Non communicable diseases (NCDs) are the group of diseases which remain restricted to the affected person only. Various diseases like Atherosclerosis, Myocardial infarction, COPDs, Diabetes, Obesity etc are included in NCDs. According to Unani system of medicine replenishment to the body is provided by Quwwat Ghādhiya (Nutritive faculty) and its four assisting Quwā i.e Quwwat Jādhiba (Absorptive faculty), Quwwat Māsika (Retentive faculty), Quwwat Hāḍima (Digestive faculty) and Quwwat Dāfi‘a (Expulsive faculty). These Quwā are served by Kayfiyāt Arba‘a (Four qualities) i.e Ḥarārat, Burūdat, Ruṭūbat and Yubūsat. So any deviation in these Kayfiyāt Arba‘a may lead to NCDs. NCDs are endogenous in origin and their causes may primarily or secondarily be related to the diet. The diet is never absolute. During Haḍm ‘Uḍwī , Quwwat Ghādhiya takes only required nutritive substances from it and remaining parts are excreted from the body in the form of Fuzlat (waste materials). The nature and duration of NCDs depends upon the nature of these Fuzlat. When Fuzlat accumulate in any organ, swelling may result e.g Waram al-Kabid (Hepatic swelling). Ṭabī‘at may divert the fuzlat to other organs of the body to decrease the Imtilā (Congestion) and protects the body from harmful effects. Various skin disorders like Taqashshur al-Jild (Psoriasis), Mental disorders like Sahr (Insomnia), Mālankhūliya (Melancholia) etc are because of Fuzlat and are included in NCDs.

Keywords: haḍm ‘uḍwī, kayfiyāt arba‘a , Ncds, prevention, quwā

Non communicable diseases (NCDs) are the group of diseases which remain restricted to the affected person only and does not transmit to other people either directly or indirectly.¹ All categories of diseases except infectious diseases come under the heading of NCDs e.g. Metabolic diseases, Endocrinal diseases, Neoplastic diseases and Nutritional diseases.² In terms of social medicine, the disease considered as NCD when the number of cases are significant and the cost of treatment is also considerable. Some of the important NCDs are Cardiovascular diseases- (Coronary artery disease), Hypertension, Obesity, Cancer, Diabetes mellitus, Blindness, Dyslipidaemia, COPD, Osteoporosis and Goitre.^2,3 Apart from these, there are number of diseases which are limited to the affected person but their incidence is quite low.

Now a days, increasing incidence of these diseases and their complications have greatly affected the world and tragedy is that there is no satisfactory treatment for these diseases and their complications. These patients impose a great economic burden on society and the country.⁴ Because of this, the government of every country is focused on preventing these diseases and taking all the possible steps towards this. Experts of every medical system are also attracted to provide satisfactory solution for containment of these diseases. The unani medicine also has a role to play in this matter. First of all, it is very important to understand the pathological unani perspective of these diseases.

 Disturbances in the Asbāb Sitta Ḍarūriyya Wa Ghair Ḍarūriyya (Six essential factors and modifiable factors), mentioned in the unani system of medicine, are the definite cause for NCDs.^5,6 Because these are the efficient causes and are responsible for maintaining the proper temperament of the body.^7,8 Therefore, any disturbance in them causes altered temperament, if this is not corrected, the remaining Umūr Ṭabῑʻiyya (Factors of the existence) are also affected as well.^9,10 In fact, life style means how a person is practicing Asbāb Sitta Ḍarūriyya Wa Ghair Ḍarūriyya (Six essential factors and modifiable factors) in his or her daily life. Thus, all the life style disorders are associated with these causes.⁵ Since Asbāb Sitta Ḍarūriyya are efficient cause for the body and temperament, therefore they affect the body as well as Mizāj (Constitution or Temperament) and Quwā (Faculties).¹⁰

Any disturbance in these causes mainly affects the Ḥarārat Gharīziyya (Innate heat), which is a common tool for the Ṭabī‘at (Medicatrix naturae) and Quwā (Faculties).^8,9 When Mizāj (Constitution or Temperament) changes it directly affects the Quwā.¹¹ Thus, Quwā do not perform theirs functions properly. First of all, Quwwat Ṭabī'iyya (Natural faculty) is affected which secondarily affects the remaining two Quwā i.e. Quwwat Ḥaywāniyya (Vital faculty) and Quwwat Nafsāniyya (Mental faculty).¹⁰ Therefore, diseases produced due to disturbance in Asbāb Sitta Ḍarūriyya are related with the alteration in Afʻāl Ṭabī'iyya (Natural functions), Afʻāl Haywāniyya (Vital functions) and Afʻāl Nafsāniyya (Mental or Psychic functions). These altered functions depend on age, sex, Mizāj, susceptibility, strength of cause and duration of contact. All are not affected equally.

