Bloating: Avicenna's Perspective and Modern Medicine

Evaluation of a Polyherbal Formulation on the Management of Migraine Headaches due to Functional Dyspepsia: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial

A holistic concept based on traditional Persian medicine (TPM) describes a headache with a gastrointestinal (GI) origin (gastric-headache). Although the neurological manifestations of this headache are similar to those of other headaches, its etiology is different. Considering its simultaneous effects on the brain and GI system, a formulation was designed based on this concept. This study aimed to determine the safety and efficacy of the designed formulation on migraine headache (MH) associated with functional dyspepsia (FD). A total of 75 diagnosed cases of MH patients with concurrent FD were randomly divided equally into 3 groups: (i) the polyherbal formulation, sodium valproate (VPA), and amitriptyline group, (ii) VPA, amitriptyline, and polyherbal formulation placebo group, and (iii) the polyherbal formulation and VPA placebo group. The primary outcomes, including frequency, duration, and severity of MH attacks, were measured at baseline and weeks 4, 8, and 12. However, secondary outcomes, including the Headache Impact Test 6 (HIT-6) Questionnaire and Parkman's score, were evaluated at baseline and end of treatment. The frequency, duration, and severity of migraine (P < 0.001 for all cases), HIT-6 (P < 0.001 for all cases), and FD (P < 0.001 for all cases) scores at the end of treatment showed a significant decrease in the 3 groups compared to the baseline. However, the differences in those variables between the 3 groups were not significant at the end of the study. The polyherbal formulation alone may improve the symptoms of migraine patients and other groups. This effect could be due to improving digestion and FD in migraine patients.

Ethnobotany of the medicinal plants used by the ethnic communities of Kerman province, Southeast Iran

BACKGROUND

Traditional medicine is a major component in the primary healthcare system in the southeast of Iran, which has a rich floral diversity. However, there is no comprehensive report on the use of medicinal herbs in this specific region. This traditional usage of medicinal plants by local communities could serve as a source for pharmacological and phytochemical studies. The main objective of this study was to identify ethnopharmacological knowledge on medicinal plant species and their local healing applications by the folk communities of Kerman province in the southeast of Iran.

METHODS

In this cross-sectional study, data were collected from 217 herbal healers using semi-structured questionnaires, open interviews, and field surveys. Factors including use reports (UR) for each species, frequency of citation (FC), and informant consensus factor (ICF) were used to analyze the data. Plant species were identified by botanists through standard taxonomic methods.

RESULTS

A total of 402 medicinal plants were used in healing practices by the local communities of Kerman province. These species belong to 273 genera of 73 families, among which 367 species are dicotyledons, 27 are monocotyledons, 7 species are cryptogam, and one species is gymnosperm. An important implication from the current study is the identification of the traditional medicinal use of 292 plant species in this region for the first time. Asteraceae, Apiaceae, Lamiaceae, and Fabaceae were the dominant medicinally utilized plant families, respectively. Leaf, flower, fruit, and seed were the most common plant parts used. Generally, crude drugs were used in the form of decoction, followed by poultice and infusion forms. Moreover, oral route is considered as the most common administration route followed by topical route. Endocrine (diabetes), dermatological, gastrointestinal, and respiratory problems were ranked as the most frequent ailment categories for which medicinal plants in this region were applied, respectively. Our findings suggested dominant use of Asteraceae and Apiaceae plants for the treatment of gastrointestinal disorders, Lamiaceae plants for respiratory and gastrointestinal ailments, and Apocynaceae plants for dermatological problems.

CONCLUSION

Our findings suggested that Asteraceae and Apiaceae plants were used for the treatment of gastrointestinal disorders, Lamiaceae plants for respiratory and gastrointestinal ailments, and Apocynaceae and Euphorbiaceae plants for dermatological problems. Among the medicinal plants with high UR and new ethnobotanical uses, Rhazya stricta was used for wound healing, Calotropis procera, Clematis ispahanica and Euphorbia spp. for eczema, Cionura erecta for the treatment of cough, Launaea acanthodes for the treatment of gastrointestinal parasites, Berberis integrrima as an antidiabetic medicinal herb, Dracocephalum polychaetum and Rydingia persica for various types of chronic diseases, Citrus limon and Citrus aurantium for the treatment of ocular diseases and making the traditional kohl, Calendula officinalis for the treatment of pterygium and Prosopis farcta for preventing nasal bleeding. The identified medicinal plants can be further evaluated for their pharmacological activity and underlying mechanisms of action.

