Regimenal Therapy a Drugless Regimen for Well Being of a Person in USM and its Important Place in the Mainstream Treatment of USM

Regimenal therapy is such core method of treatment through which the morbid matter is eliminated or its excessive production is checked or its spread is arrested and resolved by certain special techniques and thereby restoring humoral equilibrium. There are various forms of such therapy with details of its applications. There are various forms of regimenal therapy which is dealt by al qanoon which details about its principals, objectives, indications, and contraindications method of applications with its adverse effects etc. some of them are purging, emesis, venesection, cupping, turkish bath, massage, exercises, leeching, diuresis, diaphoresis etc. [1].


Introduction
Regimenal therapy is such core method of treatment through which the morbid matter is eliminated or its excessive production is checked or its spread is arrested and resolved by certain special techniques and thereby restoring humoral equilibrium. There are various forms of such therapy with details of its applications. There are various forms of regimenal therapy which is dealt by al qanoon which details about its principals, objectives, indications, and contraindications method of applications with its adverse effects etc. some of them are purging, emesis, venesection, cupping, turkish bath, massage, exercises, leeching, diuresis, diaphoresis etc. [1].

Health
Among definitions still used, probably the oldest is that health is the absence of diseases. According to WHO health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. It can be construed as a feeling of wholeness and a happy frame of mind [2].

Health promotion
Unani medicine strives to find the best possible ways by which a person can lead a healthy life with the least or zero sickness. Unani scholars believe that diseases can be kept at bay by using clean and fresh water, breathing clean air and consuming fresh food. Likewise, a balance should be maintained between the mind and the body so that the metabolic process can take place easily and the body waste evacuated. Unani medicine believes in promotion of health, prevention of diseases and cure through regimental and diet therapies. The best possible ways of health promotion in this holistic system of medicine are improvement of Tabiyat (immuity) by immunomodulators, restoration of balanced temperament, maintenance of balance in the quality and quantity of humours, moderation of Asbabe Sitta Zarooriya (six essential factors for life) and adoption of maddi wa gair maddi tadabeer (i.e. regimenal therapy and counselling) Munzij wa Mushil (concoctive and purgative) therapy and Ilaj bil ghiza (Dieto-therapy) [3].

Journal of Complementary Medicine & Alternative Healthcare Tabiat the Real Healer
As ṭabῑat performs its own role in different stages of disease. The role of physician is to adopts such regimens which favour the action of ṭabῑ' at as ṭabῑat performs its own role in different stages of disease. The role of physician is to adopts such regimens which favour the action of ṭabῑ'at. If ṭabῑ'at is overwhelmed then the disease process is evolved. Tabiyat is the best physician, and maintains the equilibrium of four body humours. For the maintenance of health, the quantity and quality of these humours should be as per the natural chemical composition of the body. Broadly speaking Tabiyat is considered as the real healer of the body and the role of the Tabeeb (physician) is to aid this Tabiyat. The physician assists ṭabῑ'at by adopting appropriate treatment modalities which are of three types: a) Regimen and diet b) Use of drugs c) Manual operation The word regimens stand for the supervision of the asbab-esittah Zarooriyah, maddi and gair maddi tadabeer (six essential factors, regimenal therapy and counseling). Therefore, the regimenal management includes the modification in six essential factors and implication of counselling and psychotherapies because to favour of ṭabῑ'at, so that health is maintained and abnormalities prevented from getting arise [4].

Role of Gair Maddi Tadabeer (Counselling and Psychotherapy)
Gair maddi tadabeer is a type of talking therapy that allows a person to talk about their problems and feelings in a confidential and dependable environment. A counsellor is trained to listen with empathy. They can help you deal with any negative thoughts and feelings you have. Sometimes the term "counselling" is used to refer to talking therapies in general, but counselling is also a type of therapy in its own right. Other psychological therapies include psychotherapy, cognitive behavioural therapy (CBT), and relationship therapy, which could be between members of a family, a couple, or work colleagues. These tadabeer or strategies aims to help you deal with and overcome issues that are causing emotional pain or making you feel uncomfortable. These six essential factors either directly or indirectly influences the ṭabῑ'at.

