Concept of Vitiligo (Bars) in Unani System of Medicine

Concept of Vitiligo in Unani system of Medicine

Vitiligo is an idiopathic, acquired, circumscribed depigmentary condition. It is characterized by the appearance of white patches on skin. These patched may be of different size and shape and have a tendency to enlarge peripherally. Vitiligo may be localized, segment or generalized. It may also become so extensive that almost all the body surface becomes white. The disease does not affect the general health of the patient. The physical disfigurement caused by this disease often leads to social embarrassment and physiological turmoil.

Vitiligo has been defined by ancient Unani physician as a skin disease. Its aetiology and treatment has been discussed in detail in the classics of Unani Medicine.[1,2,3]

According to Galen [4] the cause of vitiligo is the weakness of transformative faculty in the organs.

Rabban Tabari says impairment of blood and coldness of blood are the main cause of vitiligo. If the digestive faculty of the body cannot digest the food properly the blood of the whole body becomes impure. When this impurity occurs due to phlegm, appears the vitiligo.

Zakariya-Al-Razi has given a comprehensive description of this disease. Here are a few excerpts from his most esteemed work Al Hawi.

“Sometimes vitiligo Alba reaches a stage when grayish hair grows on the patches. Examine

whether it is curable or not by rubbing the affected areas; if the patches do not turn red then pick the lesion, if the whitish fluid comes out, then the possibility of recovery is remote and vice versa.”

“Vitiligo brings change in the skin and makes it bloodless. Sometimes the flesh beneath the skin also changes in the same manner.

“Vitiligo appears when flesh becomes phlegmatic. Thus the blood reaching this flesh also turns phlegmatic. And this (phlegmatic) flesh become (so soft) as that of molivsc. And the area getting such blood cannot be nourished properly and is changed into phlegmatic substance.

According to Razi if white patches of Vitiligo do not turn red on rubbing or when instead of blood, white fluid comes out on picking them, the possibility of recovery is

remote. If white patches are limited and non extensive and color of patches is yellowish or reddish early cure can be accepted. Conversely, when vitiligo is extensive and spreading, and where the affected areas become bloodless and the color of patches is cloudy, it is incurable. He also adds that the patches on the feet and head do not respond to treatment adequately. 

Shamoon says Vitiligo occurs due to frequent use of such food articles that contain water in excessive quantity.

Ibn-e-Sarabiyoon says, “ if Vitiligo spreads over a larger portion of the body or when it become highly chronic or when milky fluid comes out on pricking the vitiligo patch, it is not curable and vice versa”

‘The third factor is “Tashbeeh”the” the powers which convert the nutrients and give them the shape of tissue. In normal condition, this shaping is prefect by all means according to the characteristic of the particular tissue; by its consistency color etc. sometimes this function of ‘Ghazia’ (metabolism) is deranged as it happens in case of vitiligo. In this case the nutrient material reaches the

tissues and is retained there but does not take proper shape due to failure of this shaping power.

According to Unani physicians, the perfectness of tissue metabolism depends on four factors

1. Power of absorption
2. Retentive power: the power that retains the nutrients at tissue level so that they may be well assimilated with the tissue.
3. Transformative faculty: - the power that brings changes and shapes the nutrients into tissue proper.
4. Expulsive power: The power that excretes waste material from the tissue level and throws into the blood stream for final decomposition and excretion form the body.

In the above reference, Ibn-e-Sina says that the defects lie at the tissue level in the function of transformative faculty. Therefore, due to the failure of this power depigmention on occurs.

At another placed, discussing the diseases which can be transmitted from parents to offspring and from generation to generation, he says:

“There are certain diseases which transmitted from generation to generation e.g. vitiligo, baldness, phthisis, gout and leprosy.

Hakim Akbar Arzani: has also given a detail vitiligo in his famous book Tibb-e-Akbar. According to him, vitiligo is a whiteness appearing on the skin. When it spreads all over the body it is called generalized vitiligo. Its treatment becomes difficult, if it turn chronic and remains progressive. He has given an account of the prognostic factor in vitiligo. Those lesions which become red on rubbing are curable. 

“Hakim Azam Khan says:

“Vitiligo is a white patch which appears on the outer layer (skin) of the body. It may occur on certain parts or may involve whole of the body and turn its color white. This type of vitiligo is known as “Generalized vitiligo”, defect in transformative faculty being its cause.

LINEOF TREATMENT

There are lot herbal drug which enter into composition of various recipes used for the treatment of vitiligo such as Babchi, Chiraita Talkh, Ghanhak, Bhangra etc. but the most effective is Babchi.

BABCHI

Tabbi name   : Babchi

Botanical name: Psoralea Corylifolia Linn.

