This article is the first part of Aamirah’s series on Unani Medicine, in which a general introduction to this tradition and the concept of the four temperaments is given. Part two of this series, which digs deeper into the six lifestyle factors, will be published soon.
Heralded as one of the great sciences of the Islamic world, Unani Tibb (literally Greek medicine) was practiced and developed from the days of the height of Greek civilization, and successfully reached generations across a wide array of empires in Islamic civilization. A thriving system, leading with a whole-body approach, its ultimate goal was to strike a balance between mind, body, and spirit.
Some of the great pioneers of this science come from Greek civilization, including Hippocrates and Galen. During the Caliphal Period, in medieval times, the tradition began to develop within Islamic thought. This was the time when the transmission from Greek scholarship to Islamic scholars occurred, and eventually the development of medicine as an Islamic science was established.1 Many Greek physicians and translators, from the likes of Yahya ibn Masawayh to Hunayn ibn Ishaq, were even enlisted by the Abbasid caliphate to oversee translations of a number of texts from Greek into Arabic.2
In the age of classical Islamic philosophers, from ar-Razi to Ibn Rushd, there was a wealth of talented physicians and philosophers who all contributed to the development of medicine.3
Ibn Sina, also known as Avicenna, was famous for his composition of The Canon of Medicine—still famed in the West as one of the more widely used textbooks on medicine in the Arab world and Europe for centuries afterwards.4 It has been studied for the way it successfully brought together some of Galen’s work but simultaneously introduced a new approach to diagnosing and treating ailments.
Medicine in Islamic History
In the Islamic world, Unani Tibb was practiced and adhered to at the height of its glory, from the 16th to 18th century. Imagine a world where intellectuals were commissioned, to ensure knowledge was being gathered and understood by the sultans and the elites. Much progress was made under caliphal rule and into the Ottoman, Mughal, and Timurid empires.
Then came the building of hospitals and schooling for medical students, in order to disseminate the knowledge gained. The concept of the healing center, named Darüşşifa in Ottoman Turkish or the house of health5, was also developed as part of the charitable foundation tradition in the Seljuk and Ottoman Empires.
Turkish emperors had the first examples of this Darüşşifa built in Syria and Egypt. It was a place that provided what we would understand as a holistic tradition, hosting music therapy and focused on providing an exhilarating, comforting, and soothing environment in order to positively impact the soul.
A holistic experience as such was taken from the books of Ibn Sina and others, and carefully planned into the building of these healing centers. Symbolising an element that is always flowing, it also provided healing through the sounds of running water. This constituted one of the forms of treatment widely available to patients across Turkey, and was unique for its time—foreshadowing what we would conceptualise as the naturopathic healing clinic today, and hereby showing its deepest, and continuing, relevance.
An Introduction to the Four Temperaments
The four elements—earth, water, air, and fire—uphold a special place within the Unani Tibb perspective. All four are contrary in their position, and each element represents a different temperament or mizaaj (plural ʾamzijah), disposition. However, it is only when all four temperaments are in a state of balance that we can achieve true balance within. Being able to understand the universe and its four elements allows us to connect this to how minerals, plants, and animals are constituted in a similar way. The link between the four elements and our individual mizaaj is therefore intrinsic.
- Earth is cold and dry, and it allows things to be firm, stable, and lasting. It correlates with the melancholic temperament.
- Water is considered cold and moist. It lends itself to dispersion, and can be moulded easily. It therefore connects to the phlegmatic temperament.
- Air stands for lightness, and represents the hot and moist sanguine temperament.
- Fire is simple in its composition. It is hot and dry and matures, refines, and intermingles with all the other elements. It is linked to the choleric temperament.6
The temperaments can be classified by a mixture of the four humours—the bodily fluids of black bile, phlegm, blood, and yellow bile believed to exist in the blood—which forms the basis of diagnosis in the Unani Tibb tradition.
In modern medicine, it is widely understood that the humours are produced in the final stages of digestion and thus concern the stomach and liver the most, but affect the tissues and vessels if there is a significant imbalance.
It is through the temperaments that a person’s physical form and even characteristics are believed to be shaped. Further to this, different temperaments present different challenges in terms of the diseases individuals may be prone to develop. A Unani Tibb physician will be able to diagnose the predominant humours in an individual through symptoms and conditions that develop as well as appetite, amongst a number of other features. A few examples of this can be found in what follows.
