A Panoramic view of most commonly used Regimenal Modalities (Tadabeer) for joint pain in Unani System of Medicine: A Critical Review
Abstract
Pain in joints (Waja ul Mafasil) is a major clinical problem that may or may not be associated with inflammation. Researchers and Clinicians are rigorously working to find out the best treatment modality in the management of joint pain. Unani physicians claimed the management of various joint disorders with the help of several Tadabeer. The objective of this critical review is to address the claims of Unani physicians and clinical studies conducted on the efficacy of Dalk or Hijama in the management of joint pain. Classical Unani literature, peer-reviewed journal articles and RCTs that predominantly focused on the use of regimenal modalities (Hijama and Dalk) in the joint pain were included in this review. Several published studies claiming the effect of Dalk and Hijama by Unani physicians, showing significant improvement, were included along with the literature. Various published clinical trials showed the effect of Dalk and Hijama in the management of joint pain, though, the effect showed by some clinical trials was short term. Hence, rigorous, controlled, randomized, blinded, and long duration follow up studies on large sample size are to be conducted by trained clinicians or researchers to establish the efficacy of Dalk or Hijama in the management of musculoskeletal disorders (MSDs).
Keywords: Dalk; Hijama; Waja-ul-Mafasil; Joint Pain; Musculoskeletal Disorders; Unani
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References
2. Taher MA, Nayeem MAB, Ahamed MM, Chowdhury MSI, Ilaj-bil-Tadbeer (Regimenal Therapy): A Review, International Journal of Medical and Health Research, 2017; 3(10): 54-56.
3. Gruner, O. Cameron. A Treatise on the Canon of Medicine of Avicenna. London: Burleigh press. 1929
4. Ibne Sina. Alqanoon Fit Tib (Urdu Translation). New Delhi: Idara Kitab us Shifa. 2010
5. Ibne Sina, Tarjuma wa Sharha Kulliyat-e-Qanoon (Urdu Translation by Hakeem Kabeeruddin), New Delhi: Aijaz Publishing House. 1930.
6. Jong-In Kim, Myeong Soo Lee, Dong-Hyo Lee, Kate Boddy, Edzard Ernst. Cupping for Treating Pain: A Systematic Review. Evidenced-Based Complementary and Alternative Medicine. 2011:1-7.
7. Ypung Dal Kwon, Hyeon Joo Cho. Systematic Review of Cupping Including Bloodletting Therapy for Musculoskeletal Diseases in Korea. Korean J. Oriental Physiology & Pathology. 2007; 21(3):789-793.
8. Ibne Rushd. Kitabul Kulliyat (Urdu Translation by CCRUM). New Delhi. CCRUM. 1987.
9. Tanweer M.A., Ansari A.H., Anzar M.A. Dalk (Therapeutic Massage) & Their Indication for Musculoskeletal Disorder in Unani Medicine. International Journal of Advanced Ayurveda, Yoga, Unani, Siddha, and Homeopathy. 2013; 2(1):59-70.
10. Hutting N, Johnston V, Stall J B, Heerkens Y F. Promoting the use of self-management strategies for people with persistent Musculoskeletal Disorders: The Role of Physical Therapists. Journal of Orthopaedic & Sports Physical Therapy. 2019; 49(4):212-215.
11. Schaible HG, Richter F, Ebersberger A. et al. Joint Pain. Exp Brain Res. 2009; 196:153-162.
12. Murray C.J, Atkinson C, Ali MK, et al. The State of US Health, 1990-2000; burden of diseases, injuries, and risk factors, JAMA. 2013; 310:591-608.
13. Aas RW, Thingbo C, Hotte KA, et al. On long term sick leave due to musculoskeletal diseases and disorders. Experiences of work demands. Work. 2011; 39:233-242.
14. Hernandez AM, Peterson AL. Work-related musculoskeletal disorders and Pain. In: Gatchel RJ, Schultz IZ, eds. Handbook of Occupational Health and Wellness. New York, NY: Springer. 2012:63-86.
15. Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med. 2018; 52:1543-1544.
