Introduction: Aligning with the World Hepatitis Day 2025 Mandate.
Viral hepatitis represents a formidable global public health challenge, with its elimination by 2030 enshrined within the Sustainable Development Goals (SDGs).Commemorated annually on July 28th in honor of the birthday of Dr. Baruch Blumberg, the discoverer of the hepatitis B virus and its first vaccine, World Hepatitis Day galvanizes global action.2 The theme for World Hepatitis Day 2025,
"Hepatitis: Let's Break It Down," serves as an urgent call to dismantle the economic, societal, and structural obstacles—including pervasive stigma—that impede the eradication of hepatitis and the prevention of subsequent liver cancer.1 The campaign emphasizes the need for immediate, coordinated measures to simplify, scale up, and integrate essential hepatitis services into national health systems.3
Within this global strategy, traditional systems of medicine, which have catered to the health needs of vast populations for centuries, offer a rich repository of knowledge and therapeutic potential. The Unani system of medicine, with its comprehensive theoretical framework and extensive documentation on the management of liver diseases (Amraz-i-Kabid), stands as a prime example.5 The true innovation in this field lies not in the discovery of entirely new remedies, but in the
methodological innovation of applying modern scientific validation to this ancient wisdom. Through rigorous preclinical studies, randomized controlled trials, and the correlation of classical diagnostic signs with modern biochemical markers, Unani medicine is being translated into an evidence-based system. This process of validation builds trust, ensures safety, and demonstrates efficacy in a language understood by global health bodies, positioning Unani medicine to make tangible contributions to the "Let's Break It Down" mandate by offering accesThis report will explore this evolving synergy. It begins by delving into the deep-rooted Unani conceptual framework of hepatic health and disease. It then examines innovations in Unani diagnostics, showcasing how classical observational methods are being bridged with modern laboratory science. Following this, the report presents a showcase of therapeutic evidence from recent clinical research on Unani interventions for various forms of hepatitis and liver disease. Finally, it concludes by directly analyzing how the principles and practices of Unani medicine can help break down the specific economic, systemic, and societal barriers identified by the World Health Organization (WHO) and the World Hepatitis Alliance, charting a course for a more integrated future in the fight against hepatitis.
Part I: The Unani Paradigm of Hepatic Health and Disease: A Deep-Rooted Foundation
To appreciate the Unani approach to hepatitis, it is essential to first understand its foundational philosophy of liver function, which views the organ as a central metabolic and homeostatic powerhouse.
The Liver (Kabid) as the Seat of Metabolic Power (Quwat-e-Tabaiyah)
In the Unani system, the liver (Jigar or Kabid) is classified as one of the vital organs (A'zā' Ra'īsa), revered as the seat of vegetative faculties (Quwat-e-tabaiyah).7 Its primary role is in metabolism (
Istiḥāla), specifically the second stage of digestion. In this hepatic digestion, the liver transforms chylus (the product of gastric digestion) into the four fundamental humors (Akhlat): Dam (blood), Balgham (phlegm), Safra (yellow bile), and Sauda (black bile).7 These humors are the essence of nourishment, growth, and development for the entire body.9 This critical function is executed by four innate powers (
Quwa) of the liver: quwat-e-jaziba (power of absorption), quwat-e-ghaziya (power of digestion/metabolism), quwat-e-masikah (power of retention), and quwat-e-dafiya (power of excretion). A derangement in any of these four powers can disrupt humoral balance and lead to disease.10
The Concept of Temperament (Mizaj) in Liver Function
Central to Unani philosophy is the concept of Mizaj, the unique temperament or homeostatic equilibrium of the body and its organs, which arises from the qualitative interaction of the four humors.11 Every organ has a specific
Mizaj, and the liver's normal temperament is considered Haar Ratab (hot and moist).12 According to Unani scholars, the genesis of most liver diseases (
Amraz-i-Kabid) is a deviation from this normal state, a condition known as Su-e-Mizaj (pathological or abnormal temperament).7 This imbalance can be precipitated by a multitude of factors, including erratic dietary habits, excessive consumption of fatty foods, alcohol, certain drugs, and environmental influences.12
The Pathogenesis and Classification of Liver Ailments (Amraz-i-Kabid)
The Unani pathophysiological framework is inherently systemic. It does not perceive hepatitis as merely a viral infection of an isolated organ but as a systemic humoral and temperamental imbalance centered in the liver. This perspective explains why Unani treatments are holistic, incorporating diet, lifestyle modifications, and pharmacotherapy to restore systemic equilibrium. This approach has led to a detailed classification of liver ailments based on their underlying humoral cause and clinical presentation.
