Hot and Cold Natures and Some Parameters of Neuroendocrine and Immune Systems in Traditional Iranian Medicine: A Preliminary Study

The Effect of Metabolic Persian Diet on Ovulation Induction in Infertile Women

Introduction

Infertility is an important issue with a high social and psychological burden. From the perspective of Persian Medicine (PM), uterine cold temperament is one of the important causes of female infertility.

Aim

The aim of this study was to study the effect of PM or Iranian traditional medicine on improving ovulation and fertility.

Methods

From January 2017 to August 2017, sixty infertile women with eugonadotropic ovulation disorder were randomly divided into two groups. Both groups were treated with clomiphene citrate, except that the intervention group also received metabolic Persian diet (MPD). In each cycle, the dominant follicles and endometrium were investigated with ultrasound. At the end of the cycle, beta human chorionic gonadotropin (β-HCG) was evaluated and if positive, another ultrasound was performed two weeks later to confirm early pregnancy.

Results

The number of dominant follicles from the first to third cycle increased from 2.15 ± 1.14 to 2.28 ± 0.61 in the intervention group and decreased from 1.86 ± 0.79 to 1.30 ± 0.47 in the control group. The dominant follicle size changed from 16.00 ± 4.08 to 18.78 ± 2.78 and from 15.05 ± 3.11 to 15.80 ± 3.89 in the intervention and control groups, respectively. But endometrial thickness did not change significantly in the intervention group. Pregnancy results based on β-HCG and ultrasound findings were positive in 19 and 16 patients in the intervention group and in 10 and 7 patients in the control group, implying significantly higher numbers in the first group.

Conclusion

It seems that MPD may be effective in the success of ovulation induction.

Hot and Cold Theory: Evidence in Nutrition

Ancient scholars across cultures have postulated that by being less potent versions of herbs, food plays a substantive role in the maintenance of health and treatment of disease. A commonality among these traditional medical systems is in relation to the 'heating' and 'cooling' properties of foods. In this chapter, 'hot' and 'cold' classifications of foods are explored, along with ways to optimize health and combat disease. Scientific evaluations of 'hot' and 'cold' properties are also reviewed in relation to chemical compositions and physiological impacts. A broad scoping Google Scholar search was conducted to identify relevant articles. Scientific evaluations were heterogeneous and of mixed quality. Nonetheless some evidence supported the traditional 'hot' and 'cold' classifications. Overall, 'heating' foods were associated with metabolism and sympathetic nervous system enhancement via increased proportions of caffeine, carbohydrate, protein, fat, and calories; as well as greater oxidation potential; vasodilatory and pro-inflammatory effects; and higher acidity and aromatic compound content. 'Cooling' foods were contrastly found to be higher in water, fiber, alkalinity, and aliphatic compounds; as well as associated with anti-inflammatory, and detoxification (elimination) processes. With the potential to specifically tailor diets to suit individual needs, further high-quality research to substantiate traditional food classifications is warranted.

Association between multiple sclerosis and dietary patterns based on the traditional concept of food nature: a case-control study in Iran

INTRODUCTION

It remains a matter of debate whether traditional concepts regarding the nature of food affect the development and progression of multiple sclerosis (MS).To date, there are limited studies that have investigated the association between MS and dietary patterns based on the categories of food nature (hot, cold, or balanced) defined in traditional medicine.

METHOD

This case-control study was conducted from October 2019 to February 2020. In total, 60 patients diagnosed with MS within the preceding 6 months and referred to our neurology outpatient clinic were included in our case group. The control group included 180 patients who were referred to the same center for general or orthopedic surgery. Dietary intake was assessed in both groups through a reliable and valid semi-quantitative food frequency questionnaire. Data were assessed using principal component analysis.

RESULTS

The mean age of the participants was 44.9 ± 17.33 years. The analysis showed that four food patterns were distinguished (eigenvalue > 1), namely "additives and cold-natured foods", "hot and balanced foods and nuts", "dairy and legumes", and "hot and balanced starches". These food patterns explained 57.8% of the total variance. After adjusting all confounding factors, individuals in the highest quartile and medium quartile of "additives and cold-natured foods" had an elevated MS risk compared with the lowest quartile (OR = 7.21, 95%CI = 2.01-12.38 and OR = 3.37, 95%CI = 1.02-11.35, respectively). Furthermore, individuals in the highest quartile of the "hot and balanced foods and nuts" group were protected against MS compared with its lowest quartile (OR = 0.28, 95%CI = 0.08-0.90). Moreover, a protective effect against MS was seen in the highest quartile of the "hot and balanced starches" group relative to its lowest quartile (OR = 0.34, 95%CI = 0.12-0.98). No significant association was found between "dairy and legumes" and the risk of MS.

CONCLUSION

This study revealed that dietary patterns based on the traditional concept of food nature might be associated with the risk of developing MS. This represents the first work in this area, so further research is recommended.

Mizaj as an Index in Persian Traditional Medicine Index Could Associate with Sensitivity to the Radiation

Background

The sensitivity to the radiation among human population depends on various parameters. This variation could lead to dissimilar outcome of radiotherapy in similar situations. Mizaj is a well-known term in Persian medicine that present an individualized medicine viewpoint. All of the people will be categorized in cold, moderate, and warm Mizaj. In this study, we aimed to evaluate the possible association between Mizaj and radiosensitivity by comet assay.

Materials and Methods

Peripheral blood sample of 30 healthy volunteers (10 cold, 11 moderate and nine warm Mizaj) were taken and divided into two identical parts. The first part was exposed to 4 Gy x-rays, and the second part was regarded as the sham control. Then, DNA damages of samples were evaluated by the neutral comet assay.

