An approach to the milestones of spine surgery in Persian traditional medicine.

BACKGROUND: The diagnosis and treatment of spine disorders have been challenging for thousands of years in different nations and medical schools. Despite this long history, there are many information gaps in this regard. The current research deals with the milestones and progress of spine surgery from ancient times until now, emphasizing the innovations of sages in the Persian traditional medicine era. METHODS: The present study is based on searching original and library documents, data from databases such as PubMed, Scopus, and Science Direct, and search engines such as Google Scholar. RESULTS: In Persian traditional medicine, Rhazes (865-925 AD) was the first sage who applied spine surgery based on the innovative knowledge of Galen (second century AD) and Paulus Aegineta (seventh century AD). Hally Abbas (tenth century AD), by suturing two separated bones during spine surgery, and Albucasis (936-1013 AD), by inventing, describing, and drawing the surgical instruments involved in surgeries in this area, and also using cauterization in the treatment of children's hunchback, were the innovators of new methods. CONCLUSION: The modern knowledge of spine surgery is based on intelligent experiences and prominent thoughts from thousands of years worldwide. However, sometimes, these key points have remained hidden. This issue necessitates investigating this science in different schools and territories for comparative studies, identifying the firsts in the prominent points of this field, preserving the identity of sages and nations, and preventing scientific plagiarism.

PARADISE OF WISDOM: INDIAN MEDICAL CONCEPTS IN A PERSIAN ISLAMIC MEDICAL TEXT

Antique traditional medical theories created by old medical doctrines and their historical background have been significantly mentioned today by medical historian scholars. Persia and India had many interactions in different perspectives, such as knowledge, religion, and traditions. One of the most considerable aspects of the relationship between Indians and Persians is the transmission of basic theories of their medical doctrines. As it is reported in many historical texts from the first ages of the Islamic era in Iran, a large number of medical texts were gathered from contiguous civilizations in Iran by order of the Abbasid Caliph. They were then translated into Arabic, Syriac, and Persian. So, Persian physicians and authors used them that way. One of the earlier physicians who reflected the viewpoints of Indian medicine in his famous medical textbook entitled "Paradise of Wisdom" is Ali ibn Sahl Rabban al-Tabari (3rd century A.H./9th century A.D.). Persian physicians in the Islamic golden age (8th to 16th A.D.) played an astonishing role in the development of medical knowledge in several aspects through physician innovations and expression and evaluation of different ideas about medicine. In this regard, some of the Indian medical theories were expressed by a famous Persian physician, Ali ibn Sahl Rabban al-Tabari. Ali ibn Sahl Rabban al-Tabari was a Persian physician of the 3rd century A.H./9th century A.D. He wrote the book Firdous al-Hikmah (or Paradise of Wisdom), the first encyclopedia of Islamic medicine in Iran. The book introduces and describes the basics and therapeutic procedures adopted in Indian medicine, along with procedures of Persian and Greek medical doctrines, by discussing the basic medical theories in these three doctrines. In this paper, we discuss the reflection of traditional Indian medicine as described in Firdous al-Hikmah and its influence on later medical texts.

Pulmonary Circulation Discovery Before Ibn Nafis-Ancient Persian and Greek Theories: A Narrative Review.

Importance: The recognition of the pulmonary circulation is a complex evolution in medical history and draws on theories across eras and cultures. Observations: This narrative review summarizes evidence suggesting that the recognition of pulmonary circulation is older than the time of Ibn Nafis. The theory of pulmonary circulation originated in ancient Persia (ad 224-637), was overshadowed by Greek theory from the 11th century, and reestablished by Ibn Nafis in the 13th century. Conclusions and Relevance: The findings of this review may help contextualize the story of the discovery of pulmonary circulation in ancient Persian and Greek theories before Ibn Nafis.

Almond as a nutraceutical and therapeutic agent in Persian medicine and modern phytotherapy: A narrative review.

Sweet almond (Prunus dulcis (Mill.) D.A.Webb) is a known nut, which has long been used in several ethnomedical systems, especially in Persian medicine (PM) for its nutritional and therapeutic activities. In this study, we aimed to provide a summary on traditional uses, phytochemistry, and pharmacological activities of sweet almond. Thus, we reviewed textbooks of PM and electronic literature on traditional medicine. Moreover, the available data on the usage of sweet almond were searched in electronic databases to find articles on its pharmacological properties and phytochemistry. According to phytochemical investigations, this plant contains macronutrients, micronutrients, essential oils, various phenolic compounds, and phytosterols. Current pharmacological studies represent that Prunus dulcis has several biological activities including prebiotic, antimicrobial, antioxidant, antiinflammatory, anticancer, hepatoprotective, cardiometabolic protection, nootropic, anxiolytic, sedative-hypnotic, and nervous-improving effects. Further clinical trials and meta-analysis are required to draw a definitive conclusion on the efficacy and therapeutic activities of almond.

