Unani Medicine 101: From balancing humours to restoring health

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Anshu Bahanda: Have you ever felt out of sync—overly anxious or lethargic without a clear medical explanation from a standard health check? If so, Unani medicine might be what you need to reach optimal health. It’s an ancient healing system that wove its way from ancient Greece and through the Middle East. Welcome to another enriching episode at Wellness Curated. I’m your host, Anshu Bahanda. And this season, we’re talking about healing traditions across cultures and we are going to be digging into ancient medicinal systems and see how they can help us in our lives today.

As I was saying, Unani medicine is also known as Greco-Arabic medicine and the father of medicine, Hippocrates, was known to have been probably evolved in the origin of Greco-Arabic medicine. Hippocrates was born in 460 BC and he actually took away the stigma  of superstition and magic that was associated with medicine and gave it the status of science. And after that as we said this medicine wove its way through the Arabic countries and developed further. The Unani approach is really intriguing actually— they talk about four humours that need to be balanced and these four humours are blood, phlegm, yellow bile and black bile. And each humour is associated with a different bodily function and element. So, as an example, yellow bile is similar to fire. So people who have a lot of yellow bile are go-getters and energetic. But on the other hand, too much can also make you angry and irritable and also cause stomach issues. Blood, on the other hand, is like air. So people who have a lot of blood are of a cheerful personality. They’re optimistic, they’re friendly, but again, too much of it, or an imbalance of it, can lead to swelling and fever. And it’s a balance of these four humours which makes us have energy and vitality, and that’s what we’re going to discuss today. We have with us a Unani medicine practitioner, doctor Safina Anees, and she’s at the doctor Yaseer Unani Herbal Hospital and Research Centre in Tamil Nadu. So, Doctor Safina, thank you so much for being on our show and welcome to the chat today.

Dr Safina Anees: Thank you for giving me this opportunity. It’s my absolute privilege and honour to share such a rich Unani system of medicine’s historical background, steps and treatments.

AB: So, doctor Safina, let’s start at the beginning. The Unani system of medicine, like we were saying, originated in Greece, right? And then it wove its way through the Arab countries and into India and today it’s really integrated into Indian traditional medicine as well. I grew up in Delhi, I don’t live there anymore, I live in London, but I grew up in Delhi. And really, at that point, it was as prevalent in our lives as Ayurveda was. So there was very little difference between, you know, in terms of how many practitioners there were and how people use traditional medicine; we had as many hakeems as we did. So tell me a little bit about the origins of Unani medicine. How did it spread in India? How is it, you know, where did it actually develop?

Dr S: So, the Unani system of medicine has a very ancient and it has a very rich and interesting historical background. The word ‘unani’ comes from Yunan, which means Greece. So, see, more than 3000 years before, the Unani system of medicine originated in Greece. And the hippocratic theory of humours lays the foundation for this system. Later, the other scholars, like Aristotle and Galen, followed his principles and developed it. But this knowledge of medicine came to Greece from the Egypt, Babylon and mesopotamian civilization. The Egyptians used medicinal plants, and that is the base of using herbs in Unani medicine. And in Mesopotamia, they used urine as a tool of diagnosis, which is still used today. After this, the Unani system of medicine came to the Arabs and Persian lands. There’s a great scholar, a great physician called Avicenna. He wrote his book, the Canon of Medicine, which is still read and used today. And Rhazes wrote this book called Al-Hawi, which also mentions the Unani system of medicine. What the Arabs did was they preserved this system, this Greek literature, by translating it into Arabic language. And they also enriched the system by their own contributions and by using many other sciences of physics, chemistry, biology, botany, physiology and pathology. And around the 8th century, the Unani system of medicine was introduced to India by the Arabs and the Persians. So when it came, the mughal emperors, the Delhi sultans and the Tughlaqs, readily accepted the system, and they also gave state patronage to the Unani physicians. The Mughal emperors used to have these hakeems in their royal courts. At that time, 80% of the Indian population used the Unani system of medicine. It was widely accepted by the masses in India, and it took its firm roots and found its permanent home in India. During the British school, the Unani system of medicine faced a little setback because of the introduction of the western modern system of medicine. But still, during the freedom struggle, a great contributor of Unani medicine called Hakim Ajmal Khan. He established this Ayurvedic and Unani Tibbia College and the Hindustani Dawakhana, which was inaugurated by our father of nation, Mahatma Gandhi. And after independence, the government of India supported this system and it grew with other Indian systems of medicine. There was a department called the Department of Indian System of Medicine and Homoeopathy. Later it was renamed as AYUSH in 2003. And we AYUSH as— Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. So now this department is responsible for the development of this system of medicine. Today we can see the Unani system of medicine is practised not only in India, but Sri Lanka, Pakistan, Bangladesh and parts of UK, UAE and South Africa too. But India has the largest number of Unani practitioners, Unani colleges, research centres and laboratories, both from the government and the private sector.

