ABO/Rh Blood Groups and the Temperament

(Mizaj) Based on Traditional Persian Medicine

Perspective: A Cross-sectional Study

Mohammad Mahdi Parvizi1,2, Mohadeseh Molayemat3, Maryam Rezaee4, Babak Shirazi Yeganeh5, Thomas Rampp6,

Mohammad Hashem Hashempur2 

1 Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz

University of Medical Sciences, Shiraz, Iran

3 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

4 Iranian Blood Transfusion Organization, Fars Provence Branch, Shiraz, Iran

5 Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

6 Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen,

Germany

GMJ.2023;12:e3062

www.gmj.ir

 Correspondence to:

Mohammad Hashem Hashempur, Research Center for

Traditional Medicine and History of Medicine, Zand

Avenue.

Telephone Number: +989173020786

Email Address: hashempur@gmail.com

Received 2023-05-14

Revised 2023-06-06

Accepted 2023-06-09

Abstract

Background: Mizaj is a fundamental concept in traditional Persian medicine (TPM)

that explains the physiological and psychological traits of human beings. This study

aimed to investigate the association between the ABO/Rh blood groups and the Mizaj.

Materials and Methods: This cross-sectional study was conducted on 18-60 years old individu-

als who visited the Iranian Blood Transfusion Organization, Shiraz Branch. We used Mojahedi’s

Mizaj questionnaire to determine the Mizaj of the participants. The participants’ blood group and

Rh were determined based on the antibodies against types A, B, and Rh antigens of their blood.

Results: We assessed 308 individuals consisting of 174 (56.49%) male and 134 (43.51%) fe-

male. The results of our study showed a signicant relationship between the AB blood group

and the cold Mizaj in both simple and compound Mizaj categories (P=0.012, P=0.014, respec-

tively). Logistic regression analysis revealed that people with the AB blood group were 2.88

times more likely to have cold Mizaj than people with the O blood group (OR=2.88, 95% CI:

1.16 to 7.15). In addition, those with the A blood group were found to be 54% less likely to have

a dry Mizaj than those with the O blood group (OR=0.46, 95% CI: 0.23 to 0.92). There was

no signicant association between the participants’ Mizaj and their Rh blood group (P>0.05).

Conclusion: It seems that there was a signicant relation between the AB blood

group and cold Mizaj, as well as the A blood group and dry Mizaj. However, fur-

ther studies are recommended with controlling the probable confounding factors.

[GMJ.2023;12:e3062] DOI:10.31661/gmj.v12i0.3062

Keywords: ABO Blood-Group System; Persian Medicine; Temperament; Traditional Medicine

Introduction

Traditional Persian medicine (TPM) is one

of the most ancient forms of traditional

holistic medicine that is based on humoral

medical theories [1-3]. Mizaj (temperament)

is a fundamental TPM concept [4-8]. It is a

phenotype-based categorization describing

all physiological and psychological aspects

of human beings and can also explain the rea-

GMJ

This is an open-access article distributed

under the terms of the Creative Commons

Attribution 4.0 International License

(http://creativecommons.org/licenses/by/4.0/)

Email:info@gmj.ir

Parvizi MM, et al. ABO/Rh Blood Groups and the Mizaj

2GMJ.2023;12:e3062

www.gmj.ir

son for the dierence in the diseases’s presen-

tation and the response to treatment in each

person [6]. Moreover, Mizaj derives from the

interaction of contrary qualities of hotness,

coldness, dryness, and wetness in elements [6,

9]. Abnormal Mizaj or sue-Mizaj referred to

the condition of imbalance between the Mizaj

qualities and is classied into 9 general cate-

gories: hot, cold, dry, wet, cold-wet, hot-wet,

hot-dry, cold-dry, and medium type [6, 9, 10].

All humans have sanguineous (Dam), phleg-

matic (Balgham), bilious (Safra, yellow bile),

and melancholic (Savda) humor depending on

the dominant humor in the body [11, 6].

The dominant humor determined which dis-

eases the person is susceptible to, and which

treatments are more eective. In other words,

according to the concepts of TPM, Mizaj

could be dened as the presence of the hu-

mor(s) quality accumulated in the body, ac-

cording to the level of hotness and dryness.

When there is an imbalance in the amount of

humor in the body, people develop sue-Mizaj

(dystemperament) [11, 10, 12]. Previous

studies analyzed the association between the

Mizaj and many physical and mental charac-

teristics. For example, a recent study demon-

strated a correlation between hot temperament

and neuroticism [13].

