Faalij (Paralysis)

Faalij (Paralysis)

Introduction

Faalij (Paralysis) is a condition involving loss of muscle function in the body/ motor power of muscle that may be accompanied by sensory loss. It is also referred to as loss of feeling. It can affect any part of the body.

Faalij is an Arabic word meaning “to halve”. In specific meaning, it indicates paralysis (Istirkha) of longitudinal half of the body either starting from the neck sparing head and face or the entire longitudinal half of the body from head to foot. Since it affects one half of the body and leaves the other half unaffected (healthy), it has been named so because of the virtue of dividing the body into two halves; one healthy and the other diseased.

As per Unani medicine classics, it is mainly caused by drifting of Phlegmatic humour (Rutoobat-e- balghami) from brain on the nerve origin resulting in loss of sensory and motor function of the affected part of body on account of related A’asaab (nerves) being afflicted with weakness.

It can also occur due to predominance of cold (Buroodat) and wetness (Rutoobat) on the affected organ. It is characterized mainly by loss of motor power of the affected part with some other symptoms varying with the causative factor.

Unani Philosophy

In Unani classical literature description of paralysis (Istirkha) is same as that of word Hemiplegia (Faalij or Faalij-e- Nisfi). It is described as a disease causing loss of movement and sensation in longitudinal half of the body because the penetration of Rooh-e- Hassas wa Muharrik (Active Pneuma) into the organs may either be arrested or the Rooh (Pneuma) may penetrate but the organs may not respond due to Su-e- Mizaj (dystemperament).

It is a well-known since Greeco-Arab period and was first described by Hippocrates (Father of Medicine). Some other Unani physicians like Galen (Jalinoos) (129-200AD), Rabban Tabari (770/780-850AD), Sabit Bin Qurrah (836-903AD), Ali Ibn-e- Abbas Majoosi (930-994AD) and Ibn-ee Sina described it in detail and mentioned its pathophysiology, aetiology, clinical features and the management in their treatises.

Rabban Tabari described that, it is caused by an obstruction in any part of the brain.

Causes of Paralysis (Faalij)

Paralysis (Faalij) is mostly caused by damage in the nervous system, especially the spinal cord. Other major causes of paralysis (Faalij) are trauma with nerve injury, cerebral palsy, lyme disease, stroke, peripheral neuropathy, anaemia, poliomyelitis, prolonged exposure to cold, botulism, haemorrhage,  parkinson's disease, amyotrophic lateral sclerosis (ALS), also known as motor neurone disease (MND, spina bifida, environmental factors, multiple sclerosis, and Guillain–Barré syndrome.

Temporary paralysis occurs during REM sleep (Rapid eye movement sleep), and dysregulation of this system can lead to episodes of waking paralysis.

Drugs that interfere with nerve function, such as curare, can also cause paralysis. If not treated properly, Paralysis (Faalij) may cause death.

In Unani literature causes of paralysis (Faalij) have been grouped into two principal categories.

1. Cause leading to obstruction in the path of Rooh-e- Hassas wa Muharrik (Active Pneuma) preventing their penetration into the organs. This obstruction, in turn, may be due to any obstruction in nerves or organs or due to breach in continuity of nerves.
2. Causes making the organs non-responsive to Rooh-e- Hassas wa Muharrik (Active Pneuma). In absence of any obstruction and with normal penetration of Roohe hassas and muharrik (Active Pneuma), the organs sometimes may not respond to it due to ill temperament; leading to loss of sensation and movement in them. This ill temperament may be due to abnormally excessive heat, cold, dryness or moist. But this heat and dryness seldom affects movements and sensation except in extreme conditions. But, if the ill temperament is due to superfluous cold and moist, it often causes loss of movement and sensation.

Ismail Jurjani has mentioned 5 causes of obstruction (Sudda) leading to paralysis (Faalij)

1. External causes: If any part of the body is tied by means of a tight ligature, it would lead to obstruction or obstruction in the pores of the nerves serving as passages for Roohe hassas and muharrik causing temporary loss of movement and sensation.
2. Thick and Viscous fluid; Any thick and viscous fluid gains entry and gets collected in nerve cells and obstructs the routes or passages of Roohe hassas and muharrik. Mostly this fluid is phlegmatic in nature, which descends from the ventricle of brain into the nerves, their origins or their branches.
3. Inflammation: If there is inflammation in any organ, the inflammatory materials may obstruct the passages of Roohe hassas and muharrik.
4. Injury and Bruises: Compression and contusion of nerves as a result of fall or blow over their roots can also obstruct or block the passages of Rooh (pneuma).
5. Inclination or deviation of vertebrae: Inclination or deviation of any vertebrae towards right or left side may lead to contusion or compression of the nerves emerging from the spinal cord, blocking the routes of the Rooh.

