing chronic venous insufficiency and hemorrhoids, attributing to its anti-inflammatory properties." }, { "field": "primaryOutcome", "quote": "managing chronic venous insufficiency and hemorrhoids" } ] }, { "id": "pmid:38893547", "pmid": "38893547", "doi": "10.3390/molecules29112673", "nctId": null, "pmcid": "PMC11173953", "title": "Natural Products with Potential Effects on Hemorrhoids: A Review", "firstAuthor": "Liang", "multipleAuthors": true, "journal": "Molecules", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "natural products (plant, fungal, algal compounds) for hemorrhoids", "comparator": "", "primaryOutcome": "potential to improve hemorrhoid symptoms through effects like coagulation regulation, anti-inflammatory and tissue repair activity", "result": "the review screens natural products with potential hemorrhoid-improving activity but does not report a specific result for lemon", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review summarizing ideas about natural products rather than reporting a specific study result or trial data.", "directness": "indirect", "limitations": "Abstract does not mention lemon specifically, provides no trial data, patient numbers, or outcome measures, and is a broad conceptual review rather than original research.", "followUp": "", "plainFinding": "No specific lemon findings reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38893547/", "sourceText": "Hemorrhoid disease is a common anorectal disorder affecting populations worldwide, with high prevalence, treatment difficulties, and considerable treatment costs. Compared to other treatment options, medical therapy for hemorrhoids offers minimal harm, more dignity to patients, and is more economical. Unfortunately, there are few chemical hemorrhoid medications available clinically, which makes the search for efficacious, cost-effective, and environmentally friendly new medication classes a focal point of research. In this context, searching for available natural products to improve hemorrhoids exhibits tremendous potential. These products are derived from nature, predominantly from plants, with a minor portion coming from animals, fungi, and algae. They have excellent coagulation pathway regulation, anti-inflammatory, antibacterial, and tissue regeneration activities. Therefore, we take the view that they are a class of potential hemorrhoid drugs, prevention products, and medication add-on ingredients. This article first reviews the factors contributing to the development of hemorrhoids, types, primary symptoms, and the mechanisms of natural products for hemorrhoids. Building on this foundation, we screened natural products with potential hemorrhoid improvement activity, including polyphenols and flavonoids, terpenes, polysaccharides, and other types.", "provenance": [ { "field": "population", "quote": "Hemorrhoid disease is a common anorectal disorder affecting populations worldwide" }, { "field": "intervention", "quote": "searching for available natural products to improve hemorrhoids exhibits tremendous potential" }, { "field": "primaryOutcome", "quote": "They have excellent coagulation pathway regulation, anti-inflammatory, antibacterial, and tissue regeneration activities." }, { "field": "result", "quote": "we screened natural products with potential hemorrhoid improvement activity, including polyphenols and flavonoids, terpenes, polysaccharides, and other types." } ] }, { "id": "pmid:38847122", "pmid": "38847122", "doi": "10.1111/ans.19116", "nctId": null, "pmcid": null, "title": "Flavonoids and post haemorrhoidectomy recovery: a systematic review and meta-analysis", "firstAuthor": "Pitesa", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2024, "design": "meta-analysis", "n": 775, "nField": "reported", "population": "patients having surgery to remove haemorrhoids", "intervention": "flavonoids given after haemorrhoid surgery", "comparator": "not flavonoids", "primaryOutcome": "pain after surgery", "result": "significant decrease in post-operative pain and bleeding with flavonoids", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It pools multiple randomized trials, but it studies flavonoid supplements after haemorrhoid surgery, not lemon or hemorrhoid treatment itself.", "directness": "indirect", "limitations": "Abstract does not specify flavonoid source, dose, or route; notes further research needed to standardize regimes and explore topical administration.", "followUp": "", "plainFinding": "Less pain, less bleeding after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38847122/", "sourceText": "BACKGROUND: Haemorrhoidectomy is the gold standard for definitive treatment of high-grade symptomatic haemorrhoids but is often associated with substantial pain. This systematic review aims to explore the potential of flavonoids in alleviating the postoperative symptom burden following excisional haemorrhoidectomy. METHODS: A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42023472711). Randomized controlled trials (RCTs) published PubMed, MEDLINE, Embase, and Scopus from inception to 1st December 2023 were retrieved. The primary outcome investigated was post-operative pain. Meta-analysis was performed using Review Manager version 5.4.1. RESULTS: Ten articles with 775 patients were included. The meta-analysis identified statistically significant decreases in post-operative pain in favour of the flavonoid groups (Standardized Mean Difference -0.66 [95% confidence intervals (CI) -0.82, -0.52]; P < 0.00001), and bleeding (Odds Ratio 0.13 [95% CI 0.09, 0.19]; P < 0.00001). CONCLUSION: Flavonoids show promise as a means of reducing pain associated with excisional haemorrhoidectomy. Further research is required to investigate topical routes of administration and standardize regimes.", "provenance": [ { "field": "n", "quote": "Ten articles with 775 patients were included." }, { "field": "population", "quote": "following excisional haemorrhoidectomy" }, { "field": "intervention", "quote": "the potential of flavonoids in alleviating the postoperative symptom burden" }, { "field": "comparator", "quote": "in favour of the flavonoid groups" }, { "field": "primaryOutcome", "quote": "The primary outcome investigated was post-operative pain." }, { "field": "result", "quote": "statistically significant decreases in post-operative pain in favour of the flavonoid groups (Standardized Mean Difference -0.66 [95% confidence intervals (CI) -0.82, -0.52]; P < 0.00001), and bleeding (Odds Ratio 0.13 [95% CI 0.09, 0.19]; P < 0.00001)." } ] }, { "id": "pmid:38638945", "pmid": "38638945", "doi": "10.1016/j.heliyon.2024.e28947", "nctId": null, "pmcid": "PMC11024578", "title": "The genus Polygonum: An updated comprehensive review of its ethnomedicinal, phytochemical, pharmacological activities, toxicology, and phytopharmaceutical formulation", "firstAuthor": "Idoudi", "multipleAuthors": true, "journal": "Heliyon", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "Not a patient study; this is a review of plants in the Polygonum genus", "intervention": "Polygonum species used in traditional medicine (not lemon)", "comparator": "", "primaryOutcome": "Overview of traditional uses, chemical compounds, and pharmacological activities of Polygonum species", "result": "Hemorrhoids listed only as one of many traditional uses of Polygonum, with no specific efficacy data given for it", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review about a completely different plant genus (Polygonum) that only mentions hemorrhoids in passing as a traditional use, with no actual data about lemon or its effects on hemorrhoids.", "directness": "indirect", "limitations": "Abstract does not address lemon at all; it discusses Polygonum, an unrelated plant genus, and provides no clinical or experimental data on hemorrhoid treatment efficacy.", "followUp": "", "plainFinding": "Not about lemon at all.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38638945/", "sourceText": "Polygonum is a plant genus that includes annual and perennial species and is found at various temperatures, from northern temperate regions to tropical and subtropical areas. The genus Polygonum has been used for centuries for various disorders, including hypertension, intestinal and stomach pain, dysuria, jaundice, toothaches, skin allergies, hemorrhoids, cardiac disorders, kidney stones, hemostasis, hyperglycemia, and others. Various databases, including Google Scholar, Scifinder, ScienceDirect, PubMed, Scopus, ResearchGate, and Web of Science, were utilized to collect pertinent scientific literature data. According to bibliographic studies, the Polygonum genus possesses various compounds from different families, including phenolic acids (gallic acid, caffeic acid, quinic acid, p-coumaric acid, ferulic acid, protocatechuic acid, chlorogenic acid, and many other compounds), flavonoids (quercetin, catechin, epicatechin, quercitrin, kaempferol, myricetin, etc.), tannins, stilbenes (polydatin and resveratrol), terpenes (α-pinene, β-caryophyllene and β-caryophyllene oxide, bisabolene, β-farnesene, etc.), fatty acids (decanoic acid, lauric acid, linoleic acid, oleic acid, palmitic acid, stearic acid, dodecanoic acid), polysaccharides, and others. Various chemical and biological activities (in vitro and in vivo), such as antioxidant, antimicrobial, anticancer, antitumor, anti-inflammatory, antidiabetic, antiparasitic, hepatoprotective, neuropharmacological, gastroprotective, diuretic, antipyretic, and others, have been described in several biological studies involving this species. An updated summary of Polygonum species and their ethnomedicinal, phytochemical, toxicological, pharmacological, and phytopharmaceutical formulations is necessary. Considering the numerous potentialities of the Polygonum species and their wide-ranging use, it is extremely essential to provide knowledge by compiling the accessible literature to identify the topics of intense investigation and the main gaps to better design future studies. The objective of this review is to give readers a better understanding, greater comprehension, and in-depth knowledge of the genus Polygonum's traditional applications, phytochemistry, pharmacology, toxicological features, and galenic formulation. Several species of this genus have been detailed in this review, including those that were frequently used in traditional medicine (P. minus, P. aviculare, P. hydropiper, P. cuspidatum, and P. multiflorum) and many of the genus' therapeutic species, like P. equisetiforme, which do not get enough attention.", "provenance": [ { "field": "population", "quote": "Polygonum is a plant genus that includes annual and perennial species and is found at various temperatures, from northern temperate regions to tropical and subtropical areas." }, { "field": "intervention", "quote": "The genus Polygonum has been used for centuries for various disorders, including hypertension, intestinal and stomach pain, dysuria, jaundice, toothaches, skin allergies, hemorrhoids, cardiac disorders, kidney stones, hemostasis, hyperglycemia, and others." }, { "field": "primaryOutcome", "quote": "The objective of this review is to give readers a better understanding, greater comprehension, and in-depth knowledge of the genus Polygonum's traditional applications, phytochemistry, pharmacology, toxicological features, and galenic formulation." }, { "field": "result", "quote": "hemorrhoids, cardiac disorders, kidney stones, hemostasis, hyperglycemia, and others" } ] }, { "id": "pmid:38078787", "pmid": "38078787", "doi": "10.1002/cbdv.202301416", "nctId": null, "pmcid": null, "title": "In Silico Exploration of Potential Phytoconstituents from the Bark Extract of Boswellia serrata for Hemorrhoidal Disease: Molecular Docking and Molecular Dynamics Analysis", "firstAuthor": "Rao", "multipleAuthors": true, "journal": "Chem Biodivers", "year": 2024, "design": "lab", "n": null, "nField": "not-reported", "population": "No patients studied; this was a laboratory and computer-based study of plant extract compounds", "intervention": "Chemical compounds extracted from Boswellia serrata tree bark, tested by computer modeling against a hemorrhoid-related protein", "comparator": "A standard reference drug compound used for comparison in the computer docking analysis", "primaryOutcome": "How strongly plant compounds bind to the COX-2 protein in computer simulations, as a marker of potential anti-hemorrhoid activity", "result": "Three compounds from the bark extract (camptothecin, justicidin B, and taxiphyllin) scored better than the standard drug in computer binding simulations", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a computer-simulation and lab chemistry study with no patients, no lemon, and no testing in living animals or humans, so it cannot show whether this helps hemorrhoids in people.", "directness": "indirect", "limitations": "Purely in-vitro/in-silico (molecular docking and dynamics) study; no animal or human testing was done, and the plant studied was Boswellia serrata, not lemon.", "followUp": "", "plainFinding": "Not about lemon; unrelated plant extract studied.