In traditional Iranian medicine (TIM), temperament (mizaj) assessment plays a key role in prevention, treatment and lifestyle recommendations [1, 2]. In addition to the general temperament of the body, each organ also has its own temperament [3]. Distemperament (Su-e mizaj) occurs when a person does not have a normal temperament or has impaired temperament [4]. In TIM books, indicators for recognizing the temperament and distemperament of the organs are mainly expressed qualitatively. In this regard, the design and standardization of diagnostic protocols is one of the basic needs for scientific development of TIM [5].
The uterus is one of the most important organs in a woman’s body and, according to TIM, is responsible for purifying the blood and maintaining the fetus [6-8]. Distemperament of uterus is one of the most important disorders related to the uterus, which in addition to the uterus and female reproductive system, affect the function of uterine-related organs [9]. Many gynecological disorders in TIM and modern medicine, including infertility, recurrent miscarriage, oligomenorrhea and amenorrhea, hypermenorrhea, vaginitis, cervicitis, urinary incontinence and pelvic pain, have been linked to distemperament of uterus. The correct treatment of these disorders depends on the correct diagnosis and treatment of uterine distemperament [2, 4, 10–12]. In TIM books, many qualitative signs have been proposed for different types of temperaments and uterine distemperament, but there is no indicator for how to measure these symptoms [9]. In this regard, this qualitative study aims to explain the symptoms and characteristics of uterine temperaments, which provides a diagnostic protocol for warm and cold uterine distemperaments [14].

This is a qualitative study using hybrid concept analysis and includes three phases: theoretical, fieldwork, and final analytical. In the theoretical phase, TIM resources were studied and in the fieldwork phase, interviews with patients and specialists were performed to extract concepts related to temperament and distemperament of uterus. In the final analytical phase, the findings of the theoretical and fieldwork phases were compared and analyzed. By combination of the findings of the theoretical and fieldwork phases, a more complete definition of the concept of warm and cold uterine distemperaments and its symptoms was presented based on the principles of TIM. Then, during the meetings with experts in TIM, using the nominal group technique and focus group discussion, work was done on explaining the concepts obtained from the hybrid model. Symptoms were summarized and weighed, and major and minor criteria were presented to diagnose hot and cold uterine distemperaments [14]. Then, the findings related to each criterion were extracted from TIM resources, valid scientific databases and common reference books in the field of women health using several keywords related to each symptom. They were presented at a two-day conference with the presence of 10 TIM specialists with experience in gynecology. Experts examined and analyzed the criteria for each symptom through a focus group discussion, and finally reached an agreement on a clinical definition for each symptom. These definitions were presented in the form of a table entitled “Diagnostic Protocol of Uterine Temperament & Distemperament”

In the theoretical phase, 10 resources from TIM were reviewed and indicators related to determining temperament and hot and cold distemperaments of the uterus were extracted. In the fieldwork phase, interviews were conducted with 12 experts in TIM, 4 patients with cold uterine temperament and 2 patients with warm uterine temperament. In the final analytical phase, results showed that the importance of different symptoms to diagnose uterine temperament was not the same; some were more common clinically and were mostly cited by experts, while some were still unexplained and unclear or there was no criteria for measuring them.

In this study, major and minor criteria and diagnostic protocol for uterine disorders were presented, which is an essential step towards aligning the methods of diagnosis and treatment of Iranian medicine specialists in the clinic. Future research is recommended to validate the indicators presented in this study. In addition, the results of this study are the basis for designing and standardizing diagnostic tools for uterine temperament and other related diseases in Iranian medicine and can be used for research and treatment purposes.
 

This study was approved by Ethics Committee of Shahid Beheshti University of Medical Sciences (Code: IR.SBMU.RETECH.REC.1395.1.24).

This study was supported by Shahid Beheshti University of Medical Sciences.

All authors equally contributed to preparing this article.

The authors declared no conflict of interest.

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