Leucorrhoea (Sailanur Raham): A Unani Literature Review

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1 International Journal of Advances in Health Sciences (IJHS) ISSN Vol 3, Issue 3, 2016, pp Review Article Leucorrhoea (Sailanur Raham): A Unani Literature Review Shaziya Kamal 1, Syed Ayesha Fatema 2, Jaleel Ahmed 3 and Sahir Siddiqui 4 1 P.G Scholars,Dept of Ilmul-Qabalat-wa-Amraz-e-Niswan, 2 Associate Prof. Dept. ofmoalijat, 3 Associate Prof. Dept. of Kulliyat, 4 P.G Scholars, Dept of Moalijat, ZVM Unani Medical College, Pune [Received-13/08/2016, Accepted-20/08/2016, Published- 30/08/2016] ABSTRACT: Sailanur Raham (Leucorrhoea) is excessive vaginal discharge. It is a frequent gyenaecological complaint that accounts for more then 1/4 th gynaec.according to classical unani reference books sailanur raham is a discharge of fluid from the vagina.this fluid is produced in uterus due to weakness of absorptive faculty in the uterus also due to the natural evacuation or istifraghe-tabiee, where tabiyat diverts all the wastes of body to the natural manafiz, so these wastes comes in uterus to be evacuated. there is a classification made by the authors for sailanur raham, based on types of wastes upon colour and consistency of fluid it was demonstrated by hukma by asking patients to keep tampon is having blackish red colour, then the waste of sanguinic humour is there, orange red for bilious wastes, milky white of phlegmatic wasted and black colour indicates melancholic wastes. KEY WORDS: SAILANUR RAHAM (LEUCORRHOEA), VAGINAL DISCHARGE, UNANI SYSTEM OF MEDICINE. INTRODUCTION: LeucorrhoeaSAILANUR RAHAM is the most common complaint among sexually active women of childbearing age in primary health care. 1,2 Need of the study is that Physiological leucorrhoea does not required medical intervention. However leucorrhoea with profuse quantity, foul smell, with changes in its colour or with blood seek immediate medical assistance. It is a symptom associated with many illnesses and having varied aetiology. It is difficult to treat because the signs and symptoms are not specific for any single underlying cause 2,3. It accounts for more than an estimated of 1/4 th gynaec patients visit to gynaecologist 4. It is one of the common problems that women s has to face in their lifetime. Sometimes this symptom is so severe that, it over shadows actual disease and women seek the treatment of only this symptom 4-6. It is considered that changes in the vaginal epithelium; changes in the normal bacterial flora and PH of the vaginal secretion predispose to leucorrhoea. But when it turns into pathological condition it produces associated problems like low backache, itching and burning sensation of vulva, poor appetite, discomfort, general weakness, pain in both legs etc. Chronic illness, fatigue, malnutrition, emotional disturbances, unhygienic condition, improper diet, constipation and chronic retroverted uterus are responsible for leucorrhoea. Sometimes it is associated with infection like Trichomonas vaginalis, Candida albicans or mixed bacterial infections, gonococcal, monilial infections, vulvovaginitis,

2 lesions of the vaginal wall and uterine cervix have all been associated leucorrhoea 7-9. It is also difficult condition to treat satisfactorily in view of its multiple etiology. CLINICAL FEATURES: Associated symptoms of the disease are excessive vaginal discharge, pain in the thighs & calf muscles, and burning micturation etc. THE VAGINAL DISCHARGE The normal discharge is actually fluids form of all worn out and dead cells in the vaginal tract along with other toxic materials that are eliminated continuously from the vagina. The abnormal vaginal discharge may be whitish, yellowish, reddish and blackish in colour 10,11. The discharge may be accompanied with foul smelling and itchy sensation or a pain at the infected area. The watery discharge with foul and stained may be symptoms of initial stage of cervical carcinoma. 11 The discharge may range from what is called as excess of normal to one, which is a part of wide spectrum of ailments. It may be blood-stained or contaminated with urine or stool. 12,13 The vaginal discharge with foul smell makes it embarrassing to women to get into social gatherings and even engage in her personal affairs. The abnormal condition of the reproductive organs of women, if not treated in the initial stages then it may become chronic and leads to PID (Pelvic Inflammatory Diseases), which may cause infertility. Women with pale color vaginal discharge are unable to conceive 14. Irregular vaginal discharge is generally associated with body aches and thirst 15. OTHER SYMPTOMS: Leucorrhoea is physiological when associated with various phases of menstrual cycle. But, when it turns into pathological condition, it produces associated problems like low backache, itching, burning sensation of vulva, poor appetite, discomfort, general weakness and pain in legs etc. 12,13,16 Others associated symptoms of the disease with, excessive vaginal discharge are, Breathlessness, anorexia, Indigestion, Paleness, Lumbago, Polyuria, Pain & heaviness in lower abdomen, Pain in menstruation, Headache and Giddiness, Malaise, General weakness, Anaemia, Constipation, Pruritus, Local soreness. 12,15,17,18,19,20,21 ETIOPATHOGENESIS: Chronic illness, fatigue, malnutrition, emotional disturbances, unhygienic condition, improper diet, constipation and chronic retroverted uterus are responsible for leucorrhoea. The most common cause of excessive secretion is physiological excess due to increase in conditions, when the oestrogen levels become high during the puberty, menstruation cycle, pregnancy and sexual excitement; followed by vaginal and cervical causes. The vaginal infections are due to bacteria, virus, fungi and parasites. Other causes include foreign bodies, cervicitis and atrophic vaginitis 12,13,16. Infections of vaginal mucosa by Trichomonas vaginalis and Candida are the most common cause of leucorrhoea.these are treatable as well as preventable causes as both these infections are transmitted sexually. Although, 25 % of both infection are asymptomatic 12,22 ETIOPATHOGENESIS IN UNANI (MAHIYATUL MARZ): According to classical unani reference books, sailanur raham is a discharge of fluid from the vagina. 10,23,24,25, The Unani scholars have described sailanur raham (Leucorrhoea), its mahiyatulmarz, alamat and ilaj in various Unani classical literatures like Kamil al Sana a, Alqanoon, Al Hawi, Firdaus al Hikmat, Alhazique,qarabadeenandqarabadeenjadeed and Tibb-e-Akbar etc. Hakim Mohammad Azam Khan has described the disease in his famous book Akseer Azam. According to them, disease is due to poor quwwat-e-ghadhiya (nutritive faculty) of the rahim (uterus) that causes accumulation of fuzlaat (waste materials). 10 According to humoural theory, sayalan-al-rahim is caused by the excess of humours with discharge colours reddish, yellowish, whitish or blackish depending on the humors. 10,11 This fluid is Shaziya Kamal, et al. 225

3 produced in uterus due to weakness of absorptive faculty in the uterus. Also due to natural evacuation or istifraghe- tabiee, where tabiyat diverts all the wastes of body to the natural manafiz, so these wastes comes in uterus to be evacuated. 10,20,23,24 CLASSIFICATION OF SAYALAN-AL- RAHIM (LEUCORRHOEA): In general there are two types of Leucorrhoea 13 (i) Physiological (ii) Inflammatory Physiological leucorrhoea is common in almost all women and is caused by the natural defence mechanism of the vagina to maintain its chemical balance and preserve the flexibility of the vagina tissue. It has got its name 'physiological' due to the reason that vaginal discharge occurs when estrogens levels are increased. When vaginal discharge is thin, clear, odourless, mucus like and not subsequently increased in the quantity then it is considered normal and therefore need not be worried about. Inflammatory Leucorrhoea occurs when there is vaginal swelling or congestion of mucosa. The affected area very often gives out yellowish discharge with a foul smell, which indicates infection. This type of Leucorrhoea also includes vaginal discharge caused by the sexually transmitted disease (STD) and due to post-partum discharge after delivery 12 In Unani system of medicine, classification of disease is according to vaginal discharge and humours.according to the humoural theory, sailanurraham( Leucorrhoea) is classified into four types 10, 1. sailanurrahambalghmi - It is caused by excess of Khilt-e-Balgham and colour of discharge is whitish. 2. sailanurraham-safrawi - It is caused by excess of Khilt-e-Safra and the colour of discharge is yellowish 3. sailanurrahamsawdavi - It is caused by excess of Khilt-e-Sawda and the colour of the discharge is blackish. 4. sailanurrahamdamwi - It is caused by excess of Khilt-e-Dam and the colour of the discharge is reddish. According to the, in kamilussanaasailanurraham( Leucorrhoea) is classified into two types. There is a classification described in kamilussana, 23,20,vaginal discharge theoryforsailanur raham, based on two tyepes, 1.types of wastes upon colour and 2. consistency of fluid types of wastes upon colour: It was demonstrated by hukama by asking patients to keep tampons inside the vagina, then a day after it was dried and observed for colour. If the tampon is having blackish red color, then the waste of sanguinic humour is there, orange red for bilious wastes, milky white of phlegmatic wastes and black colour indicates melancholic wastes According to the vaginal discharge and consistency of fluiddescribed in kamilussana 23, it is a of two types, a. Most of the time thin and b. Sometimes thick and sticky discharge. The classification according to vaginal discharge by gulamjeelani in maghzanulilaj is is of five types 18 (i) Clitoral discharge- The fluid discharge from the external part of clitoris. (ii) Internal vaginal discharge-the vaginal discharge fluid discharge from the internal part of the vaginal. (iii) Cervical discharge- The discharge comes from the cervix of the uterus. (iv) Uterine discharge- The discharge comes directly from the uterus. (v) Ovarian discharge- The discharge comes from the ovary. 18 DIAGNOSIS OF SAILANUR RAHAM (LEUCORRHOEA): The discharge is subjected to microscopic examination for detection of pus cells to exclude the infective nature of the discharge. If pus cell is not detected then it is case of leucorrhoea but if pus cell is detected then further investigations are carried out to identify the organism in discharge. 12 The investigation should include detailed history regarding age of onset, itching intensity, Shaziya Kamal, et al. 226

