Ābzan: a prudent remedy for a plethora of medical ailments

INTRODUCTION

The word Unāni comes from the Greek word "Ionian," which means "medicine" a symbol of life. Tibb means the knowledge of the states of the human body in health and illness. The Unani system of medicine is among the oldest systems of medicine, having essentially its origins in Greece and then spreading to Rome, the Arab world, Spain, Iran, and the Indian subcontinent and has since been known as Greco-Arab medicine. This system is based on the wisdom of Hippocrates (460-370 BC), chiefly on his doctrine of four humours such as Dam (sanguineous), Balgham (phlegm), Safra (yellow bile), and Sauda (black bile) along with their qualities in terms of temperament such as hot-moist, cold-moist, hot-dry, and cold-dry, respectively. The health of an individual is maintained as long as these humours are present in the typical quantities, qualities, and locations in the body. Diseases originate from any imbalances in quantity and quality or constitutions of these humours.¹

In the Unani system of medicine, there are three methods of treatment viz; ilaj-bit-tadbeer wa ghiza (regimenal therapy and dietotherapy), ilaj-bil-dawa (pharmacotherapy), and ilaj- bil- yad (surgery). amongst these, ilaj-bit-tadbeer is one of the most popular treatments practiced by ancient unani physicians for ages.² Ilaj-bit-tadbeer is defined as any favorable modification in asbab-sitta-zarooriya (six essential factors) aimed at the treatment of disease. Asbab--sitta zaruria refers to six necessary conditions, including hawa-e-muheet (atmospheric air), makoolat wa mashroobat (food and drink), harakat-o-sukun badni (physical activity and repose), harkat o-sukun nafsani (mental activity and repose), nawm-o-yaqza ( (retention and elimination). Numerous regimens are employed in ilaj-bit-tadbeer, including Ābzan (Sitz bath), hammam (bathing), dalk (massage), takmeed (fomentation), hijamah (cupping), irsale-alaq (leeching), fasd (venesection), ishaal (purgation), riyazat (exercise), qai (emesis), and idrare baul (diuresis) etc. these regimens are used separately or in conjunction with other forms of therapy.³

Ābzan (sitz bath) is a type of bath in which hips and buttocks are immersed in water, either plain or medicated (Joshanda, Khaisanda), for therapeutic effects. Abzan is derived from the Arabic word meaning sit. Ābzan is a simple, safe, economical, non-invasive, and effective external regimen for various disorders. It is a type of bath in which only the buttocks and hips are immersed in the water with the upper body, legs, and feet out of the water. Plain or medicated water (Joshanda and Khaisanda) may be used for the therapeutic purpose. Sometimes, a whole body up to shoulder is immersed in the water.^.4,5 Studies on the literature of Ābzan in Unāni medicine are scarce. Unāni medicine is increasingly being mainstreamed and integrated into biomedicine-based healthcare systems, which makes it crucial to understand how it is used. In this paper, we have endeavored to clarify several aspects of Ābzan in Unāni medicine.

LITERATURE SEARCH

This review study on Ābzan was searched in classical Unāni textbooks available in the Kashmir Tibbia college hospital and research centre library such as Al Qanoon Fit Tib. vol. 1 and 3 part 2 (Urdu Translation), Kitabul Hawi. vol. 11, Firdous ul Hikmat, Kaamilus Sana’ah (Urdu Translation), Kitab al-Taisir Fil-Mudawat Wal-Tadbeer, Kitab Al Mukhtarat Fit Tib. Vol. 1 and 4, Matab E Hakim Alwi Khan (Urdu Translation), Tibbe Akbar (Urdu Translation), Akseere Azam (Al Ikseer) (Urdu Translation), Jami-ul-Hikmat. For more information on Ābzan, major scientific databases, namely PubMed, Science Direct, and Google Scholar, etc. were searched. “Standard unani medical terminology” was also considered to obtain the appropriate English equivalent words for Unāni terms mentioned in the article.

