COPYRIGHT NOTICE

Ibn Sina Institute of Tibb

PO Box 72449, Parkview, 2122, Johannesburg
2 Loch Avenue, Parktown, Johannesburg, 2193
Tel: 010-060-0865
Email: [email protected]
Website: www.tibb.co.za
ISBN: 978-0-620-78786-4

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given at all relevant times, notwithstanding the fact that authorization
may have been granted by the copyright owner. Any unauthorized
reproduction of this work will constitute a copyright infringement and
render the doer liable under both civil and criminal law.
 Dedication

To my wife, children and grandchildren for living a ‘Tibb’ life

The Ibn Sina Institute of Tibb, a Public Benefit Organisation
(PBO 930008393) was established by the Bhikha Family Trust in
1997 with the vision of assisting in the provision of effective, afford-
able healthcare. The Institute is academically supported by Hamdard
University Pakistan, Jamia Hamdard and Aligarh University, both from
India, as well as local tertiary institutions.

Among the objectives of the Institute is the promotion of the training

and practice of Tibb by facilitating the training of Tibb doctors, as well
as introducing the Tibb concepts of treatment and health promotion to
other healthcare practitioners.
CONTENTS
FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII
CHAPTER 1:
PHILOSOPHY OF TIBB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
DEFINITIONS AND DESCRIPTIONS . . . . . . . . . . . . . . . . . . . . . 1
NATURE OF HEALTH AND DISEASE . . . . . . . . . . . . . . . . . . . . . 4
HISTORY OF TIBB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
MAIN AXIOMS OF TIBB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
UNIQUE FEATURES OF TIBB . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
COMPARISON: TIBB AND CONVENTIONAL MEDICINE . . . . . 12
TIBB CONCEPT: PHYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
TIBB CONCEPT: CREATION . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
TIBB CONCEPT: QUALITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
TIBB CONCEPT: TEMPERAMENT . . . . . . . . . . . . . . . . . . . . . . 31
TIBB CONCEPT: THE HUMOURS . . . . . . . . . . . . . . . . . . . . . . . 38
TISSUES AND ORGANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
THE TIBB THREE-ORGAN THEORY . . . . . . . . . . . . . . . . . . . . . 45
ENERGY, FACULTIES AND FUNCTIONS . . . . . . . . . . . . . . . . . 47
TIBB CONCEPT: THE LIFESTYLE FACTORS . . . . . . . . . . . . . 51
THE AXIOMATIC CONNECTION . . . . . . . . . . . . . . . . . . . . . . . . 53
HOLISM IN TIBB - THE WHEEL OF LIFE . . . . . . . . . . . . . . . . . 57
TIBB: A SCIENCE OF MEDICINE, THE ART OF CARE . . . . . . . 58
CHAPTER REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
 CHAPTER 2:
AETIOLOGY IN TIBB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
PRINCIPLES OF CAUSE AND EFFECT . . . . . . . . . . . . . . . . . . 64
CAUSES ASSOCIATED WITH HUMOURS . . . . . . . . . . . . . . . . 70
CAUSES OF DISEASE ASSOCIATED WITH
TEMPERAMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
CAUSES ASSOCIATED WITH FUNCTION . . . . . . . . . . . . . . . . 72
CAUSES ASSOCIATED WITH THE LIFESTYLE FACTORS . . . 72
ENVIRONMENTAL AIR AND BREATHING . . . . . . . . . . . . . . . . . 74
FOOD AND DRINK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
MOVEMENT AND REST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
OUR EMOTIONAL STATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
SLEEP AND WAKEFULNESS. . . . . . . . . . . . . . . . . . . . . . . . . . . 96
ELIMINATION AND RETENTION . . . . . . . . . . . . . . . . . . . . . . . . 98
OTHER LIFESTYLE FACTORS . . . . . . . . . . . . . . . . . . . . . . . . 101
LIFESTYLE PROGRAMMES FOR DIFFERENT
TEMPERAMENTAL TYPES . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
CHAPTER REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
CHAPTER 3:
PATHOLOGY IN TIBB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
DEFINITIONS AND DESCRIPTIONS . . . . . . . . . . . . . . . . . . . 108
COMPARISON: TIBB AND WESTERN MEDICINE . . . . . . . . . 110
HUMOURS WITHIN THE CONTEXT OF PATHOLOGY . . . . . 115
PATHOLOGICAL PROCESSES AND PATHWAYS IN TIBB . . 124
ILLNESSES ASSOCIATED WITH HUMORAL . . . . . . . . . . . . . 132
IMBALANCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
PATHOLOGICAL PROCESSES FROM OTHER . . . . . . . . . . . 136
INFLUENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
QUALITIES AND PATHOLOGICAL PROCESSES . . . . . . . . . . 142
INFLAMMATION: THE TIBB INTERPRETATION . . . . . . . . . . . 145
STAGES OF DISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
THE ROLE OF PHYSIS DURING PATHOLOGICAL . . . . . . . . 152
PROCESSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
CHAPTER REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
CHAPTER 4:
DIAGNOSIS IN TIBB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
DEFINITIONS AND DESCRIPTIONS . . . . . . . . . . . . . . . . . . . 158
COMPARISON: TIBB AND WESTERN MEDICINE . . . . . . . . . 159
THE TIBB APPROACH TO DIAGNOSIS . . . . . . . . . . . . . . . . . 163
STEPWISE DIAGNOSTIC PROCEDURE . . . . . . . . . . . . . . . . 165
PULSE ANALYSIS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
TONGUE DIAGNOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
URINE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
STOOL ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
CHAPTER REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
CHAPTER 5:
THERAPEUTICS IN TIBB . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
DEFINITIONS AND DESCRIPTIONS . . . . . . . . . . . . . . . . . . . . 188
COMPARISON: TIBB AND WESTERN MEDICINE . . . . . . . . . 189
PHYSIS AND THE BODY’S HEALING PROCESSES . . . . . . . 191
THERAPEUTIC GUIDELINES FOR CLINICAL DISORDERS . 193
PHARMACOTHERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
LIFESTYLE MODIFICATION AND EMOTIONAL SUPPORT
THERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
ELIMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
INDUCED MODES OF ELIMINATION . . . . . . . . . . . . . . . . . . . 234
SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
TIBB AND INTEGRATIVE MEDICINE . . . . . . . . . . . . . . . . . . . . 251
CHAPTER REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
ANNEXURE 1:

ARABIC TRANSLATION OF ENGLISH TERMINOLOGY . . . . 263

ANNEXURE 2:
PERSONALISED LIFESTYLE PROGRAMME FOR
DIFFERENT TEMPERAMENTAL COMBINATIONS . . . . . . . . 266

ANNEXURE 3:
PULSE DIAGNOSIS: AFFECTED ORGANS/SYSTEMS . . . . . 281
 FOREWORD

FOREWORD

I first met Prof Rashid Bhikha, Founder of the Ibn Sina Institute of
Tibb, South Africa, in May 2001 when he participated in a conference
at Aligarh Muslim University. Further to the books he has already pub-
lished over the past years, I am pleased about the publication of this
reference text book which details and explains the theoretical prin-
ciples of Tibb.

This healing paradigm originates in Ancient Greece, although its roots

can be traced back to Egypt at the time of the Pharaohs, and to the
contemporary Mesopotamian civilisation. One important aspect of
Tibb – herbal medicine – was prominent back in ancient Egypt, where
botanical remedies occupied a primary place in the management of
diseases prevalent at the time. The Greek period of Tibb begins with
Aesclepius (around1200 BCE), a great scholar who refined the art
and practice of medicine at the height of medical knowledge of Egyp-
tian and Babylonian healing.

The Greek philosopher/physician Hippocrates (460-370 BCE) freed

medicine from the realm of superstition and magic, and conferred on
it the status of science. As a matter of fact, the theoretical framework
of Greek medicine is firmly based on the teachings of Hippocrates. To
develop medicine as a systematic science, he emphasised the natural
causes of disease, and recorded the medical knowledge existing at
the time. He laid the fundamental principles of Hippocratic medicine,
and these still hold good in the field of today’s scientific medicine.

After Hippocrates other Greek scholars, particularly Galen (129-200

CE), developed and enriched the system. This laid the foundations
on which Arab physicians like Rhazes (865-925 CE) and Avicenna
(aka Ibn Sina: 980-1037 CE), during the ‘Golden Islamic Age’ of con-
tribution to medicine, established an impressive healing paradigm.
The system rapidly diffused throughout Egypt, Syria, Iraq, Persia,
India, China and others Middle East and far Eastern countries, be-
coming further enriched in the process.

i
 FOREWORD

Tibb is known by different names in different parts of the world as

Graeco-Arab Medicine, Ionian Medicine, Arab Medicine, Islamic Med-
icine, Traditional Medicine and Oriental Medicine and as Unani Medi-
cine in the Indian subcontinent.

Those interested in the history of medicine will find that the practice of
medicine has had to face unique conditions from the very beginning;
it could never become a pure ‘Science’ because it concerns humans,
who by their very nature are constituted of matter and mind. Nor could
it remain pure ‘Art’ because it has to deal with many concepts and
postulates which give it the status of science. This dual character of
medicine and its relationship to human beings has been the cause of
eternal controversy whether it is an art or a science. This controversy
has never been finally resolved: sometimes it is regarded as ‘Art’,
whereas at other times it is considered as ‘Science’. As far as the
ancient philosophers were concerned, they recognised both aspects
of medicine.

In this book Prof Bhikha deals with this dilemma with his description
of Tibb as ‘A Science of Medicine and the Art of Care’ by referring to it
as a ‘Science of Medicine’ as it is based on the principle of cause and
effect as described by Ibn Sina; and the ‘Art of Care’ with respect to
health promotion and the treatment of illness taking into account the
physical, mental, emotional and spiritual aspects of the human being.

Whilst it is well established that conventional, Western medicine has

the same roots as Graeco-Arab Medicine. Western medicine has
moved away from the holistic approach of the ‘Fathers of Medicine’
Hippocrates, Galen and Ibn Sina. Ironically Graeco-Arab Medicine
has been reduced to one of many ‘Complementary Medicines’ in
Western circles.

This present book may therefore be considered to set the things in the
true perspective. The correct portrayal of theories and philosophies
of Tibb system of healthcare detailed in the text will lead to a better
appraisal of healing, and directly result in a more accurate orientation

ii
 FOREWORD

of diagnostic principles and healthcare management which will ulti-

mately be in the larger interest of human health and healing.

I strongly maintain that this book is another milestone in our under-

standing of the letter and spirit of medical education. Prof Bhikha
deserves our full, sincere commendation for his efforts in this complex
area. I am confident that this book will fulfil a long time need for
elucidation of this supremely important subject.

Dr Mohammad Khalid Siddiqui

Former Director General
Central Council for Research in Unani Medicine
Ministry of Health & Family Welfare
Government of India

iii
 INTRODUCTION

INTRODUCTION

My Tibb journey began more than twenty-five years ago when my

youngest daughter was diagnosed with fibrosing alveolitis and a prog-
nosis of merely six months to live. A pharmacist at the time, deal-
ing with such a traumatic illness so close to home, made me realise
that whilst Western Medicine has made great strides in technological
advancements especially with regards to diagnostic procedures and
emergency care, there was limited understanding of the causes of
disease and the treatment options that could be offered. This turn-
ing point made me realise that focusing on the pharmacokinetics and
pharmacodynamics of Western medication was only one aspect of
the puzzle of understanding aetiology, pathology, diagnosis and treat-
ment. The medical care offered to my young daughter highlighted
several limitations of current Western medicine, whose philosophy is
based largely on the germ theory and doctrine of specific aetiology,
where most illness conditions are linked to a single cause, either a
micro-organism or a distortion of a biochemical or physiological
nature.

My personal experience sparked the catalyst to research a health

system that could have a better understanding of not only treatment
methods, but also the ‘causes’ of illnesses. After years of research
into different philosophies of healthcare, including, amongst others,
Ayurveda and Chinese medicine, I uncovered the hidden history
of medicine. Founded and refined by the fathers of medicine -
Hippocrates, Galen and Ibn Sina this scientific and tested approach
to health that most Western trained practitioners are not even aware
of. I endeavoured to study this theory and practice of medicine, which
over the centuries has been known by different names such as Greco-
Arab medicine, Western herbal medicine, Unani medicine and simply
as Tibb.

Tibb places equal emphasis on the treatment of illness and the main-
tenance of health. Whilst the name ‘Tibb’ does differentiate what we
do from Western medicine, it is in fact simply the Arabic word for

IV
 INTRODUCTION

‘medicine’ and expresses our willingness to incorporate any medical

knowledge and practice that coincides with the basic philosophy of
the founders of medicine.

In 1994, in order to research and study the philosophy of Tibb, I met

with Hakim Mohamed Said of Hamdard University in Pakistan for
academic support. To this day, the Institute is academically supported
by the University through the munificence of Mrs Sadia Rashid, and
Dr Navaid ul Zafar. Inspired by the legacy of Hakim Said, and after
attending training in Unani-Tibb for healthcare professionals designed
by Hamdard University, I established the Ibn Sina Institute of Tibb in
1997, to promote the training and practice of Tibb in South Africa.

To achieve this, three tasks had to be achieved; Firstly, official rec-

ognition of Unani-Tibb with the South African Department of Health
was imperative. This was achieved in September 2001, when Unani-
Tibb was included as the eleventh modality under the auspices of
the Allied Health Professions Council of South Africa together with,
amongst others Homeopathy, Naturopathy, Ayurveda and Chinese
Medicine. Secondly, the inclusion of Unani-Tibb medication as one of
the categories of Complementary medicines with the Medicine
Control Council of South Africa had to be initiated. This was accom-
plished in July 2002. Finally, establishing the training of Unani-Tibb
doctors had to be realised. This was attained in the 2003 academic
year at the University of the Western Cape (UWC)’s School of Natural
Medicine (SoNM), where training at both a Postgraduate and at an
Undergraduate level commenced.

To ensure that the facilitation of Unani-Tibb at UWC was in keeping

with international standards, Dr Abdul Haq was seconded from Ham-
dard, Pakistan in 1998 to assist with curriculum development.
Training was further supported by Dr Mohammad Khalid Siddiqui,
former Director General of the Central Council for Research in Unani
Medicine (CCRUM), and Prof. Anis Ansari, former Advisor of the
Central Council of Indian Medicine, Ministry of AYUSH, Department of
Health and Welfare, Government of India.

V
 INTRODUCTION

In November 2002, before the training of Unani-Tibb commenced at

UWC, a review of the training material was conducted. The review
committee included Prof. Jamil Ahmad from Jamia Hamdard Univer-
sity, India and Prof. Hakim Abdul Hannan from Hamdard University,
Pakistan. A second Curriculum Review Workshop was held in May
2010 with participation from representatives from the University of
Kwa-Zulu Natal, Cape Peninsula University of Technology as well as
academics from Hamdard University, Pakistan, Indian Foundation for
Traditional Knowledge, Jamia Hamdard and Aligarh Muslim
University from India.

In addition to the formal Curriculum Review with participation from

international experts, research, has been an important activity of the
Institute. Both research reviews as well as on-going research projects
have been conducted at the Institute’s Treatment Centres in Cape
Town (Langa 2006, Saartjie Baartman 2008), which have been estab-
lished for the clinical practice of Tibb and UWC’s Unani-Tibb students.

The continuation of the training and practice of Tibb in South Africa

has remained a focus of the Institute of Tibb. Early in 2017, an excit-
ing development, which would further our education endeavours, was
the offer from Lambert Academic Publishing in Germany to publish
and distribute books on behalf of the Institute. This, together with a
request from Dr Barrie Oldham, founder and Chairman of The Centre
for Bio-Regulatory Medicine to establish the training of Unani-Tibb in
Greece was the stimulus for the compilation of this reference book.

As a comprehensive overview of philosophy, aetiology, pathology,

diagnosis and treatment from a Tibb perspective, this reference book
is aimed at medical professionals trained in Western medicine, wish-
ing to integrate the principles of Tibb into their current practice. This
book may further contribute positively to undergraduate students of
Unani-Tibb.

Prof Rashid Bhikha

January 2018

VI
 ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS

Before acknowledging the individuals who were directly involved in

the completion of the book I would like to take this opportunity to
thank the many students with whom I have interacted during the lec-
ture sessions of the first six years of training of Unani-Tibb at the
School of Natural Medicine, University of the Western Cape, South
Africa. In addition, interaction with, and reviewing of the case studies
and research activities with Tibb doctors at the Tibb treatment centres
in Cape Town has been invaluable in my further understanding of the
Tibb principles in medical practice. For me this interaction was, and
will always be, an essential component in the development and
implementation of Tibb.

With reference to the successful completion of this reference book, it

would not have been possible without contribution from the medical
team at the Institute, including Dr Hakim Abdul Haq, Dr Joy Saville,
Dr Yumna Abrahams, and especially Dr John Glynn for his immense
dedication, commitment and guidance during the task of finalising this
book. A special thanks is also extended to Magdalene du Sart, my
personal assistant, for the many hours of typing and re-typing.

Of special significance is the contribution of the following persons who

reviewed the contents of this book: Prof. M M Wamiq Amin - Dean,
Faculty of Unani Medicine Aligarh Muslim University; Prof. Shakir
Jamil, School of Unani Medicine, Jamia Hamdard University and
former Director General, CCRUM; Dr Merajul Haqur - Research
Officer CCRUM; Prof. Hakim Abdul Hannan - Former Vice
Chancellor, Hamdard University Pakistan; Dr Mohammad Khalid
Siddiqui - Former Director General CCRUM and Advisor to Hamdard
Archives and Research Centre; Dr Mujeeb Hoosen - Head of Unani-
Tibb, UWC; Prof Mutaq Ahmed - former Unani Chair UWC; and Dr
Barrie John Oldham - The Centre for Bio-Regulatory Medicine.

A special thank you to Dr Ghazala Javed, from the CCRUM, who not
only contributed towards reviewing the contents of the book, but is

VII
 ACKNOWLEDGEMENTS

actively supporting the establishment of the training of Unani-Tibb in

Greece.

Finally, I am most grateful to my family for their continuous support of

all activities at the Institute. My wife Mariam, who remains my
greatest support and pillar of strength. My daughters, Nasira and
Nasima, for their work at the Institute since its inception.

Nasira, for the proof-reading and editing of this book. My son, Zain,
who ably manages the product division of Tibb in South Africa and my
youngest daughter, Zaheera, who overcame illness and whose test
became my life journey.

Above all, my gratitude to the Almighty for the opportunity to serve

others in health.

God Bless
Rashid Bhikha
January 2018
Johannesburg
South Africa

VIII
 PHILOSOPHY OF TIBB

CHAPTER 1: PHILOSOPHY OF TIBB

INTRODUCTION

Tibb is a total system of healthcare, based on the original principles of

medicine practiced by Hippocrates, Galen and Ibn Sina (Avicenna),
the founders of present day medicine. It includes the basic principles
of modern clinical science, embracing both its theory and practice.
Tibb recognises the physical, mental, emotional, and spiritual origins
of both health and illness. It promotes the early diagnosis of possible
predispositions to diseases, well before physical symptoms appear.
This prevents these diseases from appearing in a more severe form.
Thereafter, treatment is integrative – combining various therapies in
response to specific needs. Tibb embraces a whole new way of look-
ing at the body. It considers our health to be the result of a natural,
harmonious balance. It believes that our bodies have a way of find-
ing the path back to health. Healing comes from within. Recognition
of this inherent wisdom to self-healing is essential in the treatment of
disease and maintenance of health. In this chapter we cover the basic
philosophical aspects of Tibb, especially the main axioms of Physis,
Qualities, Temperament, Humours and Lifestyle Factors. The inter-
relationship between the individual and the environment, both internal
and external is also dealt with.

DEFINITIONS AND DESCRIPTIONS

Tibb. The term ‘Tibb’ is derived from the Arabic word meaning medi-
cine. Tibb is also known as ‘Western Holistic Medicine’, ‘Greco-Arabic
Medicine’, or ‘Unani Medicine’. This system of healthcare is practiced
extensively on the Indian sub-continent. The healing philosophy un-
derpinning Tibb is derived not only from Greek and Arabic principles,
but also from Indian and European medical systems. Generally, the
term ‘medicine’ refers to the art and science of preserving health,
preventing illnesses and curing or alleviating disease. Tibb defines
medicine more extensively - as the science by which we learn.

1
 PHILOSOPHY OF TIBB

It embraces knowledge and understanding of:

• The various states of the human body, in both health and disease;
• The means by which health is likely to be lost; and when lost, how
health can to be restored.

This is highlighted in Ibn Sina’s definition of Tibb:

“Tibb is a branch of knowledge that deals with the states of health

and disease in the human body for the purpose of adopting suit-
able measures for the preservation or restoration of health.”

The above epitomises the Tibb approach of equal emphasis on the

preservation (maintenance) of health, and the restoration (treatment)
of clinical disorders.

Complementary medicine. There is a wide variety of medical or heal-

ing systems which are different in theory and practice to conventional
medicine. These are conveniently termed complementary or alterna-
tive (to conventional medicine). The term complementary medicine is
a vague and confused one in many minds. It is a general term used
interchangeably with terms such as alternative; holistic and natural.

Many forms of complementary medicine appear, at first glance,

to be completely unconnected. However, most of them are
united in one important core aspect – when treating the pa-
tient, they act primarily to support the body’s inner healing sys-
tems, rather than merely suppressing the patient’s symptoms.

Complementary medicine encourages self-healing and the preven-

tion of disease, rather than reacting to and suppressing symptoms as
they arise. In contrast, conventional or Western medicine’s approach
is mainly treating with medication and or surgical procedures. Fur-
thermore, whilst conventional medicine has proven reasonable suc-
cess at treating acute disorders, complementary medicine is far more
efficient for those people who suffer from chronic complaints. Com-
plementary medicine includes therapies which can be used alongside
conventional medicine in order to improve the treatment outcome.
2
 PHILOSOPHY OF TIBB

Complementary medicine can be divided into four categories:

• Healthcare systems or paradigms – for example Tibb,
Naturopathy, Ayurveda, Homeopathy, Chinese medicine.
• Diagnostic techniques – for example Iridology, Hair Analysis.
• Therapeutic techniques – for example Aromatherapy,
Hypnotherapy, Chiropractic, Osteopathy.
• Self-help techniques – for example Yoga, Detoxification and
Dieting.

Western medicine is the standard scientific or medical model (para-

digm) for Western and developed countries; also termed convention-
al, orthodox bio-medicine or modern medicine.

Alternative is a general term for any therapy which is used instead

of Western medicine. It can refer to traditional systems such as
Chinese medicine, Ayurveda and African traditional medicine, or to
specific techniques like aromatherapy and acupuncture.

CAM. The common abbreviation for Complementary and

Alternative Medicine.

Integrative medicine is the deliberate and logical combination of

complementary and conventional therapy in a systematic manner
aimed at diagnosing and treating the patient’s clinical disorder.

Holistic is a state of well-being in which the person’s body, mind,

emotions and spirit are in tune with the physical, mental, spiritual
and social environment. Holistic therapy refers to treatment in which
the physical, mental and social factors are taken into account, rather
than just the overt diagnosed disease.

Traditional medicine is an indigenous medical system, typical of a

particular region, in different parts of the world. This is often termed
‘folk medicine’ or ‘ethno-medicine’.

Translation. Arabic translation of English terminology (Annexure1).

3
 PHILOSOPHY OF TIBB

NATURE OF HEALTH AND DISEASE

Attaining and maintaining optimum health is a major preoccupation

of modern times. We live in a time where there is unrelenting inter-
est in and awareness of health-related issues. Advice on changes
to our diet, the use of supplements, exotic herbs, taking more exer-
cise, stress relieving measures and much more assail us continually,
especially in the print and electronic media. Health itself, however, is
not an easy concept to define.

Health is generally described in terms of either how we feel, or how ca-

pable we are of functioning. It does not merely mean not being sick, and
is more than the absence of illness or unwanted physical symptoms. A
person would be considered healthy if he is able to carry out his gener-
al physical, mental, occupational and social functions to his complete
satisfaction. In line with this is the World Health Organisation definition:

“Health is a state of complete physical, mental and social

well-being, and not merely the absence of disease or infirmity.”
[WHO]

However, health usually denotes the absence of disease. According

to the dictionary, health is:

“Freedom from bodily or mental disease or decay; a state of

bodily or organic soundness; the absence of disease”.
[Cassell’s English Dictionary]

In the Tibb context, health is seen as a balance between the four hu-
mours in relation to the temperament of an individual (concepts that
will be discussed later on in this chapter).

According to Tibb, therefore, health is:

“A state of physical, emotional, and spiritual harmony resulting
from the most favourable balance of humours in a person”
[Chishti, 1985]

4
 PHILOSOPHY OF TIBB

Tibb believes that good health is more than the absence of signs and
symptoms. Even without troublesome symptoms, a person’s ability to
resist illness may be low, and his or her essential vitality may be seri-
ously depressed. In Tibb, health is present when our body, emotions,
mind and spirit maintain a correct and sound balance between quali-
ties, temperament, structure and functions. A disease is contrary to the
above – it is an abnormal condition which produces a functional disor-
der as a primary consequence. It can be an expression of a tempera-
mental imbalance, humoral imbalance or a disorder of tissue structure.

Conversely, conventional, Western medicine defines disease as:

“... a disorder with a specific cause and recognisable signs and

symptoms; any bodily abnormality or failure to function properly,
except that resulting directly from physical injury”.
[Oxford Medical Dictionary]

According to this definition:

• Western medicine reduces the human body to series of
mechanistic causes and effects. A consequence of this is that
patients are regarded as collections of body parts and systems,
not as holistic beings.
• Western medicine is primarily concerned with the physical
dimension of the person. This contrasts with complementary sys-
tems, such as Tibb, which place no barriers between physical,
mental and spiritual well-being.
• Western medicine looks for single causes for single diseases.
Complementary medicine, especially Tibb, regards most, if
not all diseases as arising from multiple causes (‘multifactorial’).
These include accumulation of toxins or humoral imbalances
from an imprudent lifestyle, exposure to toxins and poor personal
habits.

[The differences between Tibb and Western medicine are detailed

later.]

5
 PHILOSOPHY OF TIBB

HISTORY OF TIBB

Historically, codified medical practice goes back as far as 10,000

BCE (Before the Common Era). Chinese Herbal Medicine is re-
corded as far back as 3000 BCE, and Egyptian Pharaohic Medi-
cine, which was practiced by Imhotep, as long ago as 2980 BCE.

Originally, the school of Greek Medicine at Cnidus placed emphasis

on subjective symptoms, but little on objective signs. It originated the
organ-based scheme of disease and therapy. A breakaway group,
led by Hippocrates (460-375 BCE: “the Father of Medicine”), set up
Medical Schools in Greece (on the Isle of Cos and at Athens) and
elsewhere. Traditionally, Hippocrates has been regarded as the em-
bodiment of the ideal physician, and the origins of Tibb can be traced
back to him. Hippocrates believed that health is the expression of
a harmonious balance between the various components of our na-
ture, the environment that surrounds us, and our adopted lifestyle. He
also believed that there is a natural and powerful tendency towards
self-healing, which is driven by Physis. This is the body’s innate vital
life force, which helps to maintain the body’s equilibrium or harmony,
so allowing the proper functioning of the cells, tissues and organs.

“Life is short and the Art of medicine long, the occasion

fleeting, experience fallacious and judgement difficult”.
[Hippocrates]

During the Roman Era and afterwards, medicine stagnated for more
than a millennium. The Romans apparently preferred divine to medi-
cal intervention. However, Galen, a Greek philosopher living in Per-
gamum, Asia Minor, around 130 CE, compiled Hippocrates’ work and
all other available medicinal information. He introduced both the term
“pneuma” – the creative force for being – and the idea of tempera-
ment. Not only did he accept the humoral theory, but he extended
it to include foods, each of which, he suggested, had a character-
istic temperament. The science of dietetics arose from his findings.
During the Dark Ages in Europe, which lasted for more than 800

6
 PHILOSOPHY OF TIBB

years, little of note was produced in the medical sphere. Howev-

er, Ibn Sina (known in the West as Avicenna – “the Prince of Phy-
sicians”) came to the fore in 980 CE, in Bokhara (Afghanistan).
He is justifiably the most famous physician in history. Resident in
Persia, he was famous as a polymath, being responsible for 270
books. He codified medicine into a science in the late 10th and ear-
ly 11th centuries. Tibb was guarded and nurtured by Ibn Sina, and
his fellow Arab physicians. He authored two major books on medi-
cine: The Book of Healing (metaphysics of health) and The Canon
of Medicine – the latter being “the single most famous book in the
history of medicine”, according to the Encyclopaedia Britannica.

Ibn Sina’s philosophy of medicine was adopted by medieval schools

of thought, and his influence on the development of medicine cannot
be overstated. It has maintained its authority well over 1000 years.
His Canon of Medicine is still the preferred reference handbook for
Tibb practitioners.

Muslim practitioners of Tibb introduced, amongst others, medical bot-

any and chemistry; organisation of the pharmacy; and the founding
of hospitals, with lecture halls, charity wards, kitchens, dispensaries,
qualified medical and nursing staff. Innovative techniques also ap-
peared at this time – distillation, filtration, sublimation and calcination.

By the early 1700’s, Tibb was the basis of virtually all medicine in
most parts of the world. It formed the basis of Homeopathy, (devel-
oped by S. Hahnemann, 1755-1843). In the mid-1800s, Tibb prin-
ciples underpinned the foundation of natural therapeutics, and these
were introduced into the Western medical discipline of Naturopathy.

However, the advent of the germ theory of disease at the end of the
19th century, and the arrival of chemical or pharmaceutical medicine
in the 20th century heralded major changes in medical practice. At
the present time, Tibb is practiced in its original form predominantly
on the Indian Sub-continent. However, healing traditions directly in-
spired by Tibb remain the treatment of choice for more than a billion
people in many parts of the world.
7
 PHILOSOPHY OF TIBB

MAIN AXIOMS OF TIBB

The main axioms of Tibb are:

Physis. Is the intrinsic ability of the body to preserve health, and the
mechanism that activates the body’s healing processes. Physis is the
vital life force, inherent in the human body, which helps to maintain
equilibrium or harmony within the internal environment, so allowing
the proper functioning of the cells, tissues and organs. It is the power
behind the body’s innate capacity for inner or self-healing. In addition,
it regulates the reservoir of energy which is the driving force behind
maintaining health.
Temperament. The temperamental theory is derived from Greek phi-
losophers who hypothesised that everything in the universe is created
from four primary elements with corresponding qualities: fire (Hot &
Dry), air (Hot & Moist), water (Cold & Moist), and earth (Cold & Dry).
Depending on the ratio of the four primary elements that make up an
entity, the opposing qualities in the entity will reach a state of equi-
librium resulting in an overall quality. This overall quality is known as
temperament. Every part of creation, be it mineral, plant or animal,
has a particular temperament with an overall quality. Temperament in
human beings describes the uniqueness of an individual with respect
to physical, mental, emotional and spiritual attributes divided into four
broad categories: sanguinous, phlegmatic, bilious and melancholic,
with a combination of qualities of hot, cold, moist and dry.
Humours. The humoral theory is based on the hypothesis that each
individual has an ideal humoral balance which is made up from the
four humours. This unique balance has to be in harmony with the
unique temperament of an individual for health to be maintained. The
humours, produced in the liver from the food and drink consumed, are
also four in number: sanguinous, phlegmatic, bilious and melancholic
also with a combination of qualities of hot, cold, moist and dry.
Lifestyle Factors. There are six main Lifestyle Factors, namely
Environmental Air and Breathing, Food and Drink, Movement and
Rest, Our Emotional Life, Sleep and Wakefulness, Elimination and
Retention. There are also a number of minor ones, such as the place
of residence, age or gender, habits, and nature of occupation. All are

8
 PHILOSOPHY OF TIBB

interpreted within the context of qualities.

Qualities. The qualities of hot, cold, moist and dry, common to ele-
ments, temperament, humours and Lifestyle Factors, are also associ-
ated with most illness conditions. Qualities form the basis of interpret-
ing aetiology, pathology, diagnosis and treatment.

