Government Unani Dispensary, Kota North, Directorate Unani Medical Department, Rajasthan, India
Necrotizing pancreatitis is a serious and life-threatening complication of acute pancreatitis known as Waram-i-B?nqar?s H?d in Unani medicine, which results from premature activation of zymogen granules, most commonly caused by alcohol and gall stones. Its diagnosis is based on clinical, pathological, and radiological findings. According to the Unani concept, it usually can be treated by adopting a regimen of Waram-i-H?r (acute inflammation) and Fas?d-i-Dam wa Uf?nat (blood impurities & sepsis). The present paper deals with a case study of a 44-year-old married male patient suffering from alcohol-induced acute necrotizing pancreatitis treated with Unani formulation; Naq?‘-i-Shahatra, Arq Mako, Arq Kasni, Arq Badyan, and Jigrol as oral administration, by applying an interdisciplinary therapeutic approach with the aim to evaluate the efficacy of the drugs clinically, pathologically, and radiologically. Patients have shown excellent and admirable results in clinical characteristics and pathological reports, and finally acute necrotizing pancreatitis has completely resolved, and the pancreas was found normal in size and echotexture just after four and a half months of treatment as confirmed by ultrasonography. The drugs were found to be safe and highly effective.
Necrotizing pancreatitis is a serious and life-threatening complication of acute pancreatitis known as Waram-i-B?nqar?s H?d in Unani medicine, which is characterized by an acute inflammatory condition of the pancreas.[1] Pathophysiologically, acute pancreatitis occurs as a consequence of premature activation of zymogen granules, releasing proteases that digest the pancreas and surrounding tissue.[1] In about 80% of all cases, acute pancreatitis is mild and self-limiting with a mortality of less than 5%., but in 20% of the patients, however, it is severe, with local complications such as necrosis, pseudocyst, or abscess, and systemic complications leading to multi-organ failure, associated with 98% of mortality.[1] If less than 30% of the pancreas is necrotic, the morbidity prevailed at 40%, but mortality, infection, and organ failure rates have been reported at 20%. If more than 50% of the pancreas is necrotic, the rate of morbidity rises to 100%, mortality to 40%, infection to 50%, the need for debridement to 70%, and multi-organ dysfunction to 65%. Gall stones and alcohol are the most common causes of acute necrotizing pancreatitis. [2] Although the pancreas and its pathology have not been mentioned in any classic literature of Unani medicine, similar illnesses to acute pancreatitis can be explained under Waram-i-H?r (acute inflammation), Waram-i-Falgham?ni (sanguineous inflammation), ?umm? ‘Uf?niyyah (infective fever), and ?umm? Waramiyyah (inflammatory fever) described by Ali Ibn Al-Abb?s Maj?si (930-994 AD) and Al-Sheikh al-Ra'is Ab? ?Al? al-?usayn ibn ?Abd All?h ibn Al-Hasan ibn Ali ibn S?n? (Bu Al? S?n?) (980-1037 AD) in his famous book, Kamil al-Sana'ah al-Tibbiyyah (The Complete Art of Medicine), and Al-Q?n?n f? al-?ibb (The Canon of Medicine), respectively. [3,4] Waram-i-B?nqar?s Nakhri H?d (acute necrotizing pancreatitis) usually can be treated by adopting a regimen of Waram-i-H?r (acute inflammation) and Fas?d-i-Dam wa Uf?nat (blood impurities & sepsis). The principles of treatment for Waram-i-H?r (acute inflammation) are to abolish the causes (Asb?b), reduce congestion (Imtil?’), and provide rest (Suk?n) to the inflamed organ, and these can be achieved by utilizing Unani drugs that have multiple spectrum of actions including Muhallil-e-Waram (anti-inflammatory), Musakkin-i-Alam (analgesic), Mudirr-i-Bawl (diuretic), Mufatti?-i-Sudud (deobstruents), and Dafey-i-Safra (antibilious) in this patient.