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Neela Thotha (Copper sulphate): An important mineral drug of Unani medicine to be used in the management of various ailments

*Kaleem Ahmad¹, Haqeeq Ahmad², Khadija Abdul Hafiz³

¹ Ph.D scholar of Moalejat (Medicine), National Institute of Unani Medicine, Kottigepalya, Magadi Main Road, Bengalore-560091

^{2, 3} Ph.D scholar of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Kottigepalya, Magadi Main Road, Bengalore-560091

1. Introduction

The traditional system of medicines viz. Unani, Ayurvedic, Siddha and Chinese medicine exist since antiquity. The principles of all alternative system of medicine are based on history and philosophical relationship between nature, life, health, and disease ¹. Unani system of medicine originally derived from Greek based on seven natural factors that contributes to build up living body including Human viz. Arkan (element), Mizaj (Temperament), Akhlat (Humours), A’aza (Organs), Arwah (Sprit), Quwa (Power) and Af’al (functions) ^{2, 3, 4, 5}. Hippocrates (Buqrat) purpose most acceptable theory that “the disease and health of individual mainly depend on equilibrium between Akhlat-i-Arba  viz. Dam (Blood), Balgham (Phlegm), Safra (Yellow bile) and Sauda (Black bile) with respect to Kaifiyat (Quality) and Kimiyat (Quantity) ^{6, 5}. If imbalance occurs in between them either in Kaifiyat or in Kimiyat leads to varieties of Amrad (diseases) based on culprit Akhlat (humours) viz. Amrad Damwi, Amrad Balghami, Amrad Safrawi, and Amrad Saudawi ^{2, 5}. In USM, Amrad successfully treated through different modalities viz. Ilaj bi’l-Ghiza (Dietotherapy), Ilaj bi’l-Tadbir (Regimental therapy), Ilaj bi’l-Dawa (Pharmacotherapy) and Ilaj bi’l-Yad (Surgery) based on principle of Ilaj bi’l-Zid (Hetrotherapy). Ilaj Bil Dawa is one of the most popular and acceptable method of treatment that includes drugs of Nabatat (Plants), Haiwanat (Animals), and Jamadat (Minerals) origin ^{3, 5, 7}. Mineral origin substances used in pharmacy or medicine since long time by all existing system of medicine including USM. These substances (chemical entity or drug) may contain their therapeutic uses either intrinsic or extrinsic form but may causes toxicity in higher dose ⁸. Chemical substances is either work as a drug or poison (depends on dose), world health organization (WHO) define as “Drug is any substance or product that is used or is intended to be used to modify or explore physiological system or pathological states for the benefit of the recipient” ⁹. Any substances that produce toxic effect in human body after administration are called poison. Therefore, a medicine in their toxic dose is a poison and a poison in low dose is may be a drug ¹⁰. 

Neela Thotha is mineral origin drug that widely described in USM with respect to their uses, toxicity and antidote in numerous conditions ¹¹. It has several pharmacological actions like Qabid (Constipative), Muqi (emetic), Habis al-dam (Coagulant), Muqawwi Dam (erythropoietic), Musaffi Khoon (Blood Purifier), Daf-i-Tasannuj (Antispasmodic), Aakal (Corrosive), Muhallil (resolvent), Mujafif (Desiccant), Muqawwi A’sab (Nervine tonic), Mukhrij Balgham (expectorant), Daf-i-Ta’affun (anti-infective). Neela Thotha with therapeutic dose used in various diseases like Qarooh (Ulcer), Qarooh-i-Atishak (syphilitic ulcer), Qula (stomatitis), Ishal (diarrhoea), Zujam (leprosy), Atishak (syphilis), and Zeequn Nafas (Asthma). ^{11, 12, 13}. In high or non-therapeutic dose of Neela Thotha is associated with toxic effect, characterized by nausea, vomiting, abdominal pain, diarrhoea, jaundice, muscle cramps, circulatory collapse, convulsion, coma, and even may death occurs ^{10, 14, 13}. 

Since literature available on this important drug is very scant therefore, in the present paper authors have an attempt to compile the available information on Neela Thotha and its different formulations so as to bring to light the therapeutic potential of this lesser known drug of Unani system of medicine.

