Maarifat e Tib Course / Umoor e tabiya / Kulliyat / Principles of Eastern Medicine
Temperament/ Mizaj:
In nature no two things, however allied in origin and structure, resemble each other perfectly. This
is true of the animate as well as the inanimate creatures and applies most forcibly to that standing
puzzle man in whom these diversities or peculiarities, find their most conspicuous embodiment.
The name ‘Mizaj’ has been given to certain physical and moral differences in individuals. Every
person has a unique Mizaj, which includes his physical characteristics, physiological profile,
psychological and emotional status.
The Hippocrates (460-370BC) gave the fundamental principles of Greco-Arab System of Medicine
with a belief that the body of the individual is composed of four basic elements, which together,
are termed as ‘Anasir-e-Arba’ or Arkan’(Elements) comprising earth, water, air and fire. These
Anasir-e-Arba possess four different qualities, i.e. hot, cold, dry and wet. The admixture of these
four basic elements results in the formation of four biological fluids or Humors viz. Blood (Dam),
Phlegm (Balgham), Bile (Safra) and Black bile (Sauda); a right proportion, according to quality
and quantity constitutes health and upright proportion and irregular distribution, according to their
quantity and quality constitutes disease.When these different Kaifiate Arba (qualities) of Arkan
(elements) acts and reacts by their powers, then previous qualities become diminished and a new
moderate quality is developed which is known as Mizaj.
Mizaj theory has its roots in the ancient four humors theory. It was the Greek physician Buqrat
(Hippocrates 460-370 BC) who systematized and developed it into a medical theory. He believed
certain human moods, emotions and behaviors were caused by body fluids (called “Humors”):
blood, yellow bile, black bile, and phlegm. Next, Galen (AD 131-200) developed the first typology
of Mizaj in his dissertation De temperamentis, and searched for physiological reasons for different
behaviors in humans.
A lot was done and developed by Hippocrates and Galen, but the Arabs worked more attentively
on the theory of mizaj. They were the first to locate relationship between diseases, various humors
and the disturbance of mizaj.
The Literal Meaning of Mizaj (Temperament) -The literal meaning of mizaj according to Nafis is
“Intermixture” as he says “The word mizaj originated from Arabic word imtizaj meaning
intermixture” -Mizaj is derived from Arabic word “mzj” which means mixing of humors. At other places it is described that mizaj refers to the intermixture of four humors within human body, it is
the basis of body. (Lisan-ul-Arab) -Azmi says “mizaj is an admixture”. He writes “mizaj denotes
admixture, it is a verb but metaphorically used as tempered (Mamzuj)”.
Temperament: Quoting the words of Rudolf E. Siegri, Azmi says:“The Greek used to call the
mixture of humors as “krasis” which is derived from “kerannyni” meaning “to mix”. The word
kerasis is usually translated as temperament. ”
The word “temperament” is derived from the Latin word “tempero” which means “to mix”. This
word temperament is used in the English language as a synonym of the Arabic word mizaj.
Azmi explains further saying, “there is another word constitution which is used as an equivalent
of mizaj. This word means the natural condition of the body and mind and when it is used in
chemistry, it denotes not only kinds and number of atoms but also the way they are linked. This
meaning is fully in accordance with the elemental concept of temperament which I hold correct”.
But, Shah has a different opinion, he says, “in modern medicine the terms “constitution” and
“temperament” are often used synonymously but not so in the cannon of Avicenna. Constitution
is tabiyat comprised of seven physical factors, al umoor al tabaiyah,of which temperament is one”.
The Arab physicians described the concept of mizaj in a universal manner as compared to the
modern concept of temperament that is limited to the psycho – somatic behavior only. Therefore,
the word temperament does not hold the same meaning as mizaj meant in Greeco Arab medicine
rather mizaj has broader meaning.
In this regard, Grunner says, “the word temperament is not satisfactory for the Arabic word mizaj
which contains the idea of mixture so the medieval translators used the word “commixtio” or
“complexio” which carry the idea of mixing or blending and weaving. But neither words fit in with
modern usage.
The Definitions of Mizaj: The physicians of Unani medicine have dealt with Mizaj in detail and they defined it to the best of their knowledge and concepts. The Arab medical authors worked on the theory of most assiduously and its description is found in the Arab medical literature under the heading “mizaj”.
Concept of Mizaj according to different Scholar:
Ali Ibn Abbas Majoosi (930-994 AD) has defined the mizaj:“All sorts of bodies (light or heavy),
which are found in this ever-changing world are formed by four elements (ustuqussat) after mixing
in different or uniform quantities in accordance with the needs (of the body). As a result of this
mixing, one or two qualities become dominant, over the body, and this is called ‘mizaj’. It is
derived from Arabic word ‘imtizaj’, meaning ‘to mix with each other”
.
Abu Sehal Masihi describes Mizaj as:“Because there are so many primary components
(ustuqussat) of the body which are mixed together not in close proximity, it is necessary that the
qualities of primary components must be mixed as a whole new qualities arise from inter-mixing
of primary components which will be in between the previous qualities, called mizaj”.
Ibn Sina (980-1037 AD) says “The Mizaj is a quality resulting from the interaction of opposite
qualities present in elements consisting of minute particles so that most of the particles of each of
the elements may touch most of the others. Thus when these particles act and react on one another
with their properties, there emerges from their total properties, a uniform qualitywhich is present
in all of them. This is the temperament (Mizaj).
Ibn Sina further writes that “Since the primary properties in the aforesaid elements are four namely
hotness, coldness, moistness and dryness, it is obvious that the temperaments of the integrating
bodies are the products of these very properties”.
Ismaeel Jurjanee writes about mizaj that:“When different qualities of elements acts and reacts by
their powers then previous qualities become diminished and a new moderate quality is developed
which is known as mizaj”.
Galen (130-200 AD) says that:“Mizaj is a quality produced by action and reaction of opposite
qualities of body fluids (Akhlat). When these components interact by virtue of their respective
powers (qualities) a condition is achieved which is found in equal proportions in all the
components of that intermixture; this is called Mizaj”.
Ibn-e-Habal Baghdadi states that:“When elements get admixed, most of the elements mix with
each other and their various qualities act and react so heat breaks the cold and cold breaks the heat.
