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* Corresponding author: Saeed Changizi-Ashtiyani, Traditional and Complementary Medicine Research Center, Arak University of
Medical Sciences, Arak, Iran. Tel: +988634173526; Email: dr.ashtiyani@arakmu.ac.ir
Please cite this paper as:
Asadi MH, Changizi Ashtiyani S, Latifi SAH. Evaluation of the Infantile Colic Causes in Persian Medicine. Iranian Journal
of Neonatology. 2021 Jan: 12(1). DOI: 10.22038/ijn.2020.47287.1810
Review Article
Open Access
Evaluation of the Infantile Colic Causes in Persian
Medicine
Mohammad Hosein Asadi1, Saeed Changizi Ashtiyani1*, Seyed Amir Hossein Latifi1
1. Traditional and Complementary Medicine Research Center, Arak U niversity of Medical Sciences, Arak, Iran
ABSTRACT
Background: Infantile colic is a common condition among neonates; however, its etiology is not fully identified. This
study aimed to evaluate this complication and search for treatments by investigating the experiences of Iranian
physicians.
Methods: In this review study, the infantile colic was initially studied in modern medicine. To this end, an electronic
search was performed in databases, such as Web of Science, Medline (via PubMed), Scopus, EBASE, UpToDate
(International databases), Magiran, SID, Irandoc, IranMedex (National databases), and the Google Scholar search
engines. Subsequently, this complication was investigated in the original references of Persian medicine. In this regard,
the words related to the subject matter of the research were taken from the original books of Iranian medicine,
including Al-Mansouri Fi Al-Tibb, Canon, Kholasatol Hekmah, and Kholasat Al-Tajarob.
Results: The results of this study indicated that factors, such as maternal mood during pregnancy, inappropriate
maternal nutrition, gastrointestinal problems, and infantile cerebral problems are some of the causes that have been
mentioned regarding infantile colic in modern and Persian medicine. Other causes, such as spinal nerve stimulation,
insomnia, and sleep apnea are also raised in Persian medicine. Almost all of these causes are due to poor digestion of
milk and pneuma in the gastrointestinal tract. Iranian physicians have considered solutions, such as massage with
special oils, nutrition modification, and the use of hypnotics to reduce pneuma production in the gastrointestinal tract
as well as its side effects. The application of these recommendations together can help better treat infantile colic. In
this regard, the data were categorized by reviewing the works of Iranian scholars, as well as combining modern
medical findings and Iranian experience. Accordingly, a new definition of colic can be provided and some new
treatments are added for infantile colic based on modern and traditional medicine
Conclusion: Since the positive role of some measures, such as massage and swaddling in modern medicine is
confirmed, the investigation and recommendations of Iranian physicians in the field of infantile colic seem to be able to
compensate for the gap in identification, prevention, and treatment of this complication.
Keywords: Infantile colic, Infant crying, Persian medicine
Introduction
Infantile colic is a common problem observed
among neonates in the first three months of birth.
Wessel (1954) first defined this syndrome in
modern medicine. According to his definition, colic
is severe crying and restlessness along with face
flush for at least 3 hours a day, 3 days a week,
which continues 3 weeks (1). Possible causes of
colic include gastrointestinal, biological, and
psychosocial causes (2). Changes in the intestinal
microbial flora, intolerance of cow's milk protein or
lactose, increased serotonin secretion, as well as
external factors, such as stress during pregnancy
and delivery, inappropriate communication with
infants, stresses at home, and malnutrition of
infants, are some of the factors in this regard (3).
Since the exact cause of colic is unknown,
different therapies are common in the treatment
of infantile colic; however, none of these methods
are completely effective (4). According to the
scientific publications, provided evidence indicate
the rising trend of the positive effects of some
treatments in this field. Diet control, medication
therapy, behavioral therapy, and complementary
medicine are options to control this complication
Asadi MH et al
Infantile Colic in Persian Medicine
34 Iranian Journal of Neonatology 2021; 12(1)
Figure 1. A late Babylonian tablet spelling out a ritual to quiet
a crying child
(5). The use of medical experiences in different
schools can also be useful. Although the ancients
did not have a precise definition of infantile colic,
human understanding of this complication is in
such a way that the use of Papaver somniferum
(poppy) was stated by Egyptians to stop the
continuous crying of the infant in Ebers Papyrus
(1600 BC) (6). Moreover, lullabies, religious songs,
and sacred soil were being used to stop crying
infants in the second half of the first millennium
BC in Mesopotamian civilization. Moreover, the
Babylonian tablet discovered in the south of
Baghdad confirms this issue (Figure 1) (7).
