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Qurṣ-i-Shibb: A review on polyherbal Unani formulation in the management of Kathrat-i-Ṭamth (HMB)

Najeeb Ghufran 1, Begum Wajeeha 2, Sumaiya Syeda 3*

1. PG Scholar, Dept of Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine, Bengaluru, Karnataka, India

2. Professor & HoD, Dept. of Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine, Bengaluru, Karnataka, India

3. PG Scholar, Dept of Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine, Bengaluru, Karnataka, India

Article Info:

__________________________________________

 Article History:

Received 17 December 2021      

Reviewed 23 January 2022

Accepted 31 January 2022  

Published 15 February 2022  

__________________________________________

Cite this article as: 

Najeeb G, Begum W, Sumaiya S, Qurṣ-i-Shibb: A review on polyherbal Unani formulation in the management of Kathrat-i-Ṭamth (HMB), Journal of Drug Delivery and Therapeutics. 2022; 12(1-s):180-185

DOI: http://dx.doi.org/10.22270/jddt.v12i1-s.5332                     __________________________________________

*Address for Correspondence:  

Sumaiya Syeda, PG Scholar, Dept of Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine, Bengaluru, Karnataka, India

Abstract

______________________________________________________________________________________________________________

Heavy flow during menstruation is called Menorrhagia or Heavy Menstrual Bleeding, is generally referred to excessive bleeding, either in duration or quantity of blood loss or both (> 8 days and/or >80 ml) at regular intervals. It can be associated with several conditions, including problems with the uterus, hormonal problems, or other conditions. While abundant bleeding may make it difficult to participate in normal daily life at certain times. But currently Several drugs and Hysterectomy is recommended for the treatment of HMB that has different side effects as well as gastrointestinal symptoms, liver disease, obesity, hypoestrogenic state and thromboembolic diseases. In classical texts Qurṣ-i-Shibb is used in the management of Kathrat-i-Ṭamth (Heavy Menstrual Bleeding) as this formulation has pharmacological activity such as ḥābis al-dam (haemostatic or haemostyptic), qābiḍ (astringent), mujafif (siccative), mugharrī (glutinous) and mubarrid (refrigerant). So, this review aims to explore the role of Qurs-i-Shibb in the management of Heavy Menstrual Bleeding. The ingredients of Qurs-i-shibb are shibb-i-yamāni, dam al-khwayn, gulnār each of them 10.5 gram, katīra 21 gram, samagh-i-ʻarabī 7 gram. These drugs having the properties of ḥābis al-dam, qābiz, mujaffif, mugharrī and mubarrid produce vasoconstriction and reduce heavy bleeding. The granules were formulated into 500 mg tablets. Three tablets thrice daily for 5days will help in reducing the bleeding. 

Keyword: Kathrat-i-ṭamth; Heavy menstrual bleeding; Qurṣ-ī-Shibb; hemostatic, astringent.

 


 

1.     Introduction

Heavy Menstrual Bleeding (HMB) or kathrat-i-tamth is a common gynaecological problem,1 menstrual bleeding can be so severe and heavy that it may leave some adverse effects on the women’s social, physical, and emotional quality of life and may lead to complications such as anaemia, iron deficiency, increasing cost of medical services, anxiety and depression.2

 It is caused by conditions affecting the uterus and its vascularity, such condition prevail in uterine fibroid, adenomyosis, uterine polyp, myohyperplasia and endometrial hyperplasia, chronic pelvic inflammatory disease, pelvic endometriosis, IUCD etc. or it may be the result of bleeding disorder.3

Treatment of menorrhagia includes oral contraceptives with oestrogen or progesterone alone, GnRH agonists, anti-fibrinolytics, NSAIDs such as mefenamic acid and desmopressin4, Mirena IUCD and minimal invasive surgery include endometrial thermal ablation, endometrial resection and hysterectomy in selected cases3