Similarly dryness try to breaks wetness and wetness try to breaks dryness. Low grade Qualities
mix with high grade qualities light weight Particles mix with heavy weight Particles until a new
Quality is developed which is equally found in all the components of elements this new and
moderate Quality is known as mizaj”.
Allama Nafees says that:“When elements mix with each other they act and reacts which result in
developing a new moderate Quality in between the all four previous Qualities and new Quality is
known as mizaj”.
Gruner says that Arabic word mizaj contains the idea of mixture’, medical translators used the
word commixtio or complexion which carry the idea of mixing or blending or weaving” [14].
Mehdi Hasan described Mizaj along with the four elements, he says that:
“The four elements are result of four qualities cold, heat, moisture and dryness. Two qualities in
combination constitute an element e.g. Cold + Moisture = Water
The ultimate units are pure qualities. These have been identified as follows:
Heat = Oxidation, Moisture = Hydration, Cold = Reduction, &Dryness = Dehydration.
So the Mizaj can be understood by the following examples: Saudavi or Melancholic Mizaj should
be interpreted not as cold and dry but in which reduction and dehydration are preponderating”.
Taiyyab suggest in “Greco-Arab Medicine” that: “The temperament is a synthetic concept which
express the various physical as well as psychological tendencies of the individual in terms of matter
and energy i.e. activity as, heat and cold reactivity as dryness and moisture”.
Zaidi and Zulkifle writes that:“The temperament is an intrinsic state which enables an individual
to survive and to procreate comfortability and is responsible for distinctive morpho-bio-physioimmuno-psychological identity of an individual”.
• Habit of eating of cold and hot food
• Habit of eating in specific time
• Habit of bathing
• Habit of sleep and wakefulness
• Habit of coitus.
• Habit of Istifragh (elimination) etc.
An organism can exist only when it responds to environmental changes which demands respective
adaptation. Each animal or organism, as a part of nature, is a complex and integral system, whose
internal forces work so long as it exist, are equilibrated at every moment
Determination of Human Mizaj:
Mizaj is one of the peculiarities of Tibbi Unani System of Medicine, as compared with other
concept. Near about all scholars described the meaning and importance of Mizaj in their most
valuable books. According to Aziz the meaning of Mizaj is “habit, or mental attitude of the individual”. Many of the great (Pioneer) authors have accepted the facts given by the Ibn Sinna.
According to him“uniform state or the state of equilibrium emerging after Imtizaj (intermixture
or chemical combinations) of more than one arkan having contrary qualities”.
All types of bodies (animate and inanimate) which are found in this world, are formed by
four Ustaqissat (elements) after mixing of with each other in different or in uniform quantities in
accordance with the needs of the body. As a result of this mixing one quality dominates over the
body, and this is called Mizaj.
If a compound is formed by the interaction of four elements with their equal quantities,
a kafiat (quality) is produced in the compound which is known as Mizaje mo’tadil (equable
temperament). And if a compound is formed after mixing of four elements with their unequal
quantities, a quality produced in the compound, it will be Mizaj (temperament) of the compound.
For example, if the dominant element (part) in the compound is Nar (fire), the compound would
be considered as of Har Mizaj (hot temperament). Similarly, if the dominant element or part of the
compound is Maa (water), the compound would be considered as of Barid Mizaj (clod
temperament) and if, the dominant part of the compound is Hawa (air) that is called as of Ratab
Mizaj (moist temperament). And if the dominant part or element in the compound is Arz (soil),
the compound would be called as of Yabis Mizaj (dry temperament).
Similarly, if two elements out of four Ustaqissat (fire, air, water, soil) become dominant, the
compound would be called by their names. For example, if fire and air both are dominant in the
compound, it would be considered as Har Ratab. Likewise there are four types of Murakkab
Mizaj as Har Ratab, Har Yabis, Barid Ratab and Barid Yabis.
In Unani medicine, basic principle of treatment is according to particular khilt whose excess is
considered as the cause of that particular disease. So Mizaj plays an important role in assigning
specific treatment to the patients of any disease.
Types of temperament:
Generally mizaj is divided into two major categories i.e.
• Mizaj e Motadil Tabaye and
• Mizaj e Ghair Motadil i.e. Su’e Mizaj.
Human body as whole in the state of health has a equilibrium of humors viz Dam, Balgham, Safra
and Sauda which is called Mizaj e Motadil. Any deviation of this equilibrium lead to the formation
of new state called Su’e Mizaj. Su’e Mizaj produces different diseases in the body. If there is
derangement in the equilibrium of four qualities (Hararat, Burudat, Rutubat and Yabusat) then it
is called Su’e Mizaj Sada and if these imbalances occur at the level of Akhlat, then it is considered
as Su’e Mizaj Maddi. Both of Su’e Mizaj (Sada and Maddi) are responsible for a number of
diseases viz; Humma e yaum, Heat stoke, Sudda, Falij, Obesity, Dyspepsia, Humma e ruba etc. So
by knowing their Mizaj we can easily design their life style, dietary habits and other regimes
according to their needs to keep them healthy. Mijaz of a person is greatly influenced by Asbabe
sittah zarooriya, occupation and environment etc, so if we succeed to make equilibrium between
adaptation of healthy measures and avoiding harmful measures in respect to factors influencing
Mizaj we can easily avoid the forthcoming health consequences.
Types of Mizaje Mo’tadil Tibbi according to Species, Races, Persons and Organs:
Not only the human being having its specific temperament but also a species, race and organs of
the body are furnished distinct temperament that are Mo’tadil (suitable) for them. For example,
Africans and Indians having their specific Mizaj which differs from each other, but are suitable for
their body functions i.e. if African temperament is replaced by Indian temperament, it will be
harmful for them and they will feel discomfort and cannot adjust themselves with that. Same like
this, if an organ having Mizaje Asli as Mizaje Har acquired Mizaje Barid, it will lose its harmony;
as a result abnormal functions will be manifested from it. There are some factors responsible for
change in temperaments of human being like age, place or residence, weather, diets, tadabeer
(regimens), occupation and habit etc. Out of all these factors, everyone has its specific Mizaj.
