The Role of Diet and Medicinal Herbs for Management of Sjögren's Syndrome in Traditional Persian Medicine.

Dear Editor-in-Chief

Sjögren’s syndrome (SS) is a chronic systemic autoimmune disease characterized by extensive dryness throughout the body, especially in the mouth (xerostomia) and the eyes (keratoconjunctivitis), profound fatigue and chronic pain. The complications of SS, including major organs involvement and lymphoma caused by lymphocytic infiltration of exocrine glands (1). SS is mentioned as the most common rheumatic autoimmune disease after rheumatoid arthritis, which its prevalence rate is about 0.03–2.7% around the world (2). Most of the current therapeutic approaches are mainly focused on improving the patient’s quality of life that have limited efficacy and some common side effects; these have resulted in growing trend towards using of interdisciplinary treatments in these patients (1,2). The traditional medicine treatments due to its long history can be suggested along with current therapeutic approaches.

According to the traditional Persian medicine (TPM) textbooks, although the term that is carefully the same as SS is not declared as a distinct disease, regarding symptoms and signs of SS in current literature, it seems that some clinical manifestations are comparable with conditions, which have been described under the topic of dry dystemperament (DD) in the TPM sources (3). In DD, the patient may experience a degree of real dryness in various parts of the body, including in the eye, mouth, vagina, gastrointestinal tract and even throughout the body.

Based on TPM sources, whenever dryness prevails over the body or dominates on an organ, it should be moisturized via dietary recommendations and also topical or systemic administrations of those medications, which have wet temperament (4, 5). There are several nutritional advice and medicinal herbs for the treatment of DD, which also can be used to reduce some complications and dryness symptoms of the SS. This study suggest some appropriate dietary programs and medicinal plants for these patients (Tables 1,2), however, more clinical studies are required to evaluate their effectiveness.

Table 1:

Some useful moisturizing herbal medicines for management of Sjögren’s syndrome in TPM (4–6)

Family	Scientific name	Common name	Traditional name	Temperament	Traditional medicinal products
Violaceae	Viola odorata L.	Sweet violet	Banafsaj	Cold & moist
Nymphaeaceae	Nymphaea alba L.	White water-lily	Niloofar	Cold & moist	Oily drop (nasal/topical) Syrup, beverage
Asteraceae	Lactuca sativa L.	Lettuce	Khass	Cold & moist
Gramineae	Hordeum vulgare L.	Barley	Shaeer	Cold & dry	Barley water (Mā ol-shaeer)
Leguminosae	Astragalus gummifer	Gum tragacanth	Kathira	Moderate & moist	Syrup/beverage Topical ointment Emollient, softener, moisturizing
Malvaceae	Malva sylvestris L.	Common mallow	Khobbazi	Moderate & moist	Wet compress, salve Ointment
Malvaceae	Althaea officinalis L.	Altheae	Khatmi	Cold & moist	Sitz bath of leaf or flower Syrup, beverage
Rosaceae	Prunus dulcis (Mill. ) D.A.Webb	Sweet Almond	Lawz	Moderate & moist	Cooked fruit Beverage
Cucurbitaceae	Cucurbita pepo L.	Pumpkin	Qar’	Cold & moist	Ointment Emollient, softener, moisturizing Oily drop (nasal/topical)
Plantaginaceae	Plantago ovate Forssk.	Blond plantago	Bazr-e qatuna	Cold & moist	Mucilage, mouthwash, gargling, laxative
Portulacaceae	Portulaca oleracea L.	Purslane	Baqlat ol-hamqa	Cold & moist	Leaf, seed, flower Extract, juice Wet compress & salve Fresh/cooked leaves
Brassicaceae	Descurainia Sophia (L.) Webb ex Prantl	Fixweed	Khobbah	Warm & moist	Beverage/cooked seed
Caesalpinaceae	Cassia fistula L.	Purging cassia	Khiarshanbar	Moderate & moist	Mouthwash Gargling
Rosaceae	Prunus domestica L.	Plum	Ejjas	Cold & moist	Laxative

Table 2:

Therapeutic recommendations for management of Sjögren’s syndrome in TPM (4–6)

Complaints	General recommendations	Food products recommendations (Useful for all complaints)
Eye dryness	-Avoiding long-term sleeplessness, avoiding exposure to the wind, dust, hot or sunny weather	1- Moisturizing foods and beverages:
Nose dryness	- Using nasal drop of moisturizing oils e.g., almond oil, violet-almond oil, white water-lily oil, and pumpkin oil - Using nasal ointments	-Cooked rice with milk and sugar -Porridge of milk, starch and almond oil -Pottage/stew
Dryness in mouth and gastrointestinal tract	-Avoiding whatever aggravates the dryness like spicy condiment	-Chicken soup -Whey protein (Mā ol-jobon) -Barley water (Mā ol-shaeer) -Goat milk -Plum soup 2- Eating and gargling the following mixture: composition of cucumber and pumpkin seeds, soaked in goat’s milk, after extraction, mixed with quince seeds and sebestan plums boiled in water
	- Using herbal mouthwash (caries prevention) e.g., Mentha spicata (spearmint) -Gargling with mucilage herbs as a saliva substitute, such as blond plantago, quince seed, and tragacanth -Chewing or sucking lozenge/troche - Using sialogogue like sipping plum/lemon apple oxymel
Vaginal dryness/dyspareunia	- Using moisturizing oils - Using herbal vaginal douching/suppository - Using sitz bath with medicinal plants, such as altheae and common mallow	3- Tonic and moisturizing foods or beverages:
Fatigue/chronic pain	-Aerobic endurance training - Using anointment throughout the body surface with herbal oils e.g., almond oil after bathe -Gentle body massage with moisturizing oils	-Whey protein (Mā ol-jobon) -Yolk of soft boiled eggs -Nutritious broth