Clinical study to evaluate the therapeutic efficacy of Natul(Joshanda of Shibt, Susan, Babuna and Nakhuna) in the management of Izterab-i-Nafsani Umoomi (Generalized Anxiety Disorder).

Anxiety defined as a subjective sense of unease, dread, or foreboding can indicate a primary psychiatric condition or can be a component of, or reaction to a primary medical disease. Anxiety disorders, the most prevalent psychiatric illnesses in the general community, are present in 15-20% of medical clinic patients. Generalized anxiety disorder (GAD) is characterized by persistent, excessive, and/or unrealistic worry associated with muscle tension, impaired concentration, autonomic arousal, feeling "on edge" with restlessness, and insomnia. The lifetime prevalence of GAD is 5-6%; the risk is higher in first-degree relatives of patients with the diagnosis. More than 80% of patients GAD also suffer from major depression, dysthymia, or social phobia. Primary anxiety disorders include Generalized Anxiety Disorder (GAD), Phobic disorders (social or specific), obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). In Unani literature, there is description of Fikr (worry) which is used as synonym of Izterab-I-Nafsani. Literally Izterab-I-Nafsani stands for worry, excessive thinking, fear and hindrance in routine work.The description of anxiety disorders as such, is not found in Unani literature but their symptoms show a considerable overlap with other diseases, such as, like malankhuliya, waswas, maniya, sahr, hizyan, ishq and khafaqan etc. In malankhuliya, the mental functions of an individual are deranged leading to constant grief, fear, and dubious aggression. Modern management includes Cognitive behavioral therapy, deep muscle relaxation and drugs like Benzodiazepines, Selective Serotonin Receptor Uptake Inhibitors, Serotonin and Norepinephrine Reuptake Inhibitors and Beta Blockers, which are useful in short term, but long-term use can lead to dependence. Due to dependance, these drugs have many withdrawal symptoms like irritability, nausea, drowsiness, vomiting, nightmares, headache or paresthesias. On the other hand, Unani management includes use of Muqawwiyat (Tonics), Mufarrihat (Exhilarants) and Munaqqiyat  (Evacuants) along with some effective regiminal  therapies like Dalk (Massage), Natul (Irrigation), Suoot etc which work upon the principle of strengthening the essential organs and evacuation of morbid humor. In the current era of devastating effects on mental health, with the objective of improving the quality of life, a study entitled; clinical study to evaluate the therapeutic efficacy of Natul (joshanda of Shibt, Susan, Babuna and Nakhuna) in the management of Izterabi-I-Nafsani Umoomi (Generalized Anxiety Disorder) has been designed.