MONOGRAPH ON BARS (VITILIGO) ~~ CENTRAL COUNCIL FOR RESEARCH IN UNANI MEDICINE Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) Ministry of Health & Family Welfare, Government of India NEW DELHI .. CONTENTS ••••••• Foreword .... .... ... ..... .... ............. ... ... ... ...... ..... ... ...... ...... ........... ....... ... .. .... .... ............................. .... v Preface ................ ........ ..... .. .. ...... ....... .... ...... ...... .. ........ .. ... ................. .... .... ..................... ....... v11 Introduction .............. .. ...... .......... ... .... .. ... ..... .... ............. ... ..... ............... ........................... ...... .... 1 Concept of Bars (Vitiligo) in Unani Medicine ... ....... .... .......... .. .... .......... .. ................ .... ... 7 Concept of Munjiz and Mushil Therapy in Unani Medicine .. ...... ... .................. ... .... 13 Diet Recommendations and Restrictions in Bars (Vitiligo) According to Unani Classics ... ...... ..... ...... ........ ..... .... .... .... ... ......................................... ..... 15 Anatomy and Physiology of Skin .... ..... ..... .... ... ....... ....... ... ................ ............... ..... ......... .. 16 Experimental Design ... ... .. ... .. ....... ... .... ....... .. .................. ............ ..... .... ... ....................... .. ...... 2 3 Clinical Trials of Unani Drugs .. ..... ..... .. ... ... ...................... ... ............ .. ................ .... ...... .... .45 Pedigree Analysis of Vitiligo Cases ...... ....................... ..... ............. .................. ... ... ........ 150 Pathological Studies .... ... ..... .. .. .... ............... ...... ... ..... ... ................................ .... .... .... .... ....... 15 7 Biochemical Studies .... ........... ................ ... .... .. ...... .. .. ... ... .... .... .... ............. ........................... 159 Pharmacological Studies :······· ··· ························ ····· ····· ·· ...... ................ .. ...... ... ... ................ 162 Akhlath Studies ... .. ... ..... .. .. ...... ..... ..... ....... ... ..... .... ..... ... ...................................................... 165 Other Studies .. ..... .. ..... ...... ............... ........................ .. ... ..... ..... .......... .. ..................... ..... ....... 166 Unani Single Drugs Used in the Treatment of Bars (Vitiligo) ............................ .. 167 Research Paper on Bars (Vitiligo) Presented by Researchers of CCRUM .... .... ..... ..... ..... .... .... ............................................ 221 References ... .. .... ... ...... ....... .. .................. .. ... .. .... ...... .... ...... ..... ...... ... .... ............... ....... ... ... ....... 227 Scientists Associated with Clinical Studies on Bars (Vitiligo) ................................. 233 Monogra ph on Bars (Vitiligo) 111 - FOREWORD ...... ,. ....... .. V itiligo is a disfiguring dermatological cutaneous condition, not a disease per se, and is characterized by pearly white patches caused by destruction of melanocytes. The condition affects 0.5% to 2.0 % of the world population. Its prevalence varies considerably among various ethnic groups with no sex bias. Presently, various treatment options including medical therapeutics and surgical intervention are available for restoring normal color to the white patches of skin. The treatment measures include topical application, antioxidants, laser, photo-chemotherapy using psoralen and UV A and narrow band UVB. The currently available modern therapies, although effective, are less than satisfactory, and can be prohibitively expensive. Besides, the patients do not have access to adequate treatment. To the patient the condition is upsetting and depressing and can also be damaging socially, professionally and emotionally. Research is on to find the exact cause of and viable treatment for vitiligo. The Unani system of medicine has a rich treasure of therapeutically active products and extensive patient beneficial clinical experience on them. About 20 years ago the Central Council for Research in Unani Medicine (CCRUM) had brought out a publication on clinical studies on Bars (vitiligo). The volume carried valuable information gathered from the available literature on the subject. The information included hospital data on various prescribed therapeutic regimens. The document served a useful and authentic base for clinicians of Unani system of medicine and scientists trained in modern science. The present monograph on Bars (vitiligo) brought out by the Council contains various new features such as mode of administration, duration of treatment, and other useful clinical relief data on about 30,000 patients treated with Unani formulations. Treatment of over 90,000 cases of Bars (vitiligo) under the ages of the CCRUM is indeed a significant step in the right direction. It is, as a matter of fact, a welcome effort as it lays strong foundation for researchers and clinicians of both Unani and modern systems of medicine working towards developing a safe, effective and affordable product for the benefit of vitiligo victims spread globally. N c. ~, /Lv?7J -f 1 (N. K. GangM MD, D.Sc .