Principles

Introduction 

The Unani System of Medicine is one of the oldest forms of alternative, traditional and complementary medicine. It incorporates medicinal sources from the plant kingdom, the animal kingdom and natural minerals in its raw form. The current practice of this complementary medicine is preserved in its original form by the Unani scholars and physicians. Because it is seen to be effective and due to its, simplicity and affordability is becoming popular and is being introduced and practiced in many parts of the world.

Mainstream Unani Practice

The Unani System of Medicine is based on traditional Greek Medicine concepts. It follows the principles laid down by the famous Greek philosopher – physician, Hippocrates.[1]

The Unani system of Medicine is based on following seven (7) natural factors:

  1. The four elements: air, water, fire and earth. According to Unani medicine, the body is made up of these four elements.
  2. The four humours: blood, phlegm, yellow bile and black bile are the four humours present in human body. The proper balance of these four humours constitutes health, and the imbalance of them causes disease.
  3. The four temperaments: hot and dry, hot and wet, cold and dry, cold and wet. By determining the patient’s temperament a Unani physician measures the health and prescribes individualized Unani medicines as per the temperament.
  4. The four faculties: the basic and the essential functions of life, vitality nourishment, consciousness and reproduction.
  5. The vital principles: they are centred on the heart and lungs and include the respiratory, circulatory and immune systems. These are the energies and essences that give life to the organism.
  6. The organs and parts: the cell is seen as the basic unit of life and other organs and how they function are seen as the fundamental components of the body.
  7. The forces or administering virtues are as follows and these are spinal energies and brain energies. Like forces augment each other, opposites temperaments produces balance, heat produces dryness and cold temperament causes the condensation of moisture.

These seven natural factors work together in a balanced, harmonious manner to give an individual health and proper functions and when they are unbalanced and are not working together in harmony, there is dysfunction and disease. Death occurs due to dysfunction of any one of these seven natural factors or when their essential components stop functioning.[2]

The mainstream Unani practice depends on the following basic principles:

Diagnosis

The term "diagnosis" comes from the Greek, and it means, "knowing through".  Diagnosis is considered as the heart of the Unani medicine practice as it differentiates   Unani medical treatment from magic and superstition. For a good diagnosis a Unani physician must have adequate knowledge of anatomy, physiology, the seven natural factors (as above) pathology, hygiene and philosophy. The following are the methods implemented for diagnosis which are used in mainstream Unani practice [3]:

  1. Medical history of the patient
  2. Doctor - patient relationship
  3. Taking note of chief complaint, subsidiary or auxiliary complaints
  4. Advising about six hygienic factors:  ambient air, food and drink, exercise and rest, sleep and alertness, retention and evacuation of wastes, and disturbances of the mind and emotions.
  5. General review of systems by the Unani physician is in order as per the signs and symptoms of imbalance of the four humours.
  6. The Unani physician performs visual diagnosis, observation and inspection. The physician then notes down general behaviour, mannerisms, demeanour, posture, physique, complexion, or skin colour.
  7. Nail diagnosis: nails are observed for their colour and deformities to assess disease.
  8. Facial diagnosis: facial diagnosis is performed to asses any signs of stress and anxiety.
  9. Auscultation and olfaction: stethoscope is used for auscultation and the odour of urine and stool is asked for.
  10. Palpation and percussion: palpation is performed to asses any abdominal ailments and percussion is done to asses’ hernia and ascites.
  11. Tongue diagnosis: colour and morphology of the tongue is observed
  12. Pulse diagnosis: it is done to assess hypertension and other cardio vascular diseases.
  13. Urine diagnosis: it is done to assess kidney functions by physical examination of turbidity, colour, odour and viscosity.
  14. Stool diagnosis: this is done to asses liver functions by noting the colour.

Methods of Treatment in Mainstream Unani Practice

Unani Medicine has six (6) major therapeutic principles, or pathways to healing. The following are the methods of treatment:

  1. Taking Dietary therapy: food as medicine – medicine as food.
  2. Hygiene and lifestyle modification
  3. Regimental therapies:
    1. Sudation (sweating)
    2. Diuresis (urination)
    3. Emesis (vomiting)
    4. Purgation
    5. Derivation (drawing out toxins through the skin)
    6. Cauterization (destruction of tissue with cautery)
    7. Turkish bath
    8. Venesection (bloodletting)
    9. Leech therapy and
    10. Cupping.
  4. Medicines or pharmacotherapy: Unani herbal medicine treatments.
  5. Physiotherapy or bodywork: massage and deep tissue manipulations.
  6. Surgery: minor surgeries are performed.[4]