Inflammation (Waram-al-Kabid / Hepatitis): This term directly corresponds to the modern concept of hepatitis and is described as an inflammatory condition of the liver arising from a derangement in its temperament, often leading to hepatomegaly (Tashannuj-e-Kabid).14 Unani texts classify
Waram-al-Kabid based on the predominant humor involved—Damwi (sanguineous), Safrawi (bilious), Balgami (phlegmatic), and Saudawi (melancholic)—and by the anatomical location of the inflammation, such as Waram-e-Jigar Mohaddab (inflammation on the convex surface) or Waram-e-Jigar Muqar (inflammation on the concave surface).15Cirrhosis (Talayyaful-Kabid or Warm-e-Jigar Barid Saudawi): Unani medicine has recognized and treated liver cirrhosis for centuries, referring to it by terms such as Talayyaful-Kabid.5 This condition is often associated with a pathological cold (
Barid) or melancholic (Saudawi) temperament of the liver.Fatty Liver (Tashhamul Kabid): While not described under this specific name in ancient texts, the condition is well-understood as Tashhamul kabid, an accretion of morbid matter in the form of fat. This is primarily attributed to Su' mizaj barid kabid, an impaired cold temperament of the liver, which is incompatible with its normal function and allows fat to accumulate.12
Jaundice (Yaraqan): This is recognized as a cardinal sign of many liver diseases. It is understood to be caused by the accumulation and overflow of Safra (yellow bile) into the bloodstream and skin, typically resulting from an obstruction in the hepatobiliary tract or other forms of hepatic dysfunction.8
Hepatic Abscess (Dubayla al-Kabid): The Unani system's pathological depth is evident in its description of severe disease progressions, such as Dubayla al-Kabid. This localized liver abscess is understood to be a potential complication arising from unresolved Waram-e-Jigar Harr (hot liver inflammation), demonstrating a sophisticated understanding of the sequelae of untreated inflammation.7
Part II: Innovation in Diagnosis - Bridging Ancient Observation with Modern Science
The innovation in Unani hepatology is powerfully demonstrated in the field of diagnosis, where classical, observation-based methods are being validated and integrated with modern laboratory science. This synergy creates a robust diagnostic framework that is both deeply rooted in tradition and aligned with contemporary standards of evidence.
The Classical Diagnostic Pillars (Adilla-e-Tashkhees)
Classical Unani diagnosis (Tashkhees) is a holistic process that relies heavily on the physician's clinical acumen and sensory examination. The primary tools include pulse diagnosis (Nabz) and urinalysis (Bawl or Qarurah).6 The great physician Avicenna outlined ten criteria for assessing the liver's condition, which encompassed a physical examination including palpation of the liver region to detect warmth or swelling, analysis of liver-associated pain, and observation of the patient's overall state, such as skin color and body mass.9
Correlative Diagnostics: Validating Unani Signs with Laboratory Findings
Recent research has focused on correlating these classical signs with objective, modern laboratory findings, yielding remarkable results.
Urinalysis (Urognosis): Unani physicians conduct a detailed examination of urine (Bawl), assessing its color, consistency, foam, and odor to diagnose humoral imbalances and organ dysfunction.20 For instance, reddish-yellow or orange-yellow urine can indicate a liver disorder, while frothy urine with dark or orange-colored foam is a sign of jaundice.21
Modern Correlation: A landmark finding is the validation of Bawl Ghusālī, a classical sign described as urine resembling the "washings of raw meat." In two case studies of patients with Ḍu'f al-Kabid (hepatic insufficiency), this sign was found to directly correlate with modern laboratory findings of conjugated hyperbilirubinemia or excess urobilinogen, confirming a direct link between a traditional observation and a modern biochemical state.22
Comparative Efficacy: A comparative study of 1,516 patients found that the Unani visual method of urinalysis was significantly more efficient in detecting bile salts/pigments (14.45% detection rate) than the modern laboratory-based method (0.46% detection rate). This suggests that traditional urognosis could serve as a highly effective, low-cost initial screening tool for hepatic dysfunction.21
Pulse Diagnosis (Nabz): The pulse is a cornerstone of Unani diagnosis, with its various qualities reflecting the state of health and disease.19 High-tech validation of this low-tech art has been achieved through a modern study that employed machine learning algorithms (Principal Component Analysis and LASSO) to analyze digital pulse waves. The research identified a significant difference between the pulse signals of healthy individuals and patients with fatty liver and cirrhosis, achieving an identification accuracy of over 93% when using seven pulse parameters.23 This provides strong scientific evidence for the diagnostic utility of pulse examination in liver diseases.
