Obesity (Saman-e- Mufrat) has become a serious public health problem now a days. Obesity comes from a Latin word ‘obedere’, to devour and in English literature it means very fat.
It is a term used to describe body weight that is much greater than what is considered healthy. Obesity and overweight occurs due to imbalance between calories consumed and calories utilized. It is a state of abnormal growth of adipose tissue, due to enlargement of fat cell size or an increase in fat cell number or in combination. In simple words Obesity is excess accumulation of fat tissues beyond the limitation of the skeletal and muscular requirement. Almost obesity is a hereditary problem but due to excess use of fatty items in routine diet may develop this disease.
It is a vital nutritional or the metabolic disorder where the percentage of fat tissue (adipose tissue) increases disproportionately owing in imbalance of energy intake and energy expenditure. Sedentary lifestyle along with excessive calorie consumption is the main cause of Obesity.
In spite of tremendous development in the medical science several diseases are still challenging to human being and efforts are continue to conquer them. Obesity is one of them. Although certain level of weight gain is a good sign of health. If it exceeds normal limit then it becomes dangerous.
It is one of the leading preventable causes of death which is affecting the whole world. W.H.O. projects that by 2015, approximately, 2.5 billion adults will be overweight and more than 700 million will be obese. Obesity is the fifth leading risk for global deaths. At least, 2.8 million adults die each year as a result of being overweight or obese. In addition, 44% of the diabetes burden, 23% of the ischemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity. WHO global estimates for the year 2009, reported 1.5 billion people were overweight, of these, over 200 million male and nearly 300 million females were obese. Overall, more than one in ten of the world’s adult population was obese. In 2010, around 43 million children under five were overweight. Currently population of India is 1.22 billion among them 199 million are obese. The National Family Health Survey (N.F.H.S) shows that 12.1% men and 14.8% women in India are either overweight or obese. It reduces life expectancy by 7.1 years in men and 5.8 years in women.
Obesity invites the various dangerous diseases, it is a risk factor in the development of hypertension, diabetes mellitus, gall bladder diseases, coronary heart diseases, breathing difficulties during sleep, various gynaecological problems, and certain type of cancers, osteoarthritis, other musculoskeletal diseases and infertility.
Body mass index (BMI), which is a measurement which compares weight and height, defines people as overweight (pre-obese), if your BMI is between 25 kg / m2 and 30 kg / m2 and obese, if it greater than 30 kg / m. and more than 40 is considered as morbid obesity.
According to ancient Unani medicine texts, Obesity (Saman-e- Mufrat) is an oldest recognised disease. Saman-e- Mufrat means excessive fat which accumulates in the body. It is also known as farbahi, which is a persian word, means motapa (obese).
Hippocrates (Buqraat) (460 BC), was the first Physician who realizes the dangers of obesity and its association with diseases. He gave detailed description of obesity including its complications, prevention and management in his famous book “Fasool-e- Buqratia”.
Galen (Jalinoos) (119-200 AD), quoted that obese persons die early in comparison to the lean and thin persons.
Ali Bin Rabban Tabri (700-780 AD) has described aetiology and pathophysiology of Saman-e- Mufrat in his famous book Firdaus-al- Hikmat. He has emphasized that excess eating and sedentary life style are most important factors for the obesity.
Abu Bakar Mohammad Bin Zakariya Razi (860-925 AD) described that oily food (Tar Ghiza) is responsible for the obesity. He classified the obesity into general and local types and has given separate treatments for both types.
Anicena (Ibn-e- Sina) (980-1037 AD) focuses on the decrease in food intake (taqleel-e- ghiza) as the important tool for obesity treatment.
Ibn-e- Hubal Al Baghdadi (1121–1213 AD) suggested that obese persons should avoid taking fatty diets, he has stressed on the gradual decrease in diet, otherwise, adverse effects will be observed in the patient.
Ibne Baitar (1197-1248 AD) in his famous book Kitabul jameul Mufredat al Advia wal Aghzia enlisted some anti-obesity (Muhazzil) drugs and recommended their use in the treatment of Obesity.
