Concept of Kushta (calx) and Studies Carried Out on Kushta in Unani Medicine : Ancient Science of Life

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Review Article

Concept of Kushta (calx) and Studies Carried Out on Kushta in Unani Medicine

Ahmad, Haqeeq; Wadud, Abdul; Sofi, Ghulamuddin; Jahan, Nasreen; Hamiduddin, 1

Author Information
Ancient Science of Life 38(2):p 37-44, Oct–Dec 2018. | DOI: 10.4103/asl.ASL_93_19
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Abstract

Objective: 

Kushta (calx) is a well-known dosage form of Unani medicine but has always been condemned by scientific fraternity and even some traditionalists because of certain issues associated with Kushta such as safety, lack of scientific data, adverse effects, and complicated method of preparation. Very few studies are carried out on Kushta in Unani medicine and no study has explored its mechanism of action on scientific basis that may be acceptable widely.

Methodology: 

In this study, the review was done regarding the concept of Kushta in Unani medicine, and studies carried out so far along with a possible explanation of the effectiveness, classical method of preparation, superiority of Kushta over other dosage forms, challenges with use of Kushta, idea of use of herbs in making Kushta, and other issues. Literature on Kushta was collected from classical Unani books and papers published in various journals and analyzed. We found that very few scientific studies have been carried out on Kushta in Unani medicine and that too on certain set topics. Most studies are on physicochemical standardization of Kushta.

Conclusion: 

Study revealed that the research carried out so far is not satisfactory. They are also of preliminary nature. Advance toxicological and pharmacological studies are required to generate strong evidences for wide acceptability, safety, and efficacy of Kushta.

Introduction

Unani medicine uses few mineral preparations along with botanical and animal origin drugs. Most minerals and some animals intended for internal use are taken in calcined (calx) form. Classical methods of preparation of Kushta is specialized process. It is claimed that these process purify metals and make them more effective.[1] The history of use of Kushta as dosage form is very obvious. For long ago, use of metals in burnt form is evidenced in Greece and Italy. Metals were burnt in the period of Hermis. Use of metals is also evidenced from the epics of Homer.[2] Ancient Unani physicians used some remedies containing certain minerals, such as salts or oxides of copper and lead.[3] Galen (2nd Century A. D.) states that efficacy of burnt lead is unparallel in cancer. Copper was burnt before its use because it is harmful for the body when used as it is.[4] Aribasus (326–403 A. D) used ash of animals.[5] When a drug is burnt to the extent that it is reduced to ash, it is regarded as Ihraq (ignition).[6] This process is mentioned in various classical Unani texts such as Qarabadeen Qadri,[7] Bayaaz Khas,[8] Firdaus Ul Hikmat,[9] Kamil-us-Sana,[10] Khazain-ul-Advia,[11] Tohfatul Momineen,[12] and Zakhira Khwarzam Shahi.[13]

In Unani medicine, the term Kushta refers to a merge of metals, metallic oxides, nonmetals, and their compounds. It is administered orally with vehicle to make biocompatible. The efficacy depends on the method of preparation.[14] Ores are roasted at high temperature but below the melting point. Kushta is rapidly absorbed in human body.[15] Very small amount of calx can be used as compared with other dosage forms.[16,17] The benefit of calx over other preparations is its stability and low dose.[18] Unani physicians have used the term “Stabilization period of Kushta” that may be 7 days to 6 months.[19] It means when the freshly prepared Kushta is kept inside the grains or underground for a specific period, which is necessary for calx of arsenic, cinnabar, and other toxic elements. It is also mentioned that Kushta should not be used immediately after preparation; rather, it should be stabilized for at least 6 months. According to ancient Unani physicians, life of Kushta is long, provided it is stored properly as indicated. AYUSH regulatory authorities have mentioned the expiry date of a Kushta as 5 years from the date of preparation.[20]

Preparation of Kushta, as mentioned in Unani medicine, is known as Taklees (Calcination), which is derived from the word “Kills” (lime), as the end product looks like lime. Taklees is applied to metals/minerals and some animal origin drugs when to be calcinated. After processing, these substances are converted into a powder-like lime, hence called Mukallas (calcined).[11,21]

