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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 2  |  Page : 33-40

Principles and practice of Faşd (venesection) in Unani/Greco-Arabian medicine


1 Department of Ilaj Bit Tadbeer, School of Unani Medical Education and Research, Jamia Hamdard, New Delhi, India
2 Hakim Ajmal Khan Institute of Literary and Historical Research in Unani Medicine, New Delhi, India

Date of Submission04-Nov-2018
Date of Acceptance06-Nov-2018
Date of Web Publication12-Dec-2018

Correspondence Address:
Dr. Mohd Fazil
Hakim Ajmal Khan Institute of Literary and Historical Research in Unani Medicine, Jamia Millia Islamia Campus, New Delhi - 110 025
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijas.ijas_13_18

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  Abstract 


Unani or Yunani medicine, also referred to as Greco-Arabian medicine is a complementary system of medicine which originated in ancient Greece. According to Unani medicine, there are six essential factors which are responsible for the maintenance of health and any disruption in them may lead to disease. Ilāj bit Tadbīr (regimental therapy) encompasses regimes that attempt to correct this disruption and help the body to restore itself. Faşd (venesection) is a part of Ilāj bit Tadbīr which involves blood-letting by placing an incision in specified veins. It is prescribed as a minor excretory procedure which has both preventive and therapeutic benefits. Faşd has manifold benefits including istifrāgh (excretion) of wastes, removal of imtila (plethora), and reduction of viscosity of blood. Hence, if carried out according to guidelines, it serves as an effective treatment modality in many local and systemic disorders. The present review aims to present the principles and guidelines of faşd in light of traditional Greco-Arabian medicine.

Keywords: Ilāj bit Tadbīr, istifrāgh, phlebotomy, Unani medicine


How to cite this article:
Nikhat S, Fazil M. Principles and practice of Faşd (venesection) in Unani/Greco-Arabian medicine. Imam J Appl Sci 2018;3:33-40

How to cite this URL:
Nikhat S, Fazil M. Principles and practice of Faşd (venesection) in Unani/Greco-Arabian medicine. Imam J Appl Sci [serial online] 2018 [cited 2019 Jun 16];3:33-40. Available from: http://www.e-ijas.org/text.asp?2018/3/2/33/247317




  Introduction Top


Unani medicine is a healing art and science whose origin can be traced back to ancient Greece, known as Yūnān previously, and hence termed as Unani or Yunani medicine. The system of medicine originated in ancient Greece and was later on developed and established by Arab and Persian scholars; hence it is also referred to as Greco-Arabian or medicine. Every medical system has its own understanding of what constitutes the fundamental components that cause health to reign and disease to take root. In Unani medicine, these are explained in terms of asbāb-e-sitta zarūriyah (six essential factors) namely hawā-e-muḩīt (surrounding air), mākūl-wa-mashrūb (food and drinks), ḩarkat-wa-sukūn-e-badani (bodily movement and repose), ḩarkat-wa-sukūn-e-nafsāni (psychic movement and repose), nawm-wa-yaqza (sleep and wakefulness), and iḩtibās-wa-istifrāgh (excretion and retention). It is stated that as long as all these factors remain in their ideal condition, the health of the body is maintained and any disruption is pathological and manifests as disease.[1],[2]

Treatment in the Unani system of medicine is effected through any one or more of the three modes, i.e., Ilāj bit Tadbīr (Regimental therapy) including Ilāj bil Ghiza (dietotherapy), Ilāj bil Dawa (pharmacotherapy) and Ilāj bil Yad (surgery). Ilāj bit tadbīr (regimental therapy) has been defined by Ibn Sina as “taşarruf (modification) in asbāb-e-sitta zarūriyah (six essential causes).” Literally, tadbīr means “regime or systemic plan” while ilāj means therapy or treatment. Hence, in simple words, ilāj bit tadbīr may be described as a mode of treatment in Unani medicine which encompasses treatment through various regimens which are directed toward modification/correction of any abnormalities in asbāb-e-sitta zarūriyah.[2]

The primary aim of these therapies is the restoration of the physiology of the human body rather than correction of pathology. Some of these modes of treatment are relatively simple and easy to administer, for instance, massage and exercise. While at the same time, some of the modes of treatment described are complex and may produce severe effects on the human body, for example, faşd (venesection) and kayi (cauterization).[1] According to Ibn Hubal Baghdadi (1121–1213 AD), faşd excretes completely all harmful matter lurking in the blood.[2] That is why faşd is given extreme importance in the Unani system of medicine for the prevention of disease and restoration of health.[3] It is most effective when the disease-causing matter is uniformly distributed in the whole body.[4]