Mohammad Ismail Jurjani (12th century AD) has described the complications of obesity and their treatment. He has focused both diet therapy as well as drug therapy for the treatment of obesity.
Dawood Antaki (1541-1599 AD) mentioned complications and treatment of obesity in his famous book Tazkira Ulil Albaab. Azam Khan (1813-1902 AD) described treatment of Saman-e- Mufrit in his book Rumooz-e- Azam.
Hakim Rofus (98-171 AD) in his book “Tahzeel-e- Sameen” describes that obese people are more prone to diseases as they have lack of Khoon-e- Saleh (blood enriched with essential nutrients) and have excess amount of phlegm (Khilt-e- Balgham).
It is a phlegmatic (balghami) disease and hence (Khilt-e- balgham) predominates in the body of an individual. It is a predisposing factor in causation of obesity. In this condition loss of movements of organs (Aaz’a) is due to excessive accumulated phlegm (balgham) and cold temperament, hence the person becomes dull and lazy. This situation is just like arrest of body (Qaidul Badan). Phlegm after mixing with blood produces lubrication in its viscosity (Qiwaam). Increase in the phlegm (Balgham) causes increase in viscosity of the blood and also constrict blood vessels. Due to this phlegm and deposition of fat (Atherosclerosis) obstructs passage of oxygen (Nufuz-e- rooh) in the organs which finally cause death of the obese persons. When fat (Shahem) deposits in a particular organ it is called local or central obesity for example protrusion of abdomen due to the deposition of fat. When there is generalized deposition of fat in the body, is called general or peripheral obesity.
Unani scholars have mentioned that obese people are more prone to diseases as their Hararat-e- ghareezia becomes very weak due to Baroodat-e- mizaaj and constriction of vessels (Tangi-e- urooq). Due to vasoconstriction, Hararat-e- ghareezia becomes weak and slow, and weakness of Hararat-e- ghareezia causes itself vasoconstriction. Both these factors leads to decrease in the passage of “Rooh” to the organs and finally death ensue.
Causes of Obesity (Saman-e- Mufrat)
All the causes mentioned here are responsible for excess production of phleghm (balgham) as well as they also disturb body metabolism. The most common causes of obesity are Su-e- Hazam (dyspepsia), Ifraat-e- naum (excessive sleep), Ifraat-e- sukoon (excessive rest) and Qillat-e- harkat-e- badani (sedentary bodily movement). Other causes are
Complications of Obesity
Hakim Akbar Arzani has mentioned seven complications of obesity viz. Dyspnoea, palpitation, diarrhoea, infertility, haemorrhage due to rupture of blood vessels, paralysis, syncope and coma.
Classification of Obesity
It is divided into two types.
2. Umoomi Saman-e- Mufrit (Generalised or Peripheral Obesity): Generalized deposition of fat in the body is called general or peripheral obesity.
Principles of Treatment (Usool-e- Elaj)
According to Zakkaria Razi and Ibn-e- Sina, the treatment of Saman-e- Mufrat is based on the following principles:
1. To find out and eliminate the existing causes
2. Moderation of temperament (Ta’deel-e- Mizaj): Correction of abnormal cold temperament of an individual (Su-e- mizaj Baarid). Since the disease is cold in temperament, so herbal medicines having opposite temperament i.e. Hot and dry should be given. (Ilaj Bil Zid)
3. Minimize the intake of diet (Taqleel-e- Ghiza): In order to reduce Saman-e- Mufrat, bulky foods with least nutritional values should be given to obese person so that mesenteric vessels will get least time to absorb the nutrients completely. Due to bulky and less nutritious foods, it occupies the space of stomach and obese patient feels fullness in the stomach.
4. If there is accumulation of phlegm (Madda or Khilt-e- balgham) in the body, use of expectorants (Munafis-e- balgham Advia), Purgatives (Mushil-e- blagham Advia), Diuretics (Mudir Advia), diaphoretics (Mu’arrique Advia) and Desiccant (Mujaffif Advia) are highly beneficial.
