Melancholy

Melancholy is the deviation of opinions and thoughts from the natural path towards disorder, fear and corruption due to the black-billed nature, which oppresses the pneuma of the brain with its darkness and disturbs it, just as external darkness oppresses and frightens; Moreover, a cold and dry nature is unpleasant to the pneuma and weakens it, while a hot and moist nature, such as the nature of wine, is pleasant to it and strengthens it. When melancholy is combined with irritation, attacking people and malice, it is called mania, and melancholy in the proper sense only refers to a disease arising from unburned black bile. The cause of melancholy lies either in the brain itself or outside the brain. If the cause lies in the brain itself, then melancholy comes either from a cold and dry disorder of nature without matter, plunging the substance of the brain and the light nature of pneuma into darkness, or from a disorder of nature with matter. In the presence of matter, black bile matter resides either in the vessels of the brain, where it passes from another place, or turns into black bile in the vessels themselves due to combustion or clouding of their contents; this happens in most cases. Matter is either absorbed into the substance of the brain, or harms the brain with its quality and substance, pouring into the ventricles of the brain. Such melancholy often occurs after epilepsy.

If the cause of melancholy is outside the brain and acts with the complicity of some other thing from which dark juice or steam rises, then such a thing may turn out to be the whole body when the black bile nature takes over in it, or the spleen if black bile is locked up there and the spleen cannot clear itself of it or is unable, due to its weakness, to extract black bile from the blood. Or a tumor appears in the spleen, and sometimes the tumor does not appear, but other damage occurs. Melancholy may also begin due to severe heat of the liver. Such a complicit thing can be the walls of the abdomen, when excess food and vapors from the intestines collect in them and their juices burn and turn into a type of black bile, which either forms or does not form a tumor. In this case, darkening vapors rise from it into the head, and this is called heaving of the soft membranes, and such melancholy is called swelling melancholy, or melancholy depending on the walls of the abdomen. Such melancholy most often arises from a tumor at the gates of the liver, due to which the blood burns out in the walls of the abdomen; This is what Galen considers to be the cause of melancholy, which depends on the walls of the abdomen. And Diokil sees the reason for this in the intense heat of the liver and intestines, while other doctors consider the cause of such melancholy to be a blockage that occurs in the vessels known as masaryk, in the presence of a tumor. Some, however, believe that it is caused by a blockage that occurs in the Masaryk vessels, even if there is no tumor. Doctors who believe that the cause of such melancholy is blockage in the Masaryk vessels are based on the fact that food in such patients does not pass into the vessels and is spoiled, and people who claim that it arises from a tumor proceed from the fact that food in most cases lasts a long time remains in the stomach of such patients in its raw form, as it is. Such a tumor is not hot, because there is no fever, thirst or vomiting of bile.

Sometimes the cause that gives rise to melancholy is outside the brain, but the place where it begins is in the brain. So, for example, when a hot tumor forms in the stomach, its steam burns the brain fluids; the same thing happens with a tumor in the uterus or in other organs associated with the head. The cause of melancholy, which comes from cold and dryness without matter, is a black-billed disorder of the nature of the heart with or without matter. In this case, the brain participates with the heart, for the mental pneuma is connected with the animal pneuma and is identical to it in substance, so that the bad black-billed nature of the heart upsets the nature of the brain, and it becomes black-billed. Sometimes melancholy arises as a result of other cooling and drying causes that do not come from the heart alone. However, the occurrence of such melancholy is impossible without the complicity of the heart; on the contrary, its main cause probably comes from the heart. Therefore, with this disease, along with treating the brain, the heart should also be treated.

Know that if the blood of the heart is shiny, liquid, transparent and invigorating, then it resists damage to the brain and corrects it. It is not surprising that most often the place of origin of such melancholy is the heart, although such ailments take root in the brain, for it is quite likely that the nature of the heart is upset first, and the brain follows the heart. Or the nature of the brain is upset first, and the heart follows; then the pneuma nature in the heart is upset and hidden, and that part of it that penetrates the brain is damaged; The brain itself contributes to this damage. Sometimes at the end of diseases originating from matter, especially acute ones, melancholy occurs, and this is a sign of imminent death. Then death and the dead often come to mind.

So, generally speaking, black bile multiplies and is generated either as a result of a disease of the organ that acts on food, that is, a disease of the liver, if it burns the blood, or cannot expel excess black bile - this happens less often, or as a result of a disease of the organ from which black bile flows bile, that is, the spleen, if it cannot carry out two actions: firstly, to draw sediment and ash from the blood from the liver and, secondly, to drive away the excess of what rushes to it from the liver to the place of their expulsion.

