Maarifat e Tib Course / Umoor e tabiya / Kulliyat / Principles of Eastern Medicine
Humors (Akhlat)
Akhlat are the fluid components of the body produced after the metabolism of elements. They are crucial for nutrition, growth, repair, and energy production, which preserves both the individual and the species. A proper balance and distribution of these fluids, in the right quantities and qualities, are essential for health; any imbalance can lead to disease.
Humors, or Akhlat, are the body’s structural components made from various elements and natures in different mixtures, proportions, and combinations. They are considered primary body fluids resulting from digested food and are essential building blocks for organs and the body.
Avicenna acknowledged these four primary humors and introduced the concept of secondary humors found in the intracellular and extracellular fluids of tissues. According to Avicenna, the primary humors come from food digestion and are used for organ growth, repair, and energy production.
Each person has a unique humoral constitution representing their healthy state. The body possesses a self-preservation or adjustment power called Quwwat-e-Mudabbira (Vital Force), which maintains the correct humoral balance. When this power weakens, humoral imbalance and disease occur. Unani Medicine relies heavily on this power, and its treatments aim to restore it, thus maintaining humoral balance and health. Proper diet and digestion are also crucial for this balance.
The Four Humors act as metabolic agents of the Four Elements in the human body, and their right balance and purity are essential for health. The Four Humors and their corresponding elements are:
– Blood – Air
– Phlegm – Water
– Yellow Bile – Fire
– Black Bile – Earth
These humors are present in the bloodstream in varying quantities:
– Blood (Sanguine humor) is the red, hemoglobin-rich portion.
– Phlegm (Phlegmatic humor) is the clear plasma portion.
– Yellow Bile (Choleric humor) is a slight residue, bilirubin, giving a yellowish tint.
-Black Bile, or the Melancholic humor, is present as brownish grey sediment with platelets
and clotting factors.
Digestion: Origin and Metabolism of the Four Humors
The Four Humors are responsible for the nutrition, growth and metabolism of the
organism. They originate in the digestive process.
In Eastern Medicine/ Unani Medicine/Greek Medicine, digestion happens in four stages:
The First Digestion happens in the gastrointestinal tract, and produces chyle; its waste product
is the feces, or stool.
The Second Digestion happens in the liver, and produces the Four Humors. Its wastes are
eliminated via the bile, urine and sweat.
The Third Digestion happens in the blood vessels, and feeds the principal organs of the
body. Its wastes are eliminated via the urine and sweat.
The Fourth Digestion happens in the tissues, and is the final congellation of the Four Humors
into living tissue. Its wastes are eliminated similarly to the Third Digestion.
The Four Humors originate in the liver in the Second Digestion as follows:
Blood, or the Sanguine humor, is the first to arise, and receives the richest, choicest share of
nutrients. It is the most plentiful humor, and enters the general circulation.
Phlegm, as Plasma or the Phlegmatic humor, is the second to arise and receives the next richest
share of nutrients. It is also very plentiful, and enters the general circulation.
Yellow Bile, or the Choleric humor, is the third to arise and receives a rather coarse, meager
(scanty) share of nutrients. It is not so plentiful. Only a slight residue enters the general
circulation; the rest is stored in the gall bladder, its receptacle, to be used as needed.
Black Bile, or the Melancholic humor, is the last to arise, and receives the coarsest, most meager
share of nutrients. It is the least plentiful. Only a slight residue enters the general circulation; the
rest is stored in the spleen, its receptacle, to be used as needed.
The first two humors, blood and phlegm, are moist and flourishing, and are the metabolic agents
of the Wet elements – Air and Water, respectively. Most of the nutrition, growth and metabolism
of the organism depend on them.
The last two humors, yellow bile and black bile, are dry and effete, and only needed by the
organism in small amounts. They are the metabolic agents of the Dry elements. Fire and earth,
respectively. Although only needed in small amounts, they are potent and essential catalysts where
needed.
Classification of Akhlat (Humours):
1. According to their locations.
2. According to their colour.
3. According to their body needs
The above mentioned three types of Akhlat are specific for individual types of cells and tissues,
they articulate to form specialized organs and to assist their physiological functions. Their volume
and consistency in term of biochemical analysis are indicators for disease states i.e. they provide
means of laboratory diagnosis.
4. According to their conditions
Primary fluids
Secondary fluids
• Rutubat Mahshura (Encircled fluid)
• Rutubat Talliyah (Interstitial fluid)
• Rutubat Qaribah ( Congealed type fluid)
• Rutubat Manwiyah (Seminal fluids)
5. According to their qualities-
• Latafat/ fineness
• Kaseef /coarseness
6. According to their nature
• Taba’iyah (normal)
• Ghair Taba’iyah (abnormal)
Classification of Akhlat Humours according to location:
Al-Rutubat al- Ustaqussiyah
It is the khilt / humours responsible for binding the organs together. It is present in the cells and
may be identified as the intracellular fluid or protoplasm of the cell, which is the unit of az’a
mufradah( tissues). This khilt is supposed to establish the internal environment of the cells, and
the mizaj (normal temperament/ quality) of each type of cells depends upon specific predominant
type of khilt. This khilt is also called rutubat asliyah, rutubat ghariziyah or rutubat ula.
Rutubat al- Uruq
This fluid is present in the vessels i.e in arteries and veins.
Rutubat al- Tajawif
This fluid is present in the spaces between the cells, the tissues spaces and various cavities of the
body. This humour is identified as the tissue fluid, intercellular fluid and trans-cellular fluid.
Classification of humours according to color:
On the basis of color there are four major divisions of akhlat (humours)
• Red Dam
• White Balgham
• Yellow Safra
• Black Sauda
Classification of Akhlat according to their body needs
There are two such kinds:
• Akhlate mehmuda (Good humours)
• Akhlate Ghair mehmuda (Bad Humours)
Akhlat e Mehmuda:
These are produced in a normal way and perform specific physiological functions, for example:
• Normal blood and its constituents Dam taba’i
• Normal bile Safra taba’i
• Normal phlegm Balgham taba’i
• Normal black bile Sauda taba’i
Akhlat e Ghair Mehmuda
These are produced as a result of metabolism and do not perform specific physiological function
and are therefore expelled out of the body, for example:
• Urine
• Stool
• Menstrual blood
Classification of Akhlat according to their conditions:
Ibn Sina has divided all fluids of the body into two kinds
• Primary fluids Rutubat Ula
• Secondary fluid Rutubat Thaniya
Primary fluids/Rutubat e Ula
The four fluids that circulate within the blood vessels are called primary fluid rutubat ula.
Rutubat Thaniyah/ Secondary fluid
All those fluids of the body which are converted from primary condition to secondary and have
diffused into the organs but they have not become the part of the a’za mufradah (tissue-cells)
practically.
These are four in numbers
• Rutubat mashurah or the encircled fluid
• Rutubat talliyah or the interstitial fluid
• Rutubat Qaribah bi-in eqad or nearly congealed fluid
• Rutubat Manwiyah or the seminal fluid
Classification according to their Quality:
These are of two such types
Akhlat e latifah
Those fluid or part of the fluid that have the property of diffusing into the aza mufrida cell or
tissues. When the combine with Ruh (OXYGEN) they produce quwa energy to perform various
physiological functions in the body.
Akhlat e Kathifah
Those fluids or parts of fluids which perform the functions of takwin anabolism and become part
of the organs. They replace wear and tear and promote growth.
Classification of Akhlat According to their nature:
Akhlat Taba’iyah
When all the humour or akhlat are normal with reference to their quantity and quality are called as
akhlat e taba’i.
Akhlat e Ghair taba’iyah
When the quality and composition of normal akhlat is altered due to any cause, ita behavioural
patteren or tempered is altered. Hence it is called Akhlat e Ghair taba’iyah.
The invention of the microscope has taken us away from the source and origin of the problems
associated with disease. For example, most physicians would attribute an infection to one or more
bacteria and will produce actual living specimens of those bacteria which they say caused such
and such an infection. From the Unani Unani point of view, the deviation from the normal state of
the humor provided a suitable environment for the bacteria to grow to larger than normal
populations. While admitting the existence of the bacteria, the Unani scientist must look deeper to
the cause of the imbalance in the humor and its characteristic temperaments. Thus, the mode of
current medical practice that “attacks” the red- and white-cell-forming organs does not take into
account the fact that blood itself is living and not simply a conglomerate of chemical components.
Thus in Unani, the dictum “Health is a harmony of the humors” is the only valid point of view if
one desires to cure the cause of the disease. Chemical destruction of the abnormal growth of
microscopic life may result in a temporary decline or total eradication of the population of
microorganisms, but if the imbalance of the humor is not corrected, the disease will recur or will
arise in another place in the body. More important, the dramatic effects of the chemical drugs
themselves on the humors result in new imbalances, as evidenced by the many so-called side
effects of drugs.