Each medical treatment has its side effects. Today, public concerns around the side effects of pharmaceutical drugs, prohibition of their use in some populations and the increasing popularity of herbal medicine have resulted in alternative treatments for HMB being sought.2 

Herbs are being used therapeutically all around the world to treat various types of ailments. Polyherbal formulations dominate as the largest segment, capturing a significant share of the overall herbal supplements and remedies market worldwide. Unani compound formulations are made with the drugs of herbal, mineral and animal origins although herbal origin has a larger share than animal and mineral ones. In Unani system of medicine there are four basic dosage forms of compound formulations: solid, semisolid, liquid and gaseous forms. These dosage forms are prepared with herbal, animal and mineral origins. The three origins are commonly known as Mawālīd-i-Thalātha (Three sources or origins of drugs).5

Qurṣ-i-Shibb is an important compound preparation in Unani system of medicine for the management of Kathrat-i-Ṭamth.6,7 The ingredients of this formulation are shibb-i-yamāni, dam al-khwayn, gulnār each of them 10.5 gram, katīra 21 gram, samagh-i-ʻarabī 7 gram.8 These drugs having the properties of ḥābis al-dam, qābiz, mujaffif, mugharrī and mubarrid produce vasoconstriction and reduce heavy bleeding.

 

 

2.     Material and method

A literature search was carried out to collect all relevant information on heavy menstrual bleeding, Qurṣ-i-Shibb and its ingredients. Through publicly available electronic databases, including PubMed, Scopus, Google Scholar, Science Direct, Research Gate and other internet sources. A large number of literature articles published up to 2020 were reviewed. The keywords used for the search included “haemostatic”, “Alum”, “Dracaena cinnabari Balf.f”, “Punica granatum Linn”, “Cochlospermum relgiosum Linn.”, “Acacia arabica Linn” “Qurṣ”, “Qurṣ-i-Shibb”, “Shibb-i-Yamānī”, “Dam al-Akhwayn”, “Gulnār”, “Katīra” and “Ṣamagh-i-ʻarabī” . The name of species has been validated by using ‘World Flora Online’ (http://www.worldfloraonline.org/). “Standard Unani Medical Terminology” published by CCRUM has been used to describe the proper Unani terminologies (http://namstp.ayush.gov.in/#/Unani), further, books published in urdu and English were used to compile the information as representative literature in unani medicine.


 

 

3.     Results

Table 1 : Ingredient of Qurṣ-i-Shibb  [8]  Qarabadeene Qadri md Akbar Arzani

Name 

Botanical name

Part used

Quantity (grams)

Shibb-i-Yamānī

Alum

Alum Crystal

10.5 

Dam al-Akhwayn

Dracaena cinnabari Balf.f.

Dry extract

10.5 

Gulnār

PunicagranatumLinn.

root, stem, bark, Fruit, seed, pulp, fresh juice 9

10.5

Katīra

Cochlospermum  religiosum (L.)

Gum 10,11

21

Ṣamagh-i-ʼarabī

Acacia arabica Linn

stem, bark, Fruit, seed 12, leaf, and gum 13,14,9

7

 


 

3.1. Method of preparation

The ingredients of the formulation, after identification and ascertaining the quality, were cleaned by the removal of foreign matter, if present, were powdered separately by pulverizer (GMP model), sieved through a mesh with a pore size of 150 µ. (Mesh No. 100, British standard sieve (BSS). Required quantities of the powders were mixed thoroughly and moistened with sterile distilled water. Then Qurṣ-i-Shibb was prepared according to the standard method. 8

3.1.2.          Important Points Regarding Preparation of Qurṣ-i-Shibb 

The tablets were prepared as per the procedure described by Mohammad Azam Khan,1315 AD15.The granules were formulated into 500 mg tablets (excluding binding material weight) using rotary tablet punching machine.