Integrating Modern Tools for Objective Therapeutic Monitoring
Contemporary Unani clinical research and practice have fully embraced modern diagnostic tools to provide objective, quantifiable evidence of treatment efficacy. This integration is crucial for building credibility and ensuring patient safety.
Biochemical Markers: Liver Function Tests (LFTs)—including serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP)—are now standard in Unani clinical trials and case reports to monitor the reduction in liver inflammation and the improvement in hepatic function following treatment.5
Virological Markers: To demonstrate efficacy against viral hepatitis, Unani research utilizes modern virological markers. Polymerase Chain Reaction (PCR) testing for Hepatitis C virus (HCV) RNA has been used to confirm viral clearance and achieve a Sustained Virologic Response (SVR).25 Similarly, Hepatitis B surface antigen (HBsAg) and HBV DNA levels are used to monitor the response to treatment in Hepatitis B patients.16
Fibrosis Assessment: To provide evidence of structural improvement in the liver, Unani studies employ non-invasive imaging techniques. FibroScan (transient elastography) and ultrasound are used to objectively measure reductions in liver stiffness (fibrosis) and fat accumulation (steatosis).5
The validation of low-cost, non-invasive Unani diagnostic methods and their correlation with high-tech results offers a powerful strategy for enhancing health equity, directly aligning with the WHD 2025 theme of breaking down barriers. High-cost diagnostics are a major obstacle in resource-limited settings.28 A validated, observation-based method like Unani urinalysis, which is virtually free, can be deployed as a widespread initial screening tool in primary care and community settings. Individuals identified as high-risk through this method can then be referred for more definitive and expensive modern tests. This two-tiered model effectively breaks down the initial economic barrier to testing, enabling earlier detection and intervention, which is a cornerstone of the global hepatitis elimination strategy.
Part III: Therapeutic Innovations - The Unani Arsenal Against Hepatitis
The therapeutic approach in Unani medicine is as systematic as its diagnostic framework, guided by clear principles and employing a rich pharmacopoeia that is increasingly being validated by modern clinical research.
The Guiding Principles of Treatment (Usool-e-Ilaj)
The Unani philosophy of treatment, or Usool-e-Ilaj, is centered on supporting the body's innate healing power, known as Tabiyat.29 Treatment is tailored to the individual and the specific stage of the disease, following a logical progression of principles:
Izala-e-Sabab (Elimination of the Cause): This involves identifying and removing the root causes of the disease, such as poor diet or lifestyle habits.29
Tadeel-e-Mizaj (Normalization of Temperament): This is the core therapeutic strategy, aimed at correcting the pathological temperament of the liver. It follows the principle of Ilaj-Bil-Zid (treatment by opposites), using drugs and dietary interventions with qualities that counteract the imbalanced temperament (e.g., using "hot" remedies for a "cold" disease).29
Tanqiya-e-Mawad (Evacuation of Morbid Matter): This principle focuses on expelling the disease-causing morbid humors from the body through methods like purgation (Ishäl), diuresis (Idrär), or venesection (Fasd).10
These principles are applied through four primary modalities: Regimental Therapy (Ilaj-bil-Tadbeer), Dietotherapy (Ilaj-bil-Ghiza), Pharmacotherapy (Ilaj-bil-Dawa), and Surgery (Ilaj-bil-Yad).6
Pharmacotherapy (Ilaj-bil-Dawa): A Review of Key Hepatoprotective Agents
Unani pharmacotherapy utilizes single herbs (Mufradat) and polyherbal compound formulations (Murakkabat) that have been used for centuries to treat liver ailments. Many of these have now been studied for their specific pharmacological actions. Herbs such as Kasni (Cichorium intybus), Mako (Solanum nigrum), Rewand Chini (Rheum emodi), and Ghafis (Gentiana olivierii) are renowned for their hepatoprotective (Muqawwi-i-Jigar), anti-inflammatory (Muhallil-e-Waram), and deobstruent (Mufattih-e-Sudad) properties.10
Extensive modern research has been conducted on plants like Phyllanthus urinaria, used in many traditional systems. Studies have shown it possesses remarkable therapeutic potential for liver diseases, including direct antiviral activity against HBV (by interfering with DNA polymerase and reducing HBsAg secretion), anti-fibrotic effects (by reducing hepatic stellate cell activity), and the ability to inhibit hepatocellular carcinoma (HCC) proliferation.31 The table below summarizes the evidence for several key Unani formulations that have been clinically and pre-clinically evaluated.
