WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Ali et al.

World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 2.786

Volume 4, Issue 02, 542-547.

Case Reports

ISSN 2278 – 4357

MANAGEMENT OF WAJAUL MAFASIL BALGHAMI (CHRONIC KNEE OSTEOARTHRITIS) WITH DIMAD (COMPOUND UNANI FORMULATION): A CASE REPORT Ali Hamid1*, Aslam Mohd2, Ahmed Shamim3 and Ahmed Kamal3 1

Dept. of Ilaj Bit Tadbeer, National Institute of Unani Medicine, Bangalore. 2

Dept.Of Moalijat,Allama Iqbal Unani Medical College, Muzaffarnagar.

3

Dept. of Ilmul Advia, National Institute of Unani Medicine, Bangalore.

Article Received on 03 Dec 2014, Revised on26 Dec 2014, Accepted on 18 Jan 2015

ABSTRACT Wajaul mafasil is also known as arthritis in modern medicine, which encompasses all types of joint pain such as Niqras (Gout), Wajaul Warik (Ischial pain), Irqun Nasa (Sciatica), Wajaur Rukbah (Knee pain) etc. Eminent Unani scholars classify Wajaul mafasil into sada or

*Correspondence for Author

maddi, on the basis of quantitative or qualitative derangement of

Ali Hamid

humours. Among maddi, Wajaul Mafasil Balghami is one, which

Dept. of Ilaj Bit Tadbeer,

occurs due to accumulation of abnormal Balgham (Phlegm) in the joint

National Institute of Unani

cavity, clinically it resembles with Chronic Knee Osteoarthritis of

Medicine, Bangalore.

modern medicine. Various modes of treatment are available in Unani

system of medicine to manage Wajaul Mafasil Balghami, among them Dimad is one, in which a thick paste of medicine is applied to the affected joint. From numerous formulations of Dimad, one formulation containing Hulba (Trigonella foenum- graecum), Tukhme Katan (Linum usitatissimum L.), Tukhme Khatmi (Althaea officinalis), Baboona (Matricaria chamomilla), Iklilul Malik (Astragalus hamosus), Aarad Jo (Hordeum vulgare L.) has been selected to evaluate its efficacy in management of Wajaul Mafasil Balghami. This Dimad was applied over the affected joint and replaced with new one after two days. Total five sittings of Dimad application were given to patient. Significant improvement was observed on Knee Injury and Osteoarthritis Outcome Score. KEYWORDS: Wajaul Mafasil Balghami, Dimad.

www.wjpps.com

Vol 4, Issue 02, 2015.

542

Ali et al.

World Journal of Pharmacy and Pharmaceutical Sciences

INTRODUCTION Wajaul mafasil is also known as arthritis in modern medicine, recognized since the beginning of human civilization. The term, Wajaul mafasil is a conjugation of two words i.e. waja and mafasil, waja stands for pain, and mafasil for joints. Hence, the term Wajaul Mafasil refers to as pain in joints, which encompasses all types of joint pain such as Niqras (Gout), Wajaul Warik (Ischial pain), Irqun Nasa (Sciatica), Wajaur Rukbah (Knee pain) etc. The concept of Wajaul mafasil has been described in detail in almost all ancient medical texts by eminent Unani physicians like Buqrat (Hippocrates 460 BC), Jalinoos (Galen 129-217 AD), Rabban Tabari (898 AD), Majoosi (930 AD), Razi (930 AD), Ibn Sena (1037 AD).[1] According to them, the pathological changes in the joints are caused mainly by quantitative or qualitative derangement of humours, which results in accumulation of Mawade Fasida (Morbid material) in the joint spaces. Hence, according to involvement of madda, Wajaul Mafasil could be of two types i.e. sada or maddi. Sada is one, in which derangement of humours is of simple type, i.e. only temperament of humour gets disturbed causing just functional disturbance of articular surfaces, known as Wajaul Mafasil Sada, it is of short duration, while in case of Wajaul Mafasil Maddi organic disturbance and quantitative changes take place in the joints, when it occur due to involvement of abnormal Balgham (Phlegm), known as Wajaul Mafasil Balghami, its clinical presentation very much resembles with the Chronic Knee Osteoarthritis of modern medicine. [2,3,4,5] As far as treatment of Wajaul Mafasil is concerned, it could be treated through Ilaj bil Tadbeer (Regimenal therapy), Ilaj bil Dawa (Pharmacotherapy) or Ilaj bil Yad (Surgery).[6] Among them, Ilaj bil Tadbeer is one mode of treatment in which various regimens like Dimad, Kimad, Dalk, Fasd, Taleeq, and Hijama etc. could be used to provide relief to the patient. From various regimens of Ilaj bil Tadbeer, Dimad (Some people write is as Zimad) is one, which is commonly prescribed in Wajaul Mafasil (sada or maddi) to provide relief and is considered to be the safest mode of treatment, as nothing goes inside the body for metabolism and excretion. In this mode of treatment (Dimad), a thick paste is prepared by mixing powdered drugs in a suitable oil or water.[7] It is used for local application. In present case study we use one such Dimad formulation containing Hulba (Trigonella foenumgraecum), Tukhme Katan (Linum usitatissimum L.), Tukhme Khatmi (Althaea officinalis), Baboona (Matricaria chamomilla), Iklilul Malik (Astragalus hamosus), Aarad Jo (Hordeum vulgare L.), and Roghan Baboona to elaborate its efficacy in the management of Wajaul Mafasil Balghami.[8]

www.wjpps.com

Vol 4, Issue 02, 2015.

