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1Jamia Tibbiya Deoband, Deoband
2Jamia Hamdard, Delhi
3National Institute of Unani Medicine, Ghaziabad
Narcolepsy is a chronic neurological sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and disrupted nocturnal sleep. Contemporary biomedical research attributes narcolepsy[2] primarily to hypocretin (orexin) deficiency[1] resulting from autoimmune-mediated destruction of hypothalamic neurons. In Unani medicine, sleep (Nawm) is governed by the equilibrium of Akhl??-e-Badan (body humors), and its disturbances are associated with S?’-i-Miz?j, particularly Ghalaba’-i-Balgham[15] (phlegmatic predominance) and Ru??bat-e-Dim?gh (cerebral moisture). This review critically examines narcolepsy from both biomedical and Unani perspectives and proposes a conceptual integrative framework linking humoral imbalance with neurochemical dysregulation. Therapeutic approaches, including pharmacological, regimen, and dietary interventions, are evaluated, highlighting the potential for integrative management. The study also identifies gaps in evidence and proposes directions for future clinical and translational research.
Narcolepsy is a lifelong neurological disorder affecting approximately 0.02–0.05% of the global population. It commonly presents during adolescence or early adulthood and significantly impairs quality of life due to persistent sleep disturbances. The disorder is clinically classified into narcolepsy[2] type 1 (with cataplexy and hypocretin deficiency) and type 2 (without cataplexy).
Modern medicine identifies narcolepsy[2] as a disorder of sleep–wake regulation associated with dysfunction of orexin-producing neurons in the lateral hypothalamus. In contrast, Unani medicine conceptualizes sleep as a physiological state governed by the balance of humors and the interaction of Ḥarārat (innate heat) and Ruṭūbat (moisture).
Classical Unani scholars, including Ibn Sīnā[8], described sleep as a state of quiescence resulting from the predominance of cerebral moisture. Disturbances in sleep (Amrāḍ-e-Nawm) are attributed to humoral imbalance, particularly the dominance of Balgham[15], which is characterized by cold and moist qualities.
METHODOLOGY
This narrative review synthesizes evidence from both classical Unani texts and contemporary biomedical literature. Databases including PubMed, Scopus, and Google Scholar were searched using keywords such as “narcolepsy[2],” “orexin,” “sleep disorders,” “Unani medicine,” and “Akhlāṭ.” Articles published between 2000 and 2025 were prioritized for modern insights, while authoritative classical texts were included to represent Unani perspectives. Inclusion criteria comprised peer-reviewed articles, systematic reviews, and standard Unani references. Non-English and non-relevant studies were excluded.
Historical Review of Sleep in Unani Medicine
Buqrāt[12] (460–370 BC): Linked sleep to humoral balance and emphasized the role of phlegm and blood in sleep–wake cycle.
Jālīnūs[11] (129–200 AD): Discussed sleep as a natural function needed for the restoration of faculties.
Rāzī[9] (865–925 AD): In Kitāb al-Hāwī, he described conditions of excessive sleep (Kathrat-e-Nawm) due to excess moisture in the brain.
Ibn Sīnā[8] (980–1037 AD): In Al-Qānūn fi’l Ṭibb, he detailed the physiology of sleep and classified its disturbances.
Jurjānī[10] (1042–1137 AD): In Dhakhīra Khawārīzm Shāhī, described narcoleptic-like symptoms as “sudden overpowering sleep due to Balgham[15] dominance.”
Akbar Arzānī[13] (18th century): In Ṭibb-ī-Akbar, he highlighted the relation of brain phlegm with abnormal sleepiness.
Pathophysiology of Narcolepsy in Modern Medicine
Narcolepsy is primarily characterized by hypocretin (orexin) deficiency[1], resulting from the selective loss of neurons in the lateral hypothalamus. The major mechanisms include:
Unani Conceptual Framework of Sleep Disorders
In Unani medicine, sleep is regulated by the balance of Akhlāṭ (humors):
|
Humor |
Temperament |
Effect on Sleep |
|
Dam (Blood) |
Hot & moist |
Restlessness, disturbed sleep |
|
Balgham (Phlegm) |
Cold & moist |
Excessive sleepiness |
|
Ṣafrā’ (Yellow bile) |
Hot & dry |
Insomnia |
|
Sawdā (Black bile) |
Cold & dry |
Fragmented sleep, anxiety |
Narcolepsy may be understood as a manifestation of Ghalaba’-i-Balgham[15], where excess coldness and moisture in the brain lead to reduced neural activity and impaired wakefulness.