The two basic functions of Quwwat Ṭabī'iyya (Natural faculty) are nutrition and reproduction.^11,12 It is not necessary that both the functions are equally affected by the impairment of Quwwat Ṭabī'iyya. The disturbance in Fi'l-i- taghdhiya (Function of Nourishment) appears first which later on affects the functions of Quwwat Nafsāniyya and Ḥaywāniyya.¹⁰ In terms of susceptibility, sometimes diseases of nervous system and vital organs appear first. Whereas the defect in the Fi'l-i- taghdhiya (Function of Nourishment) does not appear or is not noticeable.

Ghidha (Diet)provide materials that are used by Quwwat ghādhiya (Nutritive faculty) to perform the Fi'l-i-Taghdhiya-o-Tanmiya (Function of Nourishment and growth).^9,13,14 Ghidha affects the body by two things i.e. by its Kamiyat (Quantity) and Kaifiyat (Quality).^8,10,14 The balance of Akhlāṭ (Humours) in body specially depends on the Ghidha (Diet). Because Akhlāṭ are produced from Ghidha during Haḍm kabidī (Hepatic digestion).^11,15 The Ḥarārat (Heat) of liver acts on ghidha, different components of ghidha accept the act of heat differently.^10,15 The Ḥarārat Mu‘tadila (Moderate heat) of liver when acts on Ḥārr Raṭb (Hot and moist) components of ghidha then it forms Khilṭ Dam (Blood).^9,10,11,15 Similarly, Ḥārr Yābis (Hot and dry), Bārid Raṭb (Cold and moist), Bārid Yābis (Cold and dry) components form Khilṭ Ṣafrāʼ (Yellow bile), Khilṭ Balgham (Phlegm) and Khilṭ Sawdāʼ (black bile) respectively.^9,11,13,15 Increase in this Ḥarārat causes the production of more Khilṭ Ṣafrāʼ while its decrease is responsible for the production of Khilṭ Balgham.¹⁵ In this way the proportion of Akhlāṭ (Humours) deteriorates.¹⁰

During the process of Haḍm (Digestion) undigestible components accumulate in the body in the form of wastes. The quantity of these Fuzlat (Wastes) depends upon the Kayfiyat (Quality) and Kamiyat (Quantity) of ghidha.⁸ Bad quality of food and excess intake of food increase the production of Fuzlat. If their volume exceeds the capacity limit of Quwwat Dāfi‘a (Expulsive faculty), they begin to accumulate in the body.¹¹ The portion of food that is not digested is also in the same category. Anyhow part of diet beyond upper limit of Quwwat Hāḍima (Digestive faculty) and wastes over the capacity of Quwwat Dāfi‘a (Expulsive faculty), suppress the Ḥarārat Gharīziyya (Innate heat) and because of their quantity causes Burūdat (Cold).^10,14 After a duration, the Mizāj of the body becomes Bārid and gradually the symptoms of dominance of Burūdat (Cold) on the body begin to appear.^9,12,16 Māddi Amrāḍ (Materialistic diseases) also begin to appear due to the Fuzlat (Wastes) of the body.⁸ If these materials get infected then Ufooni Amrāḍ (Infective diseases) appear.⁸

