Available online on 15.10.2026 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2026 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access  Full Text Article                                                                                                Review Article

Diqq al-Shaykhūkha and Sarcopenia: A Historical and Conceptual Review of Muscle Wasting in Old Age

Mubashshera Shaikh ¹, Abdul Rehman M.I. ², Syed Mohd Abbas Zaidi ³, Meraj Meraj ⁴

¹ BUMS, PG Scholar, Department of Ilāj bi’l Tadbīr (Regimenal Therapy), Hakim Syed Ziaul Hasan Government Unani Medical College & Hospital AYUSH Campus, Nehru Nagar, Kolar Bypass Road, Behind MANIT, Bhopal - 462003 (Madhya Pradesh), India.

² BUMS, MD, Assistant Professor, Department of Ilāj bi’l Tadbīr (Regimenal Therapy), Hakim Syed Ziaul Hasan Government Unani Medical College & Hospital AYUSH Campus, Nehru Nagar, Kolar Bypass Road, Behind MANIT, Bhopal - 462003 (Madhya Pradesh), India.

³ BUMS, MD, Associate Professor, Department of Moalijat (Internal Medicine), Hakim Syed Ziaul Hasan Government Unani Medical College & Hospital AYUSH Campus, Nehru Nagar Kolar Bypass Road, Behind MANIT, Bhopal - 462003 (Madhya Pradesh), India.

⁴ BUMS, MD, Assistant Professor, Department of Ilāj bi’l Tadbīr (Regimenal Therapy), Hakeem Abdul Hameed Unani Medical College and Hospital, Dewas- 455001 (Madhya Pradesh), India.

1. Introduction

Sarcopenia is a degenerative skeletal muscle disease usually affecting the elderly population. It encompasses apathological reduction in muscular strength, mass and functions ^1,2. Primary type of Sarcopenia is agerelated. Sarcopenia affects all populations across the globe.Global prevalence of Sarcopenia has been reporteda prevalence of 15.2% and Indian prevalence of Sarcopenia has been reported at 14.2% in older adults and 3.2%in younger adults ³. The recent report suggest that Sarcopenia may affect young people as well⁴. Sarcopenia isassociated with an elevated risk of various negative health outcomes, complications after surgery, extendedhospital stays in patients with different medical conditions, as well as increased likelihood of falls, fractures,metabolic disorders, cognitive impairment, and mortality in the general population^5,6. The exact cause isunknown, research indicates a complex interaction of intrinsic and extrinsic variables. Furthermore, age is anessential factor in Sarcopenia onset, with inadequate physical activity and altered gene regulation being twocritical processes driving its advancement ^7,8. Physical activity and nutritional status represent key regulators ofmuscle metabolism and phenotype, reflecting their utility for accomplishing healthy aging^9.Lifestylemodifications are essential for ensuring better autonomy for older people. Specifically, physical exercises suchas resistance training, have been demonstrated effective in improving muscle strength and function, 5 subsequently enhancing flexibility and balance ^8,9,10,11. Resistance exercise training is currently approached as afirst-line treatment for Sarcopenia, being a superior form of physical activity for enhancing muscle mass andstrength ^12,13. Resistance exercise is considered a promising intervention, yet appropriate prescription isnecessary for maximizing desirable effects. In the traditional Unani system of medicine, classical condition Diqq al-Shaykhūkhaclosely correspond to the clinical manifestations of Sarcopenia. Diqq al-Shaykhūkha, Diqq meaning weakness, Shaykhūkharefers to oldage denotes the general debility and physiological decline seen during senescence, characterized by diminishedQuwwat (strength), reduced Ḥarārat Gharīziyya (innate heat), fatigue, and weakness^{14,15,16,17,18,19}. These conditionsdescribe a progressive weakening of bodily faculties due to age, which aligns conceptually and symptomaticallywith Sarcopenia. Therefore, Sarcopenia can be interpreted as the modern medical equivalent ofDiqq alShaykhūkha , offering a valuable bridge between traditional Unani wisdom and contemporary geriatric medicine.Despite growing recognition, Sarcopenia remains under-diagnosed and under-treated, particularly in resourcelimited settings. Conventional treatment options, though effective, are not always feasible or accessible to allsegments of the population, especially the elderly.

