Non-Pharmacological Treatments of Psoriasis in Persian Medicine a Narrative Review.

Psoriasis is a chronic disease that has no definitive cure. In this review study, the main sources of Persian Medicine (PM) such as the Canon of Medicine (by Avicenna) and Al-Havi (by Rhazes) were assessed to identify non-pharmacological treatments for psoriasis. Several treatments that are recommended for this disease include nutritional advice, lifestyle modifications, and manipulation therapy such as wet cupping (Hijamah), leech therapy, and phlebotomy (Fasd). These recommendations may help to prevent recurrence and be useful in improving psoriasis. The efficacy of PM recommendations to improve psoriasis should be evaluated in future studies.

Effectiveness of Viola Flower Syrup Compared with Polyethylene Glycol in Children with Functional Constipation: A Randomized, Active-Controlled Clinical Trial.

BACKGROUND: Functional constipation (FC) is a health concern that is prevalent in the pediatric population. It lowers the quality of life and increases the probability of comorbidities. As a complementary modality, herbal medicine has been considered useful in a variety of conditions. Persian medicine (PM) resources mention the Viola flower as an effective herb in treating constipation. The purpose of the current trial was to evaluate the efficacy of Viola flower syrup (VFS) compared with polyethylene glycol (PEG) in children with functional constipation. METHODS: This randomized, active-controlled, single-center trial was conducted on 140 children aged between 4 and 10 years with confirmed FC according to Rome III criteria. Participants were randomly assigned to receive either VFS or PEG for four weeks. Independent t-test and general linear model (GLM) repeated measures analysis of variance were used to determine the intergroup difference, and paired sample t-test was used to evaluate the intragroup difference. RESULTS: After four weeks of intervention, 133 individuals (66 in VFS and 67 in the PEG group) were analyzed. Results of both groups demonstrated significant improvement in all measured criteria at the end of the study compared to baseline (P < 0.001). No significant difference was observed between the two groups at baseline or at the end of the study (P > 0.05), except for fecal retention at baseline (P=0.028). Participants in the PEG group experienced more side effects compared to the VFS group. CONCLUSION: The findings of this investigation indicated that VFS is an effective and relatively safe medication to be used in the treatment of pediatric FC.

Effect of Cedar (Ziziphus spina-christi) topical solution in mild to moderate acne vulgaris: a randomized clinical study.

BACKGROUND: Acne is the most prevalent skin disease in the world and antibiotics as its standard treatments have limited and also adverse effects. Cedar (Ziziphus spina-christi) has medicinal properties like antibacterial activity and is used topically for treatment of some kinds of skin problems in Persian medicine. The aim of this study was to evaluation the efficacy of topical cedar solution of acne vulgaris. METHODS: Eighty patients aged between 15-45 years with mild to moderate acne vulgaris were conducted in this randomized, double blind trial. The participants were allocated to receive the topical cedar solution plus clindamycin 1% or topical placebo plus 1% clindamycin solution for six weeks. Patients were evaluated at the beginning of the study, second, sixth and eighth weeks after intervention for the acne severity index (ASI) and total acne lesions counting (TLC). Data was analyzed by SPSS software with Mann-Whitney U test. RESULTS: From 105 subjects 68 people completed the study (33 persons in cedar group and 35 persons in placebo group). The mean and standard deviation of the age was 26.1 ± 7.5 years and 22 subjects (32.4%) were male. TLC and ASI in the sixth and eighth weeks in cedar group were significantly less than in placebo group (p < 0.001). Topical cedar solution had no serious side effects. CONCLUSION: The topical cedar solution plus clindamycin 1% was more effective and safe than placebo plus 1% clindamycin for the treatment of acne vulgaris.

Evaluation of the effect of carrot seed (Daucus Carota) in women of fertile age with hypoactive sexual desire disorder: A randomized double-blind clinical trial.