Results

The results showed that the mean percentage of damaged cells, in all of the irradiated groups including A (warm), B (moderate) and C (cold) was significantly higher than the controls (P<0.001). Moreover, DNA damage rate in the irradiated warm Mizaj group was higher than both cold and moderate irradiated groups, but the difference between moderate and cold irradiated groups was not statistically significant.

Conclusion

The results are indicating that warm Mizaj persons could be more radiosensitive than other groups, which their importance in radiotherapy individualization should be evaluated in more extensive studies.

Mizaj assessment in Multiple Sclerosis (MS) patients based on Persian Medicine

OBJECTIVES

Increased incidence of Multiple Sclerosis (MS) calls for supporting complementary therapies in this field. Persian Medicine (PM) specialists present various assumptions to help patients through Mizaj (temperament) modification, but its confirmation requires scientific evidence. This study aimed at identifying the Mizaj of MS patients, and comparing it with their Mizaj before the onset of the disease, and with that of healthy people.

METHODS

Forty-two MS and fifty-four healthy subjects participated in the study as case and control groups. General and brain Mizaj in patients were identified by five PM specialists before and after the onset of the disease. Mojahedi Mizaj Questionnaire (MMQ) was completed by the two groups. The validity of MMQ was assessed using Mizaj diagnosis by PM specialists as the gold standard. T-test, McNemar-Bowker, Wilcoxon, and Chi-square (χ ²) tests were used to compare the Mizaj of patients before and after the onset of the disease, and between the two groups (p<0.05).

RESULTS

The sensitivity and specificity of MMQ for Hotness (75, 81%) and Coldness (75, 65%) were acceptable. There were no significant differences between patients and healthy subjects in terms of general Mizaj. But general and brain Mizaj of patients after developing MS inclined to coldness and dryness, although merely inclination of general Mizaj to coldness was significant (p=0.03).

CONCLUSIONS

According to our results, the Mizaj of MS patients has an inclination toward coldness and dryness; Also, MMQ can be used as a validated scale for identifying the Mizaj of MS patients in future studies.

Assessment the studies on the concept of Mizaj (temperament) in Persian Medicine

Introduction Mizaj or temperament is a main concept in Persian Medicine (PM), which the process of diagnosis, treatment and preventive prescriptions are developed based on it. In this study, the articles written on the concept of Mizaj were reviewed. Method Credited electronic resources, including Pubmed, Scopus, Cochrane Library and web-of-science were searched using keywords Temperament, Mizaj, Mizadj, Midzaj and Mezaj (with the concept of Mizaj in Persian and/or Greek medicine). Search results were limited to English articles, published in 1995-2017. The articles in which temperament had the psychoanalytic aspect or was based on Ayurveda or Chinese/Korean medicine were removed. A team of four PM experts evaluated the method and the results. Results Among the total of 32 articles were published in this field, 14 were review articles, 2 were on animal subject, 14 were on human subject and 2 were surveys for designing questionnaire for people's Mizaj assessment. Most of review studies were just new versions of ancient Persian texts translated into English and the innovations on the subject were few. Studies on animal subject and developing questionnaires were also limited. In some human studies, use of standard questionnaires and homogenous methodology in Mizaj assessment was not considered. Conclusions It seems that studies on temperaments have increased in the past few years but are still at the forefront. In human studies a homogenous method for evaluating temperament has not been used and some of them failed to address the main concept of Mizaj in PM. Therefore, it is necessary to use the original category of Mizaj and to design standard method.

In vitro and in vivo anti-diabetic activity of Citrullus colocynthis pulpy flesh with seeds hydro-ethanolic extract

Background

Diabetes is the one of the leading cause of morbidity and mortality. Traditionally phytotherapy is widely being used for diabetes treatment and highly valued. Citrus colocynthis has known anti-diabetic potential. However, anti-diabetic potential of hydro-ethanolic extract of C. colocynthis pulpy flesh with seeds is not reported yet.

Methods

The extract of C. colocynthis pulpy flesh with seeds was done by maceration method using 70% ethanol. To evaluate anti-diabetic and antioxidant potential of the seeded fruit in vitro, α-glucosidase and DPPH inhibition assays was done, respectively. In vivo study used streptozotocin (STZ) induced diabetes model of rats. Rats were randomized in five groups i. e. normal control, negative control, standard control, C. colocynthis 150 and 300 mg/kg. STZ was administered to all groups except normal control. After wards, plant extract and glibenclamide is continued for 14 days. Blood samples were collected from rat tail vein daily and from Cardiac puncture at the end of study. The blood glucose levels were monitored daily by using one-touch blood glucose monitoring system. The blood glucose level was monitored on 0, 1st, 5th, 8th, 11th, and 14th day of induction.

Results

Hydro-ethanolic extract of C. colocynthis pulpy flesh with seeds was able to decolorize DPPH and therefore possess antioxidant potential, continuous administration for 14 days showed a marked decrease in serum glucose levels (p 0.01) it is found to be somewhat less effective as glibenclamide (standard control) (p 0.001). A time-dependent decrease in blood glucose levels was observed (351.3 ± 4 to 258 m/kg).

Conclusion

Hydro-ethanolic extract of C. colocynthis pulpy flesh with seeds lowered the serum triglyceride and cholesterol levels in diabetic rats significantly as compared to negative control. The hypoglycemic effect of hydro-ethanolic extract of C. colocynthis pulpy flesh with seeds is may be due to α-glucosidase inhibition potential.