Many of the Unani physicians are of the opinion that whenever the necessity for blood-letting arises, then ḩijāmah bila-sharţ (cupping without blood-letting) should be tried first. If it is successful, then further intervention is not required. If however, further excretion is required from deeper tissues, then ta'līq (leeching) may be done. If further deeper expulsion is required, then faşd may be carried out.[5] It is clear from the above discussion that since faşd is a surgical procedure, and may lead to complications, therefore it should be attempted only when it is utmost necessary.

In recent years, faşd is translated as venesection or phlebotomy, which means blood-letting by placing an incision on a vein. However, in Tibb-e-Unani, faşd of arteries has also been described in some instances. However, since it carries more risks due to the higher pressure of blood in arteries, it is not advised as a routine procedure.[6]


  Important Guidelines Top


The ideal subject for carrying out faşd is a young adult with a wheatish or reddish complexion, prominent veins, hairy body,[5] and a muscular, nonfatty physique.[7]Faşd should be avoided in children, old people, pregnant, and menstruating women.[6]Faşd is absolutely contraindicated in children <14 years and old persons >70 years of age. According to Ibn Sina, if the need for faşd arises in these persons, then it is recommended that the physician may carry out the procedure if the patient has good general health. Faşd should also be avoided in esthetic and obese children.[4] The above discussion makes it clear that when faşd is indicated, more emphasis should be placed on the physical strength of the patient rather than his age. However, faşd should never be carried out in the first 2 months of life.[8]Faşd should also be avoided in patients suffering from weakness of the stomach, weakness of the liver, diarrhea, or any cold-wet (balghami) disease.[6] If the harmful matter is viscous, then ḩammām and heavy physical exercises should be advised before faşd. Furthermore, thin sikanjabīn should be given to the patient before the procedure.[4] It is also imperative that the physician should have good knowledge of anatomy, so that while performing faşd, he may give proper consideration to the adjacent structures. The vein for carrying out faşd should be located with great precision. Sterile instruments should be used. Hemostatic drugs should be kept available so that they may be used if the need arises.[6]

In any disease, it is recommended that faşd should always be carried out before the disease is stabilized. As a general rule, the blood carrying noxious matter should always be diverted toward an adjacent organ; from the upper to the lower part of the body. However, it should be ensured that the harmful matter does not divert toward a vital organ. However, if the disease is stabilized, then the harmful matter should not be excreted toward another organ and should be expelled from the affected organ itself.[5]

If the weather is cold-dry or hot-dry, then faşd should be avoided. Furthermore, if the patient has a hot temperament, then faşd should be carried out in the early hours of the day.[5] Before initiating faşd, make sure that the digestion has completed, bowels and bladder are empty, and the patient is not feeling hungry or full. Faşd should also be avoided in case of diarrhea or after ḩammām, unless recommended.[6] If the patient is feeling tired, faşd should be avoided. Furthermore, if the patient has a wet temperament, then faşd should be carried out only after the day has set in.[5] Ahmad Al-Hasan Jurjani (12th cent. AD) has aptly summarized the contraindications to faşd in 21 points- (1) Febrile illness, (2) Bawl-e-raqīq wa nāri (urine having low viscosity passed with color resembling fire), (3) Chills, (4) Cold temperament of the patient (phlegmatic or melancholic), (5) Cold environment/place, (6) Pain, until it is relieved, (7) After ḩammām, (8) After intercourse, (9) After undergoing tattooing or kayi (cauterization), (10) Old age, (11) Asthenia, (12) Obesity, (13) Open skin pores and gosht ki nazākat (tenderness in muscles), (14) Narm gosht (laxity of musculature), (15) Anemia, (16) Chronic illness, (17) Empty stomach, (18) Indigestion or full stomach, (19) Increased sensitivity of the fundus of the stomach, (20) Weakness of the fundus of the stomach or increased production of şafra (bilious humor) in the stomach.[7]