Greek physicians, such as Galen (Claudius
Galenus) (129-210 AD), also prescribed opium for
sedating infants who were crying repeatedly (8).
There are also ways to prevent and treat infantile
colic in Iranian medical schools. Evaluation of
these methods may lead to finding an appropriate
treatment for infantile colic.
Although some studies were conducted on the
treatment and prevention of colic using the
perspective of traditional Iranian medicine, they
investigated case-by-case and had a limited basis
only concerning some treatment methods (2, 3).
However, in traditional Iranian medicine, there
are many strategies for the treatment of this
complication, and it seems that by examining and
combining them with modern medicine, it is
possible to take more effective steps regarding the
prevention and treatment of neonatal colic.
Methods
The present review attempted to find an
answer to the main question of the study whether
there is a definition of neonatal colic in traditional
medicine and what strategies Iranian physicians
used to treat neonatal colic. To this end, the data
were collected using original reference books in
Persian medicine, such as The Canon of Medicine
(Al Qanun Fi Al-Tibb), Al-Mansouri Fi Al-Tibb,
Zakhireye Khwarazmshahi, Kholasa'tol Tajareb,
and Kholasa'tol Hikma. Moreover, a manual and
electronic search of references and articles
published by modern medicine in databases, such
as SID, PubMed, Magiran, Irandoc, IranMedex,
UpToDate, and Google scholar search engine was
performed using the keywords, including "colic",
"infant crying", and "pneuma". The obtained data
were then analyzed in this study.
Results and Discussion
Causes of Colic
Pregnancy Period and Delivery
Recent types of research indicate that stress
during pregnancy directly affects crying
and infantile colic. Furthermore, childbirth
complications have direct effects on infants.
Scientists have found a direct correlation between
childbirth complications and infant crying. More
stressful deliveries have been associated with
more crying (9). Mothers who have stressful
problems during pregnancy are more likely to
report colic in their infant, and there is a direct
correlation between infantile colic and bitter
experiences during pregnancy (10).
Iranian physicians have also been aware of the
effect of pregnancy conditions on infants, and they
have concerned about avoiding pregnant mothers
from bad moods while giving various
recommendations and mentioning them in their
textbooks. In this regard, Hakim Arzani in
Mofareh-al-Qoloub states: "Women should avoid
anger, sadness, and sorrow during pregnancy,
especially the first month" (11). Avicenna goes
farther and even advises on mental states during
sexual intercourse: "If couples intend to have
children, they should avoid sexual intercourse
when they are sad, experience any resentment, or
even when they are afraid of something" (11, 12).
Furthermore, Avicenna advises on delivery time to
keep the mother calm during delivery: "At the
time of delivery, the delivery room should be at a
moderate level in terms of coldness, warmness,
lightness, and darkness. In addition, one of the
people closest to the person should be there to
participate in activities, such as pouring hot water
on the waist and anointing oil on the back" (13). It
is not clear whether the Iranian physicians have
considered these recommendations to avoid
crying and colic. They could have been effective in
reducing infantile colic by reducing stress during
pregnancy since the effects of stress during
pregnancy and delivery have been identified today
on infant crying. Moreover, recommendations,
Infantile Colic in Persian Medicine
Asadi MH et al
35 Iranian Journal of Neonatology 2021; 12(1)
such as the cooperation of the parturient woman's
relatives with the midwife, which is still used
today in methods, such as Bradley (14) should be
accepted to alleviate maternal pain and stress.
Infantile Migraine and Subdural Hematoma
Various studies have shown the correlation
between infantile migraine and colic. Children
with migraine had a higher rate of colic, and this
ratio was reported as much as 41.6 versus 35.7 in
a study (15). In this regard, anything that helps an
infant sleep can also prevent migraine attacks.
Moreover, the prevention of some stimuli, such as
loud music and high light can help to prevent
crying infants with migraines. Slow infant
movement is also effective in this regard (16). It is
worth mentioning that subdural hematoma can
cause severe crying in infants (17).
The relationship between cerebral problems
and infant crying has also been mentioned in
Persian medicine. Hakim Arzani (17-18 AD)
indicated the reason for infant crying: "Brain
disorders are among the causes of infant crying,
and one of the treatments in this regard is to
expose the infant's nose to castoreum". Another
reason for infant crying is gathering liquid in the
infant's head. According to Iranian physicians, it is
due to the wetness of the infant's brain as well as
the pressure that is put on the infant's head by the
midwife's hand. Hakim Arzani states a remedy in
this regard: "You have to cut a sour lemon, pour
salt on it, and heat it on the fire. Subsequently,
compress it over the protuberance from the cut
side. Doing this two to three times a day for a few
days can help relieve the complication." He
eventually mentioned that this complication
occurred for his child, and he treated the child
using this technique (11,18).
Infant Gastrointestinal Disorder
Disorders, such as infantile intestinal microbial
flora, anal stenosis, and bowel motility can affect
the infantile colic in such a way that the bowel
motility in infants is known as an underlying
factor in the colic the possible cause of which is
the lack of development of the autonomic nervous
system. Anatomical causes, such as anal stenosis,
may also make this high level of motility. Chronic
constipation, flatulence, and fecal disorder caused
by a disturbance in the passage will be associated
with increased bowel motility. Studies also show a
difference between healthy infants and those who
had colic in terms of intestinal microbial factors
(Table 1). This can be responsible for changes,
such as inflammation, excess stomach gas, and
flatulence in infants with infantile colic (2, 19, 20).
Iranian physicians have also cited problems,
such as fecal retention in the digestive tract as one
of the reasons for infant crying. In this regard, Ali
Ibn Abbas Ahwazi mentions some of the reasons
for infant crying: "The reasons for the infant
crying are hunger, thirst, heat, cold, as well as pain
in the organs, urine, and fecal retention" (21).
According to physicians, one of the reasons for
fecal retention is the weakness of repulsive force
in the gastrointestinal tract and anal spasm. To
solve this problem, Avicenna and other Iranian
physicians recommend bladder and abdominal
massage with oil after birth. The midwife should
anoint her little finger into the violet oil and enter
the infant's anal to open the spasm. This should be
continued until a few days after birth (13, 22).
Since this type of care was provided to most of the
infants, it can be concluded that in addition to
assisting the fecal defection in all infants, this
complication in Persian medicine has also been
remedied in infants with anal stricture by timely
detection and treatment, which is one of the
causes of infantile colic.
Nutrition
A randomized controlled trial showed a
significant decrease in colic symptoms among
infants whose mothers followed a low-allergen
diet (23). Infants of lactating mothers who have
eliminated foods, such as cow's milk, peanuts,
wheat, soybeans, and fish from their diet are less
likely to cry during the day (24).
Iranian physicians also believe that the quality
of breast milk is influenced by the food the
mothers consume. They generally recommend
that they should consume some foods and prohibit
the consumption of certain foods. In this regard,
Avicenna states in the Canon of Medicine: "Bread
made from Roman wheat, as well as lamb, goat,
grape, fig, almond, and hazelnut, are suitable for
the mother". Moreover, regarding the prohibition
of certain foods, he states: "Mothers must avoid
the Garden cress, Mustard, and Ocimumbasilicum
(basil)" (25, 26).
Another factor that affects the quality of breast
milk is the mother's mood. Avicenna states: "The
mother must have a good mood to avoid
stubbornness and bitterness, and her physical
symptoms, such as sadness and anger should not
affect her rapidly since all these conditions can
alter the quality of milk and negatively affect the
infant" (25).
