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Open Access Full Text Article                                                                  Review Article

Irritable Bowel Syndrome (IBS) and its management by the Unani System of Medicine: A Review

Faiyaz Ahmad *¹, Vijay Bhan Singh ¹, Amreen Fatima ¹, Noman Anwar ², Mahboob us Salam ², Najmus Sehar ³

¹ Research Associate (Unani) Central Research Institute of Unani Medicine, Basaha Kursi Road, Lucknow, India 

² Research Officer (Unani), Central Research Institute of Unani Medicine, Basaha Kursi Road, Lucknow, India 

³ Deputy Director, Central Research Institute of Unani Medicine, Basaha Kursi Road, Lucknow, India 

 

 

1. Introduction

The most prevalent functional gastrointestinal worldwide is acknowledged to be irritable bowel syndrome (IBS). According to epidemiological data, between 10% and 15% of adults globally suffer with IBS, which puts a significant financial strain on healthcare systems as a result of frequent doctor visits, diagnostic testing, and lost productivity at work.¹ The clinical presentation of IBS is heterogeneous, classically diagnosed using the Rome IV criteria, which mandate the presence of recurrent abdominal pain associated with defecation or a change in bowel habits. ² Based on the predominant stool pattern, IBS is sub classified into diarrhoea-predominant (IBS-D), constipation-predominant (IBS-C), mixed (IBS-M), and unclassified (IBS-U).

The exact etiopathogenesis of IBS remains elusive in modern medicine but is widely understood to be multifactorial. Key pathophysiological mechanisms include altered gastrointestinal motility, visceral hypersensitivity, increased intestinal permeability, low-grade mucosal inflammation, alterations in the gut microbiota (dysbiosis), and dysregulation of the gut-brain axis.³  Consequently, conventional management relies heavily on symptom-specific agents: antispasmodics for pain, laxatives for constipation, antidiarrheal for loose stools, and neuromodulators (like SSRIs or TCAs) for visceral hypersensitivity and co-morbid psychological distress. However, these treatments often fail to provide complete or sustained relief and carry the risk of adverse effects upon chronic usage. ⁴  

In contrast, the Unani system of medicine offers a highly structured, holistic, and individualized approach to gastrointestinal disorders. Rooted in the Hippocratic theory of humors (Dam, Balgham, Safra, and Sauda), Unani medicine posits that health is maintained by the equilibrium of these humors and the innate temperament (Mizaj) of the body. ⁵ This paper explores the Unani conceptualization of IBS, drawing parallels between ancient wisdom and modern pathophysiology, and details the comprehensive management strategies employed by Unani physicians to treat this debilitating condition.

2. Unani Perspective

Although the precise acronym "IBS" is a modern biomedical creation, there are a few medical diseases that mirror the signs and symptoms of IBS, but there is no reference of any illness with the name "IBS" in classical Unani literature. The malfunctioning of its normal faculties, particularly quwat-e-masika (retentive faculty), may be the reason of this change in bowel habit since the sickness has no known aetiology and no organic pathology is implicated. In order to facilitate correct digestion and absorption, quwat-e-masika keeps food in the digestive tract for a sufficient length of time. Once this process is finished, it is released for quwat-e-dafiah to remove waste from the body. When this function is malfunctioning, the food is either not retained in the alimentary canal for a sufficient period of time, which results in diarrhoea, or it is retained excessively, which results in constipation.^6,7 Sabit ibn Qurrah describes symptoms similar to IBS under the heading of Ishal-e-dimaghi, which is caused by zof-e-dimagh (weakness of the brain), where waste material from the upper body (specifically the brain) falls on the gut and causes a change in its normal mizaj (temperament), disturbing quwat-e-hazima and affecting quwat-e-masika (retentive faculty), which in turn causes an alteration in bowel habit ^6,8.

Zalaqul ama (lienteric diarrhea) is another phenomenon that Unani scholars have identified with IBS signs and symptoms. This disorder also affects the intestinal faculties of quwat-e-masika (retentive faculty), quwat-e-dafiah (expulsive faculty), quwat-e-hazima (digestive faculty), and quwat-e-jaziba (absorptive faculty), resulting in altered constipation and diarrhea ^6,9.

3. The Role of Mizaj (Temperament) and Akhlat (Humors)

According to Unani philosophy, the primary cause of these functional abnormalities is a change in the stomach and intestine’s normal temperament (Su-e-Mizaj) ^6,7,10:

• Su-e-Mizaj Barid (Altered Cold Temperament): An abnormal cold temperament in the gut causes slow motility and reduced digestive fire (Hararat-e-Ghariziya). Delayed transit time, increased water absorption from the stool, and eventually constipation are the outcomes of this (correlated with IBS-C).
• Su-e-Mizaj Har (Altered Hot Temperament): An abnormally hot temperament, often exacerbated by the accumulation of Safra (yellow bile), stimulates intestinal motility. This increase in motility prevents adequate fluid absorption, leading to diarrhoea    (correlating with IBS-D).
• Su-e-Mizaj Ratab (Altered Moist Temperament): Excessive moisture, typically associated with Balgham (phlegm), causes the intestines to become relaxed and weak (Isterkha), leading to mucoid stools and a feeling of incomplete evacuation.

