Hypothyroidism (Qillat-e- Ifraz-e- Darqiyya) affects women more frequently and it’s incidence increases with age. The prevalence of hypothyroidism in is India about 11% whereas, in developed countries it is around 4-5%,. It is a condition where the thyroid gland is underactive and unable to produce enough thyroid hormone. The description of hypothyroidism as a disease is not directly found in Unani texts. However, the signs and symptom of hypothyroidism resemble the clinical manifestation associated with derangement in cold temperament (Su-e-Mizaj Barid Maddi), such as plethora (Imtila), excessive salivation (Kasrat-e- Luabe-e- Dahan), tiredness (Aa’yan), loss of appetite (Zoaf-e- Ishteha), excessive sleeping (Kasrat-e- Naum) and cold skin (Baroodat-e- Jildia). These signs and symptoms are the result of an excess in abnormal phlegm (Ghair Tabayi Balgham) in the body. The common symptoms of hypothyroidism in adults are weight gain, fatigue, lethargy, cold intolerance, constipation, change in voice and dry skin.
In other words, Hypothyroidism (Qillat-e- Ifraz-e- Darqiyya) is the most common endocrine disease caused by a defect in the thyroid gland that leads to reduced production of thyroid hormone. It has multiple aetiologies and manifestations. Long-lasting effects of untreated hypothyroidism (Qillat-e- Ifraz-e- Darqiyya) or chronic hypothyroidism (Qillat-e- Ifraz-e- Darqiyya Muzmin) can lead to various co-morbidities, such as hypertension, anaemia, mixed hyperlipidemia, hypercholesterolemia, obesity, diabetes mellitus, myopathy, weight gain, depression migraine and anxiety. One can say it can affect all systems of the body.
Literally the meaning of “Qillat-e- Ifraz-e- Darqiyya” is the decreased secretions of “Ghudda Darqiyya” (thyroid gland). In Qillat-e- Ifraz-e- Darqiyya, temperament (Mizaj) of body corresponds to Su-e- Mizaj Baarid Ratab Maddi.
In conventional medicine, hypothyroidism (Qillat-e- Ifraz-e- Darqiyya) is treated with hormone replacement therapy (thyroxine) like other endocrine diseases, whereas in Unani System of Medicine, pharmacotherapy (Ilaj Bil Dawa) consists of single and compound drugs. Single drugs are selected as per the constitution (Mizaj) of drugs as opposed to the abnormal constitution (Su-e- Mizaj) of disease and its pathology. Some drugs increase the basal metabolic rate whereas some evacuate the morbid material from the body by the action of purgation.
Unani system of medicine has addressed many currently recognized diseases using their own names and classifications. It is now practiced many of the countries, and has been recognized by the World Health Organization. Unani is a very old system of medicine that originated from central Asia, long before 500 BC. Greeks, like Asclepius, Andromacheus and Hippocrates, Romans, like Galen and Dioscorides, and Arabs of the medieval ages, like Razi and Ibn-e-Sina, all contributed to the system of Unani medicine.
In Unani medicine the disease we know as hypothyroidism (Qillat-e- Ifraz-e- Darqiyya) is not mentioned; however, Unani literature identifies signs and symptoms that are associated with deranged phlegmatic temperament (Su-e-Mizaj Barid Balghami). This seems very similar to the clinical conditions associated with contemporary diagnosis of hypothyroidism.
Clinical correlation of symptoms associated with derangement in cold temperament (Su-e-Mizaj Barid Maddi) and hypothyroidism (Qillat-e- Ifraz-e- Darqiyya)
Clinical manifestations of hypothyroidism (Qillat-e- Ifraz-e- Darqiyya) are closely associated with signs and symptoms of derangement in the cold temperament (Su-e- Mizaj Baarid Maddi), which has been thoroughly explained by eminent Unani scholars, like Zakaria Razi, Ibn-e- Sina, Rabban Tabri, Ali Ibn-e- Abbas Majusi and Hakim Akbar Arzani, in their famous books.
According to Unani philosophy, health and disease depend on the balance of temperaments and pathophysiology of disease.
Causes of Derangement in temperament (Su-e- Mizaj)
Pathophysiology of Qillat-e- Ifraz-e- Darqiyya (Hypothyroidism)
Derangement in temperament (Su-e- Mizaj) is derangement or imbalance of a temperament (Mizaj) of the body, whereas Su-e- Mizaj Baarid (abnormal cold temperament) indicates imbalance in the cold temperament. When an imbalance in the temperament of an organ develops and the signs indicate that it has a cold nature, it is called a cold temperament (Su-e- Mizaj Baarid); cold temperament can be indicated by various Alaamat (symptoms/signs), like excessive sleep, loss of appetite, increase of pallor in the body etc.
The causes of Su-e-Mizaj Barid Balghami (deranged phlegmatic temperament) or Qillat-e- Ifraz-e- Darqiyya (Hypothyroidism) mentioned in Unani medicine are alteration in Asbab-e- Sitta Zarooriyah (six prerequisites for existence), including Ghair Tabayi Balgham (Abnormal Phlegm), Zoaf-e- Dimagh (Debility of Brain), Zoaf-e- Kabid (Debility of Liver), Zoaf-e- Tihal (Splenic Debility), Zoaf-e- Gurdah (Renal Debility), Su-ul- Qinyah (Anemia), Qillat-e- Harkat (Sedentary life), Ghair Tabayi Istifragh (Excessive Evacuation) etc.
Unani literature includes Su-e- Mizaj Baarid Maddi (deranged cold temperament), Ghiza-e- Kaseef (viscid diet), Baarid Mashroobat (drinks with cooling effect), Qillat-e- Harkat (sedentary life) and alteration in Asbab-e- Sitta Zarooriayh (six prerequisites for existence) as its risk factors.
Diagnosis of Hypothyroidism (Qillat-e- Ifraz-e- Darqiyya) based on Ajnas-e- Ashra (Ten Categories of Signs)
The concept of Ajnas-e- Ashra was introduced by Ibn-e- Sina for assessment of temperament (Mizaj). Every organ and every person have their own specific temperament which may change in response to abnormal humors or disease.
Process of Temperament Assessment/ Diagnosis of Temperament (Mizaj)
Temperament (Mizaj) classifies human beings, diet, drugs etc. into four qualitative types: Hot & Dry, Hot & Wet, Cold & Wet and Cold & Dry. The knowledge about an individual’s temperament is very important for treating various diseases. For the assessment of the temperament the Unani physicians documented their different parameters. These are called as Ajnaas-e- Ashra (Ten Categories of Signs), which are as follows:
Usool-e- Ilaj (Principles of Treatment)
In Unani system of medicine, the main emphasis of principles of treatment (Usool-e- Ilaj) is to correct the abnormal temperament (Mizaj-e- Ghair Taba’yi) and six prerequisites for existence (Asbab-e- Sitta Zarooriya) to restore normal health. It is based on Black Box Design Manner (i.e., different components of treatment will be given as a package form which includes different drugs, dosages form and regimens).
In Unani system of medicine, the principle of treatment is based on Usool Bil Zid (principle of contradiction). There are four treatment methods, or modalities of treatment.