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Open Access Full Text Article  Review Article

Therapeutic Potential of Roghan-e-Haft Barg (A Polyherbal Unani Formulation) with Special Reference to Musculoskeletal Disorders

Rooshi Fareed ¹, ^*Shaziya Begum ¹*, Mohd Anwar ², Fatima Khan ³, Sadaf Nawaz ¹

¹ PG Scholar, Department of Ilaj-Bit-Tadbeer, Ajmal Khan Tibbiya College, Aligarh Muslim University, Uttar Pradesh, India. 

² Professor, Department of Ilaj-Bit-Tadbeer, Ajmal Khan Tibbiya College, Aligarh Muslim University, Uttar Pradesh, India. 

³ Assistant Professor, Department of Ilaj-Bit-Tadbeer, A&U Tibbia College & Hospital, Karol Bagh, New Delhi, India. 

 

 

Introduction:

Musculoskeletal disorders (MSDs) are generally described as conditions or injuries that affect the joints, bones, muscles, nerves, tendons, ligaments, cartilage, spinal discs, and other supportive soft tissues ¹.

The term "Waja'" is widely used in Unani literature to refer to pain. Avicenna defined ‘Waja’ as ‘one of the unnatural (abnormal) conditions that affect the body and that it is a ‘feeling of incongruity’². In Unani medicine, "Waja' al-Mafāṣil" refers to a range of joint-related illnesses, such as inflammatory, non-inflammatory, infectious, metabolic, and other musculoskeletal conditions ³.

Musculoskeletal disorders (MSDs) can develop due to sudden physical strain—such as lifting heavy objects—or from repetitive movements, prolonged exposure to force or vibration, and poor posture maintained over time⁴. Musculoskeletal (MSK) pain refers to acute or chronic discomfort affecting the bones, muscles, ligaments, tendons, or nerves. Globally, MSK pain is a significant health concern with considerable medical and socioeconomic impact⁵. It encompasses a range of pain conditions, from localised pain to neuropathic pain⁴. Chronic musculoskeletal pain is the leading cause of disability in individuals with musculoskeletal disorders (MSDs)⁶. The prevalence rate of chronic musculoskeletal pain according to the World Health Organization (WHO) is 20–33% or 1.75 billion people of world’s population⁴.Chronic musculoskeletal (MSK) pain hinders the ability to perform daily activities, leading to a significant decline in quality of life⁷.Chronic low back pain, neck pain, and pain associated with osteoarthritis, frozen shoulder, and rheumatoid arthritis are among the most common forms of musculoskeletal (MSK) pain. Although MSK pain can occur at any age, its likelihood increases with ageing. Nearly every individual experiences some form of MSK pain at least once in their lifetime^{4, 8}

A large number of pharmacological and non-pharmacological interventions are used to manage musculoskeletal (MSK) pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended as a first-line treatment, either on their own or in combination with adjuvant therapies, particularly for patients with chronic musculoskeletal (MSK) pain who have not adequately responded to non-pharmacological interventions⁹.The use of NSAIDs is associated with gastrointestinal side effects, ranging from mild symptoms such as dyspepsia or vomiting to more severe complications like gastroduodenal ulcers, bleeding, and other gastrointestinal lesions¹⁰. Some research studies have also found evidence of kidney damage and hepatotoxic consequences.^11,12,13 Moreover, other therapeutic options, such as surgical operations, are more expensive and have more irreversible effects. Because of the significant side effects of steroidal and nonsteroidal anti-inflammatory drugs, there is a growing interest in natural substances such as nutritional supplements and herbal remedies, which have long been used to relieve pain and inflammation ¹⁴.