4. The Gut-Brain Axis: Nafsani Awariz (Psychological Factors)

In the pathophysiology of IBS, modern gastroenterology places a strong emphasis on the gut-brain axis, pointing out that stress, worry, and depression worsen symptoms. ¹¹.

Remarkably, classical Unani scholars acknowledged this connection centuries ago. Nafsani Awariz (psychological states) such as Fikr (worry), Gham (grief), and Ghazab (anger) are described as potent disruptors of Hararat-e-Ghariziya (innate heat). Chronic stress diverts the body's vital forces away from the digestive organs, leading to Zof-e-Meda (gastric weakness) and subsequently precipitating IBS symptoms ¹².

5. Management by Unani System of Medicine

The Unani management of IBS does not aim solely at suppressing symptoms. Instead, it follows a systematic approach to manage it. This is achieved through Mufradat (single unani drugs) or Murakkabat (compound formulation) or a combination of both as the case may be.  Unani system of medicine utilizes an extensive arsenal of botanicals, minerals, and animal-derived substances. Mufradat and Murakkbat are selected based on their specific Afa'al (pharmacological actions) to restore gut health.

Mufradaat (Single Herbal Drugs)

• Ispaghol (Plantago ovata): Rich in mucilage and serves as a substance that forms bulk. Interestingly, it is an amphoteric medication used for both IBS-D and IBS-C. In diarrhoea, it absorbs extra fluid and gives the stool bulk; in constipation, it absorbs water to soften the stool. ^6,13.
• Pudina (Mentha arvensis / Peppermint): Menthol acts as a calcium channel blocker in intestinal smooth muscles, relaxing the gut wall and preventing painful spasms ^14,15.
• Mastagi (Pistacia lentiscus / Mastic Gum): Mastagi has strong anti-inflammatory and antioxidant qualities that aid in lowering low-grade inflammation and repairing the intestinal mucosal barrier ¹⁶.
• Badiyan (Foeniculum vulgare / Fennel): Fennel's essential oils significantly reduce bloating and distension by easing smooth muscle spasms and aiding in the ejection of flatus ¹⁰.
• Bael (Aegle marmelos): Unripe Bael fruit is very helpful for IBS-D and IBS-M because it binds the stool, lowers mucus production, and heals the intestinal lining ^6,17,1.

Murakkabaat (Compound Formulations)

• Jawarish Anarain: Jawarish Anarain may help alleviate common symptoms such as abdominal discomfort, bloating, postprandial fullness, dyspepsia, and altered bowel habits by improving gastrointestinal function and reducing excessive gas formation ¹⁹.
• Jawarish Mastagi: Formulated primarily with Mastic gum, this preparation arrests diarrhoea by strengthening the retentive power (Quwwat-e-Masika) of the stomach and intestines ²⁰.
• Majoon-e-Sangdana Murgh: Majoon-e-Sangdana Murgh is a traditional Unani remedy for intestinal atony, persistent diarrhea, and gastrointestinal weakness (ḍuʿf al-miʿda). It functions as an intestine tonic and stomachic (Muqawwi-e-Mi'da) [10,19].
• Habb-e-Raal: Habb-e-Raal is a traditional Unani formulation having astringent (Qabiz) and intestinal tonic (Muqawwi-e-Am'a) properties. It is useful in chronic diarrhoea and dysentery and may be used for the symptomatic management of diarrhoea-predominant irritable bowel syndrome (IBS-D) by reducing intestinal secretions and improving bowel consistency [10,20].
• Sufoof Muqliyasa: Sufoof Muqliyasa is a pharmacopoeial Unani powdered formulation indicated for chronic diarrhoea and intestinal weakness. Due to its astringent (Qabiz), bowel-strengthening (Muqawwi-e-Am'a), and stomachic (Muqawwi-e-Mi'da) properties, it helps in reducing excessive bowel frequency, improves stool consistency, and supports normal gastrointestinal function. Therefore, it may be considered a useful formulation for the symptomatic management of diarrhoea-predominant irritable bowel syndrome (IBS-D) ^21,22.

Psychotherapy (Ilaj Nafsani)

Psychological disturbances such as anxiety, stress, and emotional distress are recognized as important aggravating factors in patients with Irritable Bowel Syndrome (IBS). Unani physicians emphasize Ilaj Nafsani (psychotherapy) as an integral component of management, aiming to restore mental equilibrium through reassurance, counseling, stress reduction, relaxation techniques, and regulation of sleep and daily habits (Asbab-e-Sitta Zarooriyah).

