The International Statistical Classification of Disease and Related Health Problems, Tenth Revision, defines hyperemesis gravidarum (HG) as persistent and excessive vomiting starting before the end of the 22nd week of gestation [1]. These are common complaints during the first half of pregnancy. Misconceptionally taken as morning sickness, symptoms usually begins between the first and second missed menstrual period and continue until about 14-16 weeks [2,3]. Nausea and vomiting of moderate intensity are especially common until about 16 weeks. Further the condition divides into mild and severe, In some women it is severe and unresponsive to simple dietary modification and antiemetics. In severe condition leads to produce weight loss, malnutrition, reduced energy, fatigue, dehydration, electrolyte imbalance [4]. acidosis from starvation,metabolic disturbances alkalosis from loss of hydrochloric acid in vomitus and hypokalemia [2]. carbohydrate depletion, dehydration.1 It is accompanied by an increased risk of maternal stress, anxiety, depression, low quality of life and reduction in maternal physical and social function [5-7]. In classical unani literature, Qay’al Haml the term coined for nausea and vomiting in pregnancy [7-9]. It is stated that, Qay’al-hamal mainly occurs due to the accumulation of morbid matter in the stomach, which subsides after the 4th month of gestation [10]. It has a significant impact on the quality of life of pregnant women [10-12]. The exact is not known [5] [12]. 

Incidence
Up to 80% of all pregnant women experience some form of nausea and vomiting during their pregnancy [13-15].Affecting approximately 0.3%–2.0% of pregnancies, HG is the commonest indication for admission to hospital in the first half of pregnancy and is second only to preterm labor as a cause of hospitalization during pregnancy [16-18]. To evaluate the efficacy of long pepper/piper longum in the management and treatment of rheumatoid arthritis based on the
severity of diseases.
Aetiology
It mainly occurs due to endocrine factors of placental origin, i.e.; human chorionic gonadotropin (hCG). The clinical course of nausea and vomiting during pregnancy correlates closely with the hCG level [4] [6] [11-12] [19- 21]. The aetiology is obscure but the following are the known facts: It is most likely a multifactorial condition and has been associated with many risk factors [22]. It is mostly limited to the first trimester; primiparous, It is more common in first pregnancy, with a tendency to recur again in subsequent pregnancies (15)%; Younger age; Low body mass; 23 persons of color, and less likely to drink alcohol [23-24]. History of motion sickness or migraine; It has got a familial history,It is more prevalent in hydatidiform mole and multiple pregnancy, unplanned pregnancies but much less amongst illegitimate ones, women with hyperemesis gravidarum, often suffer from transient form of hyperthyroidism2 , female infant sex has also been
associated with this smoking, and socioeconomic status do not appear to differ significantly between women with it and those without [17],[25],[26],[27],[28] [23].

ASBAB
Unani scholars states the cause of is morbid material which accumulates in the cavity of the stomach or the muscles or layers of the stomach [8-9]. This material canbe bilious, phlegmatic (often balghami-milh) or black bile [8-9]. More often nausea in pregnancy is due to bile although bile is not a morbid material [8]. Bilious material causes irritation in the stomach and hence vomiting [29]. Thick and viscous material firmly accumulated on the surface of the stomach produces nausea and retching not vomiting.
Diagnosis
HG is a diagnosis of exclusion, characterized by prolonged and severe nausea and vomiting, dehydration, large ketonuria, and more than 5% body weight loss [30-31]. Hyperemnesis gravidarum and adverse fetal pregnancy outcomes It has been reported to be associated with an increased risk for adverse pregnancy outcomessuch as:low birth weight,preterm birth, small-for-gestational age infants [28],[32-33]. Usool e ilaj: (Unani principles of treatment) may be divided into
following [34] 
? Ilaj bi’l ghidha (Dieto-therapy)
? Ilaj bi’l tadbeer ( Regimental therapy)
? Ilaj bi’l Dawa ( Pharmacotherapy)
? Ilaj bi’l yad (Surgery)
Ilaj bi’l ghidha (Dieto-Therapy) [9],[11],[35]
Light diet is advisable which provides strength to the stomach and stops vomiting example titar,chuza murg.,Advise empty stomachrube reebas, rube hasram.,Eat a pomegranate in the earlymorning and lies on the bed for 1 hour, Avoid hot and warm food. Avoid sweet dishes.
Ilaj bi’l tadbeer (Regimental Therapy) [11],[36]
Moderate walk or light exercise, Zimad on the abdomen- badiyan alone or along with qinnab and sharab Rehani or grape flowers and gulnar or barge kiram, gulnar and karafs Roomi.

