The liver ailment yarqaan (jaundice) is fairly widespread. An excessive amount of bilirubin is circulating in the blood in this situation. (Bilirubin is a substance created when red blood cells’ hemoglobin breaks down; it is the yellow byproduct of healthy heme catabolism, brought on by the body’s removal of old red blood cells that contain hemoglobin.) Jaundice, also known as yarqaan, is the term used to describe the yellowish coloring of the skin, mucous membranes, and eye whites that is brought on by insufficient clearance and an elevated level of serum bilirubin in the blood. Heme is broken down into the tetrapyrrole pigment known as bilirubin (ferroprotoporphyrin IX).Each day, 250 to 300 mg of bilirubin are created, and 70 to 80 mg of that amount comes from the hemoglobin breakdown in senescent red blood cells. The remaining portion comes from erythroid cells in the bone marrow that are prematurely killed as well as from the oxidation of hemoproteins like myoglobin and cytochromes that are located in tissues all over the body. The skin, eyes, and mucous membranes of the mouth turn a yellowish color as a result of the excess bilirubin. Jaundice, or yarqaan, may not become clinically apparent until bilirubin levels reach about 2 mg/dl. Jaundice is a side effect of disorders that impair the liver’s ability to handle bilirubin, hence it is a side effect of conditions that damage the liver.Because the accumulation of bilirubin is so harmful, severe jaundice can potentially lead to liver failure. Therefore, bilirubin must be regularly excreted to avoid fatal quantities from building up.

Jaundice, or yarqaan, can be brought on by a number of factors, such as obstruction of the bile duct, which usually transports bile salts and pigment to the colon. Gallstones or hepatitis, an inflammation of the liver, can cause a clog in the bile ducts. Jaundice can also be brought on by chronic alcohol use, pancreatic cancer, hemolytic anemia, and other liver-damaging conditions like malaria, yellow fever, typhoid, and tuberculosis.

Loss of appetite, nausea, yellow discoloration of the tongue, skin, eyes, and urine, extreme weakness, severe constipation, dull liver ache, and fever are some signs of yarqaan (jaundice). (Zahid, 2016, Khan et al., 2015)

Demographic Information

Incidence and Prevalence

Gilbert syndrome (benign unconjugated hyperbilirubinemia), a hereditary condition that can cause jaundice at times of unusual stress or illness, is thought to affect about 5% of the population. Typically, this kind of jaundice is regarded as clinically unimportant. Cholelithiasis, or gallstones, affects about 10% of people and can result in jaundice.

Aetiology

Adults can develop jaundice due to a number of medical problems that interfere with bilirubin’s normal metabolism or excretion. The everyday breakdown and destruction of red blood cells in the bloodstream, which rupture and release hemoglobin, is the main source of bilirubin. The heme component of hemoglobin is then changed into bilirubin, which is then delivered to the liver via circulation for additional processing and excretion. Bilirubin is discharged into the gallbladder, where it is stored, then into the intestines after being conjugated (made more water soluble) in the liver. A portion of the bilirubin in the intestines is eliminated in the feces, while another portion is broken down by intestinal bacteria and eliminated in the urine. A malfunction of the normal metabolism or excretion of bilirubin results in jaundice. Because this interference with bilirubin metabolism or excretion can happen at different points, it is helpful to group distinct causes of jaundice according to the location of the problem. Pre-hepatic causes of jaundice are those that occur before the liver is secreted, hepatic causes that occur within the liver, and post-hepatic causes that occur after the liver has been secreted (the problem arises after bilirubin is excreted from the liver).

Differential Diagnosis

Only the elevated serum levels of urobilinogen and unconjugated bilirubin, which are elevated in cases of pre-hepatic jaundice, can be used to distinguish pre-hepatic jaundice from hepatic and post-hepatic jaundice. In the case of pre-hepatic jaundice, the serum levels of conjugated bilirubin, alkaline phosphatase, Alanine transferase, and Aspartate transferase are shown to be normal. Pre-hepatic jaundice also does not have conjugated bilirubin excretion through the urine. Based on five times higher bilirubin levels, hepatic jaundice can be distinguished from post hepatic and pre hepatic jaundice.

jaundice brought on by hepatitis.Using abdominal ultrasound and other radiological techniques, hepatic jaundice can be distinguished from post-hepatic jaundice. Based on diagnostic markers, such as alpha-1 Antitrypsin, Ceruloplasmin, Immunoglobulins, etc., hepatic jaundice can be distinguished from pre-hepatic jaundice. A major diagnosis of post-hepatic jaundice is an elevated serum bilirubin level and conjugation. Usually, serum bilirubin is less than 20 mg/dL. The blood bilirubin level in pancreatic cancer might increase to 40 mg/dL. Alkaline phosphatase, transaminases, and serum gamaglutamyltranspeptidase (Serum GGT) may be increased.

