فهرست مطالب atefeh saeidi

According to Persian medicine (PM), the uterus is an important organ in women, responsible for purifying the blood and nourishing the fetus. Each organ has a specific temperament distinct from the whole-body temperament based on PM. Dystemperament occurs when body or organ Mizaj (Persian word for temperament) deviates from what is considered normal, resulting in malfunction. Many gynecological disorders described in PM and conventional medicine, including infertility, recurrent miscarriage, oligomenorrhea/amenorrhea, hypermenorrhea, vaginitis, cervicitis, urinary incontinence, and pelvic pain, are considered to be associated with uterine dystemperaments. Hence, proper management of such disorders requires precise diagnosis and treatment of uterine dystemperaments. Accordingly, this review study aimed to collect and categorize these symptoms from PM texts and other relevant articles.

In this study, we reviewed 10 well-known PM references, including Canon in Medicine (Al-Qanun Fi al-Teb), the Great Panacea (Exir-e A’zam), the Treasure of Kharazmshah (Zakhireh Kharazmshahi), the Perfect Book of the Art of Medicine (Kamel alSana’a al-Tebbiya), Akbari’s Medicine (Tebb-E-Akbari), Gharshi’s Commentary on Canon of Medicine (Sharh-e Qarshi bar Qanun), Commentary on Hippocrates’ Aphorisms (Sharh-e Fosul-e Boqraat), Summary of Experiences (Kholasa-tut Tajarob), Description of Signs and Symptoms (Sharh-e Asbab va Alamat), and Aghili’s Treatments (Mo’alejat-e Aghili). Moreover, Scopus, PubMed, Web of Science, SienceDirect, and Google Scholar databases were queried with the keywords ‘mizaj’, ‘temperament’, ‘uterus’, ‘uterine’, ‘cold/hot or warm’, and ‘dry/wet’, while Persian databases of Magiran, Iran Medex, and SID were searched using keywords ‘mizaj’, ‘rahem’, ‘garm’, ‘sard’, ‘tar’, and ‘khoshk’ to extract signs and symptoms associated with uterine temperament and dystemperament.

Five indicators were specified in the articles and PM sources for determining the temperament and dystemperament of the uterus as follows: 1) Menstrual blood characteristics (including amount, temperature, color, odor, flow rate, and consistency); 2) Uterine discharge characteristics (including amount, consistency, color, odor, and accompanied symptoms, especially burning and itching); 3) Fertility and pregnancy status (including infertility, abortion, etc.); 4. Other characteristics of the female reproductive system (including pubic hair, menarche age, sexual desire and quality of intercourse, and vaginal and cervical condition on vaginal examination); and 5) General symptoms (including the ten PM indicators of whole-body Mizaj).

PM sources have described the characteristics of uterine temperament and dystemperament in detail. These indices can be used for more effective diagnosis, treatment, and even prevention of gynecological diseases, as well as designing and validation of standard tools for determining uterine temperament and dystemperament.

 Uterus is an important body organ in women responsible for purifying blood and carrying fetus. In Traditional Iranian Medicine (TIM), identifying the uterine temperament (mizaj) is necessary for prevention, diagnosis and treatment of this organ’s diseases. Many gynecological disorders in TIM including infertility, oligomenorrhea, amenorrhea, hypermenorrhea, vaginitis, cervicitis, urinary incontinence and pelvic pain are related to uterine distemperament (Su-e mizaj). Therefore, their appropriate treatment depends on the correct diagnosis and treatment of uterine distemperament. Criteria for uterine distemperament in TIM resources are qualitative with no method for precise measurement of its symptoms. This study aims to develop a standard diagnostic protocol of uterine temperament and distemperament for diagnostic and therapeutic purposes.

 This is a qualitative study using hybrid concept analysis including three phases: theoretical, fieldwork, and final analytical. In the theoretical phase, TIM resources were reviewed. In the fieldwork phase, experts in TIM and patients were interviewed to extract concepts related to uterine temperaments and distemperaments.

 In the final analytical phase, major and minor criteria for determination of uterine temperament were presented. Then, we had a several meetings with a panel of experts in TIM in order to design the protocol which led to the development of a standard diagnostic protocol of warm and cold uterine temperament/distemperament.

