Niqris (Gout): A comprehensive review of concepts and management in modern and Unani medicine

Gout, also called Niqris in Unani medicine, is a type of inflammatory arthritis that most often targets the great toe (metatarsophalangeal joint). Niqris is a term based on the Unani word Inqurus which as Ibn-e-Habal refers the joint of the big toe where this condition is most often found to emphasize the common location of the original attack. In modern medicine, gout is the result of increased purine metabolism or decreased renal excretion, but in Unani medicine the cause of Niqris(gout) is the imbalance of humors (Akhlaat) caused by either Dam (Blood), Balgham (Phlegm), Safra (Yellow bile) or Sawda (Black bile), or a combination of humors. The aims of this review were to compare concepts, pathogenesis, clinical features and treatment of gout in the modern and Unani system of medicine and point out areas where the two systems converged and diverged. A thorough review of the classical Unani texts, modern medical and recent scientific literature was carried out. Data synthesis was carried out to compare the conceptual framework, diagnostic profiles and treatment modalities articulated in both systems.The focus of modern medicine is on pharmacological agents, such as NSAIDs, colchicine, corticosteroids, urate-lowering treatments, and supplemented by lifestyle changes. Unani medicine, in contrast, is holistic involving Ilaj bi’l Ghidha (dietotherapy), Ilaj bi’l Dawa (pharmacotherapy with herbal medicine) and Ilaj bi’l Tadbeer (regimenal therapy) in achieving detoxification and humoral equilibrium. A comparative study shows that the understanding and management of gout are complementary through two different and overlapping perspectives of Unani and modern medicine (Niqris). Evidence based pharmacological treatment based on integrative approach, including Unani principles of lifestyle control and detoxification, can yield better long-term results in the management of gout. The classical Unani therapies should be validated by further research using modern clinical trials.