Investigating the role of body force or strength (Quwa) in causing diseases in Iranian traditional medicine and the role of cellular energy in causing diseases in conventional medicine : Journal of Family Medicine and Primary Care

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Investigating the role of body force or strength (Quwa) in causing diseases in Iranian traditional medicine and the role of cellular energy in causing diseases in conventional medicine

Akbari, Hassan1,2; Ayati, Mohammad H.1; Vaghasloo, Mahdi A.1; Karimi, Mehrdad1,3,

Author Information
Journal of Family Medicine and Primary Care: August 2022 - Volume 11 - Issue 8 - p 4137-4145
doi: 10.4103/jfmpc.jfmpc_1890_21
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Humans have always sought to find the source of diseases. For example, finding the root causes of high blood pressure, diabetes, asthma, myocardial infarction, MS, lupus, or cancer has always been a major challenge for researchers. The function of the organs of the body depends on the energy that comes from the consumption of foods. From the perspective of traditional medicine, disease occurs when the function of the organs of the body is disturbed.[1] However, in the basics of conventional medicine, it is believed that any disturbance in the function of the body’s cells causes the disease. It should also be noted that the proper functioning of cells depends on cell energy, which is the main source of cell energy is the food consumed. In this regard, the issue of nutrition has a special place in traditional medicine. The life of all living organisms depends on the process of releasing material energy and altering the composition of cells.[2]

In general, metabolism consists of two main processes, catabolism and anabolism, each of which makes up half of the body’s metabolic process, respectively. In the process of catabolism, complex molecules are broken down by cells through energy expenditure to break down glucose molecules, free fatty acids, and amino acids into energy. However, due to the difference in the amount of energy consumed for food catabolism, the process of converting them into energy is also different. Accordingly, we need to know the process of catabolism of different foods to estimate the amount of energy used to break down different molecules into glucose molecules, free fatty acids, and amino acids. Consumption of foods that expend a lot of energy to break down their structure will, in the long run, reduce the energy output of cells and organs and reduce the overall energy of the body as well as the cells. Decreased cellular energy affects the performance of sodium-potassium energy-dependent pumps at the cell surface, which in turn affects the function of major organs such as the heart, brain, and liver.[2] All the organs of the human body are made up of cells, the function of these cells guarantees the health of the whole body. Since the function of cells depends on their energy level, reduction of energy at the cellular, organic and molecular levels can lead to impaired cellular and molecular functions and the occurrence of various diseases depending on a person’s genetics. For example, in diseases such as diabetes, a reduction of cellular energy causes a dysfunction of the cell membrane that disrupts the function of insulin receptors in the cell wall and thus raises blood sugar, or as a result of dysfunction of lysosomes, antimicrobial mechanisms in the diabetic person’s immune cells are disrupted and the diabetic person becomes susceptible to bacterial infectious diseases.

According to the basics of traditional medicine, it is possible to provide a proper nutrition program based on the nature, age, occupation and other conditions of the patient. Also, providing guidelines for the proper composition of foods, along with the effect of modifiers in modifying foods, as well as the necessary instructions for observing other essential sets results in maintaining health and improving patients. According to the principles of traditional medicine, consumption of concentrated and cold foods with their energy mechanism reduces cellular energy and cell function, leading to disease. On the other hand, the reduction of cellular energy weakens the function of cellular pumps, resulting in the disruption of the process of expelling sodium ions.

As a result of the retention of sodium ions inside the cells, water enters the intercellular space through the semipermeable membrane whereas sodium ions enter the cell and cause cell swelling, which is the first stage of cell damage. Based on this, the basics of traditional medicine have identified the factors that reduce the production of cell energy by mitochondria and subsequently may cause disease (e.g., colds, low temperatures, pickles, late sleep, inactivity, stress, overeating, inappropriate diet, and eating too fast). Unfortunately, there is no exact and appropriate equivalent in the concepts of modern medicine for the cases mentioned in traditional medicine, therefore, detailed studies should be done in order to harmonize and match the concepts in this science with modern medicine. According to the principles of physics, energy is a property of matter that is transformed from one form to another or transferred from one substance to another, so any substance with energy has the ability to do work. Understanding the concepts of energy from the perspective of both modern and traditional medicine is of great help to know the cause of diseases. Therefore, the present study aimed to investigate the role of energy in causing diseases in Iranian traditional medicine and its adaptation to the role of cellular energy in causing diseases in conventional medicine.

