Case Study on the Efficacy of Fasd (Venesection) and Unani Medication in Sciatica Management: Pain Alleviation and Functional Recovery

Mohd Maruf Khan¹*, Mehmooda Begum², Arif Anees³, Nimra Fatima⁴

¹P.G. Scholar, Ilaj Bit Tadbeer, H.S.Z.H. Government Autonomous Unani Medical College,

Bhopal-462003 M.P.

²Professor, Ilaj Bit Tadbeer, H.S.Z.H. Government Autonomous Unani Medical College, Bhopal-462003 M.P.

³Reader, Ilaj Bit Tadbeer, H.S.Z.H. Government Autonomous Unani Medical College, Bhopal-462003 M.P.

⁴Research Scholar, Barkatullah University Bhopal-462026 M.P.

*Corresponding Author E-mail: marufkhan2106@gmail.com

ABSTRACT:

Background: Sciatica (Irq’al-Nasa), a condition characterized by radiating pain along the sciatic nerve, can significantly impact quality of life. This case report explores the efficacy of Fasd (venesection), a traditional Unani therapeutic intervention, in managing sciatica, in conjunction with complementary Unani treatments. Case Presentation: A 45-year-old male office worker presented with severe, radiating pain from the lower back to the right leg, accompanied by tingling and numbness, persisting for four months. Diagnostic evaluations included a Visual Analogue Scale (VAS) score of 8/10 for pain and an Oswestry Disability Index (ODI) score of 48%, indicating significant disability. Therapeutic Intervention: The patient underwent 3 weekly sessions of Fasd, alongside regular Roghan-e-Zaitoon (olive oil) massage and a regimen of Itrifal Tamar Hindi. The Fasd sessions targeted the Safravi (bilious) humor imbalance contributing to nerve inflammation and compression. Outcome: Significant improvements were observed post-treatment. The VAS score decreased from 8/10 to 2/10, and the ODI score improved from 48% to 3%, indicating relief in pain and functional recovery. The Straight Leg Raise (SLR) test improved, reflecting reduced nerve compression. No adverse effects were reported during the treatment. Conclusion: The application of Fasd, combined with supportive Unani therapies, proved to be an effective approach for managing sciatica. The treatment led to considerable pain relief and functional improvement, highlighting the potential of traditional Unani methods in contemporary clinical practice. Further studies are recommended to validate these findings and assess the broader applicability of Fasd for sciatica.

KEYWORDS: Irq’al-Nasa, Itrifal Tamar Hindi, Roghan-e-Zaitoon, Sciatica, Venesection.

INTRODUCTION:

Sciatica is a common condition found prevalent in 43% ^1,2 of the population, characterized by pain radiating along the sciatic nerve, which extends from the lower back down through the hips, buttocks, and legs. It often results from nerve compression due to conditions like herniated discs or spinal stenosis in approximately 85-90% of the cases^3,4.

In the Unani system of medicine, Irq’al-Nasa(sciatica)⁵ refers to nerve pain originating in the gluteal region and extending to the ankle. Scholars like Ibne Sina (980–1037 AD) described it as arthralgia, with pain starting at the hip and radiating down to the ankle⁶. Mohammad Ismaeel Jurjani (930–994 AD) noted its origin in the ischial joint⁷, while Ibn-e-Hubal Baghdadi (d. 1213 AD) and Razi (865–925 AD) explained its path from the hip to the calf⁸. Ibne Zuher (1092–1162 AD) mentioned the pain could start in the foot and travel up the leg, affecting either side⁹.

Conventional treatments for sciatica primarily include physiotherapy^10,11, analgesics, anti-inflammatory drugs ¹², and sometimes surgical interventions¹³. However, many of these methods focus on symptom management rather than addressing the underlying causes and often come with significant side effects, leading patients to seek alternative treatments.

