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org

Management of Primary Dysmenorrhoea by Dry Cupping: A Review


Salma Mirza1, SA Naaz2 and S.M.Alim3
1
Assistant Professor, JTD, Deoband, District Saharanpur, India.
2
Associate Professor,Deptt. Amraze Niswan wa Atfal, AKTC AMU,Aligarh India.
3
Unani Medical Officer, Bharatpur Govt. Of Rajasthan, India.

Abstract:

Dysmenorrhoea, (Usre Tams Tashannuji) one of the most frequently encountered gynaecologic disorders,
refers to painful menstruation. Dysmenorrhoea is classified as primary or secondary dysmenorrhoea.
Primary dysmenorrhoea is defined as painful menstrual cramps in the absence of any visible pelvic
pathology that could account for it. Dysmenorrhoea is most common in women between the ages of 20
and 24 years, with most of the severe episodes occurring before 25 years of age. Primary dysmenorrhoea
also occurs more frequently in unmarried women than in married women (61% vs. 51%), decreases with
age, and does not appear to be related to the type of occupation or physical condition of the woman.
In classical Unani texts dysmenorrhoea is not defined under the same heading but it is defined under
different topics like Ehtebas-e-tams and Waja-u-zahar. The menstrual bleeding in dysmenorrhoea is small
in amount and comparatively thick in consistency. The pain becomes severe before or during
menstruation.
The cupping method has the function of warming and promoting the flow of energy in the blood thus
dispelling cold, dampness, toxins and winds. It also diminishes swellings and pains.

Key words: Primary dysmenorrhoea, Cupping.

INCIDENCE
INTRODUCTION
More than 50% of postpubescent menstruating
Dysmenorrhoea, one of the most frequently women are affected by dysmenorrhoea, with 10
encountered gynecologic disorders, refers to 12% of them having severe dysmenorrhoea with
painful menstruation. Dysmenorrhoea is incapacitation for 13 days each month.6, 7, 8
Because young women constitute a significant
classified as primary or secondary
percentage of the adult work force in the United
dysmenorrhea.1, 2, 3, 4, 5, 6 Primary dysmenorrhoea States, about 600 million working hours or 2
is defined as painful menstrual cramps in the billion dollars are lost annually because of
absence of any visible pelvic pathology that incapacitating dysmenorrhoea if adequate relief
could account for it. In secondary is not provided. Women who continue to work
dysmenorrhoea, the painful menstruation is or to attend classes have been shown to have
accompanied by visible pelvic pathology that lower work output or scores during their
dysmenorrhea.9, 10
accounts for the pain. Such a classification
allows practical differentiation in the
Dysmenorrhoea is most common in women
management approach, which is based on the
between the ages of 20 and 24 years, with most
causal mechanism.
of the severe episodes occurring before 25 years
Corresponding author: of age.11 Primary dysmenorrhoea also occurs
Salma Mirza ,Assistant Professor, more frequently in unmarried women than in
Jamia Tibbiya Deoband married women (61% vs. 51%), decreases with
Email Id:ashuftanium45@gmail.com
age, and does not appear to be related to the type

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of occupation or physical condition of the months and at the very most within 2 years of
woman. Pregnancy and vaginal delivery do not menarche. Despite such fairly rigid criteria, a
necessarily relieve primary dysmenorrhoea. diagnosis of endometriosis can be extremely
Exercise does not appear to have any significant difficult to exclude because endometriosis-
effect on the incidence of dysmenorrhoea. related dysmenorrhoea has a remarkable
Associated factors that increase the risk duration resemblance to primary dysmenorrhoea.
and severity of dysmenorrhoea include early Typically, the dysmenorrhoea of endometriosis
menarche, long menstrual periods, overweight, in adolescents begins at 2.9 years after
and smoking.12 menarche.14
2. Duration of the cramps. The cramps seldom last
In classical Unani texts dysmenorrhoea is not more than 4872 hours. Usually the pain lasts
defined under the same heading but it is defined only 24 hours or less. The pain also starts a few
under different topics like Ehtebas-e-tams and hours before, or more frequently, only after the
Waja-u-zahar. The menstrual bleeding in onset of the menstrual flow. Dysmenorrhoea,
dysmenorrhoea is small in amount and which starts before the onset of menstrual flow
comparatively thick in consistency. The pain and extends into several days throughout the
becomes severe before or during menstruation.13 flow, is less likely to be primary dysmenorrhoea.
3. Character of the pain. This is described as
Classification of Dysmenorrhoea cramping or labor-like pain.
4. Pelvic examination. No abnormal findings that
a. Spasmodic or primary dysmenorrhoea (Usre could account for the primary dysmenorrhoea
Tams Tashannuji) should be found during the examination
b. Congestive or secondary dysmenorrhoea (including rectovaginal).
((Usre Tams Iltehabi)
Etiopathogenesis of spasmodic
PRIMARY DYSMENORRHOEA (Usre dysmenorrhoea 13
Tams Tashannuji)
Primary dysmenorrhoea refers to the presence of  Psychological: Girls with anxiety has low pain
recurrent crampy lower abdominal pain that
threshold and suffers more primary
occurs during menses in the absence of
demonstrable pelvic diseases. It typically occurs dysmenorrhoea.
in the first few years after menarche and affects  Muscular in coordination: Spasmodic
5% of post pubescent females. Menstrual dysmenorrhoea due to in coordinate muscle
disturbances occur during dysmenorrhoea. Due action of the uterus, which is due to an
to severity of pain, patient needs bed rest every imbalance in the autonomic nervous control of
month. After that patient feels generalized muscles, one in which an overactive sympathetic
weakness. While exploring the Unani literature
in depth it is observed that the condition of system leads to hypertonus of the circular fibers
spasmodic dysmenorrhoea is very much of the isthmus and internal os.
mimicking to balghami khilt or saudavi khilt.  Cervical obstruction: Organic stricture of the
13
Primary dysmenorrhoea should be diagnosed uterus can cause severe pain. The pinpoint os
by its positive clinical features and not through and narrow cervical canal commonly associated
exclusion of other causes of dysmenorrhoea. The with an acutely anteverted uterus or retroverted
hallmarks of primary dysmenorrhoea are:
uterus may cause delay in the passage of
menstrual blood and clots.
1. Initial onset of primary dysmenorrhoea. The
condition should have begun within a few