Saussureae Involucratae Herba (Snow Lotus): Review of Chemical Compositions and Pharmacological Properties

Saussureae Involucratae Herba is the dried ground part of Saussurea involucrata (Kar. et Kir.) Sch.-Bip, which is also named as “Snow lotus” and being used in traditional Uyghur and/or Chinese medicine. This rare herb can be found at 4,000 m elevation in western part of Tianshan Mountain, Xinjiang China. According to China Pharmacopoeia (2015), the major pharmaceutical values of “Snow lotus” (Xuě liánhuā in Chinese) are alleviating rheumatoid arthritis, accelerating blood circulation and mitigating other “cold” syndromes. Traditionally, the clinical application of “Snow lotus” includes the treatments in inflammation-associated disorder, blood circulation acceleration and heat and dampness elimination. Recent studies suggested that “Snow lotus” possessed therapeutic effects associating with anti-cancer, anti-oxidation, adipogenesis suppression and neuroprotection activities, which were proposed to be related with its bioactive constitutes, i.e. acacetin, hispidulin, and rutin. In the present review, we aim to summarize pharmacological effects and underlying cell signaling pathways of “Snow lotus” in treating various medical problems.

Traditional, complementary and alternative medicine in children constipation: a systematic review

OBJECTIVES

This review aims to evaluate the efficacy and safety of complementary and alternative medicine methods for constipation in the pediatric population.

EVIDENCE ACQUISITION

Medical literature search was performed in several databases for a variety of Traditional, Complementary and Alternative Medicine in childhood constipation. Databases included Web of Science, Scopus, Embase, Cochrane Library, PubMed, ScienceDirect, Google scholar and a number of Persian databases including IranDoc, Magiran and SID. No time limitation was determined. Clinical trials or case series that had evaluated the effectiveness of CAM therapies in functional constipation of 1-18 year old children were included. Papers not in English or Persian language were excluded. Related articles were screened independently by two reviewers according to their titles and abstracts. A data extraction form was filled in for each eligible paper. Quality assessment of eligible documents was also performed.

RESULTS

30 studies were included, comprising 27 clinical trials and 3 case series. Ten documents were on herbal medicine, nine on traditional medicine, ten on manual therapies and one on homeopathy. Except for two herbal and one reflexology interventions, all studies reported positive effects on childhood constipation, with the majority being statistically significant. As the number of studies in each method was limited, we could not perform a meta-analysis.

CONCLUSION

The scarcity of research on the efficacy and safety of different types of complementary and alternative medicine methods in children with constipation necessitates conducting more studies in each field. Graphical abstract.

The necessity for integrating traditional, complementary, and alternative medicine into medical education curricula in Iran

BACKGROUND

The use of traditional and complementary medicine (T&CM) is increasing in both developed and developing countries. The school of Persian medicine (PM) in Iran is a comprehensive medical school that is rich in history and has its own special principles, elements, philosophy, and diagnostic and treatment options. Many complementary therapy modalities are also popular and in demand among patients and physicians. The aim of this paper is to provide logic for the policymakers in Iranian medical education to make changes in medical education curricula, particularly on integrating T&CM.

METHODS

We reviewed the global experience in teaching T&CM to medical students, and highlighting the strengths of PM, described why it is necessary to integrate T&CM into general medicine curricula in Iran.

RESULTS

PM is a traditional system of medicine that dates back about 7000 years. Although there are few studies about the safety and effectiveness of PM, research into it has recently been accelerated. There is a suitable opportunity for integrating T&CM with conventional medicine. Physicians should be familiar with T&CM to avoid any contraindications, interactions, and unwanted effects.

CONCLUSION

Traditional medicine is part of Iran's heritage and, thus, needs special attention. Familiarization of physicians with T&CM can help them choose the best treatment options for their patients. To integrate T&CM into the medical education curricula of Iran, a two-credit course has been proposed for implementation across the country.

Periconceptional care and offspring health at birth and long term, from the perspective of Avicenna

Periconceptional care such as lifestyle plays an important impact role in offspring health. The aim of the present study was to clarify the perspective of Avicenna on periconceptional care. Avicenna (980-1037 A.D.) was one of the outstanding Persian physicians, who made great contributions to the field of medical sciences, in particular, obstetrics. In advance, Avicenna's book, Canon of Medicine, was considered to find his perspectives on periconceptional care. Then, his ideas and theories were compared to the current findings by searching the keywords in main indexing systems including PubMed/MEDLINE, Scopus and Institute for Scientific Information Web of Science as well as the search engine of Google Scholar. Current investigations show that gamete quality, pregnancy outcome, and offspring health at birth and long term depend on both parents' lifestyle in pre- and periconceptional period, as well as the intrauterine environment. Avicenna believed that seminal fluid, sperm, ovum, and developing conditions in utero were influenced by the stages of food digestion and the function of some organs. On the other hand, food digestion and function of the organs also depend on each parent's lifestyle and environmental factors. He mentioned 6 principles of healthy lifestyle: exercise, nutrition, sleep and awareness, excretion of body wastes and retention of necessary materials, psychic features, as well as air and climate. Thus, a multicomponent healthy lifestyle should be considered by parents of child-bearing age in an appropriate period before and in early pregnancy as well as elimination of any disorders in parents, to give birth to more healthy offspring.

The Sources of Essential Fatty Acids for Allergic and Cancer Patients; a Connection with Insight into Mammalian Target of Rapamycin: A Narrative Review

Background:

Disturbance in essential fatty acids (EFA) metabolism plays a key role in autoimmune diseases, but EFA supplementation with sources of borage, evening primrose, hemp seed and fish oils was not effective in atopic and cancer diseases, as that seen in the case of multiple sclerosis. It seems that two complexes of the mammalian target of rapamycin (mTOR) signaling, mTORC1 and mTORC2, are congruent with the two bases of the Traditional Iranian Medicine (TIM) therapy, Cold and Hot nature, which are essential for the efficacy of functional oils for controlling immune responses in autoimmune diseases.

Methods:

We searched PubMed database, Web of Science (WOS), Google Scholar, Scopus and selected studies by predefined eligibility criteria. We then assessed their quality and extracted data.

