Document Type : Review Article

Authors

1 Department of Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Pharmacology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

3 Department of Traditional Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran

4 Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran

5 Persian Medicine Network (PMN), Universal Scientific Education and Research Network (USERN), Tehran, Iran

Abstract

Background: Irritable bowel syndrome (IBS) is one of the most common functional disorders of the gastrointestinal (GI) tract. Several pathophysiological mechanisms have been proposed for this disorder, but no effective treatment exists for all patients, making it a problematic chronic disease. The present article aims to review the perspective of Persian medicine (PM) scholars, including opinions on patients’ predisposing factors and lifestyle, on this disorder and compare it with recent findings.
Methods: In this review, we searched the leading Persian medical books from the 10th to the 18th century AD regarding the pathophysiology and predisposing factors and the six essential health principles of the diseases with the most congruity with IBS. Moreover, we searched the Google Scholar, Science Direct, and PubMed databases for recent evidence on each item.
Results: According to PM, this syndrome is a heterogeneous disorder resulting from various dystemperaments of the GI tract. Dystemperaments are due to accumulated waste material or excess humors in body organs or exposure to unsuitable weather or diet. Diet, mental status, exercise, body excretions, sleep, and weather are the six essential principles for maintaining health, and imbalance in any of them can cause many diseases, including IBS. Several of these lifestyle recommendations regarding the six essential principles of health are supported by recent research.
Conclusion: PM strategies for preserving and restoring health through lifestyle modification in IBS patients may provide researchers with new viewpoints for exploration.

