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Since antiquity, the Unani system of medicine has been participating in health care system. Usually, four modes of treatment viz. regimenal therapy, dietotherapy, pharmacotherapy and surgery are applied for the treatment of diseases. Regimenal therapy is an important mode in which the morbid matter present in the body is either dispersed/excreted or its unnecessary production is blocked or its flow is restricted and the diseases are cured by natural healer of the body, consequently bring back the humoural stability. Nearly 30 regimens have been mentioned in classical Unani literature. Commonest regimenal procedures such as fasd (venesection/phlebotomy), hijāma (cupping), ta‘līq al-‘alaq (hirudotherapy/leech therapy), ishāl (purgation), qay’ (emesis), idrār-i-bawl (diuresis), huqna (enema), ta’rīq (diaphoresis), riyādat (exercise), dalk (massage), hammām (bathing), tadhīn (oiling), natūl (irrigation), sakūb (douching/spraying), inkibāb (steam/vapour application), takmīd (fomentation) etc. are usually applied for the management of various ailments. These regimenal procedures are completely based on holistic approach and are potential but needs to be explored scientifically. This review outlines the therapeutic applications of various regimens of regimenal therapy used in Unani medicine.
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Reviews
Athar Parvez Ansari*
Ilājbil-Tadbīr(regimenal therapy): a core mode
of Unani treatment
https://doi.org/10.1515/jcim-2020-0048
Received February 10, 2020; accepted April 20, 2020; published
online August 27, 2020
Abstract: Since antiquity, the Unani system of medicine
has been participating in health care system. Usually, four
modes of treatment viz. regimenal therapy, dietotherapy,
pharmacotherapy and surgery are applied for the treatment
of diseases. Regimenal therapy is an important mode in
which the morbid matter present in the body is either
dispersed/excreted or its unnecessary production is blocked
or its flow is restricted and the diseases are cured by natural
healer of the body, consequently bring back the humoural
stability. Nearly 30 regimens have been mentioned in clas-
sical Unani literature. Commonest regimenal procedures
such as fasd (venesection/phlebotomy), hijāma (cupping),
talīqal-alaq (hirudotherapy/leech therapy), ishāl(purga-
tion), qay(emesis), idrār-i-bawl (diuresis), huqna (enema),
tarīq(diaphoresis), riyādat (exercise), dalk (massage),
hammām(bathing), tadhīn(oiling), natūl(irrigation), sakūb
(douching/spraying), inkibāb(steam/vapour application),
takmīd(fomentation) etc. are usually applied for the man-
agement of various ailments. These regimenal procedures
are completely based on holistic approach and are potential
but needs to be explored scientically. This review outlines
the therapeutic applications of various regimens of regi-
menal therapy used in Unani medicine.
Keywords: Ilājbil-Tadbīr;istifragh; morbid humours;
regimenal therapy; Unani medicine.
Introduction
Unani medicine
The Unani system of medicine is one of the oldest systems of
medicine which is basically pioneered in Greece, and later
been established in Rome, Arabs, Spain, Iran and Indian
subcontinent. This system is based on the wisdom of Hip-
pocrates (460370 BC), chiefly on his doctrine of four hu-
mours such as dam(sanguineous), balgham (phlegm),
safrā(yellow bile/bilious) and sawda(black bile/melan-
cholic) along with their qualities in terms of temperament
such as hot-moist, cold-moist, hot-dry, and cold-dry,
respectively. Moreover, the body of human being is con-
sisted with seven indispensable materials like arkān(ele-
ments), mizāj(temperament), akhlāt(humours), adā
(organs), arwāh(pneuma), quwā(faculties) and afāl
(functions). An absence of any of the component threatens
the survival and derangement in the constituents result
diseases. Hence, the core aim is to restore the balance pri-
marily by aiding bodily facultiesviz. tabīat mudabbir-i-
badan (medicatrix naturae) [1]. Tabīat (Physis) is an
individualstrength to combat diseases and perform physi-
ological functions of the body [2]. Six essential prerequisites
(asbāb-i-sittāzarūriā) which include hawā-i-muheet (atmo-
spheric air), makoolāt va mashroobāt(food and drink),
harakat-o-sukūnbadnī(physical activity and repose), har-
akat-o-sukūnnafsanī(mental activity and repose), nawm-o-
yaqza (sleep and wakefulness) and ehtibās-o-istīfrāgh
(retention and elimination) are important for survival of
anybody [3]. Various environmental, geographical and so-
cioeconomic factors are considered as secondary essential
factors (asbab-e-ghair-zarūriā) for life and indirectly inu-
ence the human body. Therefore, both primary and sec-
ondary prerequisites should be strictly considered while
treating diseases [2]. The causes of diseases are basically
classied into three categories viz. (i) sū-i-mizāj(dystem-
perament),(ii) sū-i-tarkeeb (abnormal composition),and (iii)
tafarrūq-i-ittīsāl(derangement). Sū-i-Mizājrefers presence
of disease due to impairment in the temperament of an or-
gan, system or whole body. Sū-i-mizājis further classied
into two types viz. (i) sū-i-mizājsāda (dystemperament not
associated with morbid humours), (ii) sū-i-mizaj māddī
(abnormal substantial temperament) [4]. When three basic
causes are present together, the disease condition is called
marz-i-murakkab (compound/composite disease). In Unani
*Corresponding author: Athar Parvez Ansari, Regional Research
Institute of Unani Medicine, under CCRUM, Ministry of AYUSH,
Government of India, Srinagar, Jammu & Kashmir, India,
E-mail: aatharparvez@gmail.com. https://orcid.org/0000-0002-
5755-3525
J Complement Integr Med 2021; 18(3): 449458
Open Access. © 2020 Athar Parvez Ansari, published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0
International License.
medicine, the management of diseases is based on holistic
approach with aim to treat body, mind, and soul.
Mode of Unani treatment
Four core modes of treatment are usually employed in
Unani medicine such as ilājbil-tadbīr(regimenal ther-
apy), ilāj bil ghizā(dietotherapy), ilājbil-dawā(phar-
macotherapy) and ilājbil-yad (surgery) [3] (Figure 1). The
regimenal therapy is one of the imperative sort of Unani
treatment by which the morbid substances are dispersed
within the body or excreted from the body through natural
orices and the humoural equilibrium is restored by the
tabīat (physis) [5].
Ilājbil-Tadbīr(regimenal therapy)
Ilājbil-Tadbīris consisted with two words of Arabic lan-
guage i.e. ilājwhich refers treatment and tadbīrmeans
regimen. In Unani system of medicine, several regimenal
procedures mostly drug-less therapy and some regimens
with incorporation of drugs are preferred for the manage-
ment of various body ailments [6]. Through such regimens
the dietary habit and life style of the patients are modulated
[7]. Several classical Unani literatures viz. Kamil al-Sanā
also known as Kitab al-Maliki (The Complete Book of the
Medical Art) [8] written by Ali Ibn al-Abbas al-Majusi
popularly known as Haly Abbas [9] (10th Century AD) [10,
11], Al-Qanūnl Tib (The Canon of Medicine) compiled by
Ibn Sina famous by Avicenna (980 1037 AD) in West [12],
Firdaus al-Hikmah (Paradise of Wisdom) written by Abu al-
Hasan Ali ibn Sahl Rabban al-Tabri (838 870 AD) [13],
Kitab al-Mukhtarātl Tib compiled by Ibn Hubal (1121
1213 AD) [14], Kitab al-Umdāl Jarāhat written by Ibn al-
Qaff (1233 1286 AD) [15], Kitab al-Tasrīfauthored by Abu
al-Qasim Khalaf ibn al-Abbas al-Zahrawi (936 1013 AD)
also known as Abulcasis in West [16], Kitab al-Kuliyāt
compiled by Ibn Rushd also called as Averroes in Europe
(1126 1198 AD) [17], ZakhīrāKhawārizam Shahi authored
by Ahmad al-Hasan Jurjani [18], Ilāj al-Amraz written by
Hakim Muhammad Shareef Khan (1722 1807 AD) [19], Al-
Qarabadeen written by Kabeeruddin etc. have described
various regimenal procedures [20] (Table 1).
