Izteraab-e- Nafsaani (Anxiety)

Izteraab-e- Nafsaani (Anxiety)

Introduction

Mental disorders are increasing day by day throughout the globe, India being no exception. People from all communities irrespective of economic background and their culture suffer from mental disorders. Izteraab-e- Nafsaani (Anxiety) affects quite a sizeable population and has been pointed to be the most common health ailment now a days.

Izteraab-e- Nafsaani (Anxiety) is a feeling that is necessary in order for human beings to live, whether they like or dislike it. The meaning of the word anxiety is “to vex or trouble”; in either of the absence or presence of psychological stress. It can create feeling of fear, worry, uneasiness and dread. It can be defined as a specific emotion necessary for an individual to prepare himself for potential danger about threatening situations. Many researchers found that anxiety is still unclear and not easy to define in simple sentences.

According to Spielberger, anxiety is defined as subjective feeling of nervousness, tension, apprehension and worry associated with an arousal of the autonomic nervous system”.

Effects of Izteraab-e- Nafsaani (Anxiety)

There are two types of effects of anxiety i.e. positive and negative type.

Positive type of anxiety effects include alerting human beings of danger, motivating them to action, and physically preparing the body to fight or escape.
The negative effects of anxiety include palpitation, irritability, poor concentration, memory loss and insomnia. The people who are anxious are more vulnerable to other sort of emotional disturbances.

Unani Concept of Izteraab-e- Nafsaani (Anxiety)

Unani system of medicine is very rich system in view of concepts and literature. The term Izterab is used for anxiety in Arabic and Unani Texts and the word Nafsani is added to Izterab to specify its psychological state. Literally Izterab-e-Nafsani stands for worry, excessive thinking and fear. It is also used in the sense of hindrance in routine work. (Ali, 1916 and Baalabaki, 2001). In the literature of Unani system of Medicine, there is no description of Izterab-e-Nafsani but there is description of Fikr (worry) which is used as synonym of anxiety. According to Unani System of Medicine, Fikr is a psychological reaction in which the Ruh-e-Haiwaniyah moves from outside to inside slowly resulting in coldness outside which can be felt easily.

In Unani medicine, psychiatric disorders are dealt in detail under the heading of “amraze nafsaniya”. Anxiety (Izterab-e- Nafsani) is a psychological and physiological state characterized by somatic, cognitive, emotional and behavioural components. These components combine to create the feelings that typically recognize as apprehension or worry. It is considered to be a normal reaction. From the point of view of Unani Medicine, anxiety comes under the Infialat-e-Nafsaniyah (Psychic Reactions). Terminologically Infialat-e-Nafsaniyah are the movements of ruh (pneuma) and blood with the help of Quwwat-e-Haiwaniyah (vital faculty). (Kabiruddin, 1954) Therefore, it is one of the indicators of mizaj (temperament) and guide us in the assessment of temperament for instances the individuals having phlegmatic temperament are consideredas mentally dull who show slower rate of Infialat-eNafsaniyah in comparison to bilious individuals.

According to Unani System of Medicine, anxiety is controlled by Quwwat-e-Mutafakkirah (faculty of thinking) which belongs to Quwa-e-Mudrika Batinah (internal perceptive faculties) of Quwwat-e-Nafsaniyah (psychic faculty) (Ahmad, 1980; Ali, 1916; Ibn Sina, 1998; Kabeeruddin, 2001 and Kabeeruddin, 1930). On the basis of physiological functions, Unani physicians have divided the brain into three functional areas i.e. Muqaddam Dimagh (fore brain), AusatDimagh (mid brain) and Moakhkhar Dimagh (hind brain). Eacharea is associated with particular Quwa (faculties). Quwwat-eMutafakkirah is found in Ausat Dimagh (Ahmad, 1980; Grunner, 1930; Ibn Rushd, 1984; Jurjāni, 1896; Kabeeruddin, 2001; Khan, 2003 and Majoosi, 2010). A famous Arabic philosopher and physician Ibn-e-Rushd supports the division of brain in his famous book Kitab-ul-Kulliyat as: “If a disease occurs in whole brain all three faculties with their functions becomes defective. If disease limits to a specific area of brain, the defect will occur in that particular faculty only e.g. minor pathology in the mid brain may cause defect in Quwwat-e-Mutafakkirah which results in severe complications such as exaggerated thinking and mental disturbances which make the brain unable to have a proper and specific decision” (Ibn Rushd, 1984).

Management of Abnormal Anxiety

Everyone occasionally experiences some anxiety. It is a normal response to a stressful event or perceived threat. Anxiety can range from feeling uneasy and worried to severe panic. The management of anxiety is required when it becomes a problem. There are various methods in modern as well as in Unani System of medicine. Some of them are as follows:

General Measures: Some general measures to avoid as well as to treat anxiety are:

Removal of predisposing factors
Maintenance of adequate sleeping atmosphere
The room should be airy, open and fragrant
Avoidance of heavy and strenuous work
Correction of liver and spleen disorders
Avoid smoking and alcohol consumption etc.
Abstinence from excess sexual intercourse
Avoid visiting dark, overcrowded and dirty places.
Avoid prolong stay in hot climate.
Proper care of heart should also be taken into consideration and cardio tonic and Mufarrah-e- Qalb (exhilarant) drugs should be used.
A source of recreation should be provided like poetry, music etc. for keeping patient happy.

Tibb-e- Unani (Unani Medicine) deals the patient on holistic parameters jointly together for preventive and curative aspects.

In preventive aspect different high protein seeds are used to provide stimulus as brain tonic and strengthen the nervine activity for example almond, pistachio, kaju, kaddu and kahu seeds etc). In addition different forms of oils obtained from herbal medicaments are also used as massage which helps in relaxing of muscle spasm and other physical state to overcome anxiety malaise

For example Roghan Labub-e- Sab’a, Roghan-e- Kahu, White Gourd Seeds etc.).

Furthermore Murrabajaat and Muffarrehat (exhilarants) also provide the basic ingredients that are helpful as adjunct therapy for nervous tension and other similar symptoms.

Curative therapy deals to correct or otherwise physiologically, pharmacologically, or biomedically wipe out or alter or reverse the symptoms for normal human behavior.

Tibb-e- Unani (Unani Medicine) places importance on the nutritional foods. The usage of nutritional pattern also plays an important function to overcome abnormal behaviour and temperament of an individual. This therapy can be effective alternative or adjunct to herbal drug therapy.

Dietary Therapy

Unani scholars prescribe diet to the patients of anxiety (Izteraab-e- Nafsaani) on the basis of humoral theory, so that the correction of the Su-e- Mizaj (Abnormal temperament) will be done. Following are the few principles generally suggested by renowned Unani scholars are:

Yellow bile and Black bile producing items (Moallid-e- Sauda wa Safra) must be avoided like stale, salty and astringent food.
Light and delicious food items are recommended.
Emollient diet (Murattib Aghziya) such as barley water, cucumber, pumpkin, milk, green leafy vegetables like spinach, lettuce, purslane etc. are suggested.
It is advised to use bilious concoctive fruits such as orange, lemon, dampson and other citrus fruits.
It is highly recommended that the diet of an individual especially anxious person include about 20 to 30 grams of fibre a day. Most of us probably take only 10 to 11 grams a day - only half as much as we need. Inadequate intake of fibre in diet contributes to constipation.

Pharmacotherapy

Unani physicians have used many single and compound drugs for the treatment of anxiety (Izteraab-e- Nafsaani), which is mentioned in their classical texts. The purpose of the drugs used in Unani system of Medicine is correction of Su-e- Mizaj (Abnormal Temperament) as they were of the opinion that anxiety (Izterab-e- Nafsani) is due to Su-e- Mizaj Har Sada and Su-e- Mizaj Maddi i.e Su-e- Mizaj Safrawi and Su-e- Mizaj Saudawi.

In Su-e- Mizaj Har Sada, there is excess hararat (heat) in the body specially in the brain. And to reduce the Hararat-e- Dimagh, the treatment through drugs having Musakkin-e- Hararat (febrifuge) effect are used such as:

Aalu bukhara Prunus domestica Linn.
Bekh-e- kasni Cichorium intybus Linn.
Behidana Cydonia oblonga
Khurfa Portulaca oleracea Linn.
Tabasheer Bambusa arundinacea (Retz.) Roxb. Syn.: B. bambos Voss
Kahu Lactuca sativa Linn.
Ustukhudoos Lavendula stoechos
Baad aavard Fagonia arabica
Bed Mushk Salix caprea Linn.
Aftimoon Cuscuta reflexa Roxb.
Gao zaban Onosma bracteatum
Kishneez Coriandrum sativum Linn.
Halela Siyah Terminalia chebula Retz.
Sana Makki Cassia senna Linn. var. senna Syn.: C. Angustifolia Vahl
Unnab Zizyphus sativa Gaertn.
Zarishk Berberis aristata DC. Syn.: B. chitria Lindl.

In Su-e- Mizaj Maddi (Safrawi and Saudawi) restoration and normalization of humours is done by tanqiya (removal of excessive humour) and Ta’deel-e- Mizaj (restoration of normal temperament) with their respective drugs

Compound Unani formulations

Some of the polyherbal compound drugs (Murakkab advia) used by Unani physicians for anxiety are: