Introduction

Unani medicine classifies treatment into four main categories: regimental therapy (Ilaj bil Tadbeer), dietotherapy (Ilaj bil Ghiza), pharmacotherapy (Ilaj bil Dawa), and surgery (Ilaj bil Yad). Treatment is selected based on the patient’s temperament, the nature and stage of disease, the humor involved, and the patient’s overall strength. The Unani physician begins with the least invasive intervention — typically diet and lifestyle modification — and progresses to more intensive measures only when necessary. This graded approach reflects the Hippocratic principle of first doing no harm and supporting rather than overriding the body’s natural healing capacity. For the student, understanding the four treatment categories provides a complete therapeutic framework that can be applied across a wide range of conditions. For the patient, knowing the range of options available helps them participate actively in treatment decisions. For the clinician, the four categories offer a systematic approach to matching treatment intensity to disease severity.

ⓘ Information

The Unani physician follows a stepwise approach: first, eliminate the cause of disease. Second, normalize the six essential factors (air, food, movement, rest, sleep, excretion). Third, use regimental therapy. Fourth, prescribe drugs. Fifth, use surgery. Most conditions resolve at the first or second step. The classical texts emphasize that drugs should not be used when diet will suffice, and surgery should not be used when drugs will work.

Ilaj bil Tadbeer (Regimental Therapy)

Regimental therapy consists of physical procedures that directly influence the humors by removing excess, improving circulation, strengthening organs, or altering tissue temperature and moisture. These procedures are highly specific and are prescribed according to temperament and disease.

Cupping (Hijama)

Cupping involves creating negative pressure on the skin using cups, either with or without superficial incisions. Wet cupping (hijama bil shart) involves making small incisions before applying cups to draw out blood. Dry cupping (hijama bila shart) uses suction alone without incisions. Cupping is prescribed for conditions caused by blood excess or congestion — hypertension, headache, back pain, respiratory congestion, and inflammatory conditions. The sites for cupping are determined by the organ affected. Cupping between the shoulder blades is used for headaches and eye conditions. Cupping on the lower back is used for gynecological and urinary disorders. Cupping on the legs is used for gout and varicose veins.

Venesection (Fasd)

Venesection is the controlled withdrawal of blood from a vein, typically from the median cubital vein at the elbow or the saphenous vein at the ankle. It is a more potent blood-evacuating procedure than cupping and is used for severe blood humor excess. Fasd is indicated in acute inflammatory conditions, hypertension, stroke (particularly in the acute phase), pleurisy, and acute hepatitis. The amount of blood withdrawn is determined by the patient’s age, strength, and disease severity. Contraindications include pregnancy, infancy, old age, anemia, and debilitating illness.

Leech Therapy (Irsal-e-Alaq)

Leech therapy involves applying medicinal leeches (Hirudo medicinalis) to specific sites to draw blood from areas where cupping or venesection would be difficult or inappropriate. Leeches are particularly useful for drawing blood from inflamed, edematous, or congested tissues. They are used for skin conditions (eczema, psoriasis, acne), deep inflammation (arthritis, thrombophlebitis), ear infections, gum disease, and hemorrhoids. The leech’s saliva contains anticoagulants, vasodilators, and anti-inflammatory compounds that provide therapeutic benefit beyond simple blood withdrawal.

⚠ Clinical Correlation

Leech therapy has been approved by the United States Food and Drug Administration for use in reconstructive microsurgery, where leeches help restore circulation in reattached tissues. This provides a modern scientific validation of a procedure that Unani physicians have used for more than a thousand years. In Unani practice, patients are informed about the small risk of infection and the possibility of minor scarring at leech attachment sites. Leeches are used once and then discarded to prevent disease transmission.

Massage (Dalk)

Massage in Unami medicine is classified by type according to the desired effect. Soft massage (talayin) is gentle stroking that relaxes muscles, soothes nerves, and promotes sleep. Hard massage (tashdiz) is deep pressure that breaks down adhesions, improves circulation, and reduces swelling. Moderate massage (iqtisad) combines both techniques. Massage is prescribed according to temperament — warm oils for cold temperaments, cooling oils for hot temperaments. Massage is contraindicated in acute inflammation, fever, skin infections, and immediately after meals.

Exercise (Riyazat)

Exercise is prescribed as medicine in Unani, with specific types recommended for specific conditions. Gentle exercise like walking is prescribed for melancholic patients and those recovering from illness. Vigorous exercise like running and wrestling is prescribed for phlegmatic patients who need to increase body heat and metabolic rate. Respiratory exercises are prescribed for asthma. Specific exercises are described for strengthening individual organs — eye exercises for weak vision, vocal exercises for voice disorders, and abdominal exercises for digestive weakness.

Cauterization (Kai)

Cauterization involves applying heat to specific points on the body using a heated metal instrument or cauterizing herbs. It is used primarily for chronic conditions that have not responded to other treatments — chronic joint pain, epilepsy, chronic headaches, and persistent bleeding. Cauterization is considered a treatment of last resort because it is painful and leaves permanent scars.

