**Low Back Pain from the Perspective of Traditional Iranian Medicine (TIM)**

Mohammad Reza Vaez Mahdavi, Mohsen Naseri, Nafiseh Hoseini Yekta, Younes Roohany, Fatemeh Emadi and Soghrat Faghihzadeh

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/61170

#### **Abstract**

[29] HijikataY, Yasuhara A, Sahashi Y. Effect of an herbal formula containing Ganoderma lucidum on reduction of herpes zoster pain: a pilot clinical trial. Am J Chinese Med

[30] Hijikata Y, Sentou S, Yasuhara A, Yoshida Y. Effect of herbal therapy for chronic inflammation of Epstein-Barr-virus, Varicella-Zoster-virus. J Kampo Med 2003;50: 97–

[31] Hijikata Y, Yamada S, Yasuhara A. Herbal mixtures containing the mushroom Ganoder‐ ma lucidum improve recovery time in patients with herpes genitalis and labialis. J Altern

[32] HijikataY. Treatment of liver diseases with Kampo medicine. Toseikampo- kenkyushit‐

[33] Hijikata Y, Makiura N, Kano T, Higasa K, Shimizu M, Kawata K, Mine T. Kampo medicine, based on traditional medicine theory, in treating uncured glossodynia:

[34] Kano Z, et al. Analysis based on Kampo medicine and conventional medicine about success in getting live birth with the treatment based on Japanese Kampo diagnosis. J

[35] FjiwaraY, Hijikata Y. Modified xiong-gui-tiao-xue-yin (芎帰調血飲) succeeded in improv‐ ing premenstrual syndrome (PMS) in four cases. J Kampo Med 2013;60 (3): 433–41. [36] Hijikata Y, Yasuhara A, Yoshida Y, Sento S. Traditional Chinese medicine treatment of

[37] Hijikata Y. Application of "Five Elements Theory" for Treating Diseases, in: Kuang H, ed. Recent Advances in Theories and Practice of Chinese Medicine, 2012. http: // www.intechopen.com/books/recent-advances-in-theories- and- practice-of-chinese-

[38] Kotsuma Y, Hijikata Y. Application of keishi-bukuryo-gan for the diagnosis of breast

medicine/application-of-five-elements-theory-for-treating-diseases

cancer in diagnostic hormonal therapy. J Kampo Med 2000;51: 35–42.

efficacy in five clinical cases. Am J Chinese Med 2008;36: 835–47.

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2005;33: 517–23.

86 Complementary Therapies for the Body, Mind and Soul

Complement Med 2007;13: 985–7.

su. 2010;33 (1, 2): 34–46.

Kampo Med 2008;59: 35–45.

103.

In this chapter the attitudes and opinions of Traditional Iranian medicine (TIM) about "low back pain: (LBP)" are considered. According to TIM, several main mechanisms for this very common disorder are explained. The spine, being far from the body heat source (heart) that sets the spine in coldest position, is consid‐ ered in terms of temperament. The most common type of low back pain is cold temperament, simple or material. However, movements in the joints would cause heating, but the range of motion of the spine is very limited, so that its tempera‐ ment remains cold, and the most common type of low back pain is caused by a cold temperament. Pain is the most common symptom whichabates with walk‐ ing, rubbing, and warming, and usually becomes worse with the cold.

There is some adaptation of risk factors and causes of low back pain in conven‐ tional medicine compared to TIM attitudes. Traditional Iranian medicine (TIM) represents very interesting fields for research and therapy which can be consid‐ ered economically effective and lead to prevention and treatment for LBP. TIM's insight clarify that gastrointestinal disorders are one of the most important causes of low back pain, and dyspepsia is at the top of this context. In this chapter there is analysis of the results obtained during a post-after designed clinical trial on pa‐ tients who have chronic low back pain. It was treated with *Mentha longifolia*, which is known as an effective herbal medicine for dyspepsia chosen as the me‐ dicinal plant used in TIM. The results of this trial indicate that intervention was quite effective on both dyspepsia and low back pain. Our results achieved that the reduction of gastrointestinal symptoms leads to decrease in disability and pain symptoms associated with low back pain.

**Keywords:** Low back pain, Dyspepsia, Traditional Iranian Medicine (TIM), *Mentha longifolia*

© 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

## **1. Introduction**

In this chapter, the attitudes and opinions of traditional Iranian medicine regarding the very common disease of "low back pain" are examined and a clinical trial conducted based on a therapeutic theory in Iranian traditional medicine is discussed.

First, the definition of medicine, its division in Iranian traditional medicine, and a brief introduction of traditional Iranian medicine and its attitude toward humans and diseases is given. Then, with this view in mind, low back pain is discussed.

Medicine is a science that studies changes in the human body, which can lead to the preser‐ vation of health or to disease.

In his book" Al-Qanun-Fi-Teb", Abu Ali Sina states: "Medicine is a science by which the human body's conditions is known in terms of what causes health and disease in order to preserve health and, in case of loss of health, returns health to the body."

The important point in this definition is that the medical purpose and the physician's main task is to preserve human health. Treatment is second in priority, and still, it is much higher than what is proposed in conventional medicine today as "preventive medicine."

## **2. Division of the science of medicine**

Medical knowledge is divided into two parts: theoretical medicine and practical medicine.

**a.** Theoretical medicine:

The knowledge that examines the normal human function of body changes and factors affecting this function which lead to health or disease and which finally helps doctors make a diagnosis is called theoretical medicine. It consists of three parts:


Practical medicine includes methods for preserving health (health preservation science) and restoring health (treatment science). It consists of three parts:

**1.** Measures: food measures (food or regime therapy) and other related directives of principle 6, which will be presented.


Briefly, traditional Iranian medicine can be defined as a complete school and system, including diagnostic procedures, etiology, and treatment, based on intrapersonal differences (tempera‐ ment) and on health preservation and the treatment of disease. Supported scientifically and empirically by several thousand years of Iranians and other nations, it regards the moral and cultural aspects and the Islamic doctrines that were reviewed and established through efforts by great scientists of the Islamic civilization, and the point of its perfection was reached. The characteristics of this school include holism, spiritual, physical, mental, and social trust for humans, a regard for active and passive qualities and the four humors, emphasis on disease prevention by lifestyle modification, strengthening spiritual views, and providing favorable conditions for internal system activity (called management power or nature). In this school, food and natural therapies take priority over drug treatments, single drug treatments take priority over compound drugs, and finally non-invasive treatments take priority over invasive treatments.[1]Temperament or individual differences, the infrastructure of the traditional Iranian medicine viewpoint:

What is considered the base of intrapersonal differences from the perspective of traditional Iranian medicine and upon which each treatment is based is called temperament. They can also be observed in combinations of hot and dry, hot and moist, cold and dry, or cold and moist. The human body is a composition of four elements: earth, water, air, and fire. It should be considered that they are different from earth, water, air, and fire that exist around us and each of these elements have their own especial properties:

**•** Earth: cold and dry

**1. Introduction**

88 Complementary Therapies for the Body, Mind and Soul

vation of health or to disease.

**a.** Theoretical medicine:

and urine (semiotics).

**b.** Practical medicine**:**

In this chapter, the attitudes and opinions of traditional Iranian medicine regarding the very common disease of "low back pain" are examined and a clinical trial conducted based on a

First, the definition of medicine, its division in Iranian traditional medicine, and a brief introduction of traditional Iranian medicine and its attitude toward humans and diseases is

Medicine is a science that studies changes in the human body, which can lead to the preser‐

In his book" Al-Qanun-Fi-Teb", Abu Ali Sina states: "Medicine is a science by which the human body's conditions is known in terms of what causes health and disease in order to preserve

The important point in this definition is that the medical purpose and the physician's main task is to preserve human health. Treatment is second in priority, and still, it is much higher

Medical knowledge is divided into two parts: theoretical medicine and practical medicine.

The knowledge that examines the normal human function of body changes and factors affecting this function which lead to health or disease and which finally helps doctors make a

**1.** Natural matters: Matters that are the base of life, consistency and the preservation of

**2.** Factors and causes: The reasons for changes in the human body and their influencing

**3.** Arguments and symptoms: Symptoms and signs which guide the doctor to diagnose health or disease, such as temperament symptoms and the dominance of humors, pulse,

Practical medicine includes methods for preserving health (health preservation science) and

**1.** Measures: food measures (food or regime therapy) and other related directives of

factors and how to check disease incidence (etiology and pathogenesis).

than what is proposed in conventional medicine today as "preventive medicine."

therapeutic theory in Iranian traditional medicine is discussed.

given. Then, with this view in mind, low back pain is discussed.

health and, in case of loss of health, returns health to the body."

diagnosis is called theoretical medicine. It consists of three parts:

physical perfection of the human body (physiology).

restoring health (treatment science). It consists of three parts:

principle 6, which will be presented.

**2. Division of the science of medicine**


A combination of different amounts of these elements creates numerous temperaments. No two people can have the same temperaments. Accordingly, healthy people in a simple classification temperament are divided into four main qualities: hot, cold, dry, and moist. They can also be observed in combinations of hot and dry, hot and moist, cold and dry, or cold and moist. These qualities can be created with or without material if material existed. Temperament is divided as follows: sanguineous (hot and moist), choleric (hot and dry), phlegmatic (cold and moist), melancholic (cold and dry).

Everything around us has a special temperament because each is a composition of the four elements[1].

Every person is born with a temperament. If one remains in compliance with the instructions necessary to preserve health and prevent disease, one's temperament throughout life will have no adverse changes, except those expected in every season, location, and different age periods. If one does not comply with the given rules and measures for his temperament, however, one's temperament will be changed and will lean toward an adverse health condition, and those changes cause all or part of the function disorder.

The principles of health preservation and disease prevention that can be defined in terms of lifestyle is placed in the framework of six essential principles in Iranian traditional medicine: air, food, and drink; movement and rest; sleep and wakefulness; emotional states; cleansing the body; and keeping the essential material.

The most important part of the treatment program is also set by considering these six princi‐ ples. These six principles and how they are applied in preventing and treating low back pain will be explained in the following section[1-2].

Given the different perspective of traditional Iranian medicine on categories of health and disease, searching through traditional Iranian medicine resources can be useful for finding different solutions and alternatives to conventional medicine for the prevention and treatment of diseases and for opening a new window to ways of dealing with these problems. Today, an important issue in society health is chronic diseases[3]. Currently, the prevention and control of chronic diseases is a major health concern [4]. Despite surprising advances in medical knowledge, many diseases, including low back pain, remain a mystery [5]. Low back pain, despite having an ancient history, is still epidemic in modern society [6]. This disease is one of the most common health problems in different world societies, especially in industrialized countries [7].

Low back pain is one of the most common causes of low patient referral to health and treatment professionals. It has been declared the fifth leading cause of reference to a doctor in America [8-9]. Between 1/2 and 3/4 of all adults will experience low back pain. About 40% of adults had a low back pain attack in one year, and at any given moment, 15–20% of the adult population suffers from low back pain [10]. Since all individuals with low back pain will not necessarily go to a health center, exact statistics on the prevalence of this disease are not known. In fact, only about 40% of patients with low back pain refer to health professionals for this problem. Previously the prevalence of this disease was considered 7–8%; it has now been declared as 40–50% [11]. In America, 176 million hours of useful work are lost annually due to this disease, and low back pain in the United Kingdom imposes annually £480 million of direct loss and £5 billion of indirect loss on the country's economy [12]. In recent years, \$5–10 billion of rising costs in the United States are related to advanced imaging technologies. Low back pain is much more costly than other diseases such as rheumatoid arthritis, respiratory infectious diseases, Alzheimer's, diabetes, depression, multiple bridge sclerosis, embolism, and stroke [13-14]. These costs are direct costs of the disease; its social and indirect costs such as non-routine treatments and sick leave from work in the United States are estimated to be about \$75–100 billion. With the variety of available treatments and advances in imaging techniques, it is expected that better treatment results would be seen compared to the past, but the results of these investigations do not indicate improvement [15].