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38078787/", "sourceText": "Boswellia serrata Roxb. Ex Colebr is a popular medicinal plant used traditionally in herbal medicinal preparations to treat a variety of diseases. The purpose of the present investigation was to investigate the anti-hemorrhoidal property of the bark extract of B. serrata (BS). For this, the sequential Soxhlet extraction method was carried out by using different solvents such as hexane, chloroform, and methanol. After the extraction, the obtained dry extracts were tested for quantitative determinations such as total alkaloid content (TAC), total flavonoid content (TFC), total phenol content (TPC), and total tannin content (TTC) for all the extracts. Moreover, in vitro antioxidant activity was measured using 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity and scavenging activity against 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS). Methanolic bark extract showed the highest TPC (67.10±1.83), TFC (372.73±4.45), TAC (9.732±1.06), and TTC (48.932±1.82), as well as the antioxidant assays DPPH (IC50=9.88 μg/ml) and ABTS (IC50=15.09 μg/ml). In this study, both LC-MS and GC-MS were performed to identify the chemical composition of all the extracts. Consequently, 19 compounds were identified by GC-MS and 27 compounds were identified by LC-MS analysis. The identified phytoconstituent(s) that could potentially interact with the target protein cyclooxygenase-2 (COX-2) (PDB: 4RRW) using molecular dynamics simulation and in silico docking were studied. Three compounds that have passed in drug-likeness and ADME-Tox properties are having more docking score than the standard. In this study, camptothecin, justicidin B, and taxiphyllin are identified as potential lead compounds with anti-hemorrhoidal properties and may be helpful in the process of drug development and discovery of novel drugs. Hence, these results demonstrate that BS is a good source of pharmacologically active components with potential applications against hemorrhoidal disease.", "provenance": [ { "field": "population", "quote": "Boswellia serrata Roxb. Ex Colebr is a popular medicinal plant used traditionally in herbal medicinal preparations to treat a variety of diseases." }, { "field": "intervention", "quote": "the bark extract of B. serrata (BS)" }, { "field": "comparator", "quote": "Three compounds that have passed in drug-likeness and ADME-Tox properties are having more docking score than the standard." }, { "field": "primaryOutcome", "quote": "The identified phytoconstituent(s) that could potentially interact with the target protein cyclooxygenase-2 (COX-2) (PDB: 4RRW) using molecular dynamics simulation and in silico docking were studied." }, { "field": "result", "quote": "camptothecin, justicidin B, and taxiphyllin are identified as potential lead compounds with anti-hemorrhoidal properties" } ] }, { "id": "pmid:37979821", "pmid": "37979821", "doi": "10.1016/j.jep.2023.117423", "nctId": null, "pmcid": null, "title": "Wound healing potential of extract from Sambucus nigra L. leaves and its fractions", "firstAuthor": "Skowrońska", "multipleAuthors": true, "journal": "J Ethnopharmacol", "year": 2024, "design": "lab", "n": null, "nField": "not-reported", "population": "human skin cells involved in wound healing (fibroblasts, keratinocytes, and neutrophils) studied in the lab", "intervention": "elderberry (Sambucus nigra) leaf extract and its chemical fractions", "comparator": "untreated cells / different fractions of the extract", "primaryOutcome": "effect on wound healing and inflammation markers in skin cells", "result": "the extract supported wound healing and changed inflammatory signaling (TNF-α and interleukins) in cells, with the dichloromethane fraction most active", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a lab dish study on isolated skin cells, not a human trial, and it does not test lemon or hemorrhoids at all.", "directness": "indirect", "limitations": "in vitro cell-based study only; no human participants, no testing on actual hemorrhoid patients, and the substance studied is elderberry leaf extract, not lemon.", "followUp": "", "plainFinding": "Elderberry extract aided wound healing in cells", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37979821/", "sourceText": "ETHNOPHARMACOLOGICAL RELEVANCE: Sambucus nigra L. (Viburnaceae), commonly known as black elderberry, is a native species throughout Europe and Western Asia. Elderberry leaves have been used in traditional European medicine, mainly externally, to treat skin and mucosal diseases. They are usually used as decoctions for washing hemorrhoids, ulcers, insect bites, wounds, scrapes, and gingivitis. AIM OF THE STUDY: Our work aimed to scientifically verify the traditional use of the plant material in treating wounds and skin inflammations accompanied by its phytochemical characterization. MATERIALS AND METHODS: The effect of 70% (v/v) ethanolic extract and its fractions of different polarities on the inflammatory response of cells involved in wound healing (fibroblasts, keratinocytes, and neutrophils) was investigated. In addition, their effect on the migration of keratinocytes to the scratch site in an in vitro wound healing assay and their impact on the activity of the enzymes involved in skin inflammation, were assessed. The chemical composition was analyzed by UHPLC-DAD-MSn, and the structure of the isolated compounds was determined by NMR. RESULTS: The supportive effect of the elderberry leaves extract towards wound healing and modulation of the inflammatory response was demonstrated by induction of the keratinocytes. Additionally, the extract was shown to affect the cellular secretion of TNF-α and interleukins -1β, -6, and -8. Examinations of fractionated extract have shown that active principles were mainly contained in dichloromethane fraction. Eleven chemical constituents belonging to flavonoids, cyanogenic glycosides, and lignans were isolated and characterized. CONCLUSION: The beneficial effect of S. nigra leaves in treating skin diseases has been partially verified and supports its traditional use in skin ailments of different etiologies.", "provenance": [ { "field": "population", "quote": "the inflammatory response of cells involved in wound healing (fibroblasts, keratinocytes, and neutrophils)" }, { "field": "intervention", "quote": "70% (v/v) ethanolic extract and its fractions of different polarities" }, { "field": "primaryOutcome", "quote": "the effect of 70% (v/v) ethanolic extract and its fractions of different polarities on the inflammatory response of cells involved in wound healing" }, { "field": "result", "quote": "The supportive effect of the elderberry leaves extract towards wound healing and modulation of the inflammatory response was demonstrated by induction of the keratinocytes." }, { "field": "result", "quote": "Examinations of fractionated extract have shown that active principles were mainly contained in dichloromethane fraction." }, { "field": "comparator", "quote": "Examinations of fractionated extract have shown that active principles were mainly contained in dichloromethane fraction." } ] }, { "id": "pmid:37759859", "pmid": "37759859", "doi": "10.3390/brainsci13091258", "nctId": null, "pmcid": "PMC10526484", "title": "Neuroprotective Potential of Flavonoids in Brain Disorders", "firstAuthor": "Hasan", "multipleAuthors": true, "journal": "Brain Sci", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "", "intervention": "flavonoids (plant compounds, not specifically lemon)", "comparator": "", "primaryOutcome": "neuroprotection in brain disorders; hemorrhoids only mentioned in passing", "result": "abstract only mentions flavonoids being implicated as therapy for hemorrhoids among other conditions, with no specific data or findings on hemorrhoids presented", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review about flavonoids and brain health, not hemorrhoids, and gives no actual study data on hemorrhoids.", "directness": "indirect", "limitations": "The abstract does not study hemorrhoids directly, does not mention lemon specifically, and provides no data, population, or results related to hemorrhoids.", "followUp": "", "plainFinding": "No real data on hemorrhoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37759859/", "sourceText": "Flavonoids are a large subgroup of polyphenols known to be sourced from over 6000 natural products, including fruits, vegetables, bark, and herbs. Due to their antioxidant properties, flavonoids have been implicated as a therapy source for many diseases and conditions, including inflammation, vasculitis, venous insufficiency, and hemorrhoids. Currently, some flavonoids are being researched for their antioxidant ability concerning neuroprotection. These flavonoids can penetrate the blood-brain barrier and, depending on the specific flavonoid, retain adequate bioavailability in certain brain regions. Further data suggest that flavonoids could have a strong anti-inflammatory effect in the brain, which not only could be a robust therapeutic source for known neuroinflammatory diseases such as Alzheimer's Disease or Parkinson's Disease but also could be a therapeutic source for ischemic or hemorrhagic conditions such as a stroke. While flavonoid toxicity exists, they are relatively safe and non-invasive drugs from natural origins. As such, exploring the known mechanisms and therapies may highlight and establish flavonoid therapy as a viable source of therapy for stroke patients. As stated, many flavonoids are already being isolated, purified, and implemented in both in vitro and in vivo experiments. As these flavonoids proceed to clinical trials, it will be important to understand how they function as a therapy, primarily as antioxidants, and by other secondary mechanisms. This review aims to elucidate those mechanisms and