Introduction
>> Menstrual disorders may present diagnositc and management challenges for the gynecologists.
>> Disorders of menstruation are amongst the commonest of all gynaecological complaints. This is often symptomatic, the cause remain undermined. One of the customary classification of menstrual disorder is ‘Oligomenorrhoea’ (Qillat Tams)
>> Now a days Oligomenorrhoea has become the commonest problem of female in age between 18-30 years. In low socio-economic state, it is found commonly young unmarried girl’s nulliparous women. In female who are very sensitive, poor nutrition and have general ill health frequently number of patients refreshing to a Gynaecologist and Endocrinologist with this complaints. The annual frequency of a gynaecological consultation rates for this condition is 50 in 1000 cases.
>> The Unani system of medicine has a wide variety of concepts on menstrual disorders regarding their preventive, curative aspect and different disorders like oligomenorrhoea, dysmenorrhoea, menorrhagia, amenorrhoea. DUB etc. in Unani classical books oligomenorrhoea is described under Ihthibas-e-Tams (Amenorrhoea).
Definition of Oligomenorrhoea
>> Oligomenorrhoea (Qillat Tams) mean there is menstrual bleeding occurs more than 35 days apart and when menstrual blood loss is scanty both in amount and duration which remains constant at that frequency.
>> Oligomenorrhea may develop suddenly, or it may follow a period of gradually lengthening cycles. Although oligomenorrhea may alternate with normal menstrual bleeding, it can progress to secondary amenorrhea.
Aetiology
Unani Concept
>> According to the unani concept, the cause of qillate tams may be in the uterus itself or it may be due to relative affect of other organs.
Uterus
Qillat tams may be caused due to :
>> Formation of sudda secondary to warme rehm.
>> Mailanur rehm
>> Cicatrization of wound healing to obstruction of blood vessels and cervical stenosis.
>> Ritqh
>> Isqhath
>> Blow or trauma
>> According to Unani physicians, this disease is caused by the dominance of balgham and souda (phlegm and black bile) i.e. sard vo khushk leading to increase viscocity of blood, rendering it cabable to ooze out of blood vessels, in Unani system of medicine the treatment methodology is “Ilaj-Bil-Zid”.
>> According to the Unani physician Hippocrates, Rabban Tabri, Avicenna the aetiology of oligomenorrhoea (scanty menstruation or infrequent menstruation) described in amenorrhoea.
>> Hippocrates said that oligomenorrhoea due to derangement of hot or cold or dry i.e. cold temperament is due to accumulation of the cold temperament substances. Viz, phlegm gives the character like dullness, pallor, bluishness of the vessels and polyurea.
Other Organs
>> The systemic diseases for oligomenorrhoea as they said excess of heat and dryness in summer exertion, epistaxis, haemorrhoids or bleeding piles, anaemia and obesity are the main cause and the cause live primarily within the uterus itself was accumulation of fatty substances in the uterine vessels narrowing due to the lipid disorders and uterine tumours.
>> Suddae jigar
>> Istesqha
>> Sue mizaj sada or maddi
>> Kasarathe istefragh
>> Chronic fever
>> Sterneous exercise
>> And also the scant secretion (oligomenorrhoea) from the uterus or the vulvovagina may result in atrophy of the organ and/or general debility.
Modern Concept
Other etiological factors of oligomenorrhoea include :
>> Functional hypothalamic disorders.
>> Neoplasms of the pituitary and ovaries.
>> Endocrine disorders like hyperprolactinaemia, hypo thyroidism & PCOD
>> Genital tuberculosis.
>> Lactating woman and woman on oral contraceptives.
ILAJ
>> If it is due to burudath, ghilzathe khoon and farbahi then maul usool, haar mudirath are beneficial.
>> Ghaleez madda is expelled through qhai, mushily balgham and habb ayarij. Mulatthifath also beneficial.
>> Joshanda of :
Khayar shambar
Mushktramashi
Persiavishaan
Khand siyah kohna is given
>> Make joshanda with :
Shibath
Marzanjosh
Khusth
Habb balsan
Zafran
Darchini
Izkhar
>> Especially in case of obesity tries to reduce the weight and do fasad on saphenous vein on expected date of menstruation. Then give;
Ithrifal-e-zaheer
Ithrifal-e-kamooni
Gulkand badiyan then fumigation on uterus with; shahm-e-hanzal.
>> And also strenuous exercise should be suggested along with mulathiff ghiza, had huqhna, mulattif zimad.
>> If the cause is due to laghari and naqhahath, then rest, nutritious diet, massage with oils, farzajah prepared of:
Maghz and
Charbi are used.
>> If the cause is epistaxis or bleeding from any other route then cupping is applied over the legs, so that the blood flows to lower part of the body along with this mudir haiz (emmenogouge) advia are given.
>> Mudir haiz are the drug which liquefies the blood and removes the sudda there by it clears the passage of menstrual blood. Mudir haiz drugs rectifies the functional defect in the uterus and mizaj of such drugs be haar with latheef action.
>> Emmenogogues means the drugs which liquefies the blood and removes the sudda there by it clears the passage for menstrual blood.
The drugs prescribed as mudire haiz include :
hab mudir
joshanda mudir tams
hab heera kasees
qurs murmecci
pudina nehri with shahed, sabkinaj with shahed, abhal and mushk tramashi, jausheer with shahed.
>> For cold temperament or in the balgham where the viscocity is increase, give coctives and purgatives to reduce the viscocity and excretes the cold humors and later use mudir haiz drugs.
>> For this purpose do fumigation (thakmeeth) with :
Sumbul
Darcheeni
Salikha
Hab-e-balsan
Uddh-e-balsan
Josbowa
Qusth
After blood becomes thin, do fazd on saphenous vein or hajamath on calf muscles. Fazd can do 2 days before the expected date of menstruation. Fazd and hajamath are more beneficial in obese patients.
And also give the drugs which contain the property of mudire-e-haiz, musaffiyath and muqaww-e-Aza-e-Rayeeza are beneficial.