LEECH THERAPY

LEECH THERAPY

Historical Background

·         The use of leeches (Hirudo medicinalis) has been popular throughout the ages, and still has a place in modern medicine—especially in reconstructive and micro vascular surgery

·         First written document- medical poem by Nicander of Colophon (185–135 BC), a Greek poet and physician 

·         The name Hirudo medicinalis, assigned by Linnaeus in 1758

·         Broussais (1772–1838),  France Student of Marie Francois Xavier Bichat (1771–1802), the founder of modern histopathology

·         Broussais served as one of Napoleon’s physicians and became professor of general pathology in Paris 

·         Broussais applied 10 to 50 leeches at one time to any patient, thereby utilizing hundreds of worms daily in his practice

·         He treated typhoid fever, syphilis, variola, worms, tuberculosis, or mental diseases by applying leeches to the abdomen

·         Von Ronsenstein, in the first printed textbook on diseases of children, advocated leeching for difficult dentition, tooth abscess, convulsion, scarlet fever, pleurisy, or inflamed eyes. The English edition was published in 1776

·         Gross’ System of Surgery in 1859 advocated leeching as a minor surgical procedure

·         Charles de Nancrede, (Professor of Surgery) in Ann Arbor, mentioned leeches in his textbook, “Lectures on the Principles of Surgery”. The comment went unchanged from the 1889 to the 1905 edition

·         The chinese used leeches as early as the 10^th century, the authority on traditional medicine, Zhang Zhong Jing found that leeches could dissolve blood stasis and mentioned it in his famous book of medicine “Golden chamber of Jade places channel”

·         European medieval medicinal manuscripts illustrated the use of leeches for the treatment of variety of disorders.

Bloodletting is an ancient therapy with origins that are suspected to go back as far as the Stone Age. Healers attributed many illnesses to inappropriate, excessive collections of blood and its constituents.

Hippocratic concept - veins can be the site of pathologic humors and blood letting was the treatment of choice. Leeching is an alternative to instrumental bloodletting, with some advantages.

                slower, less painful; more quantitatively dependable extraction of blood

Avicenna (d. 1037), believed that leeches drew blood from deeper sources than did wet cupping.

Galen prescribed phlebotomy for diverse infirmities including epilepsy, liver disease, melancholy, and pleurisy and he used leeches

Leeching or Irsal e Alaq removes the waste/ harmful and morbid material.

Jalinoos and Abu Bakr Mohamed Bin Zakariya Razi used it in quba, saafa, qurooh-e-balkhiya, waja ul mufasil and describe it better than fasad or ishal.

Leeches

Scientific name:

                Hirudo medicinalis (Europian medicinal leech)

                Hirudinaria granulosa (Indian medicinal leech)

The two main species used in medicine are the close relatives “Hirudo medicinalis” and the “Hirudo verbana” in europe.

Diet: Blood of birds, fish, frogs, mammals

Food & feeding: Carnivore

Habitats: Freshwater

Conservation Status: Near Threatened

Relatives: Earthworm, lugworm

Description:

Leeches have segmented bodies like an earthworm, but unlike earthworms they are slightly flattened rather than round.

Sucker at the head and the tail end

Head surrounds the mouth.

The mouth contains three jaws that can break the skin of their hosts to suck their blood.

Medicinal leeches are greenish brown on their backs with thin red stripes running along the body and paler below. They grow up to 20 cm in length.

Lifestyle:

Live in shallow muddy pools and ponds with plenty of waterweeds.

When hungry, they attach themselves to a passing animal, break the skin with their jaws, and inject special chemicals that prevent the blood from clotting and reduces any pain.

They then suck the blood of the host until they are full, when they withdraw their jaws and drop off into the water.

They can consume 15 grams of blood - ten times their own body weight, before they are full, but they only need to feed every six months.

Family & friends

Like slugs, leeches are hermaphrodite, having both male and female parts, but they still need to come together to mate with each other.

Growing up: After mating, 15-50 eggs are laid in a spongy case or cocoon, above the waterline often under stones.