Similarly, A’itadal (Moderation) in other Asbāb Sitta Ḍarūriyya (Six essential factors) like Ḥarakat-o-Sukūn Badnī (Bodily movement and Repose), Ḥarakat-o-Sukūn Nafsānī (Psychic movement and Repose), Nawm-o-Yaqẓa (Sleep and Wakefulness) are also responsible for maintenance of Ḥarārat Gharīziyya (Innate heat).^5,7,8,11 These Harkāt (Movements) cause Ḥarārat (Heat) to rise which not only causes dissolution of Mawād (Matter) but also, are responsible for excellent performance of Quwā.^{5,7,8,9,17,18} Excess of Ḥarakat Nafsānī & Yaqẓa or increase in Nawm and decrease in Ḥarakat Badnī increase Burūdat in Mizāj and decrease in dissolution which lead to the accumulation of Mawād, which becomes an additional factor to reduce the Ḥarārat (Heat).^7,15 Reduced dissolution and elimination cause retention of Mawād (Matter) and consequently Ḥarārat declines.^8,9,17 In this way, Burūdat (Cold) becomes dominant due to imbalance in Asbāb Sitta Ḍarūriyya.^9,12,16 If this Burūdat persists for a long, its effects begin to appear.⁸ These effects depend on the body’s Mizāji (Temperamental), Saakhti (Structural), Jinsi (Gender), Nizāmi (Systemic) susceptibilities.¹⁰ Their prediction is not easy but overview of effects is possible.

Burūdat is Kayfiyāt Fāʻila (Active property) therefore, it acts upon the Fuzlat (waste) and Ruṭūbat.¹⁰ If Ḥarārat (Heat) acts on Ruṭūbat Ṣāliḥ (Healthy moisture) then it converts them into Laḥmiyāt (Proteins) but if Burūdat (Cold) acts then they are converted into Shaḥmiyāt (Fat). The fat accumulates in the body when Ruṭūbat (Moisture)and Burūdat exist together.^9,12,16 Shaḥm (fat) itself is a cause of Burūdat and its maintenance. In this way the amount of fat increases. Initially Ṭabī‘at (Medicatrix naturae) starts to deposit this fat on Bārid A'ḍā' (Cold organs) and then as the others organs get affected by Burūdat, the fat accumulates on them.^9,12,16 Ṭabī‘at (Medicatrix naturae) send the excess amount of fat to skin. This causes the accumulation of fat to begin below the skin, and it grows continuously which is the beginning of becoming fatty.

Excessive amount of fat makes lumen of the vessels narrow. At the same time, the effects of Burūdat cause them to constrict which in turn reduces the supply of Rūḥ (Pneuma) to certain organs.¹⁴ Because of this Burūdat, Rūḥ (Pneuma) also becomes Ghaliz (Viscous), so the Rūḥ (Pneuma) does not pass easily through narrow paths. Organs like brain and heart are affected most by decreased supply of Rūḥ (Pneuma). The functions of heart are related with Ḥarārat.¹⁴ When Burūdat affects the heart, it can cause death immediately. If brain is involved then diseases like Falij (Paralysis), Laqwa (Facial palsy), Khidar (Numbness) may occur.

Because blood is the carrier of both Rūḥ (Pneuma) and Ḥarārat Gharīziyya (Innate heat) and supplies Ḥarārat (Heat) and Rūḥ Ḥaywānī (Vital pneuma) to the whole body.^14,19 So, when the Burūdat and Ruṭūbat in the body becomes predominant, then vessels get constricted and if there is too much fat in the body, the vessels become narrower/ compressed due to excess fat.¹⁰ This process not only affects the blood vessels but also nerves, which makes the supply of Rūḥ Nafsānī (Psychic pneuma) difficult or block it. So, the heart pumps blood into the vessels with a greater force to maintain the supply of Rūḥ (Pneuma) and blood. The Quwwat Ḥaywāniyya Fāʻila (Active vital faculty) of heart increases, which in turn increases the process of contraction and relaxation of arteries and this condition is known as Ḍaghṭ al-Dam Qawi (Hypertension).⁹

Quwwat Ṭabī'iyya (Natural faculty) is affected more by Burūdat (Cold) which weakens the process of digestion and assimilation. Since the Haḍm ‘Uḍwī (Organic Digestion) also declines.¹² Therefore, the A'ḍā' (organs) are unable to use the ghidha and this ghidha is accumulated in the spaces and vessels of the organs.²⁰ Now this diet is also included in the Fuzlat (Wastes) because Ṭabī‘at (Medicatrix naturae) is not acting upon it. So, the Quwwat Dāfi‘a (Expulsive faculty) tries to expel it.^12,15 Because of Burūdat (Cold) of liver the Kaymūs (Chyme) does not go through further processing therefore, Akhlāṭ Khām (Immature humours) increases in the body.^10,15

