Soo-ul-Qinya (Anaemia) May be informative___

Anaemia is one of the most common manifestations of disease throughout the world. It constitutes a major public health problem in underdeveloped countries and tropical areas. Indeed in some developing countries the majority of apparently normal people in certain population groups are anaemic. Even in advanced nations a third or more of patients admitted in hospital are anaemic. Globally about one thousand million people are anaemic. In India this problem is more common in rural than urban areas. Anaemia is extremely common in pregnant women and infants. A high rate of maternal mortality is therefore influenced by the prevalence of anaemia. Among all types, iron deficiency anaemia is most common. It is most important single nutrient deficiency in the world. According to Unani medicine, various synonyms of anaemia are: Faqr-ud-dam, Soo-ul-qinya, Qillat-ud-dam, Kami-e-khoon, Bhus and Fasad-e-dam. The term Faqr-ud-dam was coined in 20th century. Before this period the term Soo-ul-qinya was used  as its synonym. Faqr-ud-dam is an Arabic word which means shortage of blood. The Arabic word ‘’Soo-ul-qinya’’ means alteration or deficiency in storage, attributed to the iron deficiency anaemia. Some unani physicians describe Soo-ul-qinya as “Zof-e- jigar” (Weakness of liver) with the description of “Soo-e- mizaj” (Alteration in the temperament of individual). Others have described it as “Ridhayat-e- dam” meaning alteration in qualities of blood i.e. concentration, odour, viscosity and colour.  Ibn-e- sina (1927) explained that alteration in the temperament of liver causes its weakness which leads to soo-ul-qinya. Azam Khan (1940) described that the alteration in the qualities of the blood of liver either in colour, odour, concentration or viscosity is nothing but soo-ul-qinya. According to Kabiruddin (1927) and Arzani (1923), the pre ascetic state which is called Fasaad-e- mizaj results in soo-ul- qinya. Jurjani (1903) claimed that when the liver is affected it produces the general weakness which is the indication of the early stage of ascites. This condition is commonly described as ascites by other scholars. Considering various views and opinions of Unani scholars “Faqr-ud- dam” or “Soo-ul- qinya” is shortage of red blood cells in the circulating blood i.e either there is alteration in the haemoglobin (Hb) or defect or there is shortage of Hb% in the blood or there is marked increase in other components of blood resulting suspect of shortage of Hb%. When there is condition of indigestion of stomach and intestine for a long time, it results in disturbances in liver digestion. This results in the formation of impure blood. Thus, the impure blood comes into circulation for the supply of nutrition to the body organs and tissues. This impure blood specially serum accumulates in the body tissues and organs resulting in puffiness of face, oedema on lower and upper extremities. Body becomes pale/ yellowish. Simultaneously other conditions of weakness of lever develop. This whole episode is known as soo-ul- qinya. Types of Anaemia Following three types of anaemia have been described by Unani scholars 1.     Soo-ul- qinya sawiul kurriyatee (Normocytic Anaemia) 2.     Soo-ul- qinya Kurria kibriya (Macrocytic Anaemia) 3.     Soo-ul- qinya Fauladi (Hypochromic Anaemia) Aetiology (Asbaab) In Unani classical literature following causes of anaemia have been described.   1. Amraz-e- kabid (Liver Disorders) Soo-e- mizaj jigar: resulting slow or impure blood formation 2. Amraaz-e- Meda wa Amaá (Gastrointestinal disorders) Soo-e-mizaj medi (Distemperament of stomach) Zof-e- meda  (Weakness of stomach) Zarb wa khilfa (Frequent motions/ diarrhoea)  Deedan-e- Amaá (Intestinal worms) Meda ka amal-e- jarrahi (Stomach surgery) Qai-ud-dam (Haematemesis) Qabz-e- muzmin (Chronic constipation) Soo-e- mizaj barid (Abnormal cold temperament) 3. Amraz-e- Kuliya (Renal Diseases) Baul-ud- dam (Haematuria) Iltehab-e-kuliya muzmin (Chronic nephritis) 4. Hadd/Mutaáddi amraaz (Acute and infectious diseases) Diq wa sil (Tuberculosis) Humma-e- ejamia (Malaria) 5. Amraz-e- Aaza-e- Tanasul (Genital Disorders) Kasrat-e- Jimaa (Excessive Coitus) Jalaq (Masturbation) Usrut tams (Dysmenorrhoea) Kasratut tams (Menorrhagia) Hamal (Pregnancy) 6. Amraz-e-Sadr (Cardio-Pulmonary diseases) Nafs-ud-dam (Haemoptysis) Zof-e- Qalb (Cardiac Weakness) 7. Adwia