Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: a randomized clinical trial

Objective

Chronic low back pain (CLBP) imposes considerable financial and social burden with poor response to medical and surgical treatments. Alternatively, acupuncture and venesection(Fasd) are traditionally used to alleviate nociceptive and musculoskeletal pains. This study aimed to evaluate the effectiveness and the safety of acupuncture and venesection on CLBP and patient functionality.

Methods

The current study was a single-blinded, randomized clinical trial with balanced allocation, conducted in the Department of Physical Medicine & Rehabilitation Medicine, in 2022. One hundred five CLBP patients who had no back pain-attributable structural or major diseases were randomly allocated into three parallel arms and received either physical therapy (PTG), acupuncture (APG), or venesection (VSG). Pain severity and functional aspects were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) during the study. VAS and ODI scores were defined as the primary outcomes.

Results

Ninety-five patients were reviewed in the final analysis (PTG=33, APG=30, VSG=31). Demographic data showed equal group distribution. Statistical analysis showed all procedures had reduced VAS score immediately after the first session, after the last session, and after follow-up; however, APG and VSG values were significantly lower (P<0.05). Pain reduction results in follow-up period were more sustainable in APG and VSG as compared to PTG (P<0.01). ODI results revealed global improvement after the last session of the treatment in all groups, while APG had more significant results (P<0.05). During the follow-up period, ODI still tended to decrease in VSG, non-significantly increased in APG, and significantly increased in PTG. Only two patients reported fainting after receiving venesection.

Conclusion

Considering the pain and functional scores, both acupuncture and venesection can reproduce reliable results. Acupuncture and venesection both have sustained effects on pain and daily function of the patients even after treatment termination, while physical therapy had more relapse in pain and functional limitations.

The Effectiveness of Cupping in Iranian Researches: A Systematic Review of Animal and Human Studies

Cupping has a long history in Iran which is one of the most widely used methods in prevention and treatment of diseases in Persian medicine. However, it still has many opponents in the Iranian conventional medical community. So, this systematic review study was conducted to survey the scientific and authoritative articles related to wet and dry cupping that have been done in Iran and the diseases for which Iranian researchers have suggested cupping. In general, the effect of wet and dry cupping on various kinds of pain (e.g. headache, musculoskeletal pain, postpartum pain, etc.), as well as the effect of wet cupping on hematological and biochemical factors of blood were among the most common studies. Also, persistence of therapeutic effects of wet and dry cupping on various diseases was satisfactory. The results of this study showed that wet and dry cupping, even alone, are effective in the treatment of many diseases, and if the objections to the use of these two treatments are reduced, more extensive and high-quality researches in this regard will be done.

COVID-19: General Strategies for Herbal Therapies

The coronavirus disease-2019 (COVID-19) pandemic started in early 2020 with the outbreak of a highly pathogenic human coronavirus. The world is facing a challenge and there is a pressing need for efficient drugs. Plants and natural compounds are a proven rich resource for new drug discovery. Considering the potential of natural products to manage the pandemic, this article was designed to provide an inclusive map of the stages and pathogenetic mechanisms for effective natural products on COVID-19. New drug discovery for the COVID-19 pandemic can encompass both prevention and disease management strategies. Preventive mechanisms that may be considered include boosting the immune response and hand hygiene in the preexposure phase; and blocking of virus binding and entry in the postexposure phase. Potential therapeutic target mechanisms include virus-directed therapies and host-directed therapies. Several medicinal plants and natural products, such as Withania somnifera (L.) Dunal and propolis for prevention; Tanacetum parthenium (L.) for treatment; and Ammoides verticillata (Desf.) Briq and Nigella sativa L. for both prevention and treatment have been found effective and are good targets for future research. The examples of phytochemical compounds that may be effective include aloin and terpenes as anti-septics; isothymol, dithymoquinone, and glycyrrhizin as inhibitors of virus binding and entry; glycyrrhizin, and berberine as replication suppressants; ginsenoside Rg1 and parthenolide as immunomodulators; and eriocitrin, rhoifolin, hesperidin, naringin, rutin, and veronicastroside as anti-complements. Recognizing different mechanisms of fighting against this virus can lead to a more systematic approach in finding natural products and medicinal plants for COVID-19 prevention and treatment.

Review of Pharmacological Properties and Chemical Constituents of Pastinaca sativa

Objectives

Pastinaca sativa (parsnip), is a plant with nutritional and medicinal properties which has been used in all over the world and study about it is rare. In Persian Medicine parsnip is named as zardak and has many uses such as laxative, libido enhancer, kidney stone crusher and diuretic. Because the wide traditional usage of parsnip, in this review the composition and pharmacological properties of this plant are discussed.

