Unani Tibb is part of the culture of the Indian subcontinent, and is practised widely in India, Pakistan, Bangladesh, and other countries. Based upon the concept of the humours and vital forces which control the functioning of the body, the principles of Unani Tibb are not very different to those of Ayurveda. Besides the curative aspect, Unani medicine is used for the promotion of health and rejuvenation of vigour.

Development and Revival of Unani Tibb

In the seventh century, Mohammad, the Prophet of God, and his successors, the caliphs, created a vast Arabian empire, which within a century of the passing away of the prophet, encompassed territories greater than those of any other earlier civilisation.

On the borders of Persia, in the region of Asia Minor, a small territory named Jundi-Shahpur, flourished as a centre of Greek learning. It was here that Nestorian Christians, Jews, and other scholars practised and taught Greek sciences and medicine. When the caliphs captured the area, they left it undisturbed and, in fact, during the early expansion of their empire, summoned physicians from there whenever medical aid was required.

After the Abbasids seized power in about a.d. 750, they made an organised attempt towards the pursuit of scientific learning. The procurement and translation of Greek and Indian medical texts and others was encouraged. Scholars in Iran and neighbouring countries embarked upon the translation of the best available writings in Syriac, Greek, Persian, and Sanskrit. The practice of medicine now developed into an established profession.

Translation of Greek and other medical texts into the Arabic language, and the new books written by pioneering non-Muslim scholars, coupled with the setting up of hospitals and medical libraries in the larger cities of Arab empire, ushered in an era when Muslim scholars stood poised to make original observations and innovations. The emergence of Muslim scholars, mostly Persian, took place between a.d. 900 to about 1,100. The first and surely the greatest of the physicians and authors of this period was Al-Razi.

Al-Razi, popularly known by medieval Latinists as Rhazes, was probably the first physician known to have refused to surrender to the authority of Galen’s erroneous doctrines. As chief physician of a big hospital in Baghdad, his fame spread far and wide. Combining all the knowledge available on diseases with his own observations, he composed a lengthy manuscript, which posthumously appeared in book form under the title of Al-Hawi. This book, later translated into Latin {Continpns) and other European languages and taught in European universities, influenced Western medical thought.

The detail and accuracy of Al-Hawi in recognising different diseases; differentiating among similar-looking diseases; their classification, and the methods adopted to treat them, makes Al-Hawi a highly regarded text even today. The treatise on smallpox and measles contains the first definite description of smallpox as a clinical entity.

Another great physician was Ibn Sina, also known by his Latinised name, Avicenna (980-1037). A child prodigy, Ibn Sina was interested in many fields of knowledge. In medicine, he was more interested in the theory rather than the practice of medicine. His book Al-Qanun, was translated into Latin {Canon), and studied in medieval European universities. It is still regarded in India and Pakistan as the supreme authority on all matters connected with Unani Tibb. Rhazes and Avicenna were both of Persian origin but wrote in Arabic.

When Mongol hordes under Chinghiz Khan, Hulagu, and Timur brought ruin to the flourishing Persian and Central Asian cities, scholars and physicians from these regions were compelled to flee to places where they felt comparatively safe, and where they could continue their creative activities. Since India had good relations with Persia, and the economic and political conditions therein were favourable, many physicians and scholars from Persian cities migrated to India.

Delhi, the capital of the Sultans, became an even greater centre of culture and glory than Baghdad. The Khilji and Tughluq Sultans nurtured eminent Unani physicians, surgeons, and ophthalmologists. During the reign of Sikander Lodi (1489-1517), Mian Bhowa, an eminent courtier, composed a medical treatise entitled Madan-ul-Shifa Sikander Shahi in Persian. The Mughal rulers patronised physicians and surgeons from medical centres in Persia, more particularly from Gilan, Shiraz, and Tabrez.

During the reign of Akbar, there was a mass exodus of learned men from regions where Arabian medicine was taught. People came to India in search of name and fame, the political conditions in their own countries not being favourable for their advancement. Abul-Fazl, the renowned historian, makes mention of 29 eminent physicians who paid homage to Akbar. These included Hakim Ali Gilani, Hakim Abul Fatah Gilani (who invented the Indian hookah), Ain-ul-Mulk Hakim Shamsuddin Ali Sherazi, Hakim Hummam, Hakim-ul-Mulk Gilani, and some Hindu physicians like Mahadev, Bhim Datt, and Narayan. This trend continued during the reigns of the successive great Mughals — Jahangir, Shah Jahan, Aurangzeb.

After the reign of Aurangzeb, while the Mughal emperors continued to support and encourage the teaching and practice of Unani Tibb, the gradual deterioration of their own political and economic situation acted as a setback to this system, as it did to other social facilities and activities. The English rulers showed no interest in either Unani Tibb or Ayurveda, causing these systems to be further neglected.