Methodology

An extensive survey was done to record all the accessible data on Kushta. A survey of writing was embraced utilizing the bibliographic databases viz. Pub Med, Google Scholar, Science Direct and SCOPUS. Relevant articles, periodicals, peer reviewed indexed journals and other published works available on the journals which follow COPE (Committee on publication Ethics: www.publicationethics.org) guidelines and other standard internet sources were used to regain online literature. Books published in Urdu and English were used to compile classical information. The key words viz. Kushta, calx, Unani concept, scientific studies, standardization, toxicity, phytochemical and pharmacological investigations were used. For Unani writing and Unani terms, accessible traditional writings were referred (Urdu translation gave by the Central Council to Research in Unani Medicine, Government of India). Unani books viz. Sanat al Takless, Qarabadeen Qadri, Ilaj ul Amraaz, Firdaus Al Hikmat, Kamil al Sana, Khazain ul Advia and Zakheera Khwarzam Shahi were refereed to assemble all the data with respect to Kushta.

Observation

Various aspects related to preparation and use of Kushta (calx) has been surveyed and is discussed as follows:

Method of preparation of Kushta in Unani medicine

The material is cleaned before making the Kushta. Then the material is ground in a pestle with the juice of the drugs as mentioned in the classical texts for a specified period of time. Thereafter, small cakes of the same sizes and thickness are made. These cakes are shade dried and put in an earthen pot made air tight and heat resistant by the process of Gil-e-Hikmat. Gil-e-Hikmat involves preparation of soft wet plugging material especially employed in the preparation of Kushta in which soft and moist clay and dry cotton wool are pounded together till they mix well, the clay cotton mixture is applied on all sides of and the earthen pot which is dried on fire, the drug material along with this pot is known as Boota.[22,23] After this, a pit is dug in an open space. The diameter and the depth of the pit depend on the nature of metals and minerals to be calcined. Half the pit is filled with cow dung cakes, then sealed earthen discs are placed in the pit, and the remaining space is filled with more cow dung cakes, which are then ignited. After the calcination is over, the pit is allowed to cool completely, the sealed earthen disc is removed, and the contents thereafter are taken out. These contents, thus obtained, are again powdered with specified juice as many times as prescribed in the text till the proper fineness and the quality is obtained.[24]

The process of preparation of Kushta is very specific. Any deviation from the method prescribed in classics may lead to the formation of incomplete preparation which may prove dangerous for the recipient. Precautions taken in preparing of Kushta (s) are (1) while making a Kushta, addition or deletion of any of the items, duration, and mode of mortaring, quantum of heat should strictly be followed, (2) when the fresh juice of any particular plant is to be added, it should be either Muqattar (distillate) or Muravvaq (filtered) according to the text, (3) when any dry ingredient of the plant origin drug is to be added, it should not be more than 1 year old, it should be dried and well preserved, and (4) highest precautions should be taken in subjecting the Boota to the fire. Fluctuation in the intensity of the heat should be avoided. The Boota should be subjected to the fire of cow dung cakes or charcoal according to the method given in the text. When more heat is required, old cow dung cakes are used and vice versa.[2,24]

Advantages of calx

The dose is very less; lesser dose can be ingested if the esophageal muscles are paralyzed, they may be used as a general tonic in morbid conditions of the patients, and the mode of administration of Kushta is easy. No further dispensing procedures are needed. They are useful in sexual disorders, for diseases of vital organs.[2]

Characteristics of Kamil Kushta (ideal Kushta) or well prepared Kushta

(1) There should be no metallic lusture., (2) when taken between the index finger and thumb and spread, it should be so fine as to get easily into finger lines, (3) when a small quantity is spread on cold and still water, it should float on the surface, (4) when a small quantity of Kushta is thrown on the wall, it should stick on the surface of the wall, and (5) Kushta (s), unless otherwise specified in individual formulations, are of specific color like yellowish, black, dark, white, gray, reddish black, and red colored, depending upon the predominant drugs as well as other drugs used in the process of preparation.[24]

Pharmacological actions of Kushta (s)

Kushta (s) are generally preferred for rejuvenation[25] virility, vitality, and strength. Apart from these, some other uses are aphrodisiac, digestive, appetizer, general tonic, and hematogogue.[22]