Efficacy of a vaginal tablet as a Persian medicine product on vulvovaginal candidiasis: a double-blind, randomised, placebo-controlled trial.

Context: In Persian medicine, topical ingredients such as Rosa damascena Mill. (Rosaceae), are usually recommended for the treatment of uterine diseases. Scientific evaluation of these historical documents can be valuable for finding new potential use in conventional medicine.Objective: This clinical trial was performed to determine whether the use of the 'ward' vaginal tablet, which contains Rosa damascena, Punica granatum L. (Punicaceae), Querqus infectoria Oliv. (Fagaceae), Myrtus communis L. (Myrtaceae) and Nardostachys jatamansi (D.Don) DC. (Caprifoliaceae) could alleviate the symptoms of vulvovaginal candidiasis.Materials and methods: A parallel double-blinded placebo-controlled study was done. Eighteen to fifty-year-old women with vulvovaginal candidiasis were divided into the 'ward' and placebo groups, 46 individuals in each group. The 'ward' group received the 'ward' vaginal tablet containing 200 mg of dried extract. Placebo group received a placebo (composed of corn starch and lactose). One tablet was applied through the vagina for 7 consecutive nights.Results: Two weeks after medication administration, the vaginal discharge sample of patients was re-cultured; 29 patients (63.045%) in the 'ward' group and 6 (13.04%) patients in the placebo group had negative culture (p < 0.001). All clinical symptoms including itching, irritation, and vaginal discharge were significantly reduced in the 'ward' group compared with the placebo group following the intervention and the follow up (p < 0.05).Discussion and conclusions: The findings suggest the 'ward' vaginal tablet could ameliorate vulvovaginal candidiasis. Future larger studies are recommended due to compare the therapeutic effect of the 'ward' vaginal tablet with common treatments.

Strategies in traditional Persian medicine to maintain a healthy life in the elderly.

As time goes on, a greater number of people experience an age of more than 60 years old and subsequently geriatric syndromes are increasingly more common. Despite recent improvements in modern healthy living, literature on traditional Persian medicine (TPM) about the prevention and treatment of such syndromes and healthy living of the elderly is hardly known. We aimed, in this study, to explore some traditional Persian sources and briefly explain their writers' beliefs on keeping healthy living for old people. We used several TPM sources and literature, and then based on these texts, we collected issues about geriatric temperament and syndromes and classified the results including exercise, nutrition, massage, bathing, aromatherapy, and sleeping. Our search yielded some recommendations about a healthy lifestyle for the elderly, which are in fact equivalent to primary, secondary, and tertiary preventive measures in modern medicine. Our results also showed that they believed such modifications would help the elderly to improve their geriatric conditions. In general, TPM provides some pieces of advice to prevent and treat geriatric syndromes that may be helpful in practice although the scope of their effectiveness remains to be examined in carefully designed randomized controlled trials.

Novel harmala-ocudelic tuning (HOT) for ocular disorders.

The eye contains serotonin, and possesses serotonergic receptors and modulators. Selective serotonin reuptake inhibitors (SSRIs) may impair ocular function, while other serotonin receptor-binding drugs might improve it. A putative vision-improving drug must be safe at therapeutic doses, most preferably with long-lasting benefits from a single or very few administration(s). One drug potentially satisfying these criteria is the common, botanically-occurring indole alkaloid and "major hallucinogen," harmine. Harmine is prominent in the leaves of the Generally Recognized as Safe (GRAS) Passiflora, and in Peganum and Banisteriopsis, the two preeminent "sacred" medicinal plants of India/pre-Islamic Persia/modern Iran and the Amazon respectively. Though the possibility of drug-drug or herb-drug interactions exists, especially with SSRIs, at correct patient-individualized dosages, these plants, used alone, are minimally hallucinogenic, well tolerated, potentially exerting profound therapeutic effects on vision from a single or few administration(s) lasting months or years. The hypothesized mechanism for this extraordinary action is tuning of the serotonergic receptors in the eye in their binding affinity for serotonin, a putative neurochemical "ocudelic" homologue to the psychedelic phenomenon, likely potentiated, according to clinical experience with classical hallucinogens, by therapeutic music, positive psychological "set," and conducive environmental "setting." Blinded research with harmala alkaloid-containing plants in ocular patients using psychedelic therapy accoutrements, viz. eyeshades, high fidelity classical music, headphones, two guides, pre-dosing preparation, and post-dosing integration, could non-invasively assess visual acuity in presbyopia. Significant results would stimulate further exploration of this novel approach to ocular disorders. Deeper benefit, particularly when the retina is compromised, might follow co-ingestion of the harmala alkaloid-containing plants with plants containing dimethyltryptamine.

