The Unani system of medicine is claimed to be an effective management protocol for the treatment of stroke using herbal

remedies. Although effective, the method does not require invasive intervention nor has it any side effects.

Researchers at the University of Westminster, London, have embarked on a project to scientifically validate this stroke

remedy. However, such herbal treatments are often considered to be non-scientific and represent 'quack' medicine. So, is there evidence that Unani medicine works

Greenwell, P.

Rughooputh, S.

Syeda, A.

WestminsterResearch

     University of Westminster Eprints http://eprints.wmin.ac.uk   The Unani system of medicine: does it have a scientific basis?  Ahmedi Syeda Sanjiv Rughooputh Pamela Greenwell School of Biosciences    This is an electronic version of an article published in The Biomedical Scientist, 48(9), pp. 971-972, September 2004.      The Eprints service at the University of Westminster aims to make the research output of the University available to a wider audience.  Copyright and Moral Rights remain with the authors and/or copyright owners. Users are permitted to download and/or print one copy for non-commercial private study or research.  Further distribution and any use of material from within this archive for profit-making enterprises or for commercial gain is strictly forbidden.        Whilst further distribution of specific materials from within this archive is forbidden, you may freely distribute the URL of the University of Westminster Eprints (http://eprints.wmin.ac.uk).   In case of abuse or copyright appearing without permission e-mail wattsn@wmin.ac.uk.  would, in particular, affect the poor in India,as Unani medicine is a much less expensivetherapy than the use of Western drugs.One of the major problems facing Unanimedicine is scientific validation. Althoughmany papers have been written, most arepublished in Indian journals and thereforethey have not been exposed to externalscrutiny. This has bred scepticism about itsclaims. Recently, however, several papers inpeer-reviewed journals have demonstratedthat not only is Unani medicine useful but itsefficacy can be explained scientifically. Unani medicine in diseaseDiabetesEmblica officinalis has been used as a herbalremedy to treat cataract in diabetics.Suryanarayana et al.3 demonstrated thattannoids extracted from this plant inhibitaldose reductase, which is known to beinvolved in the secondary complications ofdiabetes such as cataract. Various plants have now been shown toaffect glycaemia.4-7 Fenugreek leaves have alsobeen shown to affect hyperglycaemia,hypoinsulinaemia and glycosylatedhaemoglobin levels in diabetic rats. Key metabolic enzymes were affected and theeffect appeared to be similar to the that ofthe drug glibenclamide.8 In 2003, Virdi et al.demonstrated anti-hyperglycaemic effectswith three extracts of the bitter gourdMomordica charantia.9 The aqueous extractof the unripe fruit reduced fasting bloodglucose by 48%, which is equivalent to thefigures obtained with glibenclamide. Brain disordersBacopa monniera has been used as a mildsedative, for memory enhancement,treatment of epilepsy and insomnia. ARTICLEUnani system of medicine – does it have a scientific basis?Natural methods of healing stretch back to antiquity and many current pharmaceuticalagents owe their existence to research on plant products. In this overview, AhmediSyeda, Sanjiv Rughooputh and Pamela Greenwell consider the use of such methods in a range of conditions and seek to clarify a scientific basis for apparent efficacy.THE BIOMEDICAL SCIENTIST   September 2004 971The Unani system of medicine is claimedto be an effective management protocolfor the treatment of stroke using herbalremedies. Although effective, the methoddoes not require invasive interventionnor has it any side effects. Researchers at the University ofWestminster, London, have embarked on aproject to scientifically validate this strokeremedy. However, such herbal treatments areoften considered to