Sometimes black bile originates in some other organ, either due to increased combustion of nutrients entering it, or due to the inability to expel excesses formed by food; in this case, the rarefied part of the excess is absorbed and the dense part is precipitated in the form of black bile; The reason for this may also be strong cooling and drying of what enters this organ. Sometimes the source of black bile can also be food that generates black bile. Some doctors believe that melancholy arises from evil spirits, but the student of medicine does not inquire whether it arises from spirits or not; Moreover, we affirm that even if it arises due to spirits, it still occurs as a result of the transformation of nature into black bile, so that the immediate cause is black bile, and then let the source of this bile be Spirits or not spirits! Strong causes that give rise to melancholy include excessive sadness or fear.

You should know that the black bile that causes melancholy is either natural black bile or mucus when it turns into black bile due to thickening or slight combustion; This happens, however, rarely, from time to time. Or it turns out to be blood if it turns into black bile, boiling or thickening without significant combustion. As for yellow gall juice, when completely burned, it gives rise to mania and is not limited to melancholy. So, if each of these types of black bile gets into the mentioned place in the brain, it gives rise to melancholy, but some types along with melancholia give rise to mania. Melancholy is most prosperous when it arises from a sediment of blood and is accompanied by fun. Melancholy is often relieved by kidney pain and dilatation of the veins. This disease rarely occurs in fair-bodied and overweight people, but it occurs often in dark-skinned, hairy and lean people. It often occurs in people with a very hot heart and a moist brain. The warmth of the heart generates black bile in it, and the moisture of the brain perceives the action of what originates in the heart.

Persons prone to this disease include those who are tongue-tied, people who are sharp, who speak quickly, who blink frequently, who are red-faced or dark-skinned, who are hairy, especially with a hairy chest and coarse black hair, as well as people with wide blood vessels and thick lips: after all, some of these qualities are a sign of hotness of heart, and some indicate moisture in the brain. In appearance they often resemble people with a slimy nature. This disease occurs more often in men, and is more severe in women. It often occurs in middle-aged people and the elderly; it occurs rarely in winter, but becomes more frequent in summer and autumn. It is often also aroused in the spring, for spring raises the juices, mixing them with the blood. Sometimes melancholy intensifies periodically when the black bile is excited and rises. A person prone to melancholy quickly falls into it if he experiences fear or grief, or suffers from insomnia, or the usual bleeding from kidney cones or other places is delayed, or the flow of black bile and other juices is delayed.

Signs of melancholy and its varieties. Signs of the onset of melancholy are bad thoughts, unreasonable fear, rapid anger, love of solitude, twitching, dizziness, tinnitus, especially with melancholy depending on the walls of the abdomen.

When the disease becomes stronger, fearfulness, suspicion, melancholy, avoidance of human society, depression, talkativeness similar to delirium, lust due to the abundance of winds and all sorts of fears of what happens and what does not happen appear; For the most part, melancholic people are afraid of what people are usually not afraid of. The varieties of such fear are countless: some are afraid that the sky will fall on them, others are afraid that the earth will swallow them up, some are afraid of the Sultan, some are afraid of thieves, and some are afraid that a wild beast will break into them. At the same time, events that took place in the past also have an impact. Patients see in front of them something that is not there; They often imagine that they have become kings or turned into animals, evil spirits, birds or tools. There are also patients who constantly laugh, especially if they have blood melancholy, because they imagine something pleasant and pleasing. And other patients cry constantly, especially if their melancholy is from pure black bile. Some would like to die, and some hate the thought of death.

Signs of melancholy inherent in the brain are excessive thoughtfulness, constant obsessions, and a gaze invariably fixed on one thing or the ground. This is also indicated by the color of the head, face and eyes, the blackness and thickness of the hair on the head, previous insomnia and thoughtfulness, prolonged exposure to the sun and the like, previous diseases of the brain, the absence of the signs of disease of the organs mentioned below that are involved primarily with the brain, and that there is no benefit from treatment and cleansing of this organ. The phenomena of melancholy are very pronounced in this case. As for the signs of melancholy, which arises in association with the brain of the whole body, these are blackness and thinness of the body, retention of what could normally be excreted from the spleen or stomach, and what was excreted during urination, through the anus or during menstruation, abundance hair on the body and their sharply black color, as well as the consumption in the past of bad food that generates black bile, which you already know from Book Two, and the presence of diseases that give rise to melancholy, such as, for example, chronic and mixed fevers.