wa Sammiyat (Drugs and Poisons) Para ke murakkabat (Compounds of Mercury) Seesa (Lead) Kasrat-e- Mai Noshi (Excessive use of alcohol) Hawaam Gazeedgi (Insect Bite) 8. Mutafarreqat (Miscellaneous) Naqs-e-Taghzia (Malnutrition) Faqr wa faqa (Poverty and Starvation) Ghair mamooli mehnat wa Riyazat (Extreme exertion and Exercise) Shadeed Jiryaan-ud-dam (Severe haemorrhage) Tafaqqurat (Anxiety) Ghair Sehat Bakhsh Rehaish (Unhygienic living condition) Mitti Khane ki Aadat (Clay chewing habit) specially in children Faulad ke injezab pe asar hone wale awaamil (Factors affecting the absorption of iron) Lahmeen ka naqse taghzia (Protein malnutrition) Ghair tabai tehali meekaniyat (Abnormal spleen mechanics) Namaloom khalal (Unknown interventions) Hayateen A, B12 & C ki kami ya fuqdaan (Deficiency of Vitamin A, B12 & C) Quwat-e- muallide dam ki kamzori (Haematopoietic weakness) Ghair munazzam ghiza (Improper diet) Bad hazmi (Dyspepsia) Ghair mamooli harkat (Over activity) Nafsiatee awaamil (Psychogenic disorders) 9. Amal-e- inhezam mein khalal (Disturbances in digestive process) According to Unani concept the food materials pass into four stages after ingestion. Disturbances in any of these four digestive processes may result in faqr-ud-dam (Anaemia), which impairs the normal liver function.  1.     Hazm-e-medi (Gastric digestion) 2.     Hazm-e- kabidi (Hepatic digestion) 3.     Hazm-e- urooqui (Vascular digestion) 4.     Hazm-e- uzwi (Cellular digestion) Signs and Symptoms As per Unani classical literature, the commonest signs and symptoms of faqr-ud-dam (Anaemia) are as follows. 1.     Face and body looks pale and  white 2.     Puffiness of face and eyelids specially on the extremities. Sometimes it may be on the whole body. 3.     Dysphagia 4.     Alternate diarrhoea and constipation 5.     Indigestion 6.     Flatulence  7.     Loss of appetite, sometimes increased appetite 8.     Stomatitis 9.     Weakness on mild exertion 10.   Pyrosis (Heart burn) 11.   Glossitis 12.   Delayed healing of wounds or ulcers  13.   Excessive sweating 14.   Polyuria  15.   Sleep disturbances 16.   Pitting oedema on feet 17.   Vertigo and giddiness 18.   Cold extremities 19.   Syncope (sometimes) 20.   Prominent veins on peripheries (at times) 21.   Palpitation (at times) 22.   Extreme loss of weight (at times) 23.   Splenomegaly  24.   Hepatomegaly (at times) 25.   Spasm and tremors  26.   Defective vision (at times) 27.   Jaundice and ascites (at times) Management/ Treatment Unani physicians have been treating anaemia successfully from very ancient times. Unani drugs are highly popular in the treatment as they are easily available, cost effective and have least side effects. As per Unani philosophy the basic principles followed for the management of anaemia are: Removal of underlying cause Improvement of digestion and appetite Correction of hepatic insufficiency Supplementation of nutritious diet Medication to improve the quality of blood Some Commonly Recommended Unani Single drugs Several experimental as well as clinical trials have been conducted on antianaemic properties of some commonly used Unani drugs and the efficacy of these drugs have been proven. These are as under.   Anar Punica granatum Linn. Amla Emblica officinalis Angoor Vitis vinifera Badam Prunus amygdalus Belgiri Aegle marmelos Baranjasif Artemisia vulgaris Chiraeta sheereen Swertiachirata Choqandar Beta vulgaris Chilghoza Pinus gerardiana Date palm Acer sacrum Fundaq Corylus avellana Ganna Sacrum officinarum Gajar Daucuscarotra Gul-e-surkh Rosa domescena Injeer Ficus carica Khurma Phoenix dactylifera Kunjud Sesamum indicum Khubs-ul-hadeed Iron rust Kela Musa paradisiac Kasni Chicorium intybus Kasoos Cuscuta reflexa/ indica Mako Solanum nigrum Marjan Coralium rubrum Mawizmunaqqa Vitis vinifera Mahuwa Madhuka indica Pumbadana Gossypium arboreum Pista Pistacea vera Qandsiyah Jaggery Sammul far Arsenic Shahad Honey Satawar Aspragus recemosus Seb Maluss ylvestris/ pumila Toodri Lepidium iperis Unnab Zizyphus vulgaris Zafran Crocus sativus Zanjabil Zingiber officinalis Some commonly used Unani Compound Formulations  Majoon Dabeed-ul- Ward Majoon Khubs-ul- Hadeed Majoon Aarad khurma Jawarish-e- Jalinoos Jawarish-e- Anarain Khamira Gaozaban Ambari Kushta-e- Heerakasheesh Kushta-e- Khabsulhadeed Kushta-e- Faulad Sharbat-e- Anar Sharbat-e- Faulad Dawa-ul- Kurkum Majoon Fanjnoos Maa-ul- Laham Maa-ul- Shae’er