Arthritis is spreading worldwide as a complicated health problem. It is the main cause of disability among people over fifty-five years of age in industrialized countries. The word arthritis comes from the Greek word “arthron” means "joint" and the Latin word “itis” means "inflammation".
Arthritis involves inflammation of one or more joints. The major complaint by individuals who have arthritis is joint pain. Pain is often a constant and may be localized to the joint affected. It is characterized by pain during walking. Along with pain there is swelling, stiffness of joints and fatigue. Because of these symptoms arthritis patients look lean and thin compared with other diseases. The chances of other diseases e.g. heart diseases, diabetes, hypertension intestinal cancer increase.
According to WHO, about 0.8% of the population suffer from arthritis worldwide. In most of the countries it ranges from 0.3 to 1.0 %. It is much common in developed countries. In India more than 1% of the population suffers from arthritis.
The conventional treatment options for this condition have improved in terms of effectiveness, the use of pain killers, surgeries and other medical interventions in order to relieve pain and prevent dysfunction of joints, have all been associated with adverse effects. However, conventional treatment cannot get total control over symptoms leading to great dissatisfaction and may be disabilities in some cases.
Because of this reason, patients suffering from arthritis are likely to seek alternative methods for complete relief and are amongst the highest users of complementary and alternative medicine.
However, despite an increase in use, evidence for effectiveness and safety of these complementary therapies is limited.
Unani system identifies and attributes diseases like Arthritis to a weak immunity and poor digestive system. It suggests a number of polyherbal formulations for the treatment of this condition and other joint disorders.
In the Unani context the arthritis is known as Waja-ul- mafasil which in broader terms means pain in joints. Waja-ul- mafasil is used to describe all kinds of joint disorders including pain, swelling, and stiffness. It has been described as Waja-ul- mafaasil aam (arthritis), Waja-ul- zuhr (back pain), Niqras (gout) and Irqun Nisa (sciatica) etc.
According to Majoosi, when all the joints of the body are painful it is called as Waja-ul- mafaasil aam.
As per Jurjani,s point of view, when pain and inflammation is in the smaller joints of hand it is Waja-ul- mafaasil khas (Rheumatoid arthritis). Azam khan states in Waja-ul- mafaasil, pain occurs in joints of hand, feet, knees, and ankle joints. Waja-ul- mafaasil is also seen in temporomandibular joints and vertebrae.
According to M Azam Khan, the classification has been done on the basis of temperamental imbalance as Waja-ul- mafaasil sada, which is caused by Su-e- mizaj maddi which is accompanied by the humoral imbalance and is being further divided into 3 types:
According to Ali Ibn-e- Abbas Majusi, the etiology of Waja-ul- mafaasil is so obscure and complicated that it is not possible to pinpoint the exact causative factor of the disease.
According to Ibn-e- Sina, the psychic factors play an important role in the causation of this disease. Other factors, which are responsible for the disease, include hereditary and joint weakness etc.
According to Samarqandi the madda (substance) which is responsible for the cause of Waja-ul- mafaasil is of a very thick consistency and white in colour, whereas Ibn Sina states that this madda almost resembles to pus (Reem).
The humours responsible for the development of Waja-ul- mafaasil may be one or more e.g. Balgham (Phlegm), Dam (Blood), Safra (Yellow Bile) and Sauda (Black bile).
Ibn-e- Sina also mentioned that Waja-ul- mafaasil is caused by phlegm, blood, yellow bile and black bile in the decreasing order of frequency are: waja-ul- mafaasil balghami is more common, waja-ul- mafaasil damvi is common, waja-ul- mafaasil safravi is less common while Waja-ul- mafaasil saudavi is rarely found.
According to Majusi, the madda (Substance) causing Waja-ul- mafaasil accumulates in the joints due to the weakness of the joint called as zo’f-e-mafaasil.
According to Jurjani, the under mentioned causes are known as asbabe asli (primary causes).
He states that waja-ul- mafaasil is caused by accumulation of mawaad-e-faasida (Toxic Substances) in the joint which happens due to the factors e.g. joint movement, joint space and joint fluid.
The feature of the joint is that it attracts the fluid (Ratoobat) towards itself. The joint movement is responsible for this condition. The mawad (substances) moves towards the joint by the movement of the joint and the heat produced by the joint movement. The feature of the heat is that it attracts the fluid towards itself.
There is no power of absorption (Quwat-e-Jaziba) in the joints of the body. According to Unani Physicians the absorption of the fluid depends on the heat and as the bones, cartilage, ligaments, etc. which are the major constituents of the joint are having cold and dry temperament, so the Khilt (humour) which enters the joint cannot be reabsorbed and thus gets lodged in the joint. Since the joints does not have the excretory power (Quwat-e-Dafe‘ah) as well so the bad substances which needs to be excreted gets lodged in the joints and thus leading to disturbances in the joint.
The Khilt (humour) in the joint gets putrified and gets converted into the harmful substances, which then induce Waja-ul- mafaasil.
Secondary Factors (Asbabe Arzi)
There are few aggravating factors of arthritis mentioned in the Unani classical books. These are giving up the exercise (tarke riyazat), weakness of stomach (zo’f-e- me’da), derangement (su-e- tarteeb), sedentary life style, regular and excessive use of alcohol, excessive coitus, exercise after meals and cold and catarrh.
