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Abstract

Unani system of medicine approach to the prevention and treatment of the lifestyle and non communicable diseases is aimed at avoiding the accumulation of fasad mada (toxins) through maintaining of asbab e sitta zarooriya (six essential factors). This review was designed with the objectives to translate and compile ancient Unani literature on lifestyle disorders from classical text, to interpret Unani concept of lifestyle disorders and find proper management for lifestyle disorders through Unani system of medicine. The review was carried out from Arabic and Urdu classical texts of Unani medicine and published articles from reputed journals. In various Unani classical texts it have been stated that chronic disorders, which can also be termed as lifestyle disorders, are the conditions which arise from poor management of the asbab e sitta zarooriya (six essential factors) over an extended period. This invariably results in an accumulation of fasad mada (toxins) which is beyond the ability of physics or tabiat to deal with. Unani recognises the importance of identifying a person‟s risk factors like saman e mufrat (obesity) and interpreting the illness on the basis of the temperamental as well as humoral theory. This allows a targeted approach to deal with the humoral or structural imbalance associated with chronic lifestyle disorders such as Ziabetas shakari (type 2 diabetes mellitus) and Zaghtuddum qavi (hypertension). The matter or madda which is accumulated inside the heart or in the pericardium is mostly fasad rutoobat (morbid fluid) in nature. Excessive accumulation of morbid matter in the pericardium exerts pressure on the heart and prevents proper inbasat (relaxation) and thereby destructing the rooh (vital spirit) which leads to death. Lifestyle modification with asbab e sitta zarooriya (six essential factors) and non essential factors (asbab e ghair zarooriya) provide the ability of physis or tabiat to preserve and restore health. Keywords: Asbab e sitta zarooriya, Lifestyle disorders, Unani medicine, Fasad mada
RESEARCH ARTICLE Am. J. PharmTech Res. 2018; 8(3) ISSN: 2249-3387
Please cite this article as: Abdul Azeez Rizwana et al., Unani Concept of Prevention and Control of
Lifestyle Disorders: A Literature Review. American Journal of PharmTech Research 2018.
Unani Concept of Prevention and Control of Lifestyle Disorders: A
Literature Review
Abdul Azeez Rizwana1* MHM Hafeel1 and Zarnigar2
1.Institute of Indigenous Medicine, University of Colombo, Sri Lanka
2.National Institute of Unani Medicine, Bangalore, Karnataka, India
ABSTRACT
Unani system of medicine approach to the prevention and treatment of the lifestyle and non
communicable diseases is aimed at avoiding the accumulation of fasad mada (toxins) through
maintaining of asbab e sitta zarooriya (six essential factors). This review was designed with the
objectives to translate and compile ancient Unani literature on lifestyle disorders from classical text, to
interpret Unani concept of lifestyle disorders and find proper management for lifestyle disorders
through Unani system of medicine. The review was carried out from Arabic and Urdu classical texts of
Unani medicine and published articles from reputed journals. In various Unani classical texts it have
been stated that chronic disorders, which can also be termed as lifestyle disorders, are the conditions
which arise from poor management of the asbab e sitta zarooriya (six essential factors) over an
extended period. This invariably results in an accumulation of fasad mada (toxins) which is beyond the
ability of physics or tabiat to deal with. Unani recognises the importance of identifying a person‟s risk
factors like saman e mufrat (obesity) and interpreting the illness on the basis of the temperamental as
well as humoral theory. This allows a targeted approach to deal with the humoral or structural
imbalance associated with chronic lifestyle disorders such as Ziabetas shakari (type 2 diabetes mellitus)
and Zaghtuddum qavi (hypertension). The matter or madda which is accumulated inside the heart or in
the pericardium is mostly fasad rutoobat (morbid fluid) in nature. Excessive accumulation of morbid
matter in the pericardium exerts pressure on the heart and prevents proper inbasat (relaxation) and
thereby destructing the rooh (vital spirit) which leads to death. Lifestyle modification with asbab e sitta
zarooriya (six essential factors) and non essential factors (asbab e ghair zarooriya) provide the ability
of physis or tabiat to preserve and restore health.
Keywords: Asbab e sitta zarooriya, Lifestyle disorders, Unani medicine, Fasad mada
*Corresponding Author Email: drrizwana74@gmail.com
Received 31 December 2017, Accepted 09 January 2018
INTRODUCTION
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Lifestyle disease is a group of diseases the onset and progress of which are concerned with
lifestyle and behavior factors such as dietary habits, physical activities, rest, smoking, alcohol
consumption, etc. Chronic non communicable diseases are rapidly increasing an important global
public health problem. The lifestyle related diseases are chronic diseases including diabetes, heart
diseases, cancer, and arthritis. It is also non communicable diseases (NCDs) against which
worldwide actions are being taken. [1] According to the ancient literature of Unani system of
medicine, all the communicable (amraz e muta‟ddi) and non communicable (amraz e ghair
muta‟ddi) are the result of poor management of the six governing factors (asbab e sitta zarooriya),
beyond the ability of physis or Tabiat to maintain and restore homeostasis. Unani system of
Medicine approach to the prevention and treatment of these lifestyle and non communicable
diseases is aimed at avoiding the accumulation of toxins in the first place. [2]Unani medicine
strives to find the best possible ways by which a person can lead a healthy life with minimum or
zero sickness. Unani system of Medicine lays rules for a balanced lifestyle, which revolves around
six essential factors (asbab e Sitta Zarooriya) includes six essential pre requisites which are as
follows. [2, 3, 4, 5, 6]
1. Hawa-e-Muheet (Atmospheric air)
2. Makool wa Mashroob (Food and drinks)
3. Harkat wa Sukoon-e-Badani (Physical activity and repose)
4. Harkat wa Sukoon-e-Nafsani (Mental activity and repose)
5. Naum wa Yaqza (Sleep and wakefulness)
6. Ehtibas wa Istifragh (Retention and elimination)
The above six causes (factors) essentially influence each and every human body; therefore they are
called Asbab-e-Sitta Zarooriyah. Nobody could escape from these factors so long he is living. [6]
MATERIALS AND METHOD
The literature survey was carried out in the Unani classical text books of Arabic and Urdu.
Information was reviewed from unani scholars‟ articles in the reputed journals.
Samane Mufrat (obesity):
The first reference of Saman-e-mufrat was given by Hippocrates (460). He said that when a person
becomes extreme obese, imtila-e-dam (congestion or accumulation of blood) may lead to sudden
death because of haemorrhage (due to rupture of vessels) or due to loss of hararat (heat). He
further added that obese people have narrow vessels and poor circulations of blood and rooh
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(essence). Obese persons are prone to other diseases as well as death because of narrowing of
blood vessels. It also produces imtila (blood congestion) as well as prevents tarveeh. [7, 8]
Obesity, particularly if central or trance is an independent risk factor. Obesity can predispose the
development of other risk factors, and the greater the degree of overweight, the greater the
likelihood of developing other antecedents of atherosclerosis (such as high blood pressure and
diabetes) that will increase the probability that heart disease will develop. [9, 10]
According to Unani concept obesity is also known as Samane mufrat. It is a Balghami
(Phlegmatic) disease and hence Khilte Balgham predominates in the body of person and is a
predisposing factor in causation of obesity. In this condition loss of movements of Aaza (organs) is
due to excessive accumulated Balgham and cold temperament, hence the person becomes lazy and
dull. This situation is just like Qaidul Badan (arrest of body). Balgham after mixing with blood
produces lubrication in its Qiwam (viscosity) causes sluggish flow of the blood. [11, 12, 13]
The ancient Unani scholars like Hippocrates, Galen, Rhazes and Avicena have described the
condition Saman-e-mufrat (Obesity) causes as possible complications as paralysis, stroke,
narrowing of blood vessels, haemorrhages and sudden death in their compositions; most of these
mimic hyperlipidaemia.[7,14,15]
Unani literature clearly stated that asbab (causes) and awwarizat (complications) of Saman-e-
mufrat (Obesity).[14,15,16]
Asbab:
1. Khilqi saman-e-mufrit - Hereditary obesity
2. Martoob ghiza -Wet/Moist diet
3. Farhat vorahat-Luxurious lifestyle
4. Kasrat-e-ghiza -Excessive food like fat and meat, excessive sweets and beverages
5. Qillat e riyazat -Lack of exercise
6. Dalak with murattib roghaniyat-Massage with moist oils
Awwarizat:
1. Narrowing of blood vessels
2. Haemorrhages
3. Paralysis
4. Sudden death
The following tadhabir (regimens) and lifestyle modification were described in the Unani classical
literature to prevent and control saman e muftrat. [7,14,15]
1. Taqlil -e-ghiza (Low diet)
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2. Takan ki ziyadati (Excessive physical effort)
3. Kasrat-e- Riyazat ( Excessive exercise)
4. Ishal (Purgation )
5. Idrar-baul (Diuresis)
6. Tareeq (Diaphoresis)
7. Fasd (Venesection)
8. Dalak-e-Khashin (Rough Massage)
9. Hammam-e-Yabis (Dry bath)
10. Massage with Mohalil roganiyat (anti inflammatory oils)
11. Appetite suppressors, e.g. rice of chirchita
12. Nafsiyati Iiaj (psychological treatment)
Ziabetus shakari (Diabetes Mellitus):
As per the WHO, diabetes mellitus (DM) is a heterogeneous metabolic disorder characterized by
common features of chronic hyperglycaemia with disturbance of carbohydrate, fat, and protein
metabolism.The various classical text books also contain detailed descriptions of this disease,
differentiating its distinguished features from other diseases known as tashkhees e fariqa. [17]Ibn
Sina stated in his book of al qanoon fit tib, the word diabetes is derived from Greek word of,
“diabanein” which means to “passing through” or “run through” or “siphon” in reference to the
excessive urine produced as a symptom of this disease. It is not a new disease, ancient Greeks and
Arabic physicians knew it well. The causes of disease are sue e mizaj wa zauf e kulliya, masana
wa jigar (disordered temperament and weakness of kidney, bladder and liver). [17]Excessive and
abnormal distribution of free fatty acids and the well known existing co-morbidities / risk factors
i.e. obesity, dyslipidemia, gestational diabetes mellitus and especially fatty liver are most common
causes for insulin resistance, impaired insulin sensitivity and dysregulated insulin action in the
liver and contributes significantly to the pathogenesis of type 2 DM.Attiba (ancient physicians)
defined it in their own established language of kulliyat as sue mizaj wa zauf e jigar are the
conditions of abnormal energy (heat) generation and utilization and these conditions are also co-
existing with so called modern type 2 diabetes mellitus. If we accept this hypothesis then we can
vaguely come to the conclusion that Attiba used the terminology of Ziabetas shakari for type 2
diabetes mellitus. However that further needs extensive research studies.
Alamath (symptoms) of Ziabetas Shakari described in various classical Unani literature [17,
18]
1. Excessive thirst
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2. Frequency of urination
3. Dribbling of urine
4. Urine appears white, losing its consistency to resemble like water
5. Excessive micturition without burning sensation
6. Incontinence of urine
Awwarizat (complications) of Ziabetas Shakari are especially enumerated by ancient Unani
physicians: [17, 19]
1. Zooban (emaciation of the body), develops due to excessive dehydration of the
body which cannot overcome by intake of water.
2. Collapse of the sexual functions and diabetic gangrene.
3. Zof e badan (general debility)
Asbab e mui’ddha (predisposing factors) [20, 21, 22, 23]
1. Overweight and obesity
2. Unhealthy diet eg: fat and fast food
3. Physical inactivity
4. High blood pressure
5. Impaired glucose tolerance (IGT)
6. Poor nutrition during pregnancy
7. Family history of diabetes
8. Increasing age
9. History of gestational diabetes,
10. Polycystic ovarian syndrome
Mattaqaddam e Ziabetus shakari (Prevention and control of DM)
Greco-Arab and Islamic healers treated patients through a scheme starting with physiotherapy and
diet; if this failed, drugs were used. Rhazes‟s treatment scheme started with diet therapy, he noted
that if the physician is able to treat with foodstuffs, not medication, then he has succeeded.[24]In
classical Unani literature, ancient physicians clearly mentioned variety of ghiza (food) for
Ziabetas Shakari; Amla (Indian ghoose berry), Jamoon, Angoor (unripe grapes juice), anar (sour
pomegranate), milk, fresh fish ,teetar ,margabe ,seekh kabab, Pears , dried fruits , goat milk ,cheese
with milk, fresh vegetables, barley water, oily extract of astringent fruits, rube hamaz, and
curd.[17,18]People with diabetes should be prescribed and encouraged to incorporate regular
exercise as a key part of their treatment plan. Physical activity can help people with diabetes
achieve a variety of goals, including increased cardiorespiratory fitness, increased vigour,
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improved glycaemic control, decreased insulin resistance, improved lipid profile, blood pressure
reduction, and maintenance of weight loss.[23,25]Ibne Nafees a famous Unani philosopher
mentioned that “No alternative of riyazat present in the tibb”.
Falij (Paralysis)
Rabban Tabri (780-850AD) proposed that falij (paralysis) is caused by an obstruction in any part
of the brain (stroke). Obstruction of hassasa (sensory) and moharrika (motor) pathway of the brain
by laisdar balgham (thick phlegm) causes stroke. [26]
Stroke does not occur at random and there are risk factors which procede stroke by several years.
These risk factors can be broadly divided into modifiable and non-modifiable risk factors.
Nonmodifiable risk factors include age, sex, race/ethnicity, and family history. Major modifiable
risk factors include hypertension, cardiac disease, diabetes, hyperlipidemia, carotid stenosis,
cigarette smoking, alcohol intake, and sedentary lifestyle. Prevention of these risk factors remains
an important approach to substantially reducing the incidence, recurrence, disability, and mortality
of stroke. [27]
Zaghtuddum qawi (Hypertension):
Hypertension is the single most important and prevalent modifiable risk factor for stroke.
Hypertension contributes to 60% of all strokes. [2, 10] Rhazi stated, accumulation of normal or
abnormal fluids in the vesseles causes imtila ba hasbul auyiya means there is increase in blood
volume resulting in urooqi tamaddud (vascular tension) causes vascular pressure. Razi have been
written in his writings urooqi tamaddud causes;
1. Heaviness of head
2. Visual disturbances
3. Khafqan (palpitation)
4. Rupture of minute blood vessels
He described the haemorrhage and sudden death as the complications of hypertension. He has also
advised rest, light diet and prevention of heavy work as regimens. [28] Lifestyle change includes
diet, mainly eating more fruits and vegetables and consuming less salt, in addition to weight
reduction, aerobic activities and moderation of alcohol consumption are the best ways of
modification of pre hypertension (systolic blood pressure 120-139mmHg and diastolic blood
pressure 80-90 mmHg).[20,29] Fruits and vegetables enrich sources of potassium, magnesium and
fibre and dairy products are an important source of calcium. 6 g sodium chloride (salt) or less than
6g a day was recommended for hypertensive. [20]
According to Razi:
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Riyazat (exercise) stimulates innate heat and mature the thick morbid matters after that eliminate it
proper outlet. Riyazat enhances arterial blood supply and nutrition to affected part of the muscles.
Physical activity can help people to achieve a variety of goals, including increased cardio
respiratory fitness, increased vigour, improved glycaemic control, decreased insulin resistance,
improved lipid profile, blood pressure reduction, and maintenance of weight loss. Following
preventive strategies mentioned in Razi‟s writings to prevent amraz e qalb.
1. Avoid constipation
2. Avoid any strenuous work and provide mental relaxation
3. Light morning walking
Wajul mufasil (Pain in joints):
Ancient Unani physicians used the term wajul mufasil broadly for pain in joints or arthritis.
Wajaul mufasil is caused by ghair thabayee balgham (phlegm), khoon (blood), safra (yellow bile)
and sauda (black bile). [17]Wajul mufasil is caused by abnormal collection of humour in the
affected joints. Sometimes khilte damvi, sometimes safravi, sometimes saudawi, but for the most
part is caused by balgham or sometimes the humour is of a compound nature. [18]
The Mada (Substance) causing Wajaul Mufasil accumulates in the joints due to the weakness of
the joint called as zauf-e-mufasil. [30]
Asbab e mu’dda (predisposing factors):
1. Giving up the exercise (Tarke Riyazat)
2. Weakness of stomach (Zaufe M„ada) leading to the absorption of impaired matter
3. Derangement (Su-e-Tarteeb)
4. Sedentary lifestyle
5. Regular and excessive use of alcohol
6. Excessive coitus and exercise after meals
7. Cold and catarrh
Mataqaddam e wajul mufasil (Prevention of arthritis):
Ilaj bil ghiza, ilaj bil tadhabir and ilaj bil dawa were recommended in the classical text for
prevention and control of wajul mufasil. Ilaj bil ghiza: Razi recommended fresh vegetables and
fruits as ghiza e dawa for wajul mufasil. Further he advised all meat harmful for wajul mufasil. Ilaj
bil tadhabir: Riyazat e modhadil (moderate exercise) and dalak e roghaniyat (oil massage) have
been recommended in unnani classical literature for the management and prevention of wajul
mufasil. Hijamah (cupping), fasd (venasection) and irsal e alaq (leech therapy) have been
recommended for wajul mufasil e damavi.Ilaj bil dawa: The principle of treatment aims at
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restoring the normal temperament, and correcting the imbalance in the khilth (humour) through
diversion of morbid matter and istifaraah (evacuation of morbid matter). A large number of single
drugs i.e Surinjan (Colchium luteum), Bozidan (Tanacetum umbelliferum), Asgandh (Withania
somnifera), Baboona (Matricaria chamomilla), Sibr (Aloe barabdenis), and compound preparations
for internal as well as external applications i.e Habbe surinjan, Roghan baboona, Safoof e surinjan,
Hab e Asghand, Zimad e auja have been mentioned in classical Unani literature to manage wajul
mufasil. [31-34]
Amraz e Mashaikh (Old age related disorders):
According to Unani concept, the physiology of old age is described meticulously in terms of basic
fundamentals like temperament, humours, faculties etc. The temperament of elderly persons is
described as cold and dry and the proportion of humours in them is considered much different
from those of children and any young people. [35]In human lifespan Tahleele rutoobate ghareeziya
(dissolution of natural body fluids) by hararate ghareeziya (innate heat) takes place gradually. Over
a period, the quantity of rutoobate ghareeziya decreases due to increased tahleel of rutoobate
ghareeziya. Decrease in hararate ghareeziya changes the mizaj relatively to barid. Gradual increase
in buroodat with age results in decline of quwa (faculties), which in turn affects afa‟al (functions)
of the body. As all quwa require hararat for performing afa‟al, depravity of akhlat or dryness
process gradually goes on until it reaches the climax.i.e. death. [36] Tahallul arise from internal as
well as external causes. Of the external causes, atmospheric air (exposure to freezing cold or hot
winds) causes tahallul in the rutoobat. The internal causes are hararate Ghareeziya (innate heat),
which causes tahallul of the rutoobat (fluids) and hararate ghareeba (extrinsic heat) generated
within us from various foods and through other agents which cause taa‟ffun (putrefaction) in the
rutoobat. [11, 36]Health is maintained by homeostasis of body fluids and temperament and
derangement in these either qualitatively or quantitatively leads to different diseases. The
mechanism of homeostasis becomes weak as the age advances due to decline in quwat wa affal,
hence leads to various age related diseases and disorders in Mashaikh (old age).
Prevention or delaying of aging:
Maintaining of six essential factors (asbab e sitta zarooriya) lead to prevention and delaying of
aging. Diet is an important component of these essential factors. The Unani system of medicine
believes that a physician is not the healer but an assistant to nature Tabiyat (physique) of the body,
which is the true healer hence the diet should be in accordance with it.According to the digestion
and physical strength of the old people, they should be served with small amount of food at a time
and thus fed two or three times a day. [5] In old age there is dominancy of buroodat and yaboosat,
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therefore musakkin aur murattib (soothing of cold and moisture) diet should be advocated for
elderly people. [36]Moistening and warming foods and drinks were recommended by ancient
unani physicians. People should avoid any heavy food which produces black bile and phlegm and
similarly avoid any hot, pungent, and desiccant food, such as kawa-mikh (some kind of sauce and
pickles) through advancing age. Olive oil, vinegar, and garlic are useful to old person. Preserved
ginger, and other hot type of preserves are suitable for them. These should, however, be taken in
quantity which (merely) warms the body and aids digestion but not in a quantity which produce
dryness. Food such as meat-soup prepared with Roman wheat and barley is good for elderly. [5,
11, 35, 37, 38] Riyazath e modhadil (Moderate exercise) and har hammam and (Warm bath)
remove free radicals and provide fresh mind and soul. Reconstraction of homeostasis causes
reserve of every organ system of elders. We can delay or prevent aging and age related disorders
through modification of our personal habits and lifestyle.
Amraz e gurda (Kidney diseases):
Prevalence of kidney diseases is largely unknown. Chronic kidney disease of multi-factorial origin
is an environmentally acquired, occupational disease in which the cause is still not understood.
Consumption of polluted water seems to be the underlying reason. Recognized causes of CKD
worldwide include diabetes mellitus, hypertension, glomerulonephritis, obstructive uropathy, and
congenital diseases such as polycystic kidney disease. Various toxins and environmental factors
such as heavy metals, plant toxins, and high ambient temperatures are potential causes for kidney
damage. Soo e mizaj e gurda wa masana (disordered temperament of kidney and bladder) is
main causative factor for weakness of kidney and bladder (Zof - e - gurda wa masana). Asbab e
sitta zarooriya are six essential factors operating life in a customary way. Makhoolath wa
mashroobath (food and drink) is an important component among the six essential factors.
Cancer (Sartan):
Unani physicians have been mentioned in their writings, Sartan has been defined as a type of warm
e sulb (hard swelling) due to abnormal production of sauda (black bile).
Hifz e mataqattam of Sartan (Prevention and control of cancer):
Ancient unani physicians pursued following four basic principles to prevent and control sartan:
1. ILaj bil ghiza: Razi has been advised ghiza e latheef (light diet) and easily digestible diet. Eg:
Kaddu, Kurfa Maul jubn and Maul shagheer.
2. Ilaj bil dawa: Munzij aur mushil e sauda
3. Ilaj bil tadhabeer:: Exercise advisable
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4. Ilaj bil yad: Removal of the affected part of the organ Eg; In sartan e pistan (breast cancer)
removed whole breast in the affected site in the early stage of the disease.
CONCLUSION:
The Unani system of medicine believes that a physician is not the healer but an assistant to nature
Tabiyat (physique) of the body, which is the true healer hence the asbab e sitta zarooriya should be
in accordance with it. We can take preventive measures to modify the modifiable risk factors and
change them. Modifiable risk factor assessment is an important step towards understanding the
origin of a disease and helps in formulating appropriate preventive strategies. Modifiable risk
factors stick with lifestyle in this 21 st century. Therefore modifying the lifestyle through
maintaining of the asbab e sitta zarooriya prevents and controls all the non communicable and
lifestyle disorders.
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... Unani System of Medicine believes that the real physician is the body's intrinsic power of healing and maintaining its normal state of health. The physician is not the healer but an assistant to nature, the true healer [30]. ...
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Sahar Saleem, Sony Saleem, MujeebK, Imran KhanMd, SheraniFS. Implication of asbab-esitta zarooriyah in prevention of lifestyle diseases: a review. International Journal of Advanced Research.2015;3 (10):407-412.