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Unani Tibb

Between the 9th and 13th centuries, Graeco-Roman medicine from Hippocrates and Galen was assimilated by the Arabs, and an Arabic tradition of medicine, known as Unani Tibb, developed. The word Unani (meaning “Ionian”) reflects the strong Greek influence to this tradition, while Tibb means the knowledge of the states of the human body in health and disease.

A succession of renowned Arab physicians including Albucasis, Razis and Ibn Sina (also known as Avicenna) were particularly responsible for the development of medicine at this time, adding their own inventions and discoveries to the sum of herbal and botanical knowledge. Avicenna (980-1037 AD) brought together all that was available on the nature of disease, plant medicines, aromatics and medical theories, including the teachings of Sushruta and Charaka from the Ayurvedic tradition, in his Canon Medicinae. It was Avicenna who developed the process of distillation originated in the Alexandrian school around the 3rd century. He invented the apparatus and method of alembic distillation to extract essential oils from aromatic plants – a great landmark in the history of aromatherapy. Fragrant oils were particularly used for their purifying and restorative properties at this time and were thought to reduce the impact of destructive emotions such as grief and fear on the health of the body.

Practice in India and Beyond

When the Mongols invaded Persia and Central Asia, many scholars and physicians of Unani fled to India. Once established in India, Unani Tibb then suffered setbacks under British rule, although it still flourished unofficially. In the ensuing struggle against British colonialism a friend of Mahatma Gandhi, Muhammad Ajmal Khan, founded the Unani Tibb and Ayurvedic College in Delhi in 1916, a landmark in its survival. Today Unani is practiced in Iran, Pakistan, China, India, Bangladesh, Sri Lanka, Afghanistan, and other parts of the Middle East. In India there are now many Unani medical colleges where, after a five and half year course, graduates are awarded a BUMS (Bachelor of Unani Medicine and Surgery) degree and can practice as government approved doctors. There are about 10 Unani medical colleges awarding postgraduate degrees. There are also schools of Unani in Australia and the US. The American Institute of Unani Medicine was founded in 1986.

The Seven Components

According to Unani, the human body is composed of seven components called Umoor e Tabaiyah, which are responsible for maintenance of health. Changes to any of these can predispose to imbalance and disease, and each need to be taken in to consideration in diagnosis and assessment of the correct treatment. These are:

• Arkan (Elements)

• Mizaj (Temperament)

• Akhlaat (Humours)

• Aaza (Organs)

• Arwah (Vital forces or Neuro)

• Quwa (Faculties)

• Afaal (Functions)

The balance of one's constitution can be disrupted by emotional, psychological, social, environmental or spiritual factors, or by diet. Environmental and lifestyle factors that are vital to good health are divided into five categories, and any imbalance of these can predispose to disturbance of the humours and lead to ill health. They are:

• Fresh air

• Food and drink

• Movement and rest

• Sleep

• Emotions

The Four Humours

The four elements, known as Anasir-e-Arba (hava, pani, mitti, and dhup), are earth, water, fire and air. In varying combinations these four elements constitute four bodily humours (akhlaat):

• Blood (dam)

• Phlegm (kafa)

• Bile (safra)

• Black bile (souda)

According to Unani theory, the humours develop in the liver from digested nutrients, and are carried around the body in the blood. Each person's unique balance of these substances determines his temperament, mizaj or individual metabolic constitution; a predominance of blood gives a sanguine temperament; a predominance of phlegm makes one phlegmatic; yellow bile, bilious or choleric; and black bile, melancholic. As long as these humours are in balance, the human system is healthy; it is imbalance which leads to ill health and disease.

Alembic distillation was perfected by Arab physicians to extract oil from plants.

Each individual has their own innate healing mechanisms, akin to ojas in Ayurveda and known in Unani as the tabiyat-e-muddabare badan, which is considered the best physician, and it is this that maintains the equilibrium of the four humours or akhlat so that we can be in good health and the happy state of mind that is our birthright.

Disciplines and Diagnoses

There are eight branches of Unani medicine resembling those in the Ayurvedic system:

• Internal medicine (moalijat)

• Gynaecology including obstetrics and paediatrics

• Diseases of the head and neck

• Toxicology

• Psychiatry

• Rejuvenation therapy including geriatrics

• Sexology

• Regimental therapy

• Dietotherapy

• Hydrotherapy

The diagnostic skills of practitioners of Unani, known as hakims, include observation, pulse taking, questioning, palpation and urine analysis. Pulse diagnosis requires the hakim to be in a clear state of spiritual awareness to enable him to analyse the subtle qualities of the pulse. Practices including breathing and voice exercises and visualisations to help to calm and clear the mind. In the initial consultation, the Tibb practitioner will take a detailed case history from the patient and make observations of their skin, tongue, eyes, hands and nails. They will also take their pulse, as a considerable amount of information about the patient's state of health can be gleaned from this in just minutes.

Unani classifies health in three different stages: health, disease and neutral. Neutral exists between health and disease when symptoms have not yet manifested. Disease occurs when the functions associated with the vital, natural and psychic forces of the body are obstructed or unbalanced due to some form of deviation.

Symptoms of illness are seen in a positive light, as an opportunity to cleanse and balance us on physical, emotional, mental, as well as spiritual levels. Pain, for example, is a message that something is wrong, the underlying causes of which need to be addressed so that our health can be better in the future. A “healing crisis” is simply tabiyat, or the homoeostatic mechanisms of the body attempting to eliminate toxins through vomiting, diarrhoea, fevers, sweating, and increased urination in order to re-establish equilibrium of the humours, health and well being.

The Tibb practitioner will always take the pulse of their patient.

Treatment

Unani healers follow strict ethical codes of conduct and practice, which are based on Islam. These include earning the respect of their patients, proper cleansing routines, moderation in food and drink, and spiritual purification techniques. As in Ayurvedic and Tibetan medicine, both prevention and treatment of health problems are based on each person's body type, personality and mizaj, or individual metabolic constitution.

Treatment is aimed at rebalancing the patient physically, emotionally, mentally and spiritually. It is based largely on lifestyle advice, including advocating bathing, fresh air, fresh food and codes of conduct to promote and maintain health. Hakims also prescribe herbs, precious metals and stones (gold, silver, gems and pearls), detoxification and dietary regimes, minerals, and aromatherapy. Oils or attars are extracted from herbs and given singly or in combinations, according to the needs of the patient, to affect body, mind and emotions. Some of the herbs, such as saffron, fennel, caraway, haritaki (Terminalia chebula), bibhitaki (Terminalia bellerica), and amalaki (Emblica officinalis) are also used in Ayurvedic and Tibetan traditions. Other herbs used in the Unani tradition include guggulu (Commiphora mukul), ashwagandha (Withania somnifera), coriander, bacopa (Bacopa monnieri), violet, liquorice, long pepper, and guduchi (Tinospora cordifolia). Massage or cold/heat suction cups might be used, as well as puncturing certain reflex points to release a few drops of blood in acute disease.

Food and Taste

Foods and herbs are categorised according to their own miza, or balance of the humours and elements, and appropriate treatments are prescribed to suit the imbalances of an individual's constitution, which obviously vary from one person to another. Substances in foods and herbs are also classified according to whether their therapeutic effects are mild (which can be used by anyone), moderate, or powerful (includes potential poisons for use only by hakims). Qualities of hot, cold, wet and dry are also attributed to physical conditions, foods and herbs.

In common with Chinese, Tibetan and Ayurvedic systems, Unani Tibb emphasises the importance of tastes as well as the manner in which food is prepared to adjust the imbalances which contribute to ill health. There are five tastes: salty, sweet, bitter, pungent, and sour, each of which affects the humours in its own way. In addition appropriate warming and cooling spices and herbs are added to cooking to help address underlying imbalances of the humours. Even the aromas from preparing, cooking, eating and digesting food contribute to the healing benefit and are taken into consideration in planning meals. Cooking and eating are seen as rituals which, if containing the right foods and herbs and practiced with a pure heart, good intent and clear focus, can help transform the energy of the meal and contribute to the healing process.

HERBS COMMONLY USED IN UNANI TIBB

Althea officinalis (see page 104)

Cassia senna (see page 138)

Cinnamomum zeylanicum (see page 142)

Coriandrum sativum (see page 148)

Elettaria cardamomum (see page 159)

Emblica officinalis (see page 161)

Foeniculum vulgare (see page 169)

Glycyrrhiza glabra (see page 178)

Mentha piperita (see page 201)

Piper longum (see page 216)

Viola odorata (see page 266)

Zingiber officinale (see page 274)