Review of in gynaecological diseases with special reference to unani medicine Dr. Habiba Suhail, 1 Dr. Kouser Fathima Firdose 2 1Assistant Professor, Dept of Ilmul Qabalatwa Amraze Niswan, NIUM, Bengaluru, India 2PG Scholar, Dept of Ilmul Qabalatwa Amraze Niswan, NIUM, Bengaluru, India Abstract: as yellowish aromatic oleoresin exudates from Commiphora molmol bark ( family) has traditional history in treatment of some diseases. Exudates are used topically for treatment of ulcers, abscesses and wounds, headaches and backaches, fungal infections, relieving cramps, muscular pains, spasms, and snake bites. Volatile oil and mucilage in myrrha oil is used in treating amenorrhea, athlete's foot, bronchitis, mouth sores and toothache. Myrrh is one of the oldest remedies. The aim of this review is to collect data about its medicinal uses described in Unani literature under the heading of amrḍād niswāṉ (gynaecological disorder) like usr tamth, Kathrat-i-Hayd, Ihtibas al-Tamth qillate tamth sayalan al-rahim, salaba al- Rahim, warme Rahim Insidad Fam alRahim cervical stenosis. Details of dosage and dosage forms, along with phytochmical and pharmacological properties will be presented in this review.

Key words: Commiphora myrrha, gynaecological diseases, unani medicine.

Introduction: Myrrh is an aromatic oleo-gum resin obtained as an exudate from the stem of Commiphora myrrha and from other of the family.1 Myrrha traditional herbal medicine.(commi)They are used in indigenous medicine for the treatment of wound, pain, arthritis, fractures, obesity, parasitic infection and gastrointestinal disease.2 Myrrh consist of water-soluble gum, alcohol-soluble resins and volatile oil. The gum contains polysaccharides and proteins, while the volatile oil is composed of steroids, sterols and terpenes. Characteristic odour of myrrh is derived from furanosesquiterpenes.3 It has been used widely in clinic for treatment of fever, stomach complaints, diseases of gallbladder, skin infections, amenorrhea, ache, dysmenorrhea, tumours, chest ailments and snake bites in India, China, Rome, and Greece. Pharmacological studies also have showed that myrrh possesses multiple activities,including anti-inflammatory, cytotoxic, anesthetic, and antimicrobial effects.

There are many Gynaecological disorders found in women that needs timely diagnosis and treatment to avoid major health problems. Common gynaecological disorders include Usr-e-tams , Ehtabas-e-tams (Dysmenorrhoea and Ammenorrhea), Kasrat-e-Haiz (Menorrhagia), Sailan-e-reham (Leucorrhoea),Hikkat-ul-Farj (Pruritis vulvae),Warm-e-Farj wa Mehbal (Vulvitis and Vaginitis),Warm-e- Reham (Metritis), PCOD (Polycystic ovarian disease) etc. 4 Number of drugs and its combinations are available for the treatment of these diseases in unani system of medicine; Myrrh is one of the often used drug and has greater significance in the treatment and management of various Gynaecological disorders, hence considered for review. Material and Methods: Data collected from the various unani text book viz. Tanqeehul mufridat, tajul mufradat muhite aazam, khazaynul advia aljameul mufradat wal aghziya kanzul advia mufradah, mukhzanul mufradat, kamel sana Vol II using terms like Murmakki, samuna w tafush, murr, bol samerna wa tafubeesh in unani farsi ,urdu and . Similarly books including al hawi vol IX, Akseereazam (Al-akseer) vol II, Al Qanoon fit tib. Vol.III, dakhira Sabit bin Qurrah. Al mukhtarat fit tib Vol.1, IV. Haziq. Jami-ul-Hikmat, vol- II Tajul Hikmat. Beyaz Ajmal. Zakheerae khawarzam shahi Kamil-us Sanat, Kitabul kulliyat. Makhzanul Hikmat Kamil. Vol.2, Tibbe Akbar. Firdoos-ul-Hikmat. Ghina mina, Kulliyate Qanoon. kitab al-Taysir, MaghzanulIlaj were explored also using key words like Ihtibas al-Tamth, Quruh al-Rahim Kathrat-i-Hayd Istihada Sayalan al-Rahim, Insidad Fam alRahim, Sal‘a al-Rahim. Ethanobotanical description, habitat, pharmacological and Phytochemical properties of C Myrhh were searched in various scientific databases like scopus, pubmed, Elsevier, google scholar, medline, research scholar, research gate, science direct, orchid etc using terms like Commiphora myrrha, Commiphora molmol similar e keywords, were also searched in printed pharmacological text books namely Indian medicinal plant ,Indian materia medica ,the wealth of India ,pharmacographica indica, the unani pharmacopeia of india, text book of pharmacognosy , Indian medicinal plant reference were extensively reviewed for preparing this manuscript.