Therefore, for maintaining health of an individual and avoidance of disease, it is necessary to be
acquainted with these factors and their temperament.
The Mizaj can be divided into 8 kinds as per species, races, persons and organs of the body as:
1. Mizaje Mo’tadil Nau’ee bil Qiyas elal Kharij (Equable temperament of a species as a
whole):
This temperament distinguishes a species as a whole from the other. This temperament of a species
is most benefitting and suitable for that species (human being) and not suitable and not benefitting
for other species (like animals).
2. Mizaje Mo’tadil Nau’ee bil Qiyas elal Dakhil (Most equable temperament of a member of
the species):
3. Mizaje Mo’tadil Sinfi bil Qiyas elal Kharij (Equable temperament of a race as compared
to other races of a species):
It depends upon the climatic and geographical condition of a country. For example, Indians and
slaves have their specific temperament due to different geographical conditions.
4. Mizaje Mo’tadil Sinfi bil Qiyas elal Dakhil (Most equable temperament of a member of a
race as compared to other members of the same race of a species):
5. Mizaje Mo’tadil Shakhsi bil Qiyas elal Kharij (Equable temperament of a person of a
race):
It is the most suitable temperament for the normal functioning of the body of an individual as
compared to others.
6. Mizaje Mo’tadil Shakhsi bil Qiyas elal Dakhil (Equable temperament of a person as
compared to his own temperament in different states):
For example, the Mizaj achieved in youth or in Rabi’ season by a person will be more suitable
than that of other states of life and season.
7. Mizaje Mo’tadil Uzwi bil Qiyas elal Kharij (Equable temperament of an organ as
compared to other organs of the body):
This temperament of an organ is most benefitting and suitable for the same.
8. Mizaje Mo’tadil Uzwi bil Qiyas elal Dakhil (Equable temperament of an organ by physiological functional state):
This temperament is achieved by an organ when it is performing its functions with full efficiency.
Types of Sue Mizaj (Mizaje Ghair Mo’tadil/ Tabaye):
When a Kaifiyat (quality) is increased from E’tidal (balance) the condition is known as “Mizaje Ghair Mo’tadil” or Sue Mizaj.
Sue Mizaj is of 2 types:
• Sue Mizaj Sada (simple imbalance temperament without matter)
• Sue Mizaj Maddi ( imbalance temperament due to any matter)
Sue Mizaj Sada is of 2 types:
Sue Mizaj Mufrad Sada:
When one Kaifiyat out of Kaifiate Arba is increased in any compound, it is known as Sue Mizaj Mufrad Sada. It is of 4 types.
• Har,
• Barid
• Ratab
Yabis Sue Mizaj Murakkab Sada:
When Mizaj is deviated in 2 Kaifiyat (qualities) out of Kaifiyate Arba then it is known as Sue Mizaj Murakkab Sada. It is also of 4 types.
• Har Ratab
• Har Yabis
• Barid Ratab
Barid Yabis Sue Mizaj Maddi is of 2 types:
Sue Mizaj Mufrad Maddi (single-imbalance temperament due to any matter):
Sue Mizaj Mufrad Maddi is the temperament in which one kaifiyat dominated. It is of 4 types.
• Har Maddi,
• Barid Maddi
• Ratab Maddi
• Yabis Maddi
Sue Mizaj Murakkab Maddi (compound imbalance temperament due to any matter):
It is the temperament in which two Kaifiyat dominated increased. It is also of four types.
• Har Ratab Maddi,
• Har Yabis Maddi,
• Barid Ratab Maddi,
• Barid Yabis Maddi.
Temperament of Asnan (Ages):
According to ancient Unani physicians each and every person has a unique Mizaj in relation with different stages of age. Throughout the life human being passes from infancy childhood, adulthood, old age in which Unani physicians have divided the entire period of life into four stages based on the quality of rutubat e gariziya present in body these are known as Asnane Arba Sine Namu (growing age), Sine Shabab (adult age), Sine Kahulat (middle age) Sine Shaikhukat (old age). Whole life of the human being has been divided into 4 stages i.e. Sinne Numoo, Sinne Shabab, Sinne Kuhoolat and Sinne Shaikhookhat. 24
• Temperament of Sinne Numoo is Har Ratab.
• Temperament of Sinne Shabab is Har Yabis.
• Temperament of Sinne Kuhoolat is Barid Yabis.
• Temperament of Sinne Shaikhookhat is Barid Yabis
Gender temperament:
Females have colder temperament than male, which is the reason they are shorter than males in physique and less moist. For the coldness of their temperament they are more curious and for the lack of exercise their flesh is soft. Although a man flesh, from composition point of view, is smother due to what mixes with it, the cooling effect due to penetrating vessels and nerve fibers makes it denser.
Factors responsible for changing the temperament of human being:
The modulators or factors responsible for changing the temperament of human being are of 2 types:
1. Internal Factors (Internal environmental factors)
2. External factors (External environmental factors)
1. Internal Factors (Internal environmental factors):
These are the factors which influence the temperament of human being at the time of its formation and development in the uterus. The foetal development is the outcome of interaction between the gamets (sperm and ova) of the parents. Gamets, undoubtedly, transfer parental characters to the offspring. Unani physicians are of the opinion that some active forces (Quwwate Mughayyirae Oola and Musawwirah) in utero, finalize the morphological and biochemical composition of the foetus in the light of temperament of the gamets. Any abnormal change in the Maaddae Manwiah (gamets) may alter the temperament of the foetus because of which different types of congenital deformities are developed in the foetus. For example, if the semen or gamets is less or more in quantity, foetus will not be developed properly. If Maddae Manwiah is less in quantity any organ maybe smaller in size as ” Microcephally”. Similarly, if the quantity of Mani is more, any organ of the body may enlarge as “Macrocephally.”
There are so many kinds of congenital diseases that develop in child due to any disturbance in the genetic material (chromosomes and genes) in the uterus like,
• Congenital rubella syndrome
• Down’s syndrome
• Thelassimia
• PKU (phenylketonurea)
Till now, over 2300 hereditary diseases have been identified.
2. External Environmental Factors:
These include Age, Air, Season, Habitat (Residence), Occupation and Habits.