Treatments include conservative measures and prescriptions for topical and systemic analgesic and anti-inflammatory medications or inhibitor drugs, modulators of the immune system, and surgery [9], each of which has its own side effects. A 2001 study in Sweden showed that 53.1% of men and 57.4% of women have cervical disc hernia disease and are treated with nonsteroidal anti-inflammatory drugs [16]. Studies show that 15–20% of patients who chronically use non-steroidal anti-inflammatory drugs have ulcers of the stomach or duodenum [17]. Long-term use of these drugs has many complications for the patient, including physical dependence upon the drug, gastrointestinal disorders such as gastritis, nausea and vomiting, respiratory complications, myocardial infarction, and renal failure. Corticosteroid medications are not recommended for long-term use because of their immunosuppressive effects [18].

The efficacy of intrathecal injection is limited, and using an opioid may conversely cause increased sensitivity to pain. Moreover, surgery is sometimes associated with worse compli‐ cations [15]. It is now suggested that bed rest, long considered a key part of treatment, be limited and only short term, because its effectiveness has not been proven [19]. The proper treatment of this disease is still unknown [20].

Low back pain is usually seen in the working age population, and therefore it imposes high economic costs on society [21]. Pain affects health, functionality, and the quality of life of patients; chronic pain causes physical and mental health involvement in adults and children [22].

Results of this investigation show that low back pain is a costly problem for present-day societies, and in many cases, classic medicine is an ineffective treatment. Given the global approach to supplemental medicine, searching for treatment strategies in schools of thought of supplementation, including that of Iranian traditional medicine, seems imperative.

This chapter has two parts:

If one does not comply with the given rules and measures for his temperament, however, one's temperament will be changed and will lean toward an adverse health condition, and those

The principles of health preservation and disease prevention that can be defined in terms of lifestyle is placed in the framework of six essential principles in Iranian traditional medicine: air, food, and drink; movement and rest; sleep and wakefulness; emotional states; cleansing

The most important part of the treatment program is also set by considering these six princi‐ ples. These six principles and how they are applied in preventing and treating low back pain

Given the different perspective of traditional Iranian medicine on categories of health and disease, searching through traditional Iranian medicine resources can be useful for finding different solutions and alternatives to conventional medicine for the prevention and treatment of diseases and for opening a new window to ways of dealing with these problems. Today, an important issue in society health is chronic diseases[3]. Currently, the prevention and control of chronic diseases is a major health concern [4]. Despite surprising advances in medical knowledge, many diseases, including low back pain, remain a mystery [5]. Low back pain, despite having an ancient history, is still epidemic in modern society [6]. This disease is one of the most common health problems in different world societies, especially in industrialized

Low back pain is one of the most common causes of low patient referral to health and treatment professionals. It has been declared the fifth leading cause of reference to a doctor in America [8-9]. Between 1/2 and 3/4 of all adults will experience low back pain. About 40% of adults had a low back pain attack in one year, and at any given moment, 15–20% of the adult population suffers from low back pain [10]. Since all individuals with low back pain will not necessarily go to a health center, exact statistics on the prevalence of this disease are not known. In fact, only about 40% of patients with low back pain refer to health professionals for this problem. Previously the prevalence of this disease was considered 7–8%; it has now been declared as 40–50% [11]. In America, 176 million hours of useful work are lost annually due to this disease, and low back pain in the United Kingdom imposes annually £480 million of direct loss and £5 billion of indirect loss on the country's economy [12]. In recent years, \$5–10 billion of rising costs in the United States are related to advanced imaging technologies. Low back pain is much more costly than other diseases such as rheumatoid arthritis, respiratory infectious diseases, Alzheimer's, diabetes, depression, multiple bridge sclerosis, embolism, and stroke [13-14]. These costs are direct costs of the disease; its social and indirect costs such as non-routine treatments and sick leave from work in the United States are estimated to be about \$75–100 billion. With the variety of available treatments and advances in imaging techniques, it is expected that better treatment results would be seen compared to the past, but the results of

Treatments include conservative measures and prescriptions for topical and systemic analgesic and anti-inflammatory medications or inhibitor drugs, modulators of the immune system, and

changes cause all or part of the function disorder.

90 Complementary Therapies for the Body, Mind and Soul

the body; and keeping the essential material.

will be explained in the following section[1-2].

these investigations do not indicate improvement [15].

countries [7].


## **3. Low back pain causes in Iranian traditional medicine**

Ibn Sina considered low back pain a muscle and tendon disease (what comes from the muscles to the bones). Basically, what will come in the future from causes mainly affects the members, and what causes the members' disorder will have a serious effect on the performance of the spine. These causes are also expressed in conventional medicine for low back pain. Bone disorders are less considered for low back pain, and low back pain is mostly associated with muscle problems. Pain due to muscle spasm has been mentioned as a mechanism for low back pain, and the major role played by muscles in preserving back health has been emphasized.

Since nervous diseases are discussed, muscular disorders are presented, because, by definition in the rule book, the muscle is a part composed of nerves, and because the nerve does not have the capability of binding to the bone, a rougher part, that is the tendon, connects to it that transfers motion commands to the bone. The existing space between the nerves is filled with flesh and a membrane covers it; that, in fact, is a nerve muscle. Muscle relaxation is caused by diluted moisture that muscle strength is lower than normal and seizure in muscle where muscle length is low and its width is high includes a variety of dry and moist adverse health that moist type is condensed due to moisture and frequent and shows symptoms suddenly. Sometimes seizure is bilateral, where the length is high and width is low and is called "TAM‐ ADOD" [23]. Each of these disorders can also occur in lumbar muscles and cause pain. In other words, the causes given in the following text in most cases affect muscular structure.


## **6. With the participation of some viscera**:

**a.** GI: The four stages in traditional Iranian medicine are expressed for material entering the body to be digested as a part of the organ. First digestion occurs in the stomach, and its disorder can be directly associated with organ dysfunction, because the material's conversion process will be disrupted by the non-production of adequate mucus. Disruption in weaker organs is expressed more, and organ weakness occurs more in less heated organs. As the back is one of the coldest organs, it will suffer from dyspepsia. When digestion is impaired, more gas is produced in the GI; the existence of these gases can pass through the membranes of the gastrointestinal tract and reach the back area, thus causing low back pain. In traditional Iranian medicine resources, the stomach temperament in most patients with dyspepsia is cold. Clinical trials mentioned in this section also confirmed the result that patients with dyspepsia suffering low back pain are in fact patients who, in most cases, have cold and moist dyspepsia simultaneously in the back and stomach.


## **4. Low back pain Signs and symptoms in Iranian traditional medicine**

The signs and symptoms of each type of low back pain and methods of diagnosis will be discussed separately.

**1.** Low back pain due to simple hot temperament:

flesh and a membrane covers it; that, in fact, is a nerve muscle. Muscle relaxation is caused by diluted moisture that muscle strength is lower than normal and seizure in muscle where muscle length is low and its width is high includes a variety of dry and moist adverse health that moist type is condensed due to moisture and frequent and shows symptoms suddenly. Sometimes seizure is bilateral, where the length is high and width is low and is called "TAM‐ ADOD" [23]. Each of these disorders can also occur in lumbar muscles and cause pain. In other

**1. Simple hot temperament**: This type of low back pain is related to body heating causes. If any of the causes of heating becomes imbalanced, it can cause hot temperament. This could

**2. Simple cold temperament or phlegmatic temperament in the back**: The most common types of low back pain are cold temperament, simple or material. The spine, being far from the body heat source (heart) and lacking a range of movement in the coldest position, is considered in terms of temperament. One may propose that the joints are farther to the back. In response, it should be said that a lot of movements in the joints would cause its heating; however, the range of motion of the spine is very limited. Because of this, its temperament is cold, and the most common type of low back pain is caused by a cold

**3. Excessive sex and fatigue:** This can cause dryness due to the effect of decreased body moisture, and muscle disorder occurs due to dryness. It can stimulate the loss of raw material and condense moisture or phlegm to the area, in which case symptoms would

**4. Anger**: As previously stated, anger can stimulate material and cause phlegm to reach the back. In fact, some factors such as anger, sex, and excessive fatigue can cause low back pain due to the flux of material to the position. If pain on the back or joints occurs due to flux of material, depending on the material dilution or concentration, symptoms such as inguinal hernia and upper or lower limb swelling, enlarged lymph nodes in the inguinal,

**5. Shape change and curvature of the spine**: Anatomical changes can be caused by a hit or, without it, the direction change can be side or front and rear protrusions. From the perspective of Iranian traditional medicine, each factor consists of swelling in one direction, the presence of diluted moisture that causes loss of muscle strength, and/or condensed moisture that increases muscle strength, and shortening its length can change the direction of vertebra and their protrusion and cause low back pain. The risk of curvature of the spine structural disorder in children whose feeding is begun early is high

**a.** GI: The four stages in traditional Iranian medicine are expressed for material entering the body to be digested as a part of the organ. First digestion occurs in the stomach, and its disorder can be directly associated with organ dysfunction, because the

words, the causes given in the following text in most cases affect muscular structure.

be in general or due in part to the effect of the cause.

92 Complementary Therapies for the Body, Mind and Soul

axillary, and gluteus can be experienced.

because of the production of condensed moisture.

**6. With the participation of some viscera**:

temperament.

be different.

This type of low back pain has inflammation in the area and its pain is not with weight. There is no beat. Common symptoms of hot temperament may be chromatic urine and thirst, which abate with the ingestion of cold temperament foods.

**2.** Low back pain due to simple cold temperament:

Gradual pain without weight that abates with walking, rubbing, and warming and sometimes becomes worse with the cold. Often, the back is cold to the touch.

**3.** There is raw moisture and phlegm in the back muscles and spine that are produced in the back area:

Gradual pain with weight abates with warming, walking, and rubbing and sometimes becomes worse with the cold and at night. Sometimes the back is cold to the touch.

**4.** Extreme sex, fatigue, anger, or whatever causes flux phlegm, moisture, and/or gas in the back:

In patients who have mucus loss in the back, sudden severe with weight in the back and constant intensity. If the pain reaches the position by the preceding factors, the pain is like tension and transmitted with less weight.

Sometimes fatigue, heavy loads, bending, and excess sex without loss of materials cause pain which is felt as soreness in the muscles.

**5.** Due to deviation of the spine and herniated vertebral:

If this condition is caused by an injury, the individual's history indicates it. If it is due to the presence of moisture in the place, the oil when massaged into the skin will not be absorbed. If the low back pain occurs due to dryness of spine deviation, oil absorption will be observed when the back is massaged with oil. Sometimes gas in the spine will cause this, but in this case the pain will be different and spine protrusions will occur after low back pain.

