Astringent drugs for bleedings and diarrhoea: The history of Cynomorium coccineum (Maltese Mushroom).

The botanical identity of the ancient vernacular cynomorium does not correspond to the modern scientific genus while it is not clear how many species of hipocistis (Cytinus sp.) were differentiated by the ancient physicians and whether Cynomorium coccineum was subsumed. The early history of therapeutic uses related to the herbal drugs derived from these parasitic taxa is therefore not easily accessible. Cynomorium coccineum, became an important pharmaceutical commodity after the siege of Malta but its importance decreased in the 18th century and now is considered obsolete.We compare the morphological, ecological and therapeutic information of Cynomorium and other parasitizing plant taxa across the past 2000 years and contextualize their uses with the pharmacological properties of their principal metabolites focusing on the raise and fall of C. coccineum as a medicine.The therapeutic uses of C. coccineum, the Maltese mushroom, seem to become clearly traceable since the Canon of Medicine by Avicenna. Styptic and astringent drugs such as Cynomorium, Cytinus but also gall apples and many others have been selected for their protein-linking capacity leading to the formation of a protective precipitate on the mucous membranes, which can be used to reduce the secretion of water and electrolytes in case of diarrhoea, dysentery and external bleedings. Whether C. coccineum is effective as a systemically applied anti-haemorrhagic drug is questionable.It appears that the vernacular cynomorium of the ancients corresponds to an edible Orobanche sp. while it remains doubtful whether the vernacular hipocistis was next to Cytinus sp. also applied to C. coccineum as evidence of C. coccineum parasitizing Cistus sp. is scarce. The isolation of gallic acid used as a styptic, the increasing availability of chemical styptics in the 18th century together with the availability of effective alternative anti-diarrhoeic drugs with a more reliable supply very probably led to the decline of the importance of the Maltese mushroom in pharmacy during the 18th century. The effectiveness of gallic acid as a systemic anti-haemorrhagic, remains uncertain.