The eggs hatch in 3-5 weeks and the young leeches need two seasons of feeding before they are ready to breed themselves

According to Avicenna following leeches should be avoided

Leeches with large heads

Leeches having soft hairs, resembling eels (snake fish)

Those having azure lines

Those which can change their colours

Those having red bellies and green back especially if they are found in running water

all the above being poisonous produce swelling syncope, heamorrage, fever, paralysis and malignant ulcers

Following types can be used for the medicinal purpose

Leeches which are thin and have tiny head

Emerald green leeches predominantly green and having yellow stripes or leeches which resemble liver colour

Brown leeches with round sides

Leeches which looks like mouse tails

Actions

Secrets of salivary glands of medical leech Contains more than 100 bioactive substances. very few are known in terms of chemical structure and mechanism

• ·         Analgesic
• ·         Resolving actions
• ·         Anti oedematous
• ·         Improves immune system activity
• ·         Eliminates microcirculation disorders
• ·         Bacteriostatic
• ·         Restores permeability of tissues and organs
• ·         Eliminates hypoxia
• ·         Reduces BP
• ·         Detoxifies the organism

Benefits of Leech Saliva

• Hirudin (a potent anticoagulant) enables the blood to flow for some time without clotting
• Calin- induce secondary bleeding, which can last up to 12 hours
• Hyaluronidase – “spreading factor” – facilitates the penetration and diffusion of these pharmacologically active substances into the tissues- especially in joint pain and has antibiotic properties
• Destabilase - Dissolves fibrin and has thrombolytic effects
• Bdellins, Eglins – Anti-inflammatory effect and inhibits trypsin, plasmin and acrocin
• Acetylcholine – vasodilator
• Histamine-like substances – vasodilator, increases blood inflow at the bite site

Uses

• ·         Relieves vascular congestion - effectively used in conditions like long standing Varicose ulcers, Filariasis, post-op. skin grafting lesions.
• ·         Arthritis, Sprain or spasm to relieve the pain, inflammation & discomfort symptomatically.
• ·         Abscess, Cellulites, Thrombophlebitis and Varicose Veins
• ·         Atherosclerosis of the limb - improves circulation.
• ·         Management of non- healing ulcerative lesions like Diabetic ulcer, Leprotic wound etc. it helps to improve the local blood circulation & healing is promoted.
• ·         Cardiovascular diseases – hypertension and ischaemic disease
• ·         Respiratory – pneumonia, bronchial asthma
• ·         Paradontosis and other teeth diseases
• ·         Skin diseases – neurodermatitis, psoriasis, herpes, eczema
• ·         In pedicle flaps, perfusion problems may develop, but imbalances between arterial and venous drainage are more common. Deficient venous return leads to venous congestion (characterized by blue discoloration and the skin becomes increasingly mottled), or in extreme cases –thrombosis
• ·         Reattachment of the ear lobes

Contraindications

• ·         Anaemia
• ·         In extreme ages i.e. in children and old age
• ·         Weak patients
• ·         Allergic patients
• ·         Extreme hot or cold climate
• ·         Bleeding disorders like haemophilia
• ·         Pregnancy

Application guidelines

• ·         Clean patient’s skin thoroughly with hot water to remove odour, dirts.
• ·         Application site- rubbed till red.
• ·         Caught one day before, If possible squeeze till the contain of the stomach comes out.
• ·         Pick leech with gloved hand, wipe it
• ·         Hold the leech’s head to the application site
• ·         If did not bite make prick and smear a blood drop
• ·         Leeches will remain until they become full then removed spontaneously
• ·         When the leeches get distended and their removal is intended one should sprinkle over them a little salt or ashes or burnt cloth/wool. After its fallen suck up that place with cupping glass, so that some of the blood might get out.
• ·         Following the bite, the area can bleed for up to 48 hours (up to 50 ml of blood), allowing oxygenated blood to enter the wound area
• ·         If bleeding does not stopped by itself then pack it.  
• ·         Leech bites sometimes leave small blood spots (ecchymoses) which sometimes develop into keloids in some individuals. Most of these spots disappear within 2-3 weeks
• ·         To remove the leech, absolute care is required – Forcible removal of the leech may rupture gut contents (Aeromonas hydrophilia)
• ·         All leeches used must be destroyed with 70% Alcohol and supplier must be notified
• ·         Fresh, unused leeches should be used
• ·         Should not reuse

Humma e Diq (Tuberculosis)

Humma e Diq

It is a ghair e thabayee hararath of the body which involves organs and destroys body fluids.