Methods

Some data base such as Cochrane, Scopus, PubMed were searched up to 2018 for studies about Pastinaca sativa. In this review study after consider to exclusion criteria, all of the English review and clinical trial were included.

Results

Finally, 46 articles were selected for extraction data about the parsnip. Data extraction based on these studies the most important active ingredients of parsnip include coumarins, furanocoumarins, polyacetylenes, essential oils and flavonoids. Different studies determined that Pastinaca sativa has pharmacological effects in CNS, respiratory, gastrointestinal, liver, skin, cardiovascular and urogenital diseases.

Conclusion

The most important active ingredients in Pastinaca sativa are furanocoumarins, flavonoids and polyacetylenes, and it has many pharmacological properties, including anti-inflammatory, antispasmodic, vasodilator, antifungal, antimicrobial and antidepressant. A main mentioned side effect of parsnip is phototoxicity that was usually reported in direct skin contact. However, family and Some properties and compounds of Pastinaca sativa and Daucus carota are similar but carrots are very popular nowadays. Due to abundant active components and few clinical studies of parsnip, more Studies are recommended to evaluate the effects of it.

Treatment of Chronic Acne by Persian Medicine (Temperament Modification plus Leech Therapy): A Case Report

Acne is a multifactorial disease which causes many harmful physical and psychological effects for patients. Several therapies are used in conventional medicine for acne, but most of these methods are not stable and cause side effects. Therefore, it is considered to use complementary medicine alongside conventional therapies to achieve better results. In this article, a patient with chronic and severe acne is presented which is treated by a combination of temperament modification and leech therapy based on Persian medicine.

Evaluation of the efficacy of a topical chamomile-pumpkin oleogel for the treatment of plaque psoriasis: an intra-patient, double-blind, randomized clinical trial

Background: Plaque psoriasis is a chronic inflammatory skin disease. Conventional treatments of psoriasis are not completely effective. In addition, unwanted side effects limit their long-term use. In this regard, developing new natural treatments with fewer side effects could be an alternative option. This study was designed to evaluate the efficacy and safety of topical chamomile-pumpkin oleogel (ChP) in treating plaque psoriasis. Methods: A total of 40 patients with mild-to-moderate plaque psoriasis were enrolled in this intra-patient, double-blind, block-randomized clinical trial. In each patient, bilateral symmetrical plaques were treated with ChP or placebo twice daily for four weeks. For clinical assessment, the Psoriasis Severity Index (PSI) and the Physician's Global Assessment (PGA) scale were evaluated at baseline and after the treatment. At the end of the study, patients' satisfaction with the treatment was evaluated using a visual analog scale (VAS) ranging from 0 to 10. For safety assessment, all treatment-related side effects were recorded. Results: Thirty-seven subjects (20 female, 17 male; age 20–60 years) completed the study. The mean decreases in the PSI score in the ChP group (4.09 +/- 2.24) were significantly (p = 0.000) greater than the placebo group (0.48 +/- 1.39). According to the PGA results, 13/37 (35%) of the ChP-treated plaques could achieve marked to complete improvement compared to 0% in the placebo group. Three patients dropped out from the study due to worsening of bilateral plaques during the first week of trial. Conclusion: Our results suggest that topically applied ChP could provide a safe and effective complementary option for psoriasis plaque management. IRCT registration code: IRCT2016092830030N1.  

Evaluation of the role of whey with dodder oxymel on mild to moderate psoriasis: A double-blind, randomized controlled trial

Introduction: Psoriasis is a common chronic inflammatory disease that affects the physical, mental and sexual well-being of patients. Numerous side effects of different treatments and inadequate response to medications have resulted in pursuit of ideal treatment with low toxicity in low burden psoriasis hence complementary medicine. This study aims to evaluate the effects of whey with dodder oxymel on mild to moderate psoriatic skin lesions. Methods: A 12-week double-blind, randomized, controlled, clinical trial was designed. Ninety psoriatic patients participated in the intervention. Drug and placebo were randomly assigned to two groups identically (whey with dodder oxymel and lactose). Patients were visited twice by a dermatologist. Their clinical responses were evaluated using the Psoriasis Area Severity Index (PASI), the Dermatology Life Quality Index (DLQI), the Visual Analogue Scale (VAS) and the Body Surface Area (BSA). Results: After 12 weeks, in the intragroup analysis, the mean PASI score (P-value < 0.001) and BSA (P-value = 0.004) decreased in the intervention group. The mean VAS score (P-value < 0.001) and DLQI (Pvalue < 0.001) in both groups decreased. However, this decrease was much higher in the intervention group. In the intergroup analysis, 70% of patients reported improvement in PASI score (P-value < 0.001), the 88% improvement in quality of life (P-value < 0.001) and pruritus intensity (VAS) (P-value < 0.001), and the 54% reduction was detected in the area of lesions (BSA) (P-value = 0.001) as compared to the placebo group.  Conclusion: It appears that whey with dodder oxymel would improve psoriasis conditions and it can increase patients’ quality of life.

