Zeeq-un- Nafas Sho’abi (Bronchial Asthma)

Zeeq-un- Nafas Sho’abi (Bronchial Asthma)

“Asthma” is a Greek word derived from the verb “aazein” which means to exhale with open mouth and to pant. Buqraat (Hippocrates- a Greek physician) was the first to name this disease as ‘panting’ which means breathlessness. Later on many Unani scholars keenly studied about Asthma and mentioned it in their books.

Zeeq-un- nafas sho’abi (Bronchial Asthma) is a chronic lung disease characterized by episodes of acute bronchoconstriction causing shortness of breath, cough, chest tightness, rapid respirations and wheezing (appreciated on auscultation of the chest is the most common physical finding). In other words it is chronic inflammation of the bronchial tubes (airways) that cause swelling and narrowing (constriction) of the airways. It is a disease that affects the lungs by allergies or infections resulting in narrowing of airways which causes difficulty in breathing and cough. It is a well-known hypersensitivity disorder characterized by ventilator insufficiency.

In many asthma patients, timing of the symptoms of disease is closely related to physical activity. Even, some healthy people can develop asthma like symptoms only when exercising. This is called exercise-induced asthma (EIA) or exercise-induced bronchoconstriction (EIB).

The disease is influenced by multiple genetic developmental and environmental factors. It affects over 300 million people around the world. One in every four urban children is asthmatic. Current estimates suggest that 300 million people worldwide suffer from Bronchial Asthma and in addition 100 million may be diagnosed with Bronchial Asthma by 2025. An increasing prevalence and severity of asthma has been reported worldwide.

Unani scholars are well known about it since last 3500 years, where asthma like symptoms were recorded in an Egyptian Manuscript called “Eberus Papyrus”. At present asthma has spread globally. It affects approximately 4% of the total world population.

The affected people belong to various age groups, but children and elders are more prone.

Triggers and Precipitating Factors for Bronchial Asthma

As people with asthma have inflamed airways which are sensitive to things which may not bother other people. These things are "triggers." These triggers vary from person to person. Some people react to only a few things while others react to many.

It can be triggered by allergens (things people can get allergic to), irritants (things that irritate the airways), and certain other situations (which cause asthma through quite complicated means). Commonest are:

1) Exposure to some of the outdoor factors like pollens from plants, trees and grasses, including freshly cut grass and mould etc.

2) Exposure to some of the indoor factors like animal dander from pets with fur or feathers, dust and dust mites specially in carpeting and pillows etc., Cockroach droppings, Indoor mould etc.

3) Exercise: like running or playing hard, especially in cold weather

4) Upper respiratory tract infections (URTI): It commonly includes tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold or flu

5) Emotional upset: the commonest are anger, sadness or fear

6) Irritants: like strong smells and chemical sprays; perfumes, paint and cleaning solutions, cold air. Lawn and turf treatments, Chalk dust, weather changes, cigarette and other tobacco smoke.

Signs and Symptoms (Alamaat)

The symptoms of the disease vary from person to person and from time to time in the same person. Any asthma symptom is serious and can become deadly if left untreated.

These symptoms include, sudden and acute attack of breathlessness, cough, wheezing (a whistling or squeaky sound in your chest when breathing, especially when exhaling), shortness of breath and chest tightness etc.

Some people have all the symptoms, while others may have only cough, especially at night, during exercise or when laughing or breathlessness.

The major forms of asthma include:

1. Allergic asthma: People with a family history of allergies are more prone to developing asthma or many people with asthma also have allergies. This is called allergic asthma.

2. Cough-Variant Asthma: In the type of asthma called cough-variant asthma, severe coughing is the predominant symptom. There can be other causes of cough such as postnasal drip, chronic rhinitis, sinusitis, or gastroesophageal reflux disease (GERD or heartburn). Coughing because of sinusitis with asthma is common.

3. Occupational asthma: Occupational asthma is caused as a direct result of workplace exposure. It is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job.

4. Childhood asthma: impacts millions of children and their families. In fact, the majority of children who develop asthma do so before the age of five.

5. Night time (Nocturnal) Asthma: Night-time asthma, also called nocturnal asthma, is a common type of the disease. If you have asthma, the chances of having symptoms are much higher during sleep because asthma is powerfully influenced by the sleep-wake cycle (circadian rhythms). Your asthma symptoms of wheezing, cough, and trouble breathing are common and dangerous, particularly at night time.

