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Abstract

Proper and regular sweating plays a significant thermoregulatory role. It is a common perception that, sweating has other important homeostatic functions such as clearance of excessive micronutrients, waste products of metabolic processes, and toxins from the body, which helps to maintain human good health. In addition, sweating, thermotherapy, and sauna are commonly used to treat various diseases such as cardiovascular, respiratory and joint diseases. In traditional Persian medicine (PM) textbooks, sweating is considered a preventive care and treatment strategy as well. In this study, we aim to explain the beneficial effects of sweating in human health and its role in the management of various diseases, as well as introducing the therapeutic applications of some diaphoretic plants from the viewpoint of PM. We reviewed the most famous PM textbooks such as Kamil al-Sinaa al-Tibbiya, Al-Qānūn fī al-Tibb, Zakhireye Kharazmshahi, Kholasat al-Hikmat, Exir-e-Azam, and Hifzos-sihhat-e Naseri. Also, current evidence was searched in PubMed, Web of Science, Scopus, and other relevant databases related to the topic. The results of this study revealed that PM scientists believed proper sweating removes waste products and maintains the body's health, thus, any disturbances in the excretion of these waste products can cause diseases. They recommended the induction of sweating through hot and dry baths, sun bath, sand bath and also the use of diaphoretic herbs for the management of various diseases. Therefore, further researches are recommended to evaluate the effectiveness of these diaphoretic plants. [GMJ.2020;9:e2003]
Sweating as a Preventive Care and Treatment
Strategy in Traditional Persian Medicine
Mahboubeh Mahlouji 1, 2, Mahdi Alizadeh Vaghasloo 3, Majid Dadmehr 4, Hossein Rezaeizadeh 3,
Esmaeil Nazem 3, Haleh Tajadini 1, 2
1 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
2 Department of Traditional Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
3 School of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
4 School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
GMJ.2020;9:e2003
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Correspondence to:
Haleh Tajadini, MD-PhD, Assistant Professor of Per-
sian Medicine, Neuroscience Research Center, Institute
of Neuropharmacology, Kerman University of Medical
Sciences, Kerman, Iran
Telephone Number: +989131972312
Email Address: drhalehtajadini@gmail.com
Received 2020-08-19
Revised 2020-09-12
Accepted 2020-10-01
GMJ
Copyright© 2020, Galen Medical Journal. 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
Abstract
Proper and regular sweating plays a signicant thermoregulatory role. It is a common perception
that, sweating has other important homeostatic functions such as clearance of excessive
micronutrients, waste products of metabolic processes, and toxins from the body, which helps
to maintain human good health. In addition, sweating, thermotherapy, and sauna are commonly
used to treat various diseases such as cardiovascular, respiratory and joint diseases. In traditional
Persian medicine (PM) textbooks, sweating is considered a preventive care and treatment
strategy as well. In this study, we aim to explain the benecial effects of sweating in human
health and its role in the management of various diseases, as well as introducing the therapeutic
applications of some diaphoretic plants from the viewpoint of PM. We reviewed the most famous
PM textbooks such as Kamil al-Sinaa al-Tibbiya, Al-Qānūn fī al-Tibb, Zakhireye Kharazmshahi,
Kholasat al-Hikmat, Exir-e-Azam, and Hifzos-sihhat-e Naseri. Also, current evidence was
searched in PubMed, Web of Science, Scopus, and other relevant databases related to the topic.
The results of this study revealed that PM scientists believed proper sweating removes waste
products and maintains the body’s health, thus, any disturbances in the excretion of these waste
products can cause diseases. They recommended the induction of sweating through hot and dry
baths, sun bath, sand bath and also the use of diaphoretic herbs for the management of various
diseases. Therefore, further researches are recommended to evaluate the effectiveness of these
diaphoretic plants. [GMJ.2020;9:e2003] DOI:10.31661/gmj.v9i0.2003
Keywords: Traditional Persian Medicine; Sweating; Diaphoretic Herbs; Herbal Medicine
Introduction
Sweating has an important role in regulating
human body temperature and this phys-
iological effect is observed in periods of in-
tensive physical activity or exposure to warm
environments [1]. Furthermore, regular sweat-
ing is responsible for other types of important
homeostatic functions, including the clearance
of excessive micronutrients, waste products
of metabolic processes, and toxins from the
body [2]. Despite the important role of normal
sweating in maintaining human health, inabil-
ity to sweat normally or excessive abnormal
Mahlouji M, et al. Benecial Effects of Sweating in Traditional Persian Medicine
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Benecial Effects of Sweating in Traditional Persian Medicine Mahlouji M, et al.
sweating can cause signicant health con-
cerns. Hyporhidrosis or pathologic anhidrosis
which are inadequate or inability to sweat re-
spectively, may cause symptoms of dry skin,
heat exhaustion, heatstroke, and even death.