Effect of topical marshmallow (Althaea officinalis) on atopic dermatitis in children: A pilot double-blind active-controlled clinical trial of an in-silico-analyzed phytomedicine

Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease, which primarily affects infants and young children. Due to the side effects of commonly used drugs for its treatment, the development of safer therapeutic strategies is needed. There are many reports on the topical use of marshmallow (Althaea officinalis) for a range of skin diseases in Persian medicine. The main aim of the present investigation was evaluating the efficacy of marshmallow in children with mild-to-moderate atopic dermatitis. Another aim of the study was screening the anti-allergic and anti-inflammatory potential of phytocomponents against target proteins, including TNF-alpha, IL6, and PDEs A, B, and D enzymes with PDB IDs: 2AZ5, 1P9M, 3I8V, 4KP6, and 1Y2K, respectively, along with their respective standard ligands using computational docking analysis. A pilot clinical trial was designed to investigate the safety and efficacy of Althaea officinalis in children with AD. The diagnosis of AD was made according to the criteria of Hanifin and Rajka. Children between 3 months and 12 years old were participated in this trial and randomly allocated into two parallel intervention and control groups. The intervention group used Althaea officinalis 1% ointment while the positive control group used Hydrocortisone 1% ointment twice a day for a week and after that, three times per week for a period of 3 weeks. The severity of AD was measured using the SCORAD score at the end of each assessment visits. A total number of 22 patients completed the study. A significant decrease of the SCORAD score was observed in both groups. At the end of the study, this score change, which indicates the improvement of the patients was significantly higher in the intervention group in comparison to the baseline (p-value = .015) and week 1 (p-value = .018). In the docking analysis of the study, 33 phytochemical compounds were identified, which were docked into the active site of IL6, TNF-alpha, and human PDE4 isoenzymes. Affinity toward the selected enzymes was significantly higher in glycosylated compounds. The results of this pilot study showed that the efficacy of Althaea officinalis 1% ointment in a decrease of disease severity is more than Hydrocortisone 1% in children with AD. However, further studies are needed to confirm this finding. Moreover, the docking analysis revealed that the inhibitory activity of compounds with free hydroxyl groups such as glycosylated compounds was better than others, probably due to the hydrogen bond interaction of hydroxyl groups of the ligands with the enzymes.

The efficacy of a Persian herbal formulation on functional bloating: A double-blind randomized controlled trial

BACKGROUND

Bloating is a common gastrointestinal complaint which is difficult to treat.

OBJECTIVE

This study investigated the efficacy and compliance of a formulation called KAASER comprised of Trachyspermum ammi (L.) Sprague seed, Zingiber officinale Roscoe. rhizome and Piper nigrum L. berry in the treatment of functional bloating.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTION

A total of 106 patients with functional bloating, between 20 and 50 years of age, participated in this double-blind randomized controlled trial. Patients were divided into 3 parallel groups that received 500 mg of placebo, dimethicone or KAASER, three times a day for 2 weeks.

MAIN OUTCOME MEASURES

The frequency and severity of bloating were primary outcomes, while the frequencies of eructation, defecation, borborygmus and early satiation were secondary outcomes. All parameters were evaluated at the beginning (week 0), and also weeks 2, 4 and 10 of the study, through self-report checklists with a scoring system.

RESULTS

Among the 84 patients who completed the study, the frequency and severity of bloating (P < 0.001), the frequencies of eructation, defecation and borborygmus (P = 0.03) were significantly improved in the group receiving KAASER (36 patients) compared with the dimethicone (35 patients) and placebo (35 patients) groups, during the 3 phases of follow-up. These significant differences persisted through the 2 and 8 weeks of follow-ups after cessation of medication (week 4 and 10). In early satiation, no significant differences were observed among the 3 groups.

CONCLUSION

The results showed that KAASER can be effectively used to treat patients suffering from bloating. Bloating, eructation, defecation and borborygmus in the KAASER group remained significantly improved after 2 and 8 weeks of cessation of medication, making this mechanism an interesting area for further investigation.

TRIAL REGISTRATION

Registration trial IRCT2015100324327N on Iranian Registry of Clinical Trials.

Mentha spicata L. essential oil, phytochemistry and its effectiveness in flatulence

Flatulence as the continuous feeling of abdominal distension is equal to "Nafkh" in Iranian Traditional Medicine. Nafkh is believed to derive from the amount of stomach temperature, humidity of food or abnormal humidity in digestive tract and their interactions. Mentha spicata as cool and spicy plant with astringent and digestive property is recommended for treatment of flatulence. The information was extracted from accessible international databases, traditional books, electronic resources, and unpublished data. M. spicata essential oil with main component of carvone has potency for treatment of flatulence related to indigestion, cesarean section and dysmenorrhea. Also, it can reduce the pain severity during the colonoscopy or dysmenorrheal conditions. No hazardous effects were reported for M. spicata essential oil, if it is used in proper dosages. M. spicata essential oil can be applied for other intestinal complaints with pain and flatulence such as Irritable Bowel Syndrome (IBS) that needs more deep clinical trials for demonstrating its potential.