It was only much later, towards the last quarter of the nineteenth century and after that, that a national re­awakening aroused the interest of a few educated Indians towards their own systems of medicine.

How Unani Works

Unani Tibb is based upon the ancient Greek theory of humours. The essential constituents and the working principles of the body, according to Unani Tibb, can be classified into amur-e-tabia or seven main groups: 1) arkan or elements, comprising mitti (earth), pani (water), hawa (air), and aag (fire) as different states of matter and the materials which make up everything in the universe; 2) mizaj (temperament); 3) akhlat (humours); 4) aza (organs); 5) arwah (life, spirits or vital breaths); 6) quva (energy); and 7) afa’al (action).

Arkan (matter) in its different states, helped by the amzija, plural of mizaj (temperament), of each of its individual constituents, combines to produce the aza or organs and arwah or life spirits; the organs with the spirit develop quva or energy which manifests itself in the afa’al (actions) of the body.

Each of the elements has its own special qualities: the earth is cold and dry; water is cold and moist; fire is hot and dry; air is hot and moist. When these elements mix with one another qualitatively and quantitatively, there emerges a uniform body possessing an amalgam of these qualities. The resultant quality of the uniform body is called its mizaj (temperament).

The temperament of a substance may be a mizaj-e-mutadil (balanced one) or a mizaj-e-ghair-mutadil (imbalanced one). Different types and shades of imbalanced temperaments are described in the Unani System.
In the human body, there are four humours. These are balgham (phlegm), khoon (blood), safra (yellow bile), and sauda (black bile). They correspond to the four elements and their four primary qualities. When these humours are present in the right proportion in the body, the body remains healthy. When the proportion is disturbed, there is a loss of health. In order to restore health, it is necessary to restore the balance of these humours.

These humours are produced from digested food. In the stomach, the food undergoes a ‘first digestion’, whereby the more nutritious part of it is converted into kaylus or chyle and a portion of the unnutritious residue is converted into phlegm. The chyle is then conveyed to the liver by the portal vein. In the liver a ’second digestion’ takes place which divides the chyle into three portions: scum or froth which is the yellow bile, sediment which is the black bile, and blood which contains its choicest ingredients. The blood passes on through the superior vena cava to the heart, while disbursing its more liquid part to the kidneys for excretion. The blood is then distributed by the arteries to the various organs in which it undergoes a ‘fourth and final digestion’ (the third having taken place in the blood vessels).

Unani Tibb postulates that from birth every person is endowed with a unique humoral constitution which represents his healthy state. It is this predominance which determines which type of personality the individual has. Unani Tibb also postulates that the body contains a self-preservative power. This power strives to restore any disturbance within the limits prescribed by the constitution or state of the individual. Great reliance is placed on this power, the aim of the physician being merely to help and develop rather than supersede or impede the action of this power.

The practice of Unani Tibb seems to be following the same trends as Ayurveda today. While the basic concepts of Unani Tibb remain as before, the syllabi in some of the progressive institutions includes the teaching of modern basic sciences such as physics, chemistry and biochemistry, botany, and zoology in pre-Tibb classes; and anatomy and different surgical procedures in pre-clinical and clinical classes. Students are also made familiar with the simple diagnostic procedures used in allopathy.

In clinical practice, while the disease of the patient is diagnosed on the basis of the derangement of different humours, the assistance of some modern laboratory tests such as blood, stool, and urine examination, and examination of blood pressure is taken to confirm the diagnosis and to assess the severity of the disease wherever necessary.

A majority of the basic drugs used by Ayurvedic and Unani physicians are the same, so that research done on these drugs to assess or isolate their active principles applies to both these systems. Some new compound preparations are also being made available through reputed Tibbi drug companies.

Analysing Individual Temperaments

In Unani Tibb, diagnosis of a disease is based upon a knowledge of the patient’s inherent temperament and his present temperament in the disease state which is a result of disturbance in his humours.

The temperament of a person is measured against that of a balanced person under normal conditions. Since the skin of the body and, more particularly, the skin of the terminal phalanges is the most balanced, touch has been adopted as the best means of perception. The five senses are, however, thoroughly examined so that the general physique, pulse, feel of the body, type of hair, sleep, emotional characteristics, and colour of the stool and urine are carefully noted for proper diagnosis.

Restoring the Balance in ‘Humours’

Treatment of a patient is dictated by the diagnosis of the disturbed humour in the body, and is intended to restore to normalcy, the disturbance of this hurfiour.

As the humours are produced from the digested food, their quality is also determined tty”the ffatuce- of food that the patient takes. The disturbed balance of the humours can be aggravated by an inappropriate diet or corrected by an appropriate diet.

