Therapeutic Role of Hammam Bukhari (Traditional Steam Bath) in the Management of Rheumatoid Arthritis: A Case Report

Saima Sharfuddin^1*, Ehsan Ahmad², S.M. Abbas Zaidi³, Madiha Akhtar⁴, Madiha Ali⁵, Akansha Mishra⁶

¹M.D Scholar, Dept. of Ilaj Bit Tadbeer, H.S.Z.H Government Unani Medical College Bhopal.

²Asst.professor, Dept. of Ilaj Bit Tadbeer, H.S.Z.H Government Unani Medical College Bhopal.

³Asst.professor, Dept.of Moalajat, H.S.Z.H Government Unani Medical College Bhopal.

⁴M.D Scholar, Dept. of Amraz e Jild wa Tazeeniyat, H.S.Z.H Government Unani Medical College Bhopal M.P.

⁵M.D Scholar, Dept. of Tahaffuzi wa samaji Tib, H.S.Z.H Government Unani Medical College Bhopal M.P.

⁶JRF, Centre of Excellence in Biotechnology, M.P. Council of Science and Technology, 462003, Bhopal, M.P.

^*Corresponding Author: Saima Sharfuddin, M.D Scholar, Dept. of Ilaj Bit Tadbeer, H.S.Z.H Government Unani Medical College Bhopal, India

Received: 25 March 2026; Accepted: 04 April 2026; Published: 16 April 2026

1. Introduction

A chronic inflammatory autoimmune disease that mainly affects synovial joints, rheumatoid arthritis (RA) causes pain, swelling, and later joint destruction [1]. About 0.5–1% of people worldwide suffer from RA which is more common in women between the ages of 30 and 50. The disease is caused by abnormal immune responses, specifically the production of autoantibodies, particularly rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs), which inflame the synovial membrane. Although they target inflammation, traditional treatments like methotrexate, hydroxychloroquine, and corticosteroids frequently don't stop the progression of the disease or prevent complications like osteoporosis and cardiovascular risks [2].

1.1 Unani Perspective – Waja ‘al-Mafāṣil and Hudar

Unani medicine relates RA to Waja ‘al-Mafāṣil,’ or osteoarthritis particularly the chronic form Hudar, which involves a disturbance of humours primarily Sawdā (black bile) and Balgham (phlegm)³. Ibn Sīnā (Avicenna) and Jurjānī, two classical scholars state that the disease is caused by a humoral imbalance that results in the accumulation of "morbid matter" in joints. [3] Chronicity, inflammation, and humoral dominance are used to describe the disease (e.g., Balghami, Safrawi). Thus, the treatment of osteoarthritis is based on theguidelines ofWaja'al-Mafāsil. In Unani medicine there are three ways to treat patients: "Ilājbi'lTadbīr (Regimenal Therapy)," "Ilāj bi'l Taghdhiya (dietary)," "Ilāj bi'l Dawā" (pharmacotherapy), and "Ilāj bi'l Yad" (surgery) [4]. Ilājbi’lTadbīr includes a range of minimally drug-based or non-pharmacological treatments. There are several Regimenal Therapy mentions in unani literature Hammam-i-Bukhari (Turkish bath) is one of the important regimens used for the prevention and cure of several bodily ailments in unani system of medicine [5]. This Hammam e-Bukhari (Steam bath) had been famous throughout history and were used to improve health and to further wellbeing. Hammam-e-Bukhari is used to expel out Mada-e-Balghamia(phlegmatic substances) through sweating in the body [6].

1.2 Hammam-e- Bukhari (Steam Bath)

Hammam Bukhari is a traditional unani therapeutic modality like a Turkish or Persian steam bathused for musculoskeletal, dermatological, and detoxification purposes [7]. It is especially beneficial in conditions like Waja' al-Mafasil (joint pain), arthritis and generalized body fatigue [8]. The Hammam Bukhari cabinet is a specially designed wooden or metal chamber that encloses the patient’s body (usually from the neck down) allowing the head to remain outside to prevent overheating or discomfort (Figure 1). The structural components are displayed in Table 1 [9, 10]:

Table1 – The Structural components of Hammam-e-Bukhari

Figure 1: Sequential Setup and Clinical Application of Hammam Bukhari (Traditional Steam Bath) Therapy

2. Clinical Evaluation and Case Management

2.1 Patient Profile

• • A 48-year-old female presented to the Outpatient Department of Ilaj Bit Tadbeer at Hakim Syed Ziaul Hasan Government Unani Medical College, Bhopal, Madhya Pradesh, on 15th November 2024, with complaints of multiple joint pains, increased morning stiffness, and swelling in the bilateral feet and small joints, persisting for the past three months.
• • Age/Gender: 48-yrs old female
• • History: The patient has a history of rheumatoid arthritis for the past eight years and has been managed intermittently with methotrexate and non-steroidal anti-inflammatory drugs (NSAIDs) for recurrent episodes.
• • Symptoms: The patient reported joint pain primarily in the knees, fingers, and wrists, accompanied by morning stiffness lasting for more than one hour, along with generalized fatigue and difficulty performing daily activities.
• • Previous treatments: Methotrexate and NSAIDs with gastrointestinal side effects and limited symptom control.

2.2 Clinical Findings

2.2.1 Physical Examination:

• • The wrists and metacarpophalangeal joints were found to be swollen and tender, with a restricted range of motion observed in both the knees and wrists.
• • The patient reported a pain level of 8 out of 10 on the Visual Analog Scale (VAS) and scored 64 on the Western Ontario and McMaster Universities Arthritis Index (WOMAC), which assesses pain intensity, joint stiffness, and difficulty in performing activities of daily living (ADL).

2.2.2 Laboratory Results:

• • Elevated rheumatoid factor (RA Factor) and anti-cyclic citrullinated peptide (anti-CCP) antibody levels.
• • Elevated C-reactive protein (CRP) indicating active inflammation.
• • Elevated ESR

2.2.2 Imaging:

• • X-rays showed reduced joint space and joint destruction in the affected areas (Figure 2).

Figure 2: Clinical Photograph and X-ray of Patient Demonstrating Joint Swelling, Deformities, Reduced Joint Space, and Joint Destruction

3. Therapeutic Intervention:

3.1 Hammam Bukhari (Steam Bath Therapy)

• • Frequency: Daily for 10 minutes for 15 days.
• • Procedure: The patient was exposed to steam infused with Unani herbs known for their anti-inflammatory properties [11, 12], such as Nakhuna (Anethum graveolens), Babuna (Matricaria chamomilla), and Suranjan (Colchicum luteum). These herbs were combined with water and boiled for 10–15 minutes. After removal from heat, the steam was immediately used to treat the affected body part through localized steaming.
• • Rationale: Promotes circulation, relieves stiffness, eliminates Fuzlat (morbid matter).

4. Outcome and Follow-Up

• • Short-term Outcome:
• • Following the completion of 15 therapy sessions, the patient’s pain level decreased significantly from 8/10 to 2/10 on the Visual Analog Scale (VAS). The Western Ontario and McMaster Universities Arthritis Index (WOMAC) score also improved markedly, reducing from 64 at baseline to 22 post-treatment, indicating a substantial reduction in symptom severity. Additionally, there was a significant increase in joint range of motion and flexibility, particularly in the hands and knees.
• • Morning stiffness: Reduced from 80 to 20minutes
• • Swelling: Noticeable reduction.

The patient reported improved quality of life and continued symptom control at the 2-month follow-up.

5. Discussion

This case was managed using a comprehensive Unani therapeutic approach addressing Waja’al-Mafāsil (joint pain) through a combination of treatments including Tahleel-Mawad (dissolution of morbid matter), Ta‘dīl-i-Mizāj (restoration of natural temperament), and Imāla-Mawad (diversion of morbid matter). These therapies collectively aim to alleviate symptoms, improve joint mobility, and enhance overall functional capacity, thereby improving the patient’s quality of life while preventing further disease progression. The foundational principle in Unani medicine underlying this treatment is the elimination of morbid humours or pathological substances (Tanqiya) and the restoration of the body's natural balance or temperament (Ta‘dil). The steam therapy known as ḥammam is believed to exert its therapeutic effects through three key mechanisms: Tahleel, where the heat generated dissolves and facilitates the removal of waste and morbid matter from the body; Taqtee, which involves the release of morbid matter trapped in the interstitial spaces of organs through the action of hot water; and Talteef, where warm water stimulates the body's innate healing faculty (Quwwat Tabiya) to break down morbid substances into smaller, more manageable particles for elimination. The integration of Hammam Bukhari with Unani pharmacopeial herbs such as Nakhuna (Anethum graveolens), Babuna (Matricaria chamomilla), and Suranjan (Colchicum luteum) demonstrated a significant reduction in the symptoms of rheumatoid arthritis. This is likely due to a synergistic effect wherein the herbal formulations aid in detoxification and modulation of the patient’s Mizaj (temperament), while the heat from the steam bath enhances peripheral blood circulation and reduces cytokine-mediated inflammation. Importantly, this Unani regimen not only provided symptomatic relief but also showed clinical efficacy comparable to conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs), without causing notable adverse effects. These findings suggest that, when standardized and validated through further research, Unani therapy could serve as a safe and effective adjunct or alternative treatment modality in the integrative management of rheumatoid arthritis, offering patients holistic care that addresses both symptoms and underlying systemic imbalances.

Conclusion

The present case report highlights that Hammam Bukhari, as used in Unani medicine, offers a safe, effective, and complementary approach for managing rheumatoid arthritis. Beyond enhancing patient well-being and joint function, this traditional therapy has the potential to reduce reliance on conventional medications and thereby minimize their associated side effects. However, to establish its efficacy and safety conclusively, further rigorous research is necessary. Well-designed clinical studies with standardized protocols and larger participant groups are essential to validate the therapeutic benefits of Hammam Bukhari and to integrate it confidently into mainstream rheumatoid arthritis management.

Informed consent

The authors confirm that all necessary patient consent forms have been obtained. The patient has been informed that their name and initials will not be published, and every effort will be made to ensure their anonymity and protect their identity.

Conflict of interest

The author(s) declared to have no conflict of interest.

Ethics approval

Not required.

Acknowledgement

I would like to sincerely thank each author for their invaluable advice, inspiration, and assistance, which made this work possible. I also wish to acknowledge HSZH Unani Medical Hospital for providing the necessary facilities to carry out the therapy.

References

1. Khatoon S, Shoaib M, Azmat J, et al. Concept of Waja‘al-Mafāṣil or Hudar (Rheumatoid Arthritis) in Unani Medicine: A Review. International Journal of Herbal Medicine 11 (2023): 15-21.
2. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 388 (2016): 2023-2038.
3. Ibn e Sina, Al Qanoon Fil Tib. (Urdu translation), Idara Kitab us Shifa, New Delhi IV (2010): 1445-1447.
4. Khan Azam HM.Akseer e – Azam. (Al-Akseer) New delhi: Idara kitab al shifa; NewDelhi: YNM 836.
5. Tauseef M, Ali A, Lari IA, et al. Hammam therapy: A systemic review. International Journal of Unani and Integrative Medicine  3 (2019): 07-10.
6. Ansari MA, Noor H, Qadeer A. Application of Hammam (The Steam Bath), in the Past and Present; An Overview. International Journal of Research and Analytical Reviews  6 (2019): 1308-1315.
7. Farooqi A A, et al. Effectiveness of Herbal Steam Bath in Osteoarthritis. J Res Unani Med (2014).
8. Husain A, et al. Unani approach to arthritis. Hamdard Medicus (2010).
9. Ilaj bit Tadbeer" by Dr. Ghulam Jeelani – Describes equipment for Hammam.
10. CCRUM Guidelines on Unani Regimental Therapies – Lists design standards and usage of Hammam cabinets.
11. Unani Pharmacopoeia of India (NFUM) Part II – Describes preparation and application of steam with herbal drugs.
12. Ahmad M, et al. Medicinal plants with anti-inflammatory activity: A review. Phytomedicine (2020).
13. Sharfuddin, Saima & Ahmad, Ehsan & Zaidi, et al. Impact of cervical spondylosis on quality of life and its management through unani system of medicine: a review (2025).
14. Khan, Simran & Sharfuddin, Saima & Khan, et al. Decoding diabetic peripheral neuropathy: pathogenesis, diagnostic breakthroughs, and emerging therapeutics- a comprehensive review. International Journal of Zoology, Environment and Life Sciences (2024): 1-8.