Materials and Methods

According to the literature of traditional medicine related to the subject of the forthcoming research, all books and articles published in this field were reviewed in Persian and English from upadated databases. In this regard, the keywords of traditional medicine, Haar-e Gharizi, or the innate natural hot [substance] and Hararat-e-Garizi (natural heat), were used to search for available resources among Persian databases through comprehensive Noor software (version 1.5) as well as library search. On the other hand, the keywords of the cell, energy, and disease were used to review resources in modern medicine and to search English databases. In this regard, Science Direct and PubMed databases, as well as Google Scholar, were searched among articles from 2000 to 2020.

Initially, about 1050 different sources including 490 Persian sources consisting of 40 titles of traditional medicine books and other Persian articles published in this field and 560 sources of modern medicine topics consisting of modern medicine articles were searched using the introduced keywords. Then, using the PRISMA study method, sources with thematic similarity, and sources with low thematic relevance were removed from the study circle of the present study. Therefore, after the final screening and selection of the most important study sources and thematic relevance, the number of study sources in this study reached 43 [Figure 1].

Figure 1:
The process of selecting the articles used for review in this research based on the PRISMA method

After data collection, data analysis was performed by Colaizzi descriptive phenomenology. In order to gain a general understanding of the present study, first, the relevant concepts were fully described and important phrases were extracted. Then, in order to gain an initial understanding of the study, all the descriptions provided were carefully reviewed. It is worth mentioning that data collection was performed using the inductive model.

Traditional Medicine

According to the sources of traditional medicine, medicine is a science that examines the state of the human body in terms of health and its purpose is to maintain or restore health. In the natural and stable state, the human body has the ability to perform all the actions properly. When a person is not able to perform his actions properly and is out of the normal state, we say that the human body is sick. Accordingly, we should have sufficient knowledge of the causes of health and disease of the human body and known medicine for the same. The main causes of the disease can be identified by observing the symptoms and related complications, in this regard, the relevant causes and principles must be identified. Based on the basics of traditional medicine, the four tools for understanding the main aspects of health and disease are briefly stated in Table 1.

Table 1:
Four factors involved in the state of health and disease of the human body

Based on the contents of Iranian traditional medicine, with the correct knowledge of the actions of the human body, temperament, single and compound organs of the body, spiritual and natural and vital forces, the causes of ill health can be well identified. Awareness of the body’s causes of eating, drinking, habits, physical and mental movements can also identify the causes of unhealthy. On the other hand, by consciously eating, drinking, good living habits, healthy lifestyle, exercise, proper use of herbal drugs, as well as the optimal use of the principles of medical hand operations (such as medical massage, dry cupping, wet cupping, phelebotomy and surgery) diseases can be controlled and managed.

In this regard, in order to gain sufficient knowledge about the natural state of the body based on the topics mentioned in traditional medicine, the main items of Elements [Arkan], Temperament [Mizaj], Humors [Akhlat], Organs [Azaa], Spirits [Arwah], And Faculties or Forces [Quwa] and Functions [Af’al] should be carefully introduced and examined [Table 2]. The natural forces of man are the main pillars in understanding the nature of the human body and understanding the state of health or disease of the body, which are briefly listed in Table 3].

Table 2:
Natural affairs introduced in traditional medicine
Table 3:
Types of natural power from the perspective of traditional medicine

In order to better understand the characteristics of the body, the mechanism of the organs and the disease, we must correctly identify all the main aspects of the body’s natural forces, which are: warmth, coldness, wetness and dryness. Heat is a common aid for all four forces. While coldness indirectly helps some of the natural forces in the body, because the inherent and direct effect of cold is the opposition to all-natural forces in the body. Cold is a destructive, numbing quality, thus opposed to all-natural forces and prevents them from acting.[5]

According to the definitions of Iranian traditional medicine, a vital force arises in the organs of the body, predisposing them to accept the force of sensation and movement and vital actions. Physicians attribute the movements of fear and anger to this force because they observe that these states cause the movement of expansion and contraction of the complication on the soul attributed to this force.[2678]

Distinguishing Vital Force from Sensual and Natural Forces

Whenever the vital soul is created according to its proper temperament, it finds the ability to accept a force that prepares all the organs of the body for the acceptance of other forces, such as the psychic force and others. Therefore, psychic forces exist in the soul and the organs of the body after the emergence of this force. On the other hand, if an organ in the body loses its psychic power by lack of sensation and movement, it will not lose its vital force while it is alive.

