MohammadFazil & Sadia Nikhat
Phytotherapy Research 35:4 (2021) 2317–2335
DOI: 10.1002/ptr.6949
Abstract:
The 20th and 21st centuries have witnessed epidemics and pandemics of various infectious agents. The development of effective antimicrobials in the 20th century has been complemented with the emergence of resistant and mutant strains. In this context, we present a comprehensive overview of the preventive measures described in Unani medicine during epidemics. Unani medicine is a traditional medicine system included in the Indian Systems of Medicine. Unani medicine has an extensive description of epidemic infections and preventive and therapeutic measures for the same. Certain factors like environment, season, and geographical location of a place are known to determine the extent of infections, and their escalation to epidemics. Maintenance of general health, immune-stimulation, and disinfecting of the environment are advised as protective measures, for which many drugs are prescribed. In the case of illness, specific antimicrobial drugs of natural origin are prescribed. Herein we discuss these measures in detail, along with the scientific evidences of anti-microbial, immunomodulatory, and health-protective actions of these drugs.
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Introduction:
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Various forms of traditional and complementary medicines are practiced around the world. Like traditional Arab medicine (Saad, Azaizeh, & Said, 2005), traditional Chinese medicine, Ayurveda, Homeopathy, and Unani medicine, to name a few (Fazil & Nikhat, 2020). Many of the drugs used in these traditional medicines have scientifically proven anti-bacterial, anti-fungal (Zhang et al., 2013), and anti-viral effects, even against drug-resistant strains (Ma et al., 2015). Unani (pronounced Yunanī) is a traditional medicine system of Hellenistic origin, founded on Hippocratic principles. It was later systematized, organized, and developed by Arabian and Persian scholars during the medieval ages (500–1500 AD), hence also referred to as Greco-Arabian medicine and Persian medicine. In this period, significant developments were made in various areas of medical science by famous scholars such as Ibn Sina (Avicenna, 980–1035 AD), Zakariya Razi (Rhazes, 865–925 AD), Abul Qasim Zahrawi (Abulcasis, 930–1013 AD), Rabban Tabari (838–870 AD), and many others (Saad et al., 2005). Around the 12th century, it was introduced into the Indian subcontinent by the Mughal emperors. Indian scholars such as Azam Khan (1814–1902 AD) made improvisations in Unani medicine with the indigenous knowledge and recorded their works in treatises which are presently regarded as authentic citable sources among the researchers of Unani System of Medicine (USM) (Zargaran, Zarshenas, Borhani-Haghighi, & Mohagheghzadeh, 2014). At present, Unani medicine is recognized as a traditional medicine by World Health Organization (WHO, 2010), and is also a component of Indian Systems of Medicine (The National Commission for Indian System of Medicine, 2019).
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Selected from the text:
Terpenes and terpenoids have broad-spectrum inhibitory activity against several air-borne pathogens (Aldred, 2009; Ludwiczuk et al., 2017).
For instance, the antibacterial and antifungal activity of Cinnamomum camphora and Pistacia lentiscus is attributed to the presence of camphor (Bachrouch et al., 2010; Shalaby et al., 2016).
Diterpene esters present in Lens culinaris have anti-viral activity (Ganesan & Xu, 2017).
Trans-cinnamaldehyde has an antioxidant and anti-inflammatory activity (Da Silveira, Sá, Andrade, De Oliveira, & De Sousa, 2014).
Polyphenols exist in nearly 8,000 structural variants and are widely found in fruits, vegetables, legumes, tea, and wine. They have a wide range of biological activities such as antioxidant, anti-cancer, cardioprotective, and anti-aging.
Phenolics such as gallic acid, ellagic acid, punicalagin, quercetin present in many fruits like pomegranate, grapes, guava, apple, mango, etc. have anti-microbial activity.
Hydrolysable ellagitannins present in P. granatum have demonstrated effective anti-oxidant and anti-tumor activities in-vitro. The tannins are present in maximum amount in fruit juice (Orak, Yagar, & Isbilir, 2012). Tannins such as chebulagic acid, corilagin present in T. chebula have neuroprotective and anti-bacterial effect (Saxena et al., 2017).
Vinegar contains acetic acid (Figure 1h), oxalic acid, and benzoic acid which penetrate the bacterial cell wall and interfere with intracellular pH, thereby causing death.
Flavonoids such as taxifolin, catechin, apigenin in T. indica have demonstrated anti-inflammatory, nephroprotective, and anti-bacterial activity (Komakech et al., 2019; Ullah et al., 2014).
β-sitosterol (Figure 1k) present in P. granatum (Wu & Tian, 2017) is one of the most important phytosterols. It is a proven immunomodulatory, anti-oxidant, and has dose-dependent anti-cancer activity (Miras-Moreno et al., 2016).
Anthraquinones present in R. australe have demonstrated inhibitory activity against Helicobacter pylori, Herpes simplex virus (emodin) and Candida albicans (rhein) (Bartnik & Facey, 2017).
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Conclusions:
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The science of Unani medicine encompasses age-old wisdom on the understanding of health and disease, hypotheses founded on rational ideas, and a legacy of health-promoting and protecting measures based on diligent observation and extensive experience; resulting in a holistic approach to health care which remains irrefutable to this day. In addition to general methods of hygiene and healthmaintenance, protection during epidemics rests on a three-pronged approach: purification of air, improvement of immunity, and specific antimicrobial drugs in case of illness. The use of air-purifying drugs is a particularly interesting concept, which employs aromatic drugs such as S. benzoides, S. album, rose water etc. Besides creating a pleasant atmosphere, it is now known that they also reduce air-borne pathogens. Immuno-modulation is understandably a very important aspect of prevention. Unani physicians have advised the use of citrus fruits, vinegar, saffron and other health protective drugs which also have hepato-protective and antioxidant effects. In addition, drugs such as G. glabra, honey, Ferula narthex etc. are prescribed for their antimicrobial effects. The drugs contain several bioactive compounds as already elaborated in the paper. The most important aspect of natural medicines is that every drug contains several active molecules, which provide multiple actions, often in synergism (Pandith et al., 2018). Due to multiple modes of action, natural drugs are also capable of overcoming antibiotic resistance (Kim et al., 2016). There are certain distinct qualities of USM which set it apart from rest of the medicine systems, and provide effective solutions to control infections and epidemics. First and foremost, the drugs utilized in health-protection, immune-modulation and prevention of infection are easily available common herbs, which promotes acceptability and availability even in under-privileged areas. Second, many of the drugs used for environmental purification for example, Sandalwood, Rose water etc. have a luxurious aroma, which promotes relaxation alongwith reducing microbes. Thirdly, most drugs have multiple modes of actions, and many have a hepato-protective or nephro-protective effect alongwith other benefits (Radha & Laxmipriya, 2015). This is extremely important, as weakness of vital organs often complicates an otherwise less-serious illness (G. Guo et al., 2020). Most importantly, the presence of several bioactive ingredients in the drugs, with proven activities, strongly advocates further exploration of their beneficial effects.
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