Introduction

Unani medicine is a treatment modality with a holistic approach towards the patients. Its theory was formulated by Hippocrates and later on modified by Greek, Roman, Egyptian, Babylonian, and Arabic and later on Indian Scholars. The Unani medicine thus became a medical revolution that incorporated in itself all the medical knowledge of that time from all the civilizations. Therefore it bears resemblance to Chinese, Roman, African, Arabic and Indian (Ayurvedic) medicines.

Unani medicine believes that the basic component of the body are atoms, they interact with each other to form molecules these molecules, on further interaction form the four basic fluids (humors) of the body viz phlegm, blood, chole and melanchole. These form the organs and in their appropriate proportion perform the physiology of the body with the help of organs. When this proportion is disturbed it manifests in various pathologies. These pathologies are predisposed by the six essential factors of life i.e. environment; foods and drinks; rest and body functions; emotions and psychological rest; sleep and wakefulness and retention and excretion. When adhered to these factors in their appropriate measures promotes health and when disturbed in their appropriation predispose the body to humoral imbalances.

To aid the body of its ailments Unani medicine proposes a set of four practices starting with diet therapy followed by regimental therapy, drug therapy and surgery.

Unani scholars define stress as a reaction to loss of an opportunity, substance or life; loss of a much desired substance or circumstances wherein; a person cannot avenge or curb an unfavorable situation. However stress is also defined as an interaction between an individual and his environmental that he perceives as straining or exceeding his adaptive capacities and threatening his well being. The element of perception indicates that human stress responses reflect differences in personality and physical strength which is also described as temperament of that individual.

Temperament is designed by the supervening humor of that individual. Which in turn happens to be decided by two factors i.e. genes and the environment and in today’s world any long term medications1-9.

Stress is of three types acute, episodic and chronic. Acute stress is most common and refers to the pressures and demands of recent future. It can be thrilling, tiring or exhausting. Frequent bouts of these acute stress are referred to as episodic stress. It causes over arousal, short temper, irritability, anxiety and tension. Chronic stress is from unrelenting demands and pressures for seemingly interminable periods of time. It can prove fatal through suicide, violence, myocardial infarction, cerebrovascular accidents and perhaps even cancer10. Another type of chronic stress is post traumatic stress disorder wherein, the stressful episode keeps appearing in memory flashback and nightmares.

Causes

A certain degree of stress is a part of daily life and enriches it with aptitude, ambition and inertia. These when extend over a period of time and extend a relentless demand on the coping ability of the individual then manifest the symptoms of stress related disorders10.

Unani physicians consider disadvantageous interaction with the environment burn any one or all the four physiological humors into pathological melanchole. This forms the basis of psychological and psychiatric disorders. Stress is not a disease per se with the Unani physicians but a cause for chronic disorders like Koch’s, mania, fevers, etc1-9.

Pituitary responds to stress by increasing the production of adrenocorticotrophic hormone (ACTH), which acts on adrenals to increase production of stress hormones viz cortical and adrenaline10.

Symptoms

Stress can have both physical and psychological symptoms. Long term stimulation of the adrenals by the pituitary under chronic stress causes physical symptoms like irritable bowel syndrome, myocardial infarction and chronic headaches. Stress related emotional illness results from inadequate and inappropriate responses to major changes in ones life like completing one’s education, becoming a parent, losing a job or retirement. Hence stress related problems can also be toned down as adjustment disorder. High stress levels give a sense of burnout, loss of interest, inability to concentrate, etc.

Damage done to the body due to elevated levels of stress hormone is:

Digestive System: Stomachache or diarrheas are common symptoms of stress. Cortisol delays the release of gastric secretions, stomach emptying and increases peristalsis. It is also responsible for increased appetite and obesity.

Immune System: Cortisol levels are inversely proportional to immunity. The higher the cortical level the lower the immunity. Occasionally it causes an overactive immune system predisposing to autoimmune disorders.

Nervous System: Increased adrenaline causes anxiety, a feeling of helplessness and impending doom. Excessive cortical can cause sleep disorders, loss of appetite, loss of libido and depression.

Cardiovascular System: High cortisol causes tachycardia, hypertension, hyperlipidemia, myocardial infarction and cerebrovascular accidents.

