Yarqaan (Jaundice)

Yarqaan (Jaundice)

Introduction

Yarqaan (Jaundice) is a very common liver disorder. It is a condition in which too much bilirubin is circulating in the blood. (Bilirubin is a compound produced by the breakdown of haemoglobin from red blood cells/ it is the yellow breakdown product of normal heme catabolism, caused by the body's clearance of aged red blood cells which contain haemoglobin). Yarqaan (Jaundice) is a term used to describe the yellowing discoloration of the skin, mucous membrane and the whites of the eyes, caused by inadequate clearing and increased amount of serum bilirubin in the blood. This excess bilirubin causes the skin, eyes, and mucus membranes in the mouth to turn a yellowish in colour. Yarqaan (jaundice) may not be clinically visible until bilirubin reaches about 2mg/dl. Because the liver in involved in processing bilirubin, so jaundice is a side effect of conditions which affects the liver function. Severe jaundice can progress to even liver failure because build-up of bilirubin is extremely toxic. Consequently, bilirubin must continuously be eliminated in order to prevent lethal levels from accumulating.

Yarqaan (Jaundice) can be caused by various reasons like blockage in bile duct, which normally discharges bile salts and pigment to the intestine.  The block in the bile ducts can be due to gallstones or inflammation of liver, also known as hepatitis. Jaundice may also be caused by excessive consumption of alcohol, cancer of pancreas haemolytic anaemia and other diseases which affect the liver such as malaria, yellow fever, typhoid and tuberculosis.

Symptoms of the yarqaan (jaundice) may include loss of appetite, nausea, yellow discolouration of the tongue, skin, eyes and urine, extreme weakness, severe constipation, dull pain in the region of liver and fever

Unani Approach to Yarqaan (Jaundice)

According to the philosophy of Unani system of medicine, Yarqaan (jaundice) is visible yellowish or blackish discoloration of skin and conjunctiva due to diffusion of yellow or black bile (khilt-e- safra ya sauda respectively) in blood vessel toward skin with or without infection.

Unani Medicine (Greeco Arab Medicine) is one of the ancient system of medicine, whereaA vast array of literature about liver diseases has been documented in Unani Medicine. Liver is an organ for origin of Quwaa (Natural power).

Galen, (129-217 AD) even stated liver counterpart with sun, a source of energy for others planets. Liver is also an organ for production of humours (akhlat) for nourishment, growth and development of the body. Each of the four humours named dam (sanguine), balgham (phlegm), safra (yellow bile) and sauda (black bile), carries their own normal temperament. The derangement in quality and quantity of humours, leads to liver pathologies including jaundice. Jaundice has been stated to be caused by quantitative or /and qualitative changes in safra (yellow bile) or sauda (black bile). Jaundice (Yarqan) was discussed widely and deeply in Unani Medicine.

Some possible causes are:

• Su-e- mizaj-e- kabid (Derangement of temperament of liver)
• Waram-e- kabid (Inflammation of liver)
• Sudda-e- kabid (Obstruction in flow of bile)
• Sartaan-e- kabid (Liver carcinoma)

Some other causes are

• Excessive alcoholism
• Low birth weight
• Neonatal jaundice etc.

According to Buqraat (Hippocrates), the father of medicine in his book ‘Jawame-ul- ilaj -wal- a’araz’ as quoted by Rhazes (850-925 AD) in ‘Kitab- al- Hawi Fil Tib,’ sometimes jaundice is caused by Pathological / Abnormal hot temperament of liver (Su-e- Mizaj-e- Haar Jigar) in blood vessel whereby sanguineous humour transmuted to bilious humour (yellow bile). In his famous book ‘Qanooncha Buqratiya’, he also described jaundice (yarqaan) as ‘discoloration of conjunctiva and skin associated with or without fever, is originated by sustained intake of contaminated or infected water and food.

