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Approaches for the Treatment of Alzheimer's disease in Unani Medicine: A

Review

Article · January 2012

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Journal of Integrated Community Health 2012 (1)

Approaches for the Treatment of Alzheimer’s disease

in Unani Medicine: A Review
Md. Nafis Iqbal1 , Anis A. Ansari2 , Khalid Z. Khan2
1
PG Scholar, 2 Professor, Deptt. of Kulliyat, AKTC, AMU, Aligarh
E-mail: nafisnium22@g mail.co m

Abstract
Alzheimer’s disease is defined as a dementing illness in which anterograde amnesia is a dominant
symptom and is the most common cause of dementia among older people. There is no direct reference to this
disorder in the classical Unani literature but Alzheimer’s disease is almost always associated with Nisyan or
fasaad-e-takhayy’ul or zehan ki kharabi. If we trace back the genesis of this problem we came to know that the
ancient Unani scholars were well acquainted with the basic concept of this disorder.
Although the aetiology is not very clear but Unani scholars have mentioned that this is due to les dar
balgham (viscid phlegm) and ratubat (fluid) in the brain or in other words due to sue mizaj barid yabis or sue
mizaj barid ratab which gives a clear cut idea of the occurrence of disease in old age. In Alzheimer’s disease
there is a decline in production of the neurotransmitter acetylcholine which causes depression. Depression
stimulates the phlegmatic humour too.
Treatment of Alzheimer’s disease in modern medicine has certain limitation because of adverse effect.
The world now looks on herbal generated drug. Unani System of Medicine is rich in such Unani drugs which
have the potential to prevent and delay the Alzheimer’s disease. Unani drugs; such as Muhafizaat, Muslihat,
Muqawwiyaat, Moaddilaat, Munish-e-Haraarat Ghareeziyah acts as memory enhancer, antioxidant potential
against reactive oxygen species etc.

Key Words: A lzheimer’s disease, Unani, Nisyan, phleg matic hu mour, antio xidant.

Introduction basic concept of this disorder. They also

mentioned the symptom and signs which are
Alzheimer's disease is defined as a dementing quiet similar to Alzheimer’s disease such as
illness in which anterograde amnesia is a memory loss, loss of judgement,
dominant symptom1 . This is the commonest disorientation, changes in mood behaviour etc.
dementia, accounting for over 65% of
dementia. It is a primary degenerative disease Nisyan (dementia) is a disease caused by
of the cerebral cortex2 . Alzheimer’s disease loss/impairment of Quwat-e-Zikr but
was first identified more than 100 years ago, loss/impairment of Quwat-e-Takhayyul and
but research into its symptoms, causes, risk Quwat-e-Fikr is also considered as Nisyan.
factors and treatment has only gained Nisyan i.e.Framooshi is the name of Quwat-
momentum in the last 30 years. hafiza ka fa’el kharab hona (impairment of
There is no direct reference to this disorder in power of memory) but Atibbah has explained
the classical Unani literature but Alzheimer’s as impairment of thoughtfulness and
disease is almost always associated with impairment of power of memory and
Nisyan or fasaad-e-takhayy’ul or zehan ki metamorphically speaking Nisyan (Dementia).
kharabi. If we trace back the genesis of this The impairment of these three Quwat (power)
problem we came to know that the ancient is actually a type of Kharbiy-e-zehen. The
Unani scholars were well acquainted with the impairment of these Quwa’h (power) means
there is loss of Fa’il (Function) or Tashvish
25
Journal of Integrated Community Health 2012 (1)

(disquietude) or complete loss of fa’il ratubat (moistness) in the brain or in other

