Like all eastern spices, pepper was historically both a seasoning and a medicine. Long pepper, being stronger, was often the preferred medication, but both were used.

Black peppercorns figure in remedies in Ayurveda, Siddha and Unani medicine in India. The 5th century Syriac Book of Medicines prescribes pepper (or perhaps long pepper) for such illnesses as constipation, diarrhea, earache, gangrene, heart disease, hernia, hoarseness, indigestion, insect bites, insomnia, joint pain, liver problems, lung disease, oral abscesses, sunburn, tooth decay, and toothaches.^[20] Various sources from the 5th century onward also recommend pepper to treat eye problems, often by applying salves or poultices made with pepper directly to the eye. There is no current medical evidence that any of these treatments has any benefit; pepper applied directly to the eye would be quite uncomfortable and possibly damaging.^[21]

Pepper has long been believed to cause sneezing; this is still believed true today. Some sources say that piperine irritates the nostrils, causing the sneezing;^[22] some say that it is just the effect of the fine dust in ground pepper, and some say that pepper is not in fact a very effective sneeze-producer at all. Few if any controlled studies have been carried out to answer the question.

Pepper is eliminated from the diet of patients having abdominal surgery and ulcers because of its irritating effect upon the intestines, being replaced by what is referred to as a bland diet. Pepper is sometimes used to stop light or mild cuts from bleeding in restaurant kitchens