Pomegranate and the Mediation of Balance in Early Medicine
Different elements of the pomegranate, both tree and fruit, had a wide range of uses in pre-modern therapeutics. Pomegranate also had a rich symbolic role in the art, literature, and religion of numerous cultures. In nearly every part of the globe where the pomegranate grew, it came to represent fundamental dualities: life and death, inside and out, many and one. The medicinal purposes for which healers recommended pomegranate at times reflected broader symbolic associations, and those associations are an important part of the therapeutic tradition. The dualistic symbolism that attended the pomegranate in various cultural traditions synergized with dualistic medical concepts, reinforcing the therapeutic power of pomegranate in otherwise diverse contexts. Reflecting this duality, pomegranate was both an astringent and a laxative, an emmenagogue and an antimenorrhagic, an expectorant and an antiemetic, a pyrogen and a febrifuge, a restorative and a soporific. In both literary and medical traditions, the pomegranate mediated transitions—or maintained balance—between opposing states. This essay provides an overview of the rich and sundry uses of pomegranate in pre-modern therapeutics, revealing how cultural associations both reflected and informed medical practices.
Published on: Mar 4, 2016
Transcripts - Pomegranate and the Mediation of Balance in Early Medicine
R E S E A RC H E S S A Y | A. R. Ruis, University of Wisconsin, Madison
Pomegranate and the Mediation
of Balance in Early Medicine
Abstract: Different elements of the pomegranate, both tree and fruit,
had a wide range of uses in premodern therapeutics. Pomegranate
also had a rich symbolic role in the art, literature, and religion of
numerous cultures. In nearly every part of the globe where the
pomegranate grew, it came to represent fundamental dualities: life
and death, inside and out, many and one. The medicinal purposes
for which healers recommended pomegranate at times reflected
broader symbolic associations, and those associations are an impor-
tant part of the therapeutic tradition. The dualistic symbolism that
attended the pomegranate in various cultural traditions synergized
with dualistic medical concepts, reinforcing the therapeutic power of
pomegranate in otherwise diverse contexts. Reflecting this duality,
pomegranate was both an astringent and a laxative, an emmena-
gogue and an antimenorrhagic, an expectorant and an antiemetic,
a pyrogen and a febrifuge, a restorative and a soporific. In both lit-
erary and medical traditions, the pomegranate mediated transitions
—or maintained balance—between opposing states. This essay
provides an overview of the rich and sundry uses of pomegranate in
premodern therapeutics, revealing how cultural associations both
reflected and informed medical practices.
Keywords: pomegranate, Punica granatum, medicine, materia med-
ica, religion, duality, balance.
different elements of the pomegranate, both tree and
fruit, had a wide range of uses in premodern therapeutics.
Pomegranate was employed to regulate the stomach and
bowels, reduce fevers, staunch bleeding, prevent putrescence,
and promote expectoration. It was a common ingredient in
topical applications for abscesses, chilblains, ulcers, earache,
and ocular afflictions. The root bark expelled tapeworms, and
the tree bark repelled insects and vermin. The tough rind of the
fruit had numerous uses as a pessary in the treatment of pro-
Women (and likely men) employed the fruit in contra-
ceptive applications, which was perhaps one of its earliest uses.
What distinguishes the pomegranate from the hundreds of
other plants that filled ancient herbals and formed the core of
nonsurgical therapeutics was its symbolic importance in
numerous religious and cultural contexts. The pomegranate
is one of the seven fruits with which the Promised Land was
blessed (Deuteronomy 8:7–8), Christians regarded it as a sym-
bol of both Mary’s chastity and the resurrection of Jesus, and
the ripening of the fruit is a sign for true believers in the
Quran (VI:99). Pomegranates were frequently used in
Zoroastrian rites as symbols of prosperity and the immortality
of the soul. The pomegranate is one of the three abundances
(三多) in Buddhism, and it is a totem of the Hindu god
Ganesha, lord of beginnings. In literature, the pomegranate
often symbolized fundamental dyads: life and death, mortal-
ity and immortality, fertility and barrenness, growth and
decay, inside and out, many and one.
These symbolic associations, which were common in
numerous and diverse cultures, synergized with an equally
diverse range of medical practices. In both literary and med-
ical traditions, the pomegranate mediated transitions—or
maintained balance—between opposing states. Maintaining
or restoring the balance between opposites, such as hot and
cold, wet and dry, or retention and expulsion, was nearly
universal in premodern medical epistemologies, as was the
management of fertility (and infertility). The dualistic sym-
bolism that attended the pomegranate in various literary and
religious traditions synergized with dualistic medical con-
cepts, reinforcing the therapeutic power of pomegranate in
otherwise diverse contexts. Reflecting this duality, pomegran-
ate served a wide range of often opposing functions in med-
ical recipes. It was both an astringent and a laxative, an
emmenagogue and an antimenorrhagic, an expectorant and
an antiemetic, a pyrogen and a febrifuge, a restorative and
Furthermore, ingesting pomegranate was at
times both helpful and harmful, and like many fruits, it occu-
pied an ontological position somewhere between food and
drug in many physiological theories.
It is perhaps unsurprising that premodern medical texts
displayed such homology with literary and religious texts.
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Literate physicians and clergy were educated in similar ways
in many cultures, and there was often considerable overlap
in writing styles across genres, both scholastic and artistic
(Longrigg 1963; Oppenheim 1962; Selby 2005; Sluiter 1994).
But in the case of pomegranate, there are particularly clear
connections between cultural or religious symbolism and
medicinal use. Despite the pomegranate’s inclusion in nearly
all major therapeutic systems, from the earliest written
records to the early modern period, there was remarkable
consistency in how it was employed in medicinal recipes.