5. If there is excessive amount of blood (Khilt-e- Dam ki zyadati) in the body, then the use of venesection (Fasd) is beneficial, otherwise it is better to use purgative of phlegm (Mushil-e-khilt-e- balgham).
6. Uses of anti-obesity drugs (Muhazzil Advia ka Istemaal)
Pharmacotherapy (Ilaj Bil Dawa)
Unani system of medicine is endowed with enormous single and compound drugs and regimes for the management of obesity that are safe and highly effective. Strategies involve general lifestyle modification includes healthy diet, maintain optimal weight, physical activity etc. Non-pharmacological therapy consists of diet and exercise, but most of the cases this form of therapy may not be helpful to reduce weight satisfactorily.
Unani herbal Medicine plays an important role in the management of obesity. Number of herbs is documented in Unani classics to reduce weight and studies have also been carried out for its anti-obesity activity. These include Luk-e- Maghsool, Muqil (Commiphora mukul Linn.), Kharkhask (Tribulus terrestris Linn.), Haldi (Curcuma longa Linn.) and Zeera Siyah (Carum carvi, Linn.) etc.
Single Unani Drugs
The commonly used single drugs (Advia Mufrada) for the purpose of reduction in body weight and management of obesity are:
Luk Maghsool/ Lac Coccus lacca
Muqil Commiphora wightii/ Commiphora mukul
Khar khask Tribulus terrestris Linn.
Zard Chob Curcuma longa Linn.
Lemon Juice Citrus lemon Linn.
Baobarang Embelia ribes Burm. f.
Tukhm Suddab Ruta graveolence Linn.
Karafs Apium graveolence Linn.
Juntiyana Roomi Jentiana lutea Linn.
Zarawand Taweel Aristolochia rotunda Linn.
Mur Makkai Commiphora myrrha Nees.
Marzanjosh Oliganum vulgare
Seer/ Lahsun Allium sativum Linn.
Nankhwah Ptycholis ajowan
Boora-e- Armai Armenian bole
Zeera siyah Carum carvi Linn.
Mastagi Roomi Pistacia lentiscus Linn.
Kundur Boswellia serrata Roxb.
Gaozaban Onosma bracteatum
Gulnaar Punica granatum Linn.
Sarphoka Tephrosia purpurea Linn.
Babchi Psoralea corylifolia Linn.
Compound Unani Drugs
The commonly used compound drugs (Advia Murakkaba) used for the purpose of reduction in body weight and treatment of obesity are:
Anqaroya kabeer wa sagheer, Asaanasiya, Eyarij feqra; Baladuri, Dawa-ul- Luk, Dawa-ul- Kurkum, Itrifal Sagheer wa Kabeer, Ithrifal Sanai, Jawarish Kamoni, Jawarish Falaafali, Majoon Muqil, Majoon Falafali, Majoone Seer Alvi Khan, Safoof Muhazzil, Habb-e- Muhazzil, Majoon Muhazzil, Sikanjbeen Unsuli, Sikanjabeen Lemoni, Qurs Tinkar, Sanjarniya, Tiryaq Kabir, Sirka Jamun, Asl-e- Musaffa etc.
Some Recommended Regimental therapies (Ilaj Bil Tadbeer)
Non phrmaco- therapeutic management of obesity has been mentioned by Unani scholars under this section where only regimens are mentioned. All these activities/ regimens will help to reduce body weigh.
Some Unani Homemade Remedies
· Take Safoof-e- Muhazzil 5 gm with 20 ml Arq-e- Zeera (Carum carvi) twice a day
· Take 5 ml Honey (A’sl-e- musaffa) with one cup of water and drink at morning in empty stomach.
· Aab-e- Lemun/ Lemon juice (Citrus lemon) is quite effective for obesity patients. Take 5-10 ml of Lemun ras, mixed it with one glass of water. This preparation must be taken on empty stomach in the morning.