The primary treatment approaches in the Unani system of medicine comprise Ilāj bi’l Taghdhiya (dietotherapy), Ilāj bi’l Tadbīr (regimenal therapy), and Ilāj bi’l Dawā’ (pharmacotherapy), Ilāj bi’l Yad ¹⁵. Among these, Ilāj bi’l-Tadbīr (regimenal therapy) is the most extensively employed therapeutic modality for the management of MSDs. There are various Regimenal modalities such as Ḥijāma (Cupping), Dalk (Massage), Riyāḍat (Exercise), Ḍimād (Poultice), Inkibāb (Vapour bath), Ābzan (Sitz bath), Ḥammām (Therapeutic bath), Naṭūl (Douche), and Takmīd (Fomentation) etc. mentioned in the Unani classical literature, reported to be effective in the management of MSK pain. Among these, Dalk holds an important position as a therapeutic modality in the management of various types of painful conditions. In the Unani medical system, Dalk (massage therapy) is a widely practiced and extensively used therapeutic regimen in the management of musculoskeletal disorders, serving both curative and preventive roles. It helps to dissolve and eliminate Akhlāṭ-i-Fāsida (morbid humor), produces Laṭīf Ḥarārat in the body, and strengthens tendons and ligaments similar to Riyāḍat ^{16, 17}. Roghan (medicated oils) are commonly used in massage therapy to alleviate joint pain and ease muscle stiffness, such as Roghan-e-Qust, Roghan-e-Haft Barg, Roghan-e- Bed Anjeer, Roghan-e- Dhatura, Roghan-e-Babuna¹⁸. Roghan-e-Haft Barg is a polyherbal pharmacopeial oil that is mentioned in Unani formularies, and books of compound formulation. As its name suggests, (Haft means seven and Barg means leaves), the formulation consists of seven leaves as main ingredient and therefore it is called Roghan-e-Haft Barg. Ingredients of RHB are Barg-e-Aak (Calotropis procera Ait. RBr.), Barg-e-Bakayin (Melia azedarach Linn.), Barg-e-Bed Anjeer (Ricinus communis Linn.), Barg-e-Dhatura (Datura stramonium Linn.), Barg-e-Sambhalu (Vitex negundo Linn.), Barg-e-Sehjana (Moringa oleifera Lam.), Barg-e-Thuhar (Euphorbia neriifolia Linn.) and Roghan-e-Kunjad (Sesamum indicum DC.)(Fig.1). It has been traditionally used for years in the management of both inflammatory and degenerative musculoskeletal conditions such as Waja‘ al-Mafāṣil (arthritis), Fālij (paralysis), and Laqwa (facial palsy). Its therapeutic effects are attributed to its Musakkin-i-Alam (pain-relieving) and Muqawwī-i-A‘ṣāb (nervine tonic) properties^{19, 20}. Information about ethno-pharmacological properties of ingredients of Roghan-e-Haft Barg are listed in Table 1.

 

Figure 1: Ingredients of Roghan-e-Haft Barg

 

Materials and Methods:

The studies were conducted in accordance with the findings of recommended systematic reviews and research articles published in both national and international journals. A comprehensive literature search was carried out using databases, including Google Scholar, PubMed, Research Gate, and Science 

 

Direct. This search aimed to gather recent and relevant material for the study. The selected publications were then analyzed based on their citations to identify the pharmacological effects of various components of RHB, Shown in Table 1

 

 

