Research in Pharmacy and Health Sciences.2019, 5(3):188-192. • https://doi.org/10.32463/rphs.2019.v05i03.05 REVIEW ARTICLE e-ISSN: 2455-5258 OPEN ACCESS Gynaecological Disorders in the light of Unani System of Medicine Nahida Aqeel1*, Khan Mohd Qaiser2 1 Ilmul Atfal (Paediatrics), Z.V.M U.M.C, Hospital, Azam Campus, Pune, INDIA 2 Tahaffuzi wa samaji tib, T.U.M.C and Hospital, Mumbai, INDIA Abstract Received: 02 July,2019 Health of women is one of society's most critical issues because women must be Accepted: 09 Sept,2019 physically, mentally and emotionally well before they can devote themselves to serve their families and to consider other important social issues. *Correspondence to: There are many Gynaecological disorders found in women that needs to be timely Dr. Nahida Aqeel, diagnosed and cured to avoid major health problems. Common gynaecological disorders Email: nahidaq1.2@gmail.com Copyright: © the author(s), publisher and licensee Indian Academy of Pharmacists. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Published by: OZZIE Publishers most of the females suffer are Usr-e-tams wa Ehtabas-e-tams (Dysmenorrhoea and Ammenorrhea), Kasrat-e-Haiz (Menorrhagia), Sailan-e-reham (Leucorrhoea),Hikkat-ul-Farj (Pruritis vulvae),Warm-e-Farj wa Mehbal (Vulvitis and Vaginitis),Warm-e- Reham (Metritis), PCOD (Polycystic ovarian disease) and Uqr-Banjhpan (Sterility). The Unani System of Medicine which is holistic in nature deals with these issues in a systematic manner as evident from classification of diseases available in ancient Unani literature and the number of plant drugs and its combinations thereby available for the treatment. These herbal medicines have greater significance in the treatment and management of various Gynaecological disorders. Keywords: Unani, women health, Gynaecological disorder and Herbal medicine. INTRODUCTION Health of women is one of society's most critical issues because women must be physically, mentally and emotionally well before they can devote themselves to serve their families and to consider other important social issues. There are many Gynaecological disorders found in women that needs to be timely diagnosed and cured to avoid major health problems. bleeding. Ehtabas-e-tams means absence of menstruation with or without pain. 3Both the conditions are symptom not the disease. According to saheb-e-kamil normal menstruation starts between 10-14 years of age and cease between 3660years.The minimum duration of normal menstruation is 2 days and maximum is 7 days, if more than that it is abnormal. Common gynaecological disorders most of the females suffer are  Usr-e-tams wa Ehtabas-e-tams (Dysmenorrhoea and Ammenorrhea)  Kasrat-e-Haiz(Menorrhagia)  Sailan-e-reham(Leucorrhoea)  Hikkat-ul-Farj(Pruritis vulvae)  Warm-e-Farj wa Mehbal(Vulvitis and Vaginitis)  Warm-e- Reham(Metritis)  PCOD (Polycystic ovarian disease)  Uqr-Banjhpan (Sterility). Types of Usr-e-Tams (Dysmenorrhea)  Usr-e-tams Nazlawi/warmi- occurs due to nazlawi warm and accumulation of blood in the uterus and vagina.  Usre-e tams Tashannuji/Asbi- due to spasm (Tashannuj) of the uterus.  Usr-e-tams suddi-due to formation of thrombus (Sudda) in the uterine vessels.  Usr-e-tams due to defect in the inner layer (endometrium) of the uterus.  