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Reviews
Athar Parvez Ansari*
‘Ilājbi’l-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),
ta‘līqal-‘alaq (hirudotherapy/leech therapy), ishāl(purga-
tion), 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 man-
agement 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 regi-
menal therapy used in Unani medicine.
Keywords: ‘Ilājbi’l-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 (460–370 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), a’dā’
(organs), arwāh(pneuma), quwā(faculties) and af’āl
(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 faculties’viz. tabī‘at mudabbir-i-
badan (medicatrix naturae) [1]. Tabī‘at (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 influ-
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
classified 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 classified
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): 449–458
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 ‘ilājbi’l-tadbīr(regimenal ther-
apy), ‘ilāj bil ghizā(dietotherapy), ‘ilājbi’l-dawā’(phar-
macotherapy) and ‘ilājbi’l-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
orifices and the humoural equilibrium is restored by the
tabī‘at (physis) [5].
‘Ilājbi’l-Tadbīr(regimenal therapy)
‘Ilājbi’l-Tadbīris consisted with two words of Arabic lan-
guage i.e. ‘‘ilāj’which refers treatment and ‘tadbīr’means
‘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-Qanūnfi’l 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-Mukhtarātfi’l Tib compiled by Ibn Hubal (1121
–1213 AD) [14], Kitab al-Umdāfi’l 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) [,
]
.Ta‘līq al-‘Alaq (Hirudotherapy)
[,,,,]
.Aabzān(Sitz bath) []
.Qay’(Emesis) [,,].Ubtan (Skin cleansing)
[]
.Ishāl(Purgation) [,,,
]
.Dimād(Paste) [,,]
.Idrār-i-Bawl (Diuresis) [].Tilā’(Liniment) [,,
]
Ta’rīq(Diaphoresis) .Huqna (Enema) [,,
]
.Imāla (Diversion of morbid hu-
mours) []
.Dhūnī(Fumigation) []
.Riyādat (Exercise) [,,,
]
.Nafūkh (Insufllation)
.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),
ta‘līq al-‘alaq (hirudotherapy), ishāl(purgation), qayi’
(emesis), idrār-i-bawl (diuresis), huqna (enema), ta’rīq
(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 field of lung,
persons on the verge of epilepsy, seizure due to epi-
lepsy, pharyngotonsillitis, internal inflammatory 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 classified into two types:
(i) Hijāma bi’l Shart (cupping with scarification), and (ii)
Hijāma bilāShart (cupping without scarification) [15, 23]
(Figure 2).
(i) Hijāma bi’l Shart (Cupping with scarification):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 flow, painful piles, anal
pain
Vein over the inner
toe
Sciatica, uterine diseases
Saphenous vein Decrease menstrual flow, 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 scarification):
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 fire. Ibn Sina has suggested that the use of fire 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) flatulence, (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 significant
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 significant effect of wet cupping therapy in
decreasing pain and recovering disability in cases of
persistent non-specificlowbackpain,atleastfortwo
weeks after stoppage of the therapy [25].
(4). Ta‘līq 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 inflammation, 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. Scientific 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 beneficial 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 scientific reports have revealed that the leech
therapy possesses significant effects in many diseases.
For example, a clinical study conducted in Germany in
which the leech therapy has showed significant effect
in cases of knee osteoarthritis compare to that of
local application of diclofenac. An experimental study
in animal model showed the significant thrombin
inhibition effect of hirudin in antigen induced arthritis
as the intra-articular fibrin 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 finally 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). Ta’rīq(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 scarification 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-
ba’eed (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
benefits of exercise viz. (i) it provides normal function to all
Table :Sites of cupping with scarification.
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 Inflammatory masses in upper part of thigh,
gout, piles, elephantiasis, diseases of
uterus & bladder, renal congestion
In front of thigh Orchitis, leg ulcers
Behind hips Inflammatory 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 classified
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
scientific studies have revealed the significant effect of
massage therapy. Zarnigar et al. 2012 has reported the
significant 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 significant 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 significant 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. first, 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 beneficial 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 detoxified 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 significant
efficacy 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 difficulties 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 beneficial in the treatment of earache [20].
Athar et al. 2017 has reported the significant effect of steam
application with decoction of Butea monosperma flowers
in combination with massage cupping in a case of non-
specific 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,
barley’sflour, Althea officinalis flowers, Solanum nigrum,
Viola odorata flowers and Nympha alba flowers 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 difficult 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 flow 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
inflammatory 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,flour 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 inflammatory swelling and pain of
various organs of the body [2]. Medicated paste prepared
with pomegranate flower & 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 (Insufllation/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 significant 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 fine powder
of Murdar sang (litharge), rose oil, pomegranate flower 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 flour 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 officinalis leaves, Trigonella foenum greacum,
mucilage of Linum usitatissimum, and white part of egg is
beneficial 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 flow, (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), ta‘līq al-‘alaq (hir-
udotherapy), qay’(emesis), ishāl(purgation), idrār-i-bawl
(diuresis), ta’rīq(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
scientific 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-
fic 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 efficient
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 conflict of interest.
