Understanding the Concept of Nudj (Concoction) and the Role of Mundijat(Concoctives) in Unani Medicine

Introduction

The Unani System of Medicine (USM) has been serving the masses for hundreds and thousands of years. It relies on the theory of the four humours, the doctrine of Akhlāṭ Arba‘a, propounded by Hippocrates.^1,2 He applied this doctrine of the four humours- Dam/Khūn (blood), Balgham (phlegm), Ṣafrā’ (yellow bile), and Sawdā’ (black bile), to medicine, considering the mind and body as a single unit. He attributed illness not to evil spirits but to imbalances among these humours.^3,4 Jalinoos (Galen) believed that humours are formed in the body from various foods and stated that warm foods produce yellow bile and cold foods produce phlegm. Factors such as seasons, life stages, geography, and occupation also affect the formation of humours. A balance of humours was considered essential for health, while an imbalance or “dyscrasia,” was believed to cause disease.⁵

Unani physicians have listed four basic principles for treating disorders caused by disproportion of the khilt (humour). The first principle is treating the  disease with Mundij drugs (concoctive), followed by Mus’hilat (purgative), Tabrīd (cooling), and Taqwiyat (strengthening).^6-9 Mundij is an Arabic word derived from “Nudj”, which means concoction.¹⁰ This review paper discusses the concept of Nudj (concoction) and the role of Mundij drugs in various humoural diseases.

Materials and Methods

Unani books were referred to understand the concept of Nudj and the holistic approach to treatment through Mundijat, as well as their mechanisms of action in different humoural disorders as described by renowned Unani physicians like Buqrat (Hippocrates), Jalinoos (Galen), Zakariya Razi (Rhazes), Ibn Sina (Avicenna), Roofas, Rabban Tabri, Akbar Arzani, etc. Literature was also searched on PubMed/ Google Scholar, Proceedings, Web of Science, and Medline to achieve high-quality evidence. The keywords used were Unani Medicine, Tabiyat, Quwwat-e-Mudabbira, Khilt, Nudj, and Mundij Advia.

The Concept of Disease and Treatment in USM

According to USM, disease results from a quantitative or qualitative imbalance in the equilibrium of the humours.^1,3,5 The imbalance may involve thinning of a humour (the consistency of humour becomes thinner), thickening of a humour (its consistency becomes thicker), or hyperactivity or putrefaction of any humour.^1,3 The imbalance of humours may arise from external factors such as injury, improper diet, environmental influences, or from internal factors like improper digestion, or a combination of both. External environmental factors and daily lifestyle can also affect the human body, including air quality (Hawa-e- Muheet), food and drinks (Makool wa Mashroobat), movement and rest (Harkat wa Sakoon Badni), sleep and wakefulness, emotions, and retention and excretion (Ahtibas wa Istifragh).¹¹

It is believed that these six factors must be balanced in quality, quantity, and sequence to sustain good health.¹² According to the Unani concept, the human body possesses an inherent power of self-preservation called medicatrix naturae, which preserves health, maintains normal physiological functions, and protects the body from various diseases.¹³ Tabiyat strives to counteract the process of disease in the body. If the Ṭabī‘at succeeds in overcoming diseases, no treatment is needed; however, when the strength of Ṭabī‘at equals to that of the disease, treatment may become unnecessary.¹⁴ Therefore, Unani physicians consider the rule of Ṭabī‘at to identify the underlying causes of humoural imbalance and then proceed with general treatment to correct the root cause of the disease.^3,15 If only the quality of the khilt is altered, they treat it through Tadeel i.e., normalization of temperature. In case of excess of any morbid matter, they prefer concoction and Istifragh or Tanqia (proper elimination of morbid matter).¹⁶

To treat diseases caused by disproportion of the khilt, four basic principles are mentioned in USM. The first is to treat the disease with Mundijat (concoctive), followed by Mus’hilat (purgative), then Tabrīd, and finally Taqwiyat.^6-9 This therapy works on the principle of systemic cleansing of morbid matter from the body. It may be used alone and/or in combination with some other regimens, including Fasad (venesection), Hijamat (cupping), Qai (vomiting), Ta,leeq (leeching), and Idrar (diuresis).^11,17

Nudj (Concoction)

Ibn Rushd, in “Kitabul Kulliyat’’, states that the action of Nudj is executed by Ḥarārat Gharīziyya / Ḥarārat Ṭabī‘iyya (Innate heat), which dissolves and dries waste matter, primarily in the stomach, liver, and other organs.¹⁵ Jalinoos mentioned in his book “Buhraan” that diseases may lead to three possible outcomes: concoction, dissolution, and evacuation of the morbific matter. Nudj is defined as the gradual warming of waste morbid matter to prepare it for elimination.^18,19 Only those matters acquire Nudj that are abnormal in quantity; for example, in Imtila Bi hasbil Au,iya, a condition in which the Kammiyat (quantity) of one or more of the Khilt increases.^13,15 But Nuzj is not possible in conditions where both quantity and quality are altered, especially in severe qualitative variations of Akhlat e.g., Akhlate Muhtariqa . In such conditions, to enhance the function of Nudj, it is essential to aid the activities of Tabiyat (physic) by administering Mundij Advia, which resemble the qualities of Ḥarārat Gharīziyya, i.e., the drugs should possess the qualities like Motadil in Hararat and Rotubat or slight tendency towards Hararat.^7,15

Types of Nudj

Ismail Jurjani states that Nudj is of two types: the first is Rastini, where the fate is good, and the second is Nastuda (vicious). Both involve the deviation of matter from its normalcy, which is called Nudj. In Rastini, Quwwat-e-Mughairra overcomes the matter and induces the physic to evacuate it from the body. In Nastuda, the disease overpowers Quwwat Mughayyira, and Tabiyat fails to warm and evacuate the matter; consequently, the matter gets converted into Ufūnat, leading to a disease condition. For example, in cases of pleurisy, if the sputum is whitish-yellow in color, has a normal consistency, and does not have a foul smell, it is classified as Nudj Rastini. Conversely, if the sputum is blue, black, or green, has a foul odour, and is either thick or thin in consistency, it is referred to as Nudj Nastuda.²⁰ The principle of Nudj required in Sawdāvī Amrāḍ is achieved through Tarqīq (diluting morbid matter), in Balghamī Amrāḍ through Tarqīq and Taqtee, and in Ṣafrāvī Amrāḍ through Taghlīẓ (thickening of morbid matter).²¹

Benefits of Nudj

Nudj concocts and eases the morbid matter to easily evacuate. For example, in the early stage of pleurisy, expectoration is not initiated; this may be stimulated through Nudj with the administration of Mundij drugs, which leads to the expectoration of accumulated phlegm in the chest. Similarly, no Rasūb is seen in urine in the early phase of acute fever, but appears later in the advanced phase.⁸

Need of Nudj

1) Nudj is critically needed in Amrāḍe Muzmina (chronic diseases) lasting longer than 40 days. It is also preferable to induce Nudj in acute diseases, particularly those persisting for more than seven days.⁸

2) Nudj is crucial in Balghamī and Sawdavī diseases before purgation. In Ṣafrāvī ailments, inducing Nudj is preferable but not mandatory. Nudj is not required in Damvī diseases, but if blood is mixed with other humours, particularly black bile, the concoction of morbid matter becomes necessary.⁸

3) If evacuation of the morbific matter is done without inducing concoction, it may lead to excessive production of involved humour, as other Khaam Khilt (unripe humour) can get transformed into the involved one and becomes difficult to eliminate. Moreover, the administration of purgation initiates movement and Gilyan (fermentation) in the matter, causing unripe but healthy humours to get evacuated along with the morbific matter^.8 Hence, Nudj is quite important in diseases where matter is involved.¹⁸ Unani scholars have also mentioned the duration of use of Mundij drugs required to induce Nudj in various diseases caused by Ghayr Ṭabī‘ī Akhlāṭ (abnormal humours), which is listed below.(Table 1)^8,22,23

Stages of Nudj

Ibn Rushd has categorized the concoctive changes into four stages according to the pathology of diseases.

1) Zamān al- Ibtidā’ Initial period: This phase is characterized by moderate, constant symptoms, such as the initial period of Naubati Humma is equalized by the period of attack and remission. Tabiyat does not produce any change in urine. Likewise, expectoration is not observed in diseases of the respiratory organs.

2) Zamān al-Tazayyud Increasing period): In this period, disease symptoms intensify, such as prolonged fever episodes and reduced remission periods. The peculiar sign of this stage is the concoctive changes in the urine, manifested as cloudy appearance at the upper surface or in the middle portion, if the urine is left standing in a container, often accompanied by a slight change in colour. These changes indicate that Tabiyat is giving the Nudj in madda marz (morbid matter).

3) Zamān al- Intihā’Peak period): In this phase, the araz (symptoms) and bari (attack) are equal in intensity. Here, the action of Nudj is completed, indicated by the dominance of Rasūb (sediment) in the Baul (urine).

4) Zamān al- Inḥiṭāṭ (Decreasing period): In this stage, the severity of symptoms is markedly reduced as Ṭabī‘at overcomes the disease. The duration of remission is prolonged, while the duration of attacks decreases, indicating the onset of Zamān al- Inḥiṭāṭ.^15,16

Importance of Nudj

The intensity of fear and sadness remains in the patient before the onset of Nud. As Nudj begins, these feelings lessen, and upon its completion, the patient experiences complete relief and satisfaction.¹³

Routes of Tanqiya (Elimination) after Nudj

The route for Tanqiya can be opted based on the nature of the morbid matter (Maddah Marz) and the organ afflicted. For example, in the case of Ḥummayāt or fevers, where morbid matter is found in the blood, Tanqiya is preferably carried out through urine, because blood can be filtered and purified by the kidneys. Whereas, in pleurisy, the morbid matter is evacuated from the lungs in the form of expectoration. In cutaneous abscesses, Tanqiya can be done through skin pores, which serve as an effective route to eliminate morbid matter. In coryza, Tanqiya is done through nasal secretion, and in conjunctivitis, through the secretion of punctum.¹³

Signs of Nudj

The salient markers of changes due to Nudj may be observed in the body through urine, pulse, phlegm, and faeces.

Changes in the color of urine

1. Bawl Tibnī -urine with a light tinge of yellowness denotes a mild degree of concoction. If the colour deepens to resemble orange, it indicates the completion of Nudj and is referred to as Bawl Utrujī.16 Conversely, light-coloured urine reflects that the matter has not undergone concoction, while thick white urine indicates a predominance of raw phlegm in the diseased organs. Relatively liquid urine signifies rawness, non-concoction, and lack of yellow bile.^16,24 Raqeeq Baul (liquid urine) is an ominous sign of disease, especially if the urine is whitish. In contrast, relatively liquid urine with a yellow tinge suggests an incomplete concoction of matter.^16,25 The yellow tinge results from the mixing of yellow bile, while the earliest signs of Nudj appear in the consistency of urine, rather than its colour.¹⁶ In acute diseases, very Raqeeq Bawl is the common manifestation of non-concoction and weakness of Quwwat Hāḍima/ digestive faculty.¹⁷

2. Thick urine is a common sign of Nudj; if accompanied by reduced urine volume, it indicates dryness in the matter. When thick urine is discharged initially and is followed by clear urine, with the thicker portion settling at the bottom, it reflects the completion of Nudj and the dominance of Tabiyat over the matter.¹⁶

3. The urine colour may vary based on the Nudj of humour involved. Urine turns orange, yellowish, blackish, and muddy in Ṣafrā’i, Balghami, and Sawdā’i matters, respectively. Urine also becomes thick in Balghami and Sawdā’i states.⁸

