8.2UNEXPLAINED MEDICAL SYMPTOMS :

 

 Most patients with these complaints are managed by excluding physical causes and prescribing symptomatic treatment. Most "unexplained" physical symptoms are transient, and their management is straightforward.

 

 Unfortunately, some patients continue to suffer prolonged symptoms and disability despite negative results of medical investigation and reassurance. These "diagnostic puzzles" are difficult to treat and consume considerable medical resources to little benefit

 

Frequently, the patients turn to expensive and usually unsuccessful alternative medicine. Although most such patients have single symptoms, a conspicuous few have multiple complaints-the demanding "hypochondriacal" patients, who attend many doctors over long periods .

 

Follow up studies have repeatedly shown that if an initial assessment does not suggest a serious underlying physical cause then eventually uncovering one is extremely unlikely .

 

Doctors are rightly concerned not to miss occult physical causes, but over investigation and excessive and inappropriate use of symptomatic treatment are common. Not only is such an approach expensive but it also delays the right treatment and often reinforces patients' anxieties and erroneous beliefs .

 

When physical causes are found for symptoms they are usually trivial-for example, oesophagitis and chest wall syndromes as causes of chest pain. Some symptoms may be due to the autonomic consequences of anxiety or to over awareness of normal bodily sensations .

 

Psychiatric causes may be important in some cases. In general practice one fifth of all attenders present with physical symptoms of minor emotional disorder. Other patient’s may suffer from anxiety, panic disorders, or depression . Less common are "somatoform disorders."

 

 These are defined as physical symptoms without an obvious pathological explanation, or prominent psychological symptoms, that are resistant to medical reassurance. Subcategories include hysteria, hypochondriasis, psychogenic pain, and somatisation disorder .

 

Mixed presentations of anxiety and depression are common in primary care.  The most common presentation of psychiatric problems in primary care is with unexplained medical symptoms.

 

However a large number of such patients also mention the presence of simultaneous psychological distress. The cultural background of the patients may determine the mode of presentations whether it is psychological or somatic .

 

Unexplained medical symptoms accurately describe such cases than the psychiatric term somatisation. It focuses a holistic approach to care. It avoids the disease/distress controversy. Systematic management of persistent unexplained physical symptoms has been neglected.

 

 The numbers of patients and the extent and severity of their disability and of their demands on all forms of medical resources indicate the need for clearer and more effective clinical policies so that we can provide extra help to those who need it .

 

It is quite possible the siddha medicine system was dealing with the host of psycho-somatic disorders. These disorders form the burden ofone third of modern medical practice.

 

 Since the siddhantha deals with the body and mind and the interfaces, it was ideally suited to treat disorders like depression,anxiety, somatisation,  functional bowel disorders, chronic back pain, fibromayalgia, head ache, migraine, atypical chest pain, psychogenic asthma, psycho-cutaneous syndromes, menstrual disorders like amenorrheas, infertility, erectile failure, psycho-endocrine problems, psycho-neuro immunological disorders….etc.