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Pharmacognosy Reviews | July-December 2012 | Vol 6 | Issue 12 141
Ferula asafoetida: Traditional uses and pharmacological
activity
Poonam Mahendra, Shradha Bisht
Department of Pharmacology, School of Pharmacy, Suresh Gyan Vihar University, Jaipur, Rajasthan, India
Submitted: 15-03-2011 Revised: 02-04-2011 Published: 23-08-2012
REVIEW ARTICLEPHCOG REV.
Address for correspondence:
Miss. Poonam Mahendra, Pharmacology Division, School Of
Pharmacy, Suresh Gyan Vihar University, Jaipur-302004, India.
E-mail: poonammahendra84@gmail.com
Ferula asafoetida is herbaceous plant of the umbelliferae family. It is oleo gum resin obtained from the rhizome and root
of plant. This spice is used as a digestive aid, in food as a condiment and in pickles. It is used in modern herbalism in the
treatment of hysteria, some nervous conditions, bronchitis, asthma and whooping cough. It was at one time employed in
the treatment of infantile pneumonia and fl atulent colic. The gum resin is antispasmodic, carminative, expectorant, laxative,
and sedative. The volatile oil in the gum is eliminated through the lungs, making this an excellent treatment for asthma. The
odor of asafoetida is imparted to the breath, secretions, fl atus, and gastric eructations. Its properties are antispasmodic,
expectorant, stimulant, emmenagogue and vermifuge. Asafoetida has also been used as a sedative. It also thins the blood
and lowers blood pressure. It is widely used in India in food and as a medicine in Indian systems of medicine like ayurveda.
Asafoetida has been held in great esteem among indigenous medicines, particularly in Unani system from the earliest times.
Key words: Ferula asafoetida, spice, umbelliferae
ABSTRACT
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DOI:
10.4103/0973-7847.99948
INTRODUCTION
Plants have been a constant source of drugs and recently,
much emphasis has been placed on fi nding novel therapeutic
agents from medicinal plants. Today many people prefer to use
medicinal plants rather than chemical drugs. Ferula asafoetida Linn:
Asafoetida, the gum resin prized as a condiment in India and
Iran, is obtained chiefl y from plant Ferula asafoetida. The Latin
name ferula means “carrier” or “vehicle”. Asa is a latinized form
of Farsi asa “resin “, and Latin foetidus means “smelling, fetid”.
In ancient Rome, asafoetida was stored in jars together with pine
nuts, which were alone used to fl avor delicate dishes. Another
method is dissolving asafoetida in hot oil and adding the oil
drop by drop to the food. If used with suffi cient moderation,
asafoetida enhances mushroom and vegetable dishes, but can also
be used to give fried or barbecued meat a unique fl avor. Ancient
texts describe it as hingu and several centuries of its constant
use have bestowed upon it the peculiarity of a tempting spice
and trusted medicine. Hing is bitter and pungent in taste and
light, sharp, unctuous and hot in effect. Ayurvedic texts have
categorized hing as deepniya and sanjna-sthapaka (an appetiser
and a restorer of consciousness). It is popular household
remedies and its components are used for many prescriptions in
traditional healing.[1] Asafoetida is used as a fl avoring agent and
forms a constituent of many spice mixtures. It is used to fl avor,
curries, meatballs, dal and pickles. The whole plant is used as a
fresh vegetable. The herb is also used as an antidote of opium.
Given in the same quantity as opium ingested by the patient, it
will counteract the effect of the drug.
MYTHS AND HISTORY
As its name suggests, asafoetida has a fetid smell and a nauseating
taste; characteristics that also burdened it with the name devil’s
dung. In the middle Ages, a small piece of the gum was worn
around the neck to ward off diseases such as colds and fevers.
Whatever effectiveness it had was probably due to the antisocial
properties of the amulet rather than any medicinal virtue.
