The Measures of the Persian Medicine Vis-à-vis the Treatment of Premature Ejaculation

Premature ejaculation is a male sexual dysfunction characterized by ejaculation which occurs within about one minute of vaginal penetration and inability to delay ejaculation on the vaginal penetrations. The individuals suffering from the premature ejaculation will reach orgasm before even the minimal penile or sexual stimulation, prior to or immediately after penetration. Premature ejaculation is the most prevalent male sexual dysfunction. It has detrimental effects on the relationship of the partners; it may cause mental distress, anxiety, and depression. Its prevalence rates run the gamut from 20% to 30%. The etiology of this problem is unknown, yet again there are some hypotheses in this regard including anxiety, penile hypersensitivity, and serotonin receptor dysfunction. The use of the Persian Medicine and herbal remedies for the treatment of diseases has a long historical background. Nutrition is the principal stepping stone of the treatment in the Persian Medicine; it proffers various food and remedy options for treating premature ejaculation. Therefore, the authors of the present paper aimed at taking into account the nutritional advice and suggestions of the Persian Medicine to ameliorate the aforementioned issue. In this review article, the seminal and original books of the Persian Medicine on the male sexual dysfunction have been thoroughly reviewed. A list of available, inexpensive and effective foods and medications which has been experienced for centuries was elicited. Due to the prevalence and the effects of the premature ejaculation on both marital relationships and subsequently fertility, constructing treatments like this list can be efficacious for to solving this problem.


Introduction
Also called early ejaculation, rapid ejaculation, premature ejaculation is one of the most common sexual disorders in men-with an estimated prevalence of 30% in the world. The individuals suffering from the premature ejaculation will reach orgasm before even the minimal penile or sexual stimulation, prior to or immediately after penetration. In fact, this disorder is referred to the situation in which, first the interval between the moments of penetration to the ejaculation is unusually short and the ejaculation occurs before or shortly after the penetration. Second, the person has no control over his ejaculation.
Third, this condition causes mental and psychological pressure or dissatisfaction for the affected person, his partner or both. Men with premature ejaculation tend to report less sexual satisfaction than men who have a normal ejaculation delay. The etiology of this problem is unknown, and there are some hypothesis, including anxiety, penile hypersensitivity, and serotonin receptor dysfunction [1].
Due to its prevalence and its effects on both marital relationships and subsequently fertility, understanding the causes and treatment of premature ejaculation is of paramount importance. The Persian medical scholars deem nutrition and the rectification of the lifestyle to be quintessential for the bodily health and the reproductive system accordingly [2]. In this regard, the authors of the present study aimed at garnering a sundry of nutrition strategies or measures zoomed particularly on treating premature ejaculation through an extensive scrutiny of the literature available on the traditional medicine. The purpose of this study is proffering explanations for the causes of this problem and providing a typology of food items recommended for the improvement or treatment of this irksome disorder.

Methodology
In this mini review article, the seminal and original books of the Iranian traditional medicine on the male sexual dysfunction have been reviewed. The criteria for selecting the sources are as follows: Their writers, in addition to practicing medicine, were remarkably successful in writing and therefore could pencil their thoughts on the topic vividly.
The authors have been elicited from various centuries of medical history. These sources include the Canon of Medicine by Avicenna (Ibn Sina, 11 th century AD), Al-Hawi by Razi (9 th century AD), Zakhireye Khwarazmshahi by Ismail Gorgani (11 th century AD), Ekseer e Azam by Hakeem Muhammad Azam Khan (19 th century AD) and Tibb-i Akbari (an expanded version of the Arabic treatise Sharh al-asbab waal-'alamat ) by Muhammad Muqim Arzani (18 th century AD) and the Summary of Wisdom (Kholāsa Al-Hekma) by Mohammad Hossein Aghili Khorasani(13 th century AD), amongst others.
The aforementioned works were browsed thoroughly with germane keywords like premature ejaculation and food and nutrition recommendations and measures for premature ejaculation treatment.
Razi and Jorjani and Avicenna believed that patients must be treated with food as far as possible. Abu Zeid Balkhi, who was Razi's master, professed that food is the first thing to be noted and carefully considered in maintaining health. Under the section on Treatment he mentioned that drugs should be avoided unless it is absolutely needed, because unlike food, drugs are in contrast with human nature. Nazem Jahan wrote, "For increasing sexual power, food has more advantages than drugs" [2,3].
In the present research, a list of useful foods and nutrition in the Persian Medicine was gathered which is available to the general public; therefore, their inclusion in the diet of the individuals can be efficacious for the treatment merged with other conventional methods. In various recent studies, the role of many of these substances has been confirmed in ameliorating the premature ejaculation.