Another important factor in infant crying is the
amount of milk the infant drinks per day. Rhazes
Asadi MH et al
Infantile Colic in Persian Medicine
36 Iranian Journal of Neonatology 2021; 12(1)
Table 1. Factors Affecting Infantile Colic in Modern and Persian Medicine and Ways to Prevent or Treat Them
Suggested ways of treatment or
prevention
Factors affecting infant crying in
traditional medicine
Suggested ways of
treatment or prevention
Factors affecting infantile
colic in modern medicine
Consumption of wheat, lamb, figs,
grapes, fresh fish, almonds and
hazelnuts by breastfeeding
mothers
Avoiding garden cress, mustard,
and Ocimumbasilicum (basil),
beef, and stale fish by
breastfeeding mothers
Breastfeeding mothers with late
digestive and flatulent diet, which
cause pneuma colic in infants
Removing cows' milk,
wheat, soy, and fish from
the mothers' diet
The use of soy or
hydrolyzed infant formula
for infants who use infant
formula
Breastfeeding mothers with
allergen diet
The infant should be fed enough
milk to avoid flatulence
Drinking too much milk by the
infant leads to pneuma colic in the
infant's intestine
Compliance with nutritional
recommendations and anointing
the infant's vertebrae by pneuma
reducer oils, such as warm water,
sesame oil, and wax
Inadequate food digestion in the
infant's digestive tract due to infant
gastrointestinal weakness and pain
in the vertebrae and intestines due
to pneuma colic and infant
gastrointestinal weakness
Compliance with
nutritional
recommendations
Infantile bowel motility due
to the lack of development
of the autonomic nervous
system
Mothers' avoidance of stubborn
morality because this mood
changes the milk's temper and
affects the infant
Mothers' inappropriate mood can
cause discomfort in the infant by
affecting breast milk
Avoiding stressors during
pregnancy and using
methods such as water
delivery
Stress during pregnancy
and delivery
Smelling castoreum by infants
Hot and dry dystemperament of
the brain
Using ways that make the
infant sleep better
Migraine
Smelling castoreum
Avoid overeating and anointing
temples and vertebrae by oil
Insomnia and seeing scary dreams
by the infant due to overeating or
poor digestion and pneuma colic
vapors in brain
Recommending to open the fecal
way and inserting finger in it and
greasing the anal with oil
Fecal retention in the infant's
intestine due to weakness of the
gastrointestinal tract in defecation
Use surgery to open the
anal way
Infantile bowel motility due
to anatomical factors, such
as stenosis, as well as any
flatus and fecal disorder
(854-925 AD) states in Al-Mansouri Fi Al-Tibb:
"The infant should be fed enough milk to avoid
flatulence because excessive infant milking results
in laziness, drowsiness, restlessness, crying, and
vomiting" (27,28). However, Iranian physicians,
consider spinal pain, insomnia, and pneuma colic
as some of the factors affecting infant crying;
moreover, they believe that these complications
are directly correlated with flatulence caused by
inadequate infant nutrition (Table 1).
Pneuma Colic
The flatulence in the gastrointestinal tract can
cause pain in the intestines, which is called
pneuma colic. Avicenna states: "One of the
diseases of infants is colic, which is a pain in the
intestine. Among the symptoms, one can name
infant crying and writhing. The cure for this
disease is sesame oil, wax, and warm water" (13).
Hakim Arzani explains how to treat pneuma colic
in more detail: "Pour oil, warm water, and salt into
the bladder of a cow and compress on the
abdomen of the infant." He also suggests that the
mother should put her infant on her thighs
prostrated and massage her infant's back with
violet oil to relieve abdominal pain (18).
Spinal Pain
Another consequence of infant flatulence is
spinal pain. Iranian physicians believed that the
pneuma created in the infant's intestines can be
transferred through the vessels, nerve fibers, and
membranes to other organs, including the spine,
thereby causing pain and difficulty. On the other
hand, muscle soreness in this area doubles its
sensitivity to the long stay of the infant in the
Infantile Colic in Persian Medicine
Asadi MH et al
37 Iranian Journal of Neonatology 2021; 12(1)
cradle. Regarding this case, Baha Al-Dawla Razi
states in Kholasa'tolTajareb: "When anointing, you
should massage the infant's nerves and muscles
on both sides of the back vertebrae to the neck
and massage with your finger. I saw many infants
who were crying so close to becoming
unconscious and not breastfeeding. They were not
silent at all but they found the breast and slept
deeply using this way" (29). However, several
studies have recently provided strong evidence
regarding the effects of massage on reducing
stress, anxiety, and pain, as well as intestinal
diseases, such as colic (10).
Seeing Scary Dreams
Sometimes a child wakes up from a horrible
dream and cries. Drinking too much milk causes it
to spoil in the stomach, and the infant will see
scary dreams. The issue of how eating too much
food causes horrible dreams is discussed among
Iranian physicians, and there are two different
theories from Galen and Avicenna in this regard.