Age:
Age of an individual is the factor which influences the temperament directly. Every person has specific temperament in different phases of life which is responsible for health and diseases of an individual. Because of abnormal changes in this temperament, so many diseases may develop in the body.
Air (Wind):
It is one of the most important external environmental factors, responsible for influencing temperament of an individual. Although there are so many kinds of winds blow in the atmosphere, but, only four winds i.e. Northerly (cold dry), Southerly (hot moist), Easterly (equable temperament) and Westerly (cold dry or near to equable) are of great importance from medical point of view. Because of having their specific Mizaj, each wind is suitable for the person having oppositeMizaj and harmful or not suitable for the persons having same temperament as that of the 26 wind and may cause diseases in the body accordingly. Northerly wind having cold dry temperament may cause diseases having cold dry temperament. Same like this, remaining winds tend to develop the diseases having same temperament as that of the winds.
Season:
It is also an important factor which may affect the temperament of human being. There are four types of seasons in the year. Each season has its specific Mizaj because of which it affects the temperament of an individual. If the temperament of human being and season become same, diseases having same temperament as that of the season and of human being may be developed. That’s why; Dam (blood) related diseases occur in Rabi,’ diseases related to Safra develop in the Saif (Summer) and diseases related to Sauda prevail in the Kharif, while Balghamidiseases occur in the Winter season. The diseases occurring in the end and in the beginning of the season are related with both pre and proceeding season.
Habitat (residence/country/city):
Habitat of an inhabitant exerts its effect directly on human life by its specific temperament. For example, Northern countries with cold and dry temperament, Southern countries with hot and moist, Eastern countries with Mo’tadil temperament and Western countries with Mo’tadil mail ba Rutoobat (moderate tilt towardrutoobat) which is similar to the temperament of Mosame Kharif. Because of specific Mizaj (temperament/ climate) of habitat, some specific diseases, related to the temperament of the same, are developed.
For example, Inhabitants of hot placesare generally of soft and delicate constitution of body, complexion of the body and hair are black. Similarly, inhabitants of cold places are usually strong and brave. Because, in cold temperament Hararate Ghariziah resides inside the body resulting in good digestion of inhabitants. If the temperament of these countries becomes damp or moist along with cold, persons living in these countries will become fleshy and fatty with inconspicuous veins (invisible).
Inhabitants of damp countries are distinctly fleshy and fatty with soft and smooth skin. In dry countries, both winter and summer seasons are in their extreme condition, because of which temperaments of inhabitants of these places become dry, as a result their skin becomes rough and cracked. Their brain tends to be dry, because of which so many abnormal consequences may develop in the form of
diseases.
Residents of high altitudes are generally brave, strong and long lived. It is because of pure air having cold temperament which is present at these places.
Actual contemplation of Mizaj:
In Unani System of Medicine elements are known as unit of the body, when we follow the rules and regulation of this system Kulliyat (Basic Principles) then we have to first study these four elements, because these four elements are the base and foundation of four creatures(solid, liquid, gass and plasma). “After the admixture and action and reaction of these elements, monomers (Glucose, Amino acid, nucleotides) are formed. When these monomers mixes, macromolecules are formed like protein, polysaccharides nucleic acid etc. when these macromolecules mixes organelles are formed, which mixes to form cell and from cell to tissue, from tissue to organ, organ to system, and many systems combines together to form human body ”.(Ahmed, 1983). Beside cells and tissues, these elements also form, fluids in the body and soul. When these elements are admixture to form compound this mixture is known as Imtezaj. This imtezaj goes certain duration, with specific law. This result into synthesis and distruction of many biological and chemical particles and in the body. Besides this, a new condition is form in the compound, which is also known as the Mizaj (temperament) of the specific compound. Every organ or complete human being has a specific internal environment and homeostasis mechanism, which depends on the quantity and quality of the humours. So elements of each compound and whole body has its own specific Mizaj (Temperament). This Mizaj (temperament) balances the chemical homeostasis of compound, organs and whole body and indicates the actual and real Mizaj (Temperament) of the body, as well as these small single parts. Because of Mizaj (temperament) internal condition, individuality of a person is exposed. Mizaj (Temperament) presents the face and features of any person. Some time the difference of atoms action and reaction and chemical condition can form different species and different persons. Mizaj also indicates the properties of an atom, or molecule or an organism as a whole. According to Unani Point of view all particles have their own temperaments. Everybody has its own Mizaj (Temperament). Every organ, every element or every compound has its own Mizaj (Temperament). It controls different functions and qualities. Like-wise body’s every minute part (cell) have a specific environment according to quantity and quality of these Anasir (elements). These quantity and quality control a specific balance in the body, which results into the body functions in a right way. This Mizaj (Temperament) is under specific forms. Body has its own individual Mizaj (Temperament), that’s why it gives specific movement function, impulses and other activities to various parts of the body. Heart has its own specific Mizaj (Temperament) because of this; it has its own specific function. If brain’s Mizaj (Temperament) is exchanged with heart’s Mizaj (Temperament) then the brain’s function will be disturbed in the same way. If the heart’s Mizaj will be replaced with brain’s Mizaj (Temperament) then the heart’s function will be disturbed. So the concept of Mizaj (Temperament) is very important in Unani System of medicine. All scholars explain the relation of Mizaj (Temperament) in physiological and, pathological aspect of the body. Keeping in view the same point as said above they described the Mizaj (Temperament) of various drugs, age group, species, person, countries, weathers and atmosphere (Siddique, 1992). Through of this concept of Mizaj (Temperament) we can say that different individuals have different Mizaj (Temperament). This Mizaj (Temperament) helps us to determine and to distinguish between different personalities, behavior of different persons. So two internal Mizaj (Temperament) of two different individual will never be same. No two individuals will have same Mizaj (Temperament). Different human elements undergo different types of chemical combinations (imtezaj) producing various cellular structures and fluid of body. If we investigate the Mizaj (Temperament) of two individual then we come to know that, if one is comfortable in a particular climate the other may not be comfortable in the same climate, if a person like hot thing’s in cold climate, the other person may like cold thing in cold climate in the 29 same way people belong to a same group or religion may have different faces, language, tastes, customs, culture, thinking, ideology etc. These difference in Mizaj (Temperaments) is based on the admixture of these Anasir Arba` (Four basic elements) in different quantity and quality. That’s why we can determine the various types of Mizaj (Temperaments) of whole human beings. If the quality and quantity of the elements are similar to an extent or near to each other in the same way, their Mizaj (Temperament) will be similar to each other e.g. People belong to the same dynasty (same family), their habit and habitat, their liking and disliking will be similar. In the same way for the choice of drug and medicine for every person is done on the basis of their Mizaj (Temperament). If two patients have the same disease and if we don’t check their Mizaj (Temperament) and the same treatment given to them, then the medicine may give positive effect to one and negative effect to another person. So the Unani system of medicine has given more importance to the concept of Mizaj, patient’s Mizaj, individual Mizaj, and his internal condition. After keen observation and diagnosis of the Mizaj (Temperament) of patient, the medicine is prescribed. During the prescription of medicine the Mizaj (Temperament) of medicine or compound is also kept in mind. If we don’t keep in mind the various Mizaj (Temperaments) of drugs, individual, diseases and atmosphere etc. then the treatment will go against the patient and the disease will not be cured. So the concept of Mizaj (Temperament) is very important to stable the human health and to cure it from various diseases. Through this concept we can diagnose the various diseases of the specific Mizaj (Temperament) of different individuals so that they can be given suitable treatment. If the Cold Temperament individual is attacked, by cold diseases then he will not feel comfortable in cold climate and he will feel even colder, as the climate is very mild. In the same way individual with hot temperament will be diagnosed with different problems and diseases.
