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In Persian Medicine (PM) literature, a crisis is the culmination of the body’s response to illness, which necessitates fundamental dietary modification to improve prognosis. In this narrative review, authentic PM textbooks as well as articles on diets for critically-ill patients (CIPs) obtained from PubMed and Google Scholar databases, were reviewed, and after gathering data, they were classified, coded, analyzed, and compared. In the acute phase, both PM and conventional medicine agree on relative food restriction, but PM lays a special focus on the use of meat in cases of weakness. There are both similarities and differences between PM and conventional medicine regarding nutritional recommendations in critical illness. For example, recommendations for food restriction and protein intake are similar in both schools, but recommendations for carbohydrate intake are different. The variables addressed and emphasized in PM require further evaluation in clinical trials.

Background Many patients choose complementary and alternative medicine (CAM) to treat various conditions. Among osteoarthritis patients, acupressure is a popular CAM treatment. In Iran, Ghamz (a Persian acupressure technique) uses for musculoskeletal ailments like knee pain. Aims To examine the potential efficacy of Ghamz on osteoarthritis outcomes. Design Clinical Trial. Settings Randomized, single-blind, sham-controlled clinical trial. Participants/Subjects Eighty patients with diagnosed knee osteoarthritis, age over 35 years old. Methods Eighty adult patients with confirmed knee osteoarthritis from three outpatient clinics were recruited. Participants were randomly assigned either to intervention or placebo groups using sham acupressure. The primary outcomes included Knee injury and Osteoarthritis Outcome Score (KOOS) parameters and pain scores measured using the visual analog scales (VAS). Results Seventy-two individuals completed the trial and were included in the analysis. At baseline, there was no difference between the mean scores of both outcomes. After the intervention, the group receiving Ghamz therapy experienced an improvement in KOOS parameters, including symptoms, pain, activity daily livings, sport, recreation function, and quality of life. The mean pain score in the intervention group was significantly decreased from 5.89 at the beginning study to 4.11 at the end of the study, while the pain score did not change substantially in the sham group. These findings remained consistent after adjusting for covariates of age, weight, and pre-treatment. Conclusions This study supports evidence that Ghamz therapy provides an effective option for short-term knee pain relief in patients with knee osteoarthritis. Additional studies are recommended to confirm these findings.

Background Iranian traditional medicine, also known as Persian Medicine, is a holistic school of medicine with a long prolific history. It describes numerous concepts and the relationships between them. However, no unified language system has been proposed for the concepts of this medicine up to the present time. Considering the extensive terminology in the numerous textbooks written by the scholars over centuries, comprehending the totality of concepts is obviously a very challenging task. To resolve this issue, overcome the obstacles, and code the concepts in a reusable manner, constructing an ontology of the concepts of Iranian traditional medicine seems a necessity. Construction and content Makhzan al-Advieh, an encyclopedia of materia medica compiled by Mohammad Hossein Aghili Khorasani, was selected as the resource to create an ontology of the concepts used to describe medicinal substances. The steps followed to accomplish this task included (1) compiling the list of classes via examination of textbooks, and text mining the resource followed by manual review to ensure comprehensiveness of extracted terms; (2) arranging the classes in a taxonomy; (3) determining object and data properties; (4) specifying annotation properties including ID, labels (English and Persian), alternative terms, and definitions (English and Persian); (5) ontology evaluation. The ontology was created using Protégé with adherence to the principles of ontology development provided by the Open Biological and Biomedical Ontology (OBO) foundry. Utility and discussion The ontology was finalized with inclusion of 3521 classes, 15 properties, and 20,903 axioms in the Iranian traditional medicine General Ontology (IrGO) database, freely available at http://ir-go.net/. An indented list and an interactive graph view using WebVOWL were used to visualize the ontology. All classes were linked to their instances in UNaProd database to create a knowledge base of ITM materia medica. Conclusion We constructed an ontology-based knowledge base of ITM concepts in the domain of materia medica to help offer a shared and common understanding of this concept, enable reuse of the knowledge, and make the assumptions explicit. This ontology will aid Persian medicine practitioners in clinical decision-making to select drugs. Extending IrGO will bridge the gap between traditional and conventional schools of medicine, helping guide future research in the process of drug discovery.