(Function) 3 . words due to sue mizaj barid yabis or sue
mizaj barid ratab which gives a clear cut idea
Impairment of Quwat-e-Zikr and Quwat-e-
of the occurrence of disease in old age. In
Fikr together known as Humuq or Raoonat (in
which cognitive problems begins to interfere Alzheimer’s disease there is a decline in
with daily activities) and it affects very old production of the neurotransmitter
acetylcholine which causes depression. Apart
persons.4
from chemical causes, some psychosocial
Risk Factor factors i.e. stressful life events, death in close
relation, financial loss, loss of loved objects,
Established risk factors for Alzheimer's divorce are also responsible for depression.
disease include advancing age and a family Thus excessive depression is harmful to the
history. Putative risk factors include diabetes brain, and can lead to marked weakness of
mellitus, hypertension, cardiovascular disease, many of the body’s faculties, lack of vitality
and head trauma; evidence for and against
and energy, and to a marked lack of
each of these four conditions is inconclusive,
enthusiasm. Depression stimulates the
but the consensus is that at least diabetes and phlegmatic humour too. In addition to these
hypertension may play a role in the
they have also describe the etiology of fasad-e-
pathogenesis of Alzheimer's disease. Low
zikr, fasad-e- fikr and fasad-e-takhayul.
educational achievement is also a consistent
risk factor, but most experts believe that Fasad-e-Zikr
educational level is a proxy for some other
factor, such as socioeconomic status or the  Burudat wa ratubat: As yabusat
early childhood medical and psychosocial motadil helps in retention and it is
environment. Protective factors have also been disturbed by excess rutubat.
proposed, but their status is much debated1 .  Burudat wa yabusat: Excess yabusat
causes salabat (sclerosis) preventing
Aetiology impressions of sensory perceptions in
The cause of Alzheimer's disease (AD) is brain. It is less common.5
unknown. Increase in free radical formation
and failure of antioxidant defences may Fasad-e-Fikr
contribute to neuronal degeneration.  Burudat wa rutubat: As its Rooh
Superoxide dismutase (SOD), the free radical becomes Kaseef and Ghaleez and
defence enzyme is reduced by some 25% in cannot move from ausat dimagh (mid
AD frontal cortex and hippocampi. AD is brain) to muakhkhar dimagh (posterior
occasionally familial. Genetic studies have brain) and backwards because of
shown linkage between familial (presenile) absence of Hararat (energy)
AD (FAD) and loci on chromosome I
(presenilin, PS1 gene), chromosome 14  Burudat wa yabusat in the mid brain
(presenilin, PS2 gene) and chromosome 21  Burudat only in the mid brain
(amyloid β-protein precursor, APP gene) 2.
One of the main toxic elements associated  Hararat (energy) resulting in
with Alzheimer's disease is aluminum. In Tashvish-e-Rooh.5
addition to these some nutritional and mineral Fasad-e-Takhayyul
deficiency are also responsible for this disease
e.g. deficiency of water soluble vitamin (Vit.  Yabusat
B & C) and minerals like boron, selenium,
zinc, magnesium etc. Untreated hypertension,  Hararat sada
high cholesterol, heart disease, diabetes or  Safra.5
depressions are also responsible for this
disease. Incidence and Prevalence
Although the aetiology is unknown Alzheimer’s disease, a chronic and progressive
but Unani scholars have mentioned that this is neurodegenerative state, is the leading cause of
due to les dar balgham (viscid phlegm) and dementia in the elderly6 . Alzheimer’s disease
is the sixth-leading cause of death across all