**6.** In participation with other organs:

If it is partnered with the **digestive system** by dyspepsia, symptoms such as bloating, dys‐ pepsia, and heaviness after a meal will occur. Sometimes there may be nausea and vomiting, and low back pain or constipation may be observed. If it is partnered with the **urinary system:** the symptoms due to stones in the urinary tract and kidney failure may be exist with low back pain.In partnership with **uterus**: Low back pain is also seen at times of childbirth or menstruation and in individuals with irregular menstrual periods, low bleeding, or undesired sexual relations. Low back pain due to crisis: If fullness is in the intestines, diarrhea occurs, and if it is in the kidneys, it takes the form of increased urine volume and changes in urine color and density [23-24-25].

**•** As noted, the main cause of low back pain in most cases can be traced to muscular disease which, in most cases, includes structural abnormalities including muscle shortening and thickening, becoming long and thin or loss of muscle strength.

Among causes also expressed in modern medicine for low back pain, bone disorders are less considered. Low back pain is mostly associated with muscular problems. The mentioned mechanisms for pain in the back area and pain due to muscle spasm are accepted, and the important role of muscles in the preservation of back health is emphasized. Given the multifactorial nature of low back pain and the controversy in determining its most common cause, specific views exist regarding its natural treatment, some of which have serious opposition; however, the use of active participation methods is confirmed by all [26]. Various exercises influencing different muscles can improve low back pain [27-28-29]. Interestingly, clinical trials have shown that the only therapeutic method proven to be effective in all trials is sports and physical activities. Each of them reinforces one set of muscles of the abdomen and back, including the paravertebrals [30]. In some studies, the relationship between muscle weakness and pain intensity and also that between the muscle cross-sectional area and inability resulting from low back pain has been proven [27], and body muscle dysfunction is acceptable as a cause of low back pain continuity. Even low back pain resulting from psychological states, such as anxiety or anger, has muscle tension and stress, and by decreasing the psychological pressure, the tension and stress will be reduced [28]. traditional Iranian medicine explains this issue as a sudden loss of material in muscles. It has been seen several times at the bedside of a person with severe anger that this person's low back pain is due to a loss of material in the back muscles and tendons. Even in psychological pressure and sensual complication, the role of muscles and their involvement are emphasized and confirmed, and psychotherapy procedures for low back pain also control the removal of muscle spasms [31]. Therapeutic techniques such as water therapy can reduce pain in such patients by increasing the flexibility of muscles, which subsequently reduces muscle spasms [29].

## **5. Relationship between low back pain risk factors in conventional medicine and from the traditional medicine perspective**

Sometimes fatigue, heavy loads, bending, and excess sex without loss of materials cause pain

If this condition is caused by an injury, the individual's history indicates it. If it is due to the presence of moisture in the place, the oil when massaged into the skin will not be absorbed. If the low back pain occurs due to dryness of spine deviation, oil absorption will be observed when the back is massaged with oil. Sometimes gas in the spine will cause this, but in this case

If it is partnered with the **digestive system** by dyspepsia, symptoms such as bloating, dys‐ pepsia, and heaviness after a meal will occur. Sometimes there may be nausea and vomiting, and low back pain or constipation may be observed. If it is partnered with the **urinary system:** the symptoms due to stones in the urinary tract and kidney failure may be exist with low back pain.In partnership with **uterus**: Low back pain is also seen at times of childbirth or menstruation and in individuals with irregular menstrual periods, low bleeding, or undesired sexual relations. Low back pain due to crisis: If fullness is in the intestines, diarrhea occurs, and if it is in the kidneys, it takes the form of increased urine volume and changes in urine

**•** As noted, the main cause of low back pain in most cases can be traced to muscular disease which, in most cases, includes structural abnormalities including muscle shortening and

Among causes also expressed in modern medicine for low back pain, bone disorders are less considered. Low back pain is mostly associated with muscular problems. The mentioned mechanisms for pain in the back area and pain due to muscle spasm are accepted, and the important role of muscles in the preservation of back health is emphasized. Given the multifactorial nature of low back pain and the controversy in determining its most common cause, specific views exist regarding its natural treatment, some of which have serious opposition; however, the use of active participation methods is confirmed by all [26]. Various exercises influencing different muscles can improve low back pain [27-28-29]. Interestingly, clinical trials have shown that the only therapeutic method proven to be effective in all trials is sports and physical activities. Each of them reinforces one set of muscles of the abdomen and back, including the paravertebrals [30]. In some studies, the relationship between muscle weakness and pain intensity and also that between the muscle cross-sectional area and inability resulting from low back pain has been proven [27], and body muscle dysfunction is acceptable as a cause of low back pain continuity. Even low back pain resulting from psychological states, such as anxiety or anger, has muscle tension and stress, and by decreasing the psychological pressure, the tension and stress will be reduced [28]. traditional Iranian medicine explains this issue as a sudden loss of material in muscles. It has been seen several times at the bedside of a person with severe anger that this person's low back pain is due to a loss of material in the back muscles and tendons. Even in psychological pressure and sensual complication, the role of muscles

thickening, becoming long and thin or loss of muscle strength.

the pain will be different and spine protrusions will occur after low back pain.

which is felt as soreness in the muscles.

94 Complementary Therapies for the Body, Mind and Soul

**6.** In participation with other organs:

color and density [23-24-25].

**5.** Due to deviation of the spine and herniated vertebral:

In terms of temperament in Iranian traditional medicine, the back is far from the body's heat source (heart) and, being the body's coldest region, has a limited range of motion. The most common type of low back pain is cold type either with or without a medium of material. The low back pain risk factors in modern medicine confirm the traditional medicine viewpoint in this regard; therefore, low back pain risk factors in modern medicine are the factors that, in traditional medicine, cool the temperament [32-1]. They are given in Table 1.


**Table 1.** Adaptation of risk factors of low back pain in conventional medicine to traditional medicine view

## **6. Recommendations in traditional Iranian medicine for preventing low back pain**

Recommendations for preventing low back pain with respect to the six principles of traditional Iranian medicine are listed in the following text.

Note: Since the most common type of low back pain is the cold type (simple or material), recommendations are provided based on that type.

## **6.1. Air**

Air is the most important of the six causes, and since each person is permanently associated with it, it has a particular effect on health. In order to prevent a recurrence of low back pain, the following are recommended for everyone.


#### **6.2. Food and drink**

Nutrition is another essential cause that has direct relationship with the back, and the rela‐ tionship between low back pain and dyspepsia are clear. Three major matters 1) how much to eat; 2) what to eat; and 3) how to eat are discussed as they pertain to the prevention and treatment of low back pain.

#### *6.2.1. How much to eat?*

Traditional medicine resources and modern medicine emphasize reducing food consumption for the prevention and treatment of low back pain. In terms of the amount and number of calories, this is applicable in three forms.


Any one of the three diets is selected based on a patient's strengths and weaknesses.

It is important to note that an extreme reduction in food intake can cause a cold temperament and, consequently, low back pain.

## *6.2.2. What to eat?*

**6.1. Air**

the following are recommended for everyone.

96 Complementary Therapies for the Body, Mind and Soul

in outdoor jobs, like farming.

that transfer cold to the organ.

**6.2. Food and drink**

treatment of low back pain.

calories, this is applicable in three forms.

**ment** foods is less recommended).

*6.2.1. How much to eat?*

calorie foods.

and, consequently, low back pain.

winter or synthetic cold from air conditioners.

**4.** Cover the back with a suitable cover at all times.

**6.** Avoid living in moist and humid environments.

heated cover in the back area is strongly recommended.

Air is the most important of the six causes, and since each person is permanently associated with it, it has a particular effect on health. In order to prevent a recurrence of low back pain,

**1.** Avoid exposure to cold weather for long periods, such as normal weather turning in

**2.** Avoid exposure to hot weather for long periods, such as exposure to extreme hot weather

**3.** Avoid contact with surfaces that have low temperatures, such as tile, ceramic, and plaster

**5.** If attempting to carry out business or exercise activities in a cold environment, using a

Nutrition is another essential cause that has direct relationship with the back, and the rela‐ tionship between low back pain and dyspepsia are clear. Three major matters 1) how much to eat; 2) what to eat; and 3) how to eat are discussed as they pertain to the prevention and

Traditional medicine resources and modern medicine emphasize reducing food consumption for the prevention and treatment of low back pain. In terms of the amount and number of

**1.** Consume less food in a diet that consists of low-calorie foods; at the same time the quality of food should cause a positive effect on the quality of the disease (eating cold **tempera‐**

**2.** Maintain consistency in the amount of food consumed, and the diet should consist of low-

**3.** Reduce the amount of foods, but the diet should not be low-calorie in terms of energy.

It is important to note that an extreme reduction in food intake can cause a cold temperament

Any one of the three diets is selected based on a patient's strengths and weaknesses.

From research in modern medicine and traditional medicine resources, the following recom‐ mendations are summarized:


## *6.2.3. How to eat?*

The importance of the time of eating and drinking is noted in resources of traditional medicine and is summarized in the following:


#### **6.3. Sleep and wakefulness**

traditional Iranian medicine considers the amount and location of sleeping.

## *6.3.1. How much sleep?*


## *6.3.2. Where to sleep?*

**1.** Considering the cold quality of the disease, the temperature and location of sleep is important; it is recommended that sleeping in cold and damp locations be avoided.

## **• Movement and rest:**

One of the most important causes associated with low back pain is sports. The only method of prevention and treatment confirmed as effective in numerous articles is physical movement. Although the reviewed articles suggested that there is a need for comprehensive research to compare different sport systems, it is clear that exercise is effective in prevention of first, second, and third levels.

Exercising in moderation strengthens, and it is recommended for all. It is not recommended by the experts but after passing acute phase, exercise is recommended at all times. Because of its beneficial and positive role, balanced exercise is approved. Doing extreme movements in terms of quality or quantity can be harmful. In summary, the following recommendations are given regarding physical movement:


#### **• Emotional states:**

As in all research, the relationship between low back pain and psychological issues has been proven. In traditional medicine, this issue is also important, and one of the causes of low back pain is anger. The following recommendations are provided in this regard:


#### **6.4. Cleansing the body and keeping the essential material**

If the means of waste disposal in the body are disrupted, the body's moisture retention capacity causes low back pain, such as in menstrual disorders, being deprived of intercourse in the person who is used to having it, menopause, stopping bleeding from hemorrhoids that for some people is a way of disposal, constipation, urinary retention, impaired perspiration, or perspiration breaker treatments, delayed bathing, and similar cases which all can be effective in the development or recurrence of low back pain.

On the other hand, the loss of many materials needed by the body can make the body more prone to this disease, such as too much intercourse, excessive fatigue, prolonged disease, and prolonged and frequent bathing that removes moisture from the body (one sign of this is shriveling finger skin) [1-23-24-25].

## **7. Conclusion**

*6.3.2. Where to sleep?*

98 Complementary Therapies for the Body, Mind and Soul

**• Movement and rest:**

second, and third levels.

do heavy work.

who work in an office.

**• Emotional states:**

given regarding physical movement:

**2.** Avoid extreme immobilization and high inertia.

**1.** Considering the cold quality of the disease, the temperature and location of sleep is important; it is recommended that sleeping in cold and damp locations be avoided.