This can be explained in part by the extensive transmission
and appropriation of medical texts, even across different cul-
tures, languages, and epistemological frameworks, but it also
suggests that the pomegranate, because of its consistent sym-
bolism across numerous cultures, was an intelligible remedy
in diverse medical systems. This is not to suggest that there
are no biochemically active compounds in pomegranate that
produce observable effects in the body. But the medicinal
efficacy of a substance is based not on essential properties but
on cultural and social understandings of its use in therapy or
prevention. This essay provides an overview of the rich and
sundry uses of pomegranate in premodern therapeutics,
revealing how cultural associations both reflected and
informed medical practices.3
Cycles: The Duality of Life and Death,
Fertility and Barrenness
The pomegranate’s oldest and deepest symbolic associations
are with life, fertility, and reproduction. Both the fruit and the
tree were common totems of maternal deities in particular.
Inanna, a goddess worshipped by the Sumerians as the “Lady
of Fruitfulness and Sexuality,” was depicted on a vase from
circa 3100 BC adorned with wheat and pomegranates (Riddle
2010: 5 ff.). Kubaba, a Hittite mother goddess better known by
her Phrygian name, Cybele, was at times portrayed holding
a pomegranate, as were Tanit, Astarte, Hera, Athena, and Aph-
rodite (Muthmann 1982: 13–14, 34–38). Even the Homeric
word for pomegranate, ῥοιά, may have been etymologically
related to Rhea, the daughter of Uranos and mother of six
Olympian gods. Like Cybele and Gaea, Rhea was first revered
as a universal mother goddess. Hariti, a Gandharan demoness
who devoured children, became in Buddhist tradition a benef-
icent guardian who eased childbirth, promoted familial har-
mony, and protected the young; in some stories, it was the
consumption of a pomegranate that turned her from eating
the young to guarding them. She was invoked to cure disease,
and was often depicted in Buddhist art with a child in her arms
and a pomegranate, her personal symbol (Olson 1994: 86).
The ancient and widespread association between pome-
granate and fertility is not particularly surprising. Pomegran-
ate fruit has numerous, prominent seeds, and it is the seeds
and arils, the reproductive matter, that are eaten. The pome-
granate tree was also the source of life-giving waters in Meso-
potamian religion (Muthmann 1982: 13–14), and Neoassyrian
seals often depicted pomegranate, the “tree of life” (Avigad
1990: 165). Scholars have suggested that the Tree of Life from
the book of Genesis was a pomegranate because of this
symbolic history, though of course many fruit-bearing trees
have auditioned for this role. Nonetheless, the connection
between pomegranate and the creation of life remained
common in later Christian and Islamic traditions (Goor and
Nurock 1968: 73).4
The pomegranate later became a dualistic symbol, as
numerous ancient authors employed the fruit not only to
FIGURE 1: Punicae (Pomegranate) from Plantae Selectae
by Christoph Jacob Trew. Georg Dionysus Ehret, Nuremburg,
Germany, ca. 1750–73, pl. LXXII.
courtesy of luesther t. mertz library, nybg / art archive at art resource, ny.
represent fertility but also to suggest fundamental connec-
tions between fecundity and barrenness, life and death. The
Hymn to Demeter, composed in Greece in the seventh cen-
tury BC, introduced this more complex symbolism, for the
pomegranate instigates not fertility or life but the suppression
of it. Persephone, the daughter of Zeus and Demeter, is kid-
napped by Hades and taken into the underworld. Although
Demeter is able to secure the return of her daughter, Perseph-
one eats some pomegranate seeds given to her by Hades
before leaving his realm, condemning her to spend half the
year in the world above and half in the world below. Ingestion
of the pomegranate seeds leads not to fertility but to cyclical
barrenness. (In some later versions, Persephone spends
a month in Hades for each seed consumed, suggesting a more
direct correlation between pomegranate and infertility or
death.) This story is variously interpreted as an allegory of the
agricultural cycle of growth and decay, of death and resurrec-
tion, of the onset of menarche and the transition into wom-
anhood, of the mother-daughter relationship, of the parallels
between rape or marriage and death, and of fertility rites and
sacred marriage (ἱερός γάμος), but regardless of interpreta-
tion, the pomegranate had come to represent more than sim-
ple fecundity (Arthur 1977; Bonner 1939; Myres 1938; Suter
2002; Tsiafakis 2001).5
The historian John Riddle has argued that the prophylac-
tic properties of pomegranate were widely known by that
time, for pomegranate “kept the virgin goddess Persephone
from being fertile” (Riddle 1992: 26).6
Pomegranate was a
traditional symbol of fertility and life, but ancient medical
writers recommended it as a contraceptive. Soranus of Ephe-
sus (fl. ca. AD 100) gave six recipes for contraceptive suppos-
itories that contained pomegranate. For example, a woman
could “grind the inside of a fresh pomegranate peel with
water, and apply [it]” (Soranus’ Gynecology I.62). The Byzan-
tine healer Aetius of Amida (fl. ca. AD 500) gave several
formulae for vaginal suppositories that induce sterility, some
of which involved pomegranate. (These were quite similar to
the recipes given by Soranus.) Furthermore, he suggested that
a man could rub his penis with pomegranate rind before
coitus to prevent conception (Gynaecology and Obstetrics
XVII). Such recipes were likely well known to women in
the ancient world, and they were widely used and adapted
thereafter (Totelin 2011).7
But while the pomegranate was
symbolic of the loss of virginity (after the tale of Perseph-
one), it could also be used to restore it. In the Trotula,
a twelfth-century Latin compendium of women’s medicine
and cosmetics, a powder prepared with pomegranate rinds
(presumably included as a source of red color) and other
ingredients, dissolved in warm water, could be applied to the
opening of the uterus to create the illusion of virginity (Tro-
Despite the application of pomegranate as a contracep-
tive and its association with death and barrenness in the tale
of Persephone, the fruit remained a common token of love
and fertility. “Let us go early to the vineyards,” wrote the
author of the Song of Songs, “and if the pomegranates are in
bloom, there I will give you my love” (Song of Songs 7:12).
Roman artists juxtaposed embracing lovers with pomegra-
nates (Riddle 2010: 51). In the Egyptian Jewish folktale
“Romana,” an early version of the Snow White story, a mys-
terious old woman gives a childless queen an enchanted
pomegranate. If the queen eats half, the woman tells her,
and her husband eats the other half, the queen will give
birth to a girl within a year. The woman’s only condition
is that they name the girl Romana ( ﺭﻣـﺎﻧـﺔ ), the Egyptian
Arabic word for pomegranate (Schwartz 1986: 67–78).
Pomegranates were also a common symbol of fertility in the
wedding rites of the Bedouin, Chinese, Greeks, Indians,
Persians, and Romans, among others. In Buddhist tradition,
the pomegranate is one of the three abundances, along with
the peach and the Buddha’s Hand citron, and it represents
the abundance of offspring. The Chinese expression 多子
means both “many seeds” and “many sons,” a pun linking
the fruit to fecundity.
Although used as a contraceptive in suppositories and
topical applications, medical writers at times promoted inges-
tion of pomegranate as an aphrodisiac, reflecting its complex
metaphorical relationship with fertility. For example, the
Tacuinum Sanitatis, a widely copied thirteenth-century work
FIGURE 2: Detail from the Book of the Dead of Hirweben ca.
1075–945 BC (21st Dynasty).
courtesy of alfredo dagli orti / art archive at art resource, ny.
on the nonnaturals adapted from an earlier work by Ibn
Butlan, claimed that ingestion of sweet pomegranate promotes
coitus (Lie`ge: f. 4v, Paris: f. 5). Of course, virtually all foods
were deemed to have aphrodisiac properties at one time or
another—encouraging copulation, it turns out, is not particu-
larly difficult. But in the case of the pomegranate, this further
emphasized the fruit’s role in the mediation of fertility.
The intricate relationship between pomegranates and
(in)fertility was widely adopted and developed in Western
literature. In a second-century AD version of the story of Side
(σίδη is the Boeotian word for pomegranate), she is a young
virgin who commits suicide to avoid being raped by her
father; the blood she sheds on her mother’s grave yields
a pomegranate tree (Dionysius Periegeta, De Aucupio I.7).
In this inversion of the Hymn to Demeter, the reunion of
mother and daughter in death produces pomegranates, the
very fruit that prevented Persephone from reuniting with
Demeter. Persephone’s consumption of the seeds, which can
create life, instead condemns her to a living death; Side’s
death, in contrast, becomes the seed of new life. In both
stories, the pomegranate mediates the transition between life
and death, girl and woman, fertility and infertility.
“The Tale of Pomegranate-Flower and Badr Basim” from
the Arabian Nights collection employs a similar construction,
creating a complex correspondence between marriage and
rape, life and death. A childless king receives a virgin slave
who does not talk, even after he spends a year with her to the
exclusion of his wives and duties as a ruler. When she does
finally speak, it is to tell him that she is pregnant. Julnar
( ﺟــﻠـﻨـﺎﺭ , pomegranate blossom) informs the king that she is
the daughter of the lord of the sea. She came onto the land
in search of a new life, and the first thing she did was fight off
a would-be rapist. She tells the king that his first “violence”
nearly compelled her to throw herself back into the sea, but
she remained out of pride. As her brother remarks later in the
story, “For a girl there is but marriage or the tomb” (The Tale
of Pomegranate Flower: 35). This theme is even more pro-
nounced in Romeo and Juliet. In Act III, the nightingale sings
in a pomegranate tree (III.5: 1–5), suggesting a parallel
between Juliet and Persephone. Juliet had already drawn an
association between death and marriage in the first act, when
she says of Romeo, “If he be married, / My grave is like to be
my wedding-bed” (I.5: 134–35), and the imagery of the pome-
granate tree reinforces the connection between the loss of
virginity and death (Watson and Dickey 2005: 140ff.).
The juxtaposition of the pomegranate with marriage or
rape (which are not always distinct events in early literature)
reveals further intricacies in the fruit’s symbolic uses. Sexual
intercourse in this context represented both life (the potential
to conceive) and death (the loss of innocence). Indeed, pome-
granates were used in both wedding and funeral rites in
a number of ancient cultures (Bennett 2011). What unites
Persephone, Side, Julnar, and Juliette is not their circum-
stances, per se, but their ages; each of them is faced with
a sexual experience, namely the loss of virginity, that repre-
sents their transformation from girls into women. In each of
the stories, the pomegranate suggests transition, couched in
the duality of maiden and matron, and the protagonist must
choose between remaining a child or becoming a woman.
In addition to life, fertility, and birth, pomegranates also
represented immortality and resurrection or rebirth. The
Babylonians ate pomegranate seeds, an agent of resurrection,
for longevity (Mahdihassan 1984: 37). According to Herodo-
tus, the elite Persian soldiers known as The Immortals carried
weapons adorned with pomegranates when the armies of
Xerxes invaded Greece in 480 BC. One thousand warriors
bore spears “with golden pomegranates instead of spikes”
on the butts; another nine thousand carried spears with silver
pomegranates (Herodotus, The Histories VII.41). Aaron’s robe
in the book of Exodus is adorned with pomegranates and
golden bells, and if he wears it when he ministers, he will
not die (Exodus 28:33–35). Chinese scholars during the Six
Dynasties period (AD 222–589) referred to pomegranate blos-
soms as longevity flowers (延年花), and Daoists associated the
fruit with immortality (Fang 2004: 154; Harper 1986: 143).