Surprisingly, in Persia asafoetida was used as a condiment and
called the “food of the gods”. This herb is the major component
in the famous Ayurvedic herbal formula Hingashtak, Sanskrit
name is hing. In Persia this herb is so highly esteemed as a
condiment, it is mixed with almost all their dishes. French
gastronomers rub a little asafoetida on hot plates from which
Mahendra and Bisht: Review on Ferula asafoetida
142 Pharmacognosy Reviews | July-December 2012 | Vol 6 | Issue 12
they eat beef steaks. The distinctive fl avor of Worcestershire
sauce is obtained by the addition of this gum. When used with
discretion, it adds character to curries, stews, gravies, etc. Skilful
manipulation has made asafoetida a useful ingredient in fi ne
perfumes. It is still regarded a valuable medicinal in Europe,
Near and far East. As a condiment, it is recommended only to
the hearty and the brave. In magic and mythology, asafoetida is
used to gain insight and to banish all negative energy, evil spirits
and demons. It is used to invoke male gods, especially those of a
phallic nature. One myth claims that asafoetida developed from
the semen of a god of fertility when it soaked into the earth.
ORIGIN AND DISTRIBUTION
Ferula asafoetida is an herbaceous, monoecious, perennial plant
of the UMBELLIFERAE family. Asafoetida is native to central
Asia, eastern Iran to Afghanistan, and today it is grown chiefl y
in Iran and Afghanistan, from where it is exported to the rest of
the world. It is not native to India, but has been used in Indian
medicine and cookery for ages.
Other Names: Anghuzeh (Farsi); asafétida (Spanish);
asafoetida; awei (Chinese); aza(Greek); devil’s dung; férule
persique or merde dudiable (French); haltit or tyib (Arabic); hing
(Hindi); mvuje (Swahili); stinkasant or teufelsdreck (German);
stinking gum.
Asafoetida is extracted from the Ferula plants which have massive
taproots or carrot-shaped roots, 12.5-15 cm in diameter at the
crown when they are 4-5 years old. Just before the plants fl ower,
in March-April, the upper part of the living rhizome root is laid
bare and the stem cut off close to the crown. A dome-shaped
structure made of twigs and earth covers the exposed surface.
A milky juice exudes from the cut surface. After some days, the
exudates are scraped off and a fresh slice of the root cut when
more latex exudes; sometimes the resin is removed along with the
slice. The collection of resin and slicing of the root are repeated
until exudation ceases (about 3 months after the fi rst cut). The
resin is sometimes collected from successive incisions made at
the junction of the stem or rhizome and the taproots.
TRADITIONAL MEDICINAL USES
In Afghanistan hot water extract of the dried gum is taken
orally for hysteria and whooping cough and to treat ulcers.
[2]
Decoction of the plant is taken orally as a vermifuge in
China.
[3] Hot water extract of the dried root is taken orally as
an antispasmodic, a diuretic, a vermifuge and an analgesic in
Egypt.[4] Gum is chewed for amenorrhea in Malaysia[5] and as
antiepileptic in Morocco.[6] Water extract of the resin in Nepal
is taken orally as an anthelmintic[7] and in Saudi Arabia dried
gum is used medicinally for whooping cough, asthma, and
bronchitis.[8] In Brazil hot water extract of the dried leaf and
stem is taken orally by males as an aphrodisiac[9] and oleoresin
powder, crushed with the fi ngertips, is used as a condiment.[10]
Fluid extract of the resin is taken orally as an emmenagogue, a
stimulating expectorant, an anthelmintic, an aphrodisiac, and a
stimulant to the brain and nerves and claimed to be a powerful
antispasmodic in United State.[11]
Ferula asafoetida as traditional medicine in India
Asafoetida has been held in great esteem among indigenous
medicines from the earliest times in India. It is reputed as a
drug which expels wind from the stomach and counteracts any
spasmodic disorders. It is also a nervine stimulant, digestive
agent and a sedative. A dry Lampyris noctiluca without head is
mixed with 200–300 mg of Ferula and taken mornings and
evenings for gallstones and kidney stones and potassium nitrate
is added to the mixture for old stones.[12] Hot water extract of
the dried resin is taken orally as an emmenagogue[13] and hot
water extract of the dried gum is taken orally as a carminative,
an antispasmodic, and an expectorant in chronic bronchitis.
