Copyright © 2024 The Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Ziaur Rahman , Shah Alam , Irfan Ahmad , Nikhat Shaikh , Mohammad Adil , Piyush Yadav , Nirmala Devi MK

Regional Research Institute of Unani Medicine Mumbai CCRUM Ministry of Ayush Govt of India.

Article Info:

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Article History:

Received 21 Feb 2024

Reviewed 03 April 2024

Accepted 25 April 2024

Published 15 May 2024

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Cite this article as:

Rahman Z, Alam S, Ahmad I, Shaikh N, Adil M, Yadav P, Devi MK N, Management of Dubayla al-Kabid (Liver abscess) in Unani medicine: A review, Journal of Drug Delivery and Therapeutics. 2024; 14(5):191-193

DOI: http://dx.doi.org/10.22270/jddt.v14i5.6579 ___________________________________________

*Address for Correspondence:

Ziaur Rahman, Regional Research Institute of Unani Medicine Mumbai CCRUM Ministry of Ayush Govt of India.

Abstract

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Dubayla al-Kabid (Liver abscess) is a condition in which collection of pus occurs in the liver commonly involving the right lobe. Traditional Unani medicine offers a detailed description of liver disorders alongwith their management. Causative factors of Dubayla al-Kabid include- infection, chronic dysentery, liver injury, cholelithiasis, irregular diets etc. The symptoms are fever with chills, abdominal pain, loss of appetite and difficulty in breathing. The line of treatment under Usool-e-Ilaj of the disease is based on evacuation of pus, use of medicines with Dāfi‘-i-Ḥummā (Antipyretic) , Daf‘-i-Ta‘affun (Antiseptic), Muḥāfiẓ-i-Jigar (Hepatoprotective) and Muqawwī-i-Jigar(Liver tonic) properties. In contemporary medicine liver abscess is an encapsulated collection of suppurated material within the liver resulting from either fungal, bacterial, or parasitic infection. Although Klebsiella pneumoniae accounts for 50–70% of cases in the Asian subcontinent, Entamoeba histolytica is also frequently seen in routine clinical practice causing liver abscesses. Escherichia coli is the most common bacterium causing liver abscesses. Thus, infection that spreads throughout the biliary system is one of the most frequent causes of liver abscess requiring antibiotics. The drainage of pus is the treatment of choice in cases of large abscess while small liver abscess of 2-3 cm is conventionally treated with antibiotics. Antimicrobial resistance and persistence are associated with an elevated risk of treatment failure and relapsing infections. Hence there is a need to explore the ages old treatment strategies for the management of small liver abscess laid down in traditional Unani medicine. This paper will further pave the way of developing novel therapies for the effective management of liver abscess.

Keywords: Dubayla al-Kabid, Unani management, Usool-e-Ilaj

Liver abscess is an encapsulated collection of suppurated material within the liver that may be the result of a fungal, bacterial, or parasite infection. Pyogenic liver abscesses, as they are called, are the most common type, and are caused by bacterial infections. These infections can be caused by gram-positive cocci, gram-negative bacilli, or anaerobic organisms.¹

Leakage from the abdomen's colon moves through the portal vein to the liver, which is the typical pattern of abscess formation. An abscess is frequently directly caused by direct contact with an inflamed biliary tract.

There are several classifications for liver abscesses: One is based on the liver's location. Less frequently, the left liver lobe or caudate lobe, which is the more substantial portion of the liver with greater blood flow, is the site of single liver abscesses, accounting for 50% of cases. Examining the source is an additional technique: Most liver abscesses can be categorised into bacterial (including amebic) and parasitic (including hydatiform cyst) origins if the underlying cause is infectious.²

There are roughly 2.3 cases per 100,000 people in the annual incidence rate. Compared to females, males are more commonly impacted.[8] The type of abscess that develops depends on an individual's age. Individuals between the ages of 40 and 60 are more susceptible to liver abscesses that are not caused by trauma.³

The primary cause of liver abscesses was once thought to be appendicitis, but with improved diagnostic and treatment options, that number has dropped to fewer than 10%. Pyogenic liver abscesses are mostly caused by biliary system diseases, which include biliary stones, strictures, malignancies, and congenital defects.

