Saman-e-Mufrat (obesity) is a major public health problem as it is associated with increased health and societal costs. It is a vital nutritional or metabolic disorder where the percentage of fat tissue (adipose tissue) increases disproportionately owing to an imbalance of energy intake and energy expenditure. A sedentary lifestyle and excessive calorie consumption is the main cause of Obesity disease.
The prevalence of the disease is continuously increasing worldwide, especially in lower economic and middle-income countries. It is expected that millions of people around the globe will be affected in the next two decades. In the system of Unani medicine, obesity is described as Saman-e-Mufrat which is a combination of two words- Saman means ‘’Fat’’, Mufrat means ‘’Excessive’’. (Samane-Mufrat stands for ‘’Excessive Fat’’ and ‘’Farbahi’’ (a Persian word) means ‘’Obese’’ (motapa). While obesity term comes from the Latin word bedere‟, to devour, and in English means very fat. Weight gain of a person up to a certain level is a sign of good health. Obesity is a condition in which excess body fat is accumulated to an extent that health may negatively influence social and interpersonal relationships. (NPH.gov.pk, 2022)
Obesity with reference to BMI (body mass index)
Obesity is also defined in terms of body mass index (BMI). The formula of BMI was introduced in the early 19th century by the great mathematician Lambert Adolphe Jacqueen Quetlet. A BMI of 18.5 to 24.9 Kg/m2 is ranked normal while that above 24.9 – 29.9 kg/m2 is overweight and a BMI higher than 30 kg/m2 is defined as Obesity
Categories of obesity according to WHO
WHO classifies obesity into three sub-categories:
- BMI 30.00 – 34.99 kg/m2 is Obesity class I.
- BMI 35.00 – 39.99 kg/m2 is Obesity class II.
- BMI ≥40.00 Obesity kg/m2 is Obesity class III.
The conception of obesity (Saman-e-Mufrat) was firstly described by Buqrat (Hippocrates: 460-370 BC) in his famous book “Fasool e Buqratia”. He had described a detailed description of obesity (Saman-e-Mufrat) that includes its complications, management, and prevention. Another Unani physician Rofus (98-171 AD) in his book describes the treatment of obesity (Tahzeel Sameen) and that obese people are more prone to diseases as they lack healthy blood (Khoon Saleh) and have an excess amount of Phegmatic humour (Khilt e Bhalgam). Saman-e-Mufrat can be related to many diseases, this was described by the great Unani scholar Jalinoos (Galen: 129-210 AD) who mentioned that obese individuals are more prone to early death as compared to the lean and thin persons. The causes factors of Saman-e-Mufrat were also quite clear as another Unani scholar Ali Bin Rabban Tabri (847-861 AD) had described the etiology and pathophysiology of Saman-e-Mufrat, especially excessive eating and sedentary lifestyle have been described as the most important factors for the obesity. (NPH.gov.pk, 2022) (Itrat and Zarnigar, 2014).
Obesity is one of the leading preventable causes of death that is affecting the world. W.H.O. projects that by 2015, almost, 2.5 billion adults were overweight and more than 700 million were obese. Obesity is the leading cause of death. Almost, 2.8 million adults die each year as a result of being overweight or obese. In addition, 44% of diabetes, 23% of the ischemic heart disease, and between 7% and 41% of certain cancer burdens were attributable to overweight and obesity. WHO global estimates for the year 2009, reported 1.5 billion people were overweight, of these, over 200 million males and nearly 300 million females were obese. Overall, more than one out of ten of the world’s adult population was suffering from obesity. In 2010, around 43 million children less than five years of age were overweight. The population of India was 1.22 billion among them 199 million were obese. The National Family Health Survey (N.F.H.S) showed that 12.1% of men and 14.8% of women in India were either overweight or obese. It reduced life span by 7.1 years in men and 5.8 years in women. (Itrat and Zarnigar, 2014)
According to the Unani scholars in Saman Mufrat, Hararat-e Ghareezia is severely compromised due to increased coldness (Buroodat). Excess buroodat vasoconstriction in blood vessels causes narrowing of vessels and contributes to obstructed propagation of Rooh in the body. Ibn-e Nafis had stated that morbid matters hinder the absorption of Akhlat resulting in narrow and hard blood vessels, due to Laham or Shaham and creating a disturbance in flow and penetration of Ruh into the organs. The obstruction in the way of Rooh may results in early death in many individuals. Sometimes this narrowing and congestion are because of the increased level of fat (shaham) and balgham in blood vessels. Because of increased pressure rupture of blood vessels may occur anywhere in the body although vessels of the heart and brain are more at risk of it. As an outcome of this situation patient may develop severe shortness of breath and palpitation. When Ruh fails to accomplish the body requirement, tissues turn hard and blood flow is not adequately maintained to the heart and brain thus, the patient suffers from syncope, stroke, and even sudden death in these cases. (Azhar and Anjum, 2019)
Causes of Obesity (Saman-e- Murat)
According to National Heart, Lung, and Blood Institute many factors can play an important role in gaining and maintaining excess weight. These factors include diet, lack of physical activity, environmental factors, and inheritance. Some of these factors are mentioned in the following section.
