Int J Pharm Pharm Sci, Vol 14, Issue 5, 7-11Review Article

LAUQ KHAYAR SHAMBAR: A POLYHERBAL UNANI FORMULATION FOR THE MANAGEMENT OF COUGH

MOHD ALEEM1* , ALTAF AHMAD1, MOHAMMAD DANISH2

1Department of Pharmacology, National Institute of Unani Medicine, Bangalore, Karnataka, India, 2Department of Skin and Cosmetology, National Institute of Unani Medicine, Bangalore, Karnataka, India
Email: mohdaleem2190@gmail.com

Received: 13 Nov 2021, Revised and Accepted: 04 Mar 2022

ABSTRACT

Cough is a physiological reflex, experienced by every human, is an important protective and defensive mechanism whose action secures the removal of foreign materials and secretions from the airways (larynx, trachea and bronchi). In various circumstances, such as respiratory tract inflammation, viral infections, allergic rhinitis, or inhalation of various irritants, it is unintentionally stimulated and a cough suppressant may be needed to relieve the cough. The currently available cough suppressants (opiates, dextromethorphan, etc.) limit their use in humans due to significant side effects such as constipation, respiratory depression, drowsiness. Lauq Khayar Shambar (LKS) is used as an antitussive in Unani medicine for centuries and is also used to treat various upper respiratory tract ailments such as asthma, dyspnoea, catarrh, productive and dry cough, pharyngitis and laryngitis. So, this review aims to explore the role of LKS in the management of cough.

Keywords: Antitussive, Lauq, Munaffis-ī-balgham, Expectorant, Unani medicine

© 2022 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijpps.2022v14i5.43961. Journal homepage: https://innovareacademics.in/journals/index.php/ijpps.

INTRODUCTION

Cough is a physiological reflex, experienced by every human, is an important protective and defensive mechanism whose action secures the removal of foreign materials and secretions from the airways (larynx, trachea and bronchi). It can be considered to be an inbuilt defence mechanism [1, 2]. In various scenarios, such as respiratory tract inflammation, viral infections, allergic rhinitis, or inhalation of various irritants, it is unintentionally stimulated due to stimulation of receptors presents in the throat, respiratory passage or the lungs. In these cases, the cough has a pathological nature and a cough suppressant may be needed to relieve the cough [3, 4]. According to severity, cough can be divided into three categories: acute<three weeks; subacute>three to<eight weeks; chronic>eight weeks [5]. It is also classified as productive (producing mucus or phlegm) and non-productive (dry) cough [4]. A productive cough can require therapy to either correct the abnormality that triggers sputum development or to alter the consistency of the secretions to make it less difficult to expectorate. A non-productive cough will require drugs to mitigate the cause or minimise the frequency of the cough [6]. The currently available cough suppressants (opiates, dextromethorphan, etc.) limit their use in humans due to significant side effects such as constipation, respiratory depression, and drowsiness [7]. Medicinal plants are a potential source of drugs with high-antitussive efficiency with limited adverse effects. There are so many single and compound drugs in Unani medicine which are used to suppress the cough [8]. Lauq is a classical semisolid dosage form in Unani medicine that has been used primarily to treat various respiratory disorders. The Arabic word 'Lauq' means 'licking'. It was firstly prepared by Jalinoos, (Galen; 129-200 CE). It is thick and sticky in nature and prepared by mixing the powdered or decoction of the natural drug(s) with honey or sugar syrup. It is given orally and advised to lick [9]. LKS is one of them. It contains magz-ī-khayar shambar (Pulp of the fruit of Cassia fistula L.) as the main ingredient along with sapistan (Cordia myxa L.), aslussoos (Glycyrrhiza glabra L.) and katira (Cochlospermum religiosum (L.) Alston). It is used as an antitussive in Unani medicine for centuries and is also used to treat various upper respiratory tract ailments such as asthma, dyspnoea, catarrh, productive and dry cough, pharyngitis and laryngitis [10, 11].

A literature search was carried out to collect all relevant information on cough, antitussive, Lauq Khayar Shambar, and its ingredients. Publicly available electronic databases, including PubMed, Scopus, Google Scholar and ScienceDirect, have been scanned. A large number of literature articles published up to 2020 were reviewed. The keyword used for the search included “antitussive”, “Cassia fistula”, “Cordia myxa”, “Glycyrrhiza glabra”, “Cochlospermum religiosum”, “su‘āl” “lauq”, “lauq khayar shambar”, “magz-ī-khayar shambar”, “sapistan”, “aslussoos” and “katira”. 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).

Table 1: Ingredient of LKS

Name Botanical name Family Part used Quantity (Ratio) References
Sapistan Cordia myxa L. Boraginaceae Fruit 1.5 [10, 11]
Aslussoos Glycyrrhiza glabra L. Fabaceae Root 1.5
Magz-ī-khayar Shambar Cassia fistula L. Leguminosae Pulp of fruit 2
Katira Cochlospermum religiosum (L.) Alston Bixaceae Gum 1
Qand safaid (Sugar) 18

Method of preparation

Firstly, aslussoos (Glycyrrhiza glabra) is crushed to small pieces in an iron mortar and softened, then sapistan (Cordia myxa) and aslussoos (Glycyrrhiza glabra) are immersed in water (18 L) at night. In the morning, boil these infusion tills remain half. After that, Mesh it well and filter it, then mix floos-ī-khayar shamber in the filtrate and filter it again. Add Sugar to the filtrate of these drugs and boiled it on low fire till it acquired qiwam (consistency) of two tar. Lastly, mix the powder of katira in qiwam [10].

Important points regarding the preparation of LKS

Dose: 7 g

Action and Uses (Af ̒āl wa Mawaqe istemal)

It possesses munaffis-ī-balgham (expectorant), musakkin-ī-Su‘āl (Antitussive), munzij (concoctive), mulayyan (Laxative) properties. It is used in nazla (catarrhs), zukam (coryza), su‘āl (cough), su‘āl Balghamī (Phlegmatic Cough) and qabz (constipation) [10–14].

Table 2: Physicochemical standards of LKS

Properties Result References
Appearance Semi-solid [10, 11]
Colour Light chocolate
Smell Pleasant
Taste Sweet
Alcohol soluble matter 19.80-20%
Water-soluble matter 91.90-92.40
Successive extractive value
Pet ether 0.02-0.04%
Chloroform 0.05-0.08%
Ethyl alcohol 37.29-38.53
pH
pH of 1%solution 4.77-4.85
pH of 10%solution 4.37-4.54

Table 3: Properties of ingredient of LKS in Unani medicine

Name Temperament Pharmacological action Therapeutic uses References
Sapistan Moderate (in hot and cold) and wet in 1° Munaffis-ī-balgham (expectorant), Musakkin (sedative), Mulattif (demulcent), Mulayyin-ī-sadr (emollient of the chest) Nazla-o-Zukām Ḥārr (acute Coryza and catarrh), Khushūnat-ī-Ḥalaq wa Ṣadr (Irritation of throat and chest), Su‘āl (cough), Ḥummā Ṣafrāwī wa Damawī (Bilious and haemolytic Fevers) [15–17]
Aslussoos Hot 2 and dry in 1° Munaffis-ī-balgham (expectorant), Musakkin (sedative), Munzij-i-akhlat-i-ghalizah (Concoctive of viscous humour), Muqawwi-ī-‘asāb (nervine tonic), Muhallil-ī-warm (anti-inflammatory), Daf-ī-humma (Antipyretic) Su‘āl (cough), Su‘āl Balghamī (Phlegmatic Cough), Ḍīq al-Nafas/Dama (Bronchial asthma), Waram-i-Ḥalaq (Pharyngitis), amrad-ī-‘asāb (Nervine disordes) [18–20]
Magz-ī-khayar Shambar Hot and wet in 1° Munaffis-ī-balgham (expectorant), Muhallil-ī-warm (anti-inflammatory), Mushil-ī-Balgham (Purgative of Phlegm) Waram-i-Ḥalaq (Pharyngitis), Su‘āl (cough), Ḍīq al-Nafas/Dama (Bronchial asthma) [17, 19, 21, 22]
Katira Cold and dry in 2° Munaffis-ī-balgham (expectorant), Mushil-ī-Balgham (Purgative of Phlegm) Musakkin (sedative), Mulattif (demulcent), Habis-ī-dam (Haemostatic) Su‘āl (cough), Amrāḍ-i-Ḥalaq (Diseases of Throat), Nafs ud dam (haemoptysis), Bawl al-Dam (Haematuria) [17, 20, 23, 24]

Table 4: Important identified chemical constituents and scientific studies on ingredients of LKS

Botanical name Important chemical constituent Pharmacological studies
Cordia myxa L. Flavonoids, terpenoids, saponins, tannins, sterols, steroids, coumarin, resins, gums, mucilage, phenolic acids, stearic acid, palmitic acid, rutin, hesperidin, caffeic acid, d-arabinose, l-fructose, d-glucose, d-xylose, polysaccharides [25–27]

Antitussive [28], Smooth Muscle Relaxant [29]

Analgesic [30], Anti-inflammatory [30], Immunomodulatory [31], Antiparasitic [32]

Antimicrobial [25], Antioxidant [30]
Glycyrrhiza glabra L. Glycyrrhizin, glabrene, formononetin, glabrol, liquiritigenin, liquirtin isoliquertin, glucoliquiritin apioside [33–35]

Immunomodulatory [36], Antitussive [37], Anti-inflammatory [38], Antinociceptive [39]

Antiulcer [40], Antioxidant [41]

Antiviral [42], Antimicrobial [43]
Cassia fistula L. 1,8-dihydroxy-3-anthraquinone derivative, ziganein, rhein, methyl ester, scopoletin, vanillic acid, aspartic acid, glutamic acid and lysine [44–46].

Antioxidant [47]

Antimicrobial [48]

Anti-inflammatory [49]

Anti-rheumatic [50]

Immunomodulation [51]
Cochlospermum religiosum (L.) Alston L-rhamnose, D-galactose, α-cochlospermic acid, alanine, glutamic acid, methionine, stearic acid, palmitic acid, erucic acid [52, 53]

Anti-inflammatory [54]

Catalytic [55]

Antibacterial [56]

Insecticidal [57]

Antioxidant [57]

Table 5: Antitussive and relaxant activity of ingredient of LKS

Drug Activity Dose form Positive control Model/Method Result References
Cordia myxa L. Smooth Muscle Relaxant Activity Alcoholic extract --------- In vitro/Isolated tracheal smooth muscle of sheep Relaxed the trachea muscles contracted by acetylcholine [29]
Antitussive activity hydro-alcoholic extract Dextromethorphan Ammonia induced cough in mice Significantly inhibit the frequency of cough [28]
Glycyrrhiza glabra L. Broncho relaxant effect Powder Prednisolone 54 patients with chronic bronchial asthma Licorice has a similar effect as a standard drug but is more potent due to the presence of glycyrrhizin which shows corticosteroid like activity [58]
Antitussive activity

water-extracted

polymeric fraction

 Codeine Citric acid-induced cough in guinea-pigs Significantly suppress the cough compared to codeine [37]
Antitussive activity Hydroalcoholic extract Codeine sulphate SO2-induced cough in mice At a dose of 800 mg/kg the extract significantly inhibits the cough reflex [59]
Cassia fistula L. Antitussive activity Methanol extract Codeine phosphate SO2-induced cough in mice At a dose of 600 mg/kg the extract significantly inhibits the cough reflex [60]

A well-recognized LKS has been commonly used for respiratory complications, especially in the case of cough. The researches prove the relevant pharmacological effects of their ingredients and prescribed in asthma, chronic bronchitis, influenza and recurrent upper respiratory tract infections. Due to expectorant and demulcent properties, Cordia myxa brings up the phlegm, suppress cough and enhances respiratory system secretions [61, 62]. It significantly inhibits the frequency of cough by affecting the cough centre in the brain [28]. It also relaxed the Tracheal Smooth Muscle of sheep due to the expression and activation of Ca2+-dependent NOS isoforms [29].

