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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 4  |  Page : 235-241

Geriatric care in pandemic era: From the perspective of Unani medicine guidelines


Department of Ilmul-Amraz (Pathology), Faculty of Unani Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Date of Submission20-May-2021
Date of Decision18-Aug-2021
Date of Acceptance25-Oct-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Dr. S M Ahmer
Department of Ilmul-Amraz (Pathology), Faculty of Unani Medicine, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jism.jism_44_21

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  Abstract 

Background: Elderly people are at a greater risk of developing COVID-19. They are facing the most challenges during the pandemic era because of preexisting medical conditions (such as diabetes mellitus, cardiovascular diseases, pulmonary diseases, or neoplasm). As per the first longitudinal aging study (LASI) in India released by the Union Ministry of Family and Health Welfare on 6 January 2020, two out of every three senior citizens in India are suffering from some chronic diseases. Considering the fact that the elderly are at a higher risk of serious complications and mortality with COVID-19, dietotherapy and other regimenal therapy guidelines described by Unani physicians can possibly play a significant interventional role against COVID-19 by improving the general body condition. Aim of Study: The primary aim of this review paper is to organize all reliable literary resources in Unani medicine regarding geriatric care to make geriatric age groups safe and secure during this pandemic. Materials and Methods: This review study of geriatric care was carried out with the aid of the Unani classical textbooks and the research updates on geriatric care, aging, dietotherapy, and regimenal therapy that were retrieved from PubMed, Google Scholar, and ResearchGate. Observation and Results: The information given by Unani physicians in ancient times has proved to be very useful and authentic to overcome this pandemic. In today’s research, modern theories and inventions also validate and accept the relevance of all the recommendations or practices given by Unani physicians. Conclusion: This entire article focuses on the recommendations of Unani medicine for geriatric care. Dietotherapy and other regimenal therapy described in this article can possibly play a significant interventional role against COVID-19 by improving the general body condition.

Keywords: Aging, COVID-19, Ibne Sina, regimenal therapy, Unani medicine


How to cite this article:
Ahmer S M, Amin MW, Fahad A. Geriatric care in pandemic era: From the perspective of Unani medicine guidelines. J Indian Sys Medicine 2021;9:235-41

How to cite this URL:
Ahmer S M, Amin MW, Fahad A. Geriatric care in pandemic era: From the perspective of Unani medicine guidelines. J Indian Sys Medicine [serial online] 2021 [cited 2022 Jan 28];9:235-41. Available from: https://www.joinsysmed.com/text.asp?2021/9/4/235/334256




  Introduction Top


The Unani system of medicine provides preventive, curative, and rehabilitative health care with a holistic approach.[1],[2] In his book Al Qanun fil Tib, Ibne Sina (Avicenna 980–1037 AD) has dealt with recommendations about the context of the elderly’s frailty, under the heading of Tadabeer-e-mashayiq (regimens to keep the elderly persons healthy). Unani medicine has great importance for the prevention of diseases and for promoting health. Six factors are necessary for the maintenance of good health, and these are called Asbaab-e-sitta zarooriya; see [Figure 1].[3],[4] Growth, development, and maintenance of the anatomy and physiology of the body are completely dependent on six essential factors and nonessential factors.[5],[6]
Figure 1: Asbaab-e-sitta zarooriya(six essentials of life)

Click here to view


This review study aimed at organizing the literary resources in Unani medicine regarding geriatric care to make the geriatric age group safe and secure during this pandemic. The objective of this study is to make people understand various remedies to cope with COVID-19 and to create awareness among the people regarding geriatric care during this pandemic era.


  Materials and Methods Top


This review study of geriatric care was carried out through the Unani classical textbooks, mainly Al Qanun fil tibb (Canon of Medicine). The research update on the geriatric care, aging, and regimenal therapy was organized from PubMed, Google Scholar, and ResearchGate. The information obtained through this search is discussed and presented in this review paper.


