Evaluating the relevance of Bawl Ghusālī in the diagnosis of Ḍu‘f al-Kabid (hepatic insufficiency): A case-based correlation between unani medicine and modern pathology

Abstract

Background

Ḍu‘f al-Kabid (hepatic insufficiency) is a condition extensively described in classical Unani medicine, where impaired hepatic function arises due to structural or temperamental changes in the liver. One of the classical diagnostic markers of this condition is Bawl Ghusālī, a distinctive urinary appearance resembling the washings of raw meat, attributed to a failure of the liver’s discriminative faculty (Quwwat Mumaiyyaza). While traditional Unani texts emphasize this sign, its correlation with modern hepatic pathology remains underexplored in clinical literature.

Case Presentation

We report two cases of adult male patients with a history of chronic alcohol use who presented to the National Institute of Unani Medicine, Bangalore, with classical symptoms of hepatic insufficiency, including jaundice, anorexia, and right upper quadrant abdominal pain. Both patients exhibited dark-coloured urine without haematuria, corresponding to the Unani description of Bawl Ghusālī. Diagnostic evaluations revealed significantly elevated serum bilirubin, abnormal liver function tests, and ultrasound findings consistent with chronic liver parenchymal disease.

Discussion

These cases underscore a notable convergence between traditional Unani clinical observation and modern hepatological diagnostics. The description of Bawl Ghusālī may reflect underlying conjugated hyperbilirubinemia or urobilinogen excess, highlighting the relevance of traditional urine analysis in identifying hepatic dysfunction. The failure of Quwwat Mumaiyyaza, as described in Unani pathology, aligns conceptually with impaired hepatic clearance and altered bile metabolism seen in hepatic insufficiency.

Conclusion

The classical sign of Bawl Ghusālī remains a valuable diagnostic indicator within the Unani framework and may offer clinically meaningful insights even in contemporary medical practice. These cases advocate for the integration of traditional diagnostic principles into modern hepatology, particularly in resource-limited settings, and encourage further interdisciplinary research to validate such correlations.