EFFECT OF HAMMAM (STEAM BATH) WITH HERBAL DECOCTION OF BURG-I-NĪM AND BURG-I-HINA -A CASE STUDY

Abstract

Introduction: Boils also referred as furuncles are infections of hair follicles caused by the bacteria producing painful, nodular pus-filled lesions on skin surfaces. There are various conditions and co-morbidities which lead to the formation of boils on skin surfaces like diabetes, weaning immunity, variety of skin infections, poor hygiene. In Unani System of Medicine (USM),boil occurs due to the imbalance of Akhlat (humours) which is actually increase of hot and moist humours. This imbalance leads to the accumulation of morbid matter in blood causing skin inflammation. Hammam is a regimenal therapy which causes the diversion and evacuation of morbid wastes from the body. Clinical presentation: A 50 year old male patient with no co-morbidity visited the OPD of Regional Research Institute of Unani Medicine, Habak, Srinagar, Jammu and Kashmir in the month of November in 2024. The patient was a diagnosed case of boils which were present on the left flank of abdomen, on left iliac crest, gluteal region. The patient had no aggravating or relieving factor. Intervention: The patient was treated with Hammam therapy infused with Burg-i-Nīm(BN) and Burg-i-Hina(BH)for a period of 15days. All the pre and post treatment SOP’s were taken into consideration. Results: The presenting signs and symptoms were reduced which was assessed through Visual Analogue Scale (VAS). Discussion: Hammam, a known regimenal therapy in USM helps through the evacuation of morbid wastes from the body leading to complete detoxification. The use of Burg-i-Nīm (BN) and Burg-i-Hina (BH) as a decoction in hammam helped in blood purification. Also,beingapotent antibacterial agent,it aides in wound treatment and healing. The chemical constituents like quercetin, β-sitosterol, margolone, etc. possess antibacterial, antifungal and anti-inflammatory properties. Conclusion:In this study, it was validated that Hammam has significant effect on boils and is beneficial in the treatment of boils.

KEYWORDS:Boils, Buthūr, Hammam, Regimenal therapy, Unani treatment.

Full text

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She
1Barjes Jalal, 2*Mohammed Sheeraz Mushtaque Ahmed, 3Sahiba, 3Shugufta Hamid,
1NasirNazir wani
1PG Scholar, Department of Ilmul Advia, Regional Research Institute of Unani Medicine
(RRIUM), Srinagar-190006. J & K.
2Research Officer Scientist Level II & Reader, Department of Moalajat, RegionalResearch
Institute of Unani Medicine (RRIUM), Srinagar-190006. J & K.
3PG Scholar, Department of Moalajat, Regional Research Institute of Unani Medicine
(RRIUM), Srinagar-190006. J & K.
ABSTRACT
Introduction: Boils also referred as furuncles are infections of hair follicles caused by the
bacteria producing painful, nodular pus-filled lesions on skin surfaces. There are various
conditions and co-morbidities which lead to the formation of boils on skin surfaces like
diabetes, weaning immunity, variety of skin infections, poor hygiene. In Unani System of
Medicine (USM),boil occurs due to the imbalance of Akhlat (humours) which is actually
increase of hot and moist humours. This imbalance leads to the accumulation of morbid
matter in blood causing skin inflammation. Hammam is a regimenal therapy which causes the
diversion and evacuation of morbid wastes from the body. Clinical presentation: A 50 year
old male patient with no co-morbidity visited the OPD of Regional Research Institute of
Unani Medicine, Habak, Srinagar, Jammu and Kashmir in the month of November in 2024.
The patient was a diagnosed case of boils which were present on the left flank of abdomen,
on left iliac crest, gluteal region. The patient had no aggravating or relieving factor.
Intervention: The patient was treated with Hammam therapy infused with Burg-i-Nīm(BN)
and Burg-i-Hina(BH)for a period of 15days. All the pre and post treatment SOP’s were
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EFFECT OF HAMMAM (STEAM BATH) WITH HERBAL DECOCTION
OF BURG-I-NĪM AND BURG-I-HINA -A CASE STUDY
Sheeraz etal.
WORLD JOURNAL OF PHARMACY AND
2024
PHARMACEUTICAL
RESEARCH
Case Study
World Journal Of Pharmacy and Pharmaceutical Research
Volume: 01
Issue: 02
Page: 82-90
Accepted:11 December2024
Revised: 22 November2024
Received: 02 November2024
Corresponding Author: Mohammed Sheeraz Mushtaque Ahmed
Address: Research Officer Scientist Level II & Reader, Department of Moalajat, Regional Research Institute
of Unani Medicine (RRIUM), Srinagar-190006. J & K.

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World Journal Of Pharmacy and Pharmaceutical Research
83
taken into consideration. Results: The presenting signs and symptoms were reduced which
was assessed through Visual Analogue Scale (VAS). Discussion: Hammam, a known
regimenal therapy in USM helps through the evacuation of morbid wastes from the body
leading to complete detoxification. The use of Burg-i-Nīm (BN) and Burg-i-Hina (BH) as a
decoction in hammam helped in blood purification. Also,beingapotent antibacterial agent,it
aides in wound treatment and healing. The chemical constituents like quercetin, β-sitosterol,
margolone, etc. possess antibacterial, antifungal and anti-inflammatory properties.
Conclusion:In this study, it was validated that Hammam has significant effect on boils and is
beneficial in the treatment of boils.
KEYWORDS:Boils, Buthūr, Hammam, Regimenal therapy, Unani treatment.
INTRODUCTION
A boil, also known as a furuncle, is a bacterial infection that results in a pus-filled lump on
the skin arising from hair-bearing sites. An infection of a hair follicle and the surrounding
tissue results in boils. Boils are painful swollen bumps, ranging from roughly the size of a
cherry stone to that of a walnut. They feel warm and look red, and yellowish pus is seen
through the skin. Boils mainly occur on the face and neck, including the back of the neck. But
they sometimes also develop in the armpits, groin, and genital area, on the back, bottom or
thighs. These often arise as an associated factor with obesity, blood dyscrasis, defects in
neutrophil function (defects in chemotaxis associated with eczema and high IgE levels, etc).
If several boils develop in neighboring hair follicles and merge into a larger connected area of
infection under the skin,it's called a carbuncle. Carbuncles often occur at the back of the neck,
and go deeper into the tissue than boils.[1,2,3]
The bacteria causing boils can affect any organ system, areas draining into brain and other
vital visceras can carry serious infections there. If the patient suffers from chronic boils (more
than two years), cosmetic surgery is indicated.
Causes and risk factors:
Boils are caused by bacteria, most commonly by Staphylococcus aureus bacteria. They are
more likely to lead to boils or other skin infections in people who have weakened immune
systems. For this reason, boils are more common in people with medical conditions such as
diabetes, chronic infections or cancer. They are also more common in people with eczema,
conjunctivitis or certain allergies such as allergic asthma.
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Prevalence and outlook
Skin infections are generally very common, but most of them are caused by something else.
Only about 3 out of 100 people who go to their doctor with a skin infection have a boil.
Boils develop within a few hours or days. Once the pus has escaped from the red, swollen
lump after a few days - either on its own or following treatment – the boil heals within a few
weeks. A small scar is left behind. Sometimes boils heal without the pus coming out. The pus
is then broken down by the body.
Diagnosis
Doctors usually recognize boils based on their typical appearance and a description of the
symptoms. Further diagnostic procedures such as blood tests or a pus swab are only needed if
someone often gets boils, has several boils at the same time, or is thought to be at high risk of
complications.
The pus is then examined in a laboratory in order to find out exactly what kind of bacteria are
causing the infection, and determine which antibiotics are most likely to work the best. Blood
tests help to find out whether the infection has already spread and whether the person has any
other medical conditions that could increase the risk of bacterial infections occurring.
