Concept of Neuropathy in Unani System of Medicine.pptx

This presentation is about the concept of Neuropathy in Unani System of Medicine, specifically Diabetic Peripheral Neuropathy.

1. Unani Concept of Neuropathy Dr Mohd Shahid PhD Scholar, NIUM, Bengaluru

2. Motor neurons (large myelinated ) Sensory neurons Large myelinated – proprioception and vibratory sense. Small myelinated , and small unmyelinated – transmit pain and temperature sensation Autonomic nerves are also small in diameter. Parts of Peripheral Nervous System

3. Neuropathy refers to a broad term encompassing disorders affecting the peripheral nervous system. It involves damage or dysfunction of nerves, leading to various symptoms such as Numbness, Tingling, Burning Pain, Weakness, and pain. What is Neuropathy?

4. Mononeuropathy – single nerve affected Polyneuropathy – clinically diffuse and symmetrical, commonly developed from peripherally. Radiculopathy – disease affecting nerve roots TYPES OF PERIPHERAL NEUROPATHIES

5. Charcoat -Marie-Tooth (CMT)-( most common ) Motor and Sensory neuropathy, degenerative in nature. ( Autosomal dominant) Fabry disease – X linked dominant disease Refsum disease Tangier disease Porphyria Familial Amyloid Polyneuropathy Hereditary Neuropathies

6. Primary Amyloidosis Diabetic Neuropathy – most common cause of neuropathy in developed contries . Distal symmetric sensory or sensorymotor poly neruropathy (Most Common) Autonomic neuropathy. Polyradiculoneuropathies . Cranial neuropathies. Distal mononeuropathies . Acquired Neuropathies

7. Hypothyroidism- Polyneuropathy Rheumatoid Arthritis- more than 50% patient developed neuropathy SLE – 2-27% patient developed a peripheral neuropathies Uremic Neuropathy- about 60% patients with Renal Failure develop a polyneuropathy. ( safravi ) Chronic Liver Disease- Generalised Sensory-Motor neuropathy developed. Acquired Neuropathies

8. Leprosy (Hansen disease)- most common cause of peripheral neuropathy in Southeast Asia, Africa, and South America. (saudavi) IBD Diphtheric Neuropathy HIV related Neuropathy Cont…

9. Paraneoplastic sensory Neuropathy Lymphoma Multiple Myeloma Neuropathies associated with Malignancy

10. Neuropathies can occur as Complications of toxic effects of variuos Drugs and other Environmental Exposures . Isoniazide - Most common side effect of INH is Peripheral Neuropathy. (Pyridoxine 100mg/d). Chloroquine and Hydroxychloroquine - Toxic myopathy ( Neuromyopathy ) Amiodrone ( antiarrhythmatic ) - Neuromyopathy Colchicine – Neuromyopathy Toxic Neuropathies

11. Thalidomide ( immunomodulator ) – Peripheral neuropathy Antiretroviral agents – causes painful neuropathy (most common) Lead, Mercury, Thallium, Arsenic Cont…

12. Deficiency of Cobalamine – Pernicious anemia , diet, PPI Deficiency of Thiamine – Ch. Alcohol abuse Deficiency of Vit . E Deficiency of B 6 – by both deficiency and toxicity Deficiency of Niacin and Copper Nutritional Neuropathies

13. In > 50% patients the exact cause of Neuropathy is undiagnosed. Usually developed in 6 th or 7 th decade Characterised by distal numbness, tingling and often burning pain starts from feet. Cryoptogenic or Idiopathic Sensory and Sensorimotor Polyneuropathy

14. Median Neuropathy Ulnar Neuropathy Radial Neuropathy Femoral Neuropathy Sciatic Neuropathy Peroneal Neuropathy Mononeuropathies

15. Affects Sensory pathways – burning sensation, pain, numbness, tingling sensation Autonomic pathways – Bowel and bladder incontinence, Sexual weakness in both male and female, and palpitations etc. Motor pathways – weakness of skeletal muscles Peripheral Neuropathy (Symptoms)

16. Demyelination: GB syndrome Axonal degeneration: toxic neuropathies Compression: Carpal tunnel syndrome Infarction: diabetes Infiltration: leprosy and granuloma Mechanism

17. Managing peripheral neuropathy involves a multifaceted approach aimed Alleviating symptoms. Addressing underlying causes. Improving quality of life. Management

18. Medications such as gabapentin , pregabalin, and duloxetine . Topical treatments like capsaicin cream or lidocaine patches. Antidepressants such as amitriptyline or serotonin- norepinephrine reuptake inhibitors (SNRIs) like venlafaxine are commonly used. Pharmacological Interventions

19. Physical therapy modalities such as transcutaneous electrical nerve stimulation (TENS) or low-level laser therapy (LLLT) may provide symptomatic relief. Physical Therapy and Rehabilitation