Diq means wasting of muscles. It is characterized by low grade fever and Patient becomes thin and weak with the progression of disease. Organism infects lungs, intestine, joints, bone, meninges, etc.

Predisposing factors

• Hereditary
• Tb history of a family member
• Young age or elderly
• Over crowd,
• Poor hygiene
• Less ventilation
• Weak patients
• Hummiyat
• Humma-e-yaumiya
• Humma-e-warmiya
• Humma-e-muharrika
• Ghib-e-khalis and ghair khalis
• Shatrul ghib
• Awram
• Warm-e-gurda
• Warm-e-jigar
• Warm-e-masana
• Warm-e-ama
• Warm-e-reham
• Hararat
• Hararat-e-gurda
• Hararat-e-meda
• Hararat-e-jigar
• Hararat-e-riyah
• Suddha
• Gam, fikr, gussa, danj
• Soo-e-mizaj yabis, mosum garma, khariji harat
• Insomnia
• Ishal muzmin

Spread

• Droplet infection
• Oral route- by ingestion of infected milk

Stages

• Stage 1 – Darja e diq

o   Organ contain fluid

o   Fluid gets heated but no disturbance in function

o   Easy to treat but difficult to diagnose

• Stage 2 – Darja e zabul

o   Fluid gets heated

o   There is partial destruction of cells

o   Functions are slightly disturbed

o   Treatment is deficient

• Stage 3 – darja e mufatit

o   Fluid is completely destroyed

o   Treatment is impossible

Alamath (Clinical features)

• Fever –                 -continuous / intermittent

·         -initial stage fever present in the evening without chills and rigors

·         -later fever sustained with slight rise of temperature in the evening

• Fever can occur two times evening and night
• Evening fever lasts for 4-5 hours then it decreases with sweating and second attack occurs after 1-2 hours and lasts until early morning 2 o clock then fever decreases with profuse sweating
• General weakness specially felt in the evening
• Feels good in the morning
• Nabz – zaeef (weak) and mutawasit (irregular)
• Temperature increases after meals
• Cheeks becomes bluish
• Patient become thin and weak in stage 2
• In stage 3 urine become oily and patient is dehydrated and weak
• Clubbing of finger, loss of hair, severe wasting with bony prominence

Treatment (ilaj)

• Maintenance of sith e zarooriya
• Give daf-e hummiyat
• Mufarrihat
• Habisat
• Mubarridat
• Eliminate the real cause
• Give   nutritious food
• Dawa e diq 4 ratti with goat’s milk in morning and at night
• For weakness of the body –

o   -goats milk

o   -ab e kaddu with or without sheerajath

o   -ab e tarbooz

o   -sarthan soup

o   give 7 tola of any one for first 3 days, increase 1 tola per day for next 14 days (21 tola in 14th day), Then reduce 1 tola per day up to 7 tola.

o   -Murakabat e folad after food

Dawa e Diq contains Bilawa, Fil file siya, Tabasheer, Sat e gilo, and Dane ilachi kurd. Each 1 tola, make fine powder and use with goats milk

• For fever

o   Kurs e tabasheer

o   Kurs e kafoor

o   Sarthan is roasted and soup is made

o   Tabasheer

o   Zahar mohra

o   Gile armoni

• Diet

o   Milk

o   Egg

o   Butter

o   Yakni

o   Shorba

o   Ash e jaw

o   Fresh fruits

o   Fish

Diq e Mevi – intestinal tb

• Tb affect intestine.
• Organism circulated in the mesenteric veins and lymph nodes become hard and results wounds
• Patient becomes weak day by day

Asbab (Causes)

• Drinking cow’s milk without boiling

o   Children are affected more (diq e atfaal)

• Swallowing sputum (tb)

Alamath (Clinical features)

