Usr-e-Tams (Dysmenorrhoea)

Usr-e-Tams (Dysmenorrhoea)

Introduction

Usr-e- Tams (Dysmenorrhoea) is defined from the Greek word “Dys”, which means difficult/ painful/ abnormal, “meno” means month and “rrhoea” means flow (as a whole abnormal menstrual flow). It is a condition of painful menstruation along with specific features of its causative factors. In other words, it is a medical condition characterized by severe uterine pain during menstruation. While many females experience minor pain during menstruation in some cases.

Renowned Unani scholar “Hakim Ajmal Khan” stated, that patient feels heaviness in pelvic area and pain in thighs, hips and back side. He also feels backache and heaviness in lower abdomen. Pain appears before menstruation. Sometimes nausea and vomiting is also seen. He also mentioned that patient may become unconscious or faint due to severity of pain is some cases. Restlessness is very common in dysmenorrhoea patients.

Types of Dysmenorrhoea (Usr-e- Tams)

According to some Unani scholars it is of four types

Usr-e- Tams Nazlawi ya Warami (Dysmenorrhoea due to Phlegmatic swelling): This type of dysmenorrhea occurs due to phlegmatic swelling in uterus or cervix or due to pooling of blood. This condition is usually seen after the delivery when the uterus does not return back to its anatomical position. Mostly obese women experience this type of UsreTams.
Usr-e- Tams Tashannuji (Spasmodic Dysmenorrhoea): This type of dysmenorrhea occurs due to uterine spasm. Often it is called as neurological dysmenorrhea which usually appears in unmarried girls. The patient complains severe pain usually before two days of starting of menstruation. The pain radiates towards the suprapubic region, thigh and inguinal region.
Usr-e- Tams Suddi (Obstructive Dysmenorrhoea): This condition occurs due to small size of uterus or obstruction of cervical opening. Cervical obstruction occurs due warme fame rehm and rasooli.
Usr-e- Tams Ibtedayee (Primary Dysmenorrhoea): When the adolescent girls experience the menstruation for the first time, the blood flow in the uterus, ovaries and internal genital organ increase and causes congestion. Due to congestion the girl experience pain in lower abdomen, backache and pain in thighs etc.

While according to some Unani scholars it is only of two types

Spasmodic or primary dysmenorrhoea (Usr-e- Tams Tashannuji)
Congestive or secondary dysmenorrhoea (Usr-e- Tams Iltehaabi)

a. Spasmodic or primary dysmenorrhoea (Usr-e- Tams Tashannuji):

Spasmodic or Primary dysmenorrhoea (Usr-e- Tams Tashannuji ya Usr-e- Tams Ibtedaayi) refers to the presence of crampy, recurrent, lower abdominal pain that occurs during menses in the absence of any demonstrable pelvic diseases. It typically occurs in the first few years after menarche and affects 5% of post pubescent females.

While exploring the Unani literature in detail it is observed that the condition of Spasmodic or Primary dysmenorrhoea (Usr-e- Tams Tashannuji ya Usr-e- Tams Ibtedaayi) is very much mimicking to balghami khilt or saudavi khilt.

Etiopathogenesis of spasmodic dysmenorrhoea

Psychological: Girls with anxiety has low pain threshold and suffers more primary dysmenorrhoea.
Cervical obstruction
Hormonal imbalance
Muscular in coordination
Excessive humour
Excess prostaglandin (PGF2 alpha and PGE2)

b. Congestive or secondary dysmenorrhoea (Usr-e- Tams Iltehaabi): It is defined as menstrual pain resulting from anatomic and or macroscopic pelvic pathology, such as that seen in women with endometriosis or chronic PID. This condition is most often observed in women aged between 30-45 years of age.The condition of Congestive or secondary dysmenorrhoea (Usr-e- Tams Iltehaabi) is very much mimicking to khilt-e- damvi.

