Iranian traditional medicine

1. Introduction

Version followed: academic Persian medicine (طب ایرانی, tebb-e irani; formerly tebb-e sonnati, "traditional medicine") as taught in the university schools of Persian medicine approved by Iran's Ministry of Health and Medical Education (MOHME) since 2007, which trace their canon to Rhazes (al-Razi) and Ibn Sina (Avicenna, al-Qanun fi al-Tibb, The Canon of Medicine). The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI). [source: TUMS School of Persian Medicine; Mashhad School of Traditional and Complementary Medicine; APA CFI]

What it is. Iranian traditional medicine is a codified humoral medical system. Its schools describe it as one of the oldest forms of traditional medicine, rooted in Rhazes and Avicenna, and as giving priority to preserving health over treating disease. [source: Mashhad TIM school page; Iranzadasl et al. 2025] Its core theory, as its own scholars publish it:

Mizaj (مزاج, temperament): each person, organ, food, season, age and climate has a temperament defined by the balance of hot/cold and wet/dry qualities. A departure from a person's healthy balance is su'-e mizaj (سوء مزاج, dystemperament). [source: Alizadeh et al. 2025; Wikipedia (secondary)]
Four humors (akhlat): blood, phlegm, yellow bile and black bile (sauda), whose balance is to be maintained. [source: Iranzadasl et al. 2025]
Six essential principles (setteh zaruriyeh, سته ضروریه): air and environment; physical activity and rest; sleep and waking; food and drink; emotional states; evacuation and retention (cleansing and keeping what the body needs). Recommendations under each are tailored to the person's mizaj. [source: Iranzadasl et al. 2025; Mashhad TIM school page]

How change happens, as the system holds it. Within Persian medicine, illness reflects imbalance of temperament or humors, and recovery comes from restoring balance: first through the six principles (lifestyle), and, as practitioners judge, through medicines and evacuation procedures such as venesection (fasd), wet cupping (hejamat) and leeches. [source: Iranzadasl et al. 2025; Nimrouzi et al. 2014] These are the system's own explanations, described here, not endorsed or dismissed.

The psychotherapist's position. You do not diagnose mizaj, prescribe diets, herbs or procedures, or act as a Persian medicine practitioner. Your work is culturally responsive psychotherapy alongside it: understanding what Persian medicine means to the client, assessing with the CFI, keeping the client safe, and coordinating with qualified practitioners and prescribers when the client wishes. Change in your work comes from a formulation the client recognises as their own, which makes engagement, adherence and honest disclosure of all treatments more likely. [synthesis; source: APA CFI]