It has also been shown that there is a signif-

icant correlation between hot and dry Mizaj

and type 1 diabetes mellitus [14]. In addition,

another study showed that non-melanoma

skin cancer (NMSC) was associated with dry

Mizaj [15]. Analysis of the association be-

tween body mass index and Mizaj showed

that there is a signicant relationship between

the fat mass and cold-dry and hot-wet Mizaj

[16]. Moreover, the results of a study showed

a signicant relationship between low body

mass index (BMI<18) in teenage girls and dry

Mizaj [17]. Determination of ABO antigen in

humans blood is one of the most important,

available, unchangeable, and valuable factors

for determining the fundamental dierence

among humans genotypes which was discov-

ered by Karl Landsteiner, a Viennese pathol-

ogist, in 1900 [18]. It was divided into four

blood groups consisting of A, B, AB, and O

according to the surface antigens of red blood

cells [18, 19]. Several studies revealed the

association between the ABO blood group

and some medical conditions including can-

cer [20, 21] gastric ulcer[22], some infectious

diseases including Plamodium falciparum

malaria [23], helicobacter pylori gastritis [24],

COVID-19 [25, 26], as well as some psycho-

logical conditions including anxiety and stress

[27, 28]. There is also some signicant evi-

dence that adherence to diets specic to one’s

blood type can reduce the risk of cardiovas-

cular disease and improve overall health. The

‘Blood-Type’ diet advises individuals to eat

according to their ABO blood type to improve

their health and reduce the risk of chronic dis-

eases [29]. Since the publication of the book

“Eat Right for Your Type” by D’Adamo, there

have been many controversial discussions

about the relationship between ABO blood

types, dietary habits, and human health [30].

However, there are few studies on the associ-

ation between physical characteristics, blood

type, and Mizaj [31, 32]. The result of a study

on 640 participants in 1930 showed a signif-

icant association between the blood group

and Mizaj [31]. Another study in this regard

investigated the association between 12 blood

markers and Mizaj [32].

In contrast to previous studies, results showed

no relation between the ABO and Rh alleles

and the Mizaj [32]. There was only a signif-

icant association between the Lewis alleles

and Mizaj [32].

To the best of our knowledge, there was little

evidence of a correlation between the Mizaj

and blood groups in humans. Therefore,

this study aimed to analyze the prevalence

of Mizajs among the Iranian population by

considering the individual’s ABO/Rh blood

groups and evaluating the relationship be-

tween blood group and Mizaj among the study

participants.

Materials and Methods

Study Design, Sample Size, and Participants

This cross-sectional study was conducted from

the 1st of August to the 10th of October, 2020

at the Iranian Blood Transfusion Organiza-

tion, Shiraz Branch (one of the main branches

in Iran), Fars Province, Iran. The study pop-

ulation consisted of all voluntary blood do-

nors, aged 18-60 years, who were referred to

this organization. The convenience sampling

ABO/Rh Blood Groups and the Mizaj Parvizi MM, et al.

GMJ.2023;12:e3062

www.gmj.ir

method was used to enroll the participants in

our study. Participants with contraindications

of blood donation including taking anti-coag-

ulants, having high-risk sexual behaviors or

multiple sex partners, active seizure disease,

signicant pulmonary or cardiac diseases,

hepatitis, syphilis, and addiction to intrave-

nous drugs were excluded. Additionally, pa-

tients with kidney, hepatic, and thyroid disor-

ders were excluded due to the possible eects

of these diseases on the Mizaj. Before the en-

rollment, the study procedure was explained

to all participants, and written informed con-

sent was obtained from them.

According to the prevalence of dry Mizaj

(25%) among Rh-positive participants in our

initial pilot sampling, using the following for-

mula, the sample size was estimated to be at

least 288 with overall power of 95% at a sig-

nicant level of 0.05.

Ethics Statements

The study protocol was approved by the Eth-

ics Committee of Shiraz University of Med-

ical Sciences (Ethics Code: IR.SUMS.MED.

REC.1399.308). In addition, written informed

consent was obtained from all participants

before the enrollment. Moreover, participants

were assured that their data would remain

condential to the researchers.

Data Collection

The Mojahedi’s Mizaj Questionnaire was uti-

lized to determine the Mizaj of participants

[33]. This questionnaire contains ten ques-

tions (scored from 1 to 3, based on a three-

point Likert scale). Eight of these questions

are related to the hot/cold quality and two oth-

ers are related to the wet/dry quality. There-

fore, each participant had two scores, one for

the hot/cold quality (ranges from 8 to 24) and

the other for the wet/dry quality (ranges from

2 to 6). Participants with ≥19 scores in the hot/

cold subscale were located in the category of

hot Mizaj and those with ≤14 scores were cate-

gorized as cold Mizaj. In the dry/wet subscale,

participants with a≥5 score had dry Mizaj and

with ≤3 the score had wet Mizaj. The psycho-

metric properties of this questionnaire were

approved in the Iranian population. The reli-

ability of this questionnaire was approved by

Cronbach’s α coecient of 0.71 in the Irani-

an population. Moreover, the sensitivity and

specicity of this questionnaire for detecting

the individual’s Mizaj were acceptable.