Unani Concept of Asthma

Asthma is described with different names in Unani literature as Rabu, Buhar, Zeeq-al- nafas, Dama and Intesab- al- nafas. It is defined in the books of almost every renowned Unani scholar like Hippocrates/ Buqraat (460 BC), Galen/ Jalinoos (130-200 AD), Rabban Tabri (810-875 AD), Ibn-e- sina (980-1037), Zakariya Razi (860- 932 AD) and Ismail Jurjani (Death 1140 AD).

Unani physicians believed that asthma is caused by thick Phlegm (Ghaleez khilt or balgham-e- ghaleez) which is adhered on the bronchial mucosa to develop narrowing of the lumen. They also mentioned that due to narrowing of bronchial lumen, air becomes incapable to enter into the lungs during inspiration and to fulfil the deficit of air (O2) the subject is compelled to breathe rapidly. The rapidity of the breathing depends upon the severity of the disease.

Some Unani schorars like, Ali Ibn-e- Abbas Majoosi, Ismail Jurjani and Rabban Tabri, described that asthma is caused by cold and dilute fluid (Barid and Raqeeq khilt). They also described that such fluid develops more severe form of breathlessness.

Tabri (810-875 AD), stated that asthma is a name of thick fluid (Balgham- ghaleez) which is adhered on the inner layer of bronchioles and develops narrowing of the airways, resulting in hypoventilation of the lungs and ultimately breathlessness.

Hussain MA, stated in his book, Moaleja-e-Nafissi that asthma is caused by concentrated and unhealthy cold fluids (Ghaleez wa barid ratoobaat). He emphasized that fluids may be phlegm (Balgham) or balck bile (Sauda) or both.

The most scientific description regarding the aetiology of asthma was given by Ali Ibn-e- Abbas Majoosi (930- 994 AD), he stated that asthma is caused by bronchospasm.

According to Ibn-e- Sina as described in his famous book Al-Qanoon Fil-Tib, when there is difficulty in the passage of air during respiration due to spasm in air passage, it is called Zeequn Nafas.

Abu Bakar Muhammad Bin Zakariya Razi gave first description of status asthmaticus (a severe condition in which asthma attacks follow one another without pause). He described most severe form of asthma as Intesab- un- Nafas.

Many Unani scholars have described asthma in their own way but Ajmal Khan was the first Unani scholar to define asthma as: It is a dreadful and discomfortable disease whose treatment is very difficult. It is characterized by bronchospasm resulting in breathlessness.

Management / Treatment (Elaaj)

In Unani system of medicine treatment of the diseases of known etiology is based on administration of drugs having actions contrary to etiological changes i.e. known as Ilaj-Bil- Zid. According to this principal of treatment, Unani scholars have designed various formulations comprising of drugs with hot and dry temperament for asthma which temperament is cold and moist. Some commonest tips are:

Precautionary Measures (Ehtiyaati Tadaabeer)

Avoid exposure to the precipitating factors. Find out what triggers your asthma, and get rid of things that bother you at home and work. Exposure to cold should be avoided.

Drink plenty of water, 8 to 10 glasses a day, to keep secretions loose.
Keep your bedroom allergen-free. Sleep with a foam or cotton pillow, don’t use feather pillow.
Wear a dust filter mask when you go out in dust and allergen contact. Allergens and other substances liable to provoke attacks of asthma are to be avoided.
Wear a scarf around your mouth and nose in cold weather. Doing so will warm the air as you breathe in and will prevent cold air from reaching sensitive airways.
Sit up straight or bend forward, during an asthma attack. Do not lie down.
The patient may require hospitalization if he complaints of uncontrolled bouts of coughing or wheezing, chest tightness or pressure and intense breathing difficulty.
During an acute attack, a hot chest and shoulder pack must be given repeatedly every half an hour. It gives the quickest and most satisfactory relief. It will have a sedative effect upon the nerves and a relaxing influence generally.
Hot milk or hot water when sipped little by little, provides immediate relief from the attack.
Try steam inhalation, for an acute asthma attack. Add a few drops of eucalyptus oil in a bowl of hot water. Cover your head and the bowl with a towel.
Avoid milk products like curd, buttermilk and fruits like bananas, guavas and fried foods.

