Faqr-Ud-Dam (Anaemia) An Age- Old Malady in Unani Medicine - An Overview.

Transcription

1 Alam Md. A. et al.; International Journal of Pharmamedix India, 2014, 2(4), Faqr-Ud-Dam (Anaemia) An Age- Old Malady in Unani Medicine - An Overview. * Md. Anzar Alam a, Zaheer Ahmed b, Danish Jahan c, Qamri MA d, *Author for correspondence Md. Anzar Alam * PG Scholar (MD), Dept. of Moalajat (Medicine) National Institute of Unani Medicine (NIUM), Bangalore , (An Autonomous Organization under Dept. of AYUSH, Ministry of Health and Family Welfare, Govt. of India.) E mail: dranzarnium@gmail.com Mob: a & b PG Scholars (MD), Dept. of Moalajat (Medicine), National Institute of Unani Medicine (NIUM) Bangalore c PG Scholar (MS), Dept. of Gynae & Obs, National Institute of Unani Medicine (NIUM) Bangalore d Lecturer Dept. of Moalajat (Medicine), National Institute of Unani Medicine (NIUM) Bangalore Note- This article is property of International Journal of Pharmamedix India [ISSN: ]. Published by: Pharmamedix India TM [ This Open Access Article available on only for private and non-commercial use. Available online on Page 782

2 Abstract: Faqr-ud-Dam (~ Anemia) is the qualitative and quantitative deranged condition of blood causing inability in catering the corporal physiologic functions. Among anemia, Iron deficiency is contemplated to be the most common reason globally, but additional nutritional deficiencies (viz; folate, vitamin B12 and vitamin A,) acute and chronic inflammation, parasitic contagion, and genetic disorders that affect hemoglobin synthesis, production of red blood cells or survival of this, may all cause anemia.worldwide, anaemia is afflicted to 1.62 billion people, which estimates to 24.8% of the population. Preschool-age children are predominantly affected (47.4%) and pregnant women (41.8%). National Family Health Survey discloses that 50% of Indian woman are anaemic and 20 % maternal deaths is directly related to anaemia. Combating anaemia is still a challenge for global health activists, its eradication and management is totally depends upon methodical approach towards health education, balanced diet and apt medication to avoid harmful complications. At this juncture Unani Medicine can play a vital role in the management of anaemia though its safety, efficacy, easy availability, cost effectiveness and above all free from after effects of medication. This overview has been contemplated to highlight the beneficial aspects available in Unani classical literature pertaining to Faqr-ud-Dam (anaemia) for the betterment of humanity. Key-words: Anemia, Iron Deficiency, Su-ul-Qinya, Faqr-ud-Dam, Unani Medicine Introduction Faqr-ud-Dam (~ Anemia) is the qualitative and quantitative deranged condition of blood causing inability in catering the corporal physiological functions. Faqr-ud-Dam is literally known to be called as anemia; (Anonymous 2012), it is a condition in which the number of red blood cells (and consequently their oxygen-carrying capacity) is inadequate to meet the body s physiologic needs. Specific physiologic needs vary with a person s age, gender, residential elevation above sea level (altitude), smoking behavior, and different stages of pregnancy (WHO, 2011). WHO defines anemia as a condition in which the Hemoglobin content of blood is lower than normal as a result of deficiency of one or more essential nutrients, regardless of the cause of such deficiencies (Raghuram V et al, 2012). Iron deficiency is the most common cause of anaemia worldwide, though other factors, such as folate, vitamin B12 and vitamin A deficiencies, chronic inflammation, parasitic infestation, and inborn disorders may all be responsible for anaemia (WHO, 2004). Worldwide, anaemia is afflicted to 1.62 billion people, which estimates to 24.8% of the population. Preschool-age children are predominantly affected (47.4%) and pregnant women (41.8%). National Family Health Survey discloses that 50% of Indian woman are anaemic and 20 % maternal deaths is directly related to anaemia (Kaur K, 2014).It is reported that prevalence of anaemia in India is much more than that of Bangladesh, Nepal, Sri Lanka and Pakistan and South East Asian countries (Thacker T, 2011).According to National Family Health Survey Available online on Page 783