One of the most important causes associated with low back pain is sports. The only method of prevention and treatment confirmed as effective in numerous articles is physical movement. Although the reviewed articles suggested that there is a need for comprehensive research to compare different sport systems, it is clear that exercise is effective in prevention of first,

Exercising in moderation strengthens, and it is recommended for all. It is not recommended by the experts but after passing acute phase, exercise is recommended at all times. Because of its beneficial and positive role, balanced exercise is approved. Doing extreme movements in terms of quality or quantity can be harmful. In summary, the following recommendations are

**1.** Do moderate exercise and physical movements to prevent and treat low back pain.

**3.** Avoid heavy work and excessive fatigue. It is recommended that heavy loads be carried in the correct manner. The prevalence of low back pain in people who have heavy work is equal to people who work in an office, but radiological changes are more in people who

**4.** According to the traditional medicine view on the common temperament of the disease, it seems that using chairs made of metal that transmit cooling could have a negative effect on prevention or treatment of the disease. There is, however, a need for further research.

**5.** Traditional medicine also recommends that one wear shoes of a natural type that can be

**6.** Avoid sitting in awkward and fixed positions. This is especially recommended for people

As in all research, the relationship between low back pain and psychological issues has been proven. In traditional medicine, this issue is also important, and one of the causes of low back

**1.** Avoid continuous stress and anxiety-causing situations that can cause muscle spasms.

If the means of waste disposal in the body are disrupted, the body's moisture retention capacity causes low back pain, such as in menstrual disorders, being deprived of intercourse in the

helpful in transmitting heat and protecting feet from cold.

pain is anger. The following recommendations are provided in this regard:

**2.** Avoid computer games that cause stress in children and adolescents.

**6.4. Cleansing the body and keeping the essential material**

In most cases, low back pain is a muscular disease that causes pain, and most of its causes and reasons explained in both traditional and modern medicine confirm the important role of muscles. This very common disease is in most cases of the cold temperament type that can be prevented by complying with simple recommendations of health preservation and life style, many of which are approved by both medical points of view. In Iranian medicine, preventive recommendations are in six categories: air, foods, and drinks; movement and rest; sleep and wakefulness; emotional states; cleansing the body; and keeping the essential material, which are known health as principles. Moreover, many of these recommendations are useful in treatment or in preventing a recurrence of the disease.

## **8. Analysis on a Clinical trial on patients with chronic low back pain based on traditional Iranian medicine issue about participation back and gastrointestinal system**

As was discussed in the section on the causes of low back pain, traditional Iranian medicine views gastrointestinal disorders as causes of low back pain, and at the top of this list is dyspepsia. The elders of traditional Iranian medicine initially advised patients with low back pain to treat their disorders of digestion [23]. In order to examine this idea, a clinical trial was performed in which patients with chronic low back pain who were also diagnosed with functional dyspepsia were treated with an effective drug for dyspepsia from the perspective of traditional Iranian medicine as described in the following text.

#### **8.1. Study sample size**

Since there was no similar study, in the first stage, a sample size of 30 people for each group was considered with the provision that this number would be increased if necessary. Since the results of data analyses indicate the achievement of the study objectives, the study was completed with 60 people.

## **8.2. Sampling method**

Sampling was done by available samples to achieve desired sample size.

Target population: All patients 20–55 years old having the study inclusion criteria.

Study population: Patients 20–55 years old admitted to neurosurgery clinic.

## *8.2.1. Inclusion criteria for the study*

Men and women 20–55 years old having had symptoms of low back pain for more than 3 months and having pain at the time of inclusion, dyspepsia symptoms according to the signs of ROME III (valid questionnaires to diagnose dyspepsia) [33], consistent symptoms from 3 months prior to inclusion in the study, and onset of low back pain at least 6 months prior to inclusion in the study.

Symptoms of patients who were diagnosed comprised

	- **a.** Bothersome postprandial fullness after a normal-sized meal occurred at least several times a week.
	- **b.** Early satiation that prevented ending a regular feeding and occurred at least several times a week.

#### *8.2.2. Exclusion criteria*

Patients who reported the following symptoms were excluded from the study:


In the selection stage, patients who were taking any antibiotics or a proton pump inhibitor (PPI), H2 blockers such as ranitidine, cimetidine, or famotidine, Prokinetic drugs like Dom‐ peridone and metoclopramide, consuming lactulose or similar compositions, consuming other herbal drugs, or involved in other research projects were excluded from the study.

Duration of study: Intervention duration and the follow-up period were each 4 weeks, making a total of 8 weeks.

## **8.3. Study variables and measurement tools**


Total score is a fraction of the 50 scores (maximum possible score) multiplied by 100 to get an overall percentage. Patients were divided into the five classes including mild (0–20%), moderate (21–40%), severe (41–60%), crippled (61–80%), and bed bound (81–100%) [34].

**c.** Severity of dyspepsia was measured by LEEDS questionnaire, and its total score was considered. The results were divided to 4 groups: mild [1-12], moderate [13-24], severe [25-36], very severe [37-4] [35].

Overall body temperament and stomach and back temperaments were examined separately by questionnaire upon arrival.

In this study, pain intensity and functional disability due to low back pain and dyspepsia intensity were measured before intervention, at the end of the second and fourth weeks, and eight weeks after intervention.

## **9. Intervention**

**8.2. Sampling method**

inclusion in the study.

*8.2.1. Inclusion criteria for the study*

100 Complementary Therapies for the Body, Mind and Soul

**1.** One or more of the following:

times a week.

times a week.

focal neurological symptoms.

the symptoms.

*8.2.2. Exclusion criteria*

Symptoms of patients who were diagnosed comprised

Sampling was done by available samples to achieve desired sample size.

Study population: Patients 20–55 years old admitted to neurosurgery clinic.

Target population: All patients 20–55 years old having the study inclusion criteria.

Men and women 20–55 years old having had symptoms of low back pain for more than 3 months and having pain at the time of inclusion, dyspepsia symptoms according to the signs of ROME III (valid questionnaires to diagnose dyspepsia) [33], consistent symptoms from 3 months prior to inclusion in the study, and onset of low back pain at least 6 months prior to

**a.** Bothersome postprandial fullness after a normal-sized meal occurred at least several

**b.** Early satiation that prevented ending a regular feeding and occurred at least several

**2.** No evidence of structural disease (including at upper endoscopy) that is likely to explain

**•** Intensified pain at night or at rest, previous history of cancer, history of chronic infection, history of stroke, urinary incontinence, age over 50 years, age below 20 years, intravenous drug abuse, history of corticosteroid use, history of progressive neurological deficit, unexplained fever, unexplained weight loss, percussion pain in the spine, abdominal, rectal, and pelvic mass, percussion or Patrick heel mark, straight leg raising(SLR), and progressive

**•** Symptoms of gastro esophageal reflux disease (GERD) as burning, painful swallowing, history of gastrointestinal surgery, specific symptoms of irritable bowel syndrome (IBS), any abdominal pain, overnight diarrhea and fatty feces, immune system disease, mental abnormality, presence of risk for symptoms such as excessive weight loss, black, tarry, or bloody stools, the presence of uncontrolled severe organ diseases such as cancer or kidney disease, progressive symptoms, use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), use of steroids or narcotics, and women who were pregnant or breastfeeding. In the selection stage, patients who were taking any antibiotics or a proton pump inhibitor (PPI), H2 blockers such as ranitidine, cimetidine, or famotidine, Prokinetic drugs like Dom‐

Patients who reported the following symptoms were excluded from the study:

According to the authoritative texts of Iranian traditional medicine, *Mentha longifolia* which is known as an effective herbal medicine for dyspepsia was chosen as the medicinal plant used in this study [23-24]. Aqueous extract of *M. longifolia* was prepared. The medicine was prepared in 500 mg capsules containing 250 mg concentrated *M. longifolia* extract and 250 mg starch as filler.

#### Medicine standardization

Total phenolic compounds of this extract were determined with Folin–Ciocalteu's reagent [36] that used gallic acid as a standard phenolic compound. The total phenolic contents in the extract was 39.1±1.6 mg GA/g. The contents of flavonoids in the extract was determined with spectrophotometric method [37] using rutin as a standard. The total flavonoids contents in the examined extract was 7.58±1.47mg RU/g.

## **9.1. Analysis the results**

In order to analyze the results in four periods of the variables studied, the Friedman test was used.

## **9.2. Results**

In this study, the mean age of the patients was 41.3±9.6 years. Fourteen patients were male (46.7%) and the rest were female. The mean body mass index (BMI) was 26.3 ± 3.4.

The maximum frequency of general temperament with a frequency of 16 was related to moist and cold temperament; the maximum frequency of the stomach (a frequency of 25) was also consistent with general temperament and was moist and cold. Furthermore, 83.3% of patients had the cold and moist temperament in their back, which is still in line with the general and stomach temperaments indicating a cold and moist temperament.

Table 2 shows the results of functional disability. Results indicate that in the beginning of the study, 14 patients had moderate functional disability resulting from low back pain, 14 patients had severe functional disability due to low back pain, and 2 patients had crippled low back pain. At the end of the eighth week, all patients were placed into the group of minimal disability. Friedman's nonparametric test was used, and the results indicated that the scale had a statistically significant difference (P = 0.001).


**Table 2.** Functional disability (Oswestry disability index) due to chronic low back pain

30 patients in clinical trial with chronic low back pain with functional dyspepsia who used *Mentha longifolia for 4 weeks* Values are expressed as mean (95% confidence interval). Fried‐ man's nonparametric test was used, and the results indicated that the scale had a statistically significant difference (P = 0.001).

Table 3 shows information about severity of pain. At the beginning of the study, 22 patients had moderate low back pain, and 8 of them had severe low back pain. At the end of the eighth week, all patients were placed in the group of minimal low back pain. The Friedman non‐ parametric test was used, and results indicated that the scale of this group had a statistically significant difference (P = 0.001).


**Table 3.** Severity of pain (NRS) due to chronic low back pain percentage MODERAT TE 73.3

MILD

SEVERE

ow that all pa e, and very se

frequency

of severity

Diagram 1 sho oderate, severe

Table 4 and D including mo

30 patients in Values are ex

**9.2. Results**

102 Complementary Therapies for the Body, Mind and Soul

Relative frequency percentage of functional disability

SD: Standard deviation

significant difference (P = 0.001).

significant difference (P = 0.001).

In this study, the mean age of the patients was 41.3±9.6 years. Fourteen patients were male

The maximum frequency of general temperament with a frequency of 16 was related to moist and cold temperament; the maximum frequency of the stomach (a frequency of 25) was also consistent with general temperament and was moist and cold. Furthermore, 83.3% of patients had the cold and moist temperament in their back, which is still in line with the general and

Table 2 shows the results of functional disability. Results indicate that in the beginning of the study, 14 patients had moderate functional disability resulting from low back pain, 14 patients had severe functional disability due to low back pain, and 2 patients had crippled low back pain. At the end of the eighth week, all patients were placed into the group of minimal disability. Friedman's nonparametric test was used, and the results indicated that the scale

**Time Pre 2 weeks 4 weeks 8 weeks** The number of patient 30 30 30 30

mean±SD 43.2±8.4 21.3±4.3 6.9±1.4 4.9±1.6

30 patients in clinical trial with chronic low back pain with functional dyspepsia who used *Mentha longifolia for 4 weeks* Values are expressed as mean (95% confidence interval). Fried‐ man's nonparametric test was used, and the results indicated that the scale had a statistically

Table 3 shows information about severity of pain. At the beginning of the study, 22 patients had moderate low back pain, and 8 of them had severe low back pain. At the end of the eighth week, all patients were placed in the group of minimal low back pain. The Friedman non‐ parametric test was used, and results indicated that the scale of this group had a statistically

Friedman's nonparametric test 0.001

**Table 2.** Functional disability (Oswestry disability index) due to chronic low back pain

MINIMIZE 0 50 100 100 MODERATE 46.7 50 0 0 SEVERE 46.7 0 0 0 CRIPPLED 6.7 0 0 0 BED-BOUND 0 0 0 0

(46.7%) and the rest were female. The mean body mass index (BMI) was 26.3 ± 3.4.

stomach temperaments indicating a cold and moist temperament.

had a statistically significant difference (P = 0.001).

