Majid Nimrouzi

Hijamat in Traditional Persian Medicine Risks and Benefits

Traditional Persian medicine is based on humoral medical concepts. In the case of abundant blood in the body, tabi’at (body nature) deals with this imbalance by elimination of the morbid substances via some controlling mechanisms. If tabi’at could not react properly, the physician should prescribe an intervention to let the extra blood out. This can be done through phlebotomy, wet cupping, and the use of leech or scarification of the ears. Cupping with scarification may eliminate the morbid substance through the scarified skin, and cupping without scarification evacuates the morbid materials from the compromised organs. Wet cupping in health state is meant to be applied for preventing the blood humor dominance in susceptible individuals. In disease condition, wet cupping is defined as a treatment in which the patients confront the abundance of blood. Wet cupping may have harmful complications in extremely thin or obese patients. Wet cupping should be postponed in patients compromised by diseases especially in the thick phlegm abundance. In Asia, Iranian people, because of religious beliefs, are very interested in cupping therapy. Many unsupervised cupping procedures are performed in Iran, whereas benefits and risks of these procedures are undetermined by providers and clients. In this study, the most important indications and contraindications of wet cupping have been reviewed based on the traditional Persian medicine resources.

Myrtus communis L. Freeze-Dried Aqueous Extract Versus Omeprazol in Gastrointestinal Reflux Disease A Double-Blind Randomized Controlled Clinical Trial

The current work assessed a pharmaceutical dosage form of Myrtus communis L. (myrtle) in reflux disease compared with omeprazol via a 6-week double-blind randomized controlled clinical trial. Forty-five participants were assigned randomly to 3 groups as A (myrtle berries freeze-dried aqueous extract, 1000 mg/d), B (omeprazol capsules, 20 mg/d), and C (A and B). The assessment at the beginning and the end of the study was done by using a standardized questionnaire of frequency scale for the symptoms of gastroesophageal reflux disease (FSSG). In all groups, both reflux and dyspeptic scores significantly decreased in comparison with the respective baselines. Concerning each group, significant changes were found in FSSG, dysmotility-like symptoms and acid reflux related scores. No significant differences were observed between all groups in final FSSG total scores (FSSG2). Further studies with more precise design and larger sample size may lead to a better outcome to suggest the preparation as an alternative intervention.

Principles of Nutrition in Islamic and Traditional Persian Medicine

Nutrition has a crucial role in maintaining body health. Eating and drinking has a special place in Islamic doctrine and traditional Persian medicine. Traditional Persian medicine is a holistic medicine and provides great attention to the spiritual aspects of life as well as somatic aspects to maintain human health. In this view, people are not going to eat and drink for pleasure but to maintain a good life and physical health, due to daily tasks, as well as observing moral aspects of a human life and spiritual satisfaction.

Remedies for Children Constipation in Medieval Persia

Constipation in children with bowel movement less than 3 times a week and lasting for more than 3 months is defined as pediatric chronic constipation. According to traditional Persian medicine resources, dryness of food, low nutrition, hotness or dryness of the gastrointestinal tract, intestine sensory loss, excessive urination, increase of evaporation, and sweating because of heavy exercise will together constitute the condition for constipation occurrence. Lifestyle changes considered as premier of medical intervention for constipation. Treatment of constipation in children vastly benefitted from traditional Persian medicine, including simple dietary measures, oil massages, and herbal medicines. This investigation was performed to somewhat help the anxious academics to achieve proper findings in the field of gastroenterology, in pursuit of the traditional Persian medicine advices.

Flixweed vs. Polyethylene Glycol in the Treatment of Childhood Functional Constipation: A Randomized Clinical Trial

