Unani medicine

Named after the Greeks, preserved by Arabic physicians when Europe lost it, and now practised mainly in India by around fifty thousand registered doctors.

What it is

The Greco-Arabic medical tradition — ṭibb-i yūnānī, literally "Greek medicine" — as it developed in the Islamic world and as it is practised today, chiefly in India, Pakistan and Bangladesh.

It is Galenic medicine, continuous and unbroken. Where Western herbalism had its humoral framework demolished in the nineteenth century, Unani kept it: four humours, four qualities, and treatment by opposites, taught in degree programmes and practised in hospitals.

Its diagnostic categories are the classical ones — mizāj, the individual temperament; akhlāṭ, the humours; and the six asbāb-i sitta ḍarūriyya, the necessary causes covering air, food and drink, movement and rest, sleep and waking, retention and evacuation, and mental states.

Where it came from

Translation. From the eighth century, under Abbasid patronage, Greek medical works were systematically translated into Arabic — Ḥunayn ibn Isḥāq's translation programme in ninth-century Baghdad rendered the bulk of Galen. Much of what Europe later recovered came back through this route, and a portion of Galen survives only in Arabic.

Synthesis and extension. Al-Rāzī (Rhazes, d. c. 925) wrote the first clinical account distinguishing smallpox from measles and was notably willing to contradict Galen from observation. Ibn Sīnā (Avicenna, d. 1037) produced the Qānūn fī al-Ṭibb — the Canon of Medicine — which organised the entire system and included a materia medica of several hundred substances. It was a set textbook in European universities into the seventeenth century, which makes it plausibly the most influential medical book ever written.

Ibn al-Bayṭār, working in thirteenth-century Andalusia and Damascus, compiled a materia medica of well over a thousand substances, including many not known to Dioscorides.

Transmission to India. Unani travelled east with the Delhi Sultanate and flourished under the Mughals, absorbing Indian plants and some Ayurvedic practice. When British administration withdrew support from indigenous medicine, the Sharif and Azmi families and above all Hakim Ajmal Khan (1868–1927) fought to preserve it institutionally — Ajmal Khan founded the Ayurvedic and Unani Tibbia College in Delhi in 1921, and was simultaneously a leading figure in the independence movement.

How it is practised

By assessing temperament and humoral balance, largely through pulse (nabḍ), urine and stool, then correcting by diet, regimen and compound formulations. Preparations include majūn (electuaries), sharbat (syrups), ḥabb (pills) and rauġhan (medicated oils). Regimental therapies — cupping, leeching, sweating, purging — remain part of the system.

In India, Unani is one of the systems under the AYUSH ministry; practitioners hold a five-and-a-half year BUMS degree and there are on the order of fifty thousand registered. This describes the practice and instructs in nothing.

What we can and cannot say

We can say the historical contribution is enormous and is routinely understated. The preservation and extension of Greek medicine, the development of hospital medicine and pharmacy as institutions, the first pharmacopoeias with quality standards, and a genuinely empirical strand represented by al-Rāzī — all of this predates the European recovery and made it possible. That Europe's own medical tradition came back to it in Arabic is a fact worth sitting with.

We can say the theory is the same theory that was refuted. Unani's humoral framework is Galen's, and the objection set out under humoral theory applies without modification: there is no black bile, and cellular pathology replaced the whole scheme. This is a system practised at scale today on a foundation that the wider medical world abandoned in the nineteenth century. Practitioners respond that the framework is a clinical heuristic rather than a physical claim — which is a reasonable move, and is not how it is taught.

We can say the evidence base is thin. Some individual Unani plants overlap with the wider materia medica and carry the evidence described under the evidence on herbal medicine. Trials of Unani formulations as such are few and mostly small, and often published in journals dedicated to the system.

We can say the safety issues are shared. Unani preparations, like Ayurvedic ones, sometimes include mineral and metal ingredients — the kushta preparations are the direct counterpart of bhasmas — and heavy metal findings in the analytical literature cover both. Regimental therapies including bloodletting carry their own risks.

And we can say something about why this tradition is defended as fiercely as it is. Unani in South Asia is a Muslim medical tradition that survived colonial dismantling, was rebuilt by people who were also fighting for independence, and now serves populations for whom it is affordable and culturally familiar. Criticism of it lands in that context whether or not the critic intends it to, and a site that ignores that has not understood what it is looking at.

We cannot say the humoral framework is correct, because it is not. What can be said is that this is Galenic medicine still alive, in a form Europe would recognise, practised by tens of thousands of trained physicians — and that the reasons it survived are as much political as medical.