30 patients in clinical trial with **chronic low back pain with functional dyspepsia** who used *Mentha longifolia for 4 weeks.* Values are expressed as mean (95% confidence interval). Fried‐ man's nonparametric test was used, and the results indicated that the scale had a statistically significant difference (P = 0.001). Table 3. Sever SD: Standard of pain Mean**±** SD Friedman's rity of pain (NR d deviation nonparametr RS) due to chron ric test nic low back pain 5.8±0.9 n3.9±1.01 0.00 2.6±0.9 01 2.07±0.6

0

33.3 66.7 0

80.0 20.0 100 0 0

th different in y mild dyspeps

ntensity levels, sia.

*.*

s,

dyspepsia wit ants had only

he study had d dy, all particip

26.7

Table 4 and Diagram 1 show that all patients at the beginning of the study had dyspepsia with different intensity levels, including moderate, severe, and very severe. At the end of the study, all participants had only mild dyspepsia. 30 patients in Values are e indicated tha n clinical trial expressed as at the scale had with **chronic**  mean (95% c d a statistically **low back pai** confidence int y significant d **n with functi** terval). Friedm difference (P = **onal dyspeps** man's nonpar = 0.001). **sia** who used *M* rametric test *Mentha longifo* was used, an *olia for 4 weeks.* nd the results

> beginning of th nd of the stud

tients at the b evere. At the en

**n with functi**

**onal dyspeps**

**sia** who used *M*

*Mentha longifo*

*olia for 4 weeks.*

**2 weeks** 30 6.4 4.9 0 0

**Pre** 30 0 6.8 4.2 .4

Figure 1. Diagr ram 1: Severity of dyspepsia at four different t times. *.***Diagram 1.** Severity of dyspepsia at four different times.

with **chronic**  equency

**low back pai**

r of patient MILD MODERATE SEVERE

VERY SEVE

EERE

n clinical trial xpressed as fre

> **Time**  The numbe Relative frequency percentage of severity of dyspepsia

30 patients in clinical trial with **chronic low back pain with functional dyspepsia** who used *Mentha longifolia for 4 weeks.* Values are expressed as frequency


**Table 4.** Severity of dyspepsia due to functional dyspepsia

n clinical trial

with **chronic** 

of severity of ther in Diagra

2, the results o e shown toget

30 patients in

In Diagram 2 dyspepsia ar

Figure 2. Diagr

Values are ex

30 patients in clinical trial with **chronic low back pain with functional dyspepsia** who used *Mentha longifolia for 4 weeks.* Values are expressed as mean (95% confidence interval). Fried‐ man's nonparametric test was used, and the results for severity of **functional dyspepsia** indicated that the scale had a statistically significant difference (P = 0.001). Table 4. Sever SD: Standard Mean**±** SD Friedman's rity of dyspepsi d deviation nonparametr a due to functio ric test onal dyspepsia 22.6±6.45 12±3.6 0.0 5.3±2.6 01 2.7±1.02

In Diagram 2, the results of severity of pain and dyspepsia are shown together. The results of severity of disability and dyspepsia are shown together in Diagram 3. Values are ex severity of **fu** xpressed as m **unctional dysp** mean (95% con **pepsia** indicat nfidence inter ted that the sc **n with functi** rval). Friedma cale had a stati an's nonparam istically signif metric test wa ficant differenc as used, and t ce (P = 0.001). the results for rd

pepsia are sho

**onal dyspeps**

**sia** who used *M*

*Mentha longifo*

*olia for 4 weeks.*

*.*

disability and

of severity of d

. The results o

own together.

**low back pai**

pain and dys am 3.

different times.

**nal dyspepsia**

**a** who used *M*

*Mentha longifol*

*lia for 4 weeks.*

Disabi Dyspe

ility psia

4.90 **2.70**

8

6.87

**5.27**

<sup>4</sup> e

Patients in cl linical trial wi ith **chronic lo ow back pain with functio Diagram 2.** *.* Severity of pain and dyspepsia at four different times.

of pain and dys

spepsia at four d

21.27

**13.03**

<sup>2</sup> Tim

equency.

**22**

**2.57**

0

ram 2: Severity

xpressed as fre

43.17

8

**a** who used *M*

*Mentha longifol*

*lia for 4 weeks.*

*.*

0pai Dyspe

in

epsia

Patients in clinical trial with **chronic low back pain with functional dyspepsia** who used *Mentha longifolia for 4 weeks.* Values are expressed as frequency. Figure 2. Diagr ram 2: Severity of pain and dys spepsia at four d different times.

2.63

4

5.27

**nal dyspepsia**

**with functio**

**Diagram 3.** Severity of disability and dyspepsia at four different times

Patients in clinical trial with **chronic low back pain with functional dyspepsia** who used *Mentha longifolia for 4 weeks.* Values are expressed as frequency.

In order to investigate the correlation severity of pain and dyspepsia, Pearson's correlation coefficient was used. This analysis indicated that in 4 periods there is a direct linear relationship between severity of dyspepsia and pain severity. This result repeated about correlation between severity of dyspepsia and disability due to low back pain. There is a direct linear relationship between them in 4 periods.

## **10. Discussion and conclusion**

Table 4. Sever SD: Standard 30 patients in Values are ex severity of **fu** In Diagram 2 dyspepsia ar

Mean**±** SD Friedman's rity of dyspepsi d deviation n clinical trial xpressed as m **unctional dysp** 2, the results o e shown toget

 nonparametr a due to functio

ric test onal dyspepsia

**low back pai** nfidence inter ted that the sc pain and dys am 3.

22.6±6.45

12±3.6 0.0 5.3±2.6

2.7±1.02

*Mentha longifo* as used, and t ce (P = 0.001). of severity of d

*olia for 4 weeks.* the results for

*.*

rd

disability and

**sia** who used *M* metric test wa ficant differenc . The results o

01

**onal dyspeps** an's nonparam istically signif own together.

**n with functi** rval). Friedma cale had a stati pepsia are sho

13.03

with **chronic**  mean (95% con **pepsia** indicat of severity of ther in Diagra

22.57

Patients in cl Values are ex

linical trial wi xpressed as fre

ith **chronic lo** equency.

**ow back pain**

3.9

93

2

0

5.83

0

5

10

15

20

25

30 patients in clinical trial with **chronic low back pain with functional dyspepsia** who used

**Time Pre 2 weeks 4 weeks 8 weeks** The number of patient 30 30 30 30

Mean± SD 22.6±6.45 12±3.6 5.3±2.6 2.7±1.02

30 patients in clinical trial with **chronic low back pain with functional dyspepsia** who used *Mentha longifolia for 4 weeks.* Values are expressed as mean (95% confidence interval). Fried‐ man's nonparametric test was used, and the results for severity of **functional dyspepsia**

22.6±6.45

12±3.6 0.0 5.3±2.6

2.7±1.02

*Mentha longifo* as used, and t ce (P = 0.001). of severity of d

*olia for 4 weeks.* the results for

*.*

rd

disability and

**sia** who used *M* metric test wa ficant differenc . The results o

01

**onal dyspeps** an's nonparam istically signif own together.

In Diagram 2, the results of severity of pain and dyspepsia are shown together. The results of

**n with functi** rval). Friedma cale had a stati pepsia are sho

MILD 0 6.4 100 100 MODERATE 6.8 4.9 0 0 SEVERE 4.2 0 0 0 VERY SEVERE .4 0 0 0

*Mentha longifolia for 4 weeks.* Values are expressed as frequency

104 Complementary Therapies for the Body, Mind and Soul

Friedman's nonparametric test 0.001

indicated that the scale had a statistically significant difference (P = 0.001).

**low back pai** nfidence inter ted that the sc pain and dys am 3.

ric test onal dyspepsia

severity of disability and dyspepsia are shown together in Diagram 3.

 nonparametr a due to functio

with **chronic**  mean (95% con **pepsia** indicat of severity of ther in Diagra

**Table 4.** Severity of dyspepsia due to functional dyspepsia

Mean**±** SD Friedman's rity of dyspepsi d deviation n clinical trial xpressed as m **unctional dysp** 2, the results o e shown toget

22.57

Relative frequency percentage of severity of dyspepsia

SD: Standard deviation

Table 4. Sever SD: Standard 30 patients in Values are ex severity of **fu** In Diagram 2 dyspepsia ar

Figure 2. Diagr Patients in cl Values are ex

ram 2: Severity linical trial wi xpressed as fre

of pain and dys ith **chronic lo** equency.

3.9

93

2

21.27

**13.03**

<sup>2</sup> Tim

spepsia at four d **ow back pain**

different times. **with functio**

**Diagram 2.** *.* Severity of pain and dyspepsia at four different times.

2.63

4

5.27

**nal dyspepsia**

**a** who used *M*

*Mentha longifol*

*lia for 4 weeks.*

Disabi Dyspe

ility psia

0pai Dyspe

in epsia

4.90 **2.70**

8

2.07 2.70

8

6.87

**5.27**

<sup>4</sup> e

13.03

43.17

**22**

**2.57**

0

0

5.83

0

5

10

15

20

25

The purpose of this trial was to investigate the relationship between dyspepsia and low back pain according to traditional Iranian medicine issue. Although research indicates that dys‐ pepsia and low back pain are synchronized [38-39], so far no trial has been conducted to examine the relationship between them. The results of this trial indicate that intervention was effective on dyspepsia and low back pain simultaneously. Reduction in symptoms of gastro‐ intestinal problems leads to decrease in symptoms associated with low back pain (pain and disability). Although a positive Pearson coefficient did not show a causal relationship between them, it did indicate a direct relationship between dyspepsia and back pain. Of course, more extensive research with a larger number of participants would achieve more accurate results.

## **Author details**

Mohammad Reza Vaez Mahdavi1\*, Mohsen Naseri1 , Nafiseh Hoseini Yekta1 , Younes Roohany2 , Fatemeh Emadi1,3 and Soghrat Faghihzadeh4

\*Address all correspondence to: mh\_mahdavi@yahoo.com

1 Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran

2 School of Medicine, Shahed University, Tehran, Iran

3 Department of Iranian Traditional Medicine, Faculty of Medicine Shahed University, Teh‐ ran, IR, Iran

4 Epidemiology and Biostatistics Department, Statistics-Faculty, Zanjan, University of Medi‐ cal Sciences, Zanjan, Iran

## **References**


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**Author details**

ran, IR, Iran

**References**

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Mohammad Reza Vaez Mahdavi1\*, Mohsen Naseri1

\*Address all correspondence to: mh\_mahdavi@yahoo.com

2 School of Medicine, Shahed University, Tehran, Iran

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1 Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran

3 Department of Iranian Traditional Medicine, Faculty of Medicine Shahed University, Teh‐

4 Epidemiology and Biostatistics Department, Statistics-Faculty, Zanjan, University of Medi‐

[1] Arzani, M. A.; Mofarah-ol-Gholoub, editing and research Nazem, E., Baghbani, M.,

[2] Arzani, M. A.; Mizan-O-Teb, Revision by Hadi Nasiri, Ehyae-Tebe-Tabiee Publica‐

[3] Chakhmini Kharazmi, M.; Qanuncheh-Fi-Teb, Revision and translation by Esmaiel

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## **Anticancer Plants in Islamic Traditional Medicine**

Behjat Javadi, Milad Iranshahy and Seyed Ahmad Emami

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/61111

#### **Abstract**

Islamic Traditional Medicine (ITM) is a holistic and comprehensive medical school that has antecedents over 12 centuries ago.

