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Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 205-209

The plant Cynomorium in maltese materia medica

Centre for Traditional Chinese Medicine, University of Malta, Msida, Malta

Date of Submission07-Aug-2020
Date of Decision17-Sep-2020
Date of Acceptance10-Oct-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Prof. Charles Savona-Ventura
Centre for Traditional Chinese Medicine, University of Malta, Msida
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CMAC.CMAC_37_20

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The search for possible effective local therapeutic agents led to the discovery of a plant that was later known as Fungus Melitensis. This parasitic flowering plant was initially believed to grow only on a small islet off Gozo known variably as General's or Fungus Rock. It is now known to be more widely distributed with a range extending from the Canary Islands to China. First mentioned in 1647 by the Maltese historian Gian Francesco Abela, the plant was later described and illustrated in 1674 by the Palermo botanist Paolo Boccone, while a detailed clinical treatise was prepared in 1689 by the Maltese physician Gio Francesco Bonamico. Based on the principles of the “doctrine of signatures,” the plant was considered useful by virtue of its color in conditions involving bleeding, while on the basis of the phallic appearance, it was considered efficacious for venereal disease. The medicinal properties of the plant became renowned throughout the European continent, increasing the demand for its collection and export. Measures were introduced to limit the collection to authorized individuals while physical access to the islet was made more difficult by cutting away the sloping parts of the islet. The plant lost its medicinal reputation during the early decades of the 19th century and has now been relegated to the annals of medical history and folklore, though it is still designated a protected species.

Keywords: Maltese materia medica, Suo Yang (锁阳 Cynomorium coccineum), fungus melitensis, hemorrhage, dysentery, medical history

How to cite this article:
Savona-Ventura C. The plant Cynomorium in maltese materia medica. Chin Med Cult 2020;3:205-9

How to cite this URL:
Savona-Ventura C. The plant Cynomorium in maltese materia medica. Chin Med Cult [serial online] 2020 [cited 2021 Jan 25];3:205-9. Available from: https://www.cmaconweb.org/text.asp?2020/3/4/205/305178

  Introduction Top

The seventeenth-century prescription lists from the medieval period Santo Spirito Hospital at Rabat in Malta confirm that pharmaceutical practice during the Early Modern Period was very much in the mainstream of the Arabo-Hellenic medical tradition that flourished on the continent at the time. The Materia Medica lists available in Malta during this period show an overwhelming majority of vegetable source materials, many of which were available locally in the Maltese Islands, though some required importation from overseas, probably from the nearby Sicily. Substances derived from the animal and chemical kingdoms were also utilized but proportionately not equal to the extent of material derived from plants.[1],[2] Throughout the ensuing centuries, very little improvement appears to have been made in the development of effective pharmaceuticals despite a continuous search for possible useful agents among the Maltese flora. Pharmaceutical practice at the end of the 18th century (1769) remained similar to that in the earlier centuries, though some of the previously listed items had been identified as useless and possibly harmful, while other medications identified to originate from foreign sources were introduced in the pharmaceutical armamentarium.[3] The continuous search for possible effective therapeutic agents in the Maltese Islands led to the realization in the 17th century that the plant Suo Yang (锁阳 Cynomorium coccineum) [Figure 1] was extant in the Maltese Islands – a plant that was reputed to have pharmaceutical properties. This was quickly incorporated into the Maltese pharmacopeia and exported to the European continent.
Figure 1: Suo Yang (锁阳 Cynomorium coccineum). flowering plant stem