Eating Habits and Physical Activity
People attain weight when they consume more calories than they exert through physical activity. This is the biggest contributor to weight gain.
The environment around us affects our ability to keep a healthy weight. For example:
- Not having playgrounds and parks in your area, sidewalks, and gyms makes it difficult for people to be physically active.
- Large food portions increase calorie intake, making the physical activity even more important to maintain a healthy weight.
- Some people in many areas don’t have access to affordable healthy foods, like fresh fruits and vegetables.
- People ae encouraged to buy unhealthy foods, for example, high-fat snacks and sugary drinks by Food advertisements.
Research reveals that genetics plays a role in obesity. Genes also make a person susceptible to gain weight. Researchers believe that genes have the ability to increase a person’s likelihood of having obesity but that external factors, such as a massive food supply or less physical activity, is also responsible for a person to have excess weight.
Health Conditions and Medications
Some hormonal disorders may cause weight gain and obesity, for example, underactive thyroid, and various medicines may also responsible for weight gain, including some corticosteroids, antidepressants, and seizure medicines.
Abu Bakar Mohammad Bin Zakariya Razi (860-925 AD) described that fatty food (Tar Ghiza) is the reason for obesity. He classified obesity into general and local types and has given separate treatments for both types.
- Local or Central Obesity (Maqami Saman-e- Mufrit): When fat (Shahem) deposits in a particular organ it is called local or central obesity, for example, protrusion of the abdomen or breast due to the deposition of fat.
- Generalized or Peripheral Obesity (Umoomi Saman-e- Mufrit): Generalized deposition of fat in the body is called peripheral obesity or general. (NPH.gov.pk, 2022)
Stress, Emotional Factors, and Insomnia
Some people eat more than usual amount when they get bored, angry, upset, or stressed. Studies also have proved that insomniac people, are more likely to have overweight or obesity. This is partly because hormones that help control appetite and the body’s use of energy are released during sleep. (NIH, 2019)
According to Unani concept all the causes mentioned here are responsible for excess production of balgham (phlegm) as well as they also disturb body metabolism. The most common causes of obesity are dyspepsia (Sue- Hazam), excessive sleep (Ifraat-e- naum), excessive rest (Ifraat-e- sukoon), and sedentary bodily movement (Qillat-e- Harkat-e- badani). Other causes are
- Virasati and Khilqi Saman-e- Mufrat (Inherited and Congenital)
- Martoob Ghiza (Excessive use of fatty diets like meat and sweet dishes)
- Martoob Roghaniyat (Excessive use of fatty oils)
- Baroodat-e- Mizaj (Coldness of temperament)
- warzish ki kami (lack of exercise)
- Kasrat-e- ghiza (Excessive eating)
- Tafreeh (Excess of joy)
- soft bedding and soft cloths for sleeping
- Intake of excessive alcohol especially after a meal
- Hammam (Turkish bath) especially after meals etc. (Azhar and Anjum, 2019)
As the incidence of Saman-e-Mufrat (obesity) is increasing day by day, to date, there is no satisfactory treatment available. Although much research is being done that is accompanied by near successful outcomes. The beneficial effect of the drug is often associated with side effects and there is rebound weight gain after cessation of the pharmacotherapy. Therefore, the focus is now on complimentary or safe and effective alternative medicine, which includes the Unani system of Medicine. Unani Herbal Medicines play an important role in the management of Obesity as it is backed up by documentation and just need a shred of evidence-based validation of their claims documented by the great Unani scholars. Various studies carried out on the single drugs mentioned in the Unani classics are effective in the treatment of obesity, and animal experiments have begun to reveal the potential mechanisms of the various single drugs. (Azhar and Anjum, 2019)
Principles of Treatment (Usool-e- Elaj)
According to Zakaria Razi and Ibn-e- Sina, the treatment of obesity (Saman-e- Mufrat) is based on the following principles
To find out and remove the existing causes.
Correction of the abnormal cold temperament of an individual (Sue- mizaj Baarid). Obesity is cold in temperament disease in nature, so herbal medicines having opposite temperament i.e, Hot and dry would be given. (Ilaj Bil Zid)
Dietotherapy (Ilaj bil Ghiza)
- Avoiding fatty diets Ibn Hubal Al Baghdadi (1121–1213 AD) suggested that obese persons should avoid fatty diets and suggested a gradual decrease in diet, otherwise, adverse effects will be observed in the patient.