Signs of melancholy, depending on the spleen, are a large appetite, caused by the outpouring of black bile into the stomach with little digestion of food due to the coldness of nature, frequent rumbling in the left side of the abdomen, swelling of the spleen - this phenomenon never leaves such patients, - strong lust due to bloating; sometimes there is a four-day fever. Nature often turns out to be soft; The burning of black bile sometimes causes pain. Melancholy, depending on the stomach, is manifested by the signs of a stomach tumor mentioned in the chapter on stomach diseases, aggravation of the disease by indigestion, by fullness and during digestion. Often, when eating food, before it is assimilated, pain arises, but then, when assimilated, it calms down. If the tumor is hot, then this is indicated by burning in the walls of the abdomen, vomiting bile and thirst. Most people suffering from melancholia suffer from spleen problems.

Signs of melancholy, depending on the walls of the abdomen, are heaviness in them, pulling them up, constant nausea, bad mood, indigestion, sour belching, wet feces, rumbling in the stomach, the release of winds, burning in the stomach, a feeling of pain in the stomach and pain between shoulder blades, especially after eating and before it is completely absorbed. Often the patient vomits bile mucus, and sometimes something sour that sets the teeth on edge. All these signs appear when eating and even a few hours later; The stool of such a patient is muco-bilious. With good digestion, the disease becomes easier, and with insufficient digestion, it intensifies. Sometimes such melancholy is preceded by a tumor in the walls of the abdomen, or the tumor occurs simultaneously with melancholy; At times, twitching is felt in the walls of the abdomen. The disease worsens with indigestion and difficult digestion.

We say: if the black bile that gives rise to melancholy is of blood origin, then melancholy is accompanied by gaiety and laughter, and the patient is not always overcome by severe sadness. If black bile arose from mucus, then melancholy is accompanied by lethargy, slight fever and immobility; and if it is formed from yellow bile, the patient becomes agitated and goes a little crazy, and melancholy is then similar to mania. And with pure black bile, the patient often thinks and is less likely to show hostility until he is touched; then he gets irritated and experiences hatred, which he does not forget about.

Treatment. You should hurry with the treatment of melancholy before it becomes stronger, because at the beginning it is easy to treat, but when it becomes stronger, it is difficult. Under any circumstances, the patient must be entertained and cheerful, given a moderately warm room; humidify the air in his room and give it a pleasant smell by covering the room with fragrant plants. In general, he should be allowed to smell incense and pleasantly smelling oils, and fed with food containing excellent chyme, which is highly moisturizing. It is necessary to take measures to fatten the patient's body with the help of appropriate food, bathing before meals and pouring warm, but not very hot water on the head; if upon leaving the bath he feels a little thirsty, then it is not harmful to give him a little water to drink. The thickening rubbing mentioned in the paragraphs on maintaining health should be used. Take care of moisturizing the patient’s nature more than warming it, as much as possible.

The patient should refrain from copulation and not sweat very much. He should avoid eating beans, dried meat, lentils, cabbage, thick and young wine, as well as everything salty and salty, spicy and sour; on the contrary, he should eat fatty and sweet foods. When it is desirable to put such patients to sleep, you can pour an infusion of medicinal chamomile and common chamomile on their head. Indeed, sleep is the most suitable treatment for them. Its benefits correct the harm caused by poppy.

If melancholy arose from a cold and dry disorder of a simple nature without matter, then warming the heart with the help of invigorating agents, medicines from musk, teryak, mithridate and the like is sufficient. The head is treated with the remedies already mentioned in the chapter on dementia; strong melancholy of this kind appears after some other hot illness. It is easy to treat and even goes away with simple watering.

If melancholy arose from black gall matter entrenched in the brain, then the basis of its treatment is three things. The first of them is emptying from matter. Sometimes it is done by enemas, as well as by vomiting, but if the patient’s stomach is weak, then with this disease one should not induce vomiting at all, even when melancholy depends on the walls of the abdomen. Second: along with emptying, moisturizing with pouring and hot oils should be constantly applied. From medicines, chamomile, dill, sweet clover and iris rhizome are added to them so that the juices do not thicken from resorption alone without softening. You can also, along with moisturizers, without fear, add wormwood, bay leaf and pulegian mint: foods that generate praiseworthy blood should be prescribed, for example, fish from rocky rivers, the already mentioned light meat, and from time to time white diluted wine, but not old and not strong. The third is the use of heart-strengthening drugs. If it is felt that the nature is cold, this is done with the help of hot invigorating agents, if it is inclined to warmth, then with the help of balanced invigorating drugs, and if it is very hot, then use cold invigorating agents, but not excessively cold ones. All these qualities of netura are determined by the pulse. Let us now proceed to a detailed presentation of this method of treatment.