6. Discussion

Irritable Bowel Syndrome (IBS) is a complex disorder characterized by chronic gastrointestinal symptoms in the absence of identifiable structural pathology. Despite significant advances in understanding its pathophysiology, including the roles of altered gut motility, visceral hypersensitivity, intestinal dysbiosis, immune activation, and gut–brain axis dysfunction, the management of IBS continues to be challenging. Many patients experience only partial symptom relief with conventional therapies, and recurrence of symptoms remains common. This has led to increasing interest in complementary and traditional systems of medicine that offer a broader and more individualized approach to patient care.

The Unani system of medicine conceptualizes gastrointestinal disorders within the framework of Mizaj (temperament), Akhlaat (humours), and the functional integrity of the body's faculties (Quwa). Although IBS is not described as a distinct disease entity in classical Unani texts, its clinical manifestations closely resemble conditions associated with disturbances of digestive and intestinal functions. The concepts of impaired Quwwat-e-Masika, altered intestinal temperament, and weakness of digestive faculties provide a plausible traditional explanation for the altered bowel habits observed in IBS. Such interpretations demonstrate the ability of classical Unani scholars to recognize functional disorders even in the absence of identifiable organic lesions.

A notable aspect of the Unani approach is its emphasis on identifying and correcting the underlying imbalance rather than focusing exclusively on symptom suppression. Therapeutic measures are therefore directed towards restoring normal temperament, improving digestive function, strengthening gastrointestinal faculties, and eliminating factors that contribute to disease persistence. This comprehensive approach is particularly relevant in IBS, where multiple physiological and psychological mechanisms interact to produce symptoms.

The relationship between emotional disturbances and gastrointestinal dysfunction occupies an important place in both modern medicine and Unani thought. Contemporary research has firmly established the role of stress, anxiety, and depression in the onset and exacerbation of IBS symptoms through dysregulation of the gut–brain axis. Classical Unani literature similarly recognizes the adverse effects of Nafsani Awariz such as grief, worry, and anger on digestive health. The incorporation of Ilaj Nafsani alongside dietary regulation and pharmacotherapy reflects a holistic therapeutic philosophy that addresses both the physical and psychological dimensions of the disorder. Such an approach may be particularly valuable in improving patient well-being and reducing symptom recurrence.

The medicinal plants traditionally employed in Unani practice also merit attention. Single drugs such as Plantago ovata, Mentha arvensis, Foeniculum vulgare, Pistacia lentiscus, and Aegle marmelos possess pharmacological activities that correspond closely with the therapeutic requirements of IBS, including antispasmodic, carminative, anti-inflammatory, antioxidant, and bowel-regulating effects. Similarly, compound formulations such as Jawarish Anarain, Jawarish Mastagi, Majoon-e-Sangdana Murgh, Habb-e-Raal, and Sufoof Muqliyasa have traditionally been prescribed to improve gastrointestinal function and normalize bowel habits. Although these formulations continue to be used in clinical practice, the scientific evidence supporting their efficacy remains limited and warrants further investigation.

The growing interest in integrative medicine offers an opportunity to evaluate Unani therapies through contemporary research methodologies. Future studies should focus on standardization of formulations, identification of active constituents, assessment of safety profiles, and well-designed randomized controlled trials. Such evidence would not only strengthen the scientific basis of Unani medicine but also facilitate its integration into modern healthcare systems for the management of functional gastrointestinal disorders such as IBS.

7. Conclusion

Irritable Bowel Syndrome is a chronic functional gastrointestinal disorder in which biological, psychological, dietary, and environmental factors interact to influence disease onset and progression. The Unani system of medicine provides a holistic therapeutic framework that emphasizes restoration of humoral balance, correction of altered temperament, strengthening of digestive faculties, dietary regulation, lifestyle modification, psychological management, and the rational use of herbal (single and compound) formulations. This multidimensional approach corresponds closely with the modern understanding of the gut–brain axis and the biopsychosocial nature of IBS.

Traditional Unani medicines possess several pharmacological properties, including antispasmodic, anti-inflammatory, carminative, mucosal protective, antioxidant, and bowel-regulating effects, which may contribute to symptom relief and improvement in patients’ quality of life. However, despite centuries of empirical use and encouraging preliminary evidence, high-quality clinical studies are still required to validate their therapeutic efficacy and safety according to contemporary scientific standards. Future interdisciplinary research integrating classical Unani principles with modern biomedical methodologies may help establish evidence-based, patient-centred strategies for the effective long-term management of IBS.

Conflict of Interest: The authors declare no conflict of interest.

Funding / Financial Support: None declared.

Authors' Contributions: All authors contributed equally to the literature search, drafting, and editing of the manuscript.

Data Availability: Not applicable.

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