explore the neuroprotective role of flavonoids.", "provenance": [ { "field": "intervention", "quote": "flavonoids have been implicated as a therapy source for many diseases and conditions, including inflammation, vasculitis, venous insufficiency, and hemorrhoids" }, { "field": "result", "quote": "flavonoids have been implicated as a therapy source for many diseases and conditions, including inflammation, vasculitis, venous insufficiency, and hemorrhoids" }, { "field": "primaryOutcome", "quote": "This review aims to elucidate those mechanisms and explore the neuroprotective role of flavonoids." } ] }, { "id": "pmid:37478119", "pmid": "37478119", "doi": "10.1371/journal.pone.0289117", "nctId": null, "pmcid": "PMC10361473", "title": "Investigation of anti-proliferative and anti-angiogenic properties of Parkia javanica bark and fruit extracts in zebrafish", "firstAuthor": "Dhakal", "multipleAuthors": true, "journal": "PLoS One", "year": 2023, "design": "lab", "n": null, "nField": "not-reported", "population": "Zebrafish embryos (not human patients or hemorrhoid patients)", "intervention": "Parkia javanica bark and fruit extracts", "comparator": "", "primaryOutcome": "Anti-proliferative and anti-angiogenic effects (cell growth and blood vessel formation)", "result": "Fruit extract showed stronger anti-proliferative and anti-angiogenic effects than bark extract, with lower toxicity", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a preliminary lab study in zebrafish embryos, not humans, and does not test hemorrhoids directly.", "directness": "indirect", "limitations": "Preliminary animal/lab study only; not tested in humans or for hemorrhoid treatment specifically.", "followUp": "", "plainFinding": "Lab study, not about hemorrhoids directly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37478119/", "sourceText": "The use of herbal products as traditional medicines has been a practice in India for centuries. Due to high ethnic diversity, the pool of herbal medicines is enormous, and they are often preferred over modern medicines in certain parts of the country. Cancer is one of the major non-communicable diseases affecting people worldwide. Despite considerable research, cancer is a disease that is still not understood completely, and there have been constant efforts towards the identification of novel drugs or approaches in cancer management. Parkia javanica, an important medicinal plant and a rich source of flavonoids and terpenoids, is widely studied for its antioxidant and anti-inflammatory activities. Traditionally, the fruit and bark extracts of P. javanica find use as home remedy for dysentery and piles in NE India. Moreover, the fruits are consumed by the people of North-East (NE) India as vegetables, either in steamed or cooked form. In this study, crude extracts of P. javanica fruit and bark were obtained, the sub-lethal dose was determined and were then analyzed for anti-proliferative and anti-angiogenic properties using a battery of assays in zebrafish embryos. The sub-lethal concentration 50 (LC50) was found to be 28.66 mg/L and 346.66 mg/L for bark and fruit extract respectively, indicating a decreased toxicity of the fruit extract compared to that of the bark. The anti-proliferative and anti-angiogenic properties were more pronounced for the fruit extract compared to the bark extract. Although preliminary, the results of the study suggest that P. javanica fruits possess potent anti-angiogenic and anti-proliferative properties, which can be further studied for the isolation of active phytochemicals for use as therapeutic agents.", "provenance": [ { "field": "population", "quote": "analyzed for anti-proliferative and anti-angiogenic properties using a battery of assays in zebrafish embryos" }, { "field": "intervention", "quote": "crude extracts of P. javanica fruit and bark were obtained" }, { "field": "primaryOutcome", "quote": "analyzed for anti-proliferative and anti-angiogenic properties using a battery of assays in zebrafish embryos" }, { "field": "result", "quote": "The anti-proliferative and anti-angiogenic properties were more pronounced for the fruit extract compared to the bark extract." } ] }, { "id": "pmid:36432034", "pmid": "36432034", "doi": "10.3390/molecules27227933", "nctId": null, "pmcid": "PMC9696987", "title": "Citroflavonoids as Promising Agents for Drug Discovery in Diabetes and Hypertension: A Systematic Review of Experimental Studies", "firstAuthor": "Ortiz-Andrade", "multipleAuthors": true, "journal": "Molecules", "year": 2022, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "animal models used to study diabetes and high blood pressure (not hemorrhoid patients)", "intervention": "citrus plant compounds called citroflavonoids (mainly naringenin and hesperetin)", "comparator": "", "primaryOutcome": "effectiveness of citroflavonoids for diabetes and hypertension in animal studies", "result": "studies were too varied in methods and outcomes to draw clear conclusions; more research is needed", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this review looked at animal studies for diabetes and blood pressure, not hemorrhoids, and found the evidence too inconsistent to draw conclusions.", "directness": "indirect", "limitations": "abstract reports high heterogeneity in outcomes and methodology across the 29 studies analyzed, and states more investigation is needed.", "followUp": "", "plainFinding": "Does not address hemorrhoids directly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36432034/", "sourceText": "Flavonoids are naturally occurring compounds widely distributed in the Citrus genus. These natural compounds have many health benefits, mainly for metabolic and cardiovascular diseases. In fact, some these compounds are components of drug products with approved indications for peripheral vascular insufficiency and hemorrhoids. However, information on pharmacological effects of these compounds remains disperse and there is scarce comprehensive analysis of whole data and evidence. These kinds of evidence analyses could be necessary in drug design and the development of novel and innovate drug products in diabetes and hypertension. We aimed to systematically search for evidence on the efficacy of citroflavonoids in diabetes and hypertension in in vivo models. We searched four literature databases based on a PICO strategy. After database curation, twenty-nine articles were retrieved to analyze experimental data. There was high heterogeneity in both outcomes and methodology. Naringenin and hesperetin derivates were the most studied citroflavonoids in both experimental models. More investigation is still needed to determine its potential for drug design and development.", "provenance": [ { "field": "population", "quote": "efficacy of citroflavonoids in diabetes and hypertension in in vivo models" }, { "field": "intervention", "quote": "Naringenin and hesperetin derivates were the most studied citroflavonoids in both experimental models" }, { "field": "primaryOutcome", "quote": "We aimed to systematically search for evidence on the efficacy of citroflavonoids in diabetes and hypertension in in vivo models" }, { "field": "result", "quote": "There was high heterogeneity in both outcomes and methodology." }, { "field": "result", "quote": "More investigation is still needed to determine its potential for drug design and development." } ] }, { "id": "pmid:35883849", "pmid": "35883849", "doi": "10.3390/antiox11071358", "nctId": null, "pmcid": "PMC9311623", "title": "A Comprehensive Review of C. capsularis and C. olitorius: A Source of Nutrition, Essential Phytoconstituents and Pharmacological Activities", "firstAuthor": "Biswas", "multipleAuthors": true, "journal": "Antioxidants (Basel)", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "not a patient study; this is a review of Corchorus capsularis and olitorius plants", "intervention": "Corchorus plant compounds (leaves, stem, seed, root), not lemon", "comparator": "", "primaryOutcome": "general pharmacological properties (antitumor, antioxidant, anti-inflammatory, etc.)", "result": "mentions traditional use of the plant for piles among many other conditions, but reports no study data on lemon or hemorrhoids", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review of an unrelated plant's phytochemistry and does not test lemon or hemorrhoids with any clinical data", "directness": "indirect", "limitations": "abstract does not describe lemon at all; it only lists traditional folk uses of a different plant including piles, with no clinical evidence presented", "followUp": "", "plainFinding": "No evidence on lemon at all", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35883849/", "sourceText": "Plant bioactive compounds have gained global significance in terms of both medicinal and economic ramifications due to being easily accessible and are believed to be effective with fewer side effects. Growing relevant clinical and scientific evidence has become an important criterion for accepting traditional health claims of medicinal plants and also supports the traditional uses of Corchorus as folk medicine. C. capsularis and C. olitorius have broad applications ranging from textile to biocomposite, and young leaves and shoots are used as healthy vegetables and have long been used as traditional remedies for fever, ascites, algesia, liver disorders, piles, and tumors in many cultures. This review systematically summarized and emphasized the nutritional attributes, mostly available bioactive compounds, and biological and potential pharmaceutical properties of C. capsularis and C. olitorius, disclosed to users and non-users. Results suggest that various phytochemicals such as cardiac glycosides, phenols, flavonoids, sterols, lipids, and fatty acids were found or analytically identified in different plant parts (leaf, stem, seed, and root), and many of them are responsible for pharmacological properties and their antitumor, anticancer, antioxidant, antinociceptive, anti-inflammatory, analgesic, antipyretic, antiviral, antibacterial, anticonvulsant, antidiabetic and antiobesity, and cardiovascular properties help to prevent and cure many chronic diseases. In addition to their use in traditional food and medicine, their leaves have also been developed for skin care products, and some other possible uses are described. From this review, it is clear that the isolated compounds of both species have great potential to prevent and treat various diseases and be used as functional foods. In conclusion, this comprehensive review establishes a significant reference base for future research into various medical and functional food applications.", "provenance": [ { "field": "intervention", "quote": "C. capsularis and C. olitorius have broad applications ranging from textile to biocomposite" }, { "field": "population", "quote": "This review systematically summarized and emphasized the nutritional attributes, mostly available bioactive compounds, and biological and potential pharmaceutical properties of C. capsularis and C. olitorius" }, { "field": "result", "quote": "young leaves and shoots are used as healthy vegetables and have long been used as traditional remedies for fever, ascites, algesia, liver disorders, piles, and tumors in many cultures" }, { "field": "primaryOutcome", "quote": "antitumor, anticancer, antioxidant, antinociceptive, anti-inflammatory, analgesic, antipyretic, antiviral, antibacterial, anticonvulsant, antidiabetic and antiobesity, and cardiovascular properties" } ] }, { "id": "pmid:35334594", "pmid": "35334594", "doi": "10.3390/medicina58030418", "nctId": null, "pmcid": "PMC8955987", "title": "Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review", "firstAuthor": "Lohsiriwat", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2022, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people having surgery to remove hemorrhoids", "intervention": "various pain-reducing methods used during or after hemorrhoid surgery (anesthesia choices, surgical techniques, topical creams, oral medicines)", "comparator": "a different intervention, a sham treatment, or a placebo", "primaryOutcome": "pain after hemorrhoid removal surgery", "result": "Several anesthesia methods, surgical techniques, and topical or oral treatments reduced pain after hemorrhoid surgery; lemon is not mentioned anywhere in the abstract as a treatment studied.", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It is a systematic review of randomized trials, but it looks at surgical pain-control methods, not lemon, so it cannot tell us whether lemon helps hemorrhoids.", "directness": "indirect", "limitations": "The abstract does not study lemon at all; it covers pain after hemorrhoidectomy surgery using other pharmacological and surgical methods.", "followUp": "", "plainFinding": "Studied other treatments, not lemon.