Aging is a universal biological phenomenon that has intrigued physicians, philosophers, and scholars across civilizations. Although aging itself is not a disease, it is accompanied by progressive structural and functional changes that predispose individuals to morbidity, disability, and dependency. Among these changes, the gradual loss of skeletal muscle mass and strength is particularly significant because it directly affects mobility, balance, metabolic health, and overall quality of life.²⁰

In contemporary biomedical science, age-related muscle loss is conceptualized as sarcopenia, a condition now formally recognized as a geriatric syndrome. Sarcopenia is associated with adverse outcomes such as falls, fractures, hospitalization, institutionalization, and mortality. Over the past three decades, sarcopenia has emerged as a major focus of geriatric research, leading to the development of diagnostic criteria, consensus definitions, and preventive strategies.^21,22

However, concern with physical decline in old age is not unique to modern medicine. Historical medical systems devoted considerable attention to senescence and its manifestations. The Unani system of medicine, rooted in Greco-Arabic traditions, offers a sophisticated theoretical framework to understand aging based on concepts such as temperament (Mizāj),(innate heat)HarāratGharīziyya, and (innate moisture)RutūbatGharīziyya. Within this framework, Unani scholars described several degenerative conditions affecting the elderly, including Diqq al-Shaykhūkha, a form of chronic wasting specific to old age.

Despite growing interest in integrative and traditional medicine, the historical relationship between Diqq al-Shaykhūkha and sarcopenia has not been sufficiently explored in academic literature, particularly from the perspective of the history of medicine. This review aims to bridge that gap by presenting a comprehensive historical and conceptual analysis of Diqq al-Shaykhūkha and correlating it with the modern understanding of sarcopenia. By doing so, the paper seeks to highlight the continuity of medical thought across centuries and underscore the relevance of classical medical knowledge in addressing contemporary health challenges.

2. Methodology

This review was conducted using a narrative and historical review methodology, appropriate for studies in the history of medicine. Both classical Unani medical literature and modern biomedical literature were systematically explored to examine concepts related to age‑associated muscle wasting.²³

3. Sources of Classical Unani Literature

Primary Unani sources were consulted to understand the historical and conceptual framework of Diqq al‑Shaykhūkha. These included authoritative classical texts such as Al‑Qānūn fī al‑Tibb by Ibn Sīnā, Al‑Hāwī fi al‑Tibb by Zakariyyā Rāzī, and Zakhīra Khwārazm Shāhī by Jurjānī. Additional references from Greco‑Roman physicians such as Hippocrates and Galen, as preserved within Unani literature, were also reviewed. These texts were analyzed for descriptions related to aging, chronic wasting, muscle weakness, etiopathogenesis, and preventive principles in old age.

4. Search Strategy for Modern Literature

To correlate Unani concepts with contemporary biomedical understanding, a comprehensive literature search was conducted using electronic databases including PubMed, Web of Science, and Google Scholar. The search focused on peer‑reviewed articles published in English. The following keywords and their combinations were used: “sarcopenia,” “muscle wasting,” “age‑related muscle loss,” “pathophysiology,” “clinical manifestations,” and “aging.” Boolean operators (AND/OR) were applied to refine the search strategy.²⁴

5. Selection and Analysis of Studies

Relevant review articles, consensus papers, and key original research articles addressing the definition, pathophysiology, clinical features, and historical evolution of sarcopenia were included.²⁰ Articles unrelated to aging or skeletal muscle loss were excluded. The selected literature was analyzed narratively, and key themes were identified and compared with descriptions found in Unani texts.

This integrative approach allowed for a conceptual comparison between Diqq al‑Shaykhūkha and sarcopenia, highlighting similarities and differences across historical and modern medical paradigms.

6. Aging and Muscle Wasting in the History of Medicine

Concepts of Aging in Ancient Greek Medicine

Ancient Greek physicians were among the earliest to systematically study aging. Hippocrates (460–370 BCE) viewed aging as a natural process characterized by a gradual decline in bodily heat and moisture. According to the Hippocratic corpus, youth was associated with warmth and moisture, whereas old age was dominated by coldness and dryness. These qualitative changes were believed to impair nutrition and tissue maintenance, leading to physical weakness and emaciation.²⁴

Galen (129–216 CE) further elaborated these ideas within his humoral framework. He described old age as a state of diminished innate heat and increased dryness, resulting in reduced metabolic activity and impaired regeneration of tissues. Galen explicitly noted that muscles in the elderly lose their firmness and strength, contributing to reduced physical capacity.²⁵These observations laid the foundation for later medical theories on senescence.