[5] Fas?d-i-Dam wa Uf?nat (blood impurities & sepsis) can basically be managed by various modes of care: Ta?fiyyah wa Ta‘d?l-i-Dam (blood purification and moderation), Taly?n wa Ish?l (laxation and purgation), Ta‘r?q wa Idr?r (diaphoresis and diuresis), Daf‘-i-Ta‘affun (removal of putrefaction), and I?l??-i-Ha?m (to improve digestion), and these can be accomplished by employing Unani drugs that have Mu?aff?-i-Dam (blood purifier), D?fi‘-i-Ta‘affun (anti-infective), D?fi‘-i-Jar?seem (antibacterial), Mudammil (vulnerary), H??im (digestive), K?sir-i-Riy?? (carminative) Mu??fi?-i-Jigar (hepatoprotective), Mu??fi?-i-Kulyah (nephroprotective), and immune enhancer properties.[6]
MATERIALS AND METHODS
Case Presentations
A 44-year-old married male patient suffering from alcohol-induced acute necrotizing pancreatitis visited the Government Unani Dispensary, North Kota, Rajasthan, India, for treatment on 28 April 2024 with the chief clinical features of recurrent fever, abdominal pain, abdominal distension, nausea, vomiting, and loss of appetite for the last 10 weeks. When queried about the background of his current ailment, he replied that he was quite well prior to 9 February 2024. After intake of heavy alcohol, suddenly he felt severe abdominal pain, abdominal distension, nausea, and vomiting. With these complaints, he was admitted to Maharaja Bheem Singh (MBS) Hospital, Kota, Rajasthan, on 9 February 2024. Here diagnosed as acute pancreatitis and treated till 20 February 2024 but with no relief. Eventually he shifted to Jeevan Rekha Super Specialty Hospital Jaipur with manifestations of high-grade fever, dyspnea, severe abdominal pain, nausea, and vomiting. Here acute necrotizing pancreatitis (ANP), ascites, and bilateral pleural effusions were diagnosed and treated by a gastroenterologist pulmonologist. Pleural effusions and ascites were resolved, but acute necrotizing pancreatitis persisted. Percutaneous catheter drainage (PCD) was placed for peripancreatic collections on 23 February 2024. The patient was discharged with advised medications on 4 March 2024. The patient was readmitted to that hospital with complaints of abdominal pain, nausea, vomiting, fever, and loss of appetite under his consultant on 11 April 2024 and treated here till his condition stabilized, then he was discharged on 17 April 2024, continuing treatment of ANP. The patient was again admitted to that hospital with complaints of abdominal pain, nausea, vomiting, fever, loss of appetite, and deterioration in kidney function on 23 April 2024 and treated here till his condition stabilized. He was discharged on 25 April 2024 with advised medication of ANP. Physical examination of the patient was expressed as he was extremely weak and bedridden. His body weight was dropping 27 kg from 74 kg to 47 kg. He had a percutaneous catheter drainage (PCD) inserted for peripancreatic collections, draining foul-smelling, thick pus of approx. 50-60 cc/day. He was on a liquid diet. Pallor was found positive. On examination of vital signs, the patient’s body temperature was 98.6? Fahrenheit, pulse rate was 110 beats per minute, blood pressure was 120/80 millimeters of mercury, and respiratory rate was 20 per minute. On systemic examination of the central nervous system, the patient was conscious and oriented; of the cardiovascular system, the first and second heart sounds were normal; of the respiratory system, the bilateral chest was clear; and of the digestive system, the tenderness was present in the upper abdomen region. The pathological investigations of blood were expressive that hemoglobin (Hb) was lowered, random blood sugar was normal, serum creatinine was raised, total leucocyte count was higher, and neutrophils were also higher, as shown in Table 1. Hepatitis B surface antigen (HBsAg) was found negative.