Besides, Ibn al-Qaf Masihi (1233–1286 AD) is of the view that if the necessity for faşd arises, then due consideration should be given only to the strength of the patient and the quantity of the noxious matter present in the body.[6] In weak people with hot temperament, faşd should be carried out in the spring season as a routine, even when no signs of ill-health are evident in most of the conditions, the waste matter is mixed with healthy blood, and it is not expelled easily. Therefore, faşd should be repeated many times, so that expulsion may be possible without causing any undue weakness.[4] If a patient has eruptions such as pustules or abscess on his body or consumes an excess amount of meat, sweets, or alcohol, then faşd should be avoided.[7]Faşd should also be avoided in people who do a lot of physical work, or when anger is present.[6] Ibn Sina stated that faşd reduces the viscosity of blood so that they may further mix with the healthy blood. Therefore, it should be avoided in the initial stages of a disease. However, when these noxious matters gain a foot-hold in any of the organs, they should be immediately expelled lest the disease may become stabilized and difficult to treat.[4]

The duration of fasd and amount of blood to be expelled may be determined by a careful examination of pulse. Even when letting blood, the physician should keep examining the pulse during faşd also and stop the bleeding when signs of weakness appear. Furthermore, if the color or viscosity of blood alters, or if the pressure of blood flow decreases, the faşd should be stopped.[7]

According to Ibn Sina, repeated sessions of faşd over a period are more beneficial than expelling a large amount of blood in a single instance, as it may produce syncope.[4] An increase in şafra may occur after faşd, which is diagnosed by a dry tongue and increased thirst. Āb-e-sha'īr (barley water) and sugar may be given to alleviate these symptoms.[4] Light diet, which suppresses şafra should be given on the day of faşd and the following day. The patient may be allowed to lie on his stomach after faşd if he so wishes, but sleep should be avoided.[7] However, eating to the full, heavy physical exercises, and perspiration in the ḩammām should be strictly avoided after faşd. Light, easily assimilated diet should be given initially and then progress to normal diet gradually.[4] Until the wound is well-healed, ḩammām, alcohol, heavy physical exercises, and mental stress should be avoided. Patients having wet-temperament should preferably perform light exercise before the fast so that the humors are mobilized due to the heat.[7]

Spring has been described as the best season for faşd, especially for persons predisposed to damvi diseases. If faşd is done for prevention of disease, it should be performed in early spring and mid of autumn season. However, the recommended seasons vary according to the temperament also. If a person has a wet temperament, then end of spring is the best season for faşd. If a person has a moderate temperament, then faşd should be performed in the mid of spring; if the person has a hot temperament, then early spring is the best season for faşd.[7]Faşd should be done in with the patient recumbent, to prevent syncope. Any istifrāgh, including faşd, is contraindicated on the day of boḩrān.[4]

Finally, it should be noted that both unnecessary delay and an excess of faşd is detrimental to health. If faşd is not done despite the need, then many diseases such as meningitis, coma, damvi diphtheria, and leprosy may be caused. If, however, and excess of blood is expelled during faşd, then it may lead to general weakness and weakness of digestive organs, etc.,[9] abnormal cold temperament, ascites, etc. according to Jurjani, an excess of faşd accelerates aging. To alleviate these harmful effects, Mā'ul laḩm prepared with alcohol and musk should be given to the patient.[7] If repeated faşd is required, then some other mode of istifrāgh, for example, purgation may be employed to assist the expulsion of noxious matter.[7] This reduces the need for faşd and also protect from the adverse effects. Excessive quantity of blood should also not be expelled in extremes of temperature.[3]

Vessels for faşd

According to Ibn Hubal Baghdadi, both arteries and veins may be venesection.[2] 34 veins and 8 arteries in the human body have been recognized in Unani texts for the purpose of venesection [Table 1]. However, it is advised that faşd of arteries should be avoided as far as possible, as they carry oxygenated blood.[6] Furthermore, the blood flow in arteries is at a higher pressure, and the risk of hemorrhage is greater.[4]
Table 1: The veins for faşd

Click here to view


The arteries for faşd are-the arteries in the palm which lie between the thumb and index finger, both shāriq, both sharāyin-e-şadghi (temporal arteries) and both sharāyin-e-khalaf-ul-Uzn (posterior auricular arteries).

Therefore, venesection may be done in about 42 vessels.[6]


  Procedure Top


Keeping the above-mentioned facts in mind, faşd may be initiated. Before this, the scalpel should be carefully examined for sharpness. The blade of the scalpel should be carefully selected, so that only a small incision may be made, and the vessel may not be cut completely.

