Early description of amniotomy in medieval Persia.

AIM: Artificial rupture of the amniotic membranes during the labor, which is called amniotomy, is a common procedure in modern obstetric and midwifery protocols. There is no definite agreement regarding the timing of amniotomy in a delayed labor. In this study, we have discussed the history of amniotomy in medieval Persia mentioning the Persian medicine recommendations in this regard. METHODS: We studied main Persian medicine textbooks such as Canon of Medicine by Avicenna to investigate the history of labor management and amniotomy indications. In addition, amniotomy in current literature was studied using PubMed and Google Scholar databases. RESULTS: Persian medicine has recommended artificial rupture of membranes for labor augmentation based on its own theories. Methods for facilitation of the labor have been divided into two groups: one group before and the other during the labor. Avicenna has carefully explained the indication of amniotomy. He has recommended artificial rupture of membranes in cases of intact membranes with cervical dilatation and fetal descent. A needle or a kind of surgical knife called Mabzaa had been introduced for this procedure. CONCLUSIONS: It seems that Iranian physicians are the first scholars who have introduced the amniotomy for labor management in the 11th century. Persian medicine recommendations for labor facilitation should be considered in future studies.

The effect of plantain syrup on heavy menstrual bleeding: A randomized triple blind clinical trial.

Given the importance of heavy menstrual bleeding (HMB), we investigated the effect of plantain syrup on HMB. This randomized clinical trial was performed on 68 women with HMB who were referred to the traditional medicine clinics of Mashhad University of Medical Sciences. The intervention group received placebo capsule and plantain syrup, whereas the control group received mefenamic acid capsule and placebo syrup in the first 5 days of menstruation for three menstruation cycles. Patients were asked to complete pictorial blood assessment chart one cycle before the intervention and three intervention cycles. Hemoglobin was measured at the beginning and at the end of the study. The results showed that the bleeding duration and severity diminished in both groups. No significant difference was observed between two groups in severity of bleeding after intervention (Cohen's d = .24), but duration of bleeding in mefenamic acid group was reduced significantly in comparison with plantain group (Cohen's d = .57). Although mean hemoglobin alterations in mefenamic acid group had a significant difference before and after the intervention, there was no significant difference between the two groups in mean hemoglobin alterations postintervention. Plantain syrup could be suggested as a complementary treatment for HMB, but further studies are required.

Efficacy of a Herbal Formulation Based on Foeniculum Vulgare in Oligo/Amenorrhea: A Randomized Clinical Trial.

BACKGROUND: The aim of this study was to evaluate the efficacy of the herbal tea based on Foeniculum vulgare, on inducing regular bleeding in women with oligomenorrhea and secondary amenorrhea( oligo/amenorrhea). METHODS: Forty women aged 18- 40 with oligo/amenorrhea were enrolled in this randomized controlled clinical trial and were allocated to two groups equally. The women in the first group were treated by Fomentex (Foeniculum vulgare / Mentha longifolia / Vitex agnus-castus) herbal tea 11.2 g/day in 2 divided doses for 2 weeks and the second group were treated by medroxy progesterone acetate (MP)10 mg/day for the last 10 days of their menstrual cycles. The intervention was repeated in three cycles of menstruation in both groups. Bleeding pattern was documented by the patient on diary cards. The occurrence (yes/no) of bleeding, the regularity of bleeding pattern, the interval of cycles, the duration of bleeding, the volume of blood flow, the hormonal parameters (total testosterone, free testosterone luteinizing hormone and follicle-stimulating hormone), and the endometrial thickness in sonography before and after the intervention were evaluated and compared as outcomes. RESULTS: The number of women with bleeding during the first cycle was in the Fomentex group and the MP group 83.3% and 94.1% respectively (p = 0.61). The regularity of bleeding did not significantly differ in patients treated with Fomentex from those given MP (66.7% vs. 94.1%; p = 0.088). Mean interval of cycles decreased in both groups after intervention (P<0.001). Mean duration decreased significantly in MP group after the intervention but it was not different in patients treated with Fomentex. The difference between 2 groups was not significant (P=0.705). Volume of blood flow, with regard to Pictorial Blood Assessment Chart (PBAC), increased significantly in MP group after the intervention (P=0.001) and it was not different in patients treated with Fomentex (P=0.757); however, difference between 2 groups was not significant (P=0.063). The percentage of patients with on time menstruation in the next (drug-free) episode, was higher in the Fomentex group compared with the MP group (50% vs. 23.5%; p = 0.105). Secondary outcomes such as dysmenorrhea, acne and hirsutism reduced in the Fomentex group (P≤0.05), while they increased in the MP group (P=0.007). At the end of the treatment, there was a significant decrease in luteinizing hormone, total testosterone and free testosterone in patients taking Fomentex. The decrease of endometrial thickness, was significant in both groups after the intervention (P=0.001), but the difference between 2 groups was not significant (P=0.58). No notable complication or side effect was reported in relation to Fomentex. CONCLUSION: Fomentex herbal tea is a safe, well-tolerated, and effective choice in inducing bleeding and maintaining regular bleeding in women with oligo/amenorrhea.