3.1.3.          Dose: 3gm per day (2 Qurṣ TID) from the 1st day of menstruation for 5 days for 2 cycles of diagnosed cases of Kathrat-i-Ṭamth.16

3.1.4.          Action & Uses (Af ̒āl wa Istiʻmāl)

Qurṣ-i-shibb contains shibb which is the main ingredient of the test drug, samagh-i-ʻarabī, dam al-akhwayn, katīrā’ and gulnār. These drugs have the properties of ḥābis al-dam (haemostatic), mubarrid (refrigerant), qābiḍ (astringent) and mujaffif (desiccant) produces vasoconstriction and thereby reduce profuse bleeding.


 

 

Table 2: Properties of ingredient of Qurṣ-i-Shibb in Unani medicine

Name

Temperament

Pharmacological action

Therapeutic uses

Shibb-i-yamānī

Zāj: Hot and Dry 30C 17,18

Shibb: hot and dry 30C 19 hot and dry 20 18

Qābiḍ (astringent).19,20,12 Mulaṭṭiff (demulcent).11,20 Nāfiʻ-i-ruʻāf (beneficial in epistaxis).39,20,21 Qāṭiʻ-i-ruʻāf (prevent the epistaxis).11,19 Nāfiʻ-i-jaryān al-dam (beneficial in bleeding).19,20 Qāṭiʻ-i-dam (prevent the bleeding).10,22 Qāṭiʻi-jaryān-i-maqʻad (preventive of anal bleeding). 19,22 Nafi’-i-nazf al-raḥim (beneficial for uterine bleeding).

Zāj:Ruʻāf (epistaxis).18,19,10,20,21 Jaryān al-dam (bleeding). 19,10,20,23 Nazf al-dam (haemorrhage).19,10 Bawāsir (haemorrhoid).19,10

Katīra

Cold and dry in 20 C 17,18

Munaffith-ī-balgham (expectorant), Mushil-ī-balgham (Purgative of Phlegm) Musakkin (sedative), Mulaṭṭif (demulcent), Ḥābis-ī-dam (Haemostatic)10 acid,52

Su‘āl (cough), Amrāḍ-i-Ḥalaq (Diseases of Throat), Nafs ud dam (haemoptysis), Bawl al-dam (Haematuria)10

Dam al-akhwayn

 

Ḥābis al-dam (styptic).24,19,25,20

Qābiḍ shadīd (strong astringent).10,11 Muḥallil-i-warm (resolvent of inflammation). 24

Lādhiq-i-jarāḥat,18,19 ṭarriyya26 wa qurūḥ-i-ṭarriya 18 raṭb 27 wa jarāḥat-i-tāza111 (injury, wet and fresh wound adhesives).18, 19,27,20

Multaḥim-i-qurūḥ (sores adhesive).19,20 Muqawwī-i-miʻda (stomachic).18,28,19,10,25,27,11 Rādiʻ-i-fuḍalāt (residues derivatives) 19,25 Muqawwī-i-kabid (heptatonic).28,21,11 Dāfiʻi-ḥarārt-i-kabid, miʻda wa amʻā’ (impulsive of liver heat, stomach and intestine).24,19 Muqawwī-i-ḥalqa-i-maqʻad (tonic for the anal ring).10,11

Nazf al-dam (haemorrhage).18,24,10,20,27,11 Ishal-i-damwī wa ṣafrāwī (bloody and bilious diarrhoea).24,19,25 Zaḥīr (dysentery).24,19,25 Saḥaj al-amʻā’ (intestinal abrasion).28,10,25,11 Saḥaj al- maqʻad (anal abrasion).24 Qurūḥ al-amʻā’ (intestinal ulcer).28,21 Shuqāq al-maqʻad (anal fissure). 18,24,19,10,25,20,27,11 Awrām (swelling)24 Ākila (cancrum).20,21 Dumbal (boil).24,28,21 Khurāj (abscess).24 Jarāḥat (injury).18,28,19,20,21,27 Qurūḥ-i-raṭb (wet wound). 18,27 Qurūḥ (wound).24,19 Qurūḥ-i-tāza (fresh wound).28