Then try to make the vessel prominent by gently massaging the skin over it and placing a ligature. The ligature should always be placed near the point of faşd. The tightness of ligation may be varied according to the hardness or softness of skin, and amount of subcutaneous fat. If the patient is asthenic and veins are not visible, then the skin may be cut open to locate the vessel.[4]

The method of faşd of various vessels is as follows:

  • Warīd yāfūkh (a branch of a parietal vein):First shave off the hair from the site of faşd. Then tie a wide band of cloth around the neck so that the vein becomes prominent. Then start venesection[6]
  • 'Irq-ul-Jabha (frontal vein): The vein should be made prominent by the above method. Then gently incise it along its length[6]
  • 'Irq e Khalf-al Uzn (parotid veins): Shave the head first. Then rub the skin over the vein with a hard cloth and place a ligature around the neck. Then mark the site carefully and apply faşd[1]
  • Warīd Aranba (veins at the tip of the nose): Place a ligature around the neck. Then faşd may be done[6]
  • Warīd-e-Maiqain (veins in the lacrimal angle of the eye): Place a ligature cloth around the neck. During faşd, hold the head still. The scalpel should be small and narrow. After faşd, bandage with cotton overnigh[1]
  • Warīd ul-'Anqa: Place a ligature around the neck and ask the patient to masticate. This makes the skin prominent and faşd may be done
  • Widāj Zāhir (external jugular veins): Make the veins prominent by the above method and place the incision longitudinally.[6] The wound should be bandaged until the next day[1]
  • Warīd-e-Qīfāl (cephalic vein): Cephalic vein should be venesection at the origin of the muscle.[2] The scalpel used should be wide, and the incision should be placed on the soft part. Only one incision is enough.[1] Ligature should be placed before faşd[6]
  • Warīd-e-Akḩal (median cephalic vein): Make the vein prominent first. This vein should be venesection carefully because it lies near to a nerve. Sometimes, it may lie between two nerves. In that case, the incision should be placed longitudinally[1]
  • Warīd-e-Bāsalīq A'la (basillic vein): Make the vein prominent by a ligature then incise it[6]
  • Warīd-e-Usailum (Salvatella vein): Place the patient's hand in hot water. Then place a ligature on the wrist so that the vein becomes prominent. The incision should be slightly oblique. After incision, the hand should be continuously kept in hot water to promote blood flow, but should not be pressed. After letting the required amount of blood, put oil and salt on the wound[1]
  • Warīd-e-ḩabl-uz-Zarā'(Brachial veins): Vein should be made prominent by the above method. Then place a wide incision or the vein near the wrist joint. This faşd is somewhat risk-free as there is no underlying artery or nerve[1]
  • Warīd-e-Şāfin (Saphenous vein): Keep the leg in hot water and rub it to make the vein prominent. Then place a ligature on the ankle joint and incise it at the patient where it is most prominent.[1]


Masihi has described another method for this faşd- place a ligature on the leg about 4 cm above the ankle joint. Then ask the patient to press the leg against a hard object. This makes the vein prominent. Then incise it in the longitudinal direction.[6]

  • Warīd-e-'Irq-un-Nisa (sciatic vein): Take the patient to the hammam. Then tie the hip joint to the ankle with a 4 cm wide bandage. Also tightly bandage the heel. When the vein becomes prominent, incise it in an oblique direction. Zahrawi has stated that this is the only method to make the vein prominent[1]
  • Warīd-e-Mābiz-ur-Rakba (popliteal vein): Place a ligature about 4 cm above the knee joint. Then lie down the patient on his back and ask him to lift his leg. Incise the vein when it is prominent[6]
  • Sharāyin-e-şadghi (Temporal arteries): Place a ligature around the neck of the patient so that the artery becomes prominent. Then lift the artery with a finger and incise it from below. After letting the required amount of blood, loosen the ligature, and bandage tightly with cotton.[1]


Always keep the hemostatic drugs available while venesection of arteries.[6]


  Therapeutic Importance of Faşd in Various Disorders Top


Diseases of the central nervous system

  • Headache and migraine: If the signs of plethora are present, the skin is hot and pulse is full then venesection of the cephalic vein of the affected side, or on the side of more pain may be done.[3]


If a headache has been caused by an injury, then faşd should be done early after considering the stamina of the patient. If the patient is a young child, then cupping on the opposite side may be done to divert the noxious matter. However if the blood loss has been much, then faşd should be avoided.[10]

