A Randomized Comparative Study of Safūf Ḥābis and Ḥijāma bilā Sharṭ Versus Placebo and Ḥijāma bilā Sharṭ in Kathrat-i-Hayd (Heavy Menstrual Bleeding)

In Unani System of Medicine, Heavy Menstrual Bleeding is termed as *Kathrat-i-Tamth/ Kathrat-i-Hayd /Khun-i-Hayd /Ifrāṭ rawangi /Sailan-i-Hayd.*According to the classical Unani literature Heavy menstrual bleeding occurs due to  Sū’i-Miẓaj- i-Rahim Sada or Maddi (deranged temperament of uterus), Weakness in Quwwat Māsika or increase in  Quwwat Dāfi‘a, Imbalance in Akhlāṭ -i- Salāsa,  BawāsÄ«r al- RahÌ£im (uterine polyps), Qurūḥ al-Rahim (uterine ulcer), Nawāṣīr(fissure) and Saraṭān -e-unq al-Rahim wa Rahim (carcinoma of cervix and uterus) etc. which leads to weakening of uterine vessels and causes vasodilation.

The etiology of Heavy menstrual bleeding includes hormonal, mechanical, and clotting abnormalities. Hormonal causes include: anovulation, hypothyroidism, Mechanical causes include, endometriosis, endometritis and carcinoma. Clotting abnormalities include: vitamin K deficiency and circulating inhibitors of coagulation. HMB can be associated with fibroids, endometriosis, adenomyosis, cervical or endometrial malignance, intrauterine devices or pelvic infections.  Sometimes it can be caused by factors in relation to hypothyroidism or bleeding disorders. Women with Heavy bleeding are at higher risk for serious medical consequences. These women are likely to develop iron-deficiency anemia as a result of their blood loss. Excessive blood loss can cause anemia, tiredness, indigestion, decreased appetite, edema and pica.

After reviewing the literature Safūf Ḥābis consisting -Sange Jarahat, Mazu Sabz, Kaat Safaid and Maeen has been selected to conduct a clinical trial. As these ingredients are having the properties of Habis (styptic), Qabiz (astringent), Muhallil Auram (anti Inflammatory) etc.

Apart from oral treatment application of Ḥijāma bilā Sharṭ (Dry Cupping) has been selected to validate and compare the efficacy of Safūf Ḥābis. Ḥijāma bilā Sharṭ is a type of regimental therapy that is used in reducing menstrual blood flow in Kathrat-i-Hayd, which is non-invasive procedure and has no potential for drug. Large cups should be placed below the breast as vessel from the uterus to the breast reach here and get absorbed due to its special connection (Mushārakat).

          Various tools have been used for the assessment of blood loss. A Pictorial Blood -loss Assessment Chart (PBAC) is a practical and objective method that has high sensitivity and specificity when more than 100 score is accepted. For Quality-of-life Menorrhagia Questionnaire (MQ) is used.