Nutūl as an effective and time tested regimenal modality in Unani system of medicine: An Overview
Ilāj bit tadbīr is one of the treatment plans in the Unani system of medicine which includes the modification in asbāb-i-sitta zarooriya (six essential factors) through certain interventions. Nutūl or irrigation is a classical and effective method in regimenal therapy which refers to pouring or dripping of liquid slowly and steadily over the body part from a pre-fixed height. The benefits achieved are an amalgamation of neurological effect, psychological effect and pharmacological actions of the procedure and the drugs used. For this purpose, usually water, oil or medicated decoction is poured from a height over specific sites of body in certain diseases. Therapeutically, nutūl is effective in various ways such as dispersing the causative morbid matter from the part, normalizing the mal-temperament, relieving pain, increasing the circulation, etc. It is specifically useful as an adjuvant treatment in the management of central nervous system disorders like headache, insomnia, migraine, amnesia, melancholia, vertigo, epilepsy and also in certain other disorders like cystitis, mastitis, arthralgia, etc. These therapeutic effects are expected due to the kafiyat (quality) of liquid and the constituents of the formulation used in the procedure. Nutūl has an analgesic effect also, hence, recommended in several Musculoskeletal problems such as waja-ul-mafasil (osteoarthritis), waja-uz-zahr (low backache), waja-ul-azlat (myalgia), irq-un-nasa (sciatica), etc. The exact mechanism of action of Nutūl therapy is still not known but few preliminary reports suggested that it has an anxiolytic effect through decreasing the plasma noradrenaline and urinary serotonin excretion, decrease in rate of breathing, reduction in diastolic blood pressure and heart rate with lowered sympathetic tone.
Keywords: Taḥlīl; Kafiyat; Mizāj; Tadbīr; Joshānda
2. Nafees AB. Kulliyat-e-Nafisi (Tarjuma wa Sharah by Kabiruddin M); New Delhi: Idara Kitab-ush-Shifa; 1934.
3. Sina I. Kulliyat e Qanoon. (Urdu Translation by Kabiruddin M.). New Delhi: Aijaz Publishing House; 2006.
4. Ehtisham, Khan RM, Ansari AH. A Comprehensive Review of Bekhwabi (Insomnia). European Journal of Pharmaceutical and Medical Research. 2015; 2(5):641-69.
5. Jilani G. Makhzan ul Murakkabat. New Delhi: Aijaz Publication House; 1995.
6. Kabiruddin M. Al Qarabadeen. New Delhi: Central Council for Research in Unani Medicine; 2006.
7. Dhuri KD, Bodhe PV, Vaidya AB. Shirodhara: A psycho-physiological profile in healthy volunteers. Journal of Ayurveda & Integrative Medicine. 2013; 4(1):40-44. doi: 10.4103/0975-9476.109550.
8. Sina I. Al Qanoon Fil Tib (Urdu translation by Kantoori GH). Vol 1. New Delhi: Ejaz Publishing House; 2010.
9. Jurjani AH. Zakheera Khwarzm Shahi. New Delhi: Idara Kitab-us-Shifa; 2010.
10. Rais-ur-Rehman, Pasha A, Katoch D.C., Siddiqui KM, Khan MA, Jamil S. Unani System of Medicine the science of health and healing. New Delhi: Department of Ayush Ministry of Health and Family Welfare Govt. of India; 2013, 39-44.
11. Kabiruddin M. Kulliyat advia. Lahore: Idara Taimir-e-Tibb, Urdu bazaar; YNM
12. Jamal MA, Khan MA, Kitab ut Tadbīr, Al-Farooq Educational Society and Trust Indore, India, 2013.
13. Roohi Azam, Shafia Mushtaq, Fassihuzaman, Azhar Jabeen, Zehra Zaidi, Shah Alam, Nutool (Irrigation) - An effective mode of treatment in Ilaj bit Tadbeer (Regimenal therapy). Indo American Journal of Pharm Research.2014:4(12):5787-91.
14. Azam R, Nisar S, Jabeen A, Jilani S, Jahangir U, Parveen S. Nutool Therapy (Irrigation) and its Practical Applications in Unani System of Medicine. World Journal of Pharmaceutical Research. 2016; 5(11):599-607. DOI: 10.20959/wjpr201611-7300
15. Mushtaq S, Jabeen A, Fasihuzaman, Mushtaq M, Jilani S, Nikhat S, Alam S, Insomnia and its management in Unani medicine, Int. J Adv Pharmacy Med Bioallied Sci.; 2014; 2(1):51-53.