[14]
Dried extract with Brassica alba and rock salt is diluted with
vinegar and taken orally as an abortifacient.[15] Dried gum resin
exudates are eaten to prevent guinea worm disease.[16] Gum
resin with salt and the bark juice of Moringa pterygosperma is used
externally for stomachaches.[17]
CHEMICAL CONSTITUENT
An analysis of asafoetida shows it to consist of carbohydrates
67.8% per 100 gms, moisture 16.0%, protein 4.0%, fat
1.1%, minerals 7.0% and fi ber 4.1%. Its mineral and vitamin
contents include substantial calcium besides phosphorus,
iron, carotene, ribofl avin and niacin. Its calorifi c value is 297,
contains 40-64% resinous material composed of ferulic acid,[18]
umbel-liferone,[2,19] asaresinotannols,[18] farnesiferols A, B, and
C[20,21] etc., about 25% gum composed of glucose, galactose,
l-arabinose, rhamnose, and glucuronic acid[18] and volatile oil
(3-17%) consisting of disulfi des as its major components,
notably 2-butyl propenyl disulfi de (E- and Z-isomers),[22] with
monoterpenes (α- and β-pinene, etc.),[2] free ferulic acid, valeric
acid, and traces of vanillin (LAF). The disagreeable odor of the
oil is reported to be due mainly to the disulphide C11H20S2.[22,23]
Various chemical constituents responsible for pharmacology
has been shown in Table 1.
PHARMACOLOGICAL ACTIVITIES AND CLINICAL
TRIALS
Effect of Ferula asafoetida on gastro intestinal tract
The herb is an effective remedy for several diseases of the
stomach. It is one of the best remedies available for fl atulence
and is an essential ingredient for most of the digestive powders.
In case of fl atulence and distension of the stomach, asafoetida
should be dissolved in hot water and a pad of cloth steeped in
it may be used for fomenting the abdomen. Colloidal solution,
administered orally to rats at a dose of 50 mg/kg, 60 minutes
before experiment, produced signifi cant protection against gastric
Mahendra and Bisht: Review on Ferula asafoetida
Pharmacognosy Reviews | July-December 2012 | Vol 6 | Issue 12 143
chymotrypsin. The stimulatory infl uence was not observed when
their intake was restricted to a single oral dose.[28] Asafoetida did
not affect the digestibility of protein in sorghum.[29]
Ferula asafoetida and cancer
Ethanol (90%) extract of the dried plant, in cell culture
administered at a concentration 0.25 mg/mL, was active on
human lymphocytes. The extract was active on Vero cells,
effective dose (ED50 0.15 mg/mL; Chinese hamster ovary
(CHO) cells, ED50 0.575 mg/mL; and Dalton’s lymphoma,
ED50 0.6 mg/mL.[30] Water extract of the dried gum, in cell
culture at a concentration of 500 μg/mL, produced weak
activity on CA-mammarymicroalveolar cells.[31] Water extract
of the dried oleoresin, administered by gastric intubation
to mice at a dose of 50 mg/animal daily for 5 days, was
active on CAEhrlich ascites, 53% increase in life span (ILS).
Water extract administered intraperitoneally was inactive on
Dalton’s lymphoma, 4.8% ILS, and CA-Ehrlich ascites, 5.5%
ILS.[32] Dried resin, administered orally to Sprague–Dawley
rats at doses of 1.25 and 2.5% w/w of the diet, produced a
signifi cant reduction in the multiplicity and size of palpable
N-methyl-N-nitrosourea-induced mammary tumors, and a
delay in mean latency period of tumor appearance.[33] Oral
administration to mice increased the percentage of life span
by 52.9%. Intraperitoneal administration did not produce
any signifi cant reduction in tumor growth. The extract also
inhibited a two-stage chemical carcinogenesis induced by
7,12-dimethylbenzathracene and croton oil on mice skin with
signifi cant reduction in papilloma formation.[34] Sodium ferulate,
administered to human lymphocytes cell culture, induced
apoptosis.[35] Gum, administered to mice at a dose of 40 mg/g
of diet, was active. The dose was inactive vs 3’-methyl- 4
dimethylaminoazobenzene-induced carcinogenesis.[36] Water
extract of the dried oleoresin, administered externally to mice
at a dose of 200 μL/animal, was active vs 7,12-dimethylbenz[a]
anthracene and croton oil treatment.[30]
Ferula asafoetida as women’s ailments
The herb is considered useful in the treatment of several problems
concerning women such as sterility, unwanted abortion, pre-mature
labor, unusually painful, diffi cult and excessive menstruation and
leucorrhoea. About 12 centigrams of gum fried in ghee mixed with
120 grams of goat’s fresh milk and a tablespoon of honey, should be
given thrice daily for a month. It excites the secretion of prog esterone
hormone. Asafoetida is also useful for women after childbirth.