Also, faşd of Parotid veins followed by cauterization is beneficial in migraine.[2]

  • Coma: If coma has been caused by a plethora of blood, then cupping on the heels or faşd of Saphenous veins is recommended[10]
  • Melancholia: In case of excess of blood and sauda in the whole body and if the disease is in the initial stages, the venesection of saphenous or cephalic veins should be done and the blood should be let till the patient can tolerate it. Diet after the faşd should contain large amounts of water.[10]


If melancholia is associated with pain in the abdomen and excess salivation, the faşd of left usalaim and basilic vein should be done. The blood should be expelled until it remains dark and viscous. When the colour turns red and the viscosity decreases, the bleeding should be stopped.

If the melancholia has been caused due to meningitis or sun exposure, venesection of the cephalic vein may be done. However, if these signs are not present, then venesection of the right median cephalic vein may be done.[3] Bleeding should be stopped promptly if the blood is red in color.[11]

  • Vertigo: If the cause of vertigo is only a central nervous system disease, then faşd of cephalic vein should be done. If it is associated with any other cause, for example, indigestion, gastric pain, etc. then faşd of axillary vein is recommended[9]
  • Dizziness: Faşd of both parotid veins is recommended. If dizziness is accompanied by tinnitus and feeling of heat in the head, then also this faşd is beneficial[9]
  • Encephalitis: Faşd of the cephalic vein should be done in the initial stage, and a large amount of blood should be expelled. Then venesection of the ‘urūq nabza zāhira (jugular veins) should be done[10]
  • Epilepsy: If the patient is a young adult and epilepsy has been caused by Damvi matter, then faşd of the cephalic and saphenous veins should be done. Then, cupping on the heels and faşd of arteries of the head is recommended.[12]


Diseases of the eye

  • Chronic vascular keratitis, itching in the eye, blepharitis: Faşd of the veins in the lacrimal; angle of the eye should be done. If this is not possible, faşd of the vein of forehead should be done.[13]


If the itching is mild, then faşd of the cephalic veins, veins of the forehead, and veins in the lacrimal angle of the eye should be done and diet should be reduced in quantity[10]

  • Conjunctivitis: If the disease has been caused due to an excess of blood, then initially faşd of cephalic vein should be done. Faşd of the basilic vein before cephalic veins is also beneficial[10]
  • Wounds in the eye: If the wound is painful, then faşd of the cephalic veins followed by cupping on the heels are recommended[10]
  • Inflammation (hot in temperament) of the eye: If the disease is in the initial stages, then faşd of the cephalic vein is recommended. To alleviate the remaining disease, faşd of the veins in the lacrimal angle of the eye is beneficial[13]
  • Decreased visual acuity: Faşd of the veins at the lacrimal angle of the eye should be done first. Then leeching on the temples is advised[14]
  • Pharyngitis: Faşd of both sub-mental veins and veins of the neck is advised[14]
  • Diphtheria: Faşd should be done in the early stage of the disease.[14] After due consideration to the general health of the patient, repeated venesection on the sub-mental vein is recommended. Only a small amount of blood should be let each time. Then cupping on the back of neck, cheeks, below the chin, on buttocks, and heels are recommended. If the patient has piles (which have stopped bleeding), or if the patient is an adult female who has amenorrhea at the time of treatment, then faşd of the saphenous vein and vein of the knee should also be done, along with cupping on the heels[10]
  • Warm-e-ghisha-ul-unaf: In the initial stage, the patient should be given Nigella sativa, the bud of Jasminum spp. or bud of Narcissus poeticus to smell and faşd of the vein should be done[12]
  • Uvulitis: Faşd of the cephalic vein is beneficial in the disease.[12]


Oral diseases

  • The mobility of teeth: This disease is usually due to Balghami wastes. Faşd of cephalic veins followed by sub-lingual veins is beneficial[12]
  • Toothache: Faşd of the sub-mental veins is effective in relieving pain.[14] If the pain is sharp and pricking in nature, then faşd of cephalic vein followed by cupping is advised. The patient should be advised to keep rose water and vinegar in his mouth for some time.[3]


If gingivitis is also present, then faşd of the cephalic vein should be followed by purgation[10]

  • Gingivitis: Faşd of the Chahar-rag (infra-labial vein) is beneficial in gingivitis and wounds on the gums. Laxatives should also be prescribed after faşd.[10]


