Hysteria (Ikhtinaq-e- Rahem) is a uterine disease mistaken with epilepsy and syncope specially occurring during adolescence. Mostly it is caused by amenorrhoea (Ihtibaas-e- Haiz) for a longer duration. Important predisposing factor of Hysteria (Ikhtinaq-e- Rahem) is abstinence from sexual intercourse especially in adolescence. It is characterized by lethargy, heaviness and pain below umbilicus, feeling of upwards movement of something from abdomen followed by syncope without frothing from mouth unlike epilepsy.
In other words “Hysteria (Ikhtinaq-e- Rahem)” is an uncontrollable outburst of emotion or fear, often characterized by irrationality, laughter, weeping etc., or it is a psychoneurosis marked by emotional excitability and disturbances of the sensory, psychogenic, vasomotor and visceral functions. In other words it is a behaviour exhibiting overwhelming or unmanageable fear or emotional excess. It is a situation in which many people behave or react in an extreme or uncontrolled way because of fear, anger, etc.
Unani Philosophy of Hysteria (Ikhtinaq-e- Rahem)
Unani medicine scholar “Ibn-e- Sina” described, that hysteria is similar to epilepsy and syncope. Its origin is in the uterus, but it involves the heart and brain. It occurs due to amenorrhea and retention of semen. Mostly it occurs in pre-pubertal girls, multigravida and lactating mothers.
Due to retention of semen, the temperament of women is diverted toward the coldness (Buroodat). Thereafter, due to coldness (buroodat) the viscosity of semen and menstrual blood increased; hence it remains in the uterus. When it remains in the uterus for a long duration, it becomes toxic (Sammi), which lead to tashanuj and pressure in the vessels. Due to retention, the uterus gets diverted to one side. Sometimes toxic vapors reach up to the brain and heart, which results in unconscious and syncope.
Another Unani philosopher “Zakariya Razi” stated, that hysteria occurs due to amenorrhea and retention of semen. In most cases, it occurs due to retention of semen. It occurs in virgin females because their sexual desire is not fulfilled. If froth comes out after an attack, it is a good sign.
According to “Ismail Jurjani” and “Hakim Kabeer-ud- din” hysteria is similar to epilepsy and syncope. Its origin is in the uterus, but it involves the heart and brain. Its causes are sometimes amenorrhea and accumulation of blood or it causes increase in secretions or its retention. It generally happens in unmarried females or in those patients who are habitual coitus. So when menses or secretions are blocked, it gets diverted toward coldness, which is very usual and sometimes its conversion occurs toward the putrefaction and hotness (haraarat). Thus the toxicity is either cold (baarid) or hot (haar), which appears in the uterus and also affects the heart and brain.
There are two forms in which this toxic substance (Sammi Madda) can affect the brain and heart.
Another Unani scholar “Hassan Qarshi” stated, that disease is more common in young, sophisticated females, especially when the nervous system is congenitally deformed, or if they show inherited susceptibility to this disease. Along with this, complaints of amenorrhea, puerperium, leucorrhoea, and displacement of the uterus are common.
According to pioneers of Unani medicine, occasionally this disease also arises as a result of retention and putrefaction of seminal fluid along with severe constipation, impaired digestion, flatulence, anger, stress, anxiety, fears, sorrows, etc., and some psychological factors that are exaggerated. Sudden shocks are the predisposing factors. Prolonged insomnia and excessive fatigue are also the underlying causes.
Hakeem Ajmal Khan noted, that the origin of hysteria (Ikhtinaq-e- Rahem) is in the uterus. He stated that it occurs in rich females of delicate temperament and in females between the ages of 12–40 years living in cities. Amenorrhea (Ihtibaas-e- Haiz) and dysmenorrhea (Usr-e- Tams) can also cause this disease. He further stated that chronic constipation (Qabz-e- Muzmin), flatulence (Nafakh-e- Shikam), distress, sorrow, anxiety, fear and anger can all causes the disease.
