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Background: According to the Persian Medicine (PM) point of view, the function of the cardiovascular system and the risk of cardiovascular events would be different between subjects having warm and cold temperaments. Moreover, different foods in terms of temperament may lead to different acute and chronic effects on the body. background: According to the Persian Medicine (PM) point of view, the function of the cardiovascular system and probable future cardiovascular events would be different in warm and cold temperament subjects. Moreover, different foods in terms of temperament may lead to different acute and chronic effects in the body. Objectives: We investigated the postprandial effects of PM-based warm and cold test meals on arterial stiffness indices in healthy men with warm and cold temperaments. objective: We investigated the postprandial effects of PM-based warm and cold test meals on arterial stiffness indices in healthy men with warm and cold temperaments. Methods: Twenty-one eligible warm or cold temperament subjects with a similar range of age, weight, and heights were enrolled in this pilot cross-over randomized controlled trial study during February- October 2020. Two test meals (cold and warm PM-based temperament foods) were designed as different interventions. Pulse wave velocity (PWV) and pulse wave analysis (PWA) was obtained at the baseline state (following 12 hours fasting), 0.5, 2, and 4 hours after the test meal consumption during each test day. Results: Warm temperament participants had higher values of lean body mass, total body water, and protein content (P = 0.03, 0.02, and 0.02, respectively). Cold temperament individuals had higher aortic heart rate (HR) following 12 hours of fasting (P Conclusion: According to the results of the present study, although warm temperament individuals could have higher arterial stiffness at the fasting state, arterial stiffness indices had a greater reduction following warm-temperament meal intake compared to cold-temperament meal. Trial Registration number:: International Clinical Trials Registry Platform IRCT20200417047105N1 (Where the full trial protocol can be accessed) other: Temperament, Arterial stiffness, Complementary medicine

Background: Anal fissure (AF) is a common disease associated with severe pain and reduced quality of life. Factors related to lifestyle, including diet and bowel habits, play a pivotal role in its pathogenesis. Most of the chronic fissures are not responsive to drugs and more likely to recur. Given the significance of diet in Persian medicine (PM), investigation on physiopathology and appropriate foods can be useful for decreases in AF symptoms and consequences. Objective: This study was intended to evaluate the role of diet in the formation and progression of AF from the perspective of PM. Methods: In this study, the most important resources of PM dating back to thousands of years were reviewed. All these textbooks contained a section on AF, its causes, and treatment. Further analysis was performed on these resources in comparison with databank and resources of modern medicine to develop a food-based strategy for AF management. Results: From the view of PM, the warmth and dryness of anus temperament accounted for AF. Both Persian and modern medicine identified constipation as another cause for AF. Therefore, avoidance from some foods and commercial baked goods was recommended. Both Persian and modern medicine forbad the following foods: potato, cabbage, cauliflower, pasta, beef, fish, and so forth. High fiber and oligo-antigen diets with some limitations have garnered more attention. Conclusion: An integrative approach is recommended employing both Persian and modern medicine for AF. There have been some evidence in this regard, however standardized clinical trials are required for future research.

Introduction: Chronic anal fissure (CAF) is a common painful ailment that adversely affects quality of life. Nonsurgical treatments such as topical diltiazem are routinely administered to patients with CAF. However, diltiazem is associated with side effects such as headache and allergic reactions, which often lead to discontinuation of the treatment. The aim of this study was to determine the efficacy and safety of a topical Persian herbal remedy with analgesic, antiinflammatory and antiseptic properties versus topical diltiazem (2%) in CAF healing. Methods: In this randomized double-blind clinical trial, 70 patients with CAF were randomly divided into an intervention group receiving topical herbal medicine and control group receiving topical diltiazem (2%) for 6 weeks. Both groups were given lifestyle and dietary advice including adherence to a high-fiber diet, avoidance of spicy foods, use of a laxative (psyllium powder) in case of constipation, and taking sitz baths. Severity of pain, bleeding, and itching were measured at the first visit as well as the first, third, and sixth weeks of treatment. Wound healing and epithelialization were evaluated by anal examination. The treatment and follow-up period was 12 weeks; 6 weeks for assessing the effect of treatment and 6 weeks for examining treatment maintenance and evaluating the percentage of recurrence. Results: The herbal medicine caused significant reduction in pain compared with diltiazem (P < 0.001). The herbal medicine had a significant effect in terms of wound healing at the end of the period (P < 0.001). Recurrence rate was lower in the intervention group (32%) than the control group (56%), though this difference was not significant (P = 0.323) Conclusion: Findings of this clinical trial suggest a higher efficacy of the combination herbal remedy versus topical diltiazem 2% in the management of pain and wound associated with CAF.