Background: Polyethylene glycol (PEG) is often considered as the first-line treatment for functional constipation in children. Descurainia sophia (L.) Webb et Berth (D. sophia) is a safe recommended medicine in Iranian folk and Traditional Persian Medicine for the treatment of constipation. Objectives: To clinically compare D. sophia with PEG 4000 (without electrolyte) in pediatric constipation and to assess its efficacy and side effects. Patients and Methods: 120 patients aged 2 - 12 years with constipation for at least 3 months were included in an 8 weeks lasting randomized controlled trial within two parallel-groups. Children received either PEG, 0.4 g/kg/day, or D. sophia seeds, 2 grams (for children aged 2 - 4 years) and 3 grams (for those aged > 4 years) per day. Results: A total of 109 patients completed the study (56 in D. sophia and 53 in PEG group). At the end of the study, 36 (64.3%) patients in D. sophia group and 29 (54.7%) in PEG group were out of Rome III criteria (P = 0.205). Median weekly stool frequency in 0, 1, 2, 3 weeks of the treatment was found to be 2, 5, 5, 5 in D. sophia and 3, 4, 4, 5 in PEG group (P = 0.139, 0.076, 0.844, 0.294), respectively. The number of patients who suffered flatulence was less (5, 8.9%) in D. sophia group as compared to PEG group (6, 11.3%) at the end of the trial (P = 0.461). D. sophia taste was less tolerated. Conclusions: D. sophia is introduced as a cheap and available medication which can be applied as a safe alternative to conventional PEG in the management of pediatric chronic functional constipation.

Functional constipation in children: non-pharmacological approach

(medicine) as described by Avicenna on the opening pages of the al-Qānūn fī al-Tibb (The Cannon of Medicine) was “a science by which one learns the conditions of the human body in health and in the nonexistence of health to keep health or to bring it back”. According to Avicenna’s Canon of Medicine and other traditional Persian medicine (TPM) resources, the observance of the six essential qualities provides guidance to any medical intervention. These qualities include air, food and drink, physical activity and rest, sleep and wake, retention and release (the bodily functions of absorption and evacuation) as well as mood and mental states. According to Avicenna’s theory, there are different causes for diseases and ill health, and a single complaint may be linked to multiple combinations of excesses or deficiencies in these essential qualities. For example, the causes for developing constipation include mental stress, low food intake, dryness of food, low fluid intake, excessive urination, excessive sweating because of heavy exercise or hot weather (tissue dehydration), using astringent herbal medicines as well as intestinal sensory loss

Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double-blind placebo controlled clinical trial

Our aim is to assess the effect of cinnamon powder capsules on insulin resistance, anthropometric measurements, glucose and lipid profiles, and androgens of women with polycystic ovarian syndrome (PCOS). Out of 80 women that were diagnosed as PCOS by Rotterdam Criteria, 66 were enrolled in this randomized double‐blind placebo‐controlled clinical trial. All of the PCOS women were taking medroxy progesterone acetate 10 mg/day for the last 10 days of their menstrual cycles. The cases were randomly allocated to 2 groups. The women in the first group were treated by cinnamon powder capsules 1.5 g/day in 3 divided doses for 12 weeks and the second group by similar placebo capsules. Anthropometric measurements, fasting blood sugar, fasting insulin, blood glucose 2 hr after taking 75 g oral glucose, HbA1c, testosterone, dehydroepiandrosterone sulphate, homeostatic model assessment for insulin resistance, triglyceride, and cholesterol (low‐density lipoprotein, high‐density lipoprotein, and total) before and after the intervention were evaluated and compared as outcome measures. Fasting insulin (p = .024) and homeostatic model assessment for insulin resistance (p = .014) were reduced after 12 weeks in the cinnamon group compared with the placebo. There was also a significant decrease in low‐density lipoprotein in cinnamon group (p = .004) as compared with baseline that caused significant difference with placebo (p = .049). However, changes in other outcome measurements did not lead to statistically significant difference with placebo. The present results suggest that complementary supplementation of cinnamon significantly reduced fasting insulin and insulin resistance in women with PCOS.

Assessment of the impacts of traditional Persian medical schemes and recommendations on functional chronic constipation compared to a classic medicine lactulose, a randomized clinical trial.

