Tadaabeer-e- Mashaaikh (Geriatric Care)
Ageing (the process of growing old) is a natural process of physical, social and psychological change in multidimensional aspects. The branch of medical science dealing with the care of aged/ older people is called clinical gerontology or geriatrics. It focuses on health care of elderly people or it refers to medical care for the elderly.
The percentage of elderly people has risen from 6.5% in 1991 and 8.3% in 2011 and will be 12% in 2025. It is expected to increase rapidly, approximately from 9.5% in 1995 to 20.7% in 2050. India has thus acquired the label of “an ageing nation.”
According to Tibb-e- Unani philosophy, the people above 60 years of age are considered as mashaaikh (aged/ older people), while in modern medicine geriatric care is concerned with the people aged 65 years and above.
The health issues of the elderly/ aged people are not only restricted to a set of diseases caused at times by abnormalities of motor functions, free radicals, audio-visual degeneration and so on; but they also include major functional incapacitation due to changes in human organs.
The leading causes of death (mortality) among elderly/ aged people comprises of cardiovascular diseases, respiratory system problems, stroke and cancer. Significant causes of morbidity among this group are chronic inflammatory and degenerative conditions such as arthritis, osteoporosis, depression, diabetes, psychiatric disorders, Parkinson’s disease and age-related urinary problems.
Unlike many developed nations, there is no well-structured geriatric health care service cell in India. Lack of this kind of service calls for an urgent action to address the needs of elderly people of India. In the field of geriatrics, we can begin with integrating indigenous systems of health care like Unani medicine with the existing health care structures. Unani system of medicine, due to its holistic approach, has got the potential for prevention of diseases by promotion of health and management of diseases of old age.
In various classical Unani texts, the comprehensive explanation of geriatric care is mentioned under the heading of Tadaabeer-e- mashaaikh. Unani literature has numerous single and compound plant based medicines, herbo- animo- mineral formulations for general wellbeing as well as for disease-specific conditions relating to geriatrics.
Unani concept of Ageing
According to Unani System of Medicine, human life is categorized into four stages viz; Sinn-e- namu (Temperament is hot and wet (Haar Ratab) and is applicable up to the age of 30 years), Sinn-e- shabab (Temperament is hot and dry (Haar Yaabis) and is applicable from 30 to 40 years of age), Sinn-e- kahoolat (Temperament is cold and dry (Baarid Yaabis) and is applicable from the age of 40 to 60 years) and Sinn-e- shaikhookhat (Temperament is cold and wet (Baarid Ratab) and applies to people above60 years of age).
Sinn-e- shaikhookhat (aged/ older people) is the period in which there is diminished quantity of Ratoobat-e- ghareeziya and it is lesser than the quantity required for the preservation of Hararat-e- ghareeziya (innate body heat) for the continuation of normal body metabolism and is dominated by Ratoobat-e- ghareeba bala (abnormal metabolic products). In this period deterioration in the powers and faculties of the body is noticeable. Ratoobat-e- ghareeziya and Hararat-e- ghareeziya are markedly reduced; hence the temperament (mizaj) becomes cold and wet (Baarid Ratab).
As per Unani concept every stage of life has its own specific temperament (mizaj) and Kaifiyat according to their age. Basically, when Kaifiyat changes; temperament (mizaj) is deranged. When mizaj deviates from normal to abnormal path then, it causes premature ageing.
Ratoobat-e- ghareeziya plays a key role in maintaining equilibrium of Hararat-e- ghareeziya. When quantity and quality of Ratoobat-e- ghareeziya changes, it directly affects Hararat-e- ghareeziya. Excessive reduction (tahleel) in Hararat-e- ghareeziya affects in two ways i.e.
All quw’a requires hararat (body heat) for performing afa’al (functions). Deprivation of humours or dryness neutralises ratoobat of the body until it ceases to have a capacity for life. Thus, healthy ageing can be secured by safeguarding of innate moisture from too rapid dissipation, and maintaining it at such a level that the original constitution particular to the person shall not change even up to the last moment of life.
In Unani wisdom, health is totally dependent upon three faculties, which maintain the Harart-e- ghareeziya and regulates all functions of the body. These are as under
When disturbance occur in these faculties, it leads to degenerative changes and finally end of life. When Quwwat-e- nafsaniya is weak, it creates neurological problems such as nisyan (dementia), alzheimer's disease and parkinson’s disease etc.
