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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.

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

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 Adv J Pharm Life sci Res, 2016 4;1:1-5
of occupation or physical condition of the
woman. Pregnancy and vaginal delivery do not
necessarily relieve primary dysmenorrhoea.
Exercise does not appear to have any significant
effect on the incidence of dysmenorrhoea.
Associated factors that increase the risk duration
and severity of dysmenorrhoea include early
menarche, long menstrual periods, overweight,
and smoking.12
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.13
Classification of Dysmenorrhoea
a. Spasmodic or primary dysmenorrhoea (Usre
Tams Tashannuji)
b. Congestive or secondary dysmenorrhoea
((Usre Tams Iltehabi)
PRIMARY DYSMENORRHOEA (Usre
Tams Tashannuji)
Primary dysmenorrhoea refers to the presence of
recurrent crampy lower abdominal pain that
occurs during menses in the absence of
demonstrable pelvic diseases. It typically occurs
in the first few years after menarche and affects
5% of post pubescent females. Menstrual
disturbances occur during dysmenorrhoea. Due
to severity of pain, patient needs bed rest every
month. After that patient feels generalized
weakness. While exploring the Unani literature
in depth it is observed that the condition of
spasmodic dysmenorrhoea is very much
mimicking to balghami khilt or saudavi khilt.
13
Primary dysmenorrhoea should be diagnosed
by its positive clinical features and not through
exclusion of other causes of dysmenorrhoea. The
hallmarks of primary dysmenorrhoea are:
1. Initial onset of primary dysmenorrhoea. The
condition should have begun within a few
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months and at the very most within 2 years of
menarche. Despite such fairly rigid criteria, a
diagnosis of endometriosis can be extremely
difficult to exclude because endometriosis-
related dysmenorrhoea has a remarkable
resemblance to primary dysmenorrhoea.
Typically, the dysmenorrhoea of endometriosis
in adolescents begins at 2.9 years after
menarche.14
2. Duration of the cramps. The cramps seldom last
more than 4872 hours. Usually the pain lasts
only 24 hours or less. The pain also starts a few
hours before, or more frequently, only after the
onset of the menstrual flow. Dysmenorrhoea,
which starts before the onset of menstrual flow
and extends into several days throughout the
flow, is less likely to be primary dysmenorrhoea.
3. Character of the pain. This is described as
cramping or labor-like pain.
4. Pelvic examination. No abnormal findings that
could account for the primary dysmenorrhoea
should be found during the examination
(including rectovaginal).
Etiopathogenesis of spasmodic
dysmenorrhoea 13

Psychological: Girls with anxiety has low pain
threshold and suffers more primary
dysmenorrhoea.

Muscular in coordination: Spasmodic
dysmenorrhoea due to in coordinate muscle
action of the uterus, which is due to an
imbalance in the autonomic nervous control of
muscles, one in which an overactive sympathetic
system leads to hypertonus of the circular fibers
of the isthmus and internal os.

Cervical obstruction: Organic stricture of the
uterus can cause severe pain. The pinpoint os
and narrow cervical canal commonly associated
with an acutely anteverted uterus or retroverted
uterus may cause delay in the passage of
menstrual blood and clots.
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Uterine hypoplasia: The uterus is cochleate or
has a long cervix. In this type of uterus
myometrium contains an excessive amount of
fibrous tissue, which disturbs the normal
contraction pattern or uterus becomes triangular
in shape, i.e. body of uterus becomes short
having long cervix, causes difficulty in
menstrual flow hence patient feels severe pain.

Hormonal imbalance: Spasmodic
dysmenorrhoea is invariably associated with
ovulatory cycles. Progesterone stimulates
myometrial contraction of the smooth muscles
of the cervix and causes narrowing of the
cervical canal.

Excess prostaglandin (PGF2 alpha and PGE2):
Excess prostaglandins are released from
secretory endometrium to cause spasm of uterine
muscles during menses. It is confirmed by the
fact that, Prostaglandin triggers the contraction
of muscles of uterus therefore narrowing of
diameter of small blood vessels of uterus so
temporary shutdown of blood supply to uterus
leads to depriving muscles of oxygen resulting
menstrual cramp.