In ITM, cancer was a known disease with many options for treatment. Razi (Razhes; 865-925 AD), Ahwazi (Haly Abbas; 930-994 AD), Avicenna (980-1037AD), Jorjani (1042-1136 AD), and Aqili Khorasani (18th century) are among eminent physicians who discussed different types of cancers and their management in their books. They used a large number of plant species for treatment of different tumors.

Although modern medicine has made tremendous advances in cancer control, the effectiveness of its therapeutic approach is often limited by toxic effects on other organs. Moreover, a large number of people in the world have limited or no access to cancer treatment services. Accordingly, benefiting from traditional medicine schools and effective natural medicines to prevent and control cancer would be valuable. In addition, using the teachings of such schools can lead to the discovery of new bioactive compounds and therapeutic methods.

In this chapter, a brief history of Islamic medicine and its approach to treat cancer as well as anticancer medicinal plants have been discussed. Out of 107 ITM suggested plant species, 59 plants or their chemical compounds have proven to possess cytotoxic and antitumor activities using pharmacological investigations. These findings show the profound insight of ITM physicians into cancer treatment.

**Keywords:** Anticancer Plants, Cancer treatment

© 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

## **1. Introduction**

Islamic Traditional Medicine (ITM) is a holistic system of medicine which flourished during the Islamic Golden Age (750-1258 AD). It was practiced and taught throughout the Islamic territory. In that era, Muslim and non-Muslim medical scholars, especially Iranian physicians and pharmacists, translated the scientific knowledge which they inherited from ancient Greece and Iran. They endeavored to revive and develop this medical knowledge, remove supersti‐ tious ideas and faults from it, and establish an authentic medical school. Although most ITM scientists were not Arabs, the majority of their books are written in Arabic, the lingua franca of the Islamic civilization. Razi (Razhes; 865-925 AD), Ahwazi (Haly Abbas; 930-994 AD), Avicenna (980-1037AD), Jorjani (1042-1136 AD), and Aqili Khorasani (18th century) are eminent Iranian physicians who had the most contributions to ITM promotion.

Although significant progress has been made in cancer control in the last few decades, the effectiveness of modern therapeutic approach is often limited by toxic effects on other organs. Moreover, a large number of people in the world have limited or no access to cancer treatment services. Accordingly, utilizing information from traditional medicine systems to identify alternative methods to prevent and control cancer would be desirable. Furthermore, use of traditional medicine can lead to the discovery of new bioactive compounds as well as available, safe and affordable drugs.

In Islamic medicine, cancer was a known disease with many options for treatment. In the majority of ITM textbooks there is a chapter dedicated to cancer definition, symptoms, etiology, diagnosis, prevention, and management.

In this chapter we will discuss cancer, its etiology and management in the view of Islamic Traditional Medicine. In addition, ITM medicinal plants used to treat different types of cancers and modern pharmacological data confirming their traditional usage will be inserted in tables.

## **2. Cancer definition from ITM point of view**

ITM is based on the theory of humorism which posits that the human body consists of four basic fluids, namely humors. The four humors are blood, phlegm, yellow bile, and black bile and each one corresponds to paired qualities: blood is hot and wet, phlegm is cold and wet, yellow bile is hot and dry, and black bile is cold and dry. A proper balance between humors is essential to maintaining health. Accordingly, all diseases and disabilities including cancer result from an excess or putridity of these humors.

According to ITM, cancer is a kind of black bile swelling which is accompanied by pain, pulsation, inflammation, and angiogenesis [1]. Blood vessels surrounding a tumor are overfilled and stiff and contain a dark and black blood [2]. The reason for the appellation "cancer" is due to the similarity between the shape of a cancerous tumor affecting an organ and a crab grasping its prey. It may also due to the spherical shape and darkness of tumor and origination of blood vessels from its milieu which resembles crab's feet [3]. Cancer frequently affects soft and porous organs and for this reason, it mainly involves breast and innervated organs (such as uterus) in females, and throat, larynx, testicles and penis in males [1].

Initially, cancer is the size of a broad bean or smaller, hard, spherical, mobile, dark, and slightly warm [3]. It will then begin to grow gradually and reach to the size of a walnut or larger. It might be curable during its early stages of development, but diagnosis is difficult in these stages. On the other hand, upon progression and appearance of clinical manifestations, treatment of cancer would be difficult or even impossible [1].

Ocular, nasal cavity, breast, uterine, liver, and other visceral organs and skin cancers are among the most frequently mentioned cancers in ITM texts. Cancers are divided into two main types: ulcerative and nonulcerative cancers.

Some cancerous tumors are easily ulcerated but some others are not. Cancerous wounds usually spread centripetally and their discharges are purulent. Use of appropriate medications can prevent the ulceration of susceptible tumors. In contrast, some cancerous tumors that are not prone to ulceration would be ulcerated following the administration of improper drugs [1].

Advanced and large tumors are very sensitive and painful, with a distinctive red to yellow color and a caustic and burning pain. Such tumors might erupt spontaneously and a purulent and bloody discharge may appear on wound surface. The resulting wounds are very sensitive and can produce corrosion in surrounding tissues [2].

## **3. Cancer etiology**

**1. Introduction**

112 Complementary Therapies for the Body, Mind and Soul

safe and affordable drugs.

diagnosis, prevention, and management.

**2. Cancer definition from ITM point of view**

result from an excess or putridity of these humors.

Islamic Traditional Medicine (ITM) is a holistic system of medicine which flourished during the Islamic Golden Age (750-1258 AD). It was practiced and taught throughout the Islamic territory. In that era, Muslim and non-Muslim medical scholars, especially Iranian physicians and pharmacists, translated the scientific knowledge which they inherited from ancient Greece and Iran. They endeavored to revive and develop this medical knowledge, remove supersti‐ tious ideas and faults from it, and establish an authentic medical school. Although most ITM scientists were not Arabs, the majority of their books are written in Arabic, the lingua franca of the Islamic civilization. Razi (Razhes; 865-925 AD), Ahwazi (Haly Abbas; 930-994 AD), Avicenna (980-1037AD), Jorjani (1042-1136 AD), and Aqili Khorasani (18th century) are

Although significant progress has been made in cancer control in the last few decades, the effectiveness of modern therapeutic approach is often limited by toxic effects on other organs. Moreover, a large number of people in the world have limited or no access to cancer treatment services. Accordingly, utilizing information from traditional medicine systems to identify alternative methods to prevent and control cancer would be desirable. Furthermore, use of traditional medicine can lead to the discovery of new bioactive compounds as well as available,

In Islamic medicine, cancer was a known disease with many options for treatment. In the majority of ITM textbooks there is a chapter dedicated to cancer definition, symptoms, etiology,

In this chapter we will discuss cancer, its etiology and management in the view of Islamic Traditional Medicine. In addition, ITM medicinal plants used to treat different types of cancers and modern pharmacological data confirming their traditional usage will be inserted in tables.

ITM is based on the theory of humorism which posits that the human body consists of four basic fluids, namely humors. The four humors are blood, phlegm, yellow bile, and black bile and each one corresponds to paired qualities: blood is hot and wet, phlegm is cold and wet, yellow bile is hot and dry, and black bile is cold and dry. A proper balance between humors is essential to maintaining health. Accordingly, all diseases and disabilities including cancer

According to ITM, cancer is a kind of black bile swelling which is accompanied by pain, pulsation, inflammation, and angiogenesis [1]. Blood vessels surrounding a tumor are overfilled and stiff and contain a dark and black blood [2]. The reason for the appellation "cancer" is due to the similarity between the shape of a cancerous tumor affecting an organ and a crab grasping its prey. It may also due to the spherical shape and darkness of tumor and origination of blood vessels from its milieu which resembles crab's feet [3]. Cancer frequently

eminent Iranian physicians who had the most contributions to ITM promotion.

According to ITM, excessive accumulation of abnormal black bile in a body site is the main cause of cancer. Aging, prolonged stress exposure, consuming cold and dry food items and hardwork are leading causes of increasing black bile production [1]. In some cases, hemorrhage (such as menstruation, abnormal uterine hemorrhage, or hemorrhoids bleeding) is a defending mechanism against the accumulation of bad humors in the body. Therefore, completely stopping the bleeding by surgical procedures and other medications can result in a black bile accretion and consequently increasing the risk of cancer and other diseases originating from excessive black bile (including cancer, melancholia, liver problems, psoriasis, etc.) [2].

## **4. Cancer management**

Islamic traditional medicine suggested multiple strategies to the control and treatment of cancer. Surgical manipulation, venesection, diet adjustment, and use of natural medicines including solid, semisolid, and liquid dosage forms with oral and external route of adminis‐ tration are among these methods.

## **4.1. Surgery and manipulation**

Surgery is used to eradicate tumors in their early stages of development. Small tumors which are distant from vital organs are good candidates for surgery. The tumor should be cut from its origin and some parts of adjacent nonaffected tissues should be excised as well. In addition, bleeding should be allowed until large blood volumes come out and surrounding tissue should be pressed in order to expel blood mixed with black bile thoroughly. Afterwards, the injured site should be salved or cauterized. However, if the cancerous tumor is located in the vicinity of sensitive and vital organs, surgical procedure and cauterization would be very dangerous and may change the cancer to a nonhealing ulcer [2, 4].

Regular venesection is also suggested during the initial phases of cancer, to withdraw black bile blood from body.

## **4.2. Nutrition therapy**

In Islamic traditional medicine, dietary recommendations have been proposed to slow the progression of advanced tumors that cannot be manipulated due to metastasis concerns. In these cases, nutritional care would increase the longevity of patients. Food items with wet temperament which produce high-quality blood like beer, almond oil, fresh small fishes, softboiled egg yolk, lamb, bird meat, ripe and sweet apples, sweet plums, bananas, raisin, black gram (*Vigna mungo* (L.) Hepper), spinach (*Spinacia oleracea* L.), pumpkin, light wine, and fresh cow's milk and dough are administered [1]. On the other hand, excessive intake of foodstuffs which induce black bile production in the body (such as eggplant (*Solanum melongena* L.), lentil (*Lens esculenta* Moench), date (*Phoenix dactylifera* L*.*), cabbage (*Brassica oleracea* L.), beef, black and thick wine, and salt-cured meat) is severely restricted [5].

#### **4.3. Pharmacotherapy**

As mentioned above, from the Islamic Traditional Medicine point of view, an excess of abnormal black bile in various body sites can lead to cancer formation. In order to treat cancer, black bile should be expelled from the body by using an appropriate purgative, and then preventing the generation and accumulation of black bile in vessels as far as possible [2]. For this purpose, many single and compound medications of herbal, animal, and mineral origin have been recommended.

The essential point in pharmacotherapy of cancers and tumors is avoiding the use of caustic and irritant medications to prevent further stimulation and ulceration [2].

Cancer medications can be administered internally (oral, enemas, vaginal douches, etc.) or applied topically (cataplasms, topical oils, liniments, lotions, dusting powders, etc.) [1, 3]. Administration of local anticancer drugs has the following purposes: cancer eradication, metastasis prevention, preventing ulceration, and healing ulcerated tumors.