When Isfandiyar eats a pomegranate consecrated by the
prophet Zaratust in the Zaratust Name, a thirteenth-century
Zoroastrian poem, he becomes invincible like “stone and
bronze” (Boyce 1984: 60). The pomegranate symbolized eter-
nity in Zoroastrianism, and it was “the most highly prized of
the fruits that are blessed” (Boyce 1975: 281).
The association between pomegranate and resurrection, or
the cycle of life and death, was already strong in the tale of
Persephone, and it became even stronger in the art and liter-
ature of European Christians. Sandro Botticelli’s Madonna
della Melagrana depicts the Virgin Mary and an infant Jesus
jointly holding a pomegranate.8
The pomegranate connects
Mary to the ancient mother goddesses as an icon of divine
fertility, but paradoxically it also represents her chastity. Fur-
thermore, the pomegranate references the resurrection of
Jesus. Like Persephone, who inhabits both the land of the
living and the land of the dead, Jesus has two natures for
Christians, one mortal and one divine. The pomegranate also
reflects the torments of Jesus on the cross, for the fruit “bleeds”
when opened. In Juan de Dios y Anto´n Martı´n, a play written
by Lope de Vega circa 1610, the split pomegranate is the fruit
of Juan’s life from the seeds of Christ’s death, seeds that are
but drops of blood (esta granada partida / tiene el fruto de tu
vida/ por los granosde mimuerte, / que gotas desangre son) (Graf
2007: 114). The last of The Hunt of the Unicorn tapestries depicts
pomegranate tree, a clear reference to the suffering of Jesus. In
many pagan mythologies, however, the unicorn represented
virginity and purity, and so the tapestry also suggests the associa-
tions between the pomegranate and the lossofinnocence, recal-
ling the Hymn to Demeter and other stories.
In numerous cultures, the pomegranate symbolized cycli-
cal, dualistic relationships between life and death, fertility
and barrenness, childhood and motherhood. Importantly, the
pomegranate often mediated these dualities, serving to govern
the transition from one part of a dyad to the other. Medicinal
use of the pomegranate as both a contraceptive and an aph-
rodisiac reinforced and was reinforced by this transformative
narrative. But while pomegranate mediated transitions
between mutually exclusive states, it also established balance
between antagonistic forces.
Balance: The Duality of Hot and Cold,
Retention and Expulsion
Pomegranate enflamed the passions and represented the heat
of sexual ardor, but healers also employed it as a cooling
agent, especially in the treatment of deadly fevers. Acid pome-
granates were more cooling (ψυκτικώτεραι) than sweet pome-
granates according to Hippocratic healers (On Regimen II.55,
Littre´ VI.562), who employed the juice to treat fevers (Epi-
demics VII, Littre´ V.436).9
Aulus Cornelius Celsus, a Roman
physician who flourished in the early first century AD, wrote
that pomegranate repressed and cooled (reprimunt et refriger-
ant) (De Medicina II.33:2). This attribute was particularly
helpful in the treatment of smallpox and other deadly febrile
The Persian polymath and physician Al-Razi (Muhammad
ibn Zakariya al-Razi, AD 865–925) recommended that those
who had not yet contracted smallpox “frequently eat acid
pomegranates, and suck the inspissated juices of acid and styp-
tic fruits, as of pomegranates,” to dissipate heat (A Treatise on
the Small-Pox and Measles V.2). A maceration containing rose
water, vinegar, pomegranate peels, and pomegranate flowers
reduced heat in the blood and the liver, the organ widely
FIGURE 4: ‘‘The Unicorn in Captivity,’’ the seventh of the seven
tapestries in The Hunt of the Unicorn, woven in the Netherlands
between 1495 and 1505. The Cloisters, New York City.
courtesy of the metropolitan museum of art / art archive at art resource, ny.
FIGURE 3: Sandro Botticelli, Madonna della Melagrana, ca. 1487.
Uffizi Gallery, Florence, Italy.
courtesy of erich lessing / art archive at art resource, ny.
regarded as the source of blood (V.9–10). Acid pomegranate
juice, when dripped into the eyes of a patient just having con-
tracted smallpox, prevented the development of pustules in the
eyes (VII.1–2). The latter treatment recalled a much older
Assyrian prescription: “If a man’s eyes are full of yellow rheum,
thou shalt bray pomegranate-skin [and apply it]” (Thompson
In Abolqasem Ferdowsi’s Shahnameh, the Persian
Book of Kings, the physician Khorad-Borzin uses pomegranate
juice and cress to cure the empress’s daughter of a “fever in her
brain” (Shahnameh, “The Reign of Khosrow Parviz,” 795).
Such practices were embraced even beyond the healing
encounter. Sitala, the North Indian goddess of smallpox, was
at times depicted with a pomegranate, which symbolized
cooling. Typically called Mata, or mother, women prayed
to her and offered her cooling drinks to protect their chil-
dren from the ravages of smallpox, especially the intense
heat of fever, which was the symptom most likely to cause
death. In India, Pakistan, Bangladesh, and Nepal, many
believed that Sitala used her hosts (those with smallpox) to
rid herself of heat and restore her coolness, the very action
that pomegranate achieved in the fevered body (Arnold 1993:
121–25; Slusser 1972: 100–4). The pomegranate’s antipyretic
properties were a different aspect of the duality of life and
death. In this context, the fruit maintained the balance
between hot and cold, a common element of all ancient
medical epistemologies. Pomegranate allowed the goddess
to shed her heat, and thus live, while saving the smallpox
victim from death.