Ṣamagh          

-i-ʻarabī           

 

extremely hot.18 Mu’tadil 

(moderate),11, 19,21, 24,25,28  and  Dry20 .19, 22,24,25

Muḥallilat-i-awrām ḥārra (resolvant of acute inflammation).18,19,21,24,28 Nāfiʻ-i-awrām (beneficial to the inflammation).27 Rādi’ (repellent).19 Māniʻ-i-inṣibāb-i-mawād (prevent the effusion of residue).24 Nāfi-i-awajaʻ al-mafāṣil  (beneficial in polyarthritis).27 Maniʻ-i-istirkhā'-i-mafāṣil  image(inhibitive joint flaccidity).18,19 Muqawwī-i-istirkhā’-i-mafāṣil (fortifying joint flaccidity).10  Ḥābis al-baṭn (constipating).28 ʻĀqil-i-baṭn (constipating).11,18,27 Rādi’-i-nutū’ al-dubur/maqʻad (repelling-the anal prolapse). Rādi’-i-nutū’ alraḥim (repellent of uterine prolapse). 10,18,19,21,27,28  Muṣliḥ-iraḥim wa maqʻad (renovator of uterus and anus).22 Qāṭiʻ-i-sayalān al-raḥim muzmin (preventive for chronic leucorrhoea).10,18,24 Nāfiʻ-i-istirkhā’ al-raḥim (beneficial for flaccidity of uterus).18,19,21 Nāfiʻ-i- saḥj al-amʻā’ (beneficial for intestinal abrasion).11,18,19,20,27 Muqawwi-i-miʻda (stomachic)19,20 wa jigar (and hepatotonic). Muqawwi-i-am'ā' (tonic for intestine).19,24 Mujaffif (desiccant).105,107,116 Jādhib (absorbant).105 Qābiḍ (astringent).10,18,24 Ladhiʻ (pungent).10,25 Nāfiʻ-i-nafth aldam (beneficial for haemoptysis.21 Nāfiʻ-i-ishāl-i-damwi (beneficial for bloody diarrhoea).18,21,24 Ḥābis-i-ishāl (preventive against diarrhoea).22 Māniʻ-i-sayalān al-dam (preventive against)

Mugharrī (mucilaginous). 

10,11,18,19,24,25 Musliḥ-i-advia ḥarra (corrective for hot drugs).24 Mujaffif (desiccant). 10,11,18,24,25 Shāmil-i-tiryaqat (includes in the antidotes).18 Māniʻ-i-ḥiddat al-advia al-ḥaddah (reduce intensity of hot drug).10,11,19 Muṣliḥ-i-advia (corrective of drug).20,24 Dāfi’-i-khushūnat (beneficial for irritation).10,11,22 Nāfiʻ-i-khushūnat al-ḥalaq (beneficial for irritation of throat), 11,19,21,24,28 ṣadr (chest).19,21,24 wa qaṣbat al-ri’a (and for tracheal irritation).11,24,25,28 Mulayyin (laxative).18 Nāfiʻ (beneficial)28 wa musakkin suʻāl-i-ḥār (beneficial and sedative for acute cough).10,11 Nāfiʻ (beneficial)10,11,24 and qāṭiʻ (preventive)19 nafth al-dam (beneficial and preventive for haemoptysis).10,11,19 Mukhrij-i-balgham (expectorant).19,24 Muqawwī-i-miʻda (stomachic)10,11,18,19,24,28  wa amʻā’ (and intestinal tonic).19,24 Nāfiʻ ramad wa khushūnat-i-ajfān (beneficial for conjunctivitis and irritation in eyelid),10,11 wa qrurūḥ-i-ajfān (and ulcer in eyelid).11 Nāfiʻ-i-ḥarārat-i-chashm (beneficial for the burning sensation of the eyes).10,24 Nāfiʻ-ijarab al-ʻayn (beneficial for trachoma). Nāfiʻ-i-Sulāq (beneficial for blepharitis).19,22,24 Nāfiʻ-i- bawāsīr (beneficial for piles)22,24 wa bawāsīr al-raḥim (and uterine polyp).10 Nāfiʻ (beneficial)10,11,24 wa qāṭiʻ 19 nazf al-dam (beneficial and preventive hemorrhage).10,11,19,24 Ḥābis-i-dam 