Drugs are also assigned temperaments: hot, cold, dry, and moist, and they contain varying degrees of temperament. While prescribing a particular drug to a patient, the Unani physician has to consider whether the drug, which contains a certain degree of its own temperament, will match the inherent temperament of the patient and restore the balance of the disturbed humour.

Unani drugs do not intend only to make the human body overcome its present disturbance, but to emerge with a greater power of resistance to future disturbances. Only in the case of immediate and imminent danger to life, is it considered necessary to resort to drastic methods.

A Unani physician does not prescribe the strongest drug at the onset of the treatment. He selects the drug according to the degree of variation of the patient’s condition from his normal healthy condition, and observes the effect produced by the treatment. At the same time, he instructs the patient to observe some restrictions in diet and lifestyle. The observance of such restrictions is necessary because the therapeutic effect of these mild drugs may be counter-balanced to an extent due to a faulty diet or lifestyle. Particular care has to be taken while treating a hot, cold,/ dry, or moist disease with a food or drug of the opposite quality.

Step-by-Step Approach: If a nine-year-old child suffering from breathlessness on exertion, presents himself before a physician practising Unani Tibb, the latter first notes down the history of his illness, paying particular attention to the passage of stool and urine, the nature of sleep that the patient gets, his mental make-up, and so on. After that, he conducts the physical examination.

Since in Unani Tibb, health and disease depend upon the equilibrium or disequilibrium of the four humours, a thorough examination of the nabz (pulse) is undertaken to determine which humour is dominant at the time. The detailed examination of the pulse is an art and some hakims are known to depend largely upon it for diagnosis of a disease. The pulse is examined for the frequency of its beats (slow or fast), its force (whether the pulse beats hard or soft against the examining fingers), dilation (how much it dilates), the pause between the two beats of the pulse against the examining fingers, and many other details.

The next important item of examination is the urine. The colour of the urine, whether it is rakik (thin) or garah (thick), whether it has jhag (froth) on its surface, whether the bubbles formed are large, indicating balgham or small, indicating safra — all these features are scrutinised. Next comes the zaika (taste) of the urine. Urine was actually tasted in olden times and different shades of taste were noted. Today, however, only the change in the colour of the litmus paper is noted for its alkalinity or acidity. Heed is paid to whether the boo (smell) of the urine is mild or strong. Then comes the examination of the total quantity of the urine passed in 24 hours. And last is the examination of the rasood (sediment) of the urine, if any.

The stool is also examined in a similar way. Some Unani physicians also examine the blood pressure and use stethoscopes to hear the breathing and heart sounds.

If the examination according to Unani Tibb reveals that there is no derangement of humours in the body as a whole, but there is weakness only in one organ, the physician prescribes remedies to strengthen the affected organ. The patient is asked to rest in bed, eat a nourishing and easily digestible diet, and take whatever drugs are prescribed.

In some cases, a cure may not be possible through Unani Tibb. If the patient needs surgery, allopathy will have to be resorted to.

Precautions and Prospects

Unani Tibb, like Ayurvedic medicine, is based upon concepts on which it is difficult to plan experiments. The presence of the different akhlats (humours): balgham, khoon, sauda, and safra cannot be proved or disproved. They are not entities which can be put into test-tubes or exhibited; hence they cannot be quantified.

As such, any research on the humours can be limited only to associating with them the symptoms and signs in patients suffering from different diseases. Such clear associations can help physicians and students in discussion on such topics.

Unani physicians have not shown as much initiative towards developing their system of medicine, as have Ayurvedic physicians. The result is that even though both face more or less similar problems, Unani Tibb seems to be lagging behind in research and modernisation.

The scope of Unani Tibb is similar to that of Ayurvedic medicine. Even though Unani Tibb is based upon ancient Greek medical concepts, over the centuries, it has adapted itself to Indian conditions and made use of the drugs available in India. People understand the basic concepts of the system and believe in it in the same manner as they do in Ayurveda.

—————————————————————————————Now You Know…

Unani Tibb, based on the ancient Greek and Indian theories of four humours (phelgm, blood, yellow bile, black bile), holds an imbalance in the humours responsible for ill health. The imbalance is believed to be caused by a faulty digestion.

Diagnosis entails ‘touching’ of the skin and examination of general characteristics of the patient to identify his inherent type of temperament and compare it with his current diseased state. Treatment aims at restoring the balance in the body’s self-preservation power by correcting the diet and lifestyle and prescribing appropriate drugs.

A widely practised system, Unani Tibb is affordable and used successfully for day-to-day problems and some chronic ailments.

‘The physician must generalize the disease, and individualize the patient.’
                                                              Christoph Wilheim Hufeland