3 (NFHS) III data, the incidence of anaemia in urban children is 71%, rural 84%, and overall is 79% (N.F.H.S, 2006). 2. Sign and Symptoms Pale skin, face, lips, tongue and conjunctiva, Fatigue, Irritability, Weakness, Exertional dyspnoea, Orthostatic Hypotension, Sore tongue, Brittle and Concave nails, Pica, Anorexia especially in children, Frontal headache low Haematocrit and Hemoglobin, low Serum Ferritin (Serum Iron) Level (Khan HA, 2011; Sina I, 2010; Unicef, 2002). 3. Concept of Anaemia (Faqr ud- Dam) in Unani Medicine Anaemia in the classical literature of Unani Medicine has been described under the heading of Su-ul- Qinya (an umbrella term which stands for lack of vital treasure -blood ) and it is literally translated as Faqr-ud-Dam (anaemia), and it is being in use profusely (Anonymous, 2012). According to Unani physicians (Ibn Sina ( AD), Ismail Jurjani ( A.D), Ibn Hubal Baghdadi ( AD) and Hakim Azam Khan ( A.D), blood is considered to be the vital fluid of human body which is formed in the liver. Due to derangement of the liver functions and weakness of hepatic faculties or sometimes due to associated diseases, the resultant formation of blood is not normal for nourishment (nuqs taghzia) there by leading to anaemia with sign and symptoms such as; pallor body complexion of patient, oedematous face, eye lids and upper or lower limbs and some time generalized swelling all over the body with pitting oedema due to raddi bukharat (obnoxious gases), sometimes gingivitis, disturbed sleep and sometime excessive sleeping, loss of appetite, indigestion, flatulence, delayed healing of wound or ulcers (Khan HA, 2011; Sina I, 2010; Jurjani I, 2010; Baghdadi IH, 2004).Unani Medicine is based on theory of Akhlat (humour) and its Mizaj (temperament). If disequilibrium occurs in proportion of akhlat or change in their mizaj (temperament) it leads to disease (Ahmed S I, 2009). 4. Asbab-e- Marz (Aetiology of disease) As per Unani concept anaemia is due to various etiological factors; Zof-e-jigar (enfeeble hepatic functions), Zof-e-meda (gastric debility), Azm-e-tihal (splenomegaly), Bawaseer (piles), Ahtabas-e-Tams (amenorrhoea), Excess use of ratab wa ghaleez aghzia (moist and hardly digestible), Dushwar Hazm aur lesdar aghzia (spicy and oily diet) (Khan HM, 2011; Jurjani I, 2010; Sina I, 2010; Baghdadi IH, 2004;). 5. Usool-e-Ilaj (Principle of treatment) Avoid consumption of foods causing altered temperament of Jigar (liver) leads to baroodat (coldness) and taqleele hararate ghareeziya (decreases innate heat) of the liver. Avoid use of freezing and cold water. Avoid ratab (moist), ghaleez and dushwar hazm ghiza (spicy and hardly digeastable food). Daily riyazat (exercice) in empty stomach. Bathing in water which containing gandhak (sulphar), suhaga (borax) and shib (alum). Available online on Page 784

4 Dalk (massage) by rough cloth with garam roghan (hot oil). Avoid Hammam (bath) and Jimah (sexual intercourse) immediately after meal. Harkat fil raml (rolling over the warm sand and soil). Need of mild istefragh with the help of Ayarij (Aloe barbedensis)and Habbul Neel as it removes ghaleez (hard), lezdar (sticky) and balghami fuzla (vitiated phlegmatic fluid) from body. If aetiology is due to Ehtabas-e-tams (amenorrhoea) wa bawaseer (piles), then fasd (phlebotomy) is required when condition of patient is good, because tabiyat (physis) will be activated for the production of new cells in the blood (Khan HA, 2011;Jurjani I, 2010;Sina I, 2010). 6. Tahaffuzi tadabeer (Preventive measures) Unani Medicine recognizes the influence of environment and surroundings on health and lays great emphasis on the maintenance of proper eco balance as well as pure water, food and air. Besides, it prescribes Asbab Sitta Zaruriyya (six essentials causes) for maintaining good health adherence to which is essential for preservation of health (Sina I, 2010). Walking in open air, and to stay in open airy ventilated houses, Maintain proper Hifzan-e-Sehat Shakhsi (personal hygiene) Eatables should be washed and cooked properly Food cooked in iron pot is recommended Drink clean and boiled water Preferable consume Ma a hadeedia wa Nahasia i.e, iron and copper rich water Regular exercise is recommended Proper and adequate rest is essential Maintain equilibrium in mental activities Adequate sleep is essential Maintain equilibrium in Ehtebas wa Istefragh (retention and evacuation) of body fluids (Jurjani I, 2010; Shah MH, 2007; Sohad GA, 1991; Rushd I, 1987; Kabiruddin A, YNM). 7. Ilaj (Treatment) The principle of treatment in Unani Medicine lies with three modules viz; Ilaj bil Tadbeer (Regimenal therapy), Ilaj bil Ghiza (Dieto- therapy) and Ilaj bil Dawa (Pharmacotherapy), (Avicenna, 1993; Rushd I, 1987; Kabiruudin H, YNM;), a multipronged strategy to combat anaemia, adherence to which will result in patient out come and satisfaction. 7.1 Ilaj bil tadbeer (Regimenal therapy) Employing Riyazat (exercise), Dalk (massage), Takmeed (fomentation), Hammam yabis, (dry bath), Hammam muarriq (steam bath), Qai (emesis), Tamreekh (oil immersion) stimulates blood circulation and remove toxic substances from the body thus helps in production of Khoon Saaleh (pure blood) which is essential for Af al haiwaniya (vital Available online on Page 785