16. Razi Z. Kitabul Hawi Fit Tibb. (Urdu translation by CCRUM). Vol. 11. Govt. of India; 2002: 75-100.
17. Jurjani I. Zakheera Khawarzam Shahi. (Urdu translation by Hadi Hasan Khan). Vol.3rd. Part 6th. Lucknow: Munshi Naval Kishore; 1878: 637-41.
18. Nayab M, Anwar M, Quamri MA. Clinical Study on Waja-ul-Mafasil and evaluation of efficacy of Hijamat-bila-Shurt in the Treatment. Indian Journal of Traditional Knowledge. 2011; 10(4):697-701.
19. Arzani A. Tibb-e-Akbar. Delhi: Idara-e-Kitab-ul-Shifa; 1890: 617-28.
20. Razi Z. Kitab-ul-Hawi fil-Tibb. Vol. 11. Hyderabad: Daerat-ul-Marif; 1962: 101 - 273.
21. Al-Quamri. Ghina Muna. New Delhi: Central Council for Research in Unani Medicine. 2008
22. Farhadi K, Schwebel DC, Saeb M, et al. The Effectiveness of Wet-Cupping for nonspecific low back pain in Iran: A Randomised Controlled Trial. Complementary Therapies in Medicine. 2009; 17:9-15.
23. Hanan S.A, Eman S.E. Cupping Therapy (Al-Hijama): It’s Impact on Persistent Non-Specific Lower Back Pain and Client Disability, Life Science Journal.2013;10(4s):631-642.
24. Jong-In Kim, Tae-Hun Kim, Myeong Soo Lee, et al. Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group Pilot Trial, Trials. 2011; 12(146):1-7.
25. Khan A.A, Jahangir U, Urooj S. Management of knee osteoarthritis with cupping therapy. Journal of Ayurved Pharmaceutical Technology & Research. 2013; 4(4): 217-223.
26. Michael Teut, Stefan Kaiser, Miriam Ortiz, et al. Pulsatile dry cupping in patients with osteoarthritis of the knee – A Randomised Controlled Exploratory Trial. BMC Complementary and Alternative Medicine.2012; 12(184):1-9.
27. Romy Lauche, Holger Cramer, Kyung-Eun Choi, et al. The Influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain – A Randomised controlled pilot study. BMC Complementary and Alternative Medicine.2011; 11(63):1-11.
28. Adam I. Perlman, Ather Ali, Valentine Yachou Njike, et al. Massage Therapy for Osteoarthritis of the Knee – A Randomised Dose-Finding Trial. PLoS ONE. 2012; 7(2):1-9.
29. Dorothea V. Atkins, David A Eichler. The Effects of Self-Massage on Osteoarthritis of the Knee: A Randomised, Controlled Trial. International Journal of Therapeutic Massage & Bodywork. 2013; 6(1):4-14.
30. Karen J. Sherman, Daniel C. Cherkin, Rene J. Hawkes, et al. Randomized trial on Therapeutic Massage for Chronic Neck Pain. Clin J Pain. 2009; 25(3): 233-238.
31. Hoy DG, Smith E, Cross M, Sanchez-Riera L, Blyth FM, Buchbinder R, et al. Reflecting on the burden of Musculoskeletal conditions: Lessons learnt from Global Burden of Disease 2010 Study and the next steps forward. Ann Rheum Dis. 2015; 74:4-7.
32. Ibn-ul-Quf Masihi, Kitab-ul-Umda fil Jarahat, New Delhi: Central Council for Research in Unani Medicine.1986
33. Brummitt J. The Role of Massage in Sports Performance and Rehabilitation: Current evidence and future directions. Am j Sports Phys Ther. 2008; 3:7-21.
34. Kong LJ, Zhan HS, Cheng YW. Massage Therapy for neck and shoulder pain: a systemic review and meta-analysis. Evid Based Complementary Alternat Med. 2013.
35. Patel KC, Gross A, Graham N, Goldsmith CH, Ezzo J, Morien A, et al. Massage of Mechanical Neck disorders. Cochrane Database Syst Rev. 2012; 9:CD004871.
36. Diederik C bervoets, Pim AJ Luijsterburg, Jeroen JN Alessie, Martijn J Buijs, Arianne P Verhagen. Massage therapy has short term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. Journal of Physiotherapy. 2015; 61:106-116.

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