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 Uterine hypoplasia: The uterus is cochleate or HIJAMAH while in China gua-sha. In Arabic
has a long cervix. In this type of uterus this method of therapy was popularised by our
myometrium contains an excessive amount of Prophet Muhammad(sallallahu alaiyhi
15
fibrous tissue, which disturbs the normal wassallam) as stated in many Hadith.
contraction pattern or uterus becomes triangular
in shape, i.e. body of uterus becomes short Indication and Diseases that respond to
having long cervix, causes difficulty in Cupping:
menstrual flow hence patient feels severe pain. The cupping method has the function of
 Hormonal imbalance: Spasmodic warming and promoting the flow of energy in
dysmenorrhoea is invariably associated with the blood thus dispelling cold, dampness, toxins
ovulatory cycles. Progesterone stimulates and winds. It also diminishes swellings and
myometrial contraction of the smooth muscles pains.
of the cervix and causes narrowing of the
cervical canal. The following problems respond very well to
 Excess prostaglandin (PGF2 alpha and PGE2): Cupping:-
Excess prostaglandins are released from Disease caused by dampness, such as low back
secretory endometrium to cause spasm of uterine pain, lumbago, sciatica, pain in the arms and
muscles during menses. It is confirmed by the shoulders, pain in the legs and muscular parts of
fact that, Prostaglandin triggers the contraction the body, stomachache, vomiting, headache,
of muscles of uterus therefore narrowing of migraine, sprains, insomnia, etc. 15
diameter of small blood vessels of uterus so
temporary shutdown of blood supply to uterus Cupping (hijama) is of three types:
leads to depriving muscles of oxygen resulting
menstrual cramp. Dry cupping (hijama)-
 Excessive humor: Sometimes on eating of This is the process of using a vacuum
ghaleez diet, the excess of phlegm (balgham) on different areas of the body in order to gather
and black bile (sauda) occurs due to which the the blood in that area without incisions (small,
consistency of blood also becomes thick. light scratches using a razor).
Therefore the perfusion of blood became
difficult into small veinules, resulting Dry massage cupping (hijama)
dysmenorrhoea. This is similar to dry cupping (hijama) but olive
oil is applied to the skin (before applying the
Cupping: Cupping is a method of treatment in cups) in order to allow easy movement of the
which a jar is attached to the skin surface to cups.
cause local congestion through the negative
pressure created. An incision lightly made to Wet cupping (hijama)
This is the process of using a vacuum at
allow the congested blood to ooze out. This type
different points on the body but with incisions in
of treatment has been practised by the chinese
order to remove 'harmful' blood which lies just
and the Arabs for thousand of years.Cupping is a
beneath the surface of the skin. (It is
therapeutic process of removing this unclean
recommended that wet cupping (hijama) is only
blood from the body . It is a form of medical
administered by a cupping therapist). 16
treatment which has been recommended by
Shariah.In Malay this practice is known as
BEKAM and in Arabic it is called AL-

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Antiquity blood. 20, 22, 23, 24, 25, 26, 27 As dry cupping
(hijama) - is the process of using a vacuum
It has been documented that on all five on different areas of the body in order to gather
continents methods of cupping were found to be the blood in that area without incisions ( Imala-
in use for healing. 17 In the East Chinese have e-mawaad). 16 Relief in pain is due to imala-e-
been practicing the art of cupping for at least mawaad from uterus.
three thousand years. In the West cupping
therapy has its birth in Egypt. The Ebers Papyrus CONCLUSION:
written around 1550 BC states that bleeding by
It has been concluded that cupping is very
wet cupping removed foreign matter from the
effective for relief of pain in Usre Tams
body.18
Tashannuji. Besides relief of pain cupping is
also very effective in relieving the associated
Egyptian and Greeks have been practicing the art
symptoms related to spasmodic dysmenorrhoea.
of cupping since ancient times. Both Hippocrates
Great thing about cupping is that it is cheaper
and Galen were staunch advocates and user of
and well tolerated by the patients without having
this therapy.18, 19 Prophet Mohammad (PBUH)
any side effects.
sanctioned the use of cupping.15
ACKNOWLEDGEMENT
DISCUSSION:
I am very thankful to my co authors and other
As Uterus is an organ, which consist a staff for support.
preponderance of nerves and other fibers.
20 REFERENCES:
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