Transmission into Unani Medicine

The Greco-Roman medical tradition was preserved and expanded by Arab and Persian scholars during the Islamic Golden Age. Unani medicine, as it developed between the ninth and thirteenth centuries, incorporated Hippocratic and Galenic principles while enriching them with original observations and clinical insights.

In Unani literature, aging (Shaykhūkha) is recognized as one of the natural stages of life. It is characterized by the progressive depletion of (innate moisture) Rutūbat Gharīziyya and weakening of,( innate heat) Harārat Gharīziyya.^14,15 These changes compromise digestion, assimilation, and tissue nourishment, predisposing the elderly to degenerative conditions. Muscle wasting was not viewed merely as a cosmetic issue but as a marker of declining vitality and functional impairment.

7. The Concept of Diqq in Classical Unani Literature

Meaning and Classification of Diqq

The term Diqq in Unani medicine broadly denotes chronic wasting and emaciation.¹⁴Classical texts describe multiple forms of Diqq, distinguished by their etiology, affected age group, and clinical course. While Diqq was often associated with chronic infectious or inflammatory conditions such as phthisis, Unani scholars also recognized a distinct form related to senescence, known as Diqq al-Shaykhūkha.

This differentiation reflects an advanced nosological understanding, acknowledging that similar clinical manifestations may arise from different underlying causes. Diqq al-Shaykhūkha was specifically attributed to age-related physiological decline rather than external pathology.¹⁵

Descriptions by Ibn Sīnā and Other Scholars

Ibn Sīnā (980–1037 CE), in his seminal work Al-Qānūn fī al-Tibb, discussed wasting disorders occurring in the elderly and emphasized that old age itself predisposes individuals to chronic weakness and emaciation.¹⁴ He attributed this to excessive dryness, reduced digestive power, and diminished capacity of organs to retain nourishment.

Zakariyyā Rāzī (865–925 CE) also described the vulnerability of elderly individuals to wasting conditions due to weakened faculties (Quwā).²⁶ Jurjānī, in Zakhīra Khwārazm Shāhī, provided detailed clinical descriptions of senile weakness, emphasizing the importance of diet and lifestyle in mitigating degeneration.²⁷

8. Diqq al-Shaykhūkha: Etiopathogenesis and Clinical Features

Etiopathogenesis in Unani Framework

According to Unani theory, Diqq al-Shaykhūkha arises primarily due to the dominance of dryness (GhalbaYubūsat) along with a decline in vital heat^.15 With advancing age, there is a gradual depletion of innate moisture, which plays a crucial role in maintaining tissue integrity. At the same time, there is weakening of the digestive (Quwwat Hādima) and nutritive (Quwwat Ghādhiya) faculties, leading to impaired digestion and assimilation of nutrients. Reduced physical activity further aggravates this condition, while an inadequate or improper diet fails to compensate for the body's nutritional needs. Collectively, these factors result in insufficient production and proper distribution of healthy humors, ultimately causing poor nourishment of tissues, particularly the muscles.^{14,15,16,17,18,19}

Clinical Manifestations

Classical Unani texts describe Diqq al-Shaykhūkha as a slowly progressive condition characterized by generalized weakness, loss of muscle bulk, and a noticeable reduction in endurance and stamina. Patients often experience easy fatigability along with gradual emaciation over time.¹⁴ Importantly, these features closely resemble the clinical presentation of sarcopenia as described in modern geriatrics.