 The proposed protocol is an important step towards harmonizing the methods of diagnosis and treatment in TIM, and can be used for treatment or research purposes.

Abstract

Mizaj (temperament) refers to a concept in Persian medicine and is the basis for defining health and disease. Brain, as the most important organ of the body (Aza-e-raeiseh), controls vital functions. So far, no standardized questionnaire has been designed for distinguishing temperament in Persian medicine. Therefore, the aim of this study was to provide a reliable objective self-report questionnaire and a standardized diagnostic checklist for Mizaj identification via determining their reliability and validity in Persian medicine.

This was an exploratory sequential study in which we designed a 121-item questionnaire, and a 20-item checklist as an item pool using Mizaj-related indices searched in Persian medicine references. The number of items for questionnaire and checklist finally reached 35 and 12 after qualitative and quantitative assessments (e.g., content and face validities). The test-retest reliability of each question of the questionnaire and checklist and their consistency were evaluated by participation based on the weighted and Fleiss’ kappa statistics, and intraclass correlation coefficient (ICC). The final version of the questionnaire and checklist were divided into two subscales (i.e., warm/cold and wet/dry), and the minimum and maximum scores were determined.

Significant findings of our data showed that the weighted and Fleiss’ kappa coefficients of the 35-item questionnaire (between 0.4 and 0.9) and 12-item checklist (between 0.4 and 0.8) were found in the study based on their reliability. The degree of reliability in the self-report questionnaire was assessed using weighted kappa (WK), where 6 items of the questionnaire were omitted due to a WK less than 0.6 and the number of items reached 35. While 2 items of the checklist with Fleiss’ kappa (FK) <0.2 were omitted and the number of items reached 12 items. WK coefficients of the 35-item questionnaire (between 0.4 and 0.9) and 12-item checklist (between 0.4 and 0.8) were found in the study, suggesting their reliability. The highest WK was found to be linked to sleep, and psychic and physical functions, suggesting the appropriateness of questions/items and design. The calculated ICC of the two stages for the warm/cold and wet/dry subscales of 35-item questionnaire was determined as 0.92 and 0.91, respectively, showing the stability of total score. ICC of the final score for the warm/cold subscale of the 35-item questionnaire was 0.88 (0.86 to 0.96), while this value was 0.91 for the wet/dry subscale (0.83 to 0.95).

The present questionnaire and checklist were validated in terms of the design, reliability, and validity of a standard Mizaj determination questionnaire and checklist. The final questionnaire and checklist may be capable of distinguishing Mizaj of brain at the clinical and research levels for Persian medicine practitioners.

Uterus is one of the most important organs of a woman which purifies the blood and carries a fetus and its function is related to the main organs like the brain, heart, liver, kidneys, and stomach. Uterine distemperaments are among the most important diseases of this organ and various symptoms are mentioned for them in Persian medicine (PM). Accordingly, the evaluation of these symptoms will help the diagnosis and treatment of different types of disorders related to the female reproductive system.

This concept analysis qualitative study was conducted to collect and classify the symptoms of uterine distemperaments using a hybrid method and included theoretical, fieldwork, and analysis phases. In the theoretical phase, the resources of PM were reviewed, followed by interviewing the experts of PM and patients with uterine distemperament in the fieldwork phase. Finally, the guidelines were provided for diagnosing uterine warm and cold distemperaments.

The signs and symptoms of uterine distemperaments were classified into 5 general categories including menstrual blood characteristics (i.e., volume, consistency, color, smell, temperature, and outgoing speed), uterine discharges, pubic hair characteristics, other characteristics related to the female reproductive system, and the general symptoms. Eventually, the most important concepts were converted to a guideline of “Major and Minor Diagnostic Criteria for Uterine distemperaments”.

In general, the recognition of the symptoms of uterine distemperaments facilitates the prevention, diagnosis, and treatment of different types of gynecologic disorders. The results of the current study can be an appropriate basis for designing and standardizing diagnostic tools for uterine distemperaments and related diseases.