2. Methodology

A review of literature on Neela Thotha was done based on bibliographic database viz. Science Direct, Scopus, Pub Med, and Google Scholar. Important informative data were also collected from classical and conventional textbook like Muhit-i-Azam, Qarabadin-i-A‘zam, Khazain-Al-Advia, Qarabadin Najm-Al-Ghani, Bustan-al-Mufradat, Makhzan-Al-Mufradat, Kitab-ul-Taklees, Almukhtarat Fi’l-tib, Mufta-ul-Khazain, Bayaz-e-Khas Al Maruf Ilaj-ul-Amraz, National Formulary of Unani Medicine, Al-Jamiul Mufradat al-Advia wa al-aghzia, Ilmul Advia Nafisi, Kitab Al-fath fi Al-Tadawi, Advia Ma’dania, India Medicinal Palnt, Essentials of Medical Pharmacology, Parikh’s Textbook of Medical Jurisprudence Forensic Medicine and Toxicology, and Casarett and Doull’s Toxicology and the Basic Science of Poisons.

3. Result and Discussion

3.1 Description of Neela Thotha in ancient literature

Neela Thotha is a crystallized blue color salt that soluble in water ^{11, 12, 13, 14, 15, 16.} It is odourless, bitter, salty or astringent in taste and changes the color water into blue.  ¹¹. Roughage of Copper surfaces is produces Neela Thotha on heating while without heated roughage called as Moor Thotha ¹⁷. Moor Thotha or Moor Tuth resembles with feather color of Peacock and also prepared from Taijab-i-Gandhak. Metallic Copper is non-poisonous substances but certain compound viz. Nila Tutia (Blue Vitriol or copper sulphate), Zangal (Verdigris), Arsenite and Aceto arsenite ^10,11. Moor Thotha is more toxic than Neela Thotha in respect to toxicity ^{11, 14}. Neela Thotha may produce their toxic effect on its internal administration and precaution should be taken before and after use ¹⁴. In low doses it acts as Qabid (Constipative) and Muqi (emetic) in high dose ^{13, 14}. It is two types namely Neela Thotha and Tootiya sabj ¹⁷. One of the chemical compounds of copper is Copper sulphate (CuSO₄) ¹⁰. In Unani System of Medicine, Copper sulphate is described under name of Neela Thotha ¹¹. General population are exposed from copper that largely present in nature in the form of food, beverages and drinking water. The Oral intake of copper  sulphate rapidly release copper that produces varieties of toxic effect viz. Metallic taste, Salivation, Thirst, Nausea, Vomiting, Burning Stomach, Abdominal Pain, Diarrhoea, Jaundice, Hepatic necrosis, haemolysis, methaemoglobinaemia, acute kidney injury, urine with albumin and casts, circulatory collapse, Muscles cramps, convulsion, Coma and death ^{10, 18, 19}.