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35334594/", "sourceText": "Background and Objectives: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Materials and Methods: The databases of Ovid MEDLINE, PubMed and EMBASE were systematically searched for randomized controlled trails (published in English language with full-text from 1981 to 30 September 2021) to include comparative studies examining post-hemorrhoidectomy pain as their primary outcomes between an intervention and another intervention (or a sham or placebo). Results: Some 157 studies were included in this review with additional information from 15 meta-analyses. Fundamentally, strategies to reduce post-hemorrhoidectomy pain were categorized into four groups: anesthetic methods, surgical techniques, intraoperative adjuncts, and postoperative interventions. In brief, local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy. Regarding surgical techniques, closed (Ferguson) hemorrhoidectomy performed with a vascular sealing device or an ultrasonic scalpel was recommended. Lateral internal anal sphincterotomy may be performed as a surgical adjunct to reduce post-hemorrhoidectomy pain, although it increased risks of anal incontinence. Chemical sphincterotomy (botulinum toxin, topical calcium channel blockers, and topical glyceryl trinitrate) was also efficacious in reducing postoperative pain. So were other topical agents such as anesthetic cream, 10% metronidazole ointment, and 10% sucralfate ointment. Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain. Conclusions: This systematic review comprehensively covers evidence-based strategies to reduce pain after excisional hemorrhoidectomy. Areas for future research on this topic are also addressed at the end of this article.", "provenance": [ { "field": "design", "quote": "This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain." }, { "field": "population", "quote": "Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids." }, { "field": "intervention", "quote": "pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain" }, { "field": "comparator", "quote": "between an intervention and another intervention (or a sham or placebo)" }, { "field": "primaryOutcome", "quote": "post-hemorrhoidectomy pain as their primary outcomes" }, { "field": "result", "quote": "local anesthesia-alone or combined with intravenous sedation was the most effective anesthetic method for excisional hemorrhoidectomy" }, { "field": "result", "quote": "Postoperative administration of oral metronidazole, flavonoids, and laxatives was associated with a significant reduction in post-hemorrhoidectomy pain." } ] }, { "id": "pmid:34057643", "pmid": "34057643", "doi": "10.1007/s10151-021-02465-0", "nctId": null, "pmcid": null, "title": "Benefits of flavonoid and metronidazole use after excisional hemorrhoidectomy: a randomized double-blind clinical trial", "firstAuthor": "Rabelo", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2021, "design": "rct", "n": 68, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids", "intervention": "flavonoid supplement and/or metronidazole antibiotic after surgery", "comparator": "placebo", "primaryOutcome": "pain, bleeding, swelling, itching and straining after surgery", "result": "less severe pain and less bleeding in groups given flavonoids", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a well-designed double-blind randomized trial but very small, with only 17 patients per group.", "directness": "indirect", "limitations": "small group sizes (17 per group) and studies a different intervention (flavonoid supplement plus antibiotic) and population (post-surgical patients) than plain lemon use for hemorrhoids", "followUp": "30 days", "plainFinding": "Less pain, bleeding after hemorrhoid surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34057643/", "sourceText": "BACKGROUND: Excisional hemorrhoidectomy remains the most effective treatment for a significant group of patients with hemorrhoids, despite the potential for postoperative pain. The purpose of this study was to evaluate the effects of flavonoid and metronidazole use in the postoperative period on patients undergoing excisional hemorrhoidectomy. METHODS: A double-blind randomized clinical study was performed. Sixty-eight patients underwent excisional hemorrhoidectomy and were randomized into 4 groups of 17 patients each to receive double-placebo (G1), metronidazole plus placebo (G2), flavonoids plus placebo (G3) or metronidazole plus flavonoids (G4) in the postoperative period. A standard analgesic protocol was offered equally for all groups. Postoperative pain, bleeding, edema, pruritus and tenesmus were evaluated during the following three periods: from immediately after the operation until postoperative day (POD)7, from POD 8 to POD 14, and from POD 15 to POD 30. The patients were required to complete symptom questionnaires and to attend postoperative follow-up on PODs 7, 14 and 30. The effect of each drug was assessed for each symptom, and the groups were compared with each other and over time. RESULTS: There was less severe pain in all postoperative periods in the groups using flavonoids (G3 and G4, both p < 0.0001), with an observed synergistic effect of flavonoids combined with metronidazole during the first 14 days after surgery (p < 0.0001). Flavonoid use was also associated with decreased bleeding (G3, p = 0.031 and G4, p = 0.016) between the first and second postoperative weeks CONCLUSIONS: The use of flavonoids alone and in combination with metronidazole resulted in a reduction of most symptoms, particularly pain, after excisional hemorrhoidectomy. TRIAL REGISTRATION: The present study was registered in the SISNEP (document CAAE-0035.0.240.000-11), after approval by the research ethics committee (CEP) of the Hospital Felício Rocho (protocol nº393 / 11).", "provenance": [ { "field": "n", "quote": "Sixty-eight patients underwent excisional hemorrhoidectomy and were randomized into 4 groups of 17 patients each" }, { "field": "population", "quote": "patients undergoing excisional hemorrhoidectomy" }, { "field": "intervention", "quote": "receive double-placebo (G1), metronidazole plus placebo (G2), flavonoids plus placebo (G3) or metronidazole plus flavonoids (G4) in the postoperative period" }, { "field": "comparator", "quote": "double-placebo (G1)" }, { "field": "primaryOutcome", "quote": "Postoperative pain, bleeding, edema, pruritus and tenesmus were evaluated" }, { "field": "result", "quote": "There was less severe pain in all postoperative periods in the groups using flavonoids (G3 and G4, both p < 0.0001)" }, { "field": "result", "quote": "Flavonoid use was also associated with decreased bleeding (G3, p = 0.031 and G4, p = 0.016) between the first and second postoperative weeks" } ] }, { "id": "pmid:33217516", "pmid": "33217516", "doi": "10.1016/j.jep.2020.113593", "nctId": null, "pmcid": null, "title": "Gmelina arborea- an indigenous timber species of India with high medicinal value: A review on its pharmacology, pharmacognosy and phytochemistry", "firstAuthor": "Warrier", "multipleAuthors": true, "journal": "J Ethnopharmacol", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with various ailments, based on traditional medicine use", "intervention": "Gmelina arborea (an unrelated timber tree, not lemon) whole plant preparations", "comparator": "none reported", "primaryOutcome": "traditional medicinal uses and pharmacological activities of Gmelina arborea", "result": "the plant is traditionally described as useful for several conditions including piles, but no studies or data on lemon or hemorrhoids are reported", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a traditional-use review of a different plant with no clinical studies, data, or methodology for treating hemorrhoids presented", "directness": "indirect", "limitations": "abstract does not describe any clinical trial, mechanism study, or data specific to hemorrhoids; it only lists traditional uses of an unrelated plant species", "followUp": "", "plainFinding": "Not about lemon; no evidence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33217516/", "sourceText": "ETHNOPHARMACOLOGICAL SIGNIFICANCE: Gmelina arborea Roxb.ex Smith, a fast-growing deciduous tree belongs to the family Lamiaceae, and is an important plantation species in many tropical areas around the world. The species is naturally distributed in semi-deciduous forests in tropical/subtropical regions of South East Asia. The tree is also an important medicinal plant in the Indian Systems of Medicine. The whole plant is used in medicine. It is astringent, bitter, digestive, cardiotonic, diuretic, laxative and pulmonary and nervine tonic. It improves digestion, memory, helps overcome giddiness and is useful in burning sensation, fever, thirst, emaciation, heart diseases, nervous disorders and piles. The roots are acrid, bitter-sweet in taste, stomachic, tonic, laxative, galactagogue and antihelmintic. The flowers are sweet, refrigerant, bitter, astringent and acrid, and are used in treating leprosy and skin diseases. The fruits are acrid, sour, sweet, refrigerant, bitter, astringent, aphrodisiac, trichogenous, alterant and tonic. Fruits are edible and also used for promoting hair growth and in treating anaemia, leprosy, ulcers, constipation, leucorrhoea and colitis. The leaves are a good fodder also. The major bioactive compounds extracted from different parts of G. arborea are arboreal, verbascoside, tyrosol, iridoids, phenylpropanoid glycoside, premnazole, martynoside, iridoid glycosides, balanophonin, gmelinol, isoarboreol apigenin, umbelliferone etc. AIM OF THE REVIEW: This review provides an insight into the medicinal aspects of G. arborea. It provides the latest information on phytochemistry, pharmacological activities and traditional uses of G.arborea. MATERIALS AND METHODS: Information on G. arborea was gathered from various sources like textbooks, literature, databases such as PubMed, Science Direct, Wiley, Springer, Taylor and Francis, Scopus, Inflibnet, Sci-Finder and Google Scholar. RESULTS: Sixty-nine phytochemicals