Yarqaan (Jaundice) is a very common liver disorder. It is a condition in which too much bilirubin is circulating in the blood. (Bilirubin is a compound produced by the breakdown of haemoglobin from red blood cells/ it is the yellow breakdown product of normal heme catabolism, caused by the body's clearance of aged red blood cells which contain haemoglobin). Yarqaan (Jaundice) is a term used to describe the yellowing discoloration of the skin, mucous membrane and the whites of the eyes, caused by inadequate clearing and increased amount of serum bilirubin in the blood. This excess bilirubin causes the skin, eyes, and mucus membranes in the mouth to turn a yellowish in colour. Yarqaan (jaundice) may not be clinically visible until bilirubin reaches about 2mg/dl. Because the liver in involved in processing bilirubin, so jaundice is a side effect of conditions which affects the liver function. Severe jaundice can progress to even liver failure because build-up of bilirubin is extremely toxic. Consequently, bilirubin must continuously be eliminated in order to prevent lethal levels from accumulating.
Yarqaan (Jaundice) can be caused by various reasons like blockage in bile duct, which normally discharges bile salts and pigment to the intestine. The block in the bile ducts can be due to gallstones or inflammation of liver, also known as hepatitis. Jaundice may also be caused by excessive consumption of alcohol, cancer of pancreas haemolytic anaemia and other diseases which affect the liver such as malaria, yellow fever, typhoid and tuberculosis.
Symptoms of the yarqaan (jaundice) may include loss of appetite, nausea, yellow discolouration of the tongue, skin, eyes and urine, extreme weakness, severe constipation, dull pain in the region of liver and fever
Unani Approach to Yarqaan (Jaundice)
According to the philosophy of Unani system of medicine, Yarqaan (jaundice) is visible yellowish or blackish discoloration of skin and conjunctiva due to diffusion of yellow or black bile (khilt-e- safra ya sauda respectively) in blood vessel toward skin with or without infection.
Unani Medicine (Greeco Arab Medicine) is one of the ancient system of medicine, whereaA vast array of literature about liver diseases has been documented in Unani Medicine. Liver is an organ for origin of Quwaa (Natural power).
Galen, (129-217 AD) even stated liver counterpart with sun, a source of energy for others planets. Liver is also an organ for production of humours (akhlat) for nourishment, growth and development of the body. Each of the four humours named dam (sanguine), balgham (phlegm), safra (yellow bile) and sauda (black bile), carries their own normal temperament. The derangement in quality and quantity of humours, leads to liver pathologies including jaundice. Jaundice has been stated to be caused by quantitative or /and qualitative changes in safra (yellow bile) or sauda (black bile). Jaundice (Yarqan) was discussed widely and deeply in Unani Medicine.
Some possible causes are:
Some other causes are
According to Buqraat (Hippocrates), the father of medicine in his book ‘Jawame-ul- ilaj -wal- a’araz’ as quoted by Rhazes (850-925 AD) in ‘Kitab- al- Hawi Fil Tib,’ sometimes jaundice is caused by Pathological / Abnormal hot temperament of liver (Su-e- Mizaj-e- Haar Jigar) in blood vessel whereby sanguineous humour transmuted to bilious humour (yellow bile). In his famous book ‘Qanooncha Buqratiya’, he also described jaundice (yarqaan) as ‘discoloration of conjunctiva and skin associated with or without fever, is originated by sustained intake of contaminated or infected water and food.
According to Jalinoos (Galen), as quoted by Rhazes in his book ‘Kitab- al- Hawi Fil Tib,’ where he outlined the following aetiologies and types of jaundice,
According to Abu Sahel Maseehi, as quoted by Rhazes in ‘Kitab- al- Hawi Fil Tib,’ pathological hot temperament of liver or gall bladder (Hararat-e- kabid wa merarah) respectively are causative factors for jaundice (yarqaan). He also documented clinical features such as yellowish coloration of skin, constipation, coated tongue, weight loss and abdominal discomfort etc.
Muhammad Bin Zakariya Rhazes in his book ‘Kitab- al- Hawi Fil Tib,’ archived another causes of jaundice from the reference of Ibn-e- Maswah that are abnormality in functioning of liver, bile ducts and associated blood vessels.
According to Abu Bakr Muhammad Bin Zakariya Razi (Razes), in his well-known book ‘Al-Hawi fil Tib’ during jaundice evacuation of yellow bile/ bilirubin (safra) is obligatory. Furthermore, if physic (Tabiyat-e- mudabbira-e- badan) fails to do so, infection proceeds in yellow bile which generates fever. However fever also appears in inflammatory condition of liver, also stated.
According to Rabban Tabri (Tabri), in his renowned book ‘Firdaus-al- Hikmat’, where he also documented the mechanism of genesis of jaundice. He mentioned all the above aetiologies and also that physic (Tabiyat-e- mudabbira-e- badan) divert excessive bile from gall bladder towards skin for excretion through sweat. Which results high concentration of yellow bile (safra) in subcutaneous tissue imparting discoloration and jaundice tinge. Furthermore he also claimed that black bile (sauda) is also responsible for jaundice.