Characteristic features of the four humours:
Sanguine
The sanguine temperament is traditionally associated with air. People with this temperament tend
to be lively, sociable, carefree, talkative, and pleasure-seeking. They may be warm-hearted and
optimistic. They can make new friends easily, be imaginative and artistic, and often have many
ideas. They can be flighty and changeable; thus sanguine personalities may struggle with following
tasks all the way through and be chronically late or forgetful.
Choleric
The choleric temperament is traditionally associated with fire. People with this temperament tend
to be egocentric and extroverted. They may be excitable, impulsive, and restless, with reserves
of aggression, energy, and/or passion, and try to instill that in others.
They tend to be task-oriented people and are focused on getting a job done efficiently; their motto
is usually “do it now.” They can be ambitious, strong-willed and like to be in charge. They can
show leadership, are good at planning, and are often practical and solution-oriented. They
appreciate receiving respect and esteem for their work.
Melancholic
The melancholic temperament is traditionally associated with the element of earth. People with
this temperament may appear serious, introverted, cautious or even suspicious. They can become
preoccupied with the tragedy and cruelty in the world and are susceptible to depression and
moodiness. They may be focused and conscientious. They often prefer to do things themselves,
both to meet their own standards and because they are not inherently sociable.
Phlegmatic
The phlegmatic temperament is traditionally associated with water. People with this temperament
may be inward and private, thoughtful, reasonable, calm, patient, caring, and tolerant. They tend
to have a rich inner life, seek a quiet, peaceful atmosphere, and be content with themselves. They
tend to be steadfast, consistent in their habits, and thus steady and faithful friends.
People of this temperament may appear somewhat ponderous or clumsy. Their speech tends to be
slow or appear hesitant.
State of Dominance of a Humour:
Yellow bile
(1) Feelings of uncomfortable heat,
(2) Great suffering from fevers,
(3) Easily fatigued, as activity stimulates further production of heat,
(4) Excessive thirst,
(5) Burning and irritation in the pit of the stomach (epigastrium),
(6) Bitter taste in the mouth,
(7) pulse weak, rapid, and fast,
(8) Intolerance of hot foods,
(9) Relief and comfort from use of cold foods and other cold things,
(10) Great suffering in summer,
(11) Inflammatory conditions, and
(12) Fatigue and loss of energy.
Causes
(1) Immoderate movement, either of the spirit or the body (motion of the spirit means things like
anger or worry; motion of the body means physical exercise);
(2) Exposure to actual warmth (heat of fire, sun, etc.);
(3) Entry into the body of “potential” warmth (eating hot foods such as onions, garlic, mustard);
(4) Closing of the pores; and
(5) Putrefaction.
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, purgation or both according to individual disposition.
For purgation, banafsha, tamarind, halela zard should be given.
Phelgm
(1) weak digestion, the head is heavy,sleep prolonged
(2) diminished desire for drinks, laziness of movements, little appetite
(3) laxity of joints, slow in his gait, intelligence is slow
(4) tendency to phlegmatic type of fevers and catarrhal conditions,urine dense,
(5) cold things easily upset and hot things are pleasant and beneficial, and
(6) great suffering in winter.
Causes
(I) exposure to actual cold (snow, winter air, etc.);
(2) ingesting substances with “potential” cold (foods such as cucumber and yogurt);
(3) excess of substances that overwhelm the innate heat;
(4) lack of nutrients that produce heat (fasting);
(5) excess thickening of the residues of metabolism, which extinguishes innate heat;
(6) excess of heat in the body for a prolonged period, causing destruction of the heat regulation
function of the body (fever);
(7) excessive motion; and
(8) excessive rest.
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.
Blood
Signs are almost similar to excess of cold, but in addition there will be
(1) puffiness, heaviness of head, heaviness of shoulders, nose bleeding,
(2) excessive salivation (mucus in saliva) and nasal secretion,
(3) tendency to diarrhea and upset stomach,
(4) desire for moist type of foods,
(5) excess of sleep, and
(6) puffiness of eyelids.
Causes of this imbalance:
(1) exposure to moistening substances (baths);
(2) moisture reaching inside the body from moistening foods (fish);
(3) excess intake of food and beverages (gluttony); and
(4) emotional excess (life of ease and weakness of character).
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].
Black bile
(1) dryness and roughness of skin,
(2) insomnia,
(3) Sadness, restlessness, without agitation
(4) intolerance of dry type of foods, while moistening foods will give comfort and pleasure,
(5) The urine is white, not very dense,
Causes
(1) exposure to actual dryness (winds);
(2) administration of drying substances (vinegar, salt);
(3) lessening intake of food and beverages (starvation, fasting); and
(4) Anxiety, Permanent sadness and misery.
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.