MINI REVIEW

Traditional Medicine Research 2023;8(2):12. https://doi.org/10.53388/TMR20220516002

Umbilical displacement: a mini review

Mahboobeh Salmanian1*, Fataneh Hashem-Dabaghian2

School of Traditional Medicine, Iran University of Medical Sciences, Tehran 1114733311, Iran. 2Department of Traditional Medicine, Institute for Studies in
1

Medical History, Persian and Complementary Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran 1145847111, Iran.

*
Corresponding to: Mahboobeh Salmanian, School of Traditional Medicine, Iran University of Medical Sciences, No. 847, Behesht St. South Side of Shahr Park,
Vahdat-e-Islami St., Hasan Abad Sq., Tehran 1114733311, Iran. Email: Salma.ms219@gmail.com.

Author contributions Abstract

Mahboobeh Salmanian was responsible for the Background: Umbilical displacement is a known disorder in folk medicine of different
conceptualization, investigation, writing original draft, cultures. The various causes, clinical signs and symptoms are attributed to this disorder and
supervision; Fataneh Hashem-Dabaghian was responsible for different diagnostic and therapeutic methods are mentioned. Methods: To follow the aim of
the writing and editing the article. the study, Persian medicine literature, Google Scholar, Google, PubMed, Scopus and Web of
Competing interests Science were searched with no limit of the publication date and the article type (original
The authors declare no conflicts of interest. papers and literature reviews). The searched terms were Navel, Umbilicus and other
Acknowledgments synonyms in Persian, Turkish, Russian, German, Chinese and Indian language, Dislocation,
This research received no specific grant from any funding Sliding, Displacement, Deviation, Falling, Ptosis, Folk medicine and combination of these
agency in the public, commercial, or not-for-profit sectors. The words. We also corresponded with several experts in traditional medicine via LinkedIn. All
authors sincerely appreciate Professor Abdul Latif and Dr. available descriptive evidence related to umbilical displacement was retrieved, and the
Munawwar Husain Kazmi from India, M Salim Khan (medical contents were presented as categories including the disorder name, attributed signs and
herbalist) from Pakistan and Cui-Hong Zhu, who responded to symptoms, and the diagnostic and therapeutic methods. Results: This disorder is called
us on LinkedIn. “Taharok-e-Sorre” in Persian medicine, “Nawikkatin” in Erbil (Iraq), “Dharan or Nabhi
Abbreviations Sarakna” in Hindi, “Göbek düşmesi” in Turkish, Bēn tún in Chinese and “Cirro” in the people
UD, umbilical displacement; PM, Persian medicine. of Mayan community and Spanish, and “смещен пупок” in the folk medicine of the Kurgan
Peer review information Bashqir. Hard work, pregnancy, childbirth, fear, lifting heavy objects, rapid and sudden
Traditional Medicine Research thanks Roshanak Ghods and movements, trauma or fall and slipping of the foot are said to be causes of umbilical
other anonymous reviewers for their contribution to the peer displacement. Umbilical displacement is associated with several symptoms such as diarrhea,
review of this paper. constipation, abdominal pain, anorexia, anxiety, and depression. Conclusion: In this
Citation mini-review, umbilical displacement was expressed from the viewpoint of different cultures.
Salmanian M, Hashem-Dabaghian F. Umbilical displacement: a New cases of umbilical displacement has been reported in new articles, and the pathology of
mini review. Tradit Med Res. 2023;8(2):12. doi: umbilical displacement has been explained from the perspective of Persian medicine.
10.53388/TMR20220516002.
Keywords: umbilical displacement; Persian medicine; navel; peritoneal adhesion
Executive editor: Chun Ling.
Received: 16 May 2022; Accepted: 18 July 2022; Available
online: 24 August 2022.
© 2023 By Author(s). Published by TMR Publishing Group
Limited. This is an open access article under the CC-BY license.
(https://creativecommons.org/licenses/by/4.0/)

