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Comparison of Dyspepsia
Symptoms from the Viewpoints of Persian Traditional
and Modern Medicine: A Qualitative Study using
Content Analysis approach
Ali Taghipour (1)
Hamidreza Hosainzadeh (2)
Mahdi Yousefi (3)
Mosarreza Hosaini (3)
(1) MD, PhD Associate Professor in Epidemiology,
Department of Epidemiology & Biostatistics,
Social Determinants of Health Research Center,
Cancer Research Center, School of Health, Mashhad
University of Medical Sciences, Mashhad, Iran.
(2) PhD student in Iranian Traditional Medicine,
School of Traditional Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran,
(3) MD, PhD, Assistant professor in Traditional
Medicine, School of Traditional Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran
MD, Associate Professor in GI specialist, School
of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran
Correspondence:
Hamidreza Hosainzadeh
PhD student in Iranian Traditional Medicine,
School of Traditional Medicine,
Mashhad University of Medical Sciences,
Mashhad, Iran
Email: Hoseinzadehh1@mums.ac.ir
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Abstract
Background:
Dyspepsia is one of the most common reasons
for outpatient referrals. In Persian traditional
medicine, dyspepsia is discussed as a
basic gastrointestinal problem. Considering
the prevalence of this disease and its
diagnostic and therapeutic approaches
in Persian traditional and conventional
medicine, the current study aimed to compare
dyspepsia based on the viewpoint of these
two medical systems and provide an integrated
approach to diagnose and treat this condition.
Methods: The
current comparative study was conducted
based on a content analysis method. The
symptoms of dyspepsia were collected from
literature of modern and Persian traditional
medicine by note taking methods based
on library research strategies, and then
data were analyzed using directed content
analysis.
Results:
Etiologic agents of dyspepsia were more
than 68% similar in the two medical doctrines.
Epigastria, nausea, and vomiting were
the most common symptoms, followed by
heartburn, bloating, early satiety, decreased
appetite, burping, and weight loss. In
the Persian traditional medicine system,
dyspepsia is discussed as gastric indigestion
and its causes, symptoms, and treatments
are also discussed.
Conclusion:
Diseases causing dyspepsia are very
similar from the viewpoint of Persian
traditional and modern medicines. Some
conditions, such as gastric dysfunction,
are thought to be the most common causes
of dyspepsia in Persian traditional medicine,
and some of them can be categorized as
functional disorders. Therapeutic approaches
from Persian traditional medicine can
be used to treat such conditions as an
adjuvant treatment along with routine
methods, and give new ideas for clinical
trials.
Key words:
Dyspepsia Symptoms, Traditional Medicine,
Qualitative Study, content analysis
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Dyspepsia is a permanent or referring discomfort
in the upper abdomen [1]. Generally, pain associated
with dyspepsia is localized in the central part
of the upper abdomen and is naturally different
from that of other gastrointestinal syndromes,
such as gastric reflux and irritable bowel syndrome
[2].
Dyspepsia is one of the most common reasons
for outpatient referrals to clinics. Different
studies conducted worldwide showed that about
1.8–57% of people experience dyspepsia
during their lifetimes [3, 4]. The prevalence
of dyspepsia has been reported to be 19–41%
in European countries [4], 8–14% in Asian
countries [5], and about 3–30% in Iran
[6].
The difference in the prevalence of dyspepsia
among countries may be the result of a real
difference in the incidence, diagnostic indices,
or degree of accuracy in the identification
of gastrointestinal tract lesions (3). Dyspepsia
is diagnosed based on the latest criteria of
Rome III in modern medicine. The criteria for
dyspepsia diagnosis are as follows: 1. bothersome
postprandial fullness, 2. early satiation, 3.
Epigastric pain, 4. Epigastric burning, a criteria
fulfilled for the last 3 months with symptom
onset at least 6 months prior to diagnosis [7].
However, many other symptoms can indicate dyspepsia;
for example, some researchers used the Leeds
dyspepsia questionnaire to evaluate the prevalence
of dyspepsia. Its shortened form (SF-LDQ) with
eight items is also used in some studies [8].
Complementary and alternative medicine is a
medical approach that is different from conventional
medicine, which currently attracts more attention.
The World Health Organization (WHO) and legislative
bodies focused on the capacity of different
countries in traditional medicine and asked
for information on low cost and low risk methods
for managing medical complications [9]. Persian
traditional medicine, with a history of more
than a thousand years, and reliable books and
physicians, could be considered as a medical
doctrine for development of health and hygiene.
