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Medicinal plants have long served as essential resources for treating numerous diseases across diverse cultures worldwide, forming the backbone of traditional and modern medicine alike (; ). Notably, approximately 80% of Western pharmaceuticals are plant-derived (). Their accessibility and affordability make medicinal plants a cornerstone of healthcare in many regions, including in the management of hemorrhoids (; ). Ethnobotanical documentation of plant-based remedies provides invaluable insights, often sparking new pharmaceutical innovations grounded in traditional knowledge (). Hemorrhoids (piles), or Rid-Si-Duang in Thai, is among the most common gastrointestinal ailments globally (), characterized by the inflammation of venous blood vessels around the rectum and anus (). The condition—classified into internal and external types based on the location—affects all age groups but is especially prevalent among individuals over 50 years of age (; ). More than half of the global population experiences hemorrhoids at some stage, impacting quality of life and daily functioning across varied regions including Africa, Iran, and the United States (; ; ; ). Contributing factors include low-fiber diets, constipation, prolonged sitting, pregnancy, genetic predispositions, and aging (; ).

Conventional treatments for hemorrhoids range from dietary adjustments and fluid intake to pharmaceutical and surgical interventions (; ; ). However, the side effects of modern therapies, such as pain, discomfort, and postoperative complications, have driven growing interest in plant-based remedies due to their natural healing properties and relatively lower risk profiles (). Across countries—including Bulgaria, China, India, Nigeria, Tanzania, and Turkey—medicinal plants have demonstrated efficacy in improving vascular health and alleviating hemorrhoidal symptoms (; ; ; ; ). Critical phytochemicals such as flavonoids, tocotrienols, terpenoids, and alkaloids offer anti-inflammatory, antioxidant, analgesic, laxative, and anti-hemorrhoidal activities (; ; ; ). In Thailand, hemorrhoids remain a significant health concern, notably among the 45–65 age group (). Although various surgical and non-surgical options exist (), traditional plant-based therapies are widely favored due to their efficacy and minimal side effects ().

Given this context, the present study aims to 1) provide an ethnobotanical review of medicinal plants used for hemorrhoid treatment in Thailand and 2) identify the ethnobotanical species most frequently and effectively utilized in traditional medicine. Findings from this research are expected to support the discovery of novel plant-based therapies for hemorrhoid management and underscore the importance of conserving Thailand’s botanical diversity.

The literature review of medicinal plants used to treat hemorrhoids involved a comprehensive examination of published and unpublished research conducted between 2020 and 2023. Screening and data extraction were performed by three reviewers. Data were systematically extracted from several renowned databases and sources, including the ThaiLIS Digital Collection ( https://tdc.thailis.or.th/ ), PubMed (Medline), Google Scholar, Web of Sciences, Scopus, Thai-Journal Citation Index, and Science Direct. Additionally, unpublished data were sourced from Ethnobotany and Northern Thai Flora Laboratory at Chiang Mai University’s Department of Biology and the library of Queen Botanic Organization. The literature review encompassed articles written in both Thai and English. The search strategy employed a variety of key terms including “hemorrhoids AND Thailand AND ethnobotany,” “medicinal plant to treat hemorrhoids AND Thailand,” “hemorrhoid disease AND Thailand,” “gastrointestinal illnesses AND Thailand,” and “Rid-Si-Duang.” To avoid duplication of data, we selected information from these sources when data were presented in both theses and journal articles. The extracted data included the year of publication, study subjects, ethnic groups, provinces in Thailand, and the number of species used for treating hemorrhoids.

The screening process was carried out in two phases. In the first phase, title and abstract screening of the obtained literature was done. Subsequently, the suitable articles were downloaded and accessed onsite for further critical examination. The literature screening was based on the inclusion and exclusion criteria.

The published documents, in the form of articles, book chapters, reports, and theses, related to plants used for hemorrhoid treatment from 1990–2023 in Thailand were included in the study.

The following types of data were strictly excluded from the study: Data from review articles and experimental studies. Data from studies that did not incorporate Thailand and plants used for hemorrhoid treatment. Ethnomedicinal literature not encompassing information such as plant names (scientific or common) and hemorrhoid disease treatment. A total of 1,394 articles were initially identified through key term searches in the selected databases. After removing duplicate articles, the remaining records were subjected to a two-phase screening process. In the first phase, titles and abstracts were screened to assess their relevance. Subsequently, potentially eligible articles were retrieved and examined in full text through onsite access for further critical evaluation. The screening process was conducted in accordance with the predefined inclusion and exclusion criteria. After applying these criteria, 53 relevant articles were ultimately selected and included in the final review.