If there is Lazoojat (Adhesiveness) they become attached to the walls of cavities and vessels. Narrowing them it decreases the supply of blood and Rūḥ Ḥaywānī (Vital pneuma), causing a variety of complications/ disorders.¹⁰ This is the beginning of cardiovascular and neurovascular diseases. Circulating and delivered unprocessed Kaymūs (Chyme) cannot be digested, which leads to compositional deterioration of humours and the proportion of undigested and unprocessed components in blood increases.¹⁰ Now a days same is called as dyslipidaemia, hyperglycaemia, hypercholesterolaemia and hypertriglyceridemia.²¹

From the above discussion it is clear that when Sū-׳i-Mizāj Bārid (Impaired Cold Temperament or Constitution) occurs.⁸ It affects various organs of the body and body becomes full of Mawād (Matters). Ṭabī‘at (Medicatrix naturae)tries to expel these substances. When joints accept these Mawād (Matter), joint pain occurs. When they accumulate in a particular organ, different type of Awrām (Swellings) occur.^5,10 Becoming infected these Mawād (Matters) form abscesses.¹⁰ When they turn to the uterus, they cause menstrual disorders. The uterus is unable to nurture the zygote consequently zygote doesn’t retain and infertility result.^5,14

In this way the Burūdat affects the whole body. All the organs are more or less affected. The Quwā become weak and Ḥarārat Gharīziyya (Innate heat) drops.¹⁰ The supply of Rūḥ (Pneuma) becomes difficult. Affected one cannot reach expected age and premature death occurs.^12,14,18

After understanding the pathogenesis, the prevention of these diseases can be discussed. Prevention from NCDs especially metabolic diseases depends on the following;^5,10

1. Keeping the Ḥarārat Gharīziyya (Innate heat) at optimum level and trying to increase it.
2. Keep the body free from Fuzlat (Waste materials).
3. Moderate practice of Tadabeer Muhallilah (Dissoluting measures) in moderation.
4. Monitoring of humours and wastes production.

Body movements are important to keep innate heat aroused and help to increase it.¹⁰ Moderate mental activity and sleep also play an important role.¹⁰ Apart from these, if other causes such as Riyāḍat (Exercise), Ḥammām (Turkish Bath), Dalak (Massage), Sun bath etc.^14,22 taken in moderation the body does not lose Ḥarārat (Heat) and remains protected from the effects and complications of Burūdat (Cold).^9,12,16 These measures also facilitate the process of dissolution. Due to this dissolution, substances are released from the body in the form of vapours and sweat.^8,16 The heat makes the substances Lateef (Light weight),¹² which makes the action of Ṭabī‘at (Medicatrix naturae) easy on them and repulsive faculty, expel them through the easiest way.^5,9,12

Quwwat Ṭabī'iyya (Natural faculty) becomes strong due to preserved heat and dissolution of wastes and it acts well on food which reduces the production of wastes and food is well digested and assimilated, the rest of the faculties remain strong.⁸ By which Ṭabī‘at (Medicatrix naturae) performs all its functions well and health is maintained.

Since wastes are produced from food hence maintenance of health and treatment of disease depend on modulation in diet. In terms of Kamiyat (Quantity) the diet should be proportional to the dissolution.^10,14,23 If there are Fuzlat (Wastes) in the body, then food that produce these Fuzlat should be avoided.^10,20 Unani physicians have suggested dieting to protect health and prevent the production of wastes which is very effective method. In short, in case of predominance of certain humour, avoiding the humour producing food and intake of quality moderating food restores the healthy proportions of humours and thereby health.¹⁰

Measures to protect against NCDs such as Tadabir Muhallila (Dissoluting measures), taqleel tadabir (Dieting), heat inducing measures are to be taken in moderation. Moderation in practice of Asbāb Sitta Ḍarūriyya Wa Ghair Ḍarūriyya Ghair madhada (Six essential factors and modifiable factors) is a guarantee of protection from NCDs and also from their progress.^5,6,9,22

None.

This research did not receive any specific grant from funding agencies in the public, commercial or non-for-profit sectors.

None.

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