Waram-e- Rahem (Metritis)

Introduction

Waram-e- Rahem (Metritis) is the inflammation of uterus, affecting its different parts. ‘Taleemul Qabla’ is a book on the subject of obstetrics and gynaecology (Ilmul Qabla wa Niswan) written by Abul Razzaq, wherein Waram-e- Rahem has been mentioned as “Metritis”.

Etiopathogenesis of Waram-e- Rahem (Metritis) is based on the predominance of any of the four humours (Akhlaat) mainly sanguine (Dam). It is caused by conditions like amenorrhoea, uterine injury, suppressed post partum haemorrhage, excessive coitus, mishandling during labour and perforation of hymen due to intercourse etc.

It is one of the most common causes of mortality and morbidity in women of reproductive age groups. Unani System of Medicine involves a number of drugs of plant and mineral origin drugs against urogenital infections. Unani drugs are found to be more effective and safe for the treatment of metritis (Waram-e- rahem).

It is characterized by foul smelling vaginal discharge, fever with chills, dysuria, nausea, shooting pain in lower back and pubic region, painful defecation and specific features of causative humour (Akhlaat).

It is the inflammation (Waram) of muscular coat (Tabqai-e- Azliya) of uterus (Rahem). This inflammation (Waram) is limited to the muscular layer (Azlati parat). But sometimes it spreads to the inner membrane of the mucous coat (Tabqai-e- mukhatiya). In a very exceptional case, this waram extends to the serous coat (Tabqai-e- masliya) means its external layer (Bairooni parat) which is a part of the peritoneum (Safaq-ul- batan). In this situation, the condition of the patient appears to be very serious.

Metritis (Waram-e- Rahem) extends to the cervix (Fam-e- Rahem) and resulting in cervicitis (Waram-e- Fam-e- Rahem). Sometimes it causes abscess (dubela) of uterus (Rahem) or hardness of uterus (Salabat-e- rahem) and lastly it turns into the uterine carcinoma (Sartan-e-rahem).

Causes (Asbaab) of Waram-e- Rahem (Metritis)

According to Unani classical literature the predisposing causative factors of this disease are generally amenorrhea (Ehtabas-e- Haiz), excessive coitus (Kasarat-e- Jima’), abscess (Khuraaj), injury and shock (Zarb wa Sadma), abortion (Isqaat-e- Hamal), difficulty in labour (Waza-e- Hamal mein takleef) and inflammation of vagina (Waram-e- Andaam-e- Nehani) etc.

Classification of Waram-e- Rahem (Metritis)

According to Unani classical philosophy, Waram-e- Rahem (Metritis) is classified into two types as follows:

  1. Waram-e- Rahem Haar (Acute Metritis): It includes two subtypes: a) Sanguinous inflammation (Waram-e- Damvi): its cause is dam (blood). b) Billious inflammation (Waram-e- Safrawi). It is having severe complications (Shadeed Awaariz) and discomfort (Sakht Takleef). It is said to be very dangerous condition.
  2. Waram-e- Rahem Baarid (Chronic Metritis): It also includes two subtypes:  a) Phlegmatic inflammation (Waram-e- Balghami) and melancholic inflammation (Waram-e- Saudawi). It is having mild complications (Khafeef Awaariz) and it is said to be less dangerous condition.

Signs and Symptoms of Waram-e- Rahem (Metritis)

The signs and symptoms of Waram-e- Rahem (Metritis) are abnormal swelling with itching and pain at the pelvic site, patient feels urge of urine and stool continuously, micturition and defecation takes place with mild pain. Body temperature of the patient increases beyond normal and feels feverish at all the time with increased severity in third day of bilious inflammation (Waram-e- Safrawi). Patient also feels spasmodic pain, walks with difficulty and cannot sit for the long time.

If pain occur backside of the uterus (Rahem), then pain takes place more towards back and difficulty in defecation. If pain feels front side to the uterus (Rahem), then it refers more towards pelvic site and patient feels difficulty in micturition. Other symptoms are fever, headache, severe dyspepsia, loss of appetite, indigestion, nausea, vomiting, acute fever (Humma hadda) and black tongue with various complications.

Management/ Treatment of Waram-e- Rahem (Metritis)

Unani system of medicine has gained tremendous popularity among the society. Unani medicines have been used as a safe, effective and economical alternative to drugs presently approved for symptomatic treatment of metritis (Waram-e- Rahem). In Unani system of medicine, the treatment of metritis (Waram-e- Rahem) is based on the four principles:

  1. Analgesia (Taskin-e- Alam)
  2. Evacuation of morbid material (Tanqiya-e- Mawaad)
  3. Resolution of inflammation (Tahleel-e- Waram)
  4. Dietary control (Taqleel-e- Ghiza) in initial stage

Pharmacotherapy (Ilaj bil Dawa)

When metritis (Waram-e- Rahem) is treated with Unani drugs (Dawa), it is known as pharmacotherapy (Ilaj bil Dawa). It includes treatment with single drugs (Ilaj bil Mufradaat) and compound formulations (Ilaj bil murakkabat).

In Unani system, many single drugs and compound formulations are available having blood purifier (Musaffi-e- khoon), anti-inflammatory (Mohallil-e- waram), antiseptic (Daf’a-e- ta’ffun), antipyretic (Daf’-e- huma) properties, which are used in the treatment of metritis (Waram-e- Rahem).

Oral administration of decoction of Cassia fistula Linn. (Amaltas) and mixture of Arq-e- Mako, Arq-e- Kasni mixed with Pulp of pod of Cassia fistula Linn. (Maghz-e- Falus Khyar Shambar) and almond oil (Roghan-e Badaam) are found to be very effective in metritis (Waram-e- Rahem).

Oral administration of Joshanda-e Aftimun, when the cause is black bile (Sawda), Joshanda-e Fawakih, in case of acute inflammation (Waram-e- haar) is useful in case of metritis (Waram-e- Rahem).

Many Compound formulations are used such as Majoon-e Dabid-ul- Ward 7gms in quantity is taken orally in the morning, Safoof-e- Lajward, Majoon-e- Najah in 5-10gms quantity in case of Waram-e- Sulb (hard swelling of uterus) and use Qurs-e Kaknaj in 5gm is very effective.

Local application of the paste made up of single drugs, over pelvic region namely, Roghan-e Gul, Khashkhash (Seed of Papaver somniferum, Linn.),

Local use of pessary (Shiyaaf) consists of Shiyaf Abyaz mixed with Afiyoon (Dried latex of Papaver somniferum Linn.), application of paste of the single drugs namely, Babuna (Matricaria chamomilla Linn.), Nakhoona (Pod of Trigonella uncata, Boiss.), Aard-e- Jaw (Flour of Hordeum vulgare Linn.), Hulba (Trigonella foenum-graecum Linn.), Alsi (Linum usitatissimum, Linn.), Anjir (Ficus carica, Linn.) and use of compound formulation namely, Marham Dakhilyun, Marham-e Basliqoon and Marham-e- Ushaq over the pelvic region are very effective.

Regimenal therapy (Ilaj-bit-tadbeer)

Many regimenal therapies are used to treat metritis (Waram-e- rahem) such as bloodletting through basilic vein (Fasd-e- baasliq), bloodletting through saphenous vein (Fasd-e- saafin), emesis (Qai), purgation  (Ishaal), hot fermentation (Takm