Table 1: Ethnopharmacological Properties of Ingredients of Roghan-e-Haft Barg

Botanical names	Unani names	Effects as per Unani Medicine	Chemical constituents	Associated Pharmacological activity
Calotropis procera (Ait) R Br.	Barg-e-Aak	Muḥallil-i- Awrām (Anti-inflammatory), Musakkin (Analgesic) 21, 22, 23, 24, 25, 26	Tannins, Flavonoids, Triterpenoids27	Anti-inflammatory and Analgesic activity28
Melia azedarach Linn.	Barg-e-Bakayin	Musakkin (Analgesic), Muḥallil-i- Awrām (Anti-inflammatory) 22, 23, 25, 26, 29, 30, 31	Quercetin derivatives, Rutin, Flavonoids, Glycosides, Steroids and tannins 32, 33	Anti-inflammatory activity, Analgesic and antioxidant activity. 32, 34, 35
Ricinus communis Linn.	Barg-e-Bed Anjeer	Muḥallil-i-Awrām (Anti-inflammatory), Musakkin (Analgesic) 23, 25, 26, 36	Saponin, Steroids and alkaloids 37	Anti-inflammatory, Antinociceptive activity, Antiarthritic activity 37, 38, 39
Datura stramonium Linn.	Barg-e-Dhatura	Mukhaddir (Anasthetic), Munawwim (Hypnotic agent) Dāfi‘-i-Tashannuj (Antispasmodic), Musakkin (Analgesic), Muḥallil-i- Awrām (Anti-inflammatory) 22, 23, 26, 31, 36, 40	Terpene, Daluralactone (D1), 12, deoxywithastramonolide (D23), and daturilin (D27) 41, 42	Anti-inflammatory activity, Analgesic activity 42, 43
Vitex negundo Linn.	Barg-e-Sambhalu	Muḥallil-i- Awrām (Anti-inflammatory), Musakkin (Analgesic) 22, 23, 26, 36, 44,     45	Tannins and flavonoids  46	Anti-inflammatory and Analgesic activity, Antiarthritic activity, Antinocioceptive activity 47, 48, 49
Moringa oleifera Lam.	Barg-e-Sehjana	Muḥallil-i-Awrām (Anti-inflammatory), Musakkin (Analgesic) 22, 23, 26, 31, 36,     44, 50	Flavonoids, Tannins and alkaloids 51	Anti-inflammatory, Analgesic activity, Antiarthritic activity 51, 52, 53
Euphorbia neriifolia Linn.	Barg-e- Thuhar	Muḥallil-i- Awrām (Anti-inflammatory) 22, 23, 29	Flavonoids (Sultana et al., 2022) 55	Antiarthritic activity, Analgesic activity, Anti-inflammatory activity 55, 56, 57
Sesamum indicum DC.	Roghan-e-Kunjad	Muḥallil-i-Awrām (Anti-inflammatory) 22, 23, 26, 31,  58	Sesamin 59	Anti-inflammatory,  Antinociceptive activity, Antirheumatoid activity 59, 60

 

 

Results and Discussion:

MSDs are one of the primary causes of disability worldwide. To treat MSDs, modern medicine uses a variety of targeted medicines. However, discontinuing these drugs might result in severe side effects or possibly a recurrence of the disease. Because of the various drawbacks of using existing NSAIDs, it is possible to begin searching for newer medications for MSDs that come from natural sources. RHB, a polyherbal Unani formulation, possesses analgesic and anti-inflammatory properties, making it an effective primary treatment for the management of MSDs. Each constituent of RHB is known for their therapeutic potential in managing musculoskeletal conditions. The phytochemicals present in Aak (Calotropis procera (Ait) R Br. extract (CPE), including alkaloids, tannins, saponins, triterpenes, reducing sugars, sterols, amino acids, and glycosides, are considered significant contributors of anti-inflammatory effect. Notably, tannins and flavonoids are widely recognized for their role in reducing inflammation, with flavonoids acting through the inhibition of key enzymes involved in prostaglandin synthesis. Triterpenoids enhance anti-inflammatory activity by decreasing the expression of inducible nitric oxide synthase (iNOS) or reducing nitric oxide production. These synergistic actions of various phytochemicals emphasize the comprehensive anti-inflammatory potential of Aak ²⁷. Aoudia et al., (2013) reported that Bakayin (Melia azedarach Linn.) contained considerable amounts of quercetin derivatives and rutin and exerted strong anti-inflammatory effects by inhibiting human monoacylglycerol lipase (MAGL)³². Vekariya  et al., (2016) reported that the presence of flavonoids, glycosides, steroids and tannins in the Bakayin extract may be responsible for the analgesic property³³. According to Hossain et al. (2013), the analgesic effect of Bakayin may result from suppression of endogenous pain-mediating substances at peripheral nerve endings, indicating a mechanism of action similar to that of NSAIDs³⁵ . Taur et al., concluded that Bed Anjeer (Ricinus communis Linn.) possesses antinociceptive potential that may be due to saponin, steroids and alkaloids in it. It has antioxidant activities and is reported to contain flavonoids: rutin, quercetin, epicatechin and polyphenols (Gallic and ellagic acid) and gentesic acid. These compounds have been scientifically validated as potent antioxidant and anti-inflammatory agents³⁷. A study conducted by Hussain et al., on antiarthritic activity in rats reported that Bed Anjeer leaves significantly reduced inflammation and improved overall health by modulating pro/anti-inflammatory cytokine expression and alleviating oxidative stress ³⁹. Terpene in Dhatura (Datura stramonium Linn.) has strong anti-inflammatory effect by inhibiting the COX1 and the leukotriene⁴¹. Dhatura contains phytochemicals that have anti-inflammatory and analgesic properties. These phytochemicals suppress the production of chemical mediators that cause pain and inflammation. According to Chandan et al., three steroidal lactones isolated from Dhatura leaves—daluralactone (D1), 12-deoxywithastramonolide (D23), and daturilin (D27)—showed marked inhibition of nitric oxide production and pro-inflammatory cytokine expression. The analysis showed that these three lactone compounds actively bind with COX-1, COX-2, validating the anti-inflammatory effects of the lactones ⁴².The pharmacological properties of Sambhalu (Vitex negundo Linn.) are attributed to its diverse bioactive constituents. Maniyar et al., reported that presence of phytochemical constituents like tannins and flavonoids could be attributed to the anti-inflammatory activity ⁴⁶.   Dharmasiri et al.,revealed that the fresh leaves of Sambhalu have anti-inflammatory and pain suppressing activities possibly mediated via Prostaglandin (PG)synthesis inhibition, antihistamine, membrane stabilising and antioxidant activities ⁴⁷. The phytochemical ingredients found in leaf extract of Sehjana (Moringa oleifera Lam.) like flavonoids, which potently inhibit prostaglandins, especially the endoperoxidase, tannins, alkaloids, could also contribute to the anti-nociceptive action of Sehjana. The possible mechanism of Sehjana leaves could be due to its action on the central opioid receptors or promoted release of endogenous opioid peptides ⁵¹.The presence of flavonoids in Thuhar (Euphorbia neriifolia Linn.) is thought to be responsible for the anti-inflammatory and analgesic properties of Thuhar hydroalcoholic leaves extract ⁵⁴. Monteiro et al., reported that sesamin, an active constituent of Kunjad (Sesamum indicum Linn.), is responsible for the drug’s antinociceptive and anti-inflammatory properties ⁵⁹. Sesamin had a chondroprotective effect via inhibition of PGs and collagen degradation. Sesamin suppresses MMP-1 expression, and together with sesamolin, demonstrates notable antioxidant properties ⁶¹.Overall, RHB exhibits potent anti-inflammatory and analgesic properties, and its ability to delay joint degeneration may be ascribed to the collective and synergistic effects of all its constituent ingredients. The anti-inflammatory and analgesic properties of its ingredients enhance the function of joints and the muscles that surround them. It has been proposed that RHB may be a complementary and alternative medicine for the treatment of MSD-related pain and inflammation, gradually reducing joint range of motion (ROM) restrictions and enhancing the quality of life for MSD patients. Various studies have shown that the components of RHB have various pharmacological properties. Clinical and experimental studies of this compound formulation (RHB) have not yet been conducted, despite several studies conducted by various researchers on its different ingredients. Clinical studies evaluating the topical analgesic and anti-inflammatory effects of RHB should be conducted on a larger sample population. Furthermore, randomized controlled trials with well-defined methodologies are needed to validate its efficacy and safety. Standardization of RHB in terms of dosage, formulation, and mode of application is also essential to ensure reproducible outcomes. In addition, pharmacological and toxicological investigations should be undertaken to establish its long-term safety profile and therapeutic potential in musculoskeletal disorders.

Conclusion:

Unani medicine has long employed various single and compound formulations for treating Waja’al-Mafasil (arthritis). Among these, Roghan Haft Barg (RHB) is a well-known polyherbal oil included in the Unani pharmacopeia, traditionally used to alleviate pain associated with musculoskeletal disorders. This review compiles data on the ethno-pharmacological properties of ingredients of RHB, revealing that they exhibit a range of therapeutic effects, including analgesic and anti-inflammatory activities. These findings support the traditional Unani practice of using RHB topically for managing pain in musculoskeletal conditions. Future prospects include conducting well-designed preclinical and clinical studies to establish its efficacy, safety, and mechanism of action, which could pave the way for its wider acceptance and integration into modern healthcare practices.

Acknowledgement:

We sincerely thank all the authors for their valuable guidance, support, and encouragement throughout this work.

Conflict of Interest: The authors declare no conflict of interest.

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