UNIQUE FEATURES OF TIBB

In addition to the main axioms of Tibb, a few unique features of Tibb

are described below:

Emphasis on health. One of the most significant features of Tibb is

that it is a comprehensive system of healthcare with a sound philo-
sophical base. This provides valuable insights into the nature of en-
ergy and matter, the origin of mankind, and the relationship that exists
between humans and their environment.
Tibb fully appreciates the complex interplay of our human nature, our
make-up, and how we relate to the environment. By regarding man-
kind in the broader context of the universe in which we live, we can
better understand the causes of illnesses and equally important, how
we can maintain optimum health. According to Tibb, a healthy person
can become even healthier. It places equal emphasis on understand-
ing the states of health and disease in the human body. Its mission is
both maintaining existing health and in the case of disease, actively
supporting the individual in the restoration of optimum health.

Holistic nature. Holistic health has been defined as:

“… Not merely the absence of disease or infirmity, but a state

of complete physical, mental and social well-being” [WHO].

A similar definition of holistic health has been put forward:

“... the state of well-being in which an individual’s body, mind,

emotions and spirit are in tune with the natural, cosmic and social
environment” [American Holistic Medical Assn.]

9
 PHILOSOPHY OF TIBB

Holistic medicine therefore takes into account the physical, mental,

emotional and social factors in the patient’s illness, rather than just
the disease that has been diagnosed. In other words, Tibb has as
its basic focus of activity the optimum health of the individual – not
merely the absence of illness.
Another aspect of Tibb and holism is that both the causes of the disor-
der and the susceptibility of the person to the disorder have to be ad-
dressed. For instance, in treating a person with the common cold, Tibb
directs its efforts into two areas; firstly, the alleviation of the symptoms
(coughing, sneezing, runny nose, etc.); and secondly, enhancing the
person’s resistance, so that he or she is less likely to succumb to fur-
ther attacks of the illness.

Spiritual nature. Tibb accepts that many diseases, whether pre-

dominantly of the physical body or of an emotional or psychologi-
cal nature, have a spiritual component. It therefore strongly advo-
cates the use of spiritual activities such as meditation, prayer and
contemplation where such spiritual aberrations are recognised.

Empirical nature. Tibb treatment is largely based on centuries of

practical experience, observation and investigation. In this respect
Tibb differs from Western medicine, which is derived from experimen-
tation according to the scientific method. For example, the use of a
drug, such as a diuretic, to treat hypertension in conventional medi-
cine, follows from a number of controlled randomised clinical trials.
This is the gold standard of Western medicine. Tibb, on the other
hand, treats hypertension with a combination of changes to the per-
son’s lifestyle, plus the use of one or more herbal medications which
have proven effective over many years of clinical practice.
Tibb does, however, accept the need for scientific enqui-
ry. It is not only in complete harmony with the need for the ba-
sic medical sciences of biochemistry, anatomy and physiol-
ogy (although interpreted in different terms, such as humours,
organs and members, faculties, functions and energies) but also
includes the fundamentals of chemistry, physics and metaphysics.

10
 PHILOSOPHY OF TIBB

The Ibn Sina Institute of Tibb is actively involved in research which

is relevant and important in South Africa. Internationally, extensive
research into the theoretical and practical aspects of Tibb is being
conducted in established Institutions such as the Central Council
of Research in Unani Medicine, and the National Institute of Unani
Medicine, both under the auspices of the Ministry of Ayurveda, Yoga,
Unani, Siddha and Homeopathy (Naturopathy) – (AYUSH), Gov-
ernment of India. Extensive research is also being undertaken by
various universities which include Aligarh Muslim University, Jamia
Hamdard University (India), Hamdard University (Pakistan), as well
as universities in Bangladesh, Sri Lanka, Iran and the Middle East.

Natural healing. Tibb accepts that symptoms such as diarrhoea,

vomiting and fever are invariably reactive responses of the body to-
wards healing. They are often the body’s attempt to rid itself of tox-
ins which have disturbed the internal harmony. The process is di-
rected and controlled by Physis, so is termed a Physis response.

Tibb considers that these symptoms should not be stopped, unless

they have gone too far and are causing intolerable distress to the
person. In other words, Physis should be supported, not suppressed.
If these symptoms are actively subdued by the use of anti-diarrhoe-
al, anti-emetic and antipyretic drugs, the patient will no doubt gain
relief. However, as the toxin affecting him or her has not been to-
tally flushed from the body, the symptoms will inevitably reappear.

Everyone is unique. A primary feature of Tibb is the concept of

temperament, and its importance as part of the total diagnostic and
therapeutic procedure. As such, Tibb attaches considerable value to
assessing a patient’s authentic temperament as a precursor to a ther-
apeutic approach based on his or her uniqueness, and how to restore
health by supporting inner healing. In this, Tibb contrasts markedly
with Western medicine, which focuses almost exclusively on diagnos-
ing, describing and quantifying features of the patient’s disorder, with
scant attention paid to the individual nature of the patient. Western
medicine treats the disease; Tibb treats the person with the disease.

11
 PHILOSOPHY OF TIBB

Cost effectiveness. Tibb is ideally suited to meet the challeng-

es of the high cost of healthcare. Because of the comprehensive
understanding it has of the causes of illnesses, it allows for in-
expensive, low-tech, easily accessible means to achieve health
rather than expensive high-tech interventions. The understand-
ing of the causes as well as the progress of diseases allows the
practitioner early diagnosis of ‘syndromes’ long before the ap-
pearance of symptoms thereby preventing more serious illness.

Furthermore, by advising on meaningful changes to the patient’s Life-

style Factors, Tibb helps to reduce the chance of the disease reap-
pearing. For example, the symptoms of type 2 diabetes can be readily
suppressed by one or more of a number of hypoglycaemic drugs. How-
ever, this means continuous treatment, which is costly, inconvenient,
prone to side effects, and probably needs regular dosage adjustment.
Tibb, on the other hand, will not only treat the elevated blood sugar,
but will counsel on lifestyle changes which will result in the underly-
ing conditions that lead to the illness in the first place, being resolved.

Empowerment. Tibb emphasises empowerment of the patient as

well as preventative medicine. Here again, the understanding of the
causes of diseases enables the practitioner to advise his patients
more effectively on management of illnesses and primary healthcare.
The awareness of an individual’s temperament further empowers
people to make sound health choices.

COMPARISON: TIBB AND CONVENTIONAL MEDICINE

Although Western medicine can trace its roots as far back as Hip-
pocrates, the acknowledged ‘Father of Medicine’, its present practice
is not always in line with the early founders’ ethical principles. West-
ern medicine really originated during the period of the Renaissance,
during which the scientific thinking of the causative theory of modern
science progressively replaced the earlier holistic models which had
been dominant for nearly two thousand years. The new paradigm,
termed the “Cartesian model”, after the French philosopher, Rene

12
 PHILOSOPHY OF TIBB

Descartes (1596-1650 CE), heralded the birth of modern medicine.

It claimed to invalidate the humoral concepts and holistic principles
which underlie Tibb theory and practice, and promoted the ideology
that man was separate from nature, the mind from the body, and that
the world could be viewed objectively through experiment. This model
was supported later by Virchow (1821-1902), who demonstrated that
disease begins with changes in living cells, and by Pasteur (1822-
1895) whose role in the development of the theory of infection was of
key importance.

In this new “Germ Theory” paradigm, infectious diseases are caused

by specific pathogenic microbes. Another pillar on which convention-
al medicine is based is the “Doctrine of Specific Aetiology”, whereby
most diseases are reduced to a simple cause - a micro-organism,
an inborn error of metabolism, or one or other physiological or bio-
chemical malfunctions. The prevailing holistic approach to disease
was marginalised in favour of this doctrine, scientific reductionism,
and a tendency to view the body as a machine.

Listed below are differences between Tibb and Western medicine:

Differences in Theory
1. Tibb takes a holistic approach to the treatment of disease. For
Tibb, disease results from several negative factors coming
together, bringing disharmony to the person’s body, mind or
soul. The aim of therapy is to support and bolster physis, our
natural inner healing power. Alleviation of the person’s disease
therefore needs a multifactorial, holistic approach, based on
lifestyle changes, behaviour modification, active physical and
mental therapies and, where appropriate, herbal and other
natural remedies. Conversely, Western medicine adheres to
the theory of specific aetiology as the basis for therapy: “One
disease; one cause; one treatment”.
2. Tibb accepts that many diseases have a spiritual dimension.
Tibb feels that there is a powerful spiritual component in
13
 PHILOSOPHY OF TIBB

maintaining optimum health and alleviating chronic disease,

and that this should be considered when deciding upon therapy.
This can include spiritual support from contemplation, fasting
and prayer. Western medicine, however, downplays or rejects
any marked spiritual influence in healthcare, as it cannot be
detected physically or quantified:” If you cannot measure it, it
doesn’t exist”.
3. Tibb is true to the Hippocratic tradition. It accepts the principle
of: “First, do no harm”, a cardinal feature of the Hippocratic
Oath, and all treatment and techniques are consistent with this.
Tibb also accepts the Hippocratic advice of “Assist nature”, so
all Tibb measures cooperate with physis. Western medicine,
however, tends to pay lip-service to this. Drug treatment, by far
the major intervention, is usually negated by intolerable side
effects and long-term adverse drug reactions. Moreover, much
drug therapy actually hinders or neutralises the power of inner
healing. Antibiotics, proton pump inhibitors, steroid use and
cancer therapy are prime examples.
4. Tibb is health focused, not disease, focused. Its main objective
is achieving and maintaining realistic and optimum wellbeing.
It is prevention focused. This approach is more cost-effective
than treating disease once it is established. In this regard, Tibb
essentially believes in supporting inner healing, and adapting
to the changing environment, rather than opposing it. Western
medicine, on the other hand, has traditionally been half-hearted
in its approach to disease prevention, preferring active drug
therapy.
5. Tibb regards each patient as unique. It recognises the individuality
of everyone in terms of temperament. This is relevant in diagnosis
and treatment, and for the long-term maintenance of wellbeing.
Western medicine tends to view patients as effectively identical
carriers of a particular disorder, and with a “one size fits all”
approach to drug therapy. The disease itself is treated, not the
person.

14
 PHILOSOPHY OF TIBB

6. Tibb views living beings as highly adaptive and incredibly

complex interacting dynamic systems. This manifests in both
physical and metaphysical aspects and is probably beyond
our comprehension. Western medicine has a more simplistic,
more mechanistic, view of living beings. Malfunctioning parts
can be fixed or replaced by transplants, and faulty metabolism
corrected by drugs.
7. Tibb accepts the body-mind interaction. It is firmly convinced
of the existence of powerful and significant links between a
person’s physical, mental and spiritual states. These links have
major consequences in deciding a person’s wellbeing. Western
medicine, however, rejects the existence of non-physical
aspects of wellness, as it cannot be readily identified, isolated
and quantified.
8. Tibb differs in its definition of health. It sees health as the
result of an adaptive dynamic harmony between the person’s
temperament, (especially the genetic component), the immediate
environment, and the lifestyle adopted. Tibb also accepts that
harmony between body, mind and spirit is necessary for optimum
health. Western medicine generally defines health simply as
the absence of disease. Western medicine relies heavily on
laboratory parameters in its definition of ‘normality’ as part of
being healthy.
9. Tibb differs in its definition of disease. It sees disease as the
consequence of a breakdown in the body’s homeostasis. This is
due to physis being overwhelmed by a faulty lifestyle, a hostile
environment, self-destructive personal habits, or adverse
genetic factors. In Tibb, physical, emotional, spiritual and social
aspects are involved. Western medicine views a disease as a
physical disorder with recognisable signs and symptoms and a
specific cause which leads to metabolic abnormality or bodily
dysfunction.

15
 PHILOSOPHY OF TIBB

Difference in Diagnosis
1. Tibb does not rely only on invasive or hi-tech diagnosis. It
employs empirical, traditional and time-tested techniques to
reach both provisional and final diagnoses, although it may
resort to quantitative physical or laboratory data in support where
uncertainty exists. Western medicine, by contrast, relies very
heavily, often overwhelmingly, on quantitative data, especially
laboratory and scanning results, before making a diagnosis.

Differences in Treatment
1. Tibb supports inner healing. A major pillar of Tibb healthcare
is physis, the power behind inner healing. All Tibb therapy is
designed to support or augment physis, never to oppose, ignore
or override it. Western medicine does not accept the existence of
physis, as it cannot be isolated and quantified. In fact, Western
treatment often undermines the patient’s physis with drugs like
antibiotics and steroids.
2. Tibb treats both symptoms and underlying causes. Tibb acts to
relieve any bothersome symptoms immediately. It then seeks
to identify and correct the underlying causes of the ailment.
Western medicine generally focuses on alleviating the symptoms
troubling the patient, with little or no attention paid to redressing
any possible underlying causes.
3. Tibb is better suited for chronic, recurring disorders. Chronic
diseases, not acute disorders, demand most of the healthcare
burden and budget. Tibb focuses on rectifying any obvious
aspects of a faulty lifestyle and personal behaviour. As Tibb
treatment is humoral balance and lifestyle, not drug, focused,
it does not provoke adverse reactions. Treatment of chronic
disorders is natural, patient focused, and respectful of the force
of inner healing. Western medicine is generally successful in
alleviating symptoms with a wide variety of drugs. Over the
long-term, however, serious adverse reactions and unwanted
metabolic effects often develop. These in turn need further drug
16
 PHILOSOPHY OF TIBB

treatment, and patient compliance is often reduced or lost due

to adverse drug reactions.
4. Tibb examines a patient’s diet and lifestyle early on in therapy.
It attaches great importance to a person’s lifestyle and habits in
the healthcare scenario. Lifestyle management is accepted as a
major part of the present and future medicine. Western medicine
does not offer detailed lifestyle advice. It does not attach much
value to lifestyle changes, other than routine advising on weight
loss, smoking and drinking habits. It usually resorts to potent
drugs before lifestyle changes have been explored.
5. Tibb therapy does not impact gut bacteria. The gut microbiome
is now recognised as a major influence health and disease and
has a significant influence on the person’s immune system. No
Tibb therapy, whether lifestyle changes, diet improvement, or
herbal or regimental therapies is known to disrupt the patient’s
microbiome. Western medicine’s regular use and overuse of
antimicrobials can seriously upset the patient’s microbiome,
often leading to super-infection by pathogens.

Differences affecting the patient

1. Tibb treatment is better tolerated. Tibb therapy is natural and
has been around for centuries, so there is little chance of
unexpected or unusual surprises from it. Herbal medicine, for
instance, is demonstrably less prone to side effects or adverse
reactions than drugs are. Western medical treatment, however,
is firmly based upon synthetic drug therapy, for acute, chronic
and recurring disorders. This exposes the patient to a wide
range of side effects in the short term and potentially serious
adverse metabolic changes over the longer term. This lack of
tolerance often leads to discontinuation of therapy, or to the
need for additional drug treatment to counter these side effects
and reactions.
2. Tibb is less prone to iatrogenic problems. Tibb therapy is
based on lifestyle changes supplemented by traditional healing
17
 PHILOSOPHY OF TIBB

techniques and natural/herbal medicine. Tibb therapy is much

less prone to problems due to poor clinical practice. Conventional
medicine, in contrast, is seriously prone to iatrogenic problems,
due mainly to poor tolerance, and drug interactions.
3. Tibb therapy is less expensive and time-consuming. Tibb
therapy usually involves repeated face-to-face counselling, and
this encourages good patient compliance. It is less inclined
to need complex monitoring, as much of the clinical progress
involves lifestyle changes. Western medical treatment often
demands constant laboratory or physical monitoring of clinical
progress. For chronic disorders this is both expensive and time
consuming.
4. Tibb empowers the patient. A cardinal feature of Tibb therapy
is that the patient is more involved in diagnosis, treatment and
follow-up. In Tibb, the patient’s active participation in therapy is
expected, and personal responsibility is encouraged. Western
medicine generally adopts a ‘top-down’ approach, in which the
patient is placed in a submissive role. It assumes the doctor is
the all-knowing authority, never to be questioned or challenged.
5. The Tibb practitioner offers the patient empathy. In Tibb, care
and empathy are needed to effect optimum healing and health.
Tibb diagnosis focuses on subjective feelings and opinions, as
well as symptoms and signs. Western medicine the doctor is
emotionally neutral, detached and usually focuses on objective
data only.
6. Tibb has a constant healthcare message. The theoretical basis
and main practices of Tibb have been generally consistent
over many centuries. Western medicine, however, is constantly
changing its advice, according to new information and different
opinions. This can be confusing to both patient and practitioner.

18
 PHILOSOPHY OF TIBB

In summary, Tibb differs from Western medicine in several important

ways:

Tibb position Western Medicine position

It adheres to the Doctrine of Specific
It takes a holistic approach
Aetiology
It denies spiritual influence on health
Diseases have a spiritual dimension
status
Some therapies are traumatic to the
It is true to the Hippocratic tradition
patient
Symptom alleviation, not cure, is focus
Tibb is health focused
of therapy
Each patient has a unique tempera- Patient regarded as disease carrier,
ment not a person
Has a mechanistic model of health &
Human beings are incredibly complex
disease
Rejects the body-mind interaction in
The body-mind interaction is accepted
wellbeing
Tibb differs in its definitions of health Defines health as the absence of
& disease disease
Diagnosis does not rely on invasive/ Relies heavily/exclusively on physical
hi-tech methods data
Physis is actively protected and Does not accept existence of inner
boosted healing
Tibb treats both symptoms and under- Mainly concerned with symptom
lying causes alleviation
It is better for chronic, recurring Adverse drug reactions usually
disorders develop
Lifestyle & diet are considered before Lifestyle advice is simplistic and half-
active therapy hearted
Tibb therapy does not disturb gut Many drugs upset the patient’s micro-
bacteria biome
Treatment is better tolerated by the Poor tolerance from synthetic drug
patient therapy
Tibb is less prone to iatrogenic Commonly prone to serious iatrogenic
problems problems
Treatment is less expensive or time- Need for laboratory or physical moni-
consuming toring
Tibb values patient empowerment A ‘top down’ approach is standard
Tibb has a constant healthcare Healthcare advice is constantly
message changing

19
 PHILOSOPHY OF TIBB

TIBB CONCEPT: PHYSIS

Tibb views the human being as part of the larger cosmos – as are
all living entities in the Universe. Everything in the Universe (or Mac-
rocosm) is interconnected in one way or another. We as individuals
do not exist in our own self-contained world (or Microcosm), but are
connected to other parts of the Macrocosm: via our behaviour in our
families, our communities, our societies, our planet, and our very
existence. Everything we do has repercussions far removed from
ourselves.

As human beings, we are all ultimately made up of the same basic

material as the rest of the Universe. We connect with the Macrocosm
by our behaviour, our actions, and even the air that we breathe. We
influence all living organisms which share the earth with us.
A harmonious balance normally exists between the components of
the Macrocosm, whether at the cosmic, geological, social or physio-
logical levels. The relationship between the fauna and flora, man and
animals, the atmosphere, the oceans, and the earth are all carefully
and delicately balanced for the maintenance and perpetuation of life.
An example of the maintenance of this balance for the perpetuation
of life on this planet is seen if we consider on the salt content in the
sea. Despite the natural disasters of earthquakes, volcanic eruptions
or the effect of mankind extracting salt from the sea over thousands
of years, the saline content in the oceans is still ideal for all forms of
marine life.

This harmonious balance is guided by an organizing principle, the

Supreme Wisdom of the Universe, the essence of which exists in
every living entity. This inherent wisdom resides in our genetic make-
up (our genes), and in our folk memories (our memes). This inherent
wisdom is recognised in several medical philosophies and disciplines,
such as Chinese Herbal Medicine, Ayurvedic Medicine and Home-
opathy. Hippocrates and Galen also acknowledged its existence. In
Tibb, this inherent wisdom is called Physis, which is controlled by the
supreme wisdom of the universe.

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 PHILOSOPHY OF TIBB

Our health can be regarded as an expression of a dynamic but

harmonious balance between the various components of our nature,
our environment, and our lifestyle. Physis is the intrinsic ability of the
body to preserve health, and the mechanism that activates the body’s
healing processes.
Briefly stated, Physis is the vital life force, inherent in the human body,
which helps to maintain equilibrium or harmony within the internal en-
vironment, so allowing the proper functioning of the cells, tissues and
organs. In addition, it regulates the reservoir of energy which is the
driving force behind maintaining homeostasis in the myriad of complex
processes we recognise as life. It is the origin of movement and rest.

“Nature heals, and the physician is only nature’s assistant.”

[Hippocrates]

The various systems in the body – the circulatory, respiratory,

digestive, immune systems, etc. – have their own organisation.
However, they do not work in complete isolation, but are each
connected to the other systems in order to function effectively and
efficiently. Physis has the innate ability to orchestrate the body into
maintaining dynamic optimum functioning, better known as
homeostasis. It acts to heal the body when it is sick, restore it when
it is depleted, and to develop and thrive when supplied with suitable
nourishment. As the regulator for homeostasis, it is essentially the
human’s ‘inborn intelligence of health’.
In the event of disease (or even when the body fails to reach its ideal
state), Physis acts by correcting imbalances and disharmony. One
important feature of Physis is that it operates in all dimensions of
health – in the physical, the mental, the emotional, and spiritual.

Physis and other medical paradigms

Physis is recognised in other healing philosophies – as Prana
(Ayurvedic Medicine); Chi Energy (Chinese Medicine); Vital Force
(Homeopathic Medicine), and Nature (Naturopathy). Hippocrates
described it as Vis Medicatrix Natura. Physis is also akin to the Yin
and Yang principle of oriental philosophy. It has also been termed the
Divine Wisdom and in the Abrahamic scriptures as God Almighty.
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 PHILOSOPHY OF TIBB

In early Western holistic medicine it was labelled the Etheric Body.

It has also been variously described as the Vital Force, Natura (“the
healing power of nature”), Mother Nature and the Hierarchical Prin-
ciple. Physis was used to describe the natural vitality of what is now
recognised as the immune system, in its spontaneous response to
environmental influences. It was quickly brought into action to de-
tect and react to both supportive and disruptive factors. In fact, one
component of Physis is our immunological identity, which forms the
molecular basis of healing. Another aspect of Physis, which is a key
focus of the relatively new discipline of psycho-neuro-immunology
(PNI) is the placebo response, and the possibly associated phenom-
enon of spontaneous healing.

“When Physis is powerful enough to withstand the disease, it

does not require the aid of the physician, as in the case of minor
diseases that are self-healing” [Al-Malki]

The nature of Physis

Physis is the administrator of the body, and it operates in the physi-
cal, mental and spiritual dimensions. It embraces all metabolic and
homeostatic functions of the body. Physis comes into effect from the
instant of fertilisation, and is present until the moment of death. It
maintains harmony between the individual and both the internal and
the external environments. Physis ensures that an ideal balance ex-
ists within the body’s cells, in the tissues, between the many internal
organs, and the entire body. This dynamic maintenance of harmony
within the body is also termed homeostasis, as mentioned earlier.

In the physical context, Physis ensures that the many millions of bio-
chemical reactions taking place – for protection, for growth, tissue
maintenance, reproduction and repair – which are taking place at any
instant, are controlled.

At the psychological level, the harmony or balance of the complex of

emotions, the control of destructive urges or thoughts, and the main-
tenance of good mental health is regulated by Physis.

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 PHILOSOPHY OF TIBB

One specific aspect of Physis relevant in health and disease is the

immune system. This ensures that infections arising from outside do
not disturb the body’s internal harmony. It also maintains an extensive
surveillance on the body’s many tissues, to detect any cancers in de-
velopment, and remove them if they become established.
Other aspects of Physis in the physiological dimension are the numer-
ous biochemical feedback mechanisms which operate in the body’s
metabolic processes, and the regulation of hormone secretion from
glands.

Physis is not confined to humans – it pervades all living tissue: it is

part of the biochemical unity of life. It follows the laws of nature as we
understand them, and works in a pre-determined, instinctual manner.

Physis and medicine

The word ‘physician’ is derived from the word Physis. The true role
of the physician is to aid Physis in the healing process, by under-
standing the factors governing Physis, and plan and execute treat-
ment accordingly. For example, when a person has eaten something
that disagrees with him or her, then vomiting or diarrhoea is a natural
reaction. The physician should be aware of this natural reaction, and
assist Physis by devising effective treatment which is in harmony with
the body’s healing mechanisms.

“Each patient carries his own doctor inside him. We are at our
best when we give the doctor who resides within each patient a
chance to go to work” [Albert Schweitzer]

“Behind every natural action of the human body is an inherent

wisdom, a mechanism [Physis] that allows the body to heal itself.
In fact, no herb, no food or any other substance or procedure can
do anything on its own to heal. It can only assist the body in its
own self-healing role. If your finger is cut, it is not the stitches or
the bandage or the iodine that causes it to heal; it is the skin itself
that performs this miracle” [Chishti, 1985]

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 PHILOSOPHY OF TIBB

A major aspect of Tibb is that Physis has to be respected if the healing

process is to be successful. The treatment of illness is imposed from
outside, whereas actual healing is achieved from within.

TIBB CONCEPT: CREATION

The nature of matter

We know that energy and matter are interchangeable, as described
by the equation: E = mc2, Where E is energy, m is mass, and c is
the speed of light. However, in ancient Greece, the philosophers
Democrates and Aristotle believed that between Energy and Matter
there existed an intermediate ‘Primary Matter’; or ‘Elements’,
symbolically represented by the universal elements earth, water, air,
and fire, each of which is characterised by two qualities: Earth (Cold
& Dry), Water (Cold & Moist), Air (Hot & Moist), Fire (Hot & Dry).

Elements
According to Ibn Sina, elements are indivisible matter, which pro-
vides the basic components of everything in the Universe (the
Macrocosm), including our own body (the Microcosm). The various
substances (compounds) in nature depend on their combination,
and their variety is brought about by the degree of complexity. De-
pending on the ratios of qualities in these elements, everything in
the Universe exists in one or other states – solid, liquid, gaseous or
in the state of plasma. (Plasma is the state of matter found at very
high temperatures in nuclear reactions and inside the sun where the
electrons are stripped from the atom.)
Earth Cold and Dry solid
Water Cold and Moist liquid
Air Hot and Moist gas
Fire Hot and Dry plasma
According to Tibb philosophy, of the four elements, two are light and
two are heavy. Fire and air are light while earth and water are heavy.
These elements are described within the context of our planet, where
the earth element is in the centre of existence. In its nature it is at
rest and because of its inherent weight, all other elements gravitate

24
 PHILOSOPHY OF TIBB

towards it. It is the heaviest, densest, most solid element.

It is by means of the earth element that the parts of our body are fixed
and held together into a compacted form. This is how our outward
form is maintained.
Earth is naturally Cold and Dry, and it appears so to sight and touch,
as long as it is not changed by the other elements. It retains, solidifies,
condenses, coagulates, precipitates, sustains, supports, endures and
attracts substances towards it.

Water in its natural state surrounds earth and is in turn surrounded

by air. This positioning is because of its relative density. Water is Cold
and Moist in temperament. Water is easily dispersed and assumes
any shape without permanency. In the construction of things, the ad-
dition of water allows the possibility of their being shaped, moulded
and spread out. Shapes can readily be made from it and just as eas-
ily dispersed. Moisture dispels dryness, the latter being overruled by
the former. Moisture protects dryness from crumbling (as earth) and
likewise, dryness prevents moisture from dispersing. Thus the two
elements of earth and water are interacting and interdependent. Wa-
ter is of course absolutely essential to life. Water is the most passive,
receptive element, and the greatest receiver and absorber of ener-
gy. Its properties include cooling, moistening, lubricating, dissolving,
cleansing, and purifying.

Air is positioned in nature above both water and earth, but beneath
fire. The temperament of air is Hot and Moist and its purpose in na-
ture is to make things finer, lighter and more delicate, and thus more
able to ascend into higher spheres. When air is hot it rises and when
it is cool it descends. Therefore it is proned to both extremities and
affected by the elements around it.

Fire is situated higher than the other three elements. Fire is hot and
dry in temperament. It is the most active, energetic and volatile ele-
ment, and the greatest emitter of energy. It is light, rising and pen-
etrating. Its role in nature is to rarefy, distil, refine, extract, digest,
metabolise, transform and intermingle things. By its heat it has the
capacity to overcome coldness of the two cold elements, earth and
25
 PHILOSOPHY OF TIBB

water, and so creates and maintains harmony among the elements.

Temperament. The overall quality of primary matter/element that

make-up any substance/entity when in a state of equilibrium, is termed:
temperament. For example, a compound which is in a liquid state
will have a far larger concentration of the water element, and there-
fore have a predominant Cold and Moist temperament. Conversely, a
compound in a solid state will have more of the earth element, and so
have a Cold and Dry temperament.

Creation in the universe

Every level of organisation of matter, from the quarks and elec-
trons, through atoms and elements, to compounds, has a spe-
cific temperament. Each level of organisation is characterised
with specific temperaments, and these become the building
blocks for all materials in existence – from minerals to plants, and
from lower animals to ultimately the highest, namely human be-
ings. They exist in different shapes and structures, each with their
unique temperament. Every level of creation thus has an over-
all temperament made up from a combination of the four qualities.

The overall temperament of human beings is Hot & Moist. This is

easily understood when we consider that the human body is at a tem-
perature of 37ºC (heat) and 70% water (moistness). Similarly, ani-
mals have an overall temperament between Hot & Dry and Dry & Hot.

Creation, however, goes one step further. God has created everything
with a suitable structure having an ideal temperament to perform a
specific function. Birds have wings to enable them to fly and fish have
fins and a tail enabling them to swim. All plants, insects, animals and
man have a particular and unique structure with an assigned tem-
perament enabling them to perform a specific function.

“If we examine any corner of the universe, from the galaxies in

space to the living beings in nature, and from our own body to the
invisible cells, we see a flawless plan incorporating order, design

26
 PHILOSOPHY OF TIBB

and purpose. This order, design and purpose illustrates the per-
fection of creation.” [Yahya, 1999]
Table 1:

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 PHILOSOPHY OF TIBB

The creation of humans

As in the creation of atoms that form elements, primary matter gives
rise to cells - the basic unit of a living body. Just as the atom is the
unit for the outer environment, so cells are the basic unit for the in-
ner environment of man and all living entities. Cells combine to form
tissues, the combination of which forms organs. Ultimately from the
cells, tissues and organs the overall shape of the body is obtained.
Once again each level, whether it is a cell, tissue, organ or the total
human being (body, mind and soul), is assigned a specific
temperament.

Temperament, structure and function

According to Tibb philosophy, every part of the human being has been
created with a specific shape and structure in order to fulfil a specific
function. For example:

• The shape of ears enhances our ability to hear.

• Our nose filter out impurities from inspired air before it enters
the lungs.
• Our eyebrows prevent perspiration from entering our eyes.

When examining the geometry of our internal organs, we see many

different shapes, again performing different functions, each having a
specific temperament. For example, the shape of the heart facilitates
the pumping action whereas the overall temperament of the brain is
moist (with less heat), enabling nerve impulses to be transmitted eas-
ily, because moisture is a good conductor of electrical impulses. On
the other hand, the overall temperament of the liver is hot (with less
moistness), because of the heat generated during the process of me-
tabolism.

Delving further into the marvels of the body, we begin to realise just
how intricate the systems of the body are: the respiratory, the circula-
tory, and the digestive systems, and of special significance in the con-
text of health and disease, the immune system. Each system working
independently and yet is associated with and interconnected to each
other.
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 PHILOSOPHY OF TIBB

The human body is unbelievably complex. It has been created with

self-regulatory, self-healing mechanisms that are under the control of
Physis. This governing principle maintains the correct structure and
temperament of the body and its components, in order to perform the
desired functions. Every cell, tissue and organ is in equilibrium with
its characteristic primary qualities, or temperament, upon which its
structure and functions depend.

Changes in both structure and temperament will affect functions.

These changes can occur from the qualitative effects of the inter-
action of man and his environment. As we are part of the universe,
things that happen outside our bodies have an influence on us. As
everything in the universe possesses qualities, whether in the form of
energy or matter, qualities are the common link within the universe.

Table 2:

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TIBB CONCEPT: QUALITIES

Everything in the universe is made up of primary matter with corre-

sponding qualities. The effect that qualities have on human beings, as
well as on all living organisms, is an important consideration in Tibb.
Whether we are conscious of them or not, we are constantly experi-
encing them and being influenced by them.
According to one Cassel’s English Dictionary:

“Quality is a distinctive attribute or property which gives

individuality”.

The four universal qualities are Heat, Coldness, Dryness and

Moistnes. According to Tibb philosophy, the qualities of Heat and
Coldness are said to be the active qualities. The qualities Moistness
and Dryness are said to be the passive qualities.

To understand the influence that these qualities have on us it is

necessary to understand the interaction of qualities in nature.