Table 1: Profile of Key Unani Hepatoprotective Formulations
Clinical Evidence Showcase: Validating Efficacy in Hepatitis and Liver Disease
The true measure of innovation is clinical efficacy. A growing body of research, from case reports to randomized controlled trials, provides compelling evidence for the role of Unani medicine in managing a spectrum of liver diseases.
Hepatitis C (HCV):
A remarkable case report documented a 27-year-old male with chronic HCV (genotype 3a) and a viral load of 3.1×10³ IU/ml. After 3-6 months of treatment with a Unani regimen including Majoon Dabidulward, Arq Mako, Arq Kasni, Arq Badiyan, and Habb-e-Kabid Naushadri, the patient not only experienced complete resolution of symptoms but also tested negative for HCV RNA by PCR, achieving viral clearance.25
A double-blind, randomized controlled trial on the formulation Qurs-e-istisqua as an add-on to conventional interferon/ribavirin therapy yielded more nuanced but equally important findings. While the Unani drug did not improve SVR rates (indicating no direct anti-HCV activity), it demonstrated significant anti-fibrotic and anti-inflammatory effects. Patients in the Unani group showed a prevention of fibrosis progression on ultrasound, lower serum hyaluronic acid levels (a fibrosis marker), and a faster normalization of AST levels.24 This highlights a crucial therapeutic role in mitigating liver damage, a primary goal in managing chronic hepatitis.
Hepatitis B (HBV):
A systematic review of case studies has showcased successful outcomes in chronic HBV management. One notable case series reported that a Unani formulation containing herbs like Fumaria officinalis and Tephrosia purpurea led to HBsAg seroconversion (the loss of the surface antigen) in patients after an average of 13 weeks of treatment.16 HBsAg seroconversion is a major clinical endpoint, often considered a "functional cure."
Hepatitis A and Jaundice (Yaraqan):
In acute inflammatory conditions, Unani medicine has shown rapid efficacy. A case report of a 25-year-old male with acute jaundice (Total Bilirubin 11.4 mg/dl, AST 1550 IU/L) demonstrated complete clinical recovery and normalization of LFTs within 21 days of treatment with 'Araq-i-Mako, 'Araq-i-Käsné, and Ma'jün Dabéd al-Ward.34
The societal trust in these systems is underscored by a study from Kerala, India, which found that in the absence of a specific allopathic treatment for Hepatitis A, the majority of patients (73.28%) turned to traditional medicine for care.39
Cirrhosis and Fatty Liver:
A powerful case series on five patients with decompensated cirrhosis and portal hypertension showed dramatic results after seven months of Unani treatment. The patients exhibited significant improvements in LFTs, a definitive reduction in liver stiffness measured by FibroScan (e.g., 'E' median reduced from 45.0 kPa to 27.0 kPa in one patient), and remarkable gains in quality of life (e.g., Child-Pugh score improving from 10 to 5). In one HBV-positive patient, the viral load became undetectable.5
A clinical study on Majoon Dabidulward for Tashhamul Kabid (fatty liver) found that 21 days of treatment led to statistically significant reductions in symptoms like nausea (81.57% reduction) and anorexia (73.68% reduction), along with a 30.70% improvement in ultrasonography scores, with no adverse effects reported.27
Part IV: Unani Medicine and the "Let's Break It Down" Mandate
The ultimate goal of World Hepatitis Day 2025 is to break down the barriers preventing the elimination of hepatitis. The evidence suggests that Unani medicine, through its validated principles and practices, is uniquely positioned to contribute to this global mandate on multiple fronts.