The Unani system offers a holistic approach to treating sciatica, focusing on restoring the balance of humors (Akhlat) in the body. The treatment in Unani medicine is based on fundamental principles, including:

· Tanqiya-e-Mawad-e-Fasida: Cleansing and elimination of morbid material

· Tahleel-e-Warm: Resolution of inflammation

· Taskeen-e-Dard: Pain relief¹⁴

Various therapies are utilized, including Hijama (cupping)¹⁵, Dalk (massage)¹⁶, Taleeq (leech therapy)^17,
20, and dietary modifications, each aimed at resolving the root causes of pain and inflammation²¹. Among these, Fasd(venesection) stands out as an effective regimenal therapy. Fasd involves bloodletting to remove morbid humors, especially Khilt-e-Damwi Ghaleez (viscid sanguineous humor) and Khilt-e-Balghami Ghaleez (viscid phlegmatic humor), which are believed to accumulate in the affected areas, causing pain and discomfort.

The aim of the study is to highlight the efficacy of Fasd in managing sciatica, offering a safer, more natural alternative to modern interventions by addressing the root cause of the condition while promoting holistic recovery.

CASE PRESENTATION:

A 45-year-old male, employed in a desk-based office job, presented to the outpatient department of HSZH Government Unani Medical Hospital, Bhopal, Madhya Pradesh, with a primary complaint of sharp, radiating pain originating from the lower back and extending to the right leg, reaching down to the foot. This pain was accompanied by sensations of tingling, numbness, and discomfort, persisting for the past four months.

The patient had no history of hypertension or trauma, but his sedentary lifestyle contributed to the condition. Clinical evaluation revealed hemoglobin levels at 13 g/dL, bleeding time of 2 minutes, and clotting time of 3 minutes. His vital signs were stable, with a blood pressure of 120/80mmHg, a pulse rate of 84 beats per minute, respiratory rate at 20 breaths per minute, and a body temperature of 98.6°F.

On physical examination, there was a restricted range of motion in the lower back, with difficulty in bending forward and sideways. An X-ray of the lumbosacral spine showed evidence of lumbar spondylosis. The patient reported a pain level of 8/10 on the Visual Analogue Scale (VAS). Patient’s condition also impacted his daily activities, as assessed by the Oswestry Disability Index (ODI), which was 48% indicating moderate disability affecting his functional abilities and quality of life. The ECG was normal, and general examination confirmed that the patient was hemodynamically stable.

The Straight Leg Raise (SLR) test was positive at 30° on the right leg, indicating nerve compression, further supported by the absence of the ankle jerk reflex. Unani diagnostics identified an imbalance in Akhlat (humors), particularly a Safravi (bilious) imbalance, characterized by excess heat and dryness. This imbalance was believed to contribute to nerve inflammation and obstruction of blood flow along the sciatic nerve, exacerbating the patient's symptoms.

Treatment Plan:

Given the patient's condition and the diagnosis of humor imbalance, the Unani regimenal therapy of Fasd (venesection) was chosen as the primary treatment modality. Fasd was recommended to eliminate the morbid humors contributing to the sciatic nerve compression and inflammation, particularly targeting the Safravi (bilious) imbalance. This therapy, in combination with lifestyle modifications and supportive Unani treatments, aimed to restore humor balance, reduce nerve inflammation, and provide lasting pain relief.

Therapeutic Intervention:

After a thorough assessment, the patient was comfortably seated, and vitals were recorded before proceeding. A tourniquet was applied above the ankle joint to occlude blood flow and engorge the right saphena minor vein, making it prominent. The area was sterilized with a spirit swab, and a 20G needle was inserted to allow 17ml of blood to flow out, adhering to the limits set by the IRB guidelines. Upon completion, the needle was carefully removed, and antiseptic dressing was applied. Vital signs were reassessed, and the patient was monitored for 15minutes post-procedure to ensure stability and rule out any adverse reactions. Considering the patient’s hemoglobin status and capillary refill, Fasd (venesection) sessions were conducted once a week for 3 weeks.

Additionally, a regimen of gentle massage with Roghan-e-Zaitoon (olive oil) was introduced to relax the muscles, stimulate blood circulation, and reduce stiffness. This was performed three times a week for 20 minutes.

Halela zard (mild purgative regimen) was prescribed to aid in the elimination of excess bile (Safra), further assisting in balancing the humors.