Results:

The oils controlled by Cold or Hot nature may be helpful in maintaining homeostasis and preventing autoimmune diseases. In summary, studies of randomized controlled trials for allergy and cancer patients found no improvement in the signs or response to tests, despite a remarkable change in EFA fractions in the blood by supplementation with sources of borage, evening primrose, hemp seed and fish oils. In contrast, portulaca oleracea oil exhibited protective effects by anti-inflammatory properties via the PI3K/Akt/mTORC2 pathway with a deviation immune response to Th1 to treat atopic diseases and cancer.

Conclusions:

According to the concept of Traditional Iranian Medicine therapy, in contrast to Cold-nature oils, EFA supplementation with the sources of Hot-nature oilsis not suitable for the treatment of atopic and cancerous diseases.

Herbal Medicine for Oligomenorrhea and Amenorrhea: A Systematic Review of Ancient and Conventional Medicine

Introduction

Menstrual bleeding cessation is one of the most frequent gynecologic disorders among women in reproductive age. The treatment is based on hormone therapy. Due to the increasing request for alternative medicine remedies in the field of women's diseases, in present study, it was tried to overview medicinal plants used to treat oligomenorrhea and amenorrhea according to the pharmaceutical textbooks of traditional Persian medicine (TPM) and review the evidence in the conventional medicine.

Methods

This systematic review was designed and performed in 2017 in order to gather information regarding herbal medications of oligomenorrhea and amenorrhea in TPM and conventional medicine. This study had several steps as searching Iranian traditional medicine literature and extracting the emmenagogue plants, classifying the plants, searching the electronic databases, and finding evidences. To search traditional Persian medicine references, Noor digital library was used, which includes several ancient traditional medical references. The classification of plants was done based on the repetition and potency of the plants in the ancient literatures. The required data was gathered using databases such as PubMed, Scopus, Google Scholar, Cochrane Library, Science Direct, and web of knowledge.

Results

In present study of all 198 emmenagogue medicinal plants found in TPM, 87 cases were specified to be more effective in treating oligomenorrhea and amenorrhea. In second part of present study, where a search of conventional medicine was performed, 12 studies were found, which had 8 plants investigated: Vitex agnus-castus, Trigonella foenum-graecum, Foeniculum vulgare, Cinnamomum verum, Paeonia lactiflora, Sesamum indicum, Mentha longifolia, and Urtica dioica. Conclusion. Traditional Persian medicine has proposed many different medicinal plants for treatment of oligomenorrhea and amenorrhea. Although just few plants have been proven to be effective for treatment of menstrual irregularities, the results and the classification in present study can be used as an outline for future studies and treatment.

Plantago major in Traditional Persian Medicine and modern phytotherapy: a narrative review

Plantago major has been used widely since ancient times, to manage a wide range of diseases including constipation, coughs and wounds. The aim of this study is to review the traditional application, botanical characterization, pharmacological activities, phytochemistry effects and toxicity of Plantago major. In this review study, medicinal properties of Plantago major are collected from credible pharmacopeias, textbooks of traditional Persian medicine (TPM) belonging to the 10-18th century AD, such as "The Canon of Medicine", "Makhzan-Al- Advia" and so on. Moreover, electronic databases including Scopus, Medline and Web of science were explored for this purpose. Plantago major has been prescribed in various forms such as roasted seeds, decoction, syrup, liniment, gargle, rectal enema, vaginal suppository, eye and nasal drop for each illness by TPM scholars. Some of its traditional properties including wound healing, antipyretic, antitussive, anti-infective, anti-hemorrhagic, anti-inflammatory, diuretic, laxative, astringent and hemostatic have been confirmed in recent researches. Phytochemical investigations showed that Plantago major contains volatile compounds, triterpenoids, phenolic acids and flavonoids. Modern pharmacological studies have proven some of the traditional applications of Plantago major. Nevertheless, more investigations are required on this plant, because it has the potential to be used to produce various natural medications.

Complementary and alternative treatments of multiple sclerosis: a review of the evidence from 2001 to 2016

People with multiple sclerosis (PwMS) commonly use complementary and alternative medicines (CAM), but an understanding of their efficacy is lacking. Here, we quantitatively review the class I and class II studies of treatment efficacy for multiple sclerosis from January 2001 to January 2017, in order to assess the modern evidence for CAM use. The 38 studies included in this review are divided across five CAM types (cannabis, diet, exercise, psychological approaches and other). We found little evidence to support CAM efficacy. The studies contained little replication in intervention, primary outcomes or study design. Six of 16 CAMs included in this review were only researched in a single study. Future work in this area should build consensus around study methodologies and primary outcomes.

Association of glutathione S-transferase M1 and T1 polymorphisms and temperament

Mizaj (Temperament) is one of the basic concepts of Iranian Traditional Medicine (ITM), which has great importance in diagnosis and treatment of diseases, as well as maintaining the ideal healthy state of an individual. However, very little is known about the biological mechanisms of mizaj dependence treatment in practical ITM. This study was aimed to evaluate any association between the mizaj and glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) polymorphisms in healthy people. The samples included 247 healthy males from Fars province, southern Iran. The mizaj was determined using a self-reported mizaj identification scale. Subjects with equilibrium or any of four simple mizajes (warm, cold, moist, and dry) were included in the study. The GSTM1 and GSTT1 genotypes were determined using a polymerase chain reaction (PCR)-based method. No any differences in the frequency of GSTM1/T1 polymorphism between equilibrium and each of other mizaj groups were found. However, when equilibrium, moist, and dry groups were pooled and as a "medium warmness" group were compared to the warm group, the frequency of GSTT1-null in the warm group was significantly higher compare to that in the medium warmness group. Also, the combination genotypes of GSTM1 and GSTT1 was associated with the warmness; that is, individuals with combination of GSTM1 positive and GSTT1 null were more susceptible to have a warm temperament. This study indicated that the mizaj could be affected by GSTM1/T1 genes, although further research with larger samples is needed to reach full conclusions.