26
Journal of Integrated Community Health 2012 (1)

ages in the United States. It is the fifth-leading Eminent scholar Hakim wa Doctor Ghulam
cause of death for those aged 65 and older7 . Jeelani in Makhzan-e-hikmat described it as
Worldwide, there is a new case of dementia Ahmaq pan or hamaq-e-balahat (Dementia)
every seven seconds. More than 24.3 million and defined it as “in this disease there is slight
people in the world are living with changes in intelligence, sanity and memory
Alzheimer’s and it is the 7th leading cause of etc. the power of memory is weaken or
death today. vanished. There are anterograde amnesia and
no interest in recent or future activities rather
Pathology than become free from care or thoughtless and
Disruption of microtubule structure impairs ignorant. As the disease advances there is
the axonal transport, synaptic loss, and weakness or impairment of power of memory
neuronal cell death which are known to be the and patient behave like a childish12 .
leading causes for neurodegenerative disorders Abul Hasan Ali Bin Rabban Tabri in Firdaus-
such as Alzheimer’s disease (AD) 8 . The ul-hikmat narrates that in Nisyan there is
disease is characterized pathologically: accumulation of viscid phlegm and fluid in the
ß By neurofibril tangles in CNS, brain. Sometimes Nisyan is produced due to
excess of Yabusat (dryness) because due to
ß Formation of senile neuritic plaques excessive dryness brain has no memorizing
and cerebral amyloid deposits9 capacity. Sometimes whole body becomes
Loss of neurones, neurofibrillary cold then disease of Nisyan is produced. When
tangles, senile plaques and amyloid Nisyan occurs due to excessive fluid in brain
angiopathy are seen, especially within the then the power of memory and thinking
frontal, temporal and parietal cortex, weaken13 .
hippocampi, substantia innominata and locus
ceruleus2 . Histochemical staining demonstrates
Diagnosis
significant quantities of amyloid in plaques. Diagnosing Alzheimer’s disease still poses a
Many different neurotransmitter abnormalities serious challenge to the medical profession,
have been described, in particular impairment and it may take several years of testing before
of cholinergic transmission, although doctors can reach a decision on a patient’s
noradrenaline, 5-HT, glutamate and substance condition. A clinical evaluation of
P are also involved10 . Recent studies have Alzheimer’s disease must exclude all other
suggested that Alzheimer's disease is familial neurological, psychiatric, and medical
in about 15% of cases, usually inherited as an disorders that may be causing the mental
autosomal dominant trait. Specific genetic decline14 . Nevertheless, the diagnostic criteria
markers have been reported in some kindreds: are based on a variety of imperfect tests, as
Mutations of the amyloid precursor protein well as the experience and subjective
(APP) gene on chromosome 21 in early onset assessment of the physician performing the
cases, and the Apo lipoprotein E4 genotype in evaluation15 . Further-more, it is rare for a
families with later-onset disease11. diagnosis to be completed in one clinic visit;
rather, patients must be observed over time to
Clinical Feature document changes in cognitive function16 .
Loss of recent memory with a complaint of Strictly speaking, a definitive diagnosis of
forgetfulness is the most common presenting Alzheimer’s disease can occur only by
symptom. Loss of interest in life and pathologic examination of brain tissue after
personality change, sometimes with antisocial death17 . However the presence of
and disinhibited behavior, are also common neurofibrillary tangles (NFTs), senile plaque
early symptoms. Dysphasia, dyslexia, (SPs), neuronal death, synaptic loss, and brain
dysgraphia and dyscalculia are sometimes atrophy in specific brain areas, has been
particularly marked. Dyspraxic symptoms, shown to be hallmarks of AD18 .
such as topographagnosia (inability to find But according to Unani If a patient complaints
one's way about in familiar surroundings) and of excessive sleep, headache, secretion from
dressing apraxia, are frequent. Loss of bladder nose, mouth and eyes, forgetfulness of past
and bowel sphincter control may be an early or memory rather than the present along with
late feature. Sleep disturbance is common11 . variable pulse and crude whitish urine then it

27
Journal of Integrated Community Health 2012 (1)

is due to coldness and fluidity. If patient to these Majoon-e-Nisyan or Majoon-e-