Diseases of the chest

  • Angina: In the initial stages, faşd of sub-lingual veins is recommended.[15] This faşd is also beneficial instable angina[8]
  • Hemoptysis: The treatment should be initiated with repeated faşd over a period after considering the age, strength, and weather.[10] If the disease has been caused due to plethora, and balgham is also seen in expelled blood, then repeated faşd should also be done on the axillary vein. Only a small amount of blood should be let each time[15]
  • Pleurisy: Initially, faşd of the saphenous vein of the affected part should be done. Then after the patient gains strength, faşd of the basilic vein of the opposite side should be done[10]
  • If this is not possible, then faşd of the Warīd Ibţī (axillary vein) or cephalic vein should be done; in that order of preference. However, faşd of the cephalic vein is the least effective in this regard[15]
  • Pneumonia: Faşd of basilic vein is beneficial in this disease.[3]Faşd of saphenous vein may also be done after considering the risks and benefits. If the patient has the cold temperament, the faşd should be done so that its effects reach the lung[12]
  • Lung abscess: If the lung abscess is associated with hemoptysis, and the blood expelled is frothy, then faşd of the right axillary vein should be done immediately. Light, easily assimilable diet should be given after the faşd. Bind both the heels tightly with a cloth, so that the patient feels slight pain.[12]


Diseases of the circulatory system

  • Chest pain: If the chest pain is caused due to trapped gases, then faşd of the basillic vein is beneficial[16]
  • Palpitation: If the palpitation is associated with an excess of blood, then faşd of the basillic vein is beneficial. Diet should be given special attention.[16]


If palpitation is associated with a high pulse rate and fever, then Qurs Kafoor and Apple Juice should be given after faşd[3]

  • Varicose veins: Initially, faşd of basillic vein should be done. Then give drugs which expel sauda from the body. After that, faşd of all varicose veins should be done, and all the accumulated blood let out. Avoid diet which produces sauda. Massage of the upper part of the body is also helpful. If the varicosities have to be excised, then it must be followed by faşd of the basillic vein.[17]


If the disease is chronic, then faşd of both Saphenous veins is recommended.[17]

Diseases of the liver

  • Hepatitis: If the inflammation is Damvi, then faşd of cephalic or basilic vein of the right hand should be done, followed by application of leeches on the right hypochondrium, if necessary.[18] If hiccups are also present, then the treatment should begin with faşd of basillic vein. Then give Ma'ush-Shaeer, juice of Cucumis sativa and juice of Lagineria siceraria to the patient[19]
  • Chronic hepatitis: Faşd of the basillic vein may be done after considering the strength, age, temperament, habits, and occupation of the patient and the weather conditions[19]
  • Abnormal temperament of the liver: If the temperament of the liver has become abnormally hot, then faşd of the basillic vein of the right hand should be done followed by application of cold and dry drugs (in poultice form) on the liver.[19]


If the abnormal hot temperament is associated with an excess of blood, then faşd of the basillic vein or Warīd Ibti is recommended after due consideration of the strength and age of the patient.[10]

  • Obstruction in the liver: If the obstruction is associated with abnormal hot temperament, then faşd of the basillic vein is recommended[10]
  • Jaundice: If the disease is caused due to the abnormal hot temperament of the liver, then faşd of the basillic vein is beneficial. If it is not possible, then wet cupping near the liver ineffective.[18] This faşd is also beneficial if the jaundice is obstructive in nature[19]
  • Liver abscess: If it is suspected that an abscess may develop in the liver, then fist faşd of the basilic vein should be done; then cupping should be done on the back adjacent to the liver.[18]


Diseases of the spleen

  • Leinitis: If the inflammation is Damvi, then faşd of the basilic vein followed by purgation is recommended.[19] If the inflammation is chronic in ante and there is an excess of blood, then faşd of the basilic vein and Warīd Usalaim of the left hand should be done[18]
  • If the spleen is affected by abnormal cold temperament, then faşd of the basillic vein should be done after considering the strength of the patient.[19]


If the abnormal hot temperament is associated with excess of blood, then faşd of the basillic vein and Warīd Usalaim of the left is recommended.[18]