Pomegranate was employed to regulate balance in other
ways as well, particularly in the regulation of the stomach and
bowels, the treatment of hemorrhage, and the expulsion of
tapeworms. The fruit was either a laxative or an astringent,
depending on which parts were ingested. In the Hippocratic
treatise On Affections, the pomegranate, when eaten with its
seeds, was astringent, but taken without them, it was laxative
(On Affections, Littre´ VI.264).11
Pomegranate was also a com-
mon ingredient in Ayurvedic remedies for severe diarrhea
(Sharma 1996: 179). In fact, the use of pomegranate to regulate
the bowels was so common that even in regions where the tree
did not grow particularly well, such as Britain, it was included
in materia medica. The fifteenth-century Middle-English trans-
lation of the Compendium Medicinae, originally composed by
Gilbertus Anglicus in Latin sometime in the early thirteenth
century, relates that the bark of a pomegranate tree (psidie)
treated “a flux of dissenterie” (f. 258v–259), suggesting that
pomegranate was a remedy important enough to remain in
the text even after redaction (Healing and Society 1991).
The astringent properties of pomegranate also made it
a valuable antihemorrhagic. The Hippocratic author of On
Affections recommended sweet pomegranate for poultices
used to treat inflamed wounds (τὰ φλεγμαίνοντα) (On Affec-
tions, Littre´ VI.248), and this may have been Assyrian practice
as well (Thompson 1926: 63–64). Dioscorides suggested that
pomegranate blossoms (κύτινοι) would achieve the same end
(De Materia Medica I.110: 3), and Celsus regarded the flowers
as gentle corrosives that arrested putrescence (De Medicina
V.22: 2; cf. Al-Kindi, Medical Formulary 86, f. 109b; 128,
Furthermore, pomegranate reduced menorrhagia. Accord-
ing to Aetius, wild pomegranate blossoms were one of the
“stronger” remedies for heavy menstruation, and a bath with
decocted pomegranate rinds treated red uterine discharge
(Gynaecology and Obstetrics LXIV).12
seventeenth-century herbal, perhaps the most widely used in
the English language, recommended pomegranate seeds and
rinds, “whether the powder or the decoction be taken,” to
“stay…women’s menses” (Culpeper 2009: 301). As with the
regulation of the bowels, though, the pomegranate was also
used to induce menstruation. The Hippocratic treatise On the
Nature of Women, for example, gives numerous recipes con-
taining pomegranate to treat amenorrhagia (On the Nature of
Women, Littre´ VII.324, VII.356).
Controlling the retention and expulsion of fluids, the bal-
ance of hot and cold, and other fundamental relationships in
the body was a central element of Greco-Arabic humoral,
Ayurvedic, Siddha, and traditional Chinese and Tibetan
medical systems, suggesting one reason for the pomegranate’s
widespread adoption. In some Ayurvedic systems, for exam-
ple, health and illness were based on the interrelationship of
the three vital elements (दोष), the seven bodily constituents
(धातु), and the three waste products (मअ);13
balance of these within the body as well as the balance
between the body and its environment was a central goal of
medical practice (“Vagbhata’s Heart of Medicine” 2003: 206).
Of course there were many concepts of balance, even within
the same tradition. In Hippocratic medicine, the authors of
On Regimen and Diseases IV characterized the body as being
in a perpetual state of flux, with health being a state of
dynamic equilibrium and disease a state of exaggerated or
prolonged disequilibrium. The author of On the Nature of
Man, in contrast, suggested that the body remained in a state
of static balance until something disrupted it. Pomegranate,
which depending on application could induce either the
retention or expulsion of fluids, heating or cooling, was a par-
ticularly powerful therapeutic agent across otherwise diverse
medical frameworks in part because the maintenance or res-
toration of balance was such an important element of health
in the medical theories of the premodern world.
Perhaps the oldest and most common use of pomegranate
involved the expulsion of tapeworms. The Ebers Papyrus, com-
posed in Egypt around 1550 BC, recommended a concoction
involving pomegranate root to kill hefat-worms. The specific
kindofintestinalwormreferred tobyhefat isnot known, though
presumably it was a tapeworm (Nunn 1996: 72). According to
Dioscorides, the decoction of pomegranate root killed and
expelled tapeworms (ἕλμεις τὰς πλατείας ποθὲν ἐκτινάσσει καὶ
ἀποκτείνει) (De Materia Medica I.110: 3; cf. Paul of Aegina
IV.57), and the remedy was widely repeated in pharmacopias.
The use of pomegranate root as a vermifuge was nearly
universal. The Compendium of Materia Medica (本草綱目),
composed by Li Shizhen (李時珍) in the late sixteenth cen-
tury, contained numerous cures for tapeworms (寸白虫病).
In one, Li suggested harvesting a handful of eastward-growing
sour pomegranate roots that were not cut with an iron tool.
After boiling the roots in three pints of water until only about
one-sixth of the liquid remained, the resulting drink, if taken
just before dawn, would completely expel all the worms. (The
admonition against use of an iron tool when harvesting the
roots may have ensured that the astringent tannins were not
affected [Read 1931: 645–46, 651 n. 4].) The pomegranate
(安石榴), introduced to China no later than the third cen-
tury AD, was likely used in such treatments long before the
sixteenth century. According to Tao Hongjing (陶弘景, AD
456–536), a botanist of some repute, healers in the Six
Dynasties period were already using the roots of sour pome-
granate in their work (Harper 1986: 140).