• Sometimes patient is asymptomatic
• Takes long time for digestion
• Stomach ache
• Dyspepsia
• Anorexia
• Flatulence
• Fever in the evening and at night
• Diarrhea
• Slight pain around the umbilicus and appendix
• Abdominal distention
• Dryness of the body
• Skin wrinkles
• Angular stomatitis
• Qaroora-  greenish or whitish and bad smell

Ilaj (Treatment)

·         Elva, Tukhm e kithmi, Aslus soos, Sapistan, Unnab, Beekh e anjubaar, Nusha, Gul e Surkh, Samag e arabi, Katheera, Gile armoni, Barg e gauzaban, Tabasheer, Bisbasa, Khaskhas, Magz e tukm e kaddu, Magz e tukm e khyarain, Rubbussoos. Powder all and make pills with luab e isap goal and take twice a day.

• Astringents are contra indicated
• Use luabath such as Sapistan, Isabgol, Behidana, Katheera,  Akakiya
• Diet same as pulmonary Tb

By:

Dr. M.S.M. Shiffa

BUMS, MD

Asbabe Sitta Zarooriyah (Six essential factors)

Asbabe Sitta Zarooriyah (Six essential factors)

Unani System of medicine recognizes the influence of surroundings and ecological condition that maintaining the health and growth. This influence is based on the six essential pre-requisites or Asbabe Sitta Zarooriyah. According to Unani medicine “Asbab” is the precursor that influences on human body to generate a new state or maintain the persisting state. Unani scholars emphasized these six factors which are essential for life, without which life of humans would not be vested.

They are:

1.  Fresh Air (Hawae Muheet)

2.  Food and Drink (Makool wa Mashroob)

3.  Physical Movement and Repose (Harakat wa Sukoone Badania)

4.  Mental Movement and Repose (Harakat wa Sukoone Nafsania)

5.  Sleep and Wakefulness (Naum wa Yaqzah)

6.  Retention and Evacuation (Ihtibas wa Istifragh)

1.      Fresh Air (Hawae Muheet)

Unani scholars strongly believed that the fresh and clean air is necessary for healthy life and their opinion is that many diseases occur due to polluted air and environment. Therefore, Ancient scholars emphasized to live in open, well ventilated houses rather than living in congested and compact dwellings. By the word “air” it is not only meant the simple element (wind), but it is the atmosphere around us. Ancient physicians have mentioned different types of seasons which directly have an impact on air and causes different types or seasonal variations in the air. This seasonal variation also affects one’s healthy state of body.

Types of Seasons

I.       Fasle Rabi (Spring season)

Environment of this season is hot and wet (Har Ratab). This season is favourable for Damavi Mizaj people as their Mizaj is Har Ratab. On the other hand, this season is favourable for many diseases like paralysis, infections, melancholia, arthritis, pharyngitis, haemoptysis etc.

This season is suitable for the growth, reproduction and multiplication of many pathogenic microorganisms like bacteria, viruses, fungi and other organisms as they need hot and moist condition for their multiplications. As a result, air in this season could be polluted with pathogenic microorganisms which can produce diseases. In case of other diseases, Unani physicians view is that a man is in stressful, anger and fearful in this season and also over intakes of spicy food.  

II.    Fasle Sarma (Winter season)

Cold and moist temperament prevails during winter as the environment becomes more cold and moist. In this season phlegmatic diseases like joint pain, pneumonia, rhynorrhoea, cough, lypoma, and rhinitis etc, are very common.

III. Fasle Saif (Summer season)

During summer season hot and dry temperament is prevailed. As a result production  of  Safra  (yellow  bile)  increases and induces  Safrawi  (bilious)  diseases  like  measles, vomiting,  nettle  rash,  chicken  pox,  ascites, conjunctivitis  etc in  this season.  Therefore  one  should  consume cold  temperament  beverages,  bath  with  cold  water, avoidance from  sun light and also increase intake of water.