Also, the blood group information of the par-

ticipants was determined from their blood

samples by surveying the antibodies against

type A and B, as well as Rh in the participants’

blood.

Statistical Data Analysis

Data analysis was performed using SPSS

(IBM Corp. Released 2017. IBM SPSS Sta-

tistics for Windows, Version 25.0. Armonk,

NY: IBM Corp.) and Stata software version

14.2 (StataCorp LLC, 4905 Lakeway Drive,

College Station TX77845, USA). Qualita-

tive and quantitative data were represented as

frequency (percentage) and mean ± standard

deviation, respectively. Kolmogorov-Smirnov

test was used to determine the normality dis-

tribution of data. In addition, Chi-square and

independent t-test were used to analyze the re-

lationship between the variables. Furthermore,

multiple logistic regression was performed to

estimate the eect sizes with controlling the

eect of participants’ gender on the results of

the study. P<0.05 was considered statistically

signicant.

Results

A total of 308 subjects were enrolled in this

study. of these, 174 (56.49%) were male

and 134 (43.51%) were female. The mean

and standard deviation age of these patients

was 37.90±10.06 (CI 95%: 36.76 to 39.03).

Among the participants, 122 (39.61%) were

blood group O. The prevalence of A, B, and

AB blood groups was 27.27%, 22.40%,

and 10.71%, respectively. Moreover, 226

(73.38%) participants had positive and 82

(26.62%) of them had negative Rh group. Ta-

ble-1 shows the demographic information of

the participants in the study.

Table-2 shows the participants’ Mizaj con-

4GMJ.2023;12:e3062

www.gmj.ir

Parvizi MM, et al. ABO/Rh Blood Groups and the Mizaj

sidering their ABO/Rh blood group, as well

as the association between each simple and

compound Mizaj type with ABO/ Rh blood

groups. According to this Table, the per-

centage of cold Mizaj, in both simple and

compound Mizaj types, was signicantly

more prevalent in participants with the AB

blood group compared to other blood groups

(P=0.012 and P=0.014, respectively). In more

detail, our results indicated that the incidence

of cold Mizaj was signicantly lower in the

participants with the B blood group compared

to other blood groups (P=0.012).

We also analyzed the association between

gender and cold/hot qualities. The association

between these two variables was signicant

(P=0.029). In this regard, the frequency of hot

Mizaj was higher in men compared to women.

While there was no signicant association be-

tween wet/dry qualities and the participants’

gender (P=0.167). In addition, the moderate

Mizaj (in hotness and wetness qualities) were

the most common Mizaj types in both male

and female participants in this study.

According to logistic regression analysis,

individuals with the AB blood group were

2.88 times more likely to have cold Mizaj

(OR=2.88, 95% CI: 1.16 to 7.15) than those

Table 1. Demographic Characteristics of the Participants Enrolled Into the Study

Variables

ABO blood groups P

-value

Rh blood groups P

-value

Total A

(N=84)

(N=69)

(N=33)

(N=122)

positive

(N=226)

Rh negative

(N=82)

Age,

mean±SD a

37.90±

10.06

38.42±

9.90

37.82±

9.64

37.25±

9.09

37.75±

10.73 0.944 38.17±

10.00 37.13± 10.25 0.427

Gender, N

(%)

Male 174

(56.49)

(55.95)

(52.17)

(57.58)

(59.02) 0.834

131

(57.95) 43 (52.44) 0.387

Female 134

(43.51)

(44.05)

(47.83)

(42.42)

(40.98) 95 (42.04) 39 (47.56)

Marital

status, N

(%) b

Single 98

(32.24)

(24.10)

(41.18)

(27.17)

(34.17) 0.134

67 (30.18) 31 (37.80)

0.207

Married 206

(67.76)

(75.90)

(58.82)

(72.73)

(65.83)

155

(69.82) 51 (62.20)

Educational

level, N

(%) c

Under

diploma

(7.28) 4 (4.88) 2 (2.94) 3(9.68) 13

(10.74)

0.452

15 (6.76) 7 (8.75)

0.503

Diploma 96

(31.79)

(37.80)

(30.88)

(35.48)

(27.27) 72 (32.43) 24 (30.00)

Bachelor

degree

145

(48.01)

(42.68)

(55.88)

(45.16)

(47.93)

103

(46.40) 42 (52.50)

Master’s

degree and

higher

(12.91)

(14.63)

(10.29)

(9.68)

(14.05) 32 (14.41) 7 (8.75)

a. Missing data for 3 cases; b. Missing data for 4 cases; c. Missing data for 6 cases

GMJ.2023;12:e3062

www.gmj.ir

ABO/Rh Blood Groups and the Mizaj Parvizi MM, et al.

