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WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Naaz et al.

World Journal of Pharmacy and Pharmaceutical Sciences SJIF Impact Factor 6.041

Volume 5, Issue 9, 1547-1556

Research Article

ISSN 2278 – 4357

CLINICAL EVALUATION OF MIZAJ (TEMPERAMENT) OF THE PATIENTS OF QILLAT-E-HUWAIN-E-MANVIA (OLIGOZOOSPERMIA) Mohd. Abid*, Farah Naaz*# and Noman Khan* *Research Associate, Central Council for Research in Unani Medicine, Ministry of AYUSH, Government of India.

Article Received on 01 July 2016, Revised on 22 July 2016, Accepted on 11 Aug 2016, DOI: 10.20959/wjpps20169-7577

ABSTRACT The theory of Mizaj (Temperament) is exclusive to Unani system of Medicine and the entire system relies upon the basic philosophy of Mizaj. Hippocrates (460-370BC), the father of Medicine and the pioneer of Unani system of Medicine was the first to put forward the ideology of Mizaj (temperament). The theory of Mizaj suggests that

*Corresponding Author Dr. Farah Naaz

the every individual has a specific temperament (Mizaj) which is fixed

Research Associate,

and cannot be changed. Each individual may have their unique likes,

Central Council for

dislikes, interests and skills. These all characteristics make up the elite

Research in Unani

disposition or temperament (Mizaj) of an individual. A person‟s

Medicine, Ministry of

temperament (Mizaj) has a direct influence on the state of health and

AYUSH, Government of India.

inclination towards illnesses. Unani physicians have classified the mizaj (temperament) of an individual into four types namely Damvi

(sanguine), Balghami (phlegmatic), Safravi (bilious) and Saudavi (melancholic). Thus, knowledge of temperament can help in planning a diet that is optimum for an individual, and physical activities that promote a happy, healthy and productive lifestyle enabling people to live in harmony with self and world around them. Oligozoospermia refers to semen with a low concentration of sperm and it is one of the leading causes of male factor infertility, perhaps also the most important treatable cause. Male sterility due to oligospermia can be defined as a failure to conceive following one year of marital life with uninterrupted coitus due to low sperm count and motility. The objective of the study was to assess and establish the temperament (Mizaj) of patients of Qillat-e-Huwain-e-Manvia (Oligozoospermia). The consideration of this study had the potential to prevent and treat Oligozoospermia based on classical theory of temperament (Mizaj). The study was carried out at A& U Tibbia College, www.wjpps.com

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World Journal of Pharmacy and Pharmaceutical Sciences

Karol Bagh, New Delhi-05. 60 subjects with confirmed clinical diagnosis of Oligozoospermia complying inclusion and exclusion criteria‟s were included in the study. Mizaj (temperament) of the subjects was assessed by a standard questionnaire of temperament. In present observational study, the higher incidence of patients was observed from Damvi (Sanguine) and Safravi (Bilious) mizaj. This study is in consonance with classical Unani literature, so the temperament of a patient may be considered as an important factor in the pathogenesis of Oligozoospermia. KEYWORDS: Oligozoospermia, mizaj, temperament, damvi, balghami, safravi and saudavi mizaj. 1. INTRODUCTION Mizaj (Temperament) has been an important point of discussion among both ancient and modern researchers. The concept of Mizaj (Temperament) is exclusive to Unani system of Medicine and the whole system is based on the philosophy of Mizaj. The Hippocrates (460370BC) gave the fundamental theory of Mizaj which suggests that the every individual has a specific temperament (Mizaj) which is fixed and cannot be changed. Each individual may have their unique likes, dislikes, interests and skills. These all characteristics make up the elite disposition or temperament (Mizaj) of an individual. There are four biological fluids or Akhlat (Humors) viz. Blood (Dam), Phlegm (Balgham), Bile (Safra) and Black bile (Sauda); a right proportion, according to quality and quantity constitutes health and upright proportion and irregular distribution, according to their quantity and quality constitutes disease. Excess of any of the four basic humours (akhlat) of body obviously exerts its influence on the mizaj (temperament) of the person and treatment is based upon the correction of that particular humor (khilt). Hence mizaj (temperament) plays an important role in assigning specific treatment of any disease. The four basic mizaj include Damvi (sanguine), Balghami (phlegmatic), Safravi (Bilious), Saudavi (melancholic). Diminished quantity of Huwain-e-manvia (spermatozoa) in mani (seminal fluid) is called qillat-e-huwain-e-manvia (Oligozoospermia). Male sterility due to, oligospermia can be defined as a failure to conceive following one year of marital life with uninterrupted coitus due to low sperm count and motility. Data accumulated over the past four decades reveals that in approximately 33% of all couples evaluated for infertility, significant pathology is found only in male partners. In another 20% both male and female partners are found to be

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abnormal. Thus in approximately 50% of infertile couples, male factor is at least partly responsible for the failure to conceive.[1] In the classical Unani literature the semen deformities are mentioned under the caption “Qillat-e-mani and Riqqat-e-mani”.[13-14] The term Qillat means deficiency, Mani means Semen and Riqqat means Fluidity.[13-16] Both this Qillat and Riqqat-e-mani is mainly responsible for sexual disorders like Zofe Bah, Surat e anzal, Ehetlam, Uqar, Jiryan etc.[1-5] Qillat and Riqqat disorders are final outcome of Su-e-mizaj (morbid temperament) of body. In Unani system of medicine the general term of Muqawwi e Bah is used commonly in the management of semen and semen related problems.[6-9] The medicines or foods which improve the quality and quantity of semen are termed as Mawallid-e-Mani. All Mawallid-eMani agents are also Muqawwi-e-Bah.[2-7] There are many causes of oligozoospermia, Mizaj of a person and temperature of testes play a very important role in regulation and formation of semen.[2-4,17] Bringing back or maintaining the normal mizaj of testes and the whole body is fundamental line of treatment in Unani system of medicine.[18] The sterility and sexual disorders continues to cause lot of mental agony to innumerable couples. Hence, the collective efforts of scientists, doctors and hakims in the treatment of qillat and riqqat e mani can improve the quality of life of present generation and also to the next generations. Keeping in view, the above objectives, an attempt has been made in this study to find out the mizaj (temperament) of the patients of Oligozoospermia, so that effective treatment may be administered to the patients of oligozoospermia based on the principles of Unani medicine, which is cost-effective and least toxic. 2. Objectives of the study This study aimed to assess and establish the temperament (Mizaj) of patients of Oligozoospermia. The consideration of this study had the potential to prevent and treat oligozoospermia based on classical theory of temperament (Mizaj). An early and accurate diagnosis of is of paramount importance for the effective management and for the prevention of long-term sequelae.

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3. MATERIAL AND METHODS It is an observational study, carried out at Ayuryedic & Unani Tibbia College, Karol Bagh, New Delhi-05 during 2012-2014. A comprehensive protocol was framed and approved prior to the commencement of the study. 60 subjects with sign and symptoms of oligozoospermia as per screening criteria were enrolled for the study. All the screened subjects were then confirmed for the clinical diagnosis. During the enrollment procedure, complete history including general physical and systemic examination was carried out and recorded on a case report proforma. Mizaj of the patients was evaluated on standard parameters (Alamat-eAjnas-e-Ashra) as described in the classical unani text (Table No.1 & Annexure-I). Table 1 shows ten characteristics of different temperament (Ajnas-e- Ashra) Parameters

Damvi (Sanguine)

Safravi (Bilious)