Individual regimen
(1). Istifragh (Evacuation of morbid humours)
The diseases are caused by either dystemperament with or
without involvement of morbid humours [12]. The morbid
matters are evacuated through various regimenal
Figure 1: Modes of Unani treatment.
Table :Various regimenal procedures.
S.
No.
Regimen S.
No.
Regimen
.Istifrāgh (Evacuation of morbid
matters) []
.Sakūb(Douching or
Spraying) []
.Fasd (Venesection) [,].Inkibāb(Steam applica-
tion) [,,]
.Hijāma (Cupping) [,,,
]
.Pāshoya (Foot bath) [,
]
.Talīq al-Alaq (Hirudotherapy)
[,,,,]
.Aabzān(Sitz bath) []
.Qay(Emesis) [,,].Ubtan (Skin cleansing)
[]
.Ishāl(Purgation) [,,,
]
.Dimād(Paste) [,,]
.Idrār-i-Bawl (Diuresis) [].Tilā(Liniment) [,,
]
Tarīq(Diaphoresis) .Huqna (Enema) [,,
]
.Imāla (Diversion of morbid hu-
mours) []
.Dhūnī(Fumigation) []
.Riyādat (Exercise) [,,,
]
.Nafūkh (Insulation)
.Dalk (Massage) [,].Lakhlakha (Inhalation)
[]
.Hammām(Bathing) [,,].Humūl(Pessary) [,]
.Tadhīn(Oiling) .Qairūtī(Poultice) [,]
.Takmīd(Fomentation) [].Kaiyy(Cauterization) [,
]
.Natūl(Irrigation) [,,,
]
.Īlām(Pain induction)
450 Ansari: Regimenal therapy: A core mode of Unani treatment
procedures or uses of drugs. Istifragh is done by various
methods such as fasd (venesection), hijāma (cupping),
talīq al-alaq (hirudotherapy), ishāl(purgation), qayi
(emesis), idrār-i-bawl (diuresis), huqna (enema), tarīq
(diaphoresis), riyādat (exercise), hammām(bathing) etc.
Ibn Sina has made 10 rules for evacuation of morbid
matters from the body (Table 2). These rules must be fol-
lowed while performing istifragh. The amount of morbid
matters to beevacuated is judgedfrom the amount of morbid
humours already evacuated, strength of the patient and
clinical features of the disease. It is also mentioned that the
morbid humours should readily be evacuated when they are
present in the vessels than joints and tissues [12].
(2). Fasd (Venesection/Phlebotomy)
Fasd is a general mode of removal of excessive quantity of
morbid humours present mainly in the blood vessels. This
procedure should be done when the blood is so super-
abundant and the disease is about to develop. These cases
are initial stage of sciatica, podagra, or any arthritic con-
dition due to abnormal blood state, danger of haemoptysis
from rupture of a blood vessel in a rare eld of lung,
persons on the verge of epilepsy, seizure due to epi-
lepsy, pharyngotonsillitis, internal inammatory masses,
bleeding piles, amenorrhoea etc. Phlebotomy should not
be performed before the age of 14 or after 70 years and in
those young who are emaciated. The Unani physicians
have also mentioned various contraindications where this
therapy should not be performed. Ibn Sina has suggested
that phlebotomy is to be done on different veins according
to the indications [12] (Table 3).
In modern era, this regimenal therapy has been dis-
carded because some studies have suggested that after
phlebotomy certain pathological conditions are developed
but thousand year observation of Unani physicians, it
cannot be discarded merely on the basis of modern studies
which have been carried out on small sample size. Hence,
more studies may be carried out on large sample size to
validate scientifically this old age regimen [4].
(3). Hijāma (Cupping)
Razi has defined that cupping is a regimenal procedure in
which morbid matter is evacuated from the superficial
small blood vessels located in the muscles [21, 22]. This
regimenal procedure is mentioned in the Ebers Papyrus
(1550 BC). Hippocrates has recommended the cupping
therapy for the treatment of musculoskeletal disorders of
back and extremities, pharyngitis, gyaenocological, ear,
and lung diseases [23]. Hijāma is classied into two types:
(i) Hijāma bil Shart (cupping with scarication), and (ii)
Hijāma bilāShart (cupping without scarication) [15, 23]
(Figure 2).
(i) Hijāma bil Shart (Cupping with scarication):In
this type, small incisions are made on the skin and
blood is evacuated using cups/glasses by creating
negative pressure. Ibn al-Qaf Al-Maseehi has described
certain guidelines for this procedure viz. (i) for pro-
phylactic purposes, it should be performed in mid lu-
nar month because the humours are agitated in this
period, (ii) evening time should be preferred, (iii) hot
weather should be preferred because the humours are
not viscid in this season and evacuates easily, (iv) it
should not be performed in those patients whose blood
is viscid, (v) before performing this procedure, sto-
machic should be given to the patient, (vi) it is
Table :Rules of istifragh.
Conditions Indications/contraindications
Plethora It should be done when morbid humours are
present in the body.
Vitality It should be avoided when any of the three vital
faculties of the body are weakened.
Temperament Contraindicated in case of hot and dry tempera-
ment of the body.
Symptoms Contraindicated in case of diarrhoea or cramps.
Physique Contraindicated in case of excessive leanness or
fatty body.
Age of the patient It is avoided in children and old age.
Weather condition Avoided during extreme hot or cold weather.
Geographical
position
Contraindicated in hot tempered areas.
Habit It should be avoided when habit of the patient is
to have evacuations frequently.
Occupation Contraindicated in washer men and labourers
[].
Table :Sites of phlebotomy.
Site/vein Indications
Frontal veins Heaviness of the head and eyes & chronic
headache
Supraoccipital veins Ulcers of the scalp
Temporal veins Tortuous vein
Labial veins Gum ulcers, gingivitis
Sublingual veins Angina and tonsilar abscess
Jugular veins Angina, dyspnoea, asthma, lung abscess
Post auricular vein Glaucoma; ulcers of ear, neck and back of the
head
Popliteal vein Decrease menstrual ow, painful piles, anal
pain
Vein over the inner
toe
Sciatica, uterine diseases
Saphenous vein Decrease menstrual ow, piles, sciatica []
Ansari: Regimenal therapy: A core mode of Unani treatment 451
contraindicated in obese patients, (vii) it should not be
performed before the age of 2 and after 60 years, (viii) it
should be avoided just after bath, coitus and physical
exertion [15]. Several points where cups to be applied
have been pointed out according to diseases by Unani
physicians [12] (Table 4).
(ii) HijamābilāShart (Cupping without scarication):
In this type, incision is not made and blood is not
evacuated from the body. Cups or glasses are applied
on the body surface by creating vacuum through pump
or re. Ibn Sina has suggested that the use of re is
more advantageous [12]. This procedure should be
done following general evacuation of morbid humours
from the body. In this regimen, the morbid humours
are diverted from diseased part to the healthy part, and
in case of dislocation of an organ the anatomical po-
sition may be corrected. This therapy is given for the
treatment of many diseases viz. (i) plethoric condition,
where the morbid matter needs to be diverted, (ii) deep
seated abscess for suction of the pus, (iii) to increase
temperature of any organ, (iv) atulence, (v) displace-
ment of an organ, (vi) severe pain, (vii) atrophied organ
etc. [15].
Scientific studies have suggested that the cupping
therapy possesses significant therapeutic effect in many
diseases. Khan et al., 2013 has reported the signicant
effect of cupping therapy in overall management of
knee osteoarthritis, particularly in pain relief, swelling,
joint stiffness and disability compare with control drug
(acetaminophen) [24]. Al-Bedah et al., 2015 has reported
the signicant effect of wet cupping therapy in
decreasing pain and recovering disability in cases of
persistent non-speciclowbackpain,atleastfortwo
weeks after stoppage of the therapy [25].
(4). Talīq al-Alaq (Hirudotherapy/Leech Therapy)
The small quantity of blood is withdrawn from the body
by using medicinal leeches. This regimen was in the
practice 3,500 years back in Egypt and in other ancient
civilizationssuchasGreek,Mayan,Aztec,andRome.In
Greek, this therapy was first practiced by eminent physi-
cian, scholar and philosopher, Hippocrates (460 370 BC)
[26]. In India also, this therapy was very much popular in
olden days [18]. Various species of leeches are found
including Hirudo medicinalis and Hirudo granulosa which
are considered to have medicinal properties [26]. Ibn Sina
and Ismail Jurjani have mentioned the peculiar features of
toxic leeches which should not be used for treatment
purposes. These features are broader head, grey/green
colour, body hairs etc. [18, 27]. Toxic leeches may produce
local inammation, syncope, haemorrhage, fever [18, 27],
paralysis and malignant ulcers [27]. Leeches obtained
from the pond which found algae and frogs, better for use
[18, 27]. It is advised that when the leech is hesitant for
attachment, a small prick may be made by needle on the
skin surface to produce few drops of blood which result
keen attachment of the leech [28]. In this regimen, the
morbid matter is evacuated from the body and maintains
the homeostasis. Scientic studies have revealed that the
anti-coagulant substances such as hirudin, calin,
histamine-like vasodilators, collagenase, hyaluronidase
etc. present in the saliva of leeches, responsible for
various pharmacological actions [26]. This regimenal
procedure is very much benecial in the treatment of
especially skin diseases such as alopecia, ring worm [18,
27], non-healing ulcer, varicose vein, elephantiasis,
psoriasis, warts, eczema etc. The leech therapy is also
recommended for the treatment of some other diseases
such as arthritis, pharyngitis, lymphadenitis, sinusitis
etc. Certain scientic reports have revealed that the leech
therapy possesses signicant effects in many diseases.
For example, a clinical study conducted in Germany in
which the leech therapy has showed signicant effect
in cases of knee osteoarthritis compare to that of
local application of diclofenac. An experimental study
in animal model showed the signicant thrombin
inhibition effect of hirudin in antigen induced arthritis
as the intra-articular brin was decreased [26].
(5). Qay(Emesis)
It is a mode of evacuation of morbid matter in which
gastric contents are expelled through mouth. Sometimes,
this regimen is used in healthy individuals for prophylactic
purposes to clean the stomach. Hippocrates has depicted
that emesis is the best regimen amongst all other regimenal
procedures except purgation especially for evacuation of
the phlegmatic humour particularly from the lower part of
Figure 2: Types of hijama (cupping).
452 Ansari: Regimenal therapy: A core mode of Unani treatment
the body. He further stated that it should be performed in
two consecutive days in a month in healthy persons. The
therapeutic indications of emesis are inflammatory con-
ditions, oedema, jaundice, tremor, paralysis, dyspnoea,
gout, melancholia, leprosy [18], obesity, ulcers of kidney
and bladder etc. [12]. Excessive emesis may cause gastric
weakness [18].
(6). Ishāl(Purgation)
Usually three humours such as phlegm, bile, and black
bile are evacuated through purgation. Many drugs which
possess properties to evacuate different humours are
used for this purpose. For instance, Convolvulus scam-
monia and Polypodium vulgare are the drugs of choice to
evacuate bilious humour [12]. Citrullus colocynthis,
Operculina turpethum and Colchicum luteum are given to
evacuate phlegmatic humour whereas Helleborus niger is
used for evacuation of melancholic humour [10]. Purga-
tive drugs evacuate morbid humours in association with
the attractive faculty related to the given humour; may be
attracting the coarse and rejecting the subtle humour.
This attraction is going on until the morbid humour rea-
ches the stomach and intestines, which nally excrete
through anal route [12]. Certain guidelines have been
made for this regimenal therapy viz. (i) it should be
avoided in extreme hot and cold conditions, (ii) the dose
of the drug should be according to the body strength, (iii)
small dose of purgative should be given in hot tempered
regions, (iv) after purgation, hard physical work and
sexual intercourse should be avoided, (v) following
administration of purgative drug, the patient should be
advisedtowalkforabriefperiod[13],(vi)itshouldbe
avoided in case of weak strength of vital faculties, (vii)
purgationshouldnotbegivenincaseofexcessive
plethora, (viii) purgative drugs should not be given in
case of weakness of stomach and intestine, (ix) it should
be avoided in deafness etc. [18].
(7). Idrār-i-Bawl (Diuresis)
This is also a natural excretory route of human body. In
many disease conditions, this route is chosen for evacua-
tion of morbid matters. This mode of regimen is preferred
with incorporation of diuretic drugs in cases of joints pain,
backache, dizziness, ascitis etc. Usually Cucumis melo,
Cucumis sativus,Trachyspermum ammi,Nigella sativa,
Foenuculum vulgare etc. are used for this purpose. Exces-
sive diuresis should always be avoided as it may produce
injury in the urinary tract [18].
(8). Tarīq(Diaphoresis)
It is a kind of evacuation of waste products from the body
through sweating. This is achieved through certain pro-
cesses such as hot fomentation, hot bath, poultice, exer-
cise, massage, inhalation etc. and also by using certain
drugs internally such as Foenuculum vulgare,Piper cubeba,
Coriandrum sativum,Elettaria cardamomum,Achillea mil-
lefolium,Ruta greveolens,Crocus sativus,Piper nigrum etc.
This regimen is also useful to reduce body temperature in
case of fever and to increase nutrition of the skin [29].
(9). Imāla (Diversion of morbid humours)
As per Unani concept, sometimes the mawād(morbid
matters) is present in vital organs and accumulation of
large amount of such matters may cause weakness of vital
functions of the body. In this condition, these morbid
substances are diverted from vital organs to the less
important organs of the body where such matters may be
dispersed within the organ and evacuation is not needed.
Cupping without scarication is performed for this pur-
pose [30]. Imāla is of two types: (i) imāla-i-qareeb (diver-
sion of morbid humours to the adjacent organ), (ii) imāla-i-
baeed (diversion of morbid humours to the remote organ)
[6, 18, 30]. When the morbid humours are freshly accu-
mulated and not agitated in an organ, in this condition
such humours are diverted to the adjacent organ and in
case of vice versa these are diverted to the remote organ
from the affected part [30].
(10). Riyādat (Exercise)
Exercise is one of the important regimens described in
classical Unani literature. After moderate exercise, innate
heat of the body is increased which plays role for normal
functions such as proper digestion and excretion of excre-
tory substances from the body [11]. Ibn Sina has depicted the
benets of exercise viz. (i) it provides normal function to all
Table :Sites of cupping with scarication.
Point of application Indications
Nape of neck Heaviness of eyelids, itching of eyes, foul
smell of mouth
Between the shoulder
blade
Pain in upper arms and throat, congestion in
the lower oesophageal junction
Over the two posterior
neck veins
Tremor of head; diseases of head, face,
teeth, ear, eye and nose
Legs Cessation of menstrual blood
Under the chin Diseases of head, teeth, throat and jaw
Over the loins Inammatory masses in upper part of thigh,
gout, piles, elephantiasis, diseases of
uterus & bladder, renal congestion
In front of thigh Orchitis, leg ulcers
Behind hips Inammatory conditions and ulcers of
buttocks
In popliteal fossa Aneurysm, long standing abscess or ulcers
in leg & foot
Over malleoli Cessation of menses, sciatica, gout
Over the buttocks to-
wards the anus
Draws morbid humours from whole body,
diseases of intestine []
Ansari: Regimenal therapy: A core mode of Unani treatment 453
the organs and gives strength to the body, (ii) digestion and
absorption of the food are good, (iii) nutrition is improved
due to increase innate heat of the body, (iv) it clears pores of
the skin, (v) it removes different excreta from the body etc.
Unani physicians have recommended various forms of ex-
ercises: (i) strenuous exercise, (ii) wrestling, (iii) boxing, (iv)
marching, (v) running, (vi) jumping, [12] (vii) swimming,
(viii) horse ridding, (ix) dancing etc. [18]. Apart from exercise
of whole body, exercise of individual organ is also recom-
mended such as singing and vociferation for respiratory
system, inspecting of minute object for vision, hearing of
weak and loud sound for ear. The best time for exercise is
considered as when the body is free from excreta, so that
there is no risk to disperse unhealthychyme throughout the
body. Sometimes, massage is recommended before exercise
[12].
(11). Dalk (Massage)
Massage is done by pressure, friction or rubbing of the
body with hand or rough cloth [31]. The waste products
from almost all the organs are excreted through skin
following body massage. Unani physicians have classied
massage into various types [17] (Figure 3). Friction massage
is done as preparatory to athletes. The aim is to disperse
waste products formed in the muscles and not excreted
through exercise [12]. Sometimes, massage is advised
before commencing the exercise to prepare the body for
undergoing different movement during exercise. In this
case gentle to vigorous massage should be carried out. This
special type of massage is known as dalk-i-istīdād(prepa-
ratory massage). In some cases, it is advised that gentle to
moderate massage to be carried out after exercise which is
known as dalk-i-isterdād(relaxing massage) [29]. Some
scientic studies have revealed the signicant effect of
massage therapy. Zarnigar et al. 2012 has reported the
signicant effect of massage therapy with Roghan Qust (a
Unani pharmacopoeial formulation) in cases of post stroke
hemiplegia, particularly improvement in the Fugl-Meyer
upper limb score [32]. Amanullah et al. 2011 has revealed
the signicant effect of massage with Roghan Seer (Garlic
oil) (a Unani pharmacopoeial formulation) in voluntary
movements and basic mobility of the lower limb in patients
of post stroke hemiplegia [33]. Lone et al. 2011 has reported
the signicant effect of massage with different medicated
oils in cases of musculoskeletal and nervous system
disorders [34].
(12). Hammām(Bathing)
A special type of hammāmwas in practice in ancient
time. A traditional hammām(bath room) should have four
compartments with varied temperature viz. rst, second,
third, and fourth rooms should be temperate, warm, hot,
and cold, respectively. The air of hammām(bath room)
gives warm and the water gives moistening effects to the
human body [12]. This regimen opens the skin pores [21],
excrete waste products through skin, increase appetite,
resolve morbid humours inside the body [17] and refresh
the body [21]. This is also very much useful to reduce body
temperature in case of hectic fever. Prolong stay in the
bathroom should be avoided because it may produce
syncope, nausea, reduce innate heat, and loss of libido [12].
(13). Tadhīn(Oiling)
In this regimen, medicated oil such as Roghan Babuna,
Roghan Qust,Roghan Malkangni,Roghan Seer,Roghan
Kaddu,Roghan Kahu,Roghan Banafsha (all are Unani
pharmacopoeial preparations) etc. is locally applied on an
organ. This regimen is recommended to relieve pain, to
improve nutrition of skin and to divert morbid matters from
the diseased parts of the body [35].
(14). Takmīd(Fomentation)
In this regimen, powder drug is tied in a piece of cloth and
used in the form of fomentation locally after heating. This
therapy relives pain and resolve inflammatory swelling of
an organ [6]. Unani pharmacopoeias have mentioned
several formulary which are used in the form of hot
fomentation for the treatment of many diseases. For
instance, hot fomentation with Papaver somniferum seeds,
aqueous rose water, and turpentine oil is benecial in
mastitis [36].
(15). Natūl(Irrigation therapy)
In this regimen, the medicated decoction or oil [37] is irri-
gated over the diseased part from some vertical height.
Some amount of drug may penetrate through skin [19, 20]
and helps in dispersing of morbid matters [38]. Thereafter,
the morbid matters may be detoxied either by the body
itself [7] or it may be excreted through natural excretory
route. Ibn Sina has stated that this regimenal therapy is
very useful for the treatment of many ailments including
diseases of head [27]. In case of increase body temperature,
irrigation of cold water is to be done to decrease the tem-
perature [10]. Athar et al. 2018 has revealed the signicant
efcacy of a combination therapy of natūland massage by
Roghan Kaddu and internal use of medications such as
Itrifal Ustukhuddus,Itrifal Kishnizi and Jawarish Shahi in a
case of migraine without aura [39].
(16). Sakūb(Douching or Spraying)
This regimenal procedure is performed usually over the
head or some other parts of the body. In this regimen,
medicated decoction or plain water is spraying from a
close distance to the affected part to disperse the morbid
454 Ansari: Regimenal therapy: A core mode of Unani treatment
matters. The spray may be carried out using a jug or
similar vessel or in the form of spray or shower. Some-
times, it is performed to change the temperamental state
of an organ [12]. It is also a form of irrigation therapy in
which spraying is done gradually whereas in irrigation
therapy the douching is done rapidly. Sometimes, rapid or
quick irrigation may cause some difculties to the patient
[43].
(17). Inkibāb(Steam/vapour application)
Inkibābtherapy is a form of steam application over the
affected parts of the body. In this regimen, some herbal
drugs are boiled into a vessel and the steam is applied to
the body surface [5, 40]. Unani pharmacopoeias have
described several formulary which are used as inkibāb
therapy for the treatment of many illnesses. Steam appli-
cation with decoction of Origanum vulgare,Papa-
ver somniferum seeds, Viola odorata,Coriandrum sativum,
Smilax china is useful in the treatment of earache [19].
Steam application with decoction of Azadirachta indica
leaves is also benecial in the treatment of earache [20].
Athar et al. 2017 has reported the signicant effect of steam
application with decoction of Butea monosperma owers
in combination with massage cupping in a case of non-
specic low back pain [5].
(18). Pāshoya (Foot bath)
In this regimen, the foot is immersed in medicated decoc-
tion for the treatment of various bodily ailments. Foot bath
in the decoction prepared with Acacia arabica leaves,
barleysour, Althea ofcinalis owers, Solanum nigrum,
Viola odorata owers and Nympha alba owers is effective
in cases of severe headache and insomnia [19, 20].
(19). Aabzān(Sitz bath)
It is one of the types of bath in which lower part of the body
especially buttocks and hips are immersed into plain or
medicated water [41]. This regimen is very much useful in
the treatment of intestinal, rectal, anal, prostate, kidney,
urinary bladder, urethral, testicular, vaginal, and uterine
diseases [20]. Majusi and Ibn Sina have advised that the hot
sitz bath is useful in cases of difcult labour. Four types of
sitz bath viz. hot, cold, moderate, and compound (alternate
hot & cold) along with decoction or infusion of herbs are
commonly given for treatment purposes. The possible
mechanism of action in case of hot sitz bath is increased
blood ow and metabolism of the affected area which
causes diversion of morbid humours, and promotes heal-
ing, whereas in case of cold sitz bath, the effect is vaso-
constriction which causes decrease oedema in case of
inammatory condition and may also cease external hae-
morrhages [41].
(20). Ubtan (Skin cleansing/Body scrub)
In this regimen, paste of cosmetic herbs is applied over the
face or other parts of the body to give fairness. Commonly
preferred drugs are Sterculia urenus,our of barley, Vicia
feba, pea, Cicer arietinum,Lens culinaris,Prunus amygda-
lus,Cucumis melo etc. [20].
(21). Dimād(Medicated Paste)
It is a kind of medicated paste which is prepared with
powder of crude drugs and oil [2, 20]. This is used as local
application to resolve inammatory swelling and pain of
various organs of the body [2]. Medicated paste prepared
with pomegranate ower & peel, rose, Inula racemosa,
Swertia chiraita, alum and oil is very much useful for the
treatment of headache [19, 20].
(22). Tilā(Liniment)
The liniment is a very useful remedy which reaches the
affected part of the body itself. It is prepared with herbs, oil
and cloth or plaster, and topically applied to the diseased
part. After application, the drug penetrates through skin or
mucous membrane. The liniment is made with plaster,
coriander and crushed barely, which is useful for the
treatment of scrophulous lesions [12]. The liniment is made
with oil and lukewarm water, applied over the abdomen to
relieve constipation [18].
(23). Huqna (Enema)
The enema is an excellent remedy for evacuation of faecal
and other morbid matters from the intestines. In Unani
medicine, enemas containing different drugs are given to
relieve colicky pain of abdomen, pain caused by renal or
urinary bladder diseases; and to subside inflammatory
conditions of abdominal organs [12]. The enema may be
preferable when purgatives are contraindicated such as
weakness of stomach and intestine [18].
(24). Dhūnī/Bukhoor (Fumigation)
In this regimen, crude drugs are burnt and their smoke is
inhaled [19]. Sometimes, the smoke of crude drugs is also
given to the affected parts other than inhalation [35]. Hkm.
Shareef Khan has advised that sindoor (red oxide of lead)
Figure 3: Types of dalk (massage).
Ansari: Regimenal therapy: A core mode of Unani treatment 455
spreads over the paper, burn it and inhale the smoke which
is useful in the treatment of migraine [19]. Likewise, smoke
of Atropa belladonna root is useful in the treatment of
toothache [35].
(25). Nafūkh (Insulation/Blowing of powder drug into a
body cavity)
It is a specific regimenal procedure in which the fine
powder of single or compound drug is sprinkled into the
ear canal, nose, throat or any other orifice of the body
through air pressure with the help of specially designed
equipment [42]. This regimen is preferred for the treatment
of mainly ear, nose, and throat diseases [35]. Arif et al. 2018
has reported the signicant effect of nafūkh therapy with
Balsamodendron myrrha, Boswellia serrata, Borax, Berberis
aristata and alum in cases of otomycosis [42].
(26). Lakhlakha (Inhalation)
Some aromatic solid or liquid drugs are kept in a bottle and
inhaled. In this regimen, the drug goes to the alveoli and
absorb in the systemic circulation [35]. Unani pharmaco-
poeias have mentioned several formulary which are used
in the form of inhalation for the treatment of many dis-
eases. For instance, Santalum album and dried coriander
kept in the bottle and add aqueous water of rose and vin-
egar in it, and inhale in cases of headache [19].
(27). Humūl(Pessary)
In this regimen, the fine powder drug is mixed with oil or wax
or honey [20] and applied over the cloth or cotton, and used in
the form of pessary for the treatment of vaginal, urethral, and
anal diseases [35]. The pessary is prepared with ne powder
of Murdar sang (litharge), rose oil, pomegranate ower is
effective in the treatment of uterine diseases [13].
(28). Qairūtī(Poultice)
This is a topical application of oil with or withoutcontaining
some drugs to the affected part, but the chief ingredient of
poultices is wax or oil [20]. The most useful poultices are
those made with our of orobs boiled in vinegar and dried
before use. Sometimes, poultices are made with hot oil [12].
Poultice made with wax, Lagenaria siceraria oil, Viola odor-
ata oil, aqueous part of Malva sylvestris leaves, aqueous part
of Althea ofcinalis leaves, Trigonella foenum greacum,
mucilage of Linum usitatissimum, and white part of egg is
benecial for the treatment of convulsion [20].
(29). Kaiyy(Cauterization)
The cauterisation is considered a very useful method of
treatment since ancient time. Unani physicians have rec-
ommended this regimen for various therapeutic purposes
viz. (i) to prevent spreading of a destructive lesion, (ii) to
break up putrefactive matters present in the tissues, (iii) to
restrain the blood ow, (iv) to increase the temperature of a
cold organ etc. In olden days, cautery of golden made was
in use [12].
(30). Īlām(Pain induction)
In this regimen, sensory nerve endings are stimulated
either by compression or tying of an organ [6]. Sometimes,
the pain is induced by using stimulant or irritant drugs.
After application of such procedures, the blood vessels of
the affected area are dilated and blood circulation is
increased resulting stimulation of sensory nerve endings.
This regimenal procedure may be useful for the treatment
of certain diseases such as hypoesthesia, anaesthesia,
pain, swelling etc. [35].
Conclusion
The Unani system of medicine is fundamentally based on
Hippocratic doctrine of four humours viz. dam(sanguin-
eous), balgham (phlegm), safrā(yellow blie/bilious) and
sawda(black bile/melancholic) with their temperamental
qualities such as hot-moist, cold-moist, hot-dry and cold-
dry, respectively. According to Unani concept, the diseases
are basically caused by either qualitative or quantitative
abnormalities of these humours. In order to treatment of
diseases, such morbid humours should be evacuated from
the body or diverted from the diseased part to the other parts
of the body to restore the humoural balance. This phe-
nomenon of treatment is achieved by using different modes
of Unani treatment such as regimenal therapy and phar-
macotherapy. Regimenal therapy is one of the important
modes of Unani treatment which plays pivotal role in the
health care system. Several regimens such as fasd (vene-
section/phlebotomy), hijāma (cupping), talīq al-alaq (hir-
udotherapy), qay(emesis), ishāl(purgation), idrār-i-bawl
(diuresis), tarīq(diaphoresis), riyādat (exercise), dalk
(massage), hammām(bathing), tadhīn(oiling), natūl(irri-
gation), sakūb(douching/spraying), inkibāb(steam/vapour
application), takmīd(fomentation), aabzān(sitz bath),
pāshoya (foot bath), dhūnī(fumigation), nafūkh (blowing of
powder drug into a body cavity), lakhlakha (inhalation),tilā
(liniment), ubtan (body scrub), dimād(medicated paste),
qairūtī(poultice), kaiyy(cauterization), ilām(pain induc-
tion), etc. have been recommended by Unani physicians for
the treatment of various bodily ailments. Unani physicians
have also mentioned their proper indications, site of ap-
plications, contraindications, standard operating proced-
ures, complications and mechanism of action on the basis
of Unani principles. But, in the present scenario, only few
scientic studies on certain Unani regimens have been
carried out to validate them. Detailed studies regarding
mechanism of action and well-designed standard operating
procedures of regimenal procedures, supported by scienti-
c studies in order to open new therapeutic avenues, and
456 Ansari: Regimenal therapy: A core mode of Unani treatment
world wide acceptance would help in the safe and efcient
application of these regimens.
Acknowledgment: The author is very much thankful to the
library staff of Regional Research Institute of Unani Medi-
cine, Srinagar, J & K, India for providing sufficient litera-
ture and also indebted to the authors of research articles
whose reference has been cited in this review article.
Research funding: None declared.
Author contributions: The author has accepted
responsibility for the entire content of this manuscript
and approved its submission.
Competing interests: Author state no conict of interest.
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458 Ansari: Regimenal therapy: A core mode of Unani treatment
... These tadabeer restore the balance in the temperament through Imala (Transference) and tanqiyaemavad (Evacuation of matter). Such as riyazat (Exercise), takmeed (Fomentation), humul (Pessary), bakhoor (Fumigation), aabzan (Seitz bath), fasd (Vensetion), hijama (Cupping) [25,26] . ...
... Herbal formulations with, munzij (Concoctive), and mushil (Purgative), mufattehsudad (Deobstruent) and mulattifat (Demulscent) such as Asaroon Zoofa (Hyssopusofficinalis) are prescribed to eliminate excessive balgham and restore normal reproductive function [20,21,22,23] . Therapies such as hijamah (Cupping), and riyazat (Exercise) are employed to restore humoral balance [16,19,20,21,22,25,26,28] . Dietary interventions aim to reduce phlegmatic dominance by incorporating warm and dry foods while avoiding cold and moist substances [21] . ...
... Hijama Bil Shart has been described as a procedure that helps in the evacuation of morbid matter from the superficial small blood vessels located in the muscles [1]. Hippocrates has recommended cupping therapy for the treatment of many diseases including musculoskeletal disorders of back lung diseases and others [2,3]. The Hijama Bil Shart is widely used as a treatment for many diseases and as a complementary therapy for general well-being. ...
... The present study is the first report showing the comparative effects of negative pressure by manual suction pump and electronic suction pump on blood quantity and clinical examination of skin hijama points in healthy participants undergoing complementary wet cupping as known Hijama bil Shart in the Unani system of medicine. All the subjects were volunteers seeking complimentary wet cupping as it is regarded as beneficial per the Unani system of medicine and has also religious significance in Islamic prophetic medicine [3,6,7]. ...
Article
Full-text available
The Unani system of medicine is one of the traditional systems of medicine that offers holistic solutions for a healthy life through different modes of treatment. Hijama bil shart (Wet Cupping), a type of regimental therapy is one of the modes of treatment used for general well-being and for various diseases. Herein, a comparative evaluation of the use of manual and electrical suction pumps during the Hijama bil shart procedure is reported in terms of the volume of blood and skin health. A total of 12 healthy participants distributed in 6 groups of 2 each were taken and 3 different negative pressures were used in each of the manual suction pumps (2 pulls; 3 pulls; 4 pulls) and electrical suction pump (-300 mmHg, -400 mmHg, -500 mmHg). The total amount of blood collected generally increases with the number of pulls used in a manual suction pump. The total blood collected tends to decrease as vacuum pressure increases in the electrical suction pump. The clinical examination of the skin where Hijama was performed revealed that the increase in pressure by both manual and electrical suction pumps increases the tissue turgidity and blisters were observed at high pressures. In the comparison of the two procedures, we found the automatic suction machine more effective than the manual method of suction with -300 mmHg pressure to be considered while doing the Hijama bil Shart at these sites in healthy participants.
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... [3] During the labor, enemas are used to empty the back passage, giving the baby a compartment easy to deliver or preventing infection. [4] Strong Purgatives: It evacuates the mal-humors from the body with high potency than laxatives. So, it is contraindicated in pregnancy because it stimulates the peristalsis and increases the contraction of the uterus, leading to miscarriage in early pregnancy and premature baby delivery. ...
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Prevention of health in the antenatal stage is essential for future generations' growth and development before entering this world. Care during pregnancy is called Tadbeer-e-Hamla from Unani perspective. According to the Tibb-e-Unani and ayurvedic medicine system, health restoration and maintenance in different conditions, even diseased or healthy, is achieved by managing lifestyle factors. This management is based on which type of condition you suffer and the signs and symptoms that diagnose this condition. Then this diagnosis is also confirmed by the Unani tools that are Pulse (Nabz), Urine (Baul), and Stool (Baraz). After securing the state of the body, treatment starts with four basic principles of management (Usool-e-Ilaj). These principles of management are regimental therapy (Ilaj-bil-tadbeer), Diet therapy (Ilaj-bil-ghiza), Pharmacotherapy (Ilaj-bil-dawa), and Surgery (Jarahat). In this paper, regimental treatments and diet therapy are described in detail during pregnancy.
... Medieval doctors also regarded the Hammam as a crucial component of their healing routine. They were explained as the many types of Hammāms and their significance in therapy [15]. ...
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Background: The Concept of Istifragh (Elimination) in Unani Medicine is of utmost importance and is a unique health promoting regimen or requirement for maintaining health. Istifragh (Elimination) is the Sixth (last but not the least) component of Asbab Sitta Zaruriyya (Six essential factors) which means elimination of abnormal Mawad (matter) from the body with its another component Ehtibas (Retention) that means the retention of essential matters inside the body. Objective: This Paper provides an in-depth exploration of Istifragh encompassing its historical context, theoretical structure and diagnostic importance and various abnormal effects produced due to uncontrolled excessive elimination. There is no Ghidh’a (food item) which has completely beneficial nutrients that can be utilized by the body, so some amount of waste, abnormal and vicious matter is always produced as a result of Hazm (digestion) and that must be eliminated at the earliest. Tabiya’t (physis) plays a pivotal role in differentiating among essential and non-essential component of food for body. Method: For the collection of data and literary support, we reviewed the classical Unani text, manuscripts and their translations i.e., Kulliyat Qanu’n, Kulliyat Nafisi, The Canon of Medicine of Avicenna, Aksir-e-Azam, Firdaus al -Hikmat, Medical Journals, proceedings, periodicals, thesis, reports, dissertations, gazettes, etc. Conclusion: Strong and weak quawate dafia and masika respectively of a certain organ favors Istifragh Ghayr Tabai’i. The finding suggests caring for the general quwate badan and individual organs and taking all means to strengthen the Quwat while employing any of elimination methods.
... The absence of any of these components threatens the survival and derangement of the constituents, resulting in diseases. 13 Traditionally, Unani medicine focuses on treating and preventing different acute and chronic conditions. Ilaj Bil Ghiza (Dietotherapy), Ilāj bi'l Tadbīr (Regimenal therapies), Ilaj Bid Dawa (Pharmacotherapies), and Ilaj Bil Yad (Surgery) are the four main treatment modalities utilized in Unani medicine. ...
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Background • As one of the most prevalent musculoskeletal diseases, osteoarthritis, causes pain, deterioration in functioning, and reduction in quality of life. The condition that is thought to contribute most to disability worldwide is knee osteoarthritis. Existing pharmacological treatments for osteoarthritis raise safety concerns. In Unani medicine, several non-pharmacological regimens known as Ilāj bi’l Tadbīr (Regimenal therapies) are advised in the management of painful musculoskeletal disorders. Among all these practices, dry cupping (Ḥijāmah bilā Sharṭ) is unique and recommended as one of the most effective methods for knee osteoarthritis pain management in the majority of classical Unani literature. This report presents a case of knee osteoarthritis treated using cupping therapy. Case presentation • A 57-year-old female patient presented with a 3-year-long history of right knee pain, stiffness, and difficulty in daily activities. The patient was examined clinically before intervention and was diagnosed with right knee osteoarthritis which was further supported by radiological investigations. Cupping therapy was administered over the affected knee joint for 4 weeks. A total of 10 sittings were carried out every 2 days. The patient’s symptoms gradually ameliorated, ultimately becoming minimal following the 4-week treatment period. Specifically, the Numerical Pain Rating Scale (NPRS) score decreased from 8 to 2, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score for stiffness and functional ability improved with a decrease from 50 to 25, and the quality of life score measured by 36-Item Short Form Health Survey (SF-36) improved from 35 to 75. Conclusion • Our case study established cupping therapy's effectiveness as a secure, non-invasive treatment option and opened new possibilities for its application in the management of knee osteoarthritis. However, further research is imperative to establish the efficacy and effectiveness of cupping therapy.
... bit Tadbeer is defined as modification of asbab sita zarooriya (six essential elements) which includes hawā-i-muheet (atmo-spheric air), makoolāt va mashroobāt (food and drink), harakat-o-sukūn badnī (physical activity and repose), har-akat-o-sukūn nafsanī (mental activity and repose), nawm-o-yaqza (sleep and wakefulness) and ehtibās-o-istīfrāgh (retention and elimination). 1 The causes of diseases in USM are basically classified into three categories viz. (i) s'ū-i-mizāj (dystemperament), (ii) sū-i-tarkeeb (abnormal composition), and (iii) tafarrūq-i-ittīsāl (derangement). ...
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Ilaj bit Tadbeer, a vital therapeutic approach in the Unani system of medicine, focuses on modifying six essential elements to restore health. This approach encompasses various regimenal therapies such as cupping (Hijāma), leeching (Ta'līq or irsal-e- 'Alaq), venesection (Fasd), massage (Dalk), irrigation (Natūl), emesis (Qay'), diuresis (Idrār-i-Bawl), diaphoresis (Tariq), concoction and purgation (Mundij and Mu'shil therapy), medicated steam (Bukhoor), cauterization (Kaiyy), and enema (Huqna). Fasd is a crucial regimen in Ilaj Bit Tadbeer, serving as a method to eliminate morbid material from the body to treat diseases or maintain good health. With a history of almost 3000 years, Fasd has been effectively utilized in treating various ailments across different eras. Although venesection, or Fasd, has a historical significance, its modern application has declined due to the lack of scientific validation. This review aims to explore the historical context, therapeutic applications, contraindications, and contemporary scientific evidence of Fasd, emphasizing its potential in modern medicine. Keywords: Ilaj bit Tadbeer, Unani medicine, Fasd, venesection, therapeutic applications, scientific evidence.
... Similarly, pharmacotherapy (Ilaj-bi-dawa), involving the use of medicines, has identified pharmacotherapy to be natural, less intrusive, more effective, and more environmentally friendly than most methods used. Studies have established that more than 2000 medicines are utilized in this system and extracted from different animal, mineral, and herbal sources [33]. ...
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Infectious diseases have been a threat to human health globally. The relentless efforts and research have enabled us to overcome most of the diseases through the use of antiviral and antibiotic agents discovered and employed. Unfortunately, the microorganisms have the capability to adapt and mutate over time and antibiotic and antiviral resistance ensues. There are many challenges in treating infections such as failure of the microorganisms to respond to the therapeutic agents, which has led to more chronic infections, complications, and preventable loss of life. Thus, a multidisciplinary approach and collaboration is warranted to create more potent, effective, and versatile therapies to prevent and eradicate the old and newly emerging diseases. In the recent past, natural medicine has proven its effectiveness against various illnesses. Most of the pharmaceutical agents currently used can trace their origin to the natural products in one way, shape, or form. The full potential of natural products is yet to be realized, as numerous natural resources have not been explored and analyzed. This merits continuous support in research and analysis of ancient treatment systems to explore their full potential and employ them as an alternative or principal therapy.
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Plaque Psoriasis is a natural, genetically determined inflammatory skin disorder that affects 1- 3% of the world's population, the prevalence of psoriasis in adults varies from 0.44 to 2.8%, in India. People of any age may be affected, and men and women are equally affected. The word psoriasis is derived from Greek word ‘psora’ meaning ‘itch’ ‘iasis’ meaning ‘action, condition’. Conventional medical practices have been under use for the past half-century for treating psoriasis, but the incessant nature, reoccurrence of the disease, and lack of safe and effective drugs are on the quest. In Unani medicine, plaque psoriasis is known as Bars-e Aswad and treated according to its established etiology. Unani scholars has emphasized the Usool-e-Ilaj (principle of treatment) such as evacuations of black bile (Istifragh or Tanqiyahe Sauda), use of blood purifier (Tasfeeh-e-Dam), Munzijate Sauda (Melancholic concoctives), Mushilate Sauda (Melancholic purgatives), Tabreed Badan (genesis of ratoobat or fluids in the body), try to restore normal temperament (Tadeele Mizaj), topical application of jali (detergent), murakhi (emollient), murattib and mohallil (anti-inflammatory) advia. Methodology: Through ancient unani literature and modern journals related to the concept and management of Bars-e-Aswad (plaque psoriasis). Conclusion: Present review has been studied about concept of Bars-e Aswad (Plaque psoriasis) and its management in unani system of medicine Keywords: Bars-e Aswad, Plaque psoriasis, Unani medicine.
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Background: Non-specific low back pain is a leading contributor to disease burden and works absenteeism worldwide with a lifetime prevalence of 60-70% in industrialized countries. This clinical study aimed to assess the efficacy of hot fomentation with half-baked medicated bread (khubz) compared to hot water bag fomentation to alleviate pain and disability in non-specific low back pain. Methods: In this randomized-controlled study, fifty-four patients with low back pain were randomly assigned into two groups to receive either hot fomentation (Takmīd-e-haar) with half-baked medicated bread in the test group or hot water bag fomentation in the control group, on the lumbosacral region daily for 30 min for 15 consecutive days. Patients were assessed statistically using the visual analogue scale (VAS) and Oswestry disability index (ODI) at baseline, 7th and after treatment (15th day). Results: After the intervention, statistically significant improvements (p < 0.001) were observed in VAS and ODI scores in both the groups on the intragroup comparison. The test treatment showed better efficacy in comparison to the control treatment with a mean difference of 1.75 in VAS (p < 0.0001) and 8.20 in ODI (p = 0.001). Conclusion: The tested intervention showed significantly better efficacy in comparison to the hot water bag fomentation probably due to the analgesic (musakkin-i-alam), anti-inflammatory (muḥallil-i-awrām), and demulcent (mulaṭṭif) properties of the ingredients of tested Unani formulation in addition to the effects of heat. It may therefore be concluded that medicated fomentation is an effective, safer, feasible, and less expensive regimen for patients with non-specific low back pain. Trial registration: The Clinical Trials Registry-India (CTRI/2020/03/024107).
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According to classical literature of Unani Medicine, management of any disease depends upon the diagnosis of disease. In the diagnosis, clinical features, i.e., signs, symptoms, laboratory investigations and mizaj (temperament) are important. Any cause or factor is countered by Quwwat-e-Mudabbira-e-Badan (the power of body responsible to maintain health), the failing of which may lead to quantitatively or qualitatively derangement of the normal equilibrium of Akhlat (humors) of body which constitute the tissues and organs. This abnormal humor leads to pathological changes in the tissues anatomically and physiologically at the affected site and exhibits the clinical manifestations. The distinctive feature of the Unani system is its emphasis on the diagnostic importance of Nabz (the pulse). Nabz is the rhythmic expansion of the arteries which is felt by the fingers of the physician. Other methods of diagnosis include examination of Baul (urine) and Baraz (stool). After diagnosing the disease, Usool-e-Ilaj (principle of management) of disease is determined on the basis of etiology. The principle of management is decided which may be one or more of the four types of treatment lines such as Ilaj bil-Tadbeer (Regimental therapy), Ilaj bil-Ghiza (Diet therapy), Ilaj bil-Dawa (Pharmacotherapy), Ilaj bil-Yad or Jarahat (Surgery). Details about Ilaj bil-Tadbeer is described in this paper
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ABSTRACT The whole world are worried about non- infectious diseases and life style disorders like osteoarthritis, cervical spondylosis, lumbar spondylosis, PIVD, hypertension, diabetes mellitus, diabetic foot, skin disorders, psychological disorders, muscular disorders etc. Various methods or technics of Ilaj-Bil-Tadbeer (Regimental /Regimenal therapy) are used for such type of problem and disorders for preventive as well as curative measures by Unani physicians for thousand years. Ilaj-bil-Tadbeer (Regimental therapy) basically application of certain special techniques or physical methods of treatment to improve the constitution of body by removing waste materials and improving the defence mechanism of body to protect the health by Unani physians for a long time. It is also considered for the Istifraagh-e-akhlaat-e-radiya (evacuation of morbid humours) from the body. Because morbid humours are true culprits are responsible for the onset of disease. As soon as these morbid humours are removed from the body by applying some regimens, normal health gets restored. In other words, regimental therapy (Ilajbil- tadbeer) are mostly non medicinal technics or procedures by which Unani physicians modulate the patient‟s habitat, life style and dietary habits of the patient. The role of Ilaj-bil-tadbeer (regimental therapy) as non-medical therapy mentioned in unani system of medicine will be discussed in detail in this paper. KEYWORDS: Ilaj-bil-Tadbeer, Regimental therapy, Istifraagh-e-akhlaat-e-radiya.
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Unani System of Medicine has four modes of treatment and these are; ʹIlāj bil Ghizā (Dietotherapy), ʹIlāj bit Tadbīr (Regimenal Therapy), ʹIlāj bid Dawā (Pharmacotherapy) and ʹIlāj bil Yad (Surgery). Ilaj bit Tadbīr is a mode of treatment which works on the principle of modification or modulation in Asbāb sitta ḍarūriya (Six Essential Factors) for gaining health in sick persons or preventing from diseases in normal individuals. ʹIlāj bit Tadbīr includes a number of therapeutic interventions such as Hijāmah (Cupping Therapy), Irsal-i-ʹAlaq (Leech Therapy), Fasd (Venesection), Dalk (Massage), Nutūl (Irrigation), Ābzan (Sitz bath) etc. Among these, ābzan is a novel, simple, safe, economic, non-invasive and effective external mode of treatment for various disorders. It is basically a type of bath in which only buttock and hips are immersed in the water, either plain or medicated (Joshānda or Khaisānda) for therapeutic purposes. Sometimes, a whole body upto shoulder is immersed into the water. This regimen is used to relieve discomfort and pain in the lower as well as upper parts of the body, for example, haemorrhoids, uterine cramps, inflammatory bowel disease, an episiotomy, infections of bladder, prostate, vagina etc. Ābzan also provides relief from itching in genital area. Even though no scientific evidence is available to indicate that ābzan can promote faster healing but it is widely described in unani system of medicine for various body ailments.
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Waj al-Zahr (pain in lower back) is typically defined as pain in the lumbo-sacral area of the back which is sometimes radiated to the lower extremities of the body including buttocks, hips, thighs and legs. It is usually caused by muscle strain, degenerative disorders of vertebral column, herniated vertebral discs, gynaecological disorders in females etc. In Unani Medicine, the low back pain is known as Waj al-Zahr which is dealt under Waj al-Mafasil (arthritis). Regimenal therapy is one such core mode of treatment through which the morbid humour is diverted/ eliminated or its excessive production is checked or its spread is arrested and ultimately resolved by tabiyat (physic) of the body. Inkibab (steam application) and Hijama Muzliqa (massage cupping) are regimenal modes which are being used for the treatment of various diseases including Waj al-Zahr. A 23 year old female patient was admitted in the IPD of Regional Research Institute of Unani Medicine, Srinagar, J & K, with the chief complaint of pain in lower back. She was treated by Inkibab (steam application) from the decoction of Gul-e-Teesu (Butea monosperma flowers) and Hijama Muzliqa (massage cupping) daily for six days. At the end of the treatment and post treatment follow ups, the patient got complete relief from lower back pain. Therefore, this study suggests that Inkibab and Hijama Muzliqa may be useful in the treatment of Waj al-Zahr (Non-specific low back pain).
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The Unani system of medicine is principally based on humoural theory which was propounded by Hippocrates. According to this theory, health and disease depends on the equilibrium of four humours i.e. blood, phlegm, yellow bile and black bile. From the ancient times, experiment on animals has been part of research for so many discoveries in Unani system of medicine. The notable ancient Unani physicians such as Aristotle and Erasustratus have dissected animals for the study of anatomy and physiology of various organs. Both of them have been considered as pioneers of anatomy in medical science. The most notable ancient Unani physician Galen has also performed vivisections. He did experiment on roosters to evaluate the efficacy and safety of one of the most commonly used antidote i.e. tiryaq. Ibn al-Nafis described blood circulation in mammals. Razi had tested toxicity of mercury in monkeys. Ibn Zuhr, a most versatile physician had developed some surgical procedures in animals before applying them on human being. Presently, animals are integrally being used for the evaluation of safety and efficacy of drugs. The antiarrythmic property of Ajamline has been first tested in animals. Likewise, cardioprotective effect of Khamira abresham Hakim Arshad Wala has been evaluated in isoproterenol-induced myocardial necrosis in rats. All these studies amply prove that preclinical studies are also part of biomedical research in Unani medicine since its inception.
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Migraine is a type of headache characterized by episodic throbbing or pulsating pain usually occurring in one side of the head. According to the prevalence report, it is the third most prevalent disorder worldwide. In Unani Medicine, it is called shaqiqa derived from an Arabic word 'shaq' meaning 'half part'. The condition is difficult to treat by medication only. Unani system of medicine has a theory of imala (diversion of morbid matters) and tanqia-e-mawad (evacuation of morbid matters) by using different modes of ilaj bit tadbeer (regimenal therapy) and pharmacotherapy. A therapy including regimenal therapy and pharmacotherapy has been used in this case for 23 days. Nutool (irrigation therapy) and Dalak (massage therapy) by Rogan-e-Kaddu (medicated oil) were given as regimenal mode and Itrifal Ustukhuddus, Itrifal Kishnizi and Jawarish Shahi were given orally as pharmacotherapy. Signs and symptoms were assessed by Visual Analogue Scale (VAS) and result was assessed as per grading system, such as complete relief, relief, partial relief and no relief. After completion of the treatment and post treatment follow up, complete relief from the sign and symptoms was observed. The study suggested the authenticity of principles of treatment of Unani Medicine.
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The physical and mental health of a human being is largely dependent upon good nutrition. The carbohydrates, lipids, proteins, vitamins and minerals are considered as nutrients that are consumed from vegetable, animal and mineral sources. A well-balanced diet with adequate intake of proteins, fats, carbohydrates, vitamins and minerals, is necessary for good nutrition and for maintaining health and preventing diseases. Many Unani physicians such as Hippocrates, Galen, Rhazes, Ibn Zohar, Ibn Sina etc have compiled several books on dietetics. The makool va mashroob (food and drink) is one of the vital factors among the six essential prerequisites for preservation of life as described in Unani medicine. All the forms of diet have been classified according to the nutritional value and chyme viz. light and soft diet, attenuated highly nutritious, attenuated less nutritious, attenuated highly nutritious and good chyme forming diets etc. Some modified diets viz. barley water, mutton soup, whey, honey water, nabeez, vinegar, aabkama, murabba, halwa, gulqand etc are recommended alone or as adjuvant for the treatment of several body ailments. Selective diets are also advised according to the diseases viz. massor dal (red lentil) along with vinegar in headache, mutton of young sheep in melancholia, goat's milk in tuberculosis etc. The dietotherapy is widely acceptable, accessible and above all affordable to the patients with near nil adverse reactions. In present scenario, several life style disorders viz. hypertension, diabetes, dyslipidaemia and other diseases viz. anaemia, malnutrition, vitamin deficiency etc can be managed by selectisng appropriate diet either alone or as adjuvant with pharmacotherapy. Therefore, the study of clinical nutrition and dietetics is in vogue since centuries and the same is now scientifically validated with precision. This mode of treatment is widely prescribed by Unani physicians in various disorders successfully provided the basic fundamental principles of Unani medicine is judiciously followed, i.e. Ilaj biz Zid (antagonistic treatment). Hence the dietotherapy an integral mode of Unani treatment if adopted prudently will go a long way in alleviating the suffering of humanity.
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Otomycosis is a fungal infection of external auditory canal characterized by itching, pain, sensation of ear blocking, impaired hearing and/ or ear discharge. Two diagnosed cases of otomycosis were treated with nufookh (insufflation) therapy at E.N.T. OPD, HSZH Govt. Unani Medical College, Bhopal, Madhya Pradesh, India in 2017. Previously, the both patients were being treated with different allopathic antifungal ear drops and got temporary relief. The nufookh (insufflation) therapy of a compound Unani formulation, containing Mur makki, Kundur, Suhaga, Rasout and Phitkari was used for the treatment of both cases and showed significant result. It is recommended that this cost effective therapy with no reported adverse effect can be used for the treatment of uncomplicated cases of otomycosis.