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  Biology Top

Suo Yang (锁阳 Cynomorium coccineum) was reputed to have medicinal properties by several medieval Islamic physicians including Ibn Masawayh (777–857 AD), Al-Kindi (800–870 AD), Al-Razi (865–925 AD), and Maimonides (1135–1204 AD), though it is not clear whether these and other authors were attributing medicinal properties to Suo Yang (锁阳 Cynomorium coccineum) or rather referring to another parasitic plant belonging to the Orobanche genus. In the 17th century, the botanist Paulo Boccone from Palermo described and illustrated this very plant in his major botanical work, naming the species as Fungus Typhoides coccineus Melitensis [Figure 2]. He observed that when this was cut into thin slices and exposed to sunlight, its color changed from white to red. In addition, when squashed, its juices were noted to be colored blood red. The flesh of the plant was said to be rather bitter and astringent to the tongue and mouth. It was considered to cause constipation.[4] In 1759, Carl Linnaeus designated the plant in the binomial system as Suo Yang (锁阳 Cynomorium coccineum). In his work, Linnaeus also included an earlier treatise on Fungus melitensis by Johannes Pfeiffer [Figure 3]. Here, the plant was said to be an excellent remedy for drying up ulcers, strengthening gums, and stopping uterine bleeding.[5]
Figure 2: Fungus Typhoides coccineus Melitensis as depicted by Boccone P. (1674)

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Figure 3: Thesis title page by Johannes Pfeiffer (1755)

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The Cynomoriaceae family comprises only one species with two subspecies Suo Yang (锁阳 Cynomorium coccineum). subsp. coccineum and C. coccineum subsp. songaricum (Rupr.). The plant is an herbaceous, perennial, parasitic, nonphotosynthetic dark red-colored plant growing generally to a height of 10–40 cm. The plant grows in rocky or sandy soils in sub-desert areas, but in the Mediterranean region, it is often found in saline habitats in proximity to the coast. The plant consists of a rhizome that produces succulent cylindrical stems during the flowering stage. When cut open, the rhizome and plant yield a mucilaginous bitter tasting juice that turns to a brilliant red color. The rhizomes penetrate the roots of the host plant, establishing cellular and vascular connections. The plant itself does not perform photosynthesis but instead completely relies on nutrients from host plants belonging to various angiosperm families including Asterales, Caryophyllales, Sapindales, and Zygophyllales. It has been suggested that pollination takes place through the intervention of flies feeding on the pollen, while the seeds are dispersed after a rise in humidity breaks the pericarp.[6]

Originally deemed to have a rather restrictive distribution, the genus Cynomorium is now known to grow in a wide range extending right from the Canary Islands, through the Mediterranean and Irano-Turanian region, to the Mongolian deserts in West China. The subspecies Coccineum occurs in the western part of this distribution range from Spain to Afghanistan, while the subspecies Songaricum is found in the eastern part of the range from the Altay region to the Xinjiang region of China.[7] In the Maltese Islands, the plant, known to the locals as gherq is-sinjur or gherq il-general, is considered to be rare with a very restricted distribution. It was initially believed to grow only on a small islet off Gozo, known variably as the General's or Fungus Rock [Figure 4], but it has now been proved to grow in a number of costal localities.[8]
Figure 4: 18th-century watercolor painting (unknown artist) showing Fungus Rock and the cable car system for access

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  Traditional Use in Malta Top

This plant was first mentioned in 1647 by the Maltese historian Gian Francisco Abela who wrote that, “on the small islet off the island of Gozo known as General's Rock, there grew a plant which when dried and ground into powder and prepared as a drink was used to mange dysentery.”[9] In 1689, the plant was subsequently described by the Maltese physician Gio Francesco Bonamico who reported that this “plant cannot be found in any other European or Asian country at least according to the research conducted up to the present day because none of the then great botanists that have sailed around the countries of these two continents and have written volumes on every plant they had seen growing there, ever said that they had found a plant like this. Pietro Castello too, a great scholar of medicine and also a great botanist from the University of Messina, when receiving this plant probably from a Maltese physician, confessed that he had never seen one like it or known that it grew only on our rock.” He believed that its use as a medicine in Malta dated to the time of the Phoenicians. He further attributed its medicinal properties stating that “It is said that by this fungus sick people are cured of their illnesses faster than by any other medicine.” The plant was prepared by an oven baked in a well-sealed earthenware vessel. It was then powdered and administered with honey or as a wine infusion. It was allegedly useful for apoplexy and dysentery. The plant extract was noted to stain the skin and could also be used to dye cloth.[10]