image(heamostatics).22 Ḥābis-i-ishāl (prevents the purgation).19,24

Nāfiʻ-i-ishāl-i-ṣafrāwī (beneficial for bilious diarrhoea).19,21,24

Gulnār

pomegranate flower: Cold and Dry 

20.111,115,116

Mujaffif (desiccative).10,25,27 

Mubarrid (refrigerant).10,27 Nāfiʻ-i-sumūm (beneficial for toxins),27 wa nāfiʻ-i-nafth al-dam (beneficial for haemoptysis).10,11,18,20,21,27 wa nazf al-dam (beneficial for haemorrhage). 10,11,20,21,27 Nāfiʻ-i-liththa dāmiyya (beneficial for bleeding gums),10,11,24,27 taḥarruk al-asnān wa fatq (odontogenesis and hernia).11,24 Nāfiʻ nazf al-rahim 

(beneficial for uterine bleeding).10,11,18 Qāṭiʻ-i-ishāl-i-ṣafrāwī 

(prevent the-bilious diarrhoea).10,11,27 Ḥābis ishal-i-qawi (prevents severe diarrhoea).20 Sayalān al-rahim (uterine discharge).11,18 

Gulnār Sokhta (burnt Gulnār)  Mudammil-iqurūḥ-(wound healer),24 aqūr wa saḥūj (bed sores and abrasion). Mudammil-i-qurūḥ-i-amʻa’ (healer of intestinal ulcer).11

Gulnār (Pomegranate flower): Qurūḥ-i-raṭb (wet ulcer).25,27 

Qurūḥ-i-tāza (acute wound).11 Qurūḥ-i-atīqa (chronic wound).18 

Jarāḥat (wound).18,20 Jarāḥat-i-atiqa (chronic wound).11 Gulnār is used as a ḍimād or ṭila (paste or pain liniment) in above mentioned disease.19  

Tasammum             (toxicosis).24 Qurūḥ al-amʻā’           (intestinal 

ulcer). Nafth al-dam (haemoptysis) 11,18,27 wa nazf aldam (and haemorrhage).11,20,27 Ishāl-i-qawī (severe diarrhoea). Ishāl al-dam (bloody diarrhoea).20 Ishāl-i-aṭfāl (infantile diarrhoea).25  Qurūḥ-i- majārī al-bawl (urinary tract ulcer).10,24,25

Gulnār is used as a beverage in above mentioned disease.19 

Nazf al-raḥim (beneficial for uterine bleeding).10,11,18 It can be used as drink in this disease.11

Jamra (carbuncle).10,24 ʻUṣāra-i-gulnār (gulnār extract) is used with sirka for this disease as paint liniment. Qurūḥ (ulcer),24  wa saḥūj al-khuff (shoe abrasion). Dākhis (acute inflammation near nailbed). 10,24 ʻuṣāra-i-gulnār is used with water for this disease.24

Table 3: Important identified Chemical constituent and Scientific studies on ingredients of Qurṣ-i-Shibb

Botanical name

Important chemical constituent

Pharmacological studies

Alum

KAl(SO4)2.12H2O,29,30 

and containing aluminum, metals such as potassium, iron31 and magnesium32, etc.