Method of Tadbeer (detoxification)

The drugs, which are toxic in nature, undergo certain procedures through which their toxic effects are nullified with enhancement of their therapeutic effects. These drugs after Kushta procedures are known as Mudabbar. Through these procedures, the nature and the external shape of the drug are changed. Certain metals, nonmetals, animal origin drugs, and plant origin drugs are toxic in nature which cannot be used as such in human beings, so detoxification of that drugs is necessary before use.[26,27] A lot of drugs from inorganic origin are used in Unani system of medicine such as Sammul far, Shangraf, Faulad, Khabasul Hadeed, Seemab, Abhrak Safaid, Abhrak Siyah, Abrak Kalan, Aqeeq, Gaodanti, Hajrul Yahood, Jast, Hartal Warqi, Khar Mohra, Mirgang, Nuqra, Qalai, Ras Kapoor, Sang-e-Jarhat, Sang-e-Yashab, Surb, Tamba, Tlia Kalan, Tutia, Usrub, Yaqoot, Zahar Mohra, Zamarrud, Sankh, Sang-e-Sarmahi, and Sadaf.

Studies carried on Kushta in Unani medicine

Standardization

Irshad et al. (2011) conducted a study on Preparation of Kushta Sammul far by muffle furnace using the temperature pattern extrapolated from the classical methods of its preparation using a thermocouple. It was thought reasonable to use muffle furnace to prepare Kushta by maintaining the temperature pattern recorded during the preparation of Kushta by classical method. It was prepared first by the classical method (Kushta Sammul far Classical Method [KSCM]), and a thermogram was developed using a thermocouple, which depicted the pattern of temperature variation during the process. A similar pattern of temperature was followed when Kushta Sammul Far was prepared by muffle furnace (KCMF). Concentration of elemental arsenic as shown by AAS was found to be 6.388 + 0.711 (ppm) and 3.62 + 1.327 (ppm) in KSCM and KSMF, respectively. It provided the method of optimizing modern method of calcination by muffle furnace to the traditional Unani method, namely by applying the thermogram generated from the traditional method.[28]

Ansari et al. conducted a study on Standardization of Kushta Sammul far (calx of arsenic trioxide) prepared by two different methods. This study was carried out on two samples of Kushta Sammul far, one prepared by classical and other one by muffle furnace method in order to set the parameters for its standardization and to observe similarity or dissimilarity between the two samples, if any, to offer a more refined alternate method of calcination. The study revealed almost similar results in the two samples with a slight difference in the physicochemical properties. The study also paves the way for alternate methods of preparation, i.e., muffle furnace.[29]

Shamsi et al. conducted a study on Comparative analysis of Arsenic Estimation in Crude and Processed Sammulfar (arsenious oxide). The aim of this research was to estimate the arsenic in different samples of Sammulfar (Sammulfar ghair mudabbar [crude form] and Sammulfar mudabbar with Aab-e-Limun [processed form]) was carried out. The obtained profile provided valuable information for the differentiation of crude and processed Sammulfar and for the explanation of lesser toxicity in the processed material. This study showed that the arsenic content was found depleted in the detoxified samples of raw materials.[30]

Tariq et al. conducted a study on Physicochemical Characterization of Kushta Kharmohra (Cypraea moneta calx): an advance toward standardization. They noted that the classical test showed that the quality of Kushta prepared was good and in confirmation to the properties mentioned in classical text. The finished product had poor flow properties, minimum moisture content, and negligible amount of extractive values. The result obtained might be specified as the quality control parameters of standard Kushta Kharmohra.[31]

Tariq et al. conducted a study on Physicochemical Standardization of Kushta Abrak Safaid: a herbo-mineral Unani formulation. Kushta was evaluated on classical parameters such as finger test and fineness test as well as on modern parameters such as bulk density, tapped density, Hausner’s ratio, car’s index, pH, loss of weight on drying, total ash, acid-insoluble ash, water-soluble ash, extractive value, and loss of weight on ignition. The physicochemical parameters evaluated in this study might be considered as standard parameters of Kushta Abrak Safaid as it was the first of its kind for this preparation.[32]

