A Review on Sala-E-Sadi (Fibroadenoma of Breast) In Unani Ystem of Medicine

INTRODUCTION

In Unani system of medicine, the concept of Humors (Aqlaat) was proposed by the Father of Medicine Hippocrates also known as Buqrat. According to his Humoral theory, the human body contains four humors, which are Dam(Blood), Balgam (Phlegm), Safra (Yellow Bile) and Sauda (Black Bile). All of these humors exist in liquid form. When they are balanced, health is maintained; however, when they become imbalanced or corrupted, illness occurs.

According to Unani concept, Sala-E-Sadi is a type of benign tumor formed due to excessive accumulation of viscid phlegm in breast tissue [11][25].

AIMS & OBJECTIVES

The objective of this study is to ascertain the Unani Concept of Fibroadenoma (Sala-E-Sadi) as narrated in classical Unani literature with an aim to spread knowledge for preventive measures and the management of Sala-E-Sadi by Unani Drugs (Single/Compound) which are affordable, commonly available and free of Side effects.

To reduce the risk of surgical intervention because in Allopathy medicine, the only way to cure the Fibroadenoma is with Surgical Excision.

UNANI PATHOPHYSIOLOGY

According to ancient Unani physician, NajeebuddinSamarqandi in his book, Sharah –E-Asbaab, mentioned that there is a direct connection between, reproductive organs and breast through the circulatory vessels. During puberty, there is excessive heat generated in reproductive organs. Due to this heat, the Humors (Aqlaat) which are responsible for the regulation of menstruation will travel to the breast tissue through the circulatory vessels where some of the Humors will get absorbed in breast tissue and some may get converted into a viscid phlegm and deposit in breast tissue in the form of lump like structure called Sala-E-Sadi [11][15].

According to Hakeem Ajmal Khan in his book TalimulQabila, the cause of Fibroadenoma (Sala-E-Sadi) is due to some disease condition in which the absorbing power of breast is reduced. Due to this, the breast doesn’t get enough nutrition or proper blood supply. In this case, the phlegm gets deposited in breast tissue and forms a lump like structure called Sala-E-Sadi [6].

CAUSES

According to Waseem Ahmed Azmi, in his book Amraaz – E – Niswaan, mentioned the following causes of Fibroadenoma (Sala-E-Sadi) [13]:

1. Increased quantity of phlegm in blood.
2. Accumulation of Viscid phlegm beneath the breast skin. [25]
3. Due to local heat, the liquefied temperament of phlegm converts to viscid form.
4. Dietary intake which increases excessive production of phlegm.
5. Sedentary lifestyle or reduced physical activity.  

RISK FACTORS

According to Hakeem Ghulam Mohiuddin Sahab, in his book Mizbah – Ul- Hikmat, mentioned the following risk factors of Fibroadenoma (Sala-E-Sadi) [3]:

1. Due to some local breast injury.[25]
2. Chronic Mastitis (Muzmin Warm –E- Pistaan).
3. Early Menopause.

CLINICAL FEATURES:

According to Waseem Ahmed Azmi, in his book Amraaz – E – Niswaan, mentioned the following features of FibroadenomaSala – E-Sadi [13]: By palpation method we can identify this. The Fibroadenoma is of a peanut size in initial stage and is easily mobile. This gradually increases in size and reaches a maximum size up to 3-4 cm or >4. Once itreaches its maximum size the mobility is limited.

According to Hakeem Ghulam Mohiuddin Sahab, in his book Mizbah – Ul- Hikmat, mentioned the following features of Fibroadenoma (Sala-E-Sadi) [3]: Initially it is of a nodular structure which may increase its size from a Berry to a size of Ducks egg.

DIFFERENTIAL DIAGNOSIS:

1. Mastitis (Warm e Pistaan)
2. Breast Carcinoma (Sartaan E Sadi)
3. Breast lipoma

DIAGNOSIS:

1. Palpation of the breast to identify the size, shape, and consistency of the lump [13]. Usually, the affected area of breast is cold and pale [9].
2. Observe Signs of Phlegm Dominance: Look for other symptoms indicative of phlegm excess, such as a pale complexion, fatigue, or excessive mucus production.