Morphology: It is an oleo-gum resin obtained from bark of tree Commiphora myrrha. Myrrh occurs in somewhat irregular tears or masses. The surface is reddish- brown or reddish yellow in colour and powdery. The drug fractures and powders readily, the freshly exposed surface being of a rich brown colour and oily. Whitish marks are sometimes visible and thin splinters are translucent. Myrrh has an aromatic odour and an aromatic, bitter and acrid taste.5-7 Vernaculars:

8, 9 10 6, 10 5 Arabic: Almurr Bengali: Gandharsh, heera bol English: Myrrh C. molmol Gujrati: Gandharas,Hindi: Bol, hirabol5,6,10,11Kannada: Bola5, 10 Malayalam: Narumpasamaram, narumpasa12 vellaippolam11 , Persian: Murmakki13 Sanskrit: Bolah, rasagandh5, 11 Tamil: Vellaippapolam Telugu: Balimtra-polam5, 10 Unani credentials Unani name: Murmakki10samuna wa tafush.6 13, 14, 15 10, 16 Temperament: Hot and dry 2ᵒ dry 3ᵒ and dry 2ᵒ Use with caution: in hot temperament individuals13-15, 17 Rectifier : Honey, 13 Cinnamomum camphora,10Cold and moist diet 14,15,17 Dosage: 1 gm13 1-2 gm14,15,17 3-5gm 19 5-15gm10, 16 Part used: Gum resins,10 leaves7, 16 Part studied: Gum resins Substitute: Qust14,15,17,Jund bedaster13, 15,17 Momiyayi 15,17

Functions (Af'āl):

Dard al- raḥim –Dysmenorrhoea 6, 18 Mudirr-i-bawl wa hׅayd - ׅ Diuretic & Emmenagogue13, 16-18 Muḥallil- Resolvent8,15,17,18, Muhׅallil awrām - Anti-inflammatory13, 18 Mufattihׅ sudad Deobstruent8, 13, 15, 18, Dāfi 'aamrādׅ balgamiyya7,13, 18Mujaffif- Desiccant, Jāli – Detergent- ,Muqawwī-i-mi‘da – Stomachic, Kāsir-i-riyāhׅ - Carminative, Qātil-i- kirme shikam - Vermicidal7 13, 15,17, 18 Mudammil qurụ̄h - Cicatrizant /healing agent 13, 85 Musakhkhin -Calorific82, 85,Munaffith -i- balgham – Expectorant7, 15,17, 18 Muzliq- Lubricant8, Mulayyin– Laxative8, 18, Other therapeutic actions: Antiseptic 19, 20 Antiviral, Astringent, Bacteriostatic 19,21, Carminative ,Expectorant, Leucocytogenic agent,Stomachic 19 Stimulant 21, 22