2. Framework

2.1 The system as its institutions describe it

Institutions and training (Iran). MOHME laid the groundwork in 2006 [source: Wikipedia (secondary); uncertain: Wikipedia only]; the Department of Persian Medicine at Tehran University of Medical Sciences (TUMS) was founded in 2007, the first in Iran, with Traditional Pharmacy entering the academic system in 2008 and History of Medicine in 2013. TUMS offers a PhD in Traditional Persian Medicine, a 4-year PhD in Traditional Pharmacy, and runs three clinics. [source: TUMS School of Persian Medicine] At Mashhad, the 2007 programme was upgraded to a PhD in 2008 and MOHME approved the School of Traditional and Complementary Medicine in 2010; general physicians are among those admitted. [source: Mashhad TIM school page] Eight schools are reported active, with health centres called salamatkadeh (سلامتکده) and traditional pharmacies. [source: Wikipedia (secondary), citing Iranian news] [uncertain: Wikipedia only] Whether an MD is a formal entry requirement for the clinical PhD is [uncertain: not verified]; Aramesh (2018) reports that most academic practitioners are medical doctors with a PhD in traditional medicine.
Two streams of practice. Aramesh (2018) distinguishes a state-supported academic stream (university schools, research centres, salamatkadeh) from a largely unregulated non-academic stream whose practitioners range from people without health training to clerics; MOHME has acted against some non-academic practitioners with limited, inconsistent success. Herb shops (attari, عطاری) are regulated by the government [uncertain: possibly Wikipedia only]. [source: Aramesh 2018; Wikipedia (secondary)]
Outside Iran. No dedicated Persian medicine register or licence outside Iran is documented [uncertain: not verified]. Practitioners abroad may be physicians, herbalists or unregistered; check each person's actual registration with the relevant medical or health-professions regulator. [synthesis]
Diagnosis (as published). Practitioners assess mizaj of the whole person and of organs using signs such as pulse, build, skin, respiration, physical function and mental and emotional traits; a 2025 expert-panel study proposed major and minor criteria for heart mizaj, noting they are not yet clinically validated. [source: Alizadeh et al. 2025]
Therapies (as published), named only. Lifestyle and diet under the six principles; herbal and compound medicines (traditional pharmacy); evacuation procedures (venesection, wet cupping, leeches, ear scarification); massage (dalk), oils and baths. [source: Iranzadasl et al. 2025; Nimrouzi et al. 2014; Vakili and Gorji 2006; Wikipedia (secondary)] No doses, formulas or procedures are given in this guide.
Mental-health concepts (attributed). Classical authors, as historians report, described melancholia (malikhulia, linked to black bile and the brain), mania, ghotrab and lovesickness (eshgh), with treatments including diet, sleep, baths and head massage, travel and change of surroundings, music and company of loved ones, verbal counselling and encouragement, bloodletting and remedies. [source: Vakili and Gorji 2006] Avicenna located melancholy in the relation between the rational soul and the body, mediated by a "vaporous" spirit weakened by a melancholic temperament dominating the brain. [source: Avicenna on Melancholy, ap.isu.ac.ir] Modern academic authors describe emotional states as one of the six principles and as signs of temperament (e.g. quick, intense anger and boldness read as "hot"; slow-onset, lingering reactions read as "dry"). [source: Alizadeh et al. 2025; Iranzadasl et al. 2025] The Persian term a'raz-e nafsani (psychic states) for the emotional principle is [uncertain: not verified].
Evidence status. A 2025 review by Persian medicine researchers (not independent of the field) found 10 studies of lifestyle education and diet with positive results but called the evidence limited, with language and publication bias and variable quality. [source: Iranzadasl et al. 2025] An Iranian bioethicist's critique argues that the field retains obsolete humoral theory and anatomy, that wet cupping lacks evidence beyond a possible placebo effect on pain, that classical-text treatments have been exempted from some pre-clinical testing, and that non-academic practitioners have discouraged childhood vaccination. [source: Aramesh 2018] No independent systematic review of Persian medicine for mental disorders is cited here [uncertain: not verified].
Safety (as reported). Iran's pharmacovigilance system under-reports herbal adverse events, which the author links to weak regulation, poor quality control and uncontrolled supply; few reports do not show safety. [source: Zarei 2022] Lead and cadmium were found in most of 10 Iranian herbal drop products tested and mercury in 3, at levels the authors judged below intake limits. [source: Asghari et al. 2008] Wet cupping is often done without supervision and may harm very thin or obese people. [source: Nimrouzi et al. 2014] Herb-drug interactions are a general concern for any herbal product; route all questions to the prescriber or pharmacist. [synthesis]

2.2 The psychotherapist's work alongside (phases)

[synthesis, built on the CFI's stated uses: first evaluation, later in care, or repeatedly; source: APA CFI Supplementary Modules]

Phase	Goals	Typical sessions and format	Move on when
1. Engagement and cultural assessment	Core CFI; full inventory of treatments, practitioners and products; risk screen	1–2 sessions, individual; informant version with a family member if the client agrees	Client's own account of the problem, causes and preferred help is recorded; risk level known
2. Shared formulation and coordination	Integrate client's explanatory model (including mizaj language) with your clinical formulation; consent-based contact with prescriber and Persian medicine physician	1–3 sessions	Client agrees on goals; all treating people known; any safety issue routed
3. Treatment alongside	Your evidence-based therapy, phrased in terms the client accepts; regular check on new remedies, procedures and advice	Usual course of the chosen therapy	Goals progressing; no unaddressed conflicts between treatments
4. Review and ending	Repeat CFI modules if needed; relapse plan that names all sources of help	1–2 sessions	Client can say whom to contact for what