complaints of less sleep, dryness of mouth and Baladur etc. may be used.
nostril, memorizing capacity of past but forget
The following are the list of herbs used in
recent events, pulse slow and rigid and urine
memory enhancement in Unani medicine.
whitish and clear then it indicates that the
These drugs are mainly those which clear the
disease is due to cold and dry3 .
beta-amyloid plaques, Acetyl cholinesterase
Principle of treatment inhibitors, anti-inflammatory, and
antioxidants.
 Remove the real cause
Juglans regia (akhrot): Strengthening the
 Refrain from excess sexual intercourse
and alcoholism vital organs particularly to older people20 .
Physically it looks like human brain. Walnut is
 If there is cold and coryza then keep
made up of 15 to 20% protein, contains
away from the use of cold water and
linoleic acid (omega 6 fatty acid) and alpha
cold bath
linoleic acid (omega 3 fatty acid), vitamin E
o Avoid from cold air and vitamin B6 making them an excellent
 Keep the head away from the exposure source of nourishment to nervous system. It
of cold air shows a good free radical scavenging activity
 Avoid venesection and could be effective in reducing oxidative
 Intellectual discussions, enjoying with stress. It may be able to relieve disorders like
friends, listening musical sounds, insomnia, depression, compulsive behavior21 .
 Give nutritious diet and muqawwi drugs Withania somnifera (Asgand): Asgandh has
like Kushta-e-Faulad or compound Mohallil-e-warm (anti-inflamatory), Muqawwi
comprising Amber, Mushk, Marwareed (tonic), Muqawwi-e-Hafiza (memory
etc. enhancing) and Muqawwi-e-Bah (aphrodisiac)
Treatment property22 . It also eliminates the putrid phlegm
and black bile20 . The active principles of WS,
As the primary cause of Alzheimer’s consisting of sitoindosides VII–X, and
disease is the accumulation or production of withaferin-A have been shown to exhibit
excess quantity of abnormal phlegm in the significant anti-stress and antioxidant effect in
brain, thus eminent Unani scholars are of the rat brain frontal cortex and striatum23 . The
opinion that its treatment should be started experimental studies in animals have
with Tanqiyah-e-dimagh (removal of deranged extensively demonstrated a GABA-mediated
material from the brain) through the means of action of WS24 .
Munziz and Mushil. Besides eradication of
diseased matter, tissue metabolism and their Acorus calmus (Waj turki): It is used as
faculties may also be strengthened which Muqawwi-e-Bah (Aphrodisiac), Mufarreh
include Muhafizaat, Muslihat, Muqawwiyaat, (exhilarant) and Muqawwi-e-Hafiza ( memory
Moaddilaat, Munish-e-Haraarat Ghareeziyah improving)20 . Recently, Acorus calamus has
acts as memory enhancer, antioxidant potential been reported to possess to high antioxidant
against reactive oxygen species etc. activity25 .

After tanqiyah, for brain strengthening give Centella Asiatica (Barhami booti): In Unani
one Qurs Marjan jawaharwala mixed with system of medicine it is used as Muqawwi-e-
Khmeera Gaujuban jawaharwala 7 masha dimagh wa Hafiza (Brain and memory tonic)
(7gm.) in the morning and Majoon-e-Nisyan 7 and Musaffi-e-khoon (blood purifier)26 ,
masha (7gm.) or Majoon-e-Bolus 7 masha mufaareh (Exhilarant) and Muqawwi-e-aza-e-
(7gm) or Majoon-e-Najah 7 masha (7gm.) in raisa (vital organ tonic)20 . It increases the
the evening and Itrifal Ustookhudoos 7 masha longevity, imagination and memory powe27 .
(7gm.) in the bed time for few days19 . Recent studies show that the chemical
composition of Centella plant has a very
Make a powder of Kundur 40 tola (480gm) & important role in medicinal and nutraceutical28
8 masha (8gm.) and filfil-esiyah 10 darham applications and it is believed due to its
(35gm.) and give one Misqal (4 1/2masha) or biologically active components of triterpenes
(41/2gm) daily for 40 days in the morning saponins. Beside the triterpenes, the
before breakfast with fresh water13 . In addition

28
Journal of Integrated Community Health 2012 (1)

antioxidant protection effect of Centella is 2. Ku mar. P.J, Clark. M.L., Clinical Medicine,
contributed by its enriched flavonoids and 6th edition, Saunders Elsevier, p.1253-1256
selenium contents to stimulate cell 3. Azam Khan, Hakim Moha mmad, Iksir-e-
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the pnema, heart and brain so it is useful in AYUSH, M inistry Of Health and Family
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5. Arzani, Akbar, Tibb-e-Akbar, (Urdu
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