Basing the rationale of the therapeutic properties of this plant on the principles of the “doctrine of signatures” whereby the characteristics and appearance of the plant were linked to a particular medical condition, the plant was considered useful by virtue of its color in conditions involving blood and bleeding. In his review of the literature relating to the plant, the histographer Giovanni Pietro Agius de Soldanis in 1746 commented that “previous authors maintained that the plant extract was useful in the management of dysentery, bloody evacuations, and every hemorrhage in the chest”. It was also deemed to be useful in treating the gums, hematemesis, and for drying wounds. The plant was administered as a half-gram or more fine dry powder mixed in wine, broth, or any other liquid. Alternatively, an ounce of the plant could be mixed with citrus jam or preserve or any other astringent substance. The dose could be repeated until recovery from the disorder. It was considered very efficacious, and any failure was considered to be a certain indication that the plant used was not the genuine item. It was considered much more efficacious in the management of dysentery than the American anti-dysenteric, named the epiquecana. The plant was also used to control traumatic and surgical bleeding, and was also considered useful for the management of venereal disease.[11] Bonamico reported that, according to an elderly medical physician working in Gozo, the plant was used to subdue gonorrhea and “feminine flows,” and that women had superstitiously adopted the habit of hanging the plant between the breasts to improve fertility and guarantee future happiness.[10] The association to venereal and gynecological disease was probably contributed to it by the phallic appearance of the plant.

Named fungus melitensis, the plant gained increasing popularity in Europe and started been exported overseas. It was considered so efficacious that several grand masters of the Hospitaller Order of Saint John, then ruling the Maltese Islands, sent gift samples to various kings, nobles, relatives, and other personages in Europe. The increasing demand for this restricted plant led to the concern on its possible extinction. Collection was therefore controlled through legislation that restricted the plant collection to individuals appointed by the reigning grand master. Transgressors of this legislation were condemned to serve as rowers in the Order's galleys for a number of years.[12] The legislation alone was insufficient in serving as a deterrent to illicit collection of the plant. In 1744, the reigning grand master gave instructions to remove the sloping sides of the islet that led to the sea. This created a cliff, making access to the rock difficult. In addition, watchmen were employed to guard the rock.[13] A cable-pulley system was set up to facilitate access to authorized individuals. This cable-pulley system was described by Jean Houel in 1785:

“ To the summit of one part of the cliffs are attached two very strong cables, which, at their extremity reach the outcrop where they are also secured; from these cables hangs a large box ., similar to the tubs in which orange trees are planted. The cables pass through pulleys attached to the four upper corners of the box, which can hold one or two men; by pulling on a third, less taut, cable, the men cause the pulleys to roll on the other cables and move the box forward; thus they can easily pass from the shore to the islet or vice versa.”[14]

The civil disorder of the French interlude after the expulsion of the Order of Saint John from the islands in 1798 led to a slackening of guarding the rock. With the resumption of the civil order in 1800, the Civil Commissioner appointed to be responsible for the Maltese Islands witnessed the need to issue a specific proclamation to remind the residents that the collection of the fungus melitensis was still prohibited and that collection was only allowed by government-authorized individuals.[15]

During the early decades of the 19th century, this plant retained its medicinal reputation, but during 1821–1824, the plant was reported to have “lost its high repute, and is at present very little called for.”[16] The cable-pulley system remained in place but apparently sometime in 1842–1842, “the cables of this novel aerial conveyance gave way and precipitated the passenger into the gulf below.”[17] The cable-pulley system has never been replaced since. This plant has now both been relegated to the annals of Maltese medical history and folklore. Due to its rarity and restricted distribution on the islands, in 1992–1993 the plant was legally designated to be a protected species and the General's Rock was declared to be a Nature Reserve.