Diseases of the gastrointestinal tract

  • Epigastric burning: If it is caused due to sauda, then faşd of Warīd Usalaim should be done and as much blood let as possible, then give sikanjabīn buḑūri to the patient. Repeat the above procedure many times. Then give Murabba Halela and Āmla[19]
  • Gastric erosions: Faşd of the basillic vein should be done if the patient has good general health. Sour and spicy food should be avoided[19]
  • Gastritis: Faşd of the axillary vein should be done on the on the side of more pain, and blood should be let according to the strength of the patient[10]
  • Colic: If the colic is caused due to acute inflammation (of hot temperament), then faşd of the basillic vein of the right hand should be done many times; and a small amount of blood should be let each time. Laxatives should also be given.[10]Faşd of the cephalic vein of the right hand is also beneficial[18]
  • Hemorrhoids: If the hemorrhoids are painful and nonbleeding and signs of plethora are present, then faşd of the basillic vein followed by faşd of the saphenous or popliteal vein is effective. Wet cupping between the buttocks is effective in this disease.[18]


According to Hakim Azam Khan (1211–1320 AD), faşd of the basillic vein is effective in all types of piles[18]

  • Proctitis and anal fissure: If the fissure is associated with inflammation or trauma, then faşd of basilic, popliteal and saphenous veins is recommended. If plethora is also present, then the faşd should be followed by constipating drugs in tablet form.[18]


Diseases of the kidneys and urinary bladder

  • Nephritis: If the inflammation is hot in temperament, then faşd of the basillic vein of the affected side is recommended[10]
  • Inflammation of the urinary bladder: Faşd of basilic or saphenous vein is recommended.[10] If it is associated with nephritis, and the patient has good general health along with signs of plethora, then faşd of the axillary vein is beneficial[12]
  • Renal ulcer: If it is associated with excess and ḩiddat of blood, then faşd of basilic vein is recommended[18]
  • Jarb-e-Kulya: If the patient has good general health, then faşd of basilic vein followed by cupping on the back is recommended[20]
  • Dysuria: If it is associated with inflammation (of hot temperament), then faşd of basilic vein is beneficial.[20] If plethora is also present, then faşd of the saphenous vein is beneficial.[21]


If the dysuria has been caused due to a pelvic injury, then faşd of the basilic vein should be done. Then pour water on the site of injury followed by massage for extended periods[3]

  • Renal calculi: If the stone is causing inflammation and pain, then faşd of the basilic vein is recommended. If the stone is associated with an excess of blood and prominent, wide vessels, then faşd of popliteal vein is recommended.[21]


Diseases of the genital system

  • Orchitis: Faşd of the basilic vein of the affected side followed by faşd of the saphenous vein is beneficial. Alternatively, wet cupping on the pelvic region should be done[18]
  • Hysteria: If the disease is associated with amenorrhea, then faşd of the saphenous vein should be done at the beginning of the disease. If the signs of plethora and excess of blood are present, then faşd of both basilic and saphenous veins should be done. Then, wet cupping on the hypochondrium and back is recommended.


If the patient is pregnant, then faşd and purgation should be completely avoided[22]

  • Menorrhagia: If it is caused due to plethora, then faşd of axillary vein should be done. Then tie both arms and wet cupping on both the buttocks is recommended[23]
  • Ulcers in the uterus: Faşd in the axilla is recommended. If the noxious matters persist, then faşd of the saphenous veins followed by strong purgatives should be done[23]
  • Cervicitis: Faşd of the axillary vein followed by faşd of the saphenous vein is beneficial. Then give purgatives which expel the balgham and şafra[23]
  • Amenorrhea: Faşd of the saphenous vein is effective in restoring menstruation.[24]


Miscellaneous

  • Sciatica: Faşd of the sciatic vein is beneficial in this disease. Faşd of the saphenous vein may also be done, but it does not provide similar benefits. According to Jalinoos, faşd of the popliteal vein is better than faşd of the saphenous vein. Before faşd, it is better to ask the patient to fast for 1 day before faşd, so that it is more effective. In case of chronic sciatica, faşd in the heel is recommended[17]
  • Elephantiasis:First induce emesis. Then faşd of dāliya (deltoid artery) or saphenous vein should be done. Bind the legs from the ankle to the knee tightly, especially during walking. Faşd of the basillic vein of the opposite side is also effective[3]
  • Gout: Faşd of the cephalic vein of the opposite side of the affected limb should be done. Then expel the blood according to the rules of faşd.[12]