20. Optimal glycemic control in individuals with diabetes can help prevent or slow the progression of diabetic neuropathy. Smoking cessation and alcohol moderation are recommended lifestyle changes to reduce the risk of peripheral neuropathy. Lifestyle Modifications

21. Alpha- lipoic acid and acetyl-L- carnitine supplementation have been studied for their potential neuroprotective effects in diabetic neuropathy. Vitamin B12 supplementation may be beneficial for individuals with neuropathy associated with vitamin deficiencies. Nutritional Supplements

22. Acupuncture has shown promise in relieving neuropathic pain and improving nerve function in peripheral neuropathy. Herbal remedies such as evening primrose oil has been investigated for their potential benefits in neuropathic pain management. Complementary and Alternative Therapies

23. Pain Altered sensation Muscle atophy Weakness In DPN complications are more catastrophic Foot Ulcers Gangrenous digits and limbs Amputation Complications of Neuropathies

24. Unani Perspective on Neuropathy

25. خدر (Numbness) : Complete or partial loss of sensation of any organ of the body. خدردموی خدر صفراوی خدر بلغمی و رطوبی خدر سوداوی خدر ریحی خدر یبسی جذام خدرى Leprosy where there is no nodular formation but there is loss of sensation of organs WHO International standard terminologies on Unani Medicine

26. The complete/partial loss of sensation of any organ of the body. Its possible English equivalent is numbness. جزام : It is of two types: ‘ Uqdi / ‘ Ajri and ‘Asabi/ Khadari Waja ‘ Khadari : Numbness caused by the blockage of sensory nerve endings due to extreme cold or any other reason and congestion.) “ Khadar ” acc. to CCRUM terminologies guide/book

27. استرخا فالج تشنج کزاز لقوہ رعشہ ارتعاد خدر اختلاج امراض اعصاب

28. According to the cause these disorders can be classified as مزاجی آلی تفرق اتصالی اضافی اسباب ورم (Inflammation/Neuritis) سخت قسم کی حرکت تمدد یا دباو پڈھنا (Compression) Cont…

29. Sleep just after Dinner امتلا کی حلات میں سونا Drink chilled cold water or excessive water Alcohol abuse ( Vit . Deficiency ) Excessive use of Vinegar Excessive sexual desire/activity Risk factors

30. سو مزاج

31. Sensory function: Paresthesia . Motor function: weakness / paralysis. Condition of nerve in terms of نرمی and سختی like in case of جزام /Leprosy the peripheral nerves becomes thickened. ( cardinal sign ). Should consider the specific pain related to a particular nerve like Sciatic nerve in case of عرق انسا (Sciatica) or Median nerve in case of Saturday nerve palsy. ( Mononeuropathises ) How do you assess the function of Nerve in Unani Medicine?

32. کسی عضو کی حس لمس کے باطل یا ناقص ہو جانے کو خدر کہتے ہیں باطل means the function has been stop. Sensory function lost. ناقص means the function has been incomplete in its quality or in quantity. Sensory function is reduced/altered Burning sensation Tingling sensation Pins and needles pricking sense خدر

33. Most common cause of خدر is سو مزاج بلغمی Asab wa Aza’a mai Quawat -e- Hassasa ka dakhil na hona . Quwat ka Zati tour pr weak hona , which is due to raddi qism k bukhar k akhiri marhale mai ya Mout k qareeb hona . Mizaj ka Fasid ho jana jo do wajh se ho sakta hai , ek Afyoon ka istemal (Drug toxicity) Toxic neuropathy) ya kisi Zehreele Janwar ka kaat laina . Sue Mizaj Barid Johar asb ki Ghilzat : Sudda or obstruction. Causes

34. Many eminent physician said “if خدر is chronic and بلغمی it may transformed into استرخا . Other complications: سکتہ , صرع , تشنج , کزاز , فالج Hakim Muhammad Azam mentioned in his book Akseer Azam “I observed, if خدر is chronic it may resulted in “ جزام ”

35. If you don’t identified any cause of Khadr then emphasised on types of Excessive/Morbid Khilt (> 50% patient of Neuropathy idiopathic) Ghalba dam- Khadr Damvi Ghalba Safra - Khadr Safravi Ghalba Suad - Khadr Saudavi Ghalba Reehi – Khadr Reehi Ghalba Yabusat – Khadr Yabisi

36. For Khadr Balghami wa Ratoobi جوشاندہ منضج بلغم Mako , baikh kasni , badiyan, baikh badiyan each 6 gm, gauzaban , ustukhuddus , gule surkh each 4 gm, maweez 20 gm, and injeer 3 units. جوشاندہ مسہل بلغم Magz khyarshanbar 10 gm, revand cheeni 3 gm, sana makki 5-7 mg, ghareeqoon 1-3 gm, bisfaij 7gm. Treatment Modalities in Unani Medicine (Pharmacotherapy)