which include lignans, acylated iridoid glycosides, acylated rhamnopyranoses, flavonoids, flavones, flavone glycosides have been isolated. Many of them have been characterized for their pharmacological activity. Several researchers have identified bioactive phytochemicals like luteolin, iridoid alkaloids from the leaves, hentriacontanol and lignans such as arboreol, isoarboreol, arborone, gmelanone, gummadiol from the heartwood, flavon glycosides in roots. The extracts are reported to have wound-healing and antidiarrheal properties. Various studies demonstrated that G.arborea and its constituents possess several pharmacological activities like anti-oxidant, anti-diabetic, anti-inflammatory, antiulcer, analgesic, anti-nociceptive, anticancer and wound healing activities. CONCLUSION: G. arborea is a valuable medicinal plant used traditionally in the Indian Systems of Medicine (ISM - Ayurveda and Unani) to treat a wide variety of ailments. These phytochemicals are highly bioactive and exhibit various pharmacological activities. However, pharmacological activities of many compounds which have been identified, are yet to be understood.", "provenance": [ { "field": "population", "quote": "The whole plant is used in medicine." }, { "field": "intervention", "quote": "Gmelina arborea Roxb.ex Smith, a fast-growing deciduous tree belongs to the family Lamiaceae" }, { "field": "comparator", "quote": "MATERIALS AND METHODS: Information on G. arborea was gathered from various sources like textbooks, literature, databases such as PubMed, Science Direct, Wiley, Springer, Taylor and Francis, Scopus, Inflibnet, Sci-Finder and Google Scholar." }, { "field": "primaryOutcome", "quote": "This review provides an insight into the medicinal aspects of G. arborea." }, { "field": "result", "quote": "It improves digestion, memory, helps overcome giddiness and is useful in burning sensation, fever, thirst, emaciation, heart diseases, nervous disorders and piles." } ] }, { "id": "pmid:32953352", "pmid": "32953352", "doi": "10.7759/cureus.9845", "nctId": null, "pmcid": "PMC7497765", "title": "Calcium Dobesilate Versus Flavonoids for the Treatment of Early Hemorrhoidal Disease: A Randomized Controlled Trial", "firstAuthor": "Changazi", "multipleAuthors": true, "journal": "Cureus", "year": 2020, "design": "rct", "n": null, "nField": "not-reported", "population": "adults with early (grade I or II) hemorrhoids", "intervention": "flavonoid therapy", "comparator": "calcium dobesilate treatment", "primaryOutcome": "change in bleeding frequency/amount and hemorrhoid size after treatment", "result": "flavonoids reduced bleeding and hemorrhoid size in more patients than calcium dobesilate did", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The study does not report the total number of participants, uses only a four-week follow-up, and gives no detail on randomization or blinding, so it's hard to trust the size of the effect.", "directness": "indirect", "limitations": "No total sample size reported, short follow-up period, and no mention of blinding or randomization method.", "followUp": "four week", "plainFinding": "Flavonoids helped more than calcium dobesilate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32953352/", "sourceText": "Background and Aim Early hemorrhoidal disease is usually treated conservatively with fiber diet and medical therapy with flavonoids or calcium dobesilate. The purpose of this study was to compare the efficacy of these two agents in the treatment of early hemorrhoidal disease. Materials and Methods Patients having grade I and grade II hemorrhoidal disease were recruited in the study. One group received flavonoid therapy and the other group took calcium dobesilate treatment for three weeks. The symptoms and size of hemorrhoids were then assessed at the fourth week. Results In this study, 70.2% of patients were male and 29.8% of patients were female. Of the total patients, 58.65% of patients were below 45 years of age and 41.34% of patients were above 45 years of age. Moreover, 83.65% of patients had grade II hemorrhoids, whereas 16.34% of patients had grade I hemorrhoids; 80.8% of patients showed a decrease in frequency and amount of bleeding after being treated by flavonoids, whereas 67.3% showed a decrease in frequency and amount of bleeding after administration of calcium dobesilate. A decrease in the size of hemorrhoids was seen in 67.3% of patients after treatment with flavonoids and 38.46% after giving calcium dobesilate. Conclusions Treatment of early hemorrhoidal with flavonoid therapy was more effective in improving the symptoms of disease as compared to calcium dobesilate treatment.", "provenance": [ { "field": "population", "quote": "Patients having grade I and grade II hemorrhoidal disease were recruited in the study." }, { "field": "intervention", "quote": "One group received flavonoid therapy" }, { "field": "comparator", "quote": "the other group took calcium dobesilate treatment for three weeks" }, { "field": "primaryOutcome", "quote": "The symptoms and size of hemorrhoids were then assessed at the fourth week." }, { "field": "result", "quote": "80.8% of patients showed a decrease in frequency and amount of bleeding after being treated by flavonoids, whereas 67.3% showed a decrease in frequency and amount of bleeding after administration of calcium dobesilate." }, { "field": "followUp", "quote": "assessed at the fourth week" } ] }, { "id": "pmid:29934701", "pmid": "29934701", "doi": "10.1007/s00384-018-3102-y", "nctId": null, "pmcid": null, "title": "Flavonoid mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) in the treatment of I-III degree hemorroidal disease: a double-blind multicenter prospective comparative study", "firstAuthor": "Corsale", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2018, "design": "rct", "n": 154, "nField": "reported", "population": "patients with grade I-III hemorrhoidal disease", "intervention": "flavonoid mixture of diosmin, troxerutin, rutin, hesperidin, and quercetin", "comparator": "a different flavonoid mixture (diosmin, hesperidin, diosmetin, isoroifolin, linarin in micronized fraction)", "primaryOutcome": "bleeding from hemorrhoidal disease", "result": "bleeding improved similarly in both groups with no significant difference, though satisfaction was higher with the study mixture", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized, double-blind, multicenter trial but compared two active flavonoid products rather than a placebo, and is not a direct test of lemon.", "directness": "indirect", "limitations": "the abstract does not mention lemon as an ingredient or comparator, and the trial compares two flavonoid supplement mixtures rather than lemon itself", "followUp": "6 months", "plainFinding": "No difference between flavonoid mixtures", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29934701/", "sourceText": "PURPOSE: We evaluated the efficacy of new flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) to reduce bleeding from I-III degrees hemorrhoidal disease in the short and medium time. METHODS: One hundred fifty-four consecutive patients with hemorrhoidal disease recruited in four colorectal units were enrolled to the study. Exclusion criteria were allergy to the flavonoids, inflammatory bowel disease, obstructed defecation syndrome, pregnancy and puerperium, associated anal disease or hemorrhoidal thrombosis, proctologic surgical procedures within 1 year before recruitment, contemporary cancer or HIV, previous pelvic radiotherapy, patients receiving oral anticoagulant therapy, or contemporary administration of other therapy for hemorrhoids. Patients with inability to understand the study or mental disorders were also excluded. RESULTS: Seventy-eight were randomized to receive the mixture of diosmin, troxerutin, rutin, hesperidin, and quercetin (study group, SG), and 76 a mixture of diosmin in combination with hesperidin, diosmetin, isoroifolin, and linarin in purified micronized fraction (control group, CG). Bleeding, number of pathological piles, and Golligher's grade were assessed at each scheduled visit and compared using the Chi-square test. During the study period, bleeding improved after 1 and 6 months both in the SG (79.5 and 70.5%) and in the CG (80.2 and 75%) without significant differences between two groups. Satisfaction degree after 6 months was greater in the patients of the SG (4.05) towards the CG (3.25): this result was statistical significant (p 0.003). CONCLUSIONS: Use of flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) is a safe and effective mean of managing bleeding from hemorrhoidal disease and minimal adverse events are reported.", "provenance": [ { "field": "n", "quote": "One hundred fifty-four consecutive patients with hemorrhoidal disease recruited in four colorectal units were enrolled to the study." }, { "field": "population", "quote": "patients with hemorrhoidal disease" }, { "field": "intervention", "quote": "the mixture of diosmin, troxerutin, rutin, hesperidin, and quercetin (study group, SG)" }, { "field": "comparator", "quote": "a mixture of diosmin in combination with hesperidin, diosmetin, isoroifolin, and linarin in purified micronized fraction (control group, CG)" }, { "field": "primaryOutcome", "quote": "We evaluated the efficacy of new flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) to reduce bleeding from I-III degrees hemorrhoidal disease" }, { "field": "result", "quote": "bleeding improved after 1 and 6 months both in the SG (79.5 and 70.5%) and in the CG (80.2 and 75%) without significant differences between two groups" }, { "field": "result", "quote": "Satisfaction degree after 6 months was greater in the patients of the SG (4.05) towards the CG (3.25): this result was statistical significant (p 0.003)" } ] }, { "id": "pmid:27085938", "pmid": "27085938", "doi": "10.1016/j.jep.2016.04.014", "nctId": null, "pmcid": null, "title": "Local and traditional uses, phytochemistry, and pharmacology of Sophora japonica L.: A review", "firstAuthor": "He", "multipleAuthors": true, "journal": "J Ethnopharmacol", "year": 2016, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People in traditional Chinese medicine who use the plant Sophora japonica for various ailments, including hemorrhoids", "intervention": "Flower buds and fruits of Sophora japonica (traditional herbal remedy), not lemon", "comparator": "No comparison group reported; this is a narrative review of traditional uses and lab/animal studies, not a controlled trial", "primaryOutcome": "Review of the plant's traditional uses, chemical makeup, and biological effects, including its historical use for hemorrhoids", "result": "About 153 chemicals were isolated from the plant and showed various biological effects (anti-inflammatory, antibacterial, antioxidant, hemostatic, etc.) in lab and animal studies, but no clinical outcome data for hemorrhoids were given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a traditional-use and lab-based review of an unrelated plant (Sophora japonica), not lemon, and includes no clinical trial evidence for hemorrhoid treatment.", "directness": "indirect", "limitations": "Information on evaluating the safety of S. japonica is very limited, so further study is required; no clinical trials on hemorrhoids are reported.", "followUp": "", "plainFinding": "Different plant studied, not lemon, no clinical evidence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27085938/", "sourceText": "ETHNOPHARMACOLOGICAL