Table 1: Pathology Reports
|
Haematology
|
Results |
Units
|
Biological Reference Interval
|
|||
|
Base line |
Follow-up |
|||||
|
28 April 2024 |
04 May 2024 |
1 June 2024 |
29 June 2024 |
|||
|
Hemoglobin |
8.2 |
9.2 |
9.2 |
11.6 |
g/dl |
11.5 – 17.0 |
|
Haematocrit |
23.4 |
28.2 |
27.5 |
34.1 |
% |
37 – 54 |
|
R. B. C. count |
2.79 |
3.08 |
2.88 |
3.50 |
mill./ mm3 |
3.8 – 6.5 |
|
MCV |
83.8 |
91.4 |
95.0 |
97.4 |
fL |
80 – 100 |
|
MCH |
29.3 |
29.8 |
32.0 |
33.2 |
pg |
27 – 32 |
|
MCHC |
35.0 |
32.6 |
33.7 |
34.1 |
g/dl |
32 – 36 |
|
TLC |
12.82 |
8.68 |
8.95 |
9.06 |
th. / mm3 |
4.0 – 10.0 |
|
Neutrophils |
79.9 |
75 |
80.2 |
70 |
% |
50 – 70 |
|
Lymphocyte |
11.8 |
20 |
15.1 |
25 |
% |
20 - 40 |
|
Monocytes |
7.0 |
2 |
3.4 |
3 |
% |
0 – 10 |
|
Eosinophils |
1.2 |
3 |
0.7 |
2 |
% |
0 – 5 |
|
Basophils |
0.1 |
0 |
0.6 |
0 |
% |
0 – 2 |
|
Platelets count |
504 |
561 |
382 |
475 |
th. / mm3 |
150 - 500 |
|
Biochemistry of blood |
||||||
|
Serum Creatinine |
1.6 |
0.89 |
- |
0.94 |
mg / dl |
0.5 – 1.3 |
|
Blood Urea Nitrog. |
10.0 |
15 |
- |
13.8 |
mg / dl |
05 – 25 |
|
Potassium |
4.62 |
3.82 |
- |
4.25 |
mmol / L |
3.4 – 5.0 |
|
Sodium |
130.0 |
133.2 |
- |
136.2 |
mmol/ L |
135 – 145 |
|
Blood Sugar Random |
130.2 |
113 |
|
242.7 |
mg / dl |
< 140 |
RBC = Red Blood Cell, MCV = Mean Corpuscular Volume, MCH = Mean Corpuscular Hemoglobin, MCHC = Mean Corpuscular Hemoglobin Concentration, TLC = Total Leucocyte Count, g = gram, dl = deciliter, % = percent, mill.= million, mm3 = cubic millimeter or microliter, fL = femtoliter, pg = picograms, th. = thousands, mg = milligram, mmol = millimole, L = liter.
The magnetic resonance cholangiopancreatography (MRCP) screenings were suggestive of necrotizing pancreatitis sequelae with intra- and extra-pancreatic walled-off collections and peripancreatic fat necrosis. The detailed findings were shown in Table 2.
Table 2: Radiology Reports
|
Follow-up |
Scanning |
Findings |
|
Base-line 12.04. 2024 |
Magnetic resonance cholangio-pancreato-graphy |
The pancreas appeared bulky with heterogeneous signal intensity. A fairly large, poorly marginated, intra-extra pancreatic heterogeneous collection (8.2×4.5×4.5 cm, volume was 90 – 110 cc) was seen in the body and tail of the pancreas extending into the gastro-hepatic, gastro-splenic, lesser sac, and left paracolic gutter with internal areas of signal void – likely intra-collection air foci. A few small discrete collection pockets were seen in the gastro-hepatic space. There was marked surrounding retroperitoneal and mesenteric fat nodularity. The tip of the drainage catheter was seen in situ. Another smaller collection, measuring approx. 20 -30 cc, was seen in the pancreatic uncinate/root of the mesentery. There was marked peripancreatic fat inflammation and nodularity. There was edematous thickening of the posterior gastric wall. Marked circumferential diffuse edematous mural thickening was seen in distal transverse and proximal descending with partial luminal narrowing. No obvious bowel obstruction was seen. There was marked attenuation of the portal vein and SMV at the porto-splenic confluence. Splenic vein flow void was not visualized. Multiple tortuous peripancreatic collaterals were seen. Multiple subcentimetric-sized retroperitoneal lymph nodes were seen. |
|
Post-treatment of 7 days (04.05.2024) |
Ultrasono-graphy |
Heterogeneous in echotexture (pancreatitis) with ill-defined heteroechoic collection (measured at least 6×4 cm) in the pancreatic tail region extending up to the splenic hilum. |
|
Post-treatment of one month (01.06.2024 |
Ultrasono-graphy |
Visualized pancreatic head and body appearing normal in bulk. Tail was atrophied. Peripancreatic fat appeared markedly heterogeneous and nodular with marked retroperitoneal fat heterogeneity in the surrounding pancreatic tail and splenic hilar region with dirty appearance likely phlegm. A thin streak of free fluid was seen. No significant liquefied content was seen in the region. |
|
Post-treatment of four and half months (07.09.2024) |
Ultrasono-graphy |
Normal |
Assessment Criteria
The therapeutic efficacy of the Unani formulations was assessed on the basis of the clinical and radiological examinations as well as hematology and biochemistry of blood.