Findings
Perusing the pertinent literature, one cannot help but notice that premature ejaculation has been always the cynosure of attention for the Persian scholars; in many available sources, miscellaneous food items and nutrients have been recommended for its treatment [4].
The pioneers of the Persian medicine, like Avicenna (Ibn Sina), held that simultaneous orgasms of both males and females during copulation would be ideal for a consummate gestation to occur. In this regard, apart from providing some measures and suggestions during coitus, they zoomed on the Couples' orgasm synchronization [5].
Jorjani has written: Rapid ejaculation has four causes: excessive semen volume, thin watery semen, hot temperament of semen, and weakness of retentive power of seminal tracts. He has mentioned lowfrequency intercourse, thin semen, burning sensation on ejaculation, and ejaculation without enough erection as signs of these causes, respectively. He suggested different treatment modalities according to the causes of the disease and temperaments [6,7].
From the perspective of the Persian Medicine, the treatment for all disease or maladies in general and male sexual dysfunction in particular boils down to proper nutrition.
In this view, the cause of ejaculation speed is categorized into four main groups and based on the cause, appropriate treatment is provided.
The increase of coldness and wetness in the genitals: as an explanation of these patients it can be posited that their semen is too much diluted and the color approaches whiteness. These people usually do not have high libido or sex drive. On the other hand, the color of their urine is yellowish-white. The roster of foods that can help these patients include pistachios, almonds, cinnamon, saffron, hazelnuts, carrot seeds, alfalfa, stinging nettle (Urtica dioica), ginger jam, Abgoosht (or Dizi: an Iranian stew) with warm spices, cooked peas, turnips, coconut, flaxseed, sesame, carrot jam and milk and honey. Furthermore, these people should avoid taking dough (a savory yogurt-based beverage (and yogurt. Oiling the testicles with chamomile oil and exercise are very much recommended for these patients. Moreover, the frequency of intercourse should not exceed once or twice per week.
The increase in warmness and wetness: semen has a moderate texture and massive volume; these individuals have high physical strength and have a lot of libido; the color of their urine is strong yellow and the color of the semen tends to be yellowish. Swollen veins/ arteries of testicles are evident in these individuals. These people have the proclivity to quaff cool water.
The pungency of semen: the patient feels warm when the semen exits; the color of the fluid in these people is yellow. If the temperature of the semen is high, the semen is concentrated. However, if the temperature of the semen is not reached to the extreme, the liquid is diluted. These people tend to partake of cold foods and drinks. The consumption of lettuce seeds, tiger lotus flower sharbat or syrup, violet sharbat, rosé flower sharbat, chicory, dough and yogurt, tamarind (Tamarindus indica), Barberry juice, barley and jujube can be a great boon to these people.
Weakness of the main organs of the body: the main organs of the body are those which are vital to the survival of the person and his offspring. These organs include the brain, the heart, the liver and the testicles (and in women, the ovaries). The strength of these members is absolutely essential for the proper sexual performance.
People who have weakness in core organs of the body tend to have low sexual desire; they suffer from erectile dysfunction, ejaculation without proper erection and weakness in pulse.
Psychological causes: Other causes of premature ejaculation include depression, anxiety, and severe phobia. The use of brewed lemon balm, chamomile, basil, lavender, orange blossom, apple juice and rose water are useful for these people (Table 1).

Conclusion
To wrap up, it can be safely construed that the use of nutritional supplements in traditional medicine, along with other modern treatments, can help patients ameliorate premature ejaculation to a considerable extent. It seems that combination of medical and herbal therapy can be beneficial in obtaining better result in treatment. More clinical trials are mandatory.