Factors responsible for changing the temperament of human being:
The modulators or factors responsible for changing the temperament of human being are of 2 types:
3. Internal Factors (Internal environmental factors).
4. External factors (External environmental factors).
1. Internal Factors (Internal environmental factors):
These are the factors which influence the temperament of human being at the time of its formation and development in the uterus. The foetal development is the outcome of interaction between the gamets (sperm and ova) of the parents. Gamets, undoubtedly, transfer parental characters to the offspring. Unani physicians are of the opinion that some active forces (Quwwate Mughayyirae Oola and Musawwirah) in utero, finalize the morphological and biochemical composition of the foetus in the light of temperament of the gamets. Any abnormal change in the Maaddae Manwiah (gamets) may alter the temperament of the foetus because of which different types of congenital deformities are developed in the foetus. For example, if the semen or gamets is less or more in quantity, foetus will not be developed properly. If Maddae Manwiah is less in quantity any organ maybe smaller in size as ” Microcephally”. Similarly, if the quantity of Mani is more, any organ of the body may enlarge as “Macrocephally.” There are so many kinds of congenital diseases that develop in child due to any disturbance in the genetic material (chromosomes and genes) in the uterus like,
• · Congenital rubella syndrome
• · Down’s syndrome
• · Thelassimia
• · PKU (phenylketonurea)
Till now, over 2300 hereditary diseases have been identified.
2. External Environmental Factors:
These include
• Age
• Air
• Season
• Habitat (Residence)
• Occupation
• Habits
Age:
Age of an individual is the factor which influences the temperament directly. Every person has specific temperament in different phases of life which is responsible for health and diseases of an individual. Because of abnormal changes in this temperament, so many diseases may develop in the body.
Air (Wind):
It is one of the most important external environmental factors, responsible for influencing temperament of an individual. Although there are so many kinds of winds blow in the atmosphere, but, only four winds i.e. Northerly (cold dry), Southerly (hot moist), Easterly (equable temperament) and Westerly (cold dry or near to equable) are of great importance from medical point of view. Because of having their specific Mizaj, each wind is suitable for the person having opposite Mizaj and harmful or not suitable for the persons having same temperament as that of the wind and may cause diseases in the body accordingly. Northerly wind having cold dry temperament may cause diseases having cold dry temperament. Same like this, remaining winds tend to develop the diseases having same temperament as that of the winds.
Season:
It is also an important factor which may affect the temperament of human being. There are four types of seasons in the year. Each season has its specific Mizaj because of which it affects the temperament of an individual. If the temperament of human being and season become same, diseases having same temperament as that of the season and of human being may be developed. That’s why; Dam (blood) related diseases occur in Rabi,’ diseases related to Safra develop in the Saif (Summer) and diseases related to Sauda prevail in the Kharif, while Balghami diseases occur in the Winter season. The diseases occurring in the end and in the beginning of the season is related with both pre and proceeding season.
Habitat (residence/country/city):
Habitat of an inhabitant exerts its effect directly on human life by its specific temperament. For example, Northern countries with cold and dry temperament, Southern countries with hot and moist, Eastern countries with Mo’tadil temperament and Western countries with Mo’tadil mail ba Rutoobat (moderate tilt towardrutoobat) which is similar to the temperament of Mosame Kharif. Because of specific Mizaj (temperament/ climate) of habitat, some specific diseases, related to the temperament of the same, are developed. 32 For example, Inhabitants of hot places are generally of soft and delicate constitution of body, complexion of the body and hair are black. Similarly, inhabitants of cold places are usually strong and brave. Because, in cold temperament Hararate Ghariziah resides inside the body resulting in good digestion of inhabitants. If the temperament of these countries becomes damp or moist along with cold, persons living in these countries will become fleshy and fatty with inconspicuous veins (invisible). Inhabitants of damp countries are distinctly fleshy and fatty with soft and smooth skin. In dry countries, both winter and summer seasons are in their extreme condition, because of which temperaments of inhabitants of these places become dry, as a result their skin becomes rough and cracked. Their brain tends to be dry, because of which so many abnormal consequences may develop in the form of diseases. Residents of high altitudes are generally brave, strong and long lived. It is because of pure air having cold temperament which is present at these places.