(1) MALMAS (Touch) i) Touch Moderately Soft Dry ii) Temperature Warm Warm (2) LAHM-WA-SHAHM (Muscles and Fat) Muscular Moderately muscular Muscles are & less Fatty Muscles Body Built fully developed are moderately & strong developed/ large joint (3) SHAIR (Hairs) (i)Texture Thick & lusty Thick & curly (ii)Growth & Rapid average Rapid profuse Distribution (iii)Colour Blackish brownish (4) LON-E-BADAN (Body Complexion) Complexion Reddish Yellowish (5) HAYAT-E-AZA (Physique) (i) Built Muscular & firm Slim & firm (ii) Chest Broad Wide (iii) Height Tall Medium (iv) Blood vessels Mild prominent More prominent (6) KAIFIAT-E-INF’AL (Responsiveness of organs) (i)Tolerate well Dryness Cold (ii)Remains well in Spring Winter (7) AFAL-E-AZA (Functions of the body organs) (i) Digestion Average Strong (ii) Appetite Normal Increased (iii) Taste Sweet Bitter (iv) Thirst Normal Increased (v) Salivation Moderate Decreased (vi) Voice High Medium (vii)Respiratory rate Easily/rapid Rapid/increased

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Balghami (phlegmatic)

Saudavi (melancholic)

Soft Cold

Dry Cold

Fatty less muscular joint well covered

Lack of fat & muscle Muscles are under developed

Thin & straight

Coarse

Slow scanty

Rapid excessive

Black

white

Whitish

Blackish

Fatty & flabby Flat Short Not prominent

thin Narrow Short Narrow

Heat Summer

Dampness Autumn

Poor Less Normal Decreased Increased Slow Regular slow

Irregular Feeble Sour/normal Low low Slow slow

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(viii)Physical activity Average Hyperactive (ix) Speech Average Quick (x) Pulse Azeem wa qawi Sari wa mutawatir (xi) Nausea Sometimes Very rare (xii)Favourable diet Cold & dry Cold &moist (xiii) Dislikes Hot & moist Hot &dry (8) FUZLAT-E-BADAN (Excreta of the body) (i)Urine colour Normal/reddish Yellowish (ii) Urine quantity Moderate Less (iii) Urine conc. Concentrated Dilute (iv)Stool Consistency Semi Solid Loose (v) Stool quantity Voluminous Less amount (vi) Stool odour

Odour full

Odour full

(vii) Stool colour

Brownish

yellowish

(viii) Sweat

Odour full

More odour full

Not active Slow Saghir wa bati Frequent Hot & dry Cold &moist

Decreased Slow Bati wa sulb Frequent Hot & moist Cold & dry

whitish More Turbid Loose Voluminous Average bad odour Whitish Average bad odour

Darkish/blackish Less Turbid Constipated Less amount less Blackish Less

(9) NOM-WA-YAQZA (Sleep and Wakefulness) Sleep

Average

Less

(10) INFALAT-E-NAFSANIA (Psychic reactions) (i)Response Aggressive Brave Easily come, Frequent, severe & (ii) Anger/Joy easily lost persist for long time Enthusiastic (iii)Mental Alertness Reactive provoked prepared (iv) Memory

Excellent, Long term, retenti

(v)Behavior

Cheerful

(vi) Decision

Take bold Blood, red object

(vii) Dreams

Good, Short term, retention Angry/loose temper easily Quick Fire, red or yellow object

Excessive

Less & Disrupted

Weak Comes hardly, easily lost

Coward Infrequent but persists

Dull sluggish

Deep thinking

Not good Cannot retain for long time

Not good but excellent retention Depressed, nervous afraid Fearful, black object

Calm, quick Hesitate White, cold object

4. RESULTS During the course of the study, subjects were divided into different age groups of five year interval from 21-60 years of age. The highest number of subjects i.e., 30 (50%) subjects were reported in age group of 26-30 yrs followed in decreasing frequency by 31-35 yrs age group i.e., 15 (25%) subjects, 21-25 yrs age group i.e., 13 (21.6%) subjects and 36-40 yrs age group i.e., 2 (3.3%) subjects, no patient reported in age groups 41-45, 46-50, 51-55, 56-60. [Table.No.2]. Patients were also divided into three groups according to the number duration of illness of infertility, most of the patients presented within 1-4 years group i.e., 37 (61.6%) followed by

