TKDL - Regimental Therapy

Regimental Therapy(ILAJ-BIT-TADBEER)

Regimental therapy (‘Ilāj bi’l Tadbīr) is one of the four methods of treatment in the Unani system of medicine. The other three methods are Dietotherapy (‘Ilāj bi’l Ghidhā’), Pharmacotherapy (‘Ilāj bil-Dawa) and Surgery (‘Ilāj bi’l -Yad).

Literally, Tadbīr is an Arabic word that means ‘regimen’ (systemic plan) whereas ‘Ilāj means therapy or treatment. So ‘Ilāj bi’l Tadbīr means treatment through regimen, which is a method, through which care of a sick person and maintenance of general health is performed with the help of certain procedures, tools and equipments described by eminent Unani physicians e.g., Buqrat (Hippocrates), Jalinoos (Galen), Zakaria Razi (Rhazes), Ibn-e- Sina (Aviccena) and Abu-al-Qasim Zahrawi (Abulcassis) etc.

Regimental therapy is used independently or in combination with other methods of treatment like Pharmacotherapy, Dietotherapy and Surgery. Regimental Therapy (‘Ilāj bi’l Tadbīr) consists of cupping (Hijamat), venesection (Fasd), leeching (Taleeq), and cauterization (Kai).

The following are the different types of methods used for the treatment:

1. Exercise (Riyāḍat )

2. Massage or Friction (Dalk )

3. Fomentation (Takmeed)

4. Pouring of medicated lukewarm water on affected part (Nutool)

5. Poultice and Liniment (Zimād wa Tila )

6. Diaphoresis (Ta‘rīq )

7. Diuresis (Idrār –e-Baul)

8. Balneotherapy/therapeutic bath (Ḥammām)

9. Purgation therapy (Ishāl)

10. Emesis (Qay’)

11. Enema (Ḥuqna)

12. Diversion of morbid matter/humour (Imāla)

13. Cupping (Ḥijāma)

14. Venesection (Faṣd)

15. Leech therapy/ Hirudotherapy (Ta‘līq al-‘Alaq)

16. Cauterization (Kayy)

Each of the above-mentioned methods have been briefly explained below along with their broad indications.

Exercise (Riyāḍat): Exercise is a voluntary movement with the purpose of evacuation of waste material (Tanqiya-e-Mawaad) for an individual. It plays an important role not only in maintaining good health and prevention of diseases but in curing certain ailments as well.

The objectives of performing exercise (Riyāḍat) are enumerated below:

· To improve metabolism (Istehala) for proper functioning of body.

· To remove waste products from the body.

· To tone up individual organs.

· To maintain or improve flexibility, co-ordination and balance of the musculoskeletal system and thus strengthen the body as a whole.

· To relieve anxiety, insomnia and depression.

Massage (Dalk): Massage (Dalk) is a systematic manipulation of body tissues with the hands. Several varieties of Dalk have been recommended in Unani system of Medicine e.g. Dalk-e-sulb (hard), Dalk-e-layyan (soft), etc., for prolonged or moderate massages. Hard friction or massage is Mufatteh-e-Sudad (deobstruent) and makes the body firm. Soft massage is a sedative and relaxes the body while prolonged massage reduces the fat of the body. Moderate massage develops the body as well as improves and maintains blood circulation of the particular organ; rough friction with a rough cloth enhances vasodilation of the particular organ, etc.

The objectives of performing massage (Dalk) are enumerated below:

1. In the premature infants, it is found to enhance weight gain and females who were given massage therapy during labour have less agitation, faster delivery and less post partum psychosis.

2. Relief from symptoms of anxiety, tension, depression, insomnia and stress as well as back pain, headache, muscles pain and some form of chronic pain.

Fomentation (Takmeed): Fomentation (Takmeed) is the process, which keeps the body or part of the body warm.

The objectives of performing Takmeed are enumerated below

To relieve localized or generalized pain.
To subside the inflammatory conditions.
To increase the penetration of massage lotion.

