Hepatitis

 

Hepatitis (Waram-e- kabid) refers to an inflammatory condition of the liver or derailment of the normal temperament of the liver which can lead to an increase in the size of the liver (inflammation of the liver) and other associated symptoms. It is commonly caused as a result of a viral infection, but there are other possible causes of hepatitis.

These include autoimmune hepatitis and secondary hepatitis that occurs as a result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease condition that occurs when your body makes antibodies against your liver tissue. (Kahn, 2021)

In the Unani medicine system, hepatitis is known as “Warm-e- Kabid” or “Warm-e- Jigar”. Almost all Unani physicians described this in their classical texts, its etiology, signs, and symptoms, prevention, and treatment.

During hepatitis, there occurs an excess accumulation of blood in the liver. After that blood oozes out from vessels due to which the liver becomes inflamed and soft and its surface becomes full of rashes (An area of redness and spots). 

 In Unani medicine, (Waram-e- kabid) has been treated effectively by its holistic approach. It is caused by groups of viruses known as viruses. It is considered a serious health problem that challenges not only healthcare professionals but also the pharmaceutical industry and drug regulatory agencies.  (Nhp.gov.in, 2022)

Functions of Liver

 

The liver (Jigar/ Kabid) is a vital organ. It plays a major role in the metabolism and excretion of xenobiotics from the body. The largest organ in the human body is the liver. It plays a major role in many essential physiologic processes and is vulnerable to a wide range of toxic, microbial, metabolic, circulatory, and neoplastic insults. Because it is highly vascular, 25% of the total circulation is within the portal area. It provides the maximum amount of chemical energy (Hararat-e- ghareezia) as there is a large number of mitochondria in liver cells.

The liver (Jigar) has a wide range of functions, including protein synthesis, detoxification, and production of biochemicals that are necessary for digestion and synthesis as well as a breakdown of smaller and complex molecules, many of which are necessary for normal vital functions

Ancient Unani scholars were well aware of the significance of the liver and considered it to be one of the dynamic organs responsible for the metabolic functions chiefly the production of Akhlat (humor). The temperament (Mizaj) of the liver is hot and moist; due to erratic dietary habits, and excessive consumption of fatty foods, and drugs, its temperament is altered to cold (barid) or hot (haar), which is unsympathetic to the liver, therefore allowing the accretion of morbid matter in the form of fat (Tashahham ul kabid) which affects the liver normal functioning resulting in Su-e- mizaj baarid or haar. (Nhp.gov.in, 2022)

Common symptoms

 

If you are suffering from a chronic form like B and C, you may not show symptoms until the damage affects liver functions. By contrast, people with acute hepatitis may present with symptoms shortly after contracting the hepatitis virus.

Types

 

According to modern medicine, it has been classified on the basis of causative factors such as viral, bacterial, and protozoal, Infective hepatitis is classified as viral hepatitis and bacterial. In the A conventional system, viral infections of the liver are classified as A, B, C, D, and E viruses. A is a milder stage of the disease, whereas D is more severe.

It is a result of an infection with the hepatitis A virus (HAV). This type of hepatitis is an acute mild term disease.

Hepatitis B virus (HBV) causes hepatitis B. This is frequently an ongoing, chronic condition. According to the Centers for Disease Control and Prevention (CDC), approximately 826,000 people are living with chronic hepatitis B virus in the United States and 257 million people around the world.

Hepatitis C virus (HCV) causes hepatitis C. Hepatitis C virus is among the most vulnerable bloodborne viral infections in the United States and typically presents as a long-term disease condition.

According to the CDC, approximately 2.4 million Americans Trusted Source are currently living with a chronic form of hepatitis c infection.

It is a rare form of hepatitis that only takes place in conjunction with hepatitis B infection. The hepatitis D virus (HDV) causes inflammation in the liver like other strains, but a person cannot contract HDV without the existence of a B infection.

HDV affects almost 5 percent of trusted sources of people with chronic hepatitis B worldwide.

A water-borne disease that results from exposure to the hepatitis E virus (HEV). It mainly occurs in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply.