Purgation
In Unani Medicine, The Concept of Elimination (Istifragh) is described in the six essential pre-requisites or governing factors, referred to in Unani terminology as Asbab-e-Sitta Zarooriyah (six essential factors) Purgation (Is-hal) is one of the methods of Elimination adopted when treating various ailments. It is considered a safe method of regimenal therapy, used to eliminate toxic and other unwanted matter through the intestines. Purgation may be conducted in two ways, Laxation (Taleeyeen) and Purgation (Mus-hil) Laxation is a mild purgative whereby matter from the intestines is passed. Purgation refers to the elimination of matter from the intestines together with unwanted matter from other parts of the body such as phlegm from the lungs, black bile (melancholic humour) from the spleen, the watery part from blood or other conditions where there is an excess of unwanted accumulation that may need to be purged. Purgation increases the frequency of stool, acting in several ways, which include increasing the watery part of the intestines, increasing peristaltic movement or by lubrication of the intestines. Due to the action of this type of purgation whereby the passing of humours such as phlegm (phlegmatic humour), yellow (bilious humor) and bile black bile is also an occurrence, it is also referred to as phlegm purgative, yellow bile purgative or black bile purgative as the case may be. There are a number of drugs that may be used as purgatives. These are Single as well as Compound drugs. In this paper, these drugs will be discussed according to the particular system in which they are used [1].

General principal of istifraagh (purging)
a) Only morbid matter required to be eliminated should be removed b) Elimination should be in the direction of outflow thus gripping should be treated with purgatives and nausea with emesis.

c)
Elimination should be through an appropriate organ and towards the one where morbid matter is drifting i.e. stomach and intestine.

Contraindications
Peritonitis, indigestion, peoples who are not addicted to purgation, in pregnant womens before 4 months and after 7 months, hot dry and cold dry temperament peoples, duing the days of menstruation, in children's and older peoples, appendicitis, hemorrhoids, low B.P, T.B, too much hot and too much cold, intestinal sore, chronic constipation [7].

Days and Time of Purgative
Purgation is prohibited in too much hot, cold and in the days of epidemicity. The best seasons for purgation are weather Rabi then Kharif. It should be done early in the morning in summer and rabi and 2 hours after sunrising in winter and kharif [8].

Recommendations for Purgation
a) Before 2 days and 3 days later on of purgation one must avoid doing excessive psychological work, tiredness, and sexual activity and must feed with light and easily digestible diet like mush of moong (moong daal khichdi) b) In peoples who have weak stomach must feed with light and soft diet like Ma-ush-shaeer so that stomach could be saved from the accumulation of yellow bile. c) The patient must avoid from drinking water within 4 hours of taking mushil or purgation d) In case of intestinal colic do enema prior to purgation [9].

Complications of purgation
a) If after having purgation patient is experiencing spasm in the stomach then drink hot water bit by bit slowly slowly. b) If patient feels thirsty then drink luke warm water mix with arq gulaab.

Refrigration after purging (tabreed)
a) In those peoples who are having cold temperament and if there is no dominency of phlegm use concoction of haloon with olive oil b) In peoples having hot temperament use Luab aspghol, cold water mix with roghane banafsha and nabat safed c) Moderate temperament persons must feed with tukhme-katan d) If there are chances of intestinal sore use gile armani, aab anar, tukhm e bartang with tukhm e rehan e) Patients who underwent purging should go for hammam after two days of having mushil Venesection (Phlebotomy) is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture for the purpose of analysis, blood donations or treatment for blood disorders [11].

Current Indication of Phlebotomy
Currently, therapeutic phlebotomy is approved for three main indications: haemochromatosis, polycythaemia vera and porphyria cutaneatarda. It has also been used as a treatment alternative for many other diseases in various countries, especially in Chinese medicine, although these indications are not approved by western medicine. Relative polycythaemia is characterized by a decrease in plasma volume which causes an apparent increase in the red blood cell mass. Any condition causing fluid loss, such as any cause of dehydration and severe burns, will result in relative polycythaemia. Therapeutic phlebotomy is not indicated for these patient [12].

Contraindications
Chronic constipation, intestinal colic, during menstruation and pregnency, waek and anemic persons, in hot temperament, obese persons, too much hot and too much cold, in childrens younger than 14 years and in olders more than 60 years, after meal and sex, weak stomach, weak liver, chronic fever etc [14].

Common side effects
Patient may feel tired after giving out blood, with some local soreness or bruising, but serious side effects are very uncommon. Some people faint after giving out blood, if patient feel dizzy or unwell in the 24 hours of venesection just tell your medical team so that they manages to treat the patient in an appropriate way by giving some fluid (salt water) to replace the volume lost due to venesaction. This is more likely to happen if patient is taking medicines for blood pressure and if patient have not taken meal before attending the hospital [16].

