ROLE OF ILAJ-BIT-TADBEER (REGIMENAL THERAPY) IN MANAGEMENT OF WAJA-UL-UNQ (CERVICAL SPONDYLOSIS): A REVIEW WITH UNANI PERSPECTIVE

Dr. Furquan Ameen Inamdar Unani Medical College and Hospital, Behind Mahindra Showroom, Chacha Layout, Sedam Road, Badepur, Kalaburagi (Gulbarga), Karnataka, Pin code: 585105. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 February 2020 Final Accepted: 12 March 2020 Published: April 2020


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Tehjurul Mafasil in Unani. Disequilibrium of Ikhlat (Humours) and diversion of morbid materials towards the joints causes Tehjurul Mafasil (osteoarthritis). [14] Management of Waja-ul-Unq (cervical spondylosis) follow the same regimens which are meant to treat joint disorders in Unani system of medicine. The ultimate goal of treatment is to decrease level of disability and to reduce morbidity. In Ilaj-bit-Tadbeer (Regimenal Therapy), procedures like Hijamah (Cupping), Dalak (Massage), Riyazat (Exercise), Fasd (Venesection), Takmeed (Fomentation), Zimad (Paste), Tila (Liniment), Bakhoor (Medicated Steam), and Hammam (Bath) etc. has been found to be effective. [15] Unani system of medicine provides effective therapy for the treatment of various musculoskeletal disorders like arthritis and other lifestyle diseases. This system of medicine has it's roots from ancient Greek. Arabic and Persian regions also enhanced this pathy. Now it is included in Indian System of Medicine and recognized by govt. of India. The fundamentals of Unani medicine are based on philosophical and scientific basis. [16] Discussion:-According to Unani fundamental principles, there are seven basic components which form human body known as Umoor-e-Tabiya. These components include Arkaan (Elements), Mizaj (Temperament), Ikhlat (Humours), A'aza (Organs), Arwah (Spirit/vital force), Quwa (Power) and Afa'al (Functions). Out of these basic components, Arkaan, Ikhlat, A'aza and Arwah work as matter for the body. Mizaj and Quwa provide shape or forms and power while Afa'al gives objectives to the body for proper functioning. The normal physiological balance in these seven components is also known as Tabiyat (Physis) which maintains health. A departure from this physiological balance is considered as disease. [17] There is also another important fundamental of Unani which is known as Asbab (Causes). These Asbab are obligatory for body, health or disease. They make changes in the body and also protect health. From this principle, Asbab are classified into various types and one of it's types is Asbab-e-Sitta Zarooriya (Six Essential Causes) which is necessary for the survival of human body. These six essential causes are Hawa (Air), Makoolat-o-Mashroobat (Food & Drinks), Harkat-o-Sukoon Badni (Body Movements and Rest), Harkat-o-Sukoon Nafsani (Psychic Movements and Rest), Naum-o-Yaqza (Sleep and Wakefulness) and Ehtebas-wa-Istafragh (Retention and Evacuation). [18] There are four modes of treatment exist in Unani System of Medicine namely Ilaj-bil-Ghiza (Dietotherapy), Ilaj-bid-Dawa (Pharmacotherapy), Ilaj-bil-Yad (Jarahat) and Ilaj-bit-Tadbeer (Regimenal Therapy). From these modes of treatment, Ilaj-bit-Tadbeer revolves around Asbab-e-Sitta Zarooriya (Six Essential Causes). Any modulation, enhancement or modification in Asbab-e-Sitta Zarooriya which are done knowingly to treat disease or to prevent it, is known as Ilaj-bit-Tadbeer. This type of therapy works on the principle of Ilaj-biz-Zid (Antagonist treatment/ Heterotherapy) which means if there is a disease with hot temperament or hot morbid matter, we shall use cold regimens and if there is a disease with cold temperament or cold morbid matter, we shall use hot regimens. [19][20][21] The management of Waja-ul-Unq (cervical spondylosis) depends upon the nature, severity and duration of disease with the humours or morbid matters associated. Sue mizaj maaddi can be managed by nuzj and tanqiya. Tehleel-e-Warm (anti-inflammatory) and Taskeen-e-Alam (analgesic) regimens are needed effectively to decrease inflammation and pain. [22] Following regimens of Ilaj-bit-Tadbeer (Regimenal Therapy) are found to be effective in the management of Wajaul-Unq (cervical spondylosis).

Dalak (Massage):
It is a therapy in which pressure, friction and manipulation of tissues are applied. Dalak (Massage) has various varieties, from which Dalak-e-Laiyyan (Gentle Massage) with roghan-e-gul-e-aakh is very effective in treating the disease. It opens the skin pores, divert the morbid matter and relaxes the muscles. [23] Dalak at affected area with roghan-e-shibbat, roghan-e-baboona and roghan-e-murakkab is also beneficial. [24] Duration of massage at affected area should be lengthy for therapeutic purpose. If there is pain associated with additional cold, a massage with roghan-e-nargis or roghan-e-sosan mixed in roghan-e-dhatura is effective. If pain is associated with additional heat, a massage with roghan-e-hina is useful. [25]

Riyazat (Exercise):
This therapy involves voluntary movements at affected region. It strengthens the muscles, joints, nerves and ligaments. Peripheral circulation is increased due to Riyazat, morbid matters are diverted (Imala-e-Mawad), it opens skin pores which also helps in cleaning of matter (Tanqiya-e-Mawad). [26] Exercise of neck like flexion, extension, side flexion, right and left rotation are beneficial in cervical spine symptoms including headache, dizziness, nausea, vertigo etc. [27] The increased flow of blood at affected region enhances the movements and prevents spasm which 309 ultimately relieves pain. [28] Exercise causes endorphin production which gives feeling of well being hence body's resistance against pain is also increased. [29]

Natool (Irrigation):
This therapy features slow pouring of medicated oil or decoction from a particular height at desired region. The process of pouring is called Tanteel. Natool is classified into Natool-e-Haar and Natool-e-Barid. [33] This therapy is efficient in decreasing stiffness and pain at affected site. [33] [34]

Fasd (Venesection):
Fasd or venesection is a type of regimenal therapy which exists as oldest method of treatment in Unani. The purpose of venesection is to clean and evacuate morbid material from affected region by bloodletting, which is achieved by taking an incision over a vein. Venesection relieves inflammatory congestion. [35] According to Majoosi, if morbid matter is Dum (Blood) than venesection is done at Varid-e-Basaleeq (Basilic Vein) and the quantity of blood in bloodletting must be monitored on the basis of patient's capacity, age, temperament, season and climate. [36]

Takmeed (Fomentation):
To keep any region of the body warm, a non-invasive therapy from Ilaj-bit-Tadbeer is applied, which is known as Takmeed (Fomentation). The basic objective of Takmeed is to achieve pain relief and to decrease stiffness. Takmeed also decreases inflammation. It enhances the efficacy of massage lotion by increasing it's penetration into skin. [37] Hijamah (Cupping): It is a therapy used in Unani methods of treatment since ancient times. Hijamah, which was earlier known as 'Seenghi Lagwana', has two basic types namely Hijamah-bish-Shurt (Wet Cupping) and Hijamah-bila-Shurt (Dry Cupping).
Hijamah-bish-Shurt (Wet Cupping) works on the principle of Tanqiya-e-Mawad (Evacuation of Morbid Matter). In this method, a cup is placed over a desired region and vacuum is created by suction. After the development of congestion, multiple small incisions are taken and cup is reapplied. Blood starts to ooze out by suction and desired action is achieved. In cervical spondylosis, wet cupping is beneficial. Three cups are placed simultaneously over the region of 7 th cervical vertebra, right supraclavicular fossa and left supraclavicular fossa. [38] Hijamah-bila-Shurt (Dry Cupping), where only vacuum is created and there is no need to take incision for bloodletting. This method works on the principle of Imala-e-Mawad (Diversion of morbid material). If this procedure involves fire in creating vacuum, it is called as Hijamah-bil-Naar (Fire Cupping). Dry cupping is efficient in providing nutrition to the affected area. It is also effective in decreasing restriction of motion, and increasing the strength of muscle. It is a safe and effective procedure. [38][39][40]

Conclusion:-
In the view of Unani perspective, it can be concluded that Ilaj-bit-Tadbeer (Regimenal Therapy) is an effective nonpharmacological method of treatment for the management of Waja-ul-Unq (Cervical Spondylosis). By reviewing the literature, it can be considered that the therapies of Ilaj-bit-Tadbeer like Dalak (Massage), Riyazat (Exercise),