Pouring of medicated water (Nutool): This is a procedure in which the affected part is washed by a stream of water or medicated decoction from a height. Irrigation is done with the purpose of acceleration of excretion of morbid material (Ikhraaj-e-mawaad) and alteration of the temperament of an organ (Tabdeel-e-Mizaj-e- a’za).

The objectives of performing Nutool are enumerated below

To disperse morbid matter from affected part.
To alter the temperamental state of the organ.
To achieve the astringent effect.
To relieve several chronic diseases like paralysis, sinusitis, salpingitis, arthritis, mastitis, sleeplessness, migraine, meningitis, depression, tension, polio and even certain mental disorders.

Medicated Paste/ Liniments (Zimād wa Ṭilā’):

Liniments (Ṭilā’): A kind of medicated oil used externally for massage

Medicated paste (Zimād): A semisolid preparation of crude drugs in powder form, used for local application.

The objectives of using Zimād / Ṭilā’ are given below:

To combat pain of a particular organ e.g. headache (Suda’a), chest pain (Waja us sadr) etc.
To cure swelling of a particular organ e.g. liver (Kabid), spleen (Tihāl), etc.

Diaphoresis (Ta‘rīq):- This is the process to accelerate the secretions of the sweat glands of the skin.

The objectives of Ta‘rīq are given below:

To excrete the waste matter (Mawaad-e-Fasida) from the skin, blood and other parts of the body
To reduce the excessive heat (Hararat-e-Mufrit)
To transfer the morbid matter (Imāla-e-Mawād)
To purify blood
To improve dermal nutrition and enhance body texture

Diuresis (Idrār –e-Baul): This is one of the important processes for evacuation. Specific methods as well as drugs have been mentioned in classical Unani literature to achieve the target.

The objectives of Idrār –e-Baul are given below:

To excrete poisonous matters, waste products and excess of humours through urine
To purify blood and evacuate vitiated humours
To cure diseases of heart
To cure hepatic ailments
To cure pulmonary diseases as well as renal disorder

Balneotherapy/ therapeutic bath (Ḥammām): It is a place used for bathing, consisting of several rooms with one room leading to the other with specific provisions and conditions customized according to the disease to be treated.

The objectives of Ḥammām are given below:

To reduce viscosity of the humours (Luzūjat -e-Akhlat).
To improve health of the debilitated individuals
To strengthen body
To cure obesity
To increase innate heat of the body (Ḥarārat Gharīziyya)
To improve metabolism (Istehala)
To evacuate waste products through skin
In the treatment of paralysis (Fālij) and muscular wasting (Zubūl)

Purgation (Ishāl): This is the process used for expulsion of the waste matter through the bowels.

The objectives of Ishāl are given below:

To resolve morbid matter
To activate the derivative effect
To achieve antispasmodic and detoxicating effect

Emesis (Qay’): This is the evacuation of gastric contents through mouth. The main purpose of vomiting is to eliminate toxic/ morbid material from the gastro-intestinal tract.

The objectives of Qay’ are given below:

To cure disease like Headache (Ṣudā‘), Migraine (Shaqīqa), etc.
To cure Pneumonia (Zāt al-Ri’a)
To cure Asthma (Zeequn Nafs Shu’bi).
To cure mental disorders, e.g. Mania (Junoon) and Melancholia (Maalekholia).

Enema (Huqna): This is an excellent process for the removal of superfluities from intestine. Here, liquefied drugs are introduced per rectum by an instrument. This is one of the best methods for elimination of vitiated humours and waste material from the intestine.

The objectives of Huqna are given below:

To get rid of the superfluities from intestine
To relieve kidney and bladder pain
To resolve inflammatory condition of the adjacent organs
To relieve colic pain
To relieve constipation particularly in the case of intestinal atony

Diversion of morbid material (Imala): This involves ‘diversion’ of matter from one part of the body to another. For this purpose, different techniques are used for treatment of conditions where hyperemia (Imtala-e-Damvi) causes certain problems.