4. Thicker urine is considered better than liquid urine, indicating that Hararat is acting upon the Rutubat present in the vessels. The faster the sedimentation of urine particles, the higher the degree of concoction. Colourless and stagnant Rusub is considered better than the tinged and dynamic one, as stagnation is a better marker of concoction compared to the colour.^16,21

5. Rasūb al-Bawl: The location of Rasūb (sediments and deposits) in urine, if collected in a container, may vary. Rusub sedimented at the bottom of the pan are considered better, whereas those floating on the surface, known as Gumam (cloudy), reflect the presence of Reeh in the vessels, which prevents the matter from undergoing concoction, although it reflects milder form of Nudj. At times, Rasūb appears in the middle portion of the urine column, indicating the stronger form of concoction while Reeh prevents sedimentation.^16,26

Changes in pulse

1. A hard pulse at the onset becomes soft after Nudj, and the opposite is observed in soft pulsations. Likewise, a full or empty pulse before Nudj becomes empty and full, respectively, at the end of the Nudj.

2. In Sawdā’i diseases, the pulse turns soft on completion of Nudj in the matter. Based on these indications, physicians can confirm that the process of Nudj is being carried out by Tabiyat to eradicate the disease.⁸

Changes in Balgham (phlegm)

1. Nuh bin Mansur Al-Qamri states that liquid Balgham indicates the initial phase of concoction, whereas thick phlegm denotes the completion of Nudj.²⁷

2. Raqeeq Balgham (thin phlegm) denotes an unaccomplished concoction of the matter. Galeez Balgham (thick phlegm) indicates the thickness of the matter and may also reflect non-concoction, as the action of Nudj normalizes the consistency of phlegm. Moreover, the liquidity of the morbific matter remains adherent to the organ, while Galeez Balgham is not easily expectorated due to its density and lack of fragmentation. Razi states that the expectoration of normal, liquid-consistency phlegm denotes the initiation of Nudj, while the easy expulsion of thick phlegm signifies the completion of Nudj in the matter.

3. Ibn Hubl Bagdadi mentions that excess expectoration of phlegm is an indication of concoction and marks the final stage of the disease.¹⁶ Contrary to these, the expectoration of blackish or yellowish phlegm is a sign of Ufūnat‘(putrification) in the matter.¹³

Changes in faeces

If the disease is in Zamana-e-Inhitat (decreasing period), the Narriyat or Zardi (orange) colour may be more evident in the faeces, indicating complete concoction. The colour of the faeces may also vary based on the Nudj of the involved humours; for example, faeces becomes blackish and muddy in Sawdā’vi matters.¹⁷

Mundij Advia

Mundij is an Arabic word derived from Nudj, which means ‘concoction’.⁶ Hence, Mundij is a concoctive drug that modifies and prepares morbid humour for evacuation from the body.¹¹ It primarily acts by liquefying Galeez Khilt (thick humour), thickening Raqeeq Khilt (relatively thin humour), and splitting Lazij (viscous) Khilt.^19,22

Mundij drugs modify the consistency of Khilt due to their Musakh’khin (mild heat) property and remain in the Khilt till the completion of Nudj in the organs through their Qābiḍ (astringent) action, without causing putrefaction.^7,28

Thus, through their Musakh’khin and Qābiḍ properties, every Mundij drug performs three important actions: Muhallil, Mulattif, and Muqatte.⁶

Muhallil drugs dissipate the Khilt and remove it gradually from its source.²⁹

Mulattif drugs act by fragmentating the morbific matter into minute pieces under the influence of Quwwat-e Ṭabī‘iyya.²⁹

These drugs penetrate the surfaces of the organs and remove the viscous matter adhered to them.²⁹