3.2 Ethnomedicinal Uses of Neela Thotha

In USM, Neela Thotha after detoxification used to treat several adverse condition of body. Emesis process is induced by Neela Thotha (in 5-10 grain dose, 1grain=15.58mg) in cases of poisoning due to Afeem (Papaver somniferum), Jojmathil (Datura stramonium) and Tambaku (Nicotiana tobacum) ¹¹. Neela Thotha is also used in poisoning of Samiyat Mukhaddira for induction of emesis ^{13, 15, 20}. Diarrhoea and dysentery is managed by mixture of Afeem (0.5-1 grain) and Neela Thotha (0.25-2 grain) to reduced the frequency of defecation ¹¹.  Due to astringent properties of Neela Thotha our renowned physician Hakim Kabeeruddin is mentioned it’s used in diarrhoea and dysentery in low dose but act as emetic agent in high doses ^{13, 14}. Neela Thotha (0.25grain) along with Qunain (Cinchona officinalis) also used in treatment of Sara (Epilepsy) ¹¹.  Pichkari (Irrigation) of Neela Thotha is beneficial in the treatment of acute or chronic Aatshak (Syphilis), Juzam (Leprosy), and white discharge from uterus viz. leucorrhoea ^{11, 13, 15}. Application of Neela Thotha (2-3 ratti, 1ratti=124.62mg) on weak ulcer, oral ulcer, and throat ulcer due to Syphilis is beneficial ¹¹. Marham of Neela Thotha is apply on Kharab Goast (Morbid meat), chronic ulcer and ulcers caused by syphilis.  Its solution also used to wash surfaces of ulcers ^{13, 15, 14}. Akal (Corrosive) property of Neela Thotha is claim to be used in Kikrow (Trachoma) and Sulaaq (Tarsitis / Blepheritis) and ulcer of Aatshak ^{13, 15}. Batti (A long strip) is prepared by using Neela Thotha and Phitkari (alum), or Shora (potassium nitrate) and apply it slowly and softly on inner surface of eyelids in case of Kikrow and Sulaaq ¹⁴. In several text books of Unani Medicine also indicate that Neela Thotha is used to resolve Waram (swelling), Bad (axillary lymphodenopathy), eliminate intestinal worm, removed morbid Balgham, to clean eyes and remove redness and to reduced pain.  Roasted Neela Thotha and half roasted Suhaga (Boric acid) in equal quantity are taken to prepare tablets of pearl millet size and 1-3 tablets are used in children with Zabha (Pneumonia), vomiting and diarrhoea. Prepared mustard grain size tablet by using Magaj-i-Karanjwa (one piece) and Neela Thotha Sabj Kham or Neela Thotha (1gm) along with Jiggery prepared and used asthma. Sahab Majma al-jawame claims that Neela Thotha used in Aatshak (syphilis), Juzam (Leprosy) and Phoda (abscess). Neela Thotha is also used in purification of water in 1:40, 00, 000 respectively by some Unani scholar like Ibn-i-Zohar ¹¹. Neela Thotha used internally in syphilis, Juzam and Amrad Damwi due its Musaffi Khoon (Blood Purification). Mukhrij Balgham (Expectorant) property is used in several respiratory disorders viz. Khunaq (Diphtheria), Zabha (pneumonia), Waram Hanjra (Laryngitis) and Waram sa’ab (Bronchitis)   ^{13, 14, 15}. Hakim Kabeeruddin in his book Kitab al-taklees and Ilmul Advia Nafeeshi claims that Kushta of Neela Thotha is used in Bawaseer (Pile), Aatshak (syphilis), Nasur (fistula), Dama (asthma), chronic fever, Ulcer, and Amrad Jild (Skin disorders) ^{12, 15}. The Sanoon (Tooth powder) of Neela Thotha is used in teeth disorders viz. ulcer on gingiva, and unstable teeth. It combines with other drugs for treatment of Qula (stomatitis) and Akal-i-Dahen (Oral ulcer) ¹⁵. Hakim Karim Bakhs state in his book Muftah-ul-Khazain that Neela Thotha and its compound formulation claimed to be used in Asthma, Daba atfal (Pneumonia), Suzak (gonorrhoea), Nasur (fistula), Bawaseer (Piles), Aatshak (Syphilis), non-healing ulcer, Amrad-e-Chasm (eyes disease), Taun (Plague), Amrad Ishal (Diarrheal disease), and Waram litha (gingivitis),  ^{14, 15, 17}

3.3 Unique preparations of Neela Thotha for various ailments:

Unique preparations of Neela Thotha for various ailments mentioned below in table No. 1 ^{12, 17}.

Table 1: Showing different dosage form and composition of Neela Thotha (copper sulphate)

3.4 Properties of Neela Thotha in Unani Medicine

1. Vernacular Name

Verdigris, Crude Copper  sulphate, Blue Copper, Blue Stone, Zajul-akhzar, Totia akhzar, Zake-Sab, Totia sabz, Neela Thotha, kabood, Nila Thotha, Totia hindi, Blue Vitriol, Tutne, Tuntiya, Tutia, Neela Thotha ^{11, 13, 21, 22, 23, 24, 25}

1. Mizaj (Temperament)

Temperament of Neela Thotha has been described to be Har and Yabis (Hot & Dry) in third degree ¹¹. According to another statement, the temperament of Neela Thotha has been described to be Har and Yabis (Hot and Dry in 4^th degree) ^{13,14, 15, 20}.

1. Pharmacological Actions

Muqi (Emetics), Qabid (Astringent), Habis al-dam (Coagulant), Muqawwi Khoon (Blood tonic), Muassfi Khoon (Blood Purifier), Daf-i-Tasannuj (Antispasmodic), Daf-i-Taffun  (Anti-infective), Akkal (Corrosive), Tiryaq (Antidotes), Muqawwi A’sab (Nervine tonic), Mujafif (Desiccative), Mukhrij Balgham (Phlegmagogue), Munaffis (Expectorant) ^{11,12,13,14,15,20,26}