In malignant blockage, tumor markers such as CA-125, CA19-9, and CEA are typically high. Ultrasonography, plain abdominal x-ray, computed tomography, contrast-enhanced multi-sliced computed tomography, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), endoscopic ultrasound, magnetic resonance cholangiopancreatography (MRCP), cholescintigraphy, radionuclide scanning angiography, and staging laparoscopy are additional tests that can confirm.(Abbas et al., 2016)

Unani Concept

Jaundice (yarqan) is defined as a noticeable yellowish or blackish coloring of the skin and conjunctiva that results from the diffusion of yellow or black bile (safra or sauda, respectively), in blood vessels, toward the skin with or without infection. According to Razes (850–925 AD) in “Kitabul Hawi,” who cited Hippocrates (460–377 BC), the father of medicine, jaundice can occasionally be brought on by Sue- Mizaj Har Jigar (Abnormal/Pathological Hot Temperament of Blood Vessel), whereby sanguineous humor transforms into bilious humor (yellow bile). Furthermore, he defined jaundice as “discoloration of conjunctiva and skin coupled with or without fever, is caused by sustained ingestion of contaminated or infected diet” in his book “Qanoncha Buqratiya”. Galen, who Razes referenced in “Al- Hawi,” asserts that there are numerous causes and signs of jaundice.

• Food tainted with poison and insect bites can cause toxemia (hemolysis). As a result, there is an imbalance of the yellow pigment bilirubin (safra), which causes jaundice.
• “Obstruction in the liver” (sudda-e-kabid), another cause of jaundice, which he classified as “Obstructive Jaundice” (Yaqan-esuddi).
• Acute liver disease (Warm-e-jigar haad).
• Gall bladder that is pathological or non-functional.

Along with these etiologies, Razes in “Al-Hawi” archived additional Ibn-e-Maswahian causes of jaundice, including.

• Obstruction inside the liver (biliary canaliculi)
• Abnormalities in the function of the liver, bile ducts, and related blood vessels
• “Bohran” (a state of crisis and lysis in a disease)

PRODUCTION OF AKHLAT (HUMOURS) IN THE BODY

Something that is combined is referred to as khilt. Our bodies contain four different types of fluids: Dam (blood), Balgham (phlegm), Safra (yellow bile), and Sauda (black bile), all of which are essential in a mixed state. As a result, they go by the name Akhlat1. Akhlaat (Humours) are bodily fluids that are created as a result of the digestion and absorption of dietary products (Taghayyur wa Istehala). In reality, humours are the bodily fluids that the body absorbs from meals along with a variety of hormones and enzymes. They can be found in blood vessels, including arteries, veins, and the intervening capillaries. Humors are also found in lymphatics and lymph nodes, intercellular gaps, as well as other holes in the body between different organs1. These four liquids nourish the body and are in charge of keeping the moisture in the various organs moist. The Unani system of medicine strives to restore the humour’s equilibrium since, according to Unani physicians, any change in that equilibrium results in sickness.

Classification of Humours According to Properties

1. Khilt-e-Mehmood

It is capable of absorbing into the organ it must nourish, either alone or in combination with other Khilt, so it must replenish the contents that are lost, has broken down, ejected, or excreted from that specific organ.

2.Khilt-e-Ghair Mehmood or Khilt-e-Raddi

It is naturally formed in the body as a result of numerous metabolic processes, but it does not have the same benefits for the body that Khilt-e-Mehmood does. They go by the name Khilt-e-Fuzlah.

OTHER CLASSIFICATION

Jaundice is divided into two categories based on the nature of the discoloration and the creation of humour:

1. Yarqane Asfar (Yellow Jaundice)
2. Yarqane Aswad (Black Jaundice) (This kind of jaundice, which is rarely caused by an excess of bile, is not covered here.)