Also, hyperhidrosis, a condition that results in
excessive sweating, is associated with some
systemic diseases or anxiety that has negative
effects on patients’ quality of life [3]. Numer-
ous studies have shown that proper sweating,
in addition to preventing some diseases, can
reduce their symptoms and improves patients’
quality of life as well. Several studies demon-
strated clinical effects of induced sweating
methods such as thermotherapy, waon therapy
and sauna in common diseases such as car-
diovascular [4, 5], respiratory [6, 7], and joint
diseases [8], and chronic pain [9], as well as
in prevention and risk reduction of dementia
and Alzheimer’s disease [10]. Waon therapy
is a form of thermal treatment in a dry sauna,
which the entire body is warmed. This mo-
dality improves hemodynamics, ventricular
arrhythmias and vascular function in patients
with congestive heart failure (CHF) [5]. Re-
viewing historical medical manuscripts indi-
cates that traditional Persian medicine (PM)
scientists have described several methods for
the treatment of diseases. Sweating is one of
them which has an important role in both pre-
vention and treatment of diseases. PM physi-
cians were well aware of the health benets of
sweating and believed that sweating removes
waste products, maintains the body health, and
balances body temperature. Based on the prin-
ciples of PM, any disturbances in the excre-
tion of metabolic and dietary waste products
can cause disease; therefore, the use of several
sweating methods and even diaphoretic herbs
have been considered in maintaining human
health and as one of the therapeutic method
since many centuries ago [11]. To the best of
our knowledge, this topic has not been fully
studied; therefore, we aim to explain the bene-
cial effects of sweating in human health and
its role in the treatment of diseases, as well as
introducing therapeutic applications of some
diaphoretic plants from the viewpoint of PM.
Search Strategies
In this study, we reviewed the chapters relat-
ed to sweating and diaphoretic plants in sev-
eral PM textbooks, including Kamil al-Sinaa
al-Tibbiya (10th Century), Al-Qānūn fī al-Tibb
(11th Century), Zakhireye Kharazmshahi (12th
Century), Kholasat al-Hikmat (18th Century),
Exir-e-Azam (19th Century), and Hifzos-sih-
hat-e Naseri (19th Century). The search was
performed with the keywords “Ta’riq”, “Ta-
arroq”, “Mo’arriq”, “Araq” and “Hammam”.
Diseases of the human body, which sweating
was suggested in their treatment, were catego-
rized. Also, the diaphoretic herbal medicines
used in the treatment of diseases were gath-
ered. We collected and classied the items
related to the subject. Furthermore, a search
in PubMed, Web of Science, Scopus, and oth-
er relevant databases from June 2002 up to
June 2020 was accomplished to review recent
advances in this eld. The keywords of the
search were “sweating”, “sweat”, “bath”, “di-
aphoretic herbs”, “perspiration”, “thermother-
apy”, “sauna” and other related terms.
Results
From the perspective of PM, sweat contains
waste products that are produced during the
digestive process in the human body. In gen-
eral, foodstuff goes through four stages of di-
gestion to be converted to a matter t for as-
similation. These stages are known as gastric,
hepatic, vascular, and tissue digestion. In each
of them, different waste products are also pro-
duced, which must subsequently be excreted
from the body. Excretion of the waste prod-
ucts in the gastric and hepatic digestion occurs
via feces and urine respectively. The meta-
bolic waste products of vascular and tissue
digestion stages are excreted via sweat [12,
13]. Sweat is believed to be the excess mate-
rials produced in the third and fourth stages
of digestion which are excreted via skin pores
namely “Masam” [14]. These pores are a lot
of small holes throughout the skin that sweat
comes out of these narrow pores and reaches
the surface of the skin [11, 12, 15].