Tariq et al. conducted a study in In-house Preparation and Quality Control of a Traditional Unani formulation of Kushta Aqeeq. Aqeeq was first purified as per classical Unani literature then subjected to heat in a furnace rather than cow dung cakes due to better temperature control. The finished product was evaluated for physicochemical characteristics including preliminary tests mentioned in classical literature. The findings obtained could be considered as the standard quality control parameters of Kushta Aqeeq for future references.[33]

Tariq et al., conducted a study on Quality Control of Kushta Shora Qalmi; A Traditional Unani Formulation. The prepared Kushta was tasteless, odorless, brown in color, smooth to touch, lusterless; floating test, fineness test, and wall stick test were positive; bulk and tapped density of Kushta was 0.59 ± 0.00 and 0.79 ± 0.00, respectively; Hausner’s ratio and compressibility index were 1.32 ± 0.01 and 24.88% ± 0.68%; pH in 1% and 10% solution were 9.43 ± 0.00 and 9.27 ± 0.00; loss of weight on drying was 0.006% ± 0.00%; total ash, acid-insoluble ash, water-soluble ash, and water-insoluble ash were 89.46% ± 0.05%, 5.38% ± 0.01%, 0.935 ± 0.03%, and 88.745 ± 0.16%; water-soluble extractive value was 2.935 ± 0.08%.[34]

Tariq et al. conducted a study on Preliminary Physicochemical Evaluation of Kushta tutia (KT): a Unani Formulation. The finished product was evaluated for physicochemical characteristics including preliminary tests mentioned in classical literature. Floating and finger tests were positive. Curd test showed no discoloration after 48 h. These findings indicate correct preparation of KT according to classical literature. Bulk density (0.96 ± 0.00 g/ml); tapped density (1.53 ± 0.00 g/ml); Hausner ratio (0.62 ± 0.00); compressibility index (37.52 ± 0.19%); loss of weight on drying (0.08 ± 0.00%); pH of 1 and 10% (5.20 ± 0.00) and 5.62 ± 0.00, respectively); total ash, acid-insoluble ash, and water-soluble ash values 95.75 ± 0.09, 6.57 ± 0.02, and 45.02% ± 0.20%, respectively; and extractive values 0.85% ± 0.02% were reported in KT. Since this work has not been reported earlier, the results obtained could be considered as the standard for KT for future studies.[35]

Tariq et al. conducted two studies on Physicochemical Characterization of Kushta Naushadar (KN) and a study on Formulation and Physicochemical Evaluation of Kushta Sankh. The results showed that the prepared Kushta Sankh was tasteless, odorless, white in color, smooth to touch, lusterless; floating test, fineness test, and wall stick test were positive with Hausner’s ratio and compressibility index within normal range. pH was basic; loss of weight on drying and loss of weight on ignition; total ash, acid-insoluble ash, water-soluble ash, and water-insoluble ash were also set in for Kushta Sankh. Quality control parameters of KN were also established and two forms KN classical, one developed through modern technology, were compared. The results showed that the KN prepared through modern technology was according to the specifications of Kamil Kushta (ideal Kushta).[36,37] Yet in another study, Tariq et al.’s Formulation and Characterization of a Traditional Unani Formulation, Kushta Qalai (KQ), was studied. For finished product floating test, grain floating test, thumb finger test, and fineness test were within the norms. The bulk density and tapped density, Hausner’s ratio, and compressibility index were recorded. pH of the formulation was basic. Loss of weight on drying, total ash, acid-insoluble ash, water-soluble ash and water-insoluble ash, and water-soluble extractive value were set in. The results obtained might serve as standard for future references.[38]