Informed Consent
Written consent was taken from the patient before beginning Unani treatment.
Therapeutic intervention
The patient was advised to take fat-free diets and continue allopathic care along with Unani treatment comprised of "Naq?‘-i-Shahatra," 35 grams soaked in 100 ml of warm water overnight, strained, and consumed on an empty stomach in the form of infusion (Naq?‘) in the morning and similarly in the evening; "Arq Mako" 50 ml and "Arq Kasni" 50 ml on an empty stomach twice daily; and "Arq Badyan" 50 ml and Jigrol 2 tablets after meals twice daily with normal water as oral administrations.
Naq?‘-i-Shahatra is a self-formulated polyherb obtained from Moalajat Sharah Asbaab (Tarjama-e-Kabeer). 2nd volume, and purchased from Attar (herbalist) by the patient.[6] Arq Mako, Arq Kasni, and Arq Badyan are pharmacopeal drugs, prepared according to the Essential Drugs List and Bayaz-e-Kabeer volume-2, while the Jigrol Tablet is a proprietary drug. These drugs are manufactured and marketed by GMP-certified Company Hamdard Laboratories (India).[7-9] Naq?‘-i-Shahatra was used regularly for 2 months, and the rest of the medicines were used for four and a half consecutive months.
Ingredients of Unani Formulations
Ingredients of Naq?‘-i-Shahatra (crude herbs), Arq Mako (distillate), Arq Kasni (distillate), Arq Badyan (distillate), and Jigrol (tablet) have been described in Table 3.[6-10]
Table 3: Ingredients of Naq?‘-i-Shahatra, Arq Mako, Arq Kasni, Arq Badyan and Jigrol
|
Unani Formulations |
Ingredients |
Scientific Name |
Parts Used |
Form |
Quantity |
|
Naq?‘-i-Shahatra |
Shahatra |
Fumaria vaillantii Linn. |
Whole plant |
Infusion |
5 gm |
|
Chiraita |
Swertia chirayita Buch. |
Whole plant |
Infusion |
5 gm |
|
|
Sarphuka |
Tephrosia purpurea Linn. |
Whole plant |
Infusion |
5 gm |
|
|
Gul-e-Mundi |
Sphaeranthus Indicus Linn. |
Flower |
Infusion |
5 gm |
|
|
Unnab |
Zizyphus jujube Mill. |
Fruit |
|
5 gm |
|
|
Sandal Surkh |
Pterocarpus santalinus Linn. |
Heart Wood |
Infusion |
5 gm |
|
|
Halela Siyah |
Terminalia chebula Retz. |
Fruit |
Infusion |
5 gm |
|
|
Arq Mako (each 125 ml) |
Mako Khushk |
Solanum nigrum Linn. |
Dry Fruit |
Distillate |
10.42 gm |
|
Arq Kasni (each 125 ml) |
Tukhm-e-Kasni |
Cichorium intybus Linn. |
Seed |
Distillate |
15.60 gm |
|
Arq Badyan (Each 125 ml) |
Tukhm-e-Badyan |
