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Prevention and Treatment of Flatulence From a Traditional Persian Medicine Perspective

AUTHORS

Bagher Larijani 1 , Mohammad Medhi Esfahani 2 , Maryam Moghimi 3 , * , Mohammad Reza Shams Ardakani 3 , Mansoor Keshavarz 3 , Gholamreza Kordafshari 3 , Esmaiel Nazem 3 , Shirin Hasani Ranjbar 1 , Hoorieh Mohammadi Kenari 3 , Arman Zargaran 4

AUTHORS INFORMATION

1 Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran

2 Qoran, Hadis and Teb Sciences Research Center, Tehran University of Medical Sciences, Tehran, IR Iran

3 School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, IR Iran

4 Pharmaceutical Sciences Research Center and Department of Traditional Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran

ARTICLE INFORMATION

Iranian Red Crescent Medical Journal: 18 (4); e23664
Published Online: January 31, 2016
Article Type: Review Article
Received: September 18, 2014
Revised: October 6, 2014
Accepted: October 20, 2014
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Abstract

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

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

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

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

Keywords

Traditional Persian Medicine (TPM) Modern Medicine Flatulence

Copyright © 2016, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Context

The feeling of abdominal fullness, tightness, and movement of gas in the abdomen is a very uncomfortable condition (1). Flatulence is the passage of excessive amounts of gas and the feeling of abdominal fullness and bloating. Flatulence is one of the most common complaints of patients (2). Approximately 15 - 23% of Asians and 15 - 30% of Americans suffer from flatulence (3). Community surveys have revealed that around 10 - 30% of individuals reported bloating during the previous year. The symptom is about twice as common in women as it is in men (4). According to the ROMEIII diagnostic criteria, for a diagnosis of flatulence, a feeling of gas and an observable recurrent distention of the abdomen must have occurred for the first time ≥ 6 months before the patient presents and must have been present ≥ 3 days a month during the last 3 months without any other causative underlying disease. In that case, the condition is called functional flatulence (4, 5). Unfortunately, according to modern medicine, the cause of flatulence cannot be determined in many cases. It may occur due to functional gastrointestinal disorders, irritable bowel syndrome, psychological disorders, or because of aerophagia (2, 6). Modern medicine offers a few methods to treat simple flatulence, such as the consumption of simethicone and its derivatives and some antibiotics (7).

On the other hand, today the world is moving toward integrating complementary and alternative medicine (CAM) into modern medicine. Traditional Persian medicine (TPM) is one of the richest branches of complementary medicine (8). TPM offers a holistic outlook about health and disease, and its preventive approach precedes its curative one (9, 10). TPM has deep roots in the history of medicine. It dates back thousands of years to an ancient era (11). Persians have a well-developed system of medicine based on a humoral paradigm that existed before Islam (12). In the early Islamic era (9 - 12th century AD), Persian medicine flourished and became the main paradigm of medicine in the east and west (13). Some Persian manuscripts, such as the Canon of Avicenna and Liber continent of Razes, were still the main reference books in western universities until the 17th century AD (14, 15). This traditional system of medicine that has thousands of years of background can be considered a good potential source to find new approaches for the prevention and treatment of many conditions.

Traditional Persian references have been repeatedly discussed; traditional scholars, such as Avicenna and Razes, have comprehensively explained flatulence, its etiology, and preventive and curative methods. They have illustrated exhaustive advice, especially in regards to diet and eating manner modification, to overcome flatulence. In this study, we will discuss the causes, prevention, and remedies of flatulence from a TPM point of view.

2. Evidence Acquisition

As the first step, TPM resources and books, such as Qanun fi al-Tib, Exir-e-Azam, Teb-e-Akbari, Mofarah al-Gholoob, Makhzan-ol-Advieh, Al-Aghraz al-Tebbieh va al-Mabahes al-Alayieh, Raz-e-Darman (Table 1), were carefully studied to identify the parts related to digestive and gastrointestinal diseases; flatulence was searched for manually using the terms Nafkh, Nafkhah, and Rih. Next, the definition, etiology, and treatment of this condition were deduced, summarized, and classified. Then, their practical and usable advice and suggestions were noted. The word “flatulence” and the associated medicinal herbs were used as search terms in modern medicine texts and articles via indexing sources such as PubMed, Scopus, Google Scholar, and IranMedex. Finally, experienced and practical advice from TPM for the treatment of flatulence was explained, and evidence of the same methods in modern medicine was illustrated.

Table 1. A List of the Persian Manuscripts Used in This Paper
Persian NameLatin or English NameWriterDate WrittenReference
Qanun fi al-TebCanon of MedicineAvicenna1027(16)
Al-Aghraz al-Tebbieh va al-Mabahes al-AlayiehMedical PursuitsJorjani1131(17)
Qarabadin-e-KabirGreat PharmacopeiaAghili Khorasani Shirazic. 1770(18)
Makhzan-ol-AdviehStorehouse of MedicamentsAghili Khorasani Shirazi1771(19)
Teb-e-AkbariAkbari’s MedicineArzani18th century(20)
Mofarah al-Gholoob-Arzani18th century(21)
Exir-e-AzamGreat ElixirChashti (Azam Khan)1810(22)
Hefz–al- Sehat Naseri-Gilani1861(23)
Raz-e-DarmanSecret of TreatmentAbdollah Ahmadieh19th century(24)
3. Results
3.1. Definition of Flatulence From a Traditional Medicine Perspective

In TPM references, flatulence is called Nafkh (19), Nafkhah (20), and Rih (19). Mohammad Akbar Arzani (18th century) and Mohammad Hossein Aghili Khorasani (18th century) wrote that flatulence is the bloating of the abdomen (19, 20), and Mohammad Azam Khan (19th century) verified their statement (22). Seyed Ismaiel Jorjani (12th century) also believed that flatulence is abdominal flatus (17). In traditional scholars’ opinion, Nafkh also can occur in the liver, uterus, eyelids, and even muscles and nerves (18); however, the purpose of this article is to discuss gastrointestinal flatulence.

4. Conclusions

One of the most important causes of flatulence is an incorrect manner of eating. TPM suggested that modifications and corrections of eating habits are the best solutions for the treatment of flatulence. They proposed some valuable advice, such as eating simple and easy-to-digest foods, and some effective additives and herbal compounds to take to overcome flatulence. Paying greater attention to TPM may lead to the discovery of new preventive and curative approaches to avoid and treat flatulence. In addition, the Persian point of view in the medieval era about flatulence is historically important. This review shed light on some parts of the history of medicine in medieval Persia and suggested potential remedies to manage flatulence supported by current findings and evidences. However, further investigations will be needed to evaluate these suggestions in experimental and human studies to approve new natural remedies based on traditional knowledge.

Footnote
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