AB: Right. So tell me, how is it different from what is practised in the Middle East today as medicine of the Tibb? Tibbi medicine or is it the same thing? 

Dr S: Unani system of medicine is [practised] in many parts of the world. In each part of the world it is named differently. In the UK it’s known as complementary medicine. In Saudi it is called tibb. So they are names, but the system is the same Unani system of medicine.

AB: Now that you’ve explained the origins to us, will you explain the foundations as well? You know, you said it’s based on the four humours, right? Will you explain each one of them? And how do you, you know as a practitioner, how do you decide what treatment to give?

Dr S: Before going to the humoral theory, we have a very vast concept of Umoor-e-Tabiya that is called the factors of human physiology. The entire human body is made up of these seven factors, which we call as Arkaan, Mizaj, Akhlat, Aaza, Arwah, Quwa and Afaal. First thing is Arkaan— the elements. The four element theory. The entire universe, the entire world, is made up of four elements according to Unani. That’s aag, hawa, pani, and mitti— fire, wind, water, and soil. And each of these elements have their own qualities— like water is cold and wet, fire is hot and dry, air is cold and dry, earth is hot and dry. Hot and cold are the dominant qualities, whereas dryness and moistness are the receptive ones. Coming to the next factor is Mizaj. Mizaj means temperament. Everything in this universe, whether it is a living thing or a non-living thing, according to Unani, has its own temperament. Each person has their own unique temperament. There are four temperaments; that is hot, dry, cold and moist. Next comes the Akhlat. Akhlat is the humours. humours literally means fluids or liquids in the body. These four humours are yellow bile, black bile, phlegm and the blood. Even these humours have their qualities, like the yellow bile that is hot and dry, that represents the fire and so on. The humours are actually made from the food we eat. That’s why ancient physicians say you are what you eat. So humours, which are there in our body, come after the digestion and metabolism of the food we take. So the basic theory is, when these humours are in a state of balance and equilibrium, then the health is maintained. Any imbalance in these four things, either quantitatively or qualitatively, then disease will occur. This is Arkhan Mizaj and Akhlat. Next is Aaza, which is the organs. There are two types of organs— simple organs and compound organs according to Unani. Arwah is the pneuma. According to Hippocrates, the body is made up of three things: solid, liquid and gas. Solid are the organs, liquid are the humours, and the gas thing is the ruh, which we call as pneuma, a spirit or the soul. Next is Quwa and Afaal. Quwa are the powers, the faculties. There are different powers in our body, like the immunity power, retentive power, the digestive power. So these powers are responsible for the normal functions of the human body. Next comes the Afaal, the physiological functions of the human body.

AB: Fantastic. I’ve been writing all this down. Fantastic. So you look at all these, but are humours more important or not? Or do you need to look at all these seven?

Dr S: We need to look at all these seven. Of course, humours are important. But all these seven play a very important role in the health of the human body.

AB: Okay, so tell me, what would you recommend to adjust in our lifestyles if we want to have a… If we want to be healthy and to have a balanced life? I know that’s a very long, deep question, but if you can give me a quick answer.

Dr S: In the Unani system of medicine there’s a classical concept of Asbab-e-Sitta Zarooriya, the 6 essential factors, the lifestyle factors. These six factors are— first one is Hawa-e-Muheet, which we call the air, the surrounding air. According to Unani physicians, the air we breathe must be pure and clean to strengthen our immunity. Any impurities in the air will cause diseases. There is also a great concept of epidemic and pandemic in Unani literature which really helped during Covid pandemic also. They are called a bukhoor, that is called fumigation. Fumigation of air with sandalwood and camphor can purify the air and disinfect the air from microorganisms. Next comes the Makool-wa-Mashroob we say— that is food and drink. The correct quality food and the quantity of food that one must intake has a great impact on their health. According to the Unani system of medicine, one must take a quality and healthy and balanced diet. And adequate hydration is also important. Hippocrates has rightly said the cause of sickness is overeating and the cause of health is eating like a bird. The third one is Harkat-wa-Sakoon-e-Badani, that is physical rest and movement. There must be a balance in physical activity and rest. Both— physical exercise is also important and giving rest to the body is also important for the maintenance of health. And that is a vast subject called riyazat exercise, the different types of movements of the body. The fourth comes Harkat-wa-Sakoon-e-Nafsani, that is the mental movement, the psychic movement and rest. According to the Unani system of medicine, the mind and the brain, the human brain needs adequate stimulation and also relaxation for their intellectual well being. The next comes the Naum-wa-Yaqzah. That is called sleep and wakefulness. Proper sound sleep, at least for seven to eight hours, is important for our health. And likewise the wakefulness and movement of our body is also very important for our health. The last is Istifragh-wa-Iqtibas— it is called elimination and retention. Elimination of the harmful substances, unnecessary substances from the body keeps the body healthy. Too much elimination is also bad for health. There must be a balance between elimination and retention. Retention of good substances in the body and too much retention will cause constipation, and constipation is the mother of all diseases. So all these six factors of Asbab-e-Sitta Zarooriya are very important in one’s lifestyle to maintain their health.

AB: Okay, so this is about lifestyle, right? Now tell me about common treatments and techniques that unani medicine recommends. Talk to me a little bit about the treatments.

Dr S: There are four modes of treatments in Unani, that is called— regimental therapy, dietotherapy, pharmacotherapy, and surgery. First we go for the regimental therapy— ilaj-bil-tadbeer. These are called the non-medicinal therapies. They involve certain techniques and there are a number of techniques in these, like cupping, leeching, venesection, hammam, exercise, dalak massage and everything. One technique which is called hijama or cupping therapy… So hijama means to suck. In those ancient times, horns, animal horns were used to suck. So it was also called the horn therapy. 

AB: And, animal horns were used. Wow! I didn’t know that. 

Dr S: In one procedure, a negative pressure is applied on the skin and the skin is pulled off. And there are many types of cupping. The main one is dry cupping, wet cupping and fire cupping. In the dry cupping, just the cups are placed and there are no incisions. And in wet cupping, mild superficial incisions are made on the body and the toxic blood is drawn out and fire cupping fire is used. So these are some techniques which are used. It is also mentioned in the Ebers Papyrus, a very ancient book of the Egyptians.

AB: Okay

Dr S: 
This hijama has very good and instant results, you can say. 

AB: So that’s interesting because a lot of us know it as chinese cupping, especially the fire cupping that you’re talking about. So it’s so interesting that you’re saying all these three kinds are mentioned as far back in the Egyptian books.

Dr S: In my dissertation, the thesis in my university, I was the first one to do this topic. I had a clinical trial of cupping therapy in cases of sciatica. And the Hippocrates has rightly said, “What medicines do not heal, the lance will; what the lance does not heal, fire will.” That was one thing from regimental therapies. Next is ilaj-bil-ghiza, which is called dietotherapy. Unani physicians used to prescribe specific diets for certain ailments. And they used to alter the diet and eliminate some of the diet according to their diseases and which is still practised today. Third comes the pharmacotherapy that is Ilaj-bi-dawa. And it is the most effective one in the Unani system of medicines. Mostly it is herbs. Sometimes animal and mineral quality also are used in the natural form. Next comes ilaj-bil-yad which is surgery. This is the last option. When these three things don’t work, go for surgery.

Apart from medicines, there are also holistic therapies in Unani medicine, some of which are dal’k, which is massage, hammam, which a lot of us know of, which is the steam bath, hijama, which is cupping and nutool, which is irrigation. 

AB: In fact, nutool I believe is quite similar to Shirodhara where the oil is dropped on the forehead. Can you tell me quickly about those as well?