RELEVANCE: Sophora japonica (Fabaceae), also known as Huai (Chinese: ), is a medium-sized deciduous tree commonly found in China, Japan, Korea, Vietnam, and other countries. The use of this plant has been recorded in classical medicinal treatises of ancient China, and it is currently recorded in both the Chinese Pharmacopoeia and European Pharmacopoeia. The flower buds and fruits of S. japonica, also known as Flos Sophorae Immaturus and Fructus Sophorae in China, are most commonly used in Asia (especially in China) to treat hemorrhoids, hematochezia, hematuria, hematemesis, hemorrhinia, uterine or intestinal hemorrhage, arteriosclerosis, headache, hypertension, dysentery, dizziness, and pyoderma. To discuss feasible trends for further research on S. japonica, this review highlights the botany, ethnopharmacology, phytochemistry, biological activities, and toxicology of S. japonica based on studies published in the last six decades. MATERIALS AND METHODS: Information on the S. japonica was collected from major scientific databases (SciFinder, PubMed, Elsevier, SpringerLink, Web of Science, Google Scholar, Medline Plus, China Knowledge Resource Integrated (CNKI), and \"Da Yi Yi Xue Sou Suo (http://www.dayi100.com/login.jsp)\" for publications between 1957 and 2015 on S. japonica. Information was also obtained from local classic herbal literature, government reports, conference papers, as well as PhD and MSc dissertations. RESULTS: Approximately 153 chemical compounds, including flavonoids, isoflavonoids, triterpenes, alkaloids, polysaccharides, amino acids, and other compounds, have been isolated from the leaves, branches, flowers, buds, pericarps, and/or fruits of S. japonica. Among these compounds, several flavonoids and isoflavonoids comprise the active constituents of S. japonica, which exhibit a wide range of biological activities in vitro and in vivo such as anti-inflammatory, antibacterial, antiviral, anti-osteoporotic, antioxidant, radical scavenging, antihyperglycemic, antiobesity, antitumor, and hemostatic effects. Furthermore, flavonoids and isoflavonoids can be used as quality control markers for quality identification and evaluation of medicinal materials and their preparations. Information on evaluating the safety of S. japonica is very limited, so further study is required. To enable safer, more effective, and controllable therapeutic preparations, more in-depth information is urgently needed on the quality control, toxicology data, and clinical value of crude extract and active compounds of S. japonica. CONCLUSIONS: S. japonica has long been used in traditional Chinese medicine (TCM) due to its wide range of biological activities, and is administered orally. Phytochemical and pharmacological studies of S. japonica have increased in the past few years, and the extract and active components of this plant can be used to develop new drugs based on their traditional application as well as their biological activities. Therefore, this review on the ethnopharmacology, phytochemistry, biological activities, and toxicity of S. japonica offers promising data for further studies as well as the commercial exploitation of this traditional medicine.", "provenance": [ { "field": "population", "quote": "to treat hemorrhoids, hematochezia, hematuria, hematemesis, hemorrhinia, uterine or intestinal hemorrhage, arteriosclerosis, headache, hypertension, dysentery, dizziness, and pyoderma" }, { "field": "intervention", "quote": "The flower buds and fruits of S. japonica, also known as Flos Sophorae Immaturus and Fructus Sophorae in China, are most commonly used in Asia (especially in China) to treat hemorrhoids" }, { "field": "comparator", "quote": "this review highlights the botany, ethnopharmacology, phytochemistry, biological activities, and toxicology of S. japonica based on studies published in the last six decades" }, { "field": "primaryOutcome", "quote": "this review highlights the botany, ethnopharmacology, phytochemistry, biological activities, and toxicology of S. japonica based on studies published in the last six decades" }, { "field": "result", "quote": "Approximately 153 chemical compounds, including flavonoids, isoflavonoids, triterpenes, alkaloids, polysaccharides, amino acids, and other compounds, have been isolated from the leaves, branches, flowers, buds, pericarps, and/or fruits of S. japonica." }, { "field": "result", "quote": "exhibit a wide range of biological activities in vitro and in vivo such as anti-inflammatory, antibacterial, antiviral, anti-osteoporotic, antioxidant, radical scavenging, antihyperglycemic, antiobesity, antitumor, and hemostatic effects." } ] }, { "id": "pmid:27069720", "pmid": "27069720", "doi": "10.5455/jice.20151211063819", "nctId": null, "pmcid": "PMC4805145", "title": "Gastrokinetic activity of Amorphophallus paeoniifolius tuber in rats", "firstAuthor": "Dey", "multipleAuthors": true, "journal": "J Intercult Ethnopharmacol", "year": 2016, "design": "animal", "n": null, "nField": "not-reported", "population": "rats", "intervention": "Amorphophallus paeoniifolius (suran) tuber extract given by mouth", "comparator": "a standard prokinetic drug (metoclopramide)", "primaryOutcome": "gut movement measures: amount of stool, stomach emptying speed, and intestinal transit time", "result": "the tuber extract increased stool output, sped up stomach emptying, and increased intestinal transit, similar to the reference drug", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small animal study on a different plant (not lemon), so it offers little direct evidence for the question asked.", "directness": "indirect", "limitations": "Animal (rat) study only, extract was from a different plant (Amorphophallus paeoniifolius, not lemon), and exact number of animals is not stated in the abstract.", "followUp": "7 days", "plainFinding": "Faster gut movement in rats (unrelated plant).", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27069720/", "sourceText": "AIM: The tuber of Amorphophallus paeoniifolius (Family-Araceae), commonly called suran or jimikand, has medicinal and food value. It is used in ethnomedicinal practices for correction of gastrointestinal disturbances such as constipation and hemorrhoids. The present study evaluated the effect of A. paeoniifolius tuber on gastrointestinal motor functions. MATERIALS AND METHODS: The tuber was collected in December 2011, and its methanolic extract was standardized with the major phenolic compound, betulinic acid, by high-performance liquid chromatography. Rats were orally administered methanolic (APME) or aqueous (APAE) extract (250 and 500 mg/kg, each) of tuber for 7 days. Metoclopramide (MET) (3 mg/kg, orally) was used a reference prokinetic drug. The gastrointestinal parameters viz. number of feces, wet and dry weight and moisture content of feces, gastric emptying, and intestinal transit were evaluated. The isolated tissue preparations were used to check the effect of the extracts on fundus and intestinal contractility. The glucomannan and total phenolic and flavonoid contents were determined spectrophotometrically. RESULTS: The pre-treatment of extracts significantly increased the number of feces, wet and dry weight of feces, moisture content, gastric emptying, and intestinal transit. Results were comparable to MET. Further, APME and APAE showed a contraction of fundus and ileum in isolated preparations. APME and APAE were also found to have fair amount of glucomannan, total phenolics, and flavonoids. The results indicate the gastrokinetic potential of the tuber extracts. This may be attributed to the presence of glucomannan and betulinic acid present in the extracts. CONCLUSION: In conclusion, the tuber of A. paeoniifolius exhibits gastrokinetic activity and substantiates its traditional use in gastrointestinal motor disturbances.", "provenance": [ { "field": "population", "quote": "Rats were orally administered methanolic (APME) or aqueous (APAE) extract" }, { "field": "intervention", "quote": "methanolic extract was standardized with the major phenolic compound, betulinic acid" }, { "field": "comparator", "quote": "Metoclopramide (MET) (3 mg/kg, orally) was used a reference prokinetic drug." }, { "field": "primaryOutcome", "quote": "number of feces, wet and dry weight and moisture content of feces, gastric emptying, and intestinal transit were evaluated" }, { "field": "result", "quote": "The pre-treatment of extracts significantly increased the number of feces, wet and dry weight of feces, moisture content, gastric emptying, and intestinal transit. Results were comparable to MET." }, { "field": "followUp", "quote": "for 7 days" } ] }, { "id": "pmid:26465280", "pmid": "26465280", "doi": null, "nctId": null, "pmcid": null, "title": "[Therapeutic potential of micronized purified flavonoid fraction (MPFF) of diosmin and hesperidin in treatment chronic venous disorder]", "firstAuthor": "Hnátek", "multipleAuthors": false, "journal": "Vnitr Lek", "year": 2015, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic venous disorder, including hemorrhoid disease", "intervention": "micronized purified flavonoid fraction (MPFF) of diosmin and hesperidin", "comparator": "not stated", "primaryOutcome": "relief of venous symptoms such as pain, fatigue, swelling, and ulcers", "result": "the abstract states the substance is effective for venous symptoms, oedema, and ulcers, and lists hemorrhoidal disease as another indication, without giving specific data", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a narrative review summarizing general claims about a flavonoid drug without any specific study data, numbers, or methods for hemorrhoids.", "directness": "indirect", "limitations": "No study design, sample size, or specific results are given for hemorrhoids; this is a general review about a purified flavonoid drug (not lemon itself) mainly for venous disease.", "followUp": "", "plainFinding": "May help hemorrhoid symptoms, no real data", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26465280/", "sourceText": "Chronic venous disorder (CVD) is a common illness with high incidence existing especially in Europe and North America. The main goal of micronized purified flavonoid fraction (MPFF) of diosmin and hesperidin is to eliminate the symptoms of CVD (venous pain, fatigue, etc). But MPFF of diosmin and hesperidin has good effectiveness for treatment of venous oedema and venous ulcer too. There are many papers that prove its effectiveness in the experiment and in the microcirculation too. The other indications for MPFF of diosmin hesperidin is hemorrhoidal disease and the accessory treatment of lymphedema. It is proved that this substance could be used as an effective supplementary treatment of symptoms after venous intervention. Only MPFF diosmin and hesperidin received the best recommendation - 1B in the last guidelines for VAD therapy.", "provenance": [ { "field": "population", "quote": "Chronic venous disorder (CVD) is a common illness with high incidence existing especially in Europe and North America." }, { "field": "intervention", "quote": "micronized purified flavonoid fraction (MPFF) of diosmin and hesperidin" }, { "field": "comparator", "quote": "The other indications for MPFF of diosmin hesperidin is hemorrhoidal disease and the accessory treatment of lymphedema." }, { "field": "primaryOutcome", "quote": "The main goal of micronized purified flavonoid fraction (MPFF) of diosmin and hesperidin is to eliminate the symptoms of CVD (venous