Foeniculum vulgare Linn. |
Seed |
Distillate |
15.60 gm |
|
Jigrol (each tablet) |
Tukhm-e- Kasni |
Cichorium intybus Linn. |
Seed |
Powder |
30.2 mg |
|
Berg-e-Jhao |
Tamarix gallica Linn. |
Leaf |
Powder |
69.80 mg |
|
|
Majeeth |
Rubia cordifolia Linn. |
Root |
Powder |
30.15 mg |
|
|
Revand Chini |
Rheum emodi Wall. ex Meisn. |
Root |
Powder |
58.85 mg |
|
|
Berg-e-Kasaundi |
Cassia occidentalis Linn. |
Leaf |
Powder |
48.13 mg |
|
|
Berg-e-Sanbhalu |
Vitex negundo Linn. |
Leaf |
Powder |
20.15 mg |
|
|
Bao Khamba |
Careya arborea Roxb. |
Fruit |
Powder |
29.45 mg |
|
|
Berg-e-Bartang |
Plantago major Linn. |
Leaf |
Powder |
15.19 mg |
|
|
Gul-e-Surkh |
Rosa damascena Mill. |
Flower |
Powder |
40.74 mg |
|
|
Kateli |
Solanum xanthocarpum Schrad. |
Whole plant |
Powder |
40.74 mg |
|
|
Mako Khushk |
Solanum nigrum Linn. |
Fruit |
Powder |
28.77 mg |
|
|
Badyan |
Foeniculum vulgare Mill. |
Seed |
Powder |
30.12 mg |
|
|
Tukhm-e-Kasoos. |
Cuscuta reflexa Roxb |
Seed |
Powder |
28.88 mg |
|
|
Biskhapra |
Boerhavia repens Linn. |
Seed |
Powder |
15.34 mg |
|
|
Naushadar |
Ammonium chloride |
Crystal |
Powder |
14.16 mg |
|
|
Chob Zard |
Curcuma longa Linn. |
Rhizome |
Powder |
35.84 mg |
|
|
Filfil Siyah |
Piper nigrum Linn. |
Fruit |
Powder |
14.0 mg |
|
|
Kushta Jast |
Calcinated Zinc |
- |
Powder |
15 mg |
RESULTS
The clinical and pathological as well as radiological improvements of the patient were observed to be excellent. After seven days of Unani treatment, the patient experienced complete relief from fever, abdominal pain, nausea, and vomiting. His abdominal distension and bloating were reduced, and his appetite improved. Pus discharges with thinner consistency and fewer foul odors from the drainage tube were decreased to 20-25 cc per day. After one month of treatment, the patient was able to ingest a routine diet, he regained physical strength, and he was able to walk. After two months of treatment, the drainage tube was removed by the consultant. After four and a half months of treatment, the patient's health has significantly improved. His body weight was measured as 57 kg as he gained 10 kg. The pathological and radiological improvements of the patient were found excellent, as shown in Table 1 and Table 2, respectively. All prescribed Unani formulations were found to be safe and effective.
