Unani Regimenal Therapies: Cupping, Massage, Cleansing and Diet

What regimenal therapy is

Unani describes four levels of care: Ilaj bil Tadbeer (regimenal therapy), Ilaj bil Ghida (diet), Ilaj bil Dawa (medicines) and Ilaj bil Yad (surgery). [1] Regimenal therapy covers physical and procedural methods. A reference source lists exercise, massage, purging, cupping and spiritual awareness. [2] In Unani teaching these are used to cleanse the body or restore balance of the humors, a traditional idea described on Unani humors and mizaj. This page is information only. It gives no instructions, and several of these methods should only ever be done by trained clinicians.

Cleansing methods: enema and purging

Huqna (enema) is described by Unani authors as a key regimenal therapy "used to cleanse the bowels and restore humoral balance"; the authors of a 2025 review say further research is needed to validate its efficacy and address limitations. [1]

Outside Unani, a systematic review of colonic cleansing for general health found no methodologically rigorous controlled trials supporting it, and multiple case reports and series describing adverse effects. [3] That review looked at cleansing for general wellness, not at Unani practice specifically, but it is the best independent evidence we found. Purging, emesis, enemas and fasting as home practices are not described here. Evidence rating: no good evidence of benefit for general health; reports of harm.

Cupping

Cupping appears in Unani texts as a regimenal therapy. [2] Dry cupping and wet cupping (hijama) differ in risk; the 2025 case report below calls wet cupping an invasive traditional practice. [4] This site's pages Cupping Therapy and Hijama in Islamic practice cover them in detail.

What research found:

• A 2024 open-label randomized trial from a Unani university in New Delhi compared dry cupping with medicated steam for low back pain. Both groups improved over three short sittings, and the authors concluded both were beneficial. [5] Both groups received a treatment and there was no sham or no-treatment group, so the trial cannot show that either one works beyond expectation or natural recovery.


• A 2025 systematic review of 72 pain trials (5,720 participants) reported benefit for pain, but all included trials had high risk of bias and the evidence was low quality. [6]


• A 2023 review of musculoskeletal conditions rated the evidence for low back or neck pain as low to moderate and for other conditions as very low to low. The incidence of adverse events was reported as very low, though most studies used dry cupping. [7]

Evidence rating: promising but limited for some musculoskeletal pain; unproven for most other uses.

Risk: a 2025 forensic case report describes sudden cardiac death after wet cupping by an unlicensed practitioner in a patient with a history of stroke and a bladder tumor; the authors said a direct causal link could not be proven but was plausible, and pointed to cumulative blood loss and stress from repeated sessions. [4] It is a single case, not a measure of how common harm is. Its authors stress that invasive practices should be done under appropriate conditions by authorized health professionals. [4] See moxibustion and cupping risks.

Leeching

A 2024 review describes leech therapy as one of the most widely used treatment methods in traditional medicine. It reviewed 12 trials and reported successful outcomes across several conditions but acknowledged complications. [8] The review authors' conclusion rests on a small set of trials, so treat it as insufficient evidence for most uses. A US analysis of device reports found 19 cases of antibiotic-resistant infection linked to leech therapy, nearly half multi-drug resistant. [9]

Massage, exercise and diet

Massage and exercise are listed as regimenal therapies. [2] For modern massage see what is massage therapy. Unani writers also describe prevention as a balance of diet, exercise and rest, and stress regulation. [10] Those general lifestyle ideas overlap with ordinary health advice, but we did not find trials of Unani diet plans as a package. Proper evidence not found for Unani diet regimens as a whole.