Hakeem Akbar Arzani has added two more causes of obstruction (Sudda)

1. Constriction (freezing) of nerves: Due to severe cold or due to thickening of nerve cells.
2. Dislocation of joints of any organ: Due to external or internal cause compressing nerves and blocking the passages of pneuma (Rooh).

Risk factors

Hippocrates (Buqrat) stated that “people who often have common cold and coryza are at a risk of developing paralysis (Faalij)”.

Galen (Jalinoos) mentioned that “people having superfluous cold humours in their brain, when exposed suddenly to excessive heat or cold, develops paralysis (Faalij)”.

Ibn-e- Sina has revealed that paralysis (Faalij) is more common in severe cold of winter season and in spring. In spring it is due to haemorrhage (Jiryaan-e- khoon) and qualitative dystemperament in humours (Haijane akhlaat). He also added that it is more common in people living in southern countries, who attained 50 years of age or somewhat near it, due to excessive secretion from their heads.

Mohammad Azam khan added in this context that this disease is common in people with cold temperament especially in weak and old people and those having excessive phlegm in their body. He also described exposure to cold air and drinking enough cold water as predisposing factors for paralysis (Faalij). He further stated that people with apoplexy; epilepsy and hysteria are more susceptible to develop paralysis (Faalij).

Classification

Ancient Unani Scholars used words Istirkha and Falij synonymously to indicate paralysis irrespective of the part involved. The word Paralysis (Falij) is used for paralysis of longitudinal half of the body sparing head and face.

• If whole longitudinal half of the body including head and face is paralyzed then it is named as Hemiplegia with facial palsy (Falij ma’a Laqwa).
• When there is paralysis of whole body except face, the condition is called as Abu Bilqisya.
• When the whole body including head and face is involved then this condition is called Sakta.

Hakeem Mohammad Azam Khan has classified Faalij according to its causes into following 5 types.

1.  Falije Balghami Ratubi (due to excess of phlegm)

This type of Falij is caused by ‘excess of phlegm.’ Phlegm descends from the brain to the nerves and obstructs the routes or passages of Roohe Hassas and Muharrik leading to loss of movement and sensation. This type of Falij is characterized by sudden onset and presence of symptoms of excess of phlegm.

2. Faalije Damawi (Paralysis due to quantitative imbalance in blood)

This type of Falij is caused by ‘excess of blood.’ It is also sudden in onset and the symptoms of excess of blood are present.

3. Faalij-e- Intiqale Buhrani

This type of Falij is caused as a result of buhran in diseases like meningitis, apoplexy, epilepsy, colic, Hysteria and acute fever. It is also sudden in onset.

4. Faalij-e- Warami (Paralysis due to inflammation)

The underlying cause of this type of Falij is inflammation; hot, cold, gaseous or hard inflammation; and is characterized by gradual onset and accompanying symptoms like fever and pain or palpable swelling in the nerves.

5. Faalij-e- Wabayi

This type of paralysis (Faalij) affects many people in the same season at the same place and is believed to be caused by ‘infected air’ and often involves left side of body and is characterized by symptoms like redness in eyes, halitosis, vomiting, unconsciousness followed by delirium, incontinence of urine and faeces and sudden death within days.

Modern Classification of Paralysis (Faalij)

• Hemiplegia – affecting a side of the face and the corresponding limbs.
• Monoplegia – affecting a single limb.
• Diplegia – Paralysis of the entire body.
• Paraplegia – Affecting both left and right side of the body.

Usool-e- Ilaj (Principles of Treatment)

1. Evacuation of phlegmatic waste products (Istifraagh-e- fuzlaat-e- balghamiya)
2. To maintain temperamental equilibrium (Ta’adeel-e- mizaj)
3. Strengthening of nerves (Taqwiyat-e- a’asaab)
4. Dietary modification/ restriction (Taqleel-e- ghiza)

Ilaaj bil Tadbeer (Regimenal Therapy)

1. Enema (Huqna)
2. Massage (Dalk) with rubefacient liniment
3. Cupping (Hijamah)
4. Irrigation (Nutool)

Ilaaj Bil Ghiza (Dietotherapy)

Dietary Restriction

Aghziya-e- mughalliza

Aghziya-e- murattiba

Dietary Recommendatiom

• Ma-ul- Asl
• Ma-ul- Shaier
• Aghziya-e- yabisa e.g. Khusjkari Roti (Whole grain bread)
• Meat of Patridge, sparrow, pigeon etc.

Ilaaj Bil Dawa (Pharmacotherapy): Unani medicines in the form of crude herbal extracts of single plant or combination of plants, with or without additional minerals have been used in alleviating and curing diseases related to problems of nervous system specially paralysis (Faalij).

1. First step: Ma-ul- usool for Concoction (Nuzj) for seven days

Light diet comprising of Ma-ul- asl and whole grain bread during administration of concoctive drugs (Munzij advia)

2. Second step: Oral/ parenteral administration of Mushil-e- balgham (Purgatives of phlegm)
3. Third step: Oils of hot temperament (Adhaan-e- Harra) for strengthening of nerves (Taqwiyat-e- A’asab)

Single Unani Drugs

Several herbs, root vegetables, condiments, and fruits can help in treating paralysis in the most natural way and without any side effects. The patient can be administered herbal drinks made from these ingredients or in some cases, given with food to effectively heal their paralytic symptoms.

some of which includes Annona squamosa, Calotropis procera, Coridothymus capitatus, Thunbergia laurifolia, Annona reticulate, Cassytha filiformis, Plumeria rubra, Crateva magna, Crateva religiosa, Argyreia osyrensis, Alocasia macrorrhizos, Murraya koenigii, Suregada multiflora, Satureja thymbra,Oxyceros horrid, Hyocyamus niger, Citrus aurantifolia, Citrus medica, Cissus repens, Aloe vera, Ricinus communis, Cissus hastate.  Gardenia ternifolia, Tamarindus indica, Lygodium flexuosum, Cassia occidentalis, Datura metel, Phyllanthus reiculatus, Aerva persica, Calotropis procera, Cymbidium aloifolium, and Mikania hirsutissima. Other natural herbs include Blueberries, Cayenne, Goldenseal, Asparagus, Ginger Root, Sugarcane Root and Liquorice Root.           

Compound Unani Drugs (Unani Advia Murakkaba)

• Ayaarij Feqra
• Ayaarij Loghaziya
• Habb-e- Ayaarij
• Majoon Azaaraqi
• Anqaroya Kabir
• Habb-e- Faalij
• Majoon Jograj Googul
• Roghan-e- shifa
• Majoon Seer Alvi Khani
• Habb-e- Faalij Mulaayin
• Roghan-e- Qust
• Majoon Lana
• Habb-e- Jund

Tahaffuz (Precaution/ Prevention)

• Alcohol to be avoided
• Extreme cold to be avoided

NOTES

• Along with medicine the patients have to follow strict Unani regimen for optimum results as per the concept of Unani system of medicine. The patients are therefore, strongly advised to avoid self-medication.
• They are advised to visit the nearest authorized Unani treatment centre for advice and treatment.

 

References

http://www.florajournal.com/archives/2013/vol1issue4/PartA/12.1.pdf

http://www.ijrap.net/admin/php/uploads/1457_pdf.pdf

http://hewhocures.com/paralysis.php

http://www.niscair.res.in/sciencecommunication/researchjournals/rejour/ijtk/Fulltextsearch/2011/October%202011/IJTK-Vol%2010(4)-October%202011-pp%20731-735.htm

http://www.theindependentbd.com/printversion/details/121348

https://www.webindia123.com/medicine/article.asp?a_no=929&article=Unani+medicines+for+Paralysis+or+Paraplegia

https://www.sciencedirect.com/science/article/pii/S2225411017300159

http://www.amariapharmacy.in/ailments-diseases/home-remedies/paralysis-natural-treatment/

http://www.avnarogya.in/recommended-home-remedies-for-paralysis/