- Decrease in food intake (Taqleel Ghiza) Ibne Sina and Ibn Hubal Al Baghdadi (1121–1213 AD) has emphasized the decrease in food intake (Taqleel Ghiza) as an important tool for obesity treatment. He has used Advia Mulattifa (demulcents) and described in detail, the pharmacological action of these drugs. He also described the mechanism of non-absorption of food from the intestine as the same as the modern drugs, used in the treatment of obesity. Taqleel-e-Ghiza i.e, the concept of change in diet patterns means food low quantity and quality of food is very unique to the Unani System of Medicine which lays great stress on treating certain ailments. And this is done by administration of specific diets or by regulating the quality and quantity of food.
According to the Unani system, in addition to nutritional properties, various foods have pharmacological actions too. Therefore, the changes in eating habits must be permanent, to reduce weight. A diet chart may be prepared with the consultation of an experienced dietician. Reducing the energy density of food allows the patient to feel satiated while consuming fewer calories. Behavior therapists are required to counsel patients to make changes in the eating activity habits of obese persons. Obese persons must modify their eating habits and self-monitoring of food should also be done. (Azhar and Anjum, 2019)
Regimental therapy (Ilaj bit Tadbeer)
Tadbeer is an Arabic word meaning regimen or systemic plan, whereas Ilaj means treatment or therapy. So Ilaj Bit Tadbeer means treatment with the regimen, through which care of the sick person and maintenance of general health is performed with the help of many procedures, tools, and pieces of the equipment described by eminent Unani physicians. The following regimens may be carried out:
Physical activity (Riyazat)Continues physical activity is an essential component of health it should be encouraged to opt. these include lower rates of cardiovascular and all-cause mortality, independent of weight. Sports or fitness pursuits can help to improve health and weight stability. Patient set their goal to achieve through this exercise.
- Diaphoresis (Tareeq) & Medicated Bath (Hammam Muarriq)
Tareeq (Diaphoresis) is a process that induced sweating. It is instrumental in liquifying the sticky and adherent humors lodged in the peripheral tissues. Many Unani physicians recommended Tareeq, a mode of excretion to control the progress of Saman-e-Mufrat. Ḥammām comes from the word “Ḥamm”, which means “to bath”. Ḥammām is a place used for taking bath, consisting of several rooms with one room leading to the other with specific provisions and conditions customized. For this purpose, the steam bath could be used which may be considered the third room of a traditional hammam. In this process the rutubat inside the body comes to the periphery and when not excreted much then it moist the organs which are near the periphery. On the other hand, staying long duration in a hammam causes profuse sweating which results in heat and dryness in the organs by loss of ratubat from the body. Obese persons who cannot exercise adopt Turkish baths for the reduction of their weight.
- Idrār-i Bawl (Diuresis):
Diuresis (Idrār-i Bawl) is the procedure in which the formation and excretion of urine is enhanced for the treatment of bodily ailments. One of the essential processes adopted for the evacuation of morbid matter from the body through urine. Diuresis can be induced by adopting specific methods like exposure to cold, drinking water, and intake of plenty of fluids. (Azhar and Anjum, 2019)
Ilaj Bil Dawa (Pharmacotherapy)
A Unani medicine book Kitabul Jame le Mufradat il Advia wall Aghzia which was written by Ibne Baitar (1197-1248 AD) enlists some Muhazzil (weight-reducing) drugs and recommended their use in the treatment of Obesity. According to the Unani Medicine system, the choice of drugs for treatment is governed by three laws:
- Quality of drug in terms of Temperament,
- Quantity of drug with reference to its weight and potency
- Time of administration. The selection of drugs depends on the nature and type of the disease. The proper medication is that whose pathological temperament is opposite to the nature and qualitative pattern of the disease i.e, The weight and potency of the drug are determined by the condition of the organ, the severity of the disease, and other factors such as sex, age, weight, habit and habitat, season, built, previous treatment, and stage of the disease. The commonly used single and compound formulations for a reduction in body weight and treatment of obesity are “Baladur (Semicarpus Anacardium), Muqil (Commiphora muqil), Marzanjosh (Oliganum Vulgare), Luk Magsul (Coccus lacca), Seer (Allium sativum), Nankhwa (Ptychotis ajowan), Bora (Armenian bole), Zeera (Carum carvi), Badiyan (Foeniculum vulgare Mill.), Barg Suddab (Ruta graveolens Linn.), Sandrus (Trachylobium hornemannionum Hayne), Sazaj (Cinnamomum Tamala Nees) Zarawand (Aristolochia rotunda), Juntiyana (Gentiana lutea Linn), Sirka (vinegar), Tukhm-e-Karafs (Apium graveolans), Khardal (Brassica nigra Linn.), and Composite pharmacopeial formulations are Itrifal Sagheer, Tiryaq-e-Kabir, Jawarish Kamoooni, Anqarooya, Asanasiya, Amroosiya, Dawa e Murakkab, Dawa ul Luk, Majoon Seer Alvi Khan, Sufoof e Muhazzil, Jawarish Bisbasa, etc.”
