Understanding Basics of Menopause in Greeco-Arab Medicine: A Review

Bhat S. A.^{1, *}, Raza A.², Wani P.², M. Shahabuddin²

¹D/O IlmulQabala, A&U Tibbia College, Hospital, Karol Bagh, New Delhi

²A&U Tibbia College, Hospital, Karol Bagh, New Delhi, India

Abstract

Sine yaas (Menopause) is the age at which there is natural cassation of menstrual periods. Human female is almost unique among the mammals in that her reproductive life does not continue as her biological life. All women who live beyond the age of 55-60 years and many young agers experience a period of transition from reproductive to non reproductive life.It is assumed that reproductive function in women generally ceases at about the age of 50 years. Unani system of medicine is enriched with concepts and literature o menopause. In Unani medicine, menopause symptoms are dealt in detail. Details of concept of Menopause in unani system of medicine will be discussed in detail in full length paper.

Keywords

Unani System, Menopause, Sine Yaas, Ancient System

Received: April 2, 2015 / Accepted: April 30, 2015 / Published online: May 19, 2015

@ 2015 The Authors. Published by American Institute of Science. This Open Access article is under the CC BY-NC license. http://creativecommons.org/licenses/by-nc/4.0/

1. Introduction

According to Unani concept, the whole human body is divided in to four age groups, which are considered to carry their particular mizaj. The age group of 35-60 years is known as sinnekahulat in which mizaj becomes barid (cold) and yabis(dry). In this age, production of ratubat-e-unsirya are decreased, to that extend that they are insufficient to maintain hararta-e-unsirya and all the quwa(power) starts deteriorating(6). It is believed that, Ehtebazhaiz (stoppage of menses) in women of this age occurs naturally due to change of mizaj(1). It was the Hippocrate (460-377BC) who firstly postulated the concept of disease is due to the imbalance of humors(2-5).He mentioned in his book Tabiatulinsaan (Human Nature) Khilat-e-Sauda (Black Humor) is barid and yabis and elderly person are barid and yabis by temperament so it is dominant in this age group(6,7).Tibbie sine-e-yaas(Natural Menopause) is attained at the age of 40 years, sometimes 60 years and sometimes 60 years.The earliest reference of menopause come from Ebers Papyris a series of Egyptian text 1500 BC(9) .Aristotle says menstruation normally ceases at the age of 40 years(10).

2. Aetiopathogenesis

In Unani Medicine, the pathogenesis of general diseases has been attributed to three factors viz. mizaj (temperament), tarkeeb (structure) and ittesal (continuity of tissues). Abnormalities of these factors are considered as: sue Mizaj (altered temperament),sue Tarkeeb (altered structure) and tafarruqeIttesal (discontinuity in tissues) respectively (11,12). Mizaj is a specific and distinct state of an individual reflecting neuro-endocrine, normal menstruation genato-metabolic and somato-environmental equilibrium at the optimum functional level of adjustment(13). Unani medicine, as is well known, based on the Hippocratic humoral theory. This theory supposes the presence of four humuors in the body viz: blood, phlegm, yellow bile and black bile. The mizaj of individual are expressed by word damawi (sanguine), balghami (phlegmatic), safrawi (choleric) and saudawi (melancholic) according to the dominancy ofthe humour. Every person is supposed to have a unique humoral constitution which represents his healthy state and any change in this state causes illness of the said person. The severity of the disease depends directly upon the change in equilibrium from mizaj (14).Most of the unani scholar are of the opinion that change in the temperament towards the barid and yabis (sauda) is the leading cause of ahetebasetamas (Amenorrhea) at menopause.

According to Hipocrateskhilatesauda is barid and yabis in temperament and is dominanat in adults, ehtebasehaiz occurs in 40-50 years, sokhilatesauda is the main cause(6).

According to NafisSauda is the fourth and last humor of the body and is inferior amongst all humors(15).

According to Ismael Jurjani menstruation ceases after the age of 40 years because the temperament of women changes towards coldness at this age. Blood production in liver also declines(16).

According to Zakariarazi menstruation stops due to dominance of cold or vicious humors closer to uterus or its vessels due to obstruction or increase viscosity of blood when this amenorrhea prolonged diseases of uterus would occur In classical Unani literature it has been documented that various clinical disorders of amrazesaudavi like Ikhtenaqurrehm (hysteria), Mania, Melancholia (Melancholia) can be a result of Ihtaebazehaiz. Razi quoted that menstruation may ceased due to weakness of liver caused by other associated organs (8).