Family            : Leguminosea

 Habitat           : Throughout Indo Pak            Subcontinent

  Description    : An erect annual, 30-180 cm High leaves broadly elliptic, dentate;

         Flowers yellow or bluish purple in dense auxiliary long peduncle head; pods small 3.5-4.5*2.0-3.0mm, ovoid oblong somewhat compressed, mucronate, dark chocolate to almost black, seed one, smooth, adhering to pericrape. The fruit (seed) consists of a sticky oily pericrape; a hard seed coat and kernel. They are odorless but on chewing they emit a pungent odour and have a bitter unpleasant and acrid taste.

Part used: Seeds

Chemical Constituents: seeds contain 18.5% extractive material essential oil, a terpenoil, unsapomifiable essential oil, albumin, sugar, psoralen and isopsoralen (to which the activity of drug is attributed) and traces of manganese.

Actions: Musaffi-e-Khoon (blood purifier), Dafe Kiram-e-Ama (Anthelmintic) Akkal (Corrosive) and jail (detergent) antisauda and balghami fevers.

Harmful effect: it increases the bile.

Dosage:       1-3 gms. Twice or three times a day or as directed by Hakim.

PHARMACOLOGICAL STUDIES ON BABCHI 7(Psoralea Corylifolia Linn)

PRIMARY SCREENING/PHRAMA-COLGICAL ACTIONS, ACUTE AND SUB ACUTE TOXICITY STUDIES

         A comparative pharmacological study has been done with solvent free petroleum ether extracts of two samples of seeds Babchi (Psoralea Corylifolia). One sample was soaked in fresh ginger juice for seven days. After which the seeds were dried and extracted with petroleum ether (60 ̊C-80 ̊C).This purified extract was termed as extracted as such and this unpurified extract was designated as Extract ‘A’.

         A comparative pharmacological and toxicological study has been done with purified and unpurified extracts to see the difference between the pharmacological activates of the two samples and also to see if there was any reduction in the toxicity after purification. There was so significant difference in the yield of oil of both the samples. Yield of sample ‘A’ was

15.927% which that of sample ‘B’ was 15.746%.

Primary screening was done in male albino mice. The extracts were administered intraperitoneally as a 5% suspension in gum acacia in doses of 50, 100, 200, 400, and 800 mg per Kg body weight. The approximate L D of the drug was also estimated. Five mice were injected, intraperitoneally, 50% gum acacia was in the form of suspension to act as a control group, and PH of the drugs administered was 6.0. The most significant observation made with the both extracts, was central nervous system depression, more marked at higher doses. Both the extract potentiated barbital sodium induced sleep in mice at 1/10^th LD50 doses i-e, 3.31 mg per 100gm and 3.23mg per 100gm of extract A and B , respectively, when given intraperitoneally.

However, the extract gave no protection against metrazol induced convulsion in rates at 1/10 LFD 50 doses. A slight reduction in the body temperature was also observed.

There was no significant difference between the LD 50 values of purified extract B and unpurified A in male albino mice, the values being 323.6mg and 331.1 mg per Kg,

respectively when given intraperitoneally, as calculated by the graphic method of Litchfield and wilcoxan. A single oral dose up to 32 gm of both extracts was well tolerated and there were no significant toxic effect.

Both the extract had no action on isolated guinea pig ileum, but antagonized the contraction produced by the acetylcholine and histamine nonspecifically. The extracts had no action on guinea pig uterus but inhibited the contraction produced by histamine.

Unpurified extract ‘A’ was more effective in inhibiting the histamine induced contraction of guinea pig uterus. The extract had no appreciable effect on dog blood pressure and caused neither depression nor stimulation of isolated rabbit’s heart (Longen droff preparation). There studies indicate that there is no appreciable difference between pharmacological action and acute toxicity of seeds of psoralen Corylifolia after treating them with ginger juice.

Reference

1.         Tabari Abul Hassan Ali Bin Sahi Rabban “Firdausal Hakimat, Hamdard Foundation press 1981.
2.         Al Razi Abu Bakar Zakariya” Kitaab-ul-Hawi Fit Tibb” Hyderabad, Dairatul Marif Osmania university (1995)
3.         Ibn-e-Sina Bu Ali Shai Khur Rais “Al Qaroon Fit Tibb” vol. IV Lucknow Matba Naim(1906)
4.         Tabari Ahmed Bin Mohammad”Moalijat-e-Buqratia “Mss Hyderabad, Nizamia Tibbi College.
5.         Arzani Mohammad Akbar, Tibb-e-Akbar, vol II. Lahore Matba Islamia
6.         Azam Khan Hakim Iksir-e-Azam vol. IV, Lucknow, Nawal Kishore press(1885)
7.         Rama Lingaswami et.al. Clinical studies on Bars CCRUM page 15, New Delhi (1986).