The effect of a natural vaginal product based on honey on the success of intrauterine insemination (IUI) in infertility treatment.

OBJECTIVE: Due to high prevalence of infertility and increasing tendency towards complementary medicine, this study was conducted to investigate the effect of a vaginal natural product based on honey and 1% extract of Myristica fragrans on the extent of success of intrauterine insemination (IUI). MATERIALS AND METHODS: This non-randomized clinical trial study with a historic control group, was performed on infertile women. In this trial, 159 patients were assigned to the intervention group, and 288 patients were recruited to the control group. All the participants received clomiphene or letrozole from the third up to seventh day of menstruation, and on days 6, 7, and 8, they received human menopausal gonadotrophin (HMG) injections. IUI was performed 36 hours after human chorionic gonadotrophin (HCG) injection. In the intervention group, a natural vaginal product was used besides the above treatments, from menstruation day 7 until the day before performing IUI. Sixteen days after IUI, serum beta HCG was measured to investigate chemical pregnancy, and six weeks following IUI, vaginal sonography was performed to investigate clinical pregnancy. RESULTS: Analysis showed that the pregnancy rate was higher in the group that receiving the natural product compared to the control group. Chemical pregnancy rate was 18.1% vs. 15.4%, and clinical pregnancy rate was 15.2% vs. 13.8% for intervention and control groups, respectively; but, this difference was not significant. CONCLUSION: It seems that the use of this vaginal product for a longer period of time and across several menses cycles before IUI, may produce more positive results. Further studies, however, are needed to be done.

Efficacy of Aloe vera/ Plantago Major Gel in Diabetic Foot Ulcer: A Randomized Double-Blind Clinical Trial.

BACKGROUND: Diabetic foot ulcer (DFU) is one of the most common complications of diabetic patients. Mostly, non-healing DFU leads to infection, gangrene, amputation and even death. High costs and poor healing of the wounds need a new treatment such as alternative medicine. So, the aim of this study was to evaluate the efficacy of Aloe vera/ Plantago major gel (Plantavera gel) in healing of DFU. METHODS: Forty patients with DFU enrolled in a double-blind randomized clinical trial. The patients who were randomly assigned into the intervention group (n = 20), received topical Plantavera gel in addition to the routine cares, whereas the patients in the control group (n = 20), received topical Placebo gel in addition to the routine cares. Intervention was done twice a day for 4 weeks in the both groups. Photography and an evaluation of DFU healing were conducted by a checklist and then were scored at baseline and at the end of each week. The collected data was analyzed by SPSS software. RESULTS: At the end of the study, there was a significant difference between the two groups in terms of total ulcer score (P<0.001) and Plantavera gel significantly reduced the ulcer surface comparing with the control group (P=0.039). However, there was not a significant difference between the two groups (P=0.263) in terms of the ulcer depth. During this study, no side effect was observed for Plantavera gel in the intervention group. CONCLUSION: Topical Plantavera gel seems to be an effective, cheap and safe treatment. Of course, further studies are required to confirm the properties of the wound healing of this gel.

The efficacy of vaginal suppository based on myrtle in patients with cervicovaginal human papillomavirus infection: A randomized, double-blind, placebo trial.