Hab-o Shefa, a Persian Medicine Compound for Maintenance Treatment of Opioid Dependence: Randomized Placebo-Controlled Clinical Trial.

Objectives: The major problem in maintenance treatment of opioid use disorder is craving and relapse. The utilization of herbal compounds and complementary therapy for treatment of disease and addiction has been widely expanding. Considering the significant effect of Hab-o Shefa in detoxification phase, this clinical trial has explored the influence of this compound on maintenance treatment of opioid-dependent patients. This product is made of four herbs, including Datura stramonium L., Rheum palmatum L., Zingiber officinale Roscoe, and Acacia senegal L. Design: The authors conducted a two-group parallel randomized double-blind clinical trial on 81 opioid-dependent patients within 12 weeks. After medically assisted detoxification, participants were assigned randomly to Hab-o Shefa (n = 41) and placebo (n = 40). Outcome measures included craving assessed by craving beliefs questionnaire, self-reported opioid use, and lapse (any opioid-positive urine test) according to urinalysis and addiction severity index-lite questionnaire, retention in treatment, and depression and anxiety scores on the Hamilton's anxiety and depression scales. Results: Forty-one participants completed the study for 12 weeks, 21 subjects in the drug group and 20 subjects in the placebo group. The rates of opioid-positive urine tests and self-reported opioid use were significantly lower in Hab-o Shefa group (f = 8.41, p = 0.001). Hab-o Shefa also indicated a significant superiority over placebo in the effect of treatment by time interaction for craving (f = 5.91, p = 0.001), depression (f = 3.40, p = 0.01), and anxiety (f = 2.58, p = 0.035). The retention time was 66.6 days for drug group and 59.6 days for placebo one. Although the causes for dropping out in two groups were different, there was no significant difference (p = 0.623). The side effects of the two groups were not significantly different. Conclusion: Results indicated that Hab-o Shefa could be useful for opioid maintenance treatment, and it can also be considered as a new promising drug for prevention of craving and relapse.

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.

Nine Steps to Discover New Medicines from Traditional Sources: The Example of Persian Medicine.

Objectives: Developing a new medicine is a costly and time-consuming process. This study presents a novel method to collate a new materia medica from previously documented traditional Persian medicine (TPM) references. A well-documented materia medica will facilitate a quick and easy process to find traditional medicine for specific symptoms or diseases. Materials and methods: A nine-step algorithm is proposed to collate a new materia medica by searching and matching descriptions and references stated in various traditional Persian literature: (1) finding the equivalent of traditional description of symptoms or diseases; (2) determining the keywords to search in the references of TPM, including The Canon of Medicine (Book by Avicenna); (3) determining the best references of TPM for the aim of the study; (4) weighing up the references (a) based on the prominence of the author's prominence (b) determining whether the references are the author's own clinical findings or has citation from other scholars been used, (c) the popularity of the book that the references feature in, among other later scholars of TPM, the geographical and historical span across which the book has been distributed; (5) searching the references using keywords of symptoms or diseases; (6) finding the synonyms of terminologies in the various materia medicas and categorizing the findings; (7) revision (of references found) to ensure that nothing is neglected; (8) scoring the findings based on the defined criteria; (9) prioritization: sorting the materia medica based on the total scores. Some important economic, cultural or historical factors cannot be included in the main process of prioritization during the initial searching of the TPM materia medica. Therefore, it is necessary to take these factors into account after discovering the medicine and before using in practice to ascertain that they are a good match of a specific treatment, disease or symptom. Conclusion: A process to compile a new materia medica has been proposed which will enable the quick and easy selection of herbal treatments for various signs and symptoms of illnesses.

Galen's place in Avicenna's The Canon of Medicine: Respect, confirmation and criticism.

