Melancholia (Malankholia) is a mental condition and especially a manic-depressive condition which is characterized by extreme bodily complaints, depression and often hallucinations and delusions. Psychiatric illnesses were widely recognized in the ancient world. Melancholia and Hysteria were identified in Egypt and Sumaria as early as 2600 BC.
As per Galen (Jalinus) quoted by Zakaria Razi in his world renowned treatise “Kitab Al-Havi.” It is defined as a disorder in which the mental functions are deranged and the affected person is more prone towards constant grief, fear and dubious aggression. His ability to analyze and interpret things is grossly affected.
Melancholia comes from Greek word “melaina chole” [also ‘lugubriousness’ originated from the Latin ‘lugere’ (to mourn) and moroseness from the Latin ‘morosus’ (fastidious habit, self-willed), wistfulness from the old English ‘wist:’ (intent)].
According to Hippocrates (Buqrat) (a renowned scholar of Unani Tibb) and other Unani scholars it is caused by an excess of black bile. The term melancholia literally means “black humour” which is the predominant causative factor. Mental ill-health is one of the most disturbing and disabling disorders of life which affects not only the concerned person but also his family with social stigma attached to it.
In Global scenario the prevalence of psychiatric illness is almost same. Which is approximately about 8 to 10 per 1000 population. The problem is rising day by day due to some factors like industrialization, urbanization and increase in lifespan, along with breakup of the joint family system etc.
Melancholia (Malankholia): Unani Philosophy
Unani system of medicine which is an age old traditional system has described it in various classical texts not only the concept but also its management with various modes of treatment. These philosophies and management if pursued will mitigate the suffering humanity to a great extent.
In Unani system of medicine the psychiatric nosology is also a part of medical classification under the title of “Amraze Nafsani” (psychiatric disorders) where all the diseases are classified as syndromes rather than an individual disease entity. These diseases are categorized based on the theories and philosophies of primarily of Hippocrates followed by Plato and later Arabs. Buqraat (Hippocrates: 460 to 370 BC) is usually regarded as the one who introduced the concept of psychiatric illness into medicine. His writings described acute mental disturbances with fever (delirium), acute mental disturbances without fever (probably analogous to functional psychoses but called mania), chronic disturbance without fever (called melancholia), hysteria (broader than its later use), and Scythian disease (similar to transvestism).
According to the philosophy of Unani medicine, proper maintenance of health, management of disease and its manifestations are innate process. Hence proper and normal functioning of the bodily process must be ensured to maintain sound health all physical, mental, social and spiritual type.
The doctrine of Unani system of medicine is based on four bodily fluids i.e. humoral theory viz; Dam (Blood), Safra (Yellow Bile), Balgham (Phlegm) and Sauda (Black Bile). Any disturbance in the normal humoral balance in the human body either its qualitative or quantitative derangement, it leads to disease.
The human body is constituted of seven natural factors (Umoor-e- Tabai’ya), among which four are materialistic (Maddi) viz; Arkan (elements), Akhlaat (humours), Aaza (organs) and Arwah (pneuma) and three are non-materialistic (Ghair maddi) viz; Mizaj (temperament), Quwa (faculties) and Afaal (function).
Derangement or absence of any one of the component results in the development of disease or death of an individual respectively.
Much emphasis is given to the prevention of disease rather than its cure in Unani medicine. It stipulates six essential factors (Asbab-e- Sitta Zarooriya) which advocates on the maintenance of proper balance / equilibrium of these factors. These are:
After going through the above mentioned principles, it is clear that the concept of mental health has been in vogue in Unani system of medicine since begining. Failure to maintain balance in Harakat- wa-Sukoon Nafsani results in disability of Qoowat-e- Nafsaniya (mental faculty) includes thinking which comprehend melancholia (malankholia).
It is fact that disturbance in sleep and excessive wakefulness also leads to psychological disorders. Likewise accumulation of morbid materials (mawaad-e- faasida) which is supposed to be habitually evacuated from the body through some means i.e. menstruation, epistaxis, hemorrhoids, paroxysmal melancholic emesis etc. their retention in the body may pave way to melancholia (malankholia).