The ethnobotanical data, including scientific names and family names, were verified using Plants of the World Online (powo.science.kew.org/) and Flora of Thailand. Information on plant parts used, methods of preparation, and medicinal application was extracted from the original reports and categorized into groups according to The Economic Botany Data Collection Standard () and calculated as percentage.

For the calculation of ethnobotanical indices, the collected ethnobotanical information was systematically organized under the category of “use reports.” Each “use report” represents an instance in which a specific plant species was used to treat hemorrhoids, along with details of its preparation. In this context, a “use report” refers to the use of a particular plant part for a specific medicinal purpose by a particular ethnic group, as documented in a primary source. When a single species is reported to have multiple uses, each use is recorded as a separate use report. Any use reports lacking a scientific plant name were excluded from analysis. We carefully reviewed each use report in every reference, treating references from primary bibliographical sources as “informants” (; ). To assess the significance of medicinal plants for hemorrhoid treatment, we calculated ethnobotanical indices such as use-value (UV) and choice value of species (CVs), which provide quantitative measures of each species’ relative importance in this context. To corroborate traditional use and reported therapeutic potential, the ethnobotanical plant species were reviewed for documented pharmacological activities, including anti-inflammatory, analgesic, antioxidant, antimicrobial, anti-hemorrhoidal, vasorelaxant, local anesthetic, venotonic, and wound-healing properties.

The use-value is an ethnobotanical index, which is used to find the key species used to treat a particular disease among informants. UV was calculated according to the following formula (): where Ui represents the number of use reports in each species for treating hemorrhoids and N represents the total number of informants. Species with a high UV were popular to treat hemorrhoids; in contrast, low UV indicates that this species is mentioned in few reports to treat hemorrhoids.

This index is a tool used to define the most preferred species for treating hemorrhoids. The CVs was calculated using the following formula (): where Pcs is the percentage of informants that cited the species to treat hemorrhoids and Sc is the total number of species mentioned by all informants for treating hemorrhoids. Choice values of species range from 0 to 100; high CVs indicate that the plant species is preferred for treating hemorrhoids.

In this review, traditional knowledge from 18 ethnic groups, based on 53 references covering 33 provinces, regarding the treatment of hemorrhoids was reviewed (). Predominantly, this knowledge is derived from Tai Yuan (10 references), followed by Karen (8 references) and Tai Yai (4 references), traditions. The majority of these studies were conducted in northern Thailand, especially in Chiang Mai, Mae Hong Son, Nan, Lamphun, and Chiang Rai. In total, 288 use reports were compiled, encompassing 181 species, 147 genera, and 78 families from these 53 references (; ). Notably, the families with the most species used in hemorrhoid treatment include Fabaceae (15 species), Lamiaceae (14 species), Euphorbiaceae (9 species), Rubiaceae (8 species), Asteraceae (7 species), Apocynaceae (6 species), and Rosaceae (5 species).

To identify the most significant ethnobotanical species for treating hemorrhoids in Thailand, UV and CVs indices were calculated. The UV, derived from use reports, ranged from 0.02 to 0.25, while the CV, based on the number of informants, ranged from 0.01 to 1.10 (). The species with the highest UV and CV were Cissus quadrangularis (0.25 and 0.10), Biancaea sappan (0.11 and 0.06), Croton persimilis (0.09 and 0.04), Mimosa pudica (0.09 and 0.04), Aegle marmelos (0.08 and 0.04), Clerodendrum chinense (0.08 and 0.01), Leea indica (0.08 and 0.04), Plumbago indica (0.08 and 0.04), Rotheca serrata (0.08 and 0.04), and Tectona grandis (0.08 and 0.04). However, it is noteworthy that approximately 70% of the medicinal plants reviewed were reported only once. It should be emphasized that these ethnobotanical indices reflect the cultural prominence and citation frequency of medicinal plants within traditional knowledge systems rather than serving as direct measures of their therapeutic efficacy.