Background: Traditional Persian Medicine (TPM)-based temperament is affected by some determinant factors that seems to have close similarities to resting energy expenditure (REE) and thermic effect of food (TEF) determinants. Pulse characteristics is considered as a main tool distinguishing different temperaments and vascular function and the probability of cardiovascular events are different in hot and cold-temper individuals in TPM point of view. Additionally, all foods are divided into cold/hot-temper and dry/wet-temper in this medical school and may lead to different responses in subjects regarding their temperaments.Methods: This experiment will be an acute phase study that will be performed on two groups of healthy individuals with normal body mass index (BMI) with hot and cold temperament. Each person will receive two TPM-based hot/cold isocaloric breakfast meals in 2 different days and metabolic responses and arterial stiffness indices thorough blood samples, indirect calorimetry, and pulse wave analysis and velocimetry will be assessed at fasting state, 0.5, 2, and 4 hours following meal consumption. Discussion: We will investigate the metabolic differences between individuals with TPM-based hot and cold temperaments and also to evaluate the effects of different TPM-based temperament of isocaloric meals (hot and cold) on metabolic responses and arterial stiffness indices in TPM-based hot/cold temper healthy men in this study. The results of this research project may lead to design of novel combined TPM and modern nutrition-based diet planning to improve metabolic responses and vascular reactivity. Trial registration: International Clinical Trials Registry Platform IRCT20200417047105N1, retrospectively registered at 19/04/2020. URL: https://irct.ir/trial/47267.

Obesity is a major risk factor for many diseases in children. Considering the widespread pandemic of pediatric obesity, developing more strategies for life style management of this disorder is essential. Therefore it was decided to conduct a more comprehensive study for prevention and treatment children obesity based on Traditional Persian Medicine (TPM). In this review we searched the most important TPM textbooks (such as Al-Havi, Al-qanun fit-tib, Kamel al Sanaeh), Classical Medicine (CM) text book (Krause's Food and the Nutrition Care Process), and scientific databases such as Data sources included (Medline, Scopus, Embase, Google Scholar) the period from 2000 to 2017 in terms of obesity management. The keywords Saman Mofrat, Setteh-e-Zarurieah, lifestyle, pediatric, children and obesity have been used in this search. Based on TPM the six essential principles (Setteh-e-Zarurieah) must be observed in management of pediatric obesity that these essential factors are as follows: air, food and drink, sleep and wakefulness, evacuation and retention, body movement, mental movement and repose. Unhealthy lifestyle for example irregular sleep, constipation, overeating and wrong nutritional habits, insufficient physical activity, and emotional excitement, such as sadness and anxiety are plays an important role in obesity that confirmed by classical medicine. Moreover, TPM has a particular attention to the type of nutrients and their temperament and the children’s digestion ability. So, further clinical trials should be performed to confirm the long-term efficacy of healthy lifestyle in pediatric obesity management.

Background: Globally, female sexual dysfunction is a serious concern based on negative family and social consequences, high side effects of medications and lack of effective treatment. Thus, the evaluation of treatment approach for this problem is an important priority for healthcare systems. Sexual life and its related disorders are considered the main aspects of a healthy lifestyle in traditional Persian medicine (TPM). Objective: The present study aimed to determine and compare the effects of food products containing Daucus carota, TPM-based training program, and a combination of these two interventions on the improvement of female sexual dysfunction. Methods: This randomized clinical trial was conducted on 96 women with sexual dysfunction based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), aged 18-35 years who referred to the Gynecology Clinic of Mashhad University of Medical Sciences, Mashhad, Iran, during 2016 and 2017. The patients were randomly divided into three groups (n=32) and received the intervention over an eight-week period. The first group was provided with TPM-based sexual health training, the second group received 30 g of a traditional food product (wild carrot halva: mixed Daucus carota and several herbs with honey) on a daily basis, and the third group received a combination of this traditional food product plus education. Data analysis was http://www.ephysician.ir Page 6578 performed using Chi square test, repeated measures ANOVA, two-way ANOVA, ANCOVA, post hoc Bonferroni, Friedman and Wilcoxon signed-rank test in SPSS version 11.5. Results: According to the results of this study, there was a significant difference in terms of sexual desire (p=0.002), lubrication (p=0.002), orgasm (p=0.004) and pain (p