 According to Ali Bin Abbas Majoosi menstruation may ceased due to liver disease and obesity as the blood vessel becomes narrow and blood flow is reduced. Saabit bin-Qurrah mentioned that menstruation stops at the age of 35-60 years, once menstruation ceases various diseases and complications occur.

3. Clinical Features

Zakaria Razi mentioned in Kitabul Hawi that menopausal women suffer from following sign and symptoms (8)

1. Anorexia

2. Headache

3. Backache

4. Vomiting

5. Pain in lower limbs

6. Fever

7. Constipation

Along with these sign and symptoms various melancholic diseases would occur

According to Ibnesinna following sign and symptoms occur during menopause (16)

1. Headache

2. Chest pain

3. Sweating

4. Dryness of uterus

5. Various neurological disorders

According to Ibnesinna, Razi and  Ismael jurjani, due to ceasetion of menstruation women complaint of following signs and symptoms

1. Loss of Appetite

2. Whole body becomes heavy

3. Felling of nausea

4. Pelvic heaviness

5. Back ache

6. Neck pain

7. Oligourea

8. Blackish urine

4. Management

Unani system of medicine has described a well organized line of treatment in the management of diseases. The fundamental principle in the treatment is to restore the normalcy of patient, correction of imbalance of mizaj and to restore the balance of humors in the body by evacuation of excessive andderanged/ abnormal humorsin the management of Sinne yaas. The following pattern of treatment is prescribed by Unani physicians.

A. Correction of sue mizaj and elimination of Excessive humour

B. Dietary management

4.1. Correction of Sue Mizaj and Elimination of Excessive Humour

In sue mizaj maddi (saudawi) restoration and normalization of humors is done by tanqiya (removal of excessive humour) and ta’deelemizaj(restoration of temperament) with their respectivedrugs. In nuzj (concoction) the akhlateraddiyah (morbid matter) are assembled in order to evacuate conveniently from the diseased organ by using drugs possessing properties of tahleel, taqtie, and talteef. Once the akhlat-e-raddiya(abnormal/deranged humours) are ready for elimination from the superficial and deeper structure of affected organ after a course of munzijat, istefragh(elimination) is brought into action with the help ofmushilat. Mushilat (purgatives) are considered to facilitate the elimination of material from the body. Ta’deelemizaj is related to restoration and normalization of physiological functions after eliminating the akhlateraddiyah from the affected organ. In this phase of the treatment the alteredtemperament is brought back to normal along with Muqawwiyate Rehm(uterine tonic) drugs by usingeither alone or with tadabeer (regimental therapy)( 17,18).

Pharmacotherapy in Unani Medicine

Table 1. List of Single Drugs Generally Used By Unani Physicians In Management Of Menopausal Symptoms

Table 2. List of Poly Herbal Drugs Generally Used By Unani Physicians In Management Of menopausal Symptoms

4.2. Dietary Management

Unani scholars prescribe diet to the patient on the basis of humoral theory, so that the correction of the sui mizaj will be enhanced. Following are the fewprinciples generally suggested by renowned scholars

• Avoidance of all those items that are moallid-e-sauda and safra (yellow bile and black bile productive) like stale, salty and astringent food items.

• Intake of Lateef and lazeez aghziya (light and delicious food items) should be eaten.

• Use of Murattib (emollient) diet such as barley water, milk, pumpkin, cucumber, leafy vegetables like spinach, lettuce, purslane etc.

• Use of bilious concoctive fruits such as dampson, orange, lemon and other citrus fruits.(17,18,19)

5. Conclusion

It can be concluded that menopause in Unani system of medicine is attributed to Khilt-e-Saudawi, Baris Yabis Mizaj, obesity and liver disorders. The main symptoms are loss of appetitie, cessation of menses. All the menopausal symptoms can be managed by Ilajbilghiza, Dawa and Tadbeer on the principle of IajbilZid which means all the regimens should be used as to contradict the mizaj of Sin-e-Yaas and by initily giving Munzijat then Mushilat and lastly giving Muqawiyat to restore the lost Quwat (Power) due to munzijmushil therapy.

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