5 activity) (Ahmed K et al, 2014; Tanweer MA, 2013; Sina I, 2010; Zohr AMI, 1986; Kabiruddin A, YNM). 7.2 Ilaj bil Ghiza: (Diet therapy) Diet should be of Ghiza-e-lateef (soft diet), Kaseerut-taghzia (high nutritious diet) and Jaiyyad-ul- Kaimus (easily absorbable) Zirbaj (a sour meat dish which dressed with vinegar and honey or with acid syrup, raisins, few figs were some time added), Sikbaz (acid minced flesh similar to zirbaj), Zardah (rice dressed with Crocus sativa), Yakhni (broth prepared from meat and rice), Shurayk (a bun made of leavened dough, glazed with egg, clarified butter and flavoured with spices-cinamon, curcuma, artemisia, prunus mahalab, aniseed, nigella and camphor), Hisrimiyah (a broth made of kid s flesh of lamb and fowl seasoned with hisrim and juice expressed from the grape while unripe), Adasiyah (soup of yellow lentil made by boiling them in water till nearly dissolved and then adding vinegar, coriander and salt), Shorbae teetar (bird s soup), Ghost Daraj (meat), Masoosat (soup prepared with aromatic spices) (Sina I, 2010; Kabiruddin H, YNM). The diet which is described in Unani literature are from plant, mineral and animal sources viz; Bathua (Chenopodium album), Palak (Spinacia oleracea ), Cholai (Amaranthus polygamus), Hulba (Trigonella foenum), Tahlab(Spirulina platensis), Jaggery (Caryota urens), Cabbage (Brassica oleracea), Cauliflower (Brassica oleracea), Bean (Phaseolus vulgaris), Kaddu (Cucurbita maxima), Tuffah (Malus domestica), Tamoor (Phoenix sylvestris), Kamsara (Pyrus pyrifolia), Amrood ( Psidium guajava), Rumman (Punica granatum), Behi (Cydonia oblonga), Ananas (Ananas comosus), Anjeer (Ficus carica), Aam (Mangifera indica), Mouz (Musa pradisica), Papita (Carica papaya ), Badam (Prunus amygdalus), Anb (Vitis vinifera), Zaitoon (Oleum europium), Mulberry (Morus alba), Plum (Prunus ceracifera), Cherry (Prunus avium), Hazelnut (Corylus avellana), Jujubes (Ziziphus jujuba), Lemon (Citrus limonum), Lime (Citrus aurantifolia), Apricot (Prunus armeniaca), Shaddock (Citrus grandis), Tarbooz (Citrus lanatus), Peach (Prunus persica), Hadeed /Faulad (iron), Salajeet (Momiyai), Asl (Apis indica), Liver, Kidney, Meat, Fish, Eggs, Milk, Paneer (cheese), Marjan (Coral rubrum). The above diet recommended by ancient physicians corroborates with conventional diet as it is rich in iron, folic acid, Vitamin A and B12, Protein, Minerals etc. (Lone AH, et al, 2012; Park, Maseehi I, 2008; Gruner OC, 1930). 7.3 Ilaj bil Dawa (Drug therapy): There are many drugs which are used either in single form or compound formulations. Some single drugs include; Zafran (Crocus sativus), Saleekha (Cinnamomum verum), Darchini (Cinnamomum zeylanicum), Sadkofi (Cyperus rotundus), Asaroon (Asarum europaeum), Balchhar (Nardostachys Jatamansi), Halela (Terminalia chebula), Balela (Terminalia bellerica), Amla (Emblica officinalis), Qaranfal (Eugenia Caryophyllata), Bisfaij (Polypodium vulgare), Izkhar (Cymbopogon Citratus), Ghariqoon (Agaricus alba), Saqmuunya (Convolvulus scammonia ), Mastaghi (Pistacia lentiscus), Lahsun (Allium sativum), Zaravind Madharj (Aristolochia Available online on Page 786