Mohammad et al. conducted a study on Comparative Elemental Analysis of Kushta-e-Sadaf, a Unani formulation. One market sample was also evaluated for the same elements along with two in-house prepared samples. All the three samples were subjected to elemental analysis, and the results were found to be as follows. Calcium was found to be more in Kushta-e-Sadaf Furnace Method (KSFM) which was 47.79%, whereas it was 44.52% and 42.19% in KSCM and Kushta-e-Sadaf Market Sample (KSMS), respectively. Iron was found to be 235.8 ppm, 294 ppm, and 998.1 ppm in KSCM, KSFM, and KSMS, respectively. Copper was found to be <0.1 ppm, 2.98 ppm, and 1 ppm in KSCM, KSFM, and KSMS, respectively. Bromide was found to be 10 ppm and 5.3 ppm in KSCM and KSFM, respectively, and it was not detected in KSMS. Heavy metals (lead, cadmium, mercury, and arsenic) were found to be below the permissible limits given by the WHO in KSCM, whereas in KSFM, lead was found to be 28.7 ppm which is above the permissible limit. In KSMS, two heavy metals, namely mercury and arsenic, were found to be 112 ppm and 12.3 ppm, respectively, which is above permissible limits, and other two heavy metals were found to be below the permissible limit, namely cadmium and lead.[39]

Mohammad et al. conducted a study on Process Validation of Kushta sazi in the Preparation of Kushta-e-Sadaf.[40] The same author in another study (2017) studied Physicochemical Analysis of Kushta-e-Sadaf prepared by muffle furnace method. Trace element and heavy metal analysis was carried out on raw Sadaf and purified Sadaf to observe the changes after purification processes. It was reported that many changes were observed in the samples before purification and after purification. The study showed that changes were observed after purification procedures and validated the procedure of purification and trituration which has been in practice for ages in Unani medicine. Preparation of Kushta by using furnace was evaluated physicochemically on its organoleptics characters, pH value, bulk density, tapped density, Hausner’s ratio, Carr’s index, loss of weight on drying, and solubility. Adopted preparation methodology may be used in the preparation of various Kushtajat, with heat quantification chart modified in specific case.[41]

Ali et al. conducted Pharmaceutico-analytical Study of Kushtae Shangarf (KS) prepared with Jozbua (Myristica fragrans Houtt.) and Phitkari (Alum). Kushta was prepared by incinerating the drugs kept inside Boota in Bhatti with 24 kg of Uple (cow-dung cakes) and also in muffle furnace. Samples obtained were evaluated by Unani specifications (test), powder characterizations, loss on drying, pH, ash value, solubility, particle size, and qualitative estimation of organic and inorganic constituents, X-ray diffraction (XRD), quantitative estimation by ICP-MS, ICP-OES, and so on. Findings suggested that physicochemical standards set in were comparable in KS, prepared by classical method (KSCM) and KSMFM. XRD study revealed the presence of aluminum oxide phase and absence of mercury in both the samples. Quantitative estimation of elements in both the samples in decreasing order is as follows: Sulfur > aluminum > calcium > iron > arsenic. Arsenic was found more than iron in KSCM at parts per million levels. Preliminary understanding suggests that Shangraf incinerated above 900°C with Phitkari and Jaiphal did not show the presence of mercury in both the samples, indicating KS prepared by incinerating at higher temperature can be safer than unroasted preparation. The studied formulation can be recommended or used for its indications without the concern of mercury toxicity.[42]

Khan et al. conducted a study on Quality Assessment of a Traditional Unani Medicine, Kushta-e-Gaodanti. The raw materials, intermediates obtained during the preparation of Kushta, and the final product were characterized using modern analytical techniques such as FTIR, XRPD and TGA. The study showed that the mineral Gaodanti (calcium sulfate dihydrate) is converted into calcium sulfate hemi hydrate on the first calcination in earthen pot sealed with the process Gil-e-Hikmat. Further on calcination, this intermediate is transformed to Kushta-e-gaodanti which is orthorhombic crystalloid calcium sulfate anhydride. Microbial load of the preparation was found negative for the presence of Escherichia coli, Salmonella species, and Staphylococcus aureus. Total aerobic count was under the acceptance limit. Trace element analysis of Kushta by ICP-OES revealed the presence of some other important metals such as arsenic, lead, chromium, cadmium, mercury, and tin under acceptable limits.[43]

Aslam et al. conducted a study on Quality Control of a Marine Origin Based Herbo-Mineral Unani Formulation. FTIR spectra showed peaks attributed to calcium oxide, organic matter, and several other substances. Total weight loss during TGA was 30.09% and DSC curve showed peaks at 20°C, 65°C, 183°C, and 261°C.[44] Aslam et al. reported another study on Preparation and Physicochemical Evaluation of Kushta Sang Jarahat, a Unani formulation. Physicochemical evaluation was carried out on classical tests along with modern scientific analytic techniques. The bulk and tapped densities, Hausner’s ratio, compressibility index, pH, percentage of weight loss on drying, total ash, acid insoluble ash, water soluble ash and water insoluble ash, and percentage of the water-soluble extractive value were all measured. The results obtained may be considered as standard quality control parameters for Kushta Sang Jarahat.[45]