Galen states that overeating causes spoilage in the
stomach and spoiled food causes pneuma. The
thick gas from the spoiled food reaches the brain
and causes the spirit to panic. However, Avicenna
believes that the stomach and brain are two linked
organs, and food spoilage causes stomach
discomfort. As a result of this connection,
imaginations are created in the brain, and the
child has a terrible sleep (11, 25). Aside from
discussing how full stomachs can cause terrible
sleep, Iranian physicians agree on how to treat
this condition. Therefore, Sayyed Esmail Jorjani
states in Zakhira textbook: "Mothers should eat
easily digestible foods and prevent infants to sleep
rapidly after breastfeeding. They should stay
awake and add Cumin (Caraway), Thyme, and
Marjoram (Origanum Majorana) to their food"
(22). Concerning the treatment of this
complication, Aghili Shirazi also states: "The cure
is reducing food and not to allow the infant to
sleep rapidly after breastfeeding. If you could not
do this, it is better to put the infant in a cradle and
move for better digestion" (25).
It can be concluded from the following
recommendations that paying attention to the
quantity and quality of infant food and removing
the factors that cause flatulence in infants can
reduce infants' fear of sleep and consequently
reduce infant crying (Table 1).
Insomnia
Iranian physicians consider insomnia as one of
the reasons for infant crying, and they have
suggested some solutions to treat it. One of the
oldest methods is drug use. Rhazes suggests using
opium syrup for infant insomnia, and Avicenna
finds this syrup useful for prolonged crying (6).
Other Iranian physicians, such as Baha Al-
DawlaRazi and Jorjani, have suggested other
narcotic and sedative drugs including poppy
seeds, cannabis, lettuce seeds, castoreum, as well
as Cucurbita seed, violet, lettuce seed, and poppy
oils. To this end, these medications can be used
orally and topically; moreover, they can be inhaled
or consumed by breastfeeding mothers (22).
Aghili Shirazi also states: "One of the things
that is hypnotic and stops infant crying is putting
the infant in the cradle and singing a rich and sad
song devoted to children" (25).
Complementary strategies to reduce infant
crying in Persian medicine
Strengthening the Infant's Skin
Infant skin can be stimulated by environmental
factors, such as cold, heat, and clothing due to its
thinness and sensitivity, which makes the infant
cry. Avicenna states in the Canon of Medicine:
"The skin of a newborn infant is very delicate and
very sensitive to cold and violence, and everything
is harsh to the infant. Therefore, to strengthen the
skin after birth, the infant should be bathed with
brine and herbs, such as sumac and fenugreek.
Moreover, Alpinia galanga can be added to the
brine for better strengthening" (Table 1) (13).
Swaddling the Infant
Swaddling can protect the infant from cold and
heat, which can act the same as a mother's uterus
because of restricting the infant in terms of
movement that make the infant feel relaxed and
secure. Avicenna states in this regard, "Choose a
cloth for swaddling, which is washed and soft.
Then, wrap the infant gently." Recent studies
show that swaddling is effective in protecting the
infant from cold and heat as well as improving
sleep quality and reducing pain (13,30).
Protection against Irritants and Use of Sedatives
Physicians in the past believed that
transferring the infant from the mother's uterus to
this world makes the environmental conditions
very different for the infant. They have therefore
emphasized that the infant's body temperature
should be kept close to the mother's uterus. They
had the same idea about the amount of light and
sound to the infant's eye and ear. They
emphasized that the infant should be kept in a low
light environment and away from strong sounds.
Asadi MH et al
Infantile Colic in Persian Medicine
38 Iranian Journal of Neonatology 2021; 12(1)
Furthermore, they recommended using a good lay
and moving in the cradle for their relaxation.
Rhazes states in Al-Mansouri Fi Al-Tibb: "Put a
cloth on the infant's eyes during the first days of
birth and do not leave the infant in a bright place.
Sing for the infant until h/she starts speaking"
(27,28). AghiliShirazi, in addition to repeating the
Rhazes's recommendations, found the use of the
cradle to be more effective when singing a lullaby.
In addition, he regarded the cradle movement as
an exercise for the infant (25).
Conclusion
Control of infantile colic in Persian medicine is
based on three principles of preventive measures,
medical procedure, and reducing stimulus factors.
Based on the prevention principle of the Iranian
physicians, flatulence and its consequences
(pneuma colic, spinal pain, seeing scary dreams,
and insomnia) can be prevented by helping fecal
defection as well as a quantitative and qualitative
control of maternal and infant food. Solutions,
such as massage with oils and the use of hypnotic
medications eliminates these complications,
which also help prevent them by identifying the
stimulus factors.
Acknowledgments
The authors express their gratitude to the head
of the Department of Medical History, Arak
University of Medical Sciences, Arak, Iran.
Conflicts of interest
There is no conflict of interest regarding the
publication of the study.
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