  Observations and Results Top


Unani physicians highlighted every aspect of geriatric care scientifically and systematically. They provided a detailed description of diet, water, alcohol, massage, exercise, sleep, and drugs for the aged under the heading of Tadabeer-e-mashayiq (The regimen to keep the elderly persons healthy). They emphasized the prevention of diseases by maintaining Asbaab-e-sitta zarooriya (six essentials of life). The information regarding the geriatric care narrated by the Unani physicians was to the best of our knowledge. In today’s research, modern theories and inventions also validate and accept the relevance of all the recommendations or practices such as diet, exercise, and massage, given by Unani physicians.

Epidemiology of COVID-19 in Elderly

Liu K, Chen Y noted in their study that 1099 patients with pneumonia and who were diagnosed as having COVID-19 were found; among them, 15.1% of the patients were younger than 60 years of age, and 27.0% of those were older than 60 years.[7] It was noted in the previous studies in China that the case fatality proportion among more than 40,000 cases of COVID-19 was maximum in aged people, that is, 14.8% in those 80 and older than 80 years of age, 8.0% in 70–79 years of age, 3.6% in 60–69 years, 1.3% in 50–59 years, 0.4% in 40–49 years, and 0.2% in younger than 40 years.[8] Initial epidemiologic data of the United States reveal that the case casualty was maximum (10%–27%) in patients 80 and older than 80 years of age, 3%–11% in 65–84 years, 1%–3% in 55–64 years, and less than 1% in those younger than 54 years of age. Patients without comorbidities had an overall case fatality of 0.9%, but it was higher for patients with underlying medical conditions; for example, 10.5% for those with cardiovascular disease, 7.3% for those with diabetes, and nearly 6% each for hypertension, chronic respiratory disease, and neoplasm.[9],[10]

Pathophysiology of Aging in Unani Medicine

Aging is a natural multidimensional progressive physical, psychological, and social changes process in the human life cycle that reduces the metabolic functions of the body due to diminished Hararat-e-ghariziya (innate heat) by various internal and external causes. With advancing age, multidimensional changes, that is, physical, psychological, and social alteration, occur in the body, adversely affecting well-being. These multidimensional changes are due to Sue Mizaj Baarid and Yabis (cold and dry maltemperament).[11]

The Unani System of Medicine explained what exactly happens when the same person crosses different phases of life, that is, from Sin-e-Namu (period of growth and development) to Sin-e-Shaikhukhat (senility).[12] The same food digested by the same body produces the same nourishing juices absorbed in the same way, and it gradually slows down its function of building up tissues. In old age, the food is only used for maintenance of life, that is, to keep the tissues alive and working and not for anabolism, because of the complete maturity of all the tissues in this stage of life.

According to the type of changes that occur in the body, lifespan has been divided into four periods, known as Asnan Arba (four stages of life); see [Table 1].
Table 1: Asnan Arba (four phases of life)

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Deterioration in the functions of the organs is noticeable in Sin-e-Shaikhukhat (senility) period, and the vital centers become progressively weak until death.[13],[14]

Buqrat (Hippocrates 460–377BC) stated that aging is a natural process resulting from the gradual loss of Hararat-e-ghariziya from the body, resulting in the body becoming Barid and Yabis (cold and dry).[15]

Arastu (Aristotle 384–322BC) suggested that a finite amount of Hararat-e-ghariziya existed at the time of birth but it was gradually consumed over time.

Jalinus (Galen 129–200 AD) said that humoral equilibrium was disturbed during advanced age due to loss of Hararat-e-ghariziya.

Ibne Sina (Avicenna, 980–1037 AD) stated that aging is a natural process in the human life cycle.[15]

With advancing age, the Hararat-e-ghareeziya and Rutubat-e-ghareeziya (primitive fluid) are dispersed gradually, producing weakness in the tabiat (medicatrix naturae) and resulting in a decreased production of Akhlate saleh (normal humor) and an increased construction of inessential moisture, that is, disturbed homeostasis or altered temperament. Most of the diseases are due to diminished Hararat-e-ghareeziya and the treatment protocol of any disease in the Unani system of medicine begins with normalizing the diminished Hararat-e-ghareeziya. The existence of an individual is said to be because of Hararat-e-ghareeziya.

There are two types of changes that occur in our body that cause coldness and dryness. Gradually, the dispersion of Rutubat-e-ghareeziya (primitive fluid) of our body occurs.