Umair et al. conducted a study on Nanotization, Characterization, and In-Vitro Activity of Kushta-e-Qalai (tin calx). The finished KQ was characterized using standard analytical techniques such as SEM, TEM, and XRD. It was inferred that the KQ contains nanoparticles of tin oxide in the range of 20–40 nm. During the TLC examination of KQ, a single spot was observed in a variety of solvents implying the complete conversion of stannum into its calx. The KQ was screened for its possible biological activity and indicated that the KQ possessed significant antibacterial activity against Streptococcus mutans and Corynebacterium xerosis. The LD50 of KQ was also analyzed by the graphical method of Miller and Tainter and was found to be 1250 mg/kg b. w.[46]

Toxicity and pharmacological studies

Chronic toxicity of Kushta Sammulfar (KSF) in rats by Ansari et al. concluded that KSF produced dose-dependent toxicity. KSF at low dose did not produce remarkable toxic effects, mild-to-moderate toxicity was observed in KSF at higher doses. There was no significant derangement in liver and kidney tissue, however due to low safety margin; the use of KSF for longer periods in human should be avoided. The study also validated the claim of Unani physicians regarding the use of KSF in low dose.[47]

Irshad et al. conducted a study on Comparative Toxicity Study of Various Dosage Form of Kushta Sammulfar in mice. A study was designed to evaluate acute and subacute toxicity of Sammul far processed by different methods in albino mice with an aim to prepare their safety profile and find the safest dosage form through their toxicity comparison. The study revealed Mudabbar form to be more toxic than the calcined form. Further, Kushta prepared by furnace was safer than that prepared by classical method. Acute toxicity evaluation of some Unani drugs in crude and processed forms.[4]

Shamsi et al carried out a comparative toxicity study of Azaraqi (Strychnos nuxvomica Linn.) and Sammulfar (Arsenious oxide) in crude and processed form in mice. The effect of detoxifying process was assessed on the maximum tolerance dose of the test drugs gets affected during the treatment process. From the experimental studies, it was evidenced that the LD-50 in detoxified form of both the test drugs was found greater than crude materials.[48] Characterization and Comparative Chemical Analysis of Kushta-e-Faulad (iron calx) prepared by conventional as well as modern method was carried out by Tajuddin et al., (2015) The researchers reported the preparation and characterization of the finished Kushta by SEM, TEM, and EDAX. It was observed that the Kushta-e-Faulad contained nanoparticles of iron-oxide and metallic iron in the range of 06–49 nm. It is LD50 and the toxic dose was determined and was found to be 660 mg/kg b. w. in rats.[49]

Sub-Chronic Toxicity Study of KQ in Wistar rats of both the sexes to know their adverse effects and also to check the scientific validity of detoxification method was carried out by Showkat et al. Test substance was administered orally to the rats at the limit dose of 1000 mg/kg, and its subfractions 500 and 250 mg/kg body wt., daily for 90 days. After sacrifice at the end of the study, no statistically significant changes were observed in the general behavior, body weight, feed and water consumption, and hematological and biochemical parameters between treated and control groups. No gross histopathological changes in vital organs of rats except the test substance treated rats showed degeneration of liver and kidney tissues. The test drug showed impairment at 1000 mg/kg body weight, while as the crude material showed toxicity at all the three dose levels.[50] In another study, Showkat et al. studied Sub-Chronic Oral Toxicity Study of Kushta Hajrul-Yahood in Wistar rats. The results showed elevation of liver enzymes due to the administration of Kushta form at the dose level of 1000 mg/kg body weight only, while as in case of classically prepared unprocessed form, there was significant elevation of liver enzymes at all the three doses. This elevation of enzymes also correlates with histology changes in liver tissues. The detoxification adopted for preparing Kushta substantially reduces the toxicity.[51] Pharmacological studies of a Kushta just suspension formulation by Agarwal et al. were evaluated for sedimentation volume, viscosity, pour ability, and redispersibility. When orally administered to hyperglycemic rabbits, blood glucose levels were found to be decreased and the plasma zinc levels were significantly increased.[52] A study on Neuropsycho Behavioral Effects of Silver preparations, Raupya Bhasma, Kushta Nuqra, and Chandi Warq used in Indian Systems of Medicine was carried out by Nadeem et al. The preparations were subjected to a battery of 30 tests for general neuropsychopharmacological effects, cognitive functions, antidepressant, anxiolytic, neuroleptic and serenic activities, effects on growth, body weight, endurance and fatigue. The drugs (50 mg/kg, p. o.) caused a significant reduction of haloperidol-induced catalepsy in rats. Incorporation in the diet of rat pups (1% w/w for 6 weeks) leads to significantly higher growth rate when compared to control animals. Silver preparations used in Ayurveda and Unani-medicine showed anticataleptic and growth-promoting effects without gross or subtle toxicities, weight loss, sedation, motor deficit, aggression, or ill effects on cognitive functions.[53]

