Leucorrhoea

Sayalan-al-Rahim (Leucorrhoea) is an excessive vaginal discharge from the female genital tract and is a frequent gynaecological complaint of women that accounts for more than 1/4th gynaec patients visits to the gynaecologist [1]. 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 . 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 . 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 . Peculiar vaginal discharge is generally associated with body aches and thirst . 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. 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 an increase in conditions when the oestrogen levels become high during 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 .

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 The Unani scholars have described sayalan-al-rahim (Leucorrhoea) and its treatment in various Unani classical literatures like Kamil al Sana‘a, Al Hawi, Firdaus al Hikmat and Tibb-e-Akbar etc. According to them, disease is due to poor quwwat-e-ghadhiya (nutritive faculty) of the rahim (uterus) that causes accumulation of fuzlaat (waste materials) . The health of females is spoiled by the excessive vaginal discharge just as the health of adult male is spoiled by the spermatorrhea . General examination of the patients may reveal ill health. The patient often states the discharge as cause of ill health but in reality the ill health is due to leucorrhoea .

CLASSIFICATION OF SAYALAN-AL-RAHIM (LEUCORRHOEA) 2.1

In general there are two types of Leucorrhoea (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 [1]. 2.2. In Unani system of medicine, classification of disease is according to vaginal discharge and humours . 2.2.1 According to the humoural theory, Sayalan-al-Rahim ( Leucorrhoea) is classified into four types [4], (i) Sayalan-al-Rahim Damwi – It is caused by excess of Khilt-e-Dam and the colour of the discharge is reddish. (ii) Sayalan-al Rahim-Safrawi – It is caused by excess of Khilt-e-Safra and the colour of discharge is yellowish. (iii) Sayalan-al-Rahim Balghmi – It is caused by excess of Khilt-e-Balgham and colour of discharge is whitish. (iv) Sayalan-al-Rahim Sawdavi – It is caused by excess of Khilt-e-Sawda and the colour of the discharge is blackish 2.2.2. The classification according to vaginal discharge is of five types [11], (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.

SYMPTOMS OF SAYALAN-AL-RAHIM (LEUCORRHOEA)

Associated symptoms of the disease are excessive vaginal discharge, pain in the thighs & calf muscles, and burning micturation etc. The vaginal discharge colour may be whitish, reddish, yellowish and blackish. 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 [3, 4]. Others associated symptoms of the disease with excessive vaginal discharge are,

(i) Breathlessness

(ii) anorexia

(iii) Indigestion

(iv) Paleness

(v) Lumbago

(vi) Polyuria

(vii) Pain & heaviness in lower abdomen

(viii) Pain in menstruation

(ix) Headache and Giddiness

(x) Malaise

(xi) General weakness

(xii) Anaemia

(xiii) Constipation

(xiv) Pruritus

(xv) Local soreness

ETIOLOGY

According to Unnai scholar, the fluid is secreted in the uterus because of poor and weak Quwwat Ghadhiya (nutritive faculty). The accumulated fluid is waste materials that go down to the uterus and expel out. The body repel and drive back the fluid to the uterus. Other causative factors of the disease are:

(i) Early/young age pregnancy

(ii) Infections from bacteria, fungi or parasites – protozoa.

(iii) Spread of infection from urinary tract

(iv) Injuries to the vagina, the womb or the cervix

(v) Inflammation of uterus

(vi) Allergy or contact dermatitis

(vii) Sexually transmitted diseases

(viii) Contraceptives used by women

(ix) Pelvic inflammatory disease

(x) Lack of cleanliness or poor hygienic measures especially during menses.

(xi) Gonorrhea

(xii) Syphilis

(xiii) Gout

(xiv) Displacement of uterus

(xv) Diabetes and anemia can provoke infections due to weakened immunity

(xvi) Arthritis

(xvii) Typhoid

(xviii) Mental anxiety or sexual frustration

(xix) Diet low on nutrition

PREVENTIVE MEASURES

(i) Self-medication should be avoided because some women are allergic to certain kinds of medicines and use of such medicine may cause further infections and will complicate the issue.

(ii) Drink plenty of water to flush out the toxins from the body.

(iii) All sugary foods such as sweets, pastries, custards, ice-creams and puddings must be avoided if there is profuse discharge.

(iv) Mushrooms must be avoided in diet as they are fungi themselves.

(v) Hot and spicy foods should be reduced to the least in diet.

(vi) Avoid the intake of Alcohol.

(vii) Fresh curds must become an integral part of the diet because it not only helps in easy digestion of food but also contain lactic acid, which can reduce the discharge.

(viii) Wash the genitals during every bath and do not let moisture retain in the genitals area after the bath. Concept And Managemnet Of Leucorrhoea In Unani Sytem Of Medicine 39

(ix) Clean the innerwear yourself and with a good quality detergent which has bactericidal and fungicidal properties.

(x) Immediately change the clothes including undergarments, if clothes get wet in the rain them.

(xi) Inner bear made of Nylon material should be avoided in summer because as it may retain sweat in the genital area.

(xii) Do not unnecessarily use any cosmetics like powders or perfumes in the genital area.

(xiii) Go on a walk or jog early morning to make the body stress-free and also to increase its resistance to diseases