pain, fatigue, etc)." }, { "field": "result", "quote": "But MPFF of diosmin and hesperidin has good effectiveness for treatment of venous oedema and venous ulcer too." } ] }, { "id": "pmid:25893991", "pmid": "25893991", "doi": "10.1007/s10151-015-1302-9", "nctId": null, "pmcid": null, "title": "Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial", "firstAuthor": "Giannini", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2015, "design": "rct", "n": 134, "nField": "reported", "population": "patients with an acute hemorrhoidal crisis", "intervention": "a mixture of diosmin, troxerutin and hesperidin (flavonoids)", "comparator": "placebo", "primaryOutcome": "pain, bleeding, edema, prolapse and thrombosis symptoms of acute hemorrhoidal disease", "result": "Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It is a randomized, triple-blind, multicenter trial, but it tests a specific flavonoid drug mixture rather than lemon itself, so it only indirectly relates to the question.", "directness": "indirect", "limitations": "The abstract does not mention lemon or citrus fruit at all; it studies a pharmaceutical flavonoid blend, which is a different intervention.", "followUp": "12 days", "plainFinding": "Flavonoid pills eased hemorrhoid symptoms, not lemon", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/25893991/", "sourceText": "BACKGROUND: The role of a mixture of phlebotonics in the treatment of acute hemorrhoid crisis is investigated to test their efficacy. METHODS: One hundred and thirty-four consecutive patients with an acute hemorrhoidal crisis recruited in five colorectal units entered the study. Sixty-six of them were randomized to receive a mixture of diosmin, troxerutin and hesperidin (group A), and 68 a placebo (group B). The main symptoms, the use of oral painkillers and the Bristol scale score were recorded at each scheduled visit and compared using both Student's t test for independent samples and the ANOVA models for repeated measures. The presence of edema, prolapse and thrombosis were also recorded and compared using the Chi-square test. Furthermore, the trend of proportions during the time of the evaluations was assessed by the Chi-square test for linear trend. RESULTS: Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A. After 6 days, the number of paracetamol tablets taken by patients in group A was significantly lower than the amount of flavonoid mixture. CONCLUSIONS: The use of a mixture of diosmin, troxerutin and hesperidin is a safe and effective mean of managing symptoms of acute hemorrhoidal disease. Furthermore, in patients receiving treatment, there was faster control and lower persistence of edema and thrombosis.", "provenance": [ { "field": "n", "quote": "One hundred and thirty-four consecutive patients with an acute hemorrhoidal crisis recruited in five colorectal units entered the study." }, { "field": "population", "quote": "patients with an acute hemorrhoidal crisis" }, { "field": "intervention", "quote": "a mixture of diosmin, troxerutin and hesperidin (group A)" }, { "field": "comparator", "quote": "68 a placebo (group B)" }, { "field": "primaryOutcome", "quote": "The main symptoms, the use of oral painkillers and the Bristol scale score were recorded at each scheduled visit" }, { "field": "result", "quote": "Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A." } ] }, { "id": "pmid:24934505", "pmid": "24934505", "doi": "10.1186/1752-1947-8-194", "nctId": null, "pmcid": "PMC4070635", "title": "Uncommon serum creatine phosphokinase and lactic dehydrogenase increase during diosmin therapy: two case reports", "firstAuthor": "Milano", "multipleAuthors": true, "journal": "J Med Case Rep", "year": 2014, "design": "case-series", "n": 2, "nField": "reported", "population": "an adult with leg vein problems and an older man with acute hemorrhoid flare-up", "intervention": "diosmin (a vein medication), not lemon", "comparator": "none, before-and-after comparison in the same patients", "primaryOutcome": "side effects during diosmin treatment, including muscle and blood enzyme levels", "result": "both patients showed abnormal rises in muscle/tissue enzymes (creatine phosphokinase and lactic dehydrogenase) linked to diosmin use", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is just two individual patient case reports with no control group, so it cannot show whether diosmin or lemon actually helps hemorrhoids.", "directness": "indirect", "limitations": "Only two cases, no control group, and the drug studied (diosmin) is not lemon; one case was unrelated to hemorrhoids.", "followUp": "", "plainFinding": "Diosmin raised muscle enzymes, not hemorrhoid benefit.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24934505/", "sourceText": "INTRODUCTION: Short-term administration of diosmin is usually considered safe, with only minor side effects (stomach and abdominal pain, diarrhea, dermatological disorders, and headache) occasionally observed. Within a 4-year period, a general practitioner noticed 17 cases of mild, diosmin-induced side effects, two of which showed particular interest. CASES PRESENTATION: Case 1: A 55-year-old Caucasian woman presented with chronic leg venous insufficiency. She was prescribed diosmin 450 mg twice a day. After 5 days of therapy, she developed pain in the legs (myalgia), and diosmin therapy was suspended. She made a spontaneous attempt of drug rechallenge and her leg pain reappeared. Thus, she underwent blood analysis, which showed elevation of creatine phosphokinase levels. Creatine phosphokinase values normalized only after prolonged discontinuation of the therapy. Case 2: A 79-year-old Caucasian man, who was diagnosed with acute hemorrhoidal syndrome. After 21 days of continuous diosmin treatment, increased levels of serum lactic dehydrogenase were detected. In both cases a comprehensive analysis of all possible causes for enzyme elevation was made. CONCLUSIONS: A feasible hypothesis to explain these rare effects could be that exaggerated adrenergic activity occurred on microcirculation, leading to an excessive peripheral vasoconstriction and subsequent ischemic damage. An individual predisposition is strongly suggested. A concurrence of events was probably responsible for the elevation of nonspecific tissue necrosis markers. Physicians and patients must be aware of these rare, but possible, adverse drug reactions.", "provenance": [ { "field": "n", "quote": "Within a 4-year period, a general practitioner noticed 17 cases of mild, diosmin-induced side effects, two of which showed particular interest." }, { "field": "population", "quote": "A 79-year-old Caucasian man, who was diagnosed with acute hemorrhoidal syndrome." }, { "field": "intervention", "quote": "she was prescribed diosmin 450 mg twice a day" }, { "field": "comparator", "quote": "She made a spontaneous attempt of drug rechallenge and her leg pain reappeared." }, { "field": "primaryOutcome", "quote": "increased levels of serum lactic dehydrogenase were detected" }, { "field": "result", "quote": "Creatine phosphokinase values normalized only after prolonged discontinuation of the therapy." } ] }, { "id": "pmid:16736537", "pmid": "16736537", "doi": "10.1002/bjs.5378", "nctId": null, "pmcid": null, "title": "Meta-analysis of flavonoids for the treatment of haemorrhoids", "firstAuthor": "Alonso-Coello", "multipleAuthors": true, "journal": "Br J Surg", "year": 2006, "design": "meta-analysis", "n": 1514, "nField": "reported", "population": "people with symptomatic hemorrhoids", "intervention": "flavonoids (plant-derived compounds, not lemon specifically)", "comparator": "placebo or no treatment", "primaryOutcome": "symptoms not improving or persisting", "result": "flavonoids reduced the risk of symptoms not improving by 58%, and reduced bleeding, pain, itching and recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The studies pooled were only moderate quality, showed inconsistent results, and there was a real chance that negative studies were never published.", "directness": "indirect", "limitations": "Limitations in methodological quality, heterogeneity and potential publication bias raise questions about the apparent beneficial effects of flavonoids", "followUp": "", "plainFinding": "Flavonoid supplements eased hemorrhoid symptoms, not lemon itself.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16736537/", "sourceText": "BACKGROUND: The aim of the study was to evaluate the impact of flavonoids on those symptoms important to patients with symptomatic haemorrhoids. METHODS: A comprehensive search strategy was used. All published and unpublished randomized controlled trials comparing any type of flavonoid to placebo or no therapy in patients with symptomatic haemorrhoids were included. Two reviewers independently screened studies for inclusion, retrieved all potentially relevant studies and extracted data. RESULTS: Fourteen eligible trials randomized 1514 patients. Studies were of moderate quality and showed variability in the results with potential publication bias. Meta-analyses using random-effects models suggested that flavonoids decrease the risk of not improving or persisting symptoms by 58 per cent (relative risk (RR) 0.42 (95 per cent confidence interval (c.i.) 0.28 to 0.61)) and showed an apparent reduction in the risk of bleeding (RR 0.33 (95 per cent c.i. 0.19 to 0.57)), persistent pain (RR 0.35 (95 per cent c.i. 0.18 to 0.69)), itching (RR 0.65 (95 per cent c.i. 0.44 to 0.97)) and recurrence (RR 0.53 (95 per cent c.i. 0.41 to 0.69)). CONCLUSION: Limitations in methodological quality, heterogeneity and potential publication bias raise questions about the apparent beneficial effects of flavonoids in the treatment of haemorrhoids.", "provenance": [ { "field": "n", "quote": "Fourteen eligible trials randomized 1514 patients." }, { "field": "population", "quote": "patients with symptomatic haemorrhoids" }, { "field": "intervention", "quote": "any type of flavonoid" }, { "field": "comparator", "quote": "placebo or no therapy" }, { "field": "primaryOutcome", "quote": "flavonoids decrease the risk of not improving or persisting symptoms" }, { "field": "result", "quote": "flavonoids decrease the risk of not improving or persisting symptoms by 58 per cent (relative risk (RR) 0.42 (95 per cent confidence interval (c.i.) 0.28 to 0.61)) and showed an apparent reduction in the risk of bleeding (RR 0.33 (95 per cent c.i. 0.19 to 0.57)), persistent pain (RR 0.35 (95 per cent c.i. 0.18 to 0.69)), itching (RR 0.65 (95 per cent c.i. 0.44 to 0.97)) and recurrence (RR 0.53 (95 per cent c.i. 0.41 to 0.69))" }, { "field": "limitations", "quote": "Limitations in methodological quality, heterogeneity and potential publication bias raise questions about the apparent beneficial effects of flavonoids in the treatment of haemorrhoids." } ] }, { "id": "pmid:16245442", "pmid": "16245442", "doi": null, "nctId": null, "pmcid": null, "title": "[Butcher's Broom, in the treatment of venous insufficiency]", "firstAuthor": "Bylka", "multipleAuthors": true, "journal": "Pol Merkur Lekarski", "year": 2005, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic venous insufficiency and hemorrhoids", "intervention": "Butcher's Broom (Rusci aculeati rhizoma) extract", "comparator": "", "primaryOutcome": "not clearly stated", "result": "not stated", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review with no study data, numbers, or outcomes reported, and it does not even discuss lemon.", "directness": "indirect", "limitations": "No