Depression is a common mental disorder and the leading cause of disability in the worldwide. Based on Islamic resources, indigestion and dyspepsia can lead to depression. In modern medicine, though many somatic diseases have been named as possible causes of depression, the effect of gastrointestinal disorders on depression is still an enigma. Therefore, the focus of this study is to explore the available scientific literature of modern medicine in order to find the footprint of effect of indigestion on depression. In this study, related articles were retrieved from PubMed, Ovid, Proquest and Magiran databases by using the Medical Subject Heading keywords "depression," "psychology," "dyspepsia" and "gastrointestinal diseases." In the next step, studies, which are exactly confirm the Islamic viewpoint, were selected from the retrieved articles. Only one prospective study in 2012 has stated that people with functional gastrointestinal disorders and without elevated levels of anxiety and depression at baseline had significantly higher levels of anxiety and depression at 12-year follow-up. Based on Islamic viewpoint, indigestion can lead to depression, but this aspect approved by only one 12-year prospective population-based study in our review. It seems that it is necessary to conduct complementary studies investigating this hypothesis.

Introduction: As a common diabetic complication, foot ulcers may cause a huge burden both on the patient and healthcare system. The current study aims at investigating the effectiveness of honey dressing in the presence or absence of olive oil in diabetic foot ulcer. Case Presentation: The study attempted to report a 70-year-old female with the history of diabetes undergoing high doses of oral antidiabetes drugs (OADs). Following a car accident, she developed a neuropathic ulcer categorized as Wagner grade-II. The case was admitted in Imam Reza General hospital, Mashhad, Iran in August 2014. A combined regimen of cephalexin, cefixime and anti-inflammatory drugs was started after hospitalization. Since granulation formation and tissue repair did not occur, honey dressing with and without olive oil was used to repair the ulcer. The whole treatment period lasted a month. Conclusions: To sum up, honey dressing with and without olive oil could successfully prevent the risk of amputation in case of diabetic foot ulcers.

Background: The most prevalent endocrine disorder in women of reproductive age is polycystic ovary syndrome (PCOS). The purpose of this study was to evaluate the efficaciousness of a Persian herbal remedy, as well as electroacupuncture and the combination of them on metabolic profiles and anthropometric parameters in these patients. Materials and Methods: Eighty overweight women with PCOS were randomly divided into four groups. All of them received metformin 1000 mg and the second group received 5 g of herbal medicine per day (main components: Foeniculum vulgare, Urtica dioica, and Daucus carota), the third group were subjected to 20 electroacupuncture sessions, and the fourth group received both therapies. Results: After 12 weeks, the body fat and body mass index decreased the most in the herbal medicine+electroacupuncture group, and waist to hip ratio decreased the most in the electroacupuncture group. A significant decrease was also observed in fasting insulin, homeostasis model assessment of insulin resistance. A significant increase was seen in the quantitative insulin sensitivity check index in all intervention groups, but there was no noteworthy difference in these parameters in the control group. Total cholesterol and low-density lipoprotein cholesterol decreased significantly in the electroacupuncture groups and herbal medicine+electroacupuncture. Also, a significant decrease was observed in triglycerides, aspartate aminotransferase, and alanine aminotransferase in the herbal medicine groups and herbal medicine+electroacupuncture. Conclusion: It is advisable to use this herbal remedy and electroacupuncture for better treatment of metabolic complications and overweight problems in these patients. [GMJ.2019;8:e1389]

Background: Considering the increasing prevalence of depression in contemporary societies, general tendency for safer treatments with fewer side effects has recently been a subject of interest. Objectives: Food-based strategies, which are one of the outstanding medical solutions in Complementary and Alternative Medicine including Iranian Traditional Medicine have been investigated. Materials and Methods: In this review study, firstly some important sources of Iranian Traditional Medicine including Kamel al-Sanaat al-Tibbyyah, Al-Qanun fi al-Tibb and Zakhireh Kharazmshahi were reviewed. Next, a literature search was performed on PubMed and Magiran databases with the keywords “depression”, “depressive”, “mood”, “antidepressant”, “antidepressive”, “nutrition”, “nutritional”, “diet”, “meal”, “food”, “functional food”, “healthy food”, “healthy diet”, “medicinal food” and scientific and English terms of all singular foodstuff and some combined foodstuff which are introduced in this paper. Results: Food-based strategies for depression management in Iranian Traditional Medicine resources involving both prevention and treatment parts have been classified under three headings singular foodstuffs, combined foodstuffs, and nutrition rules with the separation of prohibition and prescription items. Among the prescribed or the prohibited singular and combined foodstuffs in Iranian Traditional Medicine manuscripts, only the effectiveness of fish, garlic, milk, oregano, mint, and spinach on depression has been examined by modern medicine methods. Conclusions: The presented food-based strategies in this study introduce a precise management for depression benefiting from Iranian Traditional Medicine Resources.

