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Concept of Dementia and its Management in Unani System of Medicine: A Review

Anam Tariq ¹*, Niyazi Abdullah Khizar ¹, Md Salman ¹, Safia Fatima ¹, Mohd Nayab ², Abdul Nasir Ansari ³

¹ PG Scholar, Dept. of Ilaj-bit-Tadbeer, National Institute of Unani Medicine, Bengaluru

² Associate Professor, Dept. of Ilaj-bit-Tadbeer, National Institute of Unani Medicine, Bengaluru

³ Professor, Dept. of Ilaj-bit-Tadbeer, National Institute of Unani Medicine, Bengaluru

 

 

Introduction 

Dementia is derived from Latin, meaning insanity or a state of mindlessness.('De' means 'without' and 'ment' means 'mind').¹ It is the seventh leading cause of death and a significant contributor to dependency and disability worldwide.² A person with dementia gradually loses their mental and cognitive capacities due to a chronic neurologically damaging disorder^.3 It demolishes the brain cells, that are essential for memory, thinking, and behavioural issues severe enough to interfere with employment, lifelong interests, and social interactions.⁴

The prevalence rate for dementia increases with advancing age.  Currently there are about 138 million older adults (aged 60 and above) in India, and this number is expected to increase to nearly 194 million by 2031⁵  Worldwide, around 50 million people currently have dementia, a figure projected to surge to 152 million by 2050. ⁶ There are many causes of dementia, but the two most common causes are Alzheimer's disease and vascular diseases. ^7,8

In the Unani system of medicine (USM), dementia is referred to as Nisyān which is caused by dysfunction of three internal faculties Qüwwate Khayal (imagination), Qüwwate Fikr (thought) and Qirwwate Zikr ( memory) the causes of this disorder are categorized into three main factors: Sü' Mizāj (abnormal temperament), Sü Tarkeeb (structural defect), and Tafarruq-i-Ittişāl (disruption of continuity), with Sü' Mizāj being the most significant. This is because the brain is highly susceptible to coldness (Burüdat) and moisture (Rutübat), which can disturb its mental faculties, ultimately leading to dysfunction in all three. When these faculties are compromised, it results in three types of deficits: Butlaan (complete cessation), Nuqsaan (deficiency), and Tashweesh (distortion or improper functioning).¹¹

Nisyan is name of that disease in which derangement of Hafiza (Memory), (Thinking) and Takheel (Imagination) occur. Forgetting what one sees or hears is a sign and symptom of Hafiza malfunction. When a patient has Fikr derangement, their cognitive power rate drops to zero and they start having negative ideas. When a patient has Takheel's derangement, everything they feel and see is lost, and they forget what they see in their dreams. Overall, the source of Fasad-e-Zikr is an excess of either coldness and moistness or coldness and dryness, which manifests in the posterior brain. In cases of Fasad-e-Fikr, it occurs in mid brain and in cases of Fasad-e-Takheel, it occurs in anterior brain.'¹²

Dementia can be divided into two main categories: primary (degenerative) and secondary (acquired). The most prevalent degenerative dementias include Alzheimer's dementia, frontotemporal dementia, Parkinson's associated dementia, and Lewy body dementia. Secondary causes primarily encompass vascular issues, central nervous system infections, trauma, metabolic disturbances, and other reversible or treatable conditions. ¹³

Risk factors: The primary risk factor for dementia is aging. Other risk factors include a family history of dementia, uncontrolled hypertension, smoking, obesity, uncontrolled diabetes, excessive alcohol consumption, low physical activity, poor sleep, lower education, social isolation, and depression.  ^14,15 

Clinical Features of Dementia:

Depending on the underlying etiology of dementia, symptoms can differ significantly. generally, short-term memory loss and forgetfulness are the first signs of dementia. early signs of dementia include getting lost while driving or walking, becoming disoriented in familiar environments, losing track of time, struggling to understand or follow conversations, having trouble with daily duties, and visually misjudging distances to objects are some additional early signs of dementia. A patient with dementia may also experience mood swings, including anxiety, sadness, or agitation due to memory loss, personality and behavioural changes, social isolation, and a loss of interest in other people's emotions.¹⁴

Classification of Dementia in Unani:

1.  The first type of memory dysfunction is caused by Sū’ Mizāj Bārid (an altered cold temperament), along with an accumulation of Balgham (phlegm) in the anterior part of the brain, where the center of Qūwwate Takhayyul (imagination) is located. Patients affected by this condition retain their long-term memory but struggle with short-term memory loss.
2.  The second type affects the midbrain, where Qūwwate Fikr (thinking) resides. This dysfunction is triggered by Ruṭūbat Ghalīẓa (thick morbid matter) and Burūdat (coldness), impairing cognitive thought processes.
3.   The third type of memory dysfunction occurs when Ghalīẓ Balghamī Mādda (morbid phlegmatic matter) and Burūdat (coldness) interfere with the faculty of memory and recollection. As a result, the patient experiences complete memory loss and an inability to retain or process new information. ¹⁶ 

 

 

Etiology: 

According to Abu Al Mansoor Al Qamari, Nisyān is caused by an excess of Balgham (phlegm), which leads to increased moisture in the Muqaddam Dimagh (anterior part of the brain). This moisture hampers the brain's capacity to retain positive information, similar to how melted wax is unable to hold an impression.¹⁷

According to "Rabban Tabri" Nisyän may be due to the accumulation of excessive viscous Phlegm (Lesdaar Balgham) and fluid (Ruțubat) or excessive cold temperament of the body. When Nisyān is caused by excessive accumulation of fluid then Qüwwate Hafiza and Qüwwate Fikr will be weak. ^18,19 

In modern medicine, the most common cause of dementia is the degeneration of brain cells due to the abnormal accumulation of proteins in the brain, which affects both mental and physical abilities. Additionally, gene mutations or polymorphisms that influence brain function are also recognized as causes of dementia.^20,21

Principle of treatment: Since dementia is caused by changes in the brain's temperament toward cold and moist or cold and dry states, the basic principles of treatment for Nisyān include: ^11,22,18,17

(1) To eliminate the real cause of the disease

(2) To correct the temperament of the brain (Tadeel-ī-Mizāj).