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Traditional Medicine Research 2023;8(2):12. https://doi.org/10.53388/TMR20220516002

umbilicus ligaments and is connected to the liver via the round

Highlights ligament of the liver (ligamentum teres hepatis). The peritoneum is
This study was conducted to introduce umbilical displacement located behind the umbilicus, and connects it to the gastrointestinal
through a review of the available evidence about this disorder. It tract and genitourinary system [4, 5].
provides preliminary information for clinical practitioners and This regularity and integrity are so much important in the PM, and
could be a suitable platform for further research in this field. any distortions of the umbilicus may cause some signs and symptoms,
especially in the abdominal region. There is no much information
Medical history of objective about the signs and symptoms of UD in PM books, but this disorder is
The early records of umbilical displacement in the folk medicine very commonly seen in daily clinical work. Although there is no
of different cultures is not known. According to the literature clinical evidence for the efficacy of the intervention in UD, but PM
found in the countries such as Turkiye, Russia, Iraq, Spain, Mexico, practitioners have reported many cases, which umbilicus
India, and Iran, umbilical displacement has been known and has a manipulation could eliminate many signs and symptoms of patients
special place in the folk medicine of these countries. This disorder such as abdominal pain, diarrhea, anxiety, and even infertility.
is frequently seen in Persian medicine clinical practice. In addition, Since this disorder is unknown in conventional medicine, this study
there are some cases of umbilical displacement in the published was conducted to introduce “UD” through review the available
articles as case reports or case series, however, it seems that the evidence about this disorder, its accompanying signs and symptoms
signs and symptoms of umbilical displacement, its causes and the and the recommended methods of UD management in different
mechanism of creation need more scientific studies. countries (Table 1) [6–19].

Methods and materials

Background
In this review, PM literature, Google Scholar, Google, PubMed, Scopus
There are numerous diagnostic and therapeutic conceptual and Web of Science were searched with the following terms of navel,
frameworks in traditional and folk medicine, which differ from umbilicus, and other synonyms of the “Navel” in Persian, Turkish,
conventional or academic medicine [1]. Considering the popularity of Russian, Spanish, German, Chinese and Indian language. The other
traditional medicine in different countries, these differences should be searched terms were dislocation, sliding, falling, movement,
evaluated, explained, and introduced to the conventional medicine displacement, deviation, ptosis, folk medicine and traditional
practitioners. One of these concepts is “umbilical displacement” (UD) medicine. We also searched LinkedIn information about this disorder
which means that the umbilicus is not in a proper position and is in any countries, sent an e-mail to authors of traditional medicine and
slippery, drooping, or knotted. It is a well-known subject in the folk asked questions about this disorder. All available evidence related to
medicine of different countries; however, it has been less discussed in UD, including its definition, diagnosis and treatment were retrieved
the textbooks of traditional medicine and is not known in academic and the contents were presented as categories including the name of
medicine. This disorder is called “Taharok-e-Sorre” in Persian the disorder, its attributed signs and symptoms, and its diagnostic and
medicine (PM), and is known in some other cultures with different therapeutic method.
terms [2]. A quick Google search with term “navel displacement” or
its synonyms in different languages such as “Nabhi Talna”, “Göbek Results
düşmesi”, “Dharan” or “Nabhi Sarakna” shows, that this disorder is
not uncommon in traditional medicine of other countries. Based on “Exir-e-Azam”, which is one of the main textbooks of PM,
The abdominal wall is formed of the skin, the superficial fascia and “Taharok-e-Sorre” is the synonym of UD, and is explained under the
fat, the superficial sheath of the abdominal muscle, the rectus category of peritoneal diseases. There are different theories about the
abdominis, the deep layer of the sheath, the subperitoneal connective pathology of UD. Some PM scholars believe, that the abdominal
tissue, and the peritoneum, respectively [3]. Due to the special muscles, which are around the navel move from their place, then the
position of the umbilicus, it is connected to the muscles of the umbilicus moves from its position and deviates to one side. Some
abdominal wall, diaphragm and pelvis through the linea alba. It scholars also believe that the intestine moves from its place and causes
connects directly to the bladder through the median and lateral the umbilicus to deviate [2, 6].
Table 1 UD in different countries
Country and
Name Causes Diagnosis Symptoms Treatment
PM
PM [2, 6] Taharok-e- Sorre Lifting heavy object Beating Abdominal pain Massage