Through this method, the flow of matter is diverted to the other side. As a result, the congestion of the affected part is reduced in a natural way.

The objectives of Imala are given below:

To relieve pain and nervous irritability
To relieve burning sensation
To relieve the hyperemesis gravidarum (Qai-e-Hawamil).
To subside inflammation
To dissolve lipoma and tumours
To absorb fluids or matter accumulated in hypodermic spaces or cavities

Cupping (Ḥijāma): This is a method used for local evacuation or diversion of morbid humours in which a horn is attached to the surface of the skin of the diseased part through which negative pressure is created by vacuum. The vacuum is created by the introduction of heat or suction.

Cupping is divided into two categories

1. Cupping with bloodletting i.e. Ḥijāma bi’l Sharṭ

2. Cupping without bloodletting i.e. Ḥijāma bilā Sharṭ

The objectives of Ḥijāma are given below:

Evacuation (Istifragh) of morbid matters
Diversion (Imāla) of matter from one part of the body to another

Venesection/Blood letting (Fasd): This is a procedure in which an incision is given to any of the superficial veins, and blood, containing waste material (Madda-e-Fasida) is allowed to flow. The purpose is evacuation of waste material is to remove excess humours in the same proportion as present in the blood vessels or the abnormal humour or both. It is applied for purification of vitiated humours in Meningitis (Sarsām), Pneumonia (Zaat-ur-Riya), Pleurisy (Zaat-ul-janb), Sciatica (Irqun Nisaa), Gout (Niqras), Rheumatic Arthritis (Waja-ul Mafasil), Coma (Subat), Melancholia (Maalekholia), Diphtheria (Khunaaq-e-wabaai), Piles (Bawaseer), Amnesia (Nisyaan), Angina Pectoris (Waja’-ul-Qalb) etc.

The objectives of Fasd are given below:

To maintain normal volume of blood in people who are predisposed to develop the diseases due to excess of blood
To stimulate metabolism (Istehala)
To check menorrhagia (Kasrat-e-Tams) and epistaxis (Ru’af).
To cure malaria (Humma-e-Ajaamiya) and splenic disorders, haemorrhoids (Bawaseer-e-Damvi), orchitis (Waram-e-Khusiya), metritis (Iltehab-e-Rahem), scabies and pruritis (Jarb-o-Hikka), boils (Khuraj), hepatitis (Iltehab-e-Kabid).

Leeching (Ta‘līq ): This is a unique method of removal of morbid matters (Mawaad-e-Faasida). Leeching draws blood from deeper tissues. The selected point of treatment should be washed with a solution of borax and rubbed until red. Leeches should be washed first and then applied. A little clay or blood should be smeared in the selected point to enable them stick better.

After achieving the target and when they get distended, leeches should be detached by dusting salt borax or the ashes of burnt cloth, wool or sponge.

The objectives of Ta‘līq are given below:

To cure baldness and favus (Sa’fa), ringworm (Qooba), morbid matter (Mawaad-e-Faasida), moles (saleel), filariasis (Da-ul-feel), meningitis (Sarsaam), pneumonia (Zaat-ur-riya)

Cauterization (Kayy): Cauterization is an effective method of treating several conditions e.g., destructive lesions, removal of putrefied matter, bleeding, etc. Unani physicians have preferred cauterant (mikwa) made of gold.

The place to be cauterized must be visible so that the cauterization is done satisfactorily after good observation. However, in the case of deep located organs e.g. mouth, nose and anus, suitable speculum is required. It should be coated with talcum and Armenian bole, soaked in vinegar, wrapped with a piece of cloth. The speculum should be subsequently cooled with rose water or several other juices.

The objectives of Kayy are given below:

To prevent the spread of putrefaction
To alter the cold temperament or to rectify the temperament of a particular organ
To disperse and remove the putrefied matters, firmly adherent to the particular organ
To arrest haemorrhage as it retains the flow of blood

To prevent the accumulation of catarrhal matter