A study on Anti-cataleptic, Anti-anxiety, and Anti-depressant Activity of Gold preparations, svarnabhasma used in Ayurveda, Kushta Tila Kalan of Unani medicine, and Auranofin of conventional medicine was studied by Bajaj and Vohora.[1] The Wistar rat and Swiss mice were subjected to video path analyzer, Vogel conflict/anxiometer, elevated plus maze, and social behavioral deficit tests for anxiolytic activity, behavioral despair, and learned helplessness tests for antidepressant activity, haloperidol-induced catalepsy tests for neuroleptic activity, and maximum tolerated dose, gross behavioral observations, and hematological parameters for safety evaluation in rats and mice. Immobility time in forced swimming test, normalization of shock-induced escape failures in learned helplessness test, and haloperidol-induced catalepsy scores were also noted in treated animals. The maximum tolerated doses were found to be more than 80 times the effective doses and no weight loss or untoward effects were observed on gross behavior and hematological parameters. Traditional gold preparations used in Ayurveda and Unani medicine exhibited anxiolytic, antidepressant, and anticataleptic actions with a wide margin of safety.

Clinical study

Rehman et al. conducted a study on Clinical Study of Qurse Kushta Khabsal-Hadeed and Habbe Marvareed in the management of Sayalan al-Raham (leucorrhea). A total of 58 cases of fertile age group patients (13–45 years) diagnosed to be afflicted with leukorrhea were studied. It was found that out of 58 cases, 36 cases were relieved, 17 were partially relieved, while no response was recorded in 05 cases. The drugs were found safe on biochemical and hematological parameters. However, the study had no control group for comparison.[54]

Discussion

Kushta (s) are the unique preparations of Unani medicine. For preparing Kushta, Taklees (Calcination) procedure is done. The procedure of calcination should be performed stepwise, i.e., first purification of the metal and then its calcination is to be carried out till it qualifies for all the required qualities of Kushta. For this purpose, the Kushta should pass all preliminary tests. Unani physician have claimed that the various metals, stones, and animal origin drug in calcined form are used for the management of various ailments, such as Kushta of Khabasul Hadeed (iron rust) in anemia and debility of stomach and liver; Sammul-Far (As) in decreased libido, neurasthenia, and sexual debility; Abhrak (Mica) in asthma, bronchitis, and general sexual debility; Aqeeq (agate) in hemorrhage, polymenorrhea, and metrorrhagia; Baiza-e-Murgh (Egg shell peels) in diabetes, excessive nocturnal emission, and leukorrhea; Busud (Coral roots) and Hartal Warqi (As) in asthma, catarrh, cold, and chronic persistent cough; faulad (Iron) in anemia, convalescence, and general debility; Gaodanti in arthritis, and nonspecific fevers; Hajrul Yahood (Jews stone) in renal and cystic calculi; Jast (Zn) in disease related to balgham, safra, leukorrhea, and spermatorrhea; Kharmohra (Yellow variety of Cowrie) in anemia, catarrh, and chronic bronchitis; Marjan Jawaharwala in catarrh, cold, distress, general debility, and headache; Marwareed (pearls) in alopecia, diseases of eyes and gums, and palpitation; Musallus (Sn, Zn, and Pb) in excessive emission and premature ejaculation; Nuqra (Ag) in anxiety state, asthma and bronchitis; Para (Hg) in asthma, cough, and facial paralysis; Qalai (Sn) in leukorrhea and sexual weakness; Qarn-ul-Aiyal (Stag horns) in bronchitis, catarrh, chest pain, and pleurisy; Raskapoor (Calomel) in syphilis; Sadaf (Oyster shell) in asthma, burns, and bronchitis; Sang-e-Jarahat (Soap stone) in bleeding piles, hemoptysis, hemorrhage leukorrhea; Sang-e-Sar-e-Mahi (Otolith from fishes) in renal and cystic calculi; Shangraf (cinnabar) in catarrh, indigestion, and general and sexual debility; Sankh (Conch shells) in biliousness, blood dyscrasias, and colic; Surb (Pb) in poor semen quality and sexual weakness; Tamba (Cu) in general debility and leukorrhea; Tila Kalan (Au) in alcoholism, chronic fevers, and epilepsy; Tutia (copper sulfate) in syphilitic sores; Yaqoot (Ruby) in epilepsy and palpitation of heart; Zahar Mohra (Bezoars stone) in palpitation of heart; and Zammarud (Emerald) in bronchitis and hepatic disorders.