Table 2. Study Participants’ Mizaj with Considering Their ABO/Rh Blood Group and the Association

between Each Simple and Compound Mizaj Types with ABO/ Rh Blood Groups

ABO blood group Rh blood group

Mizaj N (%) A B AB O P

value*Rh positive Rh negative P

value*

Simple Mizaj types

Hotness

quality

Hot 91

(29.55)

(23.81%)

(31.88%)

(15.15%)

(36.07%) 0.063 66 (29.2%) 25 (30.49%) 0.888

Moderate 166

(53.90)

(53.57%)

(59.42%)

(54.55%)

(50.82%) 0.728 125

(55.31%) 41 (50.00%) 0.439

Cold 51

(16.56)

(22.62%) 6 (8.70%) 10

(30.30%)

(13.11%) 0.012 35 (15.49%) 16 (19.51%) 0.488

Total 308 84

(100%)

(100%) 122 (100) 226 (100%) 82 (100%)

Wetness

quality

Wet 107

(34.74)

(32.14%)

(43.48%)

(30.30%)

(32.79%) 0.387 73 (32.30%) 34 (41.46%) 0.139

Moderate 122

(39.61)

(51.19%)

(31.88%)

(36.36%)

(36.89%) 0.073 89 (39.38%) 33 (40.24%) 0.896

Dry 79

(25.65)

(16.67%)

(24.64%)

(33.33%)

(30.33%) 0.112 64 (28.32%) 15 (18.29%) 0.079

Total 308 84

(100%)

(100%) 122 (100) 226 (100%) 82 (100%)

Compound Mizaj types

Cold and

wet

(4.22) 5 (5.95%) 3 (4.35%) 1 (3.03%) 4 (3.28%) 0.799 9 (3.98%) 4 (4.88%) 0.730

Hot and

wet

(10.06) 7 (8.33%) 11

(15.94%) 1 (3.03%) 12

(9.84%) 0.193 22 (9.73%) 9 (10.98%) 0.743

Hot and

dry

(7.47) 2 (2.38%) 6 (8.70%) 1 (3.03%) 14

(11.48%) 0.070 17 (7.52%) 6 (7.32%) 0.952

Cold and

dry

(3.57) 3 (3.57%) 2 (2.90%) 3 (9.09%) 3 (2.46%) 0.328 9 (3.98%) 2 (2.44%) 0.519

Hot 37

(12.01)

(13.10%) 5 (7.25%) 3 (9.09%) 18

(14.75%) 0.439 27 (11.95%) 10 (12.20%) 0.953

Cold 27

(8.77)

(13.10%) 1 (1.45%) 6

(18.18%) 9 (7.38%) 0.014 17 (7.52%) 10 (12.20%) 0.200

Wet 63

(20..45)

(17.86%)

(23.19%)

(24.24%)

(19.67%) 0.801 42 (18.58%) 21 (25.61%) 0.177

Dry 45

(14.61)

(10.71%)

(13.04%)

(21.21%)

(16.39%) 0.454 38 (16.81%) 7 (8.54%) 0.069

Moderate 58

(18.83)

(25.00%)

(23.19%) 3 (9.09%) 18

(14.75%) 0.097 45(19.91%) 13 (15.85%) 0.421

Total 308 84

(100%)

122

(100%) 226 (100%) 82 (100%)

*The P-values were calculated using chi-square test by comparing each of temperament with other tem-

peraments. P-value≤ 0.05 was considered signicant.

6GMJ.2023;12:e3062

www.gmj.ir

Parvizi MM, et al. ABO/Rh Blood Groups and the Mizaj

Table 3. Association between Mizaj And ABO and RH Blood Groups Subtypes Using Multiple Logistic Regression Adjusting by the Participants’ Gender