According to literature of Persian traditional
medicine, the gastrointestinal function is of
great importance. Dyspepsia is among the disorders
discussed and evaluated in Persian traditional
medicine. According to this doctrine, dyspepsia
is defined as, “incompatible and abnormal
digestion” [10]. Dyspepsia is diagnosed
based on the etiology and symptoms, and the
principles of treatment should rely on the proper
understanding of them [11]. Dyspepsia symptoms
in both the Persian traditional and modern medicines
can be assessed. The current comparative study
helps to better understand the high prevalence
of dyspepsia in different populations and provide
new ideas for researchers to complete the available
diagnostic criteria around the world.
A comparative study is an understanding of a
phenomenon or theory along with comparisons
based on descriptions and explanations of similar
and opposite positions, aimed at understanding
the phenomenon better and finding new ideas
through the provided description and explanations
[12]. In medical research, comparative studies
help researchers look beyond personal limits
and understand hidden aspects of many health-related
difficulties, when viewed through the perspective
of classical medicine, and understand the potential
of complementary medicines, especially traditional
Persian medicine. Considering the profound scientific
and technological developments, performing a
comparative study on the pathophysiology of
diseases from the viewpoint of traditional and
modern medicine is difficult, and possibly even
impossible. Despite the significant developments
in medical science during recent centuries,
the diagnostic model of many diseases is not
stable or consistent.
A comparison between classical and modern medicine
will help to identify the similarities and differences
of the disease, in definition, symptoms, diagnosis,
treatment, and prevention. The current study
aimed to compare and explain the symptoms of
dyspepsia, based on the directed content analysis
approach.
The current comparative study employed content
analysis methodology. First, the symptoms and
diagnosis of dyspepsia were extracted from classical
medicine references. Subsequently, the gastric
diseases along with their symptoms and diagnoses
were extracted from “the Canon” of
Avicenna. Accordingly, other reliable books
on traditional medicine were also evaluated.
Data, including symptoms and the equivalent
words in the traditional medicine references,
were provided in text tags. To analyze the data
based on the content analysis, the gist of each
tag was extracted and the gist that belonged
to each category was collected in a new tag.
In order to achieve the study aims, the extracted
gist, including all symptoms and etiologies
associated and related to the gastric diseases
were collected in text and tables. These findings
were discussed in different sessions in the
researchers’ team from the viewpoint of
accuracy and degree of compliance. They were
then analyzed and explained after the final
approval.
To increase the validity and reliability of
findings, some methods, such as the review of
tags by the research team, evaluation of reliable
and numerous traditional medicine references,
and a panel of experts were integrated. To increase
the reliability of the data, the accuracy of
explanations and the codifying process were
evaluated by the research team. For the final
consensus, the tags and codes were reviewed
by the researchers’ team; cases with no
consensus were discussed to make the final decision.
The inclusion criteria for the Persian traditional
references were as follows:
- The author of the book should have sufficient
credibility in Persian Traditional Medicine.
- The references should be gathered from different
historic eras.
- The original version of Arabic texts should
be available.
- The dictionaries used in the current study should
cover Farsi and Arabic words.
- A panel of experts should approve the inclusion
criteria and selected books.
Accordingly, 8 books were selected: Ferdows-ul-Hikmah
by Ali ibn Tabari (236 A.H.), Kamel-al-Sanatate
Tabiat by Ali ibn Abbas Majousi Ahwazi (4th
century A.H.) [13], Hedayat-ul-Moteallemin fi-tebb
by Rabie ibn Ahad Akhveini Bokhari (4th century
A.H.) [14], Zakhireye Khwarazmshahi and Aghraz-al-Tabiat
by Seyed Esmaeil Jorjani (5th and 6th centuries
A.H.) [11], and Tib-e-Akbari by Akbar Arzani
(12th century A.H.) [15].
In
modern
medicine,
dyspepsia
is
divided
into
two
categories,
organic
and
functional.
The
organic
causes
of
lesions
are:
peptic
ulcers
(15%–25%),
gastroesophageal
reflux
(5%–15%),
gastric
cancers
(less
than
3%),
biliary
tract
diseases
(rare),
abdominal
wall
pain
(rare),
pancreatitis
(rare),
gastroparesis
(rare),
carbohydrate
malabsorption
(rare),
medicines,
stress,
alcoholic
drinks,
and
pregnancy;
functional
causes
include:
gastric
motor
function,
visceral
sensitivity,
mental,
and
social
causes
[1,
4].