In China, this plant is known as suoyang meaning “locking the yang” and is supposedly used to tonify the yang, nourish the blood, alleviate old age related blood deficiency type of constipation, strengthen the tendons to lessen backache, and treat impotence. The plant extract is mentioned by Zhu Danxi (朱丹溪) in the 14th century (the Yuan dynasty) work Ben Cao Yan Yi Bu Yi (《本草衍义补遗》 Supplement to the Amplification on Materia Medica) as a management for impotence and weakness of the lower limbs which were to be caused by heat or damp-heat damaging the yin. The formulae, known as Huqian Pill (虎潜丸), is made from a composite of plants including Huang Bai (黄柏 Phellodendron amurense) and Zhi Mu (知母 Anemarrhena asphodeloides) which are used to harden the yin and clear heat source, thus to clean the flow; Cang Zhu (苍术 Rhizoma Atractylodis) and Yi Yi Ren (薏苡仁 Semen Coicis) to dispel dampness; Rou Cong Rong (肉苁蓉 Herba Cistanches), Suo Yang (锁阳 Cynomorium), and Chuan Niu Xi (川牛膝 Radix Cyathulae) with tiger's bone to strengthen the sinews and bones; Shao Yao (芍药 Paeonia) and Mu Gua (木瓜 Fructus Chaenomelis) to emolliate the sinews and relax tension; and Shu Di Huang (熟地黄 Radix Rehmanniae Preparata) and tortoise shells to enrich yin and boost the marrow. In this way, damp heat is discharged and transformed away, yin essence is subdued and astringed, the sinews are hardened and strengthened, and finally the feet are then able to walk.[18]

  Pharmacological Effects Top

The phytochemistry of Cynomorium has confirmed that the plant has more than forty different secondary metabolites including gallic acid which has the capacity to cross-link and denature proteins and serve as an antioxidant. Gallic acid was frequently used in the past few centuries as a component of styptic and anti-diarrheal remedies. It was reportedly useful in managing uterine bleeding disorders, other hemorrhages, fluxes, and for “checking the night sweats in phthisis.”[19] Pharmacognostic studies have suggested that the water-soluble extract has blood pressure-reducing properties when tested on dogs. This physiological effect may have contributed further in reducing bleeding.[20] The presence of phenolic hydroxyl groups, tannins, and tannic acids can interact with protein structures to form a precipitate on mucous membranes, which acts as a protective layer. In the intestinal tract, this protective layer serves to attenuate bowel motility, thus reducing peristalsis, contributing to decreased bowel movement, an effect that can be exploited in diarrheal conditions.[21] Extracts have also demonstrated a growth inhibitory effect on melanoma and malignant colon cells.[22] The water-soluble extract of Cynomorium appears to further have a direct spermatogenic influence in immature female rats, possibly through hormonal influences. The extract was shown to reduce gonadotropin and testosterone levels. In immature rats, the extract caused a profound folliculogenesis of the ovaries.[23],[24]

The widespread traditional use of this plant species throughout the range of its distribution, together with the growing phytochemistry and pharmacognostic evidence, suggests that this species is very likely to have useful pharmacological effects that merit further investigations.

