Abstract
Leiomyoma is the most common benign tumor of the pelvic that is associated with reproductive problems such as infertility, frequent abortions, and undesirable prenatal outcomes. High prevalence of leiomyoma and its relation with important gynecological complications, especially during reproductive ages, on the one hand, and high medical expenses and significant complications of common treatments, on the other, made us search traditional Persian medicine texts for a similar disease. In traditional Persian medicine, a condition has been introduced similar to leiomyoma (Oram-e-rahem). In this article, by collecting materials from traditional medicine texts on leiomyoma, we aim to provide theories for further studies on this topic, as there is an obvious difference between traditional Persian medicine and modern medicine with regard to leiomyoma. When modern medicine has not found a suitable response to treatment, reviewing of traditional Persian medicine for finding better treatment strategies is wise.
Leiomyoma or uterine fibroid tumor is the most common benign tumor of the pelvic, with a prevalence rate of 25% to 77% in women of reproductive age. 1,2 It has a 50% frequency rate in autopsy reports. 1 According to pathology reports, 73% of perimenopausal and 84% of menopausal women who underwent hysterectomy have leiomyoma. 3 It accounts for one third of hospitalizations due to uterine bleeding. It is the common cause of menstrual irregularities, pelvic pain, and other symptoms affecting quality of life seriously. Leiomyoma is associated with reproductive problems such as infertility, frequent abortions, and undesirable prenatal outcomes. 1,2
In spite of its high prevalence and importance, there has been no definite etiology for leiomyoma so far. Two theories including genetics and hormonal causes have been mentioned as causes of leiomyoma, and accordingly, several risk factors have been attributed to leiomyoma. 4 Perimenopausal obesity and early menarche can be mentioned as risk factors related to hormonal theory. History of infertility, first pregnancy at young age, tubectomy, menstrual cycle longer than 30 days, more than 6 days of menstrual bleeding, uterine infections like pelvic inflammatory disease, IUD-related uterine infection, and uterine traumas are among other mentioned risk factors. 5 –9
High prevalence of leiomyoma and its relation with important gynecological complications, especially during reproductive ages, on the one hand, and high medical expenses and significant complications of common treatments, on the other, made us to search traditional Persian medicine texts for a similar disease. Therefore, through reviewing well-known texts such as Avicenna’s Canon, Aghili’s Moalejat, Sharh-e Asbab-o-Alamat, Teb-e Akbari, and Alhavi, we tried to match this disease with the uterine diseases mentioned in these texts. We tried to review causes and symptoms of uterine leiomyoma in Traditional Persian Medicine.
Objectives
Since in traditional Persian medicine texts there is no exact reference to leiomyoma or other related terms, the present study aimed at searching for a disease mentioned in traditional Persian medicine texts that has maximum similarity with leiomyoma in regard to symptoms. This review was done to improve current medical strategies for the prevention and treatment of leiomyoma and reducing its complications.
Materials and Methods
In the first part of this qualitative study, based on the suggestion of an expert panel of judges, The Canon of Medicine by Avicenna (980-1037 AD) and Alhavi by Razi were reviewed. Meanwhile, different medical databases including PubMed, Scopus, SID, and Magiran were searched to gather information on symptoms of leiomyoma. In the second step, by comparing findings of traditional texts and modern databases, we tried to find the disease in traditional medicine that had the most common symptoms with clinical symptoms of whatever is called leiomyoma in modern medicine. During the study, we attempted to hold many sessions for reviewing and discussing original data in order to clarify and interpret those that were not clear. The summarized data by the first researcher were reviewed and discussed by other members of the research group, and all authors participated in data analyses. In order to ensure the soundness of the study, trustworthiness criteria of qualitative studies were considered. To select the most precise words and phrases for labeling themes, the research team held continuous and regular meetings for consultation, interpretation, and discussion over ambiguities in the process of analyses.
Results
The base of traditional Persian medicine is the “theory of humors.” According to this theory, the human body consists of 4 humors: dam (blood), balgham (phlegm), safra (yellow bile), and sauda (black bile).
10
Healthy status results from a specific proportion of the humors, while diseases are the result of any change (in terms of both quality and quantity) in this proportion.