Breaking Down Economic Barriers: The Cost-Effectiveness of Unani Interventions
One of the most significant barriers to hepatitis care, particularly in low- and middle-income countries, is cost.1 A compelling study from Nigeria that compared herbal management (HM) with conventional pharmaceutical management (PM) for Hepatitis B provides stark evidence of this disparity. The study found that PM was significantly more expensive, leading 73% of patients to adopt HM. Critically, all patients who reported being "satisfied" with their treatment were in the HM group, which was judged to be the more cost-effective intervention.40 While the cost of modern drugs like direct-acting antivirals (DAAs) for HCV has fallen, it can still be prohibitive for many.1 Furthermore, for conditions like Hepatitis A, for which there is no specific allopathic treatment, traditional systems fill a crucial therapeutic gap.39 Unani medicine, with its reliance on accessible and affordable herbal formulations, presents a viable strategy to reduce the economic burden of hepatitis treatment, directly addressing a key objective of the "Let's Break It Down" campaign.
Breaking Down Systemic Barriers: The Path to Integration, Standardization, and Safety
For Unani medicine to be integrated into mainstream healthcare systems, it must overcome systemic barriers related to regulation, quality control, and safety. This process is already well underway.
Regulation and Infrastructure: Governmental bodies like India's Ministry of AYUSH and the Central Council for Research in Unani Medicine (CCRUM) provide the essential infrastructure for education, research, and the regulated practice of Unani medicine.41 Initiatives like the Traditional Knowledge Digital Library (TKDL) are vital for protecting and formalizing this ancient knowledge base, preventing biopiracy and facilitating scientific research.41
Ensuring Quality and Safety: A balanced perspective acknowledges the potential risk of herb-induced liver injury (HILI), as has been reported with some herbs used in traditional medicine.43 The definitive solution to this concern is not the rejection of herbal medicine but the enforcement of rigorous standardization and quality control. The process of physicochemical standardization, as demonstrated in the evaluation of the Unani formulation
Habbe Mubarak, provides a scientific blueprint for safety and quality assurance. By meticulously evaluating parameters such as ash values (to detect impurities), moisture content, pill friability, hardness, and disintegration time, manufacturers can ensure that each batch of medicine is pure, consistent, and reproducible.44 This scientific rigor is the key to building trust among practitioners and patients and enabling safe integration into national health programs.
Breaking Down Societal Barriers: A Holistic, Patient-Centric Approach
Hepatitis carries a heavy psychosocial burden, often accompanied by stigma, shame, and guilt that can prevent individuals from seeking testing and treatment.1 In some communities, a historical distrust of Western medicine further complicates care delivery.46 The Unani approach, with its holistic and patient-centric framework, is well-suited to address these societal barriers. It treats the whole person, not just the virus or the liver, incorporating guidance on diet, lifestyle, and mental well-being into the treatment plan.14 This empathetic and comprehensive approach can be more culturally sensitive, fostering greater trust and patient empowerment. By focusing on restoring overall health and systemic balance, it aligns perfectly with the WHD 2025 call to amplify the voices of people living with hepatitis and provide them with the supportive care they need.47
Conclusion: A Synthesized Vision for an Integrated Future
The Unani system of medicine offers a sophisticated, time-tested, and deep-rooted framework for understanding and managing liver diseases. The contemporary "innovation" in this field is the systematic scientific validation that is transforming ancient knowledge into evidence-based medicine. Clinical studies and case reports increasingly demonstrate that Unani interventions can lead to tangible, positive outcomes, including viral clearance in Hepatitis C, HBsAg seroconversion in Hepatitis B, rapid resolution of acute jaundice, and significant improvements in liver fibrosis and cirrhosis.
The principles and practices of Unani medicine directly address the core tenets of the World Hepatitis Day 2025 theme, "Hepatitis: Let's Break It Down." It offers a path to break down economic barriers through cost-effective treatments, systemic barriers through rigorous standardization and safety validation, and societal barriers through a holistic, patient-centric approach that combats stigma and builds trust. By offering these evidence-based solutions, Unani medicine proves itself to be not a relic of the past, but a living, evolving science poised to play a significant role in the global effort to eliminate hepatitis. A collaborative, integrated approach that leverages the strengths of both modern medicine and validated traditional systems like Unani is essential to achieving the ambitious 2030 elimination targets.4
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Great work, keep it up 👍🏻
ReplyDeletethank you
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