Hotness quality

Mizaj

Blood group

Hot Mizaj Moderate Mizaj Cold Mizaj

ABO Blood

Group

Odds ratio

(95% CIb)P-value Odds ratioa

(95% CI) P-value Odds ratio

(95% CI) p-value Odds ratio

(95% CI) P-value Odds ratio

(95% CI) P-value

O1 1 1 1 1 1

A0.55

(0.30 to 1.03) 0.063 0.56

(0.30 to 1.05) 0.070 1.12

(0.64 to 1.94) 0.698 1.11

(0.63 to 1.93) 0.725 1.94

(0.93 to 4.03) 0.077 1.92

(0.92 to 4.01) 0.082

B0.83

(0.44 to 1.55) 0.560 0.87

(0.46 to 1.66) 0.659 1.42

(0.78 to 2.58) 0.253 1.39

(0.76 to 2.53) 0.285 0.63

(0.23 to 1.70) 0.361 0.61

(0.23 to 1.65) 0.334

AB 0.32

(0.11 to 0.88) 0.027* 0.31

(0.12 to 0.87) 0.027* 1.16

(0.54 to 2.51) 0.704 1.16

(0.53 to 2.51) 0.713 2.88

(1.16 to 7.15) 0.023* 2.88

(1.16 to 7.18) 0.023*

RH RH positive 0.94

(0.54 to1.63) 0.827 0.90

(0.52 to 1.58) 0.722 1.24

(0.75 to 2.05) 0.409 1.26

(0.76 to 2.10) 0.364 0.76

(0.39 to 1.45) 0.402 0.77

(0.40 to 1.48) 0.435

Wetness quality

Mizaj

Blood group

Wet Mizaj Moderate Mizaj Dry Mizaj

Odds ratio

(95% CI) P-value Odds ratio

(95% CI) P-value

ABO Blood

Group

O1 1 1 1 1 1

A0.97

(0.54 to 1.76) 0.923 0.96

(0.53 to 1.75) 0.903 1.79

(1.02 to 3.15) 0.042* 1.79

(1.02 to 3.14) 0.044* 0.46

(0.23 to 0.92) 0.028* 0.46

(0.23 to 0.93) 0.030*

B1.58

(0.86 to 2.90) 0.142 1.55

(0.84 to 2.85) 0.157 0.80

(0.43 to 1.50) 0.487 0.79

(0.42 to 1.48) 0.465 0.75

(0.38 to 1.47) 0.402 0.78

(0.39 to 1.52) 0.459

AB 0.89

(0.39 to 2.05) 0.787 0.89

(0.39 to 2.05) 0.780 0.98

(0.44 to 2.17) 0.956 0.98

(0.44 to 2.17) 0.951 1.15

(0.51 to 2.61) 0.741 1.16

(0.51 to 2.65) 0.726

RH RH positive 0.67

(0.40 to 1.13) 0.137 0.68

(0.40 to 1.15) 0.150 0.96

(0.58 to 1.62) 0.891 0.97

(0.58 to 1.63) 0.918 1.77

(0.94 to 3.31) 0.077 1.73

(0.92 to 3.25) 0.091

a. Odds ratio adjusted by gender of the participants; b. CI: condence interval; *P-value≤0.05 was considered signicant

GMJ.2023;12:e3062

www.gmj.ir

ABO/Rh Blood Groups and the Mizaj Parvizi MM, et al.

with the O blood group. Furthermore, people

with the A blood group were 54 percent less

likely to have a dry Mizaj (OR=0.46, 95%

CI: 0.23 to 0.92) than those with the O blood

group. Otherwise, the logistic regression anal-

ysis showed that there was not any signicant

association between the individuals’ Rh blood

group and the participants’ Mizaj (P>0.05).

These associations did not change after con-

trolling the individuals’ gender as a probable

confounding factor using multiple logistic re-

gression analysis, as shown in Table-3.

Discussion

The results of our study showed that there is a

signicant association between the AB blood

group and the cold Mizaj. In addition, nd-

ings revealed that the most common Mizaj

types in all ABO blood groups were moder-

ate in both hotness and wetness qualities. This

nding was in line with the study of Parvizi

et al. which demonstrated that the prevalence

of moderate Mizaj was higher than its other

types in a normal population including uni-

versity sta [13]. On the other hand, there

was no signicant association between the Rh

blood group and the participants’ Mizaj.

It seems that the current study was the rst

study that analyzed the association between

the Mizaj types and the blood groups in Iran.

While, there were a few studies analyzing

the association of the Mizaj types with the

physical and mental characteristics of the in-

dividuals, as well as the association of ABO

blood groups with the psychological charac-

teristics of individuals. However, there were

few studies assessing the relationship between

the ABO/Rh blood groups and the Mizaj. A

study conducted by Furukawa T. et al. in 1930

showed that there was a signicant correlation

between the ABO blood groups and the Mizaj

[31]. The results of our study also showed a

relation between the cold Mizaj and the ABO

blood group [31].