Individualized Treatment

The concept of the four (4) Temperaments makes the basis of all diagnosis and treatment in Unani Medicine, which enables the Unani physician to treat the patient, and not just the disease. Because of individual differences of humoral constitution and temperament, no two individuals will show the same signs and symptoms of a particular disease and they will not respond in the same way to a particular medicine or regimental treatment.[5]

Current improvements in Unani System Practice

The Ministry of Health and Social Welfare Central government of India has stipulated rules and regulations for the improvements in Unani System of Medicine Practice.[6] There has been research done by the CCRUM which has found that Unani Medical treatment is effective in treating diseases like malaria, hepatitis B, leukoderma and skin problems.[7]

Integrative management for the HIV patients using Unani Medicine has shown encouraging results. There are over 150 Unani hospitals and 1,500 Unani dispensaries spread across 18 states of India. There are around 50,000 Unani graduates in the country and most of them are practicing physicians. Unani Medicine is an integral part of national health care system in India.[8]

The central and state governments with the help of the central council for research in Unani Medicines India regulate the practice and education in Unani.

Currently the Unani System of Medicine because of its efficacy and evidence based approach has attracted international attention. There is a rising interest in the Unani System of Medicine in countries like South Africa, Malaysia, Australia, and the United States of America.

The department of Ayush has developed protocols for the GMP practices for Unani Medicine manufacture and this is being implemented throughout India.[9]

The National Institute of Unani medicine has developed the Unani Pharmacopoeia Committee (UPC) consisting of expert Unani physicians, scientists, botanists, pharmacognocists, chemists, manufacturers and experts of Unani medicine. The first committee was constituted in 1964 for three years. Every third year it is a new committee is elected. . The National Institute of Unani medicine and Unani Pharmacopoeia Committee (UPC) has prepared a National formulary of Unani Medicine (NFUM), Part-I - 441 formulations, NFUM, Part-II - 202 formulations, NFUM, Part-III - 103 formulations.

Challenges in Unani System Practice

  • The majority of the books are in Urdu, Persian and Arabic and there are very few books in English.
  • The popularity of the Unani system is on the rise and latest research has given a boost to the practice of the Unani System of Medicine but still it is behind Ayurveda, because of lack of publications of the research work on an international platform.
  • The majority of the Unani physicians in India, Pakistan and Bangladesh are Muslims, even though there are also many practitioners from other religious communities, it is thought that the Unani System of Medicine is a Muslim system of medicine.
  • The proper standardization of Unani herbs and drugs is yet to be completed.
  • The database of the Monographs of the Unani herbs is not sufficient as per the WHO standards of Monographs.

Main Modalities of Unani System Practice 

  1. Dietary therapy: food as medicine – medicine as food.
  2. Derivation (drawing out toxins through the skin)
  3. Cauterization
  4. Turkish bath
  5. Venesection (bloodletting)
  6. Leech Therapy
  7. Cupping
  8. Massage
  9. Phyto – Pharmacotherapy - Unani herbal treatment

a. Dietary Therapy: Food as Medicine – Medicine as food

Dietary therapy is a one of the fundamental units of practice in the Unani system of medicine. In Unani medicine practice and treatment, food plays a very vital role. The Unani physicians prescribe a specific diet regime by maintaining the quality and quantity of food. As per the Unani system of medicine the foods are classified into laxatives, diuretics and diaphoretics. For example eggs are prescribed as a source of instant energy and externally eggs are used in bone fractures to alleviate pain. Before any Unani treatment daily diet restrictions or alterations are advised.

b. Derivation

Derivation is a very important therapeutic concept of Unani medicine. It means the moving of congestion from one part of the body to a distant part of the body thereby helping in expelling toxins out of the body through the skin. Derivation is achieved by using poultices and herbal plasters which are applied on the skin. According to the Unani system of medicine, these poultices and herbal plasters cause drawing of excess blood and heat the skin's surface, this causes skin rashes or blisters on the skin’s surface and toxins are expelled out of the body.

c. Cauterization

Cauterization is described as the heat treatment to remove or close a part of body.  Cauterization is done by hot iron, gold, silver, copper and corrosive agents like strong vinegar. Cauterization is chiefly performed in two ways:

  • External cauterization.
  • Internal cauterization.