Management of Early Menopause Using Traditional Persian Medicine: A Case Report

Interruption of the activity of ovary before the age of forty is called premature ovarian failure (POF) in which ovaries lose their follicular and hormonal functions. A decline in the number of ovules before the age of menopause is a physiologic phenomenon. In the present case report, treatment of a patient by POF was reported using traditional Persian medicine principles. In Persian medicine, each humor has its own temperament. A change in the temperament and quality or quantity of these humors causes the disease and therefore modifying the temperament is the milestone of treatment. The patient was a 39-year-old married woman with irregular menstruation cycles and finally, cessation of menstruation. In this period, the patient had vaginal dryness, severe dyspareunia, gastritis, and parasomnia. At first, some instructions were ordered to change her lifestyle, for example, a change in food intakes, enough sleep, and exercise. In addition, several medications were ordered including the digestive system electuary (Majoun Jahaz Hazemeh), Eyaraj Fighara capsule and powder containing Glycyrrhiza glabra roots, Foeniculum vulgare and white sugar, oil massage of the abdomen and flanks, and cupping of the uterus. At the end of treatment, complete rehabilitation was achieved and menstruation irregularity, gastritis, and parasomnia were resolved. Based on the results, if a patient follows the rules and has a healthy lifestyle, inappropriate humor is unable to appear, the healing can be stable, and this disease or similar melancholic disorders fail to occur

The Role of Phlebotomy ( Fasd) and Wet Cupping ( Hijamat) to Manage Dizziness and Vertigo From the Viewpoint of Persian Medicine

Dizziness and vertigo are the most common complaints of patients that has a high economic burden on the health system. In modern medicine, treatment for dizziness and vertigo consists of chemical pharmacological therapy. Although these drugs are useful in controlling the disease, their side effects and inefficiency in full control of the disease require the use of complementary medicine in this field. Persian medicine consists of valuable experiences of Persian medicine scholars based on the theory of humors and temperaments. In Persian medicine, 2 types of disease are presented: dizziness (sadar) and vertigo (dovar). Persian medicine physicians expressed a different mechanism of action than modern medicine for these diseases. They believed that accumulation of abnormal humors, reeh (normal bloating) or causative pathologic substances, is the basic cause of sadar and dovar and that the most important treatment is cleansing the body, particularly the head from accumulated substances by bloodletting methods.

Report - Renovation of a traditional Ergh-al-Nassa pill (Hab) to a standard Pharmaceutical molded tablet

The Ergh-al-Nassa pill (Hab) is a traditional combination suggested as one of the most effective preparations useful for treatment of sciatica. Although traditional preparations can be applied as new therapeutic drugs for investigations and clinical trials, they need to be reformulated to achieve pharmacopoeial standards for modern medicine. In this research, based on seven traditional Persian pharmacopeias for Ergh-al-NassaHab, nine different molded tablets were reformulated. Each formulation comprised the same amount of colchicum, ginger, aloe and yellow myrobalan fruit. Sweet almond oil had to be added in the maximum amount needed to be absorbed by the yellow myrobalan fruit according to its particle size (30-40 mesh sizes). The studies were performed in order to optimize the formulation process according to the role of three levels in particle size of the herbal ingredients (60-70, 80-100, 100-150 mesh sizes) and three levels of initial water for granulation. The molded tablets were evaluated according to standard quality controls for tablets (mass uniformity, LOD, hardness, friability, and disintegration time at 20 and 30 min). Myrobalan powdered to 30-40 mesh size absorbed the maximum amount of sweet almond oil (1:0.75 w/v). The best formulations occurred when the particle size of colchicum, ginger, and aloe was 60-70 mesh size with an initial moisture content of 0.47 ml per 1g of dried powder. The outcome of this research is a pharmaceutical standardized formulation from the traditional Ergh-al-Nassa pill which can be suggested as a sample drug discovery based on traditional knowledge.

Akhawayni (?-983 AD): A Persian neuropsychiatrist in the early medieval era (9th-12th Century AD)

The early medieval era is also called the Islamic Golden Age because of the significant rise in sciences, including medicine. Abū Bakr Rabi' ibn Ahmad Akhawayni Bukhāri (better known as Akhawayni) was one of the notable medical practitioners in his lifetime. His fame was in neuroscience and he became known as Pezeshk-e-Divanegan (Physician to the Insane). His only surviving book, Hidāyat al-Muta'allimin fi al-Tibb (The Students' Handbook of Medicine), is the first medical textbook in Persian, after Islam. Akhawayni gathered and categorized available knowledge on neuropsychiatry and added his own. He was the first to describe sleep paralysis and to suggest pragmatic rather than supernatural treatment. He was also the first to present fever cure and his descriptions of meningitis (Lisarghos in Hidāyat), mania, psychosis (Malikhulia), dementia (Ghotrab), etc., are close to current concepts.