16. Jahan M, Shervani AMK, Ahmed U, Firdose FK, Ansari AN, Jahan N. An international trial to evaluate the efficacy of Nutool therapy in the control of primary insomnia among the elderly using structured insomnia schedule, Int.Res.J. Medical Sci.; 2014; 2(2):1-6.
17. Khan A. Akseer-e-Azam (Urdu Translation by Kabiruddin M). New Delhi: Idara Kitab-ush-Shifa. 2011.
18. Tabri M. Al-Moalijat Al-Buqratiyah. New Delhi: Central Council for Research in Unani Medicine. 1995.
19. Tabri R. Firdaus Al-Hikmat (Translation by Md. A. S. Sambhali). Pakistan, Lahore: Sheikh Mohd. Basheer and Sons; 1996.
20. Zuhr I. Kitab-al-Taisir. 1st ed. New Delhi: Central Council for Research in Unani Medicine. 1986.
21. Kumar SH, Neetu S, Dutta SV, Vyas PP. An Approach to Understand the Mechanism of Action of Shirodhara. TEJAS: The Edgy Journal of Alive Sciences 2014; 2(2):39-42.
22. Tortora GJ, Grabowski SR. Principles of Anatomy and Physiology. 9th ed. New York: Wiley, 2000.
23. Uebaba K, Feng-Hao Xu, Ogawa H, Tatsuse T, Bing-Hong Wang, Hisajima T, Venkatraman S. Psychoneuroimmunologic Effects of Ayurvedic Oil-Dripping Treatment. The Journal of Alternative and Complementary Medicine. 2008; 14(10):1189–1198. DOI: 10.1089/acm.2008.0273.
24. Uebaba K, Xu FH, Tagawa M, Asakura R, Itou T, Tatsuse T, Taguchi Y, Ogawa H, Shimabayashi M, Hisajima T. Using a healing robot for the scientific study of shirodhara. Altered states of consciousness and decreased anxiety through Indian dripping oil treatments. IEEE Eng Med Biol Mag 2005; 24(2):69-78. DOI: 10.1109/memb.2005.1411351
25. Khan S, Nayab M, Ansari RA. Effect of Nutool with Roghan-e-Banafsha in Sahar” (Primary Insomnia). IJRAR. 2019; 6(1):1271-81.
26. Gotmare A, Tawalare K, Nanote K, Dehankara M. Godugdha Shirodhara: a non-pharmacological treatment of nidranash (insomnia). Int J Res Ayurveda Pharmacy 2013; 4:541–44. DOI: 10.7897/2277-4343.04417
27. Pokharel S, Sharma A. Evaluation of Insomrid Tablet and Shirodhara in the management of anidra (insomnia). Ayu 2010; 31:40–47. doi: 10.4103/0974-8520.68209.
28. Singh AK, Chandola HM, Ravishankar B. Clinical study on psychic traits in stress-induced chronic insomnia and its management with Mamsyadi Ghrita & Dashamula Kwatha Shirodhara. AYU 2008; 29(1):9–18.
29. Vanish B, Chandola HM. Clinical study on psychic traits in stress included insomnia (anidra) and its management with tagaradi kwatha & mahishi dugdha shirodhara. AYU 2008; 29(3):133–139.
30. Xu F, Uebaba K, Ogawa H, Tatsuse T, Wang BH, Hisajima T, et al. Pharmaco-physiopsychologic effect of Ayurvedic oil-dripping treatment using essential oil from Lavendula angustifolia. J Altern Complement Med 2008; 14:947–956. doi: 10.1089/acm.2008.0240.
31. Krauchi K, Cajochen C, Werth E, Wirz-Justice A. Warm feet promote the rapid onset of sleep. Nature 1999; 401:36–37. DOI: 10.1038/43366
32. Krauchi K, Cajochen C, Werth E, Wirz-Justice A. Functional link between distal vasodilation and sleep-onset latency? Am J Physiol Regul Integr Comp Physiol 2000; 278:R741–748. DOI: 10.1152/ajpregu.2000.278.3.R741.
33. Liao WC, Wang L, Kuo CP, Lo C, Chiu MJ, Ting H. Effect of a warm footbath before bedtime on body temperature and sleep in older adults with good and poor sleep: an experimental crossover trial. Int J Nurs Stud. 2013; 50:1607–16. doi: 10.1016/j.ijnurstu.2013.04.006.
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