External cauterization is indicated for necrotic and gangrenous tissues, pain management and varicose veins while the internal cauterization is indicated for mouth ulcers anal fissures.

d. Turkish bath

It is one of the regimental therapy which is applied in treating disease through a special type of medicated bath known as Turkish bath, this concept was adopted first by the people of Turkey hence the name Turkish bath. Turkish bath is a steam chamber where hot herbal infused steam is passed all over the body. As per the Unani system of medicine the main purpose of a Turkish bath is to cleanse the body and also to obtain balance of the four humours. Turkish bath according to the practice of Unani medicine eliminates the waste material from the body in the form of sweat and vapours. Unani physicians use various formulations of herbs and aromatic oils and even sweet water is used for promoting health and prevention from disease.  

e. Venesection (bloodletting)

Venesection, or bloodletting, is the release or drawing out of blood from a punctured vein.  It is a procedure in which an incision is made to superficial veins only, and it is believed that blood, containing waste materials is removed. The purpose is to create a balance in the humours by removing excess in it. Venesection in the Unani system of medicine is indicated for maintaining normal blood volume, to initiate metabolism, to manage bleeding haemorrhoids, to reduce otitis, menorrhagia and hepatitis. Venesection is also performed in cerebral concussions and skull fractures to prevent inflammation and oedema of the brain.

f. Leech Therapy

Leech therapy is one of the regimental therapies in the Unani medicine. Leeches are used to suck out blood from different parts of the body. Unani medicine has very specific guidelines for the usage of leeches, which involves selection of the leeches, their sterilization, storage and application of leeches on the body.

There are three steps in leech therapy. They are the pre procedure, procedure and post-procedure techniques. The leech therapy in Unani medicine is used to treat skin diseases, pain management, arthritis, gangrene management, meningitis, cardiac infarctions and hypertension management.

g. Cupping

Cupping is a therapeutic method which is performed by the application of cups made from glass, plastic, clay bamboo and animal horns. Vacuum is created inside the cups by burning up an alcohol swab inside the cup or just by manual suction either by mouth or by a suction pump. According to the Unani system of medicine cupping is divided into two types:

  1. Cupping with bloodletting.
  2. Cupping without bloodletting.

Cupping with bloodletting involves the puncturing of the skin over the cupping site; this type of cupping is indicated for arthritis, skin diseases, pain management, female infertility, chronic migraines and hypertension management. Cupping without bloodletting is indicated for poor peripheral circulation, cellulite management, lymphatic drainage and facial wrinkles management.

h. Massage

Massage is a therapeutic and deep tissue systematic manipulation with the use of hands, feet and various massage equipments. There are five (5) types of massage therapies: 

  1. Hard massage. This a hard friction massage indicated for muscle injury.
  2. Soft massage. This a prolonged low friction massage indicated for depression and stress management.
  3. Deobstruent massage. It is a type of prolonged medium friction massage meant for fat reduction which helps in making body firm.
  4. Cloth Massage. This massage is done by the use of rough jute cloth, and is meant for vasodilatation of a particular area of the body.
  5. Roller massage. This massage is done by rollers made out of Jade stone. It is indicated for creating a sense of wellbeing and it is believed to be sedative.

The benefits of the massage are to manage or relief:

  • Weight in premature babies (enhance)
  • Post partum psychosis
  • Anxiety
  • Tension and stress
  • Depression
  • Insomnia
  • Low back pain
  • Headaches
  • Chronic muscular pain
  • Post stroke management
  • Arthritis

i. Phyto – Pharmacotherapy - Unani Herbal treatment

Unani pharmacotherapy implements the use of natural resources of medicine like plants, animals and naturally occurring minerals. The practice of Unani medicine depends on prescribing single natural medicines or their combinations in raw or compound formulations. The Unani system of medicine in the area of pharmacotherapy has very unique resources of knowledge and expertise. The Unani medicines are classified as per their individual or compound temperaments, potency, mode of action and types.

i. Temperament of the drugs

The Unani system of medicine believes that all the natural medicines have their own temperament because of their ingredients or constituents. This hypothesis or theory of drug temperament is based purely on experiments and studies done by the famous Unani physicians.

ii. Potency of the drugs

Drugs are graded into four classes as per their potency. The classes are:

  • Hot
  • Cold
  • Wet (moist)
  • Dry

Unani physicians use the low potency drugs initially for the treatment and according to the severity of the disease the potency is increased.

iii. Mode of action of drugs

According to the Unani system of medicine philosophy the action of a drug is due to the physical characteristics and its temperament.

iv. Types of drugs

The drugs are divided into four groups.

  • The first group contains drugs with hot temperament, which upon usage produces heat.
  • The second group contains drugs with cold temperament which upon usage induce cooling and anaesthetic effect.
  • The third group contains drugs with moist temperament. These are called lubricants.
  • The fourth group drugs have dry temperament. These are called an astringents.

Patient Education

Patient education in the Unani System of Medicine involves helping patients in a holistic way. The patients are informed in detail regarding their condition and the, Unani treatment procedures to be performed on them. Patients have the freedom to choose or reject the treatment. National Institute of Unani Medicine is the pioneer Institute to provide Unani Medicine patient education.

Patients get information about themselves and their condition in the following ways:

  • The patient and the attending Unani physician discuss regarding the chief complaint of sickness and ways of treatment.
  • Written materials in the form of handouts are given to the patients.
  • Online information is also available through the National Institute of Unani Medicine.
  • For illiterate patients a special officer or a nurse provides necessary information apart from the attending Unani physician. 

The Unani physicians at the time of graduation take an oath of ‘Best Practice Management’ and it is known as “khanoon e hikmat” meaning Laws of Unani Medicine practice.[3]

The Central Council of Indian Medicine has laid down standards of professional practice and conduct, etiquette and code of ethics for Unani Physicians. Among the following are the Practice Management regulations given by the Central government of India through the department of Central Council of Indian Medicine [10]:  

  1. Registration: Every Unani Physician after graduation and before commencing the practice must be registered with the Central Council of Indian Medicine through the State Council or the Board.
  2. Obligations and duties of practitioners of Indian medicine: 
    • A practitioner of Unani Medicine must always standby for the patients in emergency situations.
    • A practitioner of Unani Medicine must practice without the considerations of religion, nationality, race, caste, creed, party politics or social status.
  3. Responsibility of practitioner of Unani Medicine. - A Unani practitioner must maintain the confidentiality of the patients. 
  4. A practitioner of Unani Medicine shall serve the patient with their sickness without undermining or exaggerating their conditions.  
  5. A practitioner of Unani Medicine must not neglect any patient under treatment. 
  6. A practitioner of Unani Medicine must maintain the dignity and honor of his profession. 
  7. A practitioner of Unani Medicine while attending a women patient in an obstetric case must follow the professional ethics and standards of treatments. 
  8. A practitioner of Unani Medicine shall act as an advisor for the community in regards to health and healthy living.  
  9. A practitioner of Unani Medicine at all times engages himself/herself in public health work.  
  10. A practitioner of Unani Medicine must be punctual in consultation. The consultation fees must be displayed or conveyed to the patient. 
  11. A practitioner of Unani Medicine must not advertise with intention to gathers patients by any means. 
  12. A practitioner of Unani Medicine must display his/ her qualification with the correct degree or diploma before or after his name. 
  13. A practitioner of Unani Medicine may advertise only on the following conditions: 
    • On starting practice 
    • On change of type of practice 
    • On change of address 
    • On temporary absence from duty 
    • On resumption of practice 
    • On succeeding to another practice 
  14. A practitioner of Unani Medicine must not make claims on payment for professional services like "No cure, no payment". 
  15. A practitioner of Unani Medicine must always display the registration certificate to the relevant authorities when asked.

References 

  1. Aagha Ashraf et. al. Tareekh-e Tibb. First Edition Delhi India. Mahboob Book Depot.1996. pp. 29-33.
  2. National Institute of Unani Medicine (NIUM). Dept. of AYUSH, Ministry of Health & Family welfare, Govt.   of India. [Online]. Available from: http://www.nium.in/faq.htm [Accessed 22nd June 2010].
  3. Hakeem Hari Chand Multani, Alaamaat, Taj-Ul-Hikamt. Lahore Pakistan. Malik Book Depot.1966.pp.14-15.
  4. Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). Unani System of Medicine; Introduction and Origin. [Online]. Available from: http://indianmedicine.nic.in/unani.asp [Accessed 22nd June 2010].
  5. The American Institute of Unani Medicine.(AIUM) Theory of Temperaments (Mizaj). [Online]. Available from http: //www.unani.com/heating.htm [Accessed 22nd June 2010].
  6. C.C.l.M.  Central Council of Indian Medicine., Govt.   of India. The Indian Medicine Central Council Act, 1970.  [Online]. Available from: http://ccimindia.org [Accessed 22nd June 2010].
  7. Ansari, AA. Global Status of Unani Medicine. International Conclave on Traditional Medicine. India, 2006. Available from:  http://www.niscair.res.in/ [Accessed on 22nd June 2012].
  8. World Health Oraganization (WHO). Legal status of traditional medicine and complementary/ alternative medicine: a worldwide review.Geneva: WHO; 2001.
  9. Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). Gazette Notification issued under the Drugs & Cosmetics Rule 1945 [Online]. Available from: http://indianmedicine.nic.in [Accessed 10th May 2011].
  10. Central Council of Indian Medicine (CCIM) , Govt.   of India. Practitioners of INdian Medicine (Standards of professional conduct, etiquette and code of ethics regulations, 1982).  [Online]. Available from: http://www.ccimindia.org [Accessed 22nd June 2010].