BACKGROUND: Hypoactive Sexual Desire Disorder (HSDD) is a common sexual problem of women which has negative impacts on their health and quality of life. Given the side effects of pharmacologic interventions, it would be beneficial to patients trying to find new options based on herbal medicine. OBJECTIVES: To evaluate efficacy of carrot seed on sexual dysfunction of women with HSDD compared with placebo. METHODS: In this randomized double-blind clinical trial, 68 participants randomly assigned to the intervention group which took 500 mg carrot seed three times a day for 12 weeks versus placebo. Participants in two groups filled Female Sexual Function Index (FSFI) questionnaire at baseline, week six and 12. Repeated measure analysis of variance (ANOVA) test was used for statistical analysis. RESULTS: Thirty women in carrot seed group and thirty women in placebo group completed 12 weeks of the study. In general, carrot seed compared to placebo improved the total score of FSFI 7.329 ± 0.830 (p < 0.001), desire 4.1±0.7 (p < 0.001), lubrication 4.7±0.4 (p = 0.019), arousal 4.1±0.08 (p < 0.001), satisfaction 4.8±1.1 (p < 0.001), orgasm 3.9±0.9 (p < 0.001) and pain 5.4±1(p < 0.001). No adverse event was reported in this study. CONCLUSIONS: Women with HSDD may benefit from six weeks' treatment with carrot seed for improvement of sexual dysfunction. Further large clinical studies are warranted to confirm efficacy of this herbal drug.

A Randomized, Triple-Blind, Placebo-Controlled, Add-On Clinical Trial to Evaluate the Efficacy of Emblica officinalis in Uncontrolled Hypertension.

Introduction. Emblica officinalis (EO) has some cardiovascular effects, and there are some animal studies that show its antihypertensive effect. This study was conducted to determine the effect of combination of EO with standard therapy on the systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with uncontrolled hypertension. Materials and Methods. This was a randomized, triple-blind, placebo-controlled, 8-week study. Ninety-two patients with uncontrolled hypertension despite taking hypotensive drugs were randomly assigned into two groups to take EO (500 mg/TDS after meal) or placebo in combination with standard antihypertensive drugs. After 2, 4, 6, and 8 weeks of intervention, SBP and DBP and heart rate (HR) were measured. Data were analyzed by SPSS software using repeated measures ANOVA. Results. Eighty-one patients (41 in the drug group and 40 in the placebo group) completed the study for 8 weeks and were analyzed. The mean ± standard deviation of age was 53.64 ± 10.01 years. SBP decreased as 15.6 ± 8.23% in the EO group and 6.3 ± 7.49% in the placebo group (P < 0.001). DBP decreased as 12.3 ± 7.87% and 3.88 ± 7.98%, respectively (P < 0.001). Time effect was not significant, but the group effect was significant (F = 13.875, P=0.001 for systolic BP and F = 18.948, P < 0.001 for diastolic BP). No side effects were reported during the study. Conclusion. Eight-week combination therapy of EO with standard antihypertensive drugs significantly reduced the SBP and DBP more than placebo in patients with uncontrolled hypertension.

The Effects of Myrtle (Myrtus communis) and Clindamycin Topical Solution in the Treatment of Mild to Moderate Acne Vulgaris: A Comparative Split-Face Study.

OBJECTIVES: Although Acne vulgaris is a chronic skin disease, which its standard treatment causes therapeutic limitations and some common adverse effects, medicinal plants can be effective in treatment with low adverse effects as combination therapy. Myrtle (Myrtus Communis) has some beneficial properties, which has been administered topically and orally for some skin diseases in Persian medicine. This study aimed to compare the efficacy and safety of Myrtle formula and 1% clindamycin topical solution. METHODS: This was a split-face clinical trial that was done on 55 patients with mild to moderate acne vulgaris for 16 weeks. The patients received topical Myrtle solution to the right side of the face (group 1) and clindamycin solution to the left side (group 2) twice daily for 12 weeks. All participants were examined for the acne severity index (ASI) and total acne lesions counting (TLC) at certain times during the study. Then, they stopped using them for four weeks. They also did not take the drug in the final four weeks of the study. RESULTS: Forty-eight patients completed the study for 16 weeks; 40 (83.2%) patients were female and the rest of them were male. The mean age and standard deviation were 25.62 ± 7.62 years. After 12 weeks, the percentage changes of comedones, inflammatory lesions, ASI and TLC were significantly reduced in both groups (p < 0.001). The percentage change of inflammatory lesions and ASI decrease was significantly higher in the group 1 (p = 0.03). There was no significant difference in the incidence of side effects between the two groups. There was a more significant decrease in sebum percentage change in the group 1 (p = 0.003). CONCLUSION: Myrtle lotion was effective and safe for the treatment of mild to moderate acne vulgaris.