References
1. Ansari AP, Ahmed ZN, Dar PA. Empirical evidence of animals used
in biomedical research in Unani medicine. Int J Unani Integr Med
2018;2:11–3.
2. Rubi A. Regimental therapy (Ilaj bit Tadbeer) an ancient method
for promotion of health and treatment of different diseases. In
International conference on public health: issues, challenges,
opportunities, prevention, awareness. Public Health; 2016:
346–48.
3. Ansari AP, Ahmed ZN, Wadud A, Arif M, Khanday S. Ilaj bil Ghiza
(Dietotherapy): a core mode of Unani treatment. J Adv Res Pharm
Sci Pharmacol Interv 2018;2:27–5.
4. Khan JA, Siddiqui MA, It rat M, Jamal MA. A review on therapeutic
application of Fasd (venesection) in Unani medicine. J Biol Sci
Opin 2014;2:101–2.
5. Ansari AP, Dar PA, Kalam MA, Rather SA, Arif M, Nasir A. Therapeutic
effect of Inkibab (Steam application) and Hijama Muzliqa (Massage
cupping) in case of Waj al-Zahr (Non-specific low back pain): a case
report. J Ayurvedic Herb Med 2018;4:150–3.
6. Sultana A, Ahmad A, Begum M. Ilaj bil Tadbeer, a non-medical
therapy in Unani system of medicine- a review. J Complement
Altern Med 2015;1:1–6.
7. Nasir A, Fatma G, Ali W, Ahmad MA. Role of Ilaj bil Tadbeer
(Regimental therapy) as non-medical therapy in Unani system of
medicine. Eur J Pharm Med Res 2018;5:
213–8.
8. The Complete Book of the Medical Art. Available from: https://en.
wikipedia.org/wiki/The Complete Book of the Medical ArtThe
Complete Book of the Medical Art [Accessed: 01 Apr 2020].
9. ‘Ali Ibn al-’Abbas al-Majusi. Available from: https://en.wikipedia.
org/wiki/%27Ali ibn al %27Abbas al-Majusi [Accessed 01 Apr
2020].
10. Majusi AA. Kamil al-Sanac (Urdu translation by Kanturi GH),
Vol. II. New Delhi: Idarah Kitab al-Shifa; 2010. 55, 84, 87, 182–
5, 187.
11. Majusi AA. Kamil al-Sana, Vol. I, Chapter 5. (Urdu translation by
Kanturi GH). New Delhi: Idarah Kitab al-Shifa; 2010:228.
12. Avicenna. The Canon of medicine (English translation by Gruner
OC). New York: AMS Press INC; 1973. 173, 232–33, 235–7, 383–4,
386–8, 390, 398, 469, 472–3, 477, 481–2, 497–502, 504,
509–10, 525, 529.
13. Tabri R. Firdaus al-Hikmat (Urdu translation by Shah MA). New
Delhi: Idarah Kitab-us-Shifa; 2010. 258, 308–9.
14. Hubal I. Kitab al-Mukhtarat fi’l Tib, Vol. 1 (Urdu translation by
CCRUM). New Delhi: Central Council for Research in Unani
Medicine, Dept. of AYUSH, Ministry of H & FW, Govt. of India;
2005. 271, 277, 279, 287, 290, 295.
15. al-Quff I. Kitab al-Umda fi’l Jarahat, Vol. 1 (Urdu translation by
CCRUM). New Delhi: Central Council for Research in Unani
Medicine, Dept. of AYUSH, Ministry of H & FW, Govt. of India;
1986. 185, 194–6, 199–200, 218.
16. Al-Zahrawi. Jarahiyat-i-Zahrawi, Kitab al-Tasreef (Urdu
translation by Kakorwi NAA). New Delhi: Central Council for
Research in Unani Medicine, Dept. of AYUSH, Ministry of H & FW,
Govt. of India; 2012. 3, 174, 182, 187.
17. Rushd I. Kitab al-Kuliyat (Urdu translation by CCRUM). New Delhi:
Central Council for Research in Unani Medicine, Ministry of H &
FW, Govt. of India; 1987. 344–7.
18. Jurjani AH. Zakhira Khawarizm Shahi, Vol. III (Urdu translation by
Khan HH). New Delhi: Idarah Kitab al-Shifa; 2010. 101, 118, 127,
129–30, 137–8, 225–7, 232, 234.
19. Khan MS. Elaj al-Amraz (Urdu translation by Kabeeruddin M).
New Delhi: Ejaz Publishing House; 2006. 10 14–5, 21, 24–7,
31–2, 35–6, 170.
20. Kabeeruddin M. Al-Qarabadeen, 2nd ed. New Delhi: Central
Council for Research in Unani Medicine, Dept. of AYUSH,
Ministry of H & FW. Govt. of India, 2006. 3–7, 25, 48, 252, 682,
685, 957, 1252.
21. Razi ABMZ. Kitab al-Mansuri (Urdu translation by CCRUM). New
Delhi: Central Council for Research in Unani Medicine, Ministry
of H & FW, Govt. of India; 1991. 170–1, 283–4, 391–4.
22. Qureshi NA, Ali GI, Abushanab TS, El-Olemy AT, Alqaed MS, El-
Subai MS, et al. History of cupping (Hijama): a narrative review of
literature. J. Integr Med 2017;15:172–81.
23. Mehta P, Dhapte V. Cupping therapy: a prudent remedy for a
plethora of medical ailments. J Tradit Complement Med 2015;5:
127–34.
24. Khan AA, Jahangir U, Urooj S. Management of knee
osteoarthritis with cupping therapy. J Adv Pharm Technol Res
2013;4:217–23.
25. AlBedah A, Khalil M, Elolemy A, Hussein AA, AlQaed M,
AlMudaiheem A, et al. The use of wet cupping for persistent
non specific low back pain: randomized controlled clinical
trial. J Altern Compl Med 2015;21:504–8.
26. Lone AH, Ahmad T, Anwar M, Habib S, SofiG, Imam H. Leech
therapy- a holistic approach in Unani (Greeko-Arab) medicine.
Anc Sci Life 2011;31:31–5.
27. Sina I. Al-Qanoon fi’l Tib, Vol. I (Urdu translation by Kantoori
GH). New Delhi: Ejaz Publishing House; 2010. 220, 228–30
pp.
28. Nigar Z, Alam MA. Effect of Taleeq (leech therapy) in Dawali
(varicose veins). Anc Sci Life 2011;30:84–91.
29. Firdaus S, Sultana N. Regimenal therapy, a drug less therapy for
well being of a person in USM and its important place in the
mainstream treatment of USM. J Complement Med Altern Health
Care 2018;8:1–11.
30. Kabeeruddin M. Kuliyat-i-Nafeesi. New Delhi: Idarah Kitab al-
Shifa; 1954. 481–3.
31. Ahmad K, Jahan N, Aslam M, Kausar HS, Khalid M, Ali H. Dalak
(massage) in Unani medicine: a review. Int J Adv AYUSH 2014;3:
162–74.
Ansari: Regimenal therapy: A core mode of Unani treatment 457
32. Zarnigar RA. Role of Dalak (Massage) and Riyazat (Exercise) in the
rehabilitation of patients with post stroke hemiplegia. Indian J
Tradit Know 2012;11:738–44.
33. Amanullah H, Anwar M, Nasir A, SofiG, Husain S. Efficacy of
massage with Roghan Seer in motor recovery in hemiplegia
secondary to ischemic stroke. Indian J Tradit Know 2011;10:
731–35.
34. Husain A, Ahmad T, Anwar M, SofiG, Akhtar MS. Role of massage
therapy in the management and prevention of diseases: a case
series of medicated massage. Int J Res Ayurveda Pharm 2011;2:
1474–7. .
35. Jamal MA, Khan MA. Kitab al-Tadbeer. New Delhi: G. L.
International Publisher; 2017. 53–5, 55–6, 63, 291, 308–9.
36. Kabeeruddin M. Bayaz-i-Kabeer, Vol. II. New Delhi: Idarah Kitab
al-Shifa; 2010. 21.
37. Azam R, Mushtaq S, Fassihuzaman, Jabeen A, Zaidi Z, Alam S.
Nutool (Irrigation) –an effective mode of treatment in Ilaj bit
Tadbeer (Regimenal therapy). Indo Am J Pharm Res 2014;4:
5787–91.
38. Nikhat S, Fazil M. An analytical review on Nutool (Irrigation)
therapy. J Drug Deliv Therapeut 2015;5:1–4.
39. AnsariAP,IslamN,WadudA,ArifM.Efficacy of a
combined therapy in Shaqiqa (migraine without aura) –a
case report. J Ayurvedic Herb Med 2018;4:53–6.
40. Ghani N. Khazain al-Advia. New Delhi: Idarah Kitab al-Shifa, YNM.
109.
41. Nayab M. Abzan (Sitz bath) –an effective mode of treatment in
Ilaj bit Tadbeer (Regimenal therapy). Pharma Innovation J 2016;
5:45–9.
42. Arif M, Ansari AP. Otomycosis treated with Nufookh
(Insufflation) therapy in Unani system of medicine: a case
report. Int J Unani Integr Med 2018;2:128–31.
43. Qureshi EH. Muqadma-i-Ilm al-Adwiya. New Delhi: Ejaz
Publishing House; 1995. 96.
458 Ansari: Regimenal therapy: A core mode of Unani treatment