Dr S: Ilaj-bil-tadbeer— ilaj means treatment and tadbeer means regimen— that is a systematic plan. It involves certain physical methods, certain techniques mainly divert or to eliminate the morbid humour responsible for the disease and that by the immune system. Avicenna has mentioned 36 regimen therapies in his book the Canon of Medicine. So the most important ones mentioned today are cupping, leaching, venesection, dal’k, massage, exercise, nutool, enema, lactatives, purgatives, diuresis, and cauterisation. Before I tell you about the cupping therapy, effective in all the pains, you can see the instant, often effect in cupping therapy. It is advised for all types of problems like sciatica, arthritis, whether it is osteoarthritis or rheumatoid arthritis. Even in lifestyle diseases like diabetes and blood pressure we have seen patients coming out of their high blood sugar levels. So after the cupping therapy. So there are three bloodletting therapies. The cupping, leeching and venesection leeching. In leeching therapy, medicinal leeches are used to draw a small amount of toxic blood from the body. This is very effective in skin diseases and in high blood pressure. And venesection which is called fasd or phlebotomy— an incision is made on a superficial vein and the toxic blood is removed from the body from the veins. This is very effective for high, very high blood pressures. Next comes the dal’k massage. As you know, massage comes from the Arabic word mass that means to rub. There are many types of massage: hard massage, soft massage and many, many more, and so many oils are mentioned for different diseases. Next comes the riyazat exercise, which is the most important regime we follow today. And in this also, the old physicians, tension physicians, they have talked about walking, running, jumping, horse riding, swimming, wrestling and boxing as well. Nutool, that is called irrigation therapy. In this method, certain medicated water or medicated oil is poured on different diseased parts from a certain height. It’s very effective in depression, anxiety and in some of the lifestyle diseases also.

AB: Is it like Shirodhara? Is it like what people know is Shirodhara?

Dr S: Yeah, exactly. But this involves the other… The medicated oils will be different for them. Then comes the sitz bath or aabzan where the lower part of the body from the hip is immersed in warm medicated water or warm plain water. This is very effective in treating piles, treating rectal, anal, intestinal, uterine disorders and urinary bladder disorders. Next is pashoya, which is a foot bath, which is immersed in warm water and warm medicated water. That is very effective for insomnia and headache. hammam, the Turkish bath. This is a very interesting thing. This bath has three rooms. The first room is of the normal temperature. The second room will be a little high and the third room is almost of about 42 degrees celsius. You will sweat like anything. This is called as the silent doctor, the Turkish bath.

AB: I’ve had hammams in Morocco and in Turkey, so yes.

Dr S: My father-in-law has built this Turkish bath in our place. In the whole India, no one has built it like that. We’ll show that inshallah sometimes.

AB: Oh, fantastic. That sounds amazing. Is this at the hospital where you are? No. 

Dr S: No, we are not in the same city, where he lives. So that is very important.. Hammams opens the skin pores and excretes the waste products and refreshes the body. Next is dhuni or fumigation. It is very important for disinfecting the surrounding air. Even in COVID pandemic, the physicians advised to do it and it really helped. 

AB: The dhuni? 

Dr S: Yeah. 

AB: Yeah, yeah. We have done that in our houses for decades as well. Yes. Interesting that that should be part of a therapy. That’s fantastic. 

Dr S: So these were some of the important regimental therapies.

AB: So now I want to ask you about chronic illnesses. Are there any chronic illnesses which you have seen have been completely reversed using Unani medicine?

Dr S: Many, many stories like that but I’ll say one or two. Definitely, the Unani system of medicine works wonders in chronic ailments, especially asthma, diabetes, hypertension, kidney failure. We specialise, our hospital has 18 plus years of experience in treating kidney failure patients.

AB: Oh, wow.

Dr S: They come out of dialysis and transplantation, also. Those patients who come who are doing dialysis, along with that we say to take Unani medicine and gradually decrease the frequency of dialysis. And at one time they totally stop the dialysis and the kidneys, even the laboratory parameters, the creatinine level, the urea level, everything comes to normal. Yesterday, just yesterday, one patient, her creatinine before was ten, and just taking one month of medicine, it came to six.

AB: Oh my God. Amazing. That is amazing. Now tell me, tell me about a situation where you’ve helped reverse asthma, where you or someone you know has helped reverse asthma.

Dr S: Alhamdulillah. Many patients, many clients, of course, they have come out of inhalers and nebulizers. We have special medicines in Unani, like a herb called kakra singhi and it really makes wonders. And we also prepare a thing called, which is made up of menthol, thymol and camphor. This was also prescribed during the pandemic. One drop of it should be put in steam inhalation and the entire respiratory tract clears up. 

AB: Wonderful, wonderful. We also like to leave our listeners with practical tips. So are there any simple Unani practises that you can recommend? I know you’ve given us a wealth of knowledge and a wealth of information, but is there something simple that people can incorporate into their daily lives which you will say can help them with health and with wellness?

Dr S: Of course, I have told you, following the principles of Asbab-e-Sitta Zarooriya, the six essential factors that are very important in our daily life. I have a small poem which is written by myself for the listeners. 

Unanify your lives. Balance your humors. Normalise your temperaments. Honey your face. Green your tea. Saffron your milk. Cumin your water. Gingerise your foods. Pepper your soup. Cup your muscles. Purify your blood. Rest your body. Treasure your health.

AB: Lovely. That was wonderful. That was absolutely wonderful. But tell me, you mentioned Mizaj or temperament, right? Now, there are so many mental health issues today. Is that something that Unani medicine can help with mental health issues? 

Dr S: Definitely. Definitely. We have a separate subject called Amraz-i Nafsaniya— psychiatric disorders. Anxiety, stress, depression and melancholia, all these are due to the black bile. We say whatever the mental issues are, mental diseases, mental disorders are due to the excessive and the imbalance of the black bile. Recently we saw a patient, she was from UP and she had a lot of depression and she had gone just taking our medicines for three months, she came out of depression and she sent us so many gifts recently.

AB: Lovely. And what about something like digestive issues which again is prevalent all over the world? You know, I guess it’s an excess of yellow bile or an imbalance of yellow bile. 

Dr S: In Unani, we see the temperament of the person, of the disease, and then prescribe the treatment of the opposite temperament.

AB: I see

Dr S: Since it’s hot and dry, we will prescribe those diets and those drugs which will be cold and moist. Be it any humors, yellow bile or black bile or blood. All these humors are made in the liver. We call liver as the factory of the human body. Whatever the disease is, mostly all the Unani physicians, first they give liver corrective medicines, hepatoprotective medicines. And there are many amazing hepatoprotective medicines like the one is kasni. Kasni is Cichorium intybus Linn. Galen has called it the friend of liver.  So it is said that if you take care of your liver, your liver will take care of you.

AB: Yes, absolutely.

Dr S: So if yellow bile is increased, first we will correct the liver and then we will give yellow bile purgatives. To eliminate that excess yellow bile we have yellow bile laxatives and purgatives. In the diet we include a lot of vegetables like spinach. And as I told you, since yellow bile is both hot and dry, we will include those diets which are cold and wet like the fruits like pomegranate, watermelon and vegetables like cucumber and bottle gourd. Hydration is also very important. Avoid tea and coffee, spicy foods. And if there are digestive issues, along with that small combination which we can make at home, the powder of fennel seeds, the sauf, jeera and the dry ginger, make it into powder. Put a pinch before meals, twice daily.

AB: Before meals? Okay. Wonderful. Also, doctor Safina, can you tell us a story about maybe a patient whose life was transformed by Unani medicine?

Dr S: As I earlier said, there are many stories of transformation. One businessman from Kerala, he had liver issues, liver problems along with cardiac issues and skin allergy, and he went into total depression. He left his business and everything. And once he started our Unani treatment, because Unani treatment has a holistic approach for all the illnesses. And he came… He [used to] suffer a lot. And he lost his confidence because of those skin allergies and other issues. But after taking our medicine, gradually he came out of all these things. Even all his parameters came to normal. All his skin allergies faded away. It was a real story. And he came and met us with such happiness.

AB: Wonderful. And tell me, diagnostically, how do you diagnose? Do you also do the. Do you feel people’s pulse? From memory that’s what I remember.

Dr S: Yeah. The Unani system of medicine uses three things in diagnosis: Pulse, urine and stool. We do pulse, And the second thing is, as I told the temperament. It is very important to know what sort of person the disease has, not what disease the person has.

AB: Interesting, interesting. Very interesting. Thank you, Doctor Safina, for your passion and your knowledge of Unani medicine. We’re really grateful for your help. And to our listeners, we hope today’s episode has burned the fire in your mind to learn more about Unani medicine. We hope you’ll explore it. There is so much richness in the ancient cultures and in the ancient medicinal systems, and we hope we’ve taken you a little closer to leading a healthier, happier life. Thank you so much and see you next time.