Owing to its antifl atulent and digestive properties, the herb can
be taken with benefi cial results during the post-delivery period. In
southern India, the powder of the herb mixed with rice is given to
women after delivery. Methanol extract of the resin, administered
orally to Sprague–Dawley rats at a dose of 400 mg/kg daily for 10
days, prevented pregnancy in 80% of the rats. When administered
as a polyvinylpyrrolidone 1:2 complex, 100% pregnancy inhibition
was observed at this dose. Lower doses of the extract produced a
marked reduction in the mean number of implantations. Signifi cant
activity was observed in the hexane and chloroform eluents of
sulfur-containing extract in an immature rat bioassay, the methanol
Table 1: Chemical constituent responsible for
pharmacological activity
Pharmacological activity Responsible chemical
constituent
Anticancer α-pinene; α-terpineol; diallyl-
disulfi de; ferulic-acid; isopimpinellin;
luteolin; umbelliferone; vanillin
Anti-infl ammatory α-pinene; azulene; β-pinene;
ferulic-acid; isopimpinellin; luteolin;
umbelliferone
Antileukemic Luteolin
Antimutagenic Diallyl-sulfi de; ferulic-acid; luteolin;
umbelliferone; vanillin
Antineoplastic Ferulic-acid
Antitumor Diallyl-disulfi de; diallyl-sulfi de;
ferulic-acid; luteolin; vanillin
Antiviral α-pinene; diallyl-disulfi de; ferulic-
acid; luteolin; vanillin
Antibacterial α-pinene; α-terpineol; azulene;
diallyl-disulfi de; diallyl-sulfi de;
ferulic-acid; luteolin; umbelliferone
Antispasmodic Azulene; ferulic-acid; luteolin;
umbelliferone; valeric-acid
Antiseptic α-terpineol; azulene; β-pinene;
diallyl-sulfi de; umbelliferone
Lipoxygenase-inhibitor Luteolin; umbelliferone
Antiulcer Azulene
Hepatoprotective Ferulic-acid; luteolin
Anti-HIV Diallyl-disulfi de; luteolin
Antinitrosaminic Ferulic-acid
Antioxidant Ferulic-acid; luteolin; vanillin
Antiaggregant Ferulic-acid
Tranquilizer α-pinene; valeric-acid
Antiproliferative Diallyl-disulfi de
Apoptotic Luteolin
Anticarcinogenic Ferulic-acid; luteolin
β-Glucuronidase-Inhibitor Luteolin
Immunostimulant Diallyl-disulfi de; ferulic-acid
Antihepatotoxic Ferulic-acid; glucuronic-acid
Antiprostaglandin Umbelliferone
Antihyaluronidase Luteolin
Cytotoxic Luteolin
Ornithine-Decarboxylase-
Inhibitor
Ferulic-acid
PTK-Inhibitor Luteolin
Sedative α-pinene; alpha-terpineol; valeric-
acid
ulcers induced by 2 hours cold-restraint stress, aspirin, and 4
hours pylorus ligation.[24] Gum extract, administered to isolated
guinea pig ileum at a dose of 3 mg/mL, produced a decrease of
spontaneous contraction to 54 ± 7% of control. Exposure of
precontracted ileum by acetylcholine, histamine, and KCl to Ferula
gum extract produced a concentration-dependent relaxation.
