Management of Obesity in Unani System of Medicine

Hakim . Shaikh Nikhat (MD Unani Medicine)

Research OfficerRegional Research Institution of Unani Medicine Mumbai.

Ministry of AYUSH, Govt. of India E-mail ID: drnikhat.unani@gmail.com

Central Council For Research in Unani Medicine (CCRUM)

• It is a Unani council which is working under the Ministry of AYUSH, Govt. of India

• The council is engaged in multi modal research activities

• responsible for important work in the development of Unani System of Medicine in India.

• It is committed to promoting healthy outcomes for all over the India

• Providing health facilities for everyone , for healthy life

• This lecture is primarily based on the Unani concept of obesity to bring forth the most current and useful information to manage the diseases.

Objectives• Define obesity • Its Causes & consequences • Unani Concept of Obesity• Unani approach to reduce obesity • How to prevent obesity

What do you mean by Obesity???

Scientific definition of Obesity

• Definition: excessive weight that may impair health

• How do we measure If someone is obese?– Body Mass Index (BMI): is a simple index of

weight-for-height used to classify overweight and obesity in adults.

– It is defined as a (kg/m2).

Body mass index (BMI)

• The WHO definition:• BMI Categories: – Normal weight = 18.5-24.9 – Overweight = 25-29.9 – Obesity = BMI of 30 or greater(classification does not apply to people younger than

18 years of age, pregnant women, or breast-feeding women.)

Just a Example

• BMI = body weight (kg) ÷ height² (m)• Weigh: 150 lbs (68 kg) and • Height: 5'8" (5 fit & 8 inch) = (1.73 m) Calculation: 68 ∕ (1.73 × 1.73) or 2.99. Result: 22.74 (healthy range).

HIP – WAIST RATIO

Just the Facts! • According to WHO:

As of 2005– 1.6 billion adults (over 15 years old) are

overweight– 400 million are obese – Projects by 2020, 2.3 billion will be overweight

and 700 million obeseRef: World Health Organization.(2008). Obesity and

overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en

Prevalence of childhood obesity • It is one of the most serious public health challenges of the 21st

century. • The problem is global and is steadily affecting many low- and

middle-income countries. • Globally, in 2010 the number of overweight children under the age

of five years.• It is estimated to be over 42 million. Close to 35 million of these

are living in developing countries. • Overweight and obese children are likely to stay obese into

adulthood• More likely to develop non communicable diseases like diabetes

and cardiovascular diseases at a younger age.• Prevention of childhood obesity therefore needs high priority.”

Types of ObesityNow "one-size-fits-all" approach is quit changed

Six Type of Obesity

CAUSES?????What do you think about

the cause of Obesity

You are right???Obesity is extra bank balance of fat in

your body

• Simple equation…when you eat more than you use..it is stored in your body as “fat”. – Causes• Global shift in how we eat• Western diet of processed food• Higher sugar, fat and calories in what we eat• Less nutrients• Reduced intake of vitamins and minerals

What does obesity do to our bodies? (Effects)

– Cardiovascular disease– Diabetes type 2–Musculoskeletal disorders – Cancers-endometrial, cervical and colon– Infertility – PCODs– Gallstones – Premature death and disability

The secondary effect of obesity are 80 % Medicare cost factors worldwide

What Modern medicine sys about management of Obesity

• In mild to Moderate cases:• By improve quality of life (Diet, exercise)• Advice to eat a healthy, balanced (No daily diet with less than 1000 to 1200 calories)• "Crash diets“: It is a method to lose weight really fast in

a short period of time, by reducing the daily calorie intake

• "Crash diets“: are never successful in the long term because once the diet is stopped, the weight usually comes back.

• Regular physical activity

Medical intervention

• Medications aren't "magic cures" leading to permanent weight loss.

• They are only for people who are classified as obese or have secondary diseases

• Which may produce adverse effects on long term uses

Surgery is only considered when other weight management

options have not been successful

• gastric surgery• gastric bypass surgery• laparoscopic band surgery• Roux-en-Y gastric bypass• stomach "stapling“• Liposuction• Any advertisement product

Unani concept of Obesity

Obesity = Siman Mufrit Siman = Fats

Mufrit = Excessive • Obesity - Latin word ‘obedere’, to devour (eat

greedily) and in English means very fat.• Excess of shaham is due to ratoobat and

baroodat. • Thus, obesity can be defined as excessive of

shaham (fats) in which baroodat (Cold) and ratoobat (moist) is increases in the body.

