Management of Prostatomegaly (Izam-I-Ghudda-I-Mazi) in Unani System of Medicine: An Overview

Quraishi HA; Arsheed Iqbal; Shabir Ahmad Bhat; Naquibul
Islam and Qamar Alam Khan

doi:10.23880/oajun-16000167

Open Access Journal of Urology & Nephrology Research Article 8 min read

Management of Prostatomegaly (Izam-I-Ghudda-I-Mazi) in Unani System of Medicine: An Overview

Quraishi HA^*, Arsheed Iqbal, Shabir Ahmad Bhat, Naquibul Islam and Qamar Alam Khan

^* Corresponding author

ISSN: 2578-4676 10.23880/oajun-16000167 Received: September 25, 2019 Published: October 18, 2019

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18 references

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Keywords

Prostatomegaly Warm-e-Ghudda-e-Mazi Micturition Unani Medicine

Abstract

Prostatomegaly is the enlargement of prostate gland in elderly males which results urinary symptoms in them. The prevalence of prostatomegaly is age dependent with the initial development usually after 40 years reaching approximately 90 percent after 70 years of age. Since prostatomegaly itself is not a fatal disease but its most important outcome is urinary flow obstruction, which is miserable for the patient and affects physical activities and mental health of the person. The symptoms of prostatomegaly include hesitancy, increased frequency of micturition, dribbling, narrow stream, nocturia, retention of urine, urgency, incontinence etc. Great Unani physician have been managing depending upon the age and nature of the symptoms. The great ancient scholars have also managed this ailment by different regimental therapies, pharmacotherapy and dietotherapy.

Islam4 and Qamar Alam Khan5

drhaiderjamiahamdard@gmail.com regimental therapies, pharmacotherapy and dietotherapy.

Keywords: Prostatomegaly; Warm-e-Ghudda-e-Mazi; Micturition; Unani Medicine Management of Prostatomegaly (Izam-I-Ghudda-I-Mazi) in Unani System of Medicine: An Overview

Introduction

In classical literature of Unani System of Medicine prostatomegaly has been mention as Izam-i-Ghudda-i- Mazi Sada, Sala`a Ghudda-e-Mazi, Warm-e-Ghudda-e-Mazi, and Warm-e-Unq-e-Masanah [1, 2, 3]. It is a condition J Urol Nephrol

resembling the clinical feature discussed under *Usr-i-Bawl* (Dysuria), *Ihtibas-i-Bawl* (Retention of Urine) and *Taqtir-i-Bawl* (Dribbling of Urine), narrow stream, urgency, incontinence etc. in classical literature of USM. Unani Physicians have mentioned that *Warm-i-Aza-i-Mujawira* (Inflammation/swelling of neighboring organs) of urethra may compress it causing obstruction to flow urine [4, 5]. These conditions may be correlated to Benign Prostatic Hyperplasia (BPH) where enlarged prostate compresses prostatic urethra and produces symptoms such as hesitancy, intermittent voiding, diminished stream, incomplete emptying, and post void leakage.

It is caused by the abnormal accumulation of *Balgham Ghaliz* or *Mawad-e-Ghaliz* (Thick phlegm) which has been mentioned as the leading cause of swelling (*Auram*) / inflammation of any *Azw Ghudadi* (Gland) of the body [6]. It is characterized by urinary frequency, hesitancy, strangury and urgency with weak urinary stream. Patient may have feeling of incomplete bladder emptying, straining and terminal dribbling. Acute and chronic urinary retention may also be present. *Unani* physicians are treating the symptoms of BPH for centuries with safe *Unani* herbal remedies.

Review of Literature

Cause of Prostatomegaly is not much exactly understood but it is now clear that androgens have central role in its development [7]. In Unani system of medicine Prostatomegaly has been described under the headings of *Sala’a* *Ghudda-e-Mazi*, *Warm-e-Ghudda-e-Mazi*, and *Warm-e-Unq-e-Masanah*. However mostly in our classical texts symptomatic treatment of Prostatomegaly can be found under different headings like *Ehtabass-e-Baul*, *Taqteurul Baul*, *Usr-e-Baul* etc [8]. Father of medicine Hippocrates (*Buqrat*) described *Auram* (swellings) because of abnormality in four humors (*Akhlate arba*), a soft swelling is due to (Khilt-e-Balgham), a hard swelling (*Warm-e-Salb*) or *Sala’a* due to black humour *Khilt-e-Sauda* and third type is combination of the two (*Balgham and Sauda*). Attiba have categorized *Sala’a* (tumor) under the heading of *Warm* (an abnormal growth or swelling) [9]. Maseehi described *Sala’a* as a swelling or over growth due to Balgham or *Mawad-e-Galeez* [10].

The paradigm for the management of Prostatomegaly has shifted from being purely surgical to a combination of medical and surgical management in past two decades. Though trans-urethral resection of prostate (TURP) remains the gold standard in Prostatomegaly management, new clinical research has opened up avenues of medical management. Medical management is effective in reducing the symptoms and prostate size, but allopathic medicine do have various side effects like erectile dysfunction, loss of libido, impotency, vertigo, cardiovascular disorders etc [11, 12]. *Unani* physicians are treating the symptoms of Prostatomegaly by different Unani formulation and regimen.

Incidence

Benign prostatic hyperplasia (BPH) prevalence in Ghana is responsible for 60% acute retention of urine and 28.6% of haematuria. Worldwide prevalence of BPH varies from 20-62% in men over 50 years and this includes USA, UK, Japan and Ghana. BPH co-existing with PC – Reports from USA, UK and Japan and Ghana reveal moderate association of BPH and PC is 3-20%.

Prostate Cancer prevalence – There is high prevalence in USA, Scandinavian Countries, African Americans (AA) and Caribbean blacks. Ghana, Trinidad & Tobago have reported high prevalence of 6–10% in men aged 50 years and above. Overall PC causes 18% of disorders of the prostate gland. The worldwide incidence in men over 50 years is 11.7% that is 15th commonest of new cancers worldwide, 19% of new cancers in developed countries and 5% in developing countries [13]. The prevalence per population is lowest in Asia/China 1.9% or 10/100,000 in Caucasian Americans 1.4-2.4% or 104/100,000, African Americans 2.2-5.1% or 272/100,000, in Caribbean Men about 5-10% and we have established in Ghanaian Men from 6.3%-7% which is on the high side [14, 15].

Management of Prostatomegaly by different Unani formulation and regimental therapies.

*Ilaj-Bil-Ghiza* (Dietotherapy)
*Ilaj-Bil-Dawa* (Pharmacotherapy)
*Ilaj-Bil-Tadbeer* (Regimenal therapy)
*Ilaj-Bil-Yad* (Surgery)

*Usul-i-Ilaj* (Principles of Treatment)
*Tanqiya* (Evacuation of Morbid matter i.e. *Mawad-e-Ghaliz*).
*Talyin-o-Irkha-o-Tahlil-i-Waram* (To soften, relax and resolve the swelling / *Auram*).
*Ikhraj-i-Bawl* *Bazari-a-Qasatir* (Urethral catheterization) in acute retention.

*Ilaj-Bil-Dawa* (Pharmacotherapy)
Oral Administration of *Maul-Usul* with castor oil.
Oral Administration of *Joshanda* (decoction) of following drugs (Table 1) along with Gulqand in the morning [16].

	Drugs		Miqdaar (Quantity)
	Unani Names	Botanical Names
Badranjboya		Nepeta ruderalis Ham.	10.5gm
Badiyan		Foeniculum vulgare Gaertn.	10.5gm

Table 1: Ingredients of _Joshanda_. • Oral administration of _Joshanda_ (decoction) of Badiyan (Foeniculum vulgare Gaertn.) 10.5

• Oral administration of Safoof (Powder) of following

	Drugs			Miqdaar (Quantity)
	Unani Names		Botanical Names
Zanjabil		Zingiber officinale Roscoe.		4.5-7.5gm
Turbud		Ipomea turpethum Br.		4.5-7.5gm
Mastagi		Pistacia lentiscus Linn.		4.5-7.5gm

Table 2: Ingredients of _Safoof_. • Oral administration of 3.5gm of _Habb-e-Khizran_ (Pills Khizran) (prepared with fallowing ing

	Drugs			Miqdaar (Quantity)
	Unani Names		Scientific Names
Ayarij-i-Fayqra		Ayarij-i-Fayqra		10.5gm
Ghariqun		Agaricus alba Linn.		8.75gm
Shahm-i-Hanzal		Cirullus colocynthis Schard.		5.25gm
Turbud		Ipomea turpethum Br.		24.5gm
Jaoshir		Ferula galbaniflua Boiss.		4.5gm
Nawsharad		Sal ammoniac		7gm
Saqmuniya		Convolvulus scammonia Linn.		4.5gm
Juice of Gandana		Allium ampeloprasum Linn		Mix with all above

Table 3: Ingredients of _Habb-e-Khizran._ • Oral administration of 7-10.5gm _Habb-e-Wasili_ (Pills Wasili) prepared with fallowin

	Drugs			Miqdaar (Quantity)
	Unani Names		Scientific Names
Sumbul al Tib		Nardostachys jatamansi		03.5gm
Salikha		Cinnamomum aromaticum Nees		03.50gm
Shahm-i-Hanzal		Cirullus colocynthis Schard.		17.50gm
Turbud		Ipomea turpethum Br.		24.5gm
Habb-i-Balsan		Fruit of Commiphora opobalsamum Linn.		03.50gm
Asarun		Asarun europaeum		03.50gm
Saqmuniya		Convolvulus scammonia Linn.		14.00gm
Ud-i-Balsan		Commiphora opobalsamum Linn.		03.50gm
Mastagi		Pistacia lentiscus Linn.		03.50gm
Darchini		Cinnamomum zeylanicum Linn.		03.50gm
Zafaran		Crocus sativus Linn.		03.50gm
Sibr		Aloe vera Linn.		56.00gm

Table 4: Ingredients of _Habb-e-Wasili_. • Oral administration of _Safoof_ (Powder) of _Ustukhudus_ (_Lavandula stoechas_ Linn) i

Ustukhudus	Lavandula stoechas Linn	17.50gm
Namak Hindi	Common salt	07.00gm

Table 5: Ingredients of _Habb-e-Wasili_. • Oral administration of _Safoof_ (Powder) of _Ustukhudus_ (_Lavandula stoechas_ Linn) i

Table 4: Ingredients of Habb-e-Wasili.

Oral administration of Safoof (Powder) of Ustukhudus (Lavandula stoechas Linn) in a dose of 1gm with 12gm Of Itrifal Saghir, followed by administration of Joshanda (decoction) of Gul-i-Khatmi (Flower of Althae officinalis Linn.) 3gm., Mawiz Munaqqa (Vitis vinefera Linn.) 10 pices, Tukhm-e-Kasni (seed of Cichorium intybus Linn.) 6gm. Mixed with 12ml of honey and sprinkled with 6gm of Asphol (Plantago ovata Forsk).
Abzan (Sitz bath) with Joshanda (decoction) of following drugs [18] (Table 5).

	Drugs			Miqdaar (Quantity)
	Unani Names		Botanical Names
Babuna		Matricaria chamomilla Linn.		4.5-7.5gm
Shibit		Anethum sowa Roxb.		4.5-7.5gm
Bekh-e-Khatmi (Root)		Pistacia lentiscus Linn.		4.5-7.5gm

Table 6: Ingredients of _Joshanda_ with _Abzan_. • _Abzan_ (Sitz bath) with _Joshanda_ (decoction) of following drugs (Table 6).

	Drugs			Miqdaar (Quantity)
	Unani Names		Botanical Names
Babuna		Matricaria chamomilla Linn.		4.5-7.5gm
Nakhuna (Pods)		Trigonella uncata Boiss.		4.5-7.5gm
Banafsha		Viola odorata Linn.		4.5-7.5gm
Shih		Artemisia maritima Linn.		4.5-7.5gm
Qaysum		Achillea millefolium Linn.		4.5-7.5gm
Marzanjosh		Oliganum vulgare Linn.		4.5-7.5gm

Table 7: Ingredients of _Joshanda_ with _Abzan_. • _Abzan_ (Sitz bath) with _Joshanda_ (decoction) of following drugs (Table 7) i

	Drugs
	Unani Names		Botanical Names
Babuna		Matricaria chamomilla Linn.
Nakhuna ( Pods)		Trigonella uncata Boiss.
Banafsha		Viola odorata Linn.
Shibit		Anethum sowa Roxb.
Barg-i-Turb		Raphanus sativus Linn.
Bazr-i-Katan		Linum usitatissimum Linn.
Khar Khasak		Tribulus terristris Linn.
Karafs		Apium graveolens Linn.
Parsiyaoshan		Adiantum capillus-veneris Linn.
Khatmi		Althaea officinalis Linn.
Hulba		Trigonella foenum-graeceum Linn.
Sabus (Wheat husk)		Wheat husk
Barg-i-Karnab (Cabbage)		Cabbage
	Drugs			Miqdaar (Quantity)
	Unani Names		Botanical Names	Miqdaar (Quantity)
Babuna		Matricaria chamomilla Linn.		4.5-7.5gm
Shibit		Anethum sowa Roxb.		4.5-7.5gm
Bekh-i-Khatmi (Root)		Pistacia lentiscus Linn.		4.5-7.5gm

Table 8: Ingredients of _Joshanda_ with _Abzan_.