IV.  Fasle Khareef (Autumn season)

It is the time of change of colour in the leaves, and the beginning of their fall from the trees. Summer is the whole of the hot season, and winter the whole of the cold season. It is the season opposite to summer, being less or greater duration according to the latitude. In autumn, the heat subsides and the cold is not yet at its maximum. Therefore, the predominant temperament of this season is cold and dry.

During this season Safrawi diseases like ring worm, pruritis, sciatica, impetigo, excoriating scabies, tonsillitis,  intestinal  worms, joint pains, back pain  etc  are  prevailed because  of  its coldness which increases the chances of retention of Safrawi  Khilt  (yellow bile) occurs in the body; these problems occur due to indigestion, abundance of fruits, bad articles of diet, etc. therefore it is very much essential to have appropriate meal and good digestion and to take plenty of water to moisture the body.

How to Prevent the Diseases

Change of seasons has to do with the kind of diseases peculiar to each climate. Consequently the wise physician will carefully study climate (atmospheric conditions day by day and month by month) and country in order the better to treat the diseases and maintain his patient's health by an appropriate mode of life, and the regimenal measures appropriate to that climate and country.

Rabi (Spring season)

This season is hot and dry. Therefore, humours which are produced in this season may be healthy in quality, and merely superabundant in quantity, so that the channels are over distended and overfilled. In such a case movements become dangerous, the vascular channels running a risk of rupture. To relieve such, the local plethora must be rapidly relieved by venesection, avoidance from bath with hot water, and also avoidance from excess eating and drinking.

Saif (Summer season)

In summer season humours are dispersed, the blood and serous humour are diminished in amount and the bilious humour is increased in amount. Therefore, the faculties and natural functions are impaired owing to excessive dispersion.

People should have more rest in this season with avoidance from exposing to direct sunlight. Intake of Ghizae Barid (cold temperament foods), citrus fruits like orange, pomegranate, lemon etc are recommended.  To  prevent  the  problems  of digestion;  should  take  easy  digestible  Ghiza  (food) and avoid hot  and  dry  foods.   

Khareef (Autumn season)

This season has the cold and dry qualities, therefore chances of cold diseases are high. These qualities vanish the moisture from the body exposed to the air, or from the air itself, unless there is a continual reinforcement with further moisture. Consequently, continuous supply of moisture ceases, the state of dryness is rapidly reached. Intake of dry fruits in autumn season is forbidden, along with abstinence from excess coitus in this season. Use of cold water for drinking purpose as well as for bath is prohibited.

Sarma (Winter season)

During winter, environment is cold and moist, due to that more phlegmatic disorders are prevailed. It is advisable to be dressed up properly in winter. Intake of Haleem (pulses with meat) and meat is advocated for the production of more blood. It is preferable to do strenuous exercise, Hammam, etc to excrete out the dissipate material through skin pores.

2.      Food and Drink (Makool wa Mashroob)

Food and drink is second important factor in maintaining life and health by replacing the body’s used-up and broken-down components. Food and drink influence in regard to quality by their heating and cooling make the body hot in virtue of their own heat, cold in virtue of their own coldness respectively, and yet these qualities do not become an integral part of the body.  

Keeping in view the importance of food and drink, Unani Scholars have laid down certain principles on use of diet both for promotion of health and treatment of disease. A healthy man should use mainly the food of the temperament similar to his own temperament.  However, if he is threatened with a pathological shift in his temperament, he should use food of the opposite temperament.  Thus, in summer, when increasing hotness of air and environment, threatens to unbalance his normal temperament. Therefore, cold food like pomegranate preparations and other cooling affect should be used by a man of hot temperament.

Jalinoos (Galen), a renowned physician suggested that milk of mother is the best Ghiza for infants, which should be given to the baby before the teething process after that the light and liquid diet should be given. Galen has said that soft food should taken first and then hard food. As per Razi’s purview anyone wants to be healthy should consume same quality food as per his own Mizaj in small quantity. It is also advised not to take heavy fatty diets like red meats and Ghizae-Barid (cold diets) like curd and cold beverages etc together. Obese people should consume excessive amount of vegetables and fruits.