Some remedies, however, particularly those that had
crossed cultural boundaries, were not as reliable. The Roman
naturalist Pliny (AD 23–79), who received most of his informa-
tion from travelers and other secondhand sources, reported
that both the fruit and the blossoms of the pomegranate neu-
tralize scorpion stings (Natural History XXIII.59–60). Unbe-
knownst to Pliny, this was not a medical practice but rather
a religious ritual. During the Zoroastrian festival of Isfanda-
gan, a festival celebrating women, pomegranate seeds and
raisins were mashed together and eaten to nullify scorpion
poison, but this was not a medical antidote, only a symbolic
one (Flattery and Schwartz 1989: 79). Nonetheless, such rem-
edies were widely repeated in pharmacopias (cf. Culpeper
2009: 301), particularly in areas where scorpion stings were
an unlikely occurrence. Although the pomegranate’s cultural
roles and medical applications often shared common ele-
ments, which may have encouraged use of the pomegranate
across many medical systems, the conflation of symbolic and
therapeutic practices also led to misappropriations.
The ubiquity of concepts of balance in most premodern
medical systems and the pomegranate’s symbolic role as
a mediator between opposites enabled the pomegranate to
bridge the medical and the literary even across cultures. But
while the homology between cultural and medical practices
lent the pomegranate therapeutic intelligibility across time
and place, it also at times blurred the distinction between
ritual and therapy, as the example of scorpion antivenom
reveals. The similarly blurry distinction between food and
drug—and between drug and poison—in premodern medical
systems also aligned with symbolic uses of the pomegranate,
whose many prominent seeds in a single rind was often
employed to represent synecdochal relationships.
Synecdoche: The Duality of Inside and Out,
Many and One
The pomegranate’s wide range of medicinal uses stemmed
from its numerous parts (the roots, bark, and blossoms of the
tree and the rind, arils, and seeds of the fruit), each of which
had different properties in premodern therapeutics. Among
its other symbolic associations, the pomegranate represented
the superposition of inside and out, many and one. John
Chrysostom, one of the Nicene fathers, likened vainglory
(κενοδοξία) to a pomegranate: “Vainglory…has a fair sem-
blance and the beholder, as he views it, receives the impres-
sion of wholesome fruit. But if he takes in his hand
a pomegranate or apple, straightaway it is soft to his fingers
and the rind that covers it outside is crushed and lets the
fingers light upon dust and ashes” (John Chrysostom 1951:
87). Although the metaphorical duality of life (the “whole-
some fruit”) and death (the “dust and ashes”) was already
ancient in the fourth century AD, John employed a different
dimension in the traditional trope by using the pomegranate
to symbolize that which is one thing without and another
within. The Spanish rabbi Moses de Leo´n (fl. ca. 1280) sug-
gested that all Jews contain the commandments as the pome-
granate contains seeds, and the pomegranate also represented
the Shekhinah ( השכינ ), the divine presence, which similarly
contains all the commandments (Book of the Pomegranate
This use of the fruit to symbolize part-to-whole relation-
ships was especially pronounced, as the literary scholar E. C.
Graf has argued, in late medieval and early modern Spain. In
1492, Queen Isabella and King Ferdinand ended the Recon-
quista of Spain when they conquered Granada, the last Islamic
stronghold in Andalusia. Just before the city fell, Ferdinand
allegedly swore, “I will take down one by one the seeds of
that pomegranate” (Yo arrancare´ uno a uno los granos de esa
granada), a linguistic pun on the name of the city (which,
being of Arabic origin, had no etymological relationship with
“pomegranate”). The Reconquista unified Spain politically
but did nothing to stem cultural strife and interethnic violence.
Once the most cosmopolitan region of Europe, Spain became
instead a cauldron of conflict. In Don Quixote (El Ingenioso
Hidalgo Don Quijote de la Mancha), Graf argues, Cervantes
used the pomegranate as a symbol of both the cultural and
ethnic diversity of Spain and the Christian concept of “social
harmony through sacrifice,” the idea that unity can emerge
from diversity, to suggest that unification should celebrate
rather than suppress dissimilar parts to create a better whole
(Graf 2007: 105, 113).
This use of the pomegranate as a symbol for the unity that
can arise from diversity was well established in the writings of
the early Catholic Church fathers. “What is signified by
pomegranates other than the unity of faith?” posed Pope Gre-
gory the Great in AD 591. “For just as in the pomegranate
many inner grains are covered by a single exterior peel, even
so countless members of the Holy Church are covered by the
unity of the faith, members held within by a diversity of
merits” (Letter I.24, addressed to John of Constantinople
In medicine, too, the pomegranate represented multiplic-
ity in unity. Many ancient languages did not contain clear
demarcations between substances that nourish, those that
heal, and those that harm. Much like the modern “drug,”
which has both positive and negative connotations, words like
φάρμακον, venenum, and 藥 connoted alterative powers with
no intrinsic valuation, either good or bad. In cases where
“poison” and “medicine” were linguistically distinct, as in
Sanskrit and the Semitic languages, the underlying connota-
tive distinctions depended on context. As the Sanskrit word
विषप्रयोग (to poison, but also to use a poison as medicine) sug-
gests, linguistic distinctions did not necessarily connote con-
ceptual ones. The divisions that separated food, medicine,
and toxin were neither categorical nor crudely quantitative
(Amigues 2001; Flint-Hamilton 1999; Gibbs 2009; Touwaide
Manipulation of the diet was a key element of both
the maintenance and the restoration of health in every
ancient medical system, and the linkage between “food” and
“nourishment” was typically fluid and contingent. In many
cases, the pomegranate occupied a more significant role as
a medicine than as a food, its benefits transcending the
Indeed, medical authorities disagreed about whether
pomegranate provided any nourishment at all. The Bunda-
hisˇn, a Zoroastrian cosmology and cosmogony, regarded
pomegranates as fit to eat (Laufer 1919: 192), and they were
used extensively in Persian, South Asian, Arab, and Near
Eastern cuisines. But a number of ancient medical writers
were openly dubious about the nutritive value of the fruit
(and, indeed, of fruits more generally). Celsus considered
pomegranates one of the many foods that were good for the
stomach (stomacho autem aptissima sunt) (De Medicina
II.24); it is unclear whether he meant this in the nutritive
or the medicinal sense, though it was most likely the latter.