According to Jalinoos (Galen), as quoted by Rhazes in his book ‘Kitab- al- Hawi Fil Tib,’ where he outlined the following aetiologies and types of jaundice,

• Obstruction in liver (sudda-e- kabid) is another aetiology for genesis of jaundice. He categorized it as ‘Obstructive Jaundice’ (Yarqaan-e- suddi).
• Insect bite and food contaminated with poisonous material generate toxaemia (haemolysis). This leads to imbalance in yellow bile or bilirubin (safra) resulting jaundice.
• Pathological /Non-functioning Gall bladder along with these aetiologies,
• Acute hepatitis (Warm-e-jigar haad) is another aetiology according to him.  

According to Abu Sahel Maseehi, as quoted by Rhazes in ‘Kitab- al- Hawi Fil Tib,’ pathological hot temperament of liver or gall bladder (Hararat-e- kabid wa merarah) respectively are causative factors for jaundice (yarqaan). He also documented clinical features such as yellowish coloration of skin, constipation, coated tongue, weight loss and abdominal discomfort etc.

Muhammad Bin Zakariya Rhazes in his book ‘Kitab- al- Hawi Fil Tib,’ archived another causes of jaundice from the reference of Ibn-e- Maswah that are abnormality in functioning of liver, bile ducts and associated blood vessels.

• Bohran (a state of crisis and lysis in a disease) is another cause of jaundice.
• Obstruction within liver (biliary canaliculi) is another cause of jaundice.

According to Abu Bakr Muhammad Bin Zakariya Razi (Razes), in his well-known book ‘Al-Hawi fil Tib’ during jaundice evacuation of yellow bile/ bilirubin (safra) is obligatory. Furthermore, if physic (Tabiyat-e- mudabbira-e- badan) fails to do so, infection proceeds in yellow bile which generates fever. However fever also appears in inflammatory condition of liver, also stated.

According to Rabban Tabri (Tabri), in his renowned book ‘Firdaus-al- Hikmat’, where he also documented the mechanism of genesis of jaundice. He mentioned all the above aetiologies and also that physic (Tabiyat-e- mudabbira-e- badan) divert excessive bile from gall bladder towards skin for excretion through sweat. Which results high concentration of yellow bile (safra) in subcutaneous tissue imparting discoloration and jaundice tinge. Furthermore he also claimed that black bile (sauda) is also responsible for jaundice.

According to Ibn-e- Sina (Avicenna), great scholar in his book ‘Al Qanoon Fit Tib’ and Azam khan in ‘Akseer-e- Azam’, jaundice is nothing but visible discoloration of body (yellowish or blackish) due to diffusion of yellow or black bile from blood towards skin with or without infection. In case of infection, tertiary fever (humma-e-ghib) and quartan fever (humma-e- rub’o) develops in jaundice with yellow and blackish discoloration of body (yarqan safrawi wa yarqan saudawi) respectively.

Symptoms of Yarqaan (Jaundice)

Yarqaan (Jaundice) may appear suddenly or develop slowly over time. The symptoms of jaundice commonly include: Yellow colouration of skin and the white part of the eyes (sclera) -when jaundice is more severe, these areas may look brown yellow coloured inside the mouth dark or brown- coloured urine, pale or clay-coloured or bloody (black) stools, Itching, loss of appetite, weight loss, nausea, fever, abdominal pain, ascites (abdominal swelling) and fatigue.

Pathophysiology of Yarqaan (Jaundice)

Every day, a small number of red blood cells die in our body and are replaced by new ones. The liver removes the old blood cells, forming bilirubin. The liver helps in break down bilirubin so that it can be removed by the body in the stool. When too much bilirubin builds up and accumulate in the body, jaundice may result.

Management of Yarqaan (Jaundice)

The drugs used for the management of yarqaan (jaundice) stimulate the liver functioning. They prevent the liver against any damage. Very effective in treating Jaundice. They also stimulate the secretion of Bile Salts, improve appetite and increase food intake.

General Tips/ Preventive measures

Alcoholic patients can prevent or reduce the risk of yarqaan (Jaundice) by avoiding alcohol. Yarqaan (Jaundice) caused by hepatitis A and B can be prevented by taking vaccination. Other Jaundice underlying diseases like cirrhosis, thalassemia and cholestasis are inherited or autoimmune disorders and cannot be prevented.