According to the CDC, Hepatitis E is usually acute but can be particularly dangerous in pregnant women all over the world. (Kahn, 2021)

Types of Hepatitis in Unani System of Medicine

 

According to Akhlat (dominant humour), eminent and great Unani scholars such as Razi, Akbar Arzani, Ibn Hubal, Majoosi, Sheikh, and Azam Khan have classified it as:

  • Sanguineous Hepatitis (Waram-e- Kabid Damwi)
  • Bilious Hepatitis (Waram-e- Kabid Safravi )
  • Phlegmatic Hepatitis (Waram-e- Kabid Balgami)
  • Melancholic Hepatitis (Waram-e- Kabid Saudawi)

It can also be devised on the basis of its durations as

  • Waram-e- Kabid Hadd (Acute Viral Hepatitis)
  • Waram-e- Kabid Muzmin (Chronic Viral Hepatitis) (Nhp.gov.in, 2022)

Common symptoms of infectious include

 

  • Flu-like symptoms
  • Fatigue
  • Pale (yellow) stool
  • Dark urine
  • Abdominal pain (stomach pain)
  • Unexplained weight loss
  • Loss of appetite
  • Pale (yellow) skin and eyes, which may be signs of jaundice (Kahn, 2021)

Causes 

 

Hepatitis which is also called waram-e- kabid/ waram-e- jigar is most commonly caused by viral infections known as Waram-e- kabid vairoosi. Other than viral infections the liver can also become inflamed as a result of intake of contaminated food and water, frequent alcohol intake, fecal matter, sexual intercourse, infected blood, exposure to certain toxic chemicals, accumulation of fat in the liver, metabolic conditions such as Wilson’s disease, allergic reactions or overdoses of some drugs, injury of liver cell caused by various toxic chemicals and microbes is well-studied. Liver injury caused by toxins is more common nowadays.

According to the modern medicine system following are the main causes

Type

Cause

Route of Transmission

Hepatitis A

HAV

Contaminated food or water

Hepatitis B

HBV

Body fluids such as, blood, vaginal discharge, semen.

Hepatitis C

HCV

Body fluids such as, vaginal discharge, blood, semen.

Hepatitis D

HDV

Blood

Hepatitis E

HEV

Contaminated food or water

Noninfectious Causes

 

Hepatitis is most commonly caused because of infection; other factors can cause the condition.

 

Alcohol and other toxins

 

Excess alcohol intake can cause liver damage and inflammation. The alcohol is directly injurious to the cells of your liver. With the passage of time, it may cause permanent damage and lead to thickening of the liver or scarring of liver tissue cirrhosis (liver damage), and failure of the liver.

Other harmful causes include misuse of medications or self-medication and exposure to toxins.

 

Autoimmune system response

 

In many cases, the immune system mistakes the liver as harmful and attacks it. This may cause ongoing inflammation that can range from mild to severe, often hindrance to liver function. It is three times most common in females than in males. (Kahn, 2021, Nhp.gov.in, 2022)

According to the Unani Medicine System Causes of Warm-e-Kabid are

 

Ibn e Sina, Razi, and Azam Khan had described the following causes in the development of Warm-e-Kabid.

  • Su-e-Mizaj Haar Kabid
  • Su-e-Mizaj Haar Sada
  • Su-e-Mizaj Haar Maddi
  • Hyperpyrexia and chronic fever predispose hepatitis but sometimes the inflammation with no fever may result in hepatomegaly. Higher environmental heat levels can also result in hepatitis.
  • Absorbing power may increase due to hyperactivity of the stomach and the liver absorbs more matter than it normally should not, this absorbed matter cause inflammation of the liver.
  • Many digestive disorders such as weakness of the stomach (zoaf-e-meda) and constipation may be the cause, as stomach weakness (zaof-e-meda) itself produces a cool temperament which in turn caused warm-e-kabid.
  • Sometimes humour gets accumulates in the liver because of emboli. If the obstruction is bilious and emboli are closed to the gall bladder then the bile gets mixed with blood which irritated the vicinity of the liver and results in hepatomegaly. Bile excess is one of the most important causes of liver inflammation. (Akram, 2018)

Diagnosis

 

It is crucial to understand what the cause of hepatitis is in order to treat it correctly. Doctors will progress through a series of tests to accurately diagnose the condition.

History and physical exam

 

To diagnose all the forms of hepatitis, your doctor will have to take your history first to detect any risk factors the patient may have.

During a physical examination, your doctor may press down gently on your abdomen to observe if there is pain or tenderness. Your doctor may also have to check for any swelling of the liver and any yellow (pale) discoloration in your skin or eyes.

Liver function tests

 

Liver function tests (LFT) use blood samples to recognize how efficiently your liver works.

These tests’ abnormal results may be the first indication that there is a problem in the liver, especially if you don’t have any signs on a physical examination of liver disease. A high liver enzyme level may be an indication that your liver is under stress, damaged, or not functioning correctly.

Other blood tests

 

If your liver function tests (LFT) are abnormal, your doctor will likely prescribe other blood tests to detect the main cause of this problem.

