WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Minhaj.
World Journal of Pharmacy and Pharmaceutical Sciences SJIF Impact Factor 6.041
Volume 5, Issue 8, 1188-1193
Research Article
ISSN 2278 – 4357
MANAGEMENT OF IRRITABLE BOWEL SYNDROME (IBS) BY UNANI FORMULATION *Minhaj Ahmad Dptt. of Jarahiyat, Faculty of Medicine (Unani) Jamia Hamdard, Hamdard Nagar, New Delhi -110062 India.
Article Received on 31 May 2016,
ABSTRACT Irritable Bowel syndrome (IBS) is very common gastro intestinal tract
Revised on 22 June 2016, Accepted on 12 July 2016
disorder. 20 percent visiting patients of gastro intestinal tract disorder
DOI: 10.20959/wjpps20168-7376
suffer from Irritable Bowel Syndrome and this problem causes a lot of mental agony to the patients as well as the physicians who face a
*Corresponding Author Dr. Minhaj Ahmad
challenge treating this disease. The exact etiology of this disease is still unknown but most common factors are psychological disturbances like
Dptt. of Jarahiyat, Faculty
anxiety and depression. The patients present with variable abdominal
of Medicine (Unani)
symptoms, but constipation, recurrent diarrhea, pain and distention of
Jamia Hamdard, Hamdard
abdomen are predominant clinical features. The diagnosis is confirmed
Nagar, New Delhi 110062 India.
on the basis of clinical observation, otherwise most of the investigations are found in normal limit. No specific treatment is
presently available in any system of Medicine. Unani physicians have recommended different single and compound drugs for the treatment of various functional and organic gastro intestinal tract disorders. The powder of some Unani drugs: viz. bael (Aegle marmelos), Cumin (Cuminu cyminium), Aamla (Emblica Oficinalis) are reported in Unani medicine in the treatment of chronic diarrhea and dysentery. Keeping in view, an open trial was conducted in 30 patients. The compound formulation in the form of powder was administered in 15 patients of IBS, in the dose of 3 gram twice a day for 6 weeks. The placebo was also given to 15 patients for the same period and the same dose. The patients were kept under observation. The weekly clinical improvement was recorded. After 6 weeks of therapy, significant clinical improvement was observed. Re-occurrence of disease was reported in 26% patients only. KEYWORDS: Gastro colic disorder, Irritable Bowel Syndrome. Zaheer Kazib, Zalaqul Ama. www.wjpps.com ,
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INTRODUCTION Irritable Bowel Syndrome is also known as nervous indigestion, spastic colon, and intestinal neurosis, functional colitis, irritable colon and mucus colitis. There is no anatomical abnormality has been found.[1] It is extremely common gastro intestinal tract disorder, but very small proportions of patients seek treatment. 20 percent visiting patients of gastro intestinal tract disorder suffer from Irritable Bowel Syndrome. This problem causes a lot of mental agony to the patient as well as physician who face challenges for treating the problem. The problem is most frequently occurs in women and usually begins with the age of 20-30 years. The exact etiology is still unknown, but most common factor is psychological, like anxiety, hysteria and obsessive compulsive traits.[2] Irritable Bowel Syndrome is characterized by chronic gastrointestinal tract symptoms including recurrent abdominal pain, especially in left lower quadrant, altered frequency of defecation-frequent loose motion, diarrhea or constipation, a sense of incomplete evacuation, feeling of abdominal distension and flatulence etc. From Pathogenic point of view these symptoms
develops
because
of
two
factors
(i) Altered intestinal motility (ii) Increased visceral perception. The patients of Irritable Bowel Syndrome with diarrhea have accelerated transit to faecal material through the ascending and transverse colon, while patient with constipation have over all delay in colonic transit. The clinical presentation of Irritable Bowel Syndrome may be of three types: 1. First group may present with chronic abdominal pain and constipation. 2. Second group may present with chronic diarrhea may or may not be associated with pain or flatulence. 3. Third group may present with complaints-of diarrhea or constipation or both. The diagnosis of irritable bowel syndrome is based on characteristic complex symptoms and on the exclusion of organic illness, usually proctoscopy, barium enema, ESR, WBC count and microscopic stool examination is necessary to make the diagnosis. In case of IBS proctoscopy and Barium enema may reveal spasticity of the distal colon, but this is not necessary.[3] In Unani system of medicine, no such disease is mentioned in classical literature, which can be synonymous to Irritable Bowel Syndrome. But the various symptoms of Irritable Bowel www.wjpps.com
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Syndrome can be traced under the heading of different diseases such as Zalqul Ama, Zaheer Kazib, Ishal, etc. (Azam Khan). These diseases may mimic the symptoms of Irritable Bowel Syndrome. The treatment of such diseases is not only mentioned in Unani literature, but also successfully treated by Unani physicians. Although no specific and satisfactory treatment is present in western medicine, only symptomatic treatments were prescribed by most of modern physicians. However, psychotherapy contribute major role in the treatment of Irritable Bowel Syndrome and some physicians prefer to advice antidepressant drug like Amitriptyline. No doubt the antidepressant drugs give temporary relief, but produce longterm side effects. However no radical cure is achieved so for. In such circumstances, the alternative remedy is the need of hour. In Unani system of medicine several single and compound drugs are documented in ancient, Unani literature for the treatment of diarrhea, constipation, and Zaheer Kazib. The safoof of Unani formulation is prepared for the same purpose. It contains three drugs viz. 1. Bael ( Aegle marmelos), 2. Cumin (Cuminum cyminum); 3. Aamla (Emblica Officinalis) Bael (Aegle marmelos), the fruit and leaf of bael are medicinally used. It is used in chronic diarrhea, convalescent stage of typhoid, dysentery.