Background: Sekanjabin-e buzuri consisting extracts of Chicorium intybus L. (Kasni), Cuscuta chinensis Lam. (Koshus), Apium graveolens L. (Karafs) and Pimpinella anisum L. (Anison) seeds is a Traditional Persian Medicine product. These drugs have many applications in traditional medicine, but they are more effective in opening vascular obstructions and related functions, especially in cardiovascular system. Purpose: In this study we prepared a proper Sekanjabin-e buzuri and developed a HPLC method for analysis of chlorogenic acid (CGA), as an herbal marker compound, for quality control and standardization in both Sekanjabin-e buzuri syrup and its ingredient sources. Methods: Sekanjabin-e buzuri is a group of oxymels that have many different formulations. A proper formulation has chosen from literature (from Gharabadin-e-salehi) and prepared. For standardization of Sekanjabin-e buzuri we developed a method for detecting chlorogenic acid content. A reversed phase MZ C18 column (150*3.0 mm, 5µm) using a mixture of acetonitrile-phosphoric acid 0.1% with gradient elution program for 20 minutes with flow rate of 1.5 ml/min with UV detection at 330 nm. Results: The chlorogenic acid Rt =5.1 minutes and linear over the range of 0.2-1.5 µg/ml, (R2 = 0.9996). The calculated LOD and LOQ of chlorogenic acid were 0.02 and 0.06 µg/ml, respectively. The concentration of chlorogenic acid was 7.69, 10.37, 2.25, 2.88 and 22.86 µg/ml for Chicorium intybus L., Cuscuta chinensis Lam., Apium graveolens L. and Pimpinella anisum L. seeds and Sekanjabin-e buzuri syrup, respectively. Conclusion: This standardized Sekanjabin-e buzuri syrup will be used as a vascular opener (Mofatteh) complementary product for opening internal organs obstruction e.g. promoting cardiovascular health.

Objective: Cardiovascular disease (CVD) including atherosclerosis is currently the most common cause of death in the world. Atherosclerosis can be treated by a vast variety of modalities: from lifestyle modification to invasive open surgical bypass procedures. Regarding the limitations of conventional medicine, worldwide attention to complementary and alternative medicines has increased because of their holistic approach, lower cost and better public access. In this move towards Integrative Medicine -besides other traditional schools of medicine-Persian Medicine (PM) with its long historical background should be considered as a suitable source for research. Method: In this study we investigated major traditional literature of PM, Avicenna’s “Al-Qanun fi al-Tibb” [The Canon of medicine], to find suitable treatment modalities of atherosclerosis in comparison to conventional methods. Result: In the quest for a concept close to atherosclerosis, “sodde” (meaning obstruction) seems to be equal to atherosclerosis and “Mofattehaat” as opener drugs with different types including “Mohallelaat” (dissolvers) and “Moghatteaat” (cutting agents) have been recommended to remove the obstructing materials. Recent studies indicate that many of the medicinal herbs which were introduced as opener drugs by Avicenna have potential pharmacological effects on managing atherosclerosis. Conclusion: Scientific evidence confirm the efficacy of traditional herbs for elimination of atheroma. Antiobstructive traditional medicines are similar to the conventional atherectomy in targeting atheroma by removing atherosclerotic plaque directly, but they are non-invasive, user-friendly, much cheaper and probably with less side effects.

Silk worm (Bombyx Mori) protein, have been considered as potential materials for a variety of advanced engineering and biomedical applications for decades. Recently, silkworm silk has gained significant importance in research attention mainly because of its remarkable and exceptional mechanical properties. Silk has already been shown to have unique interactions with cells in tissues through bio-recognition units. The natural silk contains fibroin and sericin and has been used in various tissues of the human body (skin, bone, nerve, and so on). Besides, silk also still has anti-cancer, anti-tyrosinase, anti-coagulant, anti-oxidant, anti-bacterial, and anti-diabetic properties. This article is supposed to describe the diverse biomedical capabilities of Bombyx Mori silk as the appropriate biomaterial among the assorted natural and artificial polymers that are presently accessible, and ideal for usage in regenerative medicine fields. This article is protected by copyright. All rights reserved.

The prevalence of renal stones in industrialized countries is about 10 to 12%, and its incidence has increased in recent years. Renal stone is strongly dependent on dietary habits, so dietary changes are the most promising intervention to reduce renal stone production. Nutrition from the perspective of traditional Persian medicine is one of the important pillars of prevention and treatment of diseases such as renal stones. In this article, we intend to outline the nutritional managements indicated in Avicenna’s book of canon of medicine on renal stones. According to Avicenna, renal stone producing foods are concentrated and viscous foods, including some dairy products, meats, cereals, fruits, pastries, breads and some foods. Many such foods discriminated by Avicenna to be viscous and thus stone forming are also shown by modern science to increase the risk of renal stone production although based on diverse mechanisms. This issue may be an example that traditional medicine may suggest experienced-founded phenotype-based shortcuts for better research hypothesis designs.