This review demonstrates the widespread use of medicinal plants for hemorrhoid treatment among various ethnic groups in Thailand, particularly the Tai Yuan, to relieve symptoms such as pain, bleeding, and itching (). The plants identified account for approximately 8% of all medicinal plant species recorded in Thailand (). Fabaceae plants are the most frequently used for hemorrhoid remedies, a trend also observed in countries such as Ethiopia, Iran, and Nigeria (; ; ). Fabaceae species are also widely utilized for treating a variety of other diseases (; ; ; ). Other prominent families in hemorrhoid management include Lamiaceae, Euphorbiaceae, Rubiaceae, Asteraceae, Apocynaceae, and Rosaceae. Notably, the use of Euphorbiaceae, Apocynaceae, and Asteraceae is prevalent in South-Western Nigeria for hemorrhoid management (), while Lamiaceae and Asteraceae are globally recognized for their diverse medicinal uses (). Lamiaceae, in particular, is known for its aromatic and therapeutic properties and includes more than 3,000 species.

The most significant medicinal plants for hemorrhoid treatment were identified using UV and CV, with high values suggesting promising efficacy and popularity. To confirm traditional use and efficacy, these plants were reviewed for relevant pharmacological activities, including anti-inflammatory, analgesic, antioxidant, antimicrobial, anti-hemorrhoid, vasorelaxant, local anesthetic, venotonic, and wound-healing effects (; ; ). Key bioactive compounds associated with anti-hemorrhoidal activity include flavonoids, phenolic compounds, terpenoids, steroids, saponins, alkaloids, triterpenes, and tannins (). Notably, flavonoids, tannins, and terpenoids are linked with reducing symptoms such as bleeding, pain, and inflammation (). Prominent species identified in this study were C. quadrangularis, B. sappan, C. persimilis, M. pudica, A. marmelos, C. chinense, L. indica, P. indica, R. serrata, and T. grandis ().

Cissus quadrangularis had the highest UV and CV, being cited in 10 sources. In Thailand, it is recognized for vasoconstrictive and anti-inflammatory effects (; ). In India, a mixture of C. quadrangularis stem and honey is used to ease pain and inflammation (), and it has been reported in hemorrhoid treatment (). The methanol extract inhibits local mediators and nociceptors involved in pain and vascular contraction (). The active phytochemicals include flavonoids, triterpenoids, and stilbene derivatives (; ). Biancaea sappan , widely used in Thai folk medicine, treats ailments such as tuberculosis, diarrhea, dysentery, and anemia (). In Chinese medicine, it is valued for its analgesic and anti-inflammatory properties, as well as for increasing blood circulation and stimulating menstruation (). Important compounds include alkaloids, steroids, phenols, flavonoids, terpenoids, triterpenoids, xanthone, coumarin, tannins, and terpenoids (; ), which support antioxidant (), anti-inflammatory (), vasorelaxant (), and antibacterial () properties.

Croton persimilis is used by Thai Yuan, Karen, and Lahu communities for hemorrhoid management, as well as for cough, pain, muscle pain, and dizziness (; ). In Myanmar, it is used to treat hemorrhoids, flatulence, bowel issues, blood clotting, dysentery, and boils (). Its phytochemicals include alkaloids, flavonoids, saponins, tannins, terpenoids, steroids, phenolic compounds, and coumarin (), supporting antioxidant () and anti-inflammatory benefits (). Mimosa pudica is used internally and externally by the Tai Yai, Thai Yuan, and Karen groups in Thailand and is consumed with milk for hemorrhoid management in Myanmar (). In Thailand, it is used to treat a range of disorders, including urological, endocrine, digestive, musculoskeletal, and cardiovascular diseases (). It is also used in Chinese medicine for treating tuberculosis, insomnia, anxiety, and trauma (). Key phytochemicals are alkaloids, flavonoids, saponins, triterpenes, glycosides, quinines, tannins, and coumarin (; ), yielding anti-inflammatory (), antioxidant (; ), wound-healing (; ), and analgesic () activities.