Sudden movements Nausea, dyspepsia poor appetite Cupping

Pain Liver heaviness dyspareunia, changes in menstrual
Improper position cycle dysmenorrhea infertility
of intercourse
Both Uterine deviation or contractions
Pregnancy
Headache
Childbirth
Overeating Dry cough

Palpitation and dyspnea after activity

Persistent coldness or tingling of fingers and toes

Depression

Stabbing pains in legs

Weakness and redness of face and eyes

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Table 1 UD in different countries (continued)

Country and Name Causes Diagnosis Symptoms Treatment
PM
Erbil (Iraq) [7] Nawikkatin Fear Measuring two Weakness Massage
outstretched arms maneuver
Sudden and Lack of pulse in the Anorexia, restlessness
unforeseen fall umbilicus

Stomach-ache
Bad news excessive Asymmetry of the
sex or worry lifting position of the breasts
Vomiting
a heavy object
Loss of appetite
Red eyes
Trembling legs
Knee pain
Turkiye [8, 9] -Göbek düşmesi Fear Measure distance from Anorexia, nausea, vomiting, bloating, belching Massage
navel to nipples
-Göbek kayması Lifting heavy Pain in the umbilicus, back, abdomen Cupping
-Göbek kaçığı objects Lack of pulse in the
umbilicus
-Yürek kayması Prolonged constipation or diarrhea Jumping
-Eş kaçığı Sudden movements
Pressure to the cartilage
-Eş çıkması Depression, weakness Swinging lifting
between thumb and
-Bağırsak Excessive jumping by someone else
index finger of each
dolaşması or running
hand in women and Inability to stand
men. Medicinal plants
Abdominal
Shortness of breath
exposure to cold
Pressure to lateral leg
muscle below the
Fatigue, headache
Heavy work in kneecap in men
weak persons
Insomnia, infertility

Chronic discomfort
India [10–13] -Dharan or Nabhi Lifting heavy Measure the distance Excessive or scant menstrual periods Yoga
sarakna objects from the navel to the
nipples or the toes
Dysmenorrhea Massage
-ApolaIku Climbing
Lack of pulse in the
Sudden and prolonged constipation, diarrhea, Herbal pack
umbilicus
-Naaf Ka Jumping nausea, vomiting applied to the
Ukharna stomach
Sexual activity Pain in the calves, thighs, back, or abdomen
-Nabhi Talna
Sudden twisting
or bending
Izhemsts of Пуп у человека Lifting heavy Lack of pulse in the Walking disorder Massage
the lower не на месте objects umbilicus
(navel is out of
Abdominal pain Cupping
place)
Priob (Russia])
[14–16]
Squeeze the navel
with a ball of
woolen yarn

Kurgan region смещен Fear Infertility Massage

(Russian) пупок(displaced
navel)
Birth of a sick child Cupping

Mayan Tip’te’ Lifting heavy Lack of pulse in the Bloating Massage

[17–19] objects umbilicus
Tip ‘te tuch Stomach cramps
Mixing hot and
cold food
Cirro Headache

Excess eating
Pasmo del cirro Fever
Latido umbilical Inadequate eating
Cirro ladeado Intense activity
Diarrhea
(such as childbirth)

Nausea and vomiting

Pregnancy
UD, umbilical displacement; PM, Persian medicine.

