Efficacy of wet cupping in the pain management of cervical spondylosis - A randomized, controlled, open -label, parallel-group clinical trial.

BACKGROUND AND OBJECTIVE: Cervical spondylosis is a chronic degenerative process of the cervical spine characterized by pain in neck, degenerative changes in intervertebral disc and osteophyte formation. Cervical spondylosis is translated as Waja' ur Raqaba, a type of joint pain. The present study was aimed to evaluate the effect of wet cupping in the pain management of cervical spondylosis. METHODS: This Open, randomized, controlled, clinical study was conducted on 44 patients. Subjects in the test group (n = 22) received a series of three-staged wet cupping treatment, performed on 0, 7th and 14th day. Subjects in the control group (n = 22) received 12 sittings of Transcutaneous Electrical Nerve Stimulation (TENS): 6 sittings per week for two weeks. The objective findings of treatment were assessed with the help of VAS, Neck Disability Index (NDI) and Cervical range of motion. RESULTS: Intra group comparison in test group from baseline to 21st day were found highly significant (p < 0.001) in terms of VAS, NDI, Flexion, Extension and Left rotation score. While in Right rotation, Left rotation and Left lateral flexion score were found moderately significant (p < 0.01). Statistically significant difference was observed between two groups at 21st day in VAS scale, NDI, and Cervical range of motion score (p < 0.001). INTERPRETATION AND CONCLUSION: Hijama Bish Shart was found better in the management of pain due to cervical spondylosis than TENS. It can be concluded that Hijama Bish Shart may a better option for the pain management of cervical spondylosis. CLINICAL TRIAL REGISTRATION: The trial was registered on clinical trial registry website (www.ctri.nic.in) bearing a CTRI Number, CTRI/2020/03/024,249.

Application of hot medicated fomentation for pain alleviation in non-specific low back pain - A randomized controlled clinical trial.

BACKGROUND: Non-specific low back pain is a leading contributor to disease burden and works absenteeism worldwide with a lifetime prevalence of 60-70% in industrialized countries. This clinical study aimed to assess the efficacy of hot fomentation with half-baked medicated bread (khubz) compared to hot water bag fomentation to alleviate pain and disability in non-specific low back pain. METHODS: In this randomized-controlled study, fifty-four patients with low back pain were randomly assigned into two groups to receive either hot fomentation (Takmid-e-haar) with half-baked medicated bread in the test group or hot water bag fomentation in the control group, on the lumbosacral region daily for 30 min for 15 consecutive days. Patients were assessed statistically using the visual analogue scale (VAS) and Oswestry disability index (ODI) at baseline, 7th and after treatment (15th day). RESULTS: After the intervention, statistically significant improvements (p < 0.001) were observed in VAS and ODI scores in both the groups on the intragroup comparison. The test treatment showed better efficacy in comparison to the control treatment with a mean difference of 1.75 in VAS (p < 0.0001) and 8.20 in ODI (p = 0.001). CONCLUSION: The tested intervention showed significantly better efficacy in comparison to the hot water bag fomentation probably due to the analgesic (musakkin-i-alam), anti-inflammatory (muhallil-i-awram), and demulcent (mulattif) properties of the ingredients of tested Unani formulation in addition to the effects of heat. It may therefore be concluded that medicated fomentation is an effective, safer, feasible, and less expensive regimen for patients with non-specific low back pain. TRIAL REGISTRATION: The Clinical Trials Registry-India (CTRI/2020/03/024107).

Effect of soft and prolonged Graeco-Arabic massage in low back pain - A randomized controlled clinical trial.

BACKGROUND: Low back pain (waja-uz-zahr) due to lumbar spondylosis affects approximately 60-80% of the population at any point of life. The present study was aimed to evaluate the efficacy of soft and prolonged massage with roghan-i-suranjan on low back pain. MATERIAL AND METHODS: Clinically and radiologically diagnosed patients of low back pain were randomized into test and control groups consisting 20 patients in each group. The patients in test group received soft and prolonged massage with roghan-i-suranjan; while, in control group, short wave diathermy was given on every alternate day up to 20 min for 3 weeks. The patients were assessed before and after the treatment using the VAS and ODI (OLBP) scales. RESULTS: VAS score was reduced to 42.14%, (p < 0.001) in massage and 13.94%, (p < 0.008) in control group after the treatment [Percentual Change (PC) between the groups = 54.35%, p < 0.001]. OLBP score was improved to 37.16% (p < 0.001) in massage and 5.93% (p < 0.0012) in control group after the treatment [PC between the groups = 29.57%, p < 0.02]. CONCLUSION: Apart from the muhallil-i-awram (anti-inflammatory), mulattif (attenuative), daf-i-alam (analgesic), and musakkin (sedative) activities of the tested-drugs, the specific strokes soft and prolonged massage further enhances the evacuative and rejuvenative process through its own action of tahleel (dissolution), talteef (attenuation), taskeen (sedation), and taskheen (diaphoresis) induced by the various manipulations used in this massage. Soft and prolonged massage with tested oil was found effective in reducing the pain and improving the quality of life in the patients of low back pain.

Efficacy of Hammam-i-yabis (dry bath) in metabolic syndrome: a single arm, open-labelled clinical trial.