• Natul (Irrigation) with Joshanda (decoction) of following drugs (Table 8).

	Drugs			Miqdaar (Quantity)
	Unani Names		Botanical Names
Babuna		Matricaria chamomilla Linn.		4.5-7.5gm
Ard-i-Hulba (Flour of seed)		Trigonella foenum-graeceum Linn.		4.5-7.5gm
Khubazi		Malva sylvestris Linn.		4.5-7.5gm
Banafsha		Viola odorata Linn.		4.5-7.5gm
Nakhuna (Pods)		Trigonella uncata Boiss.		4.5-7.5gm

Table 9: Ingredients of paste. • Application of paste of _Shora Qalmi_ (Potassium nitrate) on the bladder area. • Application of

Table 9: Ingredients of paste.

Application of paste of Shora Qalmi (Potassium nitrate) on the bladder area.
Application of Roghan-i-Khasak at pubic region.
Application of Roghan-i-Babuna at pubic region.
Application of Roghan-i-Gul at pubic region.
Application of hot paste of Rewand Chini (Rheum emodi Wall.) mixed with Arq-i-Badyan at pubic area, testicles and around urethra.

Compound Unani Drugs

The compound formulations which have been given in Unani classical literature for the management of prostatomegaly are discussed below as in Table 10.


1	Itrifal Ghudadi [17]	5gm twice a day.
2	Habb-i-Ayarij [5]	2 pills twice a day.
3	Itrifal Saghir [17]	5-10gm at bed time.
4	Sharbat Dinar [16]	10-20ml after every meal.
5	Banadiq-ul-Bazur [5]	2 pills thrice a day.
6	Arq-i-Mako [16]	125ml twice a day.
7	Roghan-i-Khasak [18]	Local application on pubic region.
8	Habb-i-Hindi [16]	2 pills thrice a day.
9	Roghan-i-Babuna [18]	Local application on pubic region.
10	Roghan-i-Gul [18]	Local application on pubic region.

Table 10: Compound Formulation (Murakkab Adviya). _Ilaj-Bil-Tadbeer_ (Regimenal therapy) • Natul (Irrigation) • Urethral catheteri

Aghziya Muwallid-i-Sawda
Aghziya Muwa;;id-i-Balgham Investigation Required
USG (W/A).
Serum prostate-specific antigen (PSA).
Uroflowmetry.

Methodology

The databanks used to get information from journals and articles are Google, PubMed, Science Direct, Scopus and Google Scholar. For the search of primordial and current Unani classical literature author visited Library of Regional Research Institute of Unani Medicine (RRIUM), Srinagar, J & K, India and School of Unani Medical Education and Research Jamia Hamdard, New Delhi.

Conclusion

The morphological anatomy of the prostate gland has been established. They are the peripheral zone (PZ), transitional zone (TZ), central zone (CZ), the anterior fibro muscular area and the pre prostatic area. The contributions of zonal areas in a normal gland are PZ 70- 80%, TZ 10%, CZ 20%. In benign prostatic hyperplasia/hypertrophy/enlargement (BPH/BPE), only the transitional zone is affected and constitutes 100% of prostatomegaly. So it has been observed that these formulations when used clinically have marked effect in reducing the volume of the prostate by acting on the transitional zone. To overcome the misery of the prostatic symptoms and to maintain the proper sleep, the different regimenal therapies employed by Unani physician from time to time has in general gained the importance of Unani system of medicine for prostatomegaly.

References

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Management of Prostatomegaly (Izam-I-Ghudda-I-Mazi) in Unani System of Medicine: An Overview

Islam4 and Qamar Alam Khan5

Introduction

**Review of Literature**

**Incidence**

Compound Unani Drugs

Methodology

Conclusion

References

Cite this article

Review of Literature

Incidence