Cataract etiology and prevention in traditional Persian medicine texts

Afsaneh Bonyadi; Assie Jokar; Mostafa Moallemi

doi:10.4103/JNMS.JNMS_23_19

ORIGINAL ARTICLE

Year : 2019 | Volume : 6 | Issue : 4 | Page : 192-196

Cataract etiology and prevention in traditional Persian medicine texts

Afsaneh Bonyadi¹, Assie Jokar², Mostafa Moallemi³
¹ Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
² Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences; Persian Medicine Department, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
³ Department of Islamic Thoughts, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

Date of Submission	07-May-2019
Date of Acceptance	28-Jul-2019
Date of Web Publication	6-Sep-2019

Correspondence Address:
Dr. Assie Jokar
Department of Persian Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari; Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari
Iran

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNMS.JNMS_23_19

Abstract

Context: According to the World Health Organization, cataract is the most common retrievable blind cause in the world. Nowadays, surgery is the only treatment to restore vision in patient with cataract. In regard to the high costs of surgery, prevention has a particular importance. In modern medicine, cataract risk factors are hardly preventable.
Aims: Determination of the etiology and preventive solutions of cataract in traditional Persian medicine (TPM).
Settings and Design: This is a summative qualitative content analysis that focused on Persian medicine texts in from 4^th to 13^th AH centuries.
Materials and Methods: TPM literature were searched during centuries 4^th to 13^th AH, by using this key words: “Nuzūl-ul-mā”, “Ā’b murwārīd” and “āb āvardan chishm” or just “Mā,” and Databases (PubMed, PMC, Google Scholar, and Scopus) were searched by: Cataract; risk factor, etiology, prevention and treatment of cataract; This research has been done in seven phases.
Statistical Analysis Used: All data about the treatment of cataract were collected and categorized into modern style.
Results: According to TPM, to prevent cataract, first, it must be reduced or eliminated the causes of cataract; Those causes are classified to four themes such as physical factors, habits and inappropriate lifestyle, diseases, and age. Persian Physicians (Ḥakīm) proposed and used some prevention and medications to change some of these etiological factors to decrease the incidence of cataract.
Conclusions: In this research, a wide range of preventive measures for cataract is observed which cannot be found in modern medicine. Changes in some etiological factors such as lifestyle can prevent this disease. Affirming this claim depends on clinical researches.

Keywords: Avicenna, Cataract etiology, Cataract prevention, Traditional Persian medicine

How to cite this article:
Bonyadi A, Jokar A, Moallemi M. Cataract etiology and prevention in traditional Persian medicine texts. J Nurs Midwifery Sci 2019;6:192-6

How to cite this URL:
Bonyadi A, Jokar A, Moallemi M. Cataract etiology and prevention in traditional Persian medicine texts. J Nurs Midwifery Sci [serial online] 2019 [cited 2023 Nov 29];6:192-6. Available from: https://www.jnmsjournal.org/text.asp?2019/6/4/192/266126

Introduction

Cataract is a kind of ophthalmic disease which starts with opacity of the lens and then gradually by the increase in cloudiness of the lens the disease ends up with the decrease in vision.^[1] Cataract is the primary cause of blindness and accounting for 51% blindness throughout the world.^[2],[3] The World Health Organization estimated from a recent global review of surveys that there are 37 million people worldwide who were blind in 2002. By the year 2020, this number is predicated to reach 40 million in the world.^[4] There are many risk factors which can cause or affect the development and progress of it, such as age, smoking, alcohol consumption, exposure to sunlight, low education, poor lifestyle habits, including malnutrition and physical inactivity, metabolic syndrome, diabetes mellitus, systemic corticosteroid use, and possibly prolonged administration of high doses of inhaled corticosteroids.^[5],[6],[7] Yet, age-related cataract is the common cataract in the world.^[8] The effectiveness of physiological antioxidants such as pyruvate and nutritional antioxidants such as ascorbate Vitamin E and carotenoids in delaying the development of experimental cataract has been reported by some investigators.^{[9],[10],[11]} Prevention of reactive oxygen production or scavenging of free radicals would be effective method to prevent or delay cataract formation or progression.^[12] Nowadays, surgery is the exclusive effective treatment in these patients which is commonly used in the world.^[13],[14] Although a surgical replacement of the natural lens with an artificial lens is significantly effective in restoring vision to most patients, it is no free of complication.^[15] Thus, prevents cataract or delays the onset of cataract would be very important.