DISCUSSION

Mechanism of action

Ābzan produces local and systemic effects on the body and its mechanism of action is explained based on types of Ābzan. Its detailed description is given in Table 1.^6,7

Procedure for Ābzan

Ensure that the bathing area is clean and sanitized before each session. Take an appropriate-sized bathtub and clean it with lukewarm water mixed with bleaching powder followed by rinsing thoroughly. Fill the tub with the prescribed liquid up to 2-3 inches. In the case of ābzan ḥār, the water should be warm and not too hot to cause burns or discomfort. In the case of ābzan bārid, the water should be cold, but not too cold to cause discomfort to the patients. Provide privacy and ensure the patient's comfort throughout the procedure. Ask the patient to remove the cloth and get into the tub to immerse his perineum in water, bend his legs, or dangle them over the side of the tub to keep them out of the water and ensure the perineum is submerged. Ask the patient to stay in the water for at least 15-20 minutes in case of ābzan ḥār. Ask the patient to stay in the water for at least 5-10 minutes in case of ābzan bārid. In the case of ābzan murakkab, ask the patient to stay in hot water for 5 minutes followed by a stay in cold water for less than one minute alternatively and the cycle is repeated up to 5 times finishing on ābzan bārid. Ask the patient to dry himself with a clean cotton towel. Instruct the patient not to rub or scrub the perineum, as this may cause pain and irritation. Monitor the patient closely throughout the Abzan therapy session, observing for any signs of discomfort, allergic reactions, or adverse effects. Provide support and reassurance to the patient, addressing any concerns or questions they may have during the procedure. The procedure is completed by rinsing the bathtub thoroughly. Schedule follow-up appointments as needed to monitor the patient's progress and adjust the treatment plan accordingly. Maintain accurate documentation of Ābzan therapy sessions, including details such as water temperature, duration, herbal additives (if used), and patient responses.^7,8

Clinical applications

Ābzan therapy offers a myriad of therapeutic benefits, particularly targeted towards pelvic and perineal conditions.

Quruh-al-Rahim (cervical erosion): Medicated decoction of various herbs like mazu, juft baloot, khubs ul hadeed, shib yamani, and zaj is prepared for Ābzan in this condition.⁹

Saylan-al-Rahim (Leucorrhea): Medicated decoction of various herbs like Methi, Tukhme Katan, Tukhme Khatmi, and Birinjasaf is prepared for Abzan in this condition.⁹

Sartan-al-Rahim (Uterine cancer): Medicated decoction of various herbs like Banafsha, Nilofer, Marzanjosh, Hulba, Tamar Hindi, Karam Kalla, Khatmi, Khubbazi is prepared for Ābzan in this condition.¹⁰

Waram-al-Rahim (Metritis): Medicated decoction of various herbs like Tukhme katan, Tukhme Tera Tezak, Tukhme Gazar, Tukhme Shaljam, Sudab, Lablab, Badiyan, Barg Karafs, Gandana, Karam Kalla, Piyaz, Roghan Zaitoon is prepared for Ābzan in this condition.¹¹

Waja-ur-Rahim (Uterine pain): Medicated decoction of various herbs like hulba, tukhme katan, marzanjosh, podina, babona, aklilul malik, birinjsif, khairi is prepared for Ābzan in this condition.⁹

Mailan-al-Rahim (Uterine inversion): Medicated decoction of various herbs like kishneez, nilofer, and sandal is prepared for Ābzan in this condition.¹²

Bawaseer-al-Rahim (Uterine polyp): Medicated decoction of various herbs like nakhoona, baboona, methi, and tukhme alsi is prepared for Ābzan in this condition.¹³

Waram furj wa mahbil (Vulvitis and vaginitis): Medicated decoction of various herbs like tukhme hulba, tukhme khatmi, gule baboona, mako khushk is prepared for Ābzan in this condition.¹⁴

Istehaza (AUB): Medicated decoction of various herbs like aas, gule surkh, post anar, kharnob nabti, gulnar, reehat ul tees, mazu sabz, footnaj is prepared for Ābzan in this condition.¹³