Quwwat-e- tabai’ya is responsible for the production of pure humours and maintain the balance of Ratoobat-e- ghareeziya and Hararat-e- ghareeziya.
Quwwat-e- haiwaniya is responsible for circulation of blood and protects the body from free radicals. Free radicals also initiate the process of ageing.
Anti- ageing wisdom is not new in Unani medical philosophy, but it is mentioned by ancient Unani scholars in their ancient classical text books like, Firdaus- al- hikmat by Rabban Tabri (810-895A.D), Kitab Al Hawi- fil- Tibb by Zakariya Razi (850-923A.D), Kamil-us-sana’a by Ali Ibn-e- Abbas Majusi (930-999 A.D), Al Qanoon fil Tib by Bu Ali Sina (980-1037A.D), Zakheera khawaarizam shahi by Ismail Jurjaani (1041-1136A.D), Kitab -al-mukhtaraat -fil-Tibb by Ibn-e- hubal Baghdadi (1121-1213A.D), Kitab-al-Kulliyat by Ibn-e- Rushd (1126-1198 A.D), Kulliyat-e-Nafeesi by Allama Burhanuddin Nafees bin Ewaz kirmani (15thcentury A.D) and Akseer-e- Azam by Mohammad Azam Khan (1813-1902A.D).
Modern concept of Ageing
Modern medical science has witnessed enormous advancement and specialization in recent times. The care of elderly people has come up as a specific field now. Medical advancement and improved social conditions during last few decades has improved the life span of human beings.
According to modern philosophy, ageing is a process of gradual, progressive and generalized impairment of functions which results in loss of adaptive response to stress and increased risk of age-related diseases. In western perspective of ageing, there is progressive decline in age-specific fitness components of an organism, due to internal physiological degeneration.
Physiological changes in aged/ older people
Certain physiological changes in body occur during the process of ageing. These include diffuse hair loss, reduced neuron capacity, reduced vision, reduced sense of smell and taste, reduced number of sweat glands, high tone deafness, impaired balance, loss of lung compliance, reduced glomerular filtration rate(GFR), reduced stroke volume, systolic hypertension, postural hypotension, constipation, impaired glucose tolerance, muscle wasting, osteoporosis and osteoarthritis etc.
Pathology of Ageing
Certain factors which play important role by making life of elderly/old aged people difficult are:
Excessive use of the substances which are phlegm producing in nature like milk, vegetables, hareesa, ice water etc.; excessive use of sour foods like curd, tamarind, pickles etc.; frequent use of hammam, excessive coitus, chronic diseases (amraz-e- muzmina) like tuberculosis (sil wa diq), cancer (sartaan), diabetes mellitus (ziabetus shakari). Nervous disorders (amraz-e- a’asab) like epilepsy (sara’), meningitis (sarsaam), sakta, jumood, paralysis (faalij), istirkha weakness of brain (zo’fe dimaagh), inadequate sleep etc. Other important conditions like malnutrition, obesity (siman-e- mufrit), genetic disorders, psychological factors, abnormal temperament (su-e- mizaj) etc.
Similar factors, though operative in other age groups as well, are being well controlled by the body.
Preventive measures to slow down ageing process
Management of Ageing
Geriatric problems are of much concern for medical professionals in present day scenario. More toxic and adverse effect of allopathic medicines is reported in common problems of old age due to altered metabolic activities. Unani medicinal herbs are better in the management of geriatric problems.
The peculiarity of Unani system of medicine is the concept of individualized care with holistic approach. According to Hippocrates, it is more important to know the constitution of a person rather than what disease he is suffering from.
The physiology of aged/ older people is described meticulously in terms of basic fundamentals like temperament, humours, faculties etc. The temperament of elderly persons is described as cold and dry and the proportion of humours in them is considered much different from those of children and young people. It is also asserted that the temperament in aged people is much easily altered by extrinsic and intrinsic influences and reasons. Consequently, the homeostasis (Tabiy’at) of the elderly is also bound to change easily.
Keeping in view of the altered physiology of the aged people, the Unani scholars have discussed the care and treatment of them separately. Regular regimental therapies like blood-letting (Fasad), use of purgatives (Mushil advia), use of strong enemas (Huqna) etc. have been contraindicated in them. While giving drugs, proper calculation of doses is emphasised.
