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Open Access Full Text Article                                                          Case Report

Effectiveness of Nutool (Irrigation Therapy) in the Management of Sar’a (Epilepsy): A Case Report

 Safiya Anjum ¹*, Rumana Usmani ², Arif Anees ³, Munawwar Gauri ⁴

¹ PG Scholar, Dept. of Ilaj bit Tadbeer, Hakeem Syed Zia-ul-Hasan Govt. Unani Medical College, Bhopal (M.P.)

² PG Scholar, Dept. of Ilaj bit Tadbeer, Hakeem Syed Zia-ul-Hasan Govt. Unani Medical College, Bhopal (M.P.)

³ Reader, Dept. of Ilaj bit Tadbeer, Hakeem Syed Zia-ul-Hasan Govt. Unani Medical College, Bhopal (M.P.)

⁴ Assistant Professor, Dept. of Ilaj bit Tadbeer, Hakeem Syed Zia-ul-Hasan Govt. Unani Medical College, Bhopal (M.P.)

 

 

Introduction

Epilepsy is one of the most common neurological disorders globally, affecting nearly 50 million people¹. It affects up to 1% of the population, making it the second most prevalent neurological disorder after stroke².

In recent years, the perception of epilepsy has improved in various ways.  Epilepsy is a prevalent chronic neurological disorder marked by an imbalance between brain excitability and inhibition, leading to uncontrolled excitability and characterized by recurrent, unprovoked epileptic seizures^3,4,5

In Unani system of medicine, it is termed Sara and is believed to occur due to accumulation of morbid humours causing obstruction in the brain^6, 

Epilepsy has been described by various terms such as Ṣar‘, Qāzūn, Abrāqalsā, and Maraḍ Kāhini. The term Ṣar‘ refers to the "falling sickness." Unani scholars were among the earliest to use the term epilepsy, meaning “to attack.” Buqrāt (Hippocrates) discussed epilepsy in his treatise The Sacred Disease (Ebizemia) and rejected the belief that it was a divine or supernatural disorder. Instead, he proposed that epilepsy, like other diseases, arises from natural causes. Based on his theory of the four humors, he suggested that the condition results from qualitative and quantitative disturbances in humoral balance. 

Aristotle (384–322 BC) attributed epilepsy to harmful vapors (Raddi Bukhārāt) generated during digestion, which ascend to the brain through blood vessels. Soranus (98–138 AD) proposed that physical factors, including head trauma and brain injuries, could also cause epilepsy. 

Jālīnūs (Galen, 129–199 AD) further elaborated that epilepsy originates from pathological changes in the brain, particularly involving phlegmatic and melancholic humors affecting the cerebral ventricles. He distinguished this from sympathetic epilepsy, which begins in other organs before affecting the brain. Galen was also the first physician to describe the concept of an aura, referring to the warning signs or symptoms that precede an epileptic seizure.⁷

Nutool (irrigation therapy) is a classical regimenal therapy involving pouring medicated decoction over body parts to restore humoral balance, normalize temperament, and improve neurological function. It is specifically indicated in CNS disorders including epilepsy^8,9.

Case Description

A 20-year-old female patient presented to the Outpatient Department (OPD) of Hakeem Syed Zia-ul-Hasan Government Unani Medical College and Hospital, Bhopal, on 02 April 2026, with a history of recurrent seizures (2–3 episodes per month) for the past four years. The episodes were associated with loss of consciousness, headache, and post-ictal confusion. Following detailed history taking, clinical examination, and assessment based on Unani principles, the patient was diagnosed with Sar'a Balghami. The patient was subsequently enrolled for treatment and follow-up. There was no history of trauma, Hypertension, or T2DM and Thyroid disorder.

Clinical Findings

On examination, the patient was moderately built with stable general condition. Central nervous system examination revealed no focal neurological deficit; however, post-ictal confusion was present. According to unani assessment, the patient exhibited a predominance of Balghami mizaj associated with accumulation of morbid phlegmatic humour in the brain.

Diagnostic Assessment

• Clinical diagnosis: Generalized epilepsy 
• Unani diagnosis: Sar’a Balghami 
• Investigations
  1. EEG: Abnormal epileptiform activity.
  2. MRI: Normal 

Therapeutic Intervention of Nutool Therapy

• Type: Nutool Haar (warm irrigation) 
• Site: Scalp & forehead (head region) 
• Duration of therapy: 30 minutes on alternate day 
• Duration of study: 28 days 

Drugs used in decoction¹⁰: 

1. Babuna (Matricaria chamomilla) 6gm
2. Nakhuna (Trigonella uncata) 6gm
3. Marzanjosh (Origanum majorana) 6gm
4. Sa’tar (Thymus serphyllum) 6gm
5. Rehan (Ocimum basilicium) 6gm 

 

      

Figure 1: Administrat Nutool Therapy (Irrigation Therapy) in a patient with Sara’a  (Epilepsy)

 

Preparation of Decoction

The above-mentioned drugs were prepared in equal proportions. Approximately 30 g of the mixed formulation was boiled in 1 liter of water and reduced to about 500 ml to obtain a concentrated decoction (Joshanda). The decoction was then filtered and allowed to cool to a lukewarm temperature suitable for therapeutic application.