|
Autoimmune trigger → Orexin neuron loss → REM dysregulation → Narcolepsy
↓ (Integrative link)
Ghalaba’-i-Balgham → Ruṭūbat -e-Dimāgh → CNS hypoactivity → Excess sleep |
Integrative Pathophysiological Correlation
A theoretical bridge between Unani and modern concepts can be proposed:
|
Unani Concept |
Classical Description |
Modern Correlation |
Scientific Interpretation |
|
Ghalaba’-i-Balgham |
Cold and moist dominance |
CNS hypoactivity |
Reduced neuronal firing |
|
Ruṭūbat -e-Dimāgh |
Excess brain moisture |
Neurochemical imbalance |
Neurotransmitter dysregulation |
|
Su-i-Mizāj Bārid Raṭb |
Altered temperament |
Functional disorder |
Neuro-immunological dysfunction |
|
Ḥarārat Gharīziyya suppression |
Reduced innate heat |
Hypothalamic dysfunction |
Metabolic decline |
These correlations are interpretative and require empirical validation through interdisciplinary research.
Clinical Features
Narcolepsy presents with:
Diagnosis
Tashkhees based on Mizāj (temperament) assessment.
In narcolepsy[2], the dominance of Balgham[15] leads to excessive Ruṭūbat (moisture) in the brain, causing the nervous system to become hypoactive, hence promoting sudden and uncontrollable sleep episodes.
It refers to increased moistness in organs, especially the brain and nerves. It leads to dullness, heaviness, and impaired functioning. In narcolepsy[2], excessive ruṭūbat in the brain contributes to sleepiness by dulling wakeful responses.
The organs, particularly the brain and nervous system, become inactive or sluggish. This Sukūn is a result of cold and moist Mizāj, which dampens nerve impulses. Clinically manifests as sudden muscle relaxation (as seen in cataplexy) or general physical inactivity.
PSG is often the first step in diagnosing narcolepsy[2]. It helps determine the amount and quality of night time sleep and can identify other sleep disorders, such as sleep apnea, that may coexist with narcolepsy.
In individuals with narcolepsy[2], PSG can reveal abnormal patterns, such as shortened REM sleep latency (the time it takes to enter REM sleep) and increased REM sleep episodes. These patterns are significant indicators of narcolepsy.
The Multiple Sleep Latency Test (MSLT) is a diagnostic tool used to measure excessive daytime sleepiness and diagnose sleep disorders like narcolepsy[2] and idiopathic hypersomnia.
Cerebrospinal fluid (CSF) hypocretin levels are crucial for diagnosing narcolepsy[2], particularly type 1 narcolepsy with cataplexy[6], as low levels indicate a deficiency associated with this condition
An integrative diagnostic model combining subjective Unani assessment with objective biomedical tools may enhance diagnostic precision.
Management
|
Symptoms ↓ Modern Diagnosis → PSG + MSLT + CSF orexin ↓ Unani Diagnosis → Mizāj + Akhlāt assessment ↓ Integrated Treatment → Drug + Diet + Regimen |
Modern Pharmacotherapy
Unani management of narcolepsy[2]
1. Ilāj bi’l Tadbīr (Regimenal Therapy)
Taʻdīl-i-Nawm: Regulation of sleep–wake cycle.
Dalk (Massage): With Roghan-e-Baiza Murgh, Roghan-e-Narjeel, or stimulating oils.
Ḥammām (bath/steam bath): To mobilize excess ruṭūbat.
Qayʼ (emesis) & Ishāl (purgation): To eliminate excess Balgham[15].
2. ‘Ilāj bi’l Taghdhiya (Dietotherapy)
Avoid Balgham[15]-producing foods: milk, fish, rice, cucumber, excessive sweets.
Include warm, dry temperament foods: ginger, garlic, black pepper, honey, whole grains.
Light, easily digestible diet to reduce cerebral vapors.
3. ‘Ilāj bi’l Dawā’ (Pharmacotherapy)
Ustukhuddus (Lavandula stoechas): Clears Balgham[15], strengthens brain.
Zafran (Crocus sativus): Stimulant, improves alertness.
Asgandh (Withania somnifera): Nervine tonic.
Jund Bedastar (Castoreum): Used for neurological weakness .
Sibr (Aloe vera): Mild purgative for balancing Balgham[15].
4. Lifestyle Corrections
Regular sleep timing.
Mild physical exercise.
Avoiding daytime oversleeping.
Meditation and mental stimulation.
Therapeutic Comparison
|
Aspect |
Modern Medicine |
Unani Medicine |
|
Etiology |
Orexin deficiency |
Balgham dominance |
|
Diagnosis |
PSG, MLT |
Mizāj assessment |
|
Drug therapy |
Modafinil |
Ustukhuddus |
|
Approach |
Symptomatic |
Holistic |
Discussion
Narcolepsy is increasingly understood across both modern and traditional medical systems as a disorder of sleep–wake regulation, characterized by excessive daytime sleepiness, sudden sleep attacks, and, in some cases, cataplexy (a sudden loss of muscle tone often triggered by emotions). While the clinical features are broadly recognized, the underlying etiological explanations and therapeutic approaches differ significantly between modern biomedicine and traditional systems such as Unani medicine.