The effect of aromatherapy massage with lavender and chamomile oil on anxiety and sleep quality of patients with burns.

INTRODUCTION: Regarding the importance of anxiety management and improvement of the quality of sleep in patients with burn injuries, this study aimed to determine the effect of aromatherapy massage (using aromatic oils of lavender and chamomile) on the anxiety and sleep quality of the patients with burn injuries. METHOD: In a quasi-experimental study, 105 patients with burns were recruited by convenience sampling method and then assigned into three groups (control, placebo massage, and combined aromatic oil massage). The study intervention was performed 20min before bedtime in three sessions, within a week. The control group was only under daily routine care. The study data were collected using the Persian version of Spielberg's anxiety scale and the Pittsburgh Sleep Quality Inventory. Descriptive and inferential statistical tests were used to analyze the data in SPSS version 20. RESULTS: The results showed a significant difference among the three groups in terms of anxiety score (P<0.001) and in terms of sleep quality after the intervention (P=0.027). CONCLUSION: Since the aromatherapy massage as a non-pharmacological and simple method can improve the anxiety and quality of sleep in patients with burns, it is suggested that nurses and burn medical care team apply it to reduce burn patients' anxiety and promote their sleep quality. Applying massage alone also reduces anxiety in burn survivors.

Evaluation of anti-aphthous activity of decoction of Nicotiana tabacum leaves as a mouthwash: a placebo-controlled clinical study.

OBJECTIVE: To determine the effects of decoction derived from the leaves of Nicotiana tabacum (L.) as a mouthwash on minor recurrent aphthous. METHODS: A randomized double-blinded placebo-controlled clinical trial was conducted on 60 patients with minor recurrent aphthous. Treatment comprised of application of tobacco or placebo mouthwash (10 mL 3 times a day) for 5 days. Clinical evaluation included pain level using a visual analog scale and ulcer size on days 1, 3, and 5 were measured. Adverse effects after mouthwash application were recorded, and the oral mucosa was examined by the investigator at each visit. RESULTS: A total of 54 subjects with the mean age (38 ± 10) years fulfilled the study. No minor and major adverse effects were observed. In the treatment group, ulcer pain score was decreased by 79.2% and 93.8% and ulcer size was reduced by 69.1% and 92.2% (days 3 and 5, respectively), which was significantly greater than the control group (P < 0.01). CONCLUSION: The decoction prepared with of Nicotiana tabacum leaves, used as mouthwash are well-tolerated and safe, and can be used for the management of recurrent aphthous.

Effects of Coriandrum sativum Syrup on Migraine: A Randomized, Triple-Blind, Placebo-Controlled Trial.

BACKGROUND: Migraine is one of the most common and debilitating neurological problems. Although numerous preventive drugs are used to treat migraine, their complications are unavoidable. Application of herbal medicine, especially well-known medicinal plants, to treatment of chronic diseases, like migraine, could be effective. Coriandrum sativum L. (C. sativum) fruit is one of the most commonly prescribed herbs in Persian medicine, which has been used to treat headache. OBJECTIVES: This study was designed to evaluate the effects of C. sativum syrup on duration, severity and frequency of migraine. PATIENTS AND METHODS: A total of 68 migraineurs, who had the eligibility criteria, according to international headache society diagnostic criteria, were randomly assigned to intervention group (n = 34) or control group (n = 34). In addition to 500 mg of sodium valproate per day, in intervention group, they received 15 mL of Coriander fruit syrup and 15 mL of placebo syrup, in control group, three times a day, during a month. The subjects were followed for clinical efficacy at weeks 1, 2, 3 and 4. The number of migraine attacks per week, as well as the duration and severity of attacks, were evaluated. RESULTS: Of 68 patients randomized, 66 were included in analysis. The generalized estimating equations analysis showed that the Coriander fruit syrup decreased duration, severity and frequency of migraine, in the intervention group (P < 0.001). To be more precise, the mean migraine duration, severity and frequency, in the intervention group, were 5.7 hours, 3.65 units and about 50% less than control group, respectively. CONCLUSIONS: Results of this study showed that C. sativum fruit is efficient in reduction of the duration and frequency of migraine attacks and in diminishing pain degree.

Combination of Nigella sativa and Honey in Eradication of Gastric Helicobacter pylori Infection.