3. Guiding principles

Describe, attribute, do not adjudicate. Mizaj, humors and spirit are the system's concepts; say "in Persian medicine…" and neither assert nor ridicule. [synthesis]
Stay in your lane. Never interpret pulse or temperament, recommend foods, herbs, cupping or venesection, or comment on doses; that belongs to the Persian medicine physician and the prescriber. [synthesis]
Never advise on medicines. Do not suggest starting, stopping or changing any prescribed drug or herbal product; route to the prescriber or pharmacist. [synthesis]
Ask about all help, every time. Many clients use attari products or practitioners without telling clinicians; a routine, non-judgemental question surfaces this. [synthesis; source: APA CFI help-seeking domain]
Know the two streams. A university-trained Persian medicine physician and an unregistered online healer are not the same; check registration before any collaboration. [source: Aramesh 2018]
Safety first, culture always. Delay of urgent care, stopping essential medication, unsupervised blood-letting, and harm to children override deference; act on risk while respecting meaning. [synthesis]
Cultural humility. Examine your own assumptions about "traditional" and "scientific", and about Iranian, Afghan or Tajik clients, religion and politics. [synthesis]
The client defines the problem. Use the client's words (e.g. "my temperament has gone cold") in the formulation and goals. [source: APA CFI cultural definition domain]
Avoid both pathologising and missing illness. Holding humoral beliefs is not a symptom; but culturally framed complaints can still carry depression, psychosis or suicidal risk. [synthesis]
Consent and confidentiality govern collaboration. Contact other practitioners only with explicit, specific consent. [synthesis]
Do not over-generalise. Iranian clients vary from strongly committed to Persian medicine, to indifferent, to critical; ask, do not assume. [synthesis]
Physical procedures are not yours. You never touch for therapeutic purposes in this context; discussions of cupping or massage stay verbal. [synthesis]

[source for section 2.1: TUMS; Mashhad; Aramesh 2018; Iranzadasl et al. 2025; Alizadeh et al. 2025; Vakili and Gorji 2006; Nimrouzi et al. 2014; Zarei 2022; Asghari et al. 2008]

4. Intervention inventory

All interventions below are the psychotherapist's own. None is a Persian medicine procedure. Example language is illustrative unless quoted.

4.1 Cultural self-examination before and during the work

Purpose / when: Before working with clients who use Persian medicine, and whenever you notice strong reactions (admiration, scorn, political feelings about Iran). [synthesis]
Steps: (1) Note your beliefs about humoral medicine, "traditional" versus "scientific" care, Islam and Iranian politics. (2) Note what you know and do not know: the academic versus non-academic streams, the diaspora (Iranian, Afghan, Tajik, Kurdish, Azeri clients may each relate differently). (3) Take reactions to supervision. (4) Re-check after any session where you felt like arguing about mizaj or felt pulled to endorse a remedy. [synthesis]
Example language (illustrative, to yourself or a supervisor): "Am I hearing her temperament explanation as a belief to respect, or as an error to correct?"
Watch for: Debating the theory with the client; treating all Persian medicine as quackery or all as harmless; assuming religiosity or political views. Working when you can hold the client's account with curiosity and still name risks plainly. [synthesis]

4.2 Core Cultural Formulation Interview (DSM-5-TR)

Purpose / when: First assessment with any client, especially when the client mentions mizaj, "heat" or "cold", black bile, Persian medicine or an attari. APA describes the CFI as usable by any clinician, with any person, in any setting; it supports understanding and decisions and is not the only basis for diagnosis. [source: APA DSM-5-TR Section III; APA CFI]
Steps: Use the official form (16 questions; clinicians may reproduce it for their own patients; modifying or translating needs APA permission). Work through its four domains in your own conversational order: (1) cultural definition of the problem; (2) cultural perceptions of cause, context and support, including the role of cultural identity; (3) self-coping, past help-seeking and barriers; (4) current help-seeking preferences and the clinician-patient relationship (including language barriers and perceived discrimination). Record the client's own words. Typical duration is [uncertain: not verified]; the field trial reports later interviews took less time. [source: APA CFI; Lewis-Fernández et al. 2017]
Example language (illustrative): "In your own words, how would you describe what has been happening?" "What do you think is causing it?" "What have you already tried, including Persian medicine, herbs or anything family suggested?" "Is there anything about me or this service that could make it harder to talk freely?"
Watch for: Short answers that suggest the client expects disapproval; a cause given only in biomedical words (may be guarded); mention of help from someone the client will not name. Working when the client corrects or adds to your summary. [synthesis]

