After a complete evaluation of the innate constitution of the patient, including evaluating the temperament and quality and quantity of humours, the Unani Hakim applies therapies aimed at restoring the entire internal and external biotic environment to a state of balance.
If altered humours are the cause of metabolic changes, evacuation by purging is the course usually chosen by the Unani Hakim. Before evacuation of such matters, it is necessary transformed the abnormal and undesirable matter into a consistency which makes evacuation easy and complete. This process is called coction, a unique feature of the Unani system of Traditional Medicine.
The concept of Nuzj and Is’haal in the treatment of diseases though
seems to be archaic but has tremendous efficacy in the management of
chronic diseases. It has been advocated in many diseases including
arthritis, fevers (Huma) Headache (Suda) etc. Jalinos, Raban Tabri, Razi
have given significant importance of Munzij and Mu’shil therapy in their
literature and they themselves treated patients successfully with this mode
of treatment1
.
This therapy works on the principal of systemic cleansing. Sometime
it is recommended alone and sometimes in combination with some
regimen including cupping (HIJAMAT) leeching (TA’LEEQ), Diuresis
(IDRAR), Venesection (FASD) etc. Kabirruddin while referring Gilani states
that when the morbid materials are extracted from the intestines or nearby
structures then it is called Taleen (laxation) and when the morbid material
are extracted from vessels and other deep tissue then it is known as Is’hal
(purgation)
The entire regimen consists of two components
(a) Nuzj (Concoction)
Nuzj is defined as a process by which disease causing tenacious
morbidities (Maddah Marz) are transformed to a state that can be feasibly
eliminated out of the body with the help of Mus’hilat (purgatives).In this
way, viscous humors are diluted enough and vice versa for their easy
expulsion out of the body. Nujz is usually carried out in chronic diseases
but it is optional in acute diseases depending upon the severity and
acuteness of the condition. But if the delay, due to Nujz is going to harm
the vital organs, then is’hal (purgation) can directly be carried out without
Nuzj
In normal circumstances Nuzj is the action of Hararat Ghareezia
(innate heat of body). Nuzj is a routine phenomenon in the presence of
temperamental normalcy but if temperament is derailed then proper nuzj
cannot take place and then it is required to facilitate the immunity
from outside in order to make nuzj happen. It is for these reason
appropriate medicines are required for nuzj. The innate heat produced
by such the drugs should match with innate heat of body. Drug used
should be of moderate temperament and should be neither too cold nor
too wet. Drugs having temperament towards heat are preferably used.
Sometimes Musadid drugs (obstructant drugs) are also used as Munzij
because such drugs tends to close the pores of skin and there by bringing
core organs at optimal temperature in order to facilitate the process of
nuzj.
RECOMMONDATIONS OF (CONCOCTION)
1. Essential in case of all chronic disease as well as the disease having
duration of more than 40 days.
2. Also recommended in acute diseases where everthe duration is more
than is 7 days.
3. For diseases having duration less than 7 days, nuzj is not required
and the actual treatment may be followed without waiting for nizj.
4. In case of phlegmatic and bilious diseases, it is mandatory that
purgation should be preceded by Nuzj. However it is optional in
bilious diseases and notrequired in sanguineous diseases where blood
alteratives are the main stay of treatment.
5. If blood is made impure due to the admixture of other humors then
Nuzj should be done in accordance to the other humoral morbidities.
DURATION OF NUZJ (CONCOCTION)
Duration of Nuzj varies depending upon the humoral morbidities
involved.
Safra-e-khalis 3 days
Safra-e-Ghair khalis 5 days
Balgham Raqeeq 5 days
Balgham Ghaleez 12 days
Sauda-e-khalis 15-40 days
In case of Sanguineous diseases Moadillat-e-Dam (blood alteratives)
and Mussffiyat –e-dam (blood purifiers) are given instead of Munzij rugs3
.
ROUTES OF NUZJ
The route to be opted depends on the type of organ afflicted and
morbid material involved (Maddah Marz) e.g in case of Hummiyat (fevers)
Maddah Marz is in the blood, then Nuzj will preferably be done through
kidneys in urine. In case of pleurisy, Nuzj can be done through lungs in
the form of expectoration. In case of cutaneous abscess, through skin
pores as these serve as best channels of elimination. Razi Z.Kitabul Murshid
explains in case of nasal secretions and in conjunctivitis with the secretions
of pucntum
SIGNS OF NUZJ
For confirmation, the examination of secretions corresponding to route
of nuzj involved such as sputum, urine etc is carried out along with the
examination of pulse to see sign of completion of Nuzj
Urine
As the sign of completion of Nuzj in urine, there are changes in
viscosity, color and precipitate2
These changes however are not only noted
as a result of completion of Nuzj but can also be seen as a result of infection.
Therefore the differential diagnosis becomes mandatory and can be done
on the basis of character of precipitate2
When safra (bile) is excreated in
the urine, it turns orange or pale yellow, where as becomes blackish or
turbid if Sauda (melancholic morbidities) is excreated. The specific gravity
of urine increases when Nuzj is complete in case of balgham( phlegm )and
black bile
Pulse
In the beginning, if it is Sulb (hard), becomes Layyen (soft) towards
the end of process, and if in the beginning it is Layyen, it becomes Sulb
after the completion of Nuzj
Sputum
There are considerable changes in the sputum in the diseases of lungs
and thorax after giving concoctions. A change in expectoration and
sputum is the indication of Nuzj but can also indicative of infection. If
color of sputum is yellow or blackish then it indicates infection. If the
consistency of sputum is thin it indicates early Nuzj and when consistency
becomes changed towards thickness (viscid) and is easily expectorated
out then it signifies late Nuzj
As soon as the signs of completion of nuzj become visible, appropriate
mushilat (purgatives) are added to concoctives 1,2,3,6
There is several types
of purgatives in unani classics as per their mode of actions.
Type of Mushilat (Purgatives) According to severity of actions
1. Mushilat –e-Khafeef (Mild Purgatives)
These drugs simply increase the peristaltic movements of the intestine,
cause spasmodic pain in abdomen and produce semi loose stool e.g.
Turbuds (Ipomoea turpethum), Sana Makki (Cassia augustfolia)
2. Mushilat-e-shadeed ; (strong Purgatives)
These are the drugs which increase the peristaltic movements of the
drugs and cause watery stools without causing the spasmodic pain.
Purgatives are also classified according to their affinity to particular
humoral morbitiy and hence named as:
Bilious purgatives
Strong purgatives; Haleelah zard (Terminila chebula), Sibr (Aloe
barbedensis), Sakmoonia (Convulvulus scammony).
Mild purgatives; ijjas (Prunus domestica), Banafsha (Violo odorata).
Melancholic purgatives
Severe purgatives Harbak aswad (Veratrum album) Gile Armani (Bole
armeniae rubra),Gareekoon (Agaricus albus),Aftimoon (Cuscuta
reflexa),Haleelah siyah (Terminila chebula) and Bisfayij (Polypodium vulgare)
etc.
Phlegmatic purgatives
Strongest purgatives are Shame –hanzal (Citrullus colocynthis).Fasarul
hamar, Kuntariyoon dakeek, Turbud (Ipomoea turpethum), Bazr-ulinzirah,
Mazj kurtum etc.
Indication of Is’hal (Purgation)
1. These are recommended to eliminate and evacuate out the morbid
materials responsible for the disease.
2. To bring the temperature to normal in case of few pyrexia.
3. In rare conditions it is also recommended as a management of
hypertension.
4. To evacuate the humoral morbidities responsible for certain disease3,7
.