1. Therapeutic Uses

Neela Thotha is used after making it Mudabbar (detoxified). It is used in Humma (Fever), Amrad Jild (Skin disease), unplegent  smell, Quruh Khabisha, Juzam (Leprosy), Kikrow (Trachoma) and Sulaaq (Tarsitis / Blepheritis), Dabba Atfa’l, Zeequn Nafas, Khunaq wabayee (Diphtheria), Jabha, Waram Khanjra, Sa’ab Ria  / Waram Sa’b (Bronchitis). Neela Thotha is especially used in Suzak Mujmin (Chronic Gonorrhoea) and Sailan al-Rherm Mujmin (Chronic leucorrhoea), Aatshak (Syphilis), Amrad Fasad-i-Khoon, Sara (Epilepsy), Ra’asa (Tremor) , Ahetenaq al-rhem (Hysteria). It is also used in Qula (Stomatitis), Listha Damwia (Pyorrhoea), Bhagandar (Fistula), Dysentery, Diarrhoea, Bawaseer Khooni, Gum Ulcer, Qula Dahen, and Akala Dahen. Emesis induces by Neela Thotha in poisoning of Afeem (Opium), Dhatura (Dhatura stramonium), Tobacco, Samiyat Mukhadira and Snake bite ^{11, 12, 14, 15, 17, 20}.  

1. Substitute

Abdal-e-Advia (interchange of drugs) is one of the important principles that govern the rules pertaining to interchange of drugs. In case of non-availability of a drug like Neela Thotha, Unani scholars have suggested substitutes of this drug namely Zangar (Copper disulphide).

1. Nafah Khas (Main action)

Neela Thotha is used in the treatment of Ulcer, kidney diseases and also in the treatment of poison ^{13, 14, 20}.

1. Musleh (Corrective)

Neela Thotha has been described as being harmful to gastrointestinal tract. Roghan and Butter are used as corrective agents to reduce its harmful effect on gastrointestinal tract. The corrective agents are supposed to modify the Mizaj of Neela Thotha to reduce its untoward effects on gastrointestinal tract. Since it possesses hot and dry temperament in third degree, therefore its desiccative property is reduced by combining it with Roghan or Butter ^{13, 14, 20}.

1. Adverse Effects

The adverse effects of Neela Thotha are mentioned in various classical books of Unani system of medicine like nausea, vomiting, gastritis, Dysuria, and corrosive to body organs and death. Its adverse effects minimized up to some extent by using of Milk, Ghee or Lua’biyat ¹¹. Poisoning of Neela Thotha is treated by gastric lavage of stomach content and use of egg white along with milk is also neutralized the toxic effect of Neela Thotha ^{13, 14}

Poisoning of Neela Thotha is also managed through stomach washing with 1% solution of Potassium ferrocyanide to form insoluble cupric ferrocyanide, Albumiate copper by using albumin, use of demulcent fluids, and antidotes viz. Penicillamine, British Anti-Lewisites (BAL), and Ethylenediamine tetra acetic acid (EDTA) ¹⁰.

1. Dosage

In powder form of Neela Thotha or in Kushta (calx) form, it is used in the dose of 2-4 Chawal (30-60mg) ^11,13,20.

1. Fatal Dose

The fatal dose of Neela Thotha is mentioned 30 gm in different classical books of Unani as well as book of conventional medicine ¹⁰.

1. Fatal Period

The fatal period of Neela Thotha is mentioned 12-24 hours in classical books of Unani as well as modern books ¹⁰.

1. Advantages of Compound Formulation of Neela Thotha

A well-prepared Kushta (calcined) form or other dosage form (like Hab, Qurs and Marham)  of Neela Thotha offers many advantages over plant medicines due to its longer shelf life, lesser dose, easy storability and better palatability ²⁷. A lot of compound formulation of Neela Thotha (copper sulphate) is mentioned in Unani system of medicine viz.  Akseer-i-Deedan, Barood Hasram, Barood Kafoori, Kahal al-jawahar, Kahal chikni dawa, Shiyaf Akseer Chasm, Shiyaf Naranji, Shiyaf zarab, Zumad jabar, Kahel Chikni Dawa, Kushta Tootia, Marham Aatshak, Habbe-e-Dad, Marham Nasoor, Marham Jangar, Marham Khanazeer, Habb-e-Daba atfal, Manjan Mufeed, Marham Sa’afa Kushta Tootia, Zaroor Parsi Zaroor ramadi, Zaroor sabal and Zaroor Mamiran ^{11,12,20, 28, 29,30}. 