Temperamental approach in promotion of health:
Health promotion is the process of enabling people to increase control over and to improve health. It is not directed against any particular disease but is intended to strengthen the host through a variety of approaches or interventions. The well-known interventions in this area are health education, environmental modification, life style and behavioural changes. The best possible ways of health promotion in Unani system of medicine is maintenance of balanced temperament. This system of medicine is a comprehensive medical system, which meticulously deals with the states of health and disease. The unique holistic approach of Unani medicine is its fundamental principles. The principles related to human biology are seven natural factors that make up the totality of a human being, viz. Arkan (Elements), Mizaj (Temperament), Akhlat (Humours), Aaza (organs), Arwah (Pneuma), Quwa (Faculties) and Afa’l (Functions). Among these principles, most important is mizaj (Temperament). The meaning of the word temperament according to Taber’s dictionary is “The combination of intellectual, emotional, ethical and physical characteristics of a specific individual”. While in Unani concept, Mizaj is the quality produced by the action and reaction of opposite qualities of building components. When these components interact by virtue of their respective qualities, a condition is achieved which is found in equal proportion in all the components of the compound this is called mizaj. It represents the physical and chemical properties of the body. Thus Mizaj can be described as the resultant quality that comes out of interaction amongst the constituents of a compound. Literal meaning of word mizaj is intermixing [1,2]. Temperament of a person is given great importance for identifying the most suitable diet and lifestyle for promoting the health of a particular individual. According to Hippocrates, it is more important to know what sort of a person has a disease rather than to know what sort of a disease person has. On the basis of Mizaj human beings have been categorized into four qualitative types: sanguinous (Damvi), bilious (Safravi), phlegmatic (Balghami), melancholic (Saudawi). They were supposed to result from predominant humor in the body [3]. Temperament of the body is specific for each individual fluctuating between certain minimum and maximum limits. Any change in the temperament of person brings about change in person’s state of health [4,5]. Therefore maintenance of balanced temperament under the varying conditions of life is necessary for the preservation of health and avoidance of disease in an individual. There are some factors like age, place, season, diet and occupation having their specific temperament, responsible for influencing the temperament of an individual and predispose them to a particular group of diseases. Thus, the people of specific temperament become prone to a particular group of diseases in different phases of their life and under different climatic conditions [4,5]. If a person of safravi Mizaj adopts haryabis tadabeer, then he becomes prone to develop diseases similar to the temperament of that individual like acute fevers, heat-stroke, dehydration, hypertension, insomnia, indigestion etc. Similarly, a person of balghami mizaj gets barid tadabeer; he will be more susceptible to develop diseases like hummae balghami, obesity, nervine diseases, female infertility, asthma [4,6] etc. So, it is necessary to be acquainted with those factors responsible for change in temperament of human beings and regimens to minimize the impact of these factors on the temffigurperament.
Damvi Mizaj (Sanguine temperament):
Identification
Persons of this temperament are characterized by well-formed and prominent joints, oval face, more muscular tissues than fat; hairs of head are thick and luxuriant. They are pleasantly warm to touch. Veins are mildly prominent and pulse is full and strong. They have good appetite, balanced and sound sleep, and good faculty of judgment. They get trouble with hot things and feel comfort with cold and dry things and in cold weather. Their digestive power is wonderfully good and appetite keen. An optimistic positive mental outlook, they are persuasive extrovert, have good 34 social skills. They have romantic nature, like to travel, play games and distractions, confident, poised, graceful and enthusiastic [7].
Signs of the dominancy of blood (Ghalbae dam):
The signs of dominancy of blood are very similar to those of quantitative plethora. There is feeling of heaviness of body, especially behind eyes and over the head and temples, Sweet taste in the mouth even without cause. Stretching and yawning are frequent. Excessive tendency to drowsiness and sleep perception is poor and mind dull. Fatigue is felt even without exertion. Tongue is usually red. Boils in the body and ulcers of tongue are common. There is bleeding from the gums, nostrils, and anus because the blood vessels of these parts are easily ruptured. The characteristic dreams of this type of humoral predominance are seeing of red things, flowing of blood and being immersed in blood. The dominancy of blood predisposes them to diseases like Hummyat matbaqa, inflammations, Chronic diarrhea, Bloody diarrhea, Epistaxis, Haemoptysis, Diphtheria, Epilepsy, Gout, Headache, Tonsillitis, Sarsame damvi, Sudae damvi, Zaghtud dam qawi, Conjunctivitis etc [7,8].
Regimens:
In order to remain healthy, they should adopt the following lifestyle factors: A) Avoid staying for long in hot and moist air. They can tolerate cold easily. B) Winter is the best season for damvi mizaj persons. C) They should preferably drink cold water and avoid excessive sugar, rich fatty foods and meat consumption. E) They should use barid-yabis foods. F) Exercise should be so gentle that there is no over production of heat in the body. G) Eliminative measures such as venesection and purgation should be carried out early in spring. H) They should gargle with decoction of Mastagi, Habbul aas, and Aaqirqarha for the evacuation of morbid matter present in the brain. I) Damvi mizaj persons are more susceptible to infectious diseases. So, they should use such drugs which have dafe taffun action. J) Excessive excitement, worry, anger or emotional excesses should be avoided [9].
Safravi Mizaj (Choleric temperament):
Identification
This temperament is marked by a medium stature, sharp angular features, medium/lean built, yellowish complexion, brilliant penetrating eyes, prominent veins and hairy body. Hairs are black, abundant, thick and curly. Pulse is rapid and strong. They feel comfort with cold things and get trouble with hot things. Most suitable season for them is winter. They have good digestion, sharp and quick appetite and sleep is light. They are energetic, bold, daring, and have brilliant intellect but they are impatient, irritable, and short tempered. Often they turned into fearless and rebellious leaders. They have strong inclination to indulge in sexual pleasure. They are indefatigable in their enterprises and most persistent, zealous, passionate and revengeful [7,9].
Signs of the dominancy of bile (Ghalbae safra):
Yellow colour of eyes and complexion, bitter taste in mouth, rough and dry tongue, excessive thirst, rapid pulse, lack of appetite, nausea with bilious vomiting of green or yellow colour, irritative diarrohea, frequent attacks of tingling in the skin, feeling of burning and irritation as from hot bath or exposure to sun are signs of predominancy of bile. Characteristics dreams of bile are seeing fire and flags of yellow colour. Dominancy of safra predisposes them to diseases like Hummae ghib, T.B., Sudae safravi, Urticaria, Hyperacidity, Erysipelas, Headache, Eyestrain, Hypertension, Stress, and Cardiovascular disorders [3,7,8].
Regimens:
A) Exposure to sun or hot climate should be avoided. B) They should live in a cool, fresh and properly ventilated environment. C) Winter season is beneficial for these persons, while they get trouble in summer, because bile increases in this season. So, Mukhrije and Mushile safra drugs should be used by these persons in summer like sikanjabeen, tamarhindi, Aalubukhara, Gule neelofar, Gule banafsha etc. D) They should use barley water during summer season. E) Massage with Roghan banafsha should be done in these persons. F) Persons of safravi mizaj should avoid hammam. G) They should take meals three times a day. H) They should avoid salty, fatty and fried foods and Ratab foods should be used by these persons like Cucumber, Water melon etc I) They should avoid excessive movement and strenuous exercise, time of exercise should be early in the morning or late in the evening. J) A good night sleep is essential for such type of temperament. K) Extreme emotions of anger, irritability, excessive talkativeness, and suppression of anger are emotional extremes for this kind of temperament. L) Bile should be eliminated with emesis, 36 purgation or both according to individual disposition. For purgation, banafsha, tamarind, halela zard should be given [9,10].
Balghami Mizaj (Phlegmatic temperament):
Identification
Individuals of this temperament are flaccid, obese with soft and flabby muscles, White complexion, thin and soft hairs. Blood vessels are not prominent and pulse is slow and infrequent. Their movements and activities are sluggish. They feel comfort with hot things and in hot weather. They have round face with full cheeks, large moist eyes, have medium to large frame, more fatty tissue than muscular tissue and bones are well covered. They are calm, have sentimental subjective thinking, emotional, sensitive, tends to be religious, their mind is foggy, and slow. They are sexually frigid and do not get angry easily. Their digestive organs are weak and slow, hence they have less appetite and poor thirst. They are lethargic, dull and take excess sleep. Their memory is poor and power of perception is slow and feeble [8,11].
Signs of the dominancy of phlegm (Ghalbae balgham):
Flabbiness of body, cold and moist skin, excessive salivation and viscid saliva, excessive sleepiness, mental dullness, soft and slow pulse, weak digestion, pale urine and dreams about water, ice, rain denotes excess of phlegm. Dominancy of phlegm predisposes them to diseases like Common cold, Ascites, Oedema, Hummae balghami, Pneumonia, Asthma, Paralysis, Obesity, Sarsame balghami etc. [4,12].
Regimens:
A) Cold air negatively affects them hence air conditioners and cold and wet environment should be avoided. B) They should use hot and dry foods and avoid cold foods. C) Lack of exercise and unnecessary rest during day time especially one hour before sunset should be avoided. They should indulge in strenuous exercise for longer duration. Aerobics is beneficial for them. D) They should get up early in the morning and avoid sleep after sunrise. E) Sweating is beneficial, it should never be suppressed and laxatives are also beneficial.
Saudavi Mizaj (Melancholic temperament):
Identification
These persons are characterized by lean and thin built, prominent bones, small beady eyes with sunken hollow cheeks and coarse and rough skin. They have dark complexion and profuse body hairs. Hairs are black and thin and have slow growth. Their digestion is weak, appetite irregular, sleep interrupted and often suffers from insomnia. Their touch is dry, leathery and cool. They have sluggish inclination towards sexual activity. They are analytical, detail oriented; retentive faculty of mind is well developed.
Signs of the dominancy of Sauda (Ghalbae sauda):
Dry and dark skins, anxiety, burning in epigastrium, false appetite, thick and turbid urine, dreams is usully full of anxiety and are often of dark places and fearful objects. Excess of sauda predisposes them to diseases like Leprosy, Hummae ruba, Splenomegaly, Constipation, Anorexia, Arthritis, Neuromuscular and Psychiatric disorders.
Regimens:
A) Ibne Rushd has advocated Dalak layyan, mild exercise, long sleep, and har-ratab foods for these persons. B) They should avoid staying in cold and dry environmental conditions for long. They need to be protected in dry weather conditions. Seashore and coastal areas are beneficial for their health. C) Melancholic should avoid old, dry and stale food, excessive beans, nuts, astringent foods, peanuts, tomatoes, brinjal and rancid fats are harmful for them even in small quantities. D) Tea, coffee and artificially flavored drinks should be avoided. E) Har-Ratab foods should be given to these persons like anjeer, maveez, Chana, lobiya, apple, anar shirin, turnip, ginger etc. F) Moderate and light exercise for short durations is best suited for such temperaments; especially walk for 15 minutes after dinner. G) They should go to bed early for 6–8 hours night sleep. They are more prone to insomnia. H) Feeling of loneliness, depression and grief can have much more negative influence especially if prolonged or excessive. I) They should drink at least 2-3 litres of water daily. J) Bodily wastes like urine and stool should never be suppressed. K) Sauda should be evacuated from the body. For this purpose haleelajat and bisfaij should be used. People of one type of temperament are prone to a particular group of diseases in different phases of their life and under different climatic conditions due to dominance of particular humor in 38 particular temperament. This susceptibility can be checked by adopting the temperament specific regimens given by Unani physicians. Hence, temperament based preventive approach of Unani medicine can offer a better way for promotion and preservation of health with least cost.
Relationship between Diseases and Temperament/Tadabeer/factors:
There is a close relationship between temperament and diseases. People of one type of temperament may be prone to develop a particular group of diseases in different stages of life and under different climatic conditions. For example, a person of cold temperament is generally prone to obesity and of hot temperament is prone to acute fever, heat stroke, dehydration, hypertension etc. There are some factors / tadabeer, having their specific temperament are responsible for influencing the temperament of an individual like, age, air, place, season, diet and occupation.
Diseases associated with Sue Mizaj Har (Sada) or aggravated by Har tadabeer are:
1. a. All Physiological functions aggravated by Sue Mizaj Har Sada are
• Body movement
• Growth of hair, teeth, body
• Speaking, thinking, decision taking
• Walking etc.