· Make safoof-e- Bekh-e- Khatmi (powder of Althaea officinalis), safoof-e- Bekh-e- Qissa-al-Himaar (Powder of Pueraria tuberosa), safoof-e- Bekh-e- Jaosheer (powder of Ferula galbaniflua) in equal part and use it in the dose of 4.5 gm daily.
· Take safoof-e- Ajwain (Powder of Ptychotis ajowan), safoof-e- Tukhm sudab (Powder of Ruta graveolens), safoof-e- Zeera (Powder of Carum carvi) 1 part each, safoof-e- Marzanjosh (Powder of Oliganum vulgare), Boora-e- Armani 4 part (Armenian bole), Luk (Coccus lacca) 1 part. Preparation should be given in dose of 4.5gm (1 misqaal) with sirka (vinegar) on empty stomach.
· Daily use of decoction of Filfil (Piper nigrum) 2 part, Fitrasalyon (Apium graveolens) 2 part, Asaroon 1/2 part, Anisoon1/2 part is effective for weight reduction.
· Use Powder of Ajwain (Ptychotis ajowan), Tukhm-e- Suddab (Ruta graveolens), Zeera (Carum carvi) 1 part each, Marzanjosh (Oliganum vulgare) 4 part, Boora-e- Armani (Armenian bole) 4 part in the dose of 4.5gm daily.
· Use of Luk magsool (Coccus lacca) in the dose of 3.5gm with Sirka (Vinegar) in morning on empty stomach makes the person lean.
· Use Powder of Safoof-e- Ajwain (Powder of Ptychotis ajowan), Safoof-e- Zeera (Powder of Carum carvi Linn.), Safoof-e- Sudab (Ruta graveolens), Safoof-e- Karafs (Apium graveolens), Safoof-e- Badiyan (Foeniculm vulgare), Safoof-e- Marzanjosh (Oliganum vulgare), 1 part each, Boora-e- Armani (Armenian bole) 1/4 part, Luk (Coccus lacca) 2 part in the dose of 5gm daily.
· Use Safoof-e- Ajwain (Powder of Ptychotis ajowan), Safoof-e- Tukhm-e- Karafs (Powder of Apium graveolens), Safoof-e- Saunf (Powder of Foeniculm vulgare), Safoof-e- Sudab (Powder of Ruta graveolens), Safoof-e- Zeera (Powder of Carum carvi) each 1 part, Safoof-e- Marzanjosh (Powder of Oliganum vulgare), Boora-e- Armani (Armenian bole) 1/4 part, Luk Magsul (Coccus lacca) 2 part in the dose of 4.5gm daily.
· Use Safoof-e- Ajwain (Powder of Ptychotis ajowan), Safoof-e- Badiyan (Powder of Foeniculm vulgare), Safoof-e- Zeera siayh (Powder of Carum carvi Linn.), Boora-e- Armani (Armenian bole) 1/4 part, Luk (Coccus lacca) 2 part in the dose of 4.5 gm daily.
· Take Safoof-e- Ajwain (Powder of Ptychotis ajowan), Safoof-e- tukhm-e- Suddab (Powder of Ruta graveolens), and Safoof-e- Zeera siayh (Powder of Carum carvi Linn.) in equal quantity.
· Take Sandaroos (Trachelobium hornemanianum) 14.5 gm, Luk maghsool (Coccus lacca) 9 gm, Halelah zard (Terminalia chebula), Halelah siyah (Terminalia chebula), Haleela Qabuli (Terminalia chebula), Baleela (Terminalia bellerica), Amla (Emblica officinalis) 4.5gm each, Zeera siayh (Carum carvi) 7gm, Namak-e- lahauri 5gm. Make pills of above mentioned drugs, prescribe it according to temperament (mizaj) and age of the patient.
Note: Drugs should be taken under the advice of the qualified Unani physician. The patients are required to follow strict Unani regimen for optimum results.