Etiology of the Disease (Asbab-e- Marz)
Hippocrate (Buqraat) stated that when there is heat (Haraarat) and dryness (Yaboosat) of stomach (fawad) and coldness (Buroodat) of brain, then such persons are more prone for melancholic diseases (Saudawi amraaz). Sometimes temperament pneuma (Mizaj-e- Arwah) is deranged due to various factors, and this may also give rise to melancholia (Malankholia).
According to Ibn-e- sina (980-1037 AD), only the pathology lies in the brain of an individual (Dimaagh) whereas the real source of disease is either the stomach, uterus or accessory organ of brain in which warm-e- haar (hot swelling) exists.
Ibn-e- sina also stated that sometimes vapours (bukharaat) reach the brain and vitiates the fluids (rutoobaat) by combustion (Ihtaraaq), due to which there is excess of heat (hararat) and dryness (yaboosat), ultimately resulting in melancholia (malankholia).
The other cause for melancholia (Malankholia) is Maadi amraz particularly at the culmination of acute ones. Affected persons from this grave type usually remember death and dead ones. In less severe type of melancholia (Malankholia) the affected person are exhilarant.
However melancholia (Malankholia) is caused mainly due to black bile (Saudavi madda) or mirra sauda. In either case there is preponderance of black bile (Saudavi khilt) particularly associated with combustion (ihteraaq), at that time it is termed as malankholia saudawi.
When it is caused due to ehteraq of dam or safra or Balgham then it is expressed as malankholia damvi, safravi and balghami respectively.
Sometimes the most likely causative factor is extreme gham (grief), khouf (fear), involvement of fikr (thought) and excessive bedaari (wakefulness).
Accumulation of mawaad (morbid materials) which is supposed to be habitually evacuated from the body viz; menstruation, hemorrhoids, epistaxis, paroxysmal melancholic emesis etc’s retention also leads to malankholia.
According to Ibn-e- Hubl Baghdadi, the causative factor of this disease is the dominance of natural and unnatural black bile (Tabayi wa Ghair Tabayi Sauda) in the human body and the admixture of them with blood and mental/psychic sprit (Roohe nafsani) which results in dimness (Kadoorat), gloominess (Taariki), coldness (Baroodat) and dryness (Yaboosat) which is against the temperament of vital pneuma (rooh), due to which affected person acts insanely with thinking disability.
Black bile (Sauda) is synthesized in the liver (jigar) and stored in the spleen and reaches the brain through the blood vessels. When it is putrefied it causes obstruction and impedes mental/psychic sprit (Roohe nafsani) which disturbs the cognitive functions. It can also retain in the peritoneum (miraq) and mesentery (masaareeqa) and reaches the brain through obnoxious vapours (bukharaat-e- radiyah). Alogwith when peritoneum is also involved it is termed as Malikholiya miraqi.
In the similar manner, when there is combustion of black bile (ihteraaq-e- sauda) and blood becomes thick, grave type of melancholia (malankholia) is afflicted. Many times, the cause for melancholia (malankholia) is Sue-e- Mizaaj Baarid Yaabis of stomach (fuwad), due to which when vitiated mental/psychic sprit (Rooh-e- Nafsaani) reaches the brain, it disturbs the mental functions. Sometimes the brain and meninges deranged saudawi mizaj itself will be the causative factor for melancholia (Malankholia).
Balghami rutubat rarely causes malankholia, if it undergoes putrefaction, may turn into black bile (Sauda).
Clinical Features (Alamaat)
In the early stage of the disease, patient remains sad without any external stimulus, his thinking is perverted, deserted and he finds himself occupied by loneliness and experiences delusion and hallucinations. Patient mutters with himself, and most of the time remains silent. He feels giddy and tinnitus, sexual and food satiety is unusually increased. The nature of fear varies from patient to patient even few patients get afraid of death, some with animals, while some find themselves obsessed by the falling of sky.
Based on the involvement of humours such as blood (Dam) the patient is fond of laughter, sportive and thinks exhilarantly, if it is yellow bile (safra) patient is mentally hard working and are very hyperactive, in case of phlegm (Balgham) patient is gloomy and lethargic. The features of black bile (Saudavi) variety are severe, grave and violent.