1. b. Following fevers frequently occur due to Sue Mizaj Har Sada and Hot tadbeer:
• Hummae Yaum
• Hummae Naeba
• Hummae Ghib
• Hummae Matbaqa
• Diabetes
• Headache
• Heat stroke
• Bodyache
• Headache, toothache
• Cough and common cold
• Asthma
• Chest Pain
• Coma
• Male and Female infertility
• Weakness in the Organs or body
• Pain in the ear
• Increased thirst
• Insomnia
• Onset of senility occurs rapidly due to increased dispersion of fluid
• Complexion of body becomes black
• Complexion of hair becomes black
• Digestion is weak
• Soft and delicate constitution of body
• Sudae Shirki Medi Har .
Diseases associated with Sue Mizaj Barid Sada or aggravated by Barid tadbeer / conditions:
• All physiological functions are diminished
o Metabolism o Elimination functions like smiting etc
o Walking
o Speaking etc.
• People of Sue Mizaje Barid Sada are more susceptible to develop “Sudda” (obstruction) which may cause so many diseases in the body for example:
o If sudda (obstruction) occurs in the brain vessels it may cause falij (paralysis).
o If it occurs in the vessels of the heart it may cause angina and M.I. 40
• Sue Mizaj Barid may cause obstruction in the arteries supplying genital organs because of which infertility may be developed.
• If Sue Mizaj occurs in deep vein of the body it may cause “Deep Vein thrombosis”.
Sue Mizaj Barid is the most common cause of A’sabi Amraz (Nervine diseases) like
o Istarkha
o R`asha o Ikhtilaj o Khadar
o Falij and Laqwah
• Buhtus Soat (hoarsness of voice)
• HummaeBalghamiah and mukhtalitah are more common in the person having sue mizaj barid
• Body ache
• Wajaul Mukassir
• Wajaul Khadri
• Weakness of the body more common
• Pain in ears
• Anosmia
• Cough and Common cold
• Asthma
• Chest pain
• Jooul Qalb
• Nafakh or flatulence
• Ascites
• Obesity
• Infertility (male and female)
• Sudae Barid Sada (Khibtah)
• Following symptoms may be developed due to Sue Mizaj Barid Kabid
o Loose motion
o Looseness in the body
o Tahabbuj (Swelling on the face)
o Decreased thirst.
o Lips becomes white etc.
Diseases associated with Sue Mizaj Ratab or aggravated by Ratab Tadabeer are:
• Hummae Balgahmiah
• Hummae Mukhtalitah
• Infections frequently
• Laziness
• Buhtus Soat (Hoarseness of voice)
• Increased sleep
• Chest pain
• Zo’fe hazm (Dyspepsia)
• General weakness
• Prolonged fevers
• Diarrhoea
• Piles
• Dysmenorrhoea
• Ulcers
• Fistulae.
• Epilepsy
• Stomatitis.
Diseases associated with Sue Mizaj Yabis or aggravated by Yabis Tadabeer / conditions are as:
• Humme Rubo’
• Laghri
• Asthma
• Anosmia
• Bodyache
• Zo`fe Aaza
• Male and female infertility
• Bad thinking
• Ikhtilate Aql, fear
• Chest Pain
• Suda’e yabis
• Suda’e Jimaee (headache due to Coitus)
• Fasadus saut
• Thin and cracked skin
Diseases associated with Sue Mizaj Murakkab (Har Ratab) or aggravated by Har Ratab Tadbeer / condition are:
• Hummyat
• Chronic diarrhoea
• Epilepsy
• Bloody diarrhoea
• Epistaxis
• Inflammatory diseases and boils
• Haemoptysis
• Paralysis
• Diphtheria
• Cough
• Joints pain due to excitation of Balgham
• Deafness
• Diseases in the eyes as false membrane is formed in eye
• Headache develops frequently
• Digestion becomes weak (indigestion)
• Gout
• Itching
• Blisters in mouth
• Epilepsy
• Insomnia
• Loose motion
• Tonsillitis
• Perotitis
• Chronic fever
• Wounds in lungs
• Akhlat and Arwah become disturbed because of which many diseases may develop
• Piles
• Conjunctivitis for short period
• Decreased appetite
• Asthma with cough
• Abortion
• Falghamooni (Sarsame Damvi)
• Dawar (Vertigo)
• Sakta
• Usrul Bala (Difficulty in swallowing)
• Sudae Damvi
• Zaghtud Dam Qawi (HT)
• Malancholia
Diseases associated with Sue Mizaj Haryabis or aggravated by Har Yabis Tadabeer / conditions are:
• Hummae Ghib
• Ulcers in lung
• Epilepsy
• Loose motion
• Looseness of bowl
• Conjunctivitis
• General weakness
• Earache
• Erysipelas
• Hummae Matbaqa
• TB.
• Haemoptysis
• Inflammatory conditions
• Sudae Safravi (Bilious headache)
• Usrul Bala due to Safra
• Dawar (Vertigo) due to safra
• Darde Meda (Safravi)
Diseases associated with Sue Mizaj Barid Ratab or aggravated factors or Tadabeer are:
• Common cold
• Pneumonia
• Throat pain
• Chest pain
• Back pain
• Zatul Janb( Pleuritis)
• Hoarseness of voice
• Nervine diseases like
o Paralysis
o Bell’s palsy
o Isterkha
o Ikhtilaj
o Tashannuj
• Dribbling of urine
• Secretion from eyes, nose
• Sudae Balghami
• Dawar (Vertigo)
• Coma
• Fasade Zikr
• Epilepsy
• Saktah
• Tamaddud
• Kuzaz (Tetanus)
• Siqlul Lisan
• Usrul Bala (Difficulty in Swallowing)
• Sarsame Balghami (Lisurghus)
• Fasadus Saut
• Asthma.
Diseases associated with Sue Mizaj Barid Yabis or aggravated by Barid Yabis Tadabeer / conditions are:
• Common cold
• Asthma
• Piles
• Pleuritis
• Ulcer in lungs
• Cough frequently
• Chest pain
• Fasade Zikr
• Malancholia
• Qutrub (Type of mania)
• Epilepsy
• Saktah
• Darde me’da
• Usrul bala
• Insomnia
• Cancer
• Qooba
• Dry eczema
• Irritation in the eyes
• Constipation
• Increased urination
• Female infertility
• Severe labour pains
• Vomiting (ferquently)
• Dawar
• Jumood
• Irregular fever
• Hummae ruba (Quartern fever)
• Dysurea
• Spleeenomegaly