Development and validation of self-report Mizaj identification questionnaire Based on Persian Medicine for the elders (age over 60).

Background: Introduction: Mizaj is the basis of attention to individual differences in Persian Medicine (PM). Regarding the importance of Mizaj for health preservation and treating diseases, it is necessary to achieve a standard tool for Mizaj identification. The purpose of this study was to design a standard self-reporting Mizaj identification questionnaire for elders. Methods: In this exploratory sequential study, criteria of Mizaj identification were extracted by reviewing PM literatures and interview with PM experts and elders. The primary questionnaire was designed and its validity and reliability were assessed, using weighted Kappa statistics, Pearson correlation coefficient (PCC) assessment, receiver operating characteristic (ROC) curve and determining the specificity and sensitivity of cut-off points. Results: Among the 101 items in the primary questionnaire, 73 items had acceptable reliability. The final 20-item questionnaire was obtained after the criterion validity and PCC assessment. The sensitivity and specificity of this questionnaire were 83% and 88% for warmness, 49% and 80% for moderate in warmness-coldness, 72% and 91% for coldness, 57% and 78% for wetness, 30% and 79% for moderate in wetness-dryness, and 81% and 67% for dryness, respectively. Conclusion: The standard Mizaj identification is recommended as a supplementary diagnostic tool for clinicians and researchers in PM. Also, the people with age over 60 can use it to identify their own Mizaj and then, choose the suitable PM or Unani medicine lifestyle recommendations based on their Mizaj.

The weight of Mizaj (temperament) indices in Persian Medicine: A Delphi study.

Background: Mizaj is an individualized viewpoint in Persian Medicine (PM) that is used for the prevetion of diseases and also treatment. Evaluating Mizaj in the two domains of hotness-coldness, and wetness-dryness, 10 criteria have been introduced, most of them are qualitative. To achieve valid and reliable questionnaires, the weight of these criteria must be determined in assessing the Mizaj. Methods: In a cross-sectional study with Delphi method, 10 indices were extracted from PM references and sent to PM experts via e-mail. They were asked to score the weight of each index in determining the Mizaj from 0 to 10. The scores ranked and comparing previous preliminary studies, criteria of major and minor were proposed. Results: Out of 147 invited PM experts, 122 completed the tables. Based on scores, physical functions, physique, and responsiveness of organs obtained the highest scores in the field of hotness-coldness. In wetness-dryness muscle/fat mass and sleep/wakefulness received the highest scores from the viewpoint of experts. Conclusion: Physical functions, physique (Anthropometry), responsiveness of organs and psychic function can be used as major criteria in Mizaj assessment methods in the hotness-coldness field. In the field of wetness-dryness, muscle/fat mass, sleep/wakefulness, tactile condition and physique (anthropometry) can be considered as major criteria.

Mizaj assessment and data analysis methods in Amirkola health and aging project (AHAP cohort).

Background: One of the principles of Persian medicine (PM) is the individualized approach that is presented with the concept of Mizaj. In this viewpoint, on the whole body, Mizaj is determined for every person based on 10 criteria, which is a result of the Mizaj of the main organs, including the brain, liver, and heart. There is no standard diagnostic tool for Mizaj assessment yet. The purpose of this study is to explain the method of Mizaj assessment and data analysis in the elderly in one of the biggest health and aging projects in Iran. The second phase of the Amirkola health and aging project (AHAP) evaluated more than 1,700 clinical and laboratory examinations of 2135 elderly people. Methods: In this study, a novel Mizaj assessment method in two phases is presented. In the first phase, 1541 elderly were assessed by a PM expert and typical diagnoses (the high confidence of expert's proficiency) were determined. At the second phase, an expert panel including 5 PM experts evaluated the cases. The data of the elderly whose Mizaj agreed in the expert panel was used to assess its correlation with Mizaj. Also, the Mizaj of the main organs of these cases was evaluated this way. Conclusion: In the lack of valid and reliable questionnaires to assess the personalized viewpoint of PM, a new expert-based method has been introduced that can be used in similar studies. The result of the Mizaj assessment in this way will be used to obtain objective values for the Mizaj assessment.

Major and minor criteria for gastric dystemperaments in Persian Medicine: Sari gastric dystemperament criteria-I (SGDC-I).

Background: Gastric disorders are one of the most common human ailments, which impose a huge economic burden on countries. In Persian Medicine (PM), it is possible to predict the susceptibility to gastric diseases with diagnosis of gastric Mizajes (temperaments) and dystemperaments. The semiology of gastric dystemperaments has been investigated in PM textbooks, although the value of each sign and symptom is not mentioned. Consequently, this research is designed to determine the major and minor criteria for classifying gastric dystemperaments on the basis of valid manuscripts and with the help of PM specialists in the present era. Methods: This was a consensus-based study consisting of four phases. In the first phase, reference PM textbooks were studied. Symptoms and signs of gastric dystemperaments were collected and listed in four groups. In the second phase, semi-structured interviews with a sample of PM experts were carried out. Phase three included a focused group discussion with experts. Eventually, findings were integrated from the three study phases in a two-day meeting in Sari City. Results: Selected criteria included eight major and eight minor criteria for hot-cold dystemperament, as well as six major and eight minor criteria for wet-dry gastric dystemperament. Conclusion: Modern lifestyles and the interfering factors are responsible for some changes in diagnostic signs and symptoms according to PM. This was the first step to coordinate PM diagnostic criteria for gastric dystemperaments. Further studies are recommended to reach a unique protocol in the field of PM diagnostics. The next step includes design and validation of national diagnostic tools.

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.

The prevalence of complementary and alternative medicine use in the general population of Babol, North of Iran, 2018.