We say: as for emptying, if you see that the vessels are overfilled, no matter what the overflow, and if the black bile is of blood origin, then let the blood flow from the black vein. You should start with bloodletting even in all circumstances, unless you are afraid of severe weakening of the patient or you do not know that there is little matter and it is in the brain and that dryness has taken over the nature. Further, if during bloodletting you see that liquid blood is coming out, then do not stop the bleeding because of this, because in most cases liquid blood comes out first. Therefore, the incision must be made wide so that only liquid blood does not spill out, and thick blood does not linger and worsen the situation. Then look at which side of the head the heaviness is greater, and let the blood flow from the part of the basil adjacent to it. Sometimes you will have to bleed from both parts of the basil if this symptom turns out to be common to the entire head. Before bleeding from the frontal veins, the patient should be forced to move more.

If the juice really turns out to be black bile and prone to coldness, then empty it with pills prepared from dodder, sabur and harbak. Start by bringing the juice to maturity, then first empty it with light medicines, which include dodder, coloquinta pulp and a little scammonium resin, and after that empty it with a decoction of dodder and agaric. Then, if this does not work, use strong iyarajas, and if after this there is a need for emptying, then carefully and cautiously give harbaka and without any fear prescribe lapis lazuli and Armenian stone, as well as pills prepared from both of these remedies. Patients often benefit from long-term use of these substances with cheese whey and a reduction in the amount of medication. If this does not help, then start all over again. Every week you need to empty yourself with pills of medium mild action, and in between use atriful with dodder. They tried to feed the patients with atriful with dodder according to the following recipe: they take atriful three dirhams, dodder - one dirham and iyaraja - half a dirham. Once a month they perform a strong bowel movement with the help of strong iyarajas and large pills until they see that the disease has passed. They also resort to vomiting, especially if there is something in the stomach that aggravates the disease and the stomach is not very weak. You should also induce vomiting with the help of decoctions in which pulegium mint, artichoke gum and radish seeds were boiled. The patient takes with sikanjubin the squeezed juice of a radish, into which a harbak has been stuck and left for several days so that the power of the harbak passes into the radish, or takes the radish itself, soaked in sikanjubin. In this case, there should be three istars of sikanjubin, and one istar of squeezed radish juice. This amount can be increased or decreased in accordance with the strength of the patient, and if you fear that his strength is weak, refrain from using harbak.

When you clear your head, then turn to treating your heart using the remedies we have already mentioned many times. This same atriful with dodder is a proven useful medicine for this disease. If the illness drags on, induce vomiting with a harbak. Also use well-known chewing agents, gargles, fragrant snuffs, musk, amber, spices and aloe. When the matter is rather yellow-billed, empty it with a decoction of dodder, moderate action, ustumahikun pills and medicines that remove burnt yellow bile, which are mentioned in their place. Increase hydration and reduce warming, although when prescribing watering you cannot avoid chamomile and other medicines that have its power. Pure cooling agents should not be applied to the head.

Some ancient doctors advise in such a case that the patient take a little sabur every day or drink water daily in which three ukiyas of bitter wormwood were boiled, or ten qirats of squeezed wormwood juice soaked in water. It is also considered praiseworthy to drink strong vinegar every evening, especially from sea onions, but I personally fear the harmful action of vinegar in this disease, unless it is certain that the matter originates from burnt yellow bile and that it is hot; in this case, vinegar is the most useful thing for melancholy, especially vinegar from sea onions and sikanjubin prepared with vinegar from sea onions, as well as vinegar in which they put Dubrovnik polyum or Aristolochia. Vinegar is also sometimes useful if the disease is due to the participation of the spleen and the matter contained in it. It is necessary to delight the sense of smell of such patients with fragrant, balanced complex medicines, which include camphor, musk and a significant amount of violet oil, which overcomes the dryness of camphor and musk with its smell. Other cold incense is also used, mainly water lily.