The COVID-19 global epidemic caused by coronavirus has affected the health and other aspects of life for more than one year. Despite the current pharmacotherapies, there is still no specific treatment, and studies are in progress to find a proper therapy with high efficacy and low side effects. In this way, Traditional Persian Medicine (TPM), due to its holistic view, can provide recommendations for the prevention and treatment of new diseases such as COVID-19. The muco-obstruction of the airway, which occurs in SARS-CoV-2, has similar features in TPM textbooks that can lead us to new treatment approaches. Based on TPM and pharmacological studies, Cinnamomum verum (Darchini)'s potential effective functions can contribute to SARS-CoV-2 infection treatment and has been known to be effective in corona disease in Public beliefs. From the viewpoint of TPM theories, Cinnamon can be effective in SARS-CoV-2 improvement and treatment through its anti-obstructive, diuretic, tonic and antidote effects. In addition, there is pharmacological evidence on anti-viral, anti-inflammatory, antioxidant, organ-o-protective and anti-depression effects of Cinnamon that are in line with the therapeutic functions mentioned in TPM.Overall, Cinnamon and its ingredients can be recommended for SARS-CoV2 management due to multi-targeting therapies. This review provides basic information for future studies on this drug's effectiveness in preventing and treating COVID-19 and similar diseases., Graphical Abstract ga1

The term “crisis” in medical context is an important turning point or stage which occurs in some diseases and if not managed correctly, can become life threatening. Despite the use of the term in modern medicine, it was a much wider and sophisticated traditional medical concept. The first usage has been seen in the Greek writings of Hippocrates. In the Islamic Golden Age, this concept entered Persian Medicine by translation of Greek medical treatises. Great Persian Medicine scholars have paid particular attention to the concept and have written exclusive chapters about it. One of such scholars, Hakim Mohammad Azam Khan Chishti (1814-1902), an Indo-Persian physician and medical writer, wrote several comprehensive encyclopedic books - in Persian language - about various aspects of PM including crises. In this historical review we discuss his biography and his books, especially his important book Rokn-e-Azam, which is a comprehensive work on the concept of crisis in which he collected and discussed opinions of great medical scholars from ancient times to the 19th century. Despite his fidelity, unfortunately he rarely criticized the previous literature and thus did not add an additional value to the subject else than his comprehensive review. In the recent worldwide accepted roadmap towards Integrative Medicine, studying such inclusive traditional manuscripts may give better insight and understanding of the behavior of acute and chronic diseases and their appearance, exacerbations and remissions.

Crisis is one of the sophisticated yet important and practical concepts of Persian medicine which have been discussed and pointed out throughout traditional medical literature starting from Hippocrates, Galen, Avicenna and others or discussed independently in their related treatises. Being so important, it was used to classify the days of illnesses according to days devoted to it (critical days) or the days forecasting it (warning days) and the days in between. Crisis was known to be an important change in the process of disease which afterwards the destiny of the patient was predicted. It was categorized by its completeness/incompleteness and its good/bad prognosis, timing and direction of the pathogenic substance displacement or excretion. Many factors have been known to affect the onset and type of crisis including type of illness, the temperament of the patient, the season of disease occurrence, and even the effect of heavenly bodies especially the tidal force of the moon and the sun. Therefore many branches of science like chronobiology, physics, nanomechanics, astrophysics and rheology are needed to understand and demystify the narrated information derived from centuries of clinical observation. This understanding may lead to the decoding of unknown causes of exacerbation and remission of chronic diseases like multiple sclerosis and so on. As mentioned in previous articles, we have also designed a set of treatments named SINA therapy to simulate good crisis artificially in order to hasten the coction period and facilitate the curing of the daily increasing material diseases.

