|Year : 2020 | Volume
| Issue : 2 | Page : 84-90
Epidemic containment measures in Unani medicine and their contemporary relevance
Malik Itrat1, Tariq Nadeem Khan2, Zarnigar Riaz1, Mohd Zulkifle2
1 Department of Tahaffuzi wa Samaji Tib, National Institute of Unani Medicine, Bengaluru, Karnataka, India
2 Department of Kulliyat, National Institute of Unani Medicine, Bengaluru, Karnataka, India
|Date of Submission||01-Jun-2020|
|Date of Decision||25-Jun-2020|
|Date of Acceptance||02-Jul-2020|
|Date of Web Publication||07-Sep-2020|
Dr. Malik Itrat
Department of Tahaffuzi wa Samaji Tib, National Institute of Unani Medicine, Kottigepalya, Magadi Main Road, Bengaluru, Karnataka.
Source of Support: None, Conflict of Interest: None
Background and Objective: Nonavailability of clinically proven prophylaxis and specific drug against the coronavirus disease-2019 (COVID-19) turned the world’s attention toward finding ways to strengthen the host defense. Unani scholars fully understand and consider the host as a key determinant in disease dynamics and laid emphasis on host defense strengthening as an important disease prevention strategy. Hence, this article aimed to provide an overview of the epidemic containment measures described in Unani classical texts and their relevance in the current outbreak. Materials and Methods: A manual literature survey of classical Unani texts was conducted to collect the information on the measures suggested for epidemic containment. In addition, electronic databases such as PubMed, Google Scholar, and Science Direct were searched to identify researches conducted on Unani drugs listed in the article as well as to obtain recent information about COVID-19 outbreak. The keywords used were “Unani Medicine,” “Epidemic,” “Immunomodulator,” “Antiviral,” “Antimicrobial,” “Prevention,” and “COVID-19.”Results: The literature review shows that Unani scholars have given an elaborate description of the epidemic including its definition, etiological factors, susceptible host, clinical presentation of infected individuals, and the containment measures. Described measures can be broadly classified into cause-centric and host-centric depending on their application-at environment and individual level, respectively. Cause-centric measures are aimed to eliminate the causative agent present in the environment and host-centric measures are aimed to strengthen the host defense. Conclusion: Epidemic containment measures described in classical Unani treatises seem to be of much relevance in today’s context. These measures have been considered useful in reducing the risk of contracting the infection during epidemics. Hence, in our opinion, it is worth assessing them in the current outbreak.
Keywords: COVID-19, epidemic, host defense, immunomodulator, Unani medicine
|How to cite this article:|
Itrat M, Khan TN, Riaz Z, Zulkifle M. Epidemic containment measures in Unani medicine and their contemporary relevance. J Indian Sys Medicine 2020;8:84-90
|How to cite this URL:|
Itrat M, Khan TN, Riaz Z, Zulkifle M. Epidemic containment measures in Unani medicine and their contemporary relevance. J Indian Sys Medicine [serial online] 2020 [cited 2020 Sep 25];8:84-90. Available from: http://www.joinsysmed.com/text.asp?2020/8/2/84/294436
| Introduction|| |
The ongoing pandemic of COVID-19 (coronavirus disease-2019) has challenged the health-care systems across the globe. The current epidemic came to world attention in December 2019 in Wuhan, China. Initially, a provisional name was given to this virus as 2019-novel coronavirus (2019-nCoV). Later on, due to nucleotide identity up to a large extent with SARS-CoV, this new virus is named as SARS-CoV-2 and the disease caused by it referred to as COVID-19. The World Health Organization (WHO) declared this disease as pandemic on March 11, 2020. Evidence indicates that disease is transmitted from human to human through droplets and direct contact. It is reported that the virus may be found in aerosols for at least up to 3h; hence, the aerosol transmission is also possible in case of exposure to elevated aerosol concentrations in closed spaces. The mean incubation period of this disease is 5 days, ranging from 1 to 14 days and the mean reproduction number (R0) is estimated to be ranged from 2.20 to 3.58. The clinical picture in humans infected with SARS-CoV-2 has ranged from asymptomatic stage to severe signs and symptoms including death. The main symptoms include low-grade fever, fatigue, dry cough, myalgia, and dyspnea.
Overall estimated mortality of COVID-19 for the infected population is 0.25%–3.0%, whereas it increases to >14% in old-age group, 8%–10% in associated comorbidities such as cardiovascular diseases, hypertension, and diabetes. As of this writing, globally, the current number of cases is 97, 55, 196 along with 4,92,685 deaths. In India, the total numbers of reported cases are 4, 90,401 among them 1,89,463 are active cases, with 15,301 deaths. Real-time statistics on COVID-19 disease are available online on various government platforms.
Despite worldwide efforts to contain it, the pandemic is continuing due to lack of clinically proven prophylaxis and therapeutic strategy. This turned the world’s attention toward strengthening the body’s defense force against disease-causing agents. It provides an opportunity to revisit the wisdom of traditional systems of medicine for addressing the challenge of COVID-19 pandemic through improved immunity in combination with the proposed advisories by government authorities for hand hygiene, respiratory hygiene, physical distancing, and use of personal protective equipments. Consequently, it becomes logical to explore the literature of Unani systems of medicine for the understanding of the epidemic and the potential of this system in addressing this challenge. Hence, the authors have attempted to highlight the knowledge and practices of Unani medicine in the context of epidemic diseases that might be assessed as prophylactic measures in the present scenario.
| Materials and Methods|| |
A manual literature survey of classical Unani texts was conducted to collect the information available on epidemics and the measures suggested for its containment. In addition, a comprehensive search of electronic databases, such as PubMed, Google Scholar, and Science Direct, was carried out to identify experimental and clinical studies conducted on drugs mentioned in literature as well as to obtain the recent information about COVID-19 outbreak. For electronic databases search, medical subject headings (MeSH) and other relevant terms to the topic were used as major constructs to build a search strategy. The MeSH or other relevant terms are related to Unani medicine, Epidemic, Prophylaxis, Prevention, and COVID-19 constructs. To combine these, Boolean operators “AND” and “OR” were used appropriately. The keywords used were “Unani Medicine,” “Epidemic,” “Disinfectant,” “Antiseptic,” “Immunomodulator,” “Antiviral,” “Antimicrobial,” “Prevention,” and “COVID-19.” Time restriction was not made to extract the most useful information.
| Observations|| |
Epidemics in Unani texts are described either under the heading of wabā’ (epidemic) or hummā wabā’iyya (epidemic fever). Unani scholars have given a very elaborative description of epidemics including its definition, etiological factors, susceptible host, the clinical presentation of infected individuals, and the measures for its containment. Findings of the literature review are presented in [Tables 1]–. [Table 1] provides brief information about the aim and applicability of the measures described in Unani texts for the containment of the epidemic. [Table 2] provides information about the measures applicable at the environment level. [Table 3] represents the preventive measures (includes pharmacological and nonpharmacological) applied at the individual level. Information about the pharmacological properties revealed from contemporary researches on Unani drugs listed in this article is given in [Table 4].
|Table 3: Recommended pharmacological and nonpharmacological measures for prophylaxis during epidemics|
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| Understanding of Epidemic|| |
The putrefied change occurring in the air, water, soil, or environment, leading to putrefaction in humors of the body. This abnormal change affects a large part of the population at a particular time is known to be called as wabā’ (epidemic).,,,,, Unani scholars considered certain climatic changes as the predisposing factors for the occurrence of an epidemic., In this regard, Hippocrates opined that warm and moist airs are conducive to “ufūnat (infection). Rāzῑ mentioned that bād Junūbῑ (southern wind) is associated with wabā” and is notoriously known to flare up infections. In his another book, he further specifies that the changes in air increase during those summers which are afflicted by rainfall and cloudy weather, wherein southern air blows or in areas where the southern air is trapped. These claims have not been verified by any study, however, if these are true then this anticipation can help us to focus on the most likely threats. Accordingly, adequate arrangements and planning can be done to minimize the morbidity.
According to Unani Medicine, individuals of hārr-raṭb (hot and moist) temperament are at high risk and the individuals with bārid-yābis (cold and dry) temperament are at lower risk to acquire an infection during epidemic. Likewise, individuals whose bodies are full of morbid matter are more susceptible to contract the infection, whereas the bodies devoid of morbid matter are at lesser risk to be affected. Presence of morbid matter or the increase in the hararāt and ruṭūbat (heat and moisture) in the body or bodily tissues provides the conducive environment for the proliferation of ufūnat (infection) or in other words, we can say it reduces the disease resisting capacity of the body. Hence, the idea of prevention advocated by Unani scholars during an epidemic is mainly centred on employing all those regimens, which checks the humoral imbalance and keep the body in a nonsusceptible state.,,,, Once the susceptibility for a disease no longer exists, either we don’t contract the disease or even if contracted, the episode will be less virulent, as the body is ready to counter any intrusion of disease-causing agents.
Unani scholars described the clinical picture of an infected person during epidemics. They mentioned that usually, the infected person presents with the symptoms of low-grade fever, fatigue, dry cough, increased thirst, increased respiratory rate, dyspnoea, and bad breath. Sometime, the patient may also present with the symptoms of nausea, loss of appetite, abdominal pain, diarrhea, and splenomegaly. Interestingly, it is also mentioned that higher mortality is seen among the individuals who have developed the symptom of bad breath; the presence of this symptom is an indication that the infection has reached to the heart., The clinical features of an infected person described in Unani texts are strikingly similar to the epidemics such as swine flu, SARS, and even COVID-19.
Epidemic containment measures mentioned by Unani scholars can be broadly divided into cause centric and host-centric measures and these are applicable at the environment and individual level, respectively [Table 1]. At environmental level measures are aimed to eliminate the pathogens present in the environment. At individual level suggested measures are aimed to strengthen the host defense.
| At Environment Level|| |
Epidemic containment measures applicable at the environment level include the fumigation of medicinal herbs and the sprinkling of the medicinal herbs solution in residential places. Fumigation is done to purify the indoor air of residential places, whereas the objective behind the sprinkling of the solution is not mentioned; it may be as a surface disinfectant. A brief description of these measures is provided in [Table 2]. A large number of drugs such as Sandrūs (Trachylobium hornnemannianum), Kāfūr (Cinnamomum camphora), Qusṭ (Sausurea lappa), Kundur (Bowsellia serrata), ’Ūd (Aquilaria agallocha), Mushk (Musk), Murr (Commiphora myrrh), Lobān (Styrax benzoin), S‘ad kūfī (Cyperus rotundus), Idhkhar (Cymbopogon jwarancusa), Abhal (Juniperus communis), Waj (Acorus calamus), Tagar (Valeriana wallichii), Ās (Myrtus communis), and Safarjal (Cydonia oblonga) have been mentioned by Unani scholars for the purification of air [Table 2]. Sprinkling the mixture of sirka (vinegar) and hīng (Ferula asafoetida) or vinegar and water in residential places has also been recommended during epidemics. From the literature review of Unani classical text, and modern studies it is found that these drugs possess varied pharmacological properties. From Unani perspective, these drugs possess dāfi‘-i-ta‘affun (antiseptic) and māni‘-i-‘ufūnat (disinfectant) properties,, whereas contemporary researches,,,,, reported antibacterial, antifungal and antiseptic properties.
| At Individual Level|| |
Communicable diseases are transmitted from the reservoir/source of infection to the susceptible host. One effective way of controlling the spread of infection is to strengthen the host defense. A large number of immune individuals in the community will build up the herd immunity; which provides an immunological barrier to the spread of disease in the human herd. If herd immunity is sufficiently high, the occurrence of an epidemic is regarded as highly unlikely.
From the review of Unani texts, it has been observed that Unani scholars were very well aware of the concept of the susceptible host. In this regard, Ibn Rushd (Averroes) says that disease does not occur in all individuals. Only those individuals affected from disease, who are susceptible to it. If this would not have been the case then not even a single individual in a population had escape disease during an epidemic. It seems that this view formed the basis of the modern concept of the epidemiological triad, which propounds that “not everyone exposed to a diseased agent develops the disease, there are many other factors relating to the host and environment that are equally important to determine whether a disease will occur in an exposed person or not.” Sīnā and Rāzῑ mentioned that the individuals, whose bodies are full of morbid matter, are more prone to be affected during epidemic and whose bodies are devoid of accumulated morbid matter seldom get affected. Sīnā further specifies that infection chiefly affects akhlāṭ (humor) and due to the action of harārat gharība (abnormal temperature); it deforms their physiological functions in such a way that individuals become diseased. Rāzῑ mentioned that temperamentally bārid (cold) and yābis (dry) individuals enjoy the advantage of remaining hale, when the danger of epidemic lurks around, provided that appropriate preventive measures are taken to retain their burūdat (coldness) and yubūsat (dryness). He also mentioned that tajfῑf (desiccation) is an excellent approach to take care of temperamentally hārr-raṭb (hot and moist) individuals, who often affected during epidemics.,
Based on this perspective of the susceptible host, several measures have been recommended to strengthen the host defense and to reduce the susceptibility toward the disease. It includes both pharmacological and nonpharmacological interventions. Pharmacological measures include the use of prophylactic drugs, whereas nonpharmacological measures include diet and lifestyle recommendations. The description of these recommendations is presented in [Table 3].
| Discussion|| |
It is interesting to note that the understanding of epidemic by Unani scholars described in classical Unani treatises centuries back is very much relevant to the contemporary era and their significance cannot be ignored.
Based on the review of Unani classics, and contemporary scientific studies, here we propose a Unani compound formulation made up of Sibr (Aloe barbadensis), Murr (Commiphora myrrh), and Zafran (Crocus sativus) to be assessed as prophylaxis against COVID-19. The rationale for suggesting the formulation is the long-term experiential knowledge of ancient Unani physicians; its use has been recommended by various Unani scholars as a prophylactic drug during epidemics.,,,, This formulation is mentioned in Unani pharmacopoeia with the name of tiryāq-i-wabā’i. Rāzῑ, claimed that whoever has used this formulation during the epidemic remained healthy. Jālīnūs opined that the persons who used tiryāq-i-wabā’i as a prophylactic drug in healthy condition did not affect from infectious diseases. Jurjani mentioned in his book that the use of tiryāq during epidemics strengthens the heart, keeps the faculties strong, and prevents ufūnat (infections). According to Unani perspective, this formulation maintains the vitality of organs, protects them from untoward stimuli, and strengthens them to cope with the diverse physiological conditions.
Its efficacy has also revealed from various researches conducted on the formulation or its ingredients. These researches showed that A. barbadensis, C. myrrh, and C. sativus possessed antioxidant, immunomodulator, antibacterial, and antiviral properties [Table 4].
It is reported in studies that SARS-CoV-2 affects immune homeostasis by altering the immune regulatory network and results in “cytokine storm,” characterized by increased IL-2, IL-7, granulocyte colony-stimulating factor, IFN-gamma and TNF-alpha. Cytokine storm damages tissues of the lungs, kidney, and heart leading to rapid multi-organ failure. T helper (Th) lymphocyte balance (Th1/Th2) is crucial in orchestrating the appropriate cytokine responses and is known to be useful in reducing disease aggravation and mortality rate. Bani et al. reported the Th2 upregulating activity of Crocus sativus and suggests its use in conditions where Th1/Th2 modulation is required. Findings of these researches suggest that the use of tiryāq-i-wabā’i (owing to its ingredients) may be helpful in the modulation of host Th-1/Th-2 immunity and inducing antiviral immunity. Hence, this formulation may be assessed as prophylactic drug in the current outbreak.[40-75]
Due to the lack of substantial evidence about the antiviral activity and the uncertainty about the airborne transmission of SARS-CoV-2, measures suggested at the environment level such as fumigation of herbs to purify the air and sprinkling the solution of herbs in residential places is not justifiable to suggest in containing the present outbreak of COVID-19.
Nevertheless, owing to the antimicrobial activities of these drugs, fumigation of herbs can be suggested for reducing the microbial load in the air by taking into consideration the health benefits. Likewise, the mixture of vinegar and asafoetida can be suggested to use as regular surface disinfectants due to their antibacterial and antifungal activity.
| Conclusion|| |
Host-centric measures described in Unani literature have been considered useful in reducing the risk of contracting the infection during the epidemics, and thus these might be worth special consideration to assess as prophylactic measures in today’s context. The uncertainty about the airborne transmission of COVID-19 disease and the lack of substantial evidence of antiviral activity limits the application of cause-centric measures in the current outbreak.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]