543

Ali et al.

World Journal of Pharmacy and Pharmaceutical Sciences

CASE REPORT A 42 year old female patient was admitted in female IPD of NIUM Hospital, Bangalore with complain of diffuse progressively worsening of pain and swelling in both knee joints (left > right) since 8 years. The condition got aggravated by walking, squatting, kneeling and moving upstairs or downstairs and relieved by taking rest or by taking pain killer medications. There was no past history of trauma, weight loss, fever, diabetes mellitus, breathlessness etc. The built of the patient was average with fair colour. The gait was slightly antalgic. Her vital signs and auscultatory findings were normal. No pathology was found during systemic examinations. Physical examination of spinal column, upper and lower limbs did not show any deformity. The patient was unable to flex or extend her knee. Moderate swelling was present in both knees (left > right), palpable crepitations were observed during the active and passive movement of both knee. Complete haemogramme, serum lipid profile and radiological examinations were carried out. The biochemical and serum lipid values were found to be within normal limit. X-ray of bilateral knee reveals joint space narrowing with slightly increased radiologic density indicating osteoarthritis. On the basis of above findings, diagnosis of Wajaul Mafasil Balghami (Chronic Knee Osteoarthritis) was made. Patient has been advised to stop all sort of treatment before starting the therapy. The condition of the patient were assessed before and after the completion of treatment by clinical evaluation and direct interview with patient through a questionnaire method known as Knee Injury and Osteoarthritis Outcome Score (KOOS).[9] INTERVENTION All ingredients of Dimad formulation were grinded into powder form, and a thick paste was prepared by mixing with Roghan Baboona and lukewarm water.[7] This Dimad was applied over the affected joint and advises to keep it there for two days, after that, Dimad was replaced with new one. Total five sittings of Dimad application were given to patient. RESULTS Effect on pain score At zero time (before starting treatment) patients demonstrated poor pain control with previous medications, manifested by low pain score which indicates severe or extreme symptoms of pain. Treatment with Dimad resulted in significant increase in pain score started from the zero day (27.78 %) reaching maximum level after 5 sittings (69.44 %).

www.wjpps.com

Vol 4, Issue 02, 2015.

544

Ali et al.

World Journal of Pharmacy and Pharmaceutical Sciences

Effects on Symptom Score At zero time (before starting treatment), the patient showed poor management of arthritis symptoms, manifested by low score of symptoms (28.57%) according to the outcome of KOOS. Treatment with Dimad resulted in increase in symptoms score (64.29 %) in compare to zero days. Effects on Daily Living Activity (ADL) Score ADL score of the patient was found relatively low before starting treatment (zero time). During treatment with Dimad, improvement in ADL score was observed from the 1st sitting and becomes maximum after 5th sitting (17.65 % and 58.82 % respectively). Effects on Sport/Recreation Score Patient showed low sport/recreation score (5 %) at zero time before starting drug treatment and treatment with Dimad resulted in significant increase in sport/recreation score after 1st sitting (45 %), reaching maximum level after 5th sitting. Effects on Quality of Life Score (QOL) Before treatment (at zero time), the patient showed relatively low QOL score (12.50 %), indicating worse consequences of arthritis on the quality of life. Treatment with Dimad resulted in improvement in QOL score, started after 1st sitting (%), reaching maximum level after 5 sitting (50%). DISCUSSION The term Wajaul Mafasil may be used for variety of joint disorders, but the clinical features of Wajaul Mafasil Balghami mentioned in classical Unani text closely resembles with the Chronic Knee Osteoarthritis of modern system. Different methods of treatment has been described in detail in classical Unani text, among them Dimad is one non pharmacological method commonly used for management of Wajaul Mafasil Balghami. Hence, we use it to elaborate its efficacy in present study. During the whole course of treatment, symptoms were assessed two times (before and after) on Knee Injury and Osteoarthritis Outcome Score (KOOS), and significant improvement was observed. This outcome of treatment could be due to analgesic and anti-inflammatory affect of Dimad constituents.[10,11,12,13,14,15,16,17,18,19]

www.wjpps.com

Vol 4, Issue 02, 2015.

545

Ali et al.