Today,
the
most
common
index
to
confirm
the
diagnosis
of
dyspepsia
in
Rome
III
is
the
continuation
of
each
of
the
following
symptoms
for
at
least
3
months
within
the
last
6
months.
According
to
the
references
of
classic
medicine,
epigastria,
nausea,
and
vomiting
are
the
main
symptoms
of
dyspepsia,
followed
by
heartburn,
bloating,
early
satiety,
decreased
appetite,
burping,
and
weight
loss
[7].
According
to
the
provided
definitions,
it
can
be
concluded
that
the
definition
of
dyspepsia
is
based
on
the
symptoms,
most
of
which
are
nonspecific
and
can
be
observed
associated
with
gastric
ulcers,
reflux,
and
gastric
cancer.
From
the
viewpoint
of
Persian
traditional
medicine,
if
the
digestion
is
incompatible
and
does
not
proceed
normally,
the
condition
is
called
dyspepsia.
Complications
associated
with
digestion
are
explained
as
poor
digestion,
indigestion,
and
no
digestion
(Tekhmeh
in
the
Persian
traditional
references)
and
include
a
wide
spectrum
of
dyspepsia.
Hence,
in
case
of
poor
digestion,
food
remains
in
the
stomach
longer
than
normal.
Although
the
stomach
delivers
its
contents
to
the
small
intestine
in
a
delayed
manner,
the
stomach
contents
are
qualitatively
normal
and
the
food
is
digested
sufficiently,
and
is
useful
for
the
body.
In
dyspepsia,
the
quality
of
digestion
changes
and
the
stomach
contents
do
not
have
a
normal
quality;
therefore,
the
food
cannot
be
used
by
the
body,
and
it
is
recognized
as
waste
materials,
which
are
excreted
in
different
ways
via
the
excretory
mechanisms
and
organs.
No
digestion
refers
to
the
status
in
which
the
eaten
food
cannot
be
digested
and
is
not
affected
by
gastrointestinal
secretions;
in
other
words,
the
eaten
food
cannot
be
absorbed
and
accordingly,
the
body
excretes
it
through
vomiting
or
diarrhea.
From
the
viewpoint
of
Persian
traditional
medicine,
dyspepsia
has
different
causes
and
one
of
the
most
important
ones
is
associated
with
food
(qualitatively
and
quantitatively).
The
style
of
eating
and
drinking
refers
to
the
following
points:
insufficient
chewing,
lack
of
sufficient
time
intervals
between
meals,
eating
snacks,
taking
different
types
of
food
during
a
meal,
drinking
plenty
of
fluids
during
a
meal,
eating
hot
and
cold
food
simultaneously,
eating
slow-digesting
and
fast-digesting
foodstuff
during
a
meal,
sleeping
after
a
meal,
eating
food
while
one
is
angry
or
in
a
rage,
taking
a
bath,
exercising
or
having
intercourse
after
a
meal,
drinking
water
while
fasting,
eating
food
when
one
is
not
hungry,
and
overeating.
Other
causes
of
dyspepsia
are
as
follows:
weakness
of
stomach,
abnormal
humors
in
the
stomach,
mental
disorders,
obesity,
pregnancy,
sleeplessness,
abnormal
and
extensive
sleeping,
gastric
ulcer,
gastritis,
weakness
of
the
stomach
muscles,
stomach
tissue
damage,
and
a
congenital
small
stomach.
According
to
Persian
traditional
medicine,
symptoms
of
dyspepsia
are
as
follows:
heartburn,
bloating,
early
satiety,
decreased
appetite,
and
burping
(Jeshaa);
according
to
the
aforementioned
results
and
evaluating
the
symptoms
of
dyspepsia
based
on
modern
medicine,
it
can
be
concluded
that
epigastria,
nausea,
and
vomiting
are
the
main
symptoms
of
dyspepsia,
followed
by
heartburn,
bloating,
early
satiety,
decreased
appetite,
burping,
and
weight
loss.
The
most
important
symptoms
of
the
disease
based
on
Persian
traditional
medicine
are
stomachache,
nausea,
and
vomiting
followed
by
burping
(Jeshaa),
bloating,
decreased
appetite,
early
satiety,
stomach
heaviness,
heartburn,
and
thirst.
Definition
of
dyspepsia:
According
to
modern
medicine,
“Dyspepsia
is
a
permanent
or
recurring
discomfort
in
the
upper
abdomen,”
which
explains,
“how
the
disease
is”
and
provides
a
“description,”
and
explains
dyspepsia
based
on
some
symptoms.