From the perspective of Modern medicine, narcolepsy[2] is most commonly associated with the loss of hypothalamic neurons that produce orexin (also known as hypocretin), a neuropeptide critical for maintaining wakefulness and stabilizing the sleep–wake cycle. This orexin deficiency[1,2] is often considered to have an autoimmune basis, where the body’s immune system mistakenly attacks these critical neurons. Diagnostic advances, including polysomnography, multiple sleep latency testing (MSLT), and cerebrospinal fluid (CSF) analysis for orexin levels, have improved the identification and classification of narcolepsy into type 1 (with cataplexy and orexin deficiency) and type 2 (without cataplexy and with normal orexin levels). Treatment strategies in modern medicine typically involve pharmacological agents such as stimulants (e.g., modafinil, amphetamines), sodium oxybate, and selective serotonin/norepinephrine reuptake inhibitors (SSRIs/SNRIs) to manage symptoms and improve quality of life.
In contrast, Unani medicine, a Greco-Arabic system rooted in the teachings of Hippocrates and Galen and further developed by Islamic scholars like Avicenna (Ibn Sīnā[8]), explains narcolepsy[2] through the lens of humoral imbalance. Specifically, the condition is attributed to Ghalaba’-i-Balgham[15], or the dominance of the phlegmatic humor, which is associated with cold and moist qualities. This excessive phlegm leads to increased ruṭūbat (moisture) and a cooling of the brain’s temperament, impairing its functional activity, especially related to alertness and consciousness. The Unani concept suggests that when the brain becomes overly moist and cold, its ability to regulate wakefulness diminishes, leading to symptoms reminiscent of narcolepsy.
Therapeutic approaches in Unani medicine emphasize the restoration of humoral balance and the normalization of Mizāj (temperament). Treatment often begins with lifestyle and dietary modifications designed to reduce phlegmatic dominance. Foods that are considered cold and moist are restricted, while warm and dry foods are encouraged to counteract the imbalance. Tadbīr (Regimens) such as massage, cupping, moderate exercise, and sleep regulation are prescribed to improve circulation and brain function. Additionally, Muqawwī-i-Dimāgh (brain tonics)—herbal formulations that strengthen and stimulate the brain—are used to restore cognitive vitality and alertness. Common ingredients may include Asrol (Rauwolfia serpentina), Ustukhuddus (Lavandula stoechas), and Bahman surkh (Salvia haematodes), among others.
While the diagnostic frameworks and terminologies differ, there is a growing interest in integrative approaches that combine the symptomatic relief offered by modern pharmacotherapy with the systemic, temperament-based interventions of Unani medicine. The holistic nature of Unani interventions, particularly its emphasis on lifestyle correction, diet, and individualized regimens, may offer supportive benefits that align well with contemporary goals of personalized and patient-centered care.
CONCLUSION
Unani medicine, rooted in the humoral theory, interprets narcolepsy[2] through the dominance of Balgham[15] (phlegm) and the resultant Ruṭūbat-e-Dimāgh (moisture of the brain). The concept of Ghalaba’-i-Balgham, characterized by cold and moist temperament, provides a framework for understanding not only the symptomatic profile of narcolepsy but also its chronicity and neurological underpinnings. Classical Unani physicians, including Ibn Sīnā[8], Jurjānī[10], and Rāzī[9], have described conditions resembling narcolepsy under various terminologies such as Kathrat-e-Nawm and Sudden overpowering sleep, associating them with increased cerebral moisture, suppressed innate heat (Ḥarārat Gharīziyya), and sluggishness of vital faculties.
The diagnostic approach in Unani medicine, through Mizāj (temperament) assessment, offers a personalized perspective, identifying individuals predisposed to cold and moist imbalances. This is further corroborated by clinical signs such as sukūn al-aʻḍāʼ (inactivity of organs), heaviness in the head, mental dullness, and fatigue, which overlap with modern diagnostic criteria. While modern diagnostics such as polysomnography, MSLT, and CSF hypocretin testing provide objective confirmation, Unani diagnosis is more temperament and symptom-pattern driven, with a focus on systemic balance.
SCOPE FOR FUTURE RESEARCH
Future investigations should focus on:
REFERENCES
Shahana Parveen1, Zulnoon Khairoowala2*, Tooba Hayat3, Narcolepsy And Akhlāṭ-E-Badan: A Critical Integrative Review Of Pathophysiological Correlations And Therapeutic Approaches, Int. J. Sci. R. Tech., 2026, 3 (7), 852-858. https://doi.org/10.5281/zenodo.21534232
10.5281/zenodo.21534232