Treatment
Simple furunculosis may be aided by local application of moist heat. A furuncle surrounded
by cellulitis or one associated with fever is to be treated with systemic antibiotics. For severe
infections, antibiotics are advised through parenteral route. When lesions are large, painful
and fluctuant, then incision and drainage is advised. If the infection is recurrent or
complicated by co-morbidities, a culture is sent. Antimicrobial therapy is advised until the
evidence of inflammation has regressed.[3]
An outlook onHammam
Hammam forms an important element of Ilaj bit tadbeer(IBT). The word hammam is derived
from an Arabic root Hamm meaning ‘spreader of warmth’or that produces heat. It consists of
4 rooms: 1st room is Barid Ratab, 2nd is Har Ratab, 3rd one Garm Khushk and the 4th one is
Moatadil. The temperature ranging from 100-120° F. It is beneficial in numerous diseases
mentioned in Classical Unani literature which include weigh loss, detoxifying agent,
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strengthens nerves, reduces inflammation, has anti-microbial activity, dyspepsia, liver
weakness, etc.[4,5,6,7,8,9]
CASEREPORT
A 50year old, male patient, non-diabetic, normotensive and Euthyroidic reported to the OPD
of RRIUM on 12-11-2024 with the complaint of severe pain in nodular pustule present on left
flank. (Fig.1).The patient was unable to bend or move freely. He was a diagnosed with boils
which were pustular in nature present on the left flank of abdomen, on left iliac crest, gluteal
region. The patient was not on any allopathic treatment and there was no relevant history of
recurrence. On history taking it was found that the patient had no allergic history. Drug
history, surgical history, medical history, family history were all non- significant. Patient had
no co-morbidities and no history of any psychological disease. His sleep, appetite and bowel
were all normal. The nutritional status of the patient was good, He had a muscular body with
a weight equal to 90 kgs and height was 5"7.All the vitals were within the normal range with
B.P =120/80, Pulse =74bpm, Respiratory rate=16/min and temperature =97.6 F. Systemic
examination consisting of thorough examination of Central nervous, cardiovascular,digestive
and respiratory systems were found with the normal parameters.
LOCAL EXAMINATION
 Site:Left flank of abdomen, on left iliac crest, gluteal region.
 Nature: pustularnodules.
 Number of nodules: one to two on each site.
 Size of nodules: 3x2 cm
 Pain: Present
 Inflammation: Present
 Itching: Present
TREATMENT PROTOCOL
Oral administration of Habb-i-Musaffi (HM) was used for 15 days; topical use of Marham-i-
Kafoor (MK) was done for 15 days and Hammam was done alternatively for 15 days.
Procedure
Oral Medication Habb-i-Musaffi(HM):Habb-i-Musaffiin a dose of 250 mg twice daily (see
ingredient in Table 1) were given orally daily for a duration of 15 days.[10]
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Local application of Marham-i-Kafoor (MK):Patient was asked to locally apply Marham-i-
Kafoor (see ingredient in Table 2) twice daily for a period of 15days.
Table1:Ingredients of Habb-i-Musaffi(HM)[10]
Nameof thedrug
Botanicalname
Quantityofdrug
Post-i-HalelaZard
Terminalia chebula
3g
Sarphukra
Tephrosia purpurea
3g
Gul-i-Surkh
Rosa damascena
3g
Barg-i-Shahtara
Fumaria indica
3g
Tukhm-i-Kishneez
Coriandrum sativum
3g
Barg-i-Hina
Lawsonia inermis
2g
Dhamaya
Cassia absus
3g
Sandal Surkh
Pterocarpus santalinus
3g
Sandal Safaid
Santalun album
3g
Brahmdandi
Tricholepis glaberrima
3g
Neel Kanthi
Ajuga bracteosa
3g
Zeera Safaid
Cuminum cyminum
1g
Filfil Siyah
Piper nigrum
1g
Gul-i-Kachnal
Bauhinia racemosa
1g
Barg-i-Bakayin
Melia azedarach
5 no.
Barg-i-Neem
Azadirachta indica
5 no.
Table2:Ingredients of Marham-i-Kafoor(MK)[11,12]
Nameof thedrug
Botanicalname
Quantityofdrug
Safaidkashgari
Eucalyptus globulus
14g
Kafoor
Cinnamomum camphora
2g
Murdar-i-Sang
Plumbioxidum
14g
Rogan-i-Till
Sesamum indicum
70g
Moum
Wax
28g
Ghee
Clarified butter
As req.
Hammam with the decoction of Burg-i-Nīm and Burg-i-Hina:
Hammam therapy was given to the patient using the decoction of Burg-i-Nīm and Burg-i-
Hina on alternate days for a period of 15 days. A decoction was prepared with Burg-i-Nīm
and Burg-i-Hina at a dose of 5g each. The decoction was used in hammam which was done at
the temperature ranging from 100-120° F helping in the evacuation of toxins from the body.[4]
DURATIONOFTHESTUDY
The duration of study was 15 days. The intervention duration was 15 days and after a week
from the last sitting of Hammam, patient was again examined.