DISCUSSIONS
Naq?‘-i-Shahatra is more effective and used to treat impurities of blood, including inflammations, ulcers, abscesses, toxicity of bacteria, viruses, and drugs, and skin diseases such as rashes, itching, scabies, herpes, urticaria, and eczema, etc. [6] Arq Mako is used to cure weakness of the liver (Zof-i-Kabid) and swelling of visceral organs like the liver, stomach, pancreas, intestine, and other internal organs; it also normalizes their functioning. It normalizes excessive heat of the body.[7,8,10] Arq Kasni removes excessive heat from blood, bile, and heat-induced headache. It quenches the thirst. It is highly efficacious in inflammation and enlargement of the liver and jaundice. [7,8,10] Arq Badyan relives flatulence and indigestion. It eradicates morbid matters of liver, stomach, kidney, and urinary bladder. It is useful in disorders of the liver, stomach, and intestines and normalizes their function.[ 7,8,10] Jigrol Tablet is a potent hepatoprotective and liver tonic. It normalizes liver functions. It promotes better appetite and digestion by stimulating bile secretion. It is effective against viral hepatitis and jaundice. It has anti-inflammatory, diuretic, digestive, and laxative properties.[9] Shahatra (Fumaria vaillantii), Chiraita (Swertia chirayita), Sarphuka (Tephrosia purpurea), Gul-e-Mundi (Sphaeranthus Indicus), Unnab (Zizyphus jujube), Sandal Surkh (Pterocarpus santalinus), Haleela Siyah (Terminalia chebula), Mako (Solanum nigrum), Tukhm-e-Kasni (Cichorium intybus), Badyan (foeniculum vulgare), Berg-e-Jhao (Tamarix gallica), Berg-e-Sanbhalu (Vitex negundo), Tukhm-e-Kasoos (Cuscuta reflexa), and Biskhapra (Boerhavia repens) possess anti-inflammatory (Muhalli-i-Waram) activity; they can resolve inflammation and morbid materials of the pancreas.[11-20] Shahatra (Fumaria vaillantii), Chiraita (Swertia chirayita), Sarphuka (Tephrosia purpurea), Gul-e-Mundi (Sphaeranthus Indicus), Sandal Surkh (Pterocarpus santalinus), Berg-e-Jhao (Tamarix gallica), and Berg-e-Sanbhalu (Vitex negundo) act as analgesic (Musakkin-i-Alam) agents; they can relieve pain caused by the inflammation of the pancreas.[11,12,14,15] Shahatra (Fumaria vaillantii), Chiraita (Swertia chirayita), Sarphuka (Tephrosia purpurea), Tukhm-e-Kasni (Cichorium intybus), Badyan (foeniculum vulgare), Tukhm-e-Kasoos (Cuscuta reflexa), Biskhapra (Boerhavia repens), and Majeeth (Rubia cordifolia) have diuretic (Mudirr-i-Bawl) properties, which may excrete out the inflammatory and morbid materials of the pancreas through urine.[11] Tukhm-e-Kasni (Cichorium intybus), Badyan (foeniculum vulgare), Tukhm-e-Kasoos (Cuscuta reflexa), Majeeth (Rubia cordifolia), and Biskhapra (Boerhavia repens) own Mufatti?-i-Sudud (deobstruents) property, which can eliminate the congestion (Imtil?’) caused by inflammation in the pancreas and peripancreatic nodularity.[11] Unnab (Zizyphus jujube), Sandal Surkh (Pterocarpus santalinus), and Tukhm-e-Kasni (Cichorium intybus) possess antibilious (Dafey-i-Safra) activity, which may relive nausea and vomiting.[11,17] Jigrol and Arq Badyan have digestive (H??im) and carminative (K?sir-i-Riy??) properties, which can help in the digestion of foods and may expel gases from the gastrointestinal tract.[7-10] Shahatra (Fumaria vaillantii Linn.), Chiraita (Swertia chirayita), Sarphuka (Tephrosia purpurea), Gul-e-Mundi (Sphaeranthus Indicus), Unnab (Zizyphus jujube), and Berg-e-Jhao (Tamarix gallica) act as blood purifier (Mu?aff?-i-Dam) agents, which can eliminate toxic, putrefied, and waste products from blood and pancreas.[11] Shahatra (Fumaria vaillantii), Chiraita (Swertia chirayita), Sarphuka (Tephrosia purpurea), Gul-e-Mundi (Sphaeranthus Indicus), Unnab (Zizyphus jujube), Haleela Siyah (Terminalia chebula), and Berg-e-Sanbhalu (Vitex negundo) have anti-infective (D?fi‘-i-Ta‘affun) activity, which can remove putrefied tissues of the pancreas and can prevent it from sepsis.