What to expect
a) The procedure is safe and without side effects (in most cases). b) Immediately after the procedure you may feel dizzy. This can be minimised by resting and drinking fluids.

c)
You may feel a little lethargic for a couple of days. d) You can resume all your normal activities after the procedure.
e) Keep hydrated and drink two litres of fluid daily for 48 to 72 hours following your procedure.
f) The frequency of the venesection treatments is different for everyone and is performed according to one's condition. At first you may require up to weekly venesections. When your blood levels are under control you may only require the venesection every six to twelve weeks [17].

Cupping
Cupping therapy is an ancient form of alternative medicine in which a therapist puts special cups on your skin for a few minutes to create suction. People get it for many purposes, including to make help with pain, inflammation, blood flow, relaxation and well-being, and as a type of deep tissue massages [18].

Types
There are different methods of cupping, including: During both types of cupping, your therapist will put a flammable substance such as alcohol, herbs, or paper in a cup and set it on fire. As the fire goes out, he puts the cup upside down on your skin. as the air inside the cup cools, it creates a vacuum. This causes your skin to rise and redden as your blood vessels expand. The cup is generally left in place for up to 3 minutes. wet cupping creates a mild suction by leaving a cup in place for about

Journal of Complementary Medicine & Alternative Healthcare
3 minutes. The therapist then removes the cup and uses a small scalpel to make light, tiny cuts on your skin. Next, he or she does a second suction to draw out a small quantity of blood [19].

What does the research show
There haven't been many scientific studies on cupping. One report, published in 2015 in the Journal of Traditional and Complementary Medicine, notes that it could help with acne, herpes zoster, and pain management [20].

Commands and conditions for cupping
a) Cupping is prohibited in children's younger than 10 years and in olds more then 60 years b) If an organ is full of waste matters then do venesection prior to cupping c) Drink syrup either of pomegranate or orange or apple prior to cupping so that stomach could be save from accumulation of yellow bile. d) Avoid taking meal soon after cupping otherwise it will cause the effect of cupping to disappear e) Avoid doing cupping in obese persons [22]. It is used as hypnogogic (munawwim)

Diaphoresis (tareeq)
Tareeq is a kind of evacuation of matters with the help of which waste materials are excreted through skin, blood and other organs of the body. It also aids in lowering the temperature of the body as in fever [23].

Diuresis
Diuresis is a type of regimenal therapy the purpose of which is to clean the body from toxic or morbid matters. The drugs which are used for dieuresis known as diuretics. This method is useful in liver and kidney diseases.

Hammam
In hammam there are some rooms which are attached to each other and the purpose of which is to get heat bit by bit slowly so that later on abzan could be performed.

Journal of Complementary Medicine & Alternative Healthcare
Characteristics of hammam a) Hammam must be outdated constructed b) ventilation must be excellent c) The heat in the furnace of hammam must be at such a level so that it could be easily bear d) The air of the first room of hammam must be moderate, second room air should be hot and the last room air ought to be hot and dry. Hammam is used to heat up (maturation-nuzuj) the morbid matters so that matters become liable for evacuation.

Disadvantages of hammam a) Hammam causes weakness in patients having cardiomagaly b) It increases the chances of having infection by stimulating stagnant matters of the body c)
Through hammam the deposited waste matters in the body drives away towards such spaces and organs of the body from where these matters emerged in the form of tumors and glands

Types of hammam
Cold bath, sea bath, vapor bath, electric bath, borax bath, graduated bath, Turkish bath, acid bath, medicated bath, sand bath, mustard bath, astringent bath, foot bath, sun bath etc.