Mechanism of Action of Mundij Advia

Mundij Advia help restore the normal consistency of morbific matter and facilitates its evacuation from the body. For example, in the case of thin matter, it is thickened by Khash’khaash (poppy seeds); in the case of thick matter, it is liquefied by Joshanda Haasha (decoction of jangli pudina/ wild thyme); and to soften solid substances, drugs such as Hulba (fenugreek) are used. Nudj normalizes the quality, quantity, and consistency of the morbific matter to achieve the desired benefit. In the context of blood, the concoction implies its purity and freedom from Hiddat to make it a part of the organ. Concoction makes Safra liquid, pure, and Haad. In the case of Balgham, it restores its Mayee (liquid), Raqeeq (thin), and Mushābiha al-Ajza (similar matter) qualities so that it may easily be converted into blood, whereas Sawdā is clarified like the sedimented part of the blood, without burning it. Hence it is stated that:

“Nudj is the perfect as well as normal concoction of morbific matter”.³⁰

Mundij drugs modify the consistency of a Khilt (humour) due to their inherent properties like Musakh’khin and Qabiz effect. The astringent property of Mundijat protects a Khilt from complete dissolution, e.g., dry Injeer (fig).³⁰

Ibn Sina states that a Mundij drug acts by producing moderate heat in the morbific matter, retaining the matter for concoction through its astringent property, without causing vigorous dissolution. Thus a distinction is maintained between wet and dry substances; otherwise, Iḥtirāq (burning) of the matter may occur.²⁸

Hakim Azam Khan states that a Mundij drug is Ha’zim (digestive) in nature; therefore, the Nuzj produced by these drugs is essentially a form of digestion. Mundij drugs are generally Musakh’khin within their normal grades; hence, a Mundij drug needs to be hot in temperament, although its temperament may at times differ from hot to cold.28 Haar Mundij drugs induce Nudj “Biz-zaat” (directly), whereas Baarid Mundij drugs act “Bil-arz” (indirectly).³¹

Mundij drugs produce three important events in the Akhlat (humours):

1. They may transform the matter into a good humour (Ṭabī‘ī / Maḥmūd Khilt), and this action is known as Hazm (digestion).

2. It may cause Fasad, resulting in Ufūnat‘ ,the putrefaction of the matter.

3. The change may remain between the two, and this intermediate stage is termed as Nudj, as the action of the drug, through Ḥarārat Gharīziyya, prevents suppression of the matter and renders it evacuable.³¹

Types of Mundij Advia

Based on the matters involved, Mundij drugs are divided into three types: Munḍij-i-Ṣafrā’, Munḍij-i-Balgham, and Munḍij-i-Sawdā.^32,33

Mundij-e-Ṣafrā Advia

The drugs that help restore the normal consistency of Ṣafrāwi morbific matters. These matters are thin and do not evacuate easily from the body; so Mundije Ṣafrā drugs change them into thick by the action of Taghlīẓ.²¹ Some commonly used Mundije Ṣafrā drugs are: Unnab (Zizyphus jujube), Gule Banafsha (Violo odorata), Gule Nilofar (Nymphaea lotus), Tukhme Kasni (Cichorium intybus), Gule Surkh (Rosa damascene).^32,34

Munzij-e-Balgham Advia

Mundij drugs are the concoctive of phlegm that modify and prepare abnormal phlegm for evacuation from the body. These drugs act by Tarqīq and Taqttee of the morbid matter; therefore, drugs possessing the actions of Talteef, Taqtee, and Tahleel are associated with this category. Hakim Azam Khan says that higher grades of Musakh’khin drugs should be avoided for the concoction of Balghami matter, as they dissolve the Lateef portion of the matter, leaving behind the thicker part, which is hard to evacuate.³⁵ He further explains that the selection of the degree of Munzij-e-Balgham drugs should be based on the quantity and quality of the morbid matter. If the matter is low in quantity with poor quality, drugs of a lower degree should be selected. Conversely, when the matter is abundant with increased quality, hot drugs of the third or fourth degree should be preferred, such as Aqar Qarha (Anacyclus pyrethrum), Farfiyun (Euphorbium), etc.³⁵ Many Munzij-e-Balgham drugs have been mentioned in Unani literature, like Anisoon (Pimpinella anisum), Anjir (Ficus carica), Asl-us-Soos (Glycyrrhiza glabra), Maweez Munaqqa (Vitis vinifera), Badiyan (Foeniculum vulgare), Gaozaban (Borago officinalis), Parshiaoshan (Adiantum capillus), Sapistan (Cardia dichotoma), Balchad (Nordostachys jatamansi), Tukhme khatmi, Tukhme khubbazi (Malva sylvestris), Unnab (Zizyphus jujube), Ustukhuddoos (Lavandula stoechas), Tukhme karafs (Apium graveolens), Bekhe Izkhir (Cymbopogon citratus), Bekhe kasni (Titorium intibus), Bekh Kibr (Capparis spiosa).^28,29,32