4.3 CFI supplementary modules and Informant Version

Purpose / when: To go deeper on a topic the core CFI opened. APA lists 12 modules, usable as add-ons or alone, at first evaluation, later, or repeatedly. Most relevant here: Explanatory Model; Coping and Help-Seeking; Spirituality, Religion and Moral Traditions; Cultural Identity; Social Network; Immigrants and Refugees; Older Adults; Caregivers. The 17-question Informant Version is for a family member or friend. [source: APA CFI Supplementary Modules; APA CFI Informant Version]
Steps: (1) Pick the module matching the open thread (e.g. Explanatory Model if the client talks of dystemperament; Immigrants and Refugees if the client left Iran or Afghanistan). (2) Explain why you are asking. (3) Use the module's structure in your own wording; do not reproduce items in handouts. (4) Use the Informant Version only with the client's consent, and separately if the client prefers. [source: APA modules; synthesis for steps 2–4]
Example language (illustrative): "You said your mother first took you to a Persian medicine doctor. Would it help if I also heard how she sees the problem, with your permission?"
Watch for: Family accounts overriding the client's; religious questions felt as intrusive (Persian medicine is often taught as Iranian-Islamic medicine, but clients' faith varies). Working when the modules produce concrete information you use in the plan. [synthesis]

4.4 Eliciting the explanatory model in mizaj terms (Kleinman)

Purpose / when: When the client explains distress through temperament, humors, "cold" or "hot" foods, black bile or the heart. Kleinman, Eisenberg and Good (1978) set out eight questions on name, cause, timing, mechanism, severity and course, treatment wanted, main problems caused, and fears. [source: Tanenbaum handout; Dinos et al. 2017 via Cambridge core-reader]
Steps: (1) Ask the eight questions in your own words, using the client's terms (mizaj, sauda, su'-e mizaj). (2) Ask who told them this (a university-trained physician, a relative, an online source, an attari). (3) Ask what the explanation implies they should do, and what they fear will happen if they do not. (4) Summarise back and ask what you missed. (5) Write a two-column formulation: the client's model and your clinical understanding, noting where they agree. [source: Tanenbaum handout for questions; synthesis for steps 2–5]
Example language (illustrative): "When you say your temperament has become cold and dry, what does that do to you day to day?" "Why do you think it started this winter?" "What worries you most about it?"
Watch for: Explanations that point to a harmful plan (stopping medication, repeated bloodletting); emotions themselves described as signs of temperament (anger as "heat", lingering resentment as "dryness"), which can be a door to talk about feelings. Working when the client says you understand how they see it. [source: Alizadeh et al. 2025 for emotion-temperament links; synthesis]

4.5 Recognising Persian-medicine idioms as cultural explanations of distress

Purpose / when: DSM-5-TR groups cultural concepts of distress into idioms, explanations or perceived causes, and syndromes. Mizaj and humoral accounts work mainly as cultural explanations (perceived causes). No Iranian-specific entry appears in the DSM-5-TR list as a secondary source gives it (ataque de nervios, dhat, hikikomori, khyâl cap, kufungisisa, maladi dyab, nervios, shenjing shuairuo, susto, taijin kyofusho) [uncertain: the DSM-5-TR list is from a secondary source]. [source: APA DSM-5-TR Section III; UNMC slides]
Steps: (1) Record the explanation verbatim in the cultural formulation. (2) Assess symptoms independently with your usual instruments and interview. (3) Do not translate the idiom straight into a diagnosis ("melancholia" in the classical sense is not DSM major depression). (4) Use the client's idiom in goal-setting where it helps engagement. [synthesis]
Example language (illustrative): "In Persian medicine, you said, this is black bile rising. Alongside that, I would like to ask about sleep, appetite, hope and any thoughts of death, so we do not miss anything."
Watch for: Suicidal thinking hidden under a physical or humoral account; psychotic features described as "too much heat in the brain". Working when both frames sit in one plan without the client feeling corrected. [synthesis]