be non-scientific andrepresent ‘quack’ medicine. So, is thereevidence that Unani medicine works?A brief history ofUnani medicineThe natural means of healing now known as Unani medicine can be traced back toancient Greece (Unan) where physicians such as Hippocrates are credited with itsintroduction. Aristotle, Galen, Ibn Betar,Zakarya Razes and Avicenna developed itfurther and the Arabs later introduced Unani medicine to the Indian subcontinent. Unani medicine is based on the theory that a perfect balance of elements (arkan),humours (akhlat) and temperament (mizaj)keeps both mind and body healthy. A self-preserving force (quwwat-e-mudabbira)maintains the correct humoural balance andit is the failure of this balance that is thoughtto result in disease. The four body humours are blood (dum),phlegm (balgham), yellow bile (safra) andblack bile (saoda). A person’s behaviouralpattern or temperament (mizaj) is expressedby the preponderance of a particular humour. There are seven forces of nature(umoor-e-tibiiya) that control the body andthree forces (arwah) that control the vitalorgans.1Diagnosis and treatment in Unani medicineDiagnosis in Unani medicine is based on therecognition of signs of imbalance of thehumours. Emphasis is given to diagnosingdisorders primarily through the pulse (nabz),although urine and stool tests are alsoperformed. Forms of treatment are varied and includeregimental therapy (ilajbit-tadbeer)dietotherapy (ilajbil-ghiza), pharmacotherapy(ilajbid-dawa) and surgery (jarahat).Treatment is based mainly on dietary controland the use of single or polyherbal medicinesto regain humoural balance.2Management of stroke using Unani medicineOnce a diagnosis of stroke is established, theprinciples of Unani treatment are to ripen theexcess of humoural substance by the use of ahoney-based medicine (ma-ul-asal), followedby an extract of a core group of eight to 10herbs (munzij) carefully tailored to theindividual. Once ripened, the excess humour iseliminated by the use of herbal diuretics, andthe humours are restored to their optimaltemperament by the use of medicine(tabreed), which, when used sequentiallywith the previous regimen, treats the patient and the weakness completely in45–90 days.Scientific analysis of Unani medicineUnani medicine has met with scepticism inthe developed world and is even losing favourin India where Western drugs are nowregarded as more effective alternatives. Sadly,this threatens to bring to an end a medicalsystem that has lasted for more than 2000years. The demise of traditional medicine This herb has been shown to have free-radicalscavenging capacity and it is suggested that itis useful in conditions in which free radicalsplay a role.10 Galantamine, which is isolatedfrom a number of plants used in traditionalmedicine, including Lycoris radiata, has beenshown to act as an anticholinesterase and isnow licensed for use in the UK for thetreatment of Alzheimer’s disease.11AtherogenesisCapsHT2, a polyherbal preparation thatcomprises Comminphora mukul, Alliumsativum, Plumbago indica, Semecarpusanacardium, Hemidesmus indicus, Terminalia arjuna, Tinospora codifolia,Withania somnifera and Ocimum sanctum,has antiatherogenic effects. Mary et al.demonstrated a scavenging of superoxide and hydroxyl radicals, inhibition of ADP-induced platelet aggregation, anti-inflammatory and hypolipidaemic effects.12This illustrates the therapeutic use of theformulations against vascular intimal damageand atherogenesis. Antioxidant activity has also beendescribed for the plants Sida cordifolia,Evolvulus alsinoides and Cynodon dactylon.13Furthermore, Terminalia arjuna has beenused in patients with angina pectoris,congestive heart failure and left ventricularmass. Positive effects were seen in patientswith angina and coronary heart failure.14 IschaemiaCalcined gold preparations are used in Unanimedicine as treatments for global and focalischaemia.15 Ischaemic brain damage inexperimental rats was halted and the animalsrestored to near normal function followingEmblica officinalis: implications for theprevention of sugar cataract. Mol Vis2004; 10: 148–54.4 Elder C. Ayureda for diabetes mellitus: areview of biomedical literature. AlternTher Health Med 2004; 10: 44–50.5 Grover JK, Yadav S, Vats V. Medicinalplants of India with anti-diabetic potential.J Ethnopharmacol 2002; 81: 81–100.6 Oubre AY, Carlson TJ, King SR, ReavanGM. From plant to patient: anethnomedical approach to theidentification of new drugs for thetreatment of NIDDM. Diabetologia 1997;40: 614–7.7 Bailey CJ, Day C. Traditional plantmedicines as treatments for diabetes.Diabetes Care 1989; 12: 553–64.8 Devi BA, Kamalakkannan N, Prince PS.Supplementation of fenugreek leaves todiabetic rats. Effect on carbohydratemetabolic enzymes in diabetic liver andkidney. Phytother Res 2003; 17: 1231–3. 9 Virdi J, Sivakami S, Shahani S, Suthar AC,Banavalikar MM, Biyani MK.Antihyperglycaemic effects of threeextracts from Momordica charantia. JEthnopharmacol 2003; 88: 107–11.10 Russo A, Izzo AA, Borrelli F, Renis M,Vanella A. Free radical scavenging andprotective effects of Bacopa monniera Lon DNA damage. Phytother Res 2003; 17:870–5.11 Howes MJ, Houghton PJ. Plants used inChinese and Indian traditional medicinefor improvement of memory andcognitive function. Pharmacol BiochemBehav 2003; 75: 513–27.12 Mary NK, Babu BH, Padikkala I.Antiatherogenic effects of Caps HT2, aherbal Ayurvedic medicine formulation.Phytomedicine 2003; 10: 474–82.13 Auddy B, Ferreira M, Blasina F et al.Screening of antioxidant activity of threeIndian medicinal plants traditionally usedfor the management of neurodegenerativediseases. J Ethnopharmacol 2003; 84:131–8.14 Dwivedi S, Jauhari R. Beneficial effects ofTerminalia arjuna in coronary arterydisease. Indian Heart J 1997; 49: 507–10.15 Shah ZA, Vohora SB. Antioxidant/restorative effects of calcined goldpreparations used in Indian systems ofmedicine against global and focalischaemia. Pharmacol Toxicol 2002; 90:254–9.16 Jagtap AG, Shirke SS, Phadke AS. Effect ofa polyherbal formulation on experimentalmodels of inflammatory bowel diseases.J Ethnopharmacol 2004; 90: 195–204.972 THE BIOMEDICAL SCIENTIST   September 2004Ahmedi Syeda, Sanjiv Rughooputh andPamela Greenwell are members of theMedical and Molecular MicrobiologyResearch Group, School of Biosciences,University of Westminster, London. Mark de Fraeye/Science Photo Librarydosing with Kushta Tila Kalan, suggesting thatgold preparations have an importanttherapeutic role. Ulcerative colitisPolyherbal remedies, for example, comprisedof Aegle marmeloes, Coriandrum sativum,Cyperus rotundus and Vetiveria zinzanioids,have been used in animal models ofinflammatory bowel disease.16 Thisformulation produced results comparable tothose obtained with prednisolone in theexperimental model.Real alternativesIt is clear from a search of the currentliterature that a wide range of plants has thecapacity to treat diseases. Indeed, Unanimedicine would seem to offer a realalternative to Western pharmaceuticals incertain circumstances. Further scientific validation will allow safeuse of these products and lead to thedevelopment of new drugs. Many currentpharmaceutical agents owe their existence toresearch on plant products, and futureexploration of the basis of ethnic herbalremedies will, without doubt, highlight newand exciting therapeutic agents. nREFERENCES1 AHRQ evidence report (Chapter 41)www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.part.88879.2 Gale encyclopedia of alternative medicine.Gale-Thompson, 2002.3 Suryanarayana P, Kumar PA, Saraswat M,Petrash JM, Reddy GB. Inhibition ofaldose reductase by tannoid principal ofUnani medical textbook written in Arabic script and depicting the human skeletal system,photograph at the Nizamia General Unani Hospital, Hyderabad, India.

The Unani system of medicine: does it have a  scientific basis?

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The Unani system of medicine: does it have a scientific basis?

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