## **5. Mechanisms of action of anticancer drugs**

Anticancer drugs act through different mechanisms:

**i. Black bile purgatives** are common anticancer drugs which can facilitate elimination of abnormal black bile from whole body. Purgatives should be administered fre‐ quently. From the ITM point of view, clover dodder (*Cuscuta epithymum* Murr.) is the most valuable black bile purgative, which is commonly used to treat diseases caused by a surplus or imbalance of this humor such as all types of cancer, melancholia, leprosy, vitiligo, etc. For this purpose, a mixture of clover dodder with cheese whey or hydromel should be administered frequently. A decoction of the plant in oxymel is also prescribed [3]. Common polypody (*Polypodium vulgare* L.), French lavender (*Lavandula stoechas* L.), colocynth [*Citrullus colocynthis* (L.) Schrad.], and black hellebore (*Helleborus niger* L.) are other potent black bile purgatives.


## **6. Anticancer plants**

its origin and some parts of adjacent nonaffected tissues should be excised as well. In addition, bleeding should be allowed until large blood volumes come out and surrounding tissue should be pressed in order to expel blood mixed with black bile thoroughly. Afterwards, the injured site should be salved or cauterized. However, if the cancerous tumor is located in the vicinity of sensitive and vital organs, surgical procedure and cauterization would be very dangerous

Regular venesection is also suggested during the initial phases of cancer, to withdraw black

In Islamic traditional medicine, dietary recommendations have been proposed to slow the progression of advanced tumors that cannot be manipulated due to metastasis concerns. In these cases, nutritional care would increase the longevity of patients. Food items with wet temperament which produce high-quality blood like beer, almond oil, fresh small fishes, softboiled egg yolk, lamb, bird meat, ripe and sweet apples, sweet plums, bananas, raisin, black gram (*Vigna mungo* (L.) Hepper), spinach (*Spinacia oleracea* L.), pumpkin, light wine, and fresh cow's milk and dough are administered [1]. On the other hand, excessive intake of foodstuffs which induce black bile production in the body (such as eggplant (*Solanum melongena* L.), lentil (*Lens esculenta* Moench), date (*Phoenix dactylifera* L*.*), cabbage (*Brassica oleracea* L.), beef, black

As mentioned above, from the Islamic Traditional Medicine point of view, an excess of abnormal black bile in various body sites can lead to cancer formation. In order to treat cancer, black bile should be expelled from the body by using an appropriate purgative, and then preventing the generation and accumulation of black bile in vessels as far as possible [2]. For this purpose, many single and compound medications of herbal, animal, and mineral origin

The essential point in pharmacotherapy of cancers and tumors is avoiding the use of caustic

Cancer medications can be administered internally (oral, enemas, vaginal douches, etc.) or applied topically (cataplasms, topical oils, liniments, lotions, dusting powders, etc.) [1, 3]. Administration of local anticancer drugs has the following purposes: cancer eradication,

**i. Black bile purgatives** are common anticancer drugs which can facilitate elimination

of abnormal black bile from whole body. Purgatives should be administered fre‐

and irritant medications to prevent further stimulation and ulceration [2].

metastasis prevention, preventing ulceration, and healing ulcerated tumors.

**5. Mechanisms of action of anticancer drugs**

Anticancer drugs act through different mechanisms:

and may change the cancer to a nonhealing ulcer [2, 4].

114 Complementary Therapies for the Body, Mind and Soul

and thick wine, and salt-cured meat) is severely restricted [5].

bile blood from body.

**4.2. Nutrition therapy**

**4.3. Pharmacotherapy**

have been recommended.

One hundred and seven plant species from 53 families have been mentioned to be effective in the management and curing of different types of cancers. Plants Latin and Arabic names, their families, medicinal parts, dosage forms, and routes of administration are given in Table 1.




*Anchusa azurea* Mill.

*Boswellia sacra* Flueck. syn. *Boswellia carteri* Birdw.

*Chamaemelum nobile* (L.) All.syn*. Anthemis nobilis* L.

*Cinnamomum cassia* (L.)

syn*. Cistus ladaniferus* Curtis

*Cistus creticus* L.

J.Presl

*Amaranthus blitum* L*.* Amaranthaceae baghlat al-

116 Complementary Therapies for the Body, Mind and Soul

*Brassica oleracea* L. Brassicaceae karnab

*Capparis spinosa* L. Capparaceae kabar Rb

*Cassia fistula* L. Fabaceae khiar shanbar Lg

*Cicer arietinum* L. Fabaceae homs Se

*Cichorium intybus* L. Asteraceae hindeba Le

**Arabic common**

syn*. Anchusa italica* Retz. Boraginaceae lesan al-thawr Le all types syrup [7]

*Beta vulgris* L. Chenopodiaceae salq Le all types decoction(O) [6]

*Carthamus tinctorius* L. Asteraceae moasfar Se all types raw seeds(O) [6] *Carum carvi* L. Apiaceae kerawia Se all types raw seeds(O) [6]

Asteraceae babunaj Fl uterus

Burseraceae kondor Ogr eye

**Part**

Le Fl

uterus all types skin

uterus all types

tongue ulcerated cancer uterine

skin all types ulcerating tumor

uterus all types ulcerating tumor

Luraceae salikhah Br liver electuary [2]

Cistaceae ladan Fl all types oil (E) [3]

**used Cancer type**

yamaaniah Ap uterus cataplasm [7]

**Administration and locality**

unguent

unguent decoction(E) vaginal bath cooked(O) cooked (E)

unguent cataplasm

unguent topical oil decoction(E)

cooked(O) infusion(E) cataplasm

extract(E) cataplasm extract(O) cataplasm

extract (E) [3]

topical oil [1, 3]

condensed smoke as collyrium

**Ref.**

[2, 3, 5, 8, 9]

[1, 3, 7] [6, 8, 9]

[3] [1, 5]

[12]

[1, 3, 7, 12]

[8, 9] [2]

[1, 6, 8] [7]

**name**

*Anethum graveolens* L. Apiaceae shebeth Ap uterus



118 Complementary Therapies for the Body, Mind and Soul

*Iris × germanica* L*.* syn*. Iris ×florentina* L.

ex Roxb.

*Jasminum sambac* (L.) Aiton *Aegle marmelos* (L.) Corrêa

*Lens culinaris* Medik. syn*. Lens esculenta* Moench

*Malva pusilla* Sm. syn*. Malva rotundifolia* L. **Arabic common**

*Helleborus niger* L. Ranunculaceae kharbaq aswad <sup>R</sup> internal organs decoction(O)

*Hordeum vulgare* L. Poaceae sha`eer Se all types decoction(O) [1, 3, 6, 7] *Inula helenium L.* Asteraceae rasan R skin lotion [14]

razeqi Fl uterus

*Juglans regia* L. Juglandaceae Jawz G ulcerating tumor dusting powder(E) [2, 14]

*Lavandula stoechas* L. Lamiaceae ostokhoddus Ap internal organs decoction(O)

Fabaceae adas Se

**Part**

**used Cancer type**

uterus

uterus

irsa R uterus unguent [3]

uterus

uterus

uterus

all types uterus

uterus

Se Mu

Le Fs

*Liquidambar orientalis* Mill. Altingiaceae mi`a Ba all types unguent [3]

Malvaceae khabaazi Fl uterus

*Melilotusofficinalis* (L.) Pall. Fabaceae eklil al-malek pod eye cataplasm [1, 3]

ulcerating tumor

ulcerating tumor

**Administration and locality**

vaginal douche [7, 15]

pill(O) [1, 7, 10]

cataplasm cataplasm

syrup

unguent

extract(E) cataplasm

cataplasm cataplasm

unguent

unguent

unguent oil (E) vaginal bath decoction (E)

extract

vaginal bath cataplasm [7]

topical oil [3]

pill(O) [1]

oil(E) [3]

oil (E) [1, 3]

vaginal douche [15]

vaginal douche cataplasm

[1, 3] [6, 7]

[1, 3] [7]

[3] [7]

[3] [1, 2, 7]

**Ref.**

[12, 13] [7]

**name**

*Glycyrrhiza glabra* L. Fabaceae sous <sup>R</sup> all types

*Lactuca sativa* (L.) Mill. Asteraceae khas Le all types

*Laurus nobilis* L. Lauraceae hab al-ghar Se tongue

*Lawsonia inermis* L Lythraceae henna Le uterus

*Lilium candidum* L. Liliaceae susan Fl uterus

*Linum usitatissimum* L. Linaceae katan

*Lycium afrum* L Solanaceae hozoz



120 Complementary Therapies for the Body, Mind and Soul

syn, *Plantago ispaghula* Roxb. ex Fleming

*Prunus dulcis* (Mill.) D.A.Webb

*Raphanus raphanistrum* subsp. *sativus* (L.) Domin syn*. Raphanus sativus* L.

*Sesbania bispinosa* (Jacq.) W. Wight

Scop.

*Sisymbrium officinale* (L.)

syn. *Erysimum officinale* L.

**Arabic common**

*Platanus orientalis* L. Plantanaceae dolb Le skin decoction (E)

*Polypodium vulgare* L. Polypodiaceae basfayaj Rh internal organs decoction(O)

*Polyporus officinalis* (Vill.) Fr. Polyporaceae ghariqun all types decoction(O) [4, 7]

*Salix aegyptiaca* L. Salicaceae khelaf W skin dusting powder(E) [2]

G So Se

Fp

Brassicaceae fojl tro all types decoction(O) [6]

**Part**

**used Cancer type**

ulcerating tumor all types uterus

uterus all types

nose

eye uterus

Fabaceae sisban Le cataplasm [9]

ulcerating tumor

hard swelling cancer nonulcerating tumor

**Administration and locality**

vaginal bath [2]

extract (E) [7, 15]

pill(O) [1, 7]

extract liniment enema extract(O)

unguent oil (O)

unguent

oil(E) cataplasm vaginal douche

oil

extract

cataplasm cataplasm cataplasm cataplasm

oil (E) [1, 3]

liniment [3, 7]

ulcerating tumor juice(O) [1]

unguent

**Ref.**

[3, 8] [1] [6] [7]

[1, 3, 6, 12]

[7]

[1] [2, 3, 7, 12]

[8, 9] [2]

**name**

*Polygonum aviculare* L Polygonaceae asa al-ra`ee Ap uterus

Rosaceae samgh al-llawz

*Ricinus communis* L. Euphorbiaceae kherwa`a Se uterus

*Sempervivum tectorum* L*.* Crassulaceae hay al-alam Fl all types

Brassicaceae arismun, khabbe Se

*Portulaca oleracea* L. Portulaceae rejlah Le

*Punica granatum* L. Punicaceae romman Fr

*Rosa × damascena* Herrm. Rosaceae ward Fl

*Rhus coriaria* L. Anacardiaceae sumaagh


Use: E = external use, O = oral use. Part used Ap = aerial parts, Ba = balsam, Be = berries, Br = bark, Ff = fresh fruit, Fl = flowers, Fp = fruit pericarp, Fr = fruit, G = gum, Gre = gum resin, Le = leaves, Mu: mucilage, N = nuts, O = oil, Ogr = oleogum resin, Ore = oleoresin, R = root, Rb = root bark, Re = resin, Rdj = Root dry juice, Rf = Ripe fruit, Rh = rhizome, Se = seeds, Sh =shoots, So = seed oil, St = stigma, Tap root = Tro, Sa = sap, Urf = Unripe fruit, W = wood, Wp = whole plant.