The patient was followed up via telephonic consultations over a period of 2 months and was advised to report immediately to the hospital if any recurrence of symptoms occurred.

RESULTS:

Outcome - The patients were assessed using the Visual Analogue Scale (VAS) for pain and the Oswestry Disability Index (ODI) for quality of life. Following a series of 3 weekly sessions of Fasd (venesection) combined with Unani therapies, significant improvements were observed. Initially, the patient’s VAS score was 8 and ODI was 48% at baseline. After the first session, the VAS score decreased to 6 and the ODI improved to 24%. After the final, third session, the VAS score had further reduced to 2, and the ODI had improved remarkably to just 3%. Throughout the treatment course, no adverse events were reported. By the end of the treatment cycle, the patient's pain had reduced. The straight leg raise test was negative, indicating significant improvement in nerve function. The patient reported an 80% improvement in symptoms and resumed normal activities without pain. The patient reported feeling more energetic, with better blood circulation and reduced stiffness, attributed to the regular use of Roghan-e-Zaitoon (olive oil) massage.

FollowUp - The patient was monitored over a 2-month period through telephonic consultations, during which no recurrence of significant symptoms was reported. The patient was advised to maintain an active lifestyle with regular light exercise and continue using the regimen of Halela zard intermittently to maintain humor balance.

Table1 – Outcomes of the Treatment

Sitting	VAS Score	ODI	Range of Motion	Tingling and Numbness	Additional Observations
Baseline	8/10	48%	Limited in the lower back	Pain was accompanied by sensations of tingling, numbness, and discomfort	Difficulty bending forward or sideways
1^st	6/10	24%	Noticeable improvement in bending	Significant reduction	Less difficulty in forward bending
2^nd	3/10	10%	Considerable reduction in stiffness	Further decrease in numbness	improvement in mobility and pain
3^rd	2/10	3%	Almost full mobility regained	Mild discomfort only	Overall symptom relief and minimal pain

DISCUSSION:

This case study highlights the efficacy of Fasd (venesection) as a treatment modality for sciatica, particularly when integrated into a holistic Unani therapeutic regimen. The patient, who initially presented with severe pain, tingling, and numbness radiating from the lower back to the right leg, demonstrated significant improvement following 3 sessions of Fasd combined with complementary therapies.

Fasd effectively targeted the underlying humor imbalance, particularly the Safravi (bilious) imbalance characterized by excess heat and dryness. This approach aimed at reducing inflammation and alleviating nerve compression. The progressive reduction in pain from 8/10 to 2/10, alongside improvements in range of motion and functional ability, underscores the treatment's effectiveness in managing sciatica.

The positive outcomes observed in this case align with Unani principles that emphasize the restoration of balance among bodily humors to address the root causes of ailments. The reduction in disability as measured by the Oswestry Disability Index (ODI) from 48% to 3% reflect substantial clinical benefits and an enhancement in the patient’s quality of life.

Complementary interventions, such as Roghan-e-Zaitoon (olive oil) massage and the regimen of Halela zard, contributed to muscle relaxation, improved circulation, and balanced humors, further supporting the overall therapeutic efficacy. Regular monitoring and follow-up confirmed the sustainability of these improvements and the absence of adverse effects.

CONCLUSION:

The integration of Fasd (venesection) within a comprehensive Unani treatment plan demonstrated substantial efficacy in managing sciatica. The treatment not only alleviated pain and reduced nerve compression but also restored functional mobility and improved the patient’s quality of life. This case supports the potential of traditional Unani therapies to provide effective, holistic care for sciatica, emphasizing the importance of humor balance in treating complex conditions. Future studies with larger sample sizes and controlled designs are warranted to further validate these findings and explore the broader applicability of Fasd in contemporary clinical practice.

CONFLICT OF INTEREST:

The authors declare to have no conflicts of interest.

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Received on 02.10.2024 Revised on 21.11.2024

Accepted on 26.12.2024 Published on 18.02.2025

Available online from March 10, 2025

Int. J. of Advances in Nursing Management. 2025;13(1):1-4.

DOI: 10.52711/2454-2652.2025.00001

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