Unani Perspective regarding Dengue Fever (Humma-e- Danaj)

Unani Perspective regarding Dengue Fever (Humma-e- Danaj)

Introduction and Aetiology

Dengue fever is a mosquito-borne disease caused by any one of the four closely related dengue viruses (DENV-1, 2, 3, and 4). Because it is caused by one of four serotypes of virus, it is possible to get dengue fever repeatedly. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.

Dengue virus is transmitted from one person to another by a bite from the Aedes aegypti mosquito. Only female Aedes mosquito transmits the dengue virus. This mosquitocan bite at any time but is mainly a daytime biter, both inside and outside homes and it is most active in the hours after sunrise and before sunset. Other species of mosquito like Aedes albopictus can also transmit the virus.

It is a disease caused by family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles. The first epidemic of clinical dengue like illness was recorded in Madras, India. It now has become endemic throughout tropical Asia (India) since 1967, after that the term dengue haemorrhagic fever and dengue shock syndrome have come into general use.

Dengue goes by other names like Onyong Nyang Fever, West Nile Fever, Break Bone Fever, Abul Rakab, Humma-e- saaliba or Dandy Fever. Victims of dengue often have contortions due to the intense joint and muscle pain, hence described with the name of break bone fever.

According to the U.S. Centres for Disease Control and Prevention (CDC), there are an estimated 100 million cases of dengue fever with several hundred thousand cases of dengue haemorrhagic fever requiring hospitalization each year. Nearly 40% of the world's population lives in an area endemic with dengue.

Aedes aegypti mosquito breeds inside and outside the home in artificial containers containing water. It usually breeds in clean, stagnant water easily found in our homes. Damage caused by dengue is more dangerous than swine flu; therefore the awareness and knowledge of precautionary measures is very important. The life-cycle ofAedes aegypti averages seven days.

Unani Concept of Dengue Fever

In Unani literature, there is as such no direct description of Dengue fever, although all types of fever in general are discussed in detail. Most probably this disease is “Humma Damwi Ufooni”, where ufoonat is found in blood (khilt-e-dam) and produce rashes on skin (surkh daane). Sheikh Bu Ali Sina says, there are   abnormal changes in fluids and humours because of infectious material (madah afna’h), which disrupt the   qualities and normal activities of the fluids and humours. Humours (Akhlat) are infected sometimes both intravascularly (dakhil-e-urooq) and extravascularly (kharij-e-urooq). But in this case, intravascular (dakhil-e- Urooq) infection is found because of the vector Aedes aegypti, which bites and transmit the disease as blood borne disease.

Dengue (pronounced DENG-gay) strikes people having poor immunity. Because it is caused by one of the four serotypes of virus, it is possible to get dengue fever with any one of the strain.

It is also mentioned in "Tibbi Nabavi (PBUH)". It is nothing but the treatment suggested or practised by Prophet Mohammad (PBUH). It mentions complete cure of all diseases, including Dengue. Therefore, instead of just depending upon the modern medicine, people should look for treatment in "Tibbi Nabavi (PBUH)". Although, the treatment could be offered by a select group of Unani physicians only. 

Signs and Symptoms of Dengue Fever

It is an acute illness of sudden onset with general symptoms such as severe headache, fever for 3 to 7 days, exhaustion, severe muscle and joint pain, loss of appetite, vomiting and diarrhoea, skin rash, bleeding usually from the nose and gums and swollen glands and rash. Dengue Triad: Usually the presence of fever, rash, and headache (and other pains) are peculiar characteristic features of dengue. Other features are severe discomfort behind the eyes, and red palms and soles.

Preventive Measures of Dengue Virus Spread

How can dengue fever be prevented is most important as it is highly contagious and may prove fatal. The transmission of the virus to mosquitoes must be interrupted to prevent the disease. For this, patients are required to be kept under cover of mosquito nets, until the second bout of fever is over and they are no longer contagious.

To prevent the spread of dengue fever, one must first prevent the breeding of its vector, the Aedes aegyptimosquito. The Aedes aegypti mosquito is easily identifiable by the distinctive black and white stripes on its body.

Dengue Fever is a disease caused by dengue viruses which are transmitted to people by infected Aedes aegypti mosquito.

Aedes aegypti becomes infected when it bites a person who happens to be carrier of the dengue virus and after about 8 to 12 days can transmit the virus while biting a healthy person.

Aedes aegypti can lay eggs in small containers such as tree holes, bamboo ends, cans, discarded tyres, and rock pools holding small amount of water.

