Waram-e- Kabid Balghami (Phlegmatic Hepatitis)

Waram-e- Kabid Balghami (Phlegmatic Hepatitis)

Introduction

Unani Medicine (Greco-Arab Medicine) is one of the ancient systems of medicine. A vast array of literature about liver diseases has been documented in this system of medicine. Liver (Kabid) is an organ for origin of Natural powers (Quwaa). Galen, (129-217 AD) even stated liver as counterpart with sun, which is a source of energy for others planets.

Liver (Kabid) is also an organ for production of humours (Akhlat) for nourishment, growth and development of the human body. Each of the four humours named dam (sanguine), balgam (Phlegm), safra (Yellow bile) and sauda (Black bile) carries their own normal temperaments. The derangement in quality and quantity of humours, leads to liver pathologies. Waram-e- kabid balghami (Phlegmatic Hepatitis) is one of them.

It is a waram-e- rakhw (Soft swelling) of liver. It is also known as waram-e- tahabbuji.  It is caused by predominance of phlegm (Balgham) accumulated either due to excessive production or its deficient resolution. It is characterised by heaviness in right hypochondrium without pain and fever, softness on palpation along with the features of predominance of phlegm.

According to dominating humours (Akhlat), eminent Unani scholars such as Muhammad Bin Zakariya Razi, Ali Ibn-e- Abbas Majoosi, Sheikh Bu Ali Sina, Muhammad Akbar Arzani, Ibn-e- Hubal and Muhammad Azam Khan have classified hepatitis (Waram-e- kabid) as:

1. Waram-e- Kabid Damwi (Sanguineous Hepatitis)
2. Waram-e- Kabid Safravi (Bilious Hepatitis)
3. Waram-e- Kabid Balgami (Phlegmatic Hepatitis)
4. Waram-e- Kabid Saudawi (Melancholic Hepatitis)

Waram-e- Kabid Balgami (Phlegmatic Hepatitis)

It is a disease condition characterized by waram-e- rakhw (Soft swelling) of liver. It is caused by predominance of Balgham (Phlegm) accumulated either due to excessive production or its deficient resolution. It is characterised by heaviness in right hypochondrium without pain and fever, softness on palpation along with the features of predominance of phlegm.

In Unani medicine Waram-e- Kabid Balgami (Phlegmatic Hepatitis) has been treated very effectively by its holistic approach. It is an acute inflammatory condition of liver due to predominance of phlegm (Balgham).

Signs and symptoms of Waram-e- Kabid Balghami (Phlegmatic Hepatitis)

White colouration of face and even stool colour also white in this disease is a peculiar symptom. Along with facial whiteness, whitish colouration of tongue is also seen. Viscosity of the blood will be decreased. It is characterized by continuous low grade fever sometimes with and sometimes without chills. In mild condition of the disease fever is not a compulsory symptom. Diminished thirst, mild swelling in right hypochondriac region below the ribs.

Sometimes constipation, loss of appetite, indigestion along with other features of predominance of phlegm (Balgham) are also seen. Face of the patient will be puffy and feet of the patient becomes inflamed.

Types of Phlegmatic hepatitis (Waram-e- kabid Balghami)

• Waram-e- Jigar Moqaár: Sometimes inflammation develops in the concave part of the live
• Waram-e- Jigar Mohaddab: Sometimes inflammation develops in the convex part of the live

Causes of Phlegmatic hepatitis (Waram-e- kabid Balghami)

• Excessive cold
• Use of improper and imbalance cold temperament causing diet
• Cold temperament of the patient
• Trauma at the site of liver
• Excessive use of phlegm producing items.
• Sometimes it develops after seasonal fever

Usool-e- Ilaaj (Principles of Treatment)

• Istifraagh (Expulsion of phlegm from the body) with the help of acute enemas and diuretics are very effective in such cases.
• Taqleel-e- Ghiza (Dietary control): It is one of the basic principle of treatment found to be highly effective.
• Tanqiya-e- Balgham (Evacuation of phlegm) through Ishaal (purgation) and idraar (Diuresis): It is also one of the principle of treatment in Unani system of medicine.
• Taqwiyat-e- Meda wa Jigar (Toning up of stomach and liver): It is also basic principle of treatment of Waram-e- Kabid Balghami (Phlegmatic hepatitis).
• Taskheen-e- Jigar (Calefaction of liver): It is also very effective is this case.