Other causes of accumulation of bad humours in the joint are giving up the voluntary habitual excretion (tarke istifragh-e-aadati) e.g. vomiting, purgation, venesection etc., cessation of normal involuntary excretion e.g. menstruation, piles etc., intestinal colic, drinking of water on empty stomach, anxiety, depression and insomnia etc.
Pathogenesis
As per Unani philosophy the term mizaj (temperament) is used to describe the normal biochemical equilibrium of the cells, tissues, organs and body as a whole. Any change in this equilibrium is termed as su-e-mizaj or derangement of temperament.
Waja-ul- mafaasil is caused by an abnormal change in the body equilibrium due to the derangement of the temperament, which may affect either a whole body or may be confined to the vital organs (A‘aza-e- raiesa).
Su-e- mizaj (derangement of temperament) causing arthritis is of two types:
Symptoms of Arthritis
Symptoms of arthritis include joint pain, swelling, fatigue and weight loss. Inflammation and stiffness in the fingers, arms, legs, and wrists in the same joints or on both sides, especially soon after awakening may also be present in extreme cases of arthritis.
Preventive Measures
Environmental factors and mental status of a person affects the internal balance of humours of the body. However, maintenance of the humour via six essentials of life is beneficial. Patients of arthritis are advised to control their weight as obesity may cause osteoarthritis. Regular exercise is very useful for such patients. Exposure to sunlight is very useful. The patients should avoid extreme exertion, mental stress, anxiety and depression. Positive thinking itself may minimise the symptoms of arthritis.
Keeping is mind the principle of “Prevention is better than cure”. Unani medicine emphasises Asbab-e- sitta zarooria (Six essentials of life) from which one can prevent the communicable as well as non-communicable diseases. These are
If these essentials are in equilibrium, occurrence of major chronic diseases can be avoided.
Management of Arthritis
The Unani literature and classic text books have detailed information regarding the disease and its management. As per Unani philosophy following modes of treatment are advised for complete relief according to the preference
Foremost consideration is given to Regimental therapy along with dieto therapy. If it does not show results then it is necessary to shift to pharmacotherapy. Surgery is the last intervention used for arthritis patients.
The regimental therapies include, fomentation, massage, leeching, cupping, turkish bath, diaphoresis, concoction and purgation as per requirement of the condition. All these therapies have alone and if required collectively given excellent results in controlling the symptoms and in the general wellbeing of patient.
Fundamentals of Management
Unani physicians have been treating all types of arthritis (Waja-ul- mafaasil) successfully from very ancient times. Unani drugs are highly popular as these drugs are easily available anywhere, cost effective and have least side effects on the body.
As per Unani philosophy the basic principles followed for the management of the arthritis are:
As arthritis is caused due to derangement of one or the other humours. While determining the course of treatment, temperament of the individual and temperament of the drugs are taken into consideration. The medicines are selected on the basis of disease stage, patient temperament (imbalance of particular humour) and temperament of the medicine.
The humours responsible for the development of Waja-ul- mafaasil may be one or more of the following:
The disturbance of equilibrium or imbalance of these humours leads to diseased condition.
Diet therapy for arthritis patients
The adoption of proper dietary regimen can control the progress of the disease.When we adopt proper dietary regime, we find that the symptoms of the disease get minimised. After going through classical Unani books we find that dieto therapy plays an important role in the management of all types of arthritis. All cold and phlegm producing diets must be avoided as these types of diets not even minimise the effect of the drugs but also increases the symptoms of the disease.
Dietary Recommendations
According to Zakariya Razi, bird meat and fish are beneficial in arthritis. Research has proven that fasting has definite effect on the reduction of symptoms in arthritis.
Other dietary items recommended are wheat (Triticum aestivum), pulses specially Bengal gram, Indian millet (Panicum miliaceum), Big Beans, French Beans, Palak (Spinacia oleracea), Piyaz (Allium cepa), Beat root/ Choqandar (Beta vulgaris), Carrot (Daucus carotra), Red chilly (Capsicum annuum), Black pepper (Piper nigrum), Injeer (Ficus carica), Badam (Prunus amygdalus), Pista (Pistacea vera), Walnut, Khajoor/ Khurma (Phoenix dactylifera), Apricot, Angoor (Vitis vinifera), Aaloo (Solanum tuberosum), Pure ghee, Menthi (Trigonella foenum-graecum), Shaljam (Brassica rapa), Seb (Malus sylvestris/ pumila), Makka (Zea mays) and Papita (Carica papaya).
Dietary restrictions
Food items which are having hot temperament should be avoided in the diseases of joints particularly in arthritis. These items include most of the cold temperament drugs, red meat etc. Protein rich diet aggravate the symptoms of arthritis, e.g. red meat and kidney beans etc.
Some of the restricted dietary items are, curd, butter mixed with milk, kela (Musa paradisiaca), amrood (Psidium guajava), brinjal/ baingan (Solanum melongena), Gobhi (Brassica olearacea) etc.
The drugs beneficial in the treatment of arthritis are:
Some commonly used compound formulations