Used of Commiphora myrrha in gynaecological diseases: 1. Tablets prepared of murr and elwa are used as mudirr-i-hayd (emmenagogue).17 2. Murr mixed with afsanteen turmus and usare suddab and is used as mudirr-i-hayd 6 (emmenagogue) and musqit-i-janin (abortifacient). 3. Decoction of murr is used in usr bowl wa hayd (dysuria and dysmenorrhoea) and ihtebas bowl wa hayd (anuria and amenorrhoea).14 6,8,14,16 4. Humool of murr is effective in malodours vaginal secretion. 5. Huqna with murr and aabe hulba is helpful in salaba al- rahim 8 6. Murr with baiz neem brishst is beneficial in sayalan al-rahim 7. Tila of murr is beneficial in waja‘al-kulya wa mathana, maghs (tenesmus) and dard rahim (dysmenorrhoea). 8. Murr with zeerah siyah and roghan gao is beneficial in quruh rutba when it applied in dimad of murr. 9. Lattukh of murr with sharab and shibb-e yamani is beneficial in removing bad smell from axilla, and inguinal region. 8 10. Murr is used with elwa and iron component to induce menstruation, if cause is qillat-i- dam. 11. 1.75 g of murr with baiza neem barisht or roghan kunjad is beneficial to arrest excessive menstrual blood loss. 12. Murr used in Insidad Fam alRahim (cervical stenosis) due to its Murkhi (relaxant) property. 23 13. Humul jayyed -mur makki , fotunj makko 4 dirham abhal 5 dirham suddab khusk 10 dirham zabeeb used in firzaja form to induce menstruation in amenorrhoea 24 14. Nuskha qurse mur murmakki: ,turmus barg, suddab khushk, podeena, mushkatra mushee, heeng, sakbeenaj, jao sheer and mujeeth are beneficial in amenorrhea25 15. Murmakki and podeena, abhal suddab khushk , maveez munaqqa grind and used in humool form with (gay ke pitta ke pani me )in amenorrhea 16. Qurs murmakki or murmakki and gandah behrozah in equal quantity used with decoction of saunf and ajmood helpful in Rajā’(pseudopregnancy) 25 17. Hilteet, mur and filfil are potent emmenagogue. 18. Usarh brinjasif grind with murr and used in humool form for emmenagogue.23 19. Murr , mujeeth ,funjaask badam talkh ,sauter used with aabe turmus or decoction of mushkatramushee.23 20. Farzaja prepared with murr and roghan zanbaq and used in humool form with roghane baan. 21. Decoction of murr with bargh anjarh is helpful in inducing menstruation.23 22. Bukhor of Sunbul and murmakki is helpful in maeene hamal. 25 Other uses o Murr is drug of choice for amraz-e-sadar (respiratory disease) like surfa muzmin (chronic cough) usr tanaffus and dard-i- pahlu (chest ailment).8 o Myrrh is dissolved in human or ass’s milk and dropped into the eye to cure purulent ophthalmia.7 o Murr increases milk secretion if used with jaggery. o Murr is beneficial in shadakhe‘adalat, warmi‘adalat and dard‘aAdalat. 8 o Murr is beneficial in -waja‘al-mufasil (polyarthritis) ‘Irq al-Nasa ( sciatica ) Niqris (gout) both as oral and local use. 8 o Kohal prepared of murr and other drugs are beneficial in eye diseases like the ulcer of eye due to its desiccant and jali (detergent) properties.16 o Fresh leaves of murr1 ½ gm mixed with kali mirch (black pepper) are beneficial in cough.6 o Ear drops Prepared from murr, jundbedastr, mameesha, and afyoon is beneficial in otorrhoea. 16 o Dimad of murr is useful in awram balgami. 17 o Gargle with joshanda of murmakki removes ta’akkul al-asnan (caries) and strengthen the teeth and its use as paste is beneficial in halitosis.7 o Local application of mur with sharab, ladan, and roghan moorad is effective in intithar al-sha‘r (hair fall) , as it possess properties like muhafiz -i- sha‘r (hair protector) muqwi -i- sha ‘r and munbit-i- sha ‘r (hair grower). 8 o Murr single or mixed with other drugs helpful in kasr ‘izam (fracture). o Its surma is helpful in quruh al- ‘ayn, quruh asar-i chasm, bayad al-‘ayn (corneal opacity), zulmat e basar and khushuna- palak.8 o Murr is also effective in sahj wa quruh al am‘a (crohn‘s disease) and ishal (diarrhoea).8 o Murr with saleekha and unsul is beneficial in masso (wart). o Murr with roghan aas, sharab mixed with solvent beneficial in intithar al-sha‘r (hair fall). o A gargle with murr mixed with rose water is beneficial in waram al-litha (gingivitis), istirkha’ halaq, qula’ (stomatitis).17

Ethano botanical description: Commiphora myrrh trees or shrubs may attain a height of upto 10 m. They have sturdy build, with knotted branches. It has a shrubby stem with spinescent branches, a very pale-grey bark and a yellowish white wood.75 Oleo gum resin is obtained from bark of tree.16, 20