If the cause of melancholy is a tumor in the stomach and viscera or the hot, burning nature of the stomach, then you treat this by cooling and moisturizing the head, and also strengthen the head so that it does not accept juices passing into it from other organs. When the cause is nested in the walls of the abdomen and you discover the presence of winds and rumbling, then if there is a hot tumor in the walls of the abdomen, treat it and make it resolve, using the proper remedies mentioned in the paragraphs on tumors; At the same time, also strengthen the head, pouring it generously with strengthening and moisturizing oils, and use blood-sucking cups with an incision to remove the blood, but do not warm the liver in such cases, but, on the contrary, cool it if it turns out that it is hot and burns the blood with its warmth. Strengthen the spleen, place cups on the walls of the abdomen, apply medicine with mustard and the like; this is done to prevent the spleen from sending matter to the brain. If the nature of the abdominal walls is cold and they are swollen, but there is no swelling and there is no burning, then give the patient a decoction of bitter wormwood and its squeezed juice, in accordance with what was mentioned above. The stomach area should be irrigated with the aforementioned hot waterings and medicinal dressings should be applied to it, which include twig seeds, rue seeds, iris rhizome and Mary tree; The bandage should be kept on the stomach for a long time, and when you remove it, put cotton moistened with hot water, or combed wool, or a sponge in this place. It is also useful to apply bandages with mustard to this place, and between the shoulder blades - Dorotheus bandages, mentioned in the Pharmacopoeia. Using cups without an incision also helps, but if there is swelling or pain is felt, this is prohibited. Often with melancholy it is necessary to give patients celery seeds, cumin and anise to drink; Give them a decoction of these seeds, as well as a decoction of rue and dill. Sometimes it is even necessary to prescribe rue and twig seeds.

In case of chronic melancholy, depending on the walls of the abdomen, it is often necessary to induce vomiting with the help of white hellebore; In the case of such melancholy, it is often necessary to correct the condition of the liver so that black bile does not arise in it. Often people suffering from such melancholy benefit from cooling substances, since the latter have a moisturizing property that counteracts the dryness of black bile; they also prevent the formation of winds and vapors that cause harm by rising into the head. However, the utility of coolants is not a utility that easily crosses the disease; from a cold substance, if it is wet, black bile does not arise and its matter is suppressed, and the already formed matter does not rise in the form of steam; therefore, there is hope that nature will prevail over it and correct matter. Know that a rough diet, which produces mucus, sometimes resists black bile, and a soft diet, in which food burns easily, sometimes promotes the formation of black bile. Do not be deceived by the fact that some patients benefit from the removal of mucus during vomiting or in bowel movements: the relief occurs not because the emptying of mucus is beneficial, but due to the fact that this eliminates the abundance of juices and their pressure on each other friend. Essentially, only emptying from black bile is beneficial.

The basic rule in the treatment of melancholy is increased hydration; Along with it, nothing should be missed regarding the emptying of black bile. Whenever food spoils in the stomach of those suffering from melancholia, make them vomit it, especially if they feel a sour taste in the mouth. In this case, they must vomit, and after vomiting they are prohibited from eating again. In such cases, they use medications to stimulate appetite, strengthening the mouth of the stomach, and refrain from introducing food into the stomach if the food taken earlier has spoiled there. A person suffering from melancholy should do something, whatever it may be, and let there be a person next to him whom he is shy and who is pleasant to him. Let him drink slightly diluted white wine in moderation, and also be entertained by music and the singing of singers; for him there is nothing more harmful than idleness and solitude. Such patients are often upset by the events that happen to them, or they are afraid of something; if they are distracted from heavy thoughts, they recover; The very distraction from heavy thoughts is the main treatment for them. If the cause of melancholy is the retention of discharge during menstruation, from the anus and from other places, then such discharge should be caused. When a loss of appetite appears, it means that the disease is malignant and dryness has prevailed throughout the body. And if ulcers appear on the patient’s body, this is a sign of imminent death. A patient whose body has black bile in motion responds better to treatment than one whose black bile does not. A person whose black bile is in motion is one whose black bile appears in vomiting, in stool and urine, and is also noticeable in skin color, bahak, freckles, ulcers, jarab, dilated veins, elephantiasis, in discharge from the anus and the like, for all this indicates that black bile is capable of secreting from their blood. If patients develop any of the listed diseases, then this is a good sign. If a patient with melancholy begins to have spasms after relaxing and defecating, and such people, due to their dryness, are more easily susceptible to spasms than others, then they should be placed in warm water, fed with bread soaked in julab with a small amount of wine, and given water mixed with wine. Then you should put them to bed and after sleep you should bathe them in the bathhouse, and as soon as they leave the bathhouse, feed them.