These tests can regulate trusted Sources if you have hepatitis with infection by checking for the presence of viruses or antibodies your body produces to combat them.

Doctors may use blood tests to determine if the patient has any signs of autoimmune hepatitis.

Liver biopsy

 

When hepatitis is diagnosed, doctors will assess your liver for potential damage Trusted Source. A liver biopsy is a procedure that involves taking a sample of tissue from your liver.

A medical professional may take the sample through your skin with the help of a needle, without any surgery. An ultrasound scan is needed for guidance during this procedure.

This test helps your doctor to recognize how infection or inflammation has affected your liver.

Ultrasound

 

An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen area. This test allows your health professional to take a deep look at your liver and organs nearby. It can reveal:

  • Abdomen fluids
  • Enlargement of liver and liver damage
  • Tumors in the liver
  • Gallbladder abnormalities

Sometimes the pancreas also shows up on ultrasound images as well as the liver. This can be a useful test in detecting the cause of your abnormal liver function.

Treatment

 

Treatment options system of medicine will vary according to the type of hepatitis you have and whether the infection is chronic or acute.

Hepatitis A

 

It is a type of short-term illness and may not require any treatment. However, if symptoms cause discomfort, bed rest may be needed. On the other hand, if you suffering from vomiting or diarrhea, your doctor may recommend a diet plan to maintain your nutritional status and hydration.

Hepatitis B

 

There is no specific medication program for acute hepatitis B.

However, if you are suffering from chronic hepatitis B, you will require antiviral medications as prescribed by your physician. This form of medical treatment can be costly, as you may have to continue medication for many months or years.

Hepatitis C

 

Treatment for chronic hepatitis C also requires medical evaluations time by time and monitoring to determine if the virus responds to the treatment of Hepatitis C

Antiviral medications help to treat both acute and chronic hepatitis C.

Typically, people who develop chronic hepatitis C will have to use antiviral drug therapies combination. They may also need further testing for the best form of treatment.

People who develop cirrhosis or liver disease due to chronic C may need a liver transplant in the future.

Hepatitis D

 

The WHO Trusted Source lists pegylated interferon-alpha as medicine for hepatitis D. However, these medications may have chances of severe side effects. As a result, it is not prescribed to people with cirrhosis and liver damage, those with psychiatric conditions, and people who have autoimmune diseases.

Hepatitis E

 

Currently, there are no specific medical therapies are available from trusted Sources for treating hepatitis E. Because the infection is acute, it typically resolves by itself. The doctor will typically suggest people with this infection get adequate rest, drink plenty of fluids (water, juices), get enough nutrients, and avoid alcohol intake. However, pregnant women who expose to this infection require deep monitoring and care.

Autoimmune hepatitis

 

Corticosteroids for example prednisone or budesonide, are very important in the early treatment. They are effective in about 80 percent of patients with this condition.

Imuran (Azathioprine), a drug that suppresses the immune system, may also be a part of medication programs.

Other immune-suppressing medicines like CellCept (mycophenolate), Prograf (tacrolimus), and Neoral (cyclosporine) can also replace azathioprine in treatment. (Kahn, 2021)

Principles of management (Usool-e- Ilaaj)

 

Medicines are used for immuno- restorative, Prophylaxis, and Hepatoprotective treatment for Opportunistic Infections to stimulate and sustain physiological activities in the human body. Drugs are also used to detox the liver with the deleterious effects of daily encounters with air, water, and food-borne toxins Drugs are used to relieve congested and catarrhal conditions of the liver and control the secretion of bile. Drugs are also used to inhibit liver cell injury and enhance the production of antibodies. · Drugs are also used to restore the immunity, vigor, and vitality of the patient to enable the patient to lead a productive energetic life.

Management of Hepatitis (Waram-e- kabid/ waram-e- jigar)

 

The available synthetic drugs to treat liver diseases in this condition also cause further damage to the liver. Unani Herbal medicines have become popular day by day and their use is widespread. Unani medicines are used for treating liver diseases for a long time and the maintenance of a healthy liver is essential for the overall well-being of an individual. These drugs are well-proven in the management of all types of hepatitis and in treating different causes of viral or non-viral for centuries. Unani herbal medicines have a very high success rate in treatment. It has been scientifically proven that these Unani medicines are highly beneficial in the management of Acute Viral and infective , Toxic or metabolic Liver Diseases, Chronic-persistent and Chronic aggressive Hepatitis, Cirrhosis of the Liver, Jaundice and Fatty Degeneration of the Liver, etc.