(lzc), FRC Path. (London), FAMS, FNA, FASc, FNASc FTWAS (!tally), FIACS (Ca nada), FlMSA Director -General Indian Council of Medical Research New Delhi, India Monograph on Bars (Vitiligo) v PREFACE ... .. ... B ars (Vitiligo) is a mysterious dermatological problem. The condition carries great medical as well as social significance. Its aetiology still remains an enigma, and its successful treatment has been a great challenge for medical scientists. However, several ancient scholars and practitioners of Unani Medicine have given a detailed account of this disorder. The father of medicine, Buqrat (Hippocrates) (460-377 BC) was the firs t to define Bars. Rabban Tabari (810- 895 AD) in his book, Firdaus al­ Hikmah, Zakaria al-Razi (850-9525 AD) in his treatise, Kitab al-Hawi, and Ibn-e-Sina (Avicenna) (980-1037 AD) in his masterpiece, Al-Qanoon fit-Tib gave a comprehensive description of the problem . There are different reports about the incidence of Bars (vitiligo) varying from 0.1 to 8.8 percent of the population in different parts of the world. But it is generally accep t e~ that this disorder affects around one percent of the world population. In India its incidence is reported to be around three percent. Although intensive research is being carried out on this disorder in different countries, its satisfactory and safe treatment still defies the modern medical world . India is one of those coun tries where Bars (vitiligo) is considered socially as well as medically significant. It is for this reason that in this country increasing attention is being paid to finding viable medical treatment for this disorder. The Central Council for Research in Unani Medicine (CCRUM) over the past 26 years of its existence has taken a lead in this direction having treated over 90,000 cases of vitiligo coming from different parts of the world. The Council's Central Research Institute of Unani Medicine (CRIUM), Hyderabad has earned international repute for the successful · treatment of this disease. This institute alone has treated over 70,000 Bars (vitiligo) patients. Twenty years ago, the Council had brought out a publication, Clinical Studies on Bars (Vitiligo), which was released on the occasion of Workshop on Bars (Vitiligo) held at Hyderabad in January 1986. The book carried results of a study on the efficacy of six Unani therapeutic regimens conducted on 6000 Bars cases attending outpatient and inpatient departments of CRIUM, Hyderabad during 1972 and 1983. Since then the Council has come a long way in clinical research on Bars as well as other diseases. The present volume - Monograph on Bars (Vitiligo) - contains outcome of a comprehensive clinical study on 29734 vitiligo cases treated w ith 11 Unani formulations of herbo-mineral nature. Like the previous one, this study too was conducted at CRIUM, Hyderabad. Of the 11 Unani formulations, seven exhibited therapeutic efficacy ranging between 72.80 and 88.74 percent, whereas one formulation showed 66.30 percent response. Rest of the three combinations consisting of Munzij (coctive) and Mushil (purgative) and other radical formulations were Monogra ph on successful in initiating repigmentation even in resistant and stubborn lesions. Bars (Vitiligo) vii We hope that the present study would attract the attention of modern medical scientists as well as the researchers and experts of Unani Medicine and other traditional therapies. The study should also provide a strong basis for further researches in the direction of finding safe and successful treatment for Bars (vitiligo). The Council would welcome constructive criticism as well as suggestions for further improving its research methodology in this area. I would like to express my gratitude to the Scientific Advisory Committee of the Council for their valuable guidance and help in this study. I also acknowledge the contribution of the Council's researchers at Central Research Institute of Unani Medicine (CRIUM), Hyderabad and other centres in making this research work a reality. My thanks are also due to Dr. Shamshad Ahmad Khan, Assistant Director (Chemistry); Hakim Abdul Hannan, Assistant Director (Unani); Mr. Suhail Mustafa Adhami, Research Officer (Statistics); Hakim Khalid Mehmood Siddiqui, Research Officer (Unani)