Dear Editor, Depression is a common mental disorder and leading cause of disability worldwide (1). As a definition, depression may be a mood state, a syndrome or a specific disorder that may be secondary to various medical illnesses (2, 3). Avicenna (980-1037 AD), a scholar in traditional medicine, believed that indigestion can lead to depression (4). Indigestion is a common gastrointestinal problem that consists of nausea, vomiting, heartburn, regurgitation and dyspepsia (5). Functional dyspepsia is one of the most common causes of indigestion (6). In the modern medicine the effect of psychological factors on indigestion has been confirmed (2). In the current study we have demonstrated evidences of the effects of indigestion on depression. A recent prospective study in 2012 has stated that people with Functional gastrointestinal disorders (FGIDs) such as functional dyspepsia who had not suffered from anxiety and depression at baseline significantly developed signs and symptoms of anxiety and depression over 12-year follow-up (7). The probable mechanisms for the relationship between depression and dyspepsia have also been studies. Functional brain imaging study has shown neurobiological link between psychological abnormalities and visceral hypersensitivity in FGIDs (8). Another study has approved the role of serotonin and noradrenalin, the two main neurotransmitters involved in the pathophysiology of depression, in indigestion (9). On the other hand, from the Avicenna's point of view the absorbable part of food converts to "chylous" in the stomach that absorbs via the mesenteric vessels to the liver. Then chylous is converted to "chymous" in the liver. Chymous is composed of four humors including "blood", "phlegm", "yellow bile" and "black bile". The body is also composed of these four humors. Humors enter to the blood circulation and supply food and energy for different organs. Abnormal humors cause functional disturbances in all organs including brain. Therefore the development of depression may be explained by the presence of the abnormal humors in the blood circulation. Production of normal humors requires appropriate composition of the gastric chylous that is delivered to the liver. Some etiological factors affect composition of the gastric chylous including: type of food consumed, the quality of gastric digestion, and also the quality of post-feeding conditions. Hence, indigestion can leads to depression with the following mechanism (4, 10) The preventive methods have a crucial importance in Iranian Traditional Medicine (ITM). To this end, some items have been considered in association with the three mentioned etiological factors for indigestion as follows: Dietary habits that cause indigestion Over eating, low eating, inappropriate time of eating like eating when stomach is full, eating slow-digesting foods before fast-digesting ones and also eating some foods like milk, watermelon, peach and mushroom Gastric Disorders that cause indigestion Primary gastric disorders like gastric impairments or secondary gastric disorders like ones due to accumulation of excessive gas in stomach or entering of post nasal discharge to it. Post-feeding conditions that cause indigestion Lack of sleep, excessive movement, intercourse, taking a shower, exposure to hot or cold weather, and also little or too much drinking after meal (4). If the Avicenna’s perspective would be considered alongside with further complementary investigations especially through observational studies, the prevention of indigestion may lead to significance decrease in the prevalence of depression.

Objectives: Considering the increasing prevalence of depression in modern societies and the positive effects of omega-3 polyunsaturated fatty acids on depression, this study aims to investigate the omega-3 and omega-6 content of various foodstuffs, prescribed or prohibited by Iranian Traditional Medicine (ITM). Materials and Methods: Firstly, reliable sources of Iranian Traditional Medicine were reviewed in order to identify the prescribed and prohibited foodstuffs for depressed patients. Afterwards, according to the online database of United States Department of Agriculture (URL: http://ndb.nal.usda.gov/ndb/search/list), the ratio of linoleic acid to alpha linolenic acid (as representatives of omega-6 and omega-3, respectively) was identified in each foodstuff. Finally, the ratios of omega-6 to omega-3 were compared between seven food groups of vegetables, fruits, dry goods, high protein products, dairies, breads, and spices. Results: Based on the resources of Iranian Traditional Medicine, the following foods are prescribed for depressed patients: basil, coriander, spinach, lettuce, squash, peppermint, dill, chicory, celery, beet, quince, cucumber, watermelon, grape, peach, pomegranate, banana, apple, currant, pistachio, dried fig, almond, egg, chicken, lamb, trout, milk, bread without bran, saffron, oregano, and coriander seeds. On the other hand, cabbage, eggplant, onion, garlic, broad beans, lentils, beef, whole wheat bread, and mustard are prohibited. It should be noted that omega-3 content in some prescribed foods is more than that of the prohibited ones. Conclusion: The present study showed that mint, basil, spinach, lettuce, squash, lamb, saffron, oregano, cucumber, pistachio, milk, and also wild trout can be considered as medicinal foods for depressed patients.