YARQANE ASFAR (YELLOW JAUNDICE)

This type causes the entire body’s skin, conjunctiva, and other secretions of the body and organs to discolor due to an abnormally excessive flow of Safra (bile) towards the circulatory system, or inside the blood. The root causes of jaundice fall into two categories.

1. Non Obstructive

a)  There is no restriction in the biliary tract’s regular course; instead, changes take place in the body’s many organs that cause the blood to turn into yellow humor.

b)  Inefficient bile excretion from the circulation 

There are numerous forms of jaundice in this group, which are briefly discussed here

Management of Yarqan in Unani Medicine

These are described as follows:

Bohran (Crisis)

Measures can be taken in this type of jaundice to aid the body’s natural expulsion systems (material). Hot water and Sikanjabeen should be provided to patients. Medicated tub baths and Sitz baths also produce positive results.

Su-e-Mizaj kabid haar (Hot temperament of liver)

Maa-ul-Sha’eer, Aab-eAnar Tursh (sour pomegranate juice/water) (barley water). You can administer Aab-e-Tarbooz, a Citrullus lanatus juice, and Aab wa Maghz Kaddu-e-Daraz, a Lagenaria siceraria pulp, and water. Afsanteen (Artemisia absinthium Linn.), Aab-e-Mako (water of Solanum nigram Linn.), Aab-e-Kasni (Cichorium intybus Linn.) (Juice prepared by straining fresh leaves), and Aalu Bukhara (Prunus domestica Linn.) are medications that can be administered as cooling as well as for blood cleansing. Qurs-e-Ward, Qurs-e-Tabasheer, and Qurs-e-Afsanteen. Granular sugar, Ijjas kibaar (Prunus domestica Linn.), 10 numbers of Tamar-e-Hindi (Tamarindus indica Linn.), and Tukhm-e Kasni (seeds of Cichorium intybus Linn.) are used as purgatives. Aab-e-Jau, also known as barley water or Hordeum vulgare, is highly advised as a diet.

Su-e-Mizaj Badan (Disturbed body temperament)

It is advisable to utilize medications that induce bile purgings, such as decanted liquid from soaked Haleela-Zard (Terminalia citrina), Aalu-Bukhara (Prunus domestica Linn.), Banafshah (Viola odorata Linn.), Tamar-eHindi (Tamarindus indica Linn.), Khayar-e-Shambar (Cassia fistula Linn.), and Cold syrups and a healthy diet should be recommended, for example, Aab-e-Kasni sabz (Cichorium intybus Linn.), Aab-e-Mako sabz (Solanum nigram Linn.), Aash-e-Jau (Semi-liquid preparation of barley), Aab-e-Kaddu (Lagenaria siceraria), palak (Spinacia Additionally effective are Qurs-e Kafoor and Aab-e Anaar-Dana-Tursh.

Amraz-e-Kabid (Hepatic disorders)

In this regard, it is important to eliminate underlying reasons and to avoid cholagogue medications.

Sammiyat-e-Haiwan (Toxic jaundice)

Several other remedies canare several other remedies that can be utilized, including Aab-e-Anaar (Punica granatum Linn.), Luaab-e-Isapghol (Plantago ovata Forsk.), Aab-e-Kasni (Cichorium intybus Linn.), Qurs-e-Kafoor, Aab-eJau (Hordeum vulgare Linn./bar, In addition, several unorthodox medications having antidote characteristics may be employed. Tiryaaq-e-Kabeer, Qurs-e-Tabasheer, and Aab-e-Anarain (punica granatum Linn. juice) or Qurs-e-Kafoor, each weighing 4.5 grammes (preparation of Cinnamomum camphora Linn.) 4.5 gramme

Hawa-e-Haar (Hot weather or air)

If jaundice is brought on by hot air, the patient’s surroundings should be cooled using ice and other items. Cold fruit juice or water, as well as a cool diet, should also be given. Examples include Aab-e-Anaar (Punica granatum Linn.), Aab-e-Seb (Malus-sylvestris Mill.), Aab-e-Tarbooz (Water of Citrullus lanatus),