In initial stages, bed rest is recommended. Thereafter return to normal activities should be gradual. Personal hygiene for the patient as well as attendant is very necessary. Proper screening of donated blood for HbsAg, anti HCV and elevated ALT has potential role in reducing the risk of transfusion associated hepatitis. Articles used by patient should be thoroughly cleaned by using disinfectant. Attendants, who come in contact with contaminated utensils, bedding and clothing should thoroughly wash their hands. Careful handling of disposable articles is also necessary.

Investigations and Follow-ups

Hepatomegaly along-with liver tenderness should be checked at regular intervals.  Splenomegaly and Enlarged lymph nodes (Epitrochliar or Cervical) should be ruled out. In initial stages signs of toxemia may be present. Urine should be checked for any signs of proteinuria and bilirubinuria in initial stages. Blood test should be repeated for bilirubin, alkaline phosphatase, Alanine transaminase (ALT)/ SGOT and aspartate aminotransferase (AST)/ SGPT.

Recommended Diet for Yarqaan (Jaundice)

Proper oil and spice free diet and adequate rest is essential for recovery from jaundice. Here are some helpful dietary tips for those affected by yarqaan (jaundice). These are natural food that help in treatment and alleviation of Jaundice and its allied symptoms.

• Easily digestible diet as much tolerable without overfeeding should be taken. Usually a liquid diet is recommended for the first 4 to 5 days.
• It is advised to take high carbohydrate diet without spices and fat.
• Always drink boiled water. A good intake of fluids helps to remove excess bilirubin from the body through the urine and stool. Make sure that you drink clean, uncontaminated water.
• Vegetables and fruit juices should be taken in raw or steamed form, as they help to regulate the balance of electrolytes in the body. Avoid canned juices. 
• Fruit juice fast for about one week is very effective for the patient.
• Once the bilirubin levels start decreasing, light food items such as fruits, yogurt and porridge may be added to the diet. At this time one can also consume vegetables such as carrots and spinach. Some amount of lean protein will help in recovery and hence you can also consume egg. It is advisable to divide your meals into smaller portions and eat them frequently during the day.
• As the bilirubin levels reduce at almost normal level, one can add foods such as rice, fish or lentil to your diet. Make sure that no oil is used to cook foods. One can eat fish either boiled or steamed. Avoid eating meat or poultry as it may be difficult to digest at this point of time.
• Once the symptoms of yarqaan (jaundice) have subsided and the patient has doctor's approval for that, foods cooked in olive oil may be used. But try to avoid eating foods rich in cholesterol and those which are hard to digest at this point of time also because the body needs time to regain its normal functioning.
• Karela (Bitter gourd) and Saijan Ki Phali (drumsticks) are very beneficial for jaundice patients.
• Increase intake of foods rich in calcium and other minerals like iron and magnesium.

Homemade Preparations: some Unani single drugs and their homemade preparations are found to be very effective in curing jaundice are:

• Tomato juice (Lycopersicon lycopersicum Linn.): One glass of tomato juice, mixed with a pinch of salt and pepper, taken on empty stomach in the morning is a very effective home remedy for jaundice.
• Radish leaves (Raphanus sativus Linn.): Take some radish leaves and extract juice from it, with the help of a sieve. Drink about half a litre of the extracted juice daily, in about ten days the patient should get relief from the disease.
• Papaya leaves (Carica papaya Linn.): Add one tablespoon of honey to one teaspoon of papaya leaves paste. Eat this regularly for about one or two weeks. This is a very effective home cure for jaundice.
• Sugarcane (Saccharum officinarum Linn.): Sugarcane helps in proper digestion and proper liver functioning, thereby helping the patient to recover quickly from jaundice (yarqaan). Take a glass of sugarcane juice and add some lime juice to this. Drink this juice twice daily for better results. Ensure to clean sugarcane properly before extracting juice from it.
• Basil leaves (Ocimum sanctum Linn.): Take   about 10-15 basil leaves and make a paste of it. Add half a glass of freshly prepared radish juice to it. Drink this preparation daily for about two to three weeks for better results.
• Gooseberry/ Karaunda (Ribes uva-crispa): Gooseberry is a good source of vitamin C and is a very useful in alleviating the symptoms of yarqaan (jaundice).
• Barley (Hordeum vulgare Linn.): Boil a cup of barley water in about three litres of water and allow it to simmer, for about three hours. Drink this water as frequently as possible throughout the day for early recovery from yarqaan (jaundice).
• Lemon (Citrus limon (Linn.) Burm.f.): The anti-inflammatory property available in lemon helps in treating jaundice (yarqaan). It also unblocks the bile ducts, thereby making it the most effective home remedy for jaundice.  Squeeze the juice of 2 lemons and add it to a glass of water. Drink this minimum thrice a day, as it protects the liver cells from damage.
• Pigeon peas leaves/ Toor Dal/ Tuvar Dal (Cajanus cajan): Extract juice from pigeon pea leaves by crushing them and take at least 60ml of this juice daily for treating jaundice. The leguminous beans of these are also very nutritive and can be added in the diet.
• Almonds/ Badaam Sheerien (Prunus dulcis Mill.): Take about 8 kernels of almonds, two dates and five cardamoms and soak them in water.  Leave it overnight. In the morning, remove the skins and make a paste of it. Add some sugar and butter. Take this mixture several times a day.
• Turmeric (Curcuma longa): Take a glass of warm water and add a pinch of turmeric to it. Mix well and drink this three or four times a day.
• Snake gourd leaves: Take about 7-10 leaves and boil it in a cup of water and allow it to cool. Take 10-15 coriander seeds and boil it in half a litre of water. Mix it with the previously prepared decoction. Drink at least thrice a day for effective cure of jaundice.
• Indian Elwa (Aloe Vera (L.) Burm.f.) leaves: Take the pulp of the leaves of Indian aloe vera and mix it with black salt and ginger. Take this every morning for about ten days.
• Beetroot (Beta vulgaris) and lemon (Citrus limon (L.) Burm.f.) juice: Take one cup of beetroot juice and mix with equal quantity of lemon juice and drink this regularly for a few days for effective results.
• Chicory (Chicorium intybus Linn.) plant: Make a juice of the herb (fruits, leaves, flowers, seeds and roots). Take one teaspoon of this juice several times a day. Use it at least 15 days. All parts of plant is useful in curing liver problems. The flowers, seeds and roots are the more common parts used. The juice of chicory help treating the enlargement of spleen, sluggishness of the liver and it also promotes healthy secretion of the bile.
• Black nightshade/ wonder berry (Solanum nigrum): Make a juice of the fruits and leaves of the herb. Take one teaspoon of this juice several times a day. Use it at least 15 days.
• Chamomile Tea (Psoralea corylifolia Linn.):  It should be taken at least once a day for several weeks and can be continued after cure of the condition as a preventive measure. Tea made of chamomile is very effective in curing yarqaan (jaundice).
• Buttermilk: Take buttermilk in sufficient quantity, add roasted alum and some black pepper.  Mix them well. Drink the preparation at least thrice a day for better results.
• Banana/ Kela (Musa paradisiaca Linn.): Crush ripe banana and add some honey and take this at least twice a day for better results in the management of yarqaan (jaundice).
• Carrot (Daucus carota Linn.) juice: Make fresh carrot juice with the help of juicer or by crushing and extracting method. Drink this juice several times a day for effective cure of yarqaan (jaundice). It can also be included in the diet of the patient also.
• Bitter luffah (Atropa belladonna Linn.) juice: Squeeze one pound bitter luffah, to extract its juice. Place the juice in the palm of the hand and draw it through the nostrils. Yellow liquid will flow out the nostrils as a result of this activity. When the toxic matter is evacuated in considerable amount the patient will feel relieved. Seeds of bitter luffah can also be used for the same purpose.
• Bael leaves (Aegle marmelos Correa ex Roxb.): Take dry bael leaves and grind to make a powder. Mix it in a glass of water. Drink this once a day for effective cure of yarqaan (jaundice).