According to the Seyed Mahtab Ali et al.’s

study, conducted in Aligarh in New Delhi,

the bilious Mizaj was the most common one

among participants with B positive blood

group [34]. Another study by Harburg et al.

showed a signicant association between the

Lewis blood marker and the Mizaj. However,

the association between the ABO/ Rh blood

group and the dierent types of Mizaj was not

signicant. Furthermore, according to the re-

sults of this study, Males’ Anger and Impul-

sivity were strongly connected with the Lewis

red blood cell phenotypes, while Females’

Sensation-seeking (a subscale of impulsivity)

was signicantly associated with the Lewis

red blood cell morphologies [32]. Although

the evidence showed that there was a signif-

icant relationship between Mizaj and person-

ality type [13], analyzing this association was

not considered in this study. It is necessary

to consider that the various results among

the Mizaj- related studies could be based on

several factors including the ethnicity of the

participants, the tools for determination of the

Mizaj, and the dierent age ranges of the par-

ticipants.

In addition, one of the important factors in the

determination of Mizaj from the TPM view-

point is psychological and mental conditions

[9, 6]. A study by Yogeeshwaran et al. showed

that there was no relationship between ABO

blood groups and the level of stress among

students [35]. While according to the study

of Pisk et al. psychiatric disorders were more

common in people with AB blood group com-

pared to other blood groups [36]. Moreover,

Kakathkar et al. found that children with AB

blood group had a signicantly higher level of

dental anxiety compared to the children with

other blood groups [27]. However, according

to the TPM, Mizaj is an inherent feature in

people, it should be considered that several

factors including gender, age, place of resi-

dence, job and occupation, lifestyle, and food

habits aect the Mizaj quality [37-39]. There-

fore, it is probable that the individual’s Mizaj

has been changed during their lifetime [9, 10].

But, the blood group is one of the non-change-

able characteristics of each person, so it seems

that this could be considered as an initial fac-

tor with the potential capacity to aect the in-

dividual’s Mizaj.

Multiple logistic regression demonstrated a

relationship between people’s Mizaj and their

ABO blood group. In this regard, it seems

that having both A and B antigens together in

the blood makes that person up to 2.88 times

more susceptible to cold Mizaj. On the other

hand, it seems that having only the A antigen

8GMJ.2023;12:e3062

www.gmj.ir

Parvizi MM, et al. ABO/Rh Blood Groups and the Mizaj

in the blood may be a protective factor against

dry Mizaj. These results could be considered

as a base for further studies to clarify more

physiological aspects of this phenomenon.

The distribution of the ABO (without con-

sidering RH) blood group in the Iranian pop-

ulation has been reported as % 38 for the O

blood group, 33% for the A, % 22 for the B,

and 7% for the AB in a previous study [40],

which were similar to our study. Therefore, it

seems that the participants of this study could

be considered representative of the normal

population of Iran. However, there were some

limitations in our study.

First, our study was a single-center study.

So multi-center studies are recommended in

this regard. Second, the ethnicity of the par-

ticipants was not considered in this study.

Ethnicity could probably be a confounding

factor in our study. Therefore, considering

the participants’ ethnicity is recommended for

further studies. Next, the temperament of the

individuals may be aected by several factors,

especially nutrition, food habits, occupation,

smoking, and psychological conditions which

were not controlled in this study. Consider-

ing the probable eects of these lifestyle and

environmental factors, it is recommended to

repeat this study using related tools, ques-

tionnaires, and developed analytical models.

Next, this study was conducted on healthy

participants who were referred to the Irani-

an Blood Transfusion Organization, Shiraz

Branch, so it could be possible that the results

of this study may not apply to unhealthy indi-

viduals and patients with Sue-Mizaj. Finally,

in this study, we only analyzed the relation-

ship between the RBO blood groups and the

Rh antigen. Future studies are proposed to

consider other surface antigens of RBCs.

Conclusion

This study showed that the cold Mizaj was

signicantly more common in participants

with the AB blood group and it was less in

participants with the B blood group compared

to other blood groups. In contrast, there was

no association between temperament and the

presence of Rh antigen on the surface of red

blood cells. Overall, this was a basic research

to analyze the relationship between two in-

dividual phenotypes, one from modern med-

icine (ABO/Rh blood groups) and the other

from the TPM concept (Mizaj). The practical

key point of this study could be emerging a

theory that manages the nutrition and food,

occupation, the place for residency, or other

factors. Depending on an individual’s blood

type, Mizaj may help people improve their

health, quality of life, and professional per-

formance. More studies are recommended on

this issue with controlling some probable con-

founding factors.

Acknowledgements

This study was a part of a thesis written by

Mohadese Molayemat as partial fulllment

of the requirements for obtaining her medical

degree (Project number: 21052). The authors

thank the Vice Chancellor of Research of Shi-

raz University of Medical Sciences, Shiraz,

Iran for nancial support.