3. Determine Constitution (Mazaj): Assess the patient’s overall temperament to identify a phlegmatic constitution, which can predispose them to conditions like fibroadenoma.
4. Environmental Factors: Assess the patient’s living conditions for dampness or cold, which may exacerbate phlegm accumulation.
5. Imaging: Though not traditionally emphasized, modern imaging techniques like Mammography, Ultrasound and FNAC (Fine Needle Aspiration Cytology) can be used for further evaluation [14].

PRINCIPLES OF TREATMENT (USOOL E ILAAJ) [13]

According to modern treatment, surgical excision is the only line of treatment. But in Unani concept:

1. Remove the cause at first step.
2. If the disease appears due to dominance of Humors (Aqlaat), then depending upon dominant Humor, it should be first treated by concoctive (Munzij), Purgative (Mushil) therapy, Tabreed (Cooling) and Evacuation (Tanqia E Mawad).
3. Medicine for local application to dissolve the Phlegm.
4. Dietary Restrictions
   1. Healthy and easily digestible diet.[24]
   1. Avoid food that increases phlegm like spicy and oily food.
5. Advised patient for regular exercise and maintain healthy lifestyle.

TREATMENT (ILAAJ) [13]:

Concoctive (Munzij Therapy):

1. Beeq e Izkhar (CymbopoganJwarancusaSchult) 7 gms
2. Beeq e Kaasni ( CichoriumIntybus Linn) 7 gms
3. Beeq e Karafs (ApiumGraveo Lens Linn) 7 gms
4. Beeq e Badiyan (FoeniculumVulgaremill) 7 gms
5. ParsiyaVisha (AdiaentumCapillus – Veneris Linn) 7 gms
6. UstuQuddus (LavandulaStoechas Linn) 7 gms
7. AnjeerZard (FicusCarica Linn) 2 Adat.
8. Mavis Munaqqa (VitisVinifera Linn) 9 Dana.

Method of Preparation: Soak the above drugs in water overnight and boil in the morning. Filter it and mix with Gulkhand e Asli 50 gms. This should be consumed for 7 days in the form of Joshanda.

Purgative (Mushil therapy):

1. Magz e FaloosKhayarshambar (Cassia Fistula Linn) 7 gms              
2. Shakar e Surkh (Brown Sugar)  50 Gms

Method of Preparation: Soak the above drugs in water overnight. Filter it; add Gulkand e Aftabi 50 gmsandRoghan e BaidAnjeer 12 ml (Ricinus Communis). This should be consumed on 8^th day in the form of Khaisanda.

Tabreed (Cooling):

1. Gulkhand e Aftabi 25 gms.
2. Arq – E – Badiyan 150 ml (FoeniculumVulgaremill)
3. Tukhm e Rehaan 4 gms (Ocimum Sanctum Linn)

Method of Preparation: Mix GulkhandAftabi in Arq e Badiyan and add Tukhm e Rehaan powder and consume it on 9^th day.

Tanqiya (Evacuation):

1. TurbudSafaid (OperculinaTurpethum Linn) 9 gms.
2. Shaham E Hanzal (CitrullusColocynthis Linn) 9 gms.
3. Moql – e –Arzaq (CommiphoraMukul Hook) 4 gms.
4. Kateera (CochlospermumReligiosum Linn) 4 gms.
5. Samagh – e – Arabi (Accacia Arabica) 4 gms.
6. Gul – e – Surkh (Rosa Damascena Mill) 4 gms.
7. Namak –e – Siyah (Sodium Chloride NaCl) 4 gms.
8. Sumbul –U- Teeb (NardostachysJatamansi DC.) 4 gms.
9. HabbulMalookMudabbir (PrunusCerasus Linn) 9gms.
10. ShahedMusaffi (Apismellifera) 20ml
11. Roghan e Gul  (Rosa Damascena Mill) 20ml

Method of Preparation: All the above drugs should be ground into fine powder and mixed with ShahedMusaffi and Roghan e Gul. Make pea-sized tablets and consume 2-3 tablets on 10^th day.

Paste for Local Application [5]:

1. BeeqKanduri (CocciniaIndica)
2. MulsriQaam (MimusopsElengi)
3. Sahajna (MoringaOlefera)

Method of Preparation: The above drugs should be taken in equal quantities and mixed with an  extract of Sahajna and applied for 3 days. 

(Or)

1. Barg E Qookh&Barg E Sadaab [22]

Method of Preparation: The above drugs should be taken in equal quantity and grinded. Mix with water and apply it. 