9. Sarcopenia: Evolution of a Modern Concept

Historical Development of the Term

The term sarcopenia was first introduced by Rosenberg in 1989 to describe age-related loss of skeletal muscle mass.²⁸ Over time, the concept evolved to incorporate not only muscle quantity but also muscle strength and physical performance. This evolution reflects growing recognition of functional outcomes as central to geriatric health.⁵

Pathophysiology and Risk Factors

Modern research identifies sarcopenia as a multifactorial condition influenced by aging-related hormonal changes, chronic low-grade inflammation, and neuromuscular degeneration.²⁹ In addition, physical inactivity and inadequate protein and energy intake further contribute to its development (Figure 1).³⁰ These factors interact in a complex manner to accelerate muscle protein breakdown while simultaneously impairing muscle regeneration.³¹

Figure 1 Pathophysiology of Sarcoppenia

Clinical Significance

Sarcopenia is now recognized as a major contributor to frailty and disability. It increases the risk of falls, fractures, hospitalization, and mortality, making it a critical focus of public health and geriatric care.³²

10. Comparative Analysis: Diqq al-Shaykhūkha and Sarcopenia

A comparative analysis reveals substantial conceptual overlap between Diqq al-Shaykhūkha and sarcopenia despite differences in theoretical language.^33,34

Table 1: Comparison between Diqq al-Shaykhūkha and Sarcopenia

This comparison supports the view that Unani physicians recognized a condition analogous to sarcopenia centuries before modern diagnostic frameworks (Table 1).

11. Preventive and Therapeutic Principles: Historical Insights

Unani Preventive Strategies

Unani medicine places strong emphasis on prevention, particularly in old age, by advocating a holistic lifestyle approach. It recommends the use of an easily digestible, nutrient-rich diet to ensure proper nourishment, along with the maintenance of moderate physical activity to preserve strength and function. Therapeutic measures such as massage (Dalak) are advised to improve circulation, while (bath therapies ) Hammāmhelp in maintaining flexibility and vitality.³⁵Additionally, the use of tonics is encouraged to strengthen the vital faculties and support overall health.

Modern Preventive Strategies

Modern medicine similarly emphasizes the importance of resistance and strength training to maintain muscle mass and function, along with adequate intake of protein and essential micronutrients to support muscle health.³⁶Physical rehabilitation plays a key role in preserving mobility and functional independence, while preventing a sedentary lifestyle is considered crucial in reducing the progression of muscle loss. The convergence of these strategies highlights enduring principles in geriatric care.^37,38,39

Discussion and Future Recommendations

The analysis presented in this review demonstrates that Diqq al-Shaykhūkha represents a historically grounded conceptualization of age-related muscle wasting. Although Unani medicine employs a humoral and temperament-based framework, its clinical observations closely align with modern descriptions of sarcopenia.³³ Classical Unani scholars carefully documented the gradual loss of strength, muscle bulk, and vitality in the elderly and attributed these changes to diminished innate heat, increased dryness, and weakened nutritive faculties. These explanations, though expressed in pre-modern scientific language, correspond conceptually to modern understandings of reduced anabolic signaling, inflammation, and impaired muscle regeneration.

From the perspective of the history of medicine, the correlation between Diqq al-Shaykhūkha and sarcopenia illustrates the continuity of medical thought across centuries. It challenges the perception that geriatric syndromes are exclusively modern constructs and demonstrates that physicians of the past possessed a nuanced understanding of aging-related degeneration.⁴⁰ The Unani emphasis on prevention, moderation, diet, and physical activity further reflects an early public health approach to aging that remains relevant today.

At the same time, it is important to acknowledge the limitations inherent in historical comparisons. Classical Unani descriptions are qualitative and lack the quantitative diagnostic criteria used in contemporary medicine. Nevertheless, the value of these texts lies in their detailed clinical observations and holistic approach to aging, which can enrich modern perspectives when interpreted cautiously.

Future research should focus on interdisciplinary approaches that integrate historical medical knowledge with modern biomedical science. Systematic textual analysis of classical Unani manuscripts may yield deeper insights into age-related disorders and their management. Translational research exploring Unani preventive principles—such as dietary moderation, lifestyle regulation, massage, and bath therapies—may offer supportive strategies for promoting musculoskeletal health in the elderly.

Comparative clinical studies and observational research may further evaluate the relevance of traditional regimens in contemporary geriatric care, particularly in culturally appropriate settings. Additionally, historians of medicine are encouraged to examine aging and degeneration as recurring themes across medical traditions, thereby enriching the global narrative of geriatric medicine.

