Unani Systems of Medicine in Bangladesh

Introduction

The Unani system of medicine is one of the systematically formulated medical sciences of the East. It is in-deed a glorious heritage of the Islamic and Muslim culture, although basically it owes its origin to Greece as its name suggests. (The word ‘Unan’ is the Arabic term of Greece.)

The theoretical framework of the Unani system of medicine is based on the teachings of Hippocrates (460-377 B.C) and Galen (131-210 A.D.). But in fact those were Arab scholars who developed this system of medicine into an elaborate medical system and gave it a scientific base. For this system is also known as Greeco-Arab Medicine as well as Islamic medicine. The terms Oriental Medicine and Traditional Medicine are also used for this system.

The foundation of Unani system of medicine was laid by Hippocrates. He was the first person to establish that disease was natural process, that its symptoms were the reactions of the body to the disease and that the chief function of the physician was to aid the natural forces of the body. He was the first physician to introduce the method of taking medical histories. The well-known humoral theory is also one of his chief contributions.

In fact Hippocrates systematized the medicine and gave it the status of ‘Science’ Galen stabilized its foundation by evaluating old theories, introducing method of pulse reading, upgrading the human Anatomy and Physiology and adding a number of new directions in diagnostic, medicine and Pharmacology on which Arab physicians of golden Muslim era like Rhazes (850-925 A. D.) and Avicenna (980-1037 A. D.) constructed an imposing edifice. Unani system of medicine got enriched by imbibing what was best in the contemporary systems of traditional medicine in Egypt, Syria, Iraq, Persia, India, China and other middle East and Far East Countries. It also benefited from the native medical systems in vogue at the time in various parts of Central Asia.

Basic Concepts

The Unani system of medicine is based on the humoral theory. This theory supposes the presence in the body of four humours: blood, phlegm, yellow bile and black bile. The temperaments of persons are accordingly expressed by the words sanguine, phlegmatic, choleric and melancholy according to the preponderance in them respectively of the above humours.

The humours themselves are assigned temperaments: blood is hot and moist; phlegm cold and moist; yellow bile hot and dry; black bile cold and dry. Drugs are also assigned temperaments. Every person is supposed to have a unique humeral constitution which represents his healthy state. Any change in this brings about a change in his state of health. There is formulated also a power of self-preservation or adjustment, which strives to restore any disturbance within the limits prescribed by the constitution of the state of an individual. This corresponds to the defense mechanism which is called to action in case of insult to the body. In the Unani system of treatment, great reliance is placed on this power, the aim of the physician being to help and develop rather than supersede or impede the action of this power.

Another distinctive feature of the Unani system is its emphasis on diagnosing a disease by feeling the pulse. Pulse is a particular kind of movement in the arteries brought about by alternative expansion and contraction. According to Avicenna there are ten features in the pulse from which an expert physician is able to discern the states of the body. These are:

(i)                  Quantity

(ii)                Force

(iii)               Duration of movement

(iv)              Condition of vessel wall; soft or hard

(v)                Volume

(vi)              Duration of rest period

(vii)             Palpation of the pulse

(viii)           Equality and inequality

(ix)              Balance of the Pulse

(x)                Rhythm

Physical examination of Urine also helps a lot in the diagnosis of urino-genital disorders, Pathogenesis of blood and other humours, metabolic disorders and liver diseases. The following properties of urine are observed:

(i)                  Colour

(ii)                Consistency

(iii)               Clearness and Turbidity

(iv)              Odour

(v)                Foam or Froth

(vi)              Precipitates

(vii)             Quantity

The physical examination of stool also helps in the diagnosis of various diseases. The color, quantity, consistency and the presence of foreign bodies are observed.

In addition to the above, other conventional modes of diagnosis such as inspection, palpation, percussion etc, have also been used by the Unani physicians. Regular case histories of patients were recorded and maintained as is evident from the books of Rhazes and Avicenna. Now-a-days Practitioners of the Unani medicine are also availing of modern techniques such as microscopic examination, chemical analysis, radiography and electro-cardiography.

Unani Concept of Human Entity

In the Unani system of medicine the human body is considered to be made up of seven components, each having a close relation and to direct bearing on the state of health of an individual and therefore, it is necessary for an Unani physician to take all these factors of the human entity into consideration for arriving at a correct diagnosis and deciding the line of treatment of the ailment. These are:

I. Elements: The human body contains four elements namely air, fire, water and earth. These elements actually symbolize the four states of the matter. The four elements have their own temperaments.