Method of Administration¹¹

The patient was made to lie comfortably in a supine position on the Nutool table, ensuring relaxation and proper support of the head and neck. A vessel containing the lukewarm decoction was placed at 1.5 feet height to allow a continuous and gentle flow. Nutool was administered by pouring the medicated decoction in a thin, continuous stream over the frontal and parietal regions of the scalp from a height of approximately 1.5 feet (Figure1). Care was taken to maintain a uniform flow and constant temperature throughout the procedure. The runoff liquid was collected in a basin and reheated if necessary to maintain the desired temperature.

Duration and Frequency

The procedure was carried out for 30 minutes on alternate day. The duration was standardized to ensure adequate therapeutic effect, allowing sufficient time for local absorption and neuro-relaxant action of the medicated decoction.

 

Post-Procedure Care

After completion of the procedure, the scalp was gently dried with a clean towel. The patient was advised to avoid exposure to cold air, wind, or direct sunlight immediately after therapy. Adequate rest was recommended for at least 15 minutes following the procedure.

Mechanism (Unani perspective):

• Removes morbid matter (Tanqiye-e-Mawad)             
• Normalizes temperament (Ta'deel-e-Mizaj) 
• Strengthens brain (Taqwiyat-e-Dimagh)⁹ 

 

 

Follow-up and Outcomes

Table 1: Timeline of intervention and follow-up

Date	2/04/2026	Day-1	Day-28	Follow up
Event	Pt enrolled	Nutool therapy started	Therapy completed	Outcome assessed

 

 

Outcome Measures

• Frequency of seizures 
• Severity of episodes 
• Associated symptoms 
• Quality of Life (QOL)
• Sleep Quality
• Cognition Function

Results                                                              

The patient showed significant improvement following the intervention. The frequency of seizures decreased from three episodes per month to one episode per month. The duration and severity of seizure episodes were also reduced, along with an improvement in associated symptoms. Additionally, the patient experienced better sleep quality and enhanced cognitive function. No adverse effects were observed during the course of treatment. Overall, Nutool therapy appeared to improve neurological and psychological functions, possibly through enhanced local drug absorption and its beneficial effects on the nervous system. 

Table 2: clinical outcomes before treatment and after treatment

Assessment Parameters	Before treatment	After treatment
Seizure frequency	3episodes/ months	1 episodes/ month
Sleep Quality	Poor	Improved
Cognition	Impaired	Improved
Headache	Present	Reduced
Quality of Life (QOL)	Poor	Improved

 

Discussion

Epilepsy is a chronic neurological disorder characterized by recurrent seizures due to abnormal neuronal excitability and imbalance between excitatory and inhibitory mechanisms^12-14. In Unani system of medicine, Sara is attributed to the accumulation of morbid humors, particularly Balgham, leading to obstruction in the brain and impaired function^15,16. The present case was diagnosed as Sar’a Balghami based on clinical features and temperament assessment.

Nutool (irrigation therapy) is a well-described regimenal therapy in Unani system of medicine used for neurological disorders. It acts by facilitating Tanqiya-e-Mawad (evacuation of morbid matter), Ta'deel-e-Mizaj (normalization of temperament), and Taqwiyat-e-Dimagh (strengthening of the brain)^8,9. In this case, the use of medicated decoction containing Babuna, Marzanjosh, Sa’tar, Rehan, and Nakhuna showed a significant reduction in seizure frequency and improvement in associated symptoms.

The therapeutic effect of Nutool may be explained through both traditional and modern perspectives. According to Unani principles, the continuous application of lukewarm medicated fluid over the scalp helps in dispersing morbid humors and improving cerebral function⁹. From a contemporary viewpoint, the procedure may enhance local circulation, provide neuro-relaxant effects, and modulate autonomic activity, thereby reducing neuronal hyperexcitability.

Additionally, the drugs used in the decoction possess known sedative, anti-inflammatory, and neuroprotective properties, which may contribute to the overall therapeutic outcome^10,11. The calming and soothing nature of the procedure may also reduce stress, a known precipitating factor for seizures.

The findings of this case agree with classical Unani literature and recent studies, which suggest that regimenal therapies like Nutool are effective and safe in managing neurological and psychosomatic disorders ^9,11. However, being a single case report, the results cannot be generalized, and further clinical studies are required to validate these observations.

Limitations: This case report is limited by its single-patient design and short duration of follow up. The findings cannot be generalized to the wider population. In Addition, Objective assessment tools for quality of life and seizure severity were not employed. Further well -designed clinical studies with larger sample sizes are required to validate the effectiveness of Nutool therapy in the management of Sara’a (Epilepsy).

Patient Perspective

The patient reported a noticeable reduction in the frequency of seizures following the treatment. In addition, sleep quality improved significantly, leading to better daily functioning and overall well-being. The patient expressed satisfaction with the treatment outcomes and perceived a positive impact on quality of life due to the improvement in symptoms and daily activities. 

Conclusion

Nutool (irrigation therapy) appears to be a safe and effective adjunctive treatment in the management of Sara (epilepsy). It helps in reducing seizure frequency, improving associated symptoms, and enhancing overall quality of life. The therapeutic benefits can be attributed to its role in eliminating morbid humours, restoring humoral balance, and strengthening brain function. However, larger clinical studies are needed to establish its efficacy and mechanism more conclusively.

Informed Consent: Written informed consent was obtained from the patient for publication.

Source of Funding: No funding sources.

Conflict of interest: The authors have no conflicting financial interest.

Acknowledgement: I owe a debt of gratitude to each and every author for their inspiration guidance and assistance in making this work possible.

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