Keywords

Main Subjects

  1. Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016;150(6):1257-61. PMID: 27147121 https://doi.org/10.1053/j.gastro.2016.03.035.
  2. Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ, 3rd. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. American journal of epidemiology. 1992;136(2):165-77. PMID: 1415139 https://doi.org/10.1093/oxfordjournals.aje.a116483.
  3. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clinical epidemiology. 2014;6:71-80. PMCID: PMC3921083 PMID: 24523597 https://doi.org/10.2147/CLEP.S40245.
  4. Mikocka-Walus A, Turnbull D, Moulding N, Wilson I, Andrews JM, Holtmann G. Psychological comorbidity and complexity of gastrointestinal symptoms in clinically diagnosed irritable bowel syndrome patients. Journal of gastroenterology and hepatology. 2008;23(7 Pt 1):1137-43. PMID: 18070012 https://doi.org/10.1111/j.1440-1746.2007.05245.x.
  5. Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. The Lancet Gastroenterology & Hepatology. 2016;1(2):133-46. PMID: 28404070 https://doi.org/10.1016/S2468-1253(16)30023-1.
  6. Jae Myung P. Long-term Prognosis of Postinfectious Irritable Bowel Syndrome (Gut 2010;59:605-611). J Neurogastroenterol Motil. 2010;16(3):337-8. PMID: 20680178 https://doi.org/10.5056/jnm.2010.16.3.337.
  7. Magni G, Pierri M, Donzelli F. Recurrent abdominal pain in children: a long term follow-up. European Journal of Pediatrics. 1987;146(1):72-4. https://doi.org/10.1007/BF00647291.
  8. Shen Y-HA, Nahas R. Complementary and alternative medicine for treatment of irritable bowel syndrome. Canadian Family Physician. 2009;55(2):143-8. PMID: 19221071
  9. Azimi M, Zahedi MJ. Persian Herbal Medicine in Functional Dyspepsia: A Systematic Review. Current Drug Discovery Technologies. 2021;18(2):272-81.
  10. Amini-Behbahani F, Bahrami M, Minaei B, Eftekhar B, Dadmehr M. Medicinal Herbal Recommendation for Irritable Bowel Syndrome in Medieval Persian Medicine. Iranian Journal of Public Health. 2019;48(11):2105.
  11. Ariyanfar S, Jahromi SR, Rezaeimanesh N, Togha M, Ghorbani Z, Khadem E, et al. Fruit and vegetable intake and odds of pediatric migraine. Nutrition & Food Science. 2019.
  12. Khadem E, Shirazi M, Rahimi R, Bioos S, Ghorat F. Perception of paralytic ileus on viewpoint of Avicenna. Iranian Journal of Public Health. 2017;46(1):150.
  13. Azimia M, Eftekharafzalib MS, Khoram PH, Hasheminasab FS. Comparative study of irritable bowel syndrome in Persian Medicine and Current Medicine: A narrative review. 2020.
  14. Azimi M, Hasheminasab F, Mokaberinejad R, Qaraaty M, Mojahedi M. A review of prevention and adjuvant therapy in acute respiratory syndrome caused by covid-19 from the perspective of persian medicine. Journal of Babol University of Medical Sciences. 2021;23(1):177-88.
  15. Raeiszadeh M, Ebrahimpour N, Iranpour M, Mehrabani M, Mehrabani M, Kordestani Z, et al. Herbal, Animal and Mineral Remedies in Burn Wound: a review of Persian Traditional Medicine literature. Journal of Kerman University of Medical Sciences. 2021;28(5):520-38.
  16. Azimi M, Niayesh H, Raeiszadeh M, Khodabandeh-Shahraki S. Efficacy of the herbal formula of Foeniculum vulgare and Rosa damascena on elderly patients with functional constipation: A double-blind randomized controlled trial. Journal of Integrative Medicine. 2022;20(3):230-6.
  17. Aghili MH. kholasat-al-hekmeh. Nazem E, editor. Gom, Iran: Research Institute for Islamic and Complementary Medicine: Esmailian press; 2006.
  18. Jorjani I. Zakhireye Kharazmshahi [Treasure of the Khwarazm Shah]. Qom, Iran: Jalaleddin Press; 2011.
  19. Arzani MA. Teb-e-Akbari [Akbari’s Medicine]. Qom, Iran: Jalaleddin Press; 2008.
  20. Avicenna. The Cannon of Medicine [In Persian]. Tehran, Iran: Sorush Publisher; 2004.
  21. Chashti MA. Exir e Azam [Great Elixir]. Tehran, Iran: Research Institute for Islamic and Complementary Medicine; 2008.
  22. Rhazes. Al-Hawi Al-Kabir Fi-Tebb(Persian). Tabatabaei SM, editor. Tehran, Iran: Al-Hawi Pharmacy Institute; 1999.
  23. Arzani MA. Mofarreḥ al-qolub. tehran, Iran: almaii Press; 2012.
  24. Hasheminasab FS, Tajadini H, Setayesh M. An evidence-based study on pharmacological treatments of non-alcoholic fatty liver disease based on traditional Persian medicine. Current Traditional Medicine. 2020;6(3):188-202.
  25. Farhud D, Zarif Yeganeh M. Nutrigenomics and nutrigenetics. Iranian journal of public health. 2010;39(4):1-14. PMCID: PMC3481686 PMID: 23113033.
  26. Weber HC. Irritable bowel syndrome and diet. Current Opinion in Endocrinology & Diabetes and Obesity. 2022;29(2):200-6.
  27. Black CJ, Staudacher HM, Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2022;71(6):1117-26.
  28. Costabile A, Santarelli S, Claus SP, Sanderson J, Hudspith BN, Brostoff J, et al. Effect of Breadmaking Process on In Vitro Gut Microbiota Parameters in Irritable Bowel Syndrome. PLoS ONE. 2014;9(10):e111225. https://doi.org/10.1371/journal.pone.0111225.
  29. Talaei B, Ravari SS. Beneficial effects of probiotics in some of the important human disorders: A narrative review. Journal of Kerman University of Medical Sciences. 2022;29(2):203-17.
  30. Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients. 2021;13(2):575.
  31. El-Salhy M, Patcharatrakul T, Gonlachanvit S. The role of diet in the pathophysiology and management of irritable bowel syndrome. Indian Journal of Gastroenterology. 2021;40(2):111-9.
  32. Feng J, Zhou S, Xie Q, Huang T, Xu X, Zhou D, et al. Traditional Chinese Medicine Shenhuang Granule in Patients with Severe/Critical COVID-19: A Randomized Controlled Multicenter Trial. Phytomedicine. 2021:153612.
  33. Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ. The brain-gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut. 2012;61(9):1284-90. PMID: 22234979 https://doi.org/10.1136/gutjnl-2011-300474.
  34. Koloski NA, Jones M, Talley NJ. Evidence that independent gut‐to‐brain and brain‐to‐gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1‐year population‐based prospective study. Alimentary Pharmacology & Therapeutics. 2016;44(6):592-600. PMID: 27444264 https://doi.org/10.1111/apt.13738.
  35. Perna E, Aguilera-Lizarraga J, Florens MV, Jain P, Theofanous SA, Hanning N, et al. Effect of resolvins on sensitisation of TRPV1 and visceral hypersensitivity in IBS. Gut. 2021;70(7):1275-86.
  36. Fan F, Chen Y, Chen Z, Guan L, Ye Z, Tang Y, et al. Blockade of BK channels attenuates chronic visceral hypersensitivity in an IBS-like rat model. Molecular Pain. 2021;17:17448069211040364.
  37. Kim N. Gut-Microbiome-Brain Axis. Sex/Gender-Specific Medicine in the Gastrointestinal Diseases: Springer; 2022. p. 343-60.
  38. Caputi V, Popov J, Giron MC, O'Mahony S. Gut microbiota as a mediator of host neuro-immune interactions: implications in neuroinflammatory disorders. Microbes and the Mind. 2021;32:40-57.
  39. Dehparvar N, Ghazaleh T, Sharifan Z, Taherkhani D, Keyhan Soltani M, Karimi Y, et al. Sleep and its effects on health from the perspective of Persian Medicine. Journal of Islamic and Iranian Traditional Medicine. 2022;12(4):263-70.
  40. Nojkov B, Rubenstein JH, Chey WD, Hoogerwerf WA. The Impact of Rotating Shift Work on the Prevalence of Irritable Bowel Syndrome in Nurses. The American journal of gastroenterology. 2010;105(4):842-7. https://doi.org/10.1038/ajg.2010.48.
  41. Kim HI, Jung SA, Choi JY, Kim SE, Jung HK, Shim KN, et al. Impact of shiftwork on irritable bowel syndrome and functional dyspepsia. Journal of Korean medical science. 2013;28(3):431-7. PMID: 23487413 https://doi.org/10.3346/jkms.2013.28.3.431.
  42. Chang W-P, Peng Y-X. Differences between fixed day shift workers and rotating shift workers in gastrointestinal problems: a systematic review and meta-analysis. Industrial health. 2021:2020-0153.
  43. Saha L, Malhotra S, Rana S, Bhasin D, Pandhi P. A preliminary study of melatonin in irritable bowel syndrome. Journal of Clinical Gastroenterology. 2007;41(1):29-32. https://doi.org/10.1097/MCG.0b013e31802df84c

 

  1. Chojnacki C, Walecka-Kapica E, Lokiec K, Pawlowicz M, Winczyk K, Chojnacki J, et al. Influence of melatonin on symptoms of irritable bowel syndrome in postmenopausal women. Endokrynologia Polska. 2013;64(2):114-20. PMID: 23653274.
  2. Poroyko VA, Carreras A, Khalyfa A, Khalyfa AA, Leone V, Peris E, et al. Chronic Sleep Disruption Alters Gut Microbiota, Induces Systemic and Adipose Tissue Inflammation and Insulin Resistance in Mice. Scientific Reports. 2016;6:35405. https://doi.org/10.1038/srep

 

  1. Conklin AI, Yao CA, Richardson CG. Chronic sleep deprivation and gender-specific risk of depression in adolescents: a prospective population-based study. BMC Public Health. 2018;18(1):1-7.
  2. YIN C, YOU Q-y, ZHANG M-y, DING L. Effect of Shenghuitang on Learning Memory, Levels of IL-6, TNF-α and COX-2 in Hippocampus of Chronic Sleep Deprivation Mice. Chinese Journal of Experimental Traditional Medical Formulae. 2019:96-100.
  3. Wu S, Chen S, Zhao Y, Ma X, Wang R, He J. Association between excessive daytime sleepiness and functional gastrointestinal disorders: a population-based study in China. Journal of neurogastroenterology and motility. 2017;23(2):298.
  4. Lei W-Y, Chang W-C, Wong M-W, Hung J-S, Wen S-H, Yi C-H, et al. Sleep disturbance and its association with gastrointestinal symptoms/diseases and psychological comorbidity. Digestion. 2019;99(3):205-12.
  5. Koloski NA, Jones M, Walker MM, Keely S, Holtmann G, Talley NJ. Sleep disturbances in the irritable bowel syndrome and functional dyspepsia are independent of psychological distress: a population‐based study of 1322 Australians. Alimentary Pharmacology & Therapeutics. 2021;54(5):627-36.
  6. Patel SR, Zhu X, Storfer-Isser A, Mehra R, Jenny NS, Tracy R, et al. Sleep duration and biomarkers of inflammation. Sleep. 2009;32(2):200-4. PMID: 19238807 PMCID: PMC2635584 https://doi.org/10.1093/sleep/32.2.200.
  7. Zhang X, Giovannucci EL, Wu K, Gao X, Hu F, Ogino S, et al. Associations of Self-Reported Sleep Duration and Snoring with Colorectal Cancer Risk in Men and Women. Sleep. 2013;36(5):681-8. PMID: 23633750 PMCID: PMC3624822 https://doi.org/10.5665/sleep.2626.
  8. Syauqy A, Hsu C-Y, Rau H-H, Kurniawan AL, Chao JC. Association of sleep duration and insomnia symptoms with components of metabolic syndrome and inflammation in middle-aged and older adults with metabolic syndrome in Taiwan. Nutrients. 2019;11(8):1848.
  9. Parvizi MM, Nimrouzi M, Lankarani KB, Alorizi SME, Hajimonfarednejad M. Health recommendations for the elderly in the viewpoint of traditional Persian medicine. Shiraz E-Medical Journal. 2018;19(1).
  10. Golbidi S, Mesdaghinia A, Laher I. Exercise in the Metabolic Syndrome. Oxidative Medicine and Cellular Longevity. 2012;2012:349710. PMID: 22829955 https://doi.org/10.1155/2012/349710.
  11. Zhou C, Zhao E, Li Y, Jia Y, Li F. Exercise therapy of patients with irritable bowel syndrome: a systematic review of randomized controlled trials. Neurogastroenterology & Motility. 2019;31(2):e13461.
  12. Nunan D, Cai T, Gardener AD, Ordóñez-Mena JM, Roberts NW, Thomas ET, et al. Physical activity for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2022(6).
  13. Johannesson E, Jakobsson Ung E, Sadik R, Ringström G. Experiences of the effects of physical activity in persons with irritable bowel syndrome (IBS): a qualitative content analysis. Scandinavian Journal of Gastroenterology. 2018;53(10-11):1194-200.
  14. Muller A, Franke H, Resch KL, Fryer G. Effectiveness of osteopathic manipulative therapy for managing symptoms of irritable bowel syndrome: a systematic review. The Journal of the American Osteopathic Association. 2014;114(6):470-9. PMID: 24917634 https://doi.org/10.7556/jaoa.2014.098.
  15. Pitsavos C, Panagiotakos D, Weinem M, Stefanadis C. Diet, Exercise and the Metabolic Syndrome. The Review of Diabetic Studies. 2006;3(3):118-26. https://doi.org/10.1900/RDS.2006.3.118.
  16. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
  17. Hinton JM, Lennard-Jones JE. Constipation: definition and classification. Postgraduate medical journal. 1968;44(515):720-3. https://doi.org/10.1136/pgmj.44.515.720.
  18. Choung RS, Rey E, Richard Locke G, Schleck CD, Baum C, Zinsmeister AR, et al. Chronic constipation and co-morbidities: A prospective population-based nested case-control study. United European Gastroenterology Journal. 2014;4(1):142-51. PMID: 26966534 PMCID: PMC4766536 https://doi.org/10.1177/2050640614558476.
  19. Sumida K, Molnar MZ, Potukuchi PK, Thomas F, Lu JL, Yamagata K, et al. Constipation and risk of death and cardiovascular events. Atherosclerosis. 2019;281:114-20.