The most effective way to prevent Dengue Fever is to stop Aedes aegypti, the carrier of the virus.  This can be achieved by eliminating the breeding grounds for the mosquito by means of good environmental hygienic practices.

The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Government initiatives to decrease mosquitoes also help to keep the disease in check, but are not enough.

There is currently no vaccine available for dengue fever.

Some Useful Tips

Personal protection and the environmental management of mosquitoes are important in preventing illness. If one is living or travelling in tropical areas where dengue fever is common, these tips may help reduce   risk of mosquito bites. Some useful and easy steps   are:

1. Keep all drains of home free from choking
2. Change water in vases and bowls on alternate days
3. Remove water from flower pot plates on alternate days
4. Turn over all water storage containers
5. Cover all containers that hold water to prevent mosquito from accessing the water
6. Properly dispose articles that are able to collect water such as empty lunch boxes, cans and glass bottles
7. Clear blockages and put BTI insecticide in roof gutters monthly
8. Wear protective clothes to prevent mosquito bites. Wear long pants and long sleeve shirts, socks and shoes
9. For personal protection, use mosquito repellent sprays that contain DEET when visiting places where dengue is endemic
10. Limiting exposure to mosquitoes by avoiding standing water
11. and staying indoors two hours after sunrise and before sunset will help

Management in Unani Medicine

Here every measure is applied to control the symptoms, restrict the complications and enhance the platelets count. Dengue being a fatal disease and not having any specific treatment is a challenge for medical fraternity and health department. As vaccines for Dengue is not available only supportive treatment (treatment of symptoms), controlling fever, therapy for pain (to avoid aspirin and other non-steroidal anti-inflammatory medications because they may increase the risk for haemorrhage and also steroids should not be used). Reminding the patients to drink more fluids/ juices, especially when they have   high fever. Avoid eating solid foods until the fever is gone.

Principles of Treatment (Usool-e-Ilaj)

• Treat the cause (Izala sabab karaein)
• Complete bed rest (Aram karaein)
• Antipyretics (Daafae Humma)
• Use of fluids and juices (Barid Mashroobaat)
• Use of Haemostyptic drugs if haemorrhage (Habis-e-dam advia)
• Use of laxatives if constipation (Mulayyanat)
• Use of General Tonics (Muqawwiyat aam advia)
• Use of Haematinic Drugs (Muwallid dam advia)

Antipyretics (Dafa’e Humma)

·         Qurs Humma 2 tab BD / Qurs Tabasheer kafoori 2tab BD or Joshanda Malaria /21 adad BD.

       Use of fluids and juices (Barid Mashroobaat wa sayyal Aghzia)

·         Maa-al- shaeer, Sharbat Neelofer, Sharbat Banafsha, SharbatAaloo, each 2 tola Aabe kahoo, Aabe Anaar, Aabe Seb,      AabeBahi, Arq- e- Mako, Arq-e-Kasni each 4 tola.

Haemostyptic Drugs (Habis-e-dam advia)

·         Qurs Habis 2tab BD+ Sharbat Injabar 2 tola BD

Blood Purifiers (Moaddelat wa Musaffiyat-e- Dam)

·         Sharbat Unnab 2 tola BD or Majoon Ushba 6gm after meal

General Tonics (Muqawwiyat-e- A'am)

·         Khameera Gaojaban Anbari, Khameera Marwareed, Khameera Sandal each 6 gm BD

Haematogenic Drugs (Muwallid dam advia):

·         Qurs Damvi 2 tab, Qurs Sadaf 2 tab, Sharbat Faulad 2 tola orSharbat Anarain 2 tola after meal, or Kushta Khabsul Hadeed4 chawal.

Precautionary Measures and Unani Homemade Remedie

Several Unani homemade remedies are easily available in the kitchen, garden and market that could easily cure   Dengue patients. Try home remedies for one or two days only. Always visit doctor and consult regarding any need of hospitalisation?

