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.