The commonly used Advia Mufrada (single drugs) for the reduction in body weight and management of obesity are:
- Coccus lacca Luk Maghsool
- Commiphora wightii Muqil
- Tribulus terrestris Linn. Khar has
- Curcuma longa Linn. Zarad Chob
- Citrus lemon Linn. Lemon Juice
- Embelia ribes Burm. f. Baobarang
- Ruta graveolence Linn. Tukhm Suddab
- Apium graveolence Linn. Karafs
- Jentiana lutea Linn. Juntiyana Roomi
- Aristolochia rotunda Linn. Zarawand Taweel
- Commiphora myrrha Nees. Mur Makkai
- Oliganum vulgare Marzanjosh
- Allium sativum Linn. Seer /Lahsun
- Ptycholis ajowan Nankhwah
- Armenian bole Boora-e- Armai
- Carum carvi Linn. Kaala Zeera
- Pistacia lentiscus Linn. Mastagi Roomi
- Boswellia serrata Roxb. Kundur
- Onosma bracteatum Gaozaban
- Punica granatum Linn. Gulnar
- Tephrosia purpurea Linn. Sarphoka
- Psoralea corylifolia Linn. Babchi
Compound Unani Drugs
The commonly used compound drugs (Advia Murakkaba) used for reduction in body weight and treatment of obesity are:
Anqaroya kabeer wa sagheer, Ithrifal Sanai, Jawarish Kamoni, Jawarish Falaafali, , Majoone Seer Alvi Khan, Safoof Muhazzil, Asaanasiya, Eyarij feqra; Baladuri, Dawa-ul- Luk, Dawa-ul- Kurkum, Itrifal Sagheer wa Kabeer, Majoon Muqil, Majoon Falafali, Habb-e- Muhazzil, Majoon Muhazzil, Sikanjbeen Unsuli, Sikanjabeen Lemoni, Qurs Tinkar, Sanjarniya, Tiryaq Kabir, Sirka Jamun, Asl-e- Musaffa etc. (NPH.gov.pk, 2022)
Complications of Obesity
Despite the development of medical science, many diseases are still challenging to human beings and efforts are continuing to reduce or control these diseases although obesity is one of them. A certain level of weight gain is a good sign of health. If it is higher than the normal limit it becomes dangerous. Excessive accumulation of Balgham and Shaham (barid ratab madda) in an individual having (Mizaj-ebarid) cold temperament can be a cause. The Mizaj-e-Barid is more prone to obese individuals. Obesity (Saman-e-mufrat) is a balghmai disease described by the loss of movement of Aza due to the deposition of Shaham in specific organs or a whole body. Unani scholars said that an individual having more fat in the body is at risk of rupture of blood vessels because vessels are compressed due to excess fat and especially if obesity develops in the early stage of life, then the blood vessels become narrow. This condition has not fulfilled the demands of rooh-e-haiwani and causes a diminution of innate heat of the body (hararat-e-Gharizia). This excess fat leads to impaired digestion and so disruption of Mizaj, which become barid and shiddat-e-barudat may cause even death many times. This shiddat-e-barudat causes the narrowing in blood vessels that directly affect the function of the liver, kidney, heart, and other important organs of the body. Hakim Akbar Arzani has described seven complications of obesity viz. Dyspnoea, palpitation, diarrhea, infertility, hemorrhage because of rupture of blood vessels, syncope, paralysis, and coma. (Itrat and Zarnigar, 2014)
Obesity is a leading cause of various dangerous diseases, it is a risk factor for hypertension, diabetes mellitus, gall bladder diseases, coronary heart diseases, breathing difficulties during sleep, various gynecological problems and certain types of cancers, osteoarthritis, other musculoskeletal diseases, and infertility.
NIH (2019). Overweight and Obesity | National Heart, Lung, and Blood Institute (NHLBI). [online] Nih.gov. Available at: https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity.
Azhar, M. and Anjum, N., 2019. Concept and Management of Saman-e-Mufrat (Obesity) in Unani Medicine. Indian Journal of Integrative Medicine, pp.8-13.
Itrat, M. and Zarnigar, S.M., 2014. Concept and management of obesity in Unani medicine. International journal of.
www.nhp.gov.in. (n.d.). Saman-e- Mufrat (Obesity) | National Health Portal of India. [online]
Available at: https://www.nhp.gov.in/obesity-saman-e-mufrat-_mtl [Accessed 4 Jun. 2022].