Cholangitis is the resultant condition in half of bacterial cases. Diverticulitis, cholecystitis, portal vein bacteremia, hepatic artery bacteremia, and penetrating trauma are fewer common causes.²

Some might have cryptogenic roots. Although they are sometimes polymicrobial, the most prevalent species are E. Coli, Klebsiella, Streptococcus, Staphylococcus, and anaerobic organisms. Finding an additional infection source (endocarditis) that has hematogenously travelled to the liver should be the main priority if staph or strep are the only ones detected. Southeast Asian countries have a high prevalence of Klebsiella pneumoniae infections, which may also have a connection to colorectal cancer in that region.⁴

Mesoderm, ectoderm, and endoderm combine to produce the human gastrointestinal system. The tube's lining is made of endoderm. The dorsal mesentery is created by the fusion of the posterior splanchnic arteries. To produce the ventral mesentery, anterior splanchnic veins merge together. The ventral mesentery encloses the septum transversum, where the liver develops. The liver and the front abdominal wall are still attached.

The liver is particularly prone to bloodstream infections and abscesses because it obtains its blood supply from the systemic and portal circulations.⁵

Bowel content leakage and peritonitis are the typical pathogenesis of pyogenic liver abscesses. Via the portal vein, bacteria are transported to and remain in the liver. The biliary system is another possible site of infection. Another possible aetiology is hematogenous spread.⁶

Before deciding on any diagnostic procedures, it is essential to get a complete history and perform a comprehensive physical examination. This encompasses, but is not restricted to, learning about the patient's past medical history, occupation, travel history, origin, and any recent infections or treatments. The development of liver abscesses is facilitated by a number of risk factors, including diabetes, cirrhosis, male gender, advanced age, impaired immune systems, and use of proton pump inhibitors.
Following the collection of a history, a physical examination and systems assessment can yield a wealth of additional information. Patients may report fever, chills, night sweats, malaise, nausea, vomiting, right shoulder discomfort (from phrenic nerve irritation), right upper quadrant pain, cough, dyspnoea, anorexia, or sudden unexplained weight loss upon system analysis. Fever is present in 90% of cases.⁷

USG of the abdomen is performed in all suspected cases of liver abscess for confirmation of the diagnosis and has a sensitivity of 85%. Nowadays, if the sonography is not revealing any abscess or the results are unclear, contrast-enhanced computed tomography (CECT) abdomen is done in cases with strong clinical suspicion.⁸

The collection of pus in liver is called as Dubayla al-Kabid. It occurs only after warm-e-jigar harr (hot inflammation of liver) as such the disease of Salabat-e-jigar occurs after the warm-e-jigar barid (cold inflammation of liver)⁹. If it is large then it is called as Dubayla and if it is small then it is called as Khurāj.It is more common in the countries having the hot weather. The most affected part of liver is right lobe. It may be single and multiple abscess. Sometimes if multiple abscesses found in the Bab-al-kabid (porta hepatis) then the prognosis will be worst.¹⁰

The causes are Muzmin Pechish (Chronic dysentery), Irregular diets. Ḍarba-o-Saqṭa’-i-Jigar (Injury to the Liver), Ta‘affun al-Dam(Toxaemia).Kathrat-e-Mai Noshi(Excessive Alcoholism).Hisat-al-Mirarah(Cholelithiasis), Sū’ Mizāj al-Kabid ,Warm-e-Zaida-Aa’war(Appendicitis).Dukhool-e-Ajsaam-e-Ghareeba (Entry of foreign body in the liver).¹¹

Dubayla al-Kabid (Liver abscess) is mostly due to the infection either of fungus, Parasites and Bacteria. In modern medicine only way of management of Liver abscess is surgical intervention and uses of Antibiotics. But now a days the unnecessary uses of antibiotic results in antibiotic resistance leading to ill cure of liver abscess. In the Unani system of medicine Liver abscess occurs due to humoural imbalance, Sū’ Mizāj al-Kabid (ill temperament of liver) and other causes. So, the mode of treatment in the unani system of medicine is evacuation of morbid matter by Mudij and Mushil therapy and correction of ill temperament of liver and by using the liver tonic. This review may be useful in determining an alternative course of treatment for an antibiotic-resistant liver abscess and this paper offers a wide range of liver abscess treatment alternatives in accordance of Unani medicine.

Acknowledgement: The authors express their sincere gratitude to Dr. N Zaheer Ahmad, the Director General CCRUM and Dr. Nirmala Devi, Assistant Director, RRIUM Mumbai for providing means and emotional support needed to complete the review.