1. Mudabbar of Neela Thotha (Detoxification of copper sulphate)

It is clearly mentioned in classical literature of Unani system of medicine and also in other traditional system of medicine that Neela Thotha in raw form is very toxic drug. Before administration of Neela Thotha in human beings it should be detoxify. Impurity of Neela Thotha removed through recrystallising process in aqueous solution and toxicity reduces by heating it after rubbing with honey and ghee in a crucible then dry in sunlight after mixing in whey (Mattha) or water for 3 days. ¹⁶

3.5 Commonly used formulations of Neela Thotha in Unani medicine

Kushta (solid), Hab (solid), and Marham (semi solid) are three important formulations of Neela Thotha. Since Neela Thotha is a metalloid origin drug, therefore it is preferred to be used in calcined form. The Kushta (calx) is prepared by heating Neela Thotha at a high temperature to oxidize it. The crude drug is however pretreated with some catalytic agents (particular herbal juice) to make it more efficacious. Kushta Neela Thotha possesses Muqi (Emetics), Qabid (Astringent), Habis al-dam (Coagulant), Muqawwi Khoon (Blood tonic), Muassfi Khoon (Blood Purifier) and Daf-i-Tasannuj (Antispasmodic) properties. It is used for the treatment of various ailments ^{11, 12, 13}.

1. Hab-i-Dad ³¹

Hab (pills) is defined as “any medicine having one or more drugs and mix together with water or a liquid in sufficient quantity to form into pills called Hab”. The pleural of Hab is called as Habub. The detailed ingredients, scientific name and their quantity are mentioned in table 2.

Table 2: Showing ingredients, scientific name and quantity of Hab-i-Dad

Method of preparation of Hab-i-Dad; Initially, Para and Gandhak Amla Sar mix together and triturate till powder is formed. After that powder of Neela Thotha and Sohaga is added and sieved with mesh number 100 and kneaded with Ab-e-Limun. Hab (Pills) of size number six is prepared, dried and preserved in a bottle. One pill converts into paste by using water or Lemon juice and applied on the dry lesion of Herpes and Taeniasis.

1. Kushta Tutiya (Calcined copper sulphate):

The word Kushta derived from Kushtan in Persian meaning to kill or conquered. In Unani Kushta define as “a medicine that is used in small quantity and effective immediately”. It is a mixture of metals, metallic oxide, non-metals and their compounds ³¹. The contents of Kushta are oxidized by process of heating ³². The detailed ingredients, scientific name and their quantity are mentioned in table 3.

Table 3: Showing ingredients, scientific name and quantity of Kushta Tutiya

Method of preparation of Neela Thotha; initially pieces of Neela Thotha were spread out between the powders of Ritha (Sapindus trifoliatus) peel in earthenware. This mixture was dried by heating in an airtight Pyrex flask of Gil-e-Hikmat. It also burned again in a pit filled with 5kg cow-dung cakes. After that this mixture place between equal layer of camphor in a cup and heated after Gil-e-Hikmat with 5 kg of cow-dung. The light greenish-white Kushta of Neela Thotha is prepared, sieved and store in air tight bottle ³¹.

1. Marham Aatshak

Marham is a semisolid mixture of more than one ingredient with wax and oil. It is usually indicate by Unani scholar in the treatment of external inflammation, swelling, abrasions, wounds, cuts, boils, and pustules. The detailed ingredients, scientific name and their quantity are mentioned in table 4 ³¹.

Table 4: Showing ingredients, scientific name and quantity of Marham Aatshak

Method of Preparation of Marham Aatshak; initially oil of Arandi (Ricinus communis) along with Lead oxide was placed in pan and heated it till color changed into black. Then wax was melt and mixed with this black color substances. After that discontinue heat and copper sulphate then Chobchini (Smilax china) was added and stirred, sieved with mesh number 100. After washing of affected area with Azadirectha indica decoction poultice of Marham Aatshak is applied. It is mainly used in syphilitic wound and chronic wound ³¹.

3.6 Morphological, Physicochemical and Clinical Studies on Neela Thotha (copper sulphate):

In this study Javed et al., was concluded that mixed powder of Sheetraj Hindi (Plumbago zeylanicum) in 100gm and Neela Thotha (Copper sulphate) 25 gm was used for duration of three month and observe as achieved cured in 6.37%, very good response in 7.00%, good response 26.33%, fair response in 25%, poor response in 16.47%, slow response in 15.5%, and no response in 3.33% of patients  ³³

Haque et al., was stated that Zimad-e-Jarb composed of Neela Thotha (Copper sulphate); (Gandhak Aamla Saar (sulphur); Kameela (Mallotus philipensis); Murdar-e-Sang (litharge), and Roghan-e-Zard (Ghee). Zimad-e-Jarb and 5% Permethrin lotion was given to the Group A (n=20) and group B (10) for 7 days locally with the follow-up at 7th, 14th , and 21st days from onset of the treatment respectively. Assessments were carried out on subjective (erythema and papules) & objective viz. VAS (pruritus) parameters weekly three times. On Statistical analysis both the intervention had significant effect on objective parameters (p<0.01). However control drug has shown more pronounced effect than test drug and. The study revealed that Zimad-e-Jarb is effective in Jarb (Scabies) in terms of itching, erythema, papules and number of lesions without any side effect.  ³⁴

Wang and Borison were concluded a study that copper sulphate has emetic property  ³⁵.