Human papillomavirus (HPV) can be detected in most of cervical cancers. Due to antiviral, antimutagenic, and proapoptotic activities of myrtle, this study was designed to investigate the effect of a herbal suppository based on myrtle in cervicovaginal HPV infections. This study was performed as a double-blind randomized trial at the Clinic of Traditional Medicine in Mashhad University of Medical Sciences between 2016 and 2017. Sixty women, 18 to 50 years old, with cervicovaginal HPV infection, were included and randomly allocated to two groups. Sixty placebo or herbal vaginal suppositories were prescribed for 3 months (20 suppositories at each menstrual cycle). Each herbal vaginal suppository contained 10% of myrtle aqueous extract and 0.5% of myrtle essential oil. The HPV test and colposcopic findings were evaluated after treatment. There was no difference between two groups as regards lesion site, diagnosis time of disease, and HPV type before intervention (p ≥ 0.05). At the end of the study, the HPV test was negative in 92.6% and 62.6% of the intervention and placebo groups, respectively (p = 0.036). The change in cervical lesion size was 71.4% and 30.4% in the intervention and placebo groups, respectively, based on colposcopic findings (p = 0.015). It seems that herbal suppository can speed up virus clearance and can be effective in treating HPV infection.

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.

Efficacy of Violet oil, a traditional Iranian formula, in patients with chronic insomnia: A randomized, double-blind, placebo-controlled study.

ETHNOPHARMACOLOGICAL RELEVANCE: Violet oil is an ancient herbal drug which has been extensively used to treat insomnia in traditional Iranian Medicine clinics. Violet oil is an almond or sesame oil-based extract of Viola odorata, which is administered as nasal drops. This study aimed to evaluate the efficacy of Violet oil in the treatment of insomnia. METHODS AND MATERIALS: This study was conducted as a 3-arm double-blind randomized trial. A total of 75 patients with chronic insomnia were enrolled and randomly assigned to three groups in Traditional Iranian Medicine Clinic of Mashhad University of Medical Sciences, Mashhad, Iran. The treatment consisted of intranasal dropping of Violet oil, Almond oil or placebo (1% solution of Carboxymethyl cellulose) in each nostril every night before sleep for 30 days, i.e. three drops of the drug (including either Violet oil or Almond oil) or the placebo was used every night before the sleep. All the patients were asked to complete Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) questionnaires before and after the intervention. RESULTS: There were no significant differences between patients in the three groups before the intervention (P > 0.05). However, there were significant differences between the three groups after the intervention in ISI scores (P<0.002) and PSQI scores (p<0.001). When comparing the pre- and post-treatment data, the ISI and PSQI scores improved significantly in all the three groups as follows: Violet oil (P<0.001), Almond oil (P<0.001) and placebo (P<0.001). The results also showed that the Violet oil had the most effect among the three groups. In addition, it was more effective on sleep quality than sleep quantity. CONCLUSION: Considering the effects of natural nasal drug on the improvement of sleep quality in insomniac patients, this study has proposed the use of Violet oil as a natural and herbal drug in a non-oral method without serious side effects for treatment of insomnia.

Food strategies of renal atrophy based on Avicenna and conventional medicine.

Kidneys have an important role in the body. Any damage to kidney role can damage many organs of the body. Traditional Persian Medicine (TPM) or Iranian traditional medicine (ITM) is an ancient temperamental medicine with many literatures about kidney diseases and Avicenna (980-1025 AD) describes kidney diseases in details. This is a review study by searching of the most important clinical and pharmaceutical TPM textbooks such as The Canon of Medicine by Avicenna and scientific data banks using keywords such as "Hozal-e-Kolye", renal atrophy, tubular atrophy, kidney, chronic kidney disease, and end stage renal disease. This paper found that "Hozal-e-Kolye" in TPM texts is the same tubular atrophy in conventional medicine due to some similar symptoms between them. Lifestyle modification and use of proposed foodstuffs can be considered as a complementary medicine in addition to conventional treatments to manage these patients. TPM scholars prescribed some foodstuffs such as camel milk, sheep's milk and Ficus carica for this disease as a complementary management. This study aimed to explain HK (the same tubular atrophy considering their similar symptoms) and introduce some foodstuffs. It seems using of foodstuffs affecting tubular atrophy based on TPM literatures can has a role as a supplemental method in company with conventional medicine management.

A Critical Review on Phytochemistry, Pharmacology of Viola odorata L. and Related Multipotential Products in Traditional Persian Medicine.

