Content uploaded by Ismath Shameem
Author content
All content in this area was uploaded by Ismath Shameem on Sep 24, 2022
Content may be subject to copyright.
1
CellMed 2022 / Volume 12 / Issue 1 / e5
ReviewArticle
Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive
Review with Scientific Evidence
Rummana Kauser Shabbir Ahmed1*, Ismath Shameem2
1*PG. Scholar,2Prof. Dept of Amraze Niswan wa Ilmul Qabalat (Gynaecology and Obstetrics), National Institute of Unani
Medicine, Bangalore, Karnataka, India
ABSTRACT
Ābzan(sitz bath or hydration therapy) is one of the important and widely practised methods of regimenal
therapy used for local evacuation or diversion of morbid humours described for various diseases in Unani
system of medicine. Itis a type of bath in which hips and buttocks are immersed in water, either plain or
medicated for therapeutic effects. Thus, it serves as an important and effective external mode of treatment.
It has been successfully practised by Greeko-Arab physicians in the management of almost all types of
gynaecological disorders like genital prolapse, leucorrhoea, pruritus vulvae, menstrual disorders,
infertility, pelvic inflammatory diseases etc, but its efficacy has been proved in very few gynaecological
diseases only. Hence, there is a need for systemic review to investigate the effectiveness of sitz bath in
gynaecological disorders to generate scientific based evidence for the clinician as well as for common
public. Based on the available literature, this review article suggests that the sitz bath has a scientific
evidence-based effect in treating gynaecological diseases.
KeywordsIlaj Bit Tadbīr, Regimenal Therapy, Ābzan, Sitz Bath, Gynaecological Disorders
INTRODUCTION
Unani system of medicine has its unique observations and
resultant methodologies for defining and treating various
gynaecological diseases. It is based on the concept of
equilibrium and balance of natural body humors, the imbalance
in the quality and quantity of these humors leads to diseases,
whereas restoration of this balance maintains the health of a
person (Peerla, 2019).Ilaj Bit Tadbīr (Regiminal therapy) is
defined as intervening and modulating the six essential factors
of life to preserve and to restore health. Regiminal therapy is
one of the main methods of treatment through which the altered
temperament is normalized or morbid matter is either
eliminated or resolved by some special techniques and hence
restores the humoral equilibrium(Nayab, 2016). These are
simple, and time-tested methods used to treat various disorders,
and thus serve as a complete detoxification process if used both
for preventive and therapeutic purposes(Peerla, 2019).
The introduction of sitz bath is credited to Vincent
Priessnitz in the early 1800s, an Austrian farmer known as the
“father of hydrotherapy.” Its name is derived from the German
verb "sitzen," meaning "to sit." A sitz bath is a type of bath in
which only the hips and buttocks are immersed in luke warm
water or with decoction prepared from herbs (Bahadorfar,
2014).Ābzan (sitz bath or hydration therapy) is one of the
important, widely practised methods of regimental therapy used
for local evacuation or diversion of akhlat-e radiya (morbid
humours) (Akhtari, & Mokaberinejad, 2017).
This regimen is frequently recommended by Unani
physicians in gynaecological disorders like genital prolapse,
leucorrhoea, pruritus vulvae, menstrual disorders, infertility,
pelvic inflammatory diseases, vaginal infections uterine cramps,
healing of episiotomy wound, etc to enhance pelvic circulation,
resolve inflammation, relieve pain and itching and promotes
wound healing, and scientific studies has proved that sitz bath
stimulates lymphatic system, increase circulation and remove
toxins (Ahmed, 2011; Peerla, 2019; Sitz bath in gynaecology
(www.encyclopedia.com)). However, there is a need for
systematic review intends to investigate the effectiveness of
sitz bath in gynaecological disorders to generate scientific
based evidence for the clinician and patients.Present article
focuses the role of sitz bath in various gynaecological disorders,
highlighting it as one of the most effective and safest treatment
in USM.
METHODOLOGY
Classical Unani text was extensively searched to compile the
nuskha’s of Ābzan (single or compound) for various
gynaecological diseases. Then, online search was done through
major scientific search engines such as Scopus, PubMed,
Google Scholar and Science Direct with key words: Ilaj
BitTadbīr, Ābzan, Sitz Bath, scientific evidence of efficacy and
safety of sitz bath in various Gynaecological disorders.
UNANI CONCEPT
Definition
Ābzan (Sitz Bath)is basically a type of bath in which only
buttock and hips are immersed in water, either plain or
medicated (Joshānda or Khaisānda) for therapeutic purposes
(Abu, 1988; Hasan, 2011; Kamaluddin, 2004). This therapy
*
Correspondence:Rummana Kauser Shabbir Ahmed
E-mail: rummanakauser22@gmail.com
Rec eiv ed
Sep 1 6, 20 21;
Acc epted
Feb2 5, 20 22 ;
Pu blishe d
Fe b2 8, 20 2
2
doi: http://dx.doi.org/10.5667/CellMed.2022.005
©2022 by CellMedOrthocellular Medicine Pharmaceutical Association
This is an open access article under the CC BY-NC license.
(http://creativecommons.org/licenses/by-nc/3.0/)
Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive Review with Scientific
Evidence
2
CellMed 2022 / Volume 12 / Issue 1/ e5
may help in disinfection of the affected organ by preventing the
growth of infectious agents or by removing the morbid matter,
together with strengthening and activating the organ in order to
restore its health (Akhtari, & Mokaberinejad, 2017).
Types of Sitz Bath (SB) (Table 1)
1. Ābzan ḥār (Hot Sitz Bath)
2. Ābzan bārid (Cold Sitz Bath)
3. Ābzan mo’tadil (Neutral Sitz Bath)
4. Ābzan murakkab (Alternate Hot and Cold Sitz Bath/
contrast) (Hamdani, SKH., 2001)
Table 1. Description of different types of sitz bath (Nayab, 2016; Sitz bath in gynaecology (www.encyclopedia.com))
Pre-requisites for SB Hot SB Cold SB Neutral
SB
Contrast/Combined/
Alternate SB
Water level Half inch below the
umbilicus
Half inch below the
umbilicus At umbilicus Half inch below the umbilicus
Temperature 105-1150F 55-750F 92-980F105-115
0
F for 2-5 mts then 55-
850F for 20-60 sec.
Duration 3-10 mts 30 sec-8 mts 15mts -2 hrs
·
Repeat for 3-5 cycles.
·Always finish with cold
SB.
·A typical cycle would be
3 mts hot and 30 sec cold.
·Temperature & duration
can be altered according
to patient’s strength.
Physiologic effect
·Vasodilatation
·Increased capillary
permeability
·Increased blood
flow
·Increased cellular
metabolism.
·
Vasoconstriction
·Decreased capillary
refill
·Decreased cellular
metabolism
·Local anaesthetic
effects
·Decreases bleeding
& congestion
·Slows bacterial
growth
-
·Increases venous and
lymphatic flow
·Causes deep tissue
vasoconstriction.
Therapeutic Uses
·
Decreases pain
·Relaxes muscle
·Increases blood
flow
·Softens exudates
·Increases elasticity
of connective
tissues
·Acute injury/trauma
·Chronic pain
·Muscle spasm
·Inflammation, and
·Edema
-
·Minimising the influence
of accumulated morbid
material at the injured site
while the healing process
is taking place
Mechanism of action
·Increasing tissue
temperature
·Stimulates
vasodilatation
hence, increases
tissue blood flow,
which promotes
healing by
increasing the
supply of nutrients
and oxygen to
injured site.
·
Activates
sympathetic
vasoconstrictive
reflex
·Prevents secondary
hypoxic damage in
injured tissues by
reducing
metabolism demand
·Inhibition of a
spinal cord reflex
loop
-
·“Pumping effect” due to
the cycle of
vasoconstriction and
vasodilatation, therefore
facilitating Imala-e-
Mavad resulting in
removal of the edematous
conditions.
Procedure
Certain specific instructions should be given to the patients for
Sitz bath, including the temperature of water and device to be
used, such as
·Prepare Sitz bath and add herbs or extracts as
preferred.
·Water should not be too hot or too cold to cause
discomfort to the patients.
·Instruct the patient to remove the cloth and get into
the tub, so that the hip and buttocks are immersed in
the water; keep the legs to the side of the tub.
·Ensure that the patient is covered and does not get
chilled or feel discomfort, especially during extended
treatment.
·Instruct the patient to stay in water for recommended
period.
·Instruct the patient to dry with a clean cotton towel
and rest at least for 30 minutes.
·Instruct the patient not to rub or scrub the perineum,
as this may cause pain and irritation. (Sitz bath in
gynaecology (www.encyclopedia.com))
Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive Review with Scientific
Evidence
3
CellMed 2022 / Volume 12 / Issue 1/ e5
It is useful to classify these gynaecological conditions into
basic categories, so as to use appropriate type of sitz bath in
different conditions (Table 2).
Table 2. Indications of Ābzan (Sitz bath) in Gynaecological Disorders in USM
S. No. Indication Unani drug / formulation Preparation References
1Quruh-al- Rahim
(cervical erosion)
·Mazu, Juft Baloot, Khubs ul Hadeed, Shib
Yamani, Zaj
Use filtered water for Ābzan
after boiling all the medicine
in water
(Razi, 2001)
·Hhabul aas, saroo leaves do (Bughdadi, 2001)
2Saylan-al- Rahim
(Leucorrhea)
·
Methi, Tukhme Katan, Tukhme Khatmi,
Birinjasaf do (Razi, 2001)
·Roghan gul, Luke warm water Ābzan with mixture of roghan
gul and luke warm water (Razi, 2001)
·Mazu Ābzan with mazu decoction (Razi, 2001)
·Mazu, Juft Baloot, Khubs ul Hadeed, Shib
Yamani, Zaj
Use filtered water for Ābzan
after boiling all the medicine
in water
(Razi, 2001)
3Sartan-al- Rahim
(Uterine Cancer)
·Methi, Khatmi, Khubbazi do (Razi, 2001)
·
Barg Khatmi, Karnab, Banafsha, Tukhme
Katan do (Khan, 2003)
·
Banafsha, Nilofer,Marzanjosh,Hulba,Tamar
Hindi,Karam Kalla,Khatmi, Khubbazi do (Bughdadi, 2001)
4Waram-al-
Rahim(Metritis)
·Methi, Tukhme Khayar, Tukhme Katan do (Razi, 2001)
·Soya, Khatmi do (Akbar, 2002)
·
Nakhoona, Baboona, Hulba, Alsi, Karam
Kalla do (Hasan MQ, 2011)
·Bartang do (Jurjani, 2010)
·Ab Sheereen, Roghan gul do (Sina, 2010)
·Astringent drugs do (Qamri, 2008)
·
Katan, Baboona, Nakhoona, Karnab, Kali
Tulsi (Advia mulayyina) do (Razi, 1991)
·
Tukhme katan, Tukhme Tera Tezak, Tukhme
Gazar, Tukhme Shaljam, Sudab, Lablab,
Badiyan, Barg Karafs, Gandana, Karam
Kalla, Piyaz, Roghan Zaitoon
Use filtered water for Ābzan
after boiling all the medicine
in water
(Kamaluddin, 2004)
5Waja-ur-Rahim
(Uterine Pain)
·Barg Ghar do (Razi, 2001)
·Waj do (Razi, 2001)
·Qust do (Razi, 2001)
·Soya do (Razi, 2001)
·
Hulba, Tukhme Katan, Marzanjosh, Podina,
Babona, Aklilul Malik, Birinjsif, Khairi do (Razi, 2001)
6Mailan-al–Rahim
(Uterine inversion)
·
Murattab advia -Kahoo, Kishneez, Nilofer
Sandal do (Akbar, 2002)
7Bawaseer-al-rahim
(Uterine polyp)
·Nakhoona, Baboona, Methi, Tukhme Alsi do (Akbar, 2002),(Sina,
2010)
·
Qabid Advia- Aqaqia, Gulnar,
Aas,Nagarmotha do (Bughdadi, 2001)
8
Waram furj wa
mahbil (Vulvitis &
Vaginitis)
·Tukhme Hulba, Tukhme Khatmi, Gule
Baboona, Mako Khushk do (Hasan MQ, 2011)
9Nafakh-al- Rahim
(Physometra)
·
Sudab, Tukme Fanjkusht, Qantoryun,
Birinjasaf, Podina, Marzanjosh, Aftimoon,
Saleekha, Nankhwa, Izkhir
do (Khan, 2003),(Sina,
2010)
·Chirayta, Birinjasaf, Aklil ul Malik do (Razi, 2001)
·
Sudab,Shambhalu,Qantaryun,Zeera,
Birinjasaf, Marzanjosh, Anisun, Podina
Jangli, Tukhme Karafs, Ajwain, Saleekha
do (Jurjani, 2010)
10 Istehaza
(AUB)
·Aab Qumqum do (Khan,
2003),(Qamri, 2008)
·
Aas, Gule Surkh, Post Anar, Kharnob Nabti,
Gulnar, Reehat ul Tees, Mazu Sabz, Footnaj do (Sina, 2010)
Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive Review with Scientific
Evidence
4
CellMed 2022 / Volume 12 / Issue 1/ e5
11 Ikhtenaq-ur-Rahim
(Hysteria)
·Abhal, Marzanjosh, Soya, Qaisoom do (Jurjani, 2010),
(Razi, 2001)
·
Banafsha, Marzanjosh,Nakhoona, Satar
Baboona, Birinjasaf do (Bughdadi, 2001)
12
Iḥtibās al-
Ṭamth(Amenorrhoea/
PCOD)
·Birinjasif do (Razi, 2001)
·Baboona do (Razi, 2001)
·Murr do (Razi, 2001)
·Fashra do (Razi, 2001)
·Footnaj, Sudab, Mushkatramshee, do (Akbar, A. A.,
YNM)
·Jaoo Sheer, Qirdmana, Hilteet,Sakbeenaj do (Akbar, A. A.,
YNM)
·Khatmi do (Razi, 2001)
·
Sudab, Abhal, Karafs, Karnab, Raziyanaj,
Mushkatramashee do (Majoosii, 1991),
(Sina, 2010)
·Methi, marzanjosh,baboona, soya do (Jurjani, 2010)
·
Karafs,Karnab,Raziyanaj,Sudab,Birinjasaf,
Abhal,Footnaj do (Majoosii, 1991)
·
Joshanda Advia Mulattifa- Podina,Shibbat,
Marzanjosh,Suddab,Baboona,Nakhoona,Sat
ar,Qirdmana,Kalonji,Heeng, Asarun,Doqu
do (Jurjani, 2010),
(Khan, 2003)
13 Kaṭhrat-i-Tamṭh
(Menorrhagia)
·Gulna, Aas,Gule Surkh, Mazoo, Post Anar do (Akbar AA, YNM)
·Aas do (Akbar AA, YNM)
·
Gulnar, Post Anar,Joz Sard, Juft Baloot,
Mazu, Kharnob, Murad, Kundur, Qarz,
Tarasees,Qishar
do (Bughdadi, 2001)
14 Inzilaq-ur-Rahim
(Uterine Prolapse)
·
Gulnar, Post Anar,Joz Sard, Juft Baloot,
Mazu, Kharnob, Murad, Kundur, Qarz,
Tarasees,Qishar
do (Bughdadi, 2001)
·Aas do (Razi, 2001)
·Aab Qumqum do (Razi, 2001)
·Mastagi do (Razi, 2001)
·
Joz, Aas, Saru, Gulnar, Jufte Baloot, Qashr,
Roghan Gul do (Razi, 2001)
·Barg Suddab do (Razi, 2001)
·Saroo, Joz Saroo, Abhal do (Razi, 2001)
·Izkhir, Aas, Gule Surkhab do (Razi, 2001),(Sina,
2010)
·
Qabid Advia- Aqaqia,
Gulnar,Aas,Nagarmotha do (Bughdadi, 2001)
15 Salabat Rahim
·Barg Karnab Shami, Namak do (Razi, 2001)
·Fardeen do (Razi, 2001)
16
Isterkha fame Rahim
(cervical
incompetence)
·Mazoo, Juft Baloot, Khubs ul Hadeed, Zaj,
Shib Yamani, do (Razi, 2001)
17
Kharish-e-Miq’ad/
Kharish-e-rahim
(Pruritus in Ano/
pruritus vulvae)
·Lukewarm Water do (Razi, 2001)
·Post Khashkhash,Gulab, Gulnar do (Razi, 2001)
18 Dyspareunia ·Sharab, Advia Qabida, Roghan Zaitoon do (Sina, 2010)
19 Uqr
(Infertility)
·
Sudab, Abhal, Karafs, Karnab, Raziyanaj,
Mushkatramashee do (Majoosii,
1991),(Sina, 2010)
·
Karafs, Karnab, Raziyanaj, Sudab,
Birinjasaf, Abhal, Footnaj do (Majoosii, 1991)
·Methi, Marzanjosh,Baboona, Soya do (Jurjani, 2010)
·
Shibbat,Podina,Marzanjosh,Suddab,Baboon
aa,
Nakhoona,Satar
do (Khan, 2003)
·
Saad koofi ,Sumbulut Teeb, Qust, Mazu,
Aqaqiya do (Qamri, 2008)
·
Anjeer, Baboona, Hulba, Tukhme Alsi,
Maghz Tukhme Qurtum do (Akbar AA, YNM)
Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive Review with Scientific
Evidence
5
CellMed 2022 / Volume 12 / Issue 1/ e5
Most of the gynaecological conditions are included in four
basic categories, which are as follows:
·Spasmodic: dysmenorrhea, chronic pelvic
inflammatory disease
·Inflammatory: acute PID, vaginitis with pruritis,
endometriosis
·Congestive: uterine fibroids, vaginitis without pruritis,
amenorrhea, PCOS
·Prolapse: prolapse, menometrorrhagia, enuresis
For Spasmodic conditions - hot sitz baths are recommended.
For congestive pelvic conditions like PCOD, infertility, uterine
fibroids etc, salt sitz baths and sulphur sitz baths are
recommended.
For inflammatory conditions like endometriosis, or vaginitis
with discharge, neutral to hot salt baths are recommended.
For Genito Urinary Prolapse -sitz bath with astringent drug are
recommended.
Sitz bath can be categorised as follows: contrast sitz baths
when there is oligo/amenorrhoea and cold sitz baths when there
is excessive menstrual flow. (Sitz bath in gynaecology
20 Kasrat isqat
(Recurrent abortion)
·Masooor, Post Anar,Mazu,Aas do (Qamri, 2008)
·
Saad Koofi, Sumbulut Teeb, Qust, Mazu,
Aqaqiya do (Qamri, 2008)
·Aas do (Khan, 2003)
·
Sandal Safaid, Barg Neelofer, Aqaqiya,
Tukhme Moorad, -each 10.5g
·Gulnar 6g, Gul Surkh 100g
do (Khan, 2003)
·
Gul surkh -10g, Gulnar, Kaz Mazuj-25g,
Barg Moorad-14g, Shib Yamani, Mazu, Post
Anar-each 1.5g.
do (Khan, 2003)
·
Adas, Gulnar,Post Anar,Anjeer Khushk,
Halela, Sirka do (Akbar AA, YNM)
·Karnab, alsi do (Akbar AA, YNM)
21 Rija
(Pseudo pregnancy)
·Loghaziya do (Sina, 2010)
·
Gul khatmi, Gul Baboona, each 25g,
Nakhoona, Mako Khushk, Marzanjosh,
Badiyan, Tukhme Hulba, Tukhme Alsi, Barg
Karnab, each 12g
Use filtered water for Ābzan
after boiling all the medicine
in 4 lit of water.
(Sina, 2010)
·Tukhme Hulba, Tukhme Khatmi,Gul
Baboona, Mako Khushk -each 12g
Use filtered water for Ābzan
after boiling all the medicine
in water.
(Hamdani, 2001
22
Usr wiladat
(Dystocia)
·Luke warm water do
(Akbar AA, YNM),
(Khan, 2003), (Sina,
2010)
·Footnaj
Use filtered water for Ābzan
after boiling footnaj in water
with 1:10 ratio
(Sina, 2010)
·Baboona, Shibbat, Marzanjosh, Nakhoona
Use filtered water for Ābzan
after boiling all the medicine
in water
(Khan, 2003),
(Akbar AA, YNM)
·
Nakhoona, Baboona, Hulba, Katan, Mako,
Marzanjosh, Majeethh- each 30g.
·Banafsha, Barg Neem, Barg Karnab, Barg
Shambhalu,, Barg Shibbat, Bastan Afroz,
Khubbazi, each 70g.
do (Khan, 2003)
·Podina
Use filtered water for Ābzan
after boiling 180g podina in
water
(Razi, 2001)
·Zard khairi ki kali
Use filtered water for Ābzan
after boiling all the medicine
in water
(Razi, 2001)
·Baboona do (Razi, 2001)
·Lahsan do (Razi, 2001)
·Birinjasaf do (Razi, 2001)
·
Baboona, sheeh, Birinjasif, Marzanjosh,
Methi, Podina,Mushkatramashee,
Zarawand,Artaneesha
do (Razi, 2001)
23 IUD/ Retained
placenta
·Qaisoom, Barg Tom, Birin jasaf do (Khan, 2003)
·
Mushkatramashee, Birinjasif, Agar Turki,
Qust Talkh, Saleekha, Nankhaua, Footnaj,
Marzanjosh, Tukhme Halyun, Hulba,
Farasiyun, Ood, Balsan,Asarun
do (Akbar AA, YNM)
24 Tanqia nifas
(Puerperial sepsis)
·Khatmi do (Razi, 2001)
·Baboona (Razi, 2001)
Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive Review with Scientific
Evidence
6
CellMed 2022 / Volume 12 / Issue 1/ e5
(www.encyclopedia.com))
Length of treatment is determined by the type of sitz bath;
cold sitz bath durations are shorter than hot or contrast; neutral
sitz baths can last up to 2 hours for complete effect.
List of retrieved scientific studies on Ābzan in
gynaecological disorders are listed in Table 3.
Table 3. List of retrieved scientific studies on Ābzan in gynaecological disorders
Studies retrieved Research drug
Research design/
sample size/
duration of treatment
Assessment tool Result References
Utero-vaginal
prolapse
Mazu (Quercus
infectoria L)
An RCT/
n=60/
8 weeks
PFDIQ, PFIQ Test
Test drugs were safe a nd
effective in improving the
utero-vaginal prolapse.
(Naim, 2017)
Mochras (Bombax
malabaricum) Oral+
Habbul Aas (Myrtus
communis) as Abzan
An RCT/
n=40/
8 weeks
PFDIQ, PFIQ &
POPQ system
Test drugs mocharas and
habbulaas were effective in
improving the quality of life
of women a ssessed by
PFDIQ and PFIQ but fail to
improve the degrees of
prolapse assessed by POPQ
system.
(Rahman,
2018)
Leucorrhoea
Aqueous extract of
Samar Babool
(Vachellia nilotica)
Single blind placebo
controlled RCT/
n=66/10days
VAS, Modified
Mc Cormack pain
scale
Test drug was effective in
relieving saylan-al-rahim.
(Rushda,
2019)
Episiotomy wound
Hydro-Alcoholic
Extract of Myrrh Gum
(Commiphora myrrha)
Double blind clinical
trial/
n=60 /
10 days
REEDA scale
Wound healing rate was
higher in the group using
myrrh plant.
(Sarbaz, 2019)
Medicated and non-
medicated sitz bath
A quasi experimental
design/ n=40/10 days REEDA scale
Episiotomy wound healing
rate was faster in medicated
group than non-medicated
group
(Kapoor,
2018)
A quasi – experimental
Design/n=50/5 days REEDA Scale
Application of non-
medicated sitzbath is not
much effective as medicated
sitzbath.
(George,
2013)
Post episiotomy
Pain/
Postpartum
Perineal Pain
Warm versus cold sitz
bath
Repeated measure
experimental design/n=
20/24 hrs
VAS
Failed to demonstrate the
difference between the two
groups
(LaFoy, 1986)
Warm versus cold sitz
bath
An experimental
study/n=40 Pain scale
cold sitz baths were
significantly more effective
in relieving perineal pain
(Ramler,
1986)
PCOS
“Raha capsule” + sitz–
bath with (Malva
sylvestris, Rosa
damascene, Marticaria
chamomilla, Althea
officinalis flower
extracts)
Case report/ 6 months Clinical
assessment
Test drug was effective in
relieving sign and symptoms
of PCOS.
(Akhtari,
2017)
Fallopian tube
obstruction
Mohalel syrup + warm
cane (Malva sylvestris,
rose (Rosa damascene),
mallow (Althea
officinalis), chamomile
(Marticaria
chamomilla)- each100g
and hedge nettle
(Stachys
schtschegleevii)- 400 g
Case report/ 4 months HSG
The fallopian tubes were
gradually disinfected of the
intruding infectious
materials accumulating in
the tube end.
(Akhtari &
Mokaberinejad
, 2017)
Episiotomy pain &
wound healing
Plain water sitz bath A quasi experimental
study/n=60/ 3days
Clinical
assessment
Application of sitz bath
therapy had significant
reduction in episiotomy pain.
(Amandeep,
2015)
Lavender oil application
versus sitz bath
Time series Research
design/n=20/ 3days REEDA Scale
Application of Lavender oil
over episiotomy wound is
significantly more effective
in reducing episiotomy pain
and enhancing episiotomy
wound healing.
(Anitha, 2018)
Povidone Iodine sitz
bath versus Lavender
oil sitzbath
A comparative study/
n=60/
5 days
REEDA Scale
Lavender oil sitzbath was
effective in reducing
episiotomy pain and wound
healing among postnatal
mothers who had normal
vaginal delivery.
(Ragania,
2016)
Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive Review with Scientific
Evidence
7
CellMed 2022 / Volume 12 / Issue 1/ e5
Advantages
There are some distinct advantages of using sitz bath as a
primary modality.The sitz bath in particular is well-suited as
home treatment with proper patient instruction. Not only it is
excellent for therapeutic purpose, even the activity engages the
patient in a unique way making her accountable for the
progress of care. (Nayab, 2016; Peerla, 2019; Sitz bath in
gynaecology (www.encyclopedia.com))
Contraindications
Weakness is the only absolute contraindication for it; other
contra indications include acute profuse bleeding, open wounds,
pressure sores, acute fever, acute skin infections, contagious
skin rashes, acute PID. (Nayab, 2016, Peerla, 2019)
Complications
Numbness after Ābzan bārid when skin temperature decreases
below 590 F, frostbite, burn, palpitation, bleeding. 2Patients can
feel dizzy or experience rapid heartbeat due to vasodilatation.
(Sitz bath in gynaecology (www.encyclopedia.com))
RESULT AND DISCUSSION
The use of Ābzan (sitz bath /hydrotherapy) is probably as old as
mankind. Use of water in various forms and with different
temperatures can produce diverse effects on different system of
the body. Sitz bath is a novel, simple, non-invasive, and
effective external mode of treatment described for various
gynecological disorders in Unani system of medicine. The
effect is probably to enhance the pelvic circulation and to
reduce swelling of tissues, itch and soothe sore vaginal tissues
and helps in episiotomy healing. Superficial cold application
may cause physiologic reactions such as decrease in local
metabolic function, local edema, nerve conduction velocity
(NCV), muscle spasm, and increase in local anesthetic
effects.Cold-SB but not warm-SB, significantly reduces edema
during postepisiotomy periodand perineal pain. (Mooventhan A
and Nivethitha L, 2014)The main role of wet Abzan is moisture
update, which is most widely used in the prevention and
treatment of diseases associated with domination of the dry
temperament. Hot Abzan, due to its effective role in stimulation
of instinct heat and strengthening the body, can be considered
alone, as one of the appropriate remedies in many conditions.
(Vakilinia, 2019)
CONCLUSION
Studies has proved that sitz bath plays an important role in
providing the thermal and mechanical effects and help in
achieving the curative treatment. Unani physicians have
mentioned extensive use of Ābzan in gynaecological disorders
which seems to be very effective and safe for the patient, even
studies provide the scientific based evidence in few
gynaecological disorders. Further, randomized, controlled,
clinical studies are recommended to authenticate the
effectiveness of sitz bath on scientific basis in other
gynecological disorders as mentioned in classical Unani text.
Furthermore, the ideal method of sitz bath, optimal duration
and how sitz bath improves various diseases needs to be
clarified.
LIST OF ABBREVIATIONS
Do: same as above
PID: Pelvic Inflammatory Diseases
IUD: Intra Uterine Death
PCOS: Polycystic Ovarian Syndrome
RCT: Randomised Controlled Trial
VAS: Visual Analogue Scale
REEDA: Redness, Edema, Ecchymosis/Bruising, Discharge,
Approximation
HSG: Hysterosalpingography
POP-Q: Pelvic Organ Prolapse Quantification System
PFDIQ: Pelvic Floor Distress Inventory Questionnaire
PFIQ: Pelvic Floor Distress Impact Questionnaire
ACKNOWLEDGEMENT
Authors are thankful to authors and editors of all those books
and journals from where the literature for this article has been
reviewed, retrieved and cited.
FUNDING
No funding sources
CONFLICT OF INTEREST
The authors have no conflicting financial interests.
REFERENCES
Abu AQ. Mojiz al Qanoon. (Urdu Trans. by Kausar Chand
Puri). 3rded. (New Delhi: Qaumi Counsil Barae Farogh Urdu
Zuban), 1988;1107;1142.
Ahmed JK. Ilaj Bil Tadbeer.(Deoband: Hira Computers), 2011,
pp.181-82.
Akbar AAT. (Deoband: Faisal Publication). YNM, pp.581,585-
88,592,596.
Akbar AM. Meezan-ut-Tib. Idara Kitabus shifa, New Delhi,
2002, pp.216-19.
Akhtari E& Mokaberinejad R. Treatment of Fallopian Tubes
Obstruction in an Infertile Woman using Iranian Traditional
Medicine. Asian Journal of Clinical Case Reports for
Traditional and Alternative Medicine, 2017;1(3-4);9-16.
Akhtari E, Mokaberinejad R & Tajadini H. Treatment of
menstrual disorder, depression and sexual dysfunction in a 27-
year-old woman with polycystic ovary syndrome based on
iranian traditional medicine (case report), 2017.
Amandeep SN, Mamta KJ& Jindal P. Effect of Sitz Bath in
Reduction of Episiotomy Pain and wound healing Among
Postnatal Mothers. International Journal of Current
Research,2015;7(02); 12461-63.
Anitha P. A study to assess the effectiveness of Povidone-
Iodine sitzbath versus Lavender oil sitzbath on episiotomy pain
Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive Review with Scientific
Evidence
8
CellMed 2022 / Volume 12 / Issue 1/ e5
and wound healing among postnatal mothers admitted in
tertiary care setting, Coimbatore (Doctoral dissertation, PSG
College of Nursing, Coimbatore), 2018.
Bahadorfar M. A study of hydrotherapy and its health benefits.
International Journal of Research, 2014;1(8), 294-305.
Bughdadi IH. Kitab al Mukhtarat Fil Tib. Part VI. (New Delhi:
CCRUM), 2005, pp.36, 38,40,44-50.
Hamdani SKH. Usool-e-tibb. Qaumi council barae farogh urdu
zaban, New Delhi, 2001, pp.365.
Hasan MQ. Jami-ul-Hikmat, Idara Kitabus shifa, New Delhi,
2011, pp.1107,1142.
Jurjani I. Zakheera Khawarzam Shahi (Urdu translation by
Khan HH). Vol. 3rd. (New Delhi: Idara Kitabush Shifa), 2010,
pp.630-32,646.
Kamaluddin H. Basic Principles of Regimental Therapy of
Unani Medicine. 2004, pp.60-61.
Kapoor J. A comparative study to assess the effectiveness of
medicated and non-medicated sitz bath on episiotomy wound
healing among postnatal mothers at govt Smgs maternity
hospital Jammu JK. International Journal of Pregnancy and
Child Birth, 2018; 4(4).
Khan MA. Al Akseer (Urdu translation by Kabeeruddin M).
VolI. 1stDelhi Aijaz Publishing House, 2003, pp.788,793,
805,812-13.
LaFoy J& Geden EA. Postepisiotomy pain: warm versus cold
sitz bath. Journal of Obstetric, Gynaecologic, & Neonatal
Nursing, 1989;18(5); 399-403.
Majoosi AIA. Kamil-Us-Sana’a’Urdu translation by Hkm.
Ghulam Hussain kantoori,(New Delhi; Idara Kitab-Us-Shifa),
2010, pp.535,538.
Mooventhan A & Nivethitha L. Scientific evidence-based
effects of hydrotherapy on various systems of the body. North
American journal of medical sciences, 2014;6(5); 199.
Naim M. Efficacy of Mazu in Uterovaginal Prolapse and its
outcome. MS Unani [Dissertation]. Banglore: Rajiv Gandhi
University of Health Sciences, Karnataka, 2017.
Nayab M. Ābzan (Sitz bath)-An effective mode of treatment in
ʹIlāj bit Tadbīr (Regimenal Therapy). The Pharma Innovation,
2016;5(12, Part A);45.
P George GLADIS. A comparative study to assess the
effectiveness of medicated and non-medicated sitz bath in
episiotomy healing on postnatal mothers admitted in selected
hospitals at Bangalore (Doctoral dissertation), 2013.
Peerla N. Hammam-i-Bukhari (Turkish bath): A promising
regimenal mode of Unani treatment. Journal of Complementary
and Integrative Medicine, 2020;17(3).
Qamri AMH. Ghana Mana. (New Delhi: CCRUM), 2008,
pp.392,406,409,414.
Ragania D. Effectiveness of povidone iodine sitzbath versus
lavender oil sitzbath on episiotomy pain and
woundhealingamong postnatal mothersundergone normal
vaginal delivery (Doctoral dissertation, Annammal College of
Nursing, Kuzhithurai), 2016.
Rahman FNA& Shameem I. Effect of mocharas (Bombax
malabaricum) and habbulaas (Myrtus communis) in
uterovaginal prolapse: randomized open clinical trial.
Ramler D & Roberts J. A comparison of cold and warm sitz
baths for relief of postpartum perineal pain. Journal of
Obstetric, Gynaecologic, & Neonatal Nursing,1986;15(6);471-
474.
Razi Z. Al-Hawi-Fil-Tib (Urdu Translation). (New Delhi;
CCRUM Publication), 2001,pp.15, 16, 27, 21, 22, 23, 29, 32,
50, 59, 159, 160, 161, 162, 163, 171, 172.
Razi, Z., & Zakaria, M. B. (1991). Kitabul Mansoori. New
Delhi: Ministry of Health and Family Welfare, Govt. of India,
388.
Rushda S. Effect of Abzan of Samar Babool In Saylan al-
Rahim- A Randamised Controlled Study: MS Unani
[Dissertation]. Banglore: Rajiv Gandhi University of Health
Sciences, Karnataka, 2019.
Sarbaz Z, Yazdanpanahi Z, Hosseinkhani A, Nazari F &
Akbarzadeh M. The effect of sitz bath of hydro-alcoholic
extract of myrrh gum on episiotomy wound healing in
nulliparous women. Journal of family & reproductive
health,2019;13(2); 89.
Sina I. Al Qanoon Fil Tib (Urdu trans. by Kantoori GH). New
Delhi: Ejaz Publication house, 2010, pp.1084-86, 1091, 1093,
1098.
Sitz bath in gynaecology (www.encyclopedia.com accessed on
19/6/2020.)
Vakilinia S. Abzan, a Simple and Effective Method for
Prevention and Treatment of Diseases from the Perspective of
Iranian Traditional Medicine. Qom University of Medical
Sciences Journal, 2019;13(5); 53-60.