Background: Iranian traditional medicine is a holistic school of medicine with a long prolific history. It describes numerous concepts and the relationships between them. However, no unified terminology has been proposed for the concepts of this medicine up to the present time. Considering the extensive use of concepts in the numerous textbooks written by the scholars over centuries, comprehending the totality of the terminology is obviously a very challenging task. To resolve this issue and overcome the obstacles, and code the concepts in a reusable manner, constructing an ontology of the concepts of Iranian traditional medicine seems a necessity.Methods: Makhzan al-Advieh, an encyclopedia of materia medica compiled by Mohammad Hossein Aghili Khorasani, was selected as the resource to create an ontology of Mizaj. The steps followed to accomplish this task included (1) compiling the list of classes for Mizaj; (2) arranging the classes in taxonomy; (3) determining object properties and their cardinalities; (4) specifying annotation properties including codes, labels, synonyms, and definitions for each concept; (5) reviewing the fields pertaining to Mizaj of all monographs in Makhzan al-Advieh. The ontology was created using Protégé with adherence to the principles of ontology development provided by the Open Biological and Biomedical Ontology (OBO) foundry. Results: Mizaj ontology was constructed with a final inclusion of 105 classes, three object properties, and 1078 axioms in the Iranian Traditional Medicine General Ontology database, IrGO, freely available at http://jafarilab.com/irgo/. An indented tree view and an interactive graph view using WebVOWL were used to visualize the ontology. All classes were linked to their instances in the UNaProd database to create a knowledge-base of Mizaj. Conclusion: We constructed an ontology-based knowledge base of ITM concepts of Mizaj in the domain of materia medica to help offer a shared and common understanding of this concept, enable reuse of the knowledge, and make the assumptions explicit. Extending IrGO will bridge the gap between traditional and conventional schools of medicine and help guide future research on new treatment options.

Objectives : Pain relief is one of the main goals of treatment in Diabetic peripheral neuropathy (DPN). Abzan (foot- bath) is one of the effective ways to relief various types of pain in Persian Medicine (PM). Design : This study is a randomized clinical trial (RCT) conducted on 60 patients of age range within 30 to 70 years, which were randomly divided into three groups. Group A (warm water bath):For one month each night before bedtime, they were asked to sit on a chair with trousers pulled up to about 5 cm above the ankles and both feet immersed in an electrical foot-bath that contained 5 liters of warm tolerable water (between 40 and 45 ° C) for 15 minutes without any massage. In Group B (salt water bath) was added and dissolved 250 grams of powdered mineral salt to their warm water. Other stages were similar to the group A. Group C (control) did not receive any interventions. Patients were evaluated prior to and following the intervention by the Douleur Neuropathique 4 questionnaire (DN4), The McGill Pain questionnaire and The World Health Organization Bref Quality of Life (WHOQOL-BREF) questionnaire. Results : Decrease in DN4 score level in the salt warm water group was significant while The McGill questionnaire showed a significant decrease of pain level the same group. Conclusions : Application of a specific Abzan (salt water bath) may significantly decrease the pain of DPN patients.

Background: Although thermal therapy is recently suggested as a safe promising adjuvant therapy for insulin resistance and diabetes, its combination with oxymel has been claimed more effective by Traditional Persian Medicine (TPM). Objectives: This study was to examine the effect of thermal therapy plus oxymel on insulin resistance and Langerhans islands in diabetic rats. Methods: This experimental study was performed in the Experimental Animal Unit of Qom University of Medical Science in Iran in 2018. Sixty-four male rats were divided into 8 groups (using block randomization): four Normal (Nl), Diseased without treatment (D), Oxymel (OXM) and Sauna (Sauna) groups and one major SINA group (oxymel plus sauna) subdivided into four groups of different intervention frequency of 1 (SINA1d), 3 (SINA3d) and 5 days (SINA5d2m) a week for 8 weeks and 5 days a week for 4 weeks (SINA5d1m). Diabetes was induced using a high-fat diet (milk butter) and low-dose streptozotocin. Measurement of serum levels of glucose, insulin, lipid profile, and glycosylated hemoglobin and histological examination of liver, pancreas, heart, and kidney was done at the end of the study. Results: The count of Langerhans Islands significantly increased in the groups of SINA3d (6.25 ± 0.94), (P = 0.05) and SINA5d2m (7 ± 0.36), (P = 0.008) in comparison to the D group (4 ± 0.44), and cell organization became nearly normal, but serum insulin and glucose levels did not change. On the other hand, despite the high-fat diet, lipid profile and histological findings did not support fatty deposition and insulin resistance context. Conclusions: Sauna-oxymel combination (SINA) therapy, which was derived from TPM philosophy to increase systemic and pancreatic blood perfusion, was shown significantly effective in inducing regeneration of Langerhans Islands, but owing to the lack of adequate ectopic fat accumulation, its effect on insulin resistance and beta-cell functions remain uncovered. More suitable studies are needed to approve or disapprove the idea.