Incorporating historical perspectives into medical education and geriatric research can foster a more comprehensive understanding of aging, emphasizing continuity rather than rupture between traditional and modern medical systems. Such efforts may contribute to more holistic and culturally sensitive approaches to the prevention and management of sarcopenia.

12. Limitations of the Study

This study has certain limitations that should be acknowledged. First, the review is primarily narrative and historical in nature, which inherently involves a degree of subjectivity in the selection, interpretation, and comparison of classical and modern sources. Although efforts were made to include authoritative Unani texts and relevant contemporary literature, the possibility of selection bias cannot be entirely excluded.Second, classical Unani descriptions of Diqq al-Shaykhūkha are qualitative and lack standardized diagnostic criteria, making direct comparison with modern definitions of sarcopenia challenging. The absence of measurable clinical parameters in historical texts limits the ability to establish precise equivalence between the two concepts.Third, the study relies on translations and interpretations of classical texts, which may lead to potential variations in meaning and understanding. Some original concepts may not be fully captured due to linguistic and contextual differences.Fourth, the review does not include empirical or clinical data to validate the conceptual correlation between Diqq al-Shaykhūkha and sarcopenia. Therefore, the findings remain theoretical and require further validation through clinical and interdisciplinary research.

Finally, the scope of the study is limited to selected classical and modern sources, and it does not encompass all available literature across different medical traditions. Future studies incorporating broader sources and quantitative analysis would strengthen the evidence base and enhance the generalizability of findings.

13. Conclusion

Diqq al-Shaykhūkha, as described in classical Unani literature, can be regarded as an early medical conceptualization of age-related muscle wasting. Its strong resemblance to sarcopenia highlights the depth of historical understanding of aging and degeneration. Recognizing this connection enriches the historiography of medicine and supports further interdisciplinary research bridging traditional and modern medical sciences.

Acknowledgment: None

Conflict of Interest: No conflict of interest

References

1. Zhang, F.-M.; Wu, H.-F.; Shi, H.-P.; Yu, Z.; Zhuang, C.-L. Sarcopenia and malignancies:Epidemiology, clinical classification and implications. Ageing Res. Rev. 2023, 91, 102057. https://doi.org/10.1016/j.arr.2023.102057 PMid:37666432

2 .Feike, Y.; Zhijie, L.; Wei, C. Advances in research on pharmacotherapy of sarcopenia. Aging Med. 2021, 4, 221-23 https://doi.org/10.1002/agm2.12168 PMid:34553120 PMCid:PMC8444957

3.Sharma N, et al.Sarcopenia and its determinants among urban Inadian and healthysubjects:an exploratory study. Acta Sci Nutr Health.2025,9(6):91-97

4.Jung HN, Jung CH, Hwang YC. Sarcopenia in youth. Metabolism. 2023;144:155557. doi:10.1016/j.metabol.2023.155557 https://doi.org/10.1016/j.metabol.2023.155557 PMid:37080353

5 .Yuan, S.; Larsson, S.C. Epidemiology of sarcopenia: Prevalence, risk factors, andconsequences. Metabolism 2023, 144, 155533. https://doi.org/10.1016/j.metabol.2023.155533 PMid:36907247

6. Zhang, X.; Huang, P.; Dou, Q.; Wang, C.; Zhang, W.; Yang, Y.; Wang, J.; Xie, X.; Zhou, J.; Zeng, Y. Falls among older adults with sarcopenia dwelling in nursing home or community: A meta-analysis. Clin. Nutr. 2020, 39, 33-39. https://doi.org/10.1016/j.clnu.2019.01.002 PMid:30665817

7.Cai, Z.; Liu, D.; Yang, Y.; Xie, W.; He, M.; Yu, D.; Wu, Y.; Wang, X.; Xiao, W.; Li, Y. The role and therapeutic potential of stem cells in skeletal muscle in sarcopenia. Stem Cell Res. Ther. 2022, 13, 28. https://doi.org/10.1186/s13287-022-02706-5 PMid:35073997 PMCid:PMC8785537