II. Temperament: The interaction of the elements produces various states which in their turn determine the temperament of an individual and it is of paramount importance to keep the temperament of an individual in mind while prescribing the course of treatment for a given disease. Each individual has a unique temperament. A temperament may be (1) Real equitable. (2) Equitable and (3) Inequitable. Temperament is ‘Real equitable’ where the temperament of the four elements used is in equal quantities; this does not exist. Equitable is the just and required amount of compatible temperaments. Inequitable temperament is an absence of just distribution of temperament according to their requirements.

 

III. Humours: Humours have already been dealt with in some detail earlier. These are in fact, the fluids which the human body obtains from the food and include the various hormones and enzymes. These fluids are (a) Primary fluids and (b) Secondary fluids. The primary fluids are the four humours. The secondary fluids are also four in number and are called four fluids. These four fluids are responsible for maintaining moisture of different organs of the body and also provide nutrition to the body.

According to the Unani system of medicine there are four stages of digestion: (1) Gastric digestion followed by and including Intestinal digestion when food is turned into chyme and chyle and carried to liver by mesenteric veins. (2)Hepatic digestion: in the course of this process chyle is converted into four humours in varying quantities, that of blood being the largest. Thus the blood which leaves the liver is intermixed with the other three humours namely phlegm, Bile and Black bile, (3) Vessels digestion and (4) Tissue digestion: While the humours are flowing in the blood vessels, every tissue absorbs its nutrition by its ‘attractive power’ and retains it by its ‘retentive power’. Then the ‘digestive power’ in conjunction with ‘assimilative power’ converts it into tissues. The waste material in humour at this stage is excreted by the ‘expulsive power’. Unani physicians maintain that when any disturbance occurs in the equilibrium of the humour it causes disease. Therefore the Unani mode of treatment aims at restoring the equilibrium of humours.

IV. Organs: These are the various organs of the human body and the health or disease of each individual organ affects the state of health of the whole body.

V. Spirits: These are considered to be the life force and are therefore given importance in the diagnosis and treatment of disease. These are carriers of different powers as defined by the Unani Physicians.

VI. Faculties: These are of three kinds:

1.      Natural power, the power of Metabolism and Reproduction. The seat of this power is liver but the process is carried on in every tissue of the body.

2.      Psychic power: Nervous and psychic power. It is seated inside the brain.

3.      Vital Power: Power that maintains life and enables all the organs to accept the effect of psychic power. Thus the vital power with Heart as its seat keeps life running in the tissues.

VII. Functions: These include the movements and functions of the various organs of the body. To maintan proper health of the body it is necessary to ensure that various organs are not only in proper shape themselves but are performing their respective functions properly. This is why Unani medical scientists have studied the functions of the human body in all their detail.

States of the Body

According to Unani physicians, states of the body are grouped under three heads:

1.      Health in which all the functions of the body are carried on normally.

2.      Disease is the opposite of Health in which one or more functions or forms of the bodily organs are at fault.

3.      Neither health nor disease in which there is neither complete health nor disease as is the case of old people or those who are convalescing.

Diseases are of two types: (1) singular disease and (2) complex disease. A singular disease is one that completes its course without complications and a complex disease is opposite of it. A singular disease may manifest itself in three forms: (1) Dyscrasia, (2) Structural diseases and (3) Diseases of solution of unity. Further divisions of diseases have been mentioned according to different conditions in Avicenna’s Al-Qanoon.

Prevention of Disease

The great scholar of Unani medicine Avicenna in his book al-Qanoon, as the definition of the knowledge of the medicine said: “This is such a knowledge by which the condition of a human body can be ascertained, by which health of a person can be retained, and if he becomes sick, then his sickness can be removed to regain his health.” This definition indicates that Unani system of medicine gives more stress on the prevention of disease than its cure. In fact Unani medicine recognized the influence of surroundings and ecological conditions on the state of health of human being long ago. Avicenna has laid down six essential pre-requisites for the prevention of disease and lays great emphasis, on the one hand on the maintenance of proper ecological balance and on the other hand on keeping air, water and food free from all pollution. These essentials are:

(i)                  Air

(ii)                Food and Drinks

(iii)               Bodily movement and repose

(iv)              Psychic movement and repose

(v)                Sleep and wakefulness

(vi)              Excretion and retention.

Therapeutics

The Unani system of medicine has the following mode of treating an ailment depending upon the nature of the ailment and its causes:

(i)                  Regimental therapy

(ii)                Diet-therapy

(iii)               Pharmacotherapy

(iv)              Surgery.

Single drugs or their combinations in raw form are preferred over compound formulations. The naturally occurring drugs used in Unani system are symbolic of life and are generally free from side-effects. And such drugs as are toxic in crude form are processed and purified in many ways before use.

Present Status

The Unani system of medicine, along with other indigenous/traditional systems, has firm root in the sub-continent in India, Pakistan, Sri-Lanka, Bangladesh and is officially recognized by the Governments of these countries.