**Table 1.** Medicinal plants mentioned in Islamic Traditional Medicine textbooks effective in the management of cancer.

## **7. Anticancer and cytotoxic activities of ITM plant species**

Many ITM-suggested plants have been shown to exert anticancer activities with different mechanisms such as cytotoxic, antitumor, antiproliferative, cytostatic, and cell-migrationinhibiting effects. Pharmacological data reinterpreting ITM evidence of cancer phytotherapy are given in Table 2.



122 Complementary Therapies for the Body, Mind and Soul

*Ziziphus jujuba* Mill. syn*. Ziziphus vulgaris* Lam.

are given in Table 2.

Stem bark

Stem bark, roots and leaves/Zeorin, dustanin, aegeline, epilupeol, lupenone and marmin

1-hydroxy-5,7-

carboxaldehyde (marmelin)

*Allium porrum* L. Bulbs/12-keto-porrigenin

dimethoxy-2-naphthalene-

*Aegle marmelos* (L.) Corrêa ex Roxb.

**Arabic common**

Rhamnaceae onnab Fr ulcerating tumor

Use: E = external use, O = oral use. Part used Ap = aerial parts, Ba = balsam, Be = berries, Br = bark, Ff = fresh fruit, Fl = flowers, Fp = fruit pericarp, Fr = fruit, G = gum, Gre = gum resin, Le = leaves, Mu: mucilage, N = nuts, O = oil, Ogr = oleogum resin, Ore = oleoresin, R = root, Rb = root bark, Re = resin, Rdj = Root dry juice, Rf = Ripe fruit, Rh = rhizome, Se = seeds, Sh =shoots, So = seed oil, St = stigma, Tap root = Tro, Sa = sap, Urf = Unripe fruit, W = wood, Wp = whole plant.

**Table 1.** Medicinal plants mentioned in Islamic Traditional Medicine textbooks effective in the management of cancer.

Many ITM-suggested plants have been shown to exert anticancer activities with different mechanisms such as cytotoxic, antitumor, antiproliferative, cytostatic, and cell-migrationinhibiting effects. Pharmacological data reinterpreting ITM evidence of cancer phytotherapy

**Species Plant part(s)/compound Solvent Activity Cell line Ref.**


cytotoxic


mice

K3R-1

ethanol

and 2,3-seco-porrigenin - antiproliferative

methanol, ethyl acetate and nhexane

**7. Anticancer and cytotoxic activities of ITM plant species**

**Part**

**used Cancer type**

liver skin

uterus

ulcerating tumor uterine cancer uterus

**Administration and locality**

decoction(E) unguent

electuary lotion

K-562, Raji, Jurkat, HEL, Colo38, HL-60, CEM, B-16, MCF-7 and MDA-MB-231

Brine shrimp [19]

HCT-116 colon cancer cell tumor xenograft in nude

J774, WEHI 164, P388 and

decoction(O) [12]

**Ref.**

[2] [14]

[16-18]

[21]

[22]

**name**

*Zingiber officinale* Roscoe Zingiberaceae zanjabil Rh



**Species Plant part(s)/compound Solvent Activity Cell line Ref.**

*Carum carvi* L. Thymoquinone from seeds - cytotoxic TNBC cells [56]

*Cicer arietinum* L. C-25 protein - cytotoxic KB cell line [61]

methanol/hexane/ ethyl acetate

Engl. Guggulsterones - cytotoxic PC3, HL60 and U973 [74]

cytotoxic and antitumor

antitumor

Polysaccharide - antitumor T739 lung cancer and S180

Not mentioned methanol cytotoxic HT-29 [55]

Stem bark methanol [58]

Leaves chloroform antiproliferative HeLa, MCF7 and A431 [62]

cytotoxic

cytotoxic

Linalool - antitumor Sarcoma-180 solid tumor [75] Leaves ethanol cytotoxic HT-29 [76]

de - LNCaP, PC-3 and DU145 [67] Coumacasia HL60 and A549 [68]


aqueous SiHa [66]

cytotoxic

HepG2 and transplanted ascites tumor H22

MDA-MB-231 breast cancer cell and normal human mammary gland cell lines

COLO 320 DM [57]

NB4 and PC3 [60]

HL60 [64]

KB, P-388; and NSCLC-N6 [69]

[70-72]

[73]

CCRF-CEM, MOLT3, H33AJ-JA-13, HUT78, H9, KM3, NAMALWA, JIYOYE, DAUDI, SDK, K562, HL60

HeLa, MDA-MB-453 and

and U973

FemX

HeLa, A549, SK-OV-3, SK-MEL-2, XF-498 and HCT-15 [65]

NB4, A549, SHSY5Y, PC3, and MCF7 [59]

Sarcoma in mice

[51, 52]

[53]

[54]

water

*Panax ginseng* - cytotoxic and

*Capparis spinosa* L. Polysaccharides and

124 Complementary Therapies for the Body, Mind and Soul

*Carthamus tinctorius*

*Cassia fistula* L.

*Cichorium intybus* L.

*Cinnamomum cassia* (L.) J.Presl

*Cistus creticus* L.

*Commiphora mukul*

*Coriandrum sativum*

L.

L.

alkaloids from fruits

*Carthamus tinctorius* and

Rhein from flowers -

Furanoflavones from stem bark -

Fistulaquinone A from

Lactucin and 13,14-secostigma 9(11),14(15) dien-3alpha-ol

Cinnamaldehyde -

Benzoyloxycinnamaldehy

diterpenoids from leaves -

Shoot ethanol

Labdane-type

fruits

Bark

2'-



**Species Plant part(s)/compound Solvent Activity Cell line Ref.**

*Lawsonia inermis* L.

*Linum usitatissimum*

*Melissa officinalis* L.

*Narcissus tazetta* L.

*Olea europaea* L.

*Papaver somniferum* L. var. *album* (Mill.)

*Physalis alkekengi* L.

*Pistacia atlantica*

M.A.

L.

Bicoumarin, biflavonoid,

compounds from flowers

Leaves water

*Myrtus communis* L. Phloroglucinols - cytotoxic

Erythrodiol -

Hydroxytyrosol rich extract from leaves

5α-Hydroxy-25,27 dihydro-4,7-didehydro-7-

*Plantago major* L. Leaves hot water cytotoxic

Secoisolariciresinol and anhydrosecoisolariciresino

and biquinone

126 Complementary Therapies for the Body, Mind and Soul

l

Essential oil - C32, ACHN, LNCaP, and

Aerial parts ethanol HCT-116 [114]

Citral and essential oil - cytotoxic GBM [116]

Alkaloids - [118]

cytotoxic

Physalin HT1080 and A375-S2 [126, 127]

Maslinic acid - HT29 [122] Tyrosol esters MCF10A [123]

methanol/water MCF-7 [121]

cytotoxic and antitumor


Essential oil - cytotoxic

Stems and leaves alkaloid extraction cytotoxic

Noscapine - anticancer

deoxyneophysalin A - cytotoxic

Desf. Polyphenol-rich extract ethanol/water cytotoxic HT29 [128] *Pistacia lentiscus* L. Gum extract hexane cytotoxic HCT116 [129]

, HL-60 and LoVo

MCF-7

HT-29


A2780 [109]

MCF-7, Hela, HCT-116, and

A549, MCF-7, Caco-2,

MCF-7, MDA-MB-468 and MDA-MB-231; DMBAinduced mammary tumors

MT-4 cells,

HL-60, K562 and B16F10 [113]

HepG2 and DU145 [117]

HL-60 [120]

PC-3 and LNCaP [125]

HL-60, K562, KT1/A3, and A3 [119]

Refractory Multiple Myeloma, Non-Hodgkin's Lymphoma and Chronic Lymphocytic Leukemia

Antileukemia and anticarcinoma

[110]

[111]

[115]

[124]

[130]


**Table 2.** Anticancer activities of ITM plant species.

## **8. Conclusion**

Taken together, it can be concluded that what physicians of Islamic medicine used for cancer treatment is proven through modern research. Out of 107 plant species which are introduced in Islamic Iranian medicine for cancer treatment, 59 plants or their chemical compounds have proven to possess cytotoxic and antitumor activity in recent investigations and some have entered clinical trials and their effectiveness has been evaluated on humans.

These findings show the profound insight of Islamic physicians on cancer treatment. In spite of the lack of modern facilities and developed equipment, they introduced anticancer plants that have shown cytotoxic properties in new researches. The correlation between these findings signifies the originality of past experiences and studies, representing a worthwhile fund and valuable science dating back more than twelve centuries. This heritage is based on the experiences of thousands years of Greek, Indian and ancient Iranian physicians and relies on immense number of clinical trials on thousands of people. Furthermore, the application of traditional medicinal knowledge reinterpreted by modern data can lead to more effective and evidence-based use of medicinal plants, which can contribute to therapeutic decisions on different illnesses.

## **Author details**

**Species Plant part(s)/compound Solvent Activity Cell line Ref.**

Tannins - cytotoxic

Diosgenin - A549 *Viola odorata* L. Cyclotides - cytotoxic MCF-7 and MCF-7/ADR [170]

Seeds water

Resveratrol -

diarylheptanoids -

[6]-Paradol and structurally related compounds

128 Complementary Therapies for the Body, Mind and Soul

Gingerols and

**Table 2.** Anticancer activities of ITM plant species.

Viniferin-enriched extracts ethanol/water


*Tanacetum parthenium* L.

*Terminalia chebula* Willd. ex Flem.

*Trigonella foenumgraecum* L.

*Vitis vinifera* L.

*Zingiber officinale* Roscoe

**8. Conclusion**

Solamargine - K562 [163] Polyphenol rich extract water PZ-HPV-7 [164] Berries ethanol Jurkat and HL-60 [165]

Parthenolide - anticancer Leukemia [166]

Fruits methanol HOS-1 [168]

cytotoxic

cytotoxic

cytotoxic

Taken together, it can be concluded that what physicians of Islamic medicine used for cancer treatment is proven through modern research. Out of 107 plant species which are introduced in Islamic Iranian medicine for cancer treatment, 59 plants or their chemical compounds have proven to possess cytotoxic and antitumor activity in recent investigations and some have

These findings show the profound insight of Islamic physicians on cancer treatment. In spite of the lack of modern facilities and developed equipment, they introduced anticancer plants that have shown cytotoxic properties in new researches. The correlation between these findings signifies the originality of past experiences and studies, representing a worthwhile fund and valuable science dating back more than twelve centuries. This heritage is based on the experiences of thousands years of Greek, Indian and ancient Iranian physicians and relies on immense number of clinical trials on thousands of people. Furthermore, the application of traditional medicinal knowledge reinterpreted by modern data can lead to more effective and

entered clinical trials and their effectiveness has been evaluated on humans.

Seed extract methanol KB cells [172]

A-549, SK-OV-3, SK-MEL-2, XF-498 and HCT-15 [167]

TCP, B-cell lymphomas, FRO and MCF7 [169]

HCC1954, HCC1500 and

HL-60, A431, K562, HeLa, HCT-116, HT-29 and

3T6 and HL60 [171]

KB [175]

[173, 174]

[176-181]

HL-60

MCF7

K562/ADR

Behjat Javadi1 , Milad Iranshahy2 and Seyed Ahmad Emami2\*

\*Address all correspondence to: emamia@mums.ac.ir

1 Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

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**Section 2**