According to Ibn-e- Sina (Avicena) the aged/ older people should have adequate sleep habits and the time spent in bed should be more than what is recommended for adults. Their bowels should be kept soft by avoiding constipation. Continuous use of mild diuretics is beneficial for them. It further mentions that body massage is very effective for elderly when it is applied/ done moderately. Specific exercises for aged/ older people are also prescribed. For example, vertigo, a common old-age problem which can be effectively cured by doing exercises involving the lower half of the body, and by avoiding such ones which involve bending and drooping of head.
Today, it is well established fact that exercise not only benefits various disease/ disorders but it also improves the mood and social interaction as well as reduces insomnia and constipation in elderly patients. With regard to diet, Unani system recommends small amounts of food at frequent intervals for old-aged persons. Milk is beneficial for them only if they can digest it fully and goat’s milk is considered best for them. Vegetables and fruits especially suitable for elderly includes cabbage, carrot, green-leafy vegetables, grapes, citrus fruits, cherry, green tea etc. The use of garlic is also regarded as beneficial for them. In the light of modern research, it is now known that anti-oxidants play as vital role in maintaining health during old age. Various anti-oxidants like Beta carotene, Vitamin C, Bioflavonoids, Indoles, Polyphenols and ellagic acid are present in the above recommended fruits and vegetables.
The unique Unani concept of organ-specific tonics is much relevant in elderly people than in any other age group. There is a vast list of such drugs, which are very much effective, and form an important part of geriatric treatment. Few of such drugs are, Jawarish Jalinoos, Majoon Falasfa, Khamira Gaozaban, Khamira Abresham, Khamira Marwarid, Majoon Azaraqi, Sharbat Faulad etc. Numerous common old-age complaints like insomnia, lethargy, constipation, and backache etc. can be effectively managed by these drugs.
It must be borne in mind that the major part of geriatrics is essentially concerned with the preventive medicine. Ageing is natural and confronting nature is never a positive step. However, various problems associated with this age can be controlled to a large extent. To sum up, it is a well-recognized fact that there is high incidence of drug related unexpected side effects in elderly, owing to their altered physiology. Moreover multiple pathology, sensory deficit, psychiatric disorders and intercurrent drug treatment interact to, both modify and mask the typical features of diseases in elderly. It is where the role of Unani system of medicine comes into play.
The regimes and drugs (single and compound) which are described by Unani Scholars in their old classical text for the management of ageing which are now scientifically proved (antioxidant, immune-modulator, nephro- protective, cardio- protective, hepato- protective, anticancer, nootropic activity etc.), as they delay the process of ageing and promote to maintain balanced health.
Most of the neurodegenerative disorders are cross-linked with a number of age -related conditions (Dementia, Insomnia, Alzheimer’s, Parkinson’s, Zofe Dimagh, Falij, Laqwa, Istirka, etc). So, most of the nootropic murakkabat (Majoon Baulas, Mojoon Waj, Majoon Falasafa, Jawarish Jalinus, Itriphalat etc.) mentioned by Unani scholars in their text are rewarded for delaying the process of aging.
Unani Atibba also mentioned the medicament, which delay the process of ageing and balance the health, are from three broad origins viz; Plant origin, Mineral origin and an Animal origin. These drugs are mostly Haar mizaj except Amla (which has Barid Mizaj) and most of the drugs have been proved as antioxidant, immune-modulator, nootropic, anticancer, free radical scavenging, Kaya Kalp/ Rasayain/ Aabe Hayat/ Elixir of life/ Iksir-e-Badan.
Ageing and recommended therapeutic regimes
Unani scholars described different regimes (Tadaabeer) for the care of elderly/ old aged people (mashaaikh) (i.e. Riyazat, Dalk, Hammam, Nutool, Hijama, Fasd) and their management through drugs of plant, animal and mineral origin, which may delay the process of ageing.
