Definition
Unani Tibb, also known as Unani medicine, is a combination of the words “Unani” where Unani means “of the Greeks” and “Tibb” which means “medicine” in Arabic. Unani Tibb is a traditional form of medicine which originates from ancient medical practices of the Greeks, Arabs and Persians and is currently practiced widely in India, Pakistan and Bangladesh.[1]
History
Origin
The practice of Unani medicine shares the same early beginnings as modern medicine but, unlike modern medicine, still retains principles developed during the period of ancient Greek and Islamic civilisations. It began with Greek medicine as practiced by the civilization which peaked in the 400 years B.C. Later, the contributions of the Islamic civilization physicians, such as Ibn Sina/Avicenna (980 – 1037 A.D.) and Rhazes/ar-Razi (865 – 923 A.D.) also contributed towards the development of the Unani medicine system.[1]
Development of Unani Medicine
The theoretical basis of Unani medicine was first documented and systematized by Hippocrates, a Greek philosopher and physician widely known as the “Father of Medicine”. Hippocrates (460 – 377 B.C.) postulated the humoural theory, the cornerstone of Unani medicine. He subscribed to the theories of his predecessors who viewed that the essence of matter was a result of four primary elements – fire, water, air and earth. Hippocrates theory of “physis”, which explains the ability of the body to heal naturally, is well known to be an important theory in the development of medicine. Other contributions of Hippocrates towards Unani medicine and modern medicine in general was his approach in treating the human body as a complete entity rather than a collection of parts, his elimination of elements of magic and superstition from medicine and his practice of keeping track of patient case histories.[2]
Galen, another Greek scholar born 600 years after Hippocrates, also contributed to the early development of Unani medicine. Galen had advanced the theory of humour by Hippocrates with his theory on the humoural characteristic of food. The theory explained an elaborate system of dietetics, as we know it today. He also refined the humoural theory by postulating that each of the four humours is qualified by natures (temperament qualities) and elements. Natures (temperament qualities) are classified as cold, dry, wet and hot while elements are fire, water, air and earth. Galen also refuted the Hippocrates’ theory on the perfect humoural balance, stating that there was no perfect equilibrium and each individual tends towards a particular humoural imbalance which characterises his or her temperament. Temperaments are defined as sanguine, phlegmatic, melancholic or choleric.[3]
Between the 9th century and 12th century, Al-Razi or Rhazes, a prominent scholar in the development of Unani medicine, authored the well known Kitab al Hawi. The 25-volume medical encyclopedia was a mixture of quotations from Greek, Indian and Arabic authors and case studies from al-Razi’s medical experience.
Nine hundred years after Galen, Hakim Abu Ali al-Husayn Abd Allah Ibn Sina or Avicenna, a Persian physician emerged as another important scholar in the development of Unani medicine. Avicenna is famed for authoring the al-Qanun fi al-Tibb or the Canon of Medicine, a famed reference book and teaching guide utilized for the longest period of time in the history of medicine and remains as a handbook for all practitioners of Unani medicine.
The practice of Unani medicine was spread in areas of Persia and Egypt, where Greek migrants had settled and the practice of Unani medicine was prevalent. Efforts of translating Greek texts for Arabic and Syriac languages by physicians such as Hunain ibn Ishaq al ‘Ibadi further spread the adoption of Unani medicine.
The Book of Concessions or Kitab al Tasrif li man ‘ajize’ an al ta’lif was an important medical text on surgery, authored by Al Zahrawi from Andalusia (936 AD – 1013 AD) who was said to be the greatest Muslim surgeon of his time. The 30-volume encyclopedia included a comprehensive and systematic write-up on surgery with illustrations of more than two hundred surgical instruments. The famous book was used as a manual for surgeons for many centuries.[3]
The 12th century saw two other important personalities in the development of Unani medicine, ibn Zuhr and ibn Rushd. Ibn Zuhr or Avenzoar wrote the first book on diet in the Muslim world, Kitab al Aghziya, while ibn Rushd or Averroes wrote the Kitab al Kulliyat which summarized the medical field in an abridged form.[3][4]
Unani medicine made its inroads to South Asia when the last Ghazni King, Khusro Shah set up the first Centre of Unani medicine in Lahore in the 1160s. Subsequent Mughal kings helped spread the influence of Unani in India by building hospitals and employing Unani physicians or also known as “hakims” in palaces and their respective provinces. The availability of medical texts in Persian was one of the factors helping the spread of Unani medicine in India. The development of Unani medicine in the 13th century was common between India and Persia due to the common language. Many Unani medicine professionals sought jobs in India during this growth period while some Indian hakims were trained in Persia before returning to India. The first Unani medical textbook found in India, Tibb-i Firuz Shahi was written by Shah Quli in 1281.
Unani medicine continued to grow in India during the 16th – 18th century under the reign of several Mughal Kings. Sher Shah (1540 – 1545) improved the coverage of Unani medicine into rural areas by placing a Unani physician in every stopover resthouse on caravan routes in his empire. The Qutub Shahi dynasty in Hyderabad set up a Unani Hospital with a capacity for 4000 in-patients in the late sixteenth century and Aurangzeb constructed Unani hospitals in smaller towns of his province in the 17th century. An important book in Unani medicine, Mizan-i Tibb or Balance of Medicine was authored by prominent physician-writer Hakim Muhammad Akhbar Arzani in the 1700s.[3][4][5][6]
Unani medicine continued to flourish in India while the Scientific Revolution occurred in Europe between years 1450 to 1700. This period in Europe gave rise to the early development of modern medicine as we know it today and brought upon the gradual replacement of traditional Greco-Islamic medicine such as Unani. The contributions of numerous scholars such as Leonardo da Vinci, Louis Pasteur and Charles Darwin during this era helped develop the modern system of medicine which prevails as the de facto standard of medicine today.[7]
Meanwhile in India in the 19th century, the hakims of Lucknow founded Anjuman i Tibbiya, the medical society for Unani practitioners in 1911. Many institutes and colleges were set up during this period to promote the education of Unani medicine.[3][4]
The era of development of Unani medicine in the 1900s was known as the Hamdard Era. Key figures of this era were brothers Hakim Muhammed Sayeed and Hakim Abdul Hameed Mutawwali, who founded the well-known Hamdard Institutes in India and Pakistan. The Hamdard centres have ever since developed into the largest facility in the world for the study, treatment and research of Unani therapeutics. The brothers had also set up Hamdard clinics or Dawakhanas, where the patients are only required to pay a modest fee for medicines. Other contributions include the establishment of the Hindustani Dawakhana in Delhi to manufacture Ayurveda and Unani medicines, the establishment of a Unani Medical School for Women, the National Islamic University in Delhi and Unani Tibbia College.[4]
In 1969, the Central Council for Research in Indian Medicine and Homeopathy (CCRIMH) was established by the Indian government to develop scientific research in Indian systems of medicine such as Ayurveda, Unani, Siddha, Yoga, Naturopathy and Homeopathy. The Central Council for Research in Unani Medicine (CCRUM) was then founded in 1978 to support scientific research in Unani medicine. In 2003, the Government of India set up the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) under the Ministry of Health & Family Welfare. The Unani infrastructure in India today is supported by a wide network of colleges, hospitals, dispensaries and research institutes.[4]
Principles
The Unani medicine system is based on the principles of humoural balance adapted from Greek Medicine. The principle states that each individual has a different humoural constitution, built from the 4 basic humours (akhlat) – Dam (Blood), Balgam (Phlegm), Safra (Yellow Bile) and Sauda (Black Bile). A healthy state is defined as a well-balanced proportion of the humoural fluids in the body while sickness is a condition where the humoural composition is imbalanced in a body system or a qualitative change in the composition or physical properties of the humours occurs.[8][9]
The natural balance of the humoural constitution in the body is regulated by a power of self- preservation or adjustment called Quwwate-Muddabira or tabiyat (Medicatrix naturae). The practice of Unani medicine helps bring Quwwate-Muddabira or tabiyat to an optimum level at the onset of disease to restore humoural balance and regain a healthy state of the body system.[8]
- Geographical condition
- Residential condition
- Occupation
- Habits
- Sex
- Other factors
- Atmospheric air
- Food and drinks
- Physical movements and response of body
- Mental movements and response of the body
- Sleep and Wakefulness
- Evacuation & Retention
- Elements
- Temperament
- Humours
- Organs
- Vital Spirit
- Powers
- Functions
Figure 1: Factors affecting the healthy state of the body in Unani medicine
The principles of Unani medicine also states that the health state of the human body is maintained by the harmonious arrangement of al-umoor–al-tabiyyah or the 7 basic physiological principles of the human body.[8] The 7 basic physiological principles of the human body are:
- Elements (Arkan)
- Temperament (Mizaj)
- Humours (Akhlat)
- Organs (Aza)
- Vital Spirit (Arwah)
- Powers (Quwa)
- Functions (Afal)
Besides the above, additional factors are also instrumental in maintaining the health state of the body.[8] These factors are known as Asbab Sitta Zaruriya or Six essential causes and are listed below:
- Atmospheric Air (Al-Hawa Al-Muhit)
- Food and drinks (Al-Makul Wal-Mashrub)
- Physical movements and response of the body (Al-Harkat Wal-sukun-Albadniya)
- Mental movements and response of the body (Al-Harkat Wal-sukun-Al Nafsaniya)
- Sleep and Wakefulness(Naum-Wal-Yaqza)
- Evacuation & Retention (Al-istifirag Wal Ihtibas)
Other non-essential factors known as Asbab Gair Zaruriya also influence the health state of individuals who come in contact with these factors.[8] These factors are listed below:
- Geographical condition (Al-Bilad)
- Residential condition (Al-Masakin)
- Occupation (Al-Senat)
- Habits (Al-Adat)
- Sex (Al-Asnan)
- Other factors (Umur Muzadaltabi)
Elements (Arkan)
Elements or Arkan are four simple individual entities which forms primary components of the human body and all other creations in the universe. The four elements are arz (earth), maa (water), nar (fire) and hawa (air). Air stands for matters in a gaseous state, water for a liquid state, earth for a solid state and fire for matter that has been transformed into heat. According to Unani practice, each element possesses unique temperament qualities – earth is cold and dry, water is cold and moist, fire is hot and dry and air is hot and moist.[8]
Humour (Akhlat )
Figure 2: Humoural theory in Unani medicine [10]
The “Humoural theory” assumes the presence of four humours – Blood (Dam), Phlegm (Balghum), Yellow Bile (Safra) and Black Bile (Sauda). This is central to the practice of Unani medicine. Each humour is assigned with respective temperament qualities of the elements – Blood like air is hot and wet; Phlegm like water is cold and wet; Yellow bile like fire is hot and dry and Black bile like earth is cold and dry. The humoural constitution in each individual is unique and represents his or her health state.[8][9][10][11]
Temperament (Mizaj)
Mizaj indicates the state of equilibrium between four humours in the body. The dominance of a particular humour combined with the temperament qualities of the elements – hot, cold, wet and dry in an individual result in his or her temperament (mizaj). The 4 basic temperaments outlined are:
- Dumwi (Sanguine) – predominance of blood
- Balghumi (Phlegmatic) – predominance of phlegm
- Safravi (Choleric) – predominance of yellow bile
- Saudawi (Melancholic) – predominance of black bile
The temperament in an individual can be classified as a balanced one (mizaj-e-mutadil) or imbalanced one (mizaj-e-ghair-mutadil). The principle of Unani medicine believes that each individual is born with a unique humoural constitution which determines their temperament and health state.[3]
Practices
Diagnosis
The first point of diagnosis in Unani medicine begins with the observation of the patient’s physical appearance and questions on dietary intake, excretions, symptoms, sleep and activity patterns by the Unani physician (hakim).[5]
Further diagnosis is further conducted through the assessment of the pulse (nabz), urine (baul) and stool (braz). Common diagnostic activities include the following:[12]
- measurement of body heat by the palpation of the pulse rhythm or using a thermometer. A thorough examination of the pulse is carried out to determine the dominant humour during the period of diagnosis.
- examination of urine to ascertain disorders in kidney, liver and other organs of digestion. The colour, odor, clarity, viscosity, presence of impurities, froth at the surface and the formation of bubbles are examined of the patient’s urine.
- examination of stools. This is carried out in a similar manner as the urine examination.
- observation, palpation and percussion to diagnose disease of the internal organs.
- The use of a stethoscope to study breathing patterns and heart sounds and the examination of blood pressure is also undertaken by some hakims.
Treatment
Once the disease has been identified from the diagnosis phase, the hakim would commence treatment of the medical condition. In Unani medicine treatment given is either preventive or curative.[13]
- Preventive treatment revolves around regulating the six essential causes/prerequisites known as Asbab e Sitta Zaruriya – atmospheric air, foods and drinks, movements and response of the body, mental/physchological movements and response of the body, sleep and wakefulness, evacuation & retention.
- Curative treatment on the other hand depends upon the nature of the ailment and its cause.
The 4 modes of treatment are as listed below:
- Regimental therapy ( Ilaj-bit-Tadabeer). Regimental therapy is carried out to normalize air, water, food and other factors to boost tabiyat. The methods used in regimental therapy include venesection, cupping, diaphoresis, diuresis, therapeutic bath, massage, cauterization, purging, vomiting, exercise, leeching, hydrotherapy and acupuncture.[13]
- Dietetic therapy (Ilaj-bi-Ghiza). Dietetic therapy involves treating the patient by administrating a specific diet and regulating the quality and quantity of food taken by the patient. Besides its role in providing nutrition, food can also be used as a pharmacological agent to act as a diuretic or laxative. Dietetic therapy in Unani medicine also involves curing a certain organ disease by prescribing the consumption of a similar organ of an animal. As an example, a patient with liver weakness/disease may need to consume the liver of a goat as a cure.[5][8]
- Pharmacotherapy (Ilaj-bi-Dawa). In addition to the regimentary and dietetic therapy, Unani medicine uses natural drugs from sources of plants, animals and minerals as a curative treatment. The practice of Unani medicine utilizes drugs from natural sources as they are considered to have little or no harmful side effects. Selections of drugs are usually done based on the following factors – specific action of the drug, its temperament, the patient’s temperament and the disease condition.[5] Some therapeutic agents commonly used in the practice of Unani medicine are listed below.[14]
- Surgery (Ilaj-bil-Yad). Surgery in Unani medicine is rare and usually used as a last resort.[8]
| Type of therapeutic agent | Examples |
| Plant drug (Advia-e-Nabati) | – Ebony ( Diospyros ebenum Koenig) – Bukhara plum (Prunus domestica Huds) – Sun Flower (Helianthus annus Linn.) – Bog Rush (Andropogan schoenanthus Lin.) – Rice (Oryza sativa Linn.) – Persian lilac (Melia azedarach Linn.) – Myrtle (Myrtus communis Linn) – India valerian (Valerian wallichii DC) – Lupin (Lupinus termis Forsk.) – Lavender (Lavandula stoechas Linn) – Emblic myrobalan (Embilica officianalis gaertn.) – Silkpod (Bombyx mori) – Dyes Bugloss (Onosma Echiodides CB) – Juniper Berry (Juniperus comunis Linn.) – Citron (Citrus Medica Linn.) |
| Animal Drug (Advia-e-Haiwani) | – Sheep milk, honey,cow urine etc. |
| Mineral Drug (Advia-e-Jamadai) | – Gold, silver,asbestos, sulphur, clay, copper,zink, silicon etc. |
Current Status
In South Asia today, Unani medicine serves as a complementary system to biomedicine and other alternative medicine systems. While maintaining its traditional principles, Unani medicine has adopted modern techniques in their practice. Some Unani practitioners now utilise diagnostic instruments such as x-rays and ultrasounds and Unani drugs are produced in tablets, capsules and syrups for easy consumption, packaging and handling.[3] Unani medicine is believed to be effective to treat the following disorders: allergic disorders, bronchial asthma, managing chronic heart failure, chronic diarrhea, chronic active hepatitis, chronic colitis, chronic liver disease, chronic dermatitis and psoriasis, diabetes mellitus, dysfunctional uterine bleeding, eczema, functional dyspepsia, hypertension, insomnia, infective hepatitis, ischemic heart disease, leucoderma, malabsorption and sprue, common cold (prevention/cure), peptic ulcer, promotion of lactation, rheumatoid arthritis, schizophrenia, and urinary stone.[5]
The annual turnover of the Unani drug market in India is estimated at US $27.7 million.[15] Unani drugs are currently manufactured for various ailments including acne, asthma, high cholesterol, common colds, chronic diarrhea and others. The Indian government through CCRUM has undertaken clinical trials of Unani drugs in various therapeutic areas to scientifically establish the efficacy of these drugs. Unani drugs frequently use plant, mineral and animal sources as active ingredients. An example of a Unani tuberculosis drug includes a mixture of camphor, sandalwood, lettuce, wheat extract, crab and sugar as active ingredients while a drug for constipation includes aloe plant and lemon.[16]
Unani medicine is currently practiced throughout the world including Afghanistan, Bangladesh, Canada, China, Denmark, Ethiopia, Republic of Germany, Finland, Japan, Netherlands, Norway, Pakistan, Poland, Korea, Saudi Arabia, Sri Lanka, South Africa, Sweden, Switzerland, Thailand, Turkey, the United Kingdom, and the United States. However, it is most prominent in South Asian countries – India, Pakistan and Bangladesh.[2]
Guidelines
|
Country |
Policy/Regulation |
|
India |
Creation of the Central Council of Indian Medicine (CCIM) Act of 1970. The functions of CCIM include[17]:
The Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) is a division of the Ministry of Health & Family Welfare, India. The Central Council for Research in Unani Medicine (CCRUM) and the National Institute of Unani Medicine (NIUM) falls under the control of this department.
|
|
Bangladesh |
The Board of Unani and Ayurvedic Systems of Medicine is responsible for:
The Bangladesh Unani and Ayurvedic Practitioners Ordinance of 1983 was set up to provide for the regulation of the qualifications and registration of practitioners of Unani and Ayurvedic systems of medicine.[17] The Department of Homeo & Traditional Medicine under the Ministry of Health and Family Welfare, Bangladesh outlined a Treatment Guideline for Unani Medicine in April 2006.[13] The document includes Unani medicine treatment guidelines for various diseases including those involving respiratory, urinary, endocrine and reproductive system among others. |
|
Pakistan |
Unani, Ayurvedic and Homeopathic Systems of Rules of 1965 was issued by the Government of Pakistan to include the following:
The National Council for Tibb, under the Ministry of Health Pakistan is the government arm entrusted to oversee the qualifications of Unani practitioners. The council is responsible for developing the curriculum, education and examination for Unani medicine in Pakistan and enable registration of practitioners.[19] |
|
South Africa |
The Allied Health Professions Council of South Africa (AHPCSA) opened their register to Unani physicians in 2007 through a government gazette.[20][21] |
Research and Publication
India
In India, there are 39 recognized medical colleges providing training in Unani medicine as of 2002. From this number, 3 institutions provide postgraduate training in Unani medicine – the Ajmal Khan Tibbia College at Aligarh Muslim University, the Government Nizamiah Tibb College in Hyderabad and the Faculty of Medicine at Jamia Hamdard, New Delhi.
Aspiring Unani professionals are able to take up the 5-year Bachelor in Unani Medical Sciences (B.U.M.S) in accredited institutions in India. Specialisations in Unani medicine can be acquired through a 2-year advanced degree in Unani Medical Science (M.D. [Unani]) where students are able to specialize in areas of Unani such as pharmacology, basic principles, gynaecology or paediatrics. Graduates of the B.U.M.S AND M.D [Unani] programs are able to register with state governments and conduct medical practice.
Pakistan
The teaching of Unani medicine in Pakistan is carried out by Tibbia colleges which are under the direct control of the National Council for Tibb, Ministry of Health. 4-year diplomas in Pakistani traditional Unani and Ayurvedic systems of Medicine are offered by 27 colleges in the country which follow the prescribed curriculum as defined by the National Council of Tibb. The Hamdard University of Pakistan also carries out a 5-year Unani medicine programme.[17]
Bangladesh
Unani formal education is controlled by the Board of Unani and Ayurvedic Systems of Medicine.[17] There are five Unani medicine institutions under the board which offer a 4-year Unani medicine diploma programme.
South Africa
The Ibn Sina Institute of Tibb, a non-governmental organization promoting the philosophy of Unani medicine in South Africa, offers a range of workshops to promote Unani medicine in the South African community. The institute carries out workshops targeted at different groups such as healthcare professionals, students and corporate audiences to increase public awareness and understanding of Unani medicine.[22]
Aspiring South African Unani practitioners may undertake the 5-year Bachelor of Complementary Medicine-Unani Tibb program at the School of Natural Medicine, The University of Western Cape, South Africa. The school has also developed a postgraduate diploma in Unani Tibb program which is currently under review.[22]
Associations
- South African Tibb Association (SATA) – http://www.satibb.co.za/
- Pakistan Tibbi Pharmaceutical Manufacturers Association (PTPMA) – http://www.ptpma.org/
- Graeco-Arabic Medicine Society Inc., Australia – http://www.traditionalmedicine.net.au/
- Unani Medical Association, India – http://umaindia.org/
- Unani Medical Welfare Association, Sri Lanka
Events
The first World Conference on Unani medicine was sponsored by the World Health Organization, the Ministry of Health, India and the Central Council for Research in Unani medicine and held in New Delhi, India in 1987. Many key events on Unani medicine are carried out in India, where Unani medicine is most popular. Most recently, The International Conference on Drug Development in Unani Medicine, 2010 held in the National Institute of Unani Medicine, Bangalore from 22nd to 24th April 2010. (http://www.iuc2010.com/10.nium.html)
Glossary
| Terms | Definitions |
| AHPCSA | Allied Health Profession Council of South Africa |
| Akhlat | Humour |
| Arkan | Elements |
| AYUSH | Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy |
| CCIM | Central Council of Indian Medicine Act |
| CCRIMH | Central Council for Research in Indian Medicine and Homeopathy |
| CCRUM | Center Council for Unani Medicine |
| Hakim | Unani Physcian |
| Mizaj | Temperament |
| NIUM | National Institute of Unani Medicine |
| Tabiyat | Power of self preservation or adjustment of the body |
| TDKL | Traditional knowledge Digital Library |
| Tibb | Unani Medicine |
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- Ministry of Health and Family Welfare Bangladesh. Treatment Guidelines for Unani Medicine. Dhaka: Department of Homeo & Traditional Medicine (DGHS). 2006.
- Chopra, R. N. and I. C. Chopra. Chopra’s Indigenous Drugs of India. Kolkata. Academic Publishers. 2006.
- Sharma, A., C. Shanker, et al. Herbal Medicine for Market Potential in India : An Overview. Academic Journal of Plant Sciences. 2008; 1(2): 26-36.
- Ahmed, S., R. Ahmad, et al. Evaluation of Five Unani Drugs for Antibacterial and Antifungal Activity. Journal of Herbal Medicine and Toxicology.2009; 3(1): pp.47-52.
- World Health Organization. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review. Geneva. WHO. 2001:. pp; 78-80,129-134.,
- Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy..Ministry of Health & Welfare, Government of India. Ayurveda Yoga Unani Sidha H. About TKDL.Available from: http://www.tkdl.res.in/tkdl/ [Accessed 26 Jan 2012].
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- Bika, R. Developing a Unani Curriculum : A South African Perspective. Available from: www.tibb.co.za/articles/Developinga vc AAP. pdf. [Accessed 26 Jan 2012].