Common violet (Viola odorata L., Violaceae) has shown various medical applications. Current study aimed to compile a review over chemical composition and medicinal properties of this plant in modern phytotherapy and its related multipotential products from traditional Persian medicine (TPM). Medicinal applications of V. odorata and respective products were derived from credible pharmaceutical textbooks of TPM (10th-18th century AD). In parallel, electronic databases including PubMed, Scopus, and ScienceDirect were explored for targeted purposes. Management of cough, fever, common cold, headache, insomnia, epilepsy, constipation, palpitation, dyspnea, dysuria, and skin diseases is of most applications of V. odorata, reported in TPM. On the other side, this herb plant has exerted antiinflammatory, analgesic, antioxidant, diuretic, antihypertensive, and antibacterial activities in modern phytotherapy. Violet TPM therapeutic preparations are including violet oil in the form of nasal or topical application for neurologic and skin disorders as well as pill, decoction, sweet syrup, and confection or semisolid oral preparations for skin, respiratory, gastrointestinal, and urinary ailments. Flavonoids, saponins, and alkaloids are responsible for pharmacological activities. Some medical applications of V. odorata in TPM have been proven by recent studies. However, more studies are needed to confirm these medicinal properties. Copyright © 2017 John Wiley & Sons, Ltd.

Breastfeeding: A Review of Its Physiology and Galactogogue Plants in View of Traditional Persian Medicine.

INTRODUCTION: The beneficial effects of breastfeeding for the infant and mother are well recognized. Many natural products are reputed to be galactogogue agents in major Traditional Persian Medicine (TPM) textbooks. The aim of this study is to review those medicinal plants that are reported to be effective in increasing breast milk in TPM and to compare the data from TPM texts with the findings of modern pharmacological and clinical research. MATERIALS AND METHODS: Data on the medicinal plants used to increase breast milk were obtained from major TPM textbooks. A detailed search in PubMed, Science Direct, Scopus, Google Scholar, and Web of Science databases was performed to confirm the effects of medicinal plants mentioned in TPM on lactation in view of the identified pharmacological actions. RESULTS: Foeniculum vulgare, Anethum graveolens, Pimpinella anisum, Nigella sativa, and Vitex agnus-castus are among the most effective galactogogue TPM plants. Many pharmacologically relevant activities have been reported for these herbs. CONCLUSION: The use of traditional knowledge can pave the way toward finding effective phytopharmaceuticals for increasing breast milk.

The role of oligomenorrhea in melasma.

Melasma is a facial hyperpigmentation in the upper lips, cheeks, forehead and chin. It is mostly seen in women. Melasma treatments include topical methods that are not only costly, but also temporary. Melasma recurs shortly after cessation of the treatment. Considering the relationship between melasma and elevated estrogen levels in patients with oligomenorrhea, systemic anti-estrogen therapies are not used for melasma. In this study, by searching in the scientific databases such as Scopus, Pubmed and the authentic books of traditional medicine such as the Canon of medicine, melasma treatment was evaluated based on oligomenorrhea systemic therapy. The results of this study showed that if melasma is due to oligomenorrhea, the use of systemic anti-estrogenic therapies can improve melasma by reducing of Melanogenesis due to decreasing α msh (alpha-Melanocyte-stimulating hormone) in addition to oligomenorrhea improvement. However, because of the extreme attention to the advertising cosmetic creams, attention to systemic therapies has been faded. According to traditional medicine, the use of menstruation-inducing systemic therapies can be more effective in melasma than topical treatments because of removing of the disease agent. Given the important role of oligomenorrhea in creating of melasma, it is suggested conducting more studies on the effect of systemic therapy of oligomenorrhea on melasma treatment. If proven, to be considered as the treatment strategies for this disease.

Analysis of Almond-Violet Oil by Gas Chromatography (A Traditional Formula).

BACKGROUND: Viola odorata L. belongs to Violaceae family and is native to Iran. It is used in the form of Almond-Violet oil in traditional Persian medicine (TPM) since ancient times. Almond-Violet oil was used for the treatment of insomnia, headache, cough, and fever based on TPM textbooks. There are two methods for the preparation of Almond-Violet oil. The first is macerating voila flowers in sweet almond oil for several days under the sunlight. The second method is cold pressing of violet flowers and sweet almond. METHODS: In this study, after mixing the violet flowers with sweet almonds in 1:2 proportions, Almond-Violet oil was obtained under pressure. Fatty acid ingredients of Almond-Violet oil were analyzed by gas chromatography (GC) technique. RESULTS: Analysis of Almond-Violet oil by GC method showed some major components such as oleic acid (70.54%), linoleic acid (Omega-6 fatty acids) (18.22%), palmitic acid (8.51%), stearic acid (1.58%), and palmitoleic acid (0.69%). Monounsaturated fat consumption has been considered to decrease low-density lipoprotein (LDL) cholesterol. Linoleic acid lipid radicals can also be used to act as an antioxidant agent in natural phenols. On the other hand, oleic acid may be responsible for the hypotensive (blood pressure reducing) effects. Palmitoleic acid is a beneficial fatty acid not only to increase insulin sensitivity by suppressing inflammation, but also to inhibit the destruction of insulin-secreting pancreatic beta cells. CONCLUSION: In some aspects, the result of the present study does not fully match with the standards of the Europe Pharmacopoeia. This could be due to differences associated with the environment and cultivation of the plants. Such differences should be considered whilst studying native plants.