Review of local herbal compounds found in the Iranian traditional medicine known to optimise male fertility

The male reproductive function can be influenced by many different factors, including genetic, environmental and socioeconomic parameters leading to a progressive decline. However, the cause of infertility cannot be found in a significant proportion of couples, and even with the presence of the sign of testicular dysfunction or obstructive azoospermia, the main aetiology is not identified. In the absence of knowledge about predisposing factor, targeted therapeutic modalities for male infertility may not be possible, and a wide variety of empiric drug approaches, even with low scientific evidence, have been utilised in current conventional medicine. According to the recently updated reports of the European Association of Urology guidelines on male infertility, the implication of previous recommendations and complementary alternative medicine based on the old literature has been suggested to improve a multifaceted integrative therapeutic approach for this disease. We have reviewed the potential herbal active compounds optimising male fertility, according to the principles of Iranian traditional medicine.

Potential therapeutic applications for Terminalia chebula in Iranian traditional medicine

Terminalia chebula (family: Combretaceae) is widely used in the traditional medicine of India and Iran to treat diseases that include dementia, constipation, and diabetes. This tree is known in Iranian traditional medicine (ITM) as halileh or halilaj and the fruit is used to develop treatments. It is described in ITM as an astringent that has a "cold" and "dry" temperament. References to the medicinal properties of Terminalia chebula were collected from important ITM sources and from modern medical databases (PubMed, Scirus, ScienceDirect, and Scopus). The medicinal properties described for this tree in ITM were compared with those reported in studies of modern phytotherapy. The results confirm that the tree referred to as halileh in traditional books is the Terminalia chebula used in present-day studies. Treatments that have not been evaluated in modern phytotherapy but have been traditionally treated with Terminalia chebula include fever, and psychological and psychiatric issues. This article confirms the medicinal uses of Terminalia chebula.

Proteomics of hot-wet and cold-dry temperaments proposed in Iranian traditional medicine: a Network-based Study

Lack of molecular biology evidence has led clinical success of alternative and complementary medicine (CAM) to be marginalized. In turn, a large portion of life Science researchers could not communicate and help to develop therapeutic potential laid in these therapeutic approaches. In this study, we began to quantify descriptive classification theory in one of the CAM branches i.e. Iranian traditional medicine (ITM). Using proteomic tools and network analysis, the expressed proteins and their relationships were studied in mitochondrial lysate isolated from PBMCs from two different temperaments i.e. Hot-wet (HW) and Cold-dry (CD). The 82% of the identified proteins are over- or under-represented in distinct temperaments. Also, our result showed the different protein-protein interaction networks (PPIN) represented in these two temperaments using centrality and module finding analysis. Following the gene ontology and pathway enrichment analysis, we have found enriched biological terms in each group which are in conformity with the physiologically known evidence in ITM. In conclusion, we argued that the network biology which naturally consider life at the system level along with the different omics data will pave the way toward explicit delineation of the CAM activities.

Bloating: Avicenna's Perspective and Modern Medicine

Bloating and abdominal distention are common complaints present in quite a number of organic and functional diseases. An important subject in traditional Persian medicine is digestive disorders, particularly bloating and its etiology. This is a literature review study conducted on The Canon in Medicine written by Avicenna and using the keywords: bloating, gas. In this article, causes for bloating, according to Avicenna, include diet causes, inappropriate lifestyle, gastrointestinal, and miscellaneous reasons. These were compared with causes suggested in modern medicine. Avicenna classifies causes based on the place of origin into upper part of the abdomen (stomach) and intestinal part of the abdomen. Also, 38 medicinal plants used as remedies were listed. Modern scientific data support all bloating causes that have been mentioned in the canon. Obviously, some causes such as uterine disorders and posterior nasal discharge need to be studied further.

Stachys lavandulifolia Vahl. and its Relation With Marmazad Activities in Traditional Manuscripts

Context:

In modern phytotherapy, Stachys lavandulifolia Vahl., a type of Stachys also known as Mountain Tea (Chay-e-Kouhi) has been widely studied based on its botanical and therapeutic characteristics over the recent decades.

Evidence Acquisition:

The present study investigated morphology, botanical characteristics, and some therapeutic activities of this plant and compares them with those of Marmazad, as the traditional equivalent of Stachys in traditional iranian medicine (TIM), to evaluate the similarities between Stachys and Marmazad.

Results:

In this study by exploring morphology, botanical properties and therapeutic activities of Stachys from modern botany and Marmazad in TIM, comparing them and considering similarities between those botanical properties and some of therapeutic activities this outcome was drawn that what had been known as Marmazad in TIM nowadays is equal to Stachys or Chay-e-Kouhi in modern botany.

Conclusions:

The achieved findings from this comparison between botanical characteristics and therapeutic activities of Stachys based on modern researches and those of Marmazad by referring to traditional manuscripts revealed significant similarities between them. Also, there were some applications mentioned for Marmazad in TIM which could help new researchers in modern phytotherapy to deal with those dimensions of this herb which are not worked out yet.

Herbal Remedies for Functional Dyspepsia and Traditional Iranian Medicine Perspective

CONTEXT

Functional dyspepsia (FD) is a functional gastro-intestinal disorder with high prevalence. Among various treatment options, treatment by complementary and alternative medicines especially herbal remedies also practiced. Traditional Iranian medicine (TIM), a valuable resource of valid applied studies of ancient Iranian scholars, recommends numerous medicinal plants to treat dyspepsia symptoms. In this study, through investigation of TIM references, we aimed to identify medicinal plants for treatment of digestion insufficiency.

