Afghanistan Traditional Medicine License Exam cheat sheet

Homeostasis: body maintains internal stability via negative feedback loops (e.g., baroreceptor control of blood pressure, insulin/glucagon glucose regulation).

Cardiac output = heart rate × stroke volume; normal adult resting output is roughly 5 L/min.

Blood pressure = cardiac output × total peripheral resistance.

Normal adult vital signs: temperature 36.5–37.5 °C, pulse 60–100/min, respiratory rate 12–20/min, systolic BP 90–120 mmHg.

Inflammation cardinal signs (Celsus): redness (rubor), heat (calor), swelling (tumor), pain (dolor), plus loss of function (functio laesa).

Cell injury becomes irreversible when mitochondrial ATP production fails and membrane integrity is lost; necrosis is passive, apoptosis is programmed.

Body fluid compartments: intracellular ~2/3 and extracellular ~1/3 of total body water; plasma is about 1/4 of extracellular fluid.

Humoral (B-cell, antibody-mediated) versus cell-mediated (T-cell) immunity distinguishes the two main adaptive immune arms.

Unani theory rests on four elements (fire, air, water, earth) producing four temperaments: hot, cold, wet (moist), dry.

Four humours in Unani: dam (blood), balgham (phlegm), safra (yellow bile), sawda (black bile); health is their balance (itidal).

Six essential factors (asbab-e-sitta zarooriya) govern health: air, food and drink, sleep and wakefulness, movement and rest, evacuation and retention, and psychic states.

The seven natural factors (umoor-e-tabaiyya) include elements, temperament, humours, organs, spirits (arwah), faculties (quwa), and actions.

Ilaj bil tadbeer (regimenal therapy) precedes or complements ilaj bil dawa (drug therapy) and ilaj bil yad (surgical/manual therapy).

Herbal energetics classify drugs by temperament (hot/cold, dry/moist) and degree (1st to 4th), determining dose and indication.

Local systems (e.g., Greco-Arabic, Ayurvedic, and folk practice) share the principle of restoring balance between body, environment, and constitution.

Nuzj (coction/maturation) of humours is a prerequisite before evacuation therapy in classical Unani practice.

Botanical nomenclature: binomial genus + species, e.g., Matricaria chamomilla; family names are capitalized but not italicized.

Primary active constituent groups: alkaloids (nitrogenous, often potent), glycosides (e.g., cardiac glycosides), tannins (astringent), volatile oils, mucilage, saponins, flavonoids.

Pharmacognosy identifies crude drugs by organoleptic (macroscopic), microscopic, physical, chemical, and biological methods.

Standardization markers: assay of marker compound, ash value, extractive value, moisture content, and volatile oil content.

Dose-response and therapeutic index: narrow-index herbs (e.g., cardiac glycoside-containing plants) require strict dosing and monitoring.

Parts used (root, bark, leaf, seed, resin) differ in constituent profile and therefore in dose and preparation.

Synergism and polypharmacy: compound Unani formulations combine drugs to enhance effect or correct temperament; interactions must be assessed.

Known toxic herbs (e.g., Aconitum, Datura, Digitalis-containing plants) require processing (detoxification) and restricted dispensing.

Pulse (nabz) assessment in Unani records rate, rhythm, volume, and character; ten classical pulse qualities are described.

Urine (baul) examination in classical practice notes color, consistency, sediment, and odor as humoral indicators.

Tongue, complexion, and stool (baraz) findings support temperament and humour assessment.

Temperament (mizaj) assessment integrates history, pulse, urine, and physical signs to classify hot/cold and dry/moist states.

Red-flag referral criteria: chest pain, dyspnea, focal neurological deficit, uncontrolled bleeding, high fever with confusion - refer to conventional care.

History structure: onset, duration, aggravating/relieving factors, and associated symptoms, plus current medications and allergies.

Vital signs and basic examination (inspection, palpation, percussion, auscultation) must precede any traditional diagnosis.

Documentation of findings and informed consent is required before initiating therapy.

Therapeutic principle in Unani: treat by contraries (ilaj bil zid) - hot disease with cold drugs and vice versa.

Ilaj bil tadbeer includes cupping (hijama), leeching (taleeq), purgation (ishal), emesis (qai), and venesection (fasd).

Treatment plan sequence: correction of causa (asbab), then regimenal measures, then drug therapy, then surgery if indicated.

Dose adjustment rules: lower doses for children, the elderly, and the weak; account for temperament and disease severity.

Contraindications to cupping/venesection: severe anemia, bleeding disorders, anticoagulant therapy, pregnancy (abdominal sites), and debility.

Herbal prescription should state drug, part, form, dose, frequency, duration, and follow-up interval.

Monitoring: reassess symptoms and adverse effects at defined intervals; modify or stop therapy when response is inadequate.

Combination with conventional drugs requires checking for interactions (e.g., anticoagulants with tannin- or coumarin-rich herbs).

Good manufacturing practice requires validated processes, batch records, and documented cleaning and equipment logs.

Quality tests: identity (organoleptic, microscopic, TLC), purity (ash value, heavy metals, microbial load), and potency (marker assay).

Heavy metal limits and microbial limits must be tested for finished herbal products; results recorded per batch.

Labeling must include product name, batch/lot number, manufacturing and expiry dates, ingredients, dose, and storage conditions.

Dispensing accuracy: verify prescription, weigh/measure precisely, label clearly, and counsel the patient on use and storage.

Storage: protect from light, heat, and moisture; volatile oils kept in tightly closed, dark containers at controlled temperature.

Expiry and stability: assign shelf life from stability data; discard products with altered appearance, odor, or consistency.

Dispensing records and adverse event reports must be retained and traceable to the batch.

Scope of practice: practitioners must act within licensed competencies and refer beyond them.

Informed consent requires disclosure of nature of therapy, expected benefits, alternatives, and material risks.

Confidentiality: patient information is protected and disclosed only with consent or where legally required.

Record keeping: maintain accurate, contemporaneous, and retrievable clinical and dispensing records.

Conflict of interest and advertising: claims must be truthful; no false or exaggerated therapeutic claims.

Mandatory reporting duties include suspected infectious disease outbreaks and adverse drug reactions per national rules.

Licensure requires valid registration, adherence to national traditional medicine law, and continuing education.

Professional boundaries: avoid dual relationships and ensure patient safety and dignity in all encounters.

Hand hygiene: wash with soap and water or use alcohol-based rub before and after every patient contact.

Standard precautions apply to all patients regardless of diagnosis: gloves, gown, mask, and eye protection as indicated.

Sharps safety: never recap by hand; dispose of needles and blades in puncture-resistant, labeled sharps containers.

Sterilization by autoclave: 121 °C at 15 psi for 15–20 minutes (or 134 °C for shorter cycles) for reusable instruments.

Cupping and leeching equipment must be single-use or properly disinfected/sterilized between patients.

Notifiable diseases and adverse events must be reported to public health authorities per national requirements.

Vaccination, cold chain, and safe water are core public health measures; practitioners should promote them.

Waste segregation: infectious waste in yellow/red-coded containers and sharps in puncture-proof containers, per local rules.