Iḥtibās alṬamth (Amenorrhoea): Medicated decoction of various herbs like sudab, abhal, karafs, karnab, raziyanaj, mushkatramashee is prepared for Ābzan in this condition.¹⁵

Kaṭhrat-i-Tamṭh (Menorrhagia): medicated decoction of various herbs like gulnar, post anar, joz sard, juft baloot, mazu, kharnob, murad, kundur, qarz, tarasees, qishar is prepared for Ābzan in this condition. ¹⁰

Inzilaq-ur-Rahim (Uterine prolapse): Medicated decoction of various herbs like izkhir, aas, gule surkhab is prepared for Ābzan in this condition.^9,13

Kharish-e-Miq’ad/ Kharish-e-rahim (Pruritus in Ano/ pruritus vulvae): Medicated decoction of various herbs like post khashkhash, gulab, gulnar is prepared for Ābzan in this condition or Ābzan with lukewarm water. ⁹

Zaheer-e-Baarid (Dysentery): Medicated decoction of various herbs khatmi, shibbat, nakhoona, baboona, bazar katan, makoh is prepared for Ābzan in this condition.^7,16

Zeequnnafs: Use lukewarm water for Aabzan in the patients of Zeequnafs.^7,16

Tamaddud-wa-Kuzaz: Medicated decoction of various herbs like paicha-e-buz, kallah barrah, chooza-e-murgh, jau-muqashshar, lu’abe-sapistan, kaddu, baboona, gul-e-khatmi, berg-e-khurfa, palak, ispaghol, behdana, aab-e-baid mushk, aab-e-gulab, aab-e-anar sheerein, aab-e-beehi sheerein, roghan-e-kaddu, roghan tukhm-etarbooz, roghan-e-badaam prepared for Ābzan in this condition.^7,16

Baul-ud-Dam (Haematuria): Medicated decoction of various herbs like Adas Muqashshar, Post-e-Anar, Beehi, Maazu, Asbatur Ra’ee is prepared for Ābzan in this condition.^7,16

Warm-e-Masana Haar (Cystitis): Medicated decoction of various herbs like Banafsha, Berg Neelofar, Baboona, and Nakhoona is prepared for Ābzan in this condition.¹⁰

Khurooj-e-Maq’ad (Rectal Prolapse): Medicated decoction of various herbs like post-e-anar, juft baloot, gulnaar, maazu, berg-e-moorad is prepared for Ābzan in this condition.^7,16

Melancholia: Hot water is used for Ābzan.¹³

Tremors: Hot oil is used for Ābzan.¹³

Fuwaq: Milk is used for Ābzan in the patients of Fuwaq.^7,16

Yarqan-e-Bohrani: Medicated decoction of various herbs like gul-e-neelofar, gul-e-kasni, gul-e-sada bahar, gul-e-gulharh, gul-ekhatmi, berg-e-hina, berg-e-baid saada, berg-e-kasni, berg-e-tamar Hindi is prepared for Ābzan in this condition.^7,16

Ikhtenaq-ur-Raham (Hysteria): Medicated decoction of various herbs like kashim, tukhm-e-hulba, tukhm-e-katan, marzanjosh, qaisoom/afsanteen is prepared for Ābzan in this condition.^7,16

Arthiritis: Ābzan Murakkab (Alternate hot and cold sitz bath) is used.¹³

CONCLUSION

Ābzan is one of the procedures of Ilaj-bit-Tadbeer described in the Unani system of medicine which works on the principle of evacuation and diversion of morbid matter from the body.

Studies have proved that Ābzan plays an important role in providing the thermal and mechanical effects and helping in achieving the curative treatment. It can be used successfully to treat a variety of conditions, especially gynecological disorders. However, for rational demonstration of the effectiveness of leech therapy in the modern period, SOP and scientific standards must be developed.

Hence, we suggest rigorous, controlled, randomized, and long-duration follow-up studies on large sample sizes, to be conducted by trained clinicians or researchers to establish the efficacy of Ābzan in the management of various diseases.

ACKNOWLEDGMENTS

Authors would thank to the library staff of Kashmir Tibbia college hospital and research centre for their support in compiling this work.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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