Preincubation with indomethacin, propanolol, atropine and
chlorpheniramine before exposure to the gum, did not produce
any relaxation.[25] Asafoetida, administered orally to rats at a dose
of 2500 mg% for 8 weeks, decreased the levels of phosphatases
and sucrase in the small intestine.[26] Powder of the dried entire
plant, administered by gastric intubation to adults at a dose of
0.2 g for 1 hour, was active.[27] Asafoetida, administered orally
to albino rats at a dose of 250 mg% for 8 weeks, enhanced
pancreatic lipase activity, stimulated pancreatic amylase and
Mahendra and Bisht: Review on Ferula asafoetida
144 Pharmacognosy Reviews | July-December 2012 | Vol 6 | Issue 12
extract was devoid of any estrogenic activity.[37] A mixture of Embella
ribes fruit, Piper longum fruit, borax, Ferula-dried gum, Piper betle,
Polianthes tuberosa, and Abrus precatorius, administered orally to female
adults at a dose of 0.28 g/person starting from the second day of
menstruation twice daily for 20 days, without sexual intercourse
during the dosing period, produced the effect for 4 months and the
activity was patented for both small and long term effects.[38,39] Hot
water extract of the plant, administered to female rats, was inactive
on estrogen of uterus. Extract administered to pregnant rats, was
inactive on uterus.[40]
Ferula asafoetida and gene expression
Asafoetida, administered orally to Sprague–Dawley rats at
doses of 1.25% and 2.5% w/w, signifi cantly restored the level
of antioxidant system, depleted by N-methyl-N-nitrosourea
treatment. There was a signifi cant inhibition in lipid peroxidation
as measured by thiobarbituric acid-reactive substances in the
liver of rats.[33] Ethanol (95%) extract of the dried resin, on agar
plate at a concentration of 15 mg/plate, produced weak activity
on streptomycin-dependent strains of Salmonella typhimurium
TA98. Metabolic activation has no effect on the result.[41] Resin,
on agar plate at a concentration of 200 μg/plate, was active on
S. typhimurium TA1537 and inactive on S. typhimurium TA1538
and S. typhimurium TA98.[42] Gum, administered by gastric
intubation to mice at a dose of 1 g/kg, was active. The results
were signifi cant at p less than 0.01 level. A dose of 0.5 g/kg,
produced weak activity. Asafoetida, administered orally to mice,
produced weak activity in spermatogonia.[43] Water extract of
the dried gum, on agar plate at a concentration of 2 mg/plate,
was inactive on S. typhimurium TA100 vs afl atoxin B1-induced
mutagenesis and a concentration of 10 mg/plate, was inactive
on S. typhimurium TA98.[44] Asafoetida, on agar plate, was active
on S. typhimurium TA100 and TA1535 microsomal activation-
dependent mutagenicity of 2-acetamidofl uorene.[45]
Ferula asafoetida and its effect on blood pressure
In one study tincture of the gland, administered intravenously to
rabbits, produced signifi cant hypotensive effects.[46] Water extract
of the dried gum resin, administered intravenously to dogs at
variable doses, shown antihypertensive activity.[47] Gum extract,
administered to anesthetized rats at doses of 0.3–2.2 mg/100 g
body weight, and signifi cantly reduced the mean arterial blood
pressure.[25]
Effect of Ferula asafoetida on blood vessels and blood
Water extract of the dried gum resin, administered to frogs, was
active on the vein and shown vasodilatation effect.[47] Tincture
of the gland, administered to rabbits, was active on the bladder
and intestine and produced signifi cant smooth muscle relaxant
effect, which may be helpful in lowering the blood pressure.[46]
Water extracts of the gum, administered intravenously to dogs
and rats at variable doses, shown anticoagulant activity.[48] Ether
extracts of the dried gum and gum resin, administered orally to
10 healthy subjects fed 100 g of butter to produce alimentary
hyperlipemia, were actively shown fi brinolytic activity.[49]
Ferula asafoetida and chemoprotective therapy
Dried gum resin, on agar plate, was active on Clostridium perfringens
and Clostridium sporogenes.[50] Essential oil of rhizome, on agar plate
at a concentration of 400 ppm, was active on Microsporum gypseum
and Trichophyton rubrum, and produced weak activity on Trichophyton
equinumi.[51] Extract of asafoetida, on agar plate at concentrations
of 5–10 mg/ mL, inhibited Aspergillus parasiticus aflatoxin
production.[52] Ethanolic (95%) extract of the dried gum on agar
plate shown antifungal activity.[53] Oleo-gum resin from roots and
stems was active on Trichomonas vaginalis.[54] Asafoetida treatment
signifi cantly reduced the levels of cytochrome P450 and b5.
There was an enhancement in the activities of glutathione-S-
transferase, deoxythymidine- diaphorase, superoxide desmutase,
catalase, and reduced glutathione. Asafoetida, administered orally
to Sprague–Dawley rats at doses of 1.25% and 2.5% w/w in diet,
produced an increase in the development and differentiation of
ducts/ductules and lobules and a decrease in terminal end buds
as compared to both normal and N-methyl-N-nitrosourea-treated
control animals.[33]
Ferula asafoetida and hypersensitivity reactions
Allergenic activity was shown when oleoresin powder,
administered externally to adults. Reactions to patch test occurred
most commonly in patients who were regularly exposed to the
substance, or who already had dermatitis on the fi ngertips.
