Comparative Pathophysiology of Fawāq (Hiccups): A Review of Unani and Modern Medical Concepts
Abstract
Aim: To comparatively analyze the pathophysiology of Fawāq (hiccups) by examining classical Unani concepts alongside contemporary biomedical understanding and identifying areas of conceptual convergence.
Objectives: This review aimed to (i) evaluate the Unani concept of Fawāq with special reference to Sū’-i-Mizāj, gastric and diaphragmatic dysfunction; (ii) summarize the current biomedical understanding of hiccup pathophysiology; and (iii) compare both systems to identify similarities and complementary interpretations.
Methods: A narrative comparative review was conducted using authoritative classical Unani texts, including Al-Qānūn fi’l-Ṭibb, Kitāb al-Ḥāwī, Firdaus al-Ḥikmat, Zakhīra Khwārazm Shāhī, Akseer-e-Aʿẓam, and Ṭibb-e-Akbar, together with contemporary peer-reviewed biomedical literature. Data were analyzed through a theme-based comparative framework focusing on anatomical involvement, etiological factors, pathophysiological mechanisms, clinical manifestations, classification, and diagnostic principles.
Results: The comparative analysis demonstrated substantial conceptual concordance between the two medical systems. Unani medicine describes Fawāq as a consequence of Sū’-i-Mizāj affecting the stomach (Miʿda), diaphragm (Ḥijāb-e-Ḥājiz), and associated organs, resulting in abnormal activation of Quwwat Dāfiʿa. Modern medicine explains hiccups as a reflex-mediated neurophysiological disorder involving vagal and phrenic afferents, brainstem integration, and diaphragmatic contraction. The Unani classification of simple (Sāda) and material (Māddī) dystemperaments showed conceptual correspondence with gastrointestinal, neurological, metabolic, and pharmacological etiological factors recognized in modern medicine.
Conclusion: The findings indicate that classical Unani descriptions of Fawāq exhibit meaningful conceptual agreement with contemporary neurogastroenterological mechanisms despite differences in theoretical frameworks. Integrating these perspectives provides a more comprehensive understanding of hiccups by combining individualized temperament-based assessment with modern pathophysiological principles. This comparative approach supports the scientific relevance of Unani medicine and highlights its potential contribution to integrative gastroenterology and future interdisciplinary research.
Keywords: Fawāq, Hiccups, Sū’-i-Mizāj, Quwwat Dāfiʿa, Miʿda, Ḥijāb-e-Ḥājiz
Keywords:
Fawāq, Hiccups, Sū’-i-Mizāj, Quwwat Dāfiʿa, Miʿda, Ḥijāb-e-ḤājizDOI
https://doi.org/10.22270/jddt.v16i8.7914References
1. Razi Z. Kitab al-Hawi (Urdu Translation). Vol. 5. New Delhi: CCRUM, Ministr of Health and Family Welfare, Government of India; 1999. P.118-125,131.
2. Sina I. Al-Qanun fi’l-Tibb (Urdu translation by Ghulam Husain Kantoori). Vol.3. New Delhi: Idara Kitab al-Shifa; 2007. P.843-846.
3. Jurjani I. Zakhira Khwarazm Shahi.(Urdu Translation by Hk. Hadi Husain Khan Sahab) Vol.6. New Delhi: Idara Kitab al-Shifa; 2010. P.345-347.
4. Arzani A. Tibb-e-Akbar. (Urdu translation by HM Hussain), New Delhi: Idara Kitab al-Shifa; 2008. P.419-422.
5. Kolodzik PW, Eilers MA. Hiccups (singultus): review and approach to management. Ann Emerg Med. 1991;20(5):565-573. https://doi.org/10.1016/S0196-0644(05)81620-8 PMid:2024799
6. Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil. 2012;18(2):123-130. https://doi.org/10.5056/jnm.2012.18.2.123 PMid:22523721 PMCid:PMC3325297
7. Steger M, Schneemann M, Fox M. Systematic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015;42(9):1037-1050. https://doi.org/10.1111/apt.13374 PMid:26307025
8. Petroianu GA, Lorke DE. The role of serotonin in singultus: a review. Front Neurosci. 2020;14:629. https://doi.org/10.3389/fnins.2020.00629 PMid:32765206 PMCid:PMC7378791
9. O’Neill J, Sinha A. Chronic hiccups. Curr Gastroenterol Rep. 2020; 22.
10. Leung AKC, Leung AAM, Wong AHC, Hon KL. Hiccups: a nonsystematic review. Curr Pediatr Rev. 2020;16(4):277-284. https://doi.org/10.2174/18756336MTA2kNDY43 PMid:32384036
11. Khan A. Akseer-e-Azam (Urdu translation by Kabiruddin). New Delhi: Idara Kitab al-Shifa; 2011. P.466-471.
12. Ibn Zuhr. Kitab al-Taisir. New Delhi: CCRUM; 1986. P.133-135.
13. Friedman NL. Hiccups: a treatment review. Pharmacotherapy. 1996;16(6):986-995. https://doi.org/10.1002/j.1875-9114.1996.tb03023.x PMid:8947969
14. Cole JA, Plewa MC. Singultus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Updated 2025.
15. Moretto EN, Wee B, Wiffen PJ, Murchison AG. Treatment of persistent hiccups. Ann Pharmacother. 2013;47(11):1483-1490.
16. Bacak BJ, Danner SM. Hiccups are a manifestation of central respiratory arrhythmias. Med Hypotheses. 2023;179:111165 https://doi.org/10.1016/j.mehy.2023.111165
17. Baghdadi IH. Mukhtarat fi’l-Tibb. Vol.3. New Delhi: CCRUM; 2005. P.209,211.
18. Razi Z. Kitab al-Fakhir. Vol.2. New Delhi: CCRUM. P.301-309.
19. Majoosi AIA. Kamil al-Sana’ah. (Urdu Translation by Hk. G.H. Kantoori) Vol.2. New Delhi: Idara Kitab al-Shifa; 2010. P.419-420.
20. Anonymous. Standard Unani Treatment Guidelines. New Delhi: CCRUM; 2014. P.59-62.
21. Petroianu GA. Hiccups and gastroesophageal reflux disease. J Clin Gastroenterol. 1997;25(1):77-88.
22. Kumar A, Dromerick AW. Intractable hiccups during stroke rehabilitation. Arch Phys Med Rehabil. 1998;79(6):697-699. https://doi.org/10.1016/S0003-9993(98)90047-8 PMid:9630152
23. Kabeeruddin M. Al-Akseer (Urdu translation by Kabiruddin), New Delhi: Ayjaz Publishing House; 2003. P.771-781.
24. Akbar M. Mizan al-Tibb ((Urdu translation by Kabiruddin), New Delhi: Qaumi Council Baraye Urdu Zaban; 1992. P.138-139.
25. Chandpuri K. Mojiz al-Qanun. New Delhi: Directorate of Qaumi Council Bara-e-Farogh-e-Urdu Zaban; 1984. P.325-327
26. Tabri R. Firdaus al-Hikmat (Urdu translation by Hakeem MA Shah), New Delhi: Idara Kitab al-Shifa; 1997. P.198-199.
27. Qamri AMH. Ghina Muna (Urdu translation by Syed Munavvar Hussain Lucknawi). New Delhi: CCRUM; 2008. P.174.
28. Tabri M. Moalejat-e-Buqratia. Vol. 3. New Delhi: CCRUM; 1992. P.126-132.
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