As like other countries of the sub-continent, in case of Bangladesh also the history of Unani medicine is closely connected with the history of Muslim preachers, traders and soldiers who came from Arabic and Persian speaking areas of Asia. There were many Tabeebs or physicians of Unani medicine amongst those religious preachers, traders and soldiers. They introduced the theory of this system of medicine in this part of the sub-continent which constitutes Bangladesh. Unani medicine has now, however, became an integral part of indigenous systems of medicine in Bangladesh along with the ancient Ayurvedic system which exists there from more than three thousand years. This was possible for dependence of Unani medicine mainly on the medicinal plants and herbs which are easily available there locally in plenty. In this connection we may remember one of the basic principles of Unani medicine which says: Treat the patients with medicinal herbs and plants of their own land.

Unani medicine flourished in the sub-continent following the movements made by Maseehul Mulk Hakim Ajmal Khan of Delhi for revival of Unani Tibb in Indo-pak-Bangla sub-continent during the early part of this century. We, the Bangladesh people, shall remain ever grateful to the late shefaul Mulk Hakim Habibur Rahman, Hakim Hafiz Azizul Islam and Dr. Hakim Md. Yusuf Harun Bhyuan of Dhaka for his glorious contributions towards wide-spread introduction of the Unani system of medicine in the eastern part of the sub-continent.

Traditional Health Systems in Bangladesh

Bangladesh has a rich cultural heritage of traditional medicine which comprises of Unani and Ayurvedic systems. Both these systems of traditional medicine have firm roots in Bangladesh and are being practiced there since a long time. Even in urban areas where some form of organized modern health care is available and inspite of all official supports to modern medicine, traditional medicine continues to be used widely and the people seem to have considerable faith in the system. On the other hand, 75 percent of the rural populations of Bangladesh still receive health care services from village practitioners-a good number of whom are practitioners of indigenous herbal medicine systems.

It is notablie that traditional medicine does not depend not depend heavily on sophisticated technology and the drugs used for common ailments are abundantly available in the soil of the country. Therefore, treatment according to traditional medicine is often easier and cheaper. Drugs of traditional medicine are also comparatively safer as these are generally without long term serious side-effects. Moreover, some of traditional techniques and drugs may provide remedies in cases where modern medicine has no effective remedy.

Considering the above mentioned facts the Government of the peoples Republic of Bangladesh, soon after independence, recognized Unani and Ayurvedic systems of medicine keeping in force the Central Act II of 1965 i.e. the Unani Ayurvedic and Homeopathic Practitioners Act 1965. An Ad-hoc Committee was constituted to run the affairs of the Board of Unani and Ayurvedic systems of Medicine under the said Act. In July 1983 the Bangladesh Unani and Ayurvedic practitioners Ordinance, 1983 was enacted repealing the 1965 Act. The functions of the Board of Unani and Ayurvedic systems of medicine constituted under the new Ordinance include registration of practitioners, recognition of the teaching institutions, maintenance of an adequate standard of efficiency in recognized institutions, holding qualifying examinations, publication of text-books, standardization of Unani and Ayurvedic drugs, preparation and publication of pharmacopoeia, and development of research.

Soon after introduction of the historic National Drug Policy of Bangladesh in 1982 Unani and Ayurvedic drugs have been brought under drug control system by legislation to control commercial manufacturing and ensure marketing of quality drugs.

In the lime of further progress in Unani and Ayurvedic drugs sector, two National Formularies, one for the Unani and the other for the Ayurvedic drugs, have already been published by the Board with the approval of the Government.

Manpower

There are about Twenty thousand practitioners of traditional systems of medicine in Bangladesh, who are registered or have been accepted for registration under law. Among them about Six thousand are institutionally trained and qualified. Moreover, the number of un-registered traditional healers scattered in rural areas will not be less than one lac.

Training

Till 1974, there were only two Unani teaching institutions in Bangladesh recognized by the Government: one at Sylhet run by Government through the Directorate General of Health Services and the other one at Dhaka managed privately. But at present there are 20 teaching institutions of traditional medicine recognized and aided by the Government 13 of Unani and 7 of Ayurvedic system. These institutions offer a four years diploma course plus six month’s internee ship in the attached outdoor hospital. The curriculum includes Anatomy, physiology, Hygiene, Pathology, Community medicine, minor surgery and other subjects of the respective system. The qualifying examinations are centrally conducted by the Board of Unani and Ayurvedic systems of medicine. The annual intake capacity of these institutions is nearly four hundred.

It is notable that the newly constructed Government Unani and Ayurvedic Degree College in Dhaka became functional since 1989-90 academic sessions which offer five years degree course under the University of Dhaka with an additional one year internee ship training in the annexed 100 bedded hospital.