Their interaction in nature is shown below, where the quality of heat

is opposite to the quality of coldness and moistness opposite to the
quality of dryness:

Opposing qualities cannot exist simultaneously. Nothing can be hot

and cold at the same time, nor moist and dry at the same time.
There is always a gradual transition between opposing qualities –
there is no rapid change from one extreme to another. For example,
the cold of winter is never followed by the heat of summer. Nature
ensures a gradual transition between extreme qualities, so

30
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minimising the negative effects of sudden change to plants, animal

and man.

This results in intermediate states of Hot & Moist, Cold & Moist, Cold
& Dry, Hot & Dry.

HEAT
Hot & Dry Hot & Moist

DRYNESS MOISTNESS

Cold & Dry Cold & Moist

COLDNESS

Qualities are the common denominator of living entities. The impor-

tant realisation of the Natural Cycle is that these four extreme quali-
ties of heat, coldness, moistness and dryness always move according
to the natural cycle from heat to moistness to coldness to dryness.
The interaction and effect of these qualities constitutes the funda-
mental laws of nature applicable to and in harmony with the laws of
physics (such as the laws of thermodynamics, or Newton’s Laws of
motion) or biochemistry (such as the Krebs Cycle), or the process-
es of catabolism and anabolism, affecting all biological systems and
physical matter.
In Tibb philosophy qualities form the basis of interpreting aetiology,
pathology, diagnosis and treatment.

TIBB CONCEPT: TEMPERAMENT

Each one of us is unique. But what is the essence of this uniqueness?

The basis of the human temperament, and why it fluctuates so much
between people of similar background and upbringing, and even be-
tween people in the same family, has been a source of fascination
for thousands of years. Every age has a preferred explanation of the
obvious differences amongst people, and many have attributed the

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 PHILOSOPHY OF TIBB

differences to physiology – in ancient times to bodily fluids, and more

recently, to genes. The subject of a person’s individuality or unique-
ness – temperament in Tibb – is now going through a revival of inter-
est, for three good reasons:
• Because of what we now know about our behaviour during per-
sonal development.
• Because of our varying responses to medical intervention; and
• Because the technological advances of the computer age has
enabled better understanding of the biochemistry and
genetics of the human body.

Importance of identifying temperament

The identification of a person’s temperament is a major pre-requi-
site for accurate diagnosis and effective therapy when practicing
Tibb. This has been highlighted by Hippocrates when he mentioned:

“It is more important to know what sort of a person has a disease

than to know what sort of disease a person has” [Hippocrates]

Temperament is a term which describes a person’s physical charac-

teristics (the constitution) plus his or her psychological, emotional,
and spiritual attributes. It assesses personality strengths and weak-
nesses, and includes the predisposition (risk factors) for particular
disorders.

Tibb therefore attaches considerable importance to assessing a

patient’s authentic temperament, as it is an important precursor to a
therapeutic approach based on his or her uniqueness, and how to
restore health by supporting inner healing. In this, Tibb contrasts
markedly with the conventional medical system, which focuses
almost exclusively on diagnosing, describing and quantifying features
of the patient’s presenting disorder, with little attention paid to the
patient’s uniqueness or individuality.

The practice of Tibb revolves around the art and skill of identifying a
person’s individual authentic temperament, combined with the

32
 PHILOSOPHY OF TIBB

science and practice of serving his or her Physis to reach and main-
tain their particular ideal state of health.

Temperamental types
Just as we have a unique fingerprint, so we have a unique tempera-
ment. Each person’s ideal temperament is fixed. In reality, we are all
a composite mixture of the four temperamental types, with a dominant
temperament combined with a subdominant temperament.
Although the number of possible temperaments is virtually infinite,
Tibb has narrowed them down to the four temperamental types la-
belled by Galen below:

• Sanguinous
• Phlegmatic – sometimes called serous
• Melancholic – sometimes called atrabilious
• Bilious – sometimes called choleric

This poem identifies the key personality traits of the four

temperamental types:

God could have made us all Sanguinous.

We would have lots of fun, but accomplish little.
He could have made us all Melancholics.
We would have been organized and chartered, but not very cheerful.
He could have made us all Choleric (Bilious).
We would have been set to lead, but impatient that no one would follow!
He could have made us all Phlegmatics.
We would have had a perfect world, but not much enthusiasm for life.
We need each temperament for the total function of
The body. Each part should do its work to unify
The action, and produce harmonious results.

[Florence Littauer, 1985]

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 PHILOSOPHY OF TIBB

From this poem we realise that each of us is a combination of all

four personality or temperamental types resulting in a dominance of
one with a sub-dominance of another, less of the third and the least
amount of the fourth temperamental type. As well as different people
being divided into the four temperamental types above, each tem-
peramental type also has a combination of qualities associated with it.

As mentioned earlier, the overall temperament of the human be-

ing is Hot & Moist. The reason is that the human body has a tem-
perature of around 37º and consisting of 60% to 70% water. How-
ever, in this Hot & Moist category of the human being there are
slight differences between each temperamental type. This is ob-
vious – some of us feel hotter or cooler than others, and some us
suffer from dry skin, or sweat less than others. Therefore each
temperamental type also has different qualities assigned to them.

• Sanguinous – the qualities of Hot and Moist

• Phlegmatic – the qualities of Cold and Moist
• Bilious – the qualities of Hot and Dry
• Melancholic – the qualities of Cold and Dry

The relationship between the four temperamental types and their

associated qualities is shown below:

The diagram above indicates that the sanguinous temperament with

qualities of Hot & Moist is opposite to the melancholic temperament
with qualities of Cold & Dry. As in nature extremes do not exist to-
gether in harmony, so it is not possible for a person who is a dominant
sanguinous (Hot & Moist) temperament to have a sub-dominant mel-

34
 PHILOSOPHY OF TIBB

ancholic (Cold & Dry) temperament. What is possible is that a person

who has a dominant temperament of sanguinous (Hot & Moist) may
have a sub-dominant of phlegmatic or bilious temperament. Similarly
a person with a dominant phlegmatic temperament will have a sub-
dominant temperament which is either sanguinous or melancholic.

Factors determining temperament

The calculation of temperament is based upon the following factors:
• Maternal food type and consumption during gestation.
• Date and time of birth.
• The temperaments of the parents.
Of the above three factors, the temperaments of the parents, ex-
pressed as hereditary factors, have the greatest influence.

Identifying temperament
Clinically, a person’s temperament can be diagnosed using
the following criteria: Frame and gait (walk); complexion and
skin texture; climatic preferences; food and drink; health prob-
lems; sleep patterns; speech; personality traits; emotional traits.

The table on the next page lists the above criteria with information
on the four different temperamental types. The column with the
most ticks will be the dominant temperament, and the sub-domi-
nant temperament with the second most ticks. The following needs
to be noted when completing the table.
• The patient’s frame may be altered due to slimming, ageing,
side effects of medication (cortisone, for example) or as a result
of a severe disorder such as HIV & AIDS.
• Shaking the patient’s hand can also provide valuable clues of
the skin texture and the qualities associated with it. It may feel
hot or cold, moist or dry.
• The personality and emotional traits are important indicators.
However, do remember that this category should be considered
for the patient under normal circumstances when he or she is
not under stress. A good indicator would be how the person is
perceived to be by his/her friends and family.

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 PHILOSOPHY OF TIBB

• Nobody fits perfectly into only one temperament, we all may

have characteristics of other temperaments. However, each one
will have a dominance of one and a sub-dominance of another
temperament – which will be next to each other and not oppo-
site.

Table 3: Description of the different temperaments

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 PHILOSOPHY OF TIBB

Qualities associated with Temperament

The adjacent diagram illustrates an individual with a dominant san-
guinous and sub-dominant phleg-
matic temperament, as indicated
by the line in the circle marked
X. This person’s ideal qualitative
state will have a dominant qual-
ity of moistness, followed in turn
by heat, then coldness, and fi-
nally the least quality of dryness.

Changes to the ideal qualitative state of an individual especially an

increase in the dominant quality will have a negative effect on an
individual’s health whereas an increase in the opposite least quality
will be beneficial for this person. As moistness is the
dominant quality associated with this individual, changes in
the level of moistness (and more particularly excess of
moistness) will negatively affect this individual the most and the
fastest. On the other hand, changes in the quality of
dryness (which is the least in concentration) will be beneficial
for this individual.

Just as each person has a unique temperament, each person will

also have a unique ideal qualitative state in line with (or according
to) the person’s temperament.

An individual’s health will depend on the maintenance of an

ideal qualitative state, which is the unique mixture of qualities
embodied in the specific temperament of the individual. Because
of the interac-tion of qualities between an individual and
the environment, there will always be a continual shift from the
ideal. However, Physis will adjust these changes to maintain the
ideal qualitative state as required by the individual. If the person’s
Physis is incapable of restoring the ideal qualitative state,
symptoms of a disorder will appear. The appearance of
symptoms suggests that Physis needs assistance in restoring a
normal qualitative state.

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 PHILOSOPHY OF TIBB

TIBB CONCEPT: THE HUMOURS

A key concept in Tibb is the Humoral Theory. The humours are the
primary fluids that are manufactured from the digestion of food and
drink, which are processed and transformed in the liver. Every level of
organisation within the body is infused by and interconnected with the
humours. A proper balance of humours ensures efficient metabolism,
and prevents the build-up of toxins. Humours give rise to all constituents
of the body. Also, a person’s temperament is maintained by the balance
of these humours. They are the agents which form the bridge linking
the microcosm of the human body to the macrocosm of the universe.

Humours are very much involved in the origin and development of a

particular illness, the diagnostic principles invoked, and the therapeu-
tic approaches adopted in the healing process.

Historically, the core concept of humours was originated by Hip-

pocrates, expanded by Galen, and formalised by Ibn Sina and his
medical contemporaries, who completed the final classification, codi-
fication and application of Tibb. The theory of humours fits comfort-
ably into the physics of primary matter or four elements (air, water,
earth, and fire) and four qualities (Hot, Cold, Dry, and Moist).
There are four humours, with different qualities:

• Blood – sanguinous humour [Arabic: dam]

(Qualities: Hot and Moist)
• Phlegm – phlegmatic humour [Arabic: balgham]
(Qualities: Cold and Moist)
• Yellow bile – bilious humour [Arabic: safra]
(Qualities: Hot and Dry)
• Black bile – melancholic humour) [Arabic: sauda]
(Qualities: Cold and Dry)

The humours can also be regarded from a more metaphysical stand-

point. In his translation of the “Canon of Medicine”, O.C. Gruner states
that:

38
 PHILOSOPHY OF TIBB

“A humour should not be regarded as matter, but more as ‘an es-

sence’ or a ‘quasi-material’ that make up the body fluids”.

The metaphysical nature of humours is similar to and associated with

the four primary matters of earth, water, air and fire. Both primary
matter and humours have assigned qualities which are in essence
the link between energy and matter. For example, whilst humours are
produced by the liver from food and drink, the food and drink also pro-
vides the primary matter component that translates into body fluids
containing minerals, amino acids, hormones, enzymes, etc.
Gruner also states that:

“In a sense the body fluids are the meeting places of various
opposing forces and/or primary matter”.

Humours exist at a cellular/sub-cellular level, from which tissues are

formed. The humours, although metaphysical, influence the outcome
of the physical manifestations of the body fluids. This includes the
cells, tissues, organs and ultimately the entire human being.

Al-Abbas describes humours as:

“…Those moist and fluid parts of the body which are produced
after the transformation and metabolism of the aliments; they
serve the function of nutrition, growth and repair; and produce
energy, for the preservation of the individual and his species. A
right proportion and inter-mixture (homeostasis) of them, accord-
ing to the quantity and quality constitutes health, whereas an im-
balance according to the quantity or quality and irregular distribu-
tion leads to disease”.

Al-Abbas interprets the role of humours in the following manner. First,

the basis of health is the right proportion and specific equilibrium of
humours according to their quality (and quantity) i.e. homeostasis in
the internal environment. As long as this homeostasis in the internal

39
 PHILOSOPHY OF TIBB

environment is maintained the body remains healthy. This is the basis

of health and preventative medicine. Second, when the normal pro-
portion and specific equilibrium of humours is altered, the internal en-
vironment reaches a state of imbalance, and thus disease develops.
This is the basis of aetiology and pathology of disease. Third, when
this wrong proportion and altered equilibrium of humours is corrected,
health can be recovered. This is the basis of treatment.

The humoral theory covers all aspects of disease i.e. prevention,

aetiology, pathology, diagnosis and treatment.

The humours have three main functions:

• Maintaining the temperamental balance.
• Providing nutrition for the maintenance of the body’s complex
structure by replacing body’s tissues.
• Provides the energy requirements for the various activities of
the body.

[The production, features and functions of the four humours, both

normal and abnormal will be detailed on further later in the chapter:
Pathology in Tibb.]

Homeostasis between temperament and humours

Just as everyone has a unique temperament, so each person has a
unique humoral combination, made up of the four humours, but with a
distinct overall quality. The human being is a dynamic entity interact-
ing physically, (in the form of catabolism and anabolism) intellectually,
emotionally and spiritually. The humours are responsible for ensur-
ing that the ideal qualitative state or temperament of the individual is
maintained according to his/her ideal requirements.

The four humours exist in an individual in different combinations. This

ensures that the overall qualitative state of the humours is in harmony
with the overall qualitative state of the temperament of an individual.
For example, if a person has a dominant sanguinous and sub-dom-
inant phlegmatic temperament, the person’s overall qualitative and
quantitative ratio will have an overall quality that has more moisture,
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then heat, then coldness and then the least, dryness. This will be en-
sured by an overall comparative dominance of sanguinous humour
over the others in this individual.
This ideal state can be altered both qualitatively (changes in qualities
of heat, coldness, moistness and dryness) and quantitatively (chang-
es in the ratios of the humours).

Health will only be maintained as long as the overall quality of the

humours is in harmony with the overall quality of the individual’s tem-
perament. The relevance of maintaining the overall quality of the
humours in relation to the overall qualities associated with tempera-
ment of an individual will be discussed in the next chapter ‘Aetiology’.
The metaphysical humours, together with elements and their respec-
tive qualities, become the basis for physical matter. This ranges from
organic compounds, to sub-cellular organelles, to cells, tissues, body
organs, organ complexes and ultimately the human anatomy.

Anatomy and the perfection of creation

In the anatomy section of the Canon of Medicine, Ibn Sina brings in
a philosophical dimension of why different organs have been created
with a perfect structure with an ideal temperament in order to perform
a specific function. Changes to either temperament or structure will
negatively affect the function/s of anatomical structures.

Regarding structure, Ibn Sina’s description of the hand stated that:

“metacarpals provide a concave surface that enables the hand to

retain liquids and firmly surround objects”.

In addition, Ibn Sina argued why there should be only three phalan-
ges in each finger, noting that:

“… if there had been more than 3 phalanges, the fingers would

have obtained a greater range of movement but they would be
weakened in strength. If the phalanges had been 2, the fingers
would have become stronger but the range of movement would

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have been restricted – noting that the fingers need greater move-
ment and nominal strength”.

In his anatomy of the brain and spinal column, Ibn Sina explains the
purpose of creating the spinal column:

He mentioned that:
• “....If the brain supplied all the nerves, it would be too big a
burden for it and;
• If all the nerves have arisen from the brain, the nerves for the
hands and feet would have to travel quite a long distance and
thus be exposed to greater risks of injury and damage. The
nerves would also be too weak to contract and expand the
heavy muscles (of the leg and the thigh). Almighty God has
therefore, provided the spinal cord from the lower part of the
brain;
• The spinal cord arises from the brain like a canal from a spring
so the nerves may reach both sides of the body;
• The source of the nerves has in this way been brought closer
to the recipient organs”.

On the maintenance of temperament: Ibn Sina describes the tem-

perament of the brain as Cold & Wet (moist), where the quality of
cold allows for the brain to work as hard as it does and the quality of
moistness is to prevent dryness in the large number of functions that
takes place within the brain. He also mentions that the blood flowing
from the heart is Hot & Moist and the brain being Cold & Moist, the
middle ventricles (in the brain/brain stem) will help with maturation of
the blood from the heart to suit the Cold & Moist temperament of the
brain.

Similarly on maintaining the temperament of compact bones, he men-

tioned that compact bones are made up of an outer cortical bone and
a central marrow cavity. Taking into account that bones have a Cold &
Dry temperament, bone marrow provides moisture to counteract the
dryness produced by exercise.

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On the functioning of organs: Ibn Sina described the function of the

bladder based on a two phase dogma which still stands in modern
physiology information. He stated that “God has created an organ
similar to a cyst in the human body to remove the useless liquids (or
urine). This allows the urine to gradually pour into the bladder and at
a necessary time, it can be completely expelled from the body. Other-
wise, the human would have to urinate every minute and every hour”.

Ibn Sina described the curvatures of the urethra and suggested that
they help in preventing involuntary voiding of urine. He wrote, “God
in his power, has made a gullet-like organ to eliminate the removable
liquids (urine) through the penile urethra. Thus, this organ that is simi-
lar to a water pipe is continuous from the bladder to the penile urethra
and it has multiple curvatures so that the liquid material would not be
expelled out suddenly and totally”.

Why different organs have been positioned where they are in the
body? “Ibn Sina opined that the lungs help to cool the heart with each
breath. This is analogous to the wings of a bird and its body where
the wings represent the lungs and the body represent the heart. As
the lungs flap they bring a cool breeze to the heart keeping it cooler.
Similarly he opined that the nasal passages facilitate exchange of
temperature (of air) between the brain and the external environment
allowing the brain to maintain its natural temperament.”

The interpretation of tissues, organs within the context of tempera-

ment is discussed below.

TISSUES AND ORGANS

Tissues
The humours form the building blocks for the four major types of tis-
sues – connective tissue, muscular tissue, epithelial tissue and ner-
vous tissue, each having its specific temperament.
Different organs are made up of different ratios of these tissues.

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Temperament of organs
Organs are made from a combination of the four tissues, each of
which has a specific temperament. The dominant quality is shown in
bold.
• Connective tissue – Cold & Dry
• Muscular tissue – Dry & Hot
• Epithelial tissue – Hot & Dry to Hot & Moist
• Nervous tissue – Moist & Hot to Cold & Moist

A specific and unique combination of the four different tissues makes

up the different organs in the body. Every organ has a specific tem-
perament, which is determined according to the following criteria:

• The ratio of the different tissues that make up the organ. This
will influence the balance of qualities.
• The amount of blood that supplies the organ. This will deter-
mine the heat and moisture of the organ or tissue.
• How much movement the organ or tissue normally undergoes.
This will influence the heat and dryness of the organ or tissue.

Temperament of specific organs. The individual temperament of

major organs and tissues within the body are shown in the following
table. The dominant quality is depicted in bold type.

Table 4: Temperament of specific organs

Blood - Hot and Moist Bones, tendons, cartilages - Cold and Dry
Lungs - Hot and Dry Lymphatic glands and vessels - Hot and Moist
to Moist and Hot
Heart - Dry and Hot Ovaries - Hot and Moist
Brain - Moist and Hot Pancreas - Hot and Moist
Kidneys - Hot and Moist Small intestine - Hot and Moist to Moist and
Hot
Liver - Hot and Moist Stomach - Dry and Hot
Gall Bladder - Dry and Hot Thyroid gland - Hot and Moist
Large intestine - Cold and Dry Uterus - Hot and Moist
Urinary bladder - Cold and Dry Veins - Hot and Moist

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Organs. Organs are divided into three main groups under the control
of the three main organs the heart (vital), liver (metabolic) and the
brain (psychic):
• Vital – these are the organs of the cardiovascular and
respiratory system, all of which are ‘controlled’ by the heart
• Metabolic – these are the organs associated with the
digestive and excretory systems, all of which are ‘controlled’
by the liver. The reproductive organs can also be included in
this group.
• Psychic – these are the organs of the central and peripheral
nervous system, all of which are ‘controlled’ by the brain.

THE TIBB THREE-ORGAN THEORY

Embryology describes the development of the human foetus from the

three germinal layers: the endoderm, mesoderm and the ectoderm.
This is equivalent to aspects of the Tibb main organ theory which is
not only in keeping with modern medical science, but also brings in
the concept of temperament and quality:

• The endoderm, or inner layer as identified in embryology,

develops into the lining of most of the gastrointestinal tract and
the organs which serve it - particularly the liver, gall bladder
and pancreas. According to Tibb the endoderm is linked with
the liver and has a dominant quality of heat.
• The mesoderm, or middle layer is the embryonic tissue which
gives rise to the urogenital system, heart, kidneys, and the
musculoskeletal system. According to Tibb the mesoderm is
linked with the heart and has a dominant quality of dryness.
• The ectoderm, or outer layer as identified in embryology,
matures into the nervous system, skin and sense organs.
According to Tibb the ectoderm is linked with the brain and has
a dominant quality of moistness.

The holistic nature of the human being is evident early in the develop-
mental stage of the three germinal layers of organ formation, and per-

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sists until the complete and total formation of the independent foetus.
This complex integration of different systems within the body persists
throughout life.

The three main organs – heart, liver and brain – are considered in
Tibb medical philosophy to be completely integrated in terms of both
information and energy transfer. Any imbalances or deficiencies can
lead to physical or emotional disorders.

“There is complete integration amongst the main organs. Each of

them is the source of preservation for the other. Thus, the pres-
ervation of the whole body depends upon the harmonious inter-
linkage or integration of energies of these main organs.”
[Abu Sahil Mashi]

This concept is in line with conventional medical science, which ac-

knowledges the presence in the body of the three self-regulatory sys-
tems – the immune, endocrine/exocrine, and nervous systems. These
are capable of communicating information, storing information, learn-
ing from pattern recognition, and activating complex feedback pro-
cesses. In addition, they are now known to communicate with each
other via neuro-peptides such as the cytokines – all under the control
of Physis.

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Table 5: Physis, the regulator of homeostasis between the three

main organs

At the center of the wheel of Life is

PHYSIS
(Responsible for maintaining homeostasis between the three main organs)

HEART LIVER BRAIN

(Control their respective systems below)
MUSCULAR GLANDULAR NERVOUS
(Which themselves comprise of)
MUSCLES & EXOCRINE & CENTRAL,
VESSELS ENDOCRINE PERIPHERAL &
GLANDS AUTONOMOUS
(Which are involved in the respective functions below)
MOVEMENT & METABOLISM PERCEPTION,
TRANSPORT ENZYMES & SYMPATHETIC &
HORMONES PARASYMPATHETIC
(Which elicit responses at the levels below)
CELLULAR HUMORAL / VASCULAR NEURAL
(Which manage the lifestyle factors below)
BREATHING, EATING, MOVING, SLEEPING
ELIMINATING & EMOTIONAL INTERACTION
(Which produce qualitative states interactive with)
THE ENVIRONMENT / MACROCOSM

The three organ theory of the heart, the liver, and the brain, fits in well
with the Tibb understanding of the three faculties: the vital faculty
associated with the heart, the metabolic faculty associated with the
liver and psychic faculty associated with the brain as discussed
below:

ENERGY, FACULTIES AND FUNCTIONS

According to Tibb, what a thing is – its essential nature – is closely

related to what it does – its function. The power of an object to behave
or function in a certain way and produce particular effects is thought
to reveal the basic nature of that object. This power is derived from
the inherent wisdom within the object, and is called a faculty.

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However, in order for the faculties to perform their functions,

energy is required.

After food has been ingested, digested and metabolised, humours

are formed in the liver, with the assistance of inspired oxygen. These
humours then act as nutrients for the formation, development and
maintenance of cells, tissues and organs.

Energy is produced by oxidative respiration – from the interaction

between the oxygen inhaled and the subsequent conversion of glu-
cose into adenosine tri-phosphate (ATP), also known as the ‘energy
currency’ of living tissues. The faculties of the body will continue their
functions as long as adequate energy, as ATP, remains available to
the respective organs. This energy is used by the three faculties to
carry out their specific, pre-determined functions.

The table on the next page highlights the integrative nature of Tibb. It
shows the relationship between the main organs, tissues, energies,
faculties, functions, qualities and the three systems of the body that it
regulates – that is, the immune system, the endocrine/exocrine sys-
tem and the nervous system.

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Table 6: Tibb: a fully Integrated system

• The heart is the seat of the vital faculty. It controls the

muscular tissues, uses mechanical energy to perform the
functions of movement/transport and regulates the immune
system; and has an overall temperament of dryness.
• The liver is the seat of the metabolic faculty. It controls the
epithelial tissues uses bio chemical energy to perform the
functions of metabolism and regulates the glandular system;
and has an overall temperament of heat.
• The brain is the seat of the psychic faculty. It controls the
nervous tissues uses electrical energy to perform the functions
of sensation/perception and regulates the nervous system;
and has an overall temperament of moistness.
Tibb physicians recognised this relationship between the three sys-
tems by means of the overall quality associated with each system and

49
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the delicate balance that exists between them. Whilst they did not
have the technology to understand the interrelationship between the
systems, they were able to appreciate this relationship via the con-
cept of qualities. They understood that an increase in quality (hyper)
associated with any one of the systems will invariably have an
opposite affect (hypo) on the other systems.

Comparing Ibn Sina’s constitution of man with the basic

sciences
Having discussed the constitution of the human being from the Tibb
perspective, that is, primary matter, temperament, humours, organs
and tissues, energies, faculties and functions, we see the relationship
between the Tibb constitution of the human being and the basic sci-
ences of biochemistry, anatomy and physiology as follows.

Biochemistry
Primary matter; Temperament; Humours
Anatomy
The tissues and organs of the body
Physiology
Energies – originating from oxygen;
Faculties – the systems which make up the body;
Functions – the actions, control mechanisms and interactions
which take place in the body.

There is complete integration between the energies, faculties and

functions of the human body. The food and drink that we consume
provides primary matter from which humours are produced. Humours
form tissues, which when combined form the organs of the body. The
organs produced form a structure with an appropriate temperament,
in order to perform specific functions. Energy is produced from the
interaction of oxygen and humours.

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TIBB CONCEPT: THE LIFESTYLE FACTORS

We now accept that the environment plays a vital role in determining

our health.

Disease is invariably the result of failure to assimilate the various

environmental factors effectively. These factors include the air we
breathe, and the food and drink we consume. However, there are
several other factors present in the environment (which modern sci-
ence is now rediscovering) that are capable of influencing our health,
both for better, or for worse.

Tibb has identified a number of Lifestyle Factors (also termed

‘governing factors’) which profoundly influence our health. How we
respond to these factors, determines how we grow, move, think and
feel. Variations in the qualities associated with the Lifestyle Factors
(especially food and drink) are the real causes of health or disease.
Management of the Lifestyle Factors determines the outcome of
health or disease. If well managed, good health will be maintained; if
poorly managed, disease will result.

Lifestyle Factors affecting health and disease

The six main Lifestyle Factors are:

• Environmental air and breathing

• Food and drink
• Movement and rest
• Our emotional life
• Sleep and wakefulness
• Elimination and retention

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 PHILOSOPHY OF TIBB

The effects of the Six Lifestyle Factors are determined by the qualities
of heat, moistness, coldness and dryness affecting an individual. For
example, the weather can be hot, cold, moist or dry; foods have inher-
ent qualities where heating foods increases metabolic rate and cool-
ing foods decrease it. Similarly, movement increases heat, resting
confers a cooling effect, and emotions (such as anger) also produce
heat. Sleeping cools the person down, increasing moisture.

These external factors were originally called the ‘non-naturals’,

because they affected the body from the outside. They were said to
have numerous inevitable effects on a person, good or bad.
For health to be maintained, all Six Lifestyle Factors need to be
regulated. This regulation comes under the heading of ‘hygiene’ in its
widest sense (Hygea, incidentally, was one of the daughters of
Aesclepius, the Greek god of health. Another one was Panacea).

The above Six Lifestyle Factors affects every person. The overall
qualities of an individual’s temperament needs to be taken into ac-
count to determine what quality and quantity of each is necessary to
maintain the optimum balance, and the manner this can be achieved.

In Tibb, the practitioner must also personally apply the rules of good
hygiene, if he or she is to assess and understand the patient correctly:

“The physician who neglects his own will hardly be thought very
careful of the health of others” [Hippocrates]

Other Lifestyle Factors. There are factors other than the six above
which may also play a part, but may or may not affect every individual.
These are:

• Occupation or career
• Place of residence
• Exposure to toxic substances
• Exposure to pathogenic organisms
• Age, gender
• Personal habits and hygiene

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 PHILOSOPHY OF TIBB

The Lifestyle Factors are responsible for maintaining the ideal qualita-
tive state of humours in relation to the unique qualitative state of the
temperament of an individual.

Ultimately the Lifestyle Factors are the main cause/s of health and
disease affecting every individual.

THE AXIOMATIC CONNECTION

The scheme (below) illustrates the constant interplay between tem-

perament, humours, the Lifestyle Factors and Physis. Although an
individual’s temperament is fixed, humours fluctuate constantly as a
result of changes to diet and other aspects of lifestyle, such as sleep,
physical activity, breathing efficiency and stress levels. This dynamic
relationship influences the humoral balance, qualitatively in relation
to the temperament, with Physis constantly striving to restore homeo-
stasis. The inability of Physis to restore homeostasis inevitably leads
to pathological processes that manifest as clinical disorders.

The Lifestyle Factors have a critical role in maintaining the overall

qualitative state of an individual’s humours in relation to his/her tem-
perament. For the maintenance of health, the rule to remember is
that an excess of the dominant quality associated with an individ-
ual’s temperament will negatively affect this person the fastest and
the most – health promotion is to ensure that Lifestyle Factors exert
opposite qualities to the dominant quality of an individual is required.

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 PHILOSOPHY OF TIBB

However, of the four qualities exerted by the Lifestyle Factors, two

qualities are of supreme importance in the body – heat and moisture.
This is because the human body has two important features. Firstly,
as mentioned previously, it contains a large amount of water – up
to 70%, present in the blood vessels, between the tissues, or in the
cells themselves. This high proportion of water is necessary in order
to let the many biological processes to take place. The body’s water
amount is strictly controlled. Too little fluid can lead to dehydration,
and too much can lead to oedema. Also, without moisture the body
would become overheated. Disturbances in the body’s water compo-
sition can lead to serious health problems.

Secondly, the human body has a normal temperature of around 370,

which is maintained by Physis in a very narrow range. This tempera-
ture is necessary for the myriad of enzymatic reactions essential for
life. Too high a temperature will result in damage to the body’s metab-
olism and structures; too low and hypothermia will develop. Both of
these extremes are potentially life-threatening. The body works best
at this temperature.

As a result of the above features, the dominant qualities in human be-

ings are not surprisingly, heat and moistness. Heat is obtained in the
body mainly from the metabolic energy locked into food, from physical
activity, and from the environment. Moistness in the body is obtained
mainly from food and drink; so these two factors are immensely im-
portant in Tibb’s approach to both health maintenance and the treat-
ment of disorders.

The other qualities have a minor role, mainly because coldness and
dryness do not support life. In order to achieve good health, it is nec-
essary to maintain homeostasis between all the qualities.
The body’s state of equilibrium of the two main qualities (heat and
moistness) is fundamental to a person’s state of health. This equilibri-
um is not rigidly fixed, but varies throughout the day and changes with
food intake, physical activities, elimination of toxins, etc. It is therefore
important to maintain these two qualities within strict boundaries or
limits through suitable lifestyle choices whenever possible.
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 PHILOSOPHY OF TIBB

In addition, these two qualities are mutually supportive, being inti-

mately related within the body. Heat prevents moisture from changing
excessively, and this avoids it corrupting the metabolic activities and
body structures. A person’s body needs the correct amount of mois-
ture balanced with heat to ensure good health.

“Health, stability and the body’s state of equilibrium are

regulated through moisture which opposes the heat. Each of the
two qualities upholds the other, and the body is upheld by them
both. When one of them exceeds the other, the body becomes
indisposed accordingly”. [Ibn Jawziyya]

Hippocrates and pepsis. The interaction between an individual and

the environment can be interpreted within the Hippocratic principles
of ‘pepsis’. Hippocrates firmly believed in the interaction of living or-
ganisms, including human beings, with the external environment. He
felt that we take from the environment the nutrients and other factors
which help us grow, develop and survive, and return to the environ-
ment the waste products rejected by the body. Our efficient interac-
tion with the environment and the ability to effectively ‘digest’ the
environment constitutes health.

According to Hippocrates, disease is as a result of the difficulty in the

digestion or ‘pepsis’, of the environment, by the organism. His term of
dyspepsia is still used today. However the understanding of
‘dyspepsia’ by Hippocrates extended beyond the inability to digest
food and drink but extended to the effective digestion of the total envi-
ronment in a state of complete harmony – which includes the Lifestyle
Factors.

Our personal health reflects the extent to which this interaction is

successful; if we fail to derive adequate nutrition from our environ-
ment, then we will fail to thrive. Also, if we are inefficient in rejecting
unwanted, waste products, then our very survival will be threatened
by a build-up of toxic materials.
Disease is invariably the result of our failure to assimilate and elimi-

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 PHILOSOPHY OF TIBB

nate the environment – the Tibb Lifestyle Factors effectively.

Lifestyle Factors in health and illness. A brief overview on the role

of Lifestyle Factors in both health promotion and in the management
of illnesses is mentioned below.

Health promotion. Identifying the dominant quality of an individu-

al’s temperament is absolutely essential in health promotion. As
previously mentioned a person with a
sanguinous/phlegmatic temperamental
combination will have an overall qual-
ity of moistness. Research has indicat-
ed that for this individual Lifestyle Fac-
tors that will increase the qualities of
moistness (such as moist foods, humid
weather etc.) will be detrimental to this
person’s health, whereas Lifestyle Factors that will increase dryness
will be most suitable for this person.

Similarly a person with a bilious/sanguinous temperamental combi-

nation, with an overall quality of heat will be negatively affected by
hot spicy foods/strenuous exercises. As mentioned earlier, an excess
of the dominant quality associated with an individual’s temperament
will negatively affect the person the fastest and the most. Therefore
health promotion is to ensure that Lifestyle Factors exert opposite
qualities to the dominant quality of an individual is required.

Illness management. Tibb interprets the signs and symptoms/illness

conditions also within the context of qualities. Colds and flu, for ex-
ample, are linked to the qualities of coldness and moistness, and os-
teoarthritis to coldness and dryness. Management of Lifestyle Factors
opposite to the qualities linked to the disorder addresses both symp-
toms and its underlying causes, thereby assisting Physis in restoring
humoral balance – homeostasis.

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 PHILOSOPHY OF TIBB

HOLISM IN TIBB - THE WHEEL OF LIFE

The Wheel of Life not only illustrates the complexity of the human
being – from single cells to tissues, organs, electrolytes, enzymes,
hormones, neurotransmitters, etc., it also illustrates the comprehen-
sive understanding of the relationship between the human being (i.e.,
microcosm) and the environment (i.e., macrocosm) and the role of
Physis in maintaining homeostasis between them. The wheel of life
emphasises the need for a holistic, integrated approach which recog-
nises every component and respects Physis, in the maintenance of
health and the alleviation and curing of disease.
Whilst other disciplines such as Chinese medicine and Ayurveda fo-
cus on the effect of energetics, the Tibb temperamental and humoral
theories allows for an understanding between the relationship of cos-
mic energy and the biochemistry of the body.

Table 7: Wheel of Life; Microcosm to Macrocosm

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 PHILOSOPHY OF TIBB

TIBB: A SCIENCE OF MEDICINE, THE ART OF CARE

Tibb is described as:

“A Science of Medicine, the Art of Care”.

It is a ‘Science of Medicine’ because it is based on the principles of

cause and effect, the foundation of which was established by Hip-
pocrates, who made the momentous break from the previous magi-
cal and superstitious attitude to disease, to a theory and practice of
medicine based on scientific principles.

It is the ‘Art of Care’ because the Tibb Philosophical principles of Phy-

sis, temperament, humours, Lifestyle Factors and qualities provides a
comprehensive understanding that enables healthcare professionals
in health maintenance as well as in the treatment of disease.
Health maintenance is achieved by managing the Lifestyle Factors,
whereas treatment of disease is designed to assist Physis in restoring
health.

Table 8:

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 PHILOSOPHY OF TIBB

CHAPTER REVIEW
This chapter details the fundamental concepts of Physis, tempera-
ment, humours, Lifestyle Factors and qualities within the context of
health and disease. The most significant outcomes are the realisation
of the relationship between man (the microcosm), and the universe
(the macrocosm), the recognition of the uniqueness of each individ-
ual, acknowledging and respecting the inherent self-healing mecha-
nism of Physis; and the appreciation of the insights provided by the
temperamental and humoral theories in the preservation and restora-
tion of health.

General: Tibb is not a newly emerging or esoteric form of healthcare,

but has its roots in traditional medicine which extends back for many
centuries to ancient Greece and Persia. In Tibb, health is present
when the body’s functions maintain a correct balance of temperament,
structure and function. Also disease is viewed as an abnormal condi-
tion which produces a functional disorder as a primary consequence.
Disease can be an expression of a temperamental imbalance, humor-
al imbalance or a disorder of tissue structure. Tibb was the mainstay
of medicine until recently, and practiced all over the Western World. In
many ways Tibb is the foundation of present-day Western medicine.

Many of Tibb’s basic principles are now being reintroduced into West-
ern conventional medicine, such as the awareness of a patient’s indi-
viduality and the importance of lifestyle factors in health maintenance.
The main therapies employed in Tibb are lifestyle adjustment, dieto-
therapy and medication. Therapy aims at encouraging inner healing,
and treats the underlying causes of disease, rather than focusing on
counteracting the patient’s symptoms. Tibb is well suited to being
combined with Western medicine, in the form of Integrative Medicine.

Tibb therapy is cost-effective, as much of its therapy involves rea-

sonable lifestyle changes which are economical to apply compared
to prescription drugs, for example. The Tibb practitioner’s care and
empathy are considered very important to the healing process. The
physician becomes a partner in healing.

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 PHILOSOPHY OF TIBB

Physis: The term ‘physician’ is derived from the word ‘Physis’. The
role of Physis is to ensure that optimum health is maintained. In Tibb,
Physis has to be respected if the healing process is to be successful.
It has a predominant role in the body’s self-healing and self-repair
processes, and actively counteracts influences which lead to injury
and illness. When illness develops, Physis always directs the healing
processes in specific ways.

The treatment of illness by the practitioner is imposed from outside,

whereas actual healing is achieved from within. Physis restores
humoral imbalances in relation to the temperament of an individual.

Temperament: Tibb adheres to the concept of temperament, which is

central to its philosophy. Temperament is the result of what emerges
from the interaction of the four primary qualities – heat, coldness,
moistness and dryness – when these qualities have attained a state
of equilibrium in an individual. Temperament is an amalgam of a per-
son’s physical, mental, emotional and spiritual attributes. Each indi-
vidual has a unique temperament, with corresponding qualities. In
Tibb, The four main temperaments are: sanguinous, phlegmatic, bil-
ious and melancholic. A person is generally a mixture of two basic
temperaments; a dominant, and a sub-dominant. A person’s tempera-
ment is maintained by the humours. The temperament of a specific
organ is largely determined by: (a) the ratio of different tissues it con-
tains; (b) its blood supply; and (c) its functional mobility.

Qualities: A person’s optimum health depends on the maintenance

of an ideal qualitative state, which is a unique combination of the four
qualities. There are continual changes or adjustments to the propor-
tions of the different qualities due to the dynamic interaction between
the person and the environment. Physis is responsible for actively
counteracting these changes, in order to maintain the person’s
ideal qualitative state in relation to their temperament. If the person’s
physis is incapable of restoring the ideal qualitative state, signs and
symptoms of a particular disorder will begin to appear. In Tibb, the
appearance of symptoms suggests that Physis needs assistance in

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restoring a normal qualitative state.

Humours: In Tibb there are four humours: sanguinous, phlegmatic,
bilious and melancholic. These humours are associated with body
fluids: sanguinous – blood; phlegmatic – phlegm or mucus; bilious –
yellow bile; melancholic – black bile. Each humour has its own char-
acteristic qualities. The sanguinous humour is Hot & Moist; the phleg-
matic humour is Cold & Moist; the bilious humour is Hot & Dry; and
the melancholic humour is Cold & Dry.

The humours are involved in providing nutrition and energy for the
body. An important function of the humours is to maintain the indi-
vidual’s ideal qualitative state, associated with the temperament of
an individual. Health is the outcome of the right quantity and quality
of humours within the body, the equilibrium between them, and the
temperament of the individual. Disease arises from imbalances in the
composition of a person’s humours.

Faculties: There are three basic faculties in the body: vital, metabolic
and psychic. Each faculty has its characteristic dominant quality: vi-
tal (dryness), metabolic (heat), psychic (moistness). The faculties are
based on three organs: the heart (vital); the liver (metabolic); and
the brain (psychic). The vital faculty controls muscular movement and
the immune system. The metabolic faculty controls the use of nutri-
tion, and the glandular system. The psychic faculty controls the bodily
senses, voluntary muscle activity and intellectual functions.

Energy: There is complete integration between the energies, the

faculties and the functions of the human body. The food and drink
that we consume provides the primary matter for the production of
humours. This process is influenced by the interaction between our
body and the environment. Energy is produced from the interaction
of oxygen from air, and humours. The humours form tissues, which
when combined form the organs of the body. The organs produced
form a structure with an appropriate temperament, in order to perform
specific functions.

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Lifestyle Factors: Tibb focuses on the relationship between the in-

dividual human being (the microcosm) and the external environment
(the macrocosm). The main Tibb Lifestyle Factors are: environmental
air & breathing, food & drink, movement & rest, sleep & wakefulness,
emotions, and elimination and retention. Variations in the qualities
associated with the Lifestyle Factors (especially food and drink) are
often the cause/s of health or disease.

Holism: Tibb recognises that the human being is an unbelievably

complex phenomenon. It regards the body, the mind and the spirit
as being interconnected. Tibb is a holistic approach to the healing of
illness through restoration of balance to the physical, mental, emo-
tional and spiritual aspects of the person. Tibb deals with the whole
patient, rather than with a particular organ or tissue, or just with the
symptoms of a disease. Tibb’s view of the holistic approach to health
and disease is illustrated in the Wheel of Life, which inter-relates the
many functions in terms of their structures, functions and qualities in
the context of the person’s microcosm and the macrocosm.

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CHAPTER 2: AETIOLOGY IN TIBB

INTRODUCTION

Aetiology according to conventional medicine is the study or science

of the causes of illnesses only. In Tibb, aetiology refers to a study
of both the causes of illnesses as well as the factors involved in the
maintenance of health. It is relatively easy to define illness in terms of
tissue or organ malfunction, but defining health is a rather more dif-
ficult challenge. Health is a positive, definite concept, not simply the
absence of illness. The practice of Tibb is as relevant to people who
are healthy as it is to patients who are ill. The appetite for health is
more than simply avoiding illness; it is the desire to pursue a lifestyle
which allows the person to function at the optimum level, and to main-
tain the physical, mental and spiritual activities which are necessary
to get the most out of life. An already healthy person can actively im-
prove his or her physical and mental health.

This chapter on Aetiology elaborates on the principles of ‘cause and

effect’ in relation to the causes of disease and also the maintenance
of optimum health. The philosophical basis of Tibb provides a strong
foundation for both a comprehensive understanding of the different
causes of illnesses, and the active maintenance of health. This chap-
ter provides insights into the principles of cause and effect from the
Tibb perspective. It accepts that the cause of disease is multifactorial
and dynamic. Tibb contends that distortions in the patient’s Lifestyle
Factors are ultimately major contributors to the onset and perpetua-
tion of most diseases, especially those which are chronic and recur-
ring. The causes of most if not all ailments are related to changes in
the qualities of heat, coldness, moistness and dryness. Tibb affirms
that for every illness there is a defined cause, or group of causes, and
this contributes to the selection of subsequent treatment. This chapter
also provides Lifestyle Management Programmes for health mainte-
nance for the different temperamental combinations.
Aetiology here discusses causes on the assumption that a person is
born with normal faculties and metabolism, and without any signifi-

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cant genetic, physical or mental abnormality. Tibb strongly believes

that everyone has a natural tendency towards health, and that this is
the normal condition.

PRINCIPLES OF CAUSE AND EFFECT

Tibb is a science of medicine and the art of care that deals with the
human body in both health and disease. It is committed to identify-
ing, isolating and possibly eliminating the cause/s of disease, and
the enhancement of factors that help maintain optimum health. With
respect to the various ailments, we arrive at a greater understanding
of a particular disease if we find out what the underlying causes are.
Although the cause may be evident in many diseases, there may be
other conditions which may have more obscure causes.

Different circumstances result in a cause being labelled differently.

For example, sometimes one disease causes another disease (as
colic can cause convulsions or epilepsy) and sometimes a symptom
becomes the cause for a disease (an acute pain in colic becomes
the cause for the occurrence of syncope, or fainting). Similarly acute
pain causes swelling (from the accumulation of matter in response to
the area of the pain). Sometimes a condition can be indicative of a
cause, a symptom and a disease. For example, a headache may be
caused by a prolonged fever, which gradually leads to meningitis.

Definition of Aetiology. In medical terms, the cause of a disease is

a specific factor associated with the definitive onset of the disease.
It can also apply to an injury, or accident. It is different to a risk or
predisposing factor, which is an attribute of behaviour or habit which
makes a person more likely, or probable, to develop a particular ill-
ness. In Tibb, the definition is more extensive. A cause is that event,
behaviour, or change in the microcosm or macrocosm from which
originates the outcome of a certain state of the human body, be it a
state of health or disease. Tibb’s understanding of the cause of the
disease includes what are generally known as risk factors.

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Ibn Sina has identified three criteria for a cause to produce an effect.
• Sufficient active power. This means that the cause must be
able to produce an effect. We do not expect a slight knock to
produce a huge bruise.
• Sufficient receptive power. This means that the body must be
able to respond to the cause by reacting appropriately. The bio-
chemical mechanisms responsible for developing an infection,
for instance, should be functioning before the infection occurs.
• Prolonged contact between the two. This means that the
cause must have realistic time to exert its action. A brief rise in
blood pressure, for example, should not cause kidney failure.

Definition of ‘effect’. An effect within the context of medicine is the

result of treatment or medical intervention. However, it does not al-
ways follow that a course of treatment with a drug, for example, re-
sults in an effect which is only due to the drug. There could be a clini-
cal improvement which is due to:

Spontaneous healing. Spontaneous healing, or remission, is the

sudden but inexplicable recovery from clinical disorders without any
real medical intervention. The recovery from the disorder may not
be due to the drug or other treatment, but in spite of it. The person’s
physis is able to restore the internal harmony which is the underlying
problem. In fact, more than 80% of clinical disorders improve or com-
pletely heal on their own, without any outside intervention.

“Spontaneous healing gives us the strongest evidence that there

is an extraordinary self-repair system lying dormant within us”
[O’Regan]

The placebo response. A placebo is a therapeutically inactive,

neutral substance made to physically resemble the active drug. A
placebo effect is an unanticipated mind-produced response to a
placebo. The placebo response would appear to be close or even
identical to the physis response.

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However, as physis transcends the physical, emotional and spiritual

dimensions of the person, it can often manifest in one form or another.

“For many doctors, the practice of placebo medicine has an un-

savoury scent about it. It seems to involve deception and trickery,
and so is not clearly distinguishable from quackery”.
[Andrew Weil]

Cause and disease. The temperamental and humoral theories have

enabled Tibb practitioners to understand the cause/s of disease for
centuries.

Let us consider the following case history:

Mr Robert M., aged 55, somewhat overweight, smokes 30 ciga-

rettes a day, drinks quite heavily at weekends, exercises very
occasionally, and is a mild type 2 diabetic. One day, after a
difficult time at the office, and during an argument with his
daughter the same evening, he suffers a non-fatal heart attack.

The question is: What caused Robert M’s myocardial infarction?

• Was it one of the several risk factors (smoking, overweight,

binge drinking, glucose intolerance) for atherosclerosis he
possesses?
• Was it the emotional stress brought about by his confrontation
with his daughter?
• Was it the atherosclerotic plaque in his coronary artery,
preventing adequate blood flow to the heart muscle?
• Was it a blood clot, formed in the leg, but carried to the heart
by the bloodstream, where it became stuck in an artery?
• Was it his sedentary lifestyle?
• Was it his genetic make-up?

There is, in this case, a series of possible causes, any one of which
could be responsible for his heart attack.

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Types of causes
According to Ibn Sina, there are four different kinds of causes:
• Material causes – substances (structures) upon which
health and disease depend. In this case, this would include dis-
harmony in circulating lipids and glucose that existed in Robert
M, ultimately as a result of a poor diet. The term material cause
would invariably refer to foods and derivatives – that is, associ-
ated with the humours.
• Formal causes – those which maintain or alter the body.
With Robert M, this would be his constitution or genetic make-
up, or temperament, and its failure to prevent the build-up of
atherosclerotic plaques in his coronary arteries (inherited)
associated with the temperament of the person.
• Efficient causes – the effect on temperament from the
environment or Lifestyle Factors. For Robert M, this would
mean his sedentary lifestyle, which causes an imbalance in
humours, which leads to structural changes in the heart’s
arteries. The heart attack would be triggered by the emotional
stress of the argument with his daughter. This is the interaction
between man and the environment associated with the Lifestyle
Factors.
• Final causes – the functions, which disturbed, leads to the
illness. In Robert M’s case, this would refer to the blockage
of the coronary artery brought about by the formation of a
blood clot, and its lodging in a particularly narrow section of
one of the heart’s blood vessels. This would be the manifestation
of the causes – a consequence of the final outcome associated
with a function of the body.

Origin of Clinical disorders. Tibb identifies two basic origins of

clinical disorders:
• Internal origin – these are diseases that originate within the
body due to a humoral, qualitative or functional imbalance
resulting from poor management of Lifestyle Factors.
(For example, inflammation of the gastric mucosa can lead to
gastric ulcers.)

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• External origin – those arising from outside the body. (For

example, an injury leading to pain, or a disorder which results
from microbes.)

Causes of clinical disorders are varied, and not specific. This

applies to both internal and external causes. They are associated with
every aspect of the human being – humours, temperament, structure
and function. There is invariably a link between cause and effect, both
externally and internally.

Sequence of cause and effect. An example, supplied by Ibn Sina, of

external causes influencing a person’s health, is as follows:

“If a person consumes hot and dry foods to excess, and other
related external hot and dry causes, such as hot weather and an-
ger, are present, an imbalance in the bilious humour can occur.
This imbalance originating externally can then become the cause
for the internal conditions of inflammation of the liver – hepatitis –
which can result in the symptoms of nausea, vomiting, shivering,
jaundice and fever”.

Effects from different causes. Ibn Sina listed a number of internal

and external factors which can cause different forms of structural or
functional disorders which themselves can lead to specific symptoms
of bodily disorders.
• Increase in body temperature – can result from putrefaction
(infection), or from excessive consumption of hot foods or drinks.
• Decrease in body temperature – can result from excessive
sleep, overeating cold and moist foods, constipation, and
certain drugs (humectants).
• Excessive dryness – results from over-exercise,
wakefulness, desiccant drugs (such as diuretics), and
starvation.
• Dyspepsia – results from lack of exercise, overeating, lack of
depletion (slow stomach emptying).
• Excessive skin smoothness or roughness – results from the
application of caustic solutions, detergents, acids, solvents
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and plaster.
• Channels dilating – results from constipation, diarrhoea.
• Ulceration – results from the rupture of skin blisters, sepsis,
corrosive pustules, and an acidic environment.
• Blockage of vessels – results from growths (tumours), kidney
stones, blockage (embolism).
• Disorders of configuration – results from abnormalities in
structural development (shape, ducts, cavities or surface of
the organs); or from displacement of the correct anatomical
position such as a prolapse of an internal organ or displacement
of a joint.
• Loss of continuity – results from damage at an anatomical
level to skin, bone, cartilage, nerves, muscles and organs.

Other points from Ibn Sina

The effects of a particular cause will vary from person to person. It
may have a different response in strong or weak persons, or in sensi-
tive or insensitive individuals. This is another example supporting the
uniqueness of the individual. The same cause may give rise to differ-
ent diseases in different people. For example, high blood pressure in
one person may lead to kidney failure, in another person to a stroke,
and in a third person to heart failure.

The concepts of cause and effect are complex from the Tibb perspec-
tive. Aetiology in Tibb is multifactorial, and associated with the main-
tenance of the ideal temperament of the individual (formal cause). It
takes into account humoral imbalances arising from biochemical and
physiological changes (material cause). Tibb recognises the role of
Lifestyle Factors in determining the outcome of health or disease
(efficient cause) and establishes that impaired functions lead to fur-
ther illnesses (final cause).

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CAUSES ASSOCIATED WITH HUMOURS

Humours are produced in the liver from the food and drink we con-
sume. As mentioned in Chapter 1, one of the main functions of the hu-
mours is to maintain the ideal qualitative state, in accordance with the
overall qualities of the temperament of an individual. Causes associ-
ated with humours – material causes – can happen either qualita-
tively from the effects of heat, coldness, dryness and moistness, and/
or quantitatively, resulting from different concentrations of the four
humours, both of which impact the overall quality of the humours.

Humoral changes resulting from diet

If a person consumes improper or unsuitable food and drink, an ex-
cess of a particular humour will be produced that may not be ide-
ally suited to the person. For example, if someone with a dominant
bilious (Hot & Dry) temperament eats excessively Hot & Dry foods,
this will lead to the formation of too much bilious humour. As a result,
the ideal composition of humours required will change, specifically
increasing the qualities of heat and dryness above the ideal for this
temperament. Similarly, if the same person eats too much in the way
of Cold & Moist foods, the excessive phlegmatic humour which will
follow will again change the ideal composition of humours. This will
reduce the ideal Hot & Dry qualities associated with the person’s bil-
ious temperament.
These changes in humours therefore affect the person:
• Quantitatively – by increasing or decreasing the amounts of
the different humours.
• Qualitatively – from changes to the ideal qualitative state of
humours in accordance with the overall qualities of the
temperament of an individual.
Either way, a humoral imbalance develops.

Humoral changes resulting from other Lifestyle Factors

A person may have the ideal balance of humours, both quantitatively
and qualitatively, because he or she eats and drinks sensibly and
avoids excess, but changes may occur to the ideal combination of

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humours because of other Lifestyle Factors. For example, if someone

reacts badly to stress or fails to achieve good sleep hygiene, the re-
sultant negative impact will alter the qualitative state of the humours
required by the temperament. A person’s humoral balance is thus
entirely dependent on Lifestyle Factors.

CAUSES OF DISEASE ASSOCIATED WITH

TEMPERAMENT

Temperament and predisposition to disease

As mentioned in the previous chapter, the relationship between tem-
perament and health (or disease) is
also based on the maintenance of the
ideal qualitative state of an individu-
al’s temperament. Each person has a
unique temperament in which one of
the four qualities is dominant. For ex-
ample, in the adjacent diagram a per-
son with a dominant/sub-dominant
sanguinous/phlegmatic temperament,
having an overall dominant quality of moistness, will be predisposed
to illness conditions with a dominant quality of moistness.

Research conducted at the Tibb Treatment Centres in Cape Town,

published in the International Journal of Recent Scientific Research,
states, “Of the 100 patients, 55% showed a link between the dominant
quality of the temperament in the context of the signs and symptoms
of the illness having the same quality. This percentage increases to
74% in patients below the age of 40, and more significantly, increas-
es to 92% in those below the age of 30. This clearly indicates that
the predisposition to illness is closely aligned to the dominant quality
of the temperament - especially in the early life during which physis
functions optimally.”

Temperament is considered to be one of the determining factors in

health and disease and like the humours, these are ultimately
dependent on the Lifestyle Factors.
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CAUSES ASSOCIATED WITH FUNCTION

The body’s structure is continually regenerated by means of cell divi-

sion and a sophisticated range of metabolic activities. The humours
are the agents for this regeneration. The maintenance of both the
temperament of organs/tissues as well as the structure to perform
efficient functions is, as discussed previously, dependent on the hu-
mours of the body. As the ideal humoral balance of an individual is
dependent on Lifestyle Factors, especially diet, causes associated
with functions (final cause) are also dependent on the Lifestyle
Factors.
Whilst Ibn Sina has identified four basic causes determining the health
and disease situation, ultimately Tibb considers that disturbances in
Lifestyle Factors are the primary causes of all illnesses (Ibn Sina’s
‘efficient cause’).
This is in keeping with the Hippocratic principles of ‘pepsis’, describ-
ing the relationship between the individual and the environment:

“All living organisms grow at the expense of the environment,

taking from it what is necessary and rejecting what is
unnecessary.” [Hippocrates]

It is the effective digestion of the environment that constitutes health.

However, if poorly managed, it becomes the cause of disease.

CAUSES ASSOCIATED WITH THE LIFESTYLE FACTORS

Tibb philosophy has identified the environment within the context

of the Lifestyle Factors, which if managed well will ensure health is
maintained. Otherwise, an accumulation of toxins will lead to excess/
abnormal humours forming, resulting in one or other ailments. The
toxins that we are currently exposed to come from four main sources:
internal, external, dietary and mental.

• Internal toxins or endotoxins are the natural end-products of

the body’s general metabolism. They include the breakdown

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products of the body’s gut microflora, or microbiome. They also

include any surplus fat soluble vitamins and minerals.
• External toxins or exotoxins encompasses tobacco smoke,
drugs, whether prescription, over-the-counter, or recreational,
and their metabolites. They also include the toxins mentioned
above, such as food additives, volatile household chemicals,
cosmetic products, agricultural/horticultural products and indus-
trial effluent. For example, oestrogen-mimicking endocrine
disrupting chemicals have recently been identified as a likely
source of the serious fall in sperm count and rise in testicular
cancer reported from parts of the Western world.
• Dietary toxins are substances present in our Westernised food
and drink, usually legally, but which are now known to have
adverse effects on our general health, mostly in the long-term,
but often in the short-term. They include artificial sweeteners,
fructose present in corn syrup and other agents, high sugar
content pastries, etc., trans acids, pesticides in eggs and other
staples, herbicides used on grain foods, fluoride in tap water.
Microbial contamination from moulds or bacteria in poorly
stored or preserved food also fits into this category.
• Mental toxins are emotional or spiritual situations which
lead to severe humoral imbalance and psychological disorders.
Anxiety, depression, social isolation or loneliness, anger,
hostility, and jealousy, for instance, often manifest as
physical disorders if not countered by appropriate measures.

The impact of the above toxins, whether from internal, external,

dietary or mental sources, is included in this section.

Six of these Lifestyle Factors are common to all individuals.

• Environmental air and breathing

• Food and drink
• Movement and rest
• Our emotional life
• Sleep and wakefulness
• Elimination and retention
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 AETIOLOGY IN TIBB

There are other factors which have varying influences in specific

circumstances.

• Occupation or career
• Place of residence
• Exposure to toxic substances
• Exposure to pathogenic organisms
• Age, gender
• Personal habits

The Lifestyle Factors, especially the six major ones, influence each
and every one of us.

ENVIRONMENTAL AIR AND BREATHING

The air we breathe is the first step in the hierarchy of physiological

needs. It is the most important living connection with our environment
– from the moment we are born, to the time of our death. Hippocrates
wrote a text – ‘Airs, Waters and Places’ – which discussed the medical
merit of different environments. Its role in the maintenance of health is
too often neglected or ignored completely.

“Air is the author of life, disease and death to the people”

[Culpeper]

Air is the main thing that all living organisms share on Earth. It flows
between us all, connecting us intimately. Physis is actively involved in
maintaining the balance between the body’s need for oxygen, and its
need to remove toxins from the body.

These days, we are increasingly exposed to alien chemicals, largely

as a result of the extensive changes in the modern lifestyle. There is
more pollution from, inter alia, industrial waste and agricultural chemi-
cals, synthetic food additives, body care products, domestic pesti-
cides, cleaning materials and packaging. An alarming observation is
that umbilical blood following childbirth in some developed countries

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contains hundreds of alien, new-to-nature chemicals, the toxicity of

which has not been quantified. The possibility that many of these
chemicals are neurotoxic, and may be contributing to the upsurge in
cancers, autism, Alzheimer’s and other dementias is currently under
active scrutiny.

The function of air in health and disease.

Air is composed of nitrogen (around 78%), oxygen (21%) and carbon
dioxide (0.04%, and rising), plus a number of rare gases such as he-
lium, methane and argon. The oxygen in environmental air is the only
component used by human beings. The air we inhale and exhale has
several vital functions:

• Air is our primary source of nutrition. The oxygen

contained in air is needed to transform the nutrients
present in our food into energy, humours and body fluids
that maintain the body.
• Air diminishes excessive heat, thus helping maintain our ideal
body temperature.
• Air cleanses the body of some forms of waste matter, such
as carbon dioxide and volatile gases formed in the breakdown
of, for example, garlic in the food.

“Air is the fountain of life, and also provides the source for the
activation of energies to form humours and body fluids and main-
tain life” [Hippocrates].

There is a growing body of evidence suggesting that changes in tem-

perature, humidity, air speed and pollution can lead to increases in
the number of people who have heart attacks, strokes, respiratory
problems and other disorders. Tibb has long recognised this.

Purity of air
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 AETIOLOGY IN TIBB

We require clean, healthy air to breathe and maintain our optimum

health. By far the most important aspect of health is the nature and
severity of pollution in the atmosphere. Industrial smoke is now ac-
cepted as the worst offender, and a real danger to life. However, do-
mestic pollution – from cooking or heating fires – is also a serious
problem.

The air we breathe should be neither contaminated by industrial pol-

lutants, domestic activity or car exhaust fumes nor made stale by peo-
ple who are confined to homes, offices, airliners and social venues
without proper ventilation. If the quality of air is poor, then the onset
and development of specific diseases can be accelerated. In fact,
many occupational diseases have their origin in lungs weakened by
exposure to poor quality air.

Today, environmental factors of all sorts, especially air pollutants, are

being implicated in the development of several diseases.The role of
good quality air in maintaining health and avoiding disease is often
neglected. This is a factor which should be considered when reloca-
ting for job, retiring or emigrating – a person should be aware of the
benefits and drawbacks arising from the environmental air he or she
will be breathing.

Changes to environmental air which can affect health

Air pollution. This can prove fatal. It poses a greater threat to health,
causing more early deaths, than previously believed. Not only does it
affect overall mortality, it increases the incidence of ischaemic heart
disease, asthma and lung cancer. Thunderstorms have been linked to
a higher incidence of hay fever, due to the circulation by the disturbed
air of pollen and spores and toxins. Burning mosquito coils is harmful
to children especially, as coils are known to produce very toxic by-
products.

Workplace toxins. In the person’s workplace, the floor, chair, desk

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and computer are contaminated by toxins which readily circulate in

the air, encouraged by electrostatic charges. The toxins include frag-
ments of insects, particularly cockroaches and mites, and plant pol-
len. In fact, offices can be more toxic than public toilets. Occupational
and domestic exposure to paint fumes should always be avoided as
they are toxic and associated with several negative health effects,
such as headaches and nausea.

Cigarette smoking. The deleterious effects of ‘side stream’ cigarette

smoke have been suspected for some time. Now there is consider-
able evidence that the dangers to innocent bystanders are real and
substantial. Not only watery eyes and asthma attacks in the short
term, but bronchitis, skin disorders and various cancers in the longer
period are some of the effects. Since the no smoking rule was intro-
duced, the improvement in people’s health is definitely noticeable.

Climatic changes. Climates do influence diseases. In recognition

of this, some medical schools have separate departments of tropi-
cal medicine, recognising that heat and humidity in the air that we
breathe can make the person more vulnerable to certain diseases.
It is well known that people living in different regions are more prone
to certain diseases. Intestinal complaints are more prevalent in warm
climates, chest diseases in cold, moist climates, and skin disorders in
moist and hot climates. Heat waves, when the air temperature is very
high both day and night, may lead to heat exhaustion, heat strokes,
heart attacks and strokes. Low temperatures also put stress on the
body. Heart attacks increase after bitterly cold weather. Deaths as a
result of respiratory disorders also increase after a cold snap.

Effect of air conditioners. As air conditioners are a central feature of

daily life in developed countries, it is important to be aware that they
can be a health hazard, especially in confined spaces such as airlin-
ers, hospitals, teaching establishments and offices. Many illnesses
are the result of exposure to air conditioners, which are known to be
very effective in rapidly spreading disease-causing microbes, toxins
and allergens. Air conditioners are responsible for sudden qualitative

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changes which can arise from their use. Persons suffering from sinus
problems or bronchial asthma are hardly likely to recover completely
from these illnesses, no matter what treatment they are receiving, if
the air conditioner is a contributory cause.

Most air conditioners increase the qualities of coldness and dryness

in the immediate environment. Therefore, the people most likely to be
adversely affected would be people with a phlegmatic or melancholic
temperament. In addition, other temperamental types could conceiv-
ably be affected by the sudden changes from hot to cold to hot, etc.
Even individuals with dominant sanguinous and bilious temperaments
will be affected negatively.