BACKGROUND: Gastric Helicobacter pylori is extremely common worldwide. OBJECTIVES: The aim of this study was to assess the effectiveness of combination of Nigella sativa and honey (Dosin) in eradication of gastric H. pylori infection. PATIENTS AND METHODS: Nineteen patients who had positive result for H. pylori infection by urea breath test (UBT) without a past history of peptic ulcer, gastric cancer or gastrointestinal bleeding, were suggested to receive one teaspoon of the mixture of Dosin (6 g/day of N. sativa as ground seeds and 12 g/day of honey) three times a day after meals for two weeks. The second UBT was used to detect the presence of H. pylori four weeks after completion of the test. In addition, symptoms of dyspepsia were scored before and after the study and analyzed with Wilcoxon signed-rank test. RESULTS: Fourteen patients completed the study. Negative UBT was observed in 57.1% (8/14) of participants after intervention. The median and interquartile range (IQR) of total dyspepsia symptoms was significantly reduced from 5.5 (5 - 12) to 1 (0 - 4) (P = 0.005). All the patients tolerated Dosin except for one who was excluded due to mild diarrhea. No serious adverse events were reported. CONCLUSIONS: Dosin was concluded to be an anti H. pylori and an anti-dyspeptic agent. Further studies are recommended to investigate the effect of Dosin plus antibiotics (concurrently or following another) on gastric H. pylori infection.

Evaluation of Efficacy of an Herbal Compound on Dry Mouth in Patients With Head and Neck Cancers: A Randomized Clinical Trial.

Dry mouth is a common complication of radiotherapy for head and neck cancers. This study compared the efficacy of an herbal compound containing Malva sylvestris and Alcea digitata (Boiss) with artificial saliva (Hypozalix) for improving the symptoms of dry mouth in head and neck cancer patients. The study examined a total of 62 subjects assigned to 2 groups. The herbal compound and Hypozalix were administered for 4 weeks. Efficacy was assessed using the visual analog scale and by grading the degree of dry mouth. Both groups showed a significant difference between visual analog scale before and following intervention. There was also a significant difference in visual analog scale between groups at 4 weeks after onset of intervention. The herbal group showed a significant difference between the grade of dry mouth before and after intervention, but no change was observed for grade of dry mouth in the Hypozalix group. This study supports the efficacy of the herbal compound for controlling symptoms of dry mouth in head and neck cancer patients.

Medicinal plants contain mucilage used in traditional Persian medicine (TPM).

CONTEXT: Conventional therapies using mucilage plants greatly used by practitioners in Iran. The usage of mucilages is rooted in traditional knowledge with a history of more than 4000 years. Scientific assessment of these historical documents could be valuable for finding new potential usage in the current medicine. OBJECTIVE: This study assembled an inventory of mucilage plants considered important therapeutic aids for alleviating the ailments in ancient Persian medicine and compared therapeutic applications of ancient times with current findings of medicinal mucilages in the same plant species. METHODS: A literature search compiled some main traditional manuscripts of Persian medicine, including the book of AlHavi, Canon of Medicine, Zakhireh-iKharazmshahi, Qarabadine-kabir, Tohfat ol Moemenin, and Makhzan-ol-advieh, and select mucilage plants used in treating the mouth and respiratory system disorders. Also, current investigations on related subjects were considered through a search of the Pub Med and Google Scholar databases. RESULTS: In Iran, the application of medicinal plants contains mucilage date back to ancient times. In mentioned medieval Persian books, 20 medicinal plants containing mucilage were identified. Mucilages have been traditionally used via oral or topical routes for a variety of disorders. According to this study, most of the cited medicinal plant species were used for their mucilaginous, anti-inflammatory, and anti-oxidant effects. CONCLUSIONS: A scientific evaluation of these historical documents can give an insight into the ideas of the past and be valuable in finding new data on clinical use of the mucilages that should lead to future opportunities to investigate their potential medicinal use.

Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo - controlled study.