Other Systems: Stress worsens may cause skin conditions such as psoriasis, eczema, urinary, acne. It can trigger an asthmatic attack. Increased cortical levels may cause Cushing’s syndrome whereas; increased adrenaline predisposes to Addison’s disease10.

Management

The management of this malady involves a three fold strategy.

1. Distracting the mind through adaptive changes and distracting methods,

2. Excretion of pathological melanchole, and

3. Strengthening the heart and mind3-9.

Adaptive changes must be introduced to make the patient comfortable and happy. Amongst the adaptive changes are living in clean, well lit house, which has provisions for fresh breezes of air, wearing white or pastel shades, ensuring comfort and entrusting with responsibility3-9.

The mind should be distracted to break the thought series through distracting methods which include:

1. Visiting hill stations, landscapes, parks, etc,

2. Viewing plays, movies, dance and drama,

3. Hearing pleasant music and lyrics as in happy and romantic songs,

4. Being in the company of religious people,

5. Listening to religious sermons,

6. Listening to interesting stories, fairy tales,

7. Reading books,

8. Inculcating hobbies,

9. Participating in mentally challenging games like sudoku, chess, quiz and

10. Participating in competitions like extempore, debates, etc3-9.

There are certain prohibitions too that should be adhered to for instance living in small congested houses, dressing in black dresses, exertion, anxiety, worry, starving, being lonely and insomnia as these induce a sense of mourning3-9.

After the adaptive and distracting methods, comes the second and third line of treatment which involves excretion of the pathological melanchole and strengthening the heart and mind. This is achieved by a combination of regimental therapy (Ilaj bit tabdeer), diet therapy (Ilaj bil ghiza) and drug therapy (Ilaj bid dawa)

Sleep is an important and an integral part of the treatment of such disorders. Oral use of sweet almond oil (roghan badaam shireen), lettuce (kahu) and compound formulations like (Sharbat Khashkhaash) are beneficial in inducing sleep due to their sedative and tranquilizing properties3-9.

Diet therapy ()

Chappaties must be preferred to over rice.

Gourd and cucumber are recommended amongst the vegetables to patients suffering from chronic stress. Both are documented diuretics which aid in the excretion of pathological melanchole. Besides this Lagenaria Siceraria (kaddu) is also beneficial in delirium. Butter milk and curd should be a part of the prescribed diet. Among the fruits, watermelon, pomegranate, sugarcane and grapes are helpful. Citrullus Lanatus (tarbooz) and sugarcane are known for their diuretic properties. Punica Granatum (anar) is a potent antioxidant. Vitis Vinifera (angoor) is effective in degenerative nervous diseases. Clinical trials have proven its efficacy in Alzheimer’s. It is also a reported nootropic diet with known adaptogenic and antioxidant effect

Constipation must be avoided and this can be attained by drinking warm milk sweetened with honey at bedtime or eating figs. Alternately, 2 tsp of drinking sweet almond oil with warm water or milk too is beneficial3-9, 11-13, 16-21.

Regimental therapy ()

The regimens that are prescribed for chronic stress are:

• Veinesection (Fasad): basilic or saphenous veins should be dissected to drain the pathological melanchole circulating with the blood 3-9, 14.

• Sauna (Hammam): cold water or lukewarm water can be used for this purpose27-28.

• Massage (Dalak): Light massage with Viola Odorata (banafsha) oil or almond oil is advisable 27.

• Shower (Natool): diluted rose water, Lactula Sativa (kahu) decoction and Viola Odorata (banafsha) are prescribed due to their exhilarant and sedative property27-28.

• Seitz bath (Abzan): decoction of Lactula Sativa (kahu) and Viola Odorata (banafsha) are advised27-28.

• Cupping (Hijamath): this should be done on the shoulders3-9, 14.

Drug therapy ()

Certain most common drugs that are beneficial in the treatment of chronic stress are:

Figure 1

Conclusion

Modern life is full of stressful situations which has turned the hitherto, normal feature of life into a causative factor for disease. Hippocrates had described constipation to be the mother of all disorders, but in the present scenario stress can be conveniently and without any opposition be attributed to as the mother of all diseases.

The principles of treatment offered by the Unani physicians still form the core of management of this which has been testified by modern medicine for its efficacy and usefulness.