Waram-e- Kabid Safravi (Bilious Hepatitis)

Waram-e- Kabid Safravi (Bilious Hepatitis)

Introduction

Unani Medicine is one of the ancient systems of medicine. A vast array of literature about liver diseases has been documented in this system. 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 safravi (Bilious Hepatitis) is one of them.

According to dominating humours (Akhlat), eminent Unani scholars such as Razi, Majoosi, Sheikh Ibn-e- Sina, Akbar Arzani, Ibn-e- Hubal, Mohammad 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 Safravi (Bilious Hepatitis) is an acute inflammatory condition of liver (jigar/ kabid) or it is acute inflammation of liver which usually may be caused by predominance of yellow bile (safra) and obstruction towards gall bladder side of liver or it occurs due to derangement in quality and quantity of bilious humours (safra) accumulated either due to its excessive production or because of an obstruction in the liver.

Signs and Symptoms

It is characterized by high grade fever, nausea, and vomiting, excessive thirst, loss of appetite, pain in right hypochondriac region, cough / hiccup, yellowish stool and eruptions of tongue along with the features of predominance of yellow bile. Tongue and face of the patient looks yellowish specially.

In this type of inflammation the signs and symptoms of heat and dryness shall be more intense as compared to waram-e- kabid damwi (Sanguineous Hepatitis).

Management

Principles of Treatment (Usool-e- Ilaaj)

1.      Evacuation of yellow bile (Ikhraaj-e- safra) in case of excessive accumulation of yellow bile.

2.      Normalization of yellow bile (Ta’adeel-e- safra) by using some drugs.

3.      Resolution of inflammation (Tahleel-e- waram) is done by evacuation of yellow bile (Sanguineous Hepatitis) through by diuresis (Idraar), when the inflammation is in the upper part of liver and by purgation (ishaal) in case of inflammation being in lower part of liver.  

4.      Cooling of liver’s temperament (Tabreed-e- kabid) is highly beneficial in this case.

5.      Laxation (Talayin): always avoid constipation for better results.

6.      Removal of hepatic obstruction (Tafteeh-e- sudad-e- kabid) if the cause of disease is obstruction.

7.      Toning up of liver (Taqwiyat-e- jigar) to get the optimum results.

8.      Use of diuretics and purgatives at regular intervals

Regemenal therapy (Ilaj bil Tadbeer)

1.      Bloodletting through basilica vein (Fasd-e- baasliq)

Pharmacotherapy (Ilaaj bil Dawa)

• Oral administration of following decoction (joshanda) containing following ingredients which are usually cold and deobstruent in nature.

Mako (Solanum nigrum Linn.), Tukhm-e- bekh-e- kasni (Cichohicoriun intybus Linn.), Tkhm-e- khira (Cucumis sativus Linn.), Pashiaoshan (Adiantum capillus- veneris Linn.), Asl-us- Soos (Glycyrrhiza glabra Linn.) alongwith vinegar (sikanjabeen)

• Oral administration of the decoction of Chahar gul with Maghz-e- falooss khayar shambar (fruit pulp of Cassia fistula Linn.)
• Local application of following paste (zimaad)

Olive oil, Aard-e-gandum (Wheat flour) and water

• Local application of following paste (zimaad)

Aard-e- jau (Flour of seed of Hordeum vulgare Linn.), Sandal (Santalum album Linn.), Arq-e- Kasni (Fresh juice of Cichorium intybus Linn.) Arq-e- gulaab (Rosa damascena Mill.) and vinegar.

• Local application of paste of sandal (Santalum album Linn.), Gul-e- surkh (Rosa damascena Mill.), Arq-e- gulaab (Rosa damascena Mill.) and kafur (Cinnamomum camphora Nees.)
• Sharbat-e- Neelofar, Aaloo Bukhara, Sikanjabeen sada and Sikanjabeen rewandi are very effective in case of Waram-e- Kabid Safravi (Bilious Hepatitis).
• Joshanda-e- Halaila is also very effective in this disease.
• Joshanda-e- fawaakih has tremendous results.

Homemade Unani Formulation: These drugs are found to be very effective in Waram-e- Kabid Safravi (Bilious Hepatitis).

Mix Aab-e- kasni sabz murawwaq 48 gms., Aab-e- mako sabz murawwaq 48 gms., Sharbat-e- buzoori mo’atadil 48 gms. and use twice daily. In case of fever mix Khaksi alongwith this prescription.

Compound Drugs

Sikanjabeen Buzoori, Sikanjabeen Sada, Sharbat-e- Deenar, Sharbat-e- Neelofar, Sharbat-e- Ward Mukarrar, Sharbat-e- Unnab, Sharbat-e- Aaloobukhara, Qurs-e- Zarishk, Qurs-e- Tabaasheer Kafoori etc. are some compound unani drugs found to be highly beneficial in Waram-e- Kabid Safravi (Bilious Hepatitis).

Dietary Recommendations

• Both leaves and roots of Raphanus indicus (Mooli) and Brassica rapa Linn. (shalgham)
• Maa-ul- Asl (Honey water)
• Maa-ul- Shaéer (Barley water)
• Goat Milk (Bakri ka doodh)
• Grape Juice (Angoos ka ras)
• Maa-ul- Fawaakeh
•  juice of sour pomegranate

Dietary Restrictions

• Heat Producing Diets (Aghziya Musakhkhina) must be avoided

Prevention/ Precaution

• Heat enhancing regimens to be avoided like excessive exercises and excessive hot turkish bath (hammam).

References:

http://www.tjfmpc.gen.tr/2015_4/1_29-1413438884_TYP.pdf

http://www.scopemed.org/?jft=11&ft=11-1404483906

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

http://innovareacademics.in/journals/index.php/ajpcr/article/viewFile/6175/3708

http://stmjournals.com/sci/index.php?journal=RRJoHS&page=article&op=view&path%5B%5D=942

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

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.