Usool-E-Ilaj (Principles of Treatment): Unani scholars also treated several bodily and mental ailments since ancient times by holistic approach through various modules of treatment viz; Ilaj-bil- Tadbeer (Regimenal therapy), Ilaj bil Ghiza (Dieto-therapy), Ilaj-bil- Dawa (Pharmacotherapy) and Ilaj-bil- Yad (Surgery).
Melancholia is usually caused due to combustion of any of the four humours which ultimately converts to black variety (Saudavi), hence the affected humour i.e predominance of black bile (sauda) from the whole body has to be eliminated. Because it depends upon the body humour affected.
Mujarrab Majoon (Effective Formulation)
Post-e- Halela siyah (bark of Terminelia chebula), Post-e- Halela kabuli (bark of Terminelia chebula), each 17.5g, Zarawand mudharaj (Aristolochia rotunda), Zarawand Taweel (Aristolochia longa), Zaranbad (Curcuma zedoria), Waj Turki (Acorus calamus) each 14g, Kalonji (Nigella sativa), Hurmul (Peganum harmala) each 7g, Dar-e- Sheeshan (Myrica nagi), Juntiana Roomi (Gentiana lutea) each 5.25g, Bisfayij Fustaqi ((Polypodium vulgare) each 10.5g, Aftimoon (Cuscuta reflexa), Afsanteen (Artemisia absinthium) each 24.5 g, Irsa (Iris ensata) 17.5g, Buzr-ul- banj safed (Hyoscyamus albus) 4.66g, Kundush (Schoenocaulon officinale) 7 g, Ustukhudoos (Lavandula stoechas), Foowah (Rubia cordifolia), Tukhm-e- karafs (Apium graveolans), Anisoon (Pimpinella anisum), Badiyaan (Foeniculum vulgare), Gharikhoon safed (Agaricus alba) 10.5g, Turbud safed mujawwaf (Operculina turpenthum) 14g, Qaranfal (Caryophyllus aromaticum), Taj (Cinnamomum cassia) 10.5g, Sibr Saqootari (Aloe barbedensis) 35g, Mastagi Roomi (Pistacia lentiscus) 10.5g, Kharbaq mudabbar (Helleborus niger) 17.5g, Gao zabaan (Borago officinalis), Barg-e- badaranjaboya (Mellisa officinalis), Barg-e- faranjmushk (Ocimum gratisimum) 14g, Zafraan (Crocus sativus) 5.25g-
This semi solid preparation (Majoon) is to be prepared with above mentioned ingredients and given in a dose of 15.75g every 10th day.
During this medication Roghan-e- banafsha (Oil of Viola odorata) be massaged over the body and instilled in nostrils and also apply over scalp.
Hijamat Naariya (fire cupping) over head and light exercises are also recommended in this case.
Itreefal sagheer, Aftimoon, Iyaerij feeqra, Majoon najah, and Majoon mufarreh are also found to be very effective.
Habbe Iyaarij, Joshanda aftimoon, Iyaarij Jalinoos, Habb-e- aftimoon, Turanjabeen and Jawarish Jalinoos is also recommended.
If melancholia is caused due to intense heat
In this condition temperament of brain (Mizaaj-e- dimaagh) may be restored/ normalised by inducing moistness. Head of the affected person to be soaked in moist oils and cold and moist diet maybe advised. Similarly boiled water (In which some Unani/ herbal drugs may be boiled) may be poured over scalp. These drugs consist of Nelumbo nucifera (Neelofer), Viola odorata Linn. (Banafsha), Papaver somniferum Linn. (Post-e- Khashkhaash), Rind of Cucurbita maxima (Kaddu ka chhilka) and Belladona atropa (Beekh-e- yabrooj).
If melancholia is caused due to involvement of peritoneum, stomach or spleen
Psychological Measures (Nafsiyaati Tadaabeer): The measures are very beneficial if applied to the patient of melancholia (Malamkholia)
To sum up the management approach, the following do’s and dont’s are summarized below for easy understanding and healthy approach: