Menstrual disorders have drawn much attention of the gynaecologists at present and physicians in the ancient times more than any other health problem of the females.
Among all gynaecological problems “Menorrhagia (Kasrat-e- Tams/ Ifrat-e- Tams)” is one of the most common complaints in menstruating females.
Approximately it affects 10 to 15% of the adult female population. It can occur at any age. It is a problem that affects physical, emotional, and social activities and quality of life of the individual.
Menorrhagia (Kasrat-e- Tams/ Ifrat-e- Tams) is nothing but abnormal uterine bleeding or excessive menstrual bleeding. It is a common and debilitating condition and patients with this disorder frequently present to general practitioners and gynaecologists now a days.
According to the strict definition, menorrhagia/ heavy menstruation is described as menstrual bleeding lasting for longer than seven days or a menstrual blood loss exceeding 80 ml.
Although all the ages are affected by menorrhagia (Kasrat-e- Tams/ Ifrat-e- Tams) but the problem is common in woman aged over 35 years, it causes considerable morbidity. It is also one of the most common causes of iron deficiency anaemia in women.
A wide variety of medical therapies are available today for the treatment of menorrhagia (Kasrat-e- Tams/ Ifrat-e- Tams) but no treatment promises complete cure. On the contrary patient develops the risk of cancer of reproductive organs, ultimately the result being hysterectomy.
Since operative morbidity, mortality and long term morbidity are not insignificant, medical treatment should remain the first line therapy. Such an approach has the potential to reduce the overall cost of care, while maintaining efficacy and overall patient satisfaction.
Unani Approach to menorrhagia (Kasrat-e- Tams/ Ifrat-e- Tams)
Complementary and traditional medicines have been used to handle menorrhagia (Kasrat-e- Tams/ Ifrat-e- Tams) for centuries in many cultures. Unani medicine is one of the best developed systems of medicine in world. Indeed, many Unani medical documents, like the Canon of Avicenna (Al-Qanun -fil- tib) were standard textbooks in medical schools until the 16th century in Europe and have been used in the 19th century in the Middle East.
Makhzan-ol-Advieh is another Unani medicine book that is written about medicinal herbs, spices, and medical vocabulary. This book, which is written by Mohammad Hussain in the 18th century, is the largest and one of the latest traditional Persian pharmacopeias.
According to Ibn-e- sina in his book “Al Qanoon” Normal menstrual flow is that which is average in quantity (Miqdar) and normal in quality (Kaifiyat) and is discharged at the time which is normal for the nature and health of a particular woman and which cleans her body by discharging all harmful constituents of her body. Normal menstrual cycle can be described of 30 days which includes the days of menstrual flow.
Causes of menorrhagia (Kasrat-e- Tams)
Important causes are weakness of the retaining power that is, Quwat-e-Masika of the uterus, or increase in the amount of blood or any humour (Khilt) and decreases in its weight or increased fluidity of blood or rupture arterioles of uterus, weakness of uterus or uterine affection like uterine polypi, prutitus uterus, or any alteration in quality or quantity of the menstrual blood that is, increase in quantity or in pressure.
Menorrhagia (Kasrat-e- Tams) may be associated with pelvic pathology, systemic disorders, or may be iatrogenic.
Management of Menorrhagia (Kasrat-e- Tams)
Unani system of medicine offers a number of remedies which are promising, long acting and cost effective as well. One can rely on them without the fear of side-effects. No doubt they are time tested as they have been prescribed since ages. The therapies can be tailored according to the temperament or requirement of the patient, duration of illness, cause of illness, complications aroused and so on. Some diets have the property of having therapeutic affect as well.
Varieties of treatments are being prescribed by Unani physicians like cupping (applied to breasts) and local applications in ancient times. Some were in favour of giving injections and astringent remedies like pessaries.
A part from above, Unani medicine physicians apply multiple drug dosage forms such as oral drugs, vaginal suppository (Ferzajeh/ Humool), sitz bath (Aabzan), lotion (Tila), cleansing (Estinja), and balm (Marham). These varieties of drug forms increase physician options to the management of menorrhagia and improve the compliance of patients.
Avicenna (Ibn-e- Sina) used to treat menorrhagia (Kasrat-e- Tams) by adding opium to some of his preparations. During the Victorian era, the treatment for menorrhagia (Kasrat-e- Tams) included oophorectomy (Surgical removal of an ovary or ovaries.) or the irrigation eg. uterine cavity with certain acids.
Thorough study of the Unani classical literature reveals that menstrual disorders especially menorrhagia can be treated or controlled by astringent drugs like Acacia arabica, Polygonum aviculare, Myrtus communis, Woodfordia floribunda, Terminalia arjuna, Solanum nigrum and cera.
In the Unani system of medicine, treatment of menorrhagia, is according to the cause i.e. astringents (Qabiz Advia) are given when the retaining power is weak, these drugs thicken the blood and increase its velocity.
If any humour (Khilt) dominates and becomes the cause of menorrhagia (Kasrat-e- Tams), specific munzijat and mushilat must be given for the excretion of dominating humour (khilt). Uterine tonics are prescribed when there is weakness of the uterus.
Ulcers of the uterus are treated with astringents and mugharriyat, Imtala-ud-dam should be treated by fasd until the patirnt acquires relief of her symptoms.
The problem can be treated confidently by unani drugs provided the patient has not developed any hyperplasic changes which are the precursor of cancer.
It can be ruled out by doing a premenstrual diagnostic D & C, ultrasound of pelvis and a pap smear.
Single Unani drugs Recommended for Menorrhagia (Kasrat-e- Tams)
A part from above mentioned botanical source drugs some animal origin drugs like cera (Mom) can also be given in single or combined forms to control the excessive bleeding.
The active constituents of above mentioned drugs are tannins. Tannins are non-nitrogenous plan constituents characterised by their astringent (Qabiz) action.
Astringents (Qabiz Advia) are applicable in arresting unhealthy discharges depending upon weakness of the blood vessels or when the exciting causes are removed or when the discharges are very profuse. They are used therapeutically to arrest haemorrhage by coagulating the blood.
Dietary Recommendations/ Dietary Modifications
According to Unani medicine manuscripts, the main step applicable for the management of menorrhgia (Kasrat-e- Tams) before starting pharmacotherapy (Ilaj Bil Dawa) is dietary modification. The patient’s diet should contain plenty of easily digestible foods like yolk of soft-boiled egg. Other recommendations are meat juice (Ma-ul- laham) containing Sumac, kabab chini, and roasted meat with aromatic spices.
Vinegar and citron pickle are suitable astringent and styptic agents in this situation.
Note: The need of the hour is to give these Unani drugs scientific bases, so that they are used on vast level to benefit thousands of ailing women. Today, when the whole word is waiting for the safer remedies for most debilitating conditions, theses drugs can do wonders if used in a scientific manner.
Note: Unani drugs should be taken under the advice of the qualified Unani physician. The patients are required to follow strict Unani regimen for optimum results.