The ethanol extracts of Glycyrrhiza glabra inhibit the SO2-induced cough reflex in experimental animals [59]. At a dose of 50 mg/kg orally, the aqueous extract of Glycyrrhiza glabra decreases the frequency of cough induced by citric acid in guinea pigs more effectively than codeine due to spasmolytic and protective effects on mucous [37]. The broncho relaxant effect of Glycyrrhiza glabra is due to the presence of glycyrrhizin which has corticosteroid-like activity [58]. Glycyrrhizic acid, which is the major active compound of Glycyrrhiza glabra, effectively ameliorate the progression of ovalbumin-induced asthmatic features in the experimental animal by suppressing IL-4, IL-5 and IL-13. It also prevented the reduction of IFN-γ and inhibit the overproduction of eosinophils and mucus [63–65]. The anti-allergic effect of Glycyrrhiza glabra is mainly due to glycyrrhizin, 18β-glycyrrhetinic acid and liquiritigenin, which is useful for asthma and allergic disease [66]. The leaf extract of Cassia fistula showed significant antitussive activity in experimentally induced cough reflex in mice, same as codeine phosphate [60].

In Unani medicine, a cough is an act by which tabiyat (internal power of the body) removes irritating substances from the lungs and adjacent structures. According to Ismail Jurjani there are three causes of cough: (1) When an asbabe badiyah (extrinsic factors) i.e., smoke, dust, fumes cold air enters into the respiratory system; (2) asbabe wasila (intrinsic factors) i.e., any type of su'-i mizaj (impaired temperament); (3) Inflammation in lungs [67]. Asbabe badiyah causes inflammation in the airways and produces ratoobat (mucus hyper-secretion) that result in a narrowing of the airways. Dry cough occurs due to su'-i mizaj har sada (impaired hot temperament) and su'-i mizaj barid sada (impaired cold temperament) and wet cough occur due to su'-i mizaj har maddi (impaired hot temperament with humoural involvement) and su'-i mizaj barid maddi (impaired cold temperament with humoural involvement). Su'-i mizaj maddi is more prevalent in the persons of balghamī mizaj (phlegmatic temperament) [68, 69]. According to the nature of the cause, su‘āl har maddi (cough of hot humours) and su‘āl barid maddi (cough of cold humours) are collectively known as su‘āl ratab (productive cough) [70, 71]. Su‘āl Ratab (productive cough) is caused by the fluids (ratubat) of the lungs and chest. It is mainly found in elderly people and people with wet temperaments. The symptoms are hoarseness of voice, and excessive discharge of phlegm during sleep and after waking [67, 68].

In Unani medicine, the principle of treatment of cough is ta'dil-i su'-i mizaj (correction of impaired temperament) through taltif (rarefaction), taskhin (warming), tartib (moistening), tajfif o tanshif (Drying) or taghriya (Soothing) as required.

In su‘āl ratab (productive cough), treatment should be started with the drugs having the property of mulattif (demulcent), munaffis-ī-balgham (expectorant) and musakkin (sedative) properties [72–74]. In the compound formulation of LKS, all the four ingredients are munaffis-ī-balgham (expectorant) and musakkin (sedative) properties, and due to its expectorant properties, it helps in clearing the airways by eliminating phlegm [10, 75, 76].

As described above, LKS is a dense, sticky dosage form and is used as a licking. The physicochemical properties and method of administration increase the transit time of the drug from the oesophagus and therefore increase the absorption of the drug into the trachea. It also induces the persistent and prolonged release of drugs to the respiratory tract [14, 77–79].

CONCLUSION

Based on the information amassed above, it can be concluded that LKS is a semisolid dosage form that has been effectively used in traditional medicines for centuries to manage cough. The physicochemical and experimental studies on the ingredient of LKS indicate that it possesses an Antitussive effect. However, to establish the efficacy, safety and mechanism of action, more experimental and clinical studies are needed.

ACKNOWLEDGEMENT

The authors are 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. This research did not receive any grant from funding agencies.

CONFLICT OF INTERESTS

There is no conflict of interest to declare.

AUTHORS CONTRIBUTIONS

All authors contributed equally.

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