BACKGROUND: Tribulus terrestris as a herbal remedy has shown beneficial aphrodisiac effects in a number of animal and human experiments. This study was designed as a randomized double-blind placebo-controlled trial to assess the safety and efficacy of Tribulus terrestris in women with hypoactive sexual desire disorder during their fertile years. Sixty seven women with hypoactive sexual desire disorder were randomly assigned to Tribulus terrestris extract (7.5 mg/day) or placebo for 4 weeks. Desire, arousal, lubrication, orgasm, satisfaction, and pain were measured at baseline and after 4 weeks after the end of the treatment by using the Female Sexual Function Index (FSFI). Two groups were compared by repeated measurement ANOVA test. RESULTS: Thirty women in placebo group and thirty women in drug group completed the study. At the end of the fourth week, patients in the Tribulus terrestris group had experienced significant improvement in their total FSFI (p < 0.001), desire (p < 0.001), arousal (p = 0.037), lubrication (p < 0.001), satisfaction (p < 0.001) and pain (p = 0.041) domains of FSFI. Frequency of side effects was similar between the two groups. CONCLUSIONS: Tribulus terrestris may safely and effectively improve desire in women with hypoactive sexual desire disorder. Further investigation of Tribulus terrestris in women is warranted.

Mentha longifolia syrup in secondary amenorrhea: a double-blind, placebo-controlled, randomized trials.

BACKGROUND: Amenorrhea is defined as the cessation of menses. Hormone therapy is the most common treatment. Due to the contraindications and side effects of it and the increasing demand for alternative medicine substitutes, Mentha longifolia L. was used in this study. Mentha longifolia L. is a known medication in Iranian traditional medicine to induce menstrual bleeding in women with secondary amenorrhea and oligomenorrhea. METHODS: A double-blind, randomized, placebo-controlled, multicenter study was conducted in 120 women with secondary amenorrhea and oligomenorrhea. Treatment consisted of sequential oral syrup, 45 ml (15 ml three times a day) for 2 weeks. If the patients did not have menstruation after 2 weeks of taking the medication, we would wait for two more weeks. If the patients had menstruation at each stage of using the drug, we started it one week after the end of menstruation. But if the patients had not menstruate after four weeks (two-week using of drug and waiting for two more weeks), the previous steps were repeated. The drug and placebo were repeated in three cycles of menstruation. Bleeding was documented by the patient on diary cards. The primary outcome variable was the occurrence (yes/no) of bleeding during the first treatment cycle. The secondary efficacy outcome was the regularity of bleeding pattern during the three cycles of the study. RESULTS: The number of women with bleeding during the first cycle were higher in the drug group as in the placebo group (68.3% vs. 13.6%; p < 0.001). The regularity of bleeding throughout the study was markedly better in the drug group compared with those given placebo (33.3% vs. 3.3%; p < 0.001). No notable complication or side effect was reported in relation to Mentha longifolia L. syrup. CONCLUSION: In conclusion, Mentha longifolia L. syrup is a safe, well-tolerated, and effective choice in inducing bleeding and maintaining regular bleeding in women with secondary amenorrhea and oligomenorrhea.

Antinociceptive effects of Peganum harmala L. alkaloid extract on mouse formalin test.

PURPOSE: To evaluate the effect of Peganum harmala (Syrian rue) a wild-growing flowering plant belonging to the family Zygophylaceae and found abundantly in Iran on formalin-induced pain response in mice. METHODS: Total alkaloid extract was prepared from dry seeds of Peganum harmala. All doses of extract were dissolved in normal saline and administered intraperitoneally 30 minutes before formalin injection to the mouse paw. Nociception was recorded 0-5 (early phase, A) and 15-40 (late phase, B) minutes after formalin injection. The alkaloid extract was subjected to silica gel column chromatography using a linear gradient with a CHCl3-MeOH system and different fractions collected. The effective fraction in formalin test were further purified and isolated by preparative thin layer chromatography (TLC) and identified on the basis of nuclear magnetic resonance (NMR) and mass spectrometry (MS) analysis. RESULTS: Alkaloid extract in doses (mg/kg) used induced significant reduction in pain response when compared to control as follow: 16 (28.63%), 20 (59.15%), 24 (80.75%), 28 (90.14%) and 30 (100%) in the early phase and 20 (24.67%), 24 (59.93%), 28 (78.52%) and 30 (100%) in late phase. Observed responses in both phases of A and B were dose-dependent with r2 of 0.93 and 0.99 respectively. ED50 for phases of A and B were 27.87 and 24.63 mg/kg respectively (p<0.001 for all groups). CONCLUSION: Harmaline, the last step of extraction is the main effective antinociceptive agent of the Peganum harmala alkaloid extract.