Abstract Background: To manage chronic constipation, numerous lifestyle modification schemes and recommendations as well as applications of natural medicaments have been mentioned in manuscripts of traditional Persian medicine (TPM). This study was aimed to compare the impacts of some of those recommendations with lactulose, on functional chronic constipation. Methods: Via a blocked randomization, 100 patients were enrolled. Schemes and recommendations from TPM as intervention group were evaluated versus lactulose as control by weekly follow-ups with standard questionnaire for 3 months. Stool frequency, hard stool, painful defecation, incomplete evacuation sensation, anorectal obstruction sensation and manual maneuvers were considered as outcome measures. Results: Eighty-six patients (42 in schemes and 44 in lactulose groups) completed the study. Median weekly stool frequency in 0, 4, 8 and 12 weeks of treatment was 1.76±1.79, 2.88±0.89, 2.95±1.05 and 2.93±1.11 in the schemes and 2.41±1.67, 2.57±0.90, 2.84±0.91 and 2.77±1.00 in lactulose groups, respectively (p=0.10, 0.11, 0.60, 0.51). Thirty-two (76.2%) patients in schemes and 24 (54.5%) patients in lactulose groups were treated at the end of the protocol as they did not meet the Rome III criteria for constipation (p=0.04). In schemes group, patients reported no undesirable effects, whereas seven (15.9%) in lactulose group reported flatulence (p=0.02). Conclusions: Studied schemes were as effective as lactulose, a gold standard to manage constipation. Results demonstrated that TPM schemes and recommendations, as lifestyle modification, for at least 3 months can be introduced as cheap, available and accessible approaches for the management of constipation.

Rhus coriaria L. increases serum apolipoprotein-A1 and high-density lipoprotein cholesterol levels: a double-blind placebo-controlled randomized clinical trial

BACKGROUND Lipid-lowering effect of Rhus coriaria L. (Rhus) has been investigated in multiple animal studies with promising results. Nonetheless, its clinical efficacy has not been adequately examined. OBJECTIVE The aim of this study was to evaluate the lipid-lowering effects of Rhus among patients with hyperlipidemia. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS The study was designed as a two-arm, double-blind placebo-controlled randomized clinical trial, using a parallel design. Eighty patients with primary hyperlipidemia were randomly assigned to receive Rhus capsules or placebo for 6 weeks. MAIN OUTCOME MEASURES The serum lipid levels, apolipoprotein-A1 (Apo-A1) and apolipoprotein-B (Apo-B) were measured. RESULTS Mean serum high-density lipoprotein cholesterol (HDL-C) and Apo-A1 levels were significantly increased in the Rhus group, compared with the placebo group, after 6 weeks of intervention (P = 0.001). The analysis of covariance test including age, gender, body mass index (BMI), and smoking as co-variables revealed that the increase in HDL-C and Apo-A1 levels remained significant, and increases in HDL-C were dependent on the increase in Apo-A1 levels. No significant difference was observed between Rhus and placebo groups in terms of mean reductions in total cholesterol, low-density lipoprotein cholesterol and triglyceride levels; however, more significant improvement was observed among obese patients (BMI ≥ 30 kg/m2). CONCLUSION The study showed significant increases in HDL-C and Apo-A1 levels in response to Rhus supplementation in patients with hyperlipidemia. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02295293.

Effects of Fumaria parviflora L on Uremic Pruritus in Hemodialysis Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

Background: Uremic pruritus (UP) is a common, bothersome symptom in hemodialysis (HD) patients with end-stage renal disease. Immunohypothesis is currently favored as an explanation of the cause of UP. Fumaria parviflora L (FP) is a medicinal herb with several pharmacological properties, including prominent anti-inflammatory activity. Objectives: This study aimed to assess the efficacy of FP for reducing UP severity among HD patients. Methods: A total of 79 HD patients with pruritus were randomly assigned to receive either FP or a placebo for eight weeks. The visual analogue scale (VAS), the Duo score for calculating pruritus score, serum interferon-γ (IFN-γ) level, interleukin-4 (IL-4), and high-sensitivity C-reactive protein were measured in the patients before and after treatment. Results: At the end of the treatment phase, the pruritus score decreased in both groups (P < 0.001); however, the mean reduction in pruritus scores was significantly higher in the FP group than the placebo group according to VAS (-6.15 ± 2.12 vs. -2.25 ± 2.46, P < 0.001) and Duo scores (-22.03 ± 9.64 vs. -8.38 ± 6.28, P < 0.001). IFN-γ mean serum levels in the FP group significantly decreased (P < 0.001), but there was no significant change in these levels in the placebo group (P = 0.604). The elevation of the mean serum IL-4 level was significant in the FP group (P = 0.028) but not in the placebo group (p = 0.100). Conclusions: FP can significantly decrease the severity of UP in HD patients.