Ilaj bi’l Dawa (Pharmacotherapy) [11],[35-37]
Nausea and vomiting in pregnancy is usually self- limiting, if it is not alleviated advice mullaiyanat, muqawwiyat -al- mi’da wa aaza ra’isa.
Single Drugs
Rewand chini ,oode kham , mastagi ,sandal safaid,,kishneez khushk , anar,leemo ,pudina, ilaiichi khurd ,beehi , quste sheerin, jooz, sak, mastagi, agar, kababa.

Compound Drugs
Gulqand, sikanjabeen sada ,sikanjabeen lemooni ,murabba leemu kaghzi.,sharab rehani asfar, sharbate turanj, sharbate leemu, sharbate ghura, qurs- qaranphal. sharbat-i-leemu , sharbat- i-anar , sharbate anar ,sharbat-i-ghaura ,sharbat-i-zanjabeel , murrabai-aml [38].

Potential Research Topics and Interventions
An open observational study was carried out in the Dept. of  Ilmul Qabalat wa Amraze Niswan, National Institute of Unani Medicine Hospital, Bengaluru. Pregnant women 18-35 years of age, having singleton pregnancy in 6-12 weeks of
gestational age with NVP (n=30) were included based on mild to moderate Pregnancy Unique Quantification of Emesis (PUQE- 24) score and patients with severe NVP, systemic diseases, multiple gestation, ectopic and molar pregnancy
were excluded. Sharbat-i-Anar Sheerin (20 ml) twice daily was administered orally on empty stomach for four weeks. The main outcome measure was a reduction in PUQE score.
?96.7% of pregnant women achieved a reduction in PUQE score and only 3.3% had no reduction. This trial provides evidence of improved effectiveness and safety of Sharbat-iAnar Sheerin in women with NVP. Moreover, no adverse
effect of the research drug was noted during the trial [39].
Three of every 10 pregnant women have nausea that is bad enough to interfere with their daily lives. Sikanjbeen lemooni is a poly herbal Unani formulation used in Unani system of medicine since the time Arab physicians. It possessing
properties viz antiemetic, antianemic, appetizer, digestive, exhilarant, ant oxidant property. Long term follow- up of the patient’s u-ntil delivery showed no adverse effect on the newborns [40].
An observational study on Various Unani drugs for the treatment of qay’al-haml including gulqand, sikanjabeen sada, sharbat anar sheerin, sikanjabeen lemooni, jawarish anarain, mastagi, ilaichi etc. In this literary research, an effort
had been made to focus on the various causes, diagnosis and management of nausea and vomiting in pregnancy by Unani system of medicine. Some herbs and Unani compound formulations used in the treatment of qay’al-hamlhave also
been highlighted [41].
Nausea and vomiting in pregnancy [42]
Zanjabeel is very often used to overcome the symptoms of nausea and vomiting in pregnancy. In a recent double-blind, randomized controlled trial, the effect of Zanjabeel on nausea and vomiting caused by pregnancy was assessed and was compared with metoclopramide drug. Though, Zanjabeel was found to be less effective than metoclopramide, but it significantly reduced the episodes of nausea and vomiting and could be a safe and effective alternative [43].
In a double-blind, randomized clinical trial, 120 women were selected and the effect of Zanjabeel in pregnancy-induced nausea and vomiting was compared with vitamin B6 and placebo. Theresults showed significant difference between groups in severity of nausea and frequency of vomiting [44-45].
In another double-blind, randomized, placebo-controlled trial, 125 mg Zanjabeel extract was given four times a day for 4 days and its effectiveness was investigated on the symptoms of morning sickness. The results showed a significant decrease in nausea as well as in retching, concluding that Zanjabeel can be considered as a useful treatment option for morning sickness [46].

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