According
to
Persian
traditional
medicine,
dyspepsia
is,
“If
the
digestion
is
incompatible
and
does
not
go
on
its
normal
way,”
which
is
different
from
the
definition
provided
by
modern
medicine.
The
definition
in
traditional
medicine
explains
“the
quiddity”
of
the
disease
and
provides
an
image
of
its
nature
[1,
10].
Symptoms
of
dyspepsia
By
evaluating
and
comparing
the
symptoms
of
the
disease
between
the
two
medical
doctrines,
many
symptoms
of
dyspepsia
in
the
Persian
traditional
medicine
are
similar
to
those
of
modern
medicine,
such
as
epigastria,
which
refers
to
stomachache
in
Persian
traditional
medicine.
In
addition,
nausea,
vomiting,
bloating,
early
satiety,
heartburn,
and
burping
are
other
symptoms.
In
contrast,
some
symptoms
in
traditional
medicine
that
are
not
mentioned
in
modern
medicine
include
thirst
(intensity
of
thirst)
and
stomach
heaviness.
However,
some
symptoms
in
modern
medicine
that
are
not
mentioned
in
Persian
traditional
medicine
include
weight
loss
[1,
10,
11.
13,
14,
15].
Among
the
symptoms
of
the
disease,
epigastria,
nausea,
and
vomiting
are
the
most
frequent
ones
followed
by
heartburn,
bloating,
early
satiety,
decreased
appetite,
burping,
and
weight
loss.
From
the
viewpoint
of
Persian
traditional
medicine,
some
symptoms
cause
dyspepsia,
among
which
stomach
ache,
nausea,
and
vomiting
had
the
highest
frequency
followed
by
bloating,
decreased
appetite,
burping,
heartburn,
stomach
heaviness,
early
satiety,
and
thirst.
When
comparing
the
symptoms
between
modern
and
traditional
medicine,
it
becomes
clear
that
the
frequency
of
diseases
causing
dyspepsia
is
almost
similar
between
the
two
doctrines.
Some
symptoms,
such
as
burping,
had
a
higher
frequency
in
Persian
traditional
medicine
compared
with
modern
medicine,
and
heartburn
was
more
frequent
in
modern
medicine
compared
to
traditional
medicine.
Diseases
causing
dyspepsia
are
similar
in
both
medical
doctrines;
however,
there
are
also
some
differences.
The
most
common
causes
of
dyspepsia
were
evaluated
in
the
current
study
and
accordingly,
out
of
16
main
causes
from
the
viewpoint
of
modern
medicine,
11
(75.68%)
causes
were
mentioned
in
traditional
medicine.
Conversely,
there
were
some
causes
for
the
disease
in
traditional
medicine,
which
were
not
available
in
modern
medicine,
such
as
stomach
dysfunction,
loss
of
eaten
food
humors,
and
retropharyngeal
secretions
[7,
1,
and
10].
Stomach
dysfunction
is
among
the
diseases
that
should
be
diagnosed
by
para-clinical
assessments
and
it
seems
that
a
major
part
of
functional
disorders
can
be
placed
in
this
category.
In
the
Persian
traditional
medicine,
stomach
dysfunctions
were
discussed;
for
example,
there
were
12
dysfunctions
for
the
stomach
and
some
of
them
were
similar
to
those
of
Rome
III,
such
as
cool
and
wet
temperaments.
Weakness
and
looseness
in
the
stomach
wall
and
tissue
is
another
disease
mentioned
in
traditional
medicine,
but
not
available
in
modern
medicine.
Since
disorders
of
the
tonicity
of
stomach
muscles
are
the
most
common
para-clinical
finding,
conducting
more
qualitative
and
quantitative
studies
is
recommended.
Diseases
causing
dyspepsia
are
similar
in
modern
and
Persian
traditional
medicine.
Some
of
them,
such
as
stomach
dysfunction,
are
common
in
dyspepsia
and
most
of
them
can
be
categorized
as
functional
diseases.
Using
Persian
traditional
therapeutic
approaches
can
be
used
along
with
routine
treatments,
in
addition
to
providing
interesting
ideas
for
clinical
trials.
Acknowledgment
This
study
is
a
part
of
the
results
of
PhD
student
project
in
Persian
traditional
medicine
which
is
approved
by
the
ethics
committee
of
Mashhad
University
of
Medical
Sciences
(Code:
IR.MUMS.REC.1394.393)
and
has
been
supported
by
deputy
research
of
Mashhad
University
of
Medical
Sciences
and
this
collaboration
is
appreciated.
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