Etiopathogenesis of congestive dysmenorrhoea

Cervical stenosis or occlusion
Intrauterine contraceptive device (IUCD’s)
Pelvic congestion syndrome (PCS)
Allen- masters syndrome
Uterine polyps
Pelvic Inflammatory Disease
Ovarian cysts or tumours
Endometriosis Fibroid tumour
Intrauterine adhesion

Factors that acts as precursor for Usr-e-Tams (Dysmenorrhoea)

Body mass index 30 kg/m2
Depression, especially if associated with an eating disorder
Anxiety or stress
Menarche at a young age
Menorrhagia
Nulliparity
Family history, especially in a first-degree relative
Adolescence
Disrupted social networks
Metrorrhagia
Smoking

Unani Philosophy: In Unani system of medicine dysmenorrhea is known as Usr-e- Tams, which means painful menstruation.

Hippocrates (Buqraat) mentioned, that the dysmenorrhea (Usr-e- Tams) occurs due to stagnation of menstrual blood secondary to cervical obstruction and causes painful menstrual period.
According to Shaikh-ur- Rayis bu Ali Sina, dysmenorrhea (Usr-e- Tams) occurs because of snag in the menstrual blood flow. He also mentioned that if the menstrual blood is mo’tadil (balanced) in quality and quantity, the cycle is regular. If the menstruation is irregular and abnormal, it may cause many diseases like amenorrhea and oligomenorrhoea.
According to Hakim Ismaeel Jurjani, Backache is also present in dysmenorrhea (Usr-e- Tams). Along with the pain of uterus, pain occurs in the abdomen and head. After a long time, the pain gets lodged in the hips.
According to Hakeem Ajmal khan, in dysmenorrhea (Usr-e- Tams), stoppage of menses occurs either from the beginning or ceases after sometimes of normal menstruation. It comes in decreased amount than normal amount. Sometimes it occurs in a small amount with gap associated with pain.
Hassan Qarshi mentioned, dysmenorrhea (Usr-e- Tams) is characterized by difficulty and pain at the time of menstruation, which is often exaggerated. Patient feels uneasiness. Sometimes initially pain is at the peak and reduces with the passage of days on the contrary, sometimes pain is minute in the beginning, but gets intensified as the days progresses.
Akber Arzani mentioned, that in dysmenorrhea (Usr-e- Tams), backache occur before and during the menstruation.

Causes of dysmenorrhea (Usr-e- Tams) in Unani system of medicine

Weakness of uterus (Zo’f-e- Reham)
Displacement of uterus
Carcinoma of uterus (Sartaan-e- Reham)
Metritis (Waram-e- Reham)
Fat accumulation in uterus (Reham)
External Os closure
Qilaat-e- Tams (Hypomenorrhea)
Internal reproductive organ’s surgical operations
Any muscular disease of uterus for example uterine atrophy
Ihtebaas-e- tams (Amenorrhea)
Exposure to cold or cold bath orxcessive use of cold products
Wearing wet clothes for long duration
Anaemic condition
Increased viscosity of blood
Severe haemorrhage
Excessive Intercourse
Excessive use of phlegm concentrated things

Unani treatment

It is very well known fact that there are limitations and toxicities of the conventional treatment in such cases. Hence, Unani medicine can play an important role as it is efficacious, safe, cost effective and it is based on evidence of their prolong successful usage on human beings.

Usool-e- Ilaaj (Principles of treatment)

Haemopoiesis (Tawleed-e- dam) in cases of decreased amount of blood in body (kami-e- khoon/ qillat-e- dam)
Evacuation of viscous humours from the body (Tanqiya-e- akhlaat-e- ghaleeza)
Dilution of humours (Talteef-e-khilt)
Deobstruction of vascular openings (Tafteeh-e- afwaah-e- urooq)
Emaciation (Tahzeel) in cases of obesity
Surgical intervention if the case is of imperforated hymen

Unani physician also advice

Always remove the cause of the disease
Always maintain hygienic condition

Preventive measures

Light exercise (Halki riyaazat)
Morning walk (Subh ki chahal qadmi)

Curative measures

Application of heat: Application of heat to the lower abdomen region appears to very effective as oral analgesics for relief of dysmenorrhoea (Usr-e- tams)
Dietotherapy (Ilaaj-bil- ghiza)

According to Unani scholars like Zakaria Razi and Ismail Jurjani, the patient should take water of soaked gram, baha ka shorba, safed baj, baize-e- murgh neem biryan ki zardi, maullaham, murgh ka shorba, anar sheeren, milk, gazar dashti

Fibrous rich diet, complex carbohydrates and calcium help to ease abdominal cramps.
Fruits and salads are advised in dysmenorrhoea (Usr-e- tams) patients.
Magnesium (which is available in sufficient quantity in whole grains, nuts and green vegetables) helps to reduce water retention. Similarly meat and fish also contain good amount of magnesium. They are specially advised to take salmon and other fishes containing Omega-3- fatty acids in such conditions.

