List of unani laxatives

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Unani laxatives list mushil mulayyin drugs classification

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https://www.unanijournal.com/articles/337/9-2-2-564.pdf

Here is a thorough list of Unani laxatives, organized by their classical Unani categories:

Unani Laxatives (Adwiya-e-Mushil/Mulayyin)

In Unani medicine, drugs that facilitate bowel evacuation fall into two broad groups:

Term	Meaning	Action
Mulayyin	Softener/mild laxative	Softens stool, gentle action
Mus'hil / Mushil	Purgative	Strong evacuation of morbid matter (khilt)

Mild Laxatives (Mulayyin)

Unani Name	Botanical Name	Common Name	Mizaj (Temperament)
Halela Zard / Post-e-Halela Kabli	Terminalia chebula	Yellow myrobalan	Cold 1°, Dry 2°
Halela Siyah	Terminalia chebula	Black myrobalan	Cold 1°, Dry 2°
Unnab	Zizyphus jujuba	Jujube / Indian plum	Motadil (balanced)
Gul-e-Banafsha	Viola odorata	Sweet violet	Cold, Wet 1°
Sheera-e-Murabba-e-Halela	Terminalia chebula	Myrobalan preserve	-
Katira	Cochlospermum religiosum	Gum karaya	Cold 1°, Dry 1°
Raughan-e-Badam	Prunus amygdalus	Almond oil	Hot, Moist 1°
Gul-e-Surkh	Rosa damascena	Damask rose	Cold, Dry 2°
Rewand Chini	Rheum emodi	Indian rhubarb	Hot, Dry 2°
Isabgol (Post)	Plantago ovata	Psyllium husk	Cold, Moist
Sapistan	Cordia dichotoma	Sebestan plum	Wet 1°, Motadil
Anjeer	Ficus carica	Fig	Hot, Moist 1°
Khubazi	Malva sylvestris	Mallow	Cold, Moist
Aloo Bukhara	Prunus domestica	Prune/Plum	Cold, Moist
Sha'ir	Hordeum vulgare	Barley (as sawiq)	Cold, Dry
Gulqand (Gul-e-Surkh)	Rose petal jam	-	-

Strong Purgatives (Mushil / Mus'hil)

Unani Name	Botanical Name	Common Name	Mizaj
Turbud (Turbith)	Operculina turpethum	Indian jalap / Turpeth	Hot 3°, Dry 2°
Saqmunia	Convolvulus scammonia	Scammony	Hot 3°, Dry 2°
Hanzal / Shahm-e-Hanzal	Citrullus colocynthis	Colocynth / Bitter apple	Hot 3°, Dry 3°
Jalap	Ipomoea purga	Jalap root	Hot, Dry
Senna (Sana Makki)	Cassia angustifolia	Senna	Hot 1°, Dry 1°
Rewand Chini	Rheum emodi / R. officinale	Rhubarb	Hot 2°, Dry 2°
Ayarij Faqra	Compound polyherbal	Hiera picra / Ayarij	-
Aftimun	Cuscuta epithymum	Dodder of thyme	Hot 2°, Dry 2°
Khiyar Shanbar	Cassia fistula	Purging cassia / Amaltas	Cold, Moist

Key Classical Corrective Drugs (Muslih) Used with Strong Purgatives

Strong purgatives (Mushil) cause tenesmus and griping - classical Unani texts prescribe corrective (Muslih) drugs alongside them:

Purgative	Muslih (Corrective)
Turbud	Zanjabeel (ginger), Mastagi (mastic)
Saqmunia	Mastagi, Qirfa (cinnamon)
Hanzal	Sandal, Mastagi

Notable Compound (Murakkab) Laxative Formulations

Itrifal Zamani - contains Post-e-Halela, Turbud, and other herbs; used for constipation
Habbe Mudir - purgative tablet
Jawarish Jalinus - digestive + mild laxative compound
Qurs Mulayyin - mild laxative tablet
Roghan-e-Kunjad (Sesame oil) - used as a mild laxative enema