In famous classical books

• First it was Buqrat (420 BC) who gave detailed description of obesity including its complications, prevention and management in his famous book “Fasoole Buqratia”.

• Al Qanoon (Canon of Medicine) by Ibne Sina • Moalijat-e-Buqratiya by Buqrat• Firdousal Hikmat by Ali Bin Rabban Tabri • Al Havee by Zakariya Razi

Types of Obesity in classical books

•Local •General

Example of local obesity (Simane Mufrit)

Vital organs

How Obesity Affects Your Liver• The term non-alcoholic fatty liver disease (NAFLD): hepatic steatosis resulting from

excess weight in the absence of a history of alcohol use or other known liver diseases.

• NASH: non-alcoholic steato -hepatitis

How Obesity Affects Your Heart

• CAD• Ischemia• Hear Attack

How Obesity Affects Your Kidney

• CKD• Nephritis• Pyelonephritis

How Obesity Affects Your Brain

• Stroke • Paralysis

How Obesity Affects Your Abdomen

Example of General obesity (Simane Mufrit)

Etio - Pathology • Disturbances in Hadhm wa Istehala

(Digestion & Metabolism)• Disturbances in temperament (Sue

Mizaj)• Disturbances in Six Essential

Factors (Asbab-e-Sitta Zarooriyah)

Disturbances in Metabolism (Islahe Hadhm wa Istehala)

• Metabolism & Digestion comes under the Hudhoom Arba

(Four Stages of Digestion)1. Hadhm-e- Medi (Stomach)2. Hadm-e- Mewi (Intestine)3. Hadhm-e -Kabidi (Liver)4. Hadhm-e- Udhvee • (Specific organ)

Specially Digestive (for Stomach) & Liver Correctives (For Stomach)

• Liver is a metabolic hub• Kitchen of the body• Functions:• Metabolism• Detoxifications• Secretes bile • Makes proteins important

for blood clotting etc….

Temperament & Disturbed temperament (Mizaj & Sue Mizaj)

Balghami Mizaj person’s are prone for the obesity.

Because Balgham is having Barid Ratab Mizaj

Obesity - a condition in which baroodat (Cold) and ratoobat (moist) in the body increases.

Peculiarity of Balghami Mizaj

Strengths• Relaxed• Quite and calm• Consistent • Faithfull friend• Accepting• Diplomatic• Peacemaking• Observant & listener• Talented

Weaknesses • Shy• Fearful of changes• Laziness• Stubborn• Not goal oriented• Un enthusiastic• Too compromising• Undisciplined• Discouraging• Non participative

Balance = Health

• Balghami Mizaj (Phlegmatic temperament) = Baroodat & Ratoobat in balance (water)

• Damvi Mizaj (Sanguine T) = Hararat & Ratoobat in Balance (Air)

• Safravi Mizaj (Bilious T) = Hararat & Yaboosat in balance (Fire)

• Saudavi Mizaj (Malencholic T) = Baroodat & Yaboosat in balance (Earth)

Sue-e-Mizaj Balghami

Increase in Baroodat & Ratoobat

Obesity

fat is presence inform of dasoomat (viscous substances) or Lathif & Ghaleez Shahm in blood

Dasoomat of blood, solidifies and deposited in the form of Ghaleez shaham (Bad Cholestrol / LDL).

BUTTER / OIL

Causes of Increase Baroodat & Ratoobat

• External: cold climate, cold season, cold bath etc

• Internal: cold foods & cold drinks,

Disturbances in Asbab-e-Sitta Zarooriyah

Hawa-Muheet(Atmospheric

Air)

Makoolat wa Mashroobat

(Foods & Drinks)

Harkatwa Sukoon-e-Badni

(Physical Movements & Rest)

Harkat wa Sukoon-e-Nafsani

(Mental Movements & Rest)

Noam wa Yaqza (Sleep &

Wakefulness)

Makoolat wa Mashroobat (Foods & Drinks)

Good nutrition is an important part of leading a healthy lifestyle.

• Diet plays an important role in the genesis of obesity.

• These Bad food habit depend:• Personal choices, • advertising, • social customs and cultural influences, • food availability and pricing

The truck is loaded with what must be consumed over a lifetime to sustain a person of average size.