[11] Chiraita (Swertia chirayita), Gul-e-Mundi (Sphaeranthus Indicus), Unnab (Zizyphus jujube), Haleela Siyah (Terminalia chebula), Berg-e-Sanbhalu (Vitex negundo), Mako (Solanum nigrum), Tukhm-e-Kasni (Cichorium intybus), and Badyan (foeniculum vulgare) have antibacterial (D?fi‘-i-Jar?seem) properties, which can kill the bacteria or stop the growth of the bacteria that are responsible for acute necrotizing pancreatitis. These drugs may relive fever, decrease total leucocytes, and inhibit pus formation in necrotizing pancreatitis by eliminating bacterial infection.[13,15,16,18-21] Shahatra (Fumaria vaillantii), Sarphuka (Tephrosia purpurea), Gul-e-Mundi (Sphaeranthus Indicus), Unnab (Zizyphus jujube), Haleela Siyah (Terminalia chebula), and Mako (Solanum nigrum) act as vulnerary (Mudammil) agents that may heal wounds of the pancreas and promote regeneration after acute necrotizing pancreatitis in humans by activating pancreatic stellate cells and their myo?broblastic offspring.[11,12,14-16,19] Sarphuka (Tephrosia purpurea), Gul-e-Mundi (Sphaeranthus Indicus), Unnab (Zizyphus jujube), Haleela Siyah (Terminalia chebula), and Mako (Solanum nigrum) act as Immune-enhancing drugs that can boost the immunity of the pancreas and body, ultimately allowing necrotizing pancreatitis to recover completely.[14,15,16,18,19] Unani philosophers believed that medicatrix naturae (Tabi‘at), a power endowed by nature to every individual, is the real healer (Mu‘alij Haqiqi) of the body, and the duty of a physician is to facilitate medicatrix naturae (Tabi‘at).[5] Jigrol, Shahatra (Fumaria vaillantii Linn.), Sarphuka (Tephrosia purpurea), Gul-e-Mundi (Sphaeranthus Indicus), Unnab (Zizyphus jujube), Haleela Siyah (Terminalia chebula), Mako (Solanum nigrum), and Tukhm-e-Kasni (Cichorium intybus) have Hepatoprotective (Mu??fi?-i-Jigar) properties that can protect the liver from the toxic effects of bacteria and viruses, as well as drug-induced toxicity.[9,12,14-16,18,19,21] Sarphuka (Tephrosia purpurea), Gul-e-Mundi (Sphaeranthus Indicus), and Tukhm-e-Kasni (Cichorium intybus) have nephroprotective (Mu??fi?-i-Kulyah) activity, which may protect the kidney from the toxic effects of the drugs and can reduce elevated serum creatinine in this case by normalizing kidney functions.[14,15,21] Chiraita (Swertia chirayita), Gul-e-Mundi (Sphaeranthus Indicus), Haleela Siyah (Terminalia chebula), Sandal Surkh (Pterocarpus santalinus), Mako (Solanum nigrum), Badyan (foeniculum vulgare), and Kasni (Cichorium intybus) possess hypoglycemic activity, which can maintain blood sugar levels of the patient in a normal range.[13,15,17-21]
CONCLUSION
It was concluded that Unani formulations; Naq?‘-i-Shahatra, Arq Mako, Arq Kasni, Arq Badyan, and Jigrol were found to be safe and highly effective in the treatment of acute necrotizing pancreatitis (Waram-i-B?nqar?s Nakhri H?d) clinically, with significant improvement in all related symptoms & signs; pathologically, with significant reduction in all elevated biochemical markers; and radiologically, as demonstrated the pancreas was found normal in size and echotexture just after four and a half months of treatment. Large-scale scientific studies are required to assess the drugs' effectiveness. Generally, emergency and acute illnesses should be treated with allopathic medicine. If the allopathic drugs are not responding, then Unani medicine, as the interdisciplinary therapy, can be adopted to provide comprehensive care for a patient and to save the life of a human being.
REFERENCE
Mohammad Shamim Khan*, Unani interventions in the Management of Acute Necrotizing Pancreatitis (Waram-i-B?nqar?s Nakhri H?d): A Case Report, Int. J. Sci. R. Tech., 2025, 2 (2), 199-205. https://doi.org/10.5281/zenodo.14916682
10.5281/zenodo.14916682