Classification Summary

Unani Laxatives
├── Mulayyin (Mild) — soften stool, gentle
│   e.g. Halela, Unnab, Gul-e-Banafsha, Isabgol, Anjeer, Aloo Bukhara
│
└── Mushil/Mus'hil (Purgative) — strong, evacuate morbid matter
    ├── Mild purgatives: Senna, Rewand Chini, Khiyar Shanbar
    └── Strong purgatives: Turbud, Saqmunia, Hanzal, Jalap

Important notes from classical Unani texts:

Strong Mushil drugs act on specific humors (khilt): e.g., Turbud removes Balgham (phlegm) and Sawda (black bile); Saqmunia removes Safra (yellow bile)
Mundij (concoctive) drugs are always given before Mushil to ripen/prepare morbid matter for elimination
Dose is titrated based on patient's mizaj (temperament), age, and strength (quwwat)

Sources: Unani Journal article on Qabd formulations | CCRUM Unani System of Medicine

Modern laxatives

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modern laxatives classification mechanism of action complete list 2024

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Here is a complete, structured overview of modern laxatives based on Katzung's Basic and Clinical Pharmacology and Sleisenger & Fordtran's Gastrointestinal and Liver Disease:

Modern Laxatives - Complete Classification

1. Bulk-Forming Laxatives

Mechanism: Indigestible, hydrophilic colloids that absorb water, form a bulky gel, distend the colon, and stimulate peristalsis. Onset: 12-72 hours

Drug	Source
Psyllium (Isabgol)	Natural (plant)
Methylcellulose	Semisynthetic
Polycarbophil	Synthetic
Wheat bran / dietary fibre	Natural

Safe for long-term use; require adequate fluid intake
May cause bloating and flatus due to bacterial fermentation

2. Stool Softeners / Surfactant Agents

Mechanism: Allow water and lipids to penetrate fecal material, softening the stool.

Drug	Route
Docusate sodium	Oral or enema
Docusate calcium	Oral
Glycerin suppository	Rectal
Mineral oil	Oral (lubricant)

Mineral oil lubricates and retards water absorption from stool
Long-term mineral oil use impairs absorption of fat-soluble vitamins (A, D, E, K); aspiration risk

3. Osmotic Laxatives

Mechanism: Non-absorbable compounds that create an osmotic gradient, drawing water into the colon and increasing stool liquidity. Onset: 1-3 hours (purgative doses); 12-48 hours (laxative doses)

a) Saline Osmotics

Drug	Notes
Magnesium hydroxide (Milk of Magnesia)	Avoid in renal insufficiency (risk of hypermagnesemia)
Magnesium sulfate	Potent; used for bowel prep
Magnesium citrate	Bowel prep
Sodium phosphate	Bowel prep; caution in renal disease

b) Non-absorbable Sugars

Drug	Notes
Lactulose	Metabolized by colonic bacteria; causes flatus and cramps; also used in hepatic encephalopathy
Sorbitol	Similar to lactulose; cheaper

c) Polyethylene Glycol (PEG)

Drug	Notes
PEG 3350 (Miralax)	17 g/day for chronic constipation; no cramps or flatus; safe in all patients
PEG + electrolytes (GoLYTELY, NuLYTELY)	Isotonic solution for full colonic cleansing before colonoscopy; 2-4 L

4. Stimulant Laxatives (Cathartics)

Mechanism: Stimulate the enteric nervous system and colonic electrolyte/fluid secretion, promoting propulsive contractions. Onset: 6-12 hours (oral); 30-60 minutes (rectal)

a) Anthraquinone Derivatives

Drug	Notes
Senna (Cassia angustifolia)	Most widely used; 6-12 hours oral action
Cascara sagrada	Milder; long-term use causes melanosis coli
Aloe	Potent; generally avoided

b) Diphenylmethane Derivatives

Drug	Notes
Bisacodyl (Dulcolax)	Oral or suppository; 6-10 hours oral, 30-60 min rectal; used in bowel prep
Sodium picosulfate	Prodrug, activated by colonic bacteria

