Etiopathogenesis of Chronic Bronchitis: A Symptom-Based Correlation with Sūʿāl and Its Management in Unani Medicine

Chronic bronchitis is a major phenotype of chronic obstructive pulmonary disease (COPD), characterized by a persistent productive cough and excessive mucus secretion resulting from chronic airway inflammation. In Unani medicine, the term Waram-i- shoab Muzmin has been used in later writings as a literal translation, though the clinical description more closely resembles Sūʿāl, particularly Sūʿāl Aṣlī mentioned in classical sources. The present review explores the etiopathogenesis, symptomatology, and management of chronic bronchitis in both modern and Unani frameworks. Modern medicine attributes its development mainly to cigarette smoking, air pollution, and oxidative stress, which trigger airway remodelling, mucus hypersecretion, and epithelial injury. Unani physicians described similar mechanisms in terms of Sū’-i-Mizāj, Waram, Yubūsat, and accumulation of Mawād-i-Fāsida, often precipitated by cold, dust, and irritants, especially in individuals of Balghamī Mizāj . Preventive strategies, lifestyle regulation, and holistic management form the core of Unani practice, including Ilāj bi’l-Tadbīr (regimenal therapy), Ilāj bi’l-Ghizā (dietotherapy), and Ilāj bi’l-Dawā (pharmacotherapy). Various single drugs such as Asl-us-Soos (Glycyrrhiza glabra), Arusa (Adhatoda vasica), Behidana (Cydonia oblonga), and compound formulations like Laʿūq-e-Sapistān and Joshānda-e-Munḍij are employed, along with preventive measures such as avoiding phlegm-producing foods and exposure to cold air. Importantly, recent clinical evidence has validated the efficacy of licorice-based formulations in chronic cough, further supporting the relevance of Unani interventions. These insights demonstrate that Unani intervention can be effectively applied in clinical practice as a complementary option, offering safer and more sustainable strategies for managing chronic bronchitis. Keywords: Chronic bronchitis, COPD, Sūʿāl, Unani medicine, Etiopathogenesis