11,12
The dominance of each humor in the body leads to a specific temperament; therefore, there are 4 temperaments: blood (dam), phlegmatic (balgham), choleric (safra), and melancholic (sauda). In Iranian traditional medicine, temperament is the base of pathology, diagnosis, and treatment, and it has a very essential role in maintaining the healthy status of individuals. Each humor has its own temperament: Blood: hot and moist Phlegm: cold and moist Yellow bile: hot and dry Black bile: cold and dry
The humoral constitution of each individual is unique and determines his or her health status. 13
Definition of Swelling (Varam) From the Perspective of Traditional Medicine
Swelling (Varam) is something that enters the organ mass and increases its volume abnormally. 14
Types of Swelling (Varam)
Symptoms of Swelling (Varam)
Symptoms of swelling (Varam) in traditional Persian medicine are presented in Table 1.
Oram-e-Rahem in Traditional Persian Medicine Books
Types of Oram-e-Rahem and Their Causes in Traditional Medicine
Varam-e-har
Causes include trauma to the uterus, oligomenorrhea, abortion, dystocia, frequent intercourse, remained hymen. 15 –19
2. Varam-e-balghami 19
3. Varam-e-solb (hard)
Varam-e-solb is due to sauda and mostly happen following varam-e-har, and its symptoms are feeling heavy in the site of swelling, feeling of tiredness at the time of movement, leg restlessness in the same side, and feeling heaviness and hardness in pubis and low back when stomach is condensed, and leads to cancer. When the varam is large in volume, it moves the uterine toward the opposite side; that is, when it is on the right side it moves the uterine to the left, and if it is in the left, it moves the uterine to the right side. The same happens when the varam is on the top or bottom. When it is small in volume, it pulls the uterine toward itself. 15 –19
Note: The location of varam based on the location of pain is presented in Table 2.
Place of Varam and Pain.
Symptoms of Oram-e-Rahem in Iranian Traditional Medicine
Varam-e-Har
Fever, pulse, severe pubic pain in anterior varam or backache in posterior varam, pelvic pain (in bilateral varam), navel pain (sometimes), 15 bladder strain, 15 problem in urination or defecation (depending on the place of pain), headache (especially in the middle of head), severe thirst, black tongue, mouth bitterness, and delirium. 15 –18
Varam-e-Solb
Mild pubic pain (in the case of not becoming cancerous yet), hardness, heavy feeling, difficulty in urination or defecation or both, slimness, lethargy, leg restlessness, tiredness due to movement, big abdomen, hand and foot edema. 15 –18
Varam-e-Balghami
Mild fever, mild pain, edema, heavy feeling in pubic area, hands and feet weakness. 19 Comparison of symptoms of leiomyoma and oram-e-solb-e-raham in modern and traditional texts is presented in Table 3.
Discussion and Conclusion
The results of the present study showed that leiomyoma has not been introduced as an independent disease with the same name or equivalent names in the traditional medicine texts. But after understanding the concept of oram-e-rahem and comparing the symptoms and types with leiomyoma, it seems that in most cases leiomyoma can be considered as varam-e-solb. Common symptoms of uterine varam-e-solb and leiomyoma are feeling a mass in physical exam, pelvic pressure or heavy sensation, urinary symptoms, constipation, ascites, discomfort in pelvic area, and painful intercourse. 1 –9 In modern medicine, infertility and abortion are among risk factors and complications of this disease, and in traditional Persian medicine they have been mentioned as the causes of it. 15 –19 There is no proved etiology for leiomyoma, but 2 theories including the role of genetics and hormonal factors have been mentioned as the causes of this disease and accordingly several risk factors have been attributed to it. 1 –9
According to the theory of humors, the base of traditional Persian medicine, human body is composed of 4 humors. Healthy status is the result of a specific proportion of these humors, while any change in their proportion, both in regard to their quality and quantity, leads to illness. 10
According to Avicenna and other traditional medicine scientists, sauda is the cause of uterine varam-e-solb and this varam mostly occurs following varam-e-har. 15 –19 In traditional medicine, treatment should be done based on the cause of disease. The importance of paying attention to the causes of diseases, mentioned in traditional medicine texts as well as the presented treatments, necessitates further studies in order to make these points more clear and practical. 18 A more in-depth view can pave the way for solving present challenges in the prevention and treatment of fibroid tumors. It is necessary to support any study in this relation in order to find more suitable and practical treatment strategies for patients.
Footnotes
Author Contributions
Mojgan Tansaz and Haleh Tajadini: Design of the study, data collection, and reviewing the manuscript and editing.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval
This study did not warrant institutional review board review as no human subjects were involved.