Leeching
Leeching is a kind of treatment by which waste or toxic or vitiated material of the body are expelled out of the body via blood to clean the body from toxicities. Leeching is beneficial in some diseases like psoriasis, scrofula, zaharbaad, hemorrhoids, scabies, cancer, chronic abscess etc. Recently, extensive researches on leech saliva unveiled the presence of a variety of bioactive peptides and proteins involving antithrombin (hirudin, bufrudin), antiplatelet (calin, saratin), factor Xa inhibitors (lefaxin), antibacterial (theromacin, theromyzin) and others. Consequently, leech has made a comeback as a new remedy for many chronic and life-threatening abnormalities, such as cardiovascular problems, cancer, metastasis, and infectious diseases. In the 20th century, leech therapy has established itself in plastic and microsurgery as a protective tool against venous congestion [9]. In addition, leech practice was also documented in Islamic literature. For instance, Avicenna (980-1037 AD) delineated in his book "Canon of Medicine" that leech can suck blood from deep veins which cannot be reached by the conventional wet cupping [10,11] and he recommended leeching for skin diseases [12]. In 12th century, Abd-el-latif al-Baghdadi mentioned in his texts the beneficial usage of leech application after surgical operations [12]. Thereafter, Ibn-e-Maseehi (1233-1286 AD) in his book "Umda Fi Jarahat" differentiated the medical leeches from the nonmedical (poisonous) ones according to their shape and colour [11].

Contraindications
Hemophilia, do not use leeches at places e.g. abdomen, stomach, liver, spleen etc.

Hazards
Infection spread by poisonous leech, bleeding etc.

Riyazat (exercises)
Riyazat is any bodily activity that enhances or maintains physical fitness and overall health and wellbeing's. It is performed for various reasons, including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, and merely enjoyment. Frequent and regular physical exercise boosts the immune system and helps to prevent the "disease of affluence" such as in cardiovascular disease, Type 2 diabetes, and obesity. It may also help to prevent depression, help to promote or maintain positive self-esteem, and improve mental health generally. In Unani system of medicine exercise is one of the sixteen methods of treatment of regimental therapy and is used as a voluntary movement with the purpose of tanqiya e mawad (evacuation of waste material), for purification of the body in an individual. It maintains good health and prevents or cures diseases as well. Partial exercise is a part of real exercise which is related to the exercise of specific organ and specific Quwa (faculties) like reading of small alphabets by the eyes, weeping is the exercise of children, likewise angriness is the exercise of Barid Mizaj (cold temperament) persons.

Another classification of Riyazat/exercise
Riyazate A΄arziya/GairIradi (unwillingly): Exercise in which there is no will to do exercise, it is done in daily ordinary occupational activities like for iron-smith and washer man etc.

Riyazate Zatiya/Khalisa (willingly):
This exercise is done purposefully to gain its benefits. It is further subdivided according to its duration, strength, and mode etc. Swinging is a free exercise which induces relaxation to reduce a state of wasteful tension in muscles. It is also used for shorter periods to mobilize the joints.

Recommendations for exercise
Exercise should be according to age, temperament, occupation, body conditions, time etc. Best time for exercise is during moderate condition of body. Refrain from strong exercise for diseased organs. Before exercise, intestine and urinary bladder should be empty. Dalak e istedad (Preparatory Massage before Starting Exercise) should be done before exercise and Dalak e isterdad (Relaxing massage) after exercise It should be done after complete digestion of food During heavy exercise there should be some Lateef (light diet) in stomach especially in summer season, and in winter there should be some Ghaleez (heavy diet) in stomach. One should take rest during heavy exercise. Exercise should be done in morning hours. On empty and full stomach, exercise should be avoided. If there is excess Hararat (hot), Yubusat (dry) and Burudat (cold) in the body, exercise should not be done.

Swelling of the organs (aaza ka phoolna)
Exercise should be continue till the organs swollen and sweating dried up and when the organs stop to swell and sweating continues, exercise should be stopped.

Dalak (Massage)
Several regimens have been used by Unani physicians since ancient time, among which Dalak (massage) is the most common and widely practiced regimen that is used for restorative, preventive as well as for therapeutic purposes. According to Hippocrates (460 BC-370 BC), the father of medicine, massage, balanced diet, exercise, rest and fresh air are essential to maintain health of a person. According to IbneRushd, massage is a type of exercise used for removal of toxins or waste metabolites from the body. In Unani medicine, Dalak is one of the very important regimes among the procedures of IlajBil-Tadbeer (Regimental therapy) for neurological and musculoskeletal disorders. A number of Unani physicians recommended Dalak as preventive as well as curative measure.
Dalak is one of the very important regimes among the procedures of IlajBil Tadbeer for neurological and musculoskeletal disorders. In Unani medicine, Dalak is considered as the method where pressure or friction, kneading, rubbing, tapping, pounding, vibrating or stimulating against the external soft parts of the body with hands or other objects like rough cloth with or without oils, creams, lotions, ointments or other similar preparations. According to IbneRushd, massage is a type of exercise and used for the removal of waste metabolites

Journal of Complementary Medicine & Alternative Healthcare
of digestion (HazmeUzwi/hazmeakheer). Number of Unani physicians advocates the use of Dalak for the preventive as well as the curative purpose in various diseases. They recommended several varieties of Dalak e.g. Dalak e sulb (hard massage), Dalak e layyin (soft massage), Dalak kaseer (prolonged massage), Dalak moatadil (moderate massage) etc. Hard friction or massage is Mufatteh-e-Sudad (deobstruent) and makes the body firm. Soft massage is sedative and relaxes the body while prolonged massage reduces the fat of the body; moderate massage develops the body as well as improves and maintains blood circulation of the particular organ; rough friction with a rough cloth (Dalak khashin) enhances vasodilatation of the particular organ etc.

Fundamental Concept of Massage
Dalak (Massage) is based on holistic approach of two fundamental concepts i.e. Tanqiya e Mawad (Evacuation of morbid humour) and Imala e Mawad (Diversion of humour). Tanqiya e Mawad means the resolution and excretion of morbid humors and excess fluids from the body, thereby maintaining the homeostasis in the quality and quantity of four bodily humors, which is actually responsible for the maintenance of normal health. Imala e Mawad refers to the diversion of the morbid fluids from the site of affected organ to the site where from it is easily expelled out from the body tissues. It also induces sedation, analgesia and increases blood circulation.

Classification of massage
Ibne Sina and Ibne Rushd have classified Dalak as Dalak Baseet (simple) and Dalak Murakkab (compound) and they again divided the Dalak Baseet on the basis of kafiyat (quality) and kammiyat (quantity) into 6 types.

1-Dalak Baseet (Single Massage)
On the basis of Kaifiyat (pressure exerted on the part) and Kammiyat (duration of massage) it is again divided into six types:   Dalak istedad (preparatory massage before starting exercise): (Qawi, zaeef, moatadil, taweel, qaseer, and moatadil) it is a special type of massage which is done gently in the beginning and then vigorously towards the end. It is done before exercise in order to prepare the body for undergoing different movements during exercise.

Dalak isterdad (relaxing massage):
It is also known as Dalak Musakk in. It is done towards the end of exercise and should be carried out gently and in moderation, preferably with oil [13]. To develops the body as well as to improve and to maintain blood circulation of the particular organ; d) For dissolution of riyah (morbid gases) from the body; e) To remove the barid mizaj (cold temperament); f) For imala (to divert the matter from one organ to another) Massage is done by using oil with an aim to retain the rutoobat (moisture of the body); g) Massage is done to relieve pain

Journal of Complementary Medicine & Alternative Healthcare Therapeutic Application of Massage
In the treatment of pain, excessive cold, excessive heat, acute neurologic pain, headach, facial paralysis, chronic spasm, sciatica, shock, melancholia, dementia, flaccidity, tremor, peraesthesia, acute spasm, asthma, frozen shoulder, backache, carpel tunnel syndrome etc.  d) A study was conducted on 'Effect of Dalak Layyan kaseer with Roghane Shibbat in slowing the progress of WajaulUnuq (cervical pain)' in NIUM Hospital. The regimen was found highly significant both statistically and clinically in relieving acute and chronic cervical pain.

Conclusion
So to conclude, the glimpses taken from the literature and classics whatever reviewed reiterates the fact that Improvement of immunity (tabiyat) by immunomodulators, moderation of 6 essential factors of life and implication of right strategy i.e. regimental therapy and psychotherapy (maddi aur gair maddi tadabeer) and administration of preliminary concoctives, then purgatives followed by drug therapy with all the given specifics taken in to consideration promotes positive health as well as prevents the diseases to get develop although there is a problem of lack of uniform standards for the present generation despite of being a fundamental therapeutatic methodology.
It therefore apparently seems essential to standardize it and to develop certain scientific parameters for evaluation of the efficacy of this regimental and psychotherapy so that the benefits may reach to the larger sections of society. This therapy must also be evaluated for prophylactic use so that some of the impending attacks/bouts of diseases might be averted. It is also concluded that ṭabῑat plays an important role in preservation and restoration of health. The disease is the consequence of defeat of ṭabῑat because when ṭabῑat is strong, it can easily combat the causative matter and maintain normalcy and it has direct or indirect relationship with the six essential pre-requisites and regimental therapy in the restoration of health.