Ilaj bil Ghiza (Dietotherapy)

Dietotherapy in Unani medicine is based on the principle that food is the most fundamental medicine. Foods are classified by their temperament (hot, cold, moist, dry, or combinations), their digestibility, their nutritive value, and their medicinal properties. The physician prescribes a diet that counteracts the humoral imbalance and supports the affected organ.

For hot temperaments and inflammatory conditions, the diet emphasizes cooling foods: cucumber, watermelon, coconut, milk, ghee, coriander, fennel, and barley water. For cold temperaments and conditions characterized by sluggishness, the diet emphasizes warming foods: ginger, black pepper, cinnamon, honey, garlic, meat soups, and wheat. For moist conditions with excessive mucus, the diet emphasizes drying foods: roasted grains, honey, bitter greens, and pungent spices. For dry conditions with tissue wasting, the diet emphasizes moistening foods: milk, ghee, bone broth, oily fish, and sweet fruits.

★ Key Concept

In Unani, the concept of ghiza-e-muwafiq (congenial food) refers to foods that are suited to the individual’s temperament regardless of nutritional content. A choleric person may find that apples and pears are congenial while mangoes cause heat and burning. A phlegmatic person may thrive on spicy food while finding dairy products heavy and mucus-producing. The physician identifies each patient’s congenial and uncongenial foods through history and clinical observation.

Ilaj bil Dawa (Pharmacotherapy)

Unani pharmacotherapy uses drugs derived from plants, animals, and minerals. The Unani materia medica includes over two thousand substances, each classified by temperament, degree of potency, and organ affinity. Drugs are prescribed according to the principle of opposites — hot drugs for cold diseases, cold drugs for hot diseases, and so on.

Drugs are classified by degree of potency into four grades. First-degree drugs produce mild, subtle effects on temperament and are safe for general use — coriander, honey, and rose water. Second-degree drugs produce moderate effects and are used for established disease — ginger, saffron, and aloe. Third-degree drugs are potent and require careful supervision — opium, nux vomica, and mercury preparations. Fourth-degree drugs are toxic and are used only in minute doses for severe conditions or as external applications.

Drugs are also classified by whether they are simple (mufrad) or compound (murakkab). Simple drugs are single substances prescribed individually. Compound drugs are formulations containing multiple ingredients designed to treat complex conditions or to balance the side effects of potent ingredients. Examples of compound drugs include Majoon (confections), Jawarish (digestive pastes), and Sharbat (syrups), which are covered in more detail in the following article on common remedies.

Ilaj bil Yad (Surgery)

Surgery in Unani medicine was highly developed by Abul Qasim al-Zahrawi (Albucasis, 936-1013 CE), whose thirty-volume medical encyclopedia included detailed descriptions of surgical instruments, techniques, and postoperative care. Al-Zahrawi is considered the father of modern surgery for his contributions including the first description of ectopic pregnancy, the use of catgut for internal sutures, and the development of over two hundred surgical instruments.

In contemporary Unani practice, surgery is generally limited to minor procedures such as incision and drainage of abscesses, removal of superficial tumors, circumcision, and minor wound management. Major surgical procedures are referred to modern surgical specialists. However, the Unani surgical tradition remains important for its historical contributions and for the minor surgical procedures that are part of regimental therapy, such as venesection and wet cupping.

Common Conditions Treated with Each Approach

Regimental therapy is particularly effective for conditions involving blood or humor congestion — cupping for hypertension and chronic headache, venesection for acute inflammatory conditions, leech therapy for skin disorders and deep inflammation, and massage for musculoskeletal pain and neurological conditions.

Dietotherapy is the primary treatment for digestive disorders, metabolic conditions, and early-stage disease of any type. Many digestive disorders including dyspepsia, irritable bowel syndrome, and gastritis are treated exclusively through dietary modification and correction of eating habits.

Pharmacotherapy is used for established disease that does not respond to diet and regimen alone. Unani drugs are particularly used for chronic conditions including diabetes, hypertension, arthritis, asthma, eczema, psoriasis, vitiligo, hepatitis, and gynecological disorders.

Surgery is used when other treatments fail or when the condition requires immediate mechanical intervention — abscesses requiring drainage, tumors requiring removal, bleeding requiring ligation, and wounds requiring closure.

Conclusion

The four treatment categories of Unani medicine provide a complete, graded therapeutic system that ranges from simple dietary advice to surgical intervention. The guiding principle is to match treatment intensity to disease severity, beginning with the least invasive approach and progressing only as needed. For the student, this graded approach teaches clinical judgment and therapeutic restraint. For the patient, it offers a range of treatment options and an emphasis on lifestyle modification that promotes long-term health. For the clinician, the Unani treatment framework provides a systematic method for managing both acute and chronic conditions that can be integrated with modern medical care. As with all medical systems, Unani treatments should be administered only by qualified practitioners.

⚠ Caution

This article is for educational purposes only. Unani medicine should be practiced only by qualified, licensed practitioners. Do not self-diagnose or self-treat based on this information. Always consult a licensed physician for any health concern, and inform your healthcare provider about any traditional treatments you are using. Unani treatments can interact with conventional medications and may not be appropriate for all medical conditions.