Traditional Persian medicine (TPM) is a style of traditional medicine based on more than 1000 years of Persian medical practice.^[16] Although TPM's rate of promotion has varied during its history, it has never been static.^[17] TPM (as a complementary medicine) is based on elements (Arkān), temperaments (Mizāj), humors (ālāt), organs (A‘’aḍā), spirits (A‘rwātḥ forces (Quwā) and function (A‘f’āl)^[16],[18] According to TPM, the human body comprised the four primary elements: Earth, water, fire, and air.^[19],[20] TPM doctrine that based on this and four simple, four combined qualities (temperaments) and four humors.^[21] The ingested food undergoes four stages of digestion, producing four humors in body; humors are blood, phlegm, yellow bile, and black bile which are constructed during the digestion process. The balance of four humors plays an important role in maintaining the health and eliminating the disease.^{[22],[23],[24],[25]}

Persian medicine physician (Ḥakīm) has given more concentration to the prevention of disease rather that it cures. Preserve health was significant that the principal duty of physicians was to keep people healthy and to treat them it they become sick. There are several factors, which are imperative for the maintenance of good health, which is referred to as follows: air, food and drink, sleep and wakefulness, evacuation and retention, body movement and repose, and mental movement and repose.^[26]

Cataract has been recognized and called under the name of descent of the water (Nuzūl-ul-mā) and “āb āvardan chishm” or just water “Mā,” in Persian medical contexts.^[18] Persian medicine physicians believe that cataract is an obstructive disease in which external moisture accumulates between the lens and cornea. They mentioned different (several) colors of the opacity that some types (kinds) could be diminished in the initial stage with effective medication and food.^{[19],[20],[21],[22],[23],[24],[25]} Based on this idea, cataract can be prevented by certain lifestyle modification and avoidance of other etiologic factors. Because they are believed that effective treatment of disease, occurs when cure and elimination of etiologic causes happen simultaneously.^{[19],[27],[28]} In this study, we tried to collect etiologic factors of cataract based on ancient Persian medicine texts. Thus to this end, we will propose solutions for the prevention of cataract to the community of new medical researchers.

Materials and Methods

This article is a summative qualitative content analysis. All approaches to qualitative content analysis require a similar analytical process of seven classic steps:^[29]

Formulating the research questions to be answered – “What is cataract disease in Persian Medicine texts?” In the Persian medicine texts, we do not find any disease that called as “Cataract.” To find the name of “Cataract” disease in the context of Persian medicine, we tried to collect all data's about cataract in the context of up to date modern texts; this information includes physiology, etiology, symptoms, signs, risk factor, and treatment of cataract. And then, we tried to find one or more diseases have the most overlap with cataract disease. As a result, Cataract in Persian Medicine texts is known as “Nuzūl-ul-mā”, “āb murwārĪd” and “āb āvardan chishm” or just “Mā”
Selecting the sample to be analyzed – In this study, all of the available Persian medicine texts that are reference for the study of specialized Ph.D. students in this field were selected. These texts included manuscripts (the book itself or its electronic file) in different centuries from 4^th to 13^th AH; first, we studied and searched seven basic therapeutic (Moalejat) books:

Cannon of Avicenna (al-Qānūnfī al-Ṭibb)^[17]
Complete book of the medical art (Kāmil al-ṣinā‘a al-ṭibbīya) of Haly Abbas ^[24]
Treasure dedicated to the king (Zakhīra-iKhwârazmshâhī) of Khwarazm of Sayyid Esmail Ğurğānī^[25]
Kirmānī 's šaḥ ’ Asbāb wa ‘ Alāmāt^[26]
Yamani's Nūr Al-uyūn ^[27]
šāh Arzāanī's Ṫibb Akbari.^[28]
NāẒim ǧahān 's iksīr ’A‘ Ẓam.^[30]

To identify explicit versus euphemistic terms – Word frequency counts for each identified term calculated with source, to contextualize the codes. Modern equivalent terms were identified.
Coding process – All Persian Medicine physicians (ḥukamā), when written about special disease, were recorded their knowledge and experience under three titles: definition and name (Name Bimari), ethology (Asbab va Elal), and treatment (Darman). According to knowing this predominant pattern in TPM context, we coded and categorized all data under these titles and six stages. We tried to translate these finding from Arabic and Ancient Persian to modern medicine language.
Defining the categories [Figure 1] – All data were classified in three categories: definition (Stages 1, 2), etiology (Stage 3), and treatment (Stage 4, 5, 6) of āb murwārīd.” “Definition” was divided to these subcategories: name of disease (Stage 1), symptom and signs (Stage 2). “Treatment” was divided into recommendations to prevention (Tadabir) (Stage 4), food and drug treatments (Stage 5), and manual intervention (Stage 6).^[31] This article is focused on Stages 3–5.
Trustworthiness – Credibility, conformability, and dependability: Given the explanation of different stage of methods such as key words and codding process. Anyone who has the ability to read and understand Arabic and Ancient Persian language and texts, can derive similar results.
Transferability – According to the goals and results of this study, this issue is not considered.
Analyzing the results ^[31],[32] – According to summative qualitative content analysis and given the skill of the authors of this article, we tried to collect all data about the prevention and treatment of cataract and categorized these findings into modern style, to achieve this goal: “These findings can be made available for new researches.”