[10]
Ethanolic (95%) extract of the resin, administered orally to
two groups of 50 patients with irritable colon, shown anti-
infl ammatory. Results were signifi cant at P < 0.001 level.[55]
Effect of Ferula asafoetida on lipid profi le
Resin, administered to rats fed an atherogenic diet, at a dose
of 1.5%, failed to reduce the serum cholesterol levels. Gum,
administered to female rats at a concentration of 1% of diet, not
shown any antihypercholesterolemic activity.[56] A hot mixture of
Nigella sativa, Commiphora myrrha, Ferula asafoetida, Aloe vera, and
Boswellia serrata, administered by gastric intubation to rats at a
dose of 0.5 g/kg for 7 days, was active vs streptozotocin-induced
hyperglycemia.[57]
Hepatoprotective effect of Ferula asafoetida
A mixture of the methanol-insoluble fraction of the dried resin,
fresh garlic, curcumin, ellagic acid, butylated hydroxytoluene, and
butylated hydroxyanisole, administered by gastric intubation to
ducklings at a dose of 10 mg/animal, shown antihepatotoxic
activity vs afl atoxin B1-induced hepatotoxicity.[58] Oleoresin,
administered to rats at a dose of 250 mg%, shown hepatic
oxidase inhibition.[59]
Effect on CNS and heart of Ferula asafoetida
Ethanol extract of the dried gum, administered orally to adults
at a dose of 20 mL/person, was active in CNS.[60] Tincture of
the gland, administered by perfusion to rabbits, produced weak
activity on the heart.[45]
Effect of Ferula asafoetida in blood sugar level
A hot mixture of Nigella sativa, Commiphora myrrha, Ferula
Mahendra and Bisht: Review on Ferula asafoetida
Pharmacognosy Reviews | July-December 2012 | Vol 6 | Issue 12 145
asafoetida, Aloe vera, and Boswellia serrata, administered by gastric
intubation to rats at a dose of 0.5 g/kg for 7 days, was active
vs streptozotocin-induced hyperglycemia.[57] Hot water extract
of the dried gum, Nigella sativa, Myrrhis odorata, and Aloe sp. in
equal parts, administered by gastric intubation to rats at a dose
of 10 mL/kg for 7 days, was active vs streptozotocin-induced
hyperglycemia. Results were signifi cant at P < 0.05 level.[61]
Antioxidant activity of Ferula asafoetida
Asafoetida, administered orally to Sprague–Dawley rats at
doses of 1.25% and 2.5% w/w, signifi cantly restored the level
of antioxidant system, depleted by N-methyl-N-nitrosourea
treatment. There was a signifi cant inhibition in lipid peroxidation
as measured by thiobarbituric acid-reactive substances in the
liver of rats.[33]
TOXIC EFFECT
Methemoglobinemia occurred in a 5-week-old infant after
treatment with a gum asafoetida formulation to alleviate
colic.[62] Asafoetida may enhance the activity of warfarin.[63]
A weak sister chromatid exchange-inducing effect in mouse
spermatogonia[43] and clastogenicity in mouse spermatocytes[64]
has been documented for asafoetida. Chromosomal damage by
asafoetida has been associated with the coumarin constituents.
CONCLUSIONS
Asafoetida is an oleo-gum-resin obtained from the exudates of
the roots of the Iranian endemic medicinal plant, F. asafoetida. It
is used widely all over the world as a fl avoring spice in a variety
of foods. Traditionally it is used for the treatment of various
diseases, such as asthma, epilepsy, stomach-ache, fl atulence,
intestinal parasites, weak digestion and infl uenza. Recent studies
including pharmacological and biological have also shown that
asafoetida possess several activities, such as antioxidant, antiviral,
antifungal, cancer chemopreventive, antidiabetic, antispasmodic,
hypotensive and molluscicidal. Asafoetida has great medicinal
importance, detailed studies of asafoetida is required prior to
clinical trial.
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How to cite this article: Mahendra P, Bisht S. Ferula asafoetida
: Traditional uses and pharmacological activity. Phcog Rev
2012;6:141-6.
Source of Support: Nil, Confl ict of Interest: None declared
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