Unani and modern concepts of Hernia

1. Fataq/ Hernia

2. Definition
• A hernia is the protrusion of a viscus or part of
a viscus through an abnormal opening in its
coverings

3. Types
Common
• Umbilical/para-umbilical.
• Inguinal (direct and indirect).
• Femoral.
• Incisional.
Uncommon
• Epigastric.
• Gluteal, lumbar, obturator.

5. Pathophysiology
• The defect in the abdominal wall may be congenital
(e.g. umbilical hernia, femoral canal) or acquired (e.g.
an incision) and is lined with peritoneum (the sac).
• Raised intra-abdominal pressure further weakens the
defect allowing some of the intra-abdominal contents
(e.g. omentum, small bowel loop) to migrate through
the opening.
• Entrapment of the contents in the sac leads to
incarceration (unable to reduce contents) and possibly
strangulation (blood supply to incarcerated contents is
compromised).

6. Clinical features
• Patient presents with a lump over the site of
the hernia.
• Femoral hernias are below and lateral to the
pubic tubercle, they usually flatten the groin
crease and are 10 times more common in
women than men. 50% present as a surgical
emergency due to obstructed contents and
50% of these will require a small bowel
resection. Femoral hernias are irreducible.

7. • Inguinal hernias start off above and medial to the
pubic tubercle but may descend broadly when
larger, they usually accentuate the groin crease.
Most are benign and have a low risk of
complications.
(a) Indirect inguinal hernias can be controlled by
digital pressure over the internal inguinal ring,
may be narrow necked and are common in
younger men (3% per annum present with
complications).
(b) Direct inguinal hernias are poorly controlled by
digital pressure, are often broad necked and are
commoner in older men (0.3% per annum
strangulate).

8. • Incisional hernias bulge, are usually broad
necked, poorly controlled by pressure and are
accentuated by tensing the recti. Large, chronic
incisional hernias may contain much of the small
bowel and may by irreducible/unrepairable due
to the ‘loss of the right of abode in the abdomen’
of the contents.
• True umbilical hernias are present from birth and
are symmetrical defects in the umbilicus due to
failure to close.
• Para-umbilical hernias develop due to an
acquired defect in the periumbilical fascia.

9. Complications of surgery
• Haematoma (wound or scrotal).
• Acute urinary retention.
• Wound infection.
• Chronic pain.
• Testicular pain and swelling leading to testicular
atrophy.
• Hernia recurrence (about 5%).

10. • ESSENTIAL MANAGEMENT
• Assess the hernia for: severity of symptoms, risk of
complications (type, size of neck), ease of repair (size,
location), likelihood of success (size, loss of right of abode).
• Assess the patient for: fitness for surgery, impact of hernia
on lifestyle
(job, hobbies).
• Surgical repair is usually offered in suitable patients for:
(a) hernias at risk of complications whatever the symptoms;
(b) hernias with previous symptoms of obstruction;
(c) hernias at low risk of complications but symptoms
interfering with lifestyle, etc.
Principles of surgery
• Herniotomy: excision of the hernial sac.
• Herniorrhaphy: repairing the defect.

11. Aqsam
• Fataq taam
• F. Naaqis
• F. Rajie
• F. Ghair Rajie
• F. mukhtaran
• F. Varmi
• F. Suddi
• F. medi

12. Asbab
Weakness
• Elderly
• Weakness of abdominal wall
• After surgery
• Any normal openings become broad

13. Increased abdominal pressure
• Lifting heavy objects
• Ascitis
• Hamal
• Qabz
• Excessive rutubat
• Flatulance

14. Alamat
• Abdominal pain
• Discomforts
• Sometimes vomiting
• Feacal incontinance
• Intestinal colic
• Frequent defeacation
• Incomplete emptyness

15. Fataq warmi
• Fever
• Vomiting
• Acute pain
• Inflammation
Fataq suddi
• Colic pain

16. Usoole ilaj
• Avoid vigorous physical activities
• Refrain from sexual intercourse
• Avoid drinking plenty of water
• Avoid flatulence producing food
• If it is reducible immediately reduce and
prevent it by applying bandage
• Daf –e-alam
• huqna

17. Ilaj
• Mastagi, badiyan, anisoon each 1 g pasted
well and mix with Gulqand 25 g , Arq-e-
badiyan and arq-e-mako each 36 ml
• Kundoor, badang, kust, 6g each pasted and
mixed with roghan-e-gao 125 ml given to
drink to induce vomiting
• Pour hot water on the hernia or take hot
abzan which make hernia soft then reduce it
• Then apply qabiz drugs

18. Mastagi, kundoor, aqaqiya, gulnar, dammul
akhwain, murmakki, anzaroot, sibr, raswat,
shab e yamani
Paste can be applied

19. apply
• Sare samagi + ab e makko sabz murawwaq
• Dammul akhwain + katheera + samag-e-arabi
• Behiroza khiushk + affiyoon water – paste
• Farfiyoon + jundube dastar + roghan-e-kunjad
Nutool
Gule baboonah, tukhm-e-sibbat, aqleelul mulk,
brinjasif, marzanjosh,

20. Massage
• R. baboonah
• R. kist
• R. shibbat
• R. sadab
• Alone or mixed with jundube dastar and apply