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  References Top

Fiorini S. A prescription list of 1546. Maltese Med J 1988;1:19-31.  Back to cited text no. 1
Cassar P. Inventory of a sixteenth century pharmacy in Malta. St Lukes Hosp Gaz (Guardamangia) 1976;11:26-34.  Back to cited text no. 2
Cassar P. Two centuries of medical prescribing in Malta 1683-1882. St. Luke's Hospital Gazette 1969;4:105-12.  Back to cited text no. 3
Boccone P. Engravings and descriptions of rare plants. Sicily , Malta, France, & Italy. Oxford: E Theatro Sheldoniano Prostant Apud Robertum Scott Bibliopolam Londinensem; 1674. p. 80.  Back to cited text no. 4
Pfeiffer J. Fungus melitensis. In: Linnaei C, editor. Academic delights: various dissertations in physics, medicine, botany, previously published separately, now collected in conjunction with a table base. Vol. 4. Holmiae: L. Salvii, 1759. p. 351. Available from: http://huntbot.org/linndiss/sites/default/files/Liden-069.pdf. [Last accessed on 2020 Aug 07].  Back to cited text no. 5
Weddell, H.A. Memorie on Cynomorium coccineum, parasite of the order Balanophorees. Arch. Du Museum Natl D'Histoire Nat 1860;10:269-308.  Back to cited text no. 6
WCSP. World Checklist of Selected Plant Families. Facilitated by the Royal Botanic Gardens, Kew. Published on the Internet; 2020. Available from: http://wcsp.science.kew.org/. [Last retrieved on 2020 Apr 08].  Back to cited text no. 7
Lanfranco E. The flora. In: Schembri PJ, Sultana J, editors. Red Data Book for the Maltese Islands. Malta: Department of Information; 1989. p. 24.  Back to cited text no. 8
Abela GF. Description of Malta island in the Sicilian sea with its antiquities and other notes. Fourth Book. Malta: P. Bonacota, Midsea Books, 1984. p. 121.  Back to cited text no. 9
Bonamico GF. Fucus Spicatus Coccineus Melitensis, Planyta singularis. In: Abela GF, Ciantar G, editors. Observations on plants from the islands of Malta & Gozo - short note. As reported. Malta: Malta Illustrata; 1772. p. 349-52.  Back to cited text no. 10
Agius de Soldanis GP. Il Gozo Antico-moderno e Sacro-profano Isola Mediterranea adiacente a Malta Africana. Ms. Gozo: National Library [English translation: Gozo Ancient and Modern Religious and Profane (trans. A. Bonnici). Malta: Media Centre; 1999. p. 179-184.  Back to cited text no. 11
De Boisgelin L. Ancient and Modern Malta. Vol. 1. London: R. Phillips; 1805. p. 71-4.  Back to cited text no. 12
Ferres A. Memoirs of the Illustrious Order of Jerusalem. Malta: C. Busuttil; 1881. p. 413.  Back to cited text no. 13
Houel J. Picturesque journey through the Isles of Sicily, Malta and Lipari. Paris: de l'Imprimerie de Monsieur; 1785. p. 83-4.  Back to cited text no. 14
Collection of Pramatic Notices and Other Official Notices Published by the Government of the Island of Malta and its dependencies. From 17 July 1784 to 4 October 1813. Malta: Government Press; 1840. p. 53.  Back to cited text no. 15
Hennin J. Sketches of the Medical topography of the Mediterranean Comprising an Account of Gibraltar, the Ionian Islands, and Malta. London: Thomas & George Underwood; 1830. p. 540.  Back to cited text no. 16
Angas GF. A Ramble in Malta and Sicily in the Autumn of 1841. London: Smith, Elder, and Co.; 1842. p. 55.  Back to cited text no. 17
Dharmananda S. Cynomorium: Parasitic Plant Widely Used in Traditional Medicine. In: Ubani LU, editor. Preventive Therapy in Complimentary Medicine: Volume I to Liberate Humankind from the Pain and Suffering of Synthetic and Chemicalized Medications). U.S.A.: Xlibris Corporation; 2011. p. 290-301.  Back to cited text no. 18
Cooley AJ, Tuson RV. Cooley's Cyclopaedia of Practical Receipts and Collateral Information in the Arts, Manufactures, Professions, and Trades Including Medicine, Pharmacy, Hygiene, and Domestic Economy: Designed as a Comprehensive Supplement to the Pharmacopoeia and General Book of Reference for the Manufacturer, Tradesman, Amateur, and Heads of Families. London: J. & A. Churchill; 1872.  Back to cited text no. 19
Ikram M, Dar MS, Fakouhi T. Hypotensive agent from Cynomorium coccineum. Pahlavi Med J 1978;9:167-81.  Back to cited text no. 20
Leonti M, Bellot S, Zucca P, Rescigno A. Astringent drugs for bleedings and diarrhoea: The history of Cynomorium coccineum (Maltese Mushroom). J Ethnopharmacol 2020;249:112368.  Back to cited text no. 21
Rosa A, Nieddu M, Piras A, Atzeri A, Putzu D, Rescigno A. Maltese mushroom (Cynomorium coccineum L.) as source of oil with potential anticancer activity. Nutrients 2015;7:849-64.  Back to cited text no. 22
Abdel-Magied EM, Abdel-Rahman HA, Harraz FM. The effect of aqueous extracts of Cynomorium coccineum and Withania somnifera on testicular development in immature Wistar rats. J Ethnopharmacol 2001;75:1-4.  Back to cited text no. 23
Al-Qarawi AA, Abdel-Rahman HA, El-Badry AA, Harraz FM, Abdel-Magied EM. The effects of extracts of Cynomorium coccineum and Withania somnifera on gonadotrophins and ovarian follicles of immature Wistar rats. Phytother Res 2000;14:288-90.  Back to cited text no. 24


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