Do you not see that the paralyzed limb (while alive) lacks the power of sensation and movement due to the occurrence of a distemperment that prevents the limb from accepting the power of sensation and movement, or due to the disruption of the wide nerves between the brain and organs. However, the organ is alive and the organ affected by death is deprived of sensation and movement and soon becomes infected and corrupt, so there is a force in the paralyzed organ that sustains life until where the barrier is removed and the force of sensation and movement returns to the limb. Their acceptance is prone to the health of the life force, and the mere existence of the barrier prevented its actual acceptance, while the dead limb does not show this.[6]

On the other hand, the force that gives ability to the members is not the nourishing force of natural force and others, so as long as the nourishing force is present, the life of the member will continue. When the nourishing force is destroyed, the organ lacks vital force, because what has been said about the differentiation of the psychic force also includes the nourishing force. It is possible that the action of the nourishing force is ruined in some organs, while life is still and it is possible that the organ is dying, while the action of the nourishing force is established. If the nourishing force creates the ability to accept sense and movement, the plant must also have the ability to accept sense and movement.[236789]

Strengthening the Forces of the Body

In order to strengthen the body, the necessary nutrients to maintain health should be provided to the body based on the knowledge of Iranian traditional medicine.[10] Sleep and wakefulness are among the factors affecting the body’s forces, thus involving in health if they are normal and moderate; otherwise, it causes disease.[23678911] Sleeping for a long time causes the body’s nature to be cold and dry. It causes difficulty in the digestion of food.[1213] In order to maintain body balance and strengthen the body as well as body moisture, special attention should be paid to eating and drinking.

In this regard, cold water should be avoided as much as possible.[1415] On the other hand, drinking plenty of water after enduring intense thirst causes a severe weakening of the body’s instinctive heat and consequently weakens the general strength of the body.[16] The presence of water in the body has many benefits, including preventing the rise in stomach temperature following the digestion of food in this organ, because, in the absence of water, food burns completely.

Accordingly, in addition to maintaining the body’s heat balance, the presence of water strengthens the body.[17]

Conventional Medicine Texts

The concept of energy from the perspective of Conventional medicine.

According to the concepts of conventional medicine, all concepts of energy in the human body refer to biochemical reactions and bioenergy of cells in the body. Accordingly, in order to understand the content of cellular energy, we must know the process of metabolism of various nutrients in the body. In order to know the amount of energy available to the cell, one must know how to create energy in the body. According to modern sources, the main source of energy is the complete oxidation of glucose to carbon dioxide and water. Glucose, glycerol, fatty acids and amino acids are produced in the gastrointestinal tract. The major part of chemical reactions in cells is related to the availability of food energy to the various physiological systems of the cell. For instance, energy is needed for muscle activity, secretion by the glands, maintenance of membrane potential by nerve and muscle fibers, synthesis of substances in cells, absorption of nutrients from the gastrointestinal tract, and many other functions.[18] Death from starvation occurs when available energy reserves are depleted, and certain forms of malnutrition are associated with energy imbalances (marasmus). Excessive energy storage leads to obesity, which is one of the most common diseases in Western societies.[19]

The most basic link between energetic and energy-producing functions in the body is adenosine triphosphate (ATP), which is called the body’s energy unit. The energy from the oxidation of carbohydrates, proteins and fats is used to convert adenosine diphosphate (ADP) to ATP, which is then consumed by various reactions in the body. The energy produced in the body is consumed in different parts, including the following[18]:

  • Active transfer of molecules through the cell membrane is necessary.
  • Muscle contraction and mechanical function.
  • Various synthetic reactions produce hormones, cell membranes and many other essential molecules in the body.
  • Conducting neural messages
  • Cell division and growth
  • Physiological functions of the body that are necessary to maintain life.

Basically, all physiological mechanisms of the human body need energy for optimal functioning, which is supplied by ATP present in all areas such as the cytoplasm and nucleoplasm of cells.[18]

The Relationship between Energy and Temperature in the Body

Not all energy in foods is transferred to ATP. Instead, much of this energy is converted into heat. On average, 35% of the energy in foods is converted to heat when ATP is formed, Furthermore, by transferring ATP to the functional system of the cell, more energy is converted to heat so that even under optimal conditions, more than 27% of the total energy from food is used by the functional systems. Even when 27% of the energy reaches the functional systems of the cells, most of this energy is eventually converted into heat. For example, when proteins are synthesized, large portions of ATP are used to form peptide bonds, and this energy is stored in these bonds. When proteins are broken down, the energy stored in peptide bonds is released as heat in the body. On the other hand, the energy expended by the heart in pumping blood plays an essential role in converting energy into heat. The blood expands the arterial system, and this dilation itself represents a reservoir of potential energy. When blood flows in the peripheral arteries, the friction of the various layers of blood flowing on top of each other and the friction of the blood against the walls of the arteries convert all this energy into heat. In any case, we must know the energy content of the food consumed.

Thermal Effect of Food (TEF)

Energy-based metabolism is the amount of energy consumed at rest, accounting for approximately 60% of the total daily energy intake. The specific dynamic effect or exotherm of diet is called the thermal effect of food (TEF), which is the increase in metabolism after a meal and accounts for approximately 10% of the total energy consumed. TEF is the energy source for digestion and storage of food as well as the metabolic effects of nutrient penetration that may decrease with age. A clinical study by Mayo in 2014 found that TEF was lower in adults than in middle-aged people. However, a decrease in TEF, along with a decrease in physical activity, may result in an increase in fat storage with age. It should also be noted that the changes observed in the TEF may indicate changes in the body’s metabolism due to changes in dietary composition.

A comparative study between active and sedentary men in both younger and older age groups showed that TEF was 45% higher in active and young men and 31% higher in active and older men as compared to sedentary groups. Based on this, the researchers concluded that physical activity increases TEF, regardless of age and body composition.[20] Numerous studies have shown that consuming more fats as well as carbohydrates increases TEF while increasing energy. On the other hand, having irregular meals with different energy content during the week causes a significant reduction in TEF.[21] A study by Hamada et al.[22] Found that slow eating with more and slower chewing times was associated with a significant increase in TEF due to blood circulation after meals. However, Calcagno et al.[23] conducted a study in this regard and emphasized that in order to more accurately study the effective factors and trends of TEF, the study of other thermogenic variables such as altered temperature, drugs and emotions can be helpful.

The Role of AMPK in Energy Metabolism (AMP-activated Protein Kinase)

AMPK has two major roles in energy metabolism, one as a glucose sensor for fuel persistence and the other as an adenine nucleotide sensor that controls the rate of subsequent fall in energy status. Glucose and lipids are the main sources of energy supply and storage in cells, and AMPK increases ATP levels by inducing their degradation, inhibition of synthesis and storage.[2425] On the other hand, AMPK regulates transcription factors by transferring to the nucleus. It increases energy production, provides cellular energy needs, and inhibits cell growth and proliferation. In mammals, AMPK is activated by a decrease in cellular energy, which begins with an increase in the AMP/ATP and ADP/ATP ratios. It is also capable of providing glucose availability independent of changes in adenine nucleotides AMPK.[25]

According to modern medicine, any defect in the production of the energy required by the body can cause fatigue, including problems with the mitochondrial system of cells. Mitochondrial energy systems are involved in creating a complex pattern of symptoms in chronic fatigue syndrome (CFS). Cellular mitochondrial damage has been reported to impair the cell’s ability to produce high-energy molecules, including NADH and ATP.[26] Any mitochondrial dysfunction can lead to fatigue. Observation of fatigue is one of the common symptoms of mitochondrial disease and fatigue-like behavior is shown in animal models by reducing the expression of mitochondrial complexes, decreased metabolic activity and changes in the morphology of mitochondria in the brain.[27] Numerous studies have examined the association between mitochondrial dysfunction and CFS. For example, Lacourt et al.[27] reported in 2018 that increased levels of oxidative stress led to a possible decrease in ATP production efficiency and a decrease in mitochondrial energy production in patients with CFS. As a result, decreased cellular energy levels in CFS patients, while lowering intracellular pH after a balanced exercise, resulted in a lower rate of ATP synthesis, indicating a disorder in the recycling of ADP to ATP in mitochondria.[28] Mitochondria produce energy by oxidative metabolism in the form of ATP when it is hydrolyzed to diphosphate to provide the energy needed for muscle contractions, nerve impulses, and all energy-consuming processes, including the chemical energy needed to synthesize all complex molecules. Therefore, any impairment of mitochondrial function leads to fatigue and can cause other symptoms of CFS. There is ample evidence that mitochondrial dysfunction is present in some CFS patients.[28]

Accordingly, any damage and disruption in the mitochondrial components are caused by the body’s lack of adequate access to energy and the body’s involvement in other parts and energy expenditure, which in turn leads to the development of chronic diseases.[27] Recent studies have shown that a significant increase in the quality of nutritional interventions has a significant impact on the improvement of patients with CFS. During chronic low-grade inflammation, nutrient availability is expected to decrease due to the body relying on aerobic glycolysis, resulting in less energy for the applicant organ.[27] Another way to achieve organic energy balance is to balance your circadian rhythm and sleep. In addition, the presence of any inflammation with low or chronic degrees can increase the pattern of energy consumption, which in turn causes an imbalance between availability and energy consumption, and the end result will be fatigue. However, the possibility of fatigue in a range of chronic diseases can be predicted. Studies on intracellular energy topics have shown a positive and significant relationship between fatigue intensity and average daily caloric intake in breast cancer patients after the fourth cycle of chemotherapy so there was no correlation between available energy and energy consumption.[27] Any disturbance in the digestive system (such as intestinal fermentation, hypochlorhydria, or pancreatic insufficiency) disrupts energy production and may cause fatigue.[28]

Relationship between Cell Energy Content and Disease

Creating any disease in the body reduces the amount of cellular energy. In this regard, the share of the nervous system seems to be higher than other organs, which can be consistent with the amount of energy consumed by this vital organ. For example, in patients with Parkinson’s, there is a decrease in glucose metabolism in the cerebral cortex, which leads to a decrease in cellular energy content.[29] Decreased blood glucose metabolism, while impairing mitochondrial function, greatly increases the symptoms of neurological diseases. In particular, it is recognized as a predictor of the onset of dementia.[29] In a similar study, Lanzillotta et al.[30] showed that in people with Alzheimer’s disease (AD), mitochondria are characterized by dysfunction such as decreased oxidative phosphorylation, decreased adenosine triphosphate production, a significant increase in the production of reactive oxygen species, and attenuated antioxidant defenses. Several cellular energy mechanisms can induce and develop neurodegenerative processes. Parkinson’s disease manifests energy and metabolic regeneration that leads to increased oxidative stress and neuroinflammation.[29]

Regulation of ATP synthesis and degradation is essential for all life forms so that any oxidative damage can play an essential role in human health and disease. This potential amount of abnormalities is controlled by one of the most complex mechanisms called autophagy, that its main role is to protect cells against stress. For example, during starvation, when nutrients are depleted, autophagy is activated to produce oxidative layers and other compounds (e.g., amino acids) necessary for cell survival, thereby reducing the production of autophagy energy.[3132] Many cells work at the basal level, requiring only part of their biological energy capacity. The difference between the ATP produced by oxidative phosphorylation at the base and the amount produced at maximal activity is called “ functional residual capacity”. If the functional residual capacity of the cell is not sufficient to supply the ATP required by the cells, there is a risk of aging or cell death.[33] Similarly, decreased respiratory capacity was described to be associated with a variety of pathologies, including heart disease, neurodegenerative disorders, and smooth muscle cell death.[34353637]

Relationship between Age and Cellular Energy Content

If ATP demand in the body is not met, this leads to aging and cell death in damaged tissue.[33] Decreased cellular energy in the elderly increases the mutation of the mitochondrial genome in the brain, heart and skeletal muscle of older humans.[383940] The main reason for this phenomenon is the change in biological energy parameters over time, for instance, Bioenergy fluxes decrease with age.[41] According to studies by Jeon et al.,[42] this phenomenon may be due to an increase in the level of chronic inflammation by ageing, thereby inhibiting the activation of AMPK in older tissues. The brain, like most organs, gradually decreases energy metabolism by aging. Because neurons require large amounts of energy to produce action potentials, neurotransmission, and other processes, a decrease in age-related metabolism contributes to a cognitive decline associated with aging. Since neurons require large amounts of energy to produce action potentials, neurotransmission, and other processes, a decrease in age-related metabolism contributes to a cognitive decline associated with aging.

Clinically, a decrease in age-related glucose utilization was observed in most areas of the human brain. Aging is also a risk factor for age-related diseases such as neurodegenerative disorders. These diseases may occur when nerve cells are unable to respond adaptively to age-related reductions in basal metabolic rate and energy-dependent tasks, such as neuromuscular coordination, cognitive function, and environmental awareness.[43]


Based on studies, it can be concluded that first of all, all the functions of our body are carried out by cells. Second, all cellular functions are performed by energy. If there is no energy, nothing is done in the cell and reduction of energy in the cells causes cell dysfunction and various diseases. In order to provide enough energy for optimal cell function, all the steps of energy production and release in the body should be done correctly and accurately, and this is undoubtedly achievable by modifying your lifestyle and fully observing the essential set, including healthy air, foods with low TEF, correct movement and stillness, correct early sleep and early wakefulness, consumption of vitamins and elimination of cellular metabolites and toxins as well as correct mental and psychological status. For example, a person who suffers from constipation will gradually suffer from digestive and absorption disorders and eventually energy loss; thus, observing the principles of eating and drinking is one of the most basic points to produce correct and balanced energy in the body. On the other hand, the quality of sleep and wakefulness, directly and indirectly, affects the digestion and absorption of food, and circadian rhythm disturbances clearly induce energy-related diseases such as chronic fatigue syndrome.

The effect of exercise has also been proven to enhance the process of energy production, and regular exercise can ensure adequate and effective production of energy in the cells of the body. The issue of peace of mind is also one of the stressors that affect all stages of energy production from the digestive to the cellular level. On the other hand, in Iranian traditional medicine, these principles are described in detail under the title of the seven essential principles, including clean air, proper nutrition with low TEF and proper drinking, proper sleep, proper exercise proper consumption of vitamins and minerals and elimination of cellular metabolites and toxins from the body with urination and defecation, avoid from pathologic stresses and praying. It seems that the concept of energy supply is the product of the correct observance of these seven principles in societies that can prevent the occurrence of most diseases as well as their actual treatment.

Therefore, it is necessary to start the correct implementation of the necessary settings in human societies, for the prevention and treatment of diseases, with extensive education and information, public culture building, consensus, synergy and improvement of agricultural, livestock and related industries. So that no more human beings get infected with deadly non-communicable diseases and epidemics like the recent Covid-19 pandemic.


Force, power or strength is the main factor to functions of organs in the sources of Iranian traditional medicine and also energy is the main factor to functions of organs in the sources of conventional medicine, organs are known as cells in modern medicine. Natural affairs in Iranian traditional medicine, including four main elements, temperaments, organs (cells), medical spirit (very soft, thin and delicate parts of organs), force (energy) and finally proper actions of organs (cells) that is the most desirable goal of creation of human by God. As can be seen, power or energy is required and it is impossible for a cell or organ to do anything without it. In conventional medicine, the cellular energy reducing agents leads to dysfunction of cells leading to disease; therefore, to prevent diseases, in Iranian traditional medicine, body force production agents composed of six necessary factors consist healthy air, healthy food and drinks, proper and timely sleep, lack of constipation and the supply of vitamins and minerals, exercise and avoidance of harmful psychological stresses, all of which should be provided. The cells of the human body must also be free from all life-threatening factors such as environmental pollution, toxins, chemical fertilizers, unauthorized preservatives, foods with high TEF, improper and untimely sleep, constipation, lack of necessary vitamins and minerals, inactivity, and harmful psychological stresses.

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Conflicts of interest

There are no conflicts of interest.


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Body forces; cellular energy; conventional medicine; disease; Iranian medicine

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