According to Ibn-e- Sina (Avicenna), great scholar in his book ‘Al Qanoon Fit Tib’ and Azam khan in ‘Akseer-e- Azam’, jaundice is nothing but visible discoloration of body (yellowish or blackish) due to diffusion of yellow or black bile from blood towards skin with or without infection. In case of infection, tertiary fever (humma-e-ghib) and quartan fever (humma-e- rub’o) develops in jaundice with yellow and blackish discoloration of body (yarqan safrawi wa yarqan saudawi) respectively.
Symptoms of Yarqaan (Jaundice)
Yarqaan (Jaundice) may appear suddenly or develop slowly over time. The symptoms of jaundice commonly include: Yellow colouration of skin and the white part of the eyes (sclera) -when jaundice is more severe, these areas may look brown yellow coloured inside the mouth dark or brown- coloured urine, pale or clay-coloured or bloody (black) stools, Itching, loss of appetite, weight loss, nausea, fever, abdominal pain, ascites (abdominal swelling) and fatigue.
Pathophysiology of Yarqaan (Jaundice)
Every day, a small number of red blood cells die in our body and are replaced by new ones. The liver removes the old blood cells, forming bilirubin. The liver helps in break down bilirubin so that it can be removed by the body in the stool. When too much bilirubin builds up and accumulate in the body, jaundice may result.
Management of Yarqaan (Jaundice)
The drugs used for the management of yarqaan (jaundice) stimulate the liver functioning. They prevent the liver against any damage. Very effective in treating Jaundice. They also stimulate the secretion of Bile Salts, improve appetite and increase food intake.
General Tips/ Preventive measures
Alcoholic patients can prevent or reduce the risk of yarqaan (Jaundice) by avoiding alcohol. Yarqaan (Jaundice) caused by hepatitis A and B can be prevented by taking vaccination. Other Jaundice underlying diseases like cirrhosis, thalassemia and cholestasis are inherited or autoimmune disorders and cannot be prevented.
In initial stages, bed rest is recommended. Thereafter return to normal activities should be gradual. Personal hygiene for the patient as well as attendant is very necessary. Proper screening of donated blood for HbsAg, anti HCV and elevated ALT has potential role in reducing the risk of transfusion associated hepatitis. Articles used by patient should be thoroughly cleaned by using disinfectant. Attendants, who come in contact with contaminated utensils, bedding and clothing should thoroughly wash their hands. Careful handling of disposable articles is also necessary.
Investigations and Follow-ups
Hepatomegaly along-with liver tenderness should be checked at regular intervals. Splenomegaly and Enlarged lymph nodes (Epitrochliar or Cervical) should be ruled out. In initial stages signs of toxemia may be present. Urine should be checked for any signs of proteinuria and bilirubinuria in initial stages. Blood test should be repeated for bilirubin, alkaline phosphatase, Alanine transaminase (ALT)/ SGOT and aspartate aminotransferase (AST)/ SGPT.
Recommended Diet for Yarqaan (Jaundice)
Proper oil and spice free diet and adequate rest is essential for recovery from jaundice. Here are some helpful dietary tips for those affected by yarqaan (jaundice). These are natural food that help in treatment and alleviation of Jaundice and its allied symptoms.
Homemade Preparations: some Unani single drugs and their homemade preparations are found to be very effective in curing jaundice are:
Compound Unani Prescriptions Recommended in Yarqaan (Yarqaan)
Grind Tukhm-e-Kasni (Endive) 3 gms, Tukhm- e-Khyarain (Cucumber) 3 gms, Zarishk (Berberry) 3 gms in Arq-e-Brinjasaf (Mugwort extract) 60 ml, Arq-e-Badyan (Fennel extract) 60 ml and give few drops after mixing in Sikanjibin Bazoori 48 gms or Sharbat Bazoori 48 gms.
Make a fine powder of equal parts of Asal-us- Soos (Liquorice), Tukhm-e- kasni (Endive seed) and Kala Namak (Black salt) then take 3 gm powder with water twice daily.
Crush fresh plant of Makoi and Kasni, squeeze the juice then warm it. During the boiling stage, mix 1gm Naushadar (Ammonium chloride) for removing foams and filter it. After filtration take 60 ml of obtained juice before meal.
Naushadar (Ammonium chloride) 1gm, Shoora Qalami (Potassium nitrate) 0.1gm, Revand Chini (Rhubarb) 3gm, make fine powder and take 3 gm in the morning.
Make a fine powder of Suahagah biryan (Borax) Naushadar (Ammonium chloride) and Phitkari (Alum) all in equal parts quantity, Shoora Qalami (Potassium nitrate) (½ part). Take 1gm powder with water, twice daily.
Take 250 mg Naushadar (Ammonium chloride), mix it in the 25ml Aab-e- barg-e- Mooli (Radish leaf juice) and take as such twice daily.
Take Gul-e-Babool (Babul flower) 6 gms, Gul-e-Nilofar (Water Lily flower) 6 gms and Revand Chini (Rhubarb) 4 gms, boil them in 250 ml of water, strain it and then take twice daily.
Take Gilo Neem subz (Margosa flower) 3.5 gms and Shahad (Honey) 12 gms. Boil them in 120 ml of water until it reduces to half of their quantity. Take twice daily.
Food items Restricted in Yarqaan (Jaundice)
Unani Compound Drugs Recommended in Yarqaan (Yarqaan)