Now a days ---We are Overloaded

Bad Drink Habits

Bad Foods Habit

Harkat-wo-Sukoon-e-Jismiah (less bodily Exercise

and More resting condition)

• There are multiple diseases associated with obesity and physical inactivity….Obesity

• Overweight Employees Are Less Productive• Reasons• In children: Indoor games , T,V, computor,mobil

etc• In females: less house hold works, recent advance

equipments • In males: sitting work, IT sectors,

What we were ??Now what we are??

Naum-o-Yaqzah (Disturbed Sleep pattern)

• Sleep is a natural, periodically recurring state of inactivity.

• It is necessary to have peace full sleep• Work burden, mobile, watts app, face books,

internet etc

Ihtebas and Istifragh (Retention and Excretion)

• Qabz - Ummul Amraz• Mother of Diseases is Constipation.• Obese patients generally have the complaint

of constipation, piles, and GIT disturbances.

Treatment of Obesity????

• Very first thing which come in our mind that is Dieting• Kya khaye aur Kya na

Khaye????• Kaha Jaye ??? • Kisse Pooche????

Specifically for the Morbid obesity….Should we go for ???

• Liposuction• Bariatric surgeries• Heavy medications• Any advertisement

product

NO NEED TO GO ANY WHERE(Mild to Moderate type of Obesity)

No need to go for • Liposuction• Bariatric surgeries• Heavy medications which

produces long term side effects• Any advertisement product

Unani System Offers

• Preventive measures: prevent health of a healthy person

• Curative measures: treat the diseases person

As a preventive measures

• U have to adopts the healthy lifestyle (Asbab Sitta Zarooriya)• Ilaj Bil Ghiza • Ilaj Bil Tadbeer

As a curative measures…. by following Golden Unani principles

• Elimination of the existing causes (Correction of Metabolism)• Correction of the Sue Mizaj• Following Asbab Sitta Zarooriyah • Ilaj Bil Tadbeer (which produce Hararat and

yaboosat in the body)

LINE OF TREATMENT

Ilaj Bil Ghiza (Diet therapy)

What do you mean by Dieting ?????

Ilaj Bil Ghiza (Diet therapy) By Unani Scholars

• Kamiyat wa Qaifiyat (Volume & Calories)• Mizaj (Temperament)• Mosam (Climate)• Umr (Age)• Oqat-e-Ghiza (Timing of Foods)

May increase in Kamiyat (quantity/ Volume)

Food should be decreased in terms of Kaifiyat (quality / Calories)

Kamiyat wa Kaifiyat (Quantity & Quality)

Kamiyat (Volume) ke Aitebaar se Zyada Faidemant

• Fruits are natural super foods with immense benefits that help in weight loss – they are high in fiber, contain natural sugars

• Different foods go through different metabolic pathways in the body.

• It is a great way to increase the volume of your meals, without increasing the calories.

Pine apple

• Bromelain is a complex mixture of substances that can be extracted from the stem and core fruit of pine apple.

• It has been used for • Weight loss• Excessive inflammation,• Excessive coagulation of the

blood• Cancer

Apple • An apple a day may keep obesity away.• Apples have many health benefits• A study suggesting that eating an apple a

day may be just as beneficial as daily statin use (vasodialatation).

• A 2011 study also claimed that apples and pears may reduce the risk of stroke by more than 50%

• If you’re on a weight loss diet, then you certainly need the apple.

• Researchers found that women who eat apples before their meals lost 33% of body weight in just one month.

Watermelon

• The watermelon is your go-to fruit for weight loss.

• It’s high in water content (90%)• 100g serving just contains 30 calories.• A rich source of amino acids called

arginine which helps burn fat. • It is the fact that not only does it keep

you hydrated, it will also keep you satiated for a long time which will lead to less unhealthy snacking

Cucumber (Vegetable)

• It is packed with immense health benefits.

• High in fibre, • it’s another potent weight loss

aid.• it perfect for diabetics as well. • it keeps our bowel & kidney

movements prim and proper which aids the overall weight loss process.

Banana

• The average banana is an excellent source of instant energy and the perfect post-workout food.

• A ‘healthy’ options. • It also helps beat muscle cramps,

keeps your BP in check, prevents acidity and even beats constipation.

Pear

• The pear fulfils one quarter of your daily fibre requirement.