Air and infectious disease

We are all familiar with the fact that different seasons of the year bring
with them different diseases. Tibb physicians were unable to iden-
tify micro-organisms (viruses, bacteria and fungi) because at the time
they lacked the appropriate technology. However they recognised
that different seasons bring illnesses that are the result of changes of
qualities in the air (Hot, Cold, Moist or Dry) which allows for greater
multiplication of certain bacteria and other micro-organisms when the
conditions are ripe for this. This explains why certain ailments are
more prevalent at certain times of the year. For example, viral respi-
ratory infections are more prevalent in winter (coryza and influenza),
respiratory allergic disorders (hay fever) in spring, and in summer
gastro-intestinal problems and fungal infections are prevalent. (The
impact of seasonal changes on humours that will result in the pro-
liferation of micro-organisms will be elaborated on in the Pathology
chapter).

The connection between air and infectious diseases can easily be

explained according to Ibn Sina’s conditions necessary for a cause to
have an effect.

As mentioned earlier, the following three conditions are necessary:

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Active power. Using the winter season example quoted above; there
may be sufficient active power. The person may be exposed to a high-
ly pathogenic viral or bacterial load in the air. Also, the person may be
exposed to a particular microbe or toxin for the very first time, so will
react very definitely.
Receptive power. Because of the internal environment, microbes will
only be capable of exerting a pathological impact if there is sufficient
receptive power within the individual’s humour, or if the individual’s
immune system is compromised. This is more likely to happen if the
person has not come into earlier contact with the pathogen or toxin.
Also, certain temperamental types will be more inclined than others to
certain illness conditions.
Prolonged contact. The third condition relates to the need for pro-
longed contact between the microorganism and the person. This
means that even if an individual’s humoral balance is strong enough
to initially withstand the onslaught of the bacteria or virus, over a sus-
tained period the immune system may become compromised. This is
more likely to happen in conditions of overcrowding, or in institutions
such as schools and prisons, where people are in very close proximity
to each other.

Environmental air and Temperament

People are affected differently by air, depending on their individual
temperament. As the qualities of environmental air varies from re-
gion to region, these differences will have different effects on different
people. For example, in the coastal regions it is more likely to be Hot
& Moist, being more humid, and on the inland plateau it is more likely
to be Cold & Dry. Unfortunately, a person cannot control the weather.
However, by knowing the temperament of a patient, you could advise
him or her to compensate for adverse weather conditions by main-
taining their ideal temperamental quality by actively invoking other
Lifestyle Factors, especially diet and exercise.

People with different temperaments will be affected differently by

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certain weather scenarios. A number of these are shown below:

• Persons with a dominant sanguinous temperament will be most

affected by the overall heat of summer, especially on the coast.
• Persons with a dominant phlegmatic temperament will be most
affected by the overall coldness of winter, especially on the coast.
• Persons with a dominant bilious temperament will be most
affected by the overall heat of summer, especially in dry regions.
• Persons with a dominant melancholic temperament will be most
affected by the overall coldness of winter, especially in dry
regions.

Breathing techniques
The manner in which we breathe can affect our health, even when
the quality of the air is fine. Poor breathing habits are a major underly-
ing cause of a number of illnesses. Often symptoms like headaches,
fatigue and irritability arise from poor, inefficient breathing, which re-
sults in sub-optimal levels of circulating oxygen in the body. A correct
breathing technique can overcome strong emotions like anger and
fear. It may also help in reducing the symptoms of anxiety – trembling,
palpitations, sweating – which arise, for example, in interviews, public
speaking and competitions.

“Life is not measured by the number of breaths we take, but by

the number of moments that take our breath away”. [Anon]

Health maintenance
It is generally accepted that seasonal changes can have a significant
effect on health. One should always be aware of these and the ad-
verse effect that exposure to extreme elements can have on health.
For example, during cold and wet climatic conditions people with a
phlegmatic temperament should take special care to ensure optimum
body heat is maintained. Similarly, a bilious person should avoid too
much exposure to summer heat.
Breathing also has different qualitative effects, depending on the
breathing techniques used. For example slow and deep breathing ex-

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ercises have a cooling effect, and are thus ideal for people with a bil-
ious or sanguinous temperament. Conversely, fast and deep breath-
ing exercises have a heating effect, ideal for people with a phlegmatic
or melancholic temperament.

FOOD AND DRINK

For Tibb practitioners, food is seen as the major external factor in

the maintenance of health, and the chief medicine at their disposal.
There is more and more data linking the food we consume to different
diseases.

“Leave your drugs in the chemist’s pot if you can heal the patient
with food” [Hippocrates]

Also:

“All diseases begin at the stomach” [Hippocrates]

The world is facing a pandemic of obesity. In the United Kingdom

alone about one thousand people die prematurely each week from
obesity or its complications. Being obese doubles your chance of get-
ting bowel and breast cancer and causes osteoarthritis, diabetes, hy-
pertension and lung disease. Excessive eating also raises levels of
cholesterol, which accumulates in arteries causing strokes and heart
attacks. Socially, too, obesity is a disaster. People who are overweight
are depressed, experience a higher divorce rate and are more prone
to committing suicide.

Whereas some Lifestyle Factors, such as the air we breathe and our
emotional state, cannot be rigorously controlled, a certain amount of
choice exists with other Lifestyle Factors, such as our sleeping pat-
terns and exercise and rest. However, the food and drink we consume
is the one lifestyle factor over which we have absolute control, as the
process is purely voluntary. People can be empowered in their deci-
sion regarding what enters, or does not enter, their stomach.

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Food is the raw material the body uses for the production of the four
humours. Therefore the quality and quantity of the food consumed
has a direct impact on the quality and quantity of the humours pro-
duced by the body.

Classification of foods
Food can be classified in different ways. Some are shown below:
• Conventionally – divided chemically into proteins, fats,
carbohydrates, vitamins and minerals.
• Nutrition-wise – allocated to groups which provide nutrition and
energy, either in different densities or at different rates.
• Protection-wise – foods which can boost the immune system
or contain antioxidants.
• Value-wise – food which are ‘good’ for you (health foods) and
those which are ‘bad’ for you (junk foods).

Temperaments of different foods

In Tibb, foods are classified according to qualities in categories of
either Hot & Moist, Hot & Dry, Cold & Dry and Cold & Moist foods.

The concept of heating and cooling applied to foods is linked to the

effect of the foods on the body. Foods which are heating in nature will
increase the rate of metabolism. Conversely, foods which are cooling
in nature will reduce the body’s metabolic rate.

Hot & Moist Foods

Meats: Mutton, lamb, liver, turkey, venison, goat, goose, Vegetables:
Sweet potato, spinach, spring onion, turnips, asparagus, olives, ar-
tichokes, Fruits: Bananas, dates, guavas, mangoes, peaches, pa-
paya, Nuts: Almonds, brazil nuts, pistachios, apricot kernels,
Grains & Seeds: Bread, rye bread, wheat, flour, pasta, macaroni,
bulgar wheat, sunflower seeds, dill seeds, Dairy Products: Cheese,
cream cheese, clarified butter, fresh cream, condensed milk, Oils:
Olive oil, sunflower oil, castor oil, Herbs & Spices: Ginger, turmeric,
fennel, cayenne pepper, black pepper, white pepper, chives, green
masala, marjoram, mint, sage, soya sauce, thyme, watercress, bay

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leaves, Drinks: Green tea, hot water, juices (see fruits), herbal teas
(see Herbs & Spices – above), Flavourants: Honey, molasses, salt,
sugar, Condiments & Spreads: Mayonnaise, Confectionery & Des-
serts: Biscuits, cakes, chocolate, licorice, vermicelli, Cereals: Oats,
puffed wheat, muesli, Weetbix, Bran flakes, bran, Taystee wheat,
Dishes: Sweet/salty dishes.

Hot & Dry Foods

Meats: Chicken, oily fish (salmon, mackerel, pilchards, sardines),
prawns, lobster, Vegetables: Onion, red pepper, yellow pepper, green
pepper, celery, leek, bitter gourd, Fruits: Avocado, grapes, Nuts: Ca-
shews, pecan nuts, hazel nuts, walnuts, Grains & Seeds: Chickpeas,
celery seeds, fenugreek seeds, mustard seeds, gram flour, papad,
Dairy Products: Eggs, Oils: Mustard oil, Herbs & Spices: Garlic,
cinnamon, fenugreek, nutmeg, oregano, green/red chilli, paprika,
parsley, rocket, rosemary, saffron, aniseed, cloves, tarragon, laven-
der, Drinks: Grape juice, herbal teas (see Herbs & Spices – above),
alcohol, Flavourants: Pungent & bitter flavourants, Condiments &
Spreads: Chilli sauce, mustard sauce, peri-peri sauce, Dishes: Spicy
dishes

Cold & Dry Foods

Meats: Beef, biltong (beef), pork, ostrich, fish (snoek, tuna), tripe,
mussels, oysters, snails, knuckles, crab, Vegetables: Potato, tomato,
cabbage, cauliflower, Brussel sprouts, eggplant, peas, green beans,
mushrooms, sauerkraut, Fruits: All sour fruit (lemon, grapefruit, lime,
naartjies, oranges, pineapple), dried fruit (sultanas, prunes), green
apples, cherries, coconut, granadilla, plums, pomegranate, raspber-
ries, strawberries, Nuts: Peanuts, Grains & Seeds: Corn, lentils,
mielies, beans (all types), barley, couscous, popcorn, poppy seeds,
samp, sesame seeds, Dairy Products: Sour milk, yoghurt, sour
cream, Oils: Coconut oil, corn oil, sesame oil, Herbs & Spices: Basil,
tamarind, Drinks: Coffee, tea (black), sour fruit juices, Condiments
& Spreads: Peanut butter, tomato ketchup, vinegar, balsamic vine-
gar, pickles, worcestershire sauce, Cereals: Cornflakes, mielie meal,
maltabella, millet, Dishes: Sour dishes.

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Cold & Moist Foods

Meats: Rabbit, duck, Vegetables: Beetroot, baby marrow, butter-
nut, broccoli, carrots, cucumber, squash, lady fingers (orka), lettuce,
pumpkin, radish, sprouts, soya beans, tofu, zucchini, Fruits: Apricot,
figs, melons, pawpaw, pears, prickly pears, mulberries, cranberries,
quince, spanspek, sweet apples, kiwi fruit, litchis, Nuts: Macadamia,
Grains & Seeds: Pumpkin seeds, rice, rice cakes, semolina, cucum-
ber seeds, linseed, melon seeds, Dairy Products: Cow’s milk, butter,
goat’s milk, buttermilk, rice milk, soya milk, coconut milk, margarine,
Oils: Herbs & Spices: Cumin, cardamom, coriander, vanilla, Drinks:
Water, rooibos, milk shakes, sugar cane juice, Flavourants: Fruc-
tose, glucose, rose syrup, Confectionary & Desserts: Custard, ice
cream, sago, Cereals: Pronutro, Rice Krispies.

It is evident from the preceding tables that all foods – meat, vegeta-
bles, grains, etc. – have qualities associated with them. If we add the
concept of qualities to the standard classification we can see the re-
lationship between proteins, fats, carbohydrates, minerals and quali-
ties.
• Protein – Overall quality of dryness, but with degrees of heat
or coldness, and the least amount of moistness.
• Fats – Overall quality of heat, but with degrees of moistness,
and the least amount of dryness and coldness.
• Carbohydrates – Overall quality of moistness, but with
degrees of heat and coldness, and the least amount of dryness.
• Water – Overall quality of cold and moistness.
• Minerals – Overall quality of cold and dryness.

The biochemistry of the body depends not only on the quantity of food
we eat but also on the quality of the food we take in.
When providing dietary advice for a patient, the practitioner should
ask three questions: What is the particular temperament of the indi-
vidual? What will produce or restore the balance in the four humours?
What is appropriate for his or her age, the season of the year, and the
climate in which he or she lives?
A balanced diet which includes heating and cooling foods is abso-
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lutely essential for the maintenance of good health.

“The throat destroys more than the sword doth” [Galen]

A diet in which nutrients consumed in excess of the body’s needs or

its ability to digest it will produce an imbalance of humours. Also, the
undigested food can lead to plethora, a feeling of fullness or satiety,
in which food accumulates without elimination.

Food and body heat

According to Tibb, many serious diseases arise from an excess of
Cold and Dry foods, aggravated by a lack of body heat. Correct body
heat is necessary so that metabolism in general and enzyme activity in
particular can proceed effectively. A confirmation of Tibb’s view of the
metabolic efficiency of foods and digestion is found in recent research
on enzymes. Research done by Dr Edward Howell, a leading author-
ity on enzyme activity in food digestion, reveals that when spices such
as ginger, cumin and cinnamon – the heating spices – are consumed,
the production of digestive enzymes by the body increases dramati-
cally, thereby facilitating digestion and improving elimination.

According to Tibb, ‘heating’ foods and spices:

• Increase the production of digestive enzymes in the
gastro-intestinal tract.
• Increase the efficiency of functioning at the cellular and
metabolic levels.
• Facilitate the assimilation of micronutrients, with a minimum
of metabolic waste.
• Achieve and maintain complete metabolic digestion.

The typical Western diet, which relies heavily on meat (overall dry-
ness), pastas and salads (overall cold), etc. would invariably increase
the cold and dry qualities within the body. This is opposite to the main-
tenance of the body’s ideal temperament, which is hot (normal temp
37ºC) and moist (contains 60% to 70% water). Not unexpectedly,

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‘diseases of lifestyle’ such as diabetes, obesity, atherosclerosis and

rheumatic disorders develop from long term adherence to the typical
Western diet.

Qualities linked to specific tastes

As well as assigning qualities to ingredients, they have also been as-
signed to different tastes: Salty (Hot & Moist), Sweet (Moist & Hot),
Sour (Cold & Dry), Bitter (Dry & Hot), Pungent or spicy (Hot & Dry),
Tasteless or bland (Cold & Moist).

These tastes have both qualitative and physiological effects which

are listed below.

Salty or tangy taste (Hot and Moist foods)

Excessive intake of salty foods increases the Heat and Moistness
qualities. These commonly consumed foods – for example, many
snack foods – can be harmful to the heart, increase the blood pres-
sure, and can lead to electrolyte imbalance, congestive headache,
dizziness, vertigo, stroke or paralysis of the right side. Examples:
salty foods.

The qualitative effects of salty foods are counteracted by foods hav-

ing an insipid or bland taste (Cold and Moist).

Sweet taste (Moist and Hot foods)

Eating sweet foods to excess will increase the Moistness and Heat
qualities of the body.These foods can be harmful to the spleen, pan-
creas and kidneys. They can also favour the onset of diabetes, slug-
gish spleen and arthritis. Examples: cakes, biscuits, sweetmeats.

The qualitative effects of sweet foods are counteracted by foods hav-

ing a sour or astringent taste (Cold and Dry).

No taste or insipid taste (Cold and Moist foods)

Excess of insipid foods increases the Coldness and Moistness
qualities of the body.These foods are potentially harmful to the glands,

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metabolism and vital faculties. They also decrease the haemoglobin

level, so promoting anemia. In addition they can lead to hypothyroid-
ism, amenorrhoea, anorexia, high level of lipids (dyslipidaemia), slug-
gish liver, impotence and loss of hair. Examples: cucumber, radish,
watermelon.

The qualitative effects of insipid foods are counteracted by foods hav-

ing a bitter, acidic or tart taste (Dry and Hot).

Sour taste (Cold and Dry foods)

Excessive consumption of sour and astringent food increases the
Cold and Dry qualities.This can negatively affect the digestive and
nervous systems, and encourages thicker blood in the circulatory sys-
tem. The net effect can be illnesses such as hyperacidity, weakness
of the nerves (neuritis), thrombosis, arteriosclerosis, constipation, kid-
ney stones, psoriasis and gout. The skin is more likely to become dry
and wrinkled. Examples: citrus fruits.

The qualitative effects of sour and astringent foods are counteracted

or overcome by foods having a pungent or spicy taste (Hot and Dry).

Bitter taste (Dry and Hot foods)

An excessive intake of bitter foods increases the Dry and Hot qualities
in the body. They can be harmful to the lungs and the arteries, and
may promote excessive bleeding. The net effect may be provocation
of illnesses such as tuberculosis and bleeding piles. They also tend to
dry out the skin. Examples: nutmeg, cinnamon, cloves.

The qualitative effects of bitter foods are counteracted by foods hav-

ing a salty or tangy taste (Hot and Moist).

Pungent or spicy taste (Hot and Dry foods)

Pungent foods taken in abnormally large portions increase the Heat
and Dryness qualities.Foods flavoured according to this taste are po-
tentially harmful to the liver, and can weaken the heart’s muscular
tone. The net effect may be conditions such as jaundice, hepatitis

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and cardiomegaly (enlargement of the heart). Examples: red chillies,

garlic, peri-peri.

The qualitative effects of pungent foods are counteracted by foods

having a sweet or honeyed taste (Moist and Hot).

The effects of qualities on specific temperaments

The effects of taste on individuals are increased or enhanced if the
tastes and the quality associated with it are similar to the individual’s
dominant temperamental quality. For example, an individual who is
dominant Bilious (Hot & Dry) is affected much more by pungent or
spicy foods (which are Hot & Dry) or bitter or tart foods (which are Dry
& Hot).

Mixing foods with different qualities

Current ideas in therapeutic dieting advocate that proteins and car-
bohydrates should not be mixed in the same serving. Tibb has tradi-
tionally discouraged the consuming of many dishes and tastes at the
same meal. For example, milk products should not be eaten at the
same time as sour foods. The combination of milk products with sour
things in the same meal would interfere with the digestive process,
and cause flatulence and bloating. Also, fish should not be taken at
the same time as milk or milkshakes. Indeed, milk (as a large portion)
should be avoided at any meal.

Temperature of foods
Whilst specific foods may have their own inherent qualities, the tem-
perature at which the foods and drinks are consumed can also have
negative effects. Bearing in mind that the average body temperature
is 37ºC, consuming foods at temperatures close to the body’s tem-
perature will have the least negative effect. The common practice of
iced drinks, especially in winter, is an aggravating factor for many
disorders.

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Water
In order to maintain the body’s 70% moisture content, one of the most
important needs of the body is water. Water plays an important role in
the processes of food digestion, nutrient metabolism, and elimination
of waste products. It also ensures the proper circulation of blood and
lymph. Virtually every function of the body, from cell division to food
digestion to tissue synthesis requires adequate moisture levels. The
importance of the maintenance of the ideal moisture content is there-
fore self-evident.

The human body is capable of dealing with excessive water intake.

However, it is unable to handle an inadequate water intake. Many
illnesses result from inadequate water intake. For example, kidney
stones and kidney failure result from dehydration. An adequate in-
take of water helps in reducing raised blood pressure, elevated levels
of cholesterol, uric acid and glucose in the body.

Health maintenance
Food is by far the most effective Lifestyle Factor, and the easiest to
implement as it is entirely within our control. Dietary advice on health
maintenance is based on the principle that an excess of food with
qualities similar to the dominant quality associated with an individu-
al’s temperament will negatively affect his/her health. This means that
foods selected from the opposite spectrum of the Diet Charts will be
most appropriate. For example, the preferred diet for an individual
with dominant sanguinous and sub-dominant phlegmatic tempera-
ment will be foods mostly from Cold & Dry followed by Hot & Dry, less
of Cold & Moist and the least amount of Hot & Moist foods. Similarly
for a dominant bilious/sub-dominant melancholic person the preferred
diet will be mostly Cold & Moist, followed by Hot & Moist, less Cold &
Dry and the least amount of Hot & Dry foods.

In addition to the Diet Charts, the taste of different recipes should also
be taken into account when making dietary choices. For example, an
individual with a temperamental phlegmatic/melancholic combination
should prefer Hot & Moist, Dry & Hot and Hot & Dry tastes to over-
come the coldness associated with their temperament.
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MOVEMENT AND REST

A harmonious balance between physical activity, movement, relax-

ation, and rest is essential for the maintenance of good health. The
concept of exercise has important implications when viewed from the
Tibb perspective. Movement and rest have an effect on the overall
heat and moistness that is associated with the temperament of the
human body with the appropriate variations of the individual tempera-
ment. Therefore, excess of either movement or rest will have harmful
effects.

Exercise and movement

For movement to occur, we have to expend energy, which in turn re-
sults in the production of body heat. People vary enormously in the
relative proportion of physical exercise, to relaxation. Some people
can endure greater degrees of physical activity or movement; others
need more rest and relaxation. This wide variation between move-
ment and rest is determined by the temperament of the individual.

Initially, movement (or exercise) produces levels of heat dependent on

the extent and intensity of the physical activity. This increased level of
heat will result in a decrease of moisture, and an increase in dryness.
As physical activity continues, a state of diminished heat and moist-
ness will come about, which then progresses into a state of coldness
and dryness. This could result in an overall loss of body functions.

Regular physical movement, whether voluntary or by reflex action,

is conducted by the action of the musculoskeletal system, in combi-
nation with, and response to, the voluntary nervous system. It is es-
sential that the person’s spinal column and associated structures are
protected from trauma, age-related deterioration, and the formation
of blockages to associated tissues from abnormal humours. This is
an important factor not only when determining the causes(s) of an ail-
ment, but in subsequent treatment.

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Physical rest
Life is a constant flux between movement and rest. This is highlighted
by the periods of rest between the heartbeats, breathing, blinking and
so forth. In fact all functions of the body are governed by this constant
interchange between movement and rest. Lack of good quality rest
has a disturbing effect on a person’s physis, making him or her more
susceptible to illnesses.

Unfortunately, many people are unable to rest properly because:

• They are over-stimulated by the caffeine present in tea, coffee

and fizzy or caffeinated drinks;
• They are affected by stimulant drugs often found in cold and
flu preparations, or herbal mixtures containing ephedrine, for
example;
• Their environment is too noisy or distracting;
• They are suffering from miscellaneous aches and pains.

However, just as too much movement is possibly harmful, excessive

rest is not good for the body either. Resting increases moisture in the
body. If this becomes excessive, the body will cool down, and even-
tually tend towards becoming cold and moist. Finally an excessively
cold and dry condition will develop. This could also progress to overall
loss of body functions. It is interesting to note that excess of move-
ment (exercise) will have the same final result as excessive rest in
terms of qualities of Cold & Dry, both affecting bodily functions.

Health benefits of exercise

A number of major benefits resulting from physical exercise have been
uncovered by research and observation in specific areas.
• The heart: Regular, mild to moderate exercise is good for
the heart.
• The brain: Exercise helps to protect against stroke in those
people who are at risk.
• Excess body mass: Regular exercise helps to reduce
excessive body mass, and maintain healthy weight.

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• Bone mass: Together with good nutrition, regular, low-impact

exercise prevents osteoporosis.
• Blood pressure: Exercise is good for maintaining normal
blood pressure.
• Stress: Exercise helps reduce the impact of constant mental or
emotional stress.
• Colds and Flu: People who exercise are less likely to get
respiratory infections.
• Asthma: The severity of asthmatic attacks is lower in those who
exercise regularly.
• Diabetes: The complications of diabetes are minimised in
people who exercise.
• Sleep: Relaxation exercises help in insomnia, and for recurrent
headache and backache.
• Impotence: Exercise helps to combat sexual problems,
especially impotence.
• Mental, emotional health: Regular, reasonable exercise helps
to maintain sound mental and emotional health.

Health maintenance
Both movement and rest are essential for maintaining health. A harmo-
nious balance between movement and rest is very important, as is the
type of exercise chosen. Different people require different amounts of
exercise or rest for the maintenance of health.This depends on their
temperament as well as their state of health. Where spinning classes
or running on a treadmill (both of which increase heat and dryness)
are excellent for some, for others who have a dominant bilious tem-
perament these activities may be too energetic and may cause health
problems. Yoga may be suited to highly-strung stressed individuals
but may be too passive for others. It is important to match a particular
exercise to the temperamental type.

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OUR EMOTIONAL STATE

Emotions are known to play a major role in the maintenance of health.

Andrew Weil (author of Spontaneous Healing) and other authorities
strongly emphasise the importance of how the mind can play a sig-
nificant role in the healing process. Time and time again research has
revealed the value and benefit of a positive attitude on the mainte-
nance of health, and in assisting the processes of healing and recov-
ery. Of interest is that the relatively new healing discipline, psycho-
neuro-immunology (PNI) is based on the premise that the conscious
mind (psycho), the central nervous system (neuro) and the body’s
defences (immuno) are interconnected. These combine and actively
co-operate in the healing process.

A good example of how emotions can affect an individual’s health

emerges from clinical trials in which placebos (so-called inactive drug
forms) are compared to active conventional drugs. Very often the par-
ticipants receiving the placebos exhibit the same or very similar quan-
titative improvement as the participants who are receiving the active
drug.

An inclination towards certain emotions is inherent in an individual’s

personality. This is part of a person’s genetic make-up. People re-
spond differently under similar circumstances. Whilst some people
can handle stress, others cannot. Some people are calm by nature,
others are easily ruffled. Reaction to a particular environment or situ-
ation results in emotional states that can seriously affect a person’s
health. Emotions such as anger produce heat, which leads to palpita-
tions; fear leads to sweaty palms.

According to Tibb, excessive, uncontrolled emotions may be func-

tionally damaging. The mind can play a significant role in helping the
healing process, and a positive attitude can play a major part in the
prognosis of a particular illness.

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The influence of emotions manifests itself by the qualities associated

with each of them. For example: Anger (Hot & Dry), Worry (Hot &
Moist), Depression (Moist & Hot), Fear (Cold & Moist), Grief (Cold &
Dry), and Excitement (Dry & Hot).

Ibn Sina was one of the pioneers who wrote extensively on the effects
of suppressed or uncontrolled emotions. Over the centuries, Tibb has
recognised the effect of, and the relationship between, emotions and
specific illnesses. The effect of the specific emotion is linked to the
quality associated with the individual as well as the quality associated
with the emotion. For example, if a bilious person whose tempera-
ment is Hot & Dry is influenced by anger, which has the similar qual-
ity of Hot & Dry, the negative effect of anger in this individual will be
intensified.

Listed below are the negative effects of the qualities of respective

emotions:

Anger (Hot and Dry quality)

Excessive anger can be harmful to the liver, and also have a nega-
tive effect on the digestive process. Anger produces stimulation in the
liver. When a person is angry, the blood circulation suddenly diverts
to the skin. With this emotion a lot of heat is produced in the body,
which can harm the internal organs. This requires Physis to shift the
circulation outward in order to protect the internal organs from dam-
age. Episodes of anger produce harmful effects on the heart and liver,
and damage the brain.

Worries (Hot and Moist quality)

Excessive worries can cause disease of the pancreas, resulting in an
imbalance of glucose levels.
Depression (Moist and Hot quality)
Excessive depression is harmful to the brain and weakens all facul-
ties.

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Fear (Cold and Moist quality)

Excessive fear leads to diseases of the kidneys and bladder, weak-
ening the adrenal and posterior pituitary glands. When a person has
excess fear, the blood circulation suddenly moves inwards, resulting
in the face and skin becoming pale and cold, and breathing becoming
shallow. Because of this emotion a lot of cold develops in the body,
so physis shifts the circulation inwards to protect the internal organs
from damage. Fear also produces negative effects in the liver and
heart.

Grief (Cold and Dry quality)

Excessive grief affects the nervous system. It weakens the nerve im-
pulses and produces negative effects on the brain, lungs, heart and
liver.

Excitement (Dry and Hot quality)

Excessive excitement can be harmful to the heart. Circulation gradu-
ally surfaces to the skin, the face and skin become red and hot, and
breathing increases. With excitement a lot of heat is produced in the
body, which can harm the internal organs, physis shifts the circulation
outward to protect the internal organs from this damage.

From the above descriptions it can be observed that emotions with

their respective qualities play a crucial role in an individual’s well-
being.
It is extremely important to recognise the effect of emotions as be-
ing a cause of many illnesses. The health professional needs to be
aware of this and should always include this factor in the treatment
programme.

“Some patients, though their condition is perilous, recover their

health simply through their contentment with the goodness of the
physician.” [Hippocrates]

Health maintenance
Different temperamental types are predisposed to certain emo-

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tional disorders, so a special effort is required to ensure that emo-

tional wellbeing is maintained. For example, sanguinous tem-
peraments are inclined towards worry, irritability and depression;
whereas bilious people are inclined towards anger and aggres-
sion. Self-help techniques such as meditation, breathing exercises,
aromatherapy, colour therapy, as well as psychotherapy and counsel-
ling are recommended.

SLEEP AND WAKEFULNESS

According to Tibb, sleep is seen as cooling and moistening. It affords

Physis the opportunity for uninterrupted action in restoring the body’s
harmonies. Wakefulness increases dryness and heat depleting the
energies caused by physical and mental activity. Sleep renews and
maintains physical and psychological performance. Sleep strength-
ens all natural functions, including digestion, metabolism, and brain
power. During sleep the body restores itself from fatigue and gives
Physis the opportunity to prepare for the elimination of toxins and the
opportunity to focus on repair and restoration of health.
When a person perspires heavily during sleep without any obvious
cause, it means that undigested and unwanted fluids have accumu-
lated in excess of the bodily requirements. With the help of sleep
these unwanted matters are eliminated through the skin.

Sleep strengthens all natural functions, including:

• Digestive processes, which it helps to complete, ready for

bowel movement on awakening.
• Metabolic processes, which repairs damage and restores
integrity, primarily under the influence of the parasympathetic
nervous system.
• Brain functions, by sorting out and filing sensory and
intellectual input from the previous day.
• Detoxification, by assisting physis in eliminating toxins from the
system.

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The requirement for sleep differs from person to person, and also for
different age groups. The amount of sleep required will also be influ-
enced by the extent of physical or mental activity which the person
undergoes through the day. Generally, women need more sleep than
men, and children more than adults. Also, the elderly will benefit from
extra sleep, as the moisture will overcome the dryness associated
with old age.

Sleep requirements vary widely, according to temperament:

• Persons with a dominant bilious temperament – 5 to 6 hours
minimum nightly;
• Persons with a dominant melancholic temperament – 6 to 7
hours minimum nightly;
• Persons with a sanguinous temperament – 6 to 7 hours
minimum nightly;
• Persons with a dominant phlegmatic temperament – 8 hours
nightly.

Insufficient sleep leads to excessive heat and dryness affecting all

individuals especially a person with a bilious temperament. This con-
dition can easily be reversed with an appropriate amount of sleep that
will help reduce the excess heat and dryness.
Insomnia is quite a prevalent problem, especially amongst the individ-
uals with melancholic temperament. Excessive dryness is the cause
behind insomnia (which is often why a glass of warm milk, which has
Hot & Moist qualities seems to help). Obviously if a person does not
get enough sleep, it will affect the person’s mental, physical and emo-
tional states. Troubled sleep indicates that a disease may be devel-
oping. Excessive awakening brings about conditions of headaches,
slurred speech, lack of concentration, mood swings, irritability, leth-
argy, melancholia, etc.

Today’s lifestyle (entertainment, TV, etc.) invariably leads to chronic

sleep debt, which often results in serious consequences. Without ad-
equate sleep, our mental, physical and emotional states are eventu-
ally impaired. Sleep deficit is often overlooked as an aggravating fac-
tor in many illnesses.
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Excessive rest and sleep (hypersomnia) gives rise to an excess of

Coldness & Moistness, which is harmful for the vital, metabolic and
psychic faculties affecting the level of available energy. Long peri-
ods of increased Cold & Moistness increases the weakness of the
muscles, disturbs the digestion and metabolism, and dulls the mind.
It further increases phlegm in the body, bradycardia (low heart rate),
weak memory and low blood pressure.

Health maintenance
The need for sleep varies from person to person, for different age
groups, and according to their physical or mental activity. For this rea-
son the quality and amount of sleep should be matched to individual
requirements. The best time to sleep is from 22h00 until just before
sunrise. Supper should be eaten at least three hours before sleep-
ing. Lying on the right-hand side allows food in the stomach to move
towards the intestines more easily and decreases the pressure on the
heart.

ELIMINATION AND RETENTION

Waste products are substances which are of no further use to the

body. According to Hippocrates, the relationship between an indi-
vidual and the environment is a dynamic process of consuming and
retaining what is necessary to support life, and efficiently eliminating
the waste that has accumulated. Tibb subscribes to the traditional
philosophy that the stomach is the home of all illnesses.