Water is one of the elements which has the special property of entering into the composition of food and drink, not that it is itself nutriment, but rather that it enables the aliment to penetrate into the human body and permeate and purify its substance. It is helpful in carrying of nutrients to the unit of the body. Water is really a "substance" which helps to attenuate the disease matter, so that it can flow easily into the blood-vessels and out of the excretory channels. Nutrition cannot be affected without water and which is the handmaid of nutrition.

Unani scholars combine drinks with food because, despite lacking nutrition, water is crucial since food becomes effective only in solution.  So, it provides extensive guidelines for the type of water and the appropriate time for drinking it.  For instance, in order to ensure proper digestion, people of hot temperament should drink water during meals, but cold temperament persons should use water only after the digestion has fully set in. Water which is salty causes dryness and weakness in the body.

Unani physicians have recommended different admixture of water for various purposes such as alum water for the patient of bleeding piles, leucorrhoea, haemoptysis etc. Likewise  copper  containing  water  beneficial  in Istisqa  (ascites)  and  can use it for the betterment of functions  of  liver  in  case  of  Sue  Kabid  (liver disorders).  Rain water is good enough for the nervous disorders.

Unani physicians also have warned that excessive use of cold water intake  creates  the  problems  of  nervous  and respiratory  systems  particularly  in  childhood  period and  older  age.  Avicenna  advocated  that  intake  of warm  water also causes improper digestion, vomiting and  occasionally  leading  cause  for  ascites and as well as weakness.

3.      Bodily Movement  and  Repose  (Harakat  wa Sukoone Badania)

The Unani system of medicine gives great importance to both appropriate movement and rest for maintaining health and for curing disease.  Greek-Arab physicians  projected  an  ideas  regarding physical  activity  which  is  essential  for the activation of innate energy and to excrete the waste products of the  body.  Rest is necessary to save the body temperature, body fluids and to retain nutrients.  Unani system of medicine offers a wide concept of exercise of all organs.  It classifies movement into two types: high frequency and intensity with short duration, which increases heat and low frequency and intensity with long duration, which increases metabolism.  It recommends moderate exercise, which produces moderate sweating, but discourages intense exercise, which produces profuse sweating. It even considers massage (Dalak), Turkish bath (Hammam), slow horse riding and swinging as moderate exercise, and prescribes the latter for paralytic persons. Boat ride is prescribed for treating chronic diseases like leprosy and dropsy.

Excess  of  both  causes coldness  of  the  body  because  motion  leads  to decrease  the  innate  fluids  as  well  as  excess  of  rest increases  the  body  fluid  which  decreases  the  innate energy. In the same manner, certain diseases can be cured by giving the body rest, while some are cured by movement of affected organs. Warm (inflammation) and Kasr (fractures) need complete rest to get properly healed.  On the other hand, paralysis require particular amount of movement. Physical activities are needed for the growth  of  muscles  and  ensure  nutrition,  increased blood  supply  and  proper  functioning  of  excretory system. 

4.      Psychic movement and Repose (Harakat wa Sukun Nafsani)

The Unani scholars have mentioned the role of psychic states in maintaining health and treating disease.  They have attributed many illnesses with psychic factors. Psychic movements increase heat while repose increases cold. So, excessive psychological factors or excessive repose of psychic movements causes hot and cold pathologies.  Psychological factors such as happiness, sorrow, fear, anger, etc.  have significant effect in producing certain illnesses like tuberculosis, hysteria, fever, etc. and mental disorders are caused, in most cases, by emotional strain and maladjustment. Therefore, there is a branch in Unani medicine  known  as  “Ilaj  Nafsania”  (psychological treatment)  which  deals  with  the  above  mentioned factors. As such, most of the time treatment is done by using non pharmacological regimens such as counseling, music, changing the environment, beautiful scenery etc.

For instance, extreme anger moves the pneuma to the exterior, making both pneuma and the body abnormally hot, which may give rise to hot mental and bodily maladies e.g. mania and epistaxis, respectively.  On the contrary, extreme fear makes the pneuma flee to the interior and the resultant cold can give rise to loss of consciousness and bradycardia.