Less equivocally, Dioscorides claimed that the fruit was
good for the stomach but not nourishing (εὐστόμαχος
ἄτροφος) (De Materia Medica I.110: 1), a view adopted by
Galen and repeated by Oribasius and Moses Maimonides
(Galen, On the Properties of Foodstuffs 605; Oribasius, Med-
ical Compilations I.51; Maimonides, The Regimen of Health
IV.14). The Persian scholar and physician Ibn Sina (ca. 980–
1037) deemed the pomegranate, like all fruits, to offer only
“feeble” nourishment (Canon of Medicine I.359–60). This
view remained common into the early modern era, as Cul-
peper’s herbal suggests: “[pomegranates] yield but slender
nourishment; they are very helpful to the stomach” (Culpe-
per 2009: 301).
In Chinese medicine, pomegranate had complex effects
on the body that were neither exclusively medicinal nor
exclusively nutritive. The Six Dynasties dietitian Cui Yuxi
(崔禹錫) warned that ingestion of the seeds would reduce
one’s vitality (精), and Tao Hongjing reported that the seeds
were better left uneaten (Harper 1986: 140, 142).15
opsis of Prescriptions of the Golden Chamber (金匱要略),
attributed to Zhang Zhongjing (張仲景, AD 150–219) but first
published during the Northern Song Dynasty (AD 960–1127),
proscribed immoderate consumption of fruits, which could
lead to pathologic conditions. Pomegranates, if eaten to
excess, would harm the lungs (損人肺) (Synopsis of Prescrip-
tions of the Golden Chamber XXV.12; cf. Hu, What Is Desir-
able and Appropriate in Food and Drink III.35A). However,
the distinction between food and medicine remained blurry.
The dietetic treatise What Is Desirable and Appropriate in
Food and Drink (飮膳正要), written during the Yuan
Dynasty (1271–1368) by the Turkic court physician Hu Sihui
(忽思慧), was both cookbook and pharmacopia. One of the
recipes, a pomegranate soup with mutton, cardamom, cin-
namon, and ginger, “treats a cold void in the primary recep-
tacle, cold pain in the belly, and aching pain in the lower
spine” (治元藏虛冷腹內冷痛腰脊酸疼) (I.41A).16
noted that pomegranates lack poison (毒) and stem leaking
vitality (止漏精) (III.35A). This provides yet another exam-
ple of the complexity intrinsic to the pomegranate’s thera-
peutic uses. Where Cui Yuxi regarded the fruit as a food that
reduces vitality, Hu Sihui suggested that it prevents such
Pomegranate fruit, characterized by its bountiful seeds, lent
itself to religious and literary metaphors linking the one and the
many, the part and the whole. As food or medicine, pomegran-
ate had complex effects on the body in premodern therapeutics.
Depending on the part of the plant used and the preparation
method, pomegranate could produce different, even opposite,
therapeutic effects. The plant and the fruit it bore were a verita-
ble pharmacopia unto themselves, one source of numerous
remedies—a source that has continued to fascinate those seek-
ing new therapeutic agents in old practices.
Interest in the medicinal properties of pomegranate contin-
ued into the modern era, both as a result of the sustained
popularity of traditional healing systems and because coloni-
zation, exploration, and global traffic expanded the transmis-
sion and appropriation of medical and botanical knowledge.
As late as the 1880s, for example, English physicians were still
“discovering” uses for pomegranate. “I found that whenever
a young child lost its appetite, had more or less irregular
bowels, somewhat tumid belly, was peevish by day and rest-
less by night, when it was wasting in flesh, and the symptoms
were negative as to worms or fevers,” wrote Brigade Surgeon
Edward Nicholson who served in India, “the decoction of
pomegranate root invariably effected a cure” (Nicholson
1886: 364). Soldiers in the American Civil War also were
aware of the pomegranate’s medicinal properties. “A decoc-
tion of the blackberry root and the rind of the pomegranate
fruit boiled in milk,” wrote a pharmacist from Atlanta in 1898,
“was a common remedy in diarrhoea” (Jacobs 1905).
Today, this interest in the medicinal properties of pome-
granate is experiencing something of a renaissance. Fewer than
thirty scientific or medical papers were published on pome-
granate in the late twentieth century, but nearly double that
number now appear every year. Studies of pomegranate
extracts in vitro have revealed a wide range of bioactive com-
pounds. Chemicals that have antiatherogenic, antibiotic, anti-
carcinogenic, antihypertensive, anti-inflammatory, antioxidant,
astringent, estrogenic, neuroprotective, spermatogenic, and
vermifugic properties have been isolated, and the actions of
many of these compounds reflect medical practices thousands
of years old (Jurenka 2008; Lansky and Newman 2007; Seeram
et al. 2006). Researchers worldwide are now seeking to learn if
pomegranate can play a significant role in yet one more med-
ical system: twenty-first-century biomedicine.
Indeed this interest, both ancient and modern, in the
medicinal properties of pomegranate has led to its use as
a symbol of medicine itself. Along with the staff of Asclepius,
the caduceus, and the red cross, the pomegranate is a widely
employed device in medical iconography. The insignias of
the British Medical Association, the Royal Colleges of Physi-
cians, Anaesthetists, Midwives, and Obstetricians & Gynae-
cologists, the Royal Australasian College of Physicians, the
Brothers Hospitallers of St. John of God, and the U.S. Army’s
61st Surgical Hospital all feature pomegranate, and the fruit
was the logo for the Millennium Festival of Medicine. This
use of the plant and its fruit in medical iconography reflects
the historical role of the pomegranate both in therapeutics
and as a religious and political symbol, as well as the current
revival of interest in pomegranate-based therapeutics.