Pullar et al., was concluded that treatment group (Copper sulphate 20 mg/day capsules with D-penicillamine 1000 mg/day) and placebo group (placebo 20 mg/day with D-penicillamine 1000 mg/day). Urinary copper was increased in the copper treated patients but no statistically significant difference occurred in Plasma viscosity, Haemoglobin, C-reactive protein, Caeruloplasmin, Articular index, Grip strength, Morning stiffness and Visual analogue pain scale (mm) in either group ³⁶

Tariq et al., (2014) were conducted a study on Preliminary physicochemical evaluation of Kushta tutia (KT); a Unani Formulation. Finished product was evaluated for physicochemical characteristics including preliminary tests mentioned in classical literature. Floating and finger test were positive. Curd test showed no discoloration after 48 h. These findings indicate correct preparation of KT according to classical literature. Bulk density (0.96 ± 0.00 g/ml); tapped density (1.53 ± 0.00 g/ml); Hausner ratio (0.62 ± 0.00), compressibility index (37.52 ± 0.19%); loss of weight on drying (0.08 ± 0.00%); pH of 1 and 10% (5.20 ± 0.00) and 5.62 ± 0.00, respectively); total ash, acid insoluble ash, and water soluble ash values 95.75 ± 0.09, 6.57 ± 0.02, and 45.02 ± 0.20%, respectively; and extractive values 0.85 ± 0.02% were reported in KT. Since this work has not been reported earlier, the results obtained could be considered as the standard for KT for future studies  ³⁷

3.7 Pharmacological Studies on Neela Thotha

Kotrannavar and Badgar was done a study and concluded that Tuttha Drava (Copper sulphate solution) produced a significant antibacterial activity viz. Tuttha Drava exhibits good Minimum inhibitory concentration (MIC) affect on Streptococcus pyogens, Pseudomonas aeruginosa  ³⁸.

Vaishagh et al., were stated Tuttha Bhasma (copper Sulphate [CuSO4.7H2O]) is showed more antifungal properties than anti-bacterial properties  ³⁹.

Mahapatra and Mahapatra were  stated that Shodhita Tuttha was found to be more effective as compared to crude have antimicrobial properties viz. Escherichia coli, Bacillus subtilis, Salmonella typhi, Staphylococcus aureus bacteria’s, Candida albicans and Trichophyton rubrum  ⁴⁰.

4. Conclusion

Neela Thotha is a mineral origin drugs that described well in classical literature of Unani system of medicine. It has several properties and uses in varieties of topical and systemic Amrad (Disease) viz. Humma (Fever), Bad (Axillary lymph node swelling), Quruh (Ulcer), Juzam (Leprosy) Kikrow (Trachoma), Sulaaq (Tarsitis/Blepheritis), Dabba Atfa’l (Pneumonia), Zeequn Nafas (Asthma), Khunaq Wabayee (Diphtheria), Waram Khanjra (Laryngitis), Waram Sa’ab Ria (Bronchitis), Sujak Mujmin (Chronic Syphilis) and Sailan al-Rherm Mujmin (Chronic leucorrhoea), Amrad Fasad Khoon, Sara (Epilepsy), Ra’asa (Tremor), Ahetenaq al-Rahem (Hysteria), Qula (Stomatitis), Listha Damwia (Pyorrhoea), Bhagandar (Fistula), Dysentery, Bawaseer (Pile) and Snake bite. But efficacy and safety of Neela Thotha are under proved. Therefore, in Unani system of medicine, it is a need of both preclinical and clinical trial on Neela Thotha to evaluate and validate the properties on scientific parameters.  

Acknowledgement

Authors are thankful to all the library staff of National Institute of Unani Medicine (NIUM), Bangalore for providing classical literature, manuscripts and other necessary materials on the subject. Authors are also thankful to Dr Mohd Shadab and Dr Husain for their valuable support during review.

Conflict of Interest

No conflict of interest

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