- The melancholic temperament is associated with black bile. Those in which this temperament dominates over the other three are generally individuals who are lean and thin, with strong bones. They tend to suffer from interrupted sleep and insomnia. Individuals with this temperament are known for their very strong analytical and detail-oriented minds.7
- The phlegmatic temperament is associated with the phlegm humour. Usually these are individuals who are flabbier, with thin hairs, and whose movements may be slower and faces tend to be rounder. Like the sea or water, they can be calm, yet emotional and sensitive. Associated with cold and moisture, a warmer climate and environment would suit these individuals.8
- The sanguine temperament is characterised by prominent joints, a higher muscle to fat ratio, thick hair, and a full pulse. A sanguine’s digestive system is known for being good as well as leading to a keen appetite. The dominant humour connected to a sanguine is the blood humour and there also comes the association of it being a warm and moist temperament.9
- Lastly a choleric temperament can generally be identified by sharp features, a lean physique, and dark hairs. The dominant humour in this case is yellow bile, which becomes visible in the individual’s complexion, through excessive thirst, and an intolerance to extreme heat. Here, the concept of Fire as an element is apt, as the temperament is hot and dry. In order to create a balance, the use of cold and moist food and activities, such as swimming and forms of meditative exercise, is crucial.10
No matter which temperament is our dominant one, we should be aware that these can shift due to emotional events, trauma, or various changes in our environment. When addressing an imbalance, no matter what its cause, it needs to be met with shifts towards the other temperaments. For example if one had a choleric imbalance (hot and dry temperament dominating), it would need to be treated with herbs and activities that would be of a cold and moist temperament. Fire needs to be balanced out with Water—thus one’s activities and lifestyle changes would reflect this until the individual had reached a closer state of balance. Our temperament is our inherent disposition, it shapes how we respond and react to things, and each of us is unique in it. It is also subject to changes based on our lifestyle factors and circumstances, from how we manage our emotions, to our food and ecological factors.11
Achieving Balance through the Six Lifestyle Factors
In today’s world, therapies dubbed holistic are common, yet none are rooted in a history spanning across civilizations and cultures as deep as that of the Unani Tibb tradition. Within the philosophy of Unani Tibb there is no exclusively singular focus on the mind or the body on its own. Instead, there is a deep connection between the way the mind, the body, and the soul are treated simultaneously. One of these Unani teachings many of us can use and apply in our lives today is the concept of the six essential lifestyle factors.
Central to this philosophy is the assertion that the real cause of most chronic diseases is the person’s adoption of a faulty lifestyle, considering an imbalance in an individual’s lifestyle to be reflected in an imbalance in their temperaments. Detected through symptoms in certain organs, an excess of any temperament creates a general imbalance in the body.
In today’s medical terms: the antibodies required to counteract disease pathogens are not created, thus leading to bodily conditions in which microbes can thrive and release toxins.12 The so-called six essential lifestyle factors, also known as al-asbaab as-sittah (literally the six causes), are considered responsible for either the state of health or the state of disease in the human being and form the preventive aspect of Unani Tibb therapy. Each of the six lifestyle factors needs to be implemented in balance and moderation, based on the individual’s temperament, to move them to the ideal state of ʾiʿtidal (balance).13 In the next part of this series on Unani Tibb, these six lifestyle factors will be discussed.
Literature for Further Reading
- Hakim M. Salim Khan, An Introduction to Islamic Medicine (Leicester: Mohsin Health, 2009)
- Laleh Bakhtiar, Avicenna On the Four Humours from the Canon of Medicine Volume 1 (Chicago: Kazi Publications, 2012)
- Muhammad Al-Akili, Muhammad Ibn Abi Bakr Ibn Qayyim Al-Jawziyah, Natural Healing with Tibb Medicine: Medicine of the Prophet (Philadelphia: Pearl Publishing House, 1993)
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- Felix Klein-Frank, “Al-Kindi”, in Oliver Leaman & Seyyed Hossein Nasr, History of Islamic Philosophy (London: Routledge, 2001), p. 172.
- Víctor Pallejà de Bustinza, “How Early Islamic Science Advanced Medicine”, National Geographic, November 12, 2016, https://www.nationalgeographic.com/history/magazine/2016/11-12/muslim-medicine-scientific-discovery-islam, accessed February 15, 2021.
- Yvette Brazier, “Why was medieval Islamic medicine important?”, Medical News Today, November 9, 2018, https://www.medicalnewstoday.com/articles/323612, accessed February 15, 2021.
- Samir S. Amr & Abdelghani Tbakhi, “Ibn Sina (Avicenna): The Prince of Physicians”, Annals of Saudi Medicine, 2007, Mar-Apr; 27(2), p. 134–135.
- Enver Şengül, Kültür Tarihi İçinde Müzikle Tedavi ve Edirne Sultan II. Bayezid Darüşşifası, master thesis (Istanbul: Sosyal Bilimlet Enstitusu, 2008).
- Hakim M. Salim Khan, An Introduction to Islamic Medicine (Leicester: Mohsin Health, 2009).
- Ibid. p. 105.
- Ibid. p. 105.
- Malik Itrat & Mohd Zulkifle, “A Temperamental Approach in Promotion of Health”, Medical Journal of Islamic World Academy of Sciences, 2014, 22(2), p. 102-106.
- Ibid. p. 105.
- Salim, Hakim, The Golden Key to Discovering Yourself (Leicester: Mohsin Health, 2018).
- Rashid Bhikha & John Glynn, “The Theory of Humours Revisited”, International Journal of Development Research, Volume 7, 2017.
- Avicenna, Kitab al-Qanun fi at-Tibb [The Canon of Medicine] (Rome: Typographia Medicea, 1593).