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.
Some common Prescriptions and Unani Homemade Remedies
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