6 longa), Arqe Gulab (Rosa damascena), Rai (Brassica Juncea), Kurras (Allium ampeloprasum), Kashim (Alstonia scholaris ), Usara-e-Ghafis (Agrimonia eupatoria Linn), Jaosheer (Ferula galbaniflua), Qunturyun (Erythraca officinalis) Barge Mazaryoon (Clitoria ternatea), Usarae Qisaul Hemar (Momordica charantia), Thukm Utangan (Blepharis edulis), Mundi (Sphaeranthus indicus), Shakbeenj (Ferula persica), Baul Shatar (camel urine), Baul Bher (sheep urine). (Alam M A et al, 2014; Jurjani I, 2010; Sina I, 2010; Khan HA, 2011; Baitar I, 2003) Compound Formulation: There are many Unani formulations containing faulad (iron) such as; Qurs Khusta Faulad, Majoon Fanjanoosh, Mauz Zahab, Khusta Shingharaf, Kushta Sammul Far, Khusta Tila Kalan, Khusta Nuqrah, Majoon-e- Dabeed-ul-Ward, Majoon Khabshiwa Fanjanoos, Araq-e ajwayn, Majoon Khabsul Hadeed, Sharbat Faulad, Jawarish Amla, Jawarish Jalinus, Daul Kurkum, Daul Luk, Masruditoos, Kalkanj Bazoori, Sharbat Afsanteen, Tabeekh Afsanteen, Itriphal Sagheer, Sharbat Anarain and Sharbat Ananas. Sharbat Anarain (Syrup of pomegranate) and Sharbat Ananas (Syrup of pine apple) is a citrus based sugar containing syrup which promotes Iron absorption (Khan HA, 2011; Jurjani I, 2010; Rizwan K, 2010; Sina I, 2010; Qamri AA, 2008; Anonymous, 2006; 1999; 1986). 8. Conclusion: With the perusal of above literary survey, our understanding of anaemia in the light of classical Unani literature underscores the need to focus on its elimination through multipronged strategy viz; drug, diet, regimenal therapies and preventive measures as adopted by Unani Scholars centuries ago in the successful management of this age old malady. This approach is more suitable to general populace as it incurs less cost, easy availability of home remedies and regimens with easy to follow health etiquettes. In this way the grave consequences of anaemia can be stalled to a great extent which will pave the way for a vigorous maternal and child health. 9. Acknowledgment: The authors gratefully acknowledge the source of reference cited and staff of Central library, N.I.U.M, Bangalore for their cooperation in providing the relevant material and texts. 10. Conflict of Interest: Nil 11. Funding: Nil References: Ahmed S I. Introduction to Al-Umur-Al- Tabi Yah. Central Council for Research in Unani Medicine New Delhi. Ministry of Health & Family Welfare, Govt. of India 2009; Ahmed K, Jahan N, Aslam M, Kausar H, Khalid M, Ali H. Dalak (Massage) in Unani Medicine: Dalak (Massage) in Unani Medicine: A Review. International Journal of Advanced Ayurveda, Yoga, Unani, Siddha and Homeopathy 2014; 3(1): Alam M A, Ahmed Z, Ansari AH, Ahmed S, Mand D, Alam M T. Iksir-e-Badan (Elixir): Unique Influence from Unani Medicine A Review. International Journal of Herbal Medicine 2014; 1 (6): Available online on Page 787