  20. Sarnelli G, D’Aniello R, Pesce M. chronic constipation is a risk factor for metabolic syndrom. Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218.https://doi.org/10.1016/S590-8658(13)60366-7.
  21. Chassard C, Dapoigny M, Scott KP, Crouzet L, Del'Homme C, Marquet P, et al. Functional dysbiosis within the gut microbiota of patients with constipated‐irritable bowel syndrome. Alimentary pharmacology & therapeutics. 2012;35(7):828-38.
  22. Zhang S, Wang R, Li D, Zhao L, Zhu L. Role of gut microbiota in functional constipation. Gastroenterology Report. 2021;9(5):392-401.
  23. Lin X, Liu Y, Ma L, Ma X, Shen L, Ma X, et al. Constipation induced gut microbiota dysbiosis exacerbates experimental autoimmune encephalomyelitis in C57BL/6 mice. Journal of Translational Medicine. 2021;19(1):1-16.
  24. Wang J-K, Yao S-K. Roles of Gut Microbiota and Metabolites in Pathogenesis of Functional Constipation. Evidence-Based Complementary and Alternative Medicine. 2021;2021.
  25. Pimentel M, Lembo A. Microbiome and its role in irritable bowel syndrome. Digestive Diseases and Sciences. 2020;65(3):829-39.
  26. Talley NJ, Boyce P, Owen BK. Psychological distress and seasonal symptom changes in irritable bowel syndrome. The American journal of gastroenterology. 1995;90(12):2115-9. https://doi.org/10.1016/0016-5085(95)27100-7.
  27. Pollard KL, Campbell C, Squires M, Palsson O, van Tilburg MA. Seasonal association of pediatric functional abdominal pain disorders and anxiety. Journal of pediatric gastroenterology and nutrition. 2018;67(1):18.
  28. Möller W, Häußinger K, Ziegler-Heitbrock L, Heyder J. Mucociliary and long-term particle clearance in airways of patients with immotile cilia. Respiratory Research. 2006;7(1):10-. https://doi.org/.1186/465-9921-7-10.
  29. Kaplan GG, Szyszkowicz M, Fichna J, Rowe BH, Porada E, Vincent R, et al. Non-specific abdominal pain and air pollution: a novel association. PLoS One. 2012;7(10):e47669. PMID: 23118887 PMCID: PMC3485276 https://doi.org/10.1371/journal.pone.0047669.
  30. Kaplan GG, Dixon E, Panaccione R, Fong A, Chen L, Szyszkowicz M, et al. Effect of ambient air pollution on the incidence of appendicitis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2009;181(9):591-7. PMID: 19805497 PMCID: PMC2764754 https://doi.org/10.1503/cmaj.082068.
  31. Kaplan GG, Hubbard J, Korzenik J, Sands BE, Panaccione R, Ghosh S, et al. The inflammatory bowel diseases and ambient air pollution: a novel association. The American journal of gastroenterology. 2010;105(11):2412-9. PMID: 20588264 PMCID: PMC3180712 https://doi.org/10.1038/ajg.2010.252.
  32. Ananthakrishnan AN, McGinley EL, Binion DG, Saeian K. Ambient air pollution correlates with hospitalizations for inflammatory bowel disease: an ecologic analysis. Inflammatory bowel diseases. 2011;17(5):1138-45. PMID: 20806342 https://doi.org/10.1002/ibd.21455.
  33. Tan T-K, Saps M, Lin C-L, Wei C-C. Is long-term ambient air pollutant exposure a risk factor for irritable bowel syndrome in children? A 12-year longitudinal cohort study. Journal of neurogastroenterology and motility. 2019;25(2):241.
  34. Salim SY, Kaplan GG, Madsen KL. Air pollution affects the gut microbiota. Gut Microbes. 2014;5(2):215-9. PMID: 24637593 https://doi.org/10.4161/gmic.27251.
  35. Beamish LA, Osornio-Vargas AR, Wine E. Air pollution: An environmental factor contributing to intestinal disease. Journal of Crohn's and Colitis. 2011;5(4):279-86. PMID: 21683297 https://doi.org/10.1016/j.crohns.2011.02.017.
  36. Bonora E. The metabolic syndrome and cardiovascular disease. Annals of medicine. 2006;38(1):64-80. PMID: 16448990 https://doi.org/10.1080/07853890500401234.
  37. Kobos L, Shannahan J. Particulate matter inhalation and the exacerbation of cardiopulmonary toxicity due to metabolic disease. Experimental Biology and Medicine. 2021;246(7):822-34.
  38. Jahromi MM, Pasalar M, Afsharypuor S, Choopani R, Mosaddegh M, Kamalinejad M, et al. Preventive care for gastrointestinal disorders; the role of herbal medicines in traditional Persian medicine. Jundishapur Journal of Natural Pharmaceutical Products. 2015;10(4).
  39. Pasalar M, Nayernouri T. Promotion of traditional Persian medicine; a neglected necessity. Arch Iran Med. 2014;17(8):593.
  40. Pasalar M. Persian medicine as a holistic therapeutic approach. Current Drug Discovery Technologies. 2021;18(2):159-.
  41. Nimrouzi M, Zarshenas MM. Holistic approach to functional constipation: Perspective of traditional Persian medicine. Chinese journal of integrative medicine. 2019;25(11):867-72.