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Dear Editor, In allopathic medicine, absence seizure is a kind of generalized seizure characterized by sudden, brief lapses of consciousness without loss of postural control (1, 2). Typical absence only lasts for a few seconds and consciousness returns suddenly as it was lost, without postictal confusion (3). “Shokhous” or “Jomoud” in Iranian traditional medicine is a disease in which patients suddenly lose their sensations and movements and they look as if they are slept. The patients keep their posture and their eyes open or close the same as before attack, but usually are open and fixed. If you talk to them, they do not understand or respond. Feeding or awakening them is impossible even by force. These attacks occur in a short time (4). According to the Avicenna, sensations completely vanish, but movements remain, because patients can breathe normally (5). In Iranian traditional medicine, “Shokhous” is not classified as a kind of seizure but as a sleep disorder (4). “Shokhous” signs are similar to signs of typical absence seizure, therefore, they might be the same disease; however, in absence seizure diagnosis, EEG is an important criterion (2, 6), and there was not EEG in ancient age. In most traditional medicine references, “Shokhous” is caused by a “soddeh” (meaning obstruction), in the posterior ventricle placed in the back part of brain. The substance known as “soda” (black bile) leads to this obstruction (4). According to Iranian traditional medicine, there are 4 basic qualities in body elements: warmth, coldness, moisture, and dryness (5). The body is composed of 4 humors (blood, phlegm, yellow bile, and black bile) and its health is based on the right proportion and specific balance of humors according to their quality and quantity. Each of them is similar to one of the 4 elements (air, water, fire, and earth) in the temperament and its activity. The black bile is similar to earth element and has some characteristics like stability, rigidity, and hardness. Black bile is divided into two categories: normal black bile and abnormal black bile. Any decrease of normal black bile in the body leads to rise in abnormal black bile, which causes a disorder (7, 8). In “Shokhous,” abnormal black bile rises in the brain and causes higher than normal dryness and coldness (4). Differential diagnosis of “Shokhous” in Iranian traditional medicine comprises the following diseases: “Sar” (tonic-clonic seizure): The attack of “Sar” causes patients to squirm and produce convulsive movements; but “Shokhous” does not cause movement, on the contrary, it stops body movements for a few seconds. “Sobat” (stupor): In “Sobat,” eyes are closed, it does not start and finish suddenly. The patient takes time to return to its normal state, and we can force the patient to understand or talk during “Sobat.” On the contrary, in “Shokhous” eyes are often open, it starts and finishes abruptly, it lasts a short time and if you talk to them, they do not understand or answer. “Sadare khaderi” (orthostatic hypotension): Dizziness unlike “Shokhous” is the main symptom of this disease. “Sekte” (stroke): Unlike “Shokhous,” force-feeding is possible in “Sekte.” “Sarsame bared” (a kind of meningitis): Patients can move eyes, close eyelids, change the posture, even speak a little, and there is fever in this disease but none of these signs and symptoms are reported in the “Shokhous” attack (4). Treatment In the allopathic medicine, valproic acid, ethosuxsimide, and lamotrigine are the drugs of choice to control absence seizures (9, 10). In Iranian traditional medicine, treatment is divided into two parts: prevention and therapy. Prevention consists of not eating some foods like eggplant, marinades, mushroom, and cabbage which produce more “soda” in the patient’s body. Therapy comprises enema with herbals such as “aftymoun” (Cuscuta epithymum), “basfayej” (Polypodium vulgare), “halile” (Terminalia chebula), and “ghariqoun” (Polyporus officinalis). According to the Iranian traditional medicine, these plants are used because of their special ability to extract “soda.” Also enema is more useful to cleanup brain but this treatment is helpful when body is strong enough. If energy is insufficient, enema with “Mae nokhale” (water bran), “varaghe salgh” (beet leaf), and dissolved oil, something like “booragh” (a kind of mineral), and “shahme hanzal” (Citrullus colocynthis) or other “ayarajate moshele” soda that are usable to extract soda, are helpful (4). According to this study, more research is suggested to assess the effect of this treatment in Iranian traditional medicine.

Dear Editor, The stomach is the most dilated portion of the GI tract (1). In Iranian traditional medicine (ITM) stomach is very important organ and its disorders can affect other organs (2-5). Avicenna (Ibn Sina), a Muslim scientist of the tenth and eleventh centuries has an important role in the history of medicine in Iran and the world (6). Canon, his famous book that was the greatest work by Avicenna, was translated into Latin in the 12th century and used as a major reference in medical education from the 12th until the 17th centuries (7). In addition, this book is one the most important textbooks in ITM. The foundation of ITM system was based on the balancing humors in the human body (8). In ITM, Mizaj (temperament) plays a key role in preventive, therapeutic, and lifestyle recommendations (9). Normally there are four humors in the human body: Phlegm or Balgham, Blood or Dam, Yellow bile or Safra, and Black bile or Sauda (10). Their imbalances in the body causes some disorders such as stomach swelling (2, 8). Persistent or repeated stomach pain that does not resolve with suitable treatments is the main symptom of stomach swelling (8). According to Avicenna, swelling is a complex disease (8). Swelling is thickness and bulging occurring in organ by material accumulation that expand it and fills the cavity. This material is usually infused by another organ or the organ of swelling itself (2, 8). Stomach swelling is divided into different types according to the materials: “warm” (Haar Safravi or Damavi), “cold Phlegm” (Barede Balghami), and “Solbe Ghaliz” (Hard and thick swelling) (8). The warm swelling is made by not only blood or yellow bile, but also any substance that is warm in essence or is heated by infection (2, 8). Prolonged and progressive pain, severe inflammation, strong burned, thirst and associated fever, and radiating pain are the symptoms of warm swelling. It may even lead to a mixing of mind, melancholy, and meningitis (8). “Cold phlegm” swelling is made by phlegm and predisposing factors such as moisture, indigestion, exercise reduction, and other moisture-generating causes. The symptoms and signs of “cold Phlegm” swelling are persistent or repeated pain even during sleep, diluted and increased mouth water, leaden face color, little thirst, poor digestion, poor appetite, hate and suffer moist food, tendency to dry food, without fever, inflammation, and obsession (8). Sometimes, hard and thick swelling in the stomach is formed primarily by “Sauda” or from transmission and conversion of warm swellings. Phlegm swelling seldom becomes the hard stomach swelling. There are strength to the touch, a lot of dryness, loss of body weight, and other symptoms associated with swelling in the stomach (2, 8). Treatment in warm swelling includes reducing the swelling matter by venesection or prescribed laxatives, reducing the swelling by rubbing astringent and cold medications over swollen stomach, and avoiding vomiting and potent laxatives. Topical use of Radea (deterrent) drugs, Quince oil, and grated cucurbit, avoiding food, and use of easily digestible food at first and then laxative food and drugs such as beer, cucurbit, and Khiarshanbar (Cassia fistula) is recommended. Safravi swelling remedy is consisted of topical cold drugs such as Sandal (Santalum album), Kafoor (Cinnamomum camphora), alcohol-free beer, and Enabolsalab (Solanum nigrum L.). Treatment in “cold Phlegm” swelling include oral use of astringent solvent drugs such as extract of Celery and Fennel, almond oil, topical use of Baboone (Matricaria chamomilla) and shebet (Anethum graveolens), and avoiding vomiting. Finally, potent solvent drugs is recommended in hard swelling astringent and use of camel bone marrow and cow calf brain in topical drugs is obligatory (2, 8). Based on this study, diagnosis and treatments of stomach swelling can be helpful in patients with persistent or repeated episodes stomachache.