Application of Sweating in the Preservation of
Health
Based on the viewpoint of PM, preservation
of health “Hifzos-sihhah” has an important
role and precedes treatment. PM scientists
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3
believed that six essential principles called
Sittat od-daruriyyah” must be considered to
preserve health and prevent diseases as well.
These principles cover various aspects of hu-
man life and include climate, food and drink,
sleep and wakefulness, motion and stillness,
psychological and mental reactions and evac-
uation and retention. The equilibrium between
these six principles is essential to have a
healthy lifestyle. Among them, regular evac-
uation and cleansing of waste products from
the body, which is done via various routes,
including stool, urine, and sweat is of special
importance [11, 13, 16]. A healthy person is
expected to have regular and adequate sweat-
ing to stay healthy. Therefore, any disturbance
in the excretion of waste products, can cause
disease and disrupt health conditions [11, 17].
Therefore, in the preventive approach and
healthy lifestyle management proper sweating
is a simple, safe, and accessible method that
is recommended in PM sources. In a healthy
person, sweating occurs during moderate ex-
ercise, daily physical activity, exposure to hot
season or climate, and regular use of baths to
maintain health and prevent diseases [11].
Application of Sweating in the Treatment of
Diseases
According to PM teachings, the accumulation
of waste products in different parts of the body
can lead to disease. Therefore, the excretion
of these substances from the body’s natural
excretory pathways is a therapeutic strategy.
One of the recommended methods of treat-
ment is the induction of sweating through the
use of hot and dry baths, sun bath, sand bath
(to be concealed), and also the use of diapho-
retic herbs [11, 12, 18]. PM physicians have
considered the use of sweating as one of the
treatment options for various diseases. Most
of these diseases are caused by the accumu-
lation of excessive moisture in the body. They
include diseases of various organs such as the
brain, gastrointestinal tract, heart, respiratory
tract, kidneys, musculoskeletal and skin, also
poisoning, and bites [18]. Some of them are
shown in Table-1.
Diaphoretic Herbal Medicines
Diaphoretic are those herbs that cause sweat to
come out of the skin pores. These plants have
special properties that cause skin pores to open
and pass diluted waste products under the skin
through these pores [13, 19]. These plants are
used locally (embrocation) and orally (decoc-
tion) and are consumed in singular or com-
pound drugs [19]. Some of the most important
diaphoretic plants are summarized in Table-2.
Discussion
According to the PM textbooks, some waste
products are produced throughout the four-
step process of digestion in the human body. It
is clear that failure to excrete these substances
and their accumulation in various organs caus-
es dysfunction and diseases of those organs,
therefore, they must be expelled from the body.
These wastes are excreted from the body in var-
ious ways, including feces, urine, and sweat.
Any change in regular and adequate sweating
in the human body can contribute to the devel-
opment of the disease in the future. Sweating
excreted the waste products in metabolic pro-
cesses and toxins from the human body, and
promotes the health. Sweat is excreted through
the very small pores on the surface of the skin
[11, 13]. These pores seem to correspond with
pilosebaceous units of sweat excretion from
eccrine and apocrine glands, which can import
and export substances and drugs and are ef-
fective in heat lowering. In other words, they
play an important thermoregulatory role [20,
21]. PM scientists believed that abnormalities
in the sweating process can lead to diseases
such as humid and phlegmatic brain diseases,
phlegmatic and sanguineous strokes, paraly-
sis, phlegmatic headache, diabetes, and phleg-
matic joint pain, so, administration of proper
sweating is considered one of the most effec-
tive treatments in these diseases [11, 12, 18].
Current studies also demonstrate that normal
sweating removes waste products and toxins
from the body and is associated with main-
taining good health and preventing diseases
[22]. Many studies have been done on the
use of sauna, waon therapy, and thermal ther-
apy as a choice treatment for some diseases.
These methods have been considered safe and
effective [23-26]. A reduced risk of dementia
and Alzheimer’s disease in middle-aged men
[10], as well as a reduced risk of stroke in
middle-aged and older men and women, who
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Table 1. Some Diseases which are Treated with Sweating in the PM Sources.