Antibacterial effect.33

Haemostatic effect.34 Antiplatelet effect.35 Healing effect.36 Anti-obesity effect.37 Spermicidal effect.38 Anticancer activity. 39

Acacia Arabica

â-sitosterol, á – amyrin, quercetin, gallic acid, cyanidin chloride, dopamine-3-O-glucoside, prosapogenin A and lupeol.40

Antihypertensive activity.41 Antimutagenic activity.42 Anti-infertility activity.43 Effect of GA on renal function.43 Effect of GA on Blood Glucose Concentration.44 Antioxidant activity of GA.45 Antimicrobial activity and Cytotoxic activity of GA. 46 Antiulcer activity of GA. 47

Cochlospermum Religiosum Linn

L-rhamnose, D-galactose and D-galacturonic acid, traces of a ketohexose, methylated uronic acid, D-galacturonic acid.48 The leave contains terpenoids, seponins, tannins. Flowers contains naringenin, beta-sitosteryl-glucoside. Seeds contain oil and some saccharine matter, gum after hydrolysis furnished a mixture of acidic oligosaccharides.49

Anti-inflammatory.50 Antioxidant activity. Antimicrobial activity. 51

Punica granatum Linn.

Tricetin 4′-O-β-glucopyranoside, tricetin, luteolin, ellagic acid, granatin B, punicalagin, apigenin,134 sitosterol, ursolic acid, maslinic acid, itosterol-β-D-glucoside, D-manitol, ellagic acid, gallic acid,52

Anti-inflammatory activity.53 Antidiabetic activity.54 Haemostyptic activity. Gastro-intestinal tract. Wound healing activity.52 Antibacterial activity. 12

Pterocarpus marsupium

Propterol,55 marsupsin, liquiritigenin, pterosupin56,55 Iepicatechin.55 epicatechin, pterostilbene, isoliquiritigenin, lupeol, sitosterol, stigmasterol and naringenin.56

Anti-carcinogenic activity.57 Anti-hyperinsulinaemic and anti-hyper triglyceridaemic activity, Cardiotonic activity.56 Antibacterial Activity. Antioxidant activity.58 COX-2 Inhibition.56 Analgesic activity. 58 Anti-diarrheal Activity. Hepatoprotective Activity. Anti–inflammatory Activity. 59

 


 

4.     Discussion

Heavy menstrual bleeding can be so severe and heavy that it may leave some adverse effects on the women’s social, physical, and emotional quality of life and may lead to complications such as anaemia, iron deficiency, increasing cost of medical services, anxiety and depression. 60

Recently, there has been a shift in the universal trend of medicine selection from synthetic to herbal medicine, which we can say “Return to Nature”. Medicinal plants have been known for millennia and are highly esteemed all over the world as a rich source of therapeutic agents for the prevention of diseases and ailments.61 The researches prove the relevant pharmacological effects of their ingredients and prescribed in heavy menstrual bleeding, as the Haemostatic effect 34 helps in retarding or stopping the blood flow, Antiplatelet effect35 inhibit platelet function and have an antithrombotic effect, COX-2 Inhibition activity56 is effective in decreasing the bleeding as it selectively inhibits the synthesis of PGI2 and thereby reduces heavy menstruation. it has been repeatedly demonstrated that increased local inflammation is associated with increased menstrual blood loss, therefore inhibition of inflammatory mediators by ant-inflammatory activity59,53,50 and wound healing52, 36 can help reduce tissue damage and help in HMB. Haemo-styptic activity50 helps in contracting the blood vessels. 

5.     Conclusion 

Based on the information amassed as above, it can be concluded that Qurṣ-i-shibb, due to its ingredient such astringent, haemostatics and refringent effect. Produce vasoconstriction and thus reduce heavy bleeding is effective and safe alternative treatment in the management of HMB. However, more experimental and clinical studies are needed to gather extensive knowledge of the formulation, 

6.     Acknowledgement 

The authors are extremely thankful to all teachers for their encouragement and the library staff of NIUM for providing all kinds of literature related to this manuscript at the time of writing. 

7.     Conflict of interest

There is no conflict of interest to declare.

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