Contra indications
1. Wet and dry climate.
2. Inflammatory condition of the intestine.
3. Pregnancy especially first and third trimester.
4. Menstruation.
5. Elderly, weak people andchildren.
6. Cases of hypertension
Preferable time for Is’hal (Purgation)
Suitable season is very important for carrying out purgation.
In summer and Rabi season, purgation should be done in the Morning.
In winter season and autumn it should be given two hours after sunset.
Purgation should not be done preferably in Rabi and Khareef seasons.
Special precautions during Is’hal (Purgative)
1. Never given empty stomach, in the morning.
2. In patients of dry temperament, the juice of pomegranate or barley
water should be given before the purgative.
3. If the drugs given as purgatives are of bad taste, then the patients
should be advised to chew Aqirqarha or Dalchini (Cinnamomum
zeyanicum).
4. If there are any chances of vomiting due to bad smell or bad taste,
then the patient can be given Sandal, Arq Gulab etc. to neutralize the
effects of bad smell or sense of vomiting.
5. The person should not move immediately after taking the drugs in
order to avoid vomiting, but after sometime the person can move.
6. In case of strong Mus’hilat (Purgatives) sleep after taking purgatives
can be helpful.
7. Bathing or taking meals should be avoided after purgation because
it can nullify the effect of purgatives.
8. Mild body massage may also be advised.
Support given in Is’hal (Purgation)
If the effects of Mushilat (Purgatives) are delayed than Maul Asl should
be given so that the toxic materials get diluted and are evacuated out in
the form of loose motions. Sharbat Wared Murakkab 250ml and Sharbat
Denar 250ml may be gives to the patient for increasing the effects of
purgatives.
Management of Complications of Is’hal (Purgation)
1. If patient experiences spasmodic pain after giving purgative drugs
then hot water should be given sip by sip.
2. Walk can also be advised after few minutes of taking of purgatives if
the patient is experiencing some restlessness
3. In case of thirst, hot water or Arq-e-Gulab and Arq-e-Badiyaan are to
be given.
4. It is advised that the patient should sleep for some time after taking
purgative drugs.
Tabreed; (cold regimen)
It is one of the basic principles of unani system of medicine that
tabreed (cold regimen) is advocated after inducing purgation as an
interrupted intervention. The reason being that all the purgatives
generally possess hot temperament like saqmonia, therefore after
purgation the body gets heated up and drained out owing to
dehydration. This loss of fluid further adds up to the increased core
tempretature and excessive dryness. To compensate these undesired
effects tabreed (cold regimen)is compulsorily be advised to avoid any
unwanted adverse effect of purgatives and also to bring normalcy in
temperament. Physicians in ancient times used to advise Loob-e-Aspaghol
(Plantago ovate) in the evening for people of hot temperament. Tukhm
Raihaan (Ocimum basilicum) and Tukhm-e-tera tezak for moderate
temperament and cold temperament are given respectively
Commonly
used formulations for Tabreed are as follows:
Khameera Goozabaan with in Warq Nuqra and Loob-e-Bihdana 3gm ;
Shera Unnab 10 pieces (to be made in Arq-e-Gaozabaan) with Sharbat
Banafsha 20ml.
Since the cause of disease Unani system is considered the derangement
of the humors, so the evacuations of such morbid materials are necessary
for which Nuzj and Ishaal is must. According to predominant humours
following combination of drugs for Munz, Mu’shil and Tabreed can also
be given.
Mushillat-e-safra
Haleelah (Terminila chebula), Aloo-bukharah (Prunus domestica),
Shahitrah (Fumeria officinalis), Sharbat Fuwakah, Sharbat Banafsha ,
Joshandah Khayar Shanbari, Sakhmoonia (Convulvulus scammony).
Haleelah zard (Terminila chebula), Unaab (Zizyphus sativa), Tamarhindi
(Tamarind indicus), shahitrah (Fumeria officinalis), Sanna (Casssia
augustifolia), Banafsha (Violo odorate), Inab-u-salab (Solanum nigrum),
Khatmi (Althoea officinalis), Tukhm kasini (Cinchorium intybus) in equal
quantities are kept overnight in water and then given with Turanjabeen.