BACKGROUND: Complementary and Alternative Medicine (CAM) have recently become more popular and accepted worldwide. One principal step to identify the status and organize strategies of CAM is evaluating the manner and the prevalence of its usage among people. This study aimed to investigate the prevalence of CAM modalities usage by the people of Babol, a central city in the North of Iran, in 2018. METHODS: Using the original International CAM Questionnaire (I-CAM-Q), a questionnaire was redesigned in Persian (Farsi) with some changes such as adding special modalities in Iran and its validity and reliability were assessed. Six hundred households were evaluated using a cluster sampling method in 2018 spring by 12 trained interviewers. RESULTS: Finally, 1770 questionnaires were correctly completed. A total of 110 participants (6.21% of the completed questionnaires) had visited CAM therapists in the last year, 109 persons (6.15%) had received prescriptions from physicians and paramedics to use CAM, and a total of 1032 people (58.30%) used herbs and herbal medicines in the last 12 months. Also, 1265 individuals (71.46%) had used CAM throughout their lives. The most popular methods were herbal medicine (65.76%), Persian Medicine (13.78%), water therapy (10.45%) and music therapy (8.36%). The use of CAM was more popular among women. CONCLUSIONS: The general use of CAM in Babol was similar to other studies, but there were fewer visits by CAM therapists and less frequent adoption of common methods including homeopathy, acupuncture, and energy therapy. It was found that CAM was mostly used for non-serious diseases such as cold and transient gastrointestinal disorders, a pattern that is different from other studies in this field.

Principle of Hot and Cold and Its Clinical Application in Persian Medicine.

Persian Medicine (PM) or Humoral Medicine is a traditional school of medicine with thousands of years of prolific history. The concept of Mizaj (temperament) and hot-cold theory is one of PM's most important foundations. In the clinical setting, Mizaj represents individual differences in phenotypical, psychological, spiritual, and physiological functions. Mizaj has a crucial role in determining the treatment plan, to the point that a similar disease in patients with different Mizaj types may demand different treatments. In this chapter, the role of hot and cold theory in the diagnosis and treatment of diseases to develop an integrative medical approach is discussed.

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.

Water Intake from the Points of View of Rhazes and Avicenna.

Owing to the effect of acute and chronic hypohydration on health and the lethal effects of hyperhydration, an appropriate amount of water intake is important for each individual. Traditional Iranian medicine (TIM) is a holistic system one of whose important parts deals with lifestyles and how to maintain health, including the amount of water intake for every person and the appropriate principles of drinking water. In this study, Avicenna's Canon of Medicine, Rhazes' Benefits of Food and Its Harmfulness, and conventional medical articles were reviewed to evaluate the amount of water intake for each person and the principles of drinking water. TIM has expressed an individualized difference in the amount of water intake in the form of temperament and the relationship between the appropriate time of drinking water with other daily activities. In this view, drinking water at the inappropriate time causes liver and gastrointestinal diseases; it can create the foundation for conducting new studies in the field of appropriate water intake and lifestyle changes to reduce malnutrition complications.

Appetite Reducing Herbal Drugs from the Perspective of Avicenna and Aghili in Iranian Traditional Medicine (Persian medicine).

The increasing prevalence of obesity is one of the major problems of today's society. Man needs food to continue living, daily activities, and even the metabolism of food; and appetite plays an important role in receiving foods. Appetite and weight reducing synthetic drugs, which are mostly costly and have significant side effects, are recommended for some patients, and have limited effectiveness in the treatment of obesity. Given the epidemic of obesity and the lack of satisfaction with synthetic drugs these days, people are more likely to use herbal medicines. Complementary medicine has always been considered for the choice of new treatment. This medicine has a long history. Persian Medicine is one of the traditional medicine systems. This study was a qualitative study on the Books of Canon and the Makhzan Al-Aladvia. Saffron has been introduced in both modern medicine and in Iranian medicine to reduce appetite. In the case of Purslane seed and Chio nut, Figs, Sesame seeds, Camphor, and Solomon's seal, and Opium poppy, which have been appetite suppressant in traditional medicine books, in the books and articles of modern medicine, they have not proved to be appetite reducing. Modern medicine has known Gourd as a weight reducing food with the effects on fat but there is no talk about its effects on appetite. According to traditional Iranian medicine, Chio nut causes anorexia due to weakness in the stomach. Therefore, it is not advisable for weight loss. More clinical studies are conducted to prove the effects of appetite suppressant and weight loss effects of these herbal medicines seem logical.

Digesters in traditional Persian medicine.

BACKGROUND: Functional gastrointestinal diseases are common in general populations and comprise more than 40% visits to gastroenterologists. Treatment options of gastrointestinal diseases have been limited. There are a few medications for functional gastrointestinal diseases and some of medications are not available in the market or in the place where the patient lives. Traditional Persian medicine (TPM) is a branch of alternative and traditional medicine based on individual viewpoint and humoral theory, focuses on lifestyle modification and uses natural products to manage the patients. METHODS: In this study, a set of compound drugs known as digesters (jawarishes) and other applications are described based on main TPM text books. RESULTS: Jawarishes have different formulations containing various medicinal herbs used for better food digestion and improved gastric functions and also used for other disorders including reinforcing the brain, heart, liver and some therapeutic approaches. CONCLUSIONS: By reviewing medieval Persian pharmaceutical manuscripts, we can conclude that many herbs are effective in different systems of the body and improve gastric functions. Zingiber officinalis and Piper nigrum are mixed together to get various formulations. The variety of jawarishes formulations and their different clinical applications can indicate continuity of their use.

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.