8. Kwak, J.Y.; Kwon, K.S. Pharmacological Interventions for Treatment of Sarcopenia: Current Status of Drug Development for Sarcopenia. Ann. Geriatr. Med. Res. 2019, 23, 98-104. https://doi.org/10.4235/agmr.19.0028 PMid:32743297 PMCid:PMC7370765

9.Hardee, J.P.; Lynch, G.S. Current pharmacotherapies for sarcopenia. Expert Opin. Pharmacother. 2019, 20, 1645-1657. https://doi.org/10.1080/14656566.2019.1622093 PMid:31120352

10.Rooks, D.; Swan, T.; Goswami, B.; Filosa, L.A.; Bunte, O.; Panchaud, N.; Coleman, L.A.;Miller, R.R.; Garcia Garayoa, E.; Praestgaard, J.; et al. Bimagrumab vs Optimized Standardof Care for Treatment of Sarcopenia in Community-Dwelling Older Adults: A RandomizedClinical Trial. JAMA Netw. Open 2020, 3, e2020836. https://doi.org/10.1001/jamanetworkopen.2020.20836 PMid:33074327 PMCid:PMC7573681

11. Agostini, F.; Bernetti, A.; Di Giacomo, G.; Viva, M.G.; Paoloni, M.; Mangone, M.; Santilli, V.; Masiero, S. Rehabilitative Good Practices in the Treatment of Sarcopenia: ANarrative Review. Am. J. Phys. Med. Rehabil. 2021, 100, 280-287. https://doi.org/10.1097/PHM.0000000000001572 PMid:33595941

12.Landi, F.; Marzetti, E.; Martone, A.M.; Bernabei, R.; Onder, G. Exercise as a remedy for sarcopenia. Curr. Opin. Clin. Nutr. Metab. Care 2014, 17, 25-31. https://doi.org/10.1097/MCO.0000000000000018 PMid:24310054

13.Hurst, C.; Robinson, S.M.; Witham, M.D.; Dodds, R.M.; Granic, A.; Buckland, C.; DeBiase, S.; Finnegan, S.; Rochester, L.; Skelton, D.A.; et al. Resistance exercise as a treatmentfor sarcopenia: Prescription and delivery. Age Ageing 2022, 51, afac003. https://doi.org/10.1093/ageing/afac003 PMid:35150587 PMCid:PMC8840798

14.Sina I. Al Qanoon Fil Tib (Urdu Trans: Kantoori GH). New Delhi: Idara Kitabu-Us-Shifa;p. 1204-1205.

15.Kirmani NA. Sharah Asbab. Darya Ganj: Aijaz Publishing House; 2012. p. 408 12

16. Kabiruddin HM, translator and annotator. Ḥimāyat-e-Qānūn. Ḥissa Duwam [Urdu]. NewDelhi: Central Council for Research in Unani Medicine (CCRUM), Ministry of AYUSH, Government of India;P. 36-37
17. Farooqi AH. Kitab al-Ḥummayāt (Muʿālajāt). P.126-127

18.Kabiruddin HM. Al-Aksir. Delhi: Matba’ Kabir Printing Works; P. 1609-1610

19. Baghdadi IH .Kitab al-Mukhtarat fial-Tibb (Urdu Trans).New Delhi.Central Council forResearch in Unani Medicine (CCRUM),Ministry of AYUSH, Government of India p. 236-237.
20. Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019;393(10191):2636-2646. doi:10.1016/S0140-6736(19)31138-9. PMID: 31171417. https://doi.org/10.1016/S0140-6736(19)31138-9 PMid:31171417 PMCid:PMC10727540
21. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2010;39(4):412-423. doi:10.1093/ageing/afq034. PMID: 20392703. https://doi.org/10.1093/ageing/afq034 PMid:20392703
22. Dent E, Morley JE, Cruz-Jentoft AJ, et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR). J Nutr Health Aging. 2018;22(10):1148-1161. doi:10.1007/s12603-018-1139-9. PMID: 30498820. https://doi.org/10.1007/s12603-018-1139-9 PMid:30498820 PMCid:PMC12280515

23 Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med. 2006;5(3):101-117. doi:10.1016/S0899-3467(07)60142-6 https://doi.org/10.1016/S0899-3467(07)60142-6 PMid:19674681