EVIDENCE ACQUISITION

In this qualitative study, dyspepsia symptoms including fullness, early satiety, bloating, nausea, and belching were checked under reliable sources of traditional medicine. Then medicinal plants recommended for the treatment of the symptoms were extracted from the books. Likewise, for investigating the pharmacological properties of medicinal plants used for the relieving of dyspepsia symptoms, electronic databases such as PubMed, Scopus, Google Scholar and some Iranian databases like SID and IranMedex were employed.

RESULTS

The study yielded 105 plants from 37 families which could treat various dyspepsia symptoms; fifty-seven plants, mainly from Apiaceae, Lamiaceae, Amaryllidaceae and Zingiberaceae had digestive effects. In this research, based on the information in TIM reference texts, we obtained 58 plants effective for bloating, 40 for nausea, 37 for appetite loss and 7 for belching. In human clinical trials conducted on medicinal plants effective for FD symptoms, 7 single plants were used.

CONCLUSIONS

Finding the medicinal plants effective on digestion insufficiency based on TIM could suggest a better strategy for the relieving of dyspepsia symptoms. Traditional Iranian medicine prescribes medicinal plants based on each patient's personal characteristics and practices multiple target therapies.

Medicinal properties of Peganum harmala L. in traditional Iranian medicine and modern phytotherapy: a review

OBJECTIVE

To review the pharmacological activities of Peganum harmala L. (P. harmala, Nitrariaceae) in traditional Iranian medicine (TIM) and modern phytotherapy.

METHODS

Opinions of TIM and modern phytotherapy about safety and acceptable dosage of this plant are discussed. Various medical properties of P. harmala were collected from important TIM references and added to scientific reports derived from modern medical databases like PubMed, Scirus, ScienceDirect and Scopus.

RESULTS

The main medicinal part of the plant is the seed. In TIM resources, this plant possesses various Pharmacological activities such as carminative, galactagogue, diuretic, emmenagogue, antithrombotic and analgesic. In modern phytotherapy, P. harmala demonstrated numerous medicinal effects including cardiovascular, neurologic, antimicrobial, insecticidal, antineoplasmic, antiproliferative, gastrointestinal and antidiabetic effects. Adverse events such as neuro-sensorial symptoms, visual hallucination, bradycardia, hypotension, agitation, tremors, ataxia, abortion and vomiting cause people to use this plant cautiously. P. harmala is contraindicated during pregnancy, due to its abortive and mutagenic activities. Because of increasing the expression of CYP1A2, 2C19, and 3A4 and inhibition of monoamine oxidase, the pharmacokinetic parameters of drugs which are mainly metabolized by these enzymes may be affected by P. harmala.

CONCLUSION

The medicinal properties declared for this plant in TIM are compared with those showed in modern phytotherapy. Some of the TIM properties were confirmed in modern phytotherapy like emetic and analgesic activities and some have not been evaluated in modern phytotherapy such as its therapeutic effects on paralysis, epilepsy and numbness. Finally, the current review provides the evidence for other researchers to use TIM properties of P. harmala as an efficacious natural drug. Further preclinical and clinical studies for adequate evaluating safety and therapeutic efficacy are recommended.

The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response

STUDY OBJECTIVE

To compare the clinical efficacy of co-induction with propofol-midazolam-ketamine with etomidate as the sole induction agent.

DESIGN

Prospective, double-blinded, randomized controlled trial.

SETTING

Operating room of a university hospital.

PATIENTS

60 ASA physical status 1 and 2 patients scheduled for limited elective surgery requiring general anesthesia.

INTERVENTIONS

Patients were randomized to two groups to receive etomidate 0.3 mg/kg (single-drug group) or propofol 0.6 mg/kg + ketamine 0.8 mg/kg + midazolam 0.06 mg/kg (three-drug group).

MEASUREMENTS

Hemodynamic responses (systolic and diastolic blood pressure, and mean arterial pressure) were examined at baseline and at one, three, and 5 minutes after tracheal intubation. Plasma catecholamine levels were measured at baseline, one, and 5 minutes after tracheal intubation.

MAIN RESULTS

Heart rate (HR) changes differed significantly between the two groups at three minutes (P = 0.01) and 5 minutes (P = 0.00) after tracheal intubation. However, the HR increase in the three-drug group was in the acceptable range. Percentage changes of epinephrine level differed between the two groups at 5 minutes after tracheal intubation (P = 0.03).

CONCLUSIONS

The higher norepinephrine/epinephrine ratio noted in the single-drug group may be implicated in lower adrenal sympathetic activity. Propofol-midazolam-ketamine co-induction may be used instead of etomidate for anesthesia induction in patients with hemodynamic instability.

Activity of liver enzymes in multiple sclerosis patients with Hot-nature diet and co-supplemented hemp seed, evening primrose oils intervention

BACKGROUND

It is unknown whether diets with a high dietary total antioxidant capacity (TAC) can modify oxidative stress, low-grade inflammation, or liver dysfunction, all of which are risk factors for multiple sclerosis disease. This study assesses alanine amino-transferase (ALT), aspartate-aminotransferase (AST) and gamma-glutamyl transferase (GGT) activities in MS patients treated with co-supplemented hemp seed and evening primrose oils as well as Hot-nature diet and the therapeutic potential this intervention.

METHODS AND MATERIALS

In this double blind, randomized trial, 100 MS patients with EDSS<6 were allocated into 3 groups: "group A", who received co-supplemented hemp seed and evening primrose oils with advised Hot-nature diet; "group B",who received olive oil; and "group C", who received the co-supplemented oils. Clinically, EDSS as well as serum level of liver enzymes (GGT, AST, and ALT) were assessed at baseline and after 6 months.

RESULTS

Mean follow-up was 180±2.9 SD days (N=65, 23 M and 42 F aged 34.25±8.07 years with disease duration of 6.80±4.33 years). There was no significant difference in the study parameters at baseline. Serum levels of liver enzymes (GGT, AST, and ALT) were serially monitored. Intervention was associated with liver function alteration in three groups. Significance decreased in EDSS score and the levels of liver enzymes were found in groups A and C, whereas elevated serum liver enzymes and EDSS score were observed in group B after the intervention.

CONCLUSION

Selecting foods according to their Total antioxidant capacity such as co-supplemented hemp seed and evening primrose oils with Hot-nature diet affects antioxidant intake and can have beneficial effects on improving EDSS score and activity of liver enzymes in RRMS patients.

The effects of seeds with hot and cold temperaments on serum thyroid hormones, corticosterone and urine vanillylmandelic acid concentrations of healthy rats

ETHNOPHARMACOLOGICAL RELEVANCE

Hot and cold temperaments are the basic concepts of Iranian traditional medicine (ITM). Nevertheless, studies on the functional mechanisms of medicinal herbs based on hot and cold temperaments are not very extensive. This study aimed to evaluate the effects of diets containing hot or cold temperament seeds according to ITM on some hormonal and neuromediator parameters with a regulatory role in thermogenesis and energy metabolism in acute (24 hr) and subacute (7-day) experiments that were performed on rats.

MATERIALS AND METHODS

Each experiment was performed on 42 male Wistar rats, which were randomly divided into 7 groups. while 1 group received usual diet (controls), 6 other groups were fed with a diet containing 10% seeds, namely, anise, fennel, or ajowan (hot temperament groups) or cucumber, pumpkin, or watermelon (cold temperament groups), respectively. The levels of the rats׳ serum free thyroxin (FT4), free triiodothyronin (FT3), triiodothyronin (T3), thyroxin (T4), corticosterone and urine vanillylmandelic acid (VMA) were analyzed.

RESULTS

After 24 hours, a significant decrease in FT3 was observed in groups that were fed anise or fennel seeds. However, a significant increase in T3 was observed in the ajowan seed-fed group, and no changes in other parameters were observed in this group. On the 7th day, FT4 was significantly increased in fennel seed-fed group; T3 was significantly increased in the anise, fennel, ajowan and watermelon seed-fed groups; corticosterone was significantly increased in the watermelon and pumpkin seed-fed groups; and VMA was significantly increased in the fennel seed-fed group and significantly decreased in the cucumber seed-fed group.

CONCLUSION

Alterations induced by hot and cold temperament seeds in measured hormonal and neuromediator levels that have a regulatory role in thermogenesis and the body׳s energy metabolism revealed that hot and cold temperament characteristics of studied seeds may most likely be related to their intervention in the body׳s energy metabolism, in that hot temperament seeds may increase energy metabolism and cold temperament ones may decrease it.

Reliability and Validity Assessment of Mizaj Questionnaire: A Novel Self-report Scale in Iranian Traditional Medicine

BACKGROUND

In Iranian Traditional Medicine, mizaj (temperament) plays a key role in preventive, therapeutic and lifestyle recommendations. A reliable self-reported scale for mizaj identification is critically needed to introduce ITM into the official medical and health care system especially in the case of designing national preventive protocols.

OBJECTIVES

The present study aimed to design a preliminary self-administered mizaj questionnaire and assessed its reliability and validity in Iran.

PATIENTS AND METHODS

In this cross-sectional study, a questionnaire with 52 items was designed based on mizaj-related indices. Subsequent to content and face validity assessment, using qualitative and quantitative method, 47 items remained. Based on the non-randomly sampling, the test-retest reliability of each question and internal consistency of the questionnaire was examined by the participation of 35 volunteers. The reliable version questionnaire was filled up by 52 volunteers wherein they were divided into warm/cold and wet/dry groups based on their mizaj which was predetermined by a team of expert practitioners. Logistic regression analysis was performed for validity process between the experts' assessment of mizaj and each of the items in the questionnaire that resulted to the final ten-item questionnaire divided into two subscales. By using ANOVA and post Hoc with Dunnet statistics, the optimum cut-off points were defined and their sensitivity and specificity was assessed.

RESULTS

The weighted kappa coefficients of the 39 items were between 0.40 and 0.82 showing their acceptable reliability and the Cronbach's α coefficient was 0.71 showing the internal consistency. The sensitivity and specificity of the final questionnaire cut-off points were 65% and 93% for the warm group, 52% and 97% cold group, 53% and 67% dry group and finally 53% and 76% wet group.

CONCLUSIONS

Our results suggested that many of the designed questions according to the literature's mizaj identification indices had satisfactory reliability and the final ten-item questionnaire could discriminate the different groups of mizaj, therefore, this can be used as the first version of a brief self-report mizaj estimating scale.

Diabetes and related remedies in medieval Persian medicine

Diabetes Mellitus is a common metabolic disorder presenting increased amounts of serum glucose and will cover 5.4% of population by year 2025. Accordingly, this review was performed to gather and discuss the stand points on diagnosis, pathophysiology, non-pharmacological therapy and drug management of diabetes this disorder as described in medieval Persian medicine. To this, reports on diabetes were collected and analyzed from selected medical and pharmaceutical textbooks of Traditional Persian Medicine. A search on databases as Pubmed, Sciencedirect, Scopus and Google scholar was also performed to reconfirm the Anti diabetic activities of reported herbs. The term, Ziabites, was used to describe what is now spoken as diabetes. It was reported that Ziabites, is highly associated with kidney function. Etiologically, Ziabites was characterized as kidney hot or cold dystemperament as well as diffusion of fluid from other organs such as liver and intestines into the kidneys. This disorder was categorized into main types as hot (Ziabites-e-har) and cold (Ziabites-e-barid) as well as sweet urine (Bole-e-shirin). Most medieval cite signs of Ziabites were remarked as unusual and excessive thirst, frequent urination and polydipsia. On the management, life style modification and observing the essential rules of prevention in Persian medicine as well as herbal therapy and special simple manipulations were recommended. Current investigation was done to clarify the knowledge of medieval scientists on diabetes and related interventions. Reported remedies which are based on centuries of experience might be of beneficial for- further studies to the management of diabetes.