Respiratory system [11, 18]
Cough (phlegmatic, cold, humid)
Catarrh /nazlah /
Fine and short sound
Epidemic diseases due to putrifactive air
Caediovascular system [11] Faint /ghashy/(related to Imtila)
Urogenital system [11, 18]
Amenorrhea due to obesity
Renal emphysema
Dysuria
Fever and infectious diseases [11, 12, 18]
Hot fever
Hyperpyrexia
Septic fever
Phlegmatic fever
Quartan fever
Phlegmatic atrabiliary fever
Phlegmatic quartan fever
Types of diurnal fever /homma al-yawm/
Synochus (paratyphoid) fever /sunukhas/
Skin [11, 12, 15, 18]
Vitiligo /baras/
Vitiligo alba /baras ol-abyad/
Pediculosis
Phlegmatic urticaria
Miliaria rubra
Pruritus
Creeping ulcers
Scabies
Leprosy
Gastrointestinal track [11, 12, 18]
Diabetes /dhiyabitos/
Severe fatness /siman mofrit/
Dropsy, anasarca, ascites /Istisqa/
Hiccough /fowaq/
Diarrhea
Cold colic /qulanj-e barid/
Splenic tumefactions
Jaundice
Intestinal abrasion /sahj/
Central and periferal nervous system [12,
15, 18]
Phlegmatic brain diseases
Brain diseases due to moisture
Hemicranial headache /shaqiqah/
Dizziness /sadar/
Vertigo /dowar/
Phlegmatic headache
Unilateral facial paralysis /laqwah/
Numbness /khadar/
Paralysis /falij/
Phlegmatic apoplexy
Senile heterotropia
Tremor/ra’shah/
Musculo-skeletal system [11, 12, 18]
Phlegmatic arthralgia
Gout /niqris/
Spasm /tashannoj/ (cold, humid)
Poisoning and bites [11, 12, 18]
Poisoning
Snake bites
Rabid dog bites
Scorpion sting
Spider bites
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Benecial Effects of Sweating in Traditional Persian Medicine Mahlouji M, et al.
Table 2. Diaphoretic Herbal Medicines Suggested in the PM Sources [11, 12, 19].
Scientc name Family Common name Persian name Used part
Agrimonia eupatoria L. Rosaceae Agrimony Ghafas All parts
Allium sativum L. Amaryllidaceae Garlic Sowm Root/bulb
Urtica dioica L. Urticaceae Common Nettle Anjoreh Seeds/ leaves
Apuim graveolens L. Apiaceae Celery Karafs Seeds/root/aerial parts
Artemisia absinthium L. Asteraceae Common
wormwood Afsantin Leaves/owering tops
Carum copticum L. Apiaceae Ajwain Nankhah Seeds
Cinnamomum citriodorum Th. Lauraceae - Sazaj Leaves
Cucumis melo L. Cucurbitaceae Melon Bettikh Fruits/seeds
Cuscuta monogyna Vahl. Cucurbitaceae - Koshous Seeds
Ficus carica L. Moraceae Common g Tin Fruits
Linum usitatissimum L. Linaceae Common ax Kattan Seeds
Matricaria chamomilla L. Asteraceae German
chamomile Babounaj Flowers
Mentha pulegium L. Labiatae Pennyroyal Foudanaj Leaves
Ocimum basilicum L. Lamiaceae Sweet basil Reihan Leaves
Tanacetum parthenium Asteraceae Feverfew Oqhowan Flowers
Pimpinella anisum L. Apiaceae Anise Anisoon Seeds
Trifolium alexandrium L. Papilionaceae Egyptian clover Handaghoughi Roots, seeds, leaves
Myrtus communis Myrtaceae Mourd Myrtle Leaves /fruits
frequently use sauna have been reported [27].
Numerous studies have suggested the effect
of sauna in the treatment of various cardio-
vascular diseases. This effect can be associat-
ed with the reduction of oxidative stress and
subsequent atherosclerosis, which is achieved
through sauna therapy [28]. In patients with
coronary risk factors, sauna therapy is relat-
ed to the improvement of vascular endothelial
cell function [23, 29]. The sauna bathing has
shown benecial effects on some cardiovascu-
lar diseases including improved ventricular ar-
rhythmias, ameliorating of clinical manifesta-
tions and heart function, decreased heart size,
and increased left ventricular ejection fraction
(EF), signicant improvement in blood pres-
sure in hypertensive people, improved chronic
heart failure (CHF) symptoms and prognosis,
and decreases in sudden cardiac death [30, 31].