Retention within the body

The term ‘retention’ is linked to the metabolic faculty, which is un-
der the control of the liver, to ensure that nutrients are retained long
enough for the assimilation to be effective and then eliminated. Very
often, a person may consume nutritious food but the body is unable to
assimilate the nutrients. Improper functioning of the metabolic faculty
will inhibit effective metabolism and the ideal period of retention will
not be met thus having negative effects on the body.

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Accumulation of toxins interferes with normal biochemical processes

of the body. This impairs not only basic bodily functions, but also af-
fects the further continuous processing of food and drink into ideal
humours. This would then introduce more toxins into the system and
eventually overcome the ability of physis to maintain health. The pres-
ence of toxins places great burdens on the liver, kidney and the lungs
eventually causing serious damage to these important organs.

The body has many levels of dealing with abnormal physiological

functions, from built-in repair and screening mechanisms, to sophisti-
cated levels of interception by the immune system. Invariably, toxins
or excess/abnormal humours which invade the bloodstream or tis-
sues can cause illnesses associated with tissue, organ damage and
even cancers.

As mentioned before, the human body is a very complex system com-

pletely integrated and interdependent. Whilst a person may be suffer-
ing from a headache or mouth sores and the link between this and a
toxin-filled colon may not be apparent, in Tibb this link as the cause is
clearly identified.

“The effective digestion, assimilation and elimination of the

Lifestyle Factors constitute health.”

Retention also applies to the inefficiency of the body to eliminate

wastes, as is the case with ascites.

Elimination from the body

As waste products are toxic if they accumulate excessively in the
body, they must be expelled regularly and totally. Elimination is a term
which embraces all natural functions in which waste products are re-
moved from the body.

There are four main routes of excretion:

• Via the kidney – by urination, as urine;
• Via the faeces – by defaecation, as faeces (stool);
• Via the lung – by respiration, as volatile substances;
• Via the skin – by perspiration, as visible or invisible sweating.
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These are the main excretory systems. However, there are a number
of others which also contribute to toxic waste expulsion. These include
coughing, sneezing, nasal mucus, vomiting, flatulence, menstruation,
ear wax and ejaculation. Elimination can only be efficient if and when
all the metabolic functions are in order. If the Lifestyle Factors are well
managed and functions are normal, elimination should be reasonably
efficient. However in a world that is not ideal, the Lifestyle Factors in-
variably are not managed well at all times resulting in accumulation of
toxins at different levels of the body. The recognition of the accumula-
tion of toxins as the biggest contributory cause of illness is absolutely
essential.

Medicine today is quite aware of the elimination mechanisms of

coughing, sneezing, vomiting, menstruation, and other routes. Unfor-
tunately, not enough attention is given to the evacuation of the colon
which leads to so many illnesses. Physiologically it is a known fact
that the re-absorption of water in the digestive tract takes place in the
colon. This process of reabsorption of water would invariably result
in a film of matter accumulating on the sides of the colon. Normal
peristaltic movement does not remove this accumulation which in turn
impedes not only subsequent reabsorption but becomes a reservoir
for toxic accumulation. The need to keep the colon clean is common
to all traditional systems of medicine. They recognize this as a major
cause of many symptoms and illnesses, and promote specific treat-
ments which ensure that effective elimination is maintained.

The importance of elimination has been highlighted in research con-

ducted at Tibb Treatment Centres in Cape Town, and published in the
International Journal of Recent Scientific Research under the heading
of “Treatment of Humoral Imbalances at a Cellular/sub-cellular Level”.

Health maintenance
The elimination of natural waste and toxins, especially via the colon,
is critically important. Throughout history, virtually every culture has
practiced the taking of natural laxatives on a regular basis – at least
once or twice a month. Unfortunately, with today’s hectic lifestyle this

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has been somewhat neglected. Although our busy schedule may not
allow someone to take a reasonable dose leading to complete evacu-
ation of the colon, even a small dose over two nights produces the
required effect. The frequency of taking a laxative will depend on the
temperament, age and requirements of the individual. In addition to
evacuation from the colon, other eliminative techniques such as mas-
sage, sauna, sneezing and cupping can also be carried out.

OTHER LIFESTYLE FACTORS

Although the six Lifestyle Factors described above are the main play-
ers in the maintenance of health and healing of disease, they are by
no means the only ones. The following are pertinent to specific indi-
viduals and under specific circumstances.

Age and gender

The age and gender of an individual will also have an impact on Ae-
tiology. Whilst a person’s temperament is fixed, (with an ideal quali-
tative state) the different stages of a person’s life from infancy to old
age, influences disease conditions that a person may be inclined to.

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Table 9: Qualitative changes from infancy to old age

This diagram shows the changes that take place during a person’s
life cycle from cold and moist to heat and eventually cold & dryness
at old age. The qualities associated with each of the stages of the life
cycle are an interpretation of the illness conditions that are associated
with those stages of life. For example; during infancy and early child-
hood most of the illnesses are associated with moistness (vomiting,
diarrhoea etc.) with teenagers and early adulthood the illnesses are
associated with heat (acne, inflammatory conditions) and finally with
late adulthood illnesses are associated with dryness (osteoporosis).

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Gender also influences predispositions to disease. Females, for in-

stance, have qualities that are slightly more moist than males with the
appropriate affectation towards the respective diseases. For example,
more women suffer from depression, which is a disease associated
with excess moisture.

Occupation or career
Illnesses associated with an individual’s career are specific to that
individual. The nature of occupations varies enormously – both physi-
cally and mentally. For example, a host of different challenges present
between a young executive sitting behind a desk, in front of a screen
all day, with little exercise and no fresh air, and a farm worker out in
the sun from dawn to dusk; or, between an academic, carrying out
research, and a manual worker on a car factory production line. A
person may also be exposed to toxic or noxious chemicals at work.
These often have major effects on the individual’s health, both over a
brief period of time, but more importantly, after chronic exposure over
an extended time span.

Place of residence
This refers to the home environment, which may be overcrowded,
or under tension, often resulting in increased challenges, aggression
and stress. Ambient noise, lack of ventilation in the home, the pres-
ence of insects and house dust mites all have deleterious effects on
many occupants’ health. Radioactive gas emanating from the bed-
rock underneath is known to be a serious health hazard in certain
geological areas.

Exposure to toxic substances

Pollution in the environment is now accepted as a major cause of
chronic disease in the developed and developing worlds. The source
of these pollutants comes from the enormous number of industrial
chemicals, process gases and fumes, nuclear materials, household
chemicals, cleaners and detergents. Also important are the numerous
additives included in processed foods and drinks, the side reaction to
the chlorination of water.

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Personal habits
Personal habits may also be the direct cause of certain illnesses, or
adversely affect existing clinical disorders. Our society is characterised
by extensive abusive lifestyle activities, for example, heavy smoking,
the use of recreational drugs, spree, seasonal or binge drinking, and
certain sporting activities. These are not ideal for a person’s health.

LIFESTYLE PROGRAMMES FOR DIFFERENT

TEMPERAMENTAL TYPES

In the light of the emphasis that Tibb places on the role of Lifestyle
Factors in the promotion and maintenance of health, Personalised
Lifestyle Programmes for the different Temperamental Combinations
have been included (Annexure 2).

CHAPTER REVIEW

Tibb Aetiology is multifactorial. Ibn Sina described four types of

causes. The first of these causes is linked to the maintenance of the
person’s ideal temperament (formal cause). It takes into account hu-
moral imbalances arising from biochemical and physiological changes
(material cause). The Lifestyle Factors are important in determining
the outcome of health or disease (efficient cause) and establish that
impaired functions lead to further illnesses (final cause). However, the
causes related to temperament, humours and impaired functions are
influenced by the Lifestyle Factors.

For a cause to be effective, it must have three features: active power,

receptive power and prolonged contact. Active power means the cause
must be sufficiently powerful, and in sufficient numbers, whether the
pathogen is a microbe, toxin or parasite, or in the food or inspired
air. Regarding receptive power, everyone’s internal environment is
effectively a culture media. However, microbes are only capable of
pathological impact when there is sufficient receptive power – when
the immune system is compromised. Prolonged contact means that
even though a person’s humoral balance is strong enough initially to

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withstand the pathogen, over a period, the immune system can be-
come worn down and compromised.

General: A person’s temperament is a unique fusion of personality,

body constitution and genetic factors. Changes to this ideal qualitative
state make the person more vulnerable to the development of illness.
Disease is ultimately the outcome of a poor interaction between the
person (microcosm) and the environment (macrocosm). Changes in
the environment will initiate changes in the person’s qualitative state,
and thus affect the temperament.

Clinical disorders, especially those which are chronic or recurring,

rarely if ever arise from a single cause. This is in contrast to Western
medicine, fixated on the ‘one disease, one cause’ idea, which has
largely proven elusive in their aetiology of disease. Tibb accepts that
diseases are multifactorial in nature, with both internal and external
causes playing a role. These do vary from patient to patient, and ac-
cording to the type and severity of the clinical disorder being experi-
enced. In addition, Tibb feels that the signs appearing and symptoms
reported by a particular patient actually reflect the balance of different
causes which led to the disorder in the first place.

Lifestyle Factors: These everyday activities determine the quality of

our health. They can affect the person’s humoral balance both quan-
titatively and qualitatively. These changes to a person’s humoral state
often arise, for example, through a poor or deficient diet, or from inef-
fective elimination. The main Tibb Lifestyle Factors, common to all,
are: environmental air and breathing, food and drink, movement and
rest, sleep and wakefulness, our emotional life, and elimination and
retention.

Environmental air and breathing: The air we breathe is the first

step in the hierarchy of physiological needs. The way we breathe is
very important. Air possesses several properties which can affect our
health: temperature, humidity, ionic content, and pollutants. Many
chronic diseases are associated with poor breathing, or inferior air

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quality. Air pollutants are implicated in the onset and progress of sev-
eral disorders. Changes in local weather can have profound effects
on a person’s health. People respond differently to changing weather
according to their temperament.

Food and drink: Food is the raw material for the production of the hu-
mours. It can be classified in different ways: as chemical components,
or nutritional value, or potential for immune protection, or as a cultural
perception value (good vs. junk). In Tibb, a particular food is classified
according to its nutritional components and whether it is heating or
cooling, with appropriate levels of moisture or dryness. The concept
of heating and cooling foods is linked to the effect of the foods on the
body. All foods have qualities associated with them.

Movement and rest: A balance between physical activity and rest is

essential for the maintenance of good health. Many people are un-
able to rest properly because of over-stimulation, the intake of certain
drugs, environmental problems, and physical disorders. The benefits
of exercise are proven for a wide range of ailments, including heart
disease, diabetes, sleep disorders and certain cancers. Energy is ex-
pended for movement to occur, which in turn results in the produc-
tion of body heat. Qualitatively, this increased level of heat decreases
moisture and increases dryness. As physical activity continues, di-
minished heat and moistness occur, which progresses to coldness
and dryness. Regular physical movement, whether voluntary or by
reflex action, is conducted by the action of the musculoskeletal sys-
tem. It is essential that the person’s spinal column and associated
structures are protected from trauma, age-related deterioration, and
the formation of blockages to associated tissues from abnormal hu-
mour accumulation.

Sleep and wakefulness: Qualitatively, good sleep is cooling and

moistening, whereas a lack leads to excessive heat and dryness. Ex-
cessive dryness is the cause behind many cases of insomnia. Sleep
lets Physis remove toxins and metabolic debris, and restore the body’s
harmonies. Wakefulness increases dryness and heat, depleting the

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energies caused by mental and physical activity. Sleep strengthens

all natural functions, especially digestion, metabolism, and brain pow-
er. It provides the opportunity to repair and restore health. Sleep re-
quirements vary widely, according to temperament; phlegmatic peo-
ple need more than those of a bilious nature. Insomnia is prevalent in
those with a melancholic temperament.

Our emotional state: Emotions play a major role in the maintenance

of sound health, and excessive, uncontrolled emotion may be psy-
chologically damaging. The mind plays a significant role in helping
the healing process, and a positive attitude can play a major part in
the prognosis for a particular illness. Emotions influence the person’s
qualitative balance. For example, anger increases Hot and Dry quali-
ties; worry, Hot & Moist; depression, Moist & Hot; fear, Cold & Moist;
grief, Cold & Dry; and excitement, Dry & Hot.

Elimination and retention: There is a dynamic relationship between

the person and the environment, consuming and retaining what is
necessary to support life, and eliminating the waste that has built up.
Accumulation of natural waste and environmental toxins interferes
with normal biochemical processes of the body. The four main routes
of excretion are via the kidney, faeces, lung and skin. Other processes
also contribute to expulsion, such as coughing, sneezing and vomit-
ing. Failure to eliminate efficiently often leads to most illness condi-
tions.

Others: There are several other Lifestyle Factors which vary in im-
portance from person to person, such as: age and gender, nature of
the person’s occupation, exposure to toxic substances, and where
a person lives: urban, peri-urban or rural. This latter is increasingly
important, as noise, pollution, crime, stress and other influences af-
fect health. Personal habits such as smoking, excessive drinking and
drugging, both recreational and prescription, fall into this category.

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CHAPTER 3: PATHOLOGY IN TIBB

INTRODUCTION

In the previous chapter on aetiology, the various causes of both dis-

ease and good health were covered. The differences between the
Tibb approach and that of present-day conventional medicine were
outlined as a preliminary factor in the nature of disease.
This chapter on pathology provides an understanding of the process-
es which lead to temperamental, qualitative, humoral, functional or
structural imbalances within the body. Tibb’s contention that any dis-
ease process can be reversed is also supported. Although certain
microbes are responsible for some diseases, this is only one of many
pathological processes. An understanding of the pathological states
associated with inflammation is also provided. Tibb affirms that clinical
signs and symptoms indicate qualitative imbalances at one or more of
the temperamental, humoral, functional or structural levels. In realis-
ing this, the temperamental and humoral theories of Tibb provide a
comprehensive understanding of pathological processes.

DEFINITIONS AND DESCRIPTIONS

Health. The term ‘health’ describes the state of a person’s body based
on complete harmony between the internal and the external environ-
ment. Health is actually the body’s natural state or default. According
to Tibb, health is the state in which the temperament, ratios of the
bodily humours, and bodily structures are in a state of dynamic bal-
ance, or harmony, maintained and regulated by Physis. In this state
all the functions in the body perform efficiently, consistently and ac-
curately.

Homeostasis. This is defined as the tendency of the body’s physi-

ological systems to maintain an environment of stability. In Tibb ho-
meostasis is described as dynamic optimum functioning. This homeo-
stasis is specific for each individual, and is under the influence of
Physis. The maintenance of homeostasis focuses on the person’s in-
ternal environment, and how it responds to both internal and external
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stimuli. Physis organises this balance via the faculties and functions
of all the systems and organs of the body, which are under the control
of the three main organs – namely, the liver, brain and heart.
The agents of homeostasis are the many physiological systems with-
in the body, such as blood pressure regulation, acid-base balance
and body temperature control, which are maintained in equilibrium,
in spite of continual variations, both major and minor, in the external
environment.

Disease. Disease is a disorder of health, with recognisable signs and

symptoms characteristic of a particular disease. It is diagnosed ini-
tially on the basis of what the physician observes (signs), and what
the patient complains of (symptoms). Diagnostic tests may be neces-
sary to confirm (or reject) the diagnosis. According to Tibb, disease is
that abnormal state of the body in which there is an alteration in the
temperamental, humoral, functional and structural level due to any
internal or external cause.

Pathology. In conventional medicine, pathology is the scientific study

of disease processes with the aim of understanding their nature and
causes. It is concerned with the cause, manifestation and diagnosis
of a particular disease. The discipline of pathology generally involves
the following considerations:
• Aetiology – is the study of what agent or activity causes
a particular disease.
• Pathogenesis – deals with the mechanisms by which a
disease originates and develops. Pathogenesis is the
basis for prognosis, which is an evaluation of the future
course and outcome of a person’s ailment.
• Structural changes – this refers to the noticeable
changes in tissue or organ structure that develop during
the course of the disease.
• Clinical significance – describes the signs and symptoms
of the disease. Signs are what the healthcare practitioner
observes by use of the five senses. They emerge from the
examination. Symptoms are usually the reason for the visit to the

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healthcare practitioner, or volunteered by the patient on exami-

nation or enquiry.
• Clinical pathology is the application of the knowledge we have
gained from the study of the pathology of the disorder to the ac-
tual treatment of the patient.

Defining pathology in Tibb. Pathology according to Tibb refers to

the state of imbalance (disturbed homeostasis) in the body which
tends to affect the body directly. This lack of harmony may be brought
about by internal or external causes, or a combination of both. Ho-
meostasis concerns both the inner, internal balance, and its adjust-
ments to the many outside, external influences. Pathology in Tibb,
therefore, is based upon the interpretation of the patient’s signs and
symptoms. These are carried out within the scope of qualitative and
humoral changes that affect variation in temperament, structure and
function from the normal healthy state. It also includes pathological
processes that result in disorders of configuration and the loss of con-
tinuity, in line with the description by Ibn Sina.

COMPARISON: TIBB AND WESTERN MEDICINE

Tibb and Western medicine differ in a number of ways in the inter-

pretation of pathology. The primary difference is that conventional
medicine examines the pathology of a clinical disorder by evaluating
the disease process in purely physical terms. In particular it tends to
obtain information only on what is quantifiable or measurable, derived
from a wide range of biochemical assays, physiological calculations
or imaging techniques. These findings, or parameters, are then inter-
preted to suggest whether or not there are functional (pathological) or
structural (morphological) abnormalities. These findings are based on
existing and verifiable knowledge of how the disease progressed in
other patients of the same age, state of health and gender.

This approach has its limitations, as it is purely objective, and oper-

ates only at the physical level. It does not take into account the impor-
tant changes that often take place in the emotional, metaphysical and

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spiritual dimensions. The reason is simple – these changes cannot be

isolated or quantified.

Western medicine tends to focus on one cause as the origin of a

particular disorder: “one cause; one effect”. The objective of conven-
tional medical research is to isolate one specific cause from a number
of others, and determining the outcome of treatment on the disease
under scrutiny. This reductionist approach, also termed the ‘Doctrine
of Specific Aetiology’ is the theory of conventional medicine, originat-
ing with Louis Pasteur in the 19th century, in which disease came
to be associated with specific microbes, rather than imbalances in
humours, or complex convergences of factors in a person’s unique
lifestyle. The conventional medical approach to pathology is to link a
particular disease to physical malfunction of an organ, tissue or meta-
bolic process. Tibb, in contrast, views pathological processes as the
result of changes or distortions in the qualities and/or humours.

This reductionist approach fails to appreciate the intense complexity

of the human body, and in so doing loses sight of the bigger picture.
The complex functioning of the human body, highlighted in the dia-
gram below, shows the intricate processes involved in the different
categories of biochemical and physiological activities of the body. This
embraces metabolic factors, energy generation and usage, cellular
synthesis processes, information processes, defence mechanisms,
and the multitude of regulatory mechanisms.

If we go into any of the topics in the scheme, whether energy produc-

tion, hormone regulation or communication structures, each requires
an elaborate series of checks and balances as well as initiators and
inhibitors, all working together in time and space, balancing and coun-
teracting each other in order to maintain homeostasis. One can only
but marvel at the intricacies which exist at every level and yet all of
which are so amazingly balanced by Physis to ensure homeostasis.

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Table 10: The complex functioning of the human body

What is even more amazing is that the above diagram highlights only
the complexity of the human body’s mechanisms with respect to the
limited knowledge that even present-day technology is able to mea-
sure. The important contributions of emotional and spiritual dimen-
sions, which are not measurable, are hence not appreciated.

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Today, rather belatedly, conventional medicine is beginning to recog-

nise the effects of these abstract or immeasurable entities. However,
it cannot focus on these effectively, as it does not have a philosophi-
cal basis for understanding these entities. Equally important perhaps,
is that what conventional medicine measures, and from which as-
sumptions are made, is usually more relevant to the final stages of
the pathological process. The final stage in the disease process often
represents only the tip of the iceberg. It is far removed from the origin
and early stages of the pathological process.

Tibb asserts that the human body should not be regarded simply as
a machine. It is too complex for us to understand the true nature of
pathology from only what we can measure. The Tibb philosophical
principles embodied in the temperamental and humoral theories allow
for a comprehensive understanding of pathological processes.

In Tibb, the understanding of pathology begins at the metaphysical

level of the humours and measures outcomes in terms of the patient’s
temperament, qualitative imbalances, organ structure and the func-
tioning of the various body systems. The physicians who practiced in
earlier times were not able to monitor, measure, and understand the
innumerable biochemical, physiological, and electrical activities oc-
curring in the human body. They were, however, able to focus on what
can be seen or reported (signs and symptoms) as well as being able
to interpret temperament, qualities and humours. Moreover, they had
immense metaphysical insights and keen intuition into the workings of
the body, in both health and disease.

Although we do not fully comprehend pathological processes, there

is a definite and consistent link between the metaphysical level and
the outcomes which can be identified and measured. This tried and
tested approach of understanding the causes of illnesses, pathologi-
cal processes and diagnosis of diseases, has proven itself empirically
over thousands of years in line with the principles of cause and effect.
The study of pathology in Tibb focuses on the lack of harmony or
homeostasis within the human being. Pathological processes begin

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when Physis is unable to maintain homeostasis and correct imbalanc-

es via the faculties and functions of the body’s systems and organs.
This imbalance occurs during the interaction between the human be-
ing and the environment represented by the Lifestyle Factors.

Pathology: The Tibb Perspective

In Tibb, pathology describes the scope of temperament, qualities,
humours, structure and function in line with the three main organs.
These are the heart, liver and brain, which respectively regulate the
immune system, the endocrine/exocrine system and the nervous sys-
tem. This approach enabled the early practitioners of Tibb to have a
comprehensive understanding of outcomes – not only on the patho-
logical process but also within the principles of cause and effect.

The starting point for Tibb

pathology, at the humoral level,
is the ideal qualitative state as-
sociated with the unique temper-
ament of each individual. In the
diagram adjacent the ideal quali-
tative state of an individual with
a dominant sanguinous and sub-
dominant phlegmatic tempera-
ment, for example, has an overall
dominant quality of moistness, followed by heat, less of coldness, and
the least amount of dryness – as represented by the point marked X.

As long as a person’s ideal humoral qualitative state is in harmony

with the overall qualitative requirement of his or her temperament,
optimum health is maintained. This state of equilibrium/homeostasis
is altered from the effect of the Lifestyle Factors which Physis is con-
stantly restoring.

Changes to this humoral balance, beyond the ability of Physis to

restore homeostasis, defines the beginning of pathological process in
Tibb.

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HUMOURS WITHIN THE CONTEXT OF PATHOLOGY

Changes to the ideal humoral composition occurs either qualitatively

or quantitatively.

“When the normal proportion and specific equilibrium of humours

is altered, the internal environment reaches a state of imbalance,
and thus disease develops. This is the basis of aetiology and pa-
thology of disease”. [Al-Abbas]

As previously mentioned the four humours are:

• Sanguinous (Hot and Moist);

• Phlegmatic (Cold and Moist);
• Bilious (Hot and Dry);
• Melancholic (Cold and Dry).

Synthesis of humours
The humours are synthesised in the liver, according to the nature of
the foods eaten and the degree of their digestion. They are trans-
ferred to the vascular system, and from here they are distributed to all
bodily cells, tissues and organs.
The production of humours is influenced by the quality of heat, which
prevails during the liver’s metabolic processes. The phlegmatic hu-
mour with Cold & Moist qualities, requires the least amount of heat, so
is produced first. This is followed by sanguinous (Hot & Moist) bilious
(Hot & Dry) and finally melancholic (Cold & Dry), which needs the
most heat.

Features and functions of normal, healthy humours

Sanguinous humour
As the overall temperament of the human body is Hot & Moist, the
sanguinous humour is present in the largest concentration. Its
function is to provide nourishment to every cell tissue and organ with-
in the body.

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Normal sanguinous humour manifests itself materially in the red

colour of blood. It has no odour, and is hot and sweet to the taste.
The sanguinous humour serves as the carrier for the other three
humours. It transports them to wherever in the body they are needed,
in order to carry out their dedicated activities.

The reason for it being hot is that it is actually hot or potentially hot.
Organs richly supplied with blood are hot whereas those whose blood
supply is comparatively less are comparatively cold. The reason for it
being moist is that it contains ± 90% water. Water has certain qualities
needed to maintain body temperature:

• High specific heat (specific heat is the amount of heat needed

to raise one gram of a substance by one degree Celsius).
• High thermal conductivity (thermal conductivity is the measure
of the ability of a material to transfer).
• High latent heat of evaporation (heat of vaporisation is heat
absorbed by a unit mass of a material at its boiling point in
order to convert the material into a gas at the same
temperature).

As mentioned previously heat and moistness are needed for the

maintenance of life. For all life to exist, an ideal balance of heat and
moistness is required. This can be observed in nature. Plants need
an ideal level of heat and moisture for survival. During spring time,
flowers blossom as the heat gradually starts increasing after the cold
of winter. If either quality of heat or moistness is deficient, death will
ensue.

As we are all uniquely created, the ideal level of heat and moistness
needed by each individual will vary according to their temperament.
Death, old age, and end stage of disease are associated with quali-
ties of coldness and dryness as it is opposite to life giving heat and
moistness. Similarly, in pathological processes, obstruction of blood
flow, ischaemia, necrosis etc. are linked to qualities of coldness and
dryness.

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Functions of the sanguinous humour

• The sanguinous humour provides nutrition to the body, and

promotes growth. Burhan al-Din Nafi’s describes this humour as:
“... The best nutriments for the body because whatever is lost
from the body is replaced by the sanguinous humour”.
• It acts as a vehicle and transports all material to the tissues.
• It keeps the body warm and maintains the body’s temperature
constant.
• The sanguinous humour is known as the carrier of oxygen.
When inspired, air reaches into the alveoli of the lungs, oxygen
is absorbed into the sanguinous humour and carried to the
tissues. It is said that the arteries are filled with oxygen, which
it transports to all the body’s tissues.
• It carries the waste products of oxygen i.e. CO2 from the
tissues to the lungs to be expelled from the body.
• It carries all other humoral waste products from the tissues to
the excretory organs to be expelled.
• The sanguinous humour carries such material which performs
functions of defence against foreign bodies.
• It produces healthy texture and shine in the skin.

The phlegmatic humour

The phlegmatic humour is the second most abundant humour. It is
similar to the sanguinous humour in that it does not have a storage
reservoir, unlike the bilious and melancholic humours. The reason is
that, like the sanguinous, the phlegmatic humour is needed by virtu-
ally every organ in the body. The material form of normal phlegmatic
humour is sweet (but to a lesser extent than the sanguinous), and
moderately cold.

The phlegmatic humour serves the following purposes:

• When there is a shortage of the sanguinous humour in the

body, the phlegmatic humour is transformed into the sanguinous
humour due to its nature of being incompletely digested.

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Burhan al-Din Nafi’s says:

“Since the phlegmatic humour can be needed at any place for

the nutrition of the body, hence there is no vessel for the storage
of the phlegmatic humour, but it has been flown with the flow of
the sanguinous humour and it has been spread away in the or-
gans (cells and tissues), so that whenever there is deficiency of
the sanguinous humour in tissues it could be readily available.”

• To supply the body’s organs, particularly the brain and

associated nervous tissues, which possess a dominance of
the phlegmatic humour, specifically the quality of moistness.
• An ideal concentration of phlegmatic humour is necessary for
normal day-to-day activities, physical maintenance and repair.
• To serve as a general lubricant within the body. It prevents
friction between and within body structures, so protecting the
body’s internal organs and structures like the skeletal joints.
The phlegmatic humour in the synovial cavities supply
nourishment to the intra-capsular parts of the joints and furnish
lubrication.
• Likewise the mucous and serous fluid are secreted from various
mucous and serous membranes of the body and perform diverse
functions e.g. gastro-intestinal tract, naso-respiratory tract, uro-
genital tract, pericardial fluid, pleural fluid and peritoneal fluid.
• The intraocular fluids (aqueous and vitreous humour) also
furnish nourishment to various parts of the eye and maintain
intraocular pressure.

The bilious humour

The bilious humour is stored in the gallbladder, secreted into the lu-
men of the gastro-intestinal tract, and excreted via the stool and urine
in the form of bilirubin, biliverdin and other substances. These and re-
lated metabolites give the stool and urine their typical brown and yel-
low colours respectively. The material form of normal bilious humour
is yellow in colour, light and pungent.

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The bilious humour has a number of functions:

• To supply nutrition to the body’s tissues and organs with a

dominance of heat, such as the lungs and the gall bladder.
• To allow thinning of the vascular fluid (specifically its Hot & Dry
qualities), in order to penetrate into the narrow capillaries.
• To prevent the formation of blood clots (emboli), by exerting its
anti-melancholic and anti-coagulant properties.
• To emulsify fats present in the diet, so aiding digestion.
• To cleanse the intestines of thick and viscous mucus, so
removing phlegmatic and melancholic humours.
• To stimulate the musculature lining of the intestines, so
promoting efficient defaecation.
• The bilious humour acts as a vermifuge.

The melancholic humour

The melancholic humour is stored in the spleen, which it nourishes.
The material form of the normal melancholic humour is a sediment or
residue which forms in collected blood when left standing. Its taste
varies between bitter and acrid.

The melancholic humour acts to:

• Supply and nourish the tissues and organs such as the bones
which have a preponderance of the melancholic humour,
specifically dryness.
• Signal the intensity of appetite experienced by the person.
• Provide density and consistency to the vascular fluid.
• Aid the activity of platelets in the blood coagulation process.
• Assist in the formation of melanin, a compound which provides
skin pigmentation.

Understanding the features and functions of normal humours is impor-

tant in understanding the pathology of disease according to the Tibb
philosophy. For example, the melancholic humour has coagulation
properties. Therefore an excess (or abnormal) melancholic humour
may be the cause of vascular lesions causing ischaemia. Similarly,
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the phlegmatic humour has lubricating properties. Joint pain in arthri-

tis for example may result due to a corruption of the normal phlegmatic
humour, causing it to become too hard or too thin thus eradicating the
soothing properties of this humour. The bilious humour being pungent
causes a burning sensation in the oesophagus when regurgitated.
And the preponderance of the sanguinous humour can lead to condi-
tions related to hyper-volaemia, such as hypertension.

As each humour has specific qualities associated with it, changes to

these qualities, brought on by the Lifestyle Factors, will result in the
conversion of the normal humoral state to an abnormal one. These
abnormal states will lead to clinical disorders if Physis is unable to
remove the abnormal humour from the body effectively, and in good
time.

Development of abnormal humours

Whilst we do not fully understand the exact mechanisms underlying
the clinical manifestation of abnormal humours, their existence can be
identified in various pathologies. A poor diet is one of many causes of
the development of abnormal states of humours. Refined, processed,
genetically modified foods etc. all affect the quality of the humours
produced: poor quality foods yield poor quality humours.

Abnormal humour also results from the effect of conventional med-

ication, which interferes with normal physiological and biochemical
processes controlled by Physis. In addition, conventional medicine
also prevents the elimination of the excess/abnormal humours, in the
form of fever, diarrhoea, vomiting etc., resulting in further abnormal
humoral states to arise.

Qualitative changes of normal humours can also develop due to oxi-

dation, with heat or coldness, or by mixture with corrupted humours.
Listed below are abnormal states of the four different humours:

Sanguinous humour
The sanguinous humour, being Hot & Moist, can be altered by a num-

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ber of factors. These include excessive heat (oxidation) or infection

(putrefaction). The changes can affect the quality and purity of the
humour, resulting in it becoming thicker or thinner, darker or paler, or
contaminated. They can also vary the odour and taste of the humour.

Oxidation of the sanguinous humour is due to excessive heat. For ex-

ample, from improper diets, which often contain an excess of refined
sugar and over-processed food items. In addition, a lingering fever
may cause the sanguinous humour to thicken, leading to stagnation.

This abnormal humour has qualities of dryness associated with it.

• Signs and symptoms include an emaciated dark, reddish tongue.
• Examples of illness: Inflammatory skin disorders, such as
eczema and psoriasis.

Phlegmatic humour
Once it has been utilised and eventually exhausted, the phlegmatic
humour is excreted from the body in a variety of forms. These vary
in quantity, texture, consistency, colour and taste. This indicates that
once the phlegmatic humour is generated it progresses through many
different qualitative changes and increasing degrees of abnormality.

The taste of one’s saliva is an important indicator of the overall state

of one’s phlegmatic humour. Saliva consists of both serous and mu-
cous fluid. The taste of normal saliva is mildly sweet or bland, but if
one’s saliva tastes unduly sweet, sour, acrid or bitter, it may indicate
morbid qualitative changes in the phlegmatic humour.