7 ANONYMOUS. National Formulary of Unani Medicine. Govt.of India Ministry of Health & Family Welfare (Dept. of AYUSH New Delhi) 2006; 1:71,132, Anonymous. Standard Unani Medical Terminology. New Delhi: C.C.R.U.M; 2012: 224. ANONYMOUS. The Unani Pharmacopoeia of India. Govt.of India Ministry of Health & Family Welfare (Dept. of AYUSH New Delhi) 1999; 1 (2):8, 73. ANONYMOUS. Qarabadeene Majidi. Published by Hamdard Wakf Laboratory, New Delhi 1986; 297, , 310, 387. Avicenna. Al Qanoon fi l tibb. (Translated by Dept of Islamic studies) Book 1. New Delhi: Jamia Hamdard 1993: Baghdadi IH. Kitab Al-Mukhtarat Fit-Tibb. Central Council for Research in Unani Medicine New Delhi. Ministry of Health & Family Welfare, Govt. of India 2004; 3: Baitar I. Al-Jameul Mufradat Al-Adviawa Al- Aghzia. Urdu Translation by Central Council for Research in Unani Medicine. Ministry of Health & Family Welfare. Govt. of India New Delhi 2003; 4: 371. Gruner OC. A Treatise on the Canon of Medicine of Avicenna (Incorporating a translation of the fi rst Book.) Luzac and Co.London 1930:416. Jurjani I. Zakhirah Kharzam Shahi. Idara Kitabul-Shifa 2010; 6: Kabiruddin A. Kulliyate Nafisi. Urdu Translation. Idara Kitab-Ul-Shifa New Delhi YNM; 2:188-38, Kabiruddin H. Kulliyate Qanun. Sheikh Mohd. Basheer& Sons. Lahore YNM: 2; 101. Kaur K. Anaemia a silent killer among women in India: Present scenario.european Journal of Zoological Research 2014; 3 (1): Khan H A. Al-Akseer. Urdu translation, by Hkm.Kabiruddin. Published by Idara Kitab-Us-Shifa New Delhi 2011: Lone AH, Ahmed T, Anwar M, Sofi GH, Imam H, Habib S. Perception of health promotion in Unani herbal medicine. Journal of Herbal Medicine 2012; 2(1):1-5. Maseehi A S. Kitab ul- Miat.. Central Council for Research In Unani Medicine New Delhi. Ministry of Health & Family Welfare, Govt. of India 2008; 1: N.F.H.S 3rd. International Institute for Population Science;. National Family Health Survey for India conducted by Mumbai, India Park K. Park's Text Book of Preventive and Social Medicine. 18 th edition. Banarsidas Bhanot publishers Jabalpur India 2005: Qamri AA. Ghena Muna. Urdu Translation. Central Council for Research In Unani Medicine New Delhi. Ministry of Health & Family Welfare, Govt. of India 2008; 331,451. Raghuram V, Manjula Anil, Jayaram S. Prevalence of anaemia amongst women in the reproductive age group in a rural area in south India. Int J Biol Med Res 2012; 3(2): Rizwzn K. SharehAsbab. Urdu Translation. Central Council for Research In Unani Medicine New Delhi. Ministry of Health & Family Welfare, Govt. of India 2010; 3: Rushd I. Kitab Al-Kulliyat. (Urdu). Central Council for Research in Unani Medicine. Ministry of Health & Family Welfare. Govt. of India New Delhi 1987: Shah MH. The General Principles of Avicenna s Canon of Medicine. New Delhi: Idara Kitabul Shifa 2007: Sina I. Al Qanoon. (Translated by Kantoori G H) Part-2. New Delhi: Idara Kitabul Shifa 2010:3(2): Sohad GA.Hookworm infection and anaemia whqlibdoc.who.int/publications /1991/ pdf. Cited on TanwirM.A, Ansari A.H., Aisha P, Anzar M.A. Dalk (Therapeutic Massage) & Their Indication for Musculoskeletal Disorder in Unani Medicine. International Journal of Advanced Ayurveda, Yoga, Unani, Siddha and Homeopathy 2013; 2(1): Thacker T. Lancet study rings alarm over anaemia prevalence in India ( Cited on ). Unicef. Prevention and Control of Nutritional Anaemia:A South Asia Priority; 2002.( Cited on ) Available online on Page 788

8 WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity ( vmnis/indicators/ haemoglobin.pdf. Cited on ). WHO/UNICEF. Towards an integrated approach for effective anaemia control ( ef-anaemiastatement.pdf.cited 0n ). Zohr AMI. Kitab Al-Taisir Fil-Mudawatwat- Tadbir.(Urdu). Central Council for Research in Unani Medicine. Ministry of Health & Family Welfare. Govt. of India New Delhi 1986: Available online on Page 789