Mundij-e-Sawdā Advia

These drugs help restore the normal consistency of Sawdāwi morbific matters, which are thick and do not evacuate easily from the body. Mundije Sawdā drugs convert these matters into thinner ones by the action of Tarqeeq.²¹Some commonly used Mundije Sawdā drugs are Gaojaban, Badiyan, Parshionshan, Ustukhuddoos, Badranjboya (Melissa officinalis), etc.^32,34

Discussion

Akhlāṭ are the moist and fluid parts of the body produced after Ṣūrat Naw‘iyya (transformation), and the metabolism of aliments. They serve the functions of nutrition, growth, and repair, and produce energy to preserve an individual and his species.^2,3 A proper proportion and inter-mixture (homeostasis) of these, according to quantity and quality, constitutes health. Their disproportion or imbalance (Sū’-i-Mizāj) in quantity and quality, and their irregular distribution, leads to diseases.^2,3,15 Nudj (concoction) and Ishaal (purgation) are the basic principles of treatment for all humoural disorders in USM, and have been used as a regimen for chronic diseases. They remain the mainstay of treatment recommended by almost all Unani physicians, including Hippocrates, Galen, Raban Tabri, Rhazes, Ibn al Nafees, Ibn Rushed, Akbar Arzani, Ibn Sina, Najmul Ghani, Hakim Azam Khan, Ibrahim Almagharbi and Hakim Alwi Khan. These scholars have emphasized the importance of Mundij therapy in their books and successfully treated patients through this mode for centuries.

The literature reviewed in this paper presents the concepts of Nudj and the mechanisms of action of Mundij drugs through Tanqia and Tadeel. Clinical trials conducted by Ali et al., and Yasir et al., on Munzidj and Mushil drugs have demonstrated the effects of this historical regimen in the management of chronic humoural disorders such as post-stroke hemiplegia and spasticity.^36-38

The effects of Mundij drugs on chronic diseases correlate with scientific reports on many Munḍij-i- Balgham drugs. For example, Glycyrrhiza glabra Linn. has been evaluated for memory-enhancing, and anxiolytic activities; Pimpinella anisum for anticonvulsant and neuroprotective effects, and for antispasmodic and relaxant properties; Melissa officinalis and Achille amillefolium Linn. for antioxidant activity; and Majoone Najah (a Unani compound formulation containing Mundij advia) for antidepressant activity.^39,44 Zingiber officinale and Cichorium intybus have also been evaluated for hepatoprotective activity.⁴⁵

Conclusion

The information on Nudj and Mundijat presented in this paper provides a conceptual base for future researchers to solve the unsolved journey of modern medicine in managing challenging chronic diseases such as cancer, hemiplegia (Falij), spasticity, Bahaq wa Bars (leucoderma), Wajaul Mafasil (rheumatoid arthritis),and various skin disorders conditions classified as chronic humoural disorders in USM.

Conflict of Interest

Nil

Acknowledgment

The authors are highly thankful to the Director, NIUM, Bangalore, for providing the best reference books, digital library, and internet facilities for the literature search of this review article. The authors also acknowledge all the scholars, writers, and scientists whose references have been cited in this paper.