Excessive humor: Sometimes on eating of
ghaleez diet, the excess of phlegm (balgham)
and black bile (sauda) occurs due to which the
consistency of blood also becomes thick.
Therefore the perfusion of blood became
difficult into small veinules, resulting
dysmenorrhoea.
Cupping: Cupping is a method of treatment in
which a jar is attached to the skin surface to
cause local congestion through the negative
pressure created. An incision lightly made to
allow the congested blood to ooze out. This type
of treatment has been practised by the chinese
and the Arabs for thousand of years.Cupping is a
therapeutic process of removing this unclean
blood from the body . It is a form of medical
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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HIJAMAH while in China gua-sha. In Arabic
this method of therapy was popularised by our
Prophet Muhammad(sallallahu alaiyhi
15
wassallam) as stated in many Hadith.
Indication and Diseases that respond to
Cupping:
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.
The following problems respond very well to
Cupping:-
Disease caused by dampness, such as low back
pain, lumbago, sciatica, pain in the arms and
shoulders, pain in the legs and muscular parts of
the body, stomachache, vomiting, headache,
migraine, sprains, insomnia, etc. 15
Cupping (hijama) is of three types:
Dry cupping (hijama)-
This is the process of using a vacuum
on different areas of the body in order to gather
the blood in that area without incisions (small,
light scratches using a razor).
Dry massage cupping (hijama)
This is similar to dry cupping (hijama) but olive
oil is applied to the skin (before applying the
cups) in order to allow easy movement of the
cups.
Wet cupping (hijama)
This is the process of using a vacuum at
different points on the body but with incisions in
order to remove 'harmful' blood which lies just
beneath the surface of the skin. (It is
recommended that wet cupping (hijama) is only
administered by a cupping therapist). 16
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Antiquity
It has been documented that on all five
continents methods of cupping were found to be
in use for healing. 17 In the East Chinese have
been practicing the art of cupping for at least
three thousand years. In the West cupping
therapy has its birth in Egypt. The Ebers Papyrus
written around 1550 BC states that bleeding by
wet cupping removed foreign matter from the
body.18
Egyptian and Greeks have been practicing the art
of cupping since ancient times. Both Hippocrates
and Galen were staunch advocates and user of
this therapy.18, 19 Prophet Mohammad (PBUH)
sanctioned the use of cupping.15
DISCUSSION:
As Uterus is an organ, which consist a
preponderance of nerves and other fibers.
20
Uterus has been grouped among the azae
ratbah, which contains more fluid in comparison
to other organs and azae harrah, in which the
rate of metabolic activity is very high.21Uterus
has also been endowed with quwate ghazia
(nutritive faculty) and remarkably the quwate
tanasuliya (reproductive faculty) 20 With the
help of these powers, uterus serves two
functions i.e. elimination of waste products in
the form of menstrual blood and development,
protection and delivery of fetus. 22
When Sue mizaj afflicts the uterus to throw the
quwate ghazia (nutritive faculty) of the uterus
out of the aitdal. Quwate masika (retentive
faculty) becomes strong which leads to retention
of nutriments for more than sufficient time. This
accumulated uterine waste turn into infected
material (mawaad). This infected material may
be deviated from normality in terms of colour,
consistency and odour. The resultant toxic
material is irritative and produces spasmodic
pain when eliminated in the form of menstrual
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blood. 20, 22, 23, 24, 25, 26, 27 As dry cupping
(hijama) - is the process of using a vacuum
on different areas of the body in order to gather
the blood in that area without incisions ( Imala-
e-mawaad). 16 Relief in pain is due to imala-e-
mawaad from uterus.
CONCLUSION:
It has been concluded that cupping is very
effective for relief of pain in Usre Tams
Tashannuji. Besides relief of pain cupping is
also very effective in relieving the associated
symptoms related to spasmodic dysmenorrhoea.
Great thing about cupping is that it is cheaper
and well tolerated by the patients without having
any side effects.
ACKNOWLEDGEMENT
I am very thankful to my co authors and other
staff for support.
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