• It is great for your digestive system

• It also helps reduce cholesterol levels,

• reduces the risk of CHD• Reduce risk of DM• it’s rich in Vitamin C.

Oranges

• It is not only great to taste,but 100g of this fruit only contains 47 calories which is great for someone looking for a snack while trying to follow a strict diet.

• It’s also sweet which will help take care of the cravings every dieter has for something sweet!

Tomatoes

• It is to be said that tomatoes are vegetable fruits , a Godsend for your weight loss battle.

• Delicious, full of antioxidants and reduce water retention.

• They also reverse leptin resistance, • leptin’s a type of protein which

prevents our body from losing weight, thus tomatoes are the perfect ally.

Leafy Greens

• Leafy greens include:• spinach, Methi, Lauki and a few others.• They have several properties that make

them perfect for a weight loss diet.• low in both calories and carbohydrates,

but loaded with fiber.• Leafy greens are also incredibly

nutritious and very high in all sorts of vitamins, minerals and antioxidants. This includes calcium, which has been shown to aid fat burning in some studies.

Salmon

• Oily fish like salmon is incredibly healthy.• It is also very satisfying, keeping you full for

many hours with relatively few calories.• Salmon is loaded with high quality protein,

healthy fats and also contains all sorts of important nutrients.

• Rich source of Iodin• which is necessary for proper function of the

thyroid, which is important to keep the metabolism running optimally.

• Salmon is also loaded with Omega-3 fatty acids, which have been shown to help reduce inflammation, which is known to play a major role in obesity and metabolic disease.

According to Mizaj:

• Most of the patients are Balghami Mizaj. Then avoid the cold foods.

• Hot spices should be added in ghiza (food) e.g. Filfil Daraz, Zeera, Lehsun because they have Mulattif property.

• Use vinegar in cooking • use dry and desiccating food• Promote fasting

Age

• In older age metabolism is slow and Quwwat hazima also weak so avoid the excessive foods

• avoid all roghni ghizayen (fatty diets). • Restrict meat, milk and liquor

Timings of foods (Secret for maintenance)

• Eat less & live best (Taqleel ghiza )..• Frequent small meal…..now a days we are eating

too much • Eat 1/3 of your stomach capacity.. Now a days we

are eating full of stomach• Heavy breakfast.. Less lunch too less dinner• (breakfast like a king, lunch like politician, dinner

like beggar)…now a days we are skipping our breakfast…lunch and full of stomach with dinner

• Always sit down for eating…..now a days dining tables..standing positions or bed etc is our habit

• Chew proper.. at least 20 chews before taking the next mouthful. …now a days we have short time for eating and more time for other activities

• Drinks water before food….always sit and drink in 3 sips… but now a days, by walking, talking, people are drinking water

• After meal immediately don’t drink the water …but now a days its fashion to take cold drinks, ice creams and etc.

• Eat fruits or salads before meal…… • Dinner should be always early (before 3 hrs to the bed

time)…. But now a days.. Dinner at 11-12 o clock at night.• After lunch always take a short nap (Qailoola).. But we

don’t have time for that• After dinner always walk (At least 40 steps of walking)… but

now immediately we are sleeping

Ilaj Bil Tadbeer (Regimenal therapies): • Increase the physical activity to produce fatigue. • Body massage with hot oils. • Rub the body with rough clothes • Exercise before meals • Reduce sleeping hours (depend on person..5-7 hrs) • Avoid late night sleep• Early morning wakeup• Sleep on hard surface • Bathing before meal • Frequent elimination of morbid matter (Qai ya Ishaal)• Stay for long time in hammam causes excessive sweating &

produce yaboosat (dryness) • Hammam should be taken before meals

U may adopt out door games like

• Swimming • Brisk walking• jogging,• running, • jumping rope• Playing tennis• Skipping• Foot ball• Basket ball• kabaddi & Cricket

Dalak, Riyazat, Hammam

Ilaj Bil Dawa (Pharmaco therapy)

Ilaj Bil Dawa (pharmaco therapy):

• A number of single and compound drugs have been used by Unani physicians in the management of obesity and studies have also been carried out for its anti obesity activity.