Compound Unani Prescriptions Recommended in Yarqaan (Yarqaan)

• Prescription- 1

Grind Tukhm-e-Kasni (Endive) 3 gms, Tukhm- e-Khyarain (Cucumber) 3 gms, Zarishk (Berberry) 3 gms in Arq-e-Brinjasaf (Mugwort extract) 60 ml, Arq-e-Badyan (Fennel extract)  60 ml and give few drops after mixing in Sikanjibin Bazoori 48 gms or Sharbat Bazoori 48 gms.

• Prescription- 2

Make a fine powder of equal parts of Asal-us- Soos (Liquorice), Tukhm-e- kasni (Endive seed) and Kala Namak (Black salt) then take 3 gm powder with water twice daily.

• Prescription- 3

Crush fresh plant of Makoi and Kasni, squeeze the juice then warm it. During the boiling stage, mix 1gm Naushadar (Ammonium chloride) for removing foams and filter it. After filtration take 60 ml of obtained juice before meal.

• Prescription- 4

Naushadar (Ammonium chloride) 1gm, Shoora Qalami (Potassium nitrate) 0.1gm, Revand Chini (Rhubarb) 3gm, make fine powder and take 3 gm in the morning.

• Prescription- 5

Make a fine powder of Suahagah biryan (Borax) Naushadar (Ammonium chloride) and Phitkari (Alum) all in equal parts quantity, Shoora Qalami (Potassium nitrate) (½ part). Take 1gm powder with water, twice daily.

• Prescription- 6

Take 250 mg   Naushadar (Ammonium chloride), mix it in the 25ml Aab-e- barg-e- Mooli (Radish leaf juice) and take as such twice daily.

• Prescription- 7

Take Gul-e-Babool (Babul flower) 6 gms, Gul-e-Nilofar (Water Lily flower) 6 gms and Revand Chini (Rhubarb) 4 gms, boil them in 250 ml of water, strain it and then take twice daily.

• Prescription- 8

Take Gilo Neem subz (Margosa flower) 3.5 gms and Shahad (Honey) 12 gms. Boil them in 120 ml of water until it reduces to half of their quantity. Take twice daily.

Food items Restricted in Yarqaan (Jaundice)

• Always avoid foods that are oily or spicy. Sugary foods, artificial sweeteners and caffeine should also be avoided during yarqaan (Jaundice). Also avoid junk and carbohydrate rich foods as liver needs to produce more bile to digest them, which may aggravate the condition of the sufferer.
• Avoid coffee, tea and alcohol during yarqaan (Jaundice). Especially Alcohol should be avoided completely as it can seriously affect the liver.
• Avoid non-pasteurized milk during yarqaan (Jaundice).
• Avoid pulses and legumes during yarqaan (Jaundice).

Unani Compound Drugs Recommended in Yarqaan (Yarqaan)

• Arq-e- Mako
• Arq-e- Kasni
• Arq-e- Baranjasif
• Sharbat-e- Deenar
• Majoon Dabeed-ul- Ward
• Habb-e- Kabid Naushadri
• Qurs-e- Jigar
• Sharbat-e- Buzoori
• Sharbat-e- Kasni
• Arq-e Murawwaqain

 REFERENCES

• http://www.tjfmpc.gen.tr/2015_4/1_29-1413438884_TYP.pdf
• http://nopr.niscair.res.in/bitstream/123456789/12253/1/NPR%202(2)%2092-93.pdf
• http://www.amberyoil.com/shop/general-health/unani-medicine-for-jaundice/
• http://www.hakeembaqai.com/jaundice.php
• http://www.dehlvi.com/disease-Jaundice-view-99.html
• http://www.nhp.gov.in/disease/digestive/liver/jaundice
• http://202.138.101.165/ayush/unani.pdf
• http://home-cure.net/remedy-treatment-jaundice/
• http://www.home-remedies-for-you.com/remedy/Jaundice.html
• http://www.gharelotips.info/2014/04/yarqan-jaundice-ka-ilaj.html

NOTES

• Along with medicine the patients have to follow strict unani regimen for optimum results 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.