In the present study, efficacy of a Unani formulation in chronic bronchitis was reported and provided the scientific basis on clinical parameter. In this study 40 patients were randomly selected into two groups. The first group (n=20) was of test study and other group (n=20) for placebo study. Both, placebo and test groups were received 3 grams of sample in powder form twice daily for four weeks by oral route. Severity of cough, sputum, breathlessness, wheezing, peak expiratory flow rate (PEFR) and chest X-ray at the beginning and the end of treatment were assessed. The test drug showed a significant improvement as compared to placebo.

INTRODUCTION

The warm-e-shoab muzmin (chronic bronchitis) is an important public health problem worldwide (Ball and Make, 1998). It is one part of chronic obstructive pulmonary disease (COPD) and proceeds to form emphysema. Chronic bronchitis and emphysema both commonly called COPD which is fourth leading cause of death in United State of America. In developed countries, the prevalence of chronic bronchitis ranges from 13-17 % of chronic inflammation in the bronchi (medium-size airways) of lungs (Ball and Make, 1998). It is generally considered one of the two forms of chronic obstructive pulmonary disease (COPD). It is defined clinically as a persistent sual (cough) that produces sputum (phlegm) and mucus, for at least three months in two consecutive years. Sual is described as a disease in Unani literature. But in modern medicine it is described as a symptom of respiratory disease. American thoracic society defined chronic bronchitis in clinical terms as chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic productive cough have been excluded (American Thoracic Society, 2005). Medical research council defined chronic bronchitis in epidemiological studies as the presence of chronic productive cough on most days for three months, in each of two successive years, in patient whom other causes of chronic cough have been excluded. There are four types of chronic bronchitis such as simple chronic bronchitis, mucopurulent chronic bronchitis, asthmatic chronic bronchitis, and chronic obstructive bronchitis. World health organization divided the severity of chronic bronchitis on the following stages. Stage 0-at risk: chronic cough with sputum production, PFT normal. Stage I-mild: chronic cough with sputum production but mild limitation in airflow and mild changes in pulmonary function tests- PFT. Stage II-moderate: worsening of airflow that leads to shortness of breath with excretion, PFT shows marked limitation. Stage III-severe: severe air flow limitation, PFT get markedly abnormal. Bronchitis the median prevalence of chronic bronchitis was 2.6% across countries (Cerveri, et al., 2001). It is a common disease that affects from 10-25 % of adult population (Reynolds, 2000). In India 5 % males and 2.7% females are affected. Over all male: female ratio is 1.6: 1 (61.6%). The higher prevalence in male is due to habit of tobacco smoking (Jindal et al., 2001). The management of chronic bronchitis is one of the most difficult problems encountered in daily practice. In view of increasing side effect and limited scope of allopathic drugs, the need is to evaluate the efficacy medicine of Unani system on modern scientific parameters through clinical studies. The role of Unani herbal drugs in treating such disorder is well recognized in Unani literature.
The poly herbal Unani formulation contains the ingredients i.e. Kakra singhi (Pistacia integerrima), Asl-us-Soos (Glycyrrhiza glabra) (Agarwal, 1990), Filfil siyah (Piper nigrum) (Dymock et al., 1976) Jawakhar (Salt of Barley) in 4:2:2:1 ratio respectively have very effective role in the treatment of warm-e-shoab muzmin. All the drugs are use full in sual (cough). The objective of these studies was to evaluate the safety and efficacy of Unani formulation in the treatment of chronic bronchitis. The pharmacological activities of these drugs are given in table 1.

CASE REPORT

A known case of chronic hepatitis B, 45 years old came to OPD (out-patient department) on 21-01-2014 in Majeedia Unani Hospital, Jamia Hamdard, New Delhi, India with complaints of: (a) Pain in right hypochondrium, (b) loss of appetite, (c) yellow coloration of urine and (d) general weakness for more than six months. Patient was alright before eight months. Patient gradually developed symptoms after taking I.V. fluid from local practitioner for dehydration. Past history (seven to eight months) of acute gastroenteritis was present. No family history of hepatitis-B or any other chronic illness was present. Patient diagnosed HbsAg positive and took treatment for hepatitis since four months from local practitioner but showed no improvement. On general physical examination patient was well oriented, normal decubitus, responded well to communication, little irritative in behavior, built was lean and thin. Icterus was found to be present while pallor and cyanosis were absent. Blood pressure was 126/80mm Hg. Pulse was 78/min. Patient was afebrile. Skin presents yellow tinge all over body especially buccal mucosa. On systemic examination mild tenderness was present all over abdomen. Organomegaly was not present. Bowel sounds were normal. Cardiovascular, respiratory and central nervous system were within normal limits on examination.
Treatment included both Fasd (venesection) and oral treatment.
Fasd (venesection) was done thrice in the study consecutive for three months under aseptic conditions. The 18 gauze needle was inserted into the Wareed-e-Akhal (right median cubital vein) (Masihi, 1986) and blood allowed to flow freely until it slowed its speed of flow itself. Prior to venesection patient was admitted in hospital. Vitals were checked before and after the Fasd. Patient was kept under observation for 24 hrs after Fasd. Each time the blood taken out was measured and was approximately 25 ml.
Oral treatment included Sharbat Jigreen 20 ml BD, Capsule Jigreena 2 BD, Arq Makooh 50 ml BD, Majoon Dabidul Warad 10 g BD, Sharbat Bazoori 25 ml BD, Jawarish Pudina Walaiti 10 g evening, Jawarish anarain 10 g after meals, Hab-e-Kabid Naushadri 1 TDS. Same treatment was given for four months. After three months kidney function test (KFT) was done for safety of patient. Liver function test (LFT) was done initially after a week later after two months. HBV DNA quantitative analysis was done thrice in the study, before starting treatment, then after one month, later after two months of follow up. Similarly surface antigen by Elisa method was done thrice, initially after one month followed by follow up of two months.

RESULTS

Patient was evaluated on clinical and biochemical parameters progressively for almost five months as follows;

Clinical parameters. Click here to view full image

Bilirubin. Click here to view full image

SGOT, SGPT, and ALP. Click here to view full image

HbsAg (Elisa method), Hepatitis B Virus, DNA (Quantitative), Ultra-sonography. Click here to view full image

DISCUSSION

Acute hepatitis is self limiting disease in 80% of cases but the present case report is a k/c/o Hepatitis B for more than six months. Sharbat Jigreen which is mukawi jigar (hepatoprotective) used in the present study (Tamanna, 1995). Capsule Jigreena has main constituent as Revind cheeni (Rheum emodi) which has known hepatoprotective (Ibrahim et al., 2008) and antioxidant activity (Rehman et al, 2014). Jawarish pudina walaiti and Jawarish anarain are appetizers thus help in proper digestion. Sharbat dinar was given for proper bowel movements. Sharbat bazoori was given for decreasing the bilirubin levels. By its strong diuretic effects it increases the excretion of urobilinogen from the body and also has known anti-inflammatory action. Habbe-kabid naushadri and Arq makooh increase the appetite and decrease the flatulence. Arq makooh is known hepato-protective drug and has anti-inflammatory effect on liver (Anonymous, 1986).

CONCLUSION

A spontaneous recovery of patient was noted initially with improvement of sign and symptoms. Then it was noted that bilirubin levels came down frequently along with SGOT and SGPT followed by HbsAg became negative showing virus is not replicating in the body. HBV-DNA analysis was done and significantly showed decrease levels after one month and finally became more then detectible. From above results it is been concluded that unani management of chronic hepatitis-B has shown promising results. Further clinical trials on large scale are needed to re-validate the treatment on modern diagnostic tools.

CONFLICT OF INTEREST
None declared.

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