  Conclusion Top


Insights into the classical literature of Unani medicine provides an intriguing conceptualization of the medical practices in yesteryears which remained the mainstay of treatment for centuries and successfully provided healthcare affordably and holistically. However, as with other cultures and traditions, with the passage of time, many of the therapies hitherto practised in medicine are gradually slipping into oblivion. Newer developments in medical sciences, conspicuous for providing convincing scientific evidence seem to refute or trivialize the previous theories and treatments, which, although primarily based on philosophies, have been practised through decades and have enough clinical evidence of safety and efficacy. Faşd is one of such therapies, which is present in limited use in certain clinical settings. Nevertheless, the vast literature provides substantial rationale to suggest its use in a wide range of disorders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zahrawi AQ. Al-Zahrawi. Translate by Alvi NA. Kanpur: Darul Ishaat; 1947. p. 39, 174, 175, 178, 181, 182.  Back to cited text no. 1
    
2.
Baghdadi IH. Kitab Al-Mukhtarat Fit-Tibb. Translate by CCRUM. 1st ed., Vol. 1. New Delhi: CCRUM; 2005. p. 272, 274, 371.  Back to cited text no. 2
    
3.
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4.
Sina I. Al Qanoon Fil-Tibb. Translate by Kinturi GH. Vol. 1 & 2. Lahore: Book Printers; 1992. p. 264-7, 274.  Back to cited text no. 4
    
5.
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6.
Masihi IQ. Kitab-Ul-Umda Fil-Jarahat. Translate by CCRUM. 1st ed., Vol. 1. New Delhi: CCRUM; 1986. p. 185-91.  Back to cited text no. 6
    
7.
Jurjani AH. Zakhira Khwar-zam Shahi. Translate by Khan HH. Vol. 1. Lucknow: Munshi Nawal Kishore; 1903. p. 196-8, 202-5.  Back to cited text no. 7
    
8.
Rushd I. Kitab Al-Kulliyat. Translate by CCRUM. 1st ed. New Delhi: CCRUM; 1980. p. 386, 431.  Back to cited text no. 8
    
9.
Razi Z. Kitab Al-Hawi. Translate by CCRUM. Vol. 6. New Delhi: CCRUM; 1999. p. 36, 50, 51, 58.  Back to cited text no. 9
    
10.
Baghdadi IH. Kitab Al-Mukhtarat Fit-Tibb. Translate by CCRUM. 1st ed., Vol. 3. New Delhi: CCRUM; 2004. p. 48, 69, 70, 72, 73, 84, 96, 137, 144, 154, 167, 172, 232, 260, 314.  Back to cited text no. 10
    
11.
Razi Z. Kitab Al-Hawi. Translate by CCRUM. Vol. 1. New Delhi: CCRUM; 1997. p. 57.  Back to cited text no. 11
    
12.
Zuhr I. Kitab-Al-Taisir. Translate by CCRUM. 1st ed. New Delhi: CCRUM; 1986. p. 29, 31, 33, 99, 105, 159, 220.  Back to cited text no. 12
    
13.
Razi Z. Kitab Al-Hawi. Translate by CCRUM. Vol. 2. New Delhi: CCRUM; 1997. p. 33, 90-1, 211.  Back to cited text no. 13
    
14.
Razi Z. Kitab Al-Hawi. Translate by CCRUM. Vol. 3. New Delhi: CCRUM; 1998. p. 46, 59, 90, 198, 228.  Back to cited text no. 14
    
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16.
Khan A. Al-Ikseer. Urdu Translate by Siddique HM. Vol. 1. Rawalpindi: Tibbi Company; 1984. p. 533, 593.  Back to cited text no. 16
    
17.
Razi Z. Kitab Al-Hawi. Translate by CCRUM. Vol. 11. New Delhi: CCRUM; 2002. p. 83, 95, 119, 127, 189, 191, 192.  Back to cited text no. 17
    
18.
Khan A. Al-Ikseer. Translate by Siddique HM. Vol. 2. Rawalpindi: Tibbi Company; 1984. p. 853, 867, 918, 935, 937, 1093, 1123, 1135, 1151, 1193, 1283.  Back to cited text no. 18
    
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20.
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21.
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22.
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23.
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24.
Nafees B. Kulliyat-e-Nafeesi. Translate by Kabiruddin M. Vol. 2. New Delhi: Idara Kitab-ush-Shifa; 1954. p. 513.  Back to cited text no. 24
    



 
 
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