• Correction of Digestion & Metabolism (Islahe Hadhm wa Istehala)

• Muqaavie Kabid (Hepatoproetctive)• Muqavvie Meda (Gastroprotective)• Muarrique Advia (diaphoretics)• Haar wa mohallil (Resolvent)

Single Drugs + Diet (Dawa-e-Ghizayi)(Kitchen Spices)

Anisoon (Pimpinella anisum) -Har-yabis

• Action:• antiseptic• Antispasmodic • carminative• digestive• Expectorant• Stomachic [an agent that

strengthens, stimulates or tones the stomach]

• Tonic (giving a feeling of well-being)

Kamoon (Zeera) (Cuminum cyminum)

• Antispasmodic • carminative• Digestive• Stimulate menstruation.

Use for swelling • relieve hiccups.

Filfil siyah (Piper nigrum) – Har-yabis

• extremely useful for respiratory disorders and asthma.

• hoarse voice, dental caries, in removing bad breadth (halitosis),

• It helps in digestion and also give reliefs from gaseous distension and indigestion.

• Used in piles, Headache, migraine, • In chronic dysentery, • It works as an antidote in the indigestion caused

due to excessive intake of pure fats such as butter.• Antispasmodic • carminative• Digestive

Kishneez (Coriandrum sativum) Barid-yabis

• Antispasmodic • carminative• Digestive• Used in nausea, vomiting, • Liver corrective• diuretic, • expectorant, • laxative, • anti-bacterial, • anti-pyretic etc

Naana (Mentha arvensis) - Har-yabis

• Podina is used as a carminative and an expectorant.

• headaches, rhinitis, cough sore throat, colic, prurigo and vomiting.

• good blood cleanser, since it is antiseptic and anti-bacterial.

• swollen gums, mouth ulcers and toothaches, fever

• Stomach pain, dysmenorrheal and diuresis.• The menthol extracted from the plant is

used in preparing balms.• It is used as a flavoring agent in many

culinary preparations.

Lehsun (Allium sativum) - Har-yabis

• Immunity boosting• Anti allergic• Anti cancer • Help to reduce sugar &

cholestrol.• It relieve intestinal

infection, dysentery, arthritis, colic in children

Nankhwah (Ptychotis ajowan) - Har-yabis

• It is used to treat weight loss• indigestion and related disorders, • Reduce flatulence, • Antibacterial, antiseptic,• Cholera, • Prevent kidney disorders• Reduce pimples and acne.• Cold & Cough• Scanty menses etc.

Saunf (Foeniculm vulgare) - Har-yabis

• It is used in:• colic, flatulence, irritable bowel, • Strength to kidneys, stomach,

spleen, liver, lungs,• Increase appetite, • Promoting menstruation, • Improving digestive system, • Increasing urine flow.• carminative• Digestive• Used in nausea, vomiting

Soya (Anethum sowa) - Har-yabis

• It is used for digestion problems including loss of appetite, intestinal gas

• Liver problems, and gallbladder complaints.

• It is also used for urinary tract disorders.• Fever and colds, cough, bronchitis ,• Hemorrhoids , genital ulcers, • Menstrual cramps , and sleep disorders.• Recent data available for the weight loss

Luk Magsul (Coccus lacca) - Har-yabis

• It’s a slick serum and secretion from a scale insect species laccifier lacca

• Astringent• Anthelmintic• Anti inflammatory• Anti obesity

Shibb-e-yamani (Aluminium hydroxide) Har-yabis

• Alum is a naturally occurring mineral. Aluminum hydroxide is an antacid.

• is used to treat symptoms of increased stomach acid

• heartburn, • upset stomach, • acid indigestion• In wounds• Now recently it has been studied for

the weight loss properties

Nuskha

• Take safoof Mohazzil 5 gm with 20 ml Arq zeera twice a day

• Take 5 ml honey with one cyp of water and drink in morning empty stomach

• Lemon juice • Safoof ajwain gm withsirka (Vinegar)• Decoction of filfilsiya 2 part, Asaroon ½ part,

Anisoon 1/2part • Applying Zandu balm on abdomen and do exercise

regularly. it is tremendous results in reducing the belly fat

Compound Forms of Medicine

• Arqiyat (Liquids)• Safoof (Powder)• Majoon (Paste)• Haboob (Tablets)• Aqras (Capsules)

Be care full about your Foods & Drinks (Makool wa Mashroob)

Hippocrates says

Follow a Healthy habits of foods & drinks

Follow a regular habits of Exercise & Sufficient Sleep

Controllable

FactorsAsbab-e-Sittah

Zarooriyah

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