Ageing and Recommended Single Unani Drugs
A number of single and compound drugs like Amla, Zanjabeel, Asgandh, Honey, Garlic, Zafraan, Kalonji, Elwa, Tiryaq-e- wabaai, Majoon falasfa etc. are the categories possessing such effects are frequently used in Unani medicine and are proven now to have anti- oxidant and immune- modulator properties. Scientific studies revealed that, antioxidants drugs have definite role in the prevention of geriatric diseases. Some common single drugs with proven efficacy are:
Drugs of Botanical/ Herbal origin
Drugs of Animal origin
Drugs of Mineral origin
Ageing and Recommended Compound Unani Drugs
Some common compound drugs with proven efficacy are enlisted here:
Murakkabat (compound drugs) which delay the process of ageing are Itriphal Ustokhuddus, Itriphal Sagheer, Itriphal Kabir, Itriphal Kishneezi, Majoon Waj, Majoon Bladur, Majoon Barhami, Majoon Bolas, Majoon Falaasfa,Majoon Atyab, Jawarish Jalinus, Tiryaqe Farooque, Tiryaaq-e- Wabai, Khamira Gaozaban Ambari Jawahar wala, Khamira Gaozaban Sada, Habb-e-Azaraqui and Anooshdaru etc.
Ghiza-e-Tadabeer in mashaaikh (contrivances of diet in aged/ older people)
Unani physicians have suggested certain principles about the Ghiza (Diet) of aged / older people. They have suggested that, it should be according to their Mizaj (temperament). Frequent meal but small in quantity is recommended by them. They believe that different types of food should be given to aged / older people, but the quantity and quality of diet should be according to their digestive capacity.
The digestive faculty of old age persons is weak and physical work is also minimal, so they should take less amount of food. Ghaleez diets which are poor to digest like Hareesa, khushk gosht, tanoorki roti, Masoorki dal etc. are better to be avoided, because they may lead to Istisqa (Ascitis) and Hisat-e-Masana (Urinary bladder stone). Viscous, tenacious and flatulence yielding diet should be avoided.
Secretion from the stomach and intestine must be excreted out by using mild laxatives. Beet root and spinach are specially advised in meals as these are good laxatives. Green Vegetables like Kasni, Kahu, Khabbazi, Chuqandar, Zanjabeel may be advised. Garam Murrabah and fruits like Injeer, Akhrot, Badam, Angoor, Toot, Munaqqa are also very useful in this age group.
Regarding non vegetarian diet, chicken or goat meat is recommended. As per recommendations of Unani scholars, diet should be taken after Hammam (bath). Use of little amount of honey, milk, rice and dates along with diet is also recommended in this age group. The food items known to eliminate Ratoobat from intestine are advised. Milk is recommended for nutrition and Tarteeb (moistness). Hot temperament Murabba (a semisolid compound preparation) is also recommended. In fruits category, figs and Alu Bukhara are advisable. Beet root and Barley water are the best diet for mashaaikh.
Avoidance of Moallid-e- balgham wa Sauda diet (Phlegm and black bile producing diet) is highly advisable. These people are also advised not to drink water immediately after and during meal. They are strongly advised to take their meal at the time of hunger only. If they have both salty and sweet diet in front of them, salty diet should be taken first. It is mentioned in classical texts that one should not enforce the tabiyat for meal.
Diet should be according to their physiology. For better sleep, moist and hot diets are advised. Sleeping should be avoided empty stomach, as it causes dryness in the body. Unani physicians also recommended the use of moist diet in case of excess dryness in the body. If the digestion of Mashaikh is good, diet should be taken in small quantum and identical. Sour diet causes early maturity, so should be avoided. Innate energy and digestion are weak in Mashaikh. In winter, hot and wet diet is prescribed. For preservation of health of Mashaikh, good, nutritive and digestible diet should be given; and property and proportion of diet should be maintained to moderate amount.
Syrup made up of honey is very useful as it prevents obstruction and joint pains. Use of garlic and onion, zanjabeel and haleelah is advised in this age group, as these have the quality to restore hararat-e- ghareezia.
Prescribed Dietary supplement
The dietary food supplements which are prescribed in Unani classical texts and recommended by Unani scholars are listed here.
Prescribed Food supplements
In food items, Honey, Milk, Meat of chicken and lamb, Olive oil, Small size fish are very useful.
Prescribed Fruits and dry fruits
Muskmelons, Grapes, Haleelah, Walnut, Almond, Mulberry, Large Raisins (Vitis), Prunus, Dates etc. are very effective.
Prescribed Vegetables and Cereals
A lot of vegetables and cereals are mentioned in Unani classical texts like Beet root, Spinach, Rice, Barley, Garlic, Onion, Ginger, Pistacia Galls (Kasni), The Lettuce (Kahu), Common Mallow, Black pepper etc.