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In Erbil (Iraq), UD is known as “Nawikkatin” and it is believed that umbilicus back in place [20, 21].
not only UD could occur after physical/mechanical, but also due to In the Mayan language “tip’te” and in the Spanish language “Cirro”
mental stress factors. The UD after an unforeseen fall means that the is a small “organ” located below the navel. The Cirro beats like the
fall is etiologically related to the fall of the soul [7]. heart and determines the speed of all parts of the body. Its vitality can
In Turkiye, UD or navel falling is known as “Göbek düşmesi” (navel be sensed by sinking fingers into the navel to see if it “jumps”; Cirro
displacement); different causes and also numerous signs and may be coming out of its original position. The form of massage called
symptoms are attributed to UD. They believe, that the navel is the Sobada is one of the most important therapeutic practices in Yucatán
center of gravity of the person’s body, and might be dislocated due to (Mexico), today. It deals with the “repositioning” of several internal
many reasons. It is important to know in which direction the organs of the human body, that are considered momentarily “out of
umbilicus has moved. If the umbilicus moves down, it causes diarrhea. place”. Treatment of dislocated Cirro consists mostly of circular
If it moves upwards, it causes nausea, anorexia, back pain, persistent massages around the navel clockwise [17, 19, 22].
thirst, and pain in the abdomen. The treatment of UD, which is called The center of gravity is the point at which all of the body mass and
“Göbek çekme” is done in different ways. In abdominal massage, the weight are equally balanced or equally distributed in all directions.
person with UD lies in a supine position. The massager’s thumb is Very generally, the center of gravity for humans is located in the
placed in the navel and constantly rotates clockwise. It is believed that vicinity of the umbilicus. Phidias number determines the ratio
once a person’s navel falls out, it is more likely to fall out in the future. between the man’s height and the height of the man’s umbilicus. It is
In addition, it is believed that untreated UD is thought to cause serious generally known that the Phidias number is the most harmonic ratio
health problems such as persistent diarrhea or constipation, inability in the nature of things. It is well known that the general center of
to stand upright and even infertility in women. Treatment of chronic gravity of an upright standing man is below the umbilicus by 0.05,
UD is difficult or even impossible. As delays in treatment increase the and it is 0.1 in women; since their umbilicus is lower than the one of
severity of the disease, the healer can help to treat the patient. Healers the men by 0.05 [19].
use two methods, arm-to-arm and kick. In the arm-to-arm method, the Common clinical findings in the middle-crossed syndrome in a
patient and the healer stand back-to-back, clasping each other’s arms. right-handed, right-footed individual are as follows; these findings are
The healer bends to the ground. As a result, the patient lies on his typically reversed for a left dominant individual. (1) In gait, the
back, with his legs dangling in the air, and the healer shakes him. This umbilicus deviates leftward on right foot ground contact but stays
process is repeated several times. In the tapping method, the patient central on left ground contact. (2) In active straight leg raise testing,
and the healer lie down so that the soles of their feet touch each other. the umbilicus deviates rightward on the right leg lift but stays central
The healer strikes the patient’s foot several times with his foot [8, 9]. on the left leg lift. (3) “In supine lateral ball roll, the umbilicus
UD is known as “Dharan or Nabhi Sarakna” in India. “Nabhi” or deviates leftward (and/or the right hip drops), when moving across
“Dharan” translates as the navel or umbilicus, and Sarakna means the ball to the left but stays central when moving to the right” [23].
movement or displacement. A clinical study was performed on 44 nulliparous women, whose
UD is known as “Dharan or Nabhi Sarakna” in India. The term pregnancies had reached at least 37 weeks’ gestation. The results
Nabhi is derived from the words “Nah-Bandhe”. It means to bind or tie showed the umbilicus and supra- or infraumbilical linea nigra
to the central point just like the spokes of a wheel held at the nave. It deviation to the right side in 31 women (70.5%); it also remained in