4.6 Non-judgemental inventory of Persian medicine use

Purpose / when: Every assessment and at regular reviews, because products and procedures change. [synthesis; source: APA CFI help-seeking domain]
Steps: (1) Normalise: say you ask everyone. (2) Ask about practitioners (who, where, qualifications as the client knows them), products (herbal medicines, distillates, oils, attari mixtures; ask the client to bring packaging or a photo for the prescriber), diets, and procedures (cupping, venesection, leeches, massage). (3) Ask whether any practitioner advised changes to prescribed medicines or vaccinations. (4) Record names and sources, not doses or instructions. (5) With consent, pass the list to the prescriber or pharmacist. [synthesis; source: Aramesh 2018 on vaccine advice; Zarei 2022 on quality-control gaps]
Example language (illustrative): "Many people I see use Persian medicine as well as other treatments. It helps me to know everything you are taking or doing, so the doctors can check it all fits together. I am not here to judge it."
Watch for: Products bought online or abroad without labels; advice to stop psychiatric medication; procedures done at home or by unregistered people. Working when the client volunteers new remedies without being asked. [synthesis]

4.7 Medication-safety routing (prescriber and pharmacist)

Purpose / when: Whenever the client uses herbal or compound medicines alongside prescribed drugs, is pregnant, has a bleeding or clotting condition, takes anticoagulants, or is considering wet cupping, venesection or leeches. [synthesis; source: Nimrouzi et al. 2014 on unsupervised cupping]
Steps: (1) Do not comment on whether a product is safe or how much to take. (2) Tell the client the prescriber or pharmacist is the right person, and why (interactions, quality and contamination concerns). (3) Offer to write a short note listing what the client reported, with consent. (4) Follow up next session. (5) If the client has stopped an essential medicine and is deteriorating, treat it as a risk issue (see 4.13). [synthesis; source: Zarei 2022; Asghari et al. 2008]
Example language (illustrative): "I can't advise on herbs or medicines, but your doctor or pharmacist can check whether this and your tablets are safe together. Shall I write down what you've told me so you can show them?"
Watch for: The client hearing this as disapproval of Persian medicine; the client stopping both. Working when the prescriber knows about all products. [synthesis]

4.8 Differential assessment: culturally held beliefs versus disorder

Purpose / when: When a humoral or spiritual explanation accompanies symptoms that could be depression, mania, psychosis, anxiety, an eating problem or a physical illness. DSM-5-TR and ICD-11 exclude trance and possession states that are part of broadly accepted cultural or religious practice (ICD-11 6B62 trance disorder, 6B63 possession trance disorder require involuntary, unwanted states with distress or impairment). [source: findacode ICD-11 mirror; PMC9199574; UMSystem Pressbooks] The DSM-5-TR wording on culturally sanctioned beliefs not counting as psychotic is [uncertain: not verified].
Steps: (1) Ask whether others in the client's family or community hold the same explanation (shared belief versus idiosyncratic conviction). (2) Assess the form of symptoms (fixity, bizarreness, functional decline, risk) separately from the content. (3) Screen for medical causes and for symptoms needing urgent medical review (weight loss, fever, neurological signs, bleeding), and refer rather than accept a temperament account alone. (4) Consult a cultural broker or a Persian-speaking clinician if unsure. (5) Document reasoning. [synthesis]
Example language (illustrative): "Do others in your family see it the same way?" "Has anything changed in how you think or what you notice that worries the people close to you?"
Watch for: Dismissing real illness as "just a belief"; diagnosing a widely held belief as a delusion. Working when your diagnosis would make sense to a clinician from the client's background. [synthesis]

4.9 Collaboration and referral with qualified Persian medicine physicians

Purpose / when: When the client values Persian medicine and wants their practitioners to work together. Evidence for collaboration comes from other settings: in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary care for psychosis reduced symptoms and harmful practices (COSIMPO, Gureje et al. 2020); in a Ghanaian prayer camp, adding psychiatric medication to usual care reduced symptoms but not days in chains (Ofori-Atta et al.). No trial of collaboration with Persian medicine practitioners is cited here [uncertain: not verified]. [source: pubannotation PubMed 32861306; Centre for Global Mental Health; APHRC repository]
Steps: (1) Ask whether the client wants collaboration and with whom. (2) Check the practitioner's registration (in Iran, a university-trained physician practising Persian medicine; elsewhere, the relevant medical or health register). Do not collaborate with unregistered practitioners who advise against essential care. [source: Aramesh 2018 for the two streams; synthesis] (3) Obtain written, specific consent: what will be shared, with whom, for what purpose. (4) Share your formulation in plain terms; ask the practitioner's view of the client's condition and what they have advised, without debating theory. (5) Agree who handles what (your therapy; the prescriber's medicines; the Persian medicine physician's lifestyle advice) and how to raise concerns. (6) Review with the client. [synthesis]
Example language (illustrative, to the practitioner): "With [client]'s consent, I'm the psychotherapist. I'd value your understanding of what is going on, and I want to make sure our advice doesn't pull in different directions." (to client) "Would you like me to talk with Dr X so we're working together?"
Watch for: Conflicting advice on medicines; the practitioner diagnosing psychiatric conditions in temperament terms only; confidentiality leaks within a close community. Working when the client reports less conflict between treatments. [synthesis]

4.10 Bridging the six principles with the therapist's own interventions

Purpose / when: When the client already organises health around the six essential principles (sleep, activity, food, air, emotions, evacuation and retention). Your evidence-based components (behavioural activation, sleep-focused work, emotion regulation) can be framed in that language without prescribing Persian medicine content. [source: Iranzadasl et al. 2025 for the principles; synthesis for the bridging]
Steps: (1) Ask which principles the client already attends to and what they have been advised. (2) Choose your intervention on clinical grounds. (3) Explain it in words that connect to the client's framework (e.g. regular sleep and activity, attention to emotional states), without claiming Persian medicine endorses it. (4) Leave diet and temperament-specific advice to the Persian medicine physician or dietitian; no food rules, targets or regimens from you. (5) Review whether the framing helps. [synthesis]
Example language (illustrative): "You've told me Persian medicine pays a lot of attention to sleep, activity and emotions. The work I'm suggesting also focuses on those. Would it fit to plan your week around them together?"
Watch for: The client hearing you as a Persian medicine authority; dietary restriction becoming rigid or linked to weight or eating concerns (assess and refer). Working when adherence improves and the client owns the plan. [synthesis]

4.11 Discussing physical procedures and touch boundaries

Purpose / when: When the client mentions wet cupping, venesection, leeches, ear scarification or massage, for themselves or a child. [source: Nimrouzi et al. 2014; Aramesh 2018]
Steps: (1) Ask who performs it, where, how often, and whether a physician supervised it. (2) Ask about bleeding, fainting, infection, scarring, and conditions such as anaemia, pregnancy, clotting disorders or anticoagulant use; route these to the medical team. (3) Never perform, demonstrate or touch; keep discussion verbal and non-explicit about the body. (4) If a procedure was done without consent, coercively, on a minor in a harmful way, or involved sexual or intimate touch, follow 4.13. [synthesis; source: Nimrouzi et al. 2014 on unsupervised cupping]
Example language (illustrative): "Who did the cupping, and did a doctor check you were well enough for it? Have you had any bleeding, dizziness or infection afterwards?"
Watch for: Repeated bloodletting in a depressed or anaemic client; procedures used as self-punishment or self-harm; touch that crossed consent. Working when the medical team knows and the client feels able to say no. [synthesis]