Usr-e-tams mubayyazi due to defect in the function of ovaries.3 Usr-e-tams wa Ehtabas-e-tams (Dysmenorrhoea and Ammenorrhea) Dysmenorrhea means Painful menstruation of sufficient magnitude so as to incapacitate day-to-day activities.1 Amenorrhea literally means absence of menstruation.2 Types of Ehtabas-e-tams (Ammenorrhea)  Ehtabas-e-tams khalqi/ibtedai-due to congenital defects in the uterus, ovaries, cervical and vaginal atresia. According to unani concept the volume of blood in usr-etams is less, consistency is thick with painful and difficult www.rphsonline.com Research in Pharmacy and Health Sciences | Vol 5 | Issue 3 | Jul-Sep, 2019; 188-192.    Ehtabas-e-tams sanwi-absence of menstruation in a women in whom normal menstruation has been established. Ehtabas-e-tams tabai-during pregnancy, lactation and following menopause. Ehtabas-e-tams ittefaqi-due to temporary causes like environmental changes, psychological and distance travelling. It requires no treatment. Alamat Ehtabas-e-tams3 Complete absence of menstruation or absence of menstruation in a women in whom normal menstruation has been established. other symptoms are according to the cause Ehtabas-e- tams due to defect in blood Weakness, pallor, dryness, weak pulse, backache, malaise, anorexia, constipation and mild headache Ehtabas-e- tams due to vaginal and cervical atresia Headache, heaviness of head, palpitation, dyspnoea, backache and pain in supra pubic region. Ehtabas-e- tams due to cold exposure Sudden stoppage of normal menstruation, backache, restlessness, palpitation, headache and constipation. Alamat-e- Usr-e- tams Painful and difficult menstruation.sometime the pain is intense with severe restlessness4 or there is intense pain in the beginning which gradually decreases as menstruation starts or the pain starts gradually and then increases.The pain starts 1-2 days before menstruation, Following good blood flow the pain stops in 24 hours.It is associated with nausea, vomiting and other discomforts. Usool-e-ilaj (Usr-e- tams wa Ehtabas-e-tams) If the patient is of sanguineous (Damvi) temperament, obese or cold is the cause of ehtabas-e-tams give pergative 2-4 days before regular menstruation. Mix 20gms of safoof –e- rai in a tub of warm water and make the women sit in for 10-15 minutes. In severe pain-Boil Gul-e-teesu(25gm) and post-ekhashkhash(12gm) in 2 liters of water. Do hot fomentation by soaking a towel in the above medicated hot water. Apply leech (Irsale Alaq) at internal side of thighs,cupping over calves5 and venesection (Fasd) of saphenous vein (Varide Safan).3 In patients of anemia advise murakkbat-e- faulad. Ilaj (Usr-e- tams wa Ehtabas-e-tams) Anemia-kustha faulad 20mg mix with dawa-ul-misk motadil jawahar wali or khameera Abresham Hakeem arshad wala 5gm. Give in the morning hours. Sharbat-e-faulad 10 ml BD Hab-e- mudir 1tab TDS with sharbat-e- bazoori 20 ml BD, 3 days before regular menstruation. Usr-e- tams wa Ehtabas-e-tams ke mujarrebat6 Hab-e- mudir-e- haiz-1 TDSfor 3-4 days Safoof-e-mudir-e-haiz- 7gm BD Dawa-e-usr-e-tams-tukhm qurtum, gaozaban, badiyan, tukhm kharpaza,tukhm karfas and beekh-e- kasni 5gm each, boil in water , filter and use with sharbat-e-bazoori motadil 20 ml BD . Abzanmudir-e-tamsMurmaki,saltiha,marzanjosh,pudina,izkhar,qust, Aklilulmalik,shunez,karnab,suddab,hasha,qarumana,1 tola each, boil in water and use as Abzan. Kasrat-e-Haiz (Menorrhagia) www.rphsonline.com Menorrhagia is defined as cyclic bleeding at normal interval, the bleeding is either excessive in amount(>80ml) or duration>7days) or both.1 Unani definition-Bleeding in excess (>than normal) with or without pain due to excess blood or defect in the uterus. Excessive cyclic bleeding is termed as kasrat-e-haiz and if bleeding occurs beside menstrual days (acyclic/abnormal uterine bleeding) it is termed as Istehaza Treatment for both is same.3 Asbab-Kasrat-e-Haiz (Menorrhagia) Imtala-e- khoon –Excessive production of blood causing dilatation and rupture of vessels Amraz-e- uterus-accumulation of blood in the uterus, sozishe –reham (Burning sensation in Uterus), reham ka gir jana, reham ka tal jana (displacement of uterus), reham ka phat jana (rupture of uterus), tumors, cancer, Huzale kulliya ,Huzale kabid, Tuberculosis, damvi mizaj excessive coitus, rikkat-e-khoon (thinning of blood),excessive use of hot and spicy food.6 Alamat Kasrat-e-Haiz (Menorrhagia) Weakness, Rapid pulse, tachycardia, Increase thirst, Pallor, Orange red colour urine (Zard basurkhi mael), Features of weakness of Aza-e- raeesa (heart, brain, liver)6Excessive menstruation. Usool-e-Ilaj Kasrat-e-Haiz (Menorrhagia) Rest in supine position, No movements, Vaginal douche with hot water 3-4 times and treatment according to the underlying cause Ilaj Kasrat-e-Haiz (Menorrhagia) Give powder of geru and sangjarahat 1gm each followed by loab-e-behdana, shira habb-ul-aas ,shira tukhm-e-khurfa siya, shira beekh anjabar 3gm each, made in arq gaozan 100ml,arq beed –e- mushk 50ml and advise to drink with sharbat-e-anar shireen 25ml. Give powder of Tabasheer, sangjarahat, dana ilaichi safed, shakr safed.5gm BD.7 If kasrat-e-tams is causing ghashi(syncope)- Hab -emarwareed 2 tab, khameera marwareed 5gm with arq ambar 100ml gives immediate relief. If weakness of uterus-kushta khabsul hadeed 20mg, kushta marjan 20mg with majoon- mochras 7gm BD.3 Kasrat-e-Haiz ke mujarrebat6 Hab –e-habisuddam 2tab with sharbat- anjabar 2 tola,arq gaozaban 12 tola BD Safof-e-Habis-5gm BD-make powder of Mazoo –esabz,sangjarahat,maeen khurd,kath safed each in equal quantity.8 Safoof-e-kishneez- 7gm BD Zimad: Mazoo sabz Aqaqiya, gulnar, kundur, surma, busud, shibbe Yamani each in equal quantity, prepare a paste of the mentioned medicine in water and use as Zimad over suprapubic region. Sailan-e-Reham (Leucorrhoea) Sailn-e- reham is defined as whitish pale (safaid zardi mael) discharge from the vagina.6There is weakness of aza –eraeesa(Heart, Brain, Liver) as well as the women suffer from failure of conception.Sometime it is present in pregnancy also.Common in newly married and young girls. Aqsam e Sailan Reham (Leucorrhea) According to discharge there are 5 types Sailan -e-farji Research in Pharmacy and Health Sciences | Vol 5 | Issue 3 | Jul-Sep, 2019; 188-192. Sailan-e-mehbali Sailan-e-Unqi Sailan-e-rehmi Sailan-e-mubayyazi Asbab Sailan-e-Reham(Leucorrhea)3 Sailan farji-the disharge is shiny mucusy white (laisdar safaid aur chamakdar) Sailan mehbali-safaidi mael tursh Sailan rehmi-the discharge is like egg white but sometime orangish pale (ande ki safaidi ki tarah magar kabhi zard) Sailan unqi- transparent (shafaf khari ande ki safaidi ki tarah) Alamat Sailan-e-Reham (Leucorrhea) Backache, Pain in suprapubic region, Frequency of urine, Malaise, Weakness, Loss of appetite, Difficult and Painful menstruation, Itching in vagina, Failure of conception.3 Usool e ilaj Sailan-e-Reham (Leucorrhea) Treatment according to the underlying cause Advise health tonics. Maintain local hygiene If the cause is akhlat-e-faseda(excrementious humours)- The dominant khilt should be eliminated with the use of munzij wa mushil Advise douche of salt or Shib-e- Yamani and warm water. Ilaj Sailan-e-Reham(Leucorrhea) Kushta musal las 2 chawal with majoon-e- mochras 1 tola Safoof-e-sailan 5 masha daily with milk Majoon-e-suparipak 