Conict of Interest

None.

References

1. Nimrouzi M, Mahbodi A, Jaladat A-M, Sa-

deghfard A, Zarshenas MM. Hijamat in tra-

ditional Persian medicine: risks and benets.

J Evid Based Complementary Altern Med.

2014;19(2):128-36.

2. Nimrouzi M, Daneshfard B, Parvizi MM.

Dream in Persian medicine perspective: a

narrative review. International Journal of

Dream Research. 2020:119-22.

3. Shakeri A, Hashempur MH, Beigomi A,

Khiveh A, Nejatbakhsh F, Zohalinezhad ME

et al. Strategies in traditional Persian medi-

cine to maintain a healthy life in the elderly.

J Complement Integr Med. 2021;18(1):29-36.

4. Hamedi A, Zarshenas MM, Sohrabpour

M, Zargaran A. Herbal medicinal oils in

traditional Persian medicine. Pharm Biol.

2013;51(9):1208-18.

5. Mozaarpur SA, Saghebi R, Khafri S, Mo-

jahedi M. An assessment of the agreement

ABO/Rh Blood Groups and the Mizaj Parvizi MM, et al.

GMJ.2023;12:e3062

www.gmj.ir

between Persian Medicine experts on Mizaj

identication. Traditional and Integrative

Medicine. 2017:113-8.

6. Mojahedi M, Naseri M, Majdzadeh SR, Ke-

shavarz M, Ebadiani M, Nazem E et al. A re-

view on identication mizaj (Temperament)

indices in Iranian traditional medicine (ITM).

Medical History Journal. 2012;4(12):37-76.

7. Alizadeh M, Khadem E, Aliasl J. Diagnosis

protocol of stomach distemperament for clin-

ical practice in Iranian traditional medicine:

A narrative review. Iran J Public Health.

2017;46(7):877.

8. Derakhshan AR, Choopani R, Dehghan S. A

new look at epicardial adipose tissue from

the perspective of Iranian traditional medi-

cine. J Integr Med. 2014;12(6):529-30.

9. Avicenna H. Al-Qanun t-tib [The Canon

of Medicine]. Beirut, Lebanon, dar-ehya-al-

torath-alarabi. 2005:87-98.

10. Arzani M: Mofarah-ol-Gholoub. editing and

research Nazem, E., Baghbani, M. almaee

publications: Tehran; 2011.

11. Miraj S, Alesaeidi S, Kiani S. A systematic

review of the relationship between dystem-

prament (sue Mizaj) and treatments and man-

agement of diseases (Ilaj and Eslah-e-Mizaj).

Electron Physician. 2016;8(12):3378.

12. Rahbar M, Zarei A, Ranjbar M, Tabarrai M,

Shirbeigi L. Etiology, clinical manifestation

and natural treatments of psoriasis from the

perspective of Persian medicine. Traditional

and Integrative Medicine. 2020:221-9.

13. Parvizi MM, Nimrouzi M, Pasalar M, Salehi

A, Hajimonfarednejad M, Amini F et al.

Association Between Personality Types and

Temperament (Mizaj) Based on Persian Med-

icine. Shiraz E-Med J. 2018;19(12): e68950.

14. Ilkhani R, Aghanouri Z, Mojahedi M, Mon-

tazeri A, Siavash M, Tabatabaei F. Compar-

ing Mizaj (temperament) in type 1 diabetes

mellitus and healthy controls: A case–control

study. J Res Med Sci. 2019;24:58.

15. Parvizi MM, Ghahartars M, Jowkar Z, Saki

N, Kamgar M, Hosseinpour P et al. Associ-

ation of Non-Melanoma Skin Cancer with

Temperament from the Perspective of Tra-

ditional Persian Medicine: A Case-Control

Study. Iran J Med Sci. 2022;47(5):477.

16. Mirtaheri E, Namazi N, Sargheini N, Hesh-

mati J, Hadi V. Dierent types of Mizaj (tem-

perament) in relation with body composition

in overweight and obese women: Avicennaâ s

opinion. Indian Journal of Traditional Knowl-

edge. 2015;14(2):240-3.

17. Moghaddam AG, Andish M, Hemati H,

Akrami R, Mohammadi M, Ghorat F. Rela-

tion between Temperament and Body Mass

Index in Teenage Girls. Iran J Public Health.

2018;47(12):1973.

18. Storry J, Olsson ML. The ABO blood group

system revisited: a review and update. Immu-

nohematology. 2009;25(2):48.

19. Watkins W. The ABO blood group sys-

tem: historical background. Transfus Med.

2001;11(4):243-65.