Hepatic duct obstruction

Different methods, such as Hijamah (Cupping), Fasd (Venesection), Idraar-e-Baul (Diuresis), Ishaal (Purgation), Tareeq (Diaphoresis), and Irsaal-e-Alaq, should be used to expel superfluous bile from the body (Leeching). Following that, several Mufatteh-e-Sudad (deobstruent medications) should be administered, such as Ghariqoon (Agaricus alba), Kasni (Cichorium intybus Linn.), Aspand (Peganum harmala Linn.), Karafs (Apium graveolens Linn.), Bekh-e-Badyan (Foeniculum vulgare Mill.), Kababah ( Aab-e-Kasni Sabz (Cichorium intybus Linn.), Aab-e-Mako Sabze (Solanum nigram Linn.), and Shikanjabeen can be administered if the temperament is heated. Additionally, Ghiza-e-Lateefah (Easy-to-digest diets) is advised.(Khan et al., 2015)

Recommended Diet for Yarqaan (Jaundice)

For the body to heal from jaundice, a proper oil- and spice-free diet and enough rest are crucial. Here are some beneficial dietary recommendations for persons who are impacted by yarqaan (jaundice). These are natural foods that aid in the treatment and relief of jaundice and the symptoms that go along with it.

• Easy-to-digest food should be consumed in moderation to avoid overeating. Usually, the first 4–5 days should be spent on a liquid diet.
• It is advisable to consume a diet high in carbohydrates without added fat or seasonings.
• Drink boiling water at all times. A healthy fluid intake facilitates the body’s removal of extra bilirubin through the urine and stools. Make sure you only consume pure, untainted water.
• Vegetables and fruit juices should be consumed fresh or cooked since they aid the body’s electrolyte balance. Avoid juices in cans.

• A one-week fruit juice fast is particularly beneficial for the patient.
• Light foods such as fruits, yogurt, and porridge may be added to the diet once the bilirubin levels start to drop. Spinach and carrots are among the vegetables that can be eaten right now. Consuming eggs can also help you recuperate because they provide a small amount of lean protein. It is best to consume meals more frequently throughout the day and in smaller portions.
• You can include items like rice, salmon, or lentils in your diet when your bilirubin levels drop to nearly normal levels. Make sure to cook food without using any oil. Fish can be eaten either boiled or steam-cooked. Avoid eating meat or poultry at this time because it may be difficult for you to digest.

• Foods prepared in olive oil may be consumed if the yarqaan (jaundice) symptoms have abated and the patient has received the doctor’s consent. However, try to refrain from consuming foods high in cholesterol and those that are difficult to digest at this time because the body requires time to return to its regular functioning.
• Both bitter gourds (Karela) and drumsticks (Saijan Ki Phali) are extremely helpful for those with jaundice.
• Increase your consumption of calcium- and mineral-rich foods like iron and magnesium.

Food items Restricted in Yarqaan (Jaundice)

• Always stay away from hot or oily foods. Avoiding coffee, sugary meals, and artificial sweeteners is also advised during yarqaan (Jaundice). Avoid junk food and foods high in carbohydrates as well because doing so requires the liver to create more bile, which could make the sufferer’s situation worse.
• Avoid drinking alcohol, coffee, and tea during yarqaan (Jaundice). Alcohol, in particular, should be avoided because it can badly harm the liver.
• During yarqaan, stay away from non-pasteurized milk (Jaundice).
• Avoid eating pulses and beans during yarqaan (Jaundice).

Unani Compound Drugs Recommended in Yarqaan (Yarqaan)

• Sharbat-e- Buzoori
• Sharbat-e- Kasni
• Arq-e- Kasni
• Arq-e- Baranjasif
• Sharbat-e- Deenar
• Majoon Dabeed-ul- Ward
• Arq-e Murawwaqain
• Arq-e- Mako
• Habb-e- Kabid Naushadri
• Qurs-e- Jigar (Zahid, 2016)

References

ABBAS, M. W., SHAMSHAD, T., ASHRAF, M. A. & JAVAID, R. 2016. Jaundice: a basic review. Int J Res Med Sci, 4, 1313-1319.

ANSARI, S., SIDDIQUI, M. A., KHAN, A. A. & SHAH, A. 2015. Concept of Jaundice in Greco-Arab Medicine. Turkish Journal of Family Medicine & Primary Care, 9.

KHAN, M. A., USAMA, A., JAMAL, A. & KHAN, M. S. 2015. Unani Concept of Jaundice and its Management. Hamdard Medicus, 58, 80.

ZAHID. 2016. Yarqaan (Jaundice) [Online]. Available  :  https://www.nhp.gov.in/yarqaan-jaundice_mtl#:~:text=According%20to%20the%20philosophy%20of,skin%20with%20or%20without%20infection. [Accessed 7/26/22].