Galen (129-199 A.D.), an ancient Greek scholar, is one of the most influential and recognized physicians and surgeons in the history of medicine. He is one of the most influential Greek scholar in Persian medicine, who has been repeatedly cited by Iranian scholars. The purpose of this article is to describe the exact position of Galen in Avicenna's The Canon of Medicine, the most important work of Persian medicine. In The Canon of Medicine, Galen is cited about 300 times, and Avicenna always admired and praised Galen repeatedly. Galen's ideas were important to Avicenna, but there are also many elements of Galen's views that Avicenna challenged or criticized. For example, Avicenna diverged from Galen's philosophical view in medicine and rejected some of Galen's pharmaceutical opinions and Galen's views on the physiology of pain, the physiology of pulse, the same nature of the tendons and nerves and separation of the mind and body. Although the views of Greek scholars, especially Galen, in The Canon of Medicine have been quoted abundantly, Avicenna revised the knowledge of the ancient scholars through critical thinking and relying on observation and testing, systematized the science of medicine and introduced many ideas and innovations. As such, Europeans considered Avicenna as the most prominent physician of the Islamic Golden Age.

Gastroprotective herbs for headache management in Persian medicine: A comprehensive review.

The gut-brain axis is a bidirectional communication system that exists between the brain and gut. Several studies claimed that some types of headaches are associated with various gastrointestinal (GI) disorders. In Persian medicine (PM), physicians believed that gastric disturbances could stimulate headache and introduced some herbs for boosting gastric function as a therapeutic remedy for headache. Here we review the current evidence for the gastroprotective and antiheadache effects of herbs used in PM. Herbs used for their gastrotonic effects in PM were identified from selected Persian medical and pharmaceutical textbooks. PubMed, Scopus and Google Scholar were used to search for contemporary scientific evidence relating to the gastric and neurologic effects of these plants. A total of 24 plants were recorded from the selected sources included in this review, most of which belonged to the Rosaceae family. Phyllanthus emblica, Zingiber officinale, Boswellias errata, Punica granatum and Hypericum perforatum had the most recent studies related to GI disorder and headache, while current research about quince, rose, apple, hawthorn and pear was limited. Reducing Helicobacter pylori growth, gastritis, erosion of the stomach lining, hemorrhage and perforation, improving gastric mucosal resistance, antisecretary, antiulcer, antipyretic, analgesic, sedative, anxiolytic, anti-inflammatory, anticonvulsant, neuroprotective and antioxidant effects as well as improvement in memory scores were some of the gastrotonic and neuroprotective mechanisms described in the current research. These results confirmed that medicinal plants prescribed in PM may improve headache in patients through the management of GI abnormalities. However, further studies are recommended to investigate the efficacy and safety of the mentioned medicinal plants.

A Historical Review of Persian Medicine Studies into Saliva Manifestations for Potential Applications for Diagnosis and Management of Metabolic Syndrome.

BACKGROUND AND OBJECTIVES: Regarding the development of diagnostic tests based on saliva and the prevalence of metabolic syndrome (MetS), the aim of this study is to review Persian Medicine manuscripts in the field of saliva manifestations, its relation to metabolic syndrome, and treatment recommendations. METHODS: This study is a mini-review. We investigated the canon of medicine and some important Persian medical or pharmaceutical manuscripts from the 9th to the 19th centuries. PubMed and Google Scholar databases were explored for finding relevant information about the relationship between saliva and metabolic syndrome and its treatment. RESULTS: Studies have suggested that maldigestion is one of the important causes of MetS. Sialorrhea may be an early symptom of maldigestion. Attention to sialorrhea and its treatment may be useful in the prevention and treatment of metabolic syndrome based on PM sources. In PM, sialorrhea is treated with 3 major approaches: lifestyle modification along with simple or compound medicines. CONCLUSION: Saliva manifestations could be considered as early symptoms of metabolic syndrome. As mentioned in WHO strategies, traditional medicine can be used along with modern medicine due to its effectiveness in the management of various ailments.

Uterine epilepsy: a historical report from Avicenna's point of view.

OBJECTIVE: Epilepsy is a common neurological disorder, the history of which dates back to thousands of years ago. Avicenna (980-1037 AD) is a famous Persian scholar who considered different types of epilepsy and their specific treatments. His book Al-Qanun fi al-Tibb was taught in Europe for several years. Along with explaining the diseases occurring in various body organs, the book describes neurological and neuropsychological conditions such as epilepsy METHODS: This article is a review of the book Al-Qanun fi al-Tibb and some of the traditional Persian medicine sources, including Kamil al-Sinaa al Tibbiya and Makhzan-O-L Advieh, on uterine epilepsy, its etiology, clinical manifestations and treatments. Also, articles related to this topic in the field of traditional Persian medicine or historical articles have been searched for in Google Scholar search engine or PubMed database. RESULTS: Avicenna categorizes the causes of epilepsy into two main groups: those caused by brain diseases and those associated with the diseases of other organs. He believed that the stomach, the spleen, the maraqq, the uterus, or other body organs influence the brain and can cause epilepsy. In uterine epilepsy, the primary pathology lies with the uterus and can affect the brain. This condition occurs due to the retention of the menses or semen. CONCLUSION: In this historical article, we intend to explain Avicenna's viewpoint on uterine epilepsy. We suggest further studies on this topic, for example, to evaluate the frequency of epilepsy in patients with the retention of the menses or the semen.