is located in the abdominal or “gut” area of the solar plexus and is the midline in 13 cases. Displacement of the umbilicus and adjacent
identified with the assertion of will and initiative. Nabhi is an abode of structures commonly occurs in term pregnancy; the pressure of the
Pranas (vital energy). Indian healers believe, that the positioning of uterus on the ligamentum teres and falciform ligament determines
the umbilicus in its accurate site is important for the movement of that displacement is invariably toward the right side [24].
Prana in the body, and they have several ways to treat UD; one of In addition to deviation, the umbilicus sometimes rotates and moves
which is the asana positioning in yoga. This position could expand or in place. The analysis of supra- and infraumbilical linea nigra in
stretch the rectus abdominal muscles, and is believed to be effective in puerperal women showed the predominance of what the authors
UD after 3–4 days. Thereafter, to prevent the recurrence, patients are named “anti-clockwise spiralization of the linea nigra sign”. “It is
encouraged to practice the “asana” positioning to strengthen the believed that this situation may be due to the 270 anti-clockwise
stomach and back muscles [10, 11]. rotation of the mesentery, which occurs during the return of the
In northeastern India, UD is known as “ApolaIku” and could occur physiological omphalocele to the abdominal cavity around the 10th
in any age groups. It causes severe pain and discomfort in the person, week of embryonic life [25].
because the umbilicus is twisted inside. The therapist improves the In the normal infant, the umbilicus marks the central point between
navel by massaging with oil. Also, sometimes the treatment is done by the crown of the head and the soles of the feet; whereas in the
simultaneously tapping of the patient’s feet heel [12]. achondroplasic child the central point of the body is above the
Based on Russian folk medicine, UD is believed to cause gait umbilicus, sometimes as high as the xiphoid process, and this
disorder and with the treatment of UD, the spine is corrected [13]. relationship continues throughout life [26].
Diseases such as osteochondrosis, muscles diseases, joints, skin The ratio of the distance from the mid umbilicus to the lower end of
diseases, hearing loss, and even colds were considered to be associated the xiphoid process and the upper edge of the symphysis is referred to
with disruption of the internal organs. Visceral chiropractic consisted as the umbilical index. In cirrhotic patients without ascites or obesity,
of rhythmic squeezing of the abdomen with the hands [14]. In the folk the distance between the xiphoid and umbilicus is more than the
medicine of the Bashqir people of the Kurgan region, such a diagnosis distance between the umbilicus and symphysis pubis (Tanyol’s sign)
is widely used for female infertility [15]. [27, 28].
In Tajik, the terms “уход пупка в сторону” or (leaving the navel to An upward deflection of the umbilicus on flexion of the neck
the side) and “уход пупка” or (displaced navel) seem to be used to (Beevor’s sign), is the result of paralysis of the inferior portion of the
describe UD, which is considered one of the reasons for women rectus abdominis muscle. The condition may be caused by the spinal
infertility [16]. cord injury at or below the level of Thorasic vertebra 10. It has also
The Volga Germans also know the disorder of navel falling. They been observed in patients with facioscapulohumeral muscular
believe that a person who is physically exhausted may experience UD. dystrophy [29].
Symptoms include nausea and vomiting. For treatment, the patient Oppenheim described UD as unilateral paralysis of the abdominal
should lay on his back on the floor, a small flat coin or an object is wall. It may develop in association with herpes, malaria, typhoid,
placed over her navel, and a small candle is attached to the coin. They alcoholism, gout and diabetes. The symptoms are unilateral or
light the candle and place a glass on the candle, allowing it to rest on bilateral pain in the region of the abdomen, tenderness to the pressure
its stomach for a while. When the candle goes out, it burns the air in of the corresponding nerve stems and paresthesia. This is followed by
the glass, creating a suction on the stomach muscles, which put the a unilateral or bilateral absence of the abdominal reflex, anesthesia

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and degenerative paralysis of the abdominal muscle. In unilateral movement of the abdominal organs, for example, loops of the bowel to
paralysis, the umbilicus deviates to the healthy side. The affected side freely slide over one another during peristalsis. If this normal property
is more prominent and shows a globular swelling, especially after is lost by obliteration, adherence to bowel surfaces occurs [37].
coughing, screaming, straining or in an attempt to move the trunk Persistent adhesions can prevent the normal sliding of the viscera
against resistance, and the umbilicus is drowning more towards the during peristalsis and movements of the body, such as respiration.
sound side [30]. Small-bowel obstruction or intestinal mal rotation, infertility, chronic
In 1921, Schlesinger described temporary UD in certain cases of abdominal and pelvic pain are the most common consequences of
gastric ulcers and acute cholecystitis, which is called “die peritoneal adhesions [38].
Nabelverziehung”. An acute abdominal lesion, causing unilateral Adhesions form following a number of injuries to the peritoneum,
rigidity of the rectus abdominis could cause lateral UD during including mechanical trauma, drying, blood clotting, and foreign
straining, which lasts several seconds. This transitory UD is toward the object implantation, after surgery or after intra-abdominal
diseased side, because of the more marked muscular contraction. The inflammatory processes, such as appendicitis, acute cholecystitis,
displacement varies much in different cases (up to 4 cm). This UD is acute diverticulitis, and pelvic inflammatory disease [39, 40]. Injury
valuable in cases where other symptoms, such as tenderness in to the peritoneum leads to the release of fibrin, which causes adjacent
pressure have been disappeared in a persisting gastric ulcer [31]. serosal surfaces to stick together and form fibrinous adhesions.
Dr. Tui and Dr. Meyer encountered a physical condition, that was a Removal of this fibrin before fibroblast invasion prevents the
prolonged displacement of the “linea alba” and the umbilicus to the formation of permanent fibrous adhesions. Normal peritoneum has
affected side with skin surface disturbances in the form of folds; it fibrinolytic activity [41]. It is likely that visceral manipulation by
creases on the side, which the linea alba and the navel are drawn. repeatedly disrupting fibrin bridges does not allow the fibroblast
They reported four cases of active duodenal ulcers, four cases of acute invasion needed to create adhesions [42].
appendicitis, and one case of penetrating ulcers near the gastric It seems that our scholars, without access to well-equipped
cardia, with UD. The side toward, which the displacement occurs in laboratories and advanced tools, found some points, researching them
these acute abdomen conditions is the side of greater rigidity as can bring us new perspectives and methods to prevent the occurrence
determined by palpation [32]. of serious diseases in the peritoneum.
So far, only one case series clinical study has been performed on UD. Various treatment methods for UD, such as cupping, massage, yoga,
In this study, 20 patients were diagnosed with UD. Gastrointestinal various maneuvers and examining the mechanism of effect of the used
problems were the most observed sign and symptoms reported by methods can help to solve many problems and complaints of patients
patients and the majority of patients reported some psychological with nonspecific clinical diagnosis.
problems. There are different methods to treat UD, including (a) This study was a brief introduction to UD, its probable causes, and
taking a nerve that passes under the armpit and applying intense sign and symptoms. Undoubtedly, we are at the start point, and
pressure to the extent, that the patient goes unconscious due to the further studies are needed to show the true nature of UD and its
severity of the pain; (b) patient sitting on all fours, while the other pathology. For example, imaging of the abdominal wall might help
person firmly holds both knees with the hands; (c) the patient bend at to understand the changes in the abdominal wall anatomy occurring
the back, so that the abdominal muscles are stretched, the patient in patients with UD. In addition, descriptive studies with control
hangs, and the abdominal muscles stretch; (d) placing a half-walnut groups could show the differences between UD patients and normal
filled with raw turpentine or placing an onion-sized object such as a individuals in terms of signs and symptoms or the risk factors. Finally,
bag of wheat or salt on the navel [33]. further interventional studies should be performed to evaluate the
efficacy of different methods of PM in UD treatment.
Conclusion
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