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.

Avicenna's Approach to Health: A Reciprocal Interaction Between Medicine and Islamic Philosophy.

This paper elucidates how Islamic philosophy is associated with health and illness. Avicenna (980-1037) as the most important physician and philosopher in the Islamic world has undoubtedly affected various fields of thought and science in Islamic civilization. The basis and infrastructure of his understanding of medicine derive from his philosophical and religious views. According to Avicenna, the soul and body are two intertwined substances from which all human beings are composed. This reciprocal interaction between soul and body is essential in analyzing his medical concepts related to "health" and "sickness." Other than soul, he believes in spirit which is originally a religious concept that he interprets. Avicenna distinguishes between soul and spirit (≈ ruh) and poses that, as an ethereal volatile substance, the spirit is a mediator between soul and body. He also proposes a hierarchical system of spirit through which he illustrates a special type which is called "Ruh Bukhari" (= RB). Faculties of the soul firstly penetrate into this type of spirit and then enter the body's organs. Consequently, health and sickness are interpreted through the terms and conditions of RB.

Comparing Mizaj (temperament) in type 1 diabetes mellitus and healthy controls: A case-control study.

BACKGROUND: Diabetes mellitus (DM), named Ziabites in Persian medicine (PM), was categorized as hot or cold Ziabites according to the Mizaj of patients. This study aimed to compare the Mizaj of patients with newly diagnosed type 1 DM (T1DM) with chronic cases and healthy children. MATERIALS AND METHODS: In a case-control study, three groups including chronic T1DM patients (n = 31), newly diagnosed T1DM patients (n = 37), and healthy children as the control group (n = 80) were recruited. Mojahedi Mizaj Questionnaire was used to measure two subscales, hot/cold and wet/dry, of Mizaj for participants. The mean scores of the Mizaj subscales were compared between the groups. Cutoff values were determined using receiver operating characteristic analysis, and the corresponding odds ratio (OR) for each subscale was identified. RESULTS: Overall 148 participants, with a mean age of 10.0 ± 6.2 years, were enrolled in the study. Analysis showed that the mean total heat and total dryness scores were significantly higher in new T1DM than that of chronic patients and healthy children (19.59 ± 1.7 vs. 16.6 ± 2.1 and 18.17 ± 1.9, P < 0.001 for hot/cold and 4.70 ± 1.0 vs. 4.09 ± 0.9 and 4.31±0.8, P= 0.02 for wet/dry). "Extra heat" based on the cutoff value of >18.5 was found to be a risk factor for T1DM (OR = 3.62, 95% confidence interval = 1.52-8.63). CONCLUSION: New T1DM patients have higher frequency of hot and dry Mizaj, which is consistent with the concept of hot Ziabites in PM. Most importantly, we found that "extra heat" in children can be considered as a risk factor for T1DM.

Management of non-healing leg ulcers in Unani system of medicine.

Non-healing leg ulcers are becoming a major public health problem. The high prevalence of leg ulcer directly affects patients' quality of life because it produces psychological (anxiety, depression), social and physical (amputation) handicap. Most leg ulcers become unsightly and they hardly if ever, yield to conventional treatment. Healing of an amputated part may pose a problem, hence amputation cannot be recommended without extensive pre-operative investigations. Prevalence is high among the poor, for whom expenses of surgery are not affordable. Few surgeons try skin graft but unfavourable local condition of the ulcer leads to rejection and all efforts prove futile. Keeping all these factors in mind, we have tested a Unani formulation for its ulcer healing properties; early results were surprising and in some cases unbelievable.

Evaluation of relationship between memory and temperament in 18-28 years old students.

Background: Mizaj (Temperament) is a concept to express individual differences in Persian medicine and according to this theory, there is a relationship between Mizaj type and the abilities of different body organs. This cross-sectional study aimed to investigate the relationship between the type of Mizaj and the memory score (Quotient). Methods: The target population was the 18 to 38 years old students of Babol University of Medical Sciences. Mojahedi's Mizaj questionnaire (MMQ) was used for determining the whole Mizaj. The physical Persian version of Wechsler Memory Scale III (WMS III) was used to assess memory score. The collected data were analyzed by SPSS Version 22 and the chi square (x2) and t-test were run and p- value 0.05 was considered as significant difference. Results: Forty-two of participants were females and 18 were males. The average age of them was 23.6 (21-27). The average of Memory Quotient (MQ) was 122.1 ± 5.7. The average of MQ in warm Mizaj was 125.46 ± 1.2 and in cold Mizaj was 118.79 ± 6.5. The difference between two groups is statistically significant (p< 0.001). The average of MQ in dry Mizaj was 124.16 ± 2.67 and in wet Mizaj was 118.40 ± 7.64. The difference between two groups is statistically significant (P= 0.005). Conclusion: The results showed there are significant relationship between memory score and warm/cold Mizaj and dry /wet Mizaj. It means students with warm or dry Mizaj had better memory score than students with cold or wet Mizaj. This relation was also detected between subtypes of memory and Mizaj expect between working memory and dry/wet Mizaj. These results are in accordance with theories in PM which indicate people with warm Mizaj and dry Mizaj have better memory and people with cold Mizaj and wet Mizaj have weaker memory and are more at risk of memory dysfunction.

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.

Relationship between anthropometric indices and Mizaj (temperament) in Persian medicine.

Background: The process of diagnosis and treatment in Persian medicine (PM) are based on the concept of Mizaj (temperament). Among the indices of Mizaj determination, anthropometric indices are less influenceable regarding age change and other environmental factors. The purpose of this study was to investigate the relationship between anthropometric indices and Mizaj. Methods: Four PM experts determined the Mizaj of 121 participants. Those who had ≥70% agreement in their Mizaj determination by the experts were selected and their anthropometric indices were measured. The best cutoff point of each index and its relationship with the defined Mizaj were extracted using Receiver Operative Characteristic Curve and Binary Logistic Regression. Results: 52 out of 121 participants entered the main study. The warm-Mizaj people had larger dimensions in height, shoulder, chest, palm and sole width, and head height. Cold-Mizaj people had smaller dimensions in weight, height, shoulder, chest and head. High levels of BMI, chest depth and head dimensions had the highest correlation with the wet Mizaj and lower dimensions of these indices had the highest correlation with the dry Mizaj. Conclusion: Among the anthropometric indices, chest, palm, sole dimensions, head height and weight had the highest correlation with warmness/coldness and BMI, head width and chest dimensions had the highest correlation with wetness/dryness. The BMI which is more closely related to the soft tissue, only correlates with the wetness/dryness, while, bone dimensions are associated with warmness/coldness. Further studies are needed to metricize the anthropometric indices for Mizaj determination.

Non-alcoholic fatty liver disease - discussed under the light of Unani medicine.

Non-alcoholic Fatty Liver Disease (NAFLD) is one of the diseases that have evolved lately into a major challenge for gastroenterologists. Although, the term NAFLD has not been familiar to the medical world since long, other conditions resembling the presentation of NAFLD have been there since primitive times. It is a reversible condition of the liver, wherein large vacuoles of triglyceride fat accumulates in liver cells via the process of steatosis, despite any evidence of excessive alcohol consumption. In the developed countries NAFLD is reported to be the most common liver disorder, with a worldwide prevalence of 6-35%, in India its prevalence has been increasing gradually. Unani physicians have described liver as one of the principal organs of the body. It is the primary source of natural faculties, where the functions of digestion, concoction, absorption and excretion are performed, normally temperament of liver is hot and moist which can get converted to cold due to mutable dietary habits, consumption of fatty and cold food in abundance etc. In Unani System of Medicine, NAFLD has not been described as such, but it can be studied under Su'-i-Mizaj Kabid Barid due to correlation of most of the symptoms. Its management mainly consists of elimination of morbid matter which is accumulated in the liver and correction of Su'-i-Mizaj Kabid Barid by using drugs having opposite temperament (Ilaj bil zid).

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.

Evaluation of general body temperament and uterine dystemperament in amenorrhoea: a cross-sectional analytical study.

OBJECTIVES: Amenorrhoea in women of reproductive age may be an indication of an undiagnosed and chronic condition. The concept of temperament is a fundamental component of health preservation and diagnosis of various disease conditions including amenorrhoea in Unani medicine. Dystemperament is the commonest cause of various diseases. Therefore, general body temperament and uterine dystemperament in amenorrhoea was determined. METHODS: A prospective, single-centre, cross-sectional observational study from June to November 2019 was conducted in 80 patients of reproductive age with amenorrhoea ≥60 days. Validated questionnaire for the assessment of women's general body temperament and clinical features of uterine dystemperament was used. The data were analysed by appropriate statistical analysis. RESULTS: The age of patients with amenorrhoea ranged from 14 to 50 years. The most prevalent general body temperament was cold (57.5%) and wet (60%). Cold and wet general temperament was more common at the age of 21-30 years (30 and 36.25%), 60-90 days of amenorrhoea (33.75 and 32.5%) and body mass index (BMI) ≥25 kg/m2 (47.5 and 50%). The most prevalent uterine dystemperament was cold and dry (95%). A significant correlation between general temperament with age, amenorrhoea and BMI >23 kg/m2 was noted. Moreover, the cold temperament of the body had a significant correlation with cold uterine temperament (r=0.864, p<0.001). CONCLUSIONS: This study corroborated the claim of Unani scholars that cold and wet general and uterine temperament is more common in amenorrhoea and obesity. However, amenorrhoea can also occur in normal and other temperaments.

Migraine (Shaqeeqa) and its management in Unani medicine.

Out of many disease conditions suffered by mankind since ancient ages, Migraine holds a significant position. It is derived from the word "hemi-crania" and is a type of primary headache. This disease is mentioned in the ancient scriptures dating back to the Mesopotamian era. It has been documented by Hippocrates (460-377 BC) in his treatise, further explored and explained on the basis of cause and location by Galen (131-201 AD). Later its etiopathogenesis clinical features and management was described by Al-Razi (850-923 AD), an eminent Unani physician. Migraine is a disease majorly affecting one side of the head and characterized by recurrent attacks of pulsating headache, mostly associated with nausea, vomiting, photophobia and phonophobia, with or without an aura. It is triggered by noise and light, based on the brightness, intensity, wavelengths or type of light that is being emitted. According to Unani physicians, the word Shaqeeqa is derived from Arabic word 'Shiq', meaning 'a part' or 'a side', hence the name Shaqeeqa. They describe it as a type of headache (Suda) in which pain occurs only in one side of head, and the causative factors for it are the morbid matters and morbid vapours (Bukharat e Radiya) arising from morbid humours which are either excessive in amount, too hot or too cold. It often results due to abnormal substantial temperament (Su-e-Mizaj Maddi) giving two variants acute (Shaqeeqa haar) and chronic (Shaqeeqa barid). The treatment mainly consists of elimination of morbid matter which is accumulated in the body, and strengthening the brain using brain tonics (Muqawwiyat-e-Dimagh).

Migraine (Shaqeeqa) and its management in Unani medicine.

Out of many disease conditions suffered by mankind since ancient ages, Migraine holds a significant position. It is derived from the word "hemi-crania" and is a type of primary headache. This disease is mentioned in the ancient scriptures dating back to the Mesopotamian era. It has been documented by Hippocrates (460-377 BC) in his treatise, further explored and explained on the basis of cause and location by Galen (131-201 AD). Later its etiopathogenesis clinical features and management was described by Al-Razi (850-923 AD), an eminent Unani physician. Migraine is a disease majorly affecting one side of the head and characterized by recurrent attacks of pulsating headache, mostly associated with nausea, vomiting, photophobia and phonophobia, with or without an aura. It is triggered by noise and light, based on the brightness, intensity, wavelengths or type of light that is being emitted. According to Unani physicians, the word Shaqeeqa is derived from Arabic word 'Shiq', meaning 'a part' or 'a side', hence the name Shaqeeqa. They describe it as a type of headache (Suda) in which pain occurs only in one side of head, and the causative factors for it are the morbid matters and morbid vapours (Bukharat e Radiya) arising from morbid humours which are either excessive in amount, too hot or too cold. It often results due to abnormal substantial temperament (Su-e-Mizaj Maddi) giving two variants acute (Shaqeeqa haar) and chronic (Shaqeeqa barid). The treatment mainly consists of elimination of morbid matter which is accumulated in the body, and strengthening the brain using brain tonics (Muqawwiyat-e-Dimagh).

IrGO: Iranian traditional medicine General Ontology and knowledge base.

BACKGROUND: Iranian traditional medicine, also known as Persian Medicine, is a holistic school of medicine with a long prolific history. It describes numerous concepts and the relationships between them. However, no unified language system has been proposed for the concepts of this medicine up to the present time. Considering the extensive terminology in the numerous textbooks written by the scholars over centuries, comprehending the totality of concepts is obviously a very challenging task. To resolve this issue, overcome the obstacles, and code the concepts in a reusable manner, constructing an ontology of the concepts of Iranian traditional medicine seems a necessity. CONSTRUCTION AND CONTENT: Makhzan al-Advieh, an encyclopedia of materia medica compiled by Mohammad Hossein Aghili Khorasani, was selected as the resource to create an ontology of the concepts used to describe medicinal substances. The steps followed to accomplish this task included (1) compiling the list of classes via examination of textbooks, and text mining the resource followed by manual review to ensure comprehensiveness of extracted terms; (2) arranging the classes in a taxonomy; (3) determining object and data properties; (4) specifying annotation properties including ID, labels (English and Persian), alternative terms, and definitions (English and Persian); (5) ontology evaluation. The ontology was created using Protégé with adherence to the principles of ontology development provided by the Open Biological and Biomedical Ontology (OBO) foundry. UTILITY AND DISCUSSION: The ontology was finalized with inclusion of 3521 classes, 15 properties, and 20,903 axioms in the Iranian traditional medicine General Ontology (IrGO) database, freely available at http://ir-go.net/ . An indented list and an interactive graph view using WebVOWL were used to visualize the ontology. All classes were linked to their instances in UNaProd database to create a knowledge base of ITM materia medica. CONCLUSION: We constructed an ontology-based knowledge base of ITM concepts in the domain of materia medica to help offer a shared and common understanding of this concept, enable reuse of the knowledge, and make the assumptions explicit. This ontology will aid Persian medicine practitioners in clinical decision-making to select drugs. Extending IrGO will bridge the gap between traditional and conventional schools of medicine, helping guide future research in the process of drug discovery.

Update of hypothyroidism and its management in Unani medicine.

Hypothyroidism is a clinical syndrome caused by thyroid hormone deficiency due to reduced production, deranged distribution, or lack of effects of thyroid hormone. The prevalence of hypothyroidism in developed countries is around 4-5%, whereas it is about 11% in India, only 2% in the UK, and 4·6% in the USA. It is more common in women than in men. Hypothyroidism has multiple etiologies and manifestations. The most common clinical manifestations are weight gain, loss of hair, cold intolerance, lethargy, constipation, dry skin, and change in voice. The signs and symptoms of hypothyroidism differ with age, gender, severity of condition, and some other factors. The diagnosis is based on clinical history, physical examination and serum level of FT3, FT4, and thyroid-stimulating hormone, imaging studies, procedures, and histological findings. The treatment of choice for hypothyroidism is levothyroxine, however; in this review article, we have discussed the epidemiology, etiology, clinical sign and symptoms, diagnosis, complications, and management of hypothyroidism in modern medicine and a comparative treatment by the Unani system of medicine (USM). In the USM, the main emphasis of the principle of treatment (Usool-e-Ilaj) is to correct the abnormal constitution (Su-e-Mizaj) and alter the six prerequisites for existence (Asbab-e-Sitta Zarooriya) to restore normal health. It is a packaged treatment, that is, different components of treatment are given as a package form which includes different drugs, dosages form, and regimens.

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.

Mizaj as an Index in Persian Traditional Medicine Index Could Associate with Sensitivity to the Radiation.

BACKGROUND: The sensitivity to the radiation among human population depends on various parameters. This variation could lead to dissimilar outcome of radiotherapy in similar situations. Mizaj is a well-known term in Persian medicine that present an individualized medicine viewpoint. All of the people will be categorized in cold, moderate, and warm Mizaj. In this study, we aimed to evaluate the possible association between Mizaj and radiosensitivity by comet assay. MATERIALS AND METHODS: Peripheral blood sample of 30 healthy volunteers (10 cold, 11 moderate and nine warm Mizaj) were taken and divided into two identical parts. The first part was exposed to 4 Gy x-rays, and the second part was regarded as the sham control. Then, DNA damages of samples were evaluated by the neutral comet assay. RESULTS: The results showed that the mean percentage of damaged cells, in all of the irradiated groups including A (warm), B (moderate) and C (cold) was significantly higher than the controls (P<0.001). Moreover, DNA damage rate in the irradiated warm Mizaj group was higher than both cold and moderate irradiated groups, but the difference between moderate and cold irradiated groups was not statistically significant. CONCLUSION: The results are indicating that warm Mizaj persons could be more radiosensitive than other groups, which their importance in radiotherapy individualization should be evaluated in more extensive studies.

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.

Approaches for preparation methods of Murakkab, an Unani formulation.

Murakkab drugs of Unani medicine have remained an important aspect of disease treatment since antiquity. Physicians prepared different formulations for various diseases. The formulations thus prepared have always been of two categories. One category of Murakkab drugs was those which were formulated empirically and remained in use without conceptual framework behind these formulations. These formulations were categorized as Mujarrab (tested) formulations. The other category of formulations was prepared in consideration with theoretical framework of Mizaj (temperament) and Usoole ilaj (treatment strategy) and then tested by physicians. This category forms a large chunk of formulations in the formulary sections of the literature of Unani medicine. Present paper explores various approaches for formulating Murakkab drugs of the second category keeping in view the actions of the ingredients of the drug formulation, and treatment strategy of the disease for which the formulation was prepared. It elucidates the approaches of formulating compound drug formulations with the logic of including various individual ingredients. The study exemplifies two compound formulations to illustrate the approaches used to formulate compound formulations of Unani medicine.

Association of glutathione S-transferase M1 and T1 polymorphisms and temperament.

Mizaj (Temperament) is one of the basic concepts of Iranian Traditional Medicine (ITM), which has great importance in diagnosis and treatment of diseases, as well as maintaining the ideal healthy state of an individual. However, very little is known about the biological mechanisms of mizaj dependence treatment in practical ITM. This study was aimed to evaluate any association between the mizaj and glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) polymorphisms in healthy people. The samples included 247 healthy males from Fars province, southern Iran. The mizaj was determined using a self-reported mizaj identification scale. Subjects with equilibrium or any of four simple mizajes (warm, cold, moist, and dry) were included in the study. The GSTM1 and GSTT1 genotypes were determined using a polymerase chain reaction (PCR)-based method. No any differences in the frequency of GSTM1/T1 polymorphism between equilibrium and each of other mizaj groups were found. However, when equilibrium, moist, and dry groups were pooled and as a "medium warmness" group were compared to the warm group, the frequency of GSTT1-null in the warm group was significantly higher compare to that in the medium warmness group. Also, the combination genotypes of GSTM1 and GSTT1 was associated with the warmness; that is, individuals with combination of GSTM1 positive and GSTT1 null were more susceptible to have a warm temperament. This study indicated that the mizaj could be affected by GSTM1/T1 genes, although further research with larger samples is needed to reach full conclusions.