Unani · Atlas

1. Introduction

Version followed: Unani (Unani Tibb, Greco-Arabic medicine) as Indian government bodies (the Ayush department of the Government of NCT of Delhi, the National Commission for Indian System of Medicine) and Pakistan's National Council for Tibb describe it, with WHO's 2022 Unani benchmarks for orientation. The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (APA 2022) and its supplementary modules (APA 2013).

What it is. Unani is a codified medical system with its own colleges, degrees, pharmacopoeia and regulators. It is not a psychotherapy. Its official descriptions trace it to Hippocrates ("Father of Medicine") and say it was developed further in Arab and Persian lands. The name links to "Ionian" (Greece, Unan), and tibb means medicine. It reached the Indian subcontinent about a thousand years ago, and the Government of India recognises it as an Indian system of medicine. [source: Delhi Ayush, Unani] Outside South Asia it is also used in other countries; the EBSCO overview names Saudi Arabia, China and Japan. [source: EBSCO Research Starter] Practice in Bangladesh and in Western countries is [uncertain: not verified].

Core idea of health and change, as the system holds it. Unani holds that the body rests on seven natural principles (umur-e-tabiya): elements (arkan), temperament (mizaj), humours (akhlat), organs (aza), vital spirit (arwah), faculties (quwa) and functions (af'al). The four humours are dam (blood), balgham (phlegm), safra (yellow bile) and sauda (black bile). Health is held to depend on a balance of elements, humours and temperament, and treatment aims to restore that balance. Each person is said to have an inner self-preserving power (quwwat-e-mudabbira), and strengthening tabiyat (the body's healing nature) is described as the best way to promote health. [source: Delhi Ayush, Unani] The system stresses prevention through six essentials (asbab-e-sitta zaruriya). One of these is harkat wa sukoon nafsani, "psychic movement and rest" (emotional activity and calm). The Delhi page states that imbalance in these factors underlies "all mental and physical diseases". [source: Delhi Ayush, Unani] These are the tradition's own concepts. They are reported here as Unani holds them, neither as established physiology nor dismissed.

The psychotherapist's place. A psychotherapist does not practise Unani. Diagnosis by pulse, urine and stool, prescribing Unani medicines and diets, and regimental procedures such as cupping (hijama) are the work of qualified, registered Unani practitioners (hakims or tabibs). This guide covers the therapist's own culturally responsive work alongside a client who uses Unani: assessment with the Cultural Formulation Interview, exploring the client's explanatory model, safe coordination with registered Unani practitioners and prescribers, and safeguarding. [synthesis]

Mental health within Unani (attributed). A recent review in the Journal of Research in Unani Medicine (Qaiser, Khan and Khan 2026) describes Dimāghī Sehat (mental health) as the healthy functioning of the brain (dimāgh), spinal cord (nukhā') and nerves (a'sāb). It says classical texts use the term interchangeably with Nafsānī Sehat (psychic health), which links mental faculties to the soul (nafs). Mental health is explained through temperament, humoral balance and organ vitality. The authors describe Unani theory as largely hypothesis-driven, supported by observation and some empiricism. [source: Qaiser et al. 2026, abstract] Classical Unani names for specific mental disorders (for example junūn and mālīkhūliyā) are widely cited [uncertain: not verified].

Evidence status in brief. An independent overview states that "robust scientific evidence of Unani medicine's benefits is lacking". [source: EBSCO Research Starter] A systematic review of wet cupping (hijama) for mental health found 9 studies, mostly of poor quality, and concluded that more rigorous trials are needed. [source: Ucun 2022] No Unani treatment is presented here as a treatment for any mental or physical disease.

2. Framework

Unani has its own framework, set by its regulators and colleges, and the therapist's work with a client who uses it has a separate one.

A. How Unani organises care (as its bodies publish it).

Assessment within Unani. The three main diagnostic tools are nabz (pulse) and examination of baul (urine) and baraz (stool). The practitioner also weighs the environment, the six essentials and the person's mizaj. [source: Delhi Ayush, Unani] The EBSCO overview adds examination of the tongue. [source: EBSCO Research Starter]
Four modes of treatment. (1) Ilaj bil-tadbir, regimental therapy: physical methods said to remove waste and strengthen the body's defences. The Delhi page lists purging, induced vomiting, sweating, diuresis, venesection (fasd), enema, Turkish bath (hammam), massage (dalk), exercise (riyazat), douches, cauterisation, cupping (hijama) and leech application (taleeq). (2) Ilaj bil-ghiza, dietotherapy: changing the quality and quantity of food. (3) Ilaj bil-dawa, pharmacotherapy: medicines of herbal, animal and mineral origin, mostly given as complex compound formulations. (4) Ilaj bil-yad, surgery. [source: Delhi Ayush, Modes of Treatment] This guide gives no doses, formulas or procedure techniques.
Prevention. Preserving health (baqa-e-sehat) means keeping the six essentials balanced in quality, quantity and sequence: air, food and drink, bodily movement and rest, psychic movement and rest, sleep and wakefulness, and retention and evacuation. [source: Delhi Ayush, Unani]

B. Who holds authority and how practitioners are recognised.

India. The National Commission for Indian System of Medicine (NCISM), set up under the NCISM Act 2020, is the statutory regulator for education, professional standards and registration in Ayurveda, Unani, Siddha and Sowa-Rigpa. Its autonomous boards include a Board of Unani, Siddha and Sowa-Rigpa. Its Board of Ethics and Registration keeps a National Register. The recognised Unani degree is the BUMS. An NCISM circular states that qualified, registered practitioners cannot lawfully be called "quacks" for practising their own system. The same circular does not let them practise modern (allopathic) medicine, which depends on state laws and court rulings. Health is a state subject. [source: Vajiram & Ravi on NCISM circular, 2026; the circular's description of qualified, registered practitioners as legally recognised is also reported by Medical Dialogues, 31 July 2026] The Ministry of Ayush runs national programmes for these systems, for example a scholarship scheme for foreign students on AYUSH degree courses, which describes the BUMS as a 5½-year degree including one year of compulsory clinical training [source: Ministry of AYUSH scholarship scheme, Embassy of India Paris]. The Central Council of Indian Medicine's minimum standards for the Unani degree (1995 amendment, hosted on the NCISM site) set 4½ years of study in three professional stages plus a 12-month compulsory rotatory internship [source: NCISM, Unani UG minimum standards]. Whether later NCISM regulations changed this is [uncertain].
Pakistan. The National Council for Tibb was set up in 1965 under section 3 of the Unani, Ayurvedic and Homoeopathic Practitioners (UAH) Act 1965. It regulates education and research and arranges registration of "duly qualified persons". It sits under the Ministry of National Health Services, Regulations and Coordination. [source: National Council for Tibb, About] The Council's website has a Registered Tabibs List page with downloadable lists for Punjab, Balochistan, Khyber Pakhtunkhwa, Sindh, Azad Jammu and Kashmir and Gilgit-Baltistan, and gives the Council's phone and email for enquiries [source: National Council for Tibb, Registered Tabibs List]. What the lists contain is [uncertain]; to confirm a tabib's registration, the client can contact the Council.
International standards. WHO published benchmarks for the training of Unani medicine and for its practice on 11 February 2022 (the training benchmarks update a 2010 edition). They set minimum criteria for training practitioners and associate service providers, minimum standards for safety and quality of practice, and regulatory, legal and ethical aspects. [source: WHO training benchmarks page; WHO practice benchmarks page] WHO lists the practice benchmarks (80 pages) as covering levels of practice, categories of Unani health-service providers, infrastructure and facilities, Unani health interventions including regimental therapies, health products and devices, key elements for safe practice, regulatory, legal and ethical aspects, and health-data management [source: WHO practice benchmarks page; WHO Quality Health Services catalogue entry]. What the benchmarks say about referral to conventional care or about mental health is [uncertain].
Elsewhere. Statutory regulation of Unani in the UK, the USA and other countries is [uncertain: not verified]. Where there is no statutory register, ask what training and registration a practitioner holds and where. [synthesis]

C. The psychotherapist's framework alongside Unani [synthesis, built on the CFI materials]

Phase	Goal	Typical sessions	Move on when
1. Engagement and cultural assessment	Learn the client's own account of the problem, including any Unani explanation and treatment; build trust	1–3 sessions; the core CFI fits in session 1 or 2 (no official time is given; a common estimate of 15–20 minutes is [uncertain])	You can state the client's explanatory model in their own words and know what Unani care they are receiving
2. Shared formulation	Combine the clinical picture with the client's cultural frame; screen for risk and medical red flags	1–2 sessions	The client agrees with a formulation that respects their frame, and safety issues are routed
3. Collaborative treatment	Deliver your evidence-based therapy; coordinate with the Unani practitioner and prescriber if the client consents	Course as your therapy requires	Goals are being reached, and coordination is working or not needed
4. Review and integration	Make sense of both kinds of care; plan relapse prevention	1–2 sessions, then as needed	Client can say what helps, from either system, and whom to call

Use the CFI supplementary modules at any phase, and repeat them when treatment changes. [source: APA CFI Supplementary Modules]

3. Guiding principles

You work alongside Unani; you do not practise it. Never take a pulse "Unani-style", suggest a temperament diet, or recommend cupping or medicines. [synthesis]
Attribute concepts; never adjudicate them. Say "in Unani, sauda is understood to…" and do not state humours as fact or dismiss them. [synthesis]
The client's model comes first. Elicit their explanation before you give your own. [source: Kleinman et al. 1978 via Tanenbaum handout; APA CFI]
The CFI supports decisions; it does not decide them. Use it to understand, not as the only basis for a diagnosis. [source: APA DSM-5-TR CFI]
Registered practitioners hold authority within Unani. For questions about Unani diagnosis or treatment, the authority is the client's registered hakim under NCISM in India or the National Council for Tibb in Pakistan, not you. [source: NCISM circular report; NCT About]
Prescribers hold authority over medicines. Route any question about starting, stopping or combining medicines, Unani or conventional, to the prescriber and the Unani practitioner. Never advise on it yourself. [synthesis]
Safety first, without contempt. Raise contamination, interactions and procedure risks as regulators and reviews state them, and in a respectful tone. [source: Lok Sabha Q.762, 2009; Wang et al. 2023; EBSCO]
No delay of urgent care. Relying on Unani alone can mean serious illness is missed or delayed. Psychosis, suicidality and medical red flags need conventional assessment now, alongside any Unani care. [source: EBSCO Research Starter; synthesis]
Consent and confidentiality govern any contact with healers. Get explicit, specific written consent before contacting a Unani practitioner. [synthesis]
Cultural humility over cultural expertise. Do not assume that a client of South Asian, Arab or Muslim background uses or values Unani. Ask. [synthesis]
Touch. You never perform or assist with bodily procedures. Clients have the right to explicit consent and to stop any regimental therapy given by others. [synthesis]

4. Intervention inventory

Everything below is the psychotherapist's own work. Unani diagnosis, medicines, diets and regimental procedures belong to registered Unani practitioners and are described only so you can talk about them knowledgeably. [synthesis]

4.1 Cultural humility and self-examination

Purpose / when: before and during work with any client who uses Unani or Greco-Arabic medicine. It helps you notice your own assumptions, whether that is scorn for "pre-scientific" humoral medicine or romanticising it. [synthesis]
Steps: (1) Write down what you believe about Unani, hijama and South Asian or Muslim health practices, and where those beliefs came from. (2) Separate what you know from what you assume. (3) Learn the basic vocabulary (mizaj, akhlat, the six essentials, the four modes of treatment) so the client does not have to teach you everything. (4) In supervision, look at how religion, migration, caste, class and racism in services shape this client's help-seeking. [synthesis]
Example language (illustrative): to yourself or a supervisor: "Am I treating the hakim as a rival, or as part of this person's care?"
Watch for: feeling irritated when the client mentions "heat" or "black bile"; correcting their words; assuming a religious meaning they did not give. It is working when the client brings up Unani without being asked. [synthesis]

4.2 Core Cultural Formulation Interview (DSM-5-TR)

Purpose / when: early in assessment (session 1–2), and whenever the client's account and your diagnosis do not fit together. APA describes the CFI as designed for any clinician, with any person, in any care setting. [source: APA DSM-5-TR Section III] It has 16 questions in four domains: cultural definition of the problem; cultural perceptions of cause, context and support; cultural factors affecting self-coping and past help-seeking; and cultural factors affecting current help-seeking, including the clinician-patient relationship. [source: APA DSM-5-TR CFI]
Steps: (1) Use the official APA form. Clinicians may reproduce it for their own patients, but modifying or translating it needs APA permission. [source: APA DSM-5-TR CFI] (2) Explain that you ask everyone about their own understanding. (3) Go through the four domains in order, in the client's words. Under past help-seeking, ask specifically about hakims, Unani dispensaries, dawakhanas, cupping, religious healers and family remedies [synthesis]. (4) Note any barriers they name, such as cost, stigma, language or a previous dismissive clinician. (5) Summarise back what you heard, and record it in the formulation. (6) Do not let the CFI stand in for diagnosis. It informs your clinical judgement. [source: APA DSM-5-TR CFI]
Example language (illustrative): "People explain problems like this in many ways: medical, religious, family, or traditional systems like Unani. How do you explain what is happening to you?" "Have you seen a hakim or anyone else about this? What did they say, and did it help?"
Watch for: the client hiding Unani use because they expect disapproval. Shorter answers and vague mentions of "home medicine" are signs of this. It is working when the client describes what the hakim said and what they are taking. The DSM-5 field trial found clinicians needed less time after their first CFI. [source: Lewis-Fernández et al. 2017 abstract]

4.3 CFI supplementary modules

Purpose / when: for deeper assessment on a topic the core CFI raised. You can give them at the first evaluation, later in care, or repeatedly. [source: APA CFI Supplementary Modules] The modules most relevant here are the Explanatory Model, Coping and Help-Seeking, Spirituality, Religion and Moral Traditions, Cultural Identity, Social Network, Immigrants and Refugees, and the Caregivers module, which is given to the caregiver. For an older parent or a teenager, use Older Adults or School-Age Children and Adolescents. An Informant Version of the core CFI is available for a family member. [source: APA CFI Supplementary Modules; APA CFI Informant Version]
Steps: (1) The core CFI form shows which module expands each topic, so pick from there. [source: APA CFI Supplementary Modules] (2) Explain why you are going deeper. (3) Use the module's structure in your own words, and do not read items out mechanically [synthesis]. (4) Bring the findings back into the formulation and treatment plan.
Example language (illustrative): "You mentioned your grandmother took you to the hakim as a child. Can we spend a little time on how your family handles illness and who they trust?"
Watch for: fatigue in the client, and modules turning into a checklist. It is working when new information changes your plan, for example a family-mandated Unani course you need to work with rather than against. [synthesis]

4.4 Eliciting the explanatory model in the client's Unani terms (Kleinman)

Purpose / when: when the client explains their distress in Unani concepts (for example, imbalance of temperament or an excess of a humour) or by another cause. Use this to find common ground for treatment. [source: Kleinman et al. 1978 via Tanenbaum handout]
Steps: Ask, in your own words, Kleinman's eight areas: (1) what they call the problem; (2) its cause; (3) why it started when it did; (4) what it does to them and how it works; (5) how severe it is and whether it will last; (6) what treatment they think they should get; (7) the main problems it has caused; (8) what they fear most about it. [source: Tanenbaum handout] Then (9) write the model down in their terms; (10) find where it overlaps with your formulation, such as sleep, appetite, stress, grief or overwork; (11) agree on goals both frames support. [synthesis]
Example language (illustrative): "You said the hakim told you your temperament has become too 'dry and cold'. What does that mean for you, and what do you expect to happen if it is put right?" "What worries you most about this?"
Watch for: you translating their model into yours too soon. Also notice an explanation that blames the client or someone else for illness, and fears of permanent damage. It is working when the client agrees with your summary and says it in their own words. [synthesis]

4.5 Using the six essentials as a shared language for daily-life work

Purpose / when: the six essentials (air, food and drink, bodily movement and rest, psychic movement and rest, sleep and wakefulness, retention and evacuation) are Unani's own frame for preserving health. [source: Delhi Ayush, Unani] They overlap with areas psychotherapists already work on, such as sleep, activity, routine and emotional regulation. Using them as a bridge is your own adaptation, not a Unani intervention. [synthesis]
Steps: (1) Ask whether the client finds this framing meaningful. Do not impose it. (2) Map your interventions onto the categories the client already values, for example behavioural activation under "bodily movement and rest", or emotion regulation and worry work under "psychic movement and rest". (3) Leave specific diets, regimens and Unani prescriptions to the hakim. Never prescribe or adjust them. (4) Check that your plan and the hakim's plan do not conflict, for instance a sleep schedule against a timed regimen. [synthesis]
Example language (illustrative): "In Unani, emotional strain is one of the six things that keep a person in balance. The work we do on worry fits there. Does that way of putting it sit right with you?"
Watch for: sliding into giving Unani advice; clients who take your framing as an endorsement of a particular remedy; framing that guilt-trips the client ("you got ill because you were unbalanced"). It is working when homework is done and described in the client's frame. [synthesis]

4.6 Cultural concepts of distress and differential assessment

Purpose / when: DSM-5-TR defines cultural concepts of distress to "include idioms, explanations or perceived causes, and syndromes". [source: APA DSM-5-TR Section III] A Unani explanation of distress (such as a humoral cause) is an explanation or perceived cause in this sense, not a symptom. Use this when you are deciding whether what the client describes is a cultural explanation, a symptom, or both. [synthesis]
Steps: (1) Record the Unani explanation as the client's explanation. (2) Assess symptoms, functioning and risk independently. (3) Do not count a culturally shared explanation, such as a belief that heat or black bile causes melancholy, as delusional. The DSM-5-TR note on culturally sanctioned beliefs and psychosis is [uncertain: not verified]. Fixed, idiosyncratic beliefs that go beyond what the client's community holds still need psychiatric assessment. [synthesis] (4) Where the client also describes spirit or possession experiences (which come from religious or folk frames rather than Unani theory [synthesis]), note that DSM-5 dissociative identity disorder may be "described in some cultures as an experience of possession". The criteria exclude experiences that are a normal part of a broadly accepted cultural or religious practice [source: PMC9199574]; a study guide citing DSM-5-TR paraphrases both points, so DSM-5-TR keeps them in substance (exact wording [uncertain]) [source: Lewis 2023 study guide]. ICD-11 6B63 possession trance disorder requires the state to be "involuntary and unwanted" [source: PMC9199574; findacode ICD-11 6B62]. (5) If you are unsure, ask a cultural broker or the client's community, with consent.
Example language (illustrative): "Many people in your community understand low mood as a problem of temperament. I take that seriously. I also want to check some things, like sleep and hopelessness, that tell me how much this is affecting you."
Watch for: pathologising a culturally normal explanation; missing a depression or psychosis because "it's just their belief". It is working when your diagnosis and the client's explanation can sit side by side in the plan. [synthesis]

4.7 Checking practitioner credentials and supporting informed choice

Purpose / when: when the client sees or plans to see a Unani practitioner, especially one who offers procedures or makes strong claims. [synthesis]
Steps: (1) Ask what qualification and registration the practitioner holds. In India that means a recognised degree such as the BUMS and registration under the NCISM Act, with a National Register kept by NCISM's Board of Ethics and Registration. [source: NCISM circular report] In Pakistan it means registration with the National Council for Tibb. [source: NCT About] (2) Explain that registered Unani practitioners are lawful within their own system but are not automatically authorised to practise modern medicine. [source: NCISM circular report] (3) Outside South Asia, ask what training they have and which registers they belong to. Regulation there is [uncertain: not verified]. (4) Leave the choice to the client.
Example language (illustrative): "It's your choice whom you see. One thing that helps people stay safe is checking that a hakim is properly qualified and registered. Do you know where yours trained?"
Watch for: coming across as hostile to Unani; practitioners who claim to cure serious mental illness or tell clients to stop psychiatric medicines; unregistered sellers. It is working when the client can say who treats them and how to reach that person. [synthesis]

4.8 Medicine-safety conversation and routing to the prescriber

Purpose / when: whenever a client takes Unani medicines (ilaj bil-dawa: herbal, animal and mineral substances, mostly compound formulations [source: Delhi Ayush, Modes of Treatment]), especially alongside psychiatric or other conventional medicines, in pregnancy, or with diabetes, liver or kidney disease. [synthesis]
What sources state: some herbs and preparations can be toxic or interfere with conventional treatment, and many Unani medicines are sugar-based and so unsuitable for people with diabetes. [source: EBSCO Research Starter] Concern about heavy metals in South Asian traditional medicines led the Indian government to report in 2009 that heavy-metal testing became mandatory from 1 January 2006 for purely herbal Ayurveda, Siddha and Unani medicines for export, and that Good Manufacturing Practices had been made mandatory for all Ayurveda, Siddha and Unani manufacturing units. That answer also described metals as intended ingredients of herbo-mineral formulations. [source: Lok Sabha unstarred Q.762, 25 Feb 2009] Lead poisoning from contaminated traditional products is documented in case reports, though the report examined concerned Chinese medicine, not Unani [source: Ma et al. 2022]. Clinicians should take detailed medication histories and consider heavy-metal poisoning when symptoms are nonspecific. [source: Ma et al. 2022]
Steps: (1) Ask what the client takes: names, who prescribed or sold them, and since when. (2) Record it. (3) With consent, tell the prescriber (psychiatrist or GP) and suggest the client show the actual products to them and to a pharmacist. (4) Never advise starting, stopping, reducing or combining any medicine. (5) Ask the client to tell the hakim about their psychiatric medicines too. (6) Watch for new physical symptoms and route them to medical review. [synthesis]
Example language (illustrative): "I'm not the right person to say whether these mix safely with your tablets. Could we let Dr. X and your hakim both know what you're taking, so they can check?"
Watch for: stopping psychiatric medication "because the hakim's treatment is natural"; abdominal pain, anaemia, fatigue or neurological symptoms that may need a heavy-metal screen; worsening blood sugar. It is working when both practitioners know the whole medication list. [synthesis]

4.9 Regimental therapies (hijama, fasd, leeches): consent and safety conversation

Purpose / when: when a client undergoes or plans ilaj bil-tadbir, such as cupping, venesection, leech application, cauterisation, induced vomiting or purging, Turkish bath or massage [source: Delhi Ayush, Modes of Treatment]. These are done by Unani practitioners. You never perform, demonstrate or assist with them. This guide gives no techniques, sites, durations or schedules.
What sources state: cupping is generally considered safe, with mostly mild effects such as scarring, burns, headache, itching, dizziness and anaemia. Wet cupping breaks the skin barrier, and serious infections are reported, including abscesses, osteomyelitis, necrotising fasciitis and one death after delayed presentation. Safety depends on hand hygiene, skin disinfection, single-use needles and sterile devices. Patients should seek urgent care for persistent pain, swelling or skin lesions near cupping sites. [source: Wang et al. 2023] Evidence for wet cupping in mental health is weak and poor-quality. [source: Ucun 2022]
Steps: (1) Ask neutrally about any procedures the client has had or plans. (2) Check for things that need medical clearance first: anticoagulants, bleeding disorders, anaemia, diabetes, immunosuppression, pregnancy, skin infection, eating disorders (where purging is involved), and needle, blood or injury phobia or fainting. Encourage the client to raise these with the practitioner and their doctor [synthesis]. (3) Remind them of their rights: explicit consent before and during, a chaperone if wanted, the right to stop, and no sexual or genital contact; any intimate area only by explicit agreement [synthesis]. (4) Give the warning signs from the sources: persistent pain, swelling, skin lesions, fever. (5) If the client has a trauma history, plan with them for how procedures that involve touch, blood or restraint might affect them. [synthesis]
Example language (illustrative): "You decide what happens to your body, and you can ask to stop at any point. If the place where cupping was done becomes painful, swollen or hot, please go to a doctor that day."
Watch for: repeated bloodletting in a client with an eating disorder, self-harm or a wish to be "cleansed" (consider whether it serves self-punishment or purging); fainting; dissociation or trauma symptoms during procedures; any sexualised contact (a safeguarding matter). It is working when the client makes informed choices and reports complications early. [synthesis]

4.10 Collaboration and referral with a registered Unani practitioner

Purpose / when: when the client wants their hakim and their therapist (and prescriber) to coordinate, or when the hakim's plan affects therapy. WHO's strategy promotes safe and effective traditional and complementary medicine within health systems, including through practitioner integration. [source: WHO TM Strategy 2014–2023 page] Evidence for collaboration comes from other traditions: in Nigeria and Ghana, shared care between traditional and faith healers and primary care workers for psychosis reduced symptoms more than usual care (COSIMPO) [source: PubAnnotation PubMed 32861306]. That trial did not involve Unani.
Steps: (1) Get explicit written consent naming the practitioner, what will be shared and for how long. (2) Check registration (see 4.7). (3) Make a respectful first contact that introduces your role, states shared goals and asks how they would like to coordinate. (4) Share only what is needed. (5) Agree who handles what: Unani assessment and medicines go to the hakim; psychiatric diagnosis and medicines to the prescriber; psychotherapy to you. (6) Agree how urgent issues will be passed on, such as suicidality, psychosis or physical red flags. (7) Review together with the client. [synthesis]
Example language (illustrative): to the hakim: "I am working with [client] on stress and sleep, with their consent. I want to make sure our approaches support each other. Is there anything in your plan I should know about?"
Watch for: the client feeling caught between the two of you; disagreements over medicines (send these to the prescriber, not to a debate); breaches of confidentiality in close-knit communities. It is working when plans are consistent and the client reports less conflict. [synthesis]

4.11 Interpreters and cultural brokers

Purpose / when: when the client's preferred language is Urdu, Hindi, Arabic, Persian, Bengali or another language, or when Unani terms need explaining. Language barriers are one of the clinician-patient relationship factors the CFI asks about. [source: APA DSM-5-TR CFI]
Steps: (1) Use a trained professional interpreter, not family members, for clinical content. (2) Brief them on Unani terms beforehand (mizaj, akhlat, hijama, hakim). (3) Check confidentiality concerns if the interpreter belongs to the same small community. (4) If you need cultural context, consult a cultural broker or a registered Unani practitioner with consent, and never in place of the client's own account. [synthesis]
Example language (illustrative): "Please translate what I say as closely as you can, and tell me if a word like 'temperament' doesn't carry over."
Watch for: the interpreter softening or editing; shame about disclosing in front of a community member. It is working when the client corrects the interpreter or adds detail. [synthesis]

4.12 Working with families

Purpose / when: when family members choose the treatment, pay for it, or disagree about Unani versus conventional care. [synthesis]
Steps: (1) With consent, use the CFI Informant Version or the Caregivers module [source: APA CFI Informant Version; APA CFI Supplementary Modules]. (2) Map who decides on treatment. (3) Acknowledge the family's trust in Unani, and present psychotherapy and psychiatric care as additions to it, not rivals. (4) Agree on a shared plan for crises. [synthesis]
Example language (illustrative): "You've looked after her health in the way your family trusts. I'd like to work alongside that. Can we agree what we'll do if things get worse at night?"
Watch for: family pressure to stop medication; blame ("she is ill because she ate wrongly"); the client's own wishes getting lost. It is working when the client's voice is present in family decisions. [synthesis]

4.13 Safeguarding and urgent care

Purpose / when: whenever a practice causes harm or delays needed care. Relying on Unani alone can mean serious illness is missed or delayed. [source: EBSCO Research Starter]
Steps: (1) Assess risk as standard (suicide, self-harm, psychosis, physical illness). (2) If treatment for a serious condition is being delayed, explain the risk calmly, involve the prescriber or GP, and record what you did. (3) For children and adults at risk, act on any harmful procedure, untreated infection, or medicine-related illness under your local safeguarding procedures. (4) Report sexual contact during procedures. (5) Document consent discussions. [synthesis]
Example language (illustrative): "I respect your treatment. These new symptoms worry me, and I think you need a doctor today as well. Can we call now?"
Watch for: being so careful about culture that you hesitate to act on risk. It is working when urgent needs are met without the client giving up care they value. [synthesis]

4.14 Integration and review

Purpose / when: at review points and at the end of therapy. [synthesis]
Steps: (1) Ask what has helped from each kind of care. (2) Look again at the explanatory model: has it changed? (3) Plan relapse prevention that includes the people the client trusts, the hakim among them. (4) Repeat relevant CFI modules if treatment has changed [source: APA CFI Supplementary Modules].
Example language (illustrative): "Looking back, what helped most: our sessions, the hakim's advice, your family, your faith? What will you keep doing?"
Watch for: the client feeling they must give credit to one system. It is working when the client has a coherent plan in their own terms. [synthesis]

5. Handling problems

None of the sources address psychotherapy problems with Unani users directly. Everything in this section is [synthesis] unless a source is cited.

Client conceals Unani use. This is common when people expect contempt. Ask every client routinely, and normalise it ("Many people use more than one kind of care"). Never react with surprise or disapproval. Return to the subject after trust builds.
Client wants you to endorse or judge their hakim's treatment. Stay inside your role: "I can't judge Unani treatment. That's your hakim's field. What I can do is help you think about how it fits with everything else." Send safety questions to the prescriber.
Client stops psychiatric medication for Unani treatment. Do not argue and do not advise. Explore their reasons using the explanatory model (4.4), tell the prescriber with consent, and assess risk. If the risk is high (psychosis, mania, suicidality), act on it under 4.13.
Stuck: the client sees the problem only as humoral imbalance, so talking therapy "won't help". Work through the six essentials framing (4.5): psychic movement and rest is itself one of Unani's essentials [source: Delhi Ayush, Unani]. Offer psychotherapy as work on that part of balance. Agree a short trial with clear review points.
Overwhelm or retraumatisation around procedures. Bloodletting, cupping and restraint during procedures can trigger trauma, fainting or dissociation. Plan with the client in advance (grounding, the right to stop, bringing a support person), and encourage them to tell the practitioner.
Purging and bloodletting with an eating disorder or self-harm. Explore what regimental purging, vomiting or bloodletting means to the client. Liaise with the eating-disorder team or doctor with consent. Do not prohibit or prescribe; route the medical questions to them.
Rupture: the client feels you disrespected their tradition. Name it, apologise for the specific thing, and ask how they would like you to talk about Unani. Repeat the relevant CFI module (Patient-Clinician Relationship) [source: APA CFI Supplementary Modules].
Rupture: the hakim discourages therapy or psychiatric care. Avoid open conflict. Ask the client what the hakim said and why. With consent, contact the hakim to understand their reasoning and find shared goals. If they will not cooperate, support the client's own informed choice and keep safety procedures in place.
Unregistered or doubtful practitioner, or products from unknown sources. Tell the client how registration works (4.7) and suggest they discuss products with a pharmacist or doctor. Report clear harm through local reporting routes [uncertain: not verified for each country].
Physical red flags after treatment (pain, swelling, skin lesions or fever near cupping sites; abdominal pain, anaemia or neurological symptoms after taking products). Arrange same-day medical review [source: Wang et al. 2023; Ma et al. 2022].
Non-adherence to homework because of Unani rules (fasting, timed regimens, food restrictions). Change the timing and content of homework to fit, and do not challenge the regimen.
Spiritual or possession explanations alongside Unani. Explore them with the CFI Spirituality, Religion and Moral Traditions module, and assess using the DSM-5 and ICD-11 criteria (4.6). Do not perform or recommend religious healing yourself. Refer only to legitimate community or religious authorities the client already trusts.
Your own discomfort, either scepticism or enthusiasm. Take it to supervision (4.1). Do not let it shape what you advise.

Sources

Unani: official bodies, regulators and WHO

Unani: reviews and safety

Cultural assessment and collaboration

Books and articles cited

Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251–258.
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision (DSM-5-TR).

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