If the absorbing power of the breast is decreased, then this can be improved by local application ofQarateenQushk and JounkQushk powder. Mix both with Roghan E Qist[6] [24]^.

CONCLUSION

Fibroadenomas are the most common breast masses in adolescent females with an overall age group 15 to 30 years.InAllopathy, surgical excision is the only line of treatment for Fibroadenoma. But in the Unani System of Medicine, to reduce the risk of surgery and adverse effect of hormonal therapy, Unani Drugs may be used as an excellent alternative for themanagement of Fibroadenoma of the breast without causing any serious side effects on  theHuman Body. This article gives us more insight on the causes and Management of Fibroadenoma in the light of classical Unani

Literature.

REFERENCES

1. Jeffcoates Principles of Gynecology, revised and updated, V edition, Pg. 100.
2. Jami UlShifaIfadaatKemrina, Hakeem SayyadAfzal Ali Khan Bahadur, Pg. 232-233.
3. Misba- Ul- HikmatBy Hakeem GulaamMohiUddinSahab, Pg. 384-385.
4. KitabUlIlaaj, Jamee UL Hikmat,Vol 2, 1104 – 1106, By Hakeem Mohammed Hassan Qhurshi, Principal Tibiya College, Lahore.
5. QarabaDeen-e-Azam, Hakeem Mohammad Azam Khan, Pg. 459.
6. TalimUlQabila – Moalijat E Amraaz E Niswaan, Part 4, HaziqUlMulk Hakeem Hafiz Mohammad Ajmal Khan Sahab, Pg. 422-423.
7. Tarjuma –E- Kabeer by Hakeem Mohammed Kabeer Uddin, Part 3, Pg. 759.
8. Haaziq, MasiUlMulk, Hakeem Hafiz Mohammad Ajmal Khan Sahab, Pg. 316-317.
9. Ghana Muna, MusannifaFazilAjal Hakeem Bebadal Abu Al Mansoor Al Hassan Qamri, Pg. 350.
10. KitabUlHawi, Part 7, Abubakr Mohammad Bin ZakriyaRazi, Pg. 22.
11. MoalijatSharah-E- Asbaab, Part 2, Hakeem AllamaNajeebUddinSamarqandi, Pg. 426.
12. Zaqeera – e- QuazamShahi, 6^thJild, Allama Ahmed Al Hassan Al Jurjani, Pg. 319 – 320.
13. Amraaz E Niswaan, Hakeem Waseem Ahmad Azmi, Pg. 444- 446.
14. D.C Dutta’s Text book of Gynaecology, VI edition, Pg. 564.
15. Efficacy of MunzijMushilandZimaad Therapy in Sala E Sadi (Fibroedenoma Of Breast) – A Randomized Single-Blind Study –  MullaShamshad, Q.N Qhuddsia, Research Article 43 to 49, ISSN 2583-7532, ACTA Traditional Medicine.
16. Al Akseer by JanabAllama Hakeem Mohammed KabeerudddinSahab, Part II, Pg. 1419
17. Tibb E Akbar by Hakeem Akbar Arzani, MutarjimAllama Hakeem Mohammed Hussain, Pg. 366.
18. MeezanUlTibb by Hakeem Mohammed Akbar, Pg. 128.
19. ShifaUlAmraaz (Moalijat E Sariri) by Shams UlAfaaqSiddiqui, Pg. 270, 271.
20. Jarahat E Umumi and Jarahat E Nizami by Hakeem Mohammed Yousuf Ansari, Pg. 777, 778.
21. KitabUlMaqtaratFiltib by Mahzabuddin Abu Al Hassan Ali Bin Ahmed Bin Ali Bin Hub Ul Baghdadi, Part III, CCRUM, Pg. 188.
22. KitabUlHawi by Abubakr Mohammed Bin ZakariyaRazi, Part VII, CCRUM, Pg. 19, 20.
23. Tibb E Ahsaniby Hakeem Ahsan Ali, Pg. 68.
24. Kulliyat E Qanoon (TarjumaWoSharha) by Hakeem Mohammed Kabeeruddin, Part II, Pg. 688.
25. MujribaatTibb E Askandari, Urdu Tarjuma, MoadanUlShifa, Sikandar E Shahi by Bahwa Bin Qawas Khan, CCRUM, Pg. 749.