7 gm or Halwa supari pak 2 tola Kushta sadaf 2 chawal Kushta marwareed 2 chawal For general weakness:Kushta faulad 2 chawal with dawa-ulmisk moatadil jawaherwali Sharbat-e-faulad 10 ml after food. Sailan-e-Reham ke mujarrebat Safoof e sailan reham- 10 gm BD Tiryaq-e- reham-2 masha with arq -e- badiyan 12 tola Hab-e-marwareed- 1 tab BD with arq-e-ambar 7 tola Majoon-e-manae sailan- 1 tola daily Halwa suparipak- 2 tola with 250 ml cow milk Eradicate local cause Advise medicine for both internal and external use Wash the vagina with warm water and apply appropriate medicine Ilaj Hikkat-ul- Farj (Pruritis vulvae) For external use Marham-e-kafoor-kafoor 1 masha,kath safaid 3 masha,gile armani 1 masha, make fine powder of the medicines and mix with Rogan-e-gul or rogan-e-banafsha 1 tola. use for local application. For internal use Arq-e- kasni, Arq -e -mako,Arq-e-gaozaban, 4 tola each with sharbat-e Nilofer or sharbat-e- bazoori Moatadil 20 ml BD Uqr-Banjhpan (Sterility) Inability to conceive due to diseases of genital tract or general disorders of the body Infertility is defined as a failure to conceive within one or more years of regular unprotected coitus.1 Hkm. Waseem Ahmaed Azmi use the term usr-e-hamal for infertility.9 Ancient unani physicians have described four type of uqr. Khalqi(Congenital) Marzi(Diseased) Faali(Functional) Sanwi(Secondary) Asbab Uqr-Banjhpan(Sterility) Causes are related to either male or female or both. Su-e-mizaj of female mani or male mani eg barudat, ratubat,yabusat, and hararat causing inability to conceive. Domination of any one type of temperament which is due to simple imbalance of temperament (sue mizaj sada) or imbalance of temperament due to change in matter (sue Mizaj maddi).10 Defect of uterus due to su-e-mizaj or weakness of its quwat masika wa jaziba(Retentive power and power of ingestion), tumours,cervical incompetency(insedad) after healing of wound. Weakness of genital organ, Weakness of aza-e-raeesa wa shareefa. Psychological problems Hikkat-ul- Farj (Pruritis vulvae) Akhlat ki tezi or other factors are also responsible for vulval itching due to which the patient become restless. 7 There are two types of Hikkat-ul-farj7 Sazaj: Itching without inflammation and boils Warmi: Itching with inflammation and boils Asbab Hikkat-ul- Farj (Pruritis vulvae) Sailan-e-reham(leucorrhea), General Weakness, Local irritation (Sozish), Menstrual problems, Urinary incontinence, Difficult labour, Diabetes, Gonorrhea, Constipation, Worms infestation, Unhygienic conditions. Alamat Hikkat-ul- Farj(Pruritis vulvae)Severe vulval itching which sometime causes local lesion due to scratching, The itching is more at night, Painful urination, the affected part become red and swollen. Uqr khalqi-Congenital: Defects of genital organ eg developmental defects and poor development of uterus and ovaries, vaginal atresia, imperforate hymene, cervical atresia, vaginal tumors. Uqr marzi -Adhesion of vaginal wall after lesions over vagina, diseases of uterus eg displacement of uterus, carcinoma of uterus, uterine ulcers (Qurooh), tumors of uterus, uterine polyp, leucorrhea, hydrometra, diseases of ovaries. Uqr faali-Excessive coitus, old age, temperamental incompatibility of couple, obesity, anemia, general weakness, use of alcohol, afyun or cocaine. Uqr sanwi-Defects after abortion and labour. Alamat Uqr-Banjhpan (Sterility)3 Inability to conceive for years in a young and healthy woman. Usool-e-ilaj Hikkat-ul- Farj(Pruritis vulvae) www.rphsonline.com Research in Pharmacy and Health Sciences | Vol 5 | Issue 3 | Jul-Sep, 2019; 188-192. Usool-Ilaj Uqr-Banjhpan (Sterility) Examine the mani of both the partner separately in water. In this situation give the medicine to male partner only as mentioned in the treatment of kasrat-e- ehtalam, suraat wa zoaf bah. Treat Gonorrhea and Syphilis Give proper treatment for menstrual irregularities, amenorrhea, leucorrhea and metritis etc. The condition remains untreatable if the cause is related to the congenital defects of genital tract. Ilaj Uqr-Banjhpan (Sterility) Ibn-e- sahul has written that if a woman uses humul of methi or rogan –e-hulba immediately after cessation from menses helps in early conception. After clearance from menstruation use of hab-e-hamal 1with majoon-e-mochras 1tola in the morning and hab-emarwareed 2 tab with arq amber 3tola, arq gaozaban 7tola and misri 2tola in the evening helps in conception. After conception constant use of majoon-e-Hamal ambari alvi khani wali 5gm or majoon-e-Nashara aajwali 5gm is good for health of mother and foetus and also protects foetus. Uqr (Sterility) ke Mujarrebat6 Majoon-e-Hamal Ambari Alvi khani-5gm with arq gaozaban in the morning. Hab-e-Hamal-After clearance from menstruation use 1tab daily for 3 days. Majoon-emoayyan-e-hamal-After clearance from menstruation 9gm daily. Farazja (suppository) -Joz buwa,kazmaj,phitkari biryan,post anar each 4masha,powder the medicine and make shiyaf with the help of water and use it in halat -e- tahar(after clearance from menstruation). Humul (Pessary)-Mushk khalis 3 ratti,zaafran 1masha,saalab misri 3masha,powder the medicine add honey, soak cloth in it and insert in vagina. Humul-Make powder of Ruhu fish and mushk(equivalent to 2johar,umber(equivalent to 4 johar,little zaafran,add in boil oil,soak in green cloth and use as humul.12 Polycystic ovarian disease (PCOD) Polycystic ovarian syndrome (PCOS) was originally described in 1935 by stein and leventhal as a syndrome manifested by amenorrhea, hirsutism and obesity with enlarged polycystic ovaries.1 This disorder is characterized by excessive androgen production by the ovaries mainly.  Diagnosis is based upon the presence of any two of the following three criteria.  Oligo and/or anovulation  Hyperandrogenism (clinical or biochemical)  Polycystic ovaries  The incidence varies between 0.5-4% more common amongst infertile women.  Patient may present with features of Diabetes mellitus (insulin resistance) Clinical features of PCOD Increasing obesity, Menstrual abnormalities (70%) in the form of oligomenorrhea, amenorrhea or DUB and infertility, Presence of hirsutism and acne are the important features (70%) and Virilism is rare. www.rphsonline.com Unani concept of PCOD In unani literature Khussiyat-ul-reham par kazib jhilli(ghair tabai jhilli) ka paida hona are the terms used for PCOD. 13 Ancient physicians were also aware of PCOD. Eventhough the exact term for PCOD is not mentioned, but the clinical features of the disease were described by them in their respective books. Razi (865-925 A.D) has discussed a case mentioned in Abizaemia in his book: A multiparous women had prolong period of amenorrhea after the sudden death of her husband, during this period of cessation her body had developed male features, abnormal hair growth occur all over the body, there is development of beard also, deepening of voice similar to that of males.14All these features are clinical features of PCOD, suggesting that ancient physicians are aware of this disease. Hippocrates (460-377 B.C.) described association between fatness and infertility. The girl get amazingly flabby and podgy. The womb is unable to receive the semen and they menstruate infrequently and little. According to Hkm Mohd.Kabiruddin one of the causes of infertility is defects in reproductive organs. He included diseases of ovaries such as formation of abnormal layer on the ovaries (Khussiyat-ul-reham par ghair tabai jhilli ka paida hona), defect in the structure of ovaries as causes of infertility. Ilaj of PCOD Boil the following medicine Bikh-e-kasni,unbus saalab khushk, bikh-e-badiyan,aslus-sus muqashar, gaozaban 5gm each tukhm-e-kasoos basra basta3gm,shahtra 5gm, in half liter water till it remains ¼ . Make a potli of afteemoon 3gm and put it in the above made water. stop heating. filter after one hour and advise to drink with sharbat-e-deenar. Zimad-Balchad,barg-e- suddab,tukh-e- hulba,sandal surkh ,aklilul- malik 6gm each anjeer khushk, make fine powder of it,ushk,muqil 5gm each dissolve in sirka sharab and filter.add the above powderd medicine in it and dissolve melted mom zard and rogn-e-gul in it.use as zimad with aab-e-makoh and sirka khalis at the site of tumour. Ibn-e-sina(980-1037 A.D) in canon stated that cupping over the calves purifies the blood and help to induce menstruation.Venesection of internal sephanous vein induces menstruation.14 Conclusion The Unani System of Medicine which is holistic in nature deals with these issues in a systematic manner as evident from classification of diseases available in ancient Unani literature and the number of plant drugs and its combinations thereby available for the treatment. These herbal medicines have greater significance in the treatment and management of various Gynaecological disorders and can be used safely and effectively. References 1. Dutta DC. Textbook of Gynecology.6th ed, Jaypee brothers medical publishers(p) Ltd, New Delhi, India, 2004: 178,185,227,459. 2. Down CS. Text book of Gynaecology and contraception,10th ed, Down Books, Calcutta, India, 1990:149. Research in Pharmacy and Health Sciences | Vol 5 | Issue 3 | Jul-Sep, 2019; 188-192. 3. Hasan QM. Jam-ul-hikmat (Jild Awwal wa duwam), Idara kitab-us-shifa, New Delhi, India, 2011:p.1114,1115,1117,1119,1122,1130. 4. Ajmal K. Haziq Hindustani Dawakhana, New Delhi, India, 1987:p326. 5. Abubakar mohd bin Zakariya Razi (2001), Kitabul Hawi (9th hissa) 6. Jeelani KG. Makhzanul-Ilaj, Idara kitabul-shifa, New Delhi, India, 2005:p.642,642,647,651,648. 7. Kabiruddin A. Moalejat-e- Sharha Asbab-Tarjuma Kabir Makammal (jild 3,4), Idara Kitabul Shifa, New Delhi, India, 2009:p.126,129,130. 8. Kabiruddin, Bayaz-e- Kabir (Hissa Awwal), Hikmat Book Depo, Hydrabad:p.191. 9. Azmi Waseem Ahamed, Amraz-e- Niswan, Ejaz publication House, New Delhi, India, 1995:p.329. 10. Ismail Jurjani, Zakheera Khuwarzam Shahi, Idara Kitab ul shifa, New Delhi, India, 2010:p.606-607. 11. Arzani mohammed Akbar (ynm), Tib-e-akbar,Faisal Publications, Dewband:p580. 12. Rabban Tabri, Firdousul Hikmat, Faisal Publication, Devband, India, 2002:p.262. 13. Kabiruddin. Tarjuma-e- Kabir,p.144,146. 14. Shah Mazhar H (1998), The General Principles of Avicenna’s Canon of Medicine, 2nd ed, Naveed Clinic, Karachi, Pakistan: p.402,407. Cite article as: Nahida Aqeel N, Qaiser K. Gynaecological Disorders in the light of Unani System of Medicine. Res Pharm Healt Sci. 2019;5(3):186-190. doi: https://doi.org/10.32463/rphs.2019.v05i03.05 www.rphsonline.com Research in Pharmacy and Health Sciences | Vol 5 | Issue 3 | Jul-Sep, 2019; 188-192.