Comparative Pathophysiology of Fawāq (Hiccups): A Review of Unani and Modern Medical Concepts

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.