Habitat and distribution: Indigenous to north-eastern collected in southern Arabia, Abyssinia, Persia, Siam and sold in India bazars. Myrrh of commerce is obtained from the resinous exudation of the tree C. myrrh. There are at least two or three varieties, two of them being known as ‘karam’ and ‘Mutiya’.21 It is an indigenous tree native to , and 22 northern . Macroscopic characters: Plant type: Trees or shrubs, often armed or thorny. 27 22, 27 Colour: Externally reddish brown, internally brown. 27 20 Odour and taste: Aromatic and agreeable, bitter and acrid. Size :1.5 -3 cm diameter (pharmacognosy) Shape: Rounded and irregular tears20  Microscopic: The gum resin secreted in the phloem cells of bark is in the form of irregular masses. when pressed they show a moist and uncuteous appearance and a rich brown hue.28, 29 Phyto Chemical Constituents:  Volatile oil (7-17%): Cuminicaldehyde, eugenol, metacresol, pinene, limonene, diterpenes and two sesquiterpenes.  Resin (25-40%):  Ether soluble portion: α, β and γ, commiphoric acids, and esters of another resin acid and two phenolic resins.  Ether insoluble portion: α, and β herabomyrrholic acids.  Gum (57-61%): Associated with enzyme oxidase and on hydrolysis yields arabinose.  Essential oil: Nine sesquiterpene hydrocarbons,elemol a sesquiterpene alcohol furano sesquiterpenoids furan diene, furanodienone,isofuranomacrene, curzerenone and lindestrene.  Impurities:3-4%.20, 27 Pharmacological studies: Cytotoxic activity: C.myrrha was reported to have cytotoxic activity on human gynaecologic cancer cell on clinical trial due to the presence of two compounds of diterpene resin acid, which significantly inhibit proliferation of human ovarian cancer.16, 30 Emmenagogue activity: Khatoon et al reported that murr is effective in PCOD related secondary amenorrhea when used in combination with muqil and abhal. This combination induced withdrawal bleeding along with menstrual regulation due to the presence of steroids and flavonoids. Moreover, murr contains phytosterols, saponins, terpenoids, lignans and phenolic compounds; and glycosides and alkaloids in abhal which exerts hormone like action in the body and thus withdrawal bleeding and menstrual regulation.16 Anti dysmenorrheic activity: Extract of myrrh exhibit significant anti-dysmenorrheic activity & 16, 30 inhibits uterine contraction and aromatase activity. Hepatoprotective effect: Commiphora myrrha improved liver histology towards more normalization in rats as evident by a reduction in liver enzymes in a dose-dependent manner. It increases hepatic antioxidant activity and decreases the oxidative stress by down-regulation of important key players such as TNF-α, IL-6, IL-10, iNOS-2, and HO-1, which might be sufficient to combat cellular damage. Histological recovery towards normalization also suggests that C. myrrha extract may protect parenchymal cells and improve liver tissue regeneration. The hepatoprotective effect is due to the presence of flavonoids, terpenoids and alkaloids.31 Antioxidant activity: Ethanol extract of C. molmol exhibit antioxidant activity on in vitro study due to the presence of phenolic and flavonoid contents. 16, 32 Anti-microbial activity: The methanolic extract of C. myrrha demonstrated antimicrobial activity against E. coli, S. aureus, B. cereus, E. coli & K. pnuemoniae due to the presence of broad-spectrum antimicrobial compounds that act against gram negative bacteria. Even its petroleum ether extract showed antibacterial effect against S. aureus, E. coli, Pseudomonas aeruginosa; and antifungal to Aspergillus niger and Candida albicans. 16, 33 Anti-fungal activity : Myrrh reported to have antifungal effect against T. rubrum, T. mentagrophytes, M. canis, M. gypseum, and T.verrucosum on in vitro study due to the presence of furanoeudesma 1,3diene and menthofuran in myrrh oil while 2-tert-butyl-1,4-napthoquinone, benzene methanol, 3-methoxy-α-phenyl, and curzerene in myrrh ethanol extract. Petroleum ether and methanol extracts of oleogum resins of C. myrrha revealed antifungal activity against of Aspergillus species: A. flavus, A.fumigatus, A.terreus and A.niger on in vitro study.34 Anti-inflammatory activity: C. myrrha extract exhibit anti inflammatory activity, inflammatory effect as evident by decrease in volume of paw oedema induced by formalin in rats probably due to an inhibition of release of inflammatory mediator prostaglandins.3 Analgesic activity: C. molmol extract exhibit analgesic activity in rats due to the presence of bioactive compounds that raised pain threshold by depressing pain receptors centrally in the brain and also by inhibiting the release of prostaglandins. Thus C. molmol extract appeared to 16 produce analgesic effect through both central and peripheral mechanisms. Myrliq: It is a myrrh extract with a high content of bioactive content of bioactive furanodienes. The result of this study indicates that myrliq has analgesic activities against some of the most prevalent and distressing pain symptoms, particularly headache, muscles ache, join pain, lower back pain, fever dependent pain, and menstrual cramps. 35 Anti-hyperlipidaemic activity: C. myrrha significantly decreased anti-hyperlipidaemic activity; the body weight gain, normalized the high levels of blood lipids and decreased atherogenic index, low-density lipoprotein / high density lipoprotein in obese hyperlipidaemic rats due to the presence of guggulsterones, plant sterol etc. 16

Conclusion: The Unani System of Medicine addresses the issues of gynaecological diseases in a varied manner, using single drugs, combinations or compound pharmacopial formulations. As evident from the review C. myrrha is one such drug that can be used in a spectrum of gynaecological disordes from luecorrhea, Amenorrhoea to cervicitis and HMB aither singly or in combination with other grugs; either in oral or local applications. A lot of research need to be carried out on each indication of C Myrrh to add on scientific validation to the heritage of medicines in ancient Unani system in the treatment and management of various Gynaecological diseases that can be used safely and effectively.

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