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5-8 years i.e., 22 (36.7%). Only 1 (1.7%) patient presented within 9-12 years group [Table No.3]. Highest number of subjects was of damvi and safravi mizaj (sanguine and bilious temperament) 21 in each (50%) followed by balghami (phlegmatic temperament) 12 (20%). 10 (16.7%) patient of damvi (sanguine temperament) and 6 (10%) patients of saudavi (melancholic temperament) was found [Table.No.4]. Table: 2 Distribution of Patients according to age group Age group (years) 21-25 26-30 31-35 36-40 41-45 46-50 51-55 55-60

No. of patients 13 30 15 2 0 0 0 0

% Percent 21.6 50 25 3.4 0 0 0 0

Table 3 Distribution of Patients according to Duration of illness Duration of illness (in years) 1-4 5-8 9-12 Total

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No. of Patients in test group 17 13 0 30

No. of Patients in Placebo group 20 9 1 30

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Total 37 22 1 60

% Percent 61.66% 36.66% 1.66% 100%

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Table 4 Distribution of Patients according to Mizaj (Temperament) Mizaj Damvi Balghami Safravi Saudavi Total

No of Patients in test group 12 3 11 4 30

No of Patients in placebo Group 9 9 10 2 30

Total 21 12 21 6 60

% Percent 35% 20% 35% 10% 100%

5. DISCUSSION The results were analyzed according to age of the study subjects, duration of illness and mizaj (temperament) of the subjects. Analysis of the results of 60 cases of oligozoospermia revealed following facts which are discussed below: 

Infertility affects about 15% of couples attempting pregnancy with male factor infertility identified in approximately 50% of the cases.[18] More than 90% of male factor infertility is characterized either by low no of sperm in semen or by production of poor quality sperm.[19] The higher incidence of oligozoospermia in this study was observed in the age

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group of 26-30 years (50%). A recent study has indicated that there is a decrease in sperm density over a period of past fifty years.[20] 

In this study most of the patients presented between 1-4 years of duration of infertility. This finding may be attributed to the fact that most of the patients become serious if they fail to conceive within few years of marriage and also the cumulative pregnancy rate is 27% in infertile couples with 2 years of follow-up with oligozoospermia as the primary cause of infertility.[21]



Mizaj of a person and temperature of testes play a very important role in regulation and formation of semen.[5,9] In this study higher incidence of patients from Damvi and Safravi group (35% each) was reported. It means that total of 70% patients were from Damwi and Safrawi group.

These findings suggested that oligozoospermia is likely to be predisposed by damvi (sanguine) and safravi (bilious) constitution, both of these temperaments have hot quality. The findings may be related to the fact that the temperature of the scrotum is 3°C lower than the core body temperature and this is an important prerequisite for optimal spermatogenesis. The germ cells and sertoli cells are highly sensitive to elevated temperature which causes partial or complete spermatogenic arrest.[22] Wang et al. (1997) reported that elevation of testicular temperature 1°C above the baseline depressess spermatogenesis by 14% and thus decreases sperm output. They postulated that heating the testes induced a depression not only in the amount but also in the quality of sperm output.[23] 6. CONCLUSION In light of this study, it can be concluded that patients with damvi (sanguine) and safravi (bilious) mizaj are prone to develop oligozoospermia and suffer from infertility. So the temperament of a patient may be considered as an important factor in the pathogenesis of oligozoospermia. Since oligozoospermia is one of the causes of male infertility, an early screening could provide opportunity to target the group for promoting healthy lifestyles and early intervention to prevent future morbidity. 7. ACKNOWLEDGMENTS The Authors are thankful to Prof. Rais-ur-Rahman, Director General (In-Charge), Central Council for Research in Unani Medicine, Advisor (Unani) to Govt. of India, Ministry of AYUSH, HOD-Department of Maolijat, A & U Tibbia College, Karol Bagh, New Delhi for