(3) To Evacuate the Morbid Matter from the brain (Tanqia Dimāgh) with the help of Munzij (Concoctive) and Mushil (Purgative) drugs.

(4) After Tanqia, Muqawwi-ī-Dimāgh (Brain tonic) drugs are used.

(5) To produce exhilaration (Tafreeh-ī-Taba).

(6) To relieve pain (Taskeen).

(7) To induce sleep (Tanwaeem).

8) The disease is commonly due to cold, moist and thick humour therefore evacuation/bio purification of the body is indicated by employing the procedure of Huqna(enema) and Mus’hilat (purgation).

(9) If the age, season and strength of the patient are favourable then Fasd (venesection) is advised.

(10) Physical and mental rest (Sukoon-ī-Jismani wa Nafsāni)

Management of Nisyan: 

In Unani medicine, the treatment of dementia primarily involves three approaches: Dietotherapy, regimental therapy, and pharmacotherapy. 

Ilaj Bil Ghiza ( Dietotherapy)

Ghiza-e-Lateef, Kasir-ut-Taghzia-wa-Jaiyyad-ul-Kaimus (attenuated highly nutritious and good chime forming), Ghiza-e-Saree-un-nafooz (fast penetrative diet) and muqawwi ghiza (vigorous diet) is suitable for the patient of nisyan.eg. Meat soup, Semi boiled eggs, Maul Jabn, Maul Laham, Maul Asl, Paneer Maya, Hareera, Sirka, Khardal, Goat meat, sparrow meat, Khurfa, Palak, Kaddu, nuts like almond, hazelnut, coconut and walnut have been recommended as good foods for people with Nisyan etc. ²³

Ilaj Bil Tadbeer:

There are several beneficial regimes for managing Nisyān, such as; riyazat (exercise), dalk (massage), nutool (pouring), takmeed (hot fomentation), Huqna (enema), Atoosh (sneezing), Shamoom (inhaler), zimad (paste), gargarah (gargle) etc. ^23,12

Ilaj Bil Dawa: There are numerous single and compound drugs used for memory enhancement.

single drugs include Brhami (Bacopa monnieri), Waj (Acorus calmus), Kundur (Boswellia serrata), Zanjabeel(Gingeber officinalis), Khardal(Brassica nigra),Halela (Terminalia chebula,)Balela(Terminalia bellerica), Amla (Emblica officinalis), Haldi(Curcuma longa), Elva (Aloe vera),Qust (Saussurea lappa), Saadkofi (Cyperus rotundus), Jatamansi (Nardostachys jatamansi), Kabab Chini (Piper cubeba), Fil Fil Daraj (Piper longum), Aqarqarha (Anacyclus pyrethrum), Gilo (Tinospora cordifolia), Khulanjan (Alpinia galangal), Asgand (Withania somnifera), Ustukhuddus (Lavandula stoechas), Baladur (Semecarpus anacardium), Darchini (Cinnamomum zeylanicum), Ood Saleeb (Paonea officinalis), Zaafran (Crocus sativus), Qaranfal (Syzygium aromaticum), Pista (Pistacia vera), Tulsi (Ocimum basilicum), Asarron (Valerina wallichil), Chilghoza (Pinus gerardiana). Almond (Prunus amygdalus).

Compound drugs include Majoon Barhami, Majoon Bolas, Majoon Baladur, Majoon Waj, Majoon Falasafa, Majoon Kundur, Itriphal Sagheer, Itriphal Ustakhuddus, Jawarish Jalinoos, Majoon Najah. ^23,12

Conclusion: 

Dementia, particularly referred to as Nisyān in Unani medicine, represents a complex and multifaceted disorder characterized by the gradual decline in cognitive functions such as memory, thinking, and imagination. The increase in the prevalence of dementia, especially among the aging population, highlights the urgent need for comprehensive understanding and effective management strategies. In Unani medicine, dementia is understood through a unique framework that emphasizes the role of internal faculties and the balance of bodily humors. The categorization of memory dysfunctions based on temperamental imbalances provides valuable insights into potential therapeutic approaches. These include dietary adjustments, regimental therapies, and the use of specific pharmacological agents that target cognitive enhancement. The holistic treatment strategy, which includes the correction of temperament and the evacuation of morbid matter, aligns well with modern medical principles of addressing underlying causes while managing symptoms.

Furthermore, understanding the various risk factors associated with dementia, such as age, family history, lifestyle choices, and comorbid conditions, is essential for prevention and early intervention. As the global population ages and the incidence of dementia continues to rise, collaborative efforts between traditional and modern medical practices will be crucial in addressing this public health challenge. Continued research into the efficacy of Unani treatments alongside conventional approaches may yield beneficial outcomes for individuals suffering from dementia, ultimately improving their quality of life and preserving cognitive function for as long as possible.

Acknowledgement: The authors express their gratitude to their co-authors and to everyone whose work has been referenced in this paper.

Author Contributions: All the authors equally contributed to this work.

Source of Support: Nil

Funding: The authors declared that this study has received no financial support.

Informed Consent:  Not applicable

Conflicts of Interest: The authors declare no potential conflict of interest with respect to the contents, authorship, and/or publication of this article.

Ethics approval: Not applicable

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