Chronic use causes "melanosis coli" (brown pigmentation of colon)
Long-term use is generally considered safe in most patients per recent evidence

5. Chloride Secretion Activators (Intestinal Secretagogues)

These are newer, prescription agents for chronic idiopathic constipation (CIC) and IBS-C.

a) Chloride Channel (CIC-2) Activator

Drug	Dose	Notes
Lubiprostone (Amitiza)	24 mcg twice daily (CIC); 8 mcg twice daily (IBS-C)	Stimulates type-2 Cl⁻ channel; >50% get bowel movement within 24h; may cause nausea

b) Guanylate Cyclase-C (GC-C) Agonists

Drug	Dose	Notes
Linaclotide (Linzess)	145 mcg/day (CIC); 290 mcg/day (IBS-C)	Minimally absorbed peptide; activates GC-C → ↑cGMP → CFTR activation → Cl⁻ and HCO₃⁻ secretion; also reduces visceral pain
Plecanatide (Trulance)	3 mg/day	Uroguanylin analogue; similar mechanism to linaclotide

6. Opioid Receptor Antagonists (for Opioid-Induced Constipation)

Mechanism: Peripherally acting μ-opioid receptor antagonists - block enteric opioid receptors without crossing the blood-brain barrier (no reversal of analgesia).

Drug	Route	Dose	Notes
Naloxegol (Movantik)	Oral	12.5-25 mg once daily	CYP3A4 substrate
Naldemedine (Symproic)	Oral	0.2 mg once daily	CYP3A4 substrate
Methylnaltrexone (Relistor)	SC or oral	0.15 mg/kg SC or 450 mg oral	Used in palliative care
Alvimopan (Entereg)	Oral	12 mg	Short-term only; postoperative ileus in hospitalized patients; cardiovascular risk limits use

7. Serotonin 5-HT4 Receptor Agonists (Prokinetics)

Mechanism: Activate 5-HT4 receptors → ↑cAMP → release of acetylcholine → high-amplitude propulsive contractions (HAPC) throughout the GI tract.

Drug	Dose	Notes
Prucalopride (Motegrity)	2 mg once daily	Approved for chronic constipation; reduces colonic transit time by ~12 hours; no cardiovascular risk (unlike older agents)

Note: Older 5-HT4 agonists cisapride and tegaserod were withdrawn from markets due to cardiac adverse effects (hERG K⁺ channel blockade).

Summary Table

Class	Onset	Examples	Best Used For
Bulk-forming	12-72 h	Psyllium, methylcellulose	Mild/chronic constipation
Softeners/Lubricants	12-72 h	Docusate, mineral oil	Prevent straining
Osmotic (saline)	1-6 h	Mg(OH)₂, sodium phosphate	Acute, bowel prep
Osmotic (sugar/PEG)	24-48 h	Lactulose, PEG 3350	Chronic constipation
Stimulant	6-12 h oral	Bisacodyl, senna	Acute; opioid-induced
Secretagogues	24 h	Lubiprostone, linaclotide, plecanatide	CIC, IBS-C
Opioid antagonists	Hours	Naloxegol, methylnaltrexone	Opioid-induced constipation
5-HT4 agonists	24-48 h	Prucalopride	Chronic constipation

Per the 2024 ASCRS guidelines, osmotic laxatives are first-line pharmacotherapy for chronic constipation, with stimulant laxatives (bisacodyl) as rescue or second-line therapy. Newer secretagogues (linaclotide, plecanatide, lubiprostone) and prucalopride are reserved for patients who fail first-line agents.

Sources: - Katzung's Basic and Clinical Pharmacology, 16th Ed. - Sleisenger & Fordtran's GI and Liver Disease - Yamada's Textbook of Gastroenterology, 7th Ed.

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