4.12 Interpreters and cultural brokers

Purpose / when: When Persian (Farsi), Dari, Tajik or another language is the client's preferred language for emotional material, or when Persian medicine terms need explaining. The CFI asks about language barriers in the clinician-patient relationship. [source: APA CFI]
Steps: (1) Offer a professional interpreter; avoid family members, especially children. (2) Brief the interpreter on confidentiality and on rendering terms such as mizaj, sauda or su'-e mizaj as said, not explained away. (3) Check the interpreter is not known to the client's community, if the client wishes. (4) Use a cultural broker (a clinician or community member familiar with Persian medicine) for consultation, with consent and without identifying details where possible. (5) Debrief. [synthesis]
Example language (illustrative): "Please translate her words exactly, including any Persian medicine terms, and tell me if a word has no English equivalent."
Watch for: Interpreters adding their own views of Persian medicine; client discomfort about community gossip. Working when the client can speak in the language of feeling. [synthesis]

4.13 Safeguarding and urgent-care risk

Purpose / when: When a practice or advice causes or risks harm: stopping essential medication (e.g. insulin, anticonvulsants, antipsychotics, lithium), delaying urgent medical care, advice against childhood vaccination, untested remedies offered for serious illness, unsupervised bloodletting, coercion, or sexual contact under the cover of treatment. Aramesh (2018) reports non-academic practitioners discouraging vaccination and offering untested remedies for serious disease. No practice described here is a treatment for cancer or other physical disease. [source: Aramesh 2018; synthesis]
Steps: (1) Assess immediate risk, including suicide risk with standard practice. (2) Explain your concern in terms of the client's own goals, without attacking the tradition. (3) Urge prompt contact with the medical team; with consent, or where law requires without it, inform them. (4) For a child, follow your local child-protection procedure; both harmful practices presented as tradition and ordinary traditional practices misread as abuse are possible, so consult before concluding. (5) Report unregistered or harmful practitioners to the relevant regulator where your jurisdiction provides for it. (6) Document. [synthesis]
Example language (illustrative): "I respect that Persian medicine matters to you. I'm worried because stopping this medicine suddenly can make you seriously unwell. Can we call your doctor together today?"
Watch for: Shame or secrecy after your concern; family pressure; the client leaving care. Working when the client stays engaged and the medical risk is managed. [synthesis]

4.14 Working with families

Purpose / when: When family members choose or pay for Persian medicine care, hold strong views for or against it, or disagree with biomedical treatment. [synthesis; source: APA CFI Informant Version and Caregivers module]
Steps: (1) Ask the client who decides about health care in the family. (2) With consent, meet relevant members; use the Informant Version structure. (3) Map each person's explanatory model. (4) Look for shared goals (the client's recovery, sleep, function) and build the plan around them. (5) Keep the client's confidential material private unless consent covers it. [synthesis]
Example language (illustrative): "It sounds as if your father trusts Persian medicine and your sister trusts psychiatry. You both want her to sleep and feel herself again. Can we start there?"
Watch for: The client silenced in family sessions; therapist taking sides in the traditional-versus-modern debate. Working when the family supports one coordinated plan. [synthesis]

4.15 Migration, identity and discrimination

Purpose / when: With clients from Iran, Afghanistan, Tajikistan or diaspora communities, for whom Persian medicine may carry identity, nostalgia, faith, or ambivalence, and who may have met discrimination in services. Use the Cultural Identity and Immigrants and Refugees modules. [source: APA CFI Supplementary Modules]
Steps: (1) Ask what Persian medicine means to the client's sense of who they are (family tradition, national heritage, religion, or something they reject). (2) Ask about migration, losses, legal status stresses and access to familiar care. (3) Ask about experiences of being dismissed or stereotyped by clinicians. (4) Fold these into the formulation and plan. [synthesis]
Example language (illustrative): "For some people, Persian medicine is a link to home and family. What does it mean for you?" "Have doctors here ever made you feel your way of seeing things was wrong?"
Watch for: Grief or homesickness expressed through bodily or temperament complaints; mistrust from past dismissal. Working when the client feels their background is respected in the room. [synthesis]