Clinical Features/ Signs and Symptoms
It starts with paroxysms of morbid fascination (imagination), darkness before eyes, tinnitus, pain below umbilicus, loss of appetite, difficulty in respiration, palpitation, fatigue, weakness in legs, and change in color occurs. Eyes become watery and when the time comes closer than suffocation, palpitation starts. Uncontrolled movements occur in the mouth, lips, and face; the teeth start making noise; the voice gets choked. Breathing becomes feeble. Patient will feel as if something is going up from her pubis symphysis. She does not talk but understands whatever is said to her, then she becomes unconscious, and there is loss of sensation.
Hysteria (Ikhtinaq-e- Rahem) commonly initiate from seizures. These seizures vary according to their severity. Most commonly, the patient feels mild pain on the left side of the pelvis, after which the sense of an air ball arising from stomach and obstructing pharynx is felt, which compels the patient to make an attempt for its elimination for which she has recurrent deglutition. This causes asphyxia, resulting into syncope.
Although the patient succeeds in recovering, she suffers from unbearable headache, fatigue, flatulence, nuchal rigidity, palpitation, impaired digestion, etc. Depressive moods and urinary incontinence are also common.
Sometimes a spasmodic condition of lymph is also reported and the patient tries to move her body forward or backward or even tends to fold herself. Stiffness is also accompanied with this condition.
If the condition is severe, the patient has shrill cries or she laughs madly and once the sensation of the air ball reaching the pharynx is felt, she soon falls on the ground. The patient beats her chest and bends her head backward along with extending the neck upward.
In some cases, the patient is as stiff as a tie, even stiffening of one limb is also seen. The patient beats her upper limbs here and there, blinks the eyes; there is ballooning of nostrils and compression of lower jaw without any ugly character of the face. The patient takes long and deep breaths upon rubbing her neck frequently.
The duration of seizures ranges from minutes to a few hours or two to three days. The reoccurrence of the seizures depend upon the intensity and severity of the disease. Once the seizures subside, the patient starts having breathlessness along with tremors on being touched and become anxious. The patient sleeps after vomiting. Many times, a few patients show fake symptoms in between the seizures, the senses are dumped.
The patient complains of incomplete symptoms such as an inability to walk, although she is capable to stand without any support and walk. Moreover, there is no urinary or stool passage involuntarily.
Mostly she complains of hemiplegic, although the condition is rare, there is no facial or lingual paralysis, only she walks crawling. In such individuals, the left aspect of the body is paralyzed. The subject is hypersensitive, complains of nausea and hoarseness of voice, flatulence, palpitations, hiccups, spasmodic cough are common.
Respiration gets ceased; pulse becomes weak. Teeth start making noise. Uncontrolled movement overtakes half of the body.
The disease occurs with fits. Fits can occur for few minutes, a few hours and in some cases, it occurs for two to four days and mostly occurs during menstrual periods. First, the patient feels pain in the hip, watering of eyes, headache, patient become weak and lazy, and darkness occurs in front of the eyes. After sometime a ball (gola) arises from the stomach of patient toward the throat and obstructs it, to which patient tries to swallow and asphyxia occurs. Rigidity occurs in the throat, belching, frequency of micturation increases, the heart beat increases, and the patient starts shouting and cries or starts laughing loudly and becomes faint and fall on the ground. The spasm occurs in her limbs, respiration increases and limbs become cold. Sometimes the patient pulls her hairs and sometimes tears her cloths. She hates the people around her and tries to bite them. She strikes her hand on the wall and takes her fingers toward the throat again and again, which indicates a sign of obstruction. When the disease starts to disappear, the patient gasps and shivers and starts and sometimes lies calmly. At last she smiles, and the fit ends and urination occurs in more quantity.
Principles of Management/ Treatment
Regimental Therapy (Ilaj Bil Tadbeer)
Pharmacotherapy (Ilaj Bil Dawa)
Anethum sowa, Kurz. (Shibt), Matricaria chamomilla, Linn. (Babuna), pod of Trigonella uncata, Linn. (Iklil)
Adiantum capillus-veneris, Linn. (Parshiyaoshan), Mentha pulegium, Linn. (Miskataraamashi), Foeniculum vulgare, Gaertn. (Baadiyan), Ruta graveolens, Linn. (Tukhm-e- Sudab) each 10.5 gm., sugar 35 gm.
Compound drugs (Advia Murakkaba)
Prevention/ Precaution (Tahaffuz)