How does Unani medicine work?

Unani means “Greek”. The name tells you where the story starts: with Hippocrates on the island of Kos, about 400 BCE, and with Galen, a Greek doctor working in Rome around 170 CE. They taught that health is a balance of four body fluids, the humours.

In the 9th century, scholars in Baghdad, many linked to the House of Wisdom, translated these Greek books into Arabic. Doctors in the Islamic world then added a great deal of their own. al-Razi (Rhazes) kept detailed case notes and was the first to describe smallpox and measles as different diseases. Ibn Sina (Avicenna) finished his Canon of Medicine in 1025. Translated into Latin, it was taught in European universities for centuries.

The system reached India with the Delhi Sultanate from the 13th century and flourished at Mughal courts, where its doctors were called hakims. In the 20th century Hakim Ajmal Khan founded Tibbiya College in Delhi, opened by Gandhi in 1921, which taught Unani and Ayurveda under one roof.

Today India is the world's biggest centre of Unani. It has more Unani colleges, hospitals and hakims than any other country. Hakims study for a 5½-year BUMS degree and are regulated by the NCISM. Research is run by the CCRUM, under the Ministry of AYUSH. Unani is also practised in Pakistan, Bangladesh, Iran and the Gulf. Its sister systems have their own boxes: see AyurvedaClear and HomeopathyClear, and MedicineClear for modern medicine.

This chapter explains Unani in its own terms, the way its classical books and today's hakims describe it. The next chapters look at how it works in practice and what science has found.

Unani teaches that the body holds four fluids, the akhlat or humours: dam (blood, hot and moist), balgham (phlegm, cold and moist), safra (yellow bile, hot and dry) and sauda (black bile, cold and dry). Their mix gives each person a mizaj, or temperament. Someone with more dam is called damvi, with more balgham balghami, and so on. A well-balanced mizaj is motadil.

In this view, health means your humours are in the right balance for your mizaj, and illness means they have drifted. The body's own healing power, tabiyat, is said to keep pushing them back. The hakim's job is to help it.

Six things are said to shape the balance, the asbab-e-sitta zarooriya or six essential factors: the air you breathe, food and drink, movement and rest, emotions, sleep and waking, and retention and elimination (what the body keeps and lets out).

Europe used the same Greek humours for about 2,000 years. English still carries them: sanguine (cheerful, from blood), phlegmatic (calm), choleric (angry) and melancholy (from “black bile”). European doctors dropped humours in the 1800s, when cells, germs and chemistry explained disease better (chapter 4). Unani kept and developed them.

A visit to a hakim starts with questions about your life: food, sleep, work, mood, the season. Then comes the examination. The classic three are the nabz (pulse), the baul (urine, looked at in a glass flask called a qaroora) and the baraz (stool). Ibn Sina described many features of the pulse: its size, strength, speed and rhythm. Hakims use them to judge the patient's mizaj.

Treatment follows a rule called ilaj bil zid, treating by opposites: a “hot” imbalance gets “cold” measures, and so on. It comes in four main kinds:

Ilaj bil tadbeer, regimental therapy: changes to routine, riyazat (exercise), dalak (massage), baths and hijama (cupping). In cupping, a cup is made airless enough to suck the skin up. Dry cupping just pulls. Wet cupping first makes tiny cuts so a little blood is drawn.

Ilaj bil ghiza, diet therapy: foods are classed hot or cold, moist or dry, and chosen to balance you. Ilaj bil dawa, medicines: mostly plant-based, sometimes with animal or mineral parts. Common forms are majoon (a paste in honey or syrup), khamira (a soft confection), sharbat (syrup) and arq (a liquid distilled from herbs, like rose water). A fourth kind, jarahat, is surgery.

Recipes are written down in India's official Unani Pharmacopoeia and National Formulary. Whether the treatments work is a separate question: chapter 5.