OBJECTIVES: This study intended to evaluate the efficacy of Hammam-i-yabis (dry bath) in metabolic syndrome as primary objective and perceived improvement and changes in quality of life as secondary objective. METHODS: The study was designed as single arm, open-labelled, pre and post without control clinical trial comprising 30 diagnosed cases of metabolic syndrome belonging to 20-50 years of age of either sex. The enrolled patients were exposed to the dry heat of Hammam-i-yabis for 15 min at a temperature of 60 degree centigrade on every third day for a duration of 30 days (a total of 10 sittings). Objective parameters comprising systolic and diastolic blood pressure and waist circumference were assessed on every follow up, while other objective parameters (FBS, HDL and Serum Triglycerides) were assessed before and after the study. RESULTS: Significant statistical difference was observed in objective parameters. Two tailed paired Student's t-test, (for pre and post) and repeated measure ANOVA (for 0, 15th and 30th day) were used to find the significance of mean change in study parameters. No significant adverse change appeared in safety parameters. CONCLUSIONS: Hammam-i-yabis was found effective, safer, more feasible and less expensive regimenal modality for the patients of metabolic syndrome.

Rationalistic approach in COVID-19 prevention through intervention of Unani medicine prevalent in epidemic - A review.

INTRODUCTION: A novel coronavirus virus (2019-nCoV) emerged in China in December 2019 and achieved a high-risk category by the World Health Organization (WHO). The initial symptoms included fever, cough, dyspnea, and sore throat. The present review aims to evaluate the available evidence for the safety and efficacy of Unani herbal drugs and formulations in the prevention of Wabai Amraz (epidemic diseases) having resemblance to SARS-CoV-2. METHODS: Sources of data for this paper are classical Unani textbooks, Unani pharmacopeia of India, Indian Medicinal Plants-An Illustrated Dictionary, and published articles in various reputed peer-reviewed journals. Collected information was then critically analyzed. RESULTS: Despite great efforts, no specific treatment has been discovered for coronavirus yet. The best choices, therefore, are prevention and management. The Unani system of medicine offers health protection during epidemics. Three important interventions practised during an outbreak are (i) purification of the environment by using certain herbal drugs as fumigants which include vinegar (acetic acid) alone or combined with Ferula foetida Regel; (ii) promotion of health and immune modulation by using the pharmacopoeial preparations Khamira-e-Khashkhash and Khamira-e-Marwareed. CONCLUSION: Several single drugs, as well as compound formulations, have been recommended in Unani medicine for the prevention and treatment of infectious diseases. The pharmacopoeial preparation Tiryaq-e-Nazla has been used for respiratory catarrhal inflammations and influenza by Hakims of the medieval period. Scientific research on these drugs reveals the presence of many pharmacologically active substances possessing significant antiviral, antipyretic, anti-tussive, and immune-modulatory properties, which can give new insight into infection and epidemic management.

Effect of gliding cupping with Roghan-e-Surkh in low back ache (Waja-uz-Zahr): a case series study.

OBJECTIVES: Pain in joints is a major clinical problem since ancient times. Waja-uz-Zahr stands for low back pain which may arise from internal or external structures of lumbosacral region due to Su-e-Mizaj sada or maddi due to the surplus of Burudat or accumulation of Kham Balgham in lower back. Imala (diversion) and Taqiya-e-Mavad (Evacuation) are inevitable in case of maddi amraz. Hijama (cupping therapy) is a simple, safe, tolerable, and effective regimenal modality, helpful in the treatment of aches and pains. Gruner mentioned a special kind of cupping method in the canon of medicine of Avicenna where cupping glasses are glided over a specified area of body intending the diversion of morbid material under the name of Bier's treatment. The purpose of present case series was to provide the insight into the effect of gliding cupping in low back ache. CASE PRESENTATION: Three patients of Waja-uz-Zahr, aged between 29 and 64 years, were given gliding cupping treatment after the application of Roghan-e-Surkh on lumbosacral region alternatively for 14 days. Oswestry disability index (ODI) and visual analogue scale (VAS) were used for the assessment of efficacy. Improvement, in case 1, case 2, and case 3 in ODI score was 42.42, 68.18, and 62.50%, respectively while in VAS score, it was 50, 62.5, and 50%, respectively, was observed without any adverse effect. CONCLUSIONS: On the basis of the above results, it can be concluded that the gliding cupping therapy may be used as an effective modality of treatment for low back ache.

Effect of dry cupping versus soft and prolonged massage in the management of knee osteoarthritis - a randomized controlled clinical trial.

OBJECTIVES: Osteoarthritis is one of the most common musculoskeletal diseases which leads to functional decline and loss of quality of life. Knee osteoarthritis is considered as highly burdensome disease as well as highest contributor to global disability. Hijamah (Cupping Therapy) and Dalk (Massage) are claimed effective in the treatment of Waja'ul Mafasil (osteoarthritis). Present study was framed to compare the efficacy of Hijamah bila Shart (Dry Cupping) and Dalk-i-Layyin Kathir (soft and prolonged massage) with Roghan-i-Babuna (chamomile oil) in the management of Waja' ur Rukbah (knee osteoarthritis). METHODS: In present randomised controlled clinical trial, a total of 48 diagnosed patients of knee osteoarthritis were allocated randomly into group A (n=24) and group B (n=24). Group A was treated with soft and prolonged massage with Roghan-i-Babuna while group B was managed with dry cupping on alternate day for 15 min. Visual Analog Scale (VAS) and Knee osteoarthritis outcome score (KOOS) were used for the assessment of efficacy. A total of 40 patients, group A (n=20) and group B (n=20), were completed the allocated duration of protocol therapy and were restricted to statistical analysis. RESULTS: Statistically highly significant improvement was observed in objective parameters using both paired and unpaired t-tests. VAS and all KOOS subscales were found to be strongly significant at 20th day when compared with baseline (p<0.001). In intergroup comparison significant change (p>0.05) was not observed. Safety parameters were in their normal range after treatment. CONCLUSIONS: Dalk-i-Layyin Kathir with Roghan-i-Babuna and Hijamah bila Shart both were found safe and effective in the management of Waja'ur Rukbah. Hence, it may be concluded that both regimenal therapies are safe, effective and almost equal in their efficacy in the management of Knee Osteoarthritis.