Is there a relationship between sinusitis and psychological disorders?

Chronic rhinosinusitis refers to inflammation of the nasal and sinuses mucosa and the main criteria for diagnosis of this disease related to the nasal cavity or the facial area. According to several reports based on the relationship of this disease with mental disorders, psychological issues are missing in the criteria of chronic rhinosinusitis diagnosis. In this study the etiology and clinical symptoms of the disease were studied by searching scientific databases and authentic Iranian Medicine books such as Avicenna's book The Canon of Medicine (Al-Qanun fi't-Tibb) that now taught in medicine schools of the Traditional East Asian; the results of this study showed that rhinosinusitis accompaniment with psychological symptoms are listed in abundance not only in old books but also in scientific literature before 1928 but after the discovery of antibiotics and extreme attention in the context of physiopathological assignment of diseases to pathogens, this relationship has been weakened. Given the positive results of recent studies on rhinosinusitis accompaniment with psychological disorders it is suggested that more studies are needed to explore the relationship between chronic rhinosinusitis and psychological diseases and, if necessary, to be included in the diagnostic criteria as a diagnostic standard.

Insomnia in Iranian traditional medicine.

CONTEXT: Insomnia is one of the most prevalent sleep disorders characterized by sleep difficulty that impairs daily functioning and reduces quality of life. The burden of medical, psychiatric, interpersonal, and societal consequences of insomnia expresses the importance of diagnosing and treatment of insomnia. The aim of study was to investigate causes of insomnia from the viewpoint of Iranian traditional medicine. EVIDENCE ACQUISITION: In this review study, we searched insomnia in a few of the most famous ancient textbooks of Iranian traditional medicine from different centuries. This books includeThe Canon of Medicine by Avicenna (the first version of Beirut), Zakhire Kharazmshahi by Jurjani (the scanned version of Bonyade Farhang-e Iran), Malfaregh by Razes (the first version of Iran University of Medical Sciences), and Aqili's cure by Aqili (the first version of Iran University of Medical Sciences). RESULTS: This study found that in Iranian traditional medicine manuscripts, insomnia was called sahar and even though many factors induce insomnia, most of them act through causing brain dystemperament. CONCLUSIONS: The brain dystemperament is considered one of the main causes of insomnia and insomnia can be well managed with an organized line of treatment, by correcting the brain dystemperament through elimination of causes. This study helps to find new solutions to treat insomnia.

Efficacy of Viola odorata in Treatment of Chronic Insomnia.

BACKGROUND: Insomnia is the most common sleep disorder that reduces quality of life. OBJECTIVES: Due to side effects of hypnotic drug and the increasing demand for alternative medicine substitutes, violet oil (VO) was used in this study. VO is a known medication in Iranian traditional medicine that induces sleep in insomniac patients. PATIENTS AND METHODS: This study was conducted as an experimental pretest-posttest evaluation on VO efficacy in 50 patients with chronic insomnia in Iranian Traditional Medicine Clinic of Mashhad University of Medical Sciences, Mashhad, Iran. Treatment consisted of intranasal drop of VO, two drops containing 66 mg of VO in each nostril nightly before sleeping for one month. All patients were asked to complete an Insomnia Severity Index (ISI) questionnaire before the start of the trial and after one month of treatment. RESULTS: Improvements in sleep and ISI scores were significantly greater in patients after a month receiving VO drop in comparison with before starting treatment (P < 0.05). A few patients reported some complications about VO consumption, most of which were mild and no serious adverse event was encountered. CONCLUSIONS: VO can be presented as a safe, well-tolerated, and effective herbal preparation in patients with chronic insomnia.