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his perpetual guidance and support. We are also thankful to the administration of A & U Tibbia College, karol Bagh, New Delhi as the piece of work presented is part of the research programme conducted during 2012-2014 at Tibbia College, Karol Bagh, New Delhi. 8. REFERENCES 1. Cooper TG, Noonan E, von Eckardstein S, et al. "World Health Organization reference values for human semen characteristics". Hum. Reprod. Update, 2010; 16(3): 231–45. 2. Kabeeruddin: Tarjuma e Kulliyat e Qanoon Basheer and sons Publication Urdu Bazar Lahore, 1930; I & II: 354-363. 3. Kabeeruddin, Sharah e Asbab (Tarjuma e Kabeer) Hikmat Book Depot, Hyderabad, 1999; III: 213-221. 4. Hakeem Imamuddin Zakai, Medical Dictionary, Idara e Kitabul shifa, kucha chelan Daryaganj New delhi, 2075; 526: 678. 5. Hakeem Kabeeruddin, Al Akseer, Aijaz Publishing House Delhi, 2003; II; 1254-1256, 1260-1262,1283 6. Shamsul Atibba Hakeem wa Doctor Ghulam Jilani “Khan Saheb” Makhzan ul Ilaj, Idara Kitab ul Shifa N-Delhi, Sep 2005; I & II; 623-625,630-632. 7. Al Majusi: Kamil us Sana„ah Munshi Nawal Kishore, Lucknow, 1958; 543-547. 8. Ajmal Khan:”Haziq” Madina Publishing company Road, Karachi, 1983; 532-534. 9. Kabeeruddin: Makhzanul Mufridat, Faisal Publication House N-Delhi, 1952; 49-52,115116,366-67,538-40. 10. Abul Hasan Ali Bin Sahal Rabban Tabri, Firdaus ul Hikmat, Diamond Publications Kabeer street Urdu Bazar Lahore, 1966. 11. Zakariya Razi: Al Hawi Fil Tib. CCRUM New Delhi, 2004; 11: 75,188. 12. Ibn Sina: Al Qanoon Fil Tibb Book I Depart ment of Islamic Studies, Jamia Hamdard NDelhi, 1993; 38-63. 13. Zakariya Razi: Al Hawi Fil Tib. CCRUM New Delhi, 2004; 11: 75: 188. 14. Ishtiyaq Ahmed S. Introduction to Al Umoor Al Tabiyat, 1980; 107-115. 15. Ibn Sina: Al Qanoon Fil Tibb Book II Depart ment of Islamic Studies, Jamia Hamdard N-Delhi, 1993; 245,323-324,350-351. 16. Najmul Ghani, Khazainatul Advia, Idara Kitab ul Shifa N-Delhi. P443-449. 17. Razi Kitab ul Mansoori CCRUM N-Delhi, 1991; 18-35. 18. Bhasin S, de Krester DM, Baker HW. Clinical review 64: pathophysiology and natural history of male infertility. J Clin Endocrinol Metab, 1994; 79: 1525–1529.

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19. Journal of Andrology, Vol. 31, No. 6, November/December “Natural Course of Severe Oligozoospermia in Infertile Male: Influence on Future Fertility Potential” 2010; 536-39. 20. Dhaliwal LK, Gupta KR and Majumdar S. Treatment of Oligospermia with Speman: A Formulation of Plant Origin. Indian Medical Gazette, Nov, 2001; 375-79. 21. Snick HK, et al. The spontaneous pregnancy prognosis in untreated subfertile couples: the Walcheren primary care study. Hum Reprod, 1997; 12(7): 1582-8. 22. Martin due Pan, R.C; Campana, A; Physiopathology of Spermatogenic arrest. Fertility and Sterility, 1993; 60: 937-46. 23. Wang, C; Berman, N; McDonald, V; Hull, L; Leung, A; Superlano, L; et al: Effect of increased scrotal temperature on sperm production in normal men. Fertility and sterility, 1996; 68: 334-39.

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