1. Take two raw papaya leaves (Carica papaya Linn), squeeze them with a cloth to strain and filter the juice. To preserve its strength, the juice should be taken raw, without altering, boiling or any additions. Leaves of Papaya tree with water should be kept in an earthen bowl for 12 hours and the same water and Kishmish should be given to the patients suffering from Dengue. It is now scientifically proven that the ‘Papain’ enzyme available in the papaya leaf has the ability to dissolve proteins and is already used for indigestion and stomach inflammation while the another enzyme present in them ‘Chymopapain’ is used successfully in spinal treatment.) Papaya juice is a natural cure for dengue fever. It has been scientifically proven now that the juice of Papaya leaf is a sure cure for platelets deficiency due to Dengue fever.
2. Tawa Tawa Tea (Euphorbia hirta) Take 5-6 full whole Tawa Tawa plants, cut the roots, wash and clean, then fill a boiling pot with clean water. Boil the tawa tawa for 1 minute, let it cool. Drink 1 to 1.5 glass of tawa tawa water every hour for 24 hours. The internal haemorrhaging will stop and the dengue fever will be cured within 24 hours.
3. Take ten pieces of Raihan leaf (Ocimum sanctum Linn) and one black pepper (Piper nigrum Linn). Grind it and make pea size pills, use it with water. This is an age old Unani herbal medicine. Boiled tulsi (Ocimum sanctum Linn) when used in a warm drink like tea, can help prevent an outbreak of dengue. This bitter and pungent herb has all the properties that strengthen the internal system against fever. 10-15 basil leaves should be chewed twice a day or these can be boiled in 200ml water on low heat. When half the quantity is left it can be taken 2-3 times a day. This strengthens the body’s defence mechanism.
4. The leaves of the kishneez (Coriandrum sativum Linn) can be taken in the form of a tonic to reduce the dengue fever.
5. Fruits rich in vitamin C like amla (Phyllanthus emblica Linn. Syn.: Emblica officinalis Gaertn) are advised as vitamin C helps in better absorption of iron.
6. Khurfa/Baqla-e-Humaqa (Portulaca oleracea Linn) is used to bring down body temperature. Hogweed produces plenty of perspiration which flushes   toxins from the body and brings down the fever.
7. The seeds of aspand/ hurmal (Peganum harmala Linn) are powdered and taken as either an infusion or as a decoction to treat intermittent and recurrent fevers that are observed in dengue.
8. Neem leaves, Neem Oil (Azadirachta indica) are a great purifying agent and should be applied on a damp warm cloth in dosages of between 15 to 60 grams 2-3 times daily.?
9. The root of the cassia tree (Cinnamomum cassia) is used as a tonic for reducing denguefever. Chiraitah/Qasab-al-Zareerah (Swertia chirayita) has tremendous medicinal properties in the reduction of fevers. It is especially used for treating   convulsions that accompany fever in dengue.
10. Dhatura/Jauz-e-Maasal (Datura stramonium Linn) is the Unani name of belladonna. Their leaves have potency in reducing the seriousness of the dengue fever. However, the dosage must not exceed 2 decigrams, or it will lead to severe negative symptoms.
11. An infusion of the Indian mallow (Abutilon indicum) is used as an efficacious treatment for reducing   dengue fever.
12. Hulba/Methi (Fenugreekleaves) scientifically known as Trigonella foenum-graecum Linnare taken as herbal tea in order to reduce fever. This drink acts as a soothing and cleansing agent for the human system, which is necessary in Dengue fever.
13. Qaisoom (Achillea millefolium) is a traditionally used remedy for all types of fevers in Unani medicine. When used in the form of   hot infusion, it causes sweating and therefore expels   toxins from the body and reduces   fever.
14. Kashim/Chatim (Devil’s tree) scientifically known as (Alstonia scholaris) is used in for the treatment of recurrent fevers as is seen in dengue. The herb is analogous in function to cinchona and quinine.
15. To increase the blood count, Anar juice (pomegranate juice) (Punica granatum Linn) and maweez munaqqa juice (Vitis vinifera Linn) should be given. The orange juice helps with digestion, increased urinary output, promotes antibodies for faster healing and recovery.
16. Administering goat's milk thrice a day could cure Dengue.
17. Decoction prepared with Afsanteen 6 gm, chiraita 6 gm, karanjwa 6gm ,filfil siya 6 gm and taken two times daily before meal is quite beneficial
18. Sharbath khaksi 10 ml can be taken
19. Arq ajeeb  Can be taken 5 times a day

Some single Unani drugs have potential to treat   Dengue are, Afsanteen, Sheerah Tukhm Khurfa10 gm in normal water, Sharbat-e- Deenar 40 ml two times daily, Qurs-e-Tabasheer with sharbat-e-Buzoori, Sharbat-e- Tamar hindi 40 ml with Arq-e- Gao Zaban 100 ml two times, Habb-e- Shifa 2 tab two times etc. However, these medicines should be taken only when prescribed by a Unani physician.

References: 
www.jbsoweb.com 
www.webindia123.com 
www.mayoclinic.org 
www.dengue.gov.sg 
www.cuhk.edu.hk 
www.sahealth.sa.gov.au 
carewellunanihospital.blogspot.in

Note: Drugs should be taken under the advice of the qualified Unani physician. The patients are required to follow strict Unani regimen for optimum results.