[4,5] Cumin (Cuminum cyminum) seeds are carminative, aromatic; stomachic.[6, 7, 8, 9] Aamla (Embilica Oficinalis) it is refrigerant, carminative, used in diarrhea.[10,4] The formulation has been in use since ancient time: either as single ingredient or in combination form, by Unani physicians, as mentioned by Ibne Baitar; Najmul Ghani and Kabiruddin. It is also mentioned by writers of modern ethno-botanical literature.[4] keeping this fact in mind the formulation was selected for the study. MATERIAL AND METHODS The preliminary study was conducted in 30 patients who attended Majeedia Hospital, Hamdard University, New Delhi. All patients who were suffering from abdominal pain, diarrhea, constipation, alternative diarrhea with constipation, incomplete sense of evacuation, flatulence, abdominal discomfort were included in the study. However, those suffering from ameobiasis, ulcerative colitis, diverticulitis and other GIT disorder were excluded from the www.wjpps.com
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study. Detailed clinical history, physical examination and appropriate investigations were carried out to evaluate the cases of Irritable Bowel Syndrome. While taking history, specific note was made regarding psychological disturbances specially anxiety and depression. The clinical diagnosis was done on the basis of clinical observations, routine investigations, especially stool examination for ova, cyst and occult blood to rule out G.I. bleeding, amoebiasis and other protozoal diseases. The patients were divided into two groups A and B, each group having 15 patients. In Group A, the test drug i.e. safoof of Bael (Aegle marmelos), Cumin (Cuminum cyminum); and Aamla (Emblica Officinalis) was administered in the dose of 3 gram twice a day for 6 weeks. In group B, the placebo was administered in the same dose and duration. Patients were kept under observation and clinical assessment was done at every 2 weeks interval. RESULT AND DISCUSSION Irritable Bowel syndrome is most important GIT disorder causing distress to the patients as well as physicians. In the present study almost all the symptoms showed a variable response during and after the study in the test group as given in Table No.1, while in the Placebo group the symptomatic relief were not found significant in comparison with test group as depicted in Table No.2. Out of 15 patient of abdominal pain, 8 patients showed remarkable improvement at the end of 6 weeks treatment. These results can be attributed to medicinal property of. bael (Aegle marmelos), Cumin (Cuminu cyminum); Aamla (Embilica Oficinalis). These observations are affirmative to the action drugs described by Najmul Ghani, Kabeeruddin. In 8 patients who. had diarrhea, 4 patients who had constipation and 3 patient who had alternative diarrhea with constipation, showed improvement after 6 weeks of therapy. The possible action may be due to bael (Aegle marmelos), Cumin (Cuminu cyminum); Aamla, (Embilica Oficinalis). These clinical improvements are consistent with the finding of Najmul Ghani and Noor Kareem. Similarly, 12 patients who had symptoms of abdominal distension and 14 patients www.wjpps.com
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who had flatulence/bloating also showed significant clinical improvement. These clinical improvements may be due to medicinal property of the test drugs. In the study it was observed that on an average 60% patient got complete symptomatic improvement with the test drugs in comparison to placebo group. However, further detailed study is required to assess the complete efficacy of the drugs. Table 1. Showing of Clinical Improvement in symptom on IBS in test group Symptoms Abdominal Pain Diarrhea Constipation Alternate diarrhea with constipation Abdominal distension Nausea & vomiting Flatulence/Bloating Tiredness
15 8 4
After treatment No. of patient 6 3 1
3
1
66
12 04 14 12
6 2 7 5
50 50 50 58
Before treatment No. of Patient
% improvement 60 62.5 75
Table 2. Clinical improvement in symptom on IBS in Placebo group Symptoms Abdominal Pain Diarrhea Constipation Alternate diarrhea with constipation Abdominal distension Nausea & vomiting Flatulence/Bloating Tiredness
Before treatment No. of Patient 12 7 5
After treatment No. of patient 10 7 4
2
1
50
14 5 12 10
12 4 10 7
14.2 20 16 30
% improvement 16 00 20
REFERENCES 1. Norman ’S Williams (2013) Bailey & love ‘s short practice of surgery, CRC Press Taylor & Francis Group, broken sound park parkway NW, Suite 300 Boca Rotan, -1179. 2.
Churchil Lewingston Christopher Haslett (19991) Davidson's Principles and Practice of Medicine, -668-670.
3.
Harvey (1976). The Principle and Practice of Medicine pp. -839-840. Nadkarni, K.M. (1989). Indian Matria Medica, published by Ramdas bhatkal Popular Parkashan Pvt. Ltd., Bombay, pp. 45,408, 480.
www.wjpps.com
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4. Mohd. Imran, (2008) Tanqeehul Mufredat -18,79,124. 5. Kabeeruddin (1916). Tarjuma Sharah Asbab,- 247, 573, 583, 596. 6. Kabeeruddin, (YNM). Makhzanul Mufridat, published by Aijaz Publishing House 2861 kucha cheelan,Dariya Ganj New Delhi, pp. 152,322,55. 7. Ram Lubhaya, Dehli ke Muntakhab Murakkabat Goswami kutub khana 2043 Gali Qasim Jan Delhi pp.162. 8. Safiuddin (1999). Unani Advia Mufrida, published by Qaumi Kauncil Brae-urduzaban, New Delhi, pp. 28, 29, 171,65. 9. Ghani, N. (YNM). Khazeenatul Advia, published by Sheikh Mohd. Basheer and Sons. Lohare.
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