Medicinal properties of Foeniculum vulgare Mill. in traditional Iranian medicine and modern phytotherapy

Foeniculum vulgare Mill. (F. vulgare), commonly known as Fennel, is a popular medicinal plant with various pharmacological activities mentioned in traditional Iranian medicine (TIM) and modern phytotherapy such as antioxidant, cytotoxic, anti-inflammatory, antimicrobial, bronchodilatory, estrogenic, diuretic, lithontripic, galactogogue, emmenagogue, antithrombotic, hypotensive, gastroprotective, hepatoprotective, memory enhancing, and antimutagenic activities. No serious adverse events were recorded after ingestion of F. vulgare except some cases of allergic reactions. The estrogenic activity of F. vulgare brings some side effects such as decrease in protein concentration and acid and alkaline phosphatase in male genital organs, increase in weight of mammary glands and reproductive organs in women and premature thelarche in girls. However, no evidence of teratogenicity was recorded, it is better not to use F. vulgare during pregnancy due to its estrogenic activity. Because of inhibition of cytochrome P450 3A4 (CYP3A4), the pharmacokinetic parameters of drugs mainly metabolized by this isozyme may be affected by F. vulgare. In addition, a significant interaction between cyprofloxacin and F. vulgare was demonstrated. The aim of current paper is to review pharmacological properties, toxicity and adverse events, and drug interactions of vulgare and brings conclusive results about the use of this plant in men, women and during pregnancy.

A review on Citrullus colocynthis Schrad.: from traditional Iranian medicine to modern phytotherapy

Citrullus colocynthis Schrad. is an annual plant that grows in the south, center, and east areas of Iran. It is recognized by different pharmacologic activities in traditional Iranian medicine (TIM) (i.e., purgative, anti-inflammatory, antidiabetic, analgesic, hair growth-promoting, abortifacient, and antiepileptic. Some of these activities were confirmed in modern phytotherapy. Adverse events such as colic, diarrhea, hematochezia, nephrosis, and vomiting and narrow therapeutic index cause herbalists to use this plant cautiously. If some points about this plant in TIM are considered, it may be possible to produce more tolerable preparations from this plant. In this article, all aspects of this plant in TIM are reviewed; also, the medicinal properties declared for this plant in TIM are compared with those showed in modern phytotherapy. In addition, opinions of TIM and modern phytotherapy about safety and acceptable dosage of this plant are discussed.

Association of Expanded Disability Status Scale and Cytokines after Intervention with Co-supplemented Hemp Seed, Evening Primrose Oils and Hot-natured Diet in Multiple Sclerosis Patients(♦)

INTRODUCTION

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). Because of limited efficacy and adverse side effects, identifying novel therapeutic and protective agents is important. The aim of this study is to examine the correlations between expanded disability status scale (EDSS) and cytokines after intervention with co-supplemented hemp seed and evening primrose oils and hot-natured diet in patients with relapsing-remitting multiple sclerosis (RRMS).

METHODS

We studied a group of 23 patients with clinically definite RRMS, with EDSS<6 who received co-supplemented hemp seed and evening primrose oils with advising hot-natured diet. Clinically EDSS and immunological factors (plasma cytokines of IL-4, IFN-γ and IL-17) were assessed at baseline and after 6 months.

RESULTS

Mean follow-up was 180±2.9 days (N=23, 7 Male and 16 Females aged 25.0±7.5 years with disease duration 6.26±3.9 years). After 6 months, significant improvements in extended disability status score were found in the patients in agreement with decrease cytokines of IFN-γ and IL-17 and increase cytokines of IL-4. Clinical and immunological parameters showed improvement in the patients after the intervention.

CONCLUSION

Our study shows that co-supplemented hemp seed and evening primrose oils with hot-natured diet can have beneficial effects in improving clinical symptoms in relapsing remitting MS patients and significant correlation was found between EDSS and immunological findings.

Temperament determination for melatonin: a bridge from Iranian traditional to modern sleep medicine

History acknowledged Ibn Sina, or Avicenna, the author of the highly skilled textbook of medicine "Al-Qanun Fi Al-Tibb" or "The Canon of Medicine", as one of the greatest physicians in medicine. According to this medical textbook, the explanation of the existence of a cold temperament for sleep was that during sleep hours, people tended to have a movement of the nature of the body toward the inside, which caused the body to become cold during sleep. Temperament determination for molecules, including drugs, has proved several applications. The present study tried to demonstrate that the multitasking melatonin molecule, as a sleep related hormone, had a cold temperament. The consideration of this temperament for melatonin had the potential to connect and integrate Iranian traditional medicine to current medicine, and also opened new frontiers for the physiopathology of modern sleep medicine, based on traditional medicine.

Relationship between temperaments of medicinal plants and their major chemical compounds

OBJECTIVE

To determine any relationship between temperaments of medicinal plants referred to traditional Iranian manuscripts and their major chemical compounds.

METHODS

Plants used in traditional Iranian medicine were categorized based on their major chemical compounds including alkaloids, phenolic compounds, and essential oils. Their temperaments were extracted from traditional herbal pharmacopeias of Iran. The possible relationship between major chemical compounds and temperaments of each group were evaluated.

RESULTS

Plants containing phenolic compounds as their major constituents are hot and dry temperaments except those contain tannins with cold and dry temperaments. Plants containing essential oils have hot and dry temperaments except those whose major essential oils with alcoholic structure which have cold and dry temperaments. Alkaloid-containing plants have cold and dry or hot and dry temperaments based on their alkaloidal structures.

CONCLUSIONS

There is a close relationship between major chemical compounds of medicinal plants and their temperaments mentioned in traditional Iranian manuscripts.