There are ameliorating effects in myocardial
perfusion after repeated sauna treatment in pa-
tients with chronic coronary-related ischemia
[29]. The use of thermal therapy on respiratory
diseases shows an improvement of the respira-
tory function in patients with allergic rhinitis,
improving pulmonary hypertension, and also
airway obstruction in patients with COPD [6,
32, 33]. Long-term prospective studies display
that a sauna bath can be effective in reducing
the risk of pneumonia [7, 34]. Thermal thera-
py is effective in improvement in pain sever-
ity and bromyalgia symptoms. Moreover,
sauna therapy has improved chronic fatigue
syndrome and chronic pain, as well as can ef-
fectively reduce the symptoms of rheumatoid
arthritis and ankylosing spondylitis [8, 9, 35,
36]. Thermal therapy and sauna affect lipid
prole and quality of life in patients with type
2 diabetes mellitus and obesity [37-39]. Reg-
ular sauna bathing has been considered effec-
tive in the management of tension headaches
[40]. Sauna-based detoxication therapy re-
duced the chronic symptoms related to the
chemical exposures of methamphetamine and
also improved the quality of life [41].
Conclusion
In both traditional PM and conventional med-
icine, proper and regular sweating is consid-
ered as a preventive care and treatment strat-
egy. According to the PM textbooks, several
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Mahlouji M, et al. Benecial Effects of Sweating in Traditional Persian Medicine Benecial Effects of Sweating in Traditional Persian Medicine Mahlouji M, et al.
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methods have been proposed for the treatment
of diseases and the use of sweating is one of
them. By inducing sweating, some diseases of
the body organs are either completely cured
or sweating has signicant effects on their
improvement. PM physicians believed that
sweating, hot and dry baths, and diaphoretic
herbs as a simple, safe, and affordable meth-
od can be used to prevent and treat diseases.
Therefore, further researches are recommend-
ed to evaluate the effectiveness of these dia-
phoretic plants.
Acknowledgment
This paper is part of Ph.D. thesis of Dr.
Mahlouji (Thesis number: 95-10-27-91).
Conict of Interest
The authors declare that they have no conict
of interest.
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Background: there are no previous studies linking repeated heat exposure of sauna and the risk of memory diseases. We aimed to investigate whether frequency of sauna bathing is associated with risk of dementia and Alzheimer's disease. Setting: prospective population-based study. Methods: the frequency of sauna bathing was assessed at baseline in the Kuopio Ischaemic Heart Disease population-based prospective cohort study of 2,315 apparently healthy men aged 42-60 years at baseline, with baseline examinations conducted between 1984 and 1989. Hazard ratios (HRs) with 95% confidence intervals (CIs) for dementia and Alzheimer's disease were ascertained using Cox-regression modelling with adjustment for potential confounders. Results: during a median follow-up of 20.7 (interquartile range 18.1-22.6) years, a total of 204 and 123 diagnosed cases of dementia and Alzheimer's disease were respectively recorded. In analysis adjusted for age, alcohol consumption, body mass index, systolic blood pressure, smoking status, Type 2 diabetes, previous myocardial infarction, resting heart rate and serum low-density lipoprotein cholesterol, compared with men with only 1 sauna bathing session per week, the HR for dementia was 0.78 (95% CI: 0.57-1.06) for 2-3 sauna bathing sessions per week and 0.34 (95% CI: 0.16-0.71) for 4-7 sauna bathing sessions per week. The corresponding HRs for Alzheimer's disease were 0.80 (95% CI: 0.53-1.20) and 0.35 (95% CI: 0.14-0.90). Conclusion: in this male population, moderate to high frequency of sauna bathing was associated with lowered risks of dementia and Alzheimer's disease. Further studies are warranted to establish the potential mechanisms linking sauna bathing and memory diseases.
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Alzheimer's disease is considered as a major problem for society health since it affects interpersonal and social relationships. With regard to the global attention toward complementary medicine, search for preventive, diagnostic, and treatment strategies in complementary medicine schools such as the old dynamic doctrine of traditional Persian medicine seems to be necessary. In this type of medicine, description and analysis of the disease and preventive and treatment methods have great importance. The present study provides a useful classification of recommendations for prevention and control of Alzheimer's disease. Prevention is prior to the treatment and is easier and less costly. Recommendations mentioned in traditional Persian medicine texts for prevention of Alzheimer's disease provide fields of clinical and complementary studies for researches.