Thus, these pathologies can be managed both by altering the mental states and by administering cold or hot drugs along with psychological methods.  This is the basis of the unique and successful psychopharmacological management of psychiatric and psychosomatic diseases in Unani medicine. By being happy a person can prevents social problems, cardiac problems and gastric problems etc.

   5.      Sleep and Wakefulness (Naum wa Yaqzah)

The effect of sleep is very similar to that produced by repose; that of wakefulness or vigilance is very similar to that produced by exercise. Sleep strengthens all natural functions (digestion of the food and the elaboration of the digestive products into good blood), it preserves the vital heat and vital heat will accumulate in the interior parts, sleep removes all types of lassitude and it restrains strong evacuations.

Lack of sleep causes dissipation of energies, mental weakness and digestive disturbances.  Proper  sleep  and  wakefulness  are necessary  because  it  is  main  instrument  to  maintain the  digestion  and  activeness  of  the  body.  Excess of sleep causes  coldness,  weakness,  laziness  in  the body, headache,  etc  and  may  develop  the Balgham  diseases,  likewise excess of wakefulness  causes  dryness  in  the  body  and indigestion.  The lack of sleep is said to cause indulgence of energy, mental weakness, digestive disturbances and leads to acute diseases. 

Wakefulness is also necessary to improve the hunger.  Excess of wakefulness produces dryness in the body, indigestion, improper function of brain, alteration of brain temperament.  Normal wakefulness improves the innate energy, sensory and motor functions.

6.      Elimination and Retention (Istifragh wa Ihtibas)

Istifragh means elimination of matter (Mawad) from the body. Waste products produced in the body during metabolic changes should be eliminated as important as continuous nutrient supply for life and normal physiological function. Gaseous waste substances are eliminated through the lungs; solid wastes are through intestines as nitrogenous end products and excess water through kidneys and skin.

Absorption and retention of substances into the body tissues is known as retention (Ihtibas). The main excretory organs responsible for excretion of waste by products are kidney, lungs, skin, intestine, and uterus, which excrete these products in the form of urine (Baul) sweat (Paseena), stool (Baraz), menses (Haiz) and during the process of respiration, these waste products are very harmful for the body and their accumulation results in various disease. For this reason their excretion is essential for the maintenance of health and life.

Proper  and  normal  functioning  of  the excretory  processes  must  be  ensured  in  order  to maintain  perfect  health.  Any  disturbance  in  the normal  excretory  balances,  whether  it  be  excess, diminution  or  blockage,  leads  to  disease.

Several types of Istifragh are mentioned in Unani such as sweating,  urination,  vomiting, purgation, normal defecation, venesection, cupping, leeching, sneezing, coughing,  enema,  epistaxis,  breast  feeding,  coitus, eye  secretions  etc.  Elimination and retention should be in the equilibrium. If elimination is in excess several diseases can occur and it will make the body weak and lethargy. It will lead to coldness and dryness in the body and makes the innate energy to become weak. 

Useful substances should be retained in the body. For example proteins should be retained, if not proteinuria will occur. Likewise food that we consumed should be retained for some times in order to get the maximum benefits of the food.

Therefore, evacuation is needed for removal of waste products which may cause obstructions or embolism and toxicity.  Retention of nutrients is needed not only for full digestion and metabolism but also to maintain reserves of nutrients and essential substances. 

Above mentioned six essentials of life are very much important for the healthy life, equilibrium and balance in Asbabe Sitta Zarooriyah is necessary for the preservation of health. These factors have direct relationship with Ilaj bit Tadbeer. Therefore, if there is any dilemma in the Asbabe Sitta Zarooriyah, disease can be prevented by adopting correct Ilaj bit Tadbeer regimen.

When prevention could not be adopted or adopted preventive measures are failed, the state of disease occurs.  Hence, treatment is necessary to regain the healthy state. It is mainly based upon Hetero-therapy (Ilaj bi’l-zid). Disease, which amounts to the emergence of an abnormal temperament, is treated by applying pharmacological and non pharmacological factors with opposite temperament.  Since, environmental factors, diet and psychological status etc., either themselves possess a temperament or affect the temperament, the Unani System of Medicine uses these non-pharmacological factors very frequently and extensively to treat illnesses.