data, methodology, or results are given; the abstract only states the review's topic without findings.", "followUp": "", "plainFinding": "Not about lemon, no results given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16245442/", "sourceText": "Numerous extracts of the plants, natural compounds and their derivatives, acting on the venous system, including horse-chestnut seed extracts aescin, rutin, troxerutin, diosmin and hesperidine. They have a long tradition in herbal medicine for their venotonic and anti-oedematous properties. This review is concerning Rusci aculeati rhizoma, which recently taken in Poland on the symptoms of chronic venous insufficiency and hemorrhoids.", "provenance": [ { "field": "population", "quote": "the symptoms of chronic venous insufficiency and hemorrhoids" }, { "field": "intervention", "quote": "Rusci aculeati rhizoma" }, { "field": "primaryOutcome", "quote": "This review is concerning Rusci aculeati rhizoma, which recently taken in Poland on the symptoms of chronic venous insufficiency and hemorrhoids." }, { "field": "result", "quote": "This review is concerning Rusci aculeati rhizoma, which recently taken in Poland on the symptoms of chronic venous insufficiency and hemorrhoids." } ] }, { "id": "pmid:11782895", "pmid": "11782895", "doi": "10.1002/jps.1168", "nctId": null, "pmcid": null, "title": "Comparison of the absorption of micronized (Daflon 500 mg) and nonmicronized 14C-diosmin tablets after oral administration to healthy volunteers by accelerator mass spectrometry and liquid scintillation counting", "firstAuthor": "Garner", "multipleAuthors": true, "journal": "J Pharm Sci", "year": 2002, "design": "rct", "n": 12, "nField": "reported", "population": "healthy male volunteers", "intervention": "micronized diosmin tablet (a purified citrus flavonoid drug, Daflon 500 mg)", "comparator": "nonmicronized diosmin tablet of the same drug", "primaryOutcome": "how much of the diosmin drug was absorbed into the body, measured by radioactivity in urine", "result": "the micronized form was absorbed significantly more than the nonmicronized form", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a very small pharmacokinetic study in healthy volunteers measuring drug absorption, not hemorrhoid symptoms or outcomes in patients.", "directness": "indirect", "limitations": "only 12 healthy male volunteers studied, no hemorrhoid patients included, and the outcome measured was drug absorption rather than any clinical symptom or benefit for hemorrhoids", "followUp": "", "plainFinding": "Better absorption of drug, not symptoms", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11782895/", "sourceText": "Daflon 500 mg, is a micronized purified flavonoid fraction, containing 90% w/w diosmin and 10% w/w of flavonoids expressed as hesperidin, used clinically in the treatment of chronic venous insufficiency and hemorrhoidal disease. This study was designed to investigate the influence of particle size on the overall absorption of diosmin after oral administration of micronized (mean particle size = 1.79 microm, with 80% of particles having a size lower than 3.45 microm) and nonmicronized diosmin (mean particle size = 36.5 microm, with 80% of particles comprised between 19.9 and 159 microm). In a double blinded, cross-over study design, 500 mg tablets containing trace amounts (approximately 25 nCi) of (14)C-diosmin were administered to 12 healthy male volunteers as a single oral dose. Accelerator mass spectrometry and liquid scintillation counting were used for the measurement of (14)C-diosmin in urine and feces. Absorption of (14)C-diosmin from the gastrointestinal tract, measured by the urinary excretion of total radioactivity, was significantly improved with the micronized (57.9 +/- 20.2%) compared with the nonmicronized material (32.7 +/- 18.8%). Statistical comparison of the urinary excretion of the two pharmaceutical formulations showed this difference to be highly significant (p = 0.0004, analysis of variance). The overall excretion of the radiolabeled dose was 100% with mean +/- SD of 109 +/- 23% and 113 +/- 20% for the micronized and nonmicronized forms, respectively. The results of this study show: 1. the impact of a reduction of particle size on the extent of absorption of diosmin, giving a pharmacokinetic explanation to the better clinical efficacy observed with the micronized formulation, and 2. the use of accelerator mass spectrometry in conjunction with liquid scintillation counting in measurement of bioavailability in a human cross-over study comparing two drug formulations containing trace amounts of radioactivity.", "provenance": [ { "field": "n", "quote": "500 mg tablets containing trace amounts (approximately 25 nCi) of (14)C-diosmin were administered to 12 healthy male volunteers as a single oral dose" }, { "field": "population", "quote": "administered to 12 healthy male volunteers as a single oral dose" }, { "field": "intervention", "quote": "micronized (mean particle size = 1.79 microm, with 80% of particles having a size lower than 3.45 microm)" }, { "field": "comparator", "quote": "nonmicronized diosmin (mean particle size = 36.5 microm, with 80% of particles comprised between 19.9 and 159 microm)" }, { "field": "primaryOutcome", "quote": "Absorption of (14)C-diosmin from the gastrointestinal tract, measured by the urinary excretion of total radioactivity" }, { "field": "result", "quote": "was significantly improved with the micronized (57.9 +/- 20.2%) compared with the nonmicronized material (32.7 +/- 18.8%)" } ] }, { "id": "pmid:9454438", "pmid": "9454438", "doi": null, "nctId": null, "pmcid": null, "title": "[Therapeutic effectiveness of flavonoids illustrated by daflon 500 mg]", "firstAuthor": "Hitzenberger", "multipleAuthors": false, "journal": "Wien Med Wochenschr", "year": 1997, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic venous insufficiency, leg ulcers, or hemorrhoids", "intervention": "Daflon 500 mg (a micronized flavonoid drug)", "comparator": "", "primaryOutcome": "effects on chronic venous insufficiency, venous leg ulcers and hemorrhoids", "result": "described as statistically highly significant effects", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a general review summarizing a drug's effects without describing specific study design, numbers, or comparison data.", "directness": "indirect", "limitations": "No study design, sample size, or methodology details are given; this concerns a specific flavonoid pharmaceutical, not lemon itself.", "followUp": "", "plainFinding": "Flavonoid drug helped hemorrhoid symptoms.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9454438/", "sourceText": "Besides the standard therapy of chronic venous insufficiency with compression drug treatment with effective substances considerably improves the prognosis. Among these substances Daflon 500 mg, consisting of a micronized fraction of flavonoids, is one of the best investigated drugs. It shows a very good tolerability: in none of the toxicological studies substance-related alterations were found. This statement refers as well to questions of acute, subacute and chronic toxicity as also to mutagenicity, fertility, embryotoxicity, respectively. Pharmacokinetic studies showed that it is well absorbed from the gastrointestinal tract, although is is not clear whether this concerns the unchanged drug or only metabolites. Pharmacodynamically an improvement of the velocity of lymphstream was shown and clinically the effects on chronic venous insufficiency, venous leg ulcers and hemorrhoids were statistically highly significant. The micronized flavonoids in Daflon 500 mg allow an exact dose regimen (2 tablets a 500 mg/day, once daily given), shows an excellent tolerability and therefore a high acceptance by the patient.", "provenance": [ { "field": "intervention", "quote": "Daflon 500 mg, consisting of a micronized fraction of flavonoids" }, { "field": "primaryOutcome", "quote": "clinically the effects on chronic venous insufficiency, venous leg ulcers and hemorrhoids were statistically highly significant" }, { "field": "result", "quote": "were statistically highly significant" }, { "field": "population", "quote": "clinically the effects on chronic venous insufficiency, venous leg ulcers and hemorrhoids were statistically highly significant" } ] } ], "faqs": [ { "q": "Does lemon juice help hemorrhoids?", "a": "No study has given people lemon juice or lemon water for hemorrhoids. The closest research tested purified flavonoid drugs made from citrus, not lemon itself, so this evidence cannot answer whether lemon helps." }, { "q": "Can I put lemon juice directly on hemorrhoids?", "a": "This hasn't been studied, so there's no evidence either way about whether it's safe or useful. Lemon juice is acidic, and applying acid to skin that's already irritated or has small tears is something to be cautious about even without a study on it." }, { "q": "Are lemon and the flavonoid drugs used in these studies the same thing?", "a": "No. The trials used purified, concentrated compounds like diosmin and hesperidin, not whole lemon or lemon juice. The amount and form you'd get from eating or applying lemon is very different from a drug dose." }, { "q": "Should I stop using lemon if I've already been trying it?", "a": "There's no evidence it treats hemorrhoids, but there's also no evidence it causes harm, because it simply hasn't been studied. If it isn't stinging or irritating you, there's nothing here that says you must stop, but don't let it delay getting checked, especially if you're bleeding." }, { "q": "What was actually tested in these studies, if not lemon?", "a": "Mostly purified flavonoid drugs given to people with hemorrhoids or recovering from hemorrhoid surgery, which showed less pain and bleeding in that specific situation. That's a different product, used a different way, than trying lemon at home." } ], "patientTakeaway": "No study has tested lemon, lemon juice, or lemon water for hemorrhoids, so there's no evidence it helps, and no evidence it's safe to use this way either — it just hasn't been looked at. If you have ongoing hemorrhoid symptoms, especially bleeding, get that checked by a doctor rather than relying on lemon. The studies that do exist tested purified citrus-derived flavonoid drugs, which are a different product with their own separate evidence, not plain lemon.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Hemorrhoids\"[Mesh] OR hemorrhoid*[tiab] OR piles[tiab]) AND (lemon*[tiab] OR \"Citrus\"[tiab] OR \"Citrus limon\"[tiab] OR diosmin[tiab] OR hesperidin[tiab] OR flavonoid*[tiab] OR \"ascorbic acid\"[tiab] OR \"vitamin C\"[tiab])" }, "pubmedQueryTranslation": "(\"Hemorrhoids\"[MeSH Terms] OR \"hemorrhoid*\"[Title/Abstract] OR \"piles\"[Title/Abstract]) AND (\"lemon*\"[Title/Abstract] OR \"Citrus\"[Title/Abstract] OR \"Citrus limon\"[Title/Abstract] OR \"diosmin\"[Title/Abstract] OR \"hesperidin\"[Title/Abstract] OR \"flavonoid*\"[Title/Abstract] OR \"ascorbic acid\"[Title/Abstract] OR \"vitamin C\"[Title/Abstract])", "searchedOn": "2026-10-05", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Is Lemon Good for Hemorrhoids?", "description": "No study has tested lemon for hemorrhoids. 25 related studies on citrus flavonoid drugs don't answer this question either." }, "lastChecked": "2026-10-05", "lastChanged": "2026-10-05", "nextCheckDue": "2026-11-05", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-05" }, "status": "published" }