Although the medical evidence is at best inconclusive, the
concept of “superfoods” with intrinsically healthful properties
has captured the popular and scientific imagination. Every-
thing from berries to yogurt, liver to mushrooms, phytoplank-
ton to microgreens, and of course pomegranate, has been
labeled at one time or another a superfood, with spending
on research in the botanic pharmaceutical industry well over
$20 billion a year worldwide. But while many premodern
writers regarded pomegranate as a medicine yet doubted its
nutritive value, today the fruit is a nutritious food whose
medicinal properties are investigated and debated. In bridg-
ing historic and modern anxieties about health and diet, the
pomegranate is even now a symbol of duality. As in Gregory’s
FIGURE 5: Stained glass window in the Museum of the History of
Science, Oxford, England, depicting the crest of the Royal College of
‘‘stained glass - royal college of physicians crest,’’ by andrew gray used under cc
metaphor of the Catholic Church, whose members were held
together by a “diversity of merits” like the seeds in a pomegran-
ate, scientists and physicians continue to seek a “diversity of
merits” in the pomegranate’s many bioactive compounds.
Research for this work was generously supported by a grant
from POM Wonderful. The opinions, findings, and conclu-
sions expressed in this work are those of the author and do not
reflect the views of POM Wonderful or its subsidiaries. Rima
Apple, Fred Gibbs, Ari Mackler, and two anonymous
reviewers provided many insightful suggestions and criti-
cisms, and Brad Schantz patiently answered numerous ques-
tions about Semitic linguistics and etymology.
1. A pessary is a rigid or semi-rigid spheroidal object inserted into the
vagina to treat and provide support for a prolapsed uterus.
2. Astringents reduce the discharge of fluid from the digestive tract,
and laxatives increase it; emmenagogues stimulate the flow of
mentrual blood, and antimenorrhagics reduce it; expectorants
encourage the discharge of fluid from the respiratory tract, and
antiemetics prevent the discharge of fluids from the digestive tract;
pyrogens induce fevers and febrifuges reduce them; restoratives
reinvigorate the body and soporifics induce sleep.
3. Wherever possible, I cite accessible, modern editions of the texts to
include as wide a base of source material as possible. I leave it to
others with expertise in the respective cultural-linguistic traditions to
explore issues of paleography, textual criticism, and manuscript tra-
dition. Translations are my own unless otherwise noted.
4. Riddle argues that the Tree of Knowledge was a pomegranate (and
thus so was the fruit that Eve ate), but he provides no direct evidence
for this assertion, and the circumstantial evidence is unconvincing.
5. An alternate version of the story can be found in Ovid,
Metamorphoses V.387–658. In Ovid’s version, Proserpina eats seven
pomegranate seeds (the number is unspecified in the Hymn to
Demeter). In the unfinished De Raptu Proserpinae by Claudianus
(fl. ca. AD 400), Zeus gives Persephone to Hades as a bride to prevent
war between the gods above and the underworld. Zeus warns her not
to eat anything, but she eats pomegranate anyway. The Persephone
stories also recalled elements of the myth of Attis, whose mother
conceived by putting to her breast a pomegranate grown from the
severed penis of the intersex being Agdistis. In these stories, too, the
pomegranate was explicitly linked to the cycle of fertility and
6. In Goddesses, Elixirs, and Witches, Riddle argues that there is
evidence for the use of pomegranate as a contraceptive in
Mesopotamia and Near Eastern cultures as far back as there are
7. The use of pomegranate as a contraceptive appears in the works of
Al-Razi, Ibn Sina, and Al-Jurjani, among others.
8. Lorenzo di Credi painted a similar work, the Madonna and Child
with a Pomegranate, sometime between 1475 and 1480, and it became
a common theme in Renaissance art.
9. Paul of Aegina considered acid pomegranates more cooling than
sweet pomegranates and the seeds more astringent than the juice or
rind (The Seven Books of Paulus Aegineta, 319).
10. To bray is to grind up or crush, as with a mortar and pestle. Ibn
Ridwan (AD 998–ca.1061) devised a recipe using both sweet and sour
pomegranates that “preserves the body in the time of a pestilence.”
He also cited a recipe composed by Ibn Masawayh that “is useful for
high fevers in an epidemic and opens obstructions” and another by
Ibn al-Jazzar that “is astonishing in its effect during a pestilence and
for erysipelas, smallpox, and measles”; both recipes employed the
juice only of sour pomegranates (Medieval Islamic Medicine 1984:
11. See also Epidemics VII, Littre´ 450; Dioscorides, De Materia
Medica I.110:2; Celsus, De Medicina IV.26:9; Pliny, Natural History
XX.53:149–50, XXIII.57–60; Al-Razi, A Treatise on the Small-Pox and
Measles XII.1, XIII.1.
12. A decoction is a liquid concentrate produced by boiling
something in liquid.
13. The three elements are air, bile, and phlegm; the seven bodily
constituents are lymph, blood, flesh, fat, bone, marrow, and semen;
and the three waste products are urine, feces, and sweat.
14. Interestingly, such fluidity does not appear to have existed in
Sanskrit or the Semitic languages (Hebrew, Aramaic, Syriac, and
Arabic), which maintained linguistic separations between words
meaning “medicine” and those meaning “poison.”
15. The word 精 (vitality) can also mean semen in some contexts.
There is no evidence that pomegranate was used as a contraceptive
in China, but this passage raises questions about the relationship
between the fruit and fertility.
16. In traditional Chinese medicine, there were two structural-
functional categories of “organs,” i.e., yin organs (藏) and yang
organs (腑). It is not entirely clear in this context what the “primary
receptacle” was, though it was likely the kidneys. The kidneys were
central to the regulation and circulation of qi (氣), and lumbar pain
was a sign of kidney ailments.
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