4.16 Drawing on the client's valued cultural resources

Purpose / when: Historians report that classical Persian physicians recommended music, the company of loved ones, change of surroundings, avoiding idleness and solitude, and verbal encouragement for melancholia. Some clients find these meaningful as part of their heritage. [source: Vakili and Gorji 2006]
Steps: (1) Ask what the client and family traditionally do to lift low mood (music, poetry, gatherings, nature, prayer). (2) Use these, chosen by the client, as activities within your own evidence-based plan (e.g. behavioural activation). (3) Do not present them as Persian medicine treatment or as replacing indicated care. [synthesis]
Example language (illustrative): "What used to lift your spirits at home? Is that something we could build into your week?"
Watch for: Activities chosen to please you; avoidance dressed as rest. Working when activities are done and mood or function shifts. [synthesis]

5. Handling problems

Unless marked otherwise, the guidance below is [synthesis].

Client asks you to confirm their temperament or recommend foods or herbs. Decline warmly and redirect: "That's for your Persian medicine doctor; what I can help with is how this is affecting your mood and life." Offer to coordinate (4.9).
Client has stopped prescribed medication on a practitioner's advice. Treat as clinical risk (4.13): assess, voice concern in their terms, get them to the prescriber quickly. Do not advise restarting or dosing yourself.
Client feels judged or goes quiet after you ask about Persian medicine (rupture). Name it: "I may have sounded doubtful; I'm asking because I want the full picture, not to criticise." Return to the client's model (4.4) and repair before continuing.
Stuck: client expects cure through restoring mizaj and sees therapy as irrelevant. Find the overlap (sleep, activity, emotions are within both frames, 4.10); agree a small, testable goal; review together. If they prefer only Persian medicine and there is no serious risk, respect the choice and keep the door open.
Resistance from scepticism of Persian medicine (client or family member is critical). Do not defend or attack it. Some Iranian scholars are critical too, and the field itself distinguishes academic from non-academic practice. [source: Aramesh 2018] Focus on the client's goals.
Overwhelm from conflicting advice (doctor, Persian medicine physician, family, social media). List all sources of advice together, sort by who is responsible for what (medicines, lifestyle, therapy), and help the client decide whom to ask about each; offer a joint contact (4.9).
Non-adherence to referrals (prescriber, pharmacist, GP). Ask about practical and cultural barriers (language, cost, fear of being lectured); offer an interpreter, a letter listing all products (4.7), or to phone together.
Unregistered or online practitioner selling remedies or procedures. Explain the difference between registered and unregistered practice without shaming the client; encourage medical review of any product; report harmful practice where your jurisdiction provides for it. [source: Aramesh 2018 on the unregulated stream]
Repeated wet cupping or bloodletting in a depressed, self-harming or anaemic client. Assess function and risk, including whether the procedure serves self-harm; involve the medical team (4.11, 4.13).
Humoral explanation alongside possible psychosis or mania. Use 4.8; avoid arguing about content; focus on safety, sleep and function; involve psychiatry; consult a cultural broker.
Eating rules become restrictive. Assess for an eating disorder in the usual way; do not set food or weight targets; involve a dietitian and the medical team.
Your own frustration or over-enthusiasm. Take it to supervision (4.1); check whether you are avoiding risk talk or over-identifying with the tradition.
Child or adolescent clients. Get assent and parental consent as your jurisdiction requires; ask about vaccinations and medical care in general terms; follow child-protection procedures if essential care is withheld (4.13).
Confidentiality in small communities. Agree with the client exactly what may be shared with practitioners, interpreters and family; use interpreters from outside the client's circle if wanted (4.12).

Sources

Persian medicine: institutions, theory, evidence and safety

Cultural assessment and collaboration

Books and papers cited by reference

Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251-258.
Ibn Sina (Avicenna). al-Qanun fi al-Tibb (The Canon of Medicine). Edition and translation [uncertain: not verified].
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).

← Previous · XI-046Unani Next · XI-048 →Arabic indigenous and Bedouin medicine