Rutubat-e-ghareeziya plays the main role in the equilibrium of hararat-e-ghareeziya. If any changes occur in rutubat-e-ghareeziya in terms of quality and quantity, it directly influences the Hararat-e-ghareeziya. If Hararat-e-ghareeziya in the body is diminished, it leads to trouble in Huzoom-e-Arba (four types of digestion, i.e. Hazm Mi‘di, hazm Kabidi, hazm ‘Uruqi, and hadm ‘Uzwi). Irregular Huzoom-e-arba is responsible for the production of abnormal Humors that directly alter the Mizaj (temperament) of the body.[16]

Quwat ghaziyah (nutritive power) is a vegetative faculty that is responsible for Taghaiur wa istahala, that is, ingestion, digestion, absorption, transformation, and assimilation of Ghiza (diet); the excretion of waste products is also weakened due to diminished Hararat-e-ghariziyah, resulting in reduced production of akhlate saleh (normal humor) and lessened availability of a substitute of Tahleel (dissolution). Diminished Hararat-e-ghareeziya also weakened the Quwa (faculties). Weak faculties of the organs are unable to perform proper physiological functions in the body, which also promotes aging; see [Figure 2].[14]
Figure 2: Pathophysiology of aging

Click here to view



  Discussion Top


Ilaj bil Tadbeer (Regimenal Therapy) for the Elderly

Regimenal therapy is the mode of treatment that is carried out by modulating Asbaab-e-sitta zarooriya, which is necessary to maintain health. As described in the book Al Qanun fil tib, Ibne Sina (Avicenna, 980–1037 AD) believes that treatment is based on the intervention and moderation in the Asbaab-e-Sitta Zarooriya (six fundamentals of life).[17]

Regimenal therapy at regular intervals is essential to maintain the equilibrium of humors and eliminate morbid material. To prevent an aged person from contracting COVID 19-disease, the following Tadabeer-e- mashaikh (practices for the aged) may be helpful.

Ghiza (Diet)

The Unani medicine places great emphasis on diet. Food enhances the Quwat-e-Mudabbira badan (immunity), which protects the body from various diseases and makes the body strong to fight against various pathogens or infections. Practically all the cultures in the world, in their traditional medicine, believe primarily in food habits for good health, indicating the significant relationship between the diet and health of an individual.[18]

Mizaj (temperament) of the aged is Barid-yabis (cold and dry). The temperament of the gastrointestinal tract in an elderly person is Barid-ratab (cold-wet) due to a diminution in the Hararat-e-ghariziyah and accretion of Balgham (phlegm).[19] Usually, Barid-yabis temperament people need Garm-tar (warm-wet) diet measurers, whereas Barid-ratab temperament people need garm-khusk (warm-dry) measures. However, it should be considered that all the elderly need Garm-tar (warm-wet) regimen to maintain and reinstate their health.[20] The digestive power of the aged is weak and physical work is also minimal, so they should reduce the amount of their meals, increase the frequency of their meals, and a nutritious diet that is effortlessly assimilated should be consumed.[17]

Food can be consumed two or three times a day, divided according to the digestive power and according to the normal state of the body. Milk and milk products are beneficial for those who can digest them fully. Milk with added salt and honey is preferable, because it does not curdle and passes down quickly.[21] The best vegetables advised for the elderly are beets and a little leek; these should be spiced with olive oil and murry. These are useful when they are consumed before the main food, because they produce a laxative effect. It is necessary state that raw leek, onion, and garlic must be utilized with care in the aged people with gastrointestinal discomfort. Preserved ginger and other hot type of preserves are suitable for them. Other foods recommended by physicians for the aged include six-month-old lamb meat, young rooster, and chicken, partridge, and milk. The elderly should avoid any heavy food that produces black bile and phlegm and similarly avoid any hot, sharp, or desiccative foods, such as dishes made with vinegar, salt, seasoning pickles, etc.[16]

Anorexia in the elderly is due to aggregation of Balgham (phlegm) in the Mi‘da (stomach) and Am‘a’ (intestines), which is because of diminished Hararat-e-ghariziyah. Therefore, the elderly should avoid such type of diets that yield Ghaleez balgham (thick phlegm) as well as the practices that are the precursors of Ghaleez balgham and Sauda (black bile).[13]

A study conducted by Keys et al.[22] revealed a drop in the basal metabolic rate with the age of 1–2% per decade; this means that a reduction of 400 kJ/day in basal metabolic rate can be estimated between the age of 20 to 70 years.

Diet is responsible for maintaining homeostasis in equilibrium and it makes the immune system strong.[23] The elderly should consume a healthy diet that is of good quality and quantity, because it is the first line of defense against diseases. The elderly should take calcium and vitamin D supplements because they strengthen the muscles and bones.[24] The physician must prescribe these Unani dietary guidelines for a healthy body and a better tomorrow.

Water

In his book Al Qanun fil tib, Ibne Sina (Avicenna, 980–1037 AD) said that drinking water immediately after a meal impairs digestive functions. He prohibits drinking two (or more) different types of water together, for example, drinking water with ice cubes.[25]

Ibne Sina (Avicenna) said that drinking water, exclusively cold water, is harmful to the body after physical activity, intercourse, and after bathing because it will diminish the Hararat-e-ghariziyah. In addition, drinking cold water on an empty stomach after sleeping is very harmful to the body.[16] The consumption of lukewarm water, which is known for its body cleansing effects, is advocated.[26],[27]

Dalk (Massage)

Regarding the Dalk (massage therapy) for the elderly, Ibne Sina (Avicenna) said that Dalk with oil should be moderate in quantity and quality to rejuvenate the skin cells and generate heat and humidity in the massaged organ. Weak and painful parts of the bodies of the elderly must not be touched at all. If a massage is to be repeated on the same day, it should be given with a piece of coarse cloth or bare hands.[16] The massage with a combination of mashed myrtle leaf, basil, and honey is helpful for the elderly person.[13]

The most important benefit of Dalk is to reduce anxiety.[28] It also gives sound sleep. It is helpful to improve body circulation and lymphatic flow, which helps the body to excrete toxic substances.[29]

Riyazat (Exercise)

According to Ibne Sina, exercise is the key to good health if it is done at the correct time and in moderate quantity. Exercise is any physical activity that augments or maintains physical fitness and overall health and well-being. Exercise in an aged person varies from person to person according to their bodily state, their customary diseases, and their habits of exercise.

An aged person performs moderate exercise regularly, according to their bodily state. Moderate exercise regularly augments the Hararat-e-ghareeziya, resulting in enhancing the body immunity, as shown in [Figure 3]. It prevents various lifestyle diseases and improves quality of life. Regular physical activity reduces the risk factors responsible for cardiovascular disease, decreases insulin resistance, and improves glycemic control. If the disease is in the chest, then only exercises for the lower limbs suit them.[16] The default mode for humans is to be physically active whereas inactivity is allied with a higher burden of disease, especially in older age. Effectively, sedentary behavior is an independent parameter of mortality.
Figure 3: Benefits of moderate exercise

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Muscle loss is a common characteristic feature found in aging. The rate of muscle loss is around 1%–2% yearly after 50 years.[30] Metabolic rate and maximal oxygen consumption decrease with the loss of muscle mass.[31]

Environmental influences or lifestyle habits such as sedentary lifestyles, inadequate exercise, and disorganized eating patterns facilitate the accumulation of metabolic wastes in the organs or body. In the elderly, the internal organs slow down and can no longer eliminate bodily wastes effectively due to the diminution of Hararat-e-ghareeziya, which leads to the development of various diseases.

Despite this, various studies pointed out that moderate exercise prevents the loss of muscle due to aging and improved body functions.[32] Exercise helps in maintaining the equilibrium of Akhlat-e-Arba (humors), meaning that it maintains homeostasis in the body. It enhances the Hararat-e-ghareeziya, which is responsible for metabolic strength, and strengthens the immune system.[33] It also maintains psychological well-being.

Hammam (Therapeutic Bath)

A therapeutic bath is a type of bath that aims at enhancing the Hararat-e- ghariziya and at improving the body metabolism. Hammam (therapeutic bath) should be done with lukewarm water at least once a week or as per the strength of the body.

A therapeutic bath reduces dryness of the skin and provides moderate warmth and moderate moisture in the body. It also relaxes the body and induces sleep. Bathing cannot be done for a long time, because it causes weakness in the organs. Bathing and swimming after meals are contraindicated, because they produce obstruction in the vessels.[13],[21]

Naum wa Yaqdha (Sleep)

The nervous system becomes dry in old age due to aging, which is a natural ongoing process. Dryness in the brain causes many complications, such as insomnia and other sleep disorders as well.

Roghane kaddu (Laginaria siceraria seed oil) or Roghane Badam (Prunus amygdalus oil) is used as a nasal drop to reduce dryness from the brain. A porridge of vegetables (parsley, leek, and spinach) with lamb and barley is also beneficial in the elderly.[34]

Moderate sleep removes all types of fatigue and stops the excessive dispersion of innate humor promoted by activity. It strengthens the vital force by preventing its dissipation. Sound sleep is the best immune modulator.[27] Immunity is well regulated by sound sleep, because it maintains homeostasis.[35] On the other hand, excessive sleep dulls the mental faculty. It produces cold diseases due to the accumulation of morbid humor in the body. Wakefulness has the opposite effect to that of excessive sleep. It increases the desire for food and stimulates appetite by dispersing waste. Sleeping on an empty stomach is bad, as it causes weakness; sleeping with a stomach replete with food that has not passed down from the upper part of the gastrointestinal tract is also prohibited, because sleep cannot be sound in such circumstances and it is accompanied by restlessness. The best pattern of sleeping advised by physicians is to first lie on the right side of the body and then to change position to the left side. Sleeping on the belly first helps digestion very much, because it confines and encompasses the innate heat and thus intensifies it.[16]

Ali Ibn-e-Abbas Majoosi stated that Tabiat is improved in two ways: One is by sleep and mental and physical rest, and the second is by the digestion and yielding of energy. Lack of sleep causes dissolution of energies, mental weakness, and digestive upsets. Sound sleep improves digestion, and it restores the natural equilibrium of Akhlat-e-Arba. It is necessary not to let the bowel become constipated, as abnormal retention of fecal matter predisposes one to infection. In a condition of sound sleep, the hormone that controls appetite, energy metabolism, and glucose metabolism is secreted by the body and less sleep disrupts these and other hormones.[36]

Ilaj Bid Dawa (Drug Therapy)

Tiryaq-e-wabai is a well-documented and well-known drug in Unani medicine that is known for its wide use for prophylaxis during an epidemic. Ibne Sina said that the Tiryaq-e-wabai was used as a prophylactic drug during an epidemic.[37] The composition of Tiryaq-e-wabai is shown in [Table 2].
Table 2: Composition of Tiryaq-e-Wabayi

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Another good medicine for old people is that which is prepared by mixing one part of the pulp of carthum seeds and 10 parts of dried figs. It should be taken before meals in order to have a laxative effect.

Any of the following compound Unani drugs may be taken for Zof-e-kabid (sluggish liver) and Faqr-ud-dam (anemia):

Jawarish jalinus, Majun dabidul ward, Anushdaru, dawa-ul-kurkum, Qurs kushta khubsul hadeed, Sharbat-e-faulad etc.[38]

Unani drugs such as Amla (Emblica officinalis), Anjeer (Ficus carica), Lehsun (Allium sativum), Zanjabeel (Zingiber officinalis), and Kalonji (Nigella sativum) have been widely used in Unani medicine since ancient times and also have proven antioxidant and immunomodulatory properties.[39]


  Conclusion Top


This article has been written to notify the readers to adopt the recommendation of Unani medicine for the elderly to break the chain of this viral infection, to boost immunity, and to fight against various symptoms that arise from this deadly infection. Practices for the aged mentioned under the heading of Tadabeer-e-Mashayiq (The regimen to keep the elderly persons healthy) in Unani literature may play a significant role in maintaining a healthy life in the current pandemic scenario.

Dietotherapy and other regimenal therapy described in this article can possibly play a significant interventional role against COVID-19 by improving the general body condition. By emphasizing the Asbaab-e-sitta zarooriya, which is an easily manageable factor, we can enhance physiological resistance and immunity against COVID-19, especially in the elderly population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Materials and Me...
Observations and...
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