3. Dysmenorrhoea patients are highly advised for the use of calcium carbonate and Vitamin B complex rich diet at regular basis.|
4. Dysmenorrhoea patients are also advised to use vegetable oils like sunflower, and safflower oils, olive oils, whole grains, nuts and green leafy vegetables.
5. They are advised to drink 6-8 glasses of water and good quantity of milk every day
6. Similarly health restoring foods are also recommended like nuts, whole grain and seeds especially in sprouted form to be taken.

Ilaaj-bil- Ghiza (Dietotherapy)

Dietary restrictions: Dietary control (Taqleel-e- ghiza) is advised in case of obesity

Dietary recommendations: Haemopoetic diet (Aghziya muallid-e- dam) is recommended in case of (Decreased quantity of blood in the body) Qillat-e- dam.

Ilaaj-bil- dawa (Pharmacotherapy)

Oral administration of the decoction of Apium graveolens (Karafs Linn.) and Zizyphora tenuior Linn. (Mushktaramasheea) along with honey.
For the treatment of generalized weakness of the patient Unani physicians recommend Kushta faulad along with Dawaul misk motadil jawaher wali, Khamira Abresham Hakeem Arshad wala, Maul Laham, Sharbat Anar are indicated.
Analgesic and antispasmodic drugs (Musakkin-e- alam wa Dafe Tashannuj advia) are advised in case of spasmodic dysmenorrhea (Tashannuji usr-e- Tams) like- Juniperus communis (Abhal), Cuscuta reflexa (Aftimun hindi), Rauwolfia serpentina (Asrol), Papaver somniferum (Afiyun), Allium sativum (Lehsun).
Oral administration of decoction of Ferula assafoetida Linn. (Hilteet) 3.5 grams along with Ma-ul- Asl (Honey water) is found to be beneficial also.
Anti-inflammatory and Antiseptic drugs (Mohallil-e- waram wa Daafa-e- Taáffun advia) are advised in case of congestive dysmenorrhea like Matricaria chamomilla (Baboona), Artemesia vulgaris (baranjasif), Cichorium intybus (Barg-e- kasni), Solanum nigrum (Barg-e- mako), Andropogon jawarancusa (izkhar), Thymus vulgaris (Hasha), Ferula foetida (Hilteet), Cinnemomum zeylanicum (Daarchini), Cinnamomum camphora (Kaafoor)
Emmenogogue and diuretic drugs (Mudirr-e- tams wa Mudirr-e- Haiz advia) are also advised in dysmenorrhea like, Sheera-e- khurfa (Portulaca oleracea Linn.) along with Sharbat-e- Bazoori (A compound preparation), Roghan-e- badaam talkh (Prunus amygdalus), Tukhm-e- Gandana (Allium ascalonicum Linn.), Tukhme Shalgham (Brassica rapa Linn.), Daarchini (Cinnamomum zeylanicum), Sazaj Hindi (Cinnamomum tamala Nees and Eberm), Turmus (Lupinus albus).
Oral administration of decoction of Mentha piperita Linn. (Fudanaj) along with Ma-ul- Asl (Honey water)
Concoctive and purgative drugs (Munzijat wa Mushilat) like Cassia fistula (Maghz-e- amaltas) and Cordia dichotoma (Sapistan).
Drugs which are concoctive and purgative of phlegm (Munzij wa mushily-e- Balgham advia) like Althoea officinalis (Khatami), Adhatoda vesica (Arusa), Adiantum capillus (Parsiyaushaan), Cordia latifolia (Sapistaan), Ficus carica (Injeer), Glycerrhiza glabra (Aslessoos) and Borage officinalis (Gaozubaan).
Munzij wa Mushil-e- Sauda advia (Concoctive and purgatives of black bile) like Lavendula steochus (Ustukhuddus), Cuscuta epithymum Linn. (Aftimoon wilayati), Borage officinalis Linn. (Gaozubaan), Zizphus sativa (Unnab), Fumeria officinalis (Shahatra), Mellisa officinalis (Badranjboya), Cordia latifolia (Sapistan), Foeniculum vulgare (Baadiyan), Croton tiglium Linn. (Maghz-e- Jamal gota), Citrullus colocynthis Schrad. (Shahm-e- Hanzal), Terminalia chebula (Halela Siyah), Ipomea turpthum (Turbud) and Agaricus alba Linn. (Ghariqoon).
Resolvent drugs (Muhallilat waram advia) are also very useful like Cichorium intybus Linn. (kasni), Matricaria chamomilla (Baboona) Artemesia vulgaris (baranjasif) and Oliganum vulgare Linn. (Marzanjosh)