World Journal of Pharmacy and Pharmaceutical Sciences

CONCLUSION Present study indicates that application of Dimad showed good results in the management of Wajaul Mafasil Balghami. Hence, it is recommended that further studies should be carried out with randomized clinical trials to evaluate the long term effectiveness of Dimad in the management of Wajaul Mafasil Balghami. The use of Dimad is relatively safe and effective, as constituents of Dimad are free from side effects. REFERENCES 1. Mohammad SH, Fasihuzzaman, Jabeen A, Siddiqui MA. Unani Concept and Management of Waja-Ul-Mafasil (Arthritis) with Special Reference to Hijamah (Cupping Therapy). Indo American Journal of Pharmaceutical Research, 2014; 4(2): 1098-1103. 2. Bagdadi IH. Kitabul Mukhtarat Fit Tib (Arabic), Vol 4. Hyderabad; Matba Jamiyat Dayiratul M'arif, 1364; AH, pp: 84-100. 3. Sena I. Alqanoon Fit Tib (Urdu, Translated by Ghulam Hasnain Kantoori), Vol 3. Lahore; Sheikh Mohammad Bashir & Sons: YNM, pp, 1119-1132. 4. Majusi AA. Kamil-us-Sena (Urdu, Translated by Ghulam Hasnain Kantoori), Vol 2. Lucknow; Matba Munshi Nawal Kishore: 1889, pp. 503-513, 521-522, 531-534. 5. Khan MA. Akseere Azam. New Delhi; Idara Kitabul Shifa: 2011, pp 836-852. 6. Nafees B. Kulliyate Nafeesi. (Tarjuma wa Sharah by Mohd Kabeeruddin). New Delhi; Idara Kitabul Shifa:YNM, pp 453. 7. Anonymous. Standard Unani Medical Terminology. New Delhi; CCRUM: 2012, pp 129. 8. Kabeeruddin M. Al-Qarabadeen, Vol 1. Karkhana Bazar, Faislabad (Pakistan); Malik Sons: N.A., pp746. 9. Roos EM, Rooj PH, Lonhmander LS, et al. Knee Injury and Osteoarthritis Outcome Score (KOOS): Development of a Safe Administration Outcome Measure. J Orthoped Sports Phys Ther, 1998; 78: 88- 96. 10. Yadav R, Kaushik R, Gupta D. The Health Benefits of Trigonella foenum-graecum: A Review. International Journal of Engineering Research and Applications, May-June 2011; 1(1): 032-035. 11. Sharififara F, Khazaelia P, Allib N. In Vivo Evaluation of Anti-inflammatory Activity of Topical Preparations from Fenugreek (Trigonella foenum-graecum L.) Seeds in a Cream Base. Iranian Journal of Pharmaceutical Sciences, Summer 2009; 5(3): 157-162.

www.wjpps.com

Vol 4, Issue 02, 2015.

546

Ali et al.

World Journal of Pharmacy and Pharmaceutical Sciences

12. Jyothi D, Koland M, Priya S. Investigation of Anti-inflammatory Activity of Ointments Containing Fenugreek Extract. Asian J Pharm Clin Res, 2014; 7(2): 66-69. 13. Kaithwas G, Mukherjee A, Chaurasia AK, and Majumdar DK, Antiinflammatory, Analgesic and Antipyretic Activities of L. usitatissimum (flaxseed/linseed) fixed oil. Indian Journal of Experimental Biology, 2011; 49(12), 932–938. 14. Kaithwas

G

and

Majumdar

DK.

Therapeutic

effect

of Linum

usitatissimum (flaxseed/linseed) fixed oil on Acute and Chronic Arthritic Models in Albino Rats. Inflammopharmacology, 2010; 18(3): 127–136. 15. Singh S, Nair V, Gupta YK. Linseed oil: an investigation of its Antiarthritic Activity in Experimental Models. Phytother Res, 2012; 26: 246-252. 16. Hajjaj G, Bounihi A, Tajani M, Cherrah Y, Zellou A. In vivo Analgesic Activity of Essential Oil and Aqueous Extract of Matricaria chamomilla (asteraceae). World Journal of Pharmacy and Pharmaceutical Sciences, 2014; 3(5): 1-13. 17. Sharifi F, Simbar M, Mojab F, Majd HA. Comparison of the Effects of Matricaria chamomila (chamomile) Extract and Mefenamic acid on the Intensity of Mastalgia Associated with Premenstrual Syndrome. Womens Health Bull, 2014; 1(2): e20042,1-5. 18. Shojaii A, Motaghinejad M, Norouzi S and Motevalian M. Evaluation of Antiinflammatory and Analgesic Activity of the Extract and Fractions of Astragalus hamosus in Animal Models. Iranian Journal of Pharmaceutical Research, 2015; 14 (1): 263-269. 19. Hakeem A, Tajuddin, Ghufran A, Nasreen J. Evaluation of Anti-inflammatory Activity of the Pods of Iklil-ul-Malik (Astragalus hamosus Linn). Indian Journal of Natural Products and Resources, March 2010; 1(1): 34-37.

www.wjpps.com

Vol 4, Issue 02, 2015.

547