Breathlessness from the Perspective of the Persian Medicine

Abstract

Dyspnea is one of the most complaints in the pulmonary diseases. Shortness of breath as a subjective symptom can decrease the quality of life of patients. Although symptomatic treatment of the patients with chemical drugs is efficient in sign reduction, drugs side effect and allowing the disease to become chronic are risky for patients. Nowadays, traditional medicine is considered as an effective strategy in patients′ treatment by World Health Organization. This study discusses the causes of shortness of breath from the view of Iranian traditional medicine and describes some suggestion for treatment of causes of this problem.
Persian medicine prioritizes prevention of diseases by offering some strategies. In case of disease occurrence, life style modifications and herbal pharmaceutical therapy are recommended.

Full text

Review Article
2016 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran
ISSN: 1735-0344 Tanaffos 2016; 15(4): 191-196
Breathlessness from the Perspective of the Persian Medicine
Ali Abdolahinia1, Mohsen Naseri 2, Alireza
Eslaminejad 3, Farzaneh Ghaffari 4, and
Ali Akbar Velayati 3
Dyspnea is one of the most complaints in the pulmonary diseases. Shortness of
breath as a subjective symptom can decrease the quality of life of patients.
Although symptomatic treatment of the patients with chemical drugs is
efficient in sign reduction, drugs side effect and allowing the disease to become
chronic are risky for patients. Nowadays, traditional medicine is considered as
an effective strategy in patients' treatment by World Health Organization. This
study discusses the causes of shortness of breath from the view of Iranian
traditional medicine and describes some suggestion for treatment of causes of
this problem.
Persian medicine prioritizes prevention of diseases by offering some strategies.
In case of disease occurrence, life style modifications and herbal pharmaceutical
therapy are recommended.
Key words: Iranian traditional medicine, Persian medicine,
Breathlessness, Dyspnea
1 Department of Iranian Traditional Medicine, Faculty of
Medicine, Shahed University, Tehran, Iran, 2 Traditional
Medicine Clinical Trial Research Center, Shahed
University, Tehran, Iran, 3 Chronic Respiratory Disease
Research Center, National Research Institute of
Tuberculosis and Lung Disease (NRITLD), Shahid
Beheshti University of Medical Sciences, Tehran, Iran,
4 School of Traditional Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
Correspondence to: Naseri M
Address: Traditional Medicine Clinical Trial
Research Center, Shahed University,
Tehran, Iran.
Email address: naseri@shahed.ac.ir
INTRODUCTION
Difficulty in breathing described as feeling of
“shortness of breath”, “cannot get enough air”, and
“tightness in the chest” is referred to as breathlessness and
the medical term for it is dyspnea (1).
Many pulmonary conditions such as pulmonary
emboli, chronic obstructive pulmonary diseases,
pneumonia and pulmonary hypertension as well as non-
pulmonary conditions such as cardiac diseases, anemia,
hernia, obesity and anxiety disorders can all cause
breathlessness. Shortness of breath as a subjective
symptom can accompany chest pain and dizziness and
decrease the quality of life of patients. Resolving this
symptom by treating the cause allows easier passage of air
into the lungs and efficient gas exchange in the alveoli.
Bronchodilators, anti-inflammatory drugs and
corticosteroids can resolve this symptom (2). Iranian
traditional medicine or Persian Medicine (PM) is based on
temperament and prioritizes prevention by modifying
lifestyle followed by treatment with medicinal herbs.
Traditional medicine has several recommendations and
strategies for treatment of shortness of breath based on the
causative agent. This study discusses the causes of
shortness of breath from the view of Iranian traditional
medicine and describes the suggested strategies for
treatment of causes of this problem.
Respiration in the Persian Medicine
Avicenna (980-1037 AD), as the pioneer of Iranian
traditional medicine, divided breathing into two
movements and two stops. The difference between
breathing and pulse is in that breathing is voluntary. He
also described different modes of breathing including large
and small, deep and shallow, fast and mild, different and
frequent, vast and narrow, easy and difficult, strong and
weak, and warm and cold. Differentiation of these
TANAFFOS

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conditions is interesting considering the limitations in
equipment at that time. Breathlessness from the
perspective of the PM refers to abnormal breathing and in
most cases, parts of the respiratory system are involved.
However, breathlessness may be due to fullness,
obstruction, proximity to compressive organs or masses,
edemas or swellings, severe pain, wound in the chest or
diaphragm, loss of strength (weakness), high fever and oral
toxins (3).
Factors Causing Shortness of Breath
According to the Persian Medicine
1. Narrowing of airways: which may occur due to the
swelling of larynx, trachea or bronchial tracts or
presence of tumors or abscess in the respiratory tract. If
the stricture is in the bronchi or bronchioles, it causes
pain and burning sensation and leads to coughing. Fast
shallow breathing accompanied by fever indicates
swelling in the lungs or other parts of the respiratory
system.
2. Presence of sputum in respiratory tracts: If breathing is
fast and shallow but is not associated with fever, it may
be due to the presence of sputum. Its location is found
based on the presence/absence of cough.
3. Presence of mucus in internal body spaces such as
pleural cavity, or presence of ascites can prevent
expansion of diaphragm and cause shortness of breath.
4. Weakness or paralysis of the muscles of respiration
contributing to inhalation and exhalation.
5. Air entrapment in the chest. (Pneumothorax)
6. Congenitally small size of the lungs and chest,
preventing complete expansion of the lungs. These
patients suffer from shortness of breath in their entire
life.
7. Enlarged and stiffed liver: Enlarged, stiffed liver
pressures the diaphragm and prevents its expansion.
8. Improper temperament such as dryness of chest and
cold temper of the lungs (as seen in the elderly)
9. Trauma and injury to the brain
10. Bleeding in the respiratory system and blood clot in
respiratory tract causing stimulation and aggravation
of shortness of breath.
11. Presence of dust or smoke in the air
12. Impairment of the diaphragm nerve
Resolving of shortness of breath in each case requires
elimination of the cause, which is different for each case.
According to Avicenna, some problems in the stomach,
liver, uterus and intestines can be responsible for
development of shortness of breath. Thus, it is important to
thoroughly examine all organs in patients suffering from
shortness of breath.
Treatment
The Iranian traditional medicine recommends three
different strategies (in terms of priority):
Lifestyle modification
Patients suffering from shortness of breath must first
modify their lifestyle. PM has some general
recommendations for these patients, which covers all types
of shortness of breath. These recommendations include air
pollution avoidance, (4) nutritional advices such as
consumption of fermented bread, with additives such as
hyssop, thyme and pennyroyal. Small freshwater fish and
small birds are suitable as protein sources for these
patients. According to the PM, chickpea is among the main
foods suitable for the lungs. However, flatulence must also
be taken into account because avoiding flatulence caused
by beans is another recommendation for prevention of
shortness of breath. Addition of plantain leaf to meals,
drinking grape juice and honey syrup have also been
recommended for these patients. Food and drinks should
not be used simultaneously and a time interval must be
considered between them. Drinking of beverages must be
slow, and drinking (water or other beverages) must be
avoided after meals. Iranian traditional medicine also has
specific recommendations for sleeping, bathing and
physical activity of these patients. Sleeping shortly after
eating should be avoided since it is highly hazardous for

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Tanaffos 2016; 15(4): 191-196
these patients unless the cause is exhaustion. In the latter
case, a short nap is recommended. Patients with shortness
of breath must avoid long baths especially after heavy
meals or long sleep. Avicenna recommended special
physical exercises for these patients. Singing (starting from
a low tone and gradually raising the tone, power and
length) is also helpful. Massage of the chest by thick fabrics
with or without oil has also been recommended to
eliminate shortness of breath in some patients (3).
Prevention and treatment of constipation must be done
prior to any other treatment for these patients.
Herbal Remedies
PM has several prescriptions for treatment of patients
with shortness of breath. Herbal medications may be
administered alone or in combination. They can be boiled
or brewed. Avicenna recommended the use of lozenges for
delivery of drug to the target site. In this method, drug is
gradually released and reaches the target site due to the
proximity of esophagus and respiratory tract (5). Of
different medicinal plants used for this purpose, the below
mentioned herbal medicines play a significant role in
treatment of shortness of breath: Table-1
Hyssop (Hyssopus officinalis, Nepeta Bracteata Benth)
Hyssop is one of the famous medicinal herb used for
treatment of pulmonary diseases and allergic rhinitis since
the Hippocrates. Studies have shown that this plant is
effective for treatment of inflammatory lung diseases and
has anti-spasm, antiviral, antimicrobial (against
Staphylococcus aureus and Escherichia coli) and antifungal
(against Candida albicans) effects (6). Avicenna used this
herbal medicine (Gol – e – Zoofa) as one of his most
effective remedies for treatment of shortness of breath (3).
It has been commonly prescribed for chronic cough,
shortness of breath and rhinitis in the past 1000 years.
Maidenhair fern (Adiantum capillus-veneris)
Aerial parts and leaves of this plant are used for
treatment of respiratory diseases (7). At present, this drug
is used in cough medicines manually prepared by
pharmacists (8). Razi in his famous book “Al Havi” states
that “Maidenhair fern is a thin plant, which grows by the
raceways and quickly loses its effect. It cleans the lungs
from thick sputum” (9). Avicenna also believed that this
medicinal plant is very effective for cleaning of the lungs
and treatment of cough (3).
Liquorice (Glycyrrhiza glabra)
Although Liquorice is known as a gastrointestinal
medication among people, animal studies have confirmed
its efficacy for decreasing the degree of inflammation of
lung parenchyma and pulmonary fibrosis (10). Also,
Liquorice root is used for treatment of severe coughs.
Avicenna recommended it for cleaning of respiratory tract
and treatment of hoarseness.
Fennel (Foeniculum vulgare)
Romans believed that snakes use fennel to strengthen
their vision. Antibacterial effects of fennel oil have been
confirmed in pulmonary patients (11). Also, anti-
inflammatory, antimicrobial and bronchodilator effects of
fennel have been previously reported (12). Avicenna
recommended addition of green fennel to breast milk to
treat shortness of breath in infants (13).
Fenugreek (Trigonella foenum-graecum)
Recent studies have confirmed the efficacy of fenugreek
for decreasing the symptoms of nasal congestion, sinusitis,
cough and sputum production due to its mucolytic
properties (14). Seeds of this plant are rich in proteins,
lysine, tryptophan, saponin and diosgenin, and contain
large amounts of soluble fibers such as hemicellulose,
saponin, mucilage, tannin and pectin, which are used for
treatment of diabetes mellitus and hypercholesterolemia
(15).Razi recommended its cooked form for chronic chest
pain without fever and its electuary for shortness of breath
(9).Avicenna recommended it for hoarseness and stated
that its dressing is suitable for pleurisy when applied on
chest (3).
Quince (Cydonia oblonga Miller)
Its seed glaze is used as a remedy for cough in many
parts of the world. Anti-allergic effects of its boiled extract
have been previously confirmed as well and its leaves and
seeds are used for treatment of bronchitis and chronic

194 Breathlessness in Persian Medicine
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cough (16). Evidence supports the anti-oxidant and
antimicrobial properties of some parts of this plant as well.
However, toxic effects of chewing the seed must also be
taken into account (17,18).
Ammmoniacumm (Dorema ammoniacum D. Don.)
Antibacterial and antifungal effects of
ammmoniacumm products have been confirmed.
Avicenna recommended its lozenge with honey or boiled
barley for shortness of breath and also prescribed it for
treatment of diaphragm wounds (19). Razi also used this
plant in his remedies for shortness of breath and cleaning
of the lungs from thick sputum. However, new evidence
regarding pulmonary effects of this plant is scarce.
Althea (Althea officinalis)
All parts of this plant produce a lot of glaze. Its boiled
flower is effective for treatment of common cold and fever
and is very beneficial for dry coughs (20).
Saffron (Crocus sativus)
Avicenna discussed the effects of saffron on shortness
of breath and stated that “saffron is highly beneficial for
treatment of breathlessness due to its effect on respiratory
tract” (3).
Sweet violet (Viola odorata)
Evidence shows that sweet violet can treat children’s
cough (21). Jorjani prescribed it along with marshmallow
plant for treatment of patients with pleurisy (22).
Several others plant combinations such as thyme and
squill have been recommended for reinforcement of
normal breathing and correction of abnormal respiration
and treatment of cough, dyspnea, pneumonia and
tuberculosis in PM. Each plant may be prescribed based on
its mechanism of action and type and cause of dyspnea
(such as accumulation of moisture, presence of air (Rih)
and retropharyngeal discharge. Avicenna believed that
honey can be used in many drug combinations for
dyspnea. Despite evidence of anaphylaxis and allergy
followed by dyspnea due to the consumption of Ficus
Carica, this fruit is recognized as a top home remedy for
treatment of asthma (23). This fruit has been used in boiled
honey as a basis for many pulmonary medications in
traditional medicine.
Treatment with manual procedures
The final phase of traditional medicine treatments for
elimination of dyspnea involves the use of hands. This
method has been recommended after performing the afore-
mentioned two phases unless in particular or emergency
cases. Massage of the chest with different oils with and
without fabrics is recommended. Type of oil and softness
of fabrics used vary depending on the type of disease.
Keeping the chest warm is a common recommendation for
most patients with shortness of breath. Cupping and
bloodletting (if required and if necessary requirements are
met) especially at the site of lumbar vertebrae and thighs
have also been recommended to alleviate cough and other
pulmonary diseases. Phlebotomy as an invasive procedure
is only indicated in emergency cases or in patients who did
not respond to non-invasive modalities and must be
performed in accord with the set regulations. Phlebotomy
of the external jugular vein and basilic vein may be
suggested in some pulmonary conditions (3).
CONCLUSION
According to the principles of the Iranian traditional
medicine, treatment of shortness of breath requires
adherence to specific measures with regard to lifestyle and
modifications in type, timing and amount of consumption
of beverages and foods, sleep regulation and physical
activity. Herbal medicines alone or in combination may be
indicated. Recommended medications must have anti-
inflammatory effects and must be capable of resolving
respiratory tract obstruction by changing the thickness of
sputum and affecting airway spasm.
Many of the recommended treatment modalities for
dyspnea have long been practiced by traditional medicine
specialists and have gained patient satisfaction. By
advances in tools and enhanced access to relevant data, we
can take advantage of the knowledge of ancient scientists.
Non-invasive interventions related to lifestyle
modifications are affordable measures with insignificant
side effects, which can gain patient satisfaction in many
cases.

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Medicinal plant
Common name
Traditional name
Part used
Pharmacological effect
Temperament
Hyssopus officinalis L.; Nepeta Bracteata Benth.
Hyssop
Zoofa
Flower
Anti-fungal, Anti-microbial
Hot and Dry
Adiantum capillus-veneris
Maidenhair fern
Parsiavoshan
Leaf
Hot and Dry
Glycyrrhiza glabra L.
Liquorice
Shirin-bayan
Root
Anti-microbial
Hot and Dry
Foeniculum vulgare L.
Fennel
Razianeh
Seed
Anti-microbial, Bronchodilator
Hot and Dry
Trigonella foenum-graecum
Fenugreek
Shanbelileh
Leaf, Seed
Mucolytic
Hot and Dry
Cydonia oblonga Miller
Quince
Safarjal, Beh
Fruit
Anti-allergic
Cold and Dry
Dorema ammoniacum D. Don.
Ammmoniacumm
Oshagh
Resin
Anti-microbial, Antifungal
Hot and Dry
Viola odorata L.
Sweet violet
Banafsheh
Flower
Anti-microbial
Cold and Wet
Althea officinalis L.
Althea
Khatmi
Flower
Anti-inflammatory
Temperate
Crocus sativus L.
Saffron
Za’feran
Flower
Hot and Dry
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