Regimenal therapies (Ilaj bil Tadabeer):

Venesection: Fasd-e- safin (Bloodletting through saphenous vein) before menstruation
Leeching: (application of leeches) is also advised in dysmenorrhea
Moistness producing bath (Hammam-e- murattib) is very useful
Hijaama (Cupping on calf) is also advisable.
Abzan (Sitz bath): With decoction of several drugs individually like, Artemesia vulgaris (Baranjaasif), Matricaria chamomilla (Baboonah), Commiphora myrrh (Mur makki), Cinnamomum cassia (Saleekha), Oliganum vulgare Linn. (Marzanjosh), Mentha arvensis (Pudina), Andropogon jawarancusa (Izkhar), Saussurea lappa (Qust) and Trigonella uncata (Iklil-ul- malik)
Abzan (Sitz bath) with the decoction of following drugs: Anethum sowa Kurz. (Shibt), Oliganum vulgare Linn. (Marzanjosh), Mentha piperita Linn. (Fudanaj), Ruta graveolens Linn. (Suddab), Mtricaria chamomilia Linn. (Baboonah) and pods of Trigonella uncata Linn. (Iklil-ul- malik)
Bukhoor (Fumigation) with Citrullus colocynthis Schard (Hanzal)
Humool (Pessary) made up of Aristolochia rotunda (Zaravand mudahraj), Swertia cheraita (Chiraita), Mentha arvensis Linn. (Podina), Artemisia absinthium (Afsanteen) along with honey.
Firzaja (Pessary) made up of following ingredients

Juice of fresh Ruta graveolens Linn. (Aab-e- suddab) and juice of fresh Mentha piperita Linn. (Aab-e- Pudina)

Zimad (Paste): Zimad-e-Izkhar (Andropogon jawarancusa).

Some Unani drugs, which are effective in spasmodic dysmenorrhoea

Balcharea Nardostachys jatamansi
Saunf Foeniculum vulgare
Lehsun Allium sativum
Qust Saussurea lappa
Hilteet Ferula asafoetida
Izkhar Andropogon jawarancusa
Asrol Rauwolfia serpentine
Siyah mirch Piper nigrum

Some Unani drugs, which are effective in congestive dysmenorrhoea

Baboonah Matricaria chamomilla
Kasus Cuscuta reflexa
Podina Mentha arvensis
Dalchini Cinnamomum zeylanicum
Tarmas Lupinus albus
Hasha Thymus serphyllum
Abhal Juniprus communis

Compound formulations used in Unani medicine

Habb-e- Mudirr
Sharbat-e- Faulaad
Safoof-e- Mudirr-e- Haiz
Dawa-e- Mudirr-e- Haiz
Dawa-e- Usr-e- Tams
Roghan-e- Babunah
Safoof-e- Muhazzil
Tiryaq-e- Farooq
Dawa-e- Mudirr
Sharbat-e- Afsanteen
If the cause is sailan-ur- reham (leucorrhoea) then Majoon Supari pak, Kushta Marwareed, Kushta Sadaf and Majoon Moosli pak is indicated.