Figure 1: Definition of categories

Click here to view

Results

In Persian Medicine contexts, treatment strategies for all disease included three main categories: the first step of the treatment is a change in lifestyle (ḥifẓi ṣiḥḥa), the second step is medication (treatment by food and herbs single or in combination), and the final step is manual intervention and surgery.^{[15],[28],[29],[30],[33],[34]} According to Persian Medicine physicians (ḥukamād) doctrine,^[35] the causes of cataract classified into four categories: physical factors, habits and inappropriate lifestyle, diseases, and age.^{[1],[15],[22],[23],[24],[25],[26],[27],[[36],[37],[38]}

Physical factors such as trauma and external exposure to cold or snowy weather
Habits and inappropriate lifestyle include:^{[28],[30],[34],[39],[40]}

Consuming foods that produce steams, such as raw garlic and onion, cabbage, kohlrabi
Consuming foods that produce dense humors, such as beet, tick and sticky foods, pizza cheese, and pasty pottage
Sleep immediately after meal
Coitus immediately after meal
Heavy body lifting
Decanting of very hot water on the head
Continual eating wet foods and the foods that are difficult for digestion: compact food and polyphagia
Everything that cools brain temperament such as consumption of all type of milks, fishes, much fatty foods, vinegar and drunkenness, and oversleeping.

Disease – History of some diseases such as severe consecutive vomiting; chronic headache; severe bleeding; any chronic disease; human with cold temperament especially after chronic diseases; and obstruction in optic nerve
Age – The last factor, old age could be risk factors for visual weakness (normal aging process makes brain temperament to be cold).^{[15],[23],[27]}

As a secondary result, decrease in the consumption of food which produces steam, and abstaining hard-digesting foods or foods that cool brain (make cold brain), and avoiding the exposure of severe cold to eyes, or trying to treat chronic headache, and decreasing of bleeding and avoiding the one-sided sleep in chronic patients during a long time are suggested to prevent or hinder cataract.

Discussion

Nowadays, new researches indicate significance treatment in cataract, but there is no proven therapy to either prevention of cataract formation or slowing progression of lens opacity once it develops.^[8] However, observational studies suggest that some interventions may be helpful such as eating a healthy diet,^{[41],[42],[43],[44],[45],[46],[47]} diets rich in lutein, zeaxanthin, and B Vitamins;^{[9],[44],[45],[48]} smoking is associated with a higher risk of developing nuclear cataract,;^{[7],[42],[46],[47],[49],[50],[51],[52]} and postmenopausal estrogen use (longer than 10 years) may reduce the risk of nuclear cataracts.^[53] Increased dietary glycemic load is not associated with risk for cataract,^[47] and no studies have been performed to evaluate whether blood sugar control in patients with diabetes correlates with cataract risk. Multiple randomized trials have investigated whether vitamin supplementation can prevent cataracts.^[43],[44]

Despite this wide and varied range of researches on the prevention of cataracts, but there is no evidence that any particular type of change performance that can be prevent cataract or slow cataract progression.^[43],[44]

Whereas according to the Persian medicine texts, several items can be preventive for the creation of cataract including trauma (head and eye); external exposure to cold or snowy weather; eating foods that produce steams, such as raw garlic and onion, cabbage, and kohlrabi; eating foods that produce dense humors, such as beet, tick and sticky foods, pizza cheese, and pasty pottage; sleep after meal; coitus immediately after meal; heavy body lifting; decanting of very hot water on head; continual eating moist foods and the foods that is difficult for digestion; compact food and polyphagia; every things that cools brain temperament such as eating all type of milks, fishes, much fatty foods, vinegar; and drunkenness and oversleeping. Severe consecutive vomiting, chronic headache, severe bleeding, chronic disease; human with cold temperament, especially after chronic diseases and obstruction in the optic nerve.^{[15],[22],[23],[25],[26],[27]}

These results can be used as hypothesis for clinical researches that can help to reduce this disease. In this study, we tried to collect etiology of cataract according to the viewpoint of Persian Medicine physicians. According to mentioned causes by Persian Medicine, some solution can be recommended to prevent cataract or hinder its development. It can mean that they have been used more commonly during centuries from 11 to 20 AD in TPM to prevent cataract. These results can be used as hypothesis for clinical researches that can help to reduce this disease.

This study has some weaknesses such as low number of books that are reviewed; lack of relevant studies in modern medicine. As a result, we could not provide a precise comparison between modern and TPM about cataract prevention.

Conclusions

According to etiology and risk factors of cataract, there are wide range of preventive measures for cataract to be observed. Those preventive measures cannot be found in modern medicine. Changes in lifestyle such as abstinence from certain foods can prevent this disease. These results can be used as hypothesis for clinical researches that can help to reduce this disease.

Conflicts of interest

There are no conflicts of interest.

Authors' contribution

All authors contributed to this research.

Financial support and sponsorship

This work was supported by a grant from the Mazandaran University of Medical Sciences (No. of Ethic's Committee: 2128).

Acknowledgments

We are thankful to all other investigators, staffs, and participants of this study.

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