The Influence of Gondeshapur Medicine during the Sassanid Dynasty and the Early Islamic Period.

The development of the most active period of Persian medicine occurred in the ancient city of Gondeshapur, between the third and seventh centuries. Rebuilt between 256 and 260 by Shapur I, the second Sassanid monarch, Gondeshapur is said to have welcomed the first hospital and the consequent study of medicine, mainly based on the Greek system. It has also been mentioned that these teachings would be expanded by his successor, Shapur II. However, both statements need solid confirmation. Nestorian priests-professors and other academics expelled from the Byzantine Empire gave fundamental encouragement to cultural and medical development in Gondeshapur. With Khosrow I, Gondeshapur became a cosmopolitan city with studies of medicine, philosophy, eloquence, and music. The medical studies were conducted in an academic setting, and practiced in a hospital, with the documentary support of a library which would be provided with the main texts, mainly of Greek, Syrian, and Indian origin. The Byzantine-inspired hospital system of Gondeshapur with its own management, organic system, and differentiated personnel, was later reproduced in several cities of the Middle East and medieval Europe under Islamic rule. The academic prestige and functionality of Gondeshapur, which peaked in the seventh century, began to decline in the following centuries apparently due to the creation of similar intellectual and hospital centres in Baghdad, by the Caliph al-Mansur, and the subsequent transfer of doctors, technicians, professors and other personnel from Gondeshapur, to ensure there the operation of hospitals and also medical studies. This cultural policy was continued and expanded by al-Mansur successors, in particular by the Caliph al-Ma'mun, until the tenth century.

Insomnia in Traditional Persian Medicine

Insomnia is a common complaint in outpatient clinics. It usually affects quality of life neg-atively, especially in severe cases. Nowadays, routine medical interventions comprise pharmacological approaches and cognitive behavioral therapy. Common medications used by afflicted patients are not competent enough in addition to their annoying side effects. It would naturally denote the need for considering novel strategies for treating insomniac patients. Approach to insomnia in traditional Persian medicine (TPM) has been cited in a scrutinized manner focusing on its main causes. Accordingly, its treatment is tailored based on the constitution of the patient, intensity of the disease, and type of the cause. In this paper we have discussed the causes of insomnia, diagnostic approach, and various medical interventions proposed in valid sources of TPM.

Use of mineral waters in the treatment of psoriasis: Perspectives of Persian and conventional medicine.

Psoriasis is a chronic inflammatory disease, which is accompanied by social and emotional complications leading to considerable disability. There is no definitive cure and treatment options carry complications. Balneotherapy has been used for years in psoriasis. Antibiotic, keratolytic, and anti-inflammatory effects of these waters have been proved. Persian medicine (PM) is a source of natural remedies for skin disease. The aim of study is to explain scientific evidences of Persian mineral waters as a treatment option for psoriasis. This is a narrative review, which investigates medical manuscripts of medieval Persia from 10th to 19th centuries AD noted as credible textbooks about mineral waters. Furthermore, balneotherapy evidences searched in databases including Pubmed, Scopus, and Cochrane until December 2017 to obtain clinical evidences related to psoriasis. In PM, mineral waters have keratolytic activity and can regulate superficial skin layers hyperproliferation, which is recommended for psoriasis treatment. In various studies, antiproliferative, keratolytic, antibiotic, anti-inflammatory, and antioxidant effects of these waters have been proved completely. There are scientific evidences, which demonstrate that mineral waters in Persia, can reduce clinical symptoms of psoriasis and improve quality of life in patients. Therefore, this method might be considered as treatment options for psoriasis.

Spine deformities and trauma in Avicenna's Canon of Medicine.

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Avicenna (980-1037) and his contribution to the diagnosis and treatment of spinal deformities and trauma. METHOD: We conducted an extensive search in libraries as well as online in Pubmed and Google Scholar. RESULTS: Avicenna in his work Canon of Medicine combines the knowledge of ancient Greek and Roman physicians and surgeons and he combines them with the extensive of Arabic medicine and pharmacology. CONCLUSION: Avicenna made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and comments in his work Canon of Medicine summarize and comment the work of his predecessors and it remained a work of reference until at least the sixteenth century.