Munzijat-e-balgam
Depending upon the derailment of temperament and quantity of
morbid material the munzij can be given for talteef (attenuation), tahleel
(resolution), taqtieh (rectifying).
Aneesoon (Pimpinella anisum), Beekh badiyan, Beekh Kibr (root of
Capparis spinosa), Ayursa (Iris ensata), Azkhar (Andropogon schaenar),
Zoofa (Hyssopus officianalis), Pudina (Mentha piperita), Sudaab (Ruta
graveolans), Baranjasif (Artemisia vulgaris),Marzanjosh (), Bargjhar (Prunus
laurocerasus), Baboona (Maticaria chamomilla),Aklielulmulq (Trigonella
ancata) and Shibt (Anethum sowa)
If more quantity of morbid humour or more temperament derailed
than add Aqir Karha (Anacylus pyrethum),Farfuraan (Rheum officinalis)
Mu’shilla balgam
Initially mild Mu’shil should be tried in Galeez (viscid) and layasdhar
(malacious) humors than gradually strong one should be given e.g. Initially
Ayarij Feekirah (Aloe barbedensis), Turbud (Ipomoea turpethum), Aftimoon
(Cuscuta reflexa), Gareekoon (Polyporus officinalis) etc. later Hab-e
shibyaar,Hab-e-Ayarij can be given.
Munzijat-e-Saudah
For munzij saudah it is necessary to give Taleeyn and Tabreed
medicine for that give Unaab (Zizyphus vulgaris), Neolofar(Nymphae lotus),
Injeer (Ficus carica),Khameerah Banafsa after that use second and third
degree anti-inflammatory drugs e.g Barj Gowzabaan (leaves of Barago
officinalis), Bisfayij (Polypodium vulgare), Barj Badranboya(leaves of Mellisa
officinalis), Sapistan (Cordial latifolia),Turanjabeen(Fraxinus ornus). It is
twice repeated because it is difficult to Nuzj melancholic morbid humors.
Following combination of drugs in the form of decoction can be given for
Munzj;Bisfayij (7 grms), Isthakhadoos (Lavendula stoechas) (7 grms),
Badranboyah (7 grms), Iftimoon(7grms),Maviez Munakah (Vitis vinefera)
(20 in number), Aloo Bukharah (Prunus domestica) (10 in number) boil in
water and add Turajabeen (Fraxinus ornus) 35grms for ten days.
Mushilat-e-sauda
Majz khayair shambar (Cassia fistula) (60grms), Sheer Khast
(Fraximus ornus) (40 grms), Sanna maki (Cassia augustifolia) (9grms),
Haleelah siyah (Terminilla chebula) (9grms), Roghan badam (oil of Prunus
amygldlus) (20 ml) mixed in Sharbat Gulaab.
Conclusion
In unani system of medine disease are attributed to qualitative or
quantitative derangement of humors leading to imbalance in homeostasis.
Restoration of health will therefore require bringing back the humoral
equilibrium. It is also a unanimously accepted fact that humoral
equilibrium is directly proportional to the evacuation of morbidities from
the body accumulated as a result of numerous metabolic activities. This
evacuation of morbidities is a routine and normal process of the body but
in certain circumstances this evacuation may not take place at its own.
Unani system of medicine has a well-established concept of concoction
and purgation for this purpose. There are ample drugs that have been in
use for centuries for the elimination of respective morbidities in diseases
and for the restoration of health. Unfortunately such drugs fell out of
favour due do paucity of data in support. Clinical trials however been
done but on limited sample size. More comprehensive and standardized
protocols are to be tailored to work upon in order to yield statistically
sufficient and structured data.
Aafiya Health Care Centre 