Proper and regular sweating plays a significant thermoregulatory role. It is a common perception that, sweating has other important homeostatic functions such as clearance of excessive micronutrients, waste products of metabolic processes, and toxins from the body, which helps to maintain human good health. In addition, sweating, thermotherapy, and sauna are commonly used to treat various diseases such as cardiovascular, respiratory and joint diseases. In traditional Persian medicine (PM) textbooks, sweating is considered a preventive care and treatment strategy as well. In this study, we aim to explain the beneficial effects of sweating in human health and its role in the management of various diseases, as well as introducing the therapeutic applications of some diaphoretic plants from the viewpoint of PM. We reviewed the most famous PM textbooks such as Kamil al-Sinaa al-Tibbiya, Al-Qānūn fī al-Tibb, Zakhireye Kharazmshahi, Kholasat al-Hikmat, Exir-e-Azam, and Hifzos-sihhat-e Naseri. Also, current evidence was searched in PubMed, Web of Science, Scopus, and other relevant databases related to the topic. The results of this study revealed that PM scientists believed proper sweating removes waste products and maintains the body’s health, thus, any disturbances in the excretion of these waste products can cause diseases. They recommended the induction of sweating through hot and dry baths, sun bath, sand bath and also the use of diaphoretic herbs for the management of various diseases. Therefore, further researches are recommended to evaluate the effectiveness of these diaphoretic plants. [GMJ.2020;9:e2003]

Nozj is a unique heterogeneous complex phenomenon discussed extensively by Traditional Persian Medicine (TPM) scholars, as a rheological change in matter for better consumption or excretion. Nozj is closely related to the many stages of digestion and affects many aspects of health and disease. Nozj status in different parts of body may be assessed and monitored using many signs and symptoms regularly not considered fairly important to other schools of treatment especially the mainstream medicine. Uncompleted process of Nozj leads to accumulation of different substances in different parts of the body. This process, generally be named as the "Bad-anbaasht" syndrome, predisposes a wide variety of famous known medical conditions.

One of guilty pathologies in insulin resistance and type 2 diabetes mellitus (T2DM) is ectopic fat accumulation in organs like pancreas, liver and skeletal muscles due to fatty acid’s bad digestion. This situation corresponds much with a spectrum of illnesses named the Soo ul Qinya & Estesgha in Traditional Persian Medicine (TPM). We renamed and redefined the concept as “The Bad-Anbaasht Syndrome” meaning bad-deposition. One of its basic treatments mentioned is thermal-therapy which interestingly also shown to benefit T2DM in recent studies. We designed a novel protocol named SINA therapy to treat T2DM including sauna’s benefits but reducing its side effects and then performed an animal pilot study. Five Wistar rats made diabetic by high fat diet and low dose streptozotocin, were treated daily by month long SINA 1.2 treatment protocol (1 cc Oxymel gavage and then 30 min thermal therapy in 37 ̊C dry sauna incubator). Weight and blood glucose were measured at beginning and at the end. Although Mean weights increased significantly from 296 to 321 (paired T test, p = 0.022) but surprisingly the mean blood glucose lowered significantly from 200mg/dl to 127mg/dl (p = 0.049). According to results of this pilot study, SINA therapy 1.2 is probable to have benefits in treatment of T2DM, but yet needs further experimental and clinical evidence.

Abnormal Uterine Bleeding (AUB) is the most common reason for women’s medical referral in the reproductive age. In Persian Medicine, one of the major causes of this disorder is known as uterine dystemperament (Su-e-Mizaj). AUB is known as “Kesrat-e Tams” in this medical school. We aimed to investigate the frequency of positive symptoms of uterine dystemperament in patients with AUB from the perspective of Persian Medicine. This cross-sectional study was conducted from October 2009 to September 2010 in Tehran, Iran. It comprised 70 patients with abnormal uterine bleeding who were 15-45 years old. Data were collected by a questionnaire prepared based on the textbooks of Persian Medicine. The frequency of each symptom of uterine dystemperament was obtained. Among the four uterine dystemperaments, the “dry” and “warm” uterine types had the highest rankings. In patients with excess uterine hemorrhage, the symptoms of warm uterine is more frequent than cold uterine. Meanwhile, the warm uterine dystemperament interference was also observed in excess uterine hemorrhage.