20. Iodice S, Maisonneuve P, Botteri E, Sandri

MT, Lowenfels AB. ABO blood group and

cancer. Eur J Cancer. 2010;46(18):3345-50.

21. Wolpin BM, Chan AT, Hartge P, Chanock SJ,

Kraft P, Hunter DJ et al. ABO blood group

and the risk of pancreatic cancer. J Natl Can-

cer Inst. 2009;101(6):424-31.

22. Yu H, Xu N, Li Z-K, Xia H, Ren H-T, Li

N et al. Association of ABO blood groups

and risk of gastric cancer. Scand J Surg.

2020;109(4):309-13.

23. Cserti CM, Dzik WH. The ABO blood group

system and Plasmodium falciparum malaria.

Blood. 2007;110(7):2250-8.

24. Chakrani Z, Robinson K, Taye B. Association

between ABO blood groups and Helicobacter

pylori infection: a meta-analysis. Sci Rep.

2018;8(1):1-11.

25. Zhao J, Yang Y, Huang H, Li D, Gu D, Lu X

et al. Relationship between the ABO Blood

Group and the COVID-19 Susceptibility.

Clin Infect Dis. 2020;509:220-3.

26. Wu Y, Feng Z, Li P, Yu Q. Relationship

between ABO blood group distribution

and clinical characteristics in patients

with COVID-19. Clinica Chimica Acta.

2020;509:220-3.

27. Kakathkar S, Srinivasan I, Setty JV, Akhil P,

Suting C, Nayana K. Correlation between A,

B, and O Blood Group System and Dental

Anxiety in Children of Age 6–12 Years in

East Bengaluru. Journal of the Internation-

al Clinical Dental Research Organization.

2020;12(2):127.

28. Ekpenyong CE, Inamete VD. Association

between ABO Blood Group Phenotype and

Reaction to Academic Stress and Coping

Strategies among College Students. Journal

of Education, Society and Behavioural Sci-

ence. 2018:1-10.

29. Tsamesidis I, Stalika E, Egwu CO, Pritsa A,

Parpori M, Gkinoudis A et al. The Poten-

tial Impact of Blood System on Dietary

Habits and Smoking. Medicines (Basel).

2022;9(1):3.

30. D'adamo PJ, D'Adamo P. Eat right for your

type. Penguin: United States; 2002.

31. Furukawa T. A study of temperament and

blood-groups. J Soc Psychol. 1930;1(4):494-

509.

32. Harburg E, Gleibermann L, Gershowitz H,

Ozgoren F, Kulik C-L. Twelve blood markers

and measures of temperament. Br J Psychia-

try. 1982;140(4):401-9.

33. Mojahedi M, Naseri M, Majdzadeh R,

Keshavarz M, Ebadini M, Nazem E et al.

Reliability and validity assessment of Mizaj

questionnaire: a novel self-report scale in Ira-

nian traditional medicine. Iran Red Crescent

Med J. 2014;16(3): e15924.

34. Ali SM, Alam M. A scientic correlation

between blood groups and temperaments in

Unani medicine. Indian Journal of Traditional

Knowledge. 2007;6(2):319-23.

35. Yogeeshwaran VV, Thimmappa B, Lokesh-

waraiah R. Comparative assessment of stress

among medical students in relation to ABO

blood groups. Natl J Physiol Pharm Pharma-

col. 2018;8(11):1558-60.

36. Pisk SV, Vuk T, Ivezić E, Jukić I, Bingu-

lac-Popović J, Filipčić I. ABO blood groups

and psychiatric disorders: a Croatian study.

Blood Transfus. 2019;17(1):66.

37. Pourshahidi S, Mansourian A, Habibzadeh

M, Parvizi MM, Nimrouzi M. Association

Between Geographic Tongue and Personal

Temperament Based on the Knowledge of

Persian Medicine. Shiraz E-Medical Journal.

2020;22(5): e102456.

38. Salmannejad H, Mojahedi M, Mozaar-

pur S, Saghebi R. The review of indices of

Mizaj-e-Damagh (temperament of brain)

identication in Persian medicine. Journal

of Babol University of Medical Sciences.

2016;18(11):71-9.

39. Akhtari M, Moeini R, Mojahedi M, Gorji

N. Assessment the studies on the concept of

Mizaj (temperament) in Persian Medicine. J

Complement Integr Med. 2020;17(3):0122.

40. World Population Review. Blood Type by

Country 2023 [internet]. Walnut: United

States; 2023. Available from: https://world-

populationreview.com/country-rankings/

blood-type-by-country

10 GMJ.2023;12:e3062

www.gmj.ir

Parvizi MM, et al. ABO/Rh Blood Groups and the Mizaj