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OUTCOME
The patient was assessed before and after the treatment based on Warm (inflammation), Alam
(pain) and Hikka (itching).
OBSERVATIONS AND RESULTS
Both the regimenal and the pharmacopoeial intervention are responsible for the results
achieved. The efficacy of the regimenal therapy was evaluated by assessing the improvement
in Buthūr (boils), using the Visual Analogue Scale (VAS). The nodules were assessed based
on their number, size and associated symptoms. The symptoms such as Warm(inflammation),
Alam(pain), Hikka(itching) were assessed using Visual Analogue Scale (VAS). The total
VAS score was documented at baseline and at follow-up visit.
The treatment led to a notable improvement in the condition, with relief reported before the
first follow-up. Furuncles improved within days, and by the 7th day inflammation was
completely gone. Erythema reduced, and normal skin appeared. By the 15th day, boils were
nearly cured without side effects. While all symptoms were moderate at baseline disappeared
after the 15 days of treatment.
Table03: Assessment of symptoms on the basisof VAS.
Clinicalfeatures
Baseline
Day 5
Day 10
Day 15
Warm(inflammation)
++++
+++
++
-
Hikka(itching)
++++
++++
-
-
Alam(pain)
++++
-
-
-
Figure1:Day1beforetreatment. Figure2: Post-treatment picture.
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DISCUSSION
The improvements achieved in this case can be attributed to the regimenal therapy that is
hammam. According to USM, illness can result from a disruption in blood balance caused by
an imbalance in the four humors. It is advised to purify blood in order to eliminate toxins,
improve immunity, prevent disease, lower cholesterol, lessen the risk of cancer, improve
heart health, and minimize inflammation brought on by toxins.13The use of Habb-i-Musaffi
renowned forits antibacterial, antifungal, wound-healing, antiulcer and antipyretictherapeutic
qualities helped to cleanse the blood.14In USM, Barg-i-Nīmis acknowledged as a blood
purifier with antibacterial properties that aids in wound treatment and healing. The chemical
constituents like quercetin, β-sitosterol, margolone, margolononeand isomargolonone which
possess antibacterial, antifungal and anti-inflammatory properties.15Burg-i-Ḥinā (henna) has
been shown to be more beneficial than hydrocortisone when it comes to treating newborn
diaper dermatitis due to its anti-inflammatory, antibacterial, and immune-modulatory
qualities.16Hammam helps through theprinciple of Imala-i-Mawad (diversion of morbid
matter) and Istifrāgh-i-Mawād (evacuation of morbid matter). The root cause of this disease
is accumulation of morbid wastes which causes congestion, stagnation and blockage which
results in pain and inflammation and through Hammam breakage of congestion, resolving of
blockage and restoring of free flow of blood circulation and eliminating toxins that isAkhlat-
i-Fasida are evacuated from the body.4,17,18
CONCLUSION
From the results and discussion, it could be concluded that boils which is one of the
commonly occurring problem also prevalent in co-morbidities like diabetes, etc. showed
significant improvement with hammam making it an important option in the treatment of
boils. It can act as a good option to the conventional treating of boils. However, studies on
large scale need to be done to validate the effectiveness of this regimenal therapy.
ACKNOWLEDGEMENT
Authors are deeply thankful to the Deputy Director In charge, clinical and non-clinical staff
of RRIUM, Srinagar, for their support throughout this work.
CONSENT OFPATIENT
The consent of the patient was taken on a written consent form, after duly explaining the
procedure of the study.
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FUNDING SOURCE
No funding source used.
CONFLICTOFINTEREST
Author declares no conflict of interest.
ABBREVATIONS
RRIUM
Regional Research Institute of Unani Medicine
USM
Unani System of Medicine
OPD
Outside Patient Department
IBT
Ilaj bit tadbeer
BN
Burg-i-Nīm
BH
Burg-i-Hina
HM
Habb-i-Musaffi
MK
Marham-i-Kafoor
VAS
Visual Analogue Scale
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