Some common Prescriptions and Unani Homemade Remedies

A combination of leaves of Arusa (Adhotoda vasica Nees), fruits of Filfil Daraz (Piper longum Linn.), roots of Kutki (Picrorhiza kurroa), flowers of Zufa (Hyossopus officinalis Linn.) and seeds of Kataan (Linum usitatissimum Linn.) is found to be very effective with a good response in chronic patients of bronchial asthma. In mild and moderate asthma the drug has shown significant symptomatic relief.
Prepare a decoction with the equal parts of root of Arusa (Adhatoda vasica), rhizome of Turmeric (Curcuma longa), stem of Giloe (Tinospora cordifolia) and the fruit of Katai (Solanum surattense Burm. F. Syn.: S. xanthocarpum Schrad. & Wendl.). Take this decoction 20 ml internally, with one gram of powdered Filfil (Safaid/Siyah (Piper nigrum Linn.) twice a day.
A creeping plant known as somalata (Sarcostemma acidum (Roxb.) Voigt Syn.: S. brevistigma Wight & Arn. / Ephedra gerardiana Wall.) is found to be highly efficacious in relieving asthma. After drying in the shade, make the powder from the whole plant. Mix it with honey or water and use at the intervals of 4 to 8 hours.
Attack of asthma may subside by the use of powder of Piper longum Linn. (Filfil Moya/Fasiwarees/Filfil Daraz) along with pure honey.
The rhizomes of Curcuma longa (Zard Chob/Haldi/ Urooq al Sufr/Urooq al Asfar/ Urooq al Zafraan) are to be baked in hot sand slightly and made into fine powder. This is to be taken 3 grams twice a day with sugar. The dose can be increased up to 10 grams in due course. This is very effective remedy available in every kitchen.
Drink some hot water with the juice of one clove of garlic. It is very effective in acute attack of asthma.
Take a tea spoonful of Sarason ka tel (Brassica rapa Linn. Syn.: B. campestris Linn.) along with jaggery, twice a day. It is a good remedy of asthma.

Some Commonly Recommended Unani Single drugs

These drugs are bronchodilator, anti-inflammatory, antihistaminic and expectorant in nature.

Common Name Scientific Name

Arusa/ Bansa (Adhatoda vasica Linn./ Adhatoda zeylanica Medic)

Filfil Daraaz (Piper longum Linn.)

Kutki (Picrorhiza) (Picrorhiza kurroa)

Kataan/Alsi (Linseed) (Linum usitatissimum Linn.)

Zufa/ Zoofah (Hyossopus officinalis Linn.)

Maghz-e- amaltas (Indian laburnum) (Cassia fistula Linn.)

Irsa/ Sosan (Iris ensata Thunb.)

Zanjabeel/ Adrak (Ginger) (Zingiber officinale Linn.)

Elaichi khurd/ Heel Khurd (Cardamom) (Elettaria cardamomum (Linn.) Maton)

Qaranfal/Laung (Cloves) (Syzygium aromaticum (Linn.) Merr. & L.M. Perry)

Ajwayin (Nankhwah) (Trachyspermum ammi (Linn.) Spragne)

Abhal/ Sarw Koohi (Juniper berry) (Juniperus communis Linn.)

Dhatura / Jauz al maasil (Datura innoxia Mill. Syn.: D. alba Nees)

Sarson (field mustard/ Mustard) (Brassica rapa Linn. Syn.: B. campestris Linn.)

Zard Chob/Haldi (Turmeric) (Curcuma longa)

Somalata (Sarcostemma acidum (Roxb.)

Gilo (Tinospora cordifolia)

Katai (Solanum surattense Burm.)

Some commonly used Unani Compound Formulations

Looq-e- Zeequn nafas, Sharbat-e- Zoofa Murakkab, Laooq-e- Nazli, Safoof-e- Zufa

Note:

Along with medicine the patients have to follow strict regimen as per the concept of Unani system of medicine. 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.

References

https://globaljournals.org/GJMR_Volume13/3-Evaluation-of-Therapeutic-Effect.pdf

http://www.ijpsr.info/docs/IJPSR14-05-12-001.pdf

http://shifaremedies.com/Asthma.php

http://www.tibb.co.za/articles/Rep%20lifestyle.pdf

http://applications.emro.who.int/imemrf/Hamdard_Med/Hamdard_Med_2014_56_4_15_23.pdf

http://www.nhp.gov.in/bronchial-asthma_mtl

http://thespicejournal.com/natural-medicines/spices-used-in-unani-medicine/

http://www.omicsgroup.org/journals/incidence-of-zeequnnafas-shoabi-bronchial-asthma-in-individuals-of-different-temperaments-2167-1206.1000147.pdf

http://www.pharmalenz.com/2013/11/bronchial-asthma-remedy-from-unani.html

http://nopr.niscair.res.in/bitstream/123456789/5090/1/IJTK%208(3)%20421-424.pdf

http://herbalniamaths.com/mar2015/article6.php