There are few studies that may explain how such preparations act and what changes occur during the preparation. Researchers have given hypothetical explanation. Constant heating of mineral (s) with particular herbal extract and vigorous wet grinding, clay pot used in preparation, and underground heating encourage the formation of pharmacologically active organometallic complex (s), which otherwise are not possible at room temperatures.[55] Vigorous grinding of the minerals with herbal extract (s) produces ultrafine particles with increased surface area for absorption. As water is evaporated, highly concentrated herbal constituents are left. Toxic minerals are claimed to be detoxified. It is interesting to note detoxification in traditional medicine has some validity. Roots of aconite-containing toxic principle aconitine are detoxified by traditional methods with enhanced lethal dose and low aconitine contents as compared to un detoxified roots.[56] The efficacy and potency could be due to improvement in the pharmacodynamics and/or pharmacokinetics profile of the drug (s). It is likely that at higher temperature, metals combine with organic compounds present in herbs to form organometallic complex (s) or metal may act as a catalyst in transformation of herbal constituents to highly active compound (s) which are actually responsible for the therapeutic success of the Kushta. As we know, There are also several examples of modern medicine available in which the presence of metallic ions markedly affects therapeutic activity. For example, antitubercular activity of P acetamidobenzaldehyde thiosemicarbazide is increased in the presence of copper ions; it is also possible that the process of preparing Kushta may transform the heavy metals into the readily excretal form that reduces the cumulative toxicity of the metallic elements. For example, EDTA forms highly water-soluble complex with lead and renders it to be excreted through urine. Therefore, it is used in lead poisoning.[57] The organic salts of minerals are considered more tolerable than their inorganic salts; for example, ferrous fumarate is better tolerated than ferrous sulfate, as the former does not cause gastric irritation.[58]

The drugs, which are toxic in nature, undergo certain procedures through which their toxic effects are nullified but their therapeutic effects are maximized. These procedures are known as detoxification. Through these procedures, the nature and the external shape of the drug is changed.

Conclusion

This study reviewed precious information regarding, concept of Kushta (s), classical method of preparation of Kushta, advantages of Taklees, characteristics of Kamil Kushta (ideal Kushta), pharmacological actions of Kushta, method of detoxification, possible explanation of the effectiveness of Kushta (s), and studies carried on the Kushta (s) in Unani system of medicine. The review revealed that the studies carried out so far are not satisfactory too. They are also of preliminary nature. Advance morphological, toxicological, and pharmacological studies are required to generate strong evidences for wide accessibility, safety, and efficacy of Kushta.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

The authors are thankful to all the library staff of the National Institute of Unani Medicine (NIUM), Bengaluru, for providing classical literature, manuscripts, and other necessary materials on the subject.

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Keywords:

Calx; challenges; Kushta; scientific studies; Unani medicine

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