Insipid phlegmatic humour

• This is thin and watery. It is produced from coldness, such as
exposure to cold weather, or from drinking ice-cold drinks.
• It is the most Cold & Moist variant of the phlegmatic humour,
and is tasteless and odourless.
• Signs and symptoms include: watery, tearing eyes; runny
nose; moist, glossy, pale tongue. Examples of illness: Post-nasal
drip, phlegmatic asthma.

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Salty phlegm
• This arises from being mixed with abnormal bilious humour.
It is the hottest, driest and lightest form of the phlegmatic
humour. Salty phlegm is Hot and Dry comparative to normal
phlegmatic humour. This variety of phlegm being thinner than
the normal phlegmatic humour has qualities of heat and
dryness, where heat dominates. Being hot, the salty
phlegmatic humour reduces the nourishment and soothing
protection offered by the phlegmatic humour. Phlegmatic fluids
that require a certain degree of viscosity, such as the synovial
fluid, when made unduly thin, diminishes the supportive and
protective function resulting in increased friction and irritability
of the skeletal joints.
• Example of illness: Allergic rhinitis. This manifests as a runny,
nose, with thin mucus and red, inflamed nasal mucous
membranes.

Phlegmatic humour corrupted by abnormal sanguinous humour

• This is very sweet in nature, and has qualities of moistness.
It is due to excessive heat and moisture arising from the
digestive and metabolic processing of an improper diet. Example
of illness: Metabolic disorders such as diabetes.

Mucilaginous phlegmatic humour

• Is thick and slimy and may be clear, milky and translucent, or
white and opaque. It is the result of excessive intake of
mucous producing foods. Example of illness: Sinusitis.

Calcerous phlegmatic humour

• Is white and chalky, and has qualities of coldness and dryness
associated with it. Example of illness: Arthritis and rheumatic dis
orders associated with the elderly.

Bilious humour
• Oxidation of the bilious humour due to excessive heat and dry
ness may result in it becoming thick and hard. Example of ill
ness: tuberculosis.

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Melancholic humour
Abnormal melancholic humour is often the charred, oxidised residue
of any of the four humours, including the melancholic humour itself.
These abnormal variations are hotter and lighter in quality compared
to the normal melancholic humour, so they have a greater penetrating
power, and are more corrosive.

Abnormal melancholic humour can be generated from several caus-

ative factors:
• Excessive heat in the liver, causing burning, charring or
excessive oxidation of the humours.
• Excessive heat generated by certain types of chronic or
extreme fevers.
• Excessive cold that congeals and solidifies the humours and
secretions in the body, resulting in prolonged stagnation that
leads to putrefaction. The residue that is left behind from
putrefaction is usually a type of abnormal melancholic humour.

Examples of the possible causes and illness conditions associated

with abnormal melancholic humour are listed below:

Abnormal Melancholic from the Sanguinous humour

• Cause – excessive oxidation or putrefaction. Example of illness:
Complications of diabetes mellitus, such as gangrene.

Abnormal Melancholic from the Phlegmatic humour

• Cause – oxidation of the mucous and serous fluids of varying
composition and consistency. Excessive cold results in stagna
tion and coagulation. Example of illness: Angina.

Abnormal Melancholic from the Bilious humour

• Oxidation of the bilious humour renders it very corrosive, caustic
and toxic. Example of Illness: Cirrhosis of the liver.

Abnormal Melancholic from the Melancholic humour

• Many cancers arise from abnormal states of the melancholic
humour. Example of Illness: Carcinoma of the colon.
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PATHOLOGICAL PROCESSES AND PATHWAYS IN TIBB

The Western medicine technique for treating disease is based on

identifying the cause, usually a microbial infection, allergen or inflam-
matory process. After alleviating or suppressing the symptoms, if an
infective agent, allergen or other toxic substance is considered the
cause, treatment consists of antibiotic, anti-allergen or anti-inflamma-
tory drugs. This is consistent with the ‘one disease, one cause’ phi-
losophy, or ‘doctrine of specific aetiology’.
Tibb has a different approach, based on identifying the putative causes
related to the humoral composition of the patient, and the influence
of the patient’s diet, and other the Lifestyle Factors, and how these
make someone susceptible to disease by preparing the terrain.

Tibb considers that illnesses arise from three processes

• From a sudden change or excess in qualities resulting in a
qualitative/humoral imbalance – Pathway 1;
• From an accumulation of excess or abnormal humours
- Pathway 2;
• From the influence of an infectious or toxic agent.

Pathway 1: Sudden change or excess in qualities - Qualitative/

humoral imbalance

Illnesses that follow Pathway 1 are invariably associated with acute

disorders. They arise unexpectedly in people who are in most cases
physically healthy, and whose humoral balance is in harmony with
their personal temperament. In these people, their Physis is in com-
plete control. Although homeostasis is firmly established and opti-
mum health maintained, it can happen that a sudden change in one
or more of the qualities - heat, moistness, coldness or dryness - can
occur. It could be from emotional or environmental excess, physical or
mental shock, excessively hot food, badly disturbed sleep, or a sud-
den change in the weather. It is these changes which lead to the signs
and symptoms typical of a specific ailment.

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As mentioned earlier, signs and symptoms in general are associated

with a combination of qualities which invariably begin with an excess
of one quality in particular, whether it is heat, coldness, moistness or
dryness. The pathological processes (below) arise from an excess of
each quality:

Excessive heat - leads to a bilious and/or the sanguinous humour

imbalance. This has a negative influence on the functioning of the
phlegmatic humour, and to a lesser extent, of the melancholic humour.

Excessive coldness - leads to a phlegmatic and/or the melancholic

humour imbalance. This has a negative influence on the functioning
of the bilious and/or the sanguinous humour.

Excessive moistness – leads to a sanguinous and/or phlegmatic hu-

mour imbalance. This has a negative influence on the functioning of
the melancholic and/or the bilious humour.

Excessive dryness – leads to a melancholic and/or bilious humour

imbalance. This has a negative influence on the functioning of the
sanguinous and/or the phlegmatic humour.

Pathway 1, resulting from a sudden change or excess qualities is

common in most cases of self-limiting illnesses, such as headaches,
vomiting, diarrhoea and dyspepsia. A typical example is when some-
one is exposed to a cold environment immediately after warm one
- like going outside during a cold winter’s day from a warm room in
the office or home. A runny nose immediately develops in response to
the cold as Physis attempts to balance this quality. Rectifying this by
moving back into the warm environment or eating heating foods, sup-
ports Physis, so restoring the body to the normal homeostatic state.
However, prolonged exposure usually leads to symptoms typical of
colds and flu.
Similarly emotions can also elicit a qualitative effect. For example, a
heated personal exchange usually results in an elevated stress level.
This is linked to the heat quality, so a serious confrontation

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often leads to the person involved experiencing nausea, diarrhoea

and other stress-related disorders.

Although most Pathway 1 ailments begin with an excess of one of the

qualities in particular, they are invariably associated with a combina-
tion of dominant and sub-dominant qualities.

For example, cold and flu commonly manifest in the colder season
of the year. If this cold imbalance is not corrected, then flu-like symp-
toms develop, such as a runny nose and a productive cough. These
are associated with an increase in mucous production. Such respira-
tory symptoms are therefore associated with Cold & Moist qualities,
with cold being the dominant quality. Similarly, peptic ulcers, which
often arise from consumption of excessively spicy foods, are associ-
ated with Hot & Dry qualities, with heat being the dominant quality.

These qualitative changes are generally associated with most acute

disorders, and these may affect certain functions. Physis can actively
restore health once the excess quality situation has been counter-
acted and corrected. However the effect of these qualitative changes,
if not addressed or reversed, can worsen, and lead to marked distor-
tions at the humoral level.

If the effect of the Cold & Moist qualities is prolonged, the humoral
balance will be negatively affected, and other, serious, disorders as-
sociated with the phlegmatic humour, chronic sinusitis and bronchial
asthma for instance, can develop.
Also included in Pathway 1 are flare-ups associated with chronic dis-
orders. Examples abound: an episode of epigastric distress after con-
suming a highly spiced meal in a patient with peptic ulcer disease,
or one of acute inflammation in a gout patient who has binged on
alcohol.

Pathway 2: Accumulation of excess or abnormal humours

Illness conditions arising from Pathway 2 are invariably from either
excess or abnormal humours. Excess of one of the four humours
manifests itself at a quantitative level, resulting from the types of
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foods consumed. For example, excessive intake of Hot & Moist foods
will result in the production of excess sanguinous humour, leading to
signs and symptoms associated with this excess. Similarly excess
intake of Cold & Dry foods will increase the melancholic humour, lead-
ing to signs and symptoms associated with the melancholic humour.

Listed below are selected signs and symptoms associated with ex-
cess humours. Each affects virtually all the body’s physiological and
metabolic systems, resulting in the signs and symptoms typical of a
particular ailment.

Sanguinous humour

• Typical signs: viscous urine, spider naevi, flushed complexion.

• Cardiovascular disorders: raised blood pressure, nosebleed,
temporal headache.
• Inflammatory disorders: gingivitis, eczema.
• Musculo-skeletal disorders: general lassitude, drowsiness.
• Other disorders: liver congestion, urinary tract infection.

Phlegmatic Humour

• Typical signs: slow pulse, clammy skin, poor muscle tone, puffy
eyelids, pale lips.
• Breathing disorders: phlegmatic cough, rhinorrhoea, sinus con-
gestion.
• Mental changes: lethargy, mental dullness, frontal headache.
• Digestive disorders: indigestion, sluggishness, post-prandial
drowsiness.
• Other disorders: amenorrhoea.

Bilious Humour

• Typical signs: rapid pulse, dark urine, restlessness, bloodshot

eyes, food intolerance.
• Nervous disorders: insomnia, migraines, unilateral headache.

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• Behavioural changes: anger, impatience, excessive thirst.

• Digestive system disorders: mouth ulcers, coated tongue, bitter
taste, hepatitis, constipation.
• Skin disorders: rashes, hives, itchy, sensitive skin.
• Organ malfunction: hepatomegaly, gastric hyperacidity, liver
problems, ulcers, gallstones.

Melancholic Humour

• Typical signs: weak pulse, cold, dry and rough skin, nervous ex-
haustion, intellectual cynicism, anxiety, moodiness.
• Nervous disorders: headaches, insomnia, tinnitus, vertigo, food
craving.
• Digestive disorders: poor appetite, constipation, irregular eating
patterns.
• Respiratory disorders: painful breathing.
• Organ malfunction: hepatomegaly, splenomegaly, portal conges-
tion, colic, intestinal obstruction, bloating.
• Circulatory disorders: poor circulation, cold extremities, viscous
blood, emboli formation.
• Musculoskeletal disorders: arthritis, muscle tremors and spasms,
muscle stiffness, aching joints, sciatica, numbness in digits.
• Gynaecological disorders: Irregular menses, dysmenorrhoea,
irregular menstrual flow, inappropriate lactation.

The above signs and symptoms, related to an excess of each of the

humours, if not corrected will inexorably alter the person’s ideal ratio
of humours. This results in both quantitative and qualitative imbal-
ances in humours, which exerts a wide range of outcomes on the
functions they affect, as well as structural changes to cells, vessels,
tissues and organs. All possibilities are dependent on, and in line with,
the group of causes referred to in the chapter: ‘Aetiology in Tibb’ as-
sociated with temperament, qualities, humours and functions.

A humoral imbalance ultimately leads to specific clinical disorders

associated with the humour. For instance, the melancholic humour,
in excess or abnormal in form, can lead to both a quantitative and
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a qualitative imbalance. If not corrected in time by Physis, this ulti-

mately leads to disorders such as osteoarthritis, atherosclerosis and
kidney stone. Similar clinical outcomes occur for the other humours.

Accumulation of excess or abnormal humours usually takes place

over an extended period of time. It is the outcome of Physis’ inability
to restore homeostasis. From birth until death, just as our metabolic
rate deteriorates, so does the ability of Physis to restore balance. Ill-
nesses that arise from this accumulation are invariably all chronic ill-
nesses such as hypertension, diabetes mellitus, atherosclerosis and
arthritis.

Chronic illnesses progress in three distinct stages:

Stage 1- Humoral Imbalance: Operates at the

vascular level, involving the body’s humours. It
results in a marked imbalance in the person’s hu-
moral composition, usually occurring when the
quality or quantity of specific humours alters due
to the impact of one or more distorted Lifestyle
Factors. If this process is not quickly reversed, in
time the second stage is reached.
Stage 2 - Functional Imbalance: In this stage
distortions take place in the body’s physiologi-
cal operations: for example, in the blood circula-
tory system, digestive enzyme activity, and nerve
conduction.
Stage 3 - Structural imbalance: Results when
the excess or abnormal humours lead to
structural changes to vessels, tissues or organs.
This final stage is often associated with serious
disease.

When evaluating the pathology of different illnesses, Tibb takes into

account the changes in qualities and/or humours that have progressed
as far as physiological malfunctioning or structural damage.

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Infectious agents
Tibb offers a view of diseases arising from infectious agents which
is markedly different to that put forward by proponents of Western
medicine. As they did not possess today’s impressive microbiological
technology at the time, Tibb physicians were unable to recognise the
links between pathogenic agents, specifically viruses, bacteria and
fungi, and the patient’s infections, such as those between M. tubercu-
losis and tuberculosis, and S. pneumoniae and pneumonia. However,
they were aware of the existence and nature of infection, or as they
termed it, putrefaction.

Tibb physicians were also aware that different types of infections pre-
vail according to the season of the year. For example, during winter,
which is characterised by a Cold & Moist environment, and so linked
to an excess of the phlegmatic humour, streptococcal infections such
as pneumonia are more common. Similarly, tuberculosis occurs more
frequently in times when Heat & Dryness conditions prevail, which
are characteristic of the bilious humour. This infers that there is a link
between an infectious agent and seasons during which humoral im-
balance facilitate a favourable ‘medium’ or ‘terrain’ for the infection to
develop in.

In Tibb philosophy, an infection due to a pathogenic microbe is only

possible when an imbalance exists at the humoral level. This imbal-
ance provides a benign environment in the body’s tissues and fluids
which encourage the infective microbes to survive, multiply, spread
and prosper. This explains why some people are, for example, sus-
ceptible to a particular bacterial infection, whereas other people whose
humours are in balance, are not.

There is, therefore, a definite humoral link between the infective agent
and the resulting disease. Infection will only take place when there is
imbalance in humours which is beyond the ability of Physis and the
immune system to correct. Treatment in Tibb therefore focuses on re-
storing normal humoral harmony, whilst bearing in mind the tempera-
ment of the individual, and its working via the immune system.

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(The Tibb approach to treating infections is described in the chapter

‘Therapeutics in Tibb’)

Table 11: Pathological processes and Pathways in Tibb

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ILLNESSES ASSOCIATED WITH HUMORAL

IMBALANCES

Imbalances result from variation in the different humours, from normal

to abnormal, and from excess humours. Most diseases, especially
the chronic ones, result from a complex culmination of both qualitative
and quantitative imbalances.
Described below are examples of chronic diseases associated with
excess and/or abnormal states of the four humours. These also indi-
cate progression of the illness from one qualitative state to another, as
well as (where applicable) the signs and symptoms associated with it.

Imbalance of the sanguinous humour

As the concentration of the sanguinous (Hot & Moist) humour is the
highest of all humours, illnesses associated with the sanguinous hu-
mour are often the result of the increased volume linked to the sangui-
nous humour. Primary hypertension is a good example of this.

Primary hypertension (Hot & Moist)

Primary hypertension, also termed essential hypertension, is the re-

sult of increased blood volume (hypervolaemia), brought on by excess
sanguinous humour. The blood volume is influenced by moistness as-
sociated with the phlegmatic temperament. Moreover, if a hyperten-
sive patient has a temperament which is either dominant/sub-dom-
inant sanguinous or phlegmatic (that is, sanguinous/phlegmatic, or
phlegmatic/sanguinous), the severity of the hypertension will probably
be more severe. This is because of increased blood volume arising
from the common moistness quality in his/her temperament. Excess
moistness is therefore an important target when treating hyperten-
sion. This is reflected in the use of diuretics in its management, either
alone or in combination with other agents.

Imbalance of the phlegmatic humour

Typical illnesses associated with quantitative and qualitative changes
to the phlegmatic humour are rheumatoid arthritis and diabetes.

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Rheumatoid arthritis (Hot & Dry to Cold & Dry)

The onset of rheumatoid arthritis is characterised by abnormal phleg-

matic state/salty phlegmatic humour with qualities of heat and dryness.
This state lacks the soothing properties of the normal phlegmatic hu-
mour, thus resulting in signs and symptoms of acute inflammation in
the joints. As the disease progresses, an increase in heat dissipates
the moistness of the phlegmatic humour, causing it to thicken. This in
turn causes the phlegmatic humour to thicken, with qualities of dry-
ness and heat. The heat oxidises the abnormal phlegmatic humour
to an abnormal melancholic humour, with qualities of coldness and
dryness. The formation of fibrous tissue and subcutaneous nodules
begins.

Phlegmatic imbalance - Rheumatoid arthritis

Start Abnormal phlegmatic humour:
Symptoms of acute inflammation - heat, redness,
swelling, pain and fever (Hot & Dry Qualities)

Progression Increase heat:

Thickening of the phlegmatic humour
Symptoms of chronic inflammation - mainly
severe swelling and pain (Dry & Hot Qualities)

End stage Dried calcified phlegmatic humour:

Abnormal melancholic humour
Nodular End stage (Cold & Dry Qualities)

This scheme shows that the signs, symptoms and clinical features of
rheumatoid arthritis vary during the different stages of the imbalanced
phlegmatic humour. This means that treatment needs to be tailored
according to the particular clinical phase the patient is in.
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Diabetes mellitus (Moist & Hot, to Cold & Dry)

This disease is associated with Moist & Hot qualities. If uncon-

trolled, the excessive moistness will completely diminish heat, so
deteriorating the condition towards coldness and moistness. If
the condition continues to degenerate, coldness will predominate,
causing poor blood circulation. This results in complications like gan-
grene, which are linked to the qualities of coldness and dryness.

Phlegmatic imbalance - Diabetes mellitus

Start Abnormal phlegmatic humour
Acute Diabetes (Hot & Moist Qualities)

Progession Chronic diabetes (Moist & Hot Qualities)

Further
Progression Uncontrolled diabetes leading to the start of
gangrene (Cold & Moist Qualities)

End stage Phlegmatic-Melancholic Humour

Uncontrolled diabetes - gangrene
(Cold & Dry Qualities)

Imbalance of the bilious humour (Hot & Moist to Cold & Dry)

Excess bilious humour and/or its abnormal states disturb the tem-
peramental and functional harmony of the liver. These imbalances
can lead to its inflammation. If not corrected in good time, the disor-
der can deteriorate further, causing serious structural damage, a life-
threatening situation.
The flow chart illustrates the progression of the liver from its normal
healthy state to a state where serious structural damage has devel-
oped. It shows the sequence of changes of normal bilious humour
to excess levels, to abnormal states of the bilious humour (which in-
cludes a melancholic state), and its clinical consequences.

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Bilious imbalance - Hepatitis/cirrhosis

Start Beginning of excess bilious humour

(Hot & Moist Qualities)

Progression Bilious humour accumulation - acute hepatitis

(Hot & Dry Qualities)

Further
Progression Oxidation of bilious humour from increased
heat leading to abnormal bilious humour: Chronic
hepatitis (Dry & Hot Qualities)

Further
Progression Increased dryness - beginning of structural
damage - Acute cirrhosis. (Excessive dryness)

End stage Abnormal Melancholic humour:

Chronic cirrhosis (Cold & Dry Qualities)

The above chart clearly illustrates how a progressive illness linked to

excess bilious humour develops. There is the final conversion of the
abnormal bilious humour by oxidation into abnormal melancholic hu-
mour. The signs and symptoms reflect mild inflammation, progress-
ing to more severe forms. However, the causes and risk factors asso-
ciated with its onset and progression will, to a large extent, remain the
same. Accurate assessment of the patient and the qualitative state is
necessary to employ effective treatment.

Imbalance of the melancholic humour

Illnesses associated with the melancholic humour invariably develop
from (a) excess melancholic humour, or (b) from abnormal states of
the melancholic humour.
Illnesses typically associated with changes to the melancholic humour
are osteoarthritis and haemorrhoids.

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Osteoarthritis (Cold & Dry)

Osteoarthritis results from a melancholic imbalance associated with
the qualities of Coldness & Dryness. The onset of osteoarthritis is of-
ten the result of excess melancholic humour, and/or abnormal states
of melancholic humour arising from the other humours.

Haemorrhoids (Dry & Hot/Cold & Dry)

Haemorrhoids develop from a melancholic imbalance, associated
with the qualities of Dry & Hot (the type that bleeds) or Cold & Dry (the
type that does not bleed). The onset of haemorrhoids is also the result
of excess melancholic humour and/or abnormal states of melancholic
humour arising from the other humours.

PATHOLOGICAL PROCESSES FROM OTHER

INFLUENCES

Influence of temperament in pathological processes

In Chapter 2: Aetiology in Tibb, the relationship between temperament
and clinical disorders was highlighted. For example, an individual who
has a dominant sanguinous, sub-dominant phlegmatic temperament
is inclined to disorders that have a dominance of moistness, such as
diabetes. This principle applies broadly to other temperamental types.
Pathology in relation to temperamental predisposition is not absolute.

It is important to note that if the ideal qualitative state associated with

a person’s temperament moves from the original dominant quality (as
a result of poor lifestyle management) into another qualitative state,
the person will be inclined to illnesses that are associated with the

new qualitative state as well. This means that even for a short duration
the person may be inclined to acute conditions, associated with that
quality. Moreover a longer duration will incline the person to chronic
disorders associated with the new quality.
Below is an example that supports the above.

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Mrs M has a dominant bilious with a sub-dominant sanguinous

temperament. Being a typical, active, dominant bilious personal-
ity, she develops endometriosis (Heat with Dryness condition)
at the age of 35. By the age of 45, she starts gaining weight,
slows down somewhat, and as a result develops hypertension
(Heat with Moistness condition). By the age of 50, with increased
weight gain, and unable to manage additional worries, her me-
tabolism slows down considerably, and she develops diabetes
(Moistness with Heat condition). This gradual movement from
the ideal qualitative state required by temperament can lead to
other illness conditions.

This highlights the relationship between qualitative changes, a per-

son’s temperament, the pathological processes which follow, and the
resulting clinical consequences. It also stresses the importance of
adjusting the Lifestyle Factors according to age, thus maintaining the
ideal qualitative state associated with temperament. The movement
from one quality into another will have a direct bearing on the de-
velopment of certain illnesses. Therefore not respecting the qualita-
tive and quantitative changes which occur whilst ageing has profound
pathological implications for a person’s health.

Pathological processes arising from loss of continuity

Loss of continuity can be defined as a break in the efficient commu-
nication and functioning of the different anatomical and physiological
systems of the body. This occurs when there is damage, resulting
from humoral imbalance, or injury, to the structures of different tissues
and/or organs.
As the nervous system coordinates and maintains continuity between
all structures of the human body, pathological processes arising from
loss of continuity, especially pathologies related to the musculoskel-
etal system are associated with the spinal column.

Diet and humours in pathological processes

Humours are produced from food and drink. The effect of diet on the
production and type of humour, and their relationship to associated

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disease is therefore important. Obviously diet increasing a specific

humour to excess will result in illnesses associated with the respec-
tive humour.
• Hot & Moist foods increase the sanguinous humour. This may
cause or aggravate disorders such as hypertension and dys-
menorrhoea.
• Hot & Dry foods increase the bilious humour. This may cause
or aggravate disorders such as hepatitis, pancreatitis and hyper-
thyroidism.
• Cold & Moist foods increase the phlegmatic humour. This may
cause or aggravate disorders such as colds and flu, anaemia
and syphilis.
• Cold & Dry foods increase the melancholic humour. This may
cause or aggravate disorders such as fibrosis, psoriasis and
kidney stones.

Importance of heating foods

The typical Western diet of milk, beef, potatoes, lettuce salads, refined
white sugars, cheese, butter and margarine etc. are all cold foods.
And cold foods lead to an imbalance of the phlegmatic humour, and
cause a list of complaints that are epidemic around the western world
– migraine headaches, menstrual cramps, lung and chest problems,
arthritis, constipation etc. As the indiscretion in food consumption is
continued, in time the other humours also become imbalanced. When
such imbalances progress, abnormal melancholic humour is pro-
duced, and diseases such as cancer, arteriosclerosis, emphysema,
and others arise. Heating foods are necessary for the body to achieve
and maintain a complete metabolic digestion of foods. Food is the
source of heat, the fuel for the body. The body’s digestive process are
also in a continuous effort to heat or ‘cook’ the nutrients so that they
may be broken down into component parts, utilized by the body, and
then eliminated completely.
The secret of human health and wellness is not only in maintaining a
balanced diet, but also in avoiding excess food and drink. The state-
ment: “the stomach is the home of disease” is the essence of medi-

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cine, made by the Prophet Muhammad (PBUH) more than 1400 years
ago. More recently, some prophetic-minded physicians have agreed
with this dictum. Hippocrates believed it. Galen believed it. Ibn Sina
established it as a law of medicine. Yet today it is ignored. Since the
human body’s metabolism causes nutrient substances to become the
human body (including its disease-fighting mechanisms), the ultimate
origin of most illness is in food, or diet.

Movement of illnesses from one qualitative state to another

Regression or deterioration of a person’s disease results in move-
ment from one qualitative state to another. An example is the case of
people infected with the HI virus. Patients infected with the HI virus
suffer from suppressed immunity. As a result, they become suscepti-
ble to opportunistic infections irrespective of their temperament. How-
ever, differences in temperament provide an explanation why people
who are HIV positive respond differently to infections or other illness
conditions.

According to Tibb, HIV-positive people with a dominant/sub-dominant

bilious temperament, associated with Hot & Dry qualities, will present
with signs and symptoms such as tuberculosis (TB), night sweats, dry
cough, weight loss and other inflammation-related disorders. How-
ever, HIV-positive people with a dominant/sub-dominant phlegmatic
temperament, associated with Cold & Moist qualities, will present
with signs and symptoms which include vomiting, diarrhoea, thrush,
and weight loss. These people will deteriorate and develop full-blown
AIDS more rapidly as increased moistness increases the risk of op-
portunistic infections.

With time both temperamental combinations, if left untreated, will de-

teriorate to full blown AIDS, characterised by the wasting syndrome,
which is associated with Cold & Dry qualities.

Influence of age and gender on pathological processes

In Chapter 2: Aetiology of Tibb, features of the human life cycle from
infancy to senility were examined. The significance of the life cycle

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is the qualities associated with each stage of the life cycle and its
relevance to pathology. For example, during infancy and babyhood
the dominant quality of the period is moistness which results in con-
ditions with excessive moistness such as vomiting and diarrhoea. At
the other extreme is senility, with its typical qualities of coldness and
dryness. These are associated with the characteristic illnesses
osteoarthritis and osteoporosis. Similarly gender differences, where
females are somewhat moister than males and will be more inclined
to diseases associated with excess moisture, such as depression and
a number of reproductive system problems.

Indirect influence of one humour on another humour

Whilst most illness conditions are the result of an excess/abnormal
specific humour, an excess of one humour can also have a negative
effect on the functioning of another humour. The indirect influence of
the phlegmatic humour on the functioning of the bilious humour is il-
lustrated in the pathology resulting in high cholesterol levels.

The word cholesterol is derived from the words chole meaning bile,
and steros meaning freeze. An appropriate concentration of the bil-
ious humour is essential in maintaining required cholesterol levels by
ensuring that the ‘freezing’ of cholesterol does not occur.
Balanced heat and dryness – resulting in efficient bilious humour
functioning.

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Indirect influence of the Bilious humour

Start Optimum Bilious humour functioning

Balanced levels of fat and cholesterol

Progression Excess phlegmatic humour - Imbalance in heat

level

Further
Progression Accumulation of fat - high level of cholesterol

Further
Progression Deposition of cholesterol in the arteries

End stage Atherosclerosis and finally arteriosclerosis

The development of increased cholesterol levels is not only depen-

dent on the concentration of the bilious humour. It can also result from
an increase of coldness/moistness, from Cold & Moist foods (excess
phlegmatic humour) and Cold & Dry foods (excess melancholic hu-
mour), and/or other Lifestyle Factors which increase the cold/moist-
ness.

Pathological changes due to conventional medication

Many patients present with conditions that result as a side effect or
metabolic response to short-term (acute) or long-term (chronic) treat-
ment with conventional medication. Often, multiple regimes of addi-
tional medication are prescribed to counteract the side effects caused
by the original prescribed drug. An example is the ACE inhibitors,
commonly used in the treatment of hypertension. These have side
effects of coughing for which theophylline or other antitussives are
given to suppress. Another example is the use of thiazides or loop
diuretics in the treatment of hypertension, oedema or cardiac failure.
A patient may develop gout as a side effect and thus be prescribed

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allopurinol. Each time a new medication is added, the side effect pro-
file increases, which often requires management with an additional
drug. Also, as aforementioned, suppression of the symptoms only re-
sults in the manifestation of abnormal humoral states and more seri-
ous illnesses.

QUALITIES AND PATHOLOGICAL PROCESSES

Temperament and qualities in relation to signs and symptoms

An individual’s temperament in relation to the signs and symptoms
should be taken into consideration. Using arthritis as an exam-
ple which is associated with Cold & Dry qualities, a person with a
dominant/sub-dominant melancholic/bilious combination will most
likely suffer from an excess of dryness which is the common qual-
ity for this temperamental combination. Similarly an individual with a
melancholic/phlegmatic combination will most likely have arthritis as-
sociated with excessive cold.

This highlights the influence of the temperament and associated

quality, which will, in all likelihood, be the dominant quality associ-
ated with the illness condition that a person presents. However, if the
melancholic/bilious person mentioned above overindulges in Cold &
Moist foods, or prolonged exposure to cold, the dominant quality as-
sociated with his/her arthritis can move from dryness to coldness. It is
therefore essential to look at the whole picture of pathology, including
inherent temperament, any possible changes that may have present-
ed over time, and the current presentation of signs and symptoms
before establishing qualitative states to illness conditions.

Qualitative changes affecting tissues and organs

The qualitative changes affecting tissues and organs are similar to
those occurring to the ideal qualitative state of an individual. Changes
to the ideal qualitative state, especially an excess of the quality as-
sociated with a particular organ, will affect that organ the most. For
example, the liver which has a dominant quality of heat is affected by
excess heat, resulting in illnesses such as jaundice and pancreatitis.

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This applies to all the organs which have a dominant quality of heat.
This dominance of heat is the result of a higher proportion of epithelial
tissues found in these organs.

However, organs which have a larger proportion of tissues, other than

epithelial tissue, may also be negatively affected by excess heat qual-
ity, depending on the proximity of the epithelial tissues. For example,
although the stomach is a predominantly muscular organ (being dry,
with heat), the lining of the stomach contains epithelial tissue (heat,
with dryness). This region of the stomach will therefore be negatively
affected by excess of heat leading to gastritis. This principle will apply
to all the organs and tissues associated with the heart and brain as
well.

As indicated above, an excess in quality which is the same as the

dominant quality associated with the organ affects that organ the
most. However, an excess in quality that is not the same as the domi-
nant quality of the organ could also affect the organ, depending on
the site of the different tissues that make up the organ. So as in the
above explanation, excess heat will not only negatively affect epithe-
lial tissues, but will also reduce the appropriate moistness required by
tissues or organs associated with the brain (Hot & Moist) and nervous
system (Cold & Moist). However, this effect will be gradual.

Pathology in Tibb acknowledges the causative influences at both (a)

the physical dimension of tissues and organs, and (b) the metaphysi-
cal dimension, involving changes in humours and qualities.

Presentation of illnesses with opposite qualities

Another consideration is that patients may present with signs and
symptoms of illnesses in which the humoral imbalances and quali-
tative states are opposite. For example, a person who suffers from
primary hypertension (Hot & Moist) may develop colds and flu symp-
toms which are associated with Cold & Moist qualities. In fact, these
anomalies of opposite qualities may be present in a patient at the
same time. Management of these patients who present with condi-

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tions with opposite qualities will be dealt with in the chapter on Thera-
peutics.
However, generally it will be found that most chronic illnesses asso-
ciated with the patient will be in relation to the dominant quality as-
sociated with his or her temperament. Acute illnesses, on the other
hand may be associated with qualities of immediate exposure often
unrelated to his/her dominant quality.