Aegle marmelos was historically used for hemorrhoid management in Persia and Iran () and for addressing bowel and diarrhea issues in Myanmar (). The leaf and root flavonoids show anti-nociceptive effects (), while flower extracts have anti-inflammatory effects in rats (), and leaf extracts demonstrate analgesic and antipyretic properties (). Leea indica roots and stems are used for treating hemorrhoids, and its shoots help reduce swelling (; ). It is also applied to ease joint pain, sores, leprosy, eczema, fractures, allergies, and diarrhea (). Main compounds include alkaloids, coumarin, flavonoids, saponins, phenolics, terpenoids, phthalic acid derivatives, and steroids (; ). It displays antioxidant (), analgesic (), anti-inflammatory (), and wound-healing () effects. Plumbago indica is mainly used internally for hemorrhoid management () and also for bronchitis, digestive disorders, neurological conditions, and inflammatory diseases (). Active compounds are alkaloids, flavonoids, steroids, and tannin (). Methanolic extracts reduce pain () and exert anti-inflammatory activity through naphthoquinone plumbagin (). Root extracts are rich in antioxidant compounds (). Plumbago zeylanica , from the same genus, is also reported for hemorrhoid treatment (; ).

Rotheca serrata has a long history in Indian (), Myanmar (), and Thai traditional medicine () for management of pain, inflammation, rheumatism, and respiratory disorders. Its key compounds are phenolics, tannins, flavonoids, and saponins (; ), and it exhibits hepatoprotective, antioxidant, and anti-inflammatory activities (). Tectona grandis is known for its wound-healing properties () and is used in Thai medicine for diabetes, blood pressure, stomach ache, and pain (). It demonstrates potent analgesic (), anti-inflammatory (; ), antioxidant (), and wound-healing effects (). Major phytochemicals include triterpenoids, steroids, lignans, fatty esters, phenolics, flavonoids, saponins, alkaloids, and tannins (). In summary, these plants, notable for their UV and CV, are used not only traditionally for hemorrhoid management but also for treating numerous other ailments in different regions, with substantial pharmacological evidence to support their effects. To validate their medicinal use, further clinical trials are recommended.

Hemorrhoids is one of the most prevalent diseases in Thailand. Various ethnic groups use medicinal plants to treat this condition. Some plant species, such as C. quadrangularis , are commonly used for hemorrhoid treatments across multiple ethnic groups. This study identifies promising plant species for the treatment of hemorrhoids in Thailand, based on their high ethnobotanical index and reported pharmacological activities. These pharmacological properties support the effectiveness of medicinal plants in treating hemorrhoids. All promising species exhibit various pharmacological activities, including antioxidant, anti-inflammatory, analgesic, antimicrobial, anti-hemorrhoid, vasorelaxant, and venotonic effects, along with local anesthetic and wound-healing properties. These activities are directly related to the treatment of hemorrhoids.

This literature review can serve as a foundation for selecting plants for future clinical studies on hemorrhoid treatments and for developing medicinal plants into commercial products. Moreover, it provides valuable information as an alternative treatment for hemorrhoids, particularly considering the side effects associated with surgical hemorrhoidectomy. Based on quantitative ethnobotany, the present work selects the most important medicinal plants used for hemorrhoid treatments in Thailand. Further studies should focus on the pharmacological validation and clinical testing of promising plant species identified through ethnobotanical surveys. Although long-standing traditional use reflects cultural importance, it does not necessarily guarantee safety or clinical efficacy. Investigating the mechanisms of action, safety profiles, and active compounds of these plants will help bridge the gap between traditional knowledge and scientific evidence. In addition, exploring the potential of lesser-known or novel plant species may lead to the discovery of alternative therapies for hemorrhoid treatment. Continued documentation of traditional practices is also essential to preserve ethnobotanical knowledge for future generations.

However, it is important to note the limitations of the current literature in Thailand. Many existing studies rely primarily on ethnobotanical surveys based on self-reported or recalled data, with limited pharmacological or clinical validation. There is a lack of standardized research methodologies, and much of the relevant research is published in Thai-language journals, which restricts accessibility and recognition in the international scientific community. Addressing these limitations through well-designed pharmacological studies and clinical trials will be crucial for fully validating and utilizing Thai medicinal plant resources for hemorrhoid treatment.

Edited by: Thomas Efferth , Johannes Gutenberg University Mainz, Germany Reviewed by: César Antonio Echeverría , Universidad de las Américas, Chile Awadhesh Kumar , Mizoram University, India

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