Ilaaj Bil Tadbeer (Regimenal Therapy): Some Unani regimens which are very effective for the management of phlegmatic hepatitis are.

• Exercise (Riyaazat)
• Medicated bath (Hammam)
• Bloodletting through basilica vein (Fasad-e- Baasaliq)

Ilaaj Bil Ghiza (Dietotherapy)

Dietary Recommendation

• Maa-ul- Asl

Dietary Restriction

• Fruits
• Dry fruits
• Dairy products

Ilaaj Bil Dawa (Pharmacotherapy)

• Local use of acute enema of undermentioned drugs are very effective

Joshanda Beekh-e- Karafs, Beekh-e- Izkhar, Shaghoofa-e- izkhar, Anisoon, Booti ghafis, Zoofa, Pudina, Ghaareeqoon, Turbud, Qanturiyoon Daqeeq, Maweez Munaqqa, Injeer along with Sugar.

• Oral administration of decoction of afsanteen (Artemisia absinthium Linn.) with castor oil
• Oral administration of decoction of Tkhme-e- karafs (Apium graveolens Linn.), Anisoon (Pimpnella anisum Linn.), Baadiyan (Foeniculum vulgare, Gaertn.), Nankhwah (Ptycotis ajowan, D.C.) and Beekh-e kasni (Cichorium intybus Linn.)
• Oral administration of following diuretics are very effective

      Joshanda-e- tukhm-e- karafs, anisoon, baadiyaan, ajwain desi, beekh-e- kasni along with sikanjabeen buzoori

Apart from that uses of hot temperament diets and drugs to make the temperament of the live hot is important in such cases.

Hot Temperament Drugs: Use of capsule made up of following drugs are very effective.

Gul-e- surkh, aneesoon, tukhm-e- karafs, shaghoofa-e- izkhar, mastagi, sumbul-ut- teeb, asaaroon, rewand, foowa, luk, and zaafaran.

Hot Temperament Diets: Diets specially made up of Teehoo, Teetar, Chana, Roghan-e- Zaitoon, Muri (Kanji) Zeerah and Daarcheeni.

Local application of following paste (Zimaad)

• Local application of the paste of khardal (Brassica nigra Linn.) with cow milk is very effective in waram-e- kabid balghami (Phlegmatic hepatitis).

Single Drugs Recommended

• Afsanteen (Artemisia absinthium Linn.)
• Castor oil (Ricinus communis Linn.)
• Tkhme-e- karafs (Apium graveolens Linn.)
• Anisoon (Pimpnella anisum Linn.)
• Baadiyan (Foeniculum vulgare, Gaertn.)
• Nankhwah (Ptycotis ajowan, D.C.)
• Beekh-e kasni (Cichorium intybus Linn.)
• Khardal (Brassica nigra, Linn.)

Compound Drugs Recommended

• Murawwaqain
• Majoon Dabeed-ul- ward
• Qurs-e Afsanteen
• Qurs-e- Rewand
• Dawa-ul- kurkum
• Qurs-e- zarishk rewandi
• Gulqand asli
• Sikanjabeen unsuli
• Roghan-e- Yaasmin
• Arq-e- Mako
• Arq-e- Kasni
• Arq-e- Baranjaasif
• Sharbat-e- Buzoori

Tahaffuz (Prevention/ Precaution)

• Regimens that increases the production of phlegm should be avoided

References

http://www.nhp.gov.in/waram-e-kabid-damwi-sanguineous-hepatitis_mtl

http://www.nhp.gov.in/waram-e-kabid-hepatitis_mtl

http://nopr.niscair.res.in/bitstream/123456789/8540/1/IJTK%204(4)%20416-420.pdf

http://www.unaniherbal.org/hepatitis-treatment-unani-medicine.html

http://www.nhp.gov.in/disease/digestive/liver/hepatitis

Note:

• Along with medicine the patients have to follow strict regimen as per the concept of Unani system. The patients are therefore, strongly advised to avoid self-medication.
• They are advised to visit the nearest authorized Unani treatment centre for advice and treatment.