24 Hippocrates.Aphorisms. (Arabic/Unani translations in classical compilations).

25 Galen.Kitab fi al-Quwa al-Tabi’iyya (On the Natural Faculties). (Arabic translation).

26 Rāzī Z. Al-Hāwī fi al-Tibb (Liber Continens). Hyderabad: Dairat-ul-Maarif

27 Jurjānī I. Zakhīra Khwārazm Shāhī. Tehran: Bunyad-e Farhang.

28 Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127(5 Suppl):990S-991S. https://doi.org/10.1093/jn/127.5.990S PMid:9164280

29 Jensen GL. Inflammation: roles in aging and sarcopenia. JPEN J Parenter Enteral Nutr. 2008;32(6):656-659. doi:10.1177/0148607108324585 https://doi.org/10.1177/0148607108324585 PMid:18974248

30 Coelho-Junior HJ, Calvani R, Azzolino D, et al. Protein Intake and Sarcopenia in Older Adults: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(14):8718. Published 2022 Jul 18. doi:10.3390/ijerph19148718 https://doi.org/10.3390/ijerph19148718 PMid:35886571 PMCid:PMC9320473

31 Araújo LP, Figueiredo Godoy AC, Fortes Frota F, et al. Sarcopenia in the Aging Process: Pathophysiological Mechanisms, Clinical Implications, and Emerging Therapeutic Approaches. Int J Mol Sci. 2025;26(24):12147. Published 2025 Dec 17. doi:10.3390/ijms262412147 https://doi.org/10.3390/ijms262412147 PMid:41465572 PMCid:PMC12734266

32 Beaudart C, Zaaria M, Pasleau F, Reginster JY, Bruyère O. Health Outcomes of Sarcopenia: A Systematic Review and Meta-Analysis. PLoS One. 2017;12(1):e0169548. Published 2017 Jan 17. doi:10.1371/journal.pone.0169548s https://doi.org/10.1371/journal.pone.0169548 PMid:28095426 PMCid:PMC5240970

33 Kim TN, Choi KM. Sarcopenia: definition, epidemiology, and pathophysiology. J Bone Metab. 2013;20(1):1-10. doi:10.11005/jbm.2013.20.1.1 https://doi.org/10.11005/jbm.2013.20.1.1 PMid:24524049 PMCid:PMC3780834

34 Santilli V, Bernetti A, Mangone M, Paoloni M. Clinical definition of sarcopenia. Clin Cases Miner Bone Metab. 2014;11(3):177-180. https://doi.org/10.11138/ccmbm/2014.11.3.177

35 Malik Itrat. (2020)

Methods of health promotion and disease prevention in Unani medicine.

J Educ Health Promot. 2020;9:168.

PMID: 33015201

36 Song Z, Pan T, Tong X, Yang Y, Zhang Z. The effects of nutritional supplementation on older sarcopenic individuals who engage in resistance training: a meta-analysis. Front Nutr. 2023;10:1109789. Published 2023 Apr 25. doi:10.3389/fnut.2023.1109789 https://doi.org/10.3389/fnut.2023.1109789 PMid:37181154 PMCid:PMC10167299

37 Xie C, Yan R, Tao R. Combined resistance training and amino acid-based supplementation for sarcopenia in older adults: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2026;27(1):35. Published 2026 Jan 15. doi:10.1186/s12891-025-09436-8

 https://doi.org/10.1186/s12891-025-09436-8 PMid:41540398 PMCid:PMC12809905

38 Coelho-Junior HJ, Calvani R, Azzolino D, et al. Protein Intake and Sarcopenia in Older Adults: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(14):8718. Published 2022 Jul 18. doi:10.3390/ijerph19148718 https://doi.org/10.3390/ijerph19148718 PMid:35886571 PMCid:PMC9320473

39 Li ML, Zhang F, Luo HY, et al. Improving sarcopenia in older adults: a systematic review and meta-analysis of randomized controlled trials of whey protein supplementation with or without resistance training. J Nutr Health Aging. 2024;28(4):100184. doi:10.1016/j.jnha.2024.100184 https://doi.org/10.1016/j.jnha.2024.100184 PMid:38350303 PMCid:PMC12877251

40 Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169 https://doi.org/10.1093/ageing/afy169 PMid:30312372