Unani medicine system, whole plant or their parts are extensively used to cure liver derangements. The Unani physician’s system of Medicine has been treating various forms of hepatitis for centuries. Warm-e- Jigar in Unani literature, mimic CHB and its associated constellation of symptoms.

Few Unani Formulas for Hepatitis (waram-e- kabid or waram-e- jigar)

 

The drugs utilized in the treatment of waram-e- kabid or waram-e- jigar found to be very effective primarily involve a decoction constituted of six plants namely, Fumaria officinalis (shahatara), Tephrosia purpurea (sarphokah), Swertia chirata (chiraita), Sphaeranthus indicus (gul-e- Mundi) and Pterocarpussantalinus (sandal surkh).

The formulation was used in the form of capsule (hab) with ingredients that included Rubia cordifolia, Valerina Officinalis, Piper cubeba, and Chenopodium album, to be taken two times a day daily after food.

Single Drugs Recommended in Unani Medicine

 

Unani Herbal remedies are focused on the pharmaceutical industry to evolve a safe route for liver disorders. some hepato-protective Unani drugs such as Eclipta alba, Andrographis paniculate, Silybum marianum, Ficus carica,  Coccinia Grandis, Lepidium sativum, Solanum nigrum, Swertia chirata, Phyllanthus emblica, Picrorhiza kurroa, Curcuma longa,  Azadirachta indica, Foeniculum vulgare, Trigonella foenum graecum, Aegle marmelos,  Garcinia mangostana Linn are found to be very effective

Compound Drugs Recommended in Unani Medicine

 

Prevention

 

There are vaccinations that can help to protect against many hepatitis viruses. Minimizing your risk of exposure to substances that contain these viruses that can also be important for the prevention of hepatitis.

Vaccines

 

A vaccine is a series of two doses and most children begin vaccination at the age of 12 to 23 months trusted Source. This vaccination is also available for adults and can also include the hepatitis B vaccine.

The CDC Trusted Source recommended hepatitis B vaccinations for all newborn babies. Doctors typically administered three doses of vaccines over the first 6 months of childhood.

The CDC also recommended vaccinations for all healthcare professionals. Vaccination against the hepatitis B virus can also prevent hepatitis D.

Vaccinations for hepatitis C or E are currently not available.

Reducing exposure

 

Viruses will be transmitted from person to person through contact with body fluids, water, and foods that contain infectious agents.

Effective hygiene practice is the only way to avoid contracting hepatitis A and E. Virus that causes these conditions would be present in water. If you are traveling to a country there is a high prevalence of hepatitis, you should avoid:

  • local water
  • ice
  • raw or undercooked shellfish and oysters
  • raw fruit and vegetables
  • The hepatitis B, C, and D viruses can transmit through contact with bodily fluids which contain these infectious agents.

You can reduce the risk trusted Sources of coming into contact with fluids containing these viruses by:

  • not sharing needles
  • not sharing razors
  • not using someone else’s toothbrush
  • not touching spilled blood

Hepatitis B and C can be transferred through sexual contact. Using precaution methods, such as condoms and dental dams, during sexual activity can help to decrease the risk of infection. (Kahn, 2021)

Complications

 

Because the virus affects the liver severe health problems are caused by chronic hepatitis B and C, in patients with this disease there is a risk of developing following diseases:

  • Chronic liver disease
  • Liver cancer
  • Cirrhosis

Liver failure can occur, when your liver is functioning abnormally. Complexity of liver failure involves:

  • Bleeding disorders
  • Ascites; accumulation of fluid in patient’s abdomen.
  • Portal hypertension results which is increased blood pressure in portal veins that enter your liver.
  • kidney failure
  • Hepatic encephalopathy, which includes fatigue, memory loss, and loss of mental capability.
  • Hepatocellular carcinoma, that is a form of liver cancer
  • Death

Alcohol consumption can increase Liver disease and failure is accelerated in People with chronic hepatitis B and C so they should avoid alcohol. Liver function is also affected by some supplements and medications. Check with your physician, before taking any new medications. If you have chronic hepatitis B or C.  (Kahn, 2021)

AKRAM, J. A. K. A. M. 2018. Perception of hepatitis as Warm-e-Kabid in literature of

Unani medicine

The Pharma Innovation Journal 2018, 7, 687-691.

KAHN, A. 2021. Hepatitis: What Is It? Types, Symptoms, Causes, and More.

NHP.GOV.IN. 2022. Waram-e- Kabid (Hepatitis) | National Health Portal of India [Online]. Nhp.gov.in.

 [Accessed 14-06-2022].

 

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