Some things the old masters did have lasted. In his Canon, Ibn Sina set out rules for testing a medicine: use it pure, try it on one simple illness, check the effect comes at the right time and happens again and again, and test it in people, not only animals. These are early seeds of the clinical trial. Before him, al-Razi compared patients who were bled with patients who were not, an early kind of controlled comparison. Big hospitals called bimaristans treated rich and poor alike.

The Canon also says some illnesses pass from person to person. You may read online that Ibn Sina invented a 40-day quarantine. That claim is repeated a lot, but historians have not found it in the Canon. The first recorded quarantine was in Ragusa (now Dubrovnik) in 1377, and the word comes from Venetian quaranta giorni, “40 days”.

What did not last was the theory of why we fall ill. Blood, phlegm and bile are real, but there is no “black bile”, and disease is not an imbalance of four fluids. From the 1850s, scientists found that bodies are made of cells (Virchow, 1858) and that many diseases are caused by germs (Pasteur and Koch). Bloodletting, once used for almost everything, was shown to do more harm than good. Modern medicine is built on that newer picture: see MedicineClear, and ImmuneClear for how the body fights germs.

How do we know if any treatment works, Unani or modern? Many people get better anyway, and simply taking something you believe in can make you feel better: the placebo effect. So we need a fair test. Split patients into two groups by chance (randomising), give one the remedy and the other a look-alike dummy (placebo), and make sure nobody knows who got which (blinding). Only the difference between the groups is the remedy's real effect. MedicineClear has a bigger trial simulator.

What trials of Unani show. Ibn Sina asked for careful testing, but good modern trials of Unani medicines are still few. Reviews find most studies are small, and many are not randomised or blinded. A 2024 review of Unani medicines for type 2 diabetes found hopeful results but called for better trials. For cupping, a 2012 review of 135 trials found some possible benefit for pain and a few other conditions, but most trials were of low quality. The CCRUM runs clinical studies, and Indian trials must be registered with CTRI (run by ICMR). Some plants from these traditions did become real drugs: reserpine, a blood-pressure medicine, came from Rauvolfia serpentina (asrol in Unani, sarpagandha in Ayurveda), tested by Indian doctors in the 1930s and 1940s.

Safety. “Natural” does not mean safe. Some kushtas (medicines made by burning metals) contain lead or mercury, and studies of traditional medicines sold in India have found heavy metals above safe limits. Cupping can bruise, and wet cupping with dirty or reused tools can spread infection. Herbs can interact with medicines. In India, Unani medicines are licensed under the Drugs and Cosmetics Act, export batches must be tested for heavy metals, and the Ministry of AYUSH runs a scheme for reporting side effects. The biggest danger is delay: using any unproven remedy instead of seeing a doctor for a serious illness. Its sister systems face the same questions: see AyurvedaClear, HomeopathyClear, SiddhaClear and NaturopathyClear.

Many Indian families use Unani, Ayurveda, homeopathy and modern medicine side by side. That is a personal choice, and it can be made safely if you follow a few rules.

Never stop a prescribed medicine on your own, for example for diabetes, blood pressure, epilepsy, asthma or tuberculosis. Tell every doctor and hakim everything you take, including herbal medicines, because they can interact. For a serious or sudden illness, such as chest pain, high fever in a baby, trouble breathing or signs of stroke, go to a qualified doctor or hospital straight away (in India call 112 or 108). Choose registered practitioners and licensed products, and be wary of anyone promising a cure for everything.

There is real common ground, too. Unani's six essential factors (air, food and drink, movement and rest, emotions, sleep and waking, and what the body keeps and lets out) match much of today's advice on healthy living. The reasons differ: Unani talks of humours, modern science of cells, germs and chemistry. But clean air, good food, exercise, sleep and a calm mind are backed by strong evidence. Indian bodies such as ICMR-NIN, which writes India's dietary guidelines, and NIMHANS give practical targets. Modern medicine has its own limits, like side effects, antibiotic resistance and cost: see MedicineClear.