1. Context
Skin is representative of all internal organs and is the first barrier against external stressors. Although environmental factors like sunlight, air pollution, seasonal changes (especially extreme cold or hot weather), chemical and mechanical stimulation are the main causes of skin aging, internal factors such as genetic, malnutrition, obesity, alcohol consumption, smoking, etc. via the production of free species of oxygen can speed up the process of aging (1-3).
In general, it seems that disruption in homeostasis can influence skin aging (4). Although sunscreens and topical antioxidants can postpone the process of skin aging, the role of dietary supplements and nutrients in preventing skin aging has been one of the most noteworthy factors (5). Long-term dietary supplements consumption in the form of chemical agents are likely to cause potential adverse effects and oral administration of natural foods such as fruits, vegetables, beans, and grains can decrease the mentioned risk (6-9). Interestingly, loss of fat and water content in different skin layers is an important factor resulting in skin aging. As a result, elasticity, and skin turgor is gradually reduced leading to a dry skin. Thus several skin disorders such as xerosis, wrinkles, and itching happen (10-13). According to traditional persian medicine (TPM), this factor is one of the main causes of skin aging and could be avoided by considering simple essential commands named “Setteh‑ye‑Zarurieah” (six essential schemes for health) (14). Nutrition and applying herbal medicine in the form of additives to people’s diet is considered completely in this scheme. According to TPM, it is believed that aging process and internal organ problems could be avoided or postponed by controlling dietary habits. Other alternative and complementary medical systems like Ayurveda, Unani medicine, etc. have the same attitude about people’s diet (15). Therefore, the aim of this study was explanation of aging phenomenon, skin aging and herbal remedies to prevent it from perspective of TPM.
2. Evidence Acquisition
Medieval reports encompassing the profile of definition, terminology and etiology of aging were collected and analyzed from selected medical textbooks of TPM. The mentioned collection was based on the analysis of medieval Iranian textbooks from 9th to 18th centuries AD. In this regard, manuscripts namely Mansuri-Fi-Teb (9th and 10th centuries), Kamel-ol-sanaeh (10th century), Canon of Medicine (11th century), Zakhireh Kharazmshahi (12th century), Kholasat-ol-tajarob (16th century), Mofarah -ol-Gholoub (18th century), Kholasat-al- hekma (18th century A.D) and Exir-e-Aazam (19th century) were selected for analysis (16-23). These texts have been the most famous and important sources among Iranian medical textbooks.
A search on databases such as PubMed, Science direct, Scopus and Google scholar was also performed to reconfirm anti-aging activities of reported herbs. Studies that included the evidences of mentioned information were selected for review. Only publications without available full text and letters to the editor were excluded from the review. Unpublished data was also excluded and duplication was avoided by excluding reviews of multiple copies of the same article in several databases.
3. Results
3.1. Aging and Skin Aging Mechanism
Human body organs consist of four fundamental humors named “cardinal humors” including blood, phlegm, yellow bile and black bile. All of them composed of very specific quantity and quality and any kind of diseases can be resulted from an excess or deficit of one of these humors. Thus, any disease in TPM is based on distemperment or (Sue-Mizaj) (24, 25). Accordingly, aging process causes a big humoral change in the body. It looks like the whole body gets cold and dry (16-23).
Therefore, the skin gets cold and dry distemperament. It means skin layers lose their lipid, moisture, and water content continuously and wrinkles appear at first step. At the second step, skin detachment forms in wrinkled area. This phenomenon (skin detachment) in TPM is called “Tafarrogh-e-Ettesal”, which leads to a redundant skin in the affected areas. The cause of skin laxity is mentioned below:
At the beginning of human creation, all body organs such as skin, bones and muscles consist of certain type of moisture called “natural moisture”, which could give the organs ability to be flexible and soft enough. In the aging process, this essential material vanishes gradually and “exotic moisture “or (Rotoubat-e-Gharibe) replaces natural moisture and penetrates all over the body and skin; skin laxity is the result of exotic moisture replacement.
Brief Information About Skin Aging Mechanism
Therefore, superficial layers become wrinkled and dry and additionally, exotic moisture in deeper layers cannot penetrate the surface. Therefore, wrinkles, xerosis, and flaccidity occur all together (Figure 1). Ancient Iranian scientists believed that aging phenomena could be prevented or postponed effectively by simple specific instructions which are mentioned below.
3.2. Remedies for Postponing Aging Process in the Body
3.2.1. Sleep
“Sleep” raises entire body energy, causes complete food digestion and creates “natural moisture”, which can penetrate easily inside the organs such as skin. There is certain condition for proper sleep:
- Sleeping time should be performed after eating moderate meal and should be avoided during severe hunger or eating heavy amounts of meal. As both of them destroy body homeostasis. After the age of 40, sleeping hours increase (between 6 - 12 hours) as the body needs much more time for rehabilitation.
- Sleeping after sunrise is very harmful to the body and weakens digestive and nervous system (causes memory loss) (16-18, 20, 21).
3.2.2. Diet
According to TPM, nutrition has an important role to prevent aging. The most important foods are listed below:
- Honey and royall jelly
- Milk
Adding honey and a piece of ginger to a glass of boiling milk improves its property. Long-term continuous drinking of goat milk with “Sisymbrium irio” can prevent skin drying specifically.
- Egg Yolk
3.2.3. Herbal Medicines
There are some specific herbal medicines which can prevent aging process such as “Theryagh” and “Triphala” or (Etrifel). They are powerful antidotes and can strengthen body. “Theryagh-e-Kabir” is one of the most important traditional herbal drugs, which can strengthen and adjust the immune system. There are different types of “Triphala” (23). One of them known as “Etrifel-e-saqir” composed of Terminalia chebula and Terminalia bellerica. Table 1 illustrates the constituents and performance of mentioned drugs.
| Plant Family | Scientific Name | Traditional Name | Part | Current Finding of Anti-Aging Effect | Fraction/Constituent (s) |
|---|---|---|---|---|---|
| Hycinthaceae | Urginea maritime | squill | Bulb | high antioxidant activity (26) acetylcholinesterase inhibitory effect. preventive effect of brain aging (27) | glucoscillarene a, proscillaridin a, scillarene a, scillicyanoside, scilliglaucoside (28) |
| Piperaceae | Piper nigrum | Felfel-e-syah (black pepper) | fruit | immunomodulatory and antitumour activity (29). Synergistic effect on hyaluronic acid in skin (30) | sabinene, limonene, caryophyllene, betapinene, alpha-pinene, delta3-carene, acid amides: piperine, piperylin, piperolein a and b, cumaperine, 3,4-dihydroxy phenyl ethanol glycosides, polysaccharides (28) |
| Lauraceae | Cinnamomum verum | Darchin | Bark | A source for antioxidants. delay aging (31) | cinnamaldehyde, weiterhin, eugenol, cinnamyl acetate, cinnamyl alcohol, o-methoxycinnamaldehyde, cinnamic acid, diterpenes: cinnzeylanol, cinnzeylanin, oligomeric proanthocyanidins, mucilages (28) |
| Roseaceae | Rosa gallica | Vard-e-ahmar | Flower | antioxidative properties (32) | oligomeric proanthocyanidins, citronellol, geraniol, nerol, phenyl ethanol, including as well linalool and citral (28) |
| Iridaceace | Iris germanica | Irsa | Root | antioxidant, antimutagenic activities (33) | irone: alpha-beta- and gamma-irone, triterpenes: iridale (mono, bi- and spirocyclic compounds, precursors of the irones), isoflavonoids: irilon, irisolone, irigenine, tectorigenin and their glycosides including iridine, flavonoids, xanthones: c-glucosylxanthones (28) |
| Piperaceae | Piper elongatum | Dar felfel | Leaf | inhibitor of tyrosinase activity (34) effective in age-related and cognitive disorders (35) | dill apiol, asaltone, parsley apiol, tannins, sesquiterpene: maticin (28) |
| Iridaceace | Crocus sativus | Saffron | Stigma and style | antioxidant and possible anti-aging effects (36), immune-stimulating effect (37), anti-inflammatory, hepatoprotective (38) | apocarotinoid glycosides, picrocrocin, apocarotinoids and picrocrocin, components 4,5-dehydro-betacyclocitral (safranal), 4-hydroxy-beta-cyclocitral, carotinoids: lycopene, alpha-, beta-, gamma-carotene (28) |
| Poaceae (Graminae) | Cymbopogon citratus | Ezkher | Leaf | protective effect against hydrogen peroxide (H2O2)–induced oxidative stress (39, 40) | citral, myrcene (28) |
| Lamiaceae (Labiatae) | Lavandula angustifolia | Ostokhoddus | Flower | effects of ultra-dry treatment on antiaging ability (41) | linalool, d linalyl acetate, cis-ocimene, terpinene-4-ol, betacaryophyllene, lavandulyl acetate, hydroxycoumarins,umbelliferone, herniarin, tannins, rosmaric acid (28) |
| Zingiberaceae | Costus speciosus | Ghost | Rhizome | antioxidant activity (42) | glycosides, flavonoids, triterpenoids, tannins, and steroids. curcuminoids (28) |
| Anacardiaceae | Pistacia lentiscus | Mastaki | Resin | antigenotoxic and antioxidant activity. prevent cancer and delay aging (43) | triterpenes mastic acid, isomastic acid, oleanolic acid, alpha-pinene, myrcene, linalool, beta-pinene, beta-caryophyllene (28) |
| Zingiberaceae | Zingiber officinale | Zanjebil (Ginger) | Root | radical scavenging activity (44) | zingiberene, arcurcumene, beta-bisabolene and ar-curcumene, neral and geranial, d-camphor, beta-phellandrene, geranial, neral and linalool, (e)-alpha-farnesene, aroma carrier zingiberol, aryl alkanes gingerols, gingerdiols, diarylheptanoids (28) |
| Combretaceae | Terminalia chebula | Halileh | Fruit | cyto-protective effects (45) cytochrome P450 inhibitory effect (46) the effects of chebulic acid against the progression of AGE-induced endothelial cell dysfunction (47) | gallotannins, terchebulin, terflavin a, punicalagin, corilagin, chebulic acid, and chebulinic acid, d-glucose, d-fructose, saccharose, quinic acid, shikimic acid (28) |
| - | Honey | Asal | antitumour and antioxidant activity (48), immunomodulator (49) | amino acids, proteins, carotenes, phenolic compounds, flavonoids, ascorbic acid, organic acids (50) |
Teryagh-E-Kabir and Etrifel-E-Saqir, Herbal Components
3.2.4. Digestive System Strengthening
Whole body weakness and aging process in skin and body could be accelerated by gastrointestinal problems (51). Therefore, increasing the number of meals and reducing each serving size is preferable in a poor digestive system. The best time of eating is when men feel real hunger and digestive system could be strengthened by consuming different kinds of jams such as Ginger jam. Complete defecation is one of the treatment rules in TPM, as chronic constipation causes specific toxins accumulation in the intestinal loop and facilitates its spread all over the body.