37. مسہل عام کے بعد مسہل خاص استعمال کریں Habbe Ayarij Habbe Qoqaya Tiryaq etc. مسہل خاص

38. ) مالش کرنا Massage ( : Roghan Qust or Roghan Farfiyoon Hammam Tila : Aqarqarha with vinegar Ointment: Khardl with vinegar was practising formulation of Hakim Sharif Khan. Regimenal therapy

39. If above treatment is not working Hijamah bish Shart Then apply alum powder, Tinkar and Aabe Lemon like “ Tila ” After healing, apply aqarqarha , khardal and sheeshaan as an ointment in vinegar Or apply Roghan Hartal another practising formulation in this disease. Second line of treatment

40. Slowing the progression of disease Preservation of nerve function To delay further complications, like foot ulceration, gangrene and amputation The concept of neuroprotection is claimed to be formulated recently, but in fact the basis of this approach was laid by Unani physicians , thousands of years ago. Therefore, drugs possessing above mentioned properties not only will relieve pain, but also potentiate nerve functions, and eventually stimulate sensory and motor functions Neuroprotection مقوی اعصاب

41. Azaraqi Waj Aqarqarha Balchad Beesh Darchini Jadwar Safoof Khadr Habbe Asab Habbe Azaraqi Single/ Polyherbal drugs used as Neuroprotective in Unani medicine

42. Case Studies or Clinical Evidence

43. Leach therapy: MANAGEMENT OF DIABETIC NEUROPATHY BY IRSAL-e-ALAQ (HIRUDOTHERAPHY): A CASE REPORT Conclusion: Irsal -e- Alaq is found effective in the treatment of diabetic neuropathy as well as in improving the quality of life in such patients Regimenal case report published

44. Efficacy of  Habb -e- Asab  in diabetic peripheral neuropathy: a randomized placebo control study Test drug: Habb -e- Asab 250mg BD. Conclusion: Improved the clinical symptoms in 45 days without any significant side effect. Clinical studies

45. Evaluation of a Unani formulation, in diabetic peripheral neuropathy: A randomized single blind standard controlled study Test drug: Habbe Azaraqi 500 mg BD @ NIUM, bengaluru (2011-12) Conclusion: Test drug is effective and safe in the management of diabetic peripheral neuropathy Clinical studies

46. Neuroprotection Offered by Majun Khadar , a Traditional Unani Medicine, during Cerebral Ischemic Damage in Rats Test drug: Majoon Khadar  Majoon Khadar exhibits neuroprotective effect in cerebral ischemia by potentiating the antioxidant defence system of the brain. Preclinical studies

47. Comparison with Modern Medicine

48. According to Unani medicine alcohol abuse categorically damaging for Nerves. Chronic alcohol consumption developed vitamin B1, B6 and B12 deficiency which plays a vital role in health of Nerves. How alcohol is risk factor for Neuropathy?

49. In > 50% patients the exact cause of Neuropathy is undiagnosed. Unani medicine gives hope in these cases, If you don’t identified any cause of Khadr then emphasised on type of Excessive/Morbid Khilt (> 50% patient of Neuropathy idiopathic) Ghalba dam- Khadr Damvi Ghalba Safra - khadr Safravi Ghalba Suad - khadr Saudavi Ghalba Reehi – khadr Reehi Ghalba Yabusat – Khadr Yabisi Cryoptogenic or Idiopathic Sensory and Sensorimotor Polyneuropathy

50. Systemic Lupus Erythematosus- 2-27% patient خدردموی

51. Rheumatoid Arthritis- more than 50% patient Uremic Neuropathy - about 60% patients Chronic Liver Disease خدر صفراوی

52. Hypothyroidism Rheumatoid Arthritis خدر بلغمی و رطوبی

53. Leprosy (Hansen disease)- most common cause of peripheral neuropathy in Southeast Asia, Africa, and South America. Neuropathies associated with Malignancies. Toxic Neuropathies usually due to drugs or Heavy metals خدر سوداوی

54. Leprosy (Hansen disease) جذام خدرى

55. Benefits and Limitations

56. As an Adjuvant treatment Unani medicine can give more effient treatment in > 50% unidentified cause of neuropathy than allopathic medicine. We have so many Regimenal therapies which are proven significant in managing neuropathies. Benefits

57. Lacking evidence based data Unani researchers are not willing to publish their work in peer reviewed journals Free hand for pharmaceutical companies Need a strict institutional body to check irregularities in pharmacy companies Limitations

58. Unani medicine explains Khadr or Neuropathy extensively with comprehensive management. Allopathic medicine unable to explain about 5o% patient and only give symptomatic treatment. Efficacy and safety of the therapy in different diseases as indicated by the Unani physicians can be evaluated on modern parameters, and can be used single or as an adjuvant with other therapies. Conclusion

59. Thank You