4 duration of vaginal discharge etc., general examination like features of malnutrition or anaemia, evidence of fungal infection in fingers & toes and patches elsewhere in the body etc. and local examination of the affected area. 13 DIAGNOSIS OF DOMINANT MORBID HUMOUR (KHILTE GHALIB) : In Unani system of medicine, classification of disease is according to vaginal discharge and humours. There is a classification described in kamilussana, 23,20, for sailanur raham, based on types of wastes upon colour and consistency of fluid. 23 Colour of dried vaginal swab blackish red color orange red milky white black colour Involvement of Dominant morbid humour sanguinic humour Bilious phlegmatic wastes Melancholic Table: table for diagnosis of khilte ghalib 23 It was demonstrated by hukama by asking patients to keep tampons/clothes inside the vagina, then a day after it was dried and observed for colour. If the tampon is having blackish red color, then the waste of sanguinic humour is there, orange red for bilious wastes, milky white of phlegmatic wastes and black colour indicates melancholic wastes. 23 GENERAL PRINCIPLES OF TREATMENT (USOOLE ILAJ): According to Unani reference books basic Usoole ilaj, If the disease appears due to the dominance of any one Khild (humour) then is to evacuate the dominant morbid humour from the body 10,20, 21, 24,. This evacuation could be done with munzijwamushil course 10,20, 21, 24, or fasd 24. Although habisat and qabisatare required to use. 10,20, 21, 24, after that farjazat (suppositories), which are used in treatment of menorrhagia, should be given. The treatment method of leucorrhoea is similar to the line of treatment of menorrhagia. 10,11,18, 21. In the condition of Anaemia, iron compound should be given. 21 If warm-i-rahim (Metritis) is cause of leucorrhoea then the same treatment should be prescribed as the treatment for warm-i-rahim. In the presence of general weakness the Muqqawiyat must be given. 21 If Leucorrhoea is caused by local vaginal infection, then treatment should be given to evacuate the morbid humour from the stomach and liver. 10 In the treatment of the disease, digestion should be maintained and constipation in patients should be removed. 10 Maintain and give strength to all vital organs of body to improve the general health of the patients. 21 If the disease is due to the weakness of quwwat-e-ghazia (neutritive power) them Bahi, Apple and Sharbat of lemon or sandal should be given. Mufarrehatlatif (easily digestible foods ) and beverages increased the quwwateghazia (nutritive power) of uterus. Unnai scholars Abu Bark ZakaryaRazi have also preferred this line of treatment. 20 UNANI FORMULATION USED IN MANAGEMENT 10,20,25,26, 27,28,29,30 Majoon Supari Pak MajoonMoochras MajoonMuqawwi Rahim Majoon Suhag Sonth Sufoof-e-Sailan Qurs-e-Sailan Habb-e-Marwareed Qurs-e-Kusta-Khabs-al-Hadeed KustaQalai KustaBaizaMurgh KustaMusallas (Compound Unani drugs Kustas should be mixed with one Majoon) 31 Sailanur raham can also be cured by putting vaginal pack of a herbomineral powder formulation in vagina. 10 one of the formula is here, the formulation contains aqaqiya, gulnar, mazoo, sak, each 2gm, balchar, phitkaribiryan each 1gm. 10 CONCLUSION: SailanurReham is a universal problem of all women and afflicts upto 75% women s atleast once in their life time. It is very common complaint in clinical practice. Almost 20 % of patient attending gynaecological clinics, complains of vaginal discharge, indicating some form of infection.unani drugs and its compound formulations can be used as good alternative for Shaziya Kamal, et al. 227

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