Concept of Ziabetus (Diabetes) in Unani Medical Science

In Unani medicine “Ziabetus” is the term which is used generally for diabetes, and “Ziabetus Shakari” for diabetes mellitus. It is mentioned in Unani literature like Al Qaanon (Canon of Medicine), Al Hawi Fit Tibb, Kamilus Sana’ah, etc. Arabian scholars have also mentioned it by terms like Atsha, Istisqa-e-Amnas, Mo’attisha, Dulaab, Dawwarah, Barkariyyah, Zalaqul kuliya, Ziyasqoos and Qaramees. Egyptians have described clinical features similar to Diabetes almost 3000 years back. The word “Diabetes” comes from the Greek word “Diabanmo” which means to run through or passing through. It is characterized by excessive urination (polyurea) excessive thirst (polydypsea), increased appetite (polyphasia), presence of sugar in urine, gradual loss of body weight, etc.
As per Unani medical philosophy, it is a disease in which the consumed water is passed out through the kidney immediately after its intake by an individual without any metabolic change. Due to hot temperament of kidneys, the water is absorbed from the blood circulation and sent to the urinary bladder. The causation of disease is based on mizaji and saakhti (structural) deviation. Any imbalance between mizaj and saakht results in disease. Diabetes is one of the five leading causes of death. Diabetes mellitus (DM) is a metabolic disorder complex in nature, resulting in either insulin insufficiency or insulin dysfunction. It is of two types, that is, Type I diabetes (insulin dependent) and Type II diabetes (noninsulin dependent), constituting 90% of the diabetic population. As per December, 2020 data, approximately 463 millino adults in age group 20 to 79 were living with diabtes; by 2045, this will rise to 700 million. The proportion of people with type 2 diabetes is increasing in most countries. 79% of adults with diabetes were living in low-and middle-income countries. It is a multifactorial disease leading to several complications.

Classification of Ziabetus as per Unani Medical Concept

A-According to the presence or absence of sugar in the urine, it is divided into two types:
1.Ziabetus Sada or Ziabetus ghair shakari (Diabetes insipidus), characterized by excessive thirst and urination, without the presence of sugar in the urine.
2.Ziabetus Shakari (Diabetes mellitus), characterized by excessive thirst and urination, but with sugar in the urine.
B - According to the khiffat-wa-shiddat (intensity) of disease, it is also divided into two types:
1.Ziabetus Haar (refer here as Diabetes with hot temperament): Here symptoms develop abruptly with severity such as excessive thirst (polydipsia), increased urination (polyuria), increased appetite (polyphasia), with the signs and symptom of other su-e-mizaj haar (hot distemperament), such as heat in flanks and dryness of the body caused due to su-e-mizaj haar sada (excess of heat) of kidneys.
2. Ziabetus Baarid (refer here as Diabetes with cold temperament): Here onset of symptoms is gradual with less severity comparatively such as less thirst and frequency of urine.

Causative Factors

Unani physicians like Ali ibn-e-Abbas Majoosi, Ibn-e-Sina (980-1037AD) and Najeeb- ud-Deen Samarqandi (Died 1222 AD), etc, describe some underline etiopathogenesis of the disease while describing about the disease in classical texts. It was supposed that the disease is related to kidney.
“Their concept of invovlment of kidney in this disese is quite contrary to modern concept where functional derangement of pancreas occurs causing diabetes”.
The important etiological factors as per Unani concept are the following:
•Zof’e Gurda (Weakness of kidney)
•?u? f al-Kulya (Renal insufficiency)
•Su-e-Mizaj Haar Gurda (Hot derangement in the temperament of kidney)
•Su-e-Mizaj Baarid Gurda (Cold derangement in temperament of kidney)
•Ittesa-e-Gurda-wa-Majra-e-Baul (Dilatation of kidney and urinary tract)
•Baroodat-e-Badan, Jigar-wa-Gurda (Cold derangement in temperament of body, kidney and liver).

Management (Ilaj-bil-Dawa or Pharmacotherapy

We recommend single and compound drug formulations in such patients as per plan which are quite safe and free from side effects and are holistic in nature. Uncontrolled diabetes may lead to kidney disease, heart disease, blindness, gangrene and even coma. Modifications in diet and lifestyle can reduce the possibility and complications of the disease. There are many Unani medicines available for lifestyle diseases, especially diabetes. Traditional or AYUSH medicines are being looked up once again for its treatment; the WHO also recommended its further investigation. So, for the management of type 2 diabetes mellitus, the single drugs used in formulation with reported anti-diabetic and related beneficial properties are Kalonji (Nigella sativa), Gudmar booti (Gymnema sylvestre), Neem (Azadirachta indica), Elva (Aloe vera), Bitter melon (Momordica charantia), Babul (Acacia arabica (Lam.) Willd, Jamun/Black plum (Eugenia jambolana Lam.), Methi (Trigonella foenum-graecum), Anar (Punica granatum), etc, having hypoglycemic activity, inhibition of glucose uptake in the intestine, stimulation of insulin secretion, isolation of human islets and enhance glucose induced insulin. Phytomedicine used in Unani medicine presents an exciting opportunity for the development of new types of therapeutics for diabetes mellitus with a holistic approach, which includes various phytochemical groups such as alkaloids, terpenes, and phenolic compounds. Beside hypoglycemic activity, these drugs also have antioxidants, bitter and other activity related to disturbance in carbohydrate metabolism. They are used in the form of decoctions, infusions, tablets, pills, and powder.
The compound drug fromulations used for the management of diabetes are Qurse Dhayabitus, Qurse Tabasheer, Qurse Marwareed, Qurse Gulnar, Qurs Tabasheer (all, compound polyherbal Unani formulations in the form of Pills), Safoof Gilo (a compound polyherbal Unani formulation in the form of Powder), Dawaul Misk Talkh (a compound polyherbal Unani formulation in the form of Semi-jelly), etc, etc.
Various common marketed formulations avalaible are Dolabi tablets, Qurs Kushta baiza murgh, Qurs Kushta Zamarrud, Qurs Ziabetus, Qurs Tabashee (all, compound polyherbal Unani formulations in the form of Pills), Safoof Ziabtes (a compound polyherbal Unani formulation in the form of Powder), etc. There is the tremendous scope of Unani single and compound drug formulations in the comprehensive management of diabetes particularly type-2 diabetes; it can also be utilized as an adjuvant with the conventional drug due to its diverse and related beneficial pharmacological activity in diabetes. (To Be Continued)

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