3.2.5. Moderate Rubbing Massage With Oil
Regular massage with appropriate oil such as olive oil or sweet almond oil can prevent the skin and body from drying. This kind of massage should be performed periodically to be effective.
4. Conclusions
According to both attitudes (modern medicine and traditional persian medicine), skin aging is followed by the whole body aging. Modern medicine believes that the main cause of skin aging contributes to environmental factors such as sunlight, air pollution, chemical and mechanical stimulation (1-3). On the other hand, internal factors such as malnutrition, obesity, alcohol consumption, smoking and etc can also speed up the process of aging with production of oxygen free radicals and DNA damage (2, 4, 5). Also in skin aging, loss of lipid and water content in different skin layers is one of the important damaging factors. As a result, skin disorders such as xerosis, wrinkles and itching occur constantly (10-12).
TPM also believes that external and internal factors are responsible for this phenomena and qualitative change of humors can destroy human body homeostasis (4). Ancient Iranian scientists believed that aging process induces cold and dry temperament in whole body and skin. Therefore, wrinkles and flaccidity appear after skin detachment, which is caused by loss of “skin natural moisture” (16, 18, 20-22). They believe that aging could be prevented or postponed by some specific instructions mentioned bellow.
Sleep: Iranian medicine acknowledges that “Sleep” raises entire body energy, causes complete food digestion and creates “Natural moisture”, which can penetrate easily inside organs such as skin (16, 18, 20, 21). Also modern medicine believes that circadian rhythm of the body would be affected by insomnia, and ultimately skin collagen integrity would be disrupted gradually (52, 53).
Diet: According to Modern medicine and TPM, a healthy diet can have an important role to prevent aging in the body and skin (7-9). For example, honey and royal jelly consumption have anti-cancer effect and promote skin collagen formation incredibly (54-57). Long-term continuous drinking of goat milk can prevent skin drying and adding honey with a piece of ginger to a glass of boiling milk improves its property significantly (16, 17, 19, 21, 23). Egg yolks are also the main dishes of traditional medicine in the prevention of aging process and modern medicine believes that egg yolks are particularly important sources of antioxidants such as carotenoids (58). “Medical beer” is a very dilute barleycorn soup and is one of the important nutritional supplements in TPM that can avoid aging process. Barley consists of the peptide Lunasin, so it has anti-inflammatory properties and is a powerful antioxidant agent (59, 60).
Herbal medicines: There are some medicinal herbal drugs which can prevent aging process such as “Theryagh-e-Kabir” and “Etrifel-e-saqir”. They prevent skin aging process by antioxidant effect and hyaluronic acid formation in the skin.
Digestive system strengthening: Aging process in skin and body could be accelerated by gastrointestinal problems (51). Also modern medicine believes that there is strong relationship between skin and digestive system (61). This important organ could be strengthened by consuming different digestive tonic such as ginger because of its gastro-protective effect (62).
Moderate rubbing massage with oil: Regular massage with sweat almond oil or olive oil can protect skin completely from environmental stress (63, 64). Also ancient Iranian scientists believed that moderate massage can eliminate waste products accumulation in the muscle and skin, therefore they become strengthened (16-18, 21, 22).
The current investigation was performed to show the knowledge of ancient Iranian scientists on aging process and related interventions. Reported herbal drugs might be beneficial for further studies for the management of skin aging and aging process. This review concludes in favor of TPM, but some ambiguities necessitate further research before claiming its efficacy.