Prevention and Treatment of Flatulence From a Traditional Persian Medicine Perspective

Context

The feeling of abdominal fullness, bloating, and movement of gas in the abdomen is a very uncomfortable sensation termed flatulence. Since flatulence is one of the most common gastrointestinal symptoms that is bothersome to patients, it is important to identify effective methods to resolve this issue. In modern medicine, management of flatulence is often not satisfactory. On the other hand, traditional systems of medicine can be considered good potential sources to find new approaches for preventing and treating flatulence. The aim of this study is to review flatulence treatments from a traditional Persian medicine (TPM) viewpoint.

Evidence Acquisition

In this study, the reasons for flatulence and methods for its prevention and treatment are reviewed in traditional Persian medicine (TPM) texts and then related with evidence from modern medicine by searching in databases, including PubMed, Scopus, Google Scholar, and IranMedex.

Results

From a traditional Persian scholar viewpoint, one of the most important causes of flatulence is an incorrect manner of eating; valuable advice to correct bad eating habits will be illustrated. In addition, traditional practitioners describe some herbs and vegetables as well as herbal compounds that are effective food additives to relieve flatulence. The anti-flatulent effect of most of these herbs has been experimentally verified using modern medicine.

Conclusions

Attention to TPM can lead to the identification of new preventive and curative approaches to avoid and treat flatulence. In addition, Persian viewpoints from the medieval era regarding flatulence are historically important.

Criteria for evidence-based practice in Iranian traditional medicine

The major difference between Iranian traditional medicine and allopathic medicine is in the application  of  evidence  and  documents.  In  this  study,  criteria  for  evidence-based  practice  in  Iranian traditional medicine and its rules of practice were studied. The experts' views were investigated through in- depth, semi-structured interviews and the results were categorized into four main categories including Designing clinical questions/clinical question-based search, critical appraisal, resource search criteria and clinical prescription appraisal. Although the application of evidence in Iranian traditional medicine follows Evidence Based Medicine (EBM) principles but it benefits from its own rules, regulations, and criteria that are compatible with EBM.

Nutritional Aspects to Prevent Heart Diseases in Traditional Persian Medicine

Cardiovascular diseases are major health complications currently in various societies. Management of heart diseases as a prevention step or as treatment with low-cost procedures like lifestyle modifications including nutrition are important current trends. Although the term nutrition dates back to 2 past centuries, Persian physicians contributed to this term at least from 1000 years ago. Rhazes (865-925 AD) was one of the pioneers in this field. He preferred using foods in treating illnesses. “Foods and drinks” were 1 subject from 6 principles ( Setteh Zarorieh) that Persian physicians believed can affect human health. In this review, we described some medieval Persian views on the role of nutrition in heart diseases and compare their prescriptions with current findings. Interestingly, current investigations mostly support Persian medicine principles. Historically, this work shows that the concept of nutrition in heart diseases has had a successful background at least from 1000 years ago in Persia.

A Randomized Clinical Trial Study: Anti-Oxidant, Anti-hyperglycemic and Anti-Hyperlipidemic Effects of Olibanum Gum in Type 2 Diabetic Patients

Diabetes is a common metabolic disease in the world that has many adverse effects. Olibanum gum resin (from trees of the genus Boswellia) has traditionally been used in the treatment of various diseases such as diabetes. The aim of this study was the comparison of Olibanum gum resin effect with placebo on the treatment of type 2 diabetes. Inclusion criteria was diabetic patients with fasting blood sugar (FBS) =140-200 mg/dL. This study has been designed as double-blined clinical trial on 71 patients with type 2 diabetes and the patients randomly were divided to interventional and placebo groups. The patients on standard anti-diabetic therapy (metformin) treated with Olibanum gum resin (400 mg caps) and placebo tow times per day for 12 weeks, respectively. At the end of the twelfth week, the FBS, HbA1c, Insulin, total Cholesterol (Chol), LDL, Triglyceride (TG), HDL and other parameters were measured. The Olibanum gum resin lowered the FBS, HbA1c, Insulin, Chol, LDL and TG levels significantly (p < 0.001, p < 0.001, p <0.001, p = 0.003, p < 0.001 and p < 0.001, respectively) without any significant effects on the other blood lipid levels and liver/kidney function tests (p > 0.05) compared with the placebo at the endpoint. Moreover, this plant showed anti-oxidant effect and also no adverse effects were reported. The results suggest that Olibanum gum resin could be used as a safe anti-oxidant, anti-hyperglycemic and anti-hyperlipidemic agent for type 2 diabetic patients.