Guidelines for assigning qualities to illnesses

Whilst associating qualities to signs and symptoms of illness condi-
tions may be obvious in some conditions such as hyperacidity/ulcers
(Hot & Dry), phlegmatic asthma (Cold & Moist), it is also important to
note that qualities associated with illnesses, whether at the onset of
the condition or after the condition has manifested itself, is not abso-
lute in all illness conditions.

There are often multiple causes associated with certain illnesses,

which could vary from different causes, as indicated below:

• Dizziness can be caused by: (a) excessive menstrual

bleeding associated with Hot & Dry qualities; (b) anaemia
(Cold & Moist); or (c) low blood pressure (Cold & Moist).
• Epistaxis, or nose bleed (Hot & Dry), can also be caused by
nasal polyps (Cold & Dry).
• Leucorrhoea (Hot & Moist) can arise from: (a) general
weakness; (b) low blood pressure; (c) anaemia; (d) excessive
tiredness; or (d) constipation all of which have varying qualities.
• Urticaria, or skin rash (Hot & Dry), can result from eating the
wrong foods, or by food poisoning.
• Insomnia (Cold & Dry) can be due to aches and pains, worries,
stress and excessive heat.
• Acne (Dry & Hot) is most common in teenagers, but can occur
in any age group. It can result from: (a) suppressed
menstruation (Cold & Moist to Moist & Hot); (b) constipation
(Cold & Dry); (c) the use of oral contraceptives; and (d) reaction
towards cosmetics, and other chemicals.

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• Eczema (Hot & Moist) can be caused by Cold & Dry to Dry
& Hot humoral imbalances, especially when it is treated with
cortisone-based medication for extended periods. But it can be
caused by reactions to any external applications such as olive
oil, mustard oil or by excessive intake of Hot & Dry foods.
• Alopecia, or loss of hair (Hot & Dry), can also be caused by:
(a) lack of cleansing of the hair; (b) excessive Cold & Dryness
on the scalp; (c) general weakness; (d) anaemia; (e) by harsh
shampoos; (f) medication.
• Lack of appetite (Cold & Moist) can be: (a) the result of
excessive bilious humour (Heat & Dryness); (b) the result of
constipation (Cold & Dry); or (c) from conscious suppression of
the appetite (Anorexia).
• Diarrhoea (Cold & Moist) can be the result of: (a) food poison-
ing; (b) unwise mixing of foods; (c) hepatitis or jaundice; (d)
excessive bilious humour. It is often a consequence of: (a)
colon cancer (Cold & Dry); (b) Crohn’s disease or ulcerative
colitis; or c) Irritable Bowel Syndrome (Moist & Hot).

INFLAMMATION: THE TIBB INTERPRETATION

An important aspect of the pathology of many diseases is the devel-

opment of inflammation. This is the reaction of living tissues to any
form of injury. It is a warning sign alerting us to the impending danger
of infection in the body. Inflammation is a necessary precursor in the
healing and repair of the body. It protects the body by triggering an
immune reaction, thereby halting the spread of infection, and ridding
the body of damaged and dead cells. The source of the inflammation
needs to be found by identifying the trigger factors causing the inflam-
mation.

Triggers of inflammation
• Physical, such as trauma, a weak immune system, poor
muscle and ligament strength, microbe infections, co-existing
chronic medical conditions, and autoimmune reactions.
• Environmental, such as air pollution, climatic, temperature

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changes, and humidity.

• Emotions, such as bereavement, marital separation, academic
examinations, or the stress caring for a terminally ill loved one.
• Chemical, such as irradiation, and toxins from pesticides or
mercury.
• Nutrition, such as obesity, and a diet high in saturated and
trans fats, high carbohydrate and low protein intake, refined
sugar and low levels of antioxidants.

Processes in Inflammation
Step 1: The arterioles supply blood to the injury, resulting in an
increase in its blood flow. There are changes in the vascular flow.
Step 2: The capillaries become more permeable, enabling blood
proteins and fluid exudate to penetrate into the interstitial spaces.
Step 3: The neutrophils as well as macrophages move out of the
capillaries and venules into the interstitial spaces. Both neutrophils
and macrophages are white blood cells which have the ability to
digest the invading microbes.

Cardinal signs of inflammation

• Pain – originally “dolor”
• Redness – originally “rubor”
• Swelling – originally “tumor”
• Heat – originally “calor”
• Loss of function – originally “rigor”

Stages of Inflammation
• First stage - Irritation is a natural, systematic self-defence
(Physis) mechanism which attempts to stop or limit the
process, and which aids in the healing process.
• Second stage – Suppuration (the formation of pus) in an effort
to expel the toxins out of the body.
• Third stage – Granulation is the formation of rounded, fleshy
masses of tissue which is formed in the wound, which aids in
the healing response.

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Benefits of Inflammation
• Destruction of microbes
• Detoxification of toxins
• Clearance of infections
• Facilitation of the healing process
• Repair of damaged tissues

Drawbacks of Inflammation
• Inflammatory responses may be harmful, as in anaphylactic
shock.
• Inflammation of the peritoneum leads to fibrous bands that
cause intestinal obstruction.
• Pericardial inflammation results in the formation of dense
pericardium that impairs heart function.

Patho-physiology of Inflammation in the healing process

• Haemostasis is the arrest of bleeding by vascular constriction,
fibrin clots, and the release of platelets, fibroblasts and
epidermal growth factors.
• The Inflammatory Phase involves the infiltration of neutrophils,
macrophages and lymphocytes. It consists of the acute phase,
where histamines dilate the capillaries, arterioles and venules
which increase in permeability and blood flow to the site, with
the formation of inflammatory exudates to defend the body
from further damage and/or invasion of pathogens. The sub-
acute phase produces pus in an effort to expel the toxins
out of the body in a process called phagocytosis.
• The Proliferative Phase involves the proliferation of the
epithelial cells, with capillary growth and the formation of
collagen and granulation tissue, with the aid of fibroblasts
and endothelial cells.
• The Remodelling Phase – Tissue regeneration, involving apopto-
sis, plays a major role in promoting the resolution of the acute
inflammatory response, by clearing away unwanted cells, and re-
modelling the inflamed site by deletion of myo-fibroblasts. The
body adapts to its original tissue after the elimination of the

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injurious agent, and the effective inflammatory responses are

activated to repair the damaged tissue. However, should this not
be possible, loss of function, (functio laesa) of the damaged part
may develop.

Pathways of Inflammation
• A qualitative imbalance - Pathway 1, or:
• A humoral imbalance (excessive or abnormal) - Pathway 2,
which results in cellular or tissue damage.

Acute Inflammation - Pathway 1 – Qualitative imbalance

The acute inflammatory response is the immediate defence reaction
of the body’s tissue affected by injury from infection, chemicals, or
physical agents. It is of short duration, usually lasting from a few min-
utes to several days, with the formation of inflammatory exudates. An
exudate is a slow release of liquid which contains proteins and white
cells (leucocytes) which pass through the walls of intact blood vessels
and into tissues which then become inflamed. This phase may be ac-
companied by the five cardinal signs of inflammation, which typically
lasts for one to three days. Not all of these signs may be present.
The Physis response corrects the negative influence, protecting or
reducing the extent of possible damage. The following examples il-
lustrate two different ways that Physis protects the epithelial mucosal
tissues from sudden changes that lead to inflammatory conditions,
through the secretion of mucosal fluids:
• Someone moving rapidly from a hot or warm environment to
a cold environment will present symptoms of runny nose and
watery eyes as well as other symptoms associated with colds.
This inflammation would be as a result of excessive coldness.
• Someone eating excessively spicy foods will also present with
symptoms of runny nose and watery eyes, and possibly
perspiration. This inflammation is the result of excessive heat.

Most inflammatory conditions result from excessive heat, but some-

times, and to a lesser extent, from cold. Inflammatory conditions can
also be caused by the qualities of moistness and dryness. For exam-

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ple, moistness is a typical quality associated with rheumatoid arthritis,

and dryness a typical feature associated with osteoarthritis. Both dis-
orders are inflammatory disorders.

In Tibb, inflammation is viewed as a Physis response to a change in

the body’s structure or activity due to a qualitative change (excessive
or sudden), humoral (excessive or abnormal) infectious (from patho-
genic microbes), or effect of physical trauma.

Several typical acute, Pathway 1, inflammatory conditions are:

• Acute rhinitis – also known as hay fever; inflammation of the
nasal passages.
• Conjunctivitis – ‘pink-eye’; inflammation of the mucous
membranes of the eyes.
• Appendicitis – inflammation of the appendix.
• Acute bronchitis – inflammation of the breathing passages of
the lung.
• Cholecystitis – inflammation of the gall bladder.

Chronic Inflammation - Pathway 2 – Humoral imbalance

Chronic inflammation: is the prolonged or long term response of the
body to a persistent injurious or inflammatory stimulus. More often it is
the result of biochemical influences, such as the imbalance of dietary
fats, absence of specific substances that adversely affect the produc-
tion of anti-inflammatory cells, and specific nutrient problems.

Examples of chronic inflammation of Pathway 2:

• Tuberculosis – qualities of Hot & Dry.
• Bronchial asthma – phlegmatic in nature; qualities of Cold &
Moist.
• Bronchial asthma – melancholic nature; qualities of Cold & Dry.
• Rheumatoid arthritis – qualities of Hot & Moist.
• Osteoarthritis – qualities of Cold & Dry.

Homeostasis is restored when inflammation is limited by anti-inflam-

matory responses that are rapid, reversible, localized, and adaptive to

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changes in input and integrated by the nervous system. It is possible

to have an acute phase during a period of chronic inflammation. This
is called a flare-up.

Possible outcomes of inflammation

The outcome of an acute inflammatory episode varies, depending on
a number of factors. These include the patient’s diet, the power of
Physis, status of the immune system, and the patient’s age. Chronic
inflammation occurs mainly from the inability of Physis to restore the
humoral balance.
• Complete resolution or remission. The body’s harmony or
Physis is completely restored. This occurs at the temperamen-
tal, humoral, functional and structural levels. There is little or
no permanent effects are suffered by the patient.
• Formation of fibrosis. Thickening and scarring of connective
tissue, usually as a consequence of inflammation and physical
injury.
• Formation of an abscess. A localised accumulation of pus
forms around the tissue affected by inflammation. An example
is a boil within the skin. Pus is the thick yellow-green matter
formed at the site of inflammation. It contains dead white blood
cells, bacteria – both dead and alive – and fragments of dead
tissue. The cause is the failure of the body’s defences to over-
come the agent responsible, which is usually a bacterial
infection.
• Progression to a chronic inflammatory condition. This develops
when the acute inflammatory responses launched by the body
fail to overcome and destroy the agent causing the inflamma-
tion. In other words, the inflammation is unresolved.

Once the roles of temperamental and humoral imbalances and the

Physis response in the inflammatory process are understood, we can
interpret the causes, the processes and the stages of the inflammato-
ry activity according to Tibb. This understanding helps us to evaluate
the inflammatory process as a diagnostic tool. By observing the signs
and symptoms of the inflammatory condition, the healthcare provider

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can readily identify the causative abnormal/excess humour and qual-

ity associated with the inflammatory condition. This allows him or her
to assist in the appropriate treatment.

STAGES OF DISEASE

According to Ibn Sina, there are four distinct stages of an illness or dis-
ease. These apply to all disorders and episodes of illnesses, whether
they are acute, such as headache and diarrhoea, or chronic, such as
diabetes and asthma.

The Commencement Stage – ‘the beginning’

This stage is the earliest start of the disease, in which the signs and
symptoms are not yet prominent, but the disease starts its progress
in the body. This arises either from a temperamental or a humoral im-
balance. Physis is still relatively in control, as there are no apparent
signs of functional imbalances.

The Progression Stage – ‘the increase’

In this stage the disease process accelerates where functional dis-
turbances are apparent and the beginning of structural damage may
be evident. Physis is now under pressure to restore balance with
the appropriate systems of the body.

The Cresting Stage – ‘the peak’

The disease process peaks, Physis is now on maximum readiness
to overcome the imbalance. During the peak state, the disease can
either be overcome by Physis, so that the body returns to a healthy
state; or Physis succumbs to the disease, and severe chronic dis-
ability or death may ensue.

The Decline Stage – ‘the decay’

The disturbance in the body has been rectified; homeostasis is re-
stored, and health returns.

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THE ROLE OF PHYSIS DURING PATHOLOGICAL

PROCESSES

Throughout the pathological process, from the moment a person

moves away from the ideal qualitative state associated with his/her
temperament, Physis does its best to restore homeostasis. Many
pathological states as viewed by Western medicine are actually Phy-
sis responses initiated by the body to restore the ideal qualitative
state of an individual. Symptoms such as sudden fever, sneezing,
runny nose, diarrhoea and vomiting are regarded as actual ailments
by Western Medicine - and treated as such, rather than considered as
a Physis reaction.

Listed below are a few examples of how Physis reacts with a ‘healing
response’.
• A rise in body temperature occurs, even a fever, when there is
a phlegmatic accumulation.
• An increase in heart rate (palpitations) occurs when blood
pressure falls to an unacceptably low level, as in shock or when
anaemia develops. This action compensates for low blood
pressure, so increasing the circulation of blood through the
body.
• Perspiration, tears, runny nose, and the build-up of mucus in
the upper respiratory and digestive channels occur when hot,
spicy foods are consumed. This protects the mucous
membranes from possible inflammation.
• The occurrence of vomiting/diarrhoea resulting from an
accumulation of toxins/undigested food in the GIT.

Physis not only attempts to restore balance at every step of the dis-
ease process, but also acts to minimise the possible damage that
might ensue. It achieves this by directing injury towards lesser impor-
tant organs in order to safeguard the more essential organs.
In anaemic conditions, for example, blood circulation will be re-direct-
ed for priority use by the key internal organs (brain, heart, liver). This
results in the extremities and non-essential organs and tissues re-

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ceiving less blood than they actually need. Similarly, when a ligament
has been over stretched or injured, it can no longer stabilise a skeletal
joint. This results in the surrounding muscles taking on the stabilising
role by contracting and supporting the affected joint.

Listed below are examples of how physis acts to minimise damage as

illustrated in the healing routes of physis.

Route 1: Diverting from the upper body to the lower body

This means directing the healing process from the upper part of
the body (particularly the head and brain) to the lower part of the
body. For example, a nosebleed relieves the pressure in the cranial
area.
Another example is offered in persistently high blood pressure. The
congestion within the head caused by the increase in volume is rather
diverted down to the colon and kidneys. This results in increased
urination, particularly at night. This process of shifting the circulation
will release pressure from the skull, so saving the patient from pos-
sible brain haemorrhage.

Route 2: Diverting from inside the body to outside the body

The diseased matter is diverted from the inside regions that may
be affected to the outside of the body (that is, the skin).
For example, in the clinical conditions eczema, psoriasis, and skin
allergies, an accumulation of toxins within the body due to excess or
abnormal humours, could cause possible damage to internal organs
such as the liver, kidneys, and lungs. Physis would automatically shift
these toxins towards the skin, saving the internal organs. Assisting
this cleansing process should be the role of the physician.
Suppressing it might have serious long term consequences.

Route 3: Diverting from the main organs to the extremities

Diseased matter is diverted from the main organs affected
(particularly the brain, heart and liver) to the body’s extremities
(that is, the limbs). The internal organs are often safeguarded by
Physis, which diverts the disease process to the arms and limbs,

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which become dysfunctional or even paralysed. In extreme

conditions, when toxic humours accumulate, paralysis develops
in either the right or left side, or even the lower body.
For example, in severe phlegmatic accumulation, paralysis of the
left side occurs; in sanguinous accumulation paralysis of the right side
occurs; and in severe melancholic accumulation, paralysis of the
lower body occurs.

Route 4: Diverting from inside the body towards the orifices

Toxins accumulated within the body are expelled via the various
bodily orifices. Vomiting, diarrhoea, coughing, sneezing, perspiration,
nose-bleeds, excess ear wax etc., are all natural elimination process-
es. Rather than take measures to stop or impede these mechanisms,
they should be encouraged. For example, pollen, dust and fungal
spores are continually being inhaled into the lungs. There are power-
ful mechanisms (sneezing, coughing and the muco-ciliary escalator)
which exist to remove them. The use of cough suppressants and anti-
histamines, which suppress these mechanisms, should therefore not
be a first line solution.

Route 5: Shifting from dangerous to less dangerous symptoms

Physis always attends to symptoms which are dangerous or life-
threatening, whatever the clinical condition. For example, a
relatively minor nosebleed relieves the pressure in the cranial area,
replacing a relatively major symptom such as a brain haemorrhage.
Recognising the Physis response, whether it is aimed at healing or
protection, is an important factor in understanding pathological
processes and its impact on diagnosis and subsequent treatment.

CHAPTER REVIEW

Although the human body is infinitely complex, the temperamental

and humoral theories provide a comprehensive understanding of the
pathological processes that lead to temperamental, qualitative,
humoral, functional and structural imbalances.

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General: Homeostasis, or inner dynamic harmony, concerns both the

internal balance (microcosm), and its adjustments to the outside
environment (macrocosm). In Tibb, pathology and diagnosis are inter-
preted from the patient’s signs and symptoms, in relation to changes
in temperament, structure and function from the normal healthy state.
Humours are synthesised from our daily consumption of food and
drink. The production of humours is effected from the four basic quali-
ties (heat, coldness, moistness and dryness) of food and the Lifestyle
Factors. The primary role of the humours is to maintain temperament
at the ideal level throughout the body. Changes in humoral balance
which are beyond the ability of Physis to compensate for, or reverse,
result, sooner or later, in the onset of a pathological state.

Pathology: Tibb interprets pathological states in the light of the rela-

tionship between the three main organs and the qualities associated
with each. Pathology in Tibb is completely integrative, using terminol-
ogy which can also be consistent with Western conventional medi-
cine. Tibb acknowledges that the causes of a disease lie at both (a)
the metaphysical level, involving changes in humours and qualities,
and (b) the physical level in the tissues and organs. These result from
abnormal humour accumulation, or from disorders of anatomical
configuration, leading to loss of functional continuity. Pathological
states are defined in terms of temperament, qualities, humours, struc-
ture and function, all of which are controlled by Physis.

Pathological processes in Tibb occur from a sudden change or ex-

cess in qualities, accumulation of excess/abnormal humours, infec-
tious agents, the untoward effects of Western medication, loss of con-
tinuity between the different systems, as well as qualitative changes to
different tissues and organs. The qualities associated with an illness
can change with the deterioration of the condition. Most illnesses can
be allocated to one of two pathways; namely, Pathway 1 (mostly acute
disorders) or Pathway 2 (mostly chronic) with associated qualities.

Pathological processes and humoral imbalance: This induces

various changes in many functions, depending on the body tissue af-

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fected. An imbalance can occur for two distinct reasons: either excess
of specific humours, or the presence of abnormal forms of the differ-
ent humours. These imbalances largely occur as a consequence of a
person’s distorted Lifestyle Factors.

Pathological processes from other influences: As humours are

originally produced from the food and drink consumed, diet has a
profound influence on humoral imbalance. A diet which increases a
specific humour to excess leads to illnesses associated with that re-
spective humour.The typical Western diet encourages a phlegmatic
humoral imbalance, which increases the risk of many common chron-
ic disorders. Moreover, a diet which is excess to the body’s immediate
requirements leads inexorably to a humoral imbalance.
Humoral imbalance also arises from intake of conventional synthetic
medication. The body’s response to exposure to such ‘new-to-nature’
chemical entities is to develop a humoral imbalance, which expresses
as specific signs and symptoms.
Humoral imbalance also arises from the ageing progression. Chang-
es in the humoral balance from childhood, to maturity, to senility, is
accompanied by marked humoral changes, which promote the typical
disorders of ageing.

Pathological processes and qualities: Diseases generally begin

with an excess of one of the four qualities. If this imbalance is not
corrected, then the disease progresses, with characteristic clinical
features. These changes are not absolute, but vary between patients
of different temperaments, and can be influenced by their Lifestyle
Factors.

Phases of disease: A chronic disease develops in three distinct

phases. First, a humoral imbalance occurs, which the person’s Phy-
sis is unable to resolve. Second, functional imbalance follows, during
which distortion of the normal physiology manifests. Third, a struc-
tural imbalance begins, in which the normal tissues undergo changes
in their form.

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Stages of disease: Ibn Sina identified four distinct stages of a dis-

ease. The first, beginning or commencement, is characterised by
minimal signs and symptoms, but the disease process is underway.
This is followed by the progressive stage. The disease gains inten-
sity, functional and structural disorder become apparent, and Physis
is under severe pressure to restore balance. The third stage is the
cresting, or peak, of the disease, when Physis is at full stretch. Either
the disease is overcome with normal health restored, or the disease
becomes established, leading to disability or death. If Physis is suc-
cessful, the decline or decay stage is reached. The body’s homeosta-
sis is restored, recuperation takes place, and normal health returns.

Inflammation: Tibb regards inflammation as a Physis response to

temperamental or humoral changes, aimed at correcting negative
influences and reducing damage. Most inflammatory disorders are
the result of excess build-up of the quality heat. Inflammatory disor-
ders can also involve disturbances in the other qualities. Tibb inter-
prets and assesses the causes and progression of a disorder from
qualitative, humoral, functional and structural changes.

Physis: Throughout the pathological process, Physis does its best

to restore homeostasis. It not only attempts to restore balance at ev-
ery step of the disease process, but also acts to minimise the pos-
sible damage that might ensue. Often, the signs and symptoms of a
disorder can be the result of a Physis response to the pathological
process. The nature of the patient’s Physis response is important in
understanding pathological processes.

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CHAPTER 4: DIAGNOSIS IN TIBB

INTRODUCTION
In previous chapters, the basic philosophy of Tibb was described in
detail, as was Tibb’s position on aetiology of disease and the nature
of the variety of pathological processes. The present chapter outlines
the theory and practice of diagnosis according to Tibb, and examines
the areas which are similar to that of Western medicine, and how it
differs from it.

A major feature of Tibb is the importance it attaches to the art of diag-

nosis. The saying below encompasses the importance of an accurate
diagnosis.

“Life is short and the Art of medicine long, the occasion fleeting,
experience fallacious and judgement difficult.” [Hippocrates]

Unfortunately, the art of diagnosis has been somewhat overshad-

owed in present times, largely because of the extensive dependence
on technology.

DEFINITIONS AND DESCRIPTIONS

Diagnosis can be defined as the process involved in finding out the

cause of a patient’s medical concern by considering the signs and
symptoms, his or her medical history, and any other relevant clinical,
social and psychological factors. The word diagnosis (from the Greek:
gnosis, to know, learn, recognise) is commonly used in everyday con-
versation when referring to the analysis of a problem. It is used in
disciplines as varied as economics, politics and zoology.
In medicine the term diagnosis includes various activities by which
the nature of a clinical disorder is determined. It consists of obtain-
ing information with respect to a patient’s medical history and family
background, noting the patient’s signs and symptoms as well as an
in-depth clinical examination.

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The physician’s diagnosis may need confirming by observation and

testing samples of blood, urine, faeces, sputum and diseased tissue
obtained from the living patient or at post-mortem (autopsy), as well
as by using invasive (endoscopy) or non-invasive imaging (such as
X-rays, CT scans and sonars).

Diagnosis in Tibb includes the above activities and procedures, inter-

preting signs and symptoms within the context of qualitative and hu-
moral deviations resulting in changes at a temperamental, functional
and structural level.

Clinical sign. A feature of a person’s appearance or behaviour which

indicates the presence or development of a particular disorder or
state of disharmony, which may or may not be apparent to the person
examined.

Symptom. An established and unambiguous disturbance in appear-

ance, body functions or personal behaviour which indicates the onset
or progress of a specific disease. A presenting symptom is a symptom
that encourages the person to consult a healthcare specialist.

COMPARISON: TIBB AND WESTERN MEDICINE

Both medical paradigms can trace their origins back to philosophers

and practitioners, such as Hippocrates and Ibn Sina. They have
evolved, incorporating different viewpoints from other disciplines, es-
pecially Western technology. This has resulted in the traditional art of
diagnosis being superceded to a large extent by medical technology.

Today’s Western medicine is a well-defined and structured monolithic

system, with a rigid logical approach based on the clinical study of
disease signs and symptoms, clinical and scientific evidence for the
efficacy of therapy, and the use of hi-tech diagnosis, surgical interven-
tion and pharmacological agents.

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The Western system is maintained by a highly specific, unambiguous

and uncompromising agenda which barely acknowledges and invari-
ably excludes any traditional, alternative or complementary medical
paradigm. The system is maintained through a stringent, undeviating
curriculum in Western-orientated medical schools, and by post-grad-
uate education and specialisation programmes.

Today’s technology lets the practitioner assess biochemical imbal-

ances, and detect and quantify changes at the microscopic level, rap-
idly and accurately. It is very much committed to laboratory assays.
For example, biochemical tests (blood sugar, total cholesterol, liver
enzymes, etc.) physiological parameters (blood pressure, bone mass
index, etc.), or imaging techniques (gastroscopy, X-ray, magnetic res-
onance imaging, etc.). Western medicine focuses sharply on specific
parts of the body – diseases of the heart, of the lung, of the kidney,
etc. – instead of on the body as a whole. This approach is reductionist,
rather than holistic. Not surprisingly, not only have healthcare prac-
titioners missed the bigger picture in terms of understanding health;
they have also largely lost the art of diagnosis.

From the Tibb point of view, clinical diagnosis involves a lot more
than just looking at the results of blood tests, X-rays, and chemical
and physiological processes in isolation. All the various relevant com-
ponents need to be gathered together in relation to the total patient,
considering all aspects of the patient; body, mind and spirit. In addi-
tion, Tibb considers the assessment of a person’s temperament to
be important in diagnosis, and in the subsequent forms of treatment
selected. [The Tibb system of diagnosis is described in greater detail
in a later section.]

Another aspect of diagnosis where Tibb often differs from Western

medicine is attitude to the patient. Over and above looking at the pa-
tient holistically, the interaction with him/her – listening with under-
standing and perhaps even including family members, then discuss-
ing the problem and asking for opinions – is equally important.
Each system has its advantages. Western diagnosis provides objec-

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tive, detailed and accurate information on the various metabolic pro-

cesses in the patient’s body. In addition, it can reveal abnormal fea-
tures, such as malignancies. However, Western diagnosis is usually
expensive, requiring specialised equipment, facilities, and dedicated
well-trained staff. Moreover, the results often take some time to be-
come available, so delaying the onset of therapy. Also, there is often
a large amount of data generated, much of which is irrelevant, contra-
dictory or may actually obscure the diagnostic process.

Traditional diagnostic techniques, such as those practiced in Tibb, are

usually cost effective, and can be obtained in a short time, so allowing
treatment to start early. Furthermore, they often pick up an abnormal-
ity or imbalance in the patient very early in the progress of the illness.
Although many of the tests are subjective, a trained Tibb practitioner
can obtain valuable information that may not be readily obtained from
other sources. Diagnosis is not only confined to evaluating signs and
symptoms, but also noting patient input, and acknowledging intuition.

The role of intuition in diagnosis

An important difference, regarding diagnosis, between Tibb and West-
ern medicine relates to intuition. This is the capacity which allows the
‘mind’s eye’ to visualise what is in fact invisible to the naked eye.
Western medicine has to some extent been seduced by its capac-
ity for exquisite analysis and faultless logic, and has suppressed the
capacity for acute perception of the clinical condition. As we noted
earlier, the practitioner’s intuition has been put in servitude to labo-
ratory testing. The experienced Tibb practitioner, on the other hand,
sometimes makes a clinical assessment of a disease based on an in-
ternal subconscious perception – ‘gut feel’ – conditioned by years of
experience and familiarity with the disorder that cannot be explained.
Intuition can play a major role in the process leading to accurate diag-
nosis. It supports the practitioner’s knowledge of the condition, which
is then further enhanced by analysis of the clinical picture, by referring
to signs and symptoms, then further investigations.

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The Tibb diagnostic process

A Tibb practitioner develops professionally in three distinct phases:

Being aware of the type of person the practitioner is dealing with pro-
vides additional skills that reinforce the ability to diagnose. Because
of the lack of technology, the physicians in years gone by (who also
projected a marked capacity for spirituality, and compassion) relied
heavily on the powers of observation. They therefore developed acute
powers of perception, deduction and intuition to a high degree.
The integration of the philosophical principles of Tibb into modern
technology can further provide an effective diagnostic system that is
also not only efficient but cost-effective – the art and science of diag-
nosis combined.

Furthermore, by understanding the kind of person the patient is, the

practitioner is already empowered with some knowledge which could
indicate the possible origin of the disorder. The correlation between
the symptoms presented and the temperament of the illness will as-
sist the practitioner in the diagnosis of the condition.

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THE TIBB APPROACH TO DIAGNOSIS

During the times of the major Tibb luminaries Hippocrates, Galen and
Ibn Sina, healthcare practitioners did not have access to the impres-
sive diagnostic technology of today. However, they had a compre-
hensive understanding of temperament, qualities and humours and
were able to diagnose effectively not only the illness itself, but also
the underlying causes of the illness. The Tibb approach to diagnosis
emphasises the need for meaningful interaction with the patient as
a prerequisite for accurate diagnosis. This diagnostic process being
within the context of:

“It is more important to know what sort of a person has a disease

than to know what sort of disease a person has”. [Hippocrates]

Within comprehension of the above, Tibb adopts a scientific yet holis-

tic approach to diagnosis, thus arriving at an accurate identification of
the nature and cause of disorders, within the context of the tempera-
mental and humoral theories. This translates into identification of the
cause/s of illness/es by evaluating a patient’s temperament, history,
lifestyle factors, signs and symptoms within the context of pathologi-
cal processes/pathways to clearly identify qualitative and humoral im-
balances.

Tibb diagnostic techniques and procedures

During ancient times Tibb practitioners relied entirely on traditional
diagnostic approaches of pulse, tongue, urine and stool analysis in
order to reach a reasonably accurate diagnosis of patient’s illness
condition/s. The skills of tongue and more particularly pulse diagnosis
required comprehensive knowledge, insight, dedication, intuition and
practice. In fact, pulse and tongue diagnosis provided practitioners
with exceptional diagnostic abilities to identify not only humoral and
qualitative imbalances but also the organs and systems that were
affected. Today Tibb practitioners are fortunate to be able to incorpo-
rate all the latest diagnostic aids currently used in Western medical
practice, i.e. technology of X-rays, sonars and CT scans within the
context of the Tibb principles so that structural changes can easily be
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However, the relevance of traditional Tibb diagnostic techniques is

still important, not only in interpreting the qualities and humoral imbal-
ances but also to provide information regarding the pathological pro-
cesses linked to systems and organs. Ideally Tibb doctors should only
request pathological and image testing to confirm their diagnosis and
not resort to blanket tests to exclude normal functions and anatomical
structures. A brief overview of pulse, tongue, urine and stool analysis
is included later on in this chapter.

Over and above the traditional diagnostic techniques, the following

are also incorporated:

Physical examination: This refers to the actual procedures carried

out by the Tibb practitioner. The main ones are:

• Visual inspection – This is the direct observation of the

patient’s frame and gait, complexion and skin texture, speech
and body language. Temperamental analysis involves this
technique.
• Palpation – Examining the patient by carefully feeling parts of
the body using the hands or fingertips. This helps identifying
abnormalities related to the musculoskeletal system and
internal organs, such as cysts, hernias, lipomas and nodules.
• Percussion – Tapping parts of the body with the finger or an
instrument such as diagnostic tuning fork, and sensing the
resulting vibrations. This technique can detect fluid accumula-
tion in the lung, or excess gas in the intestines, for example.
• Auscultation – Listening with a stethoscope to sounds
produced by moving masses of gas or liquid in certain parts
of the body.
• Articulation – Assessing the range of movement of the spinal
joints and the joints of the extremities.

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Additional investigations: Whenever necessary additional patho-

logical information, imaging techniques and laboratory and challenge
tests are initiated to provide more information of any functional and
structural abnormalities. However changes to the tissues and organs
brought about by the disorder are interpreted in relation to their spe-
cific temperaments and functions.

Tibb diagnostic procedure: Includes the following three processes:

• History, complaints, signs & symptoms, current treatment. This
includes the patient’s recent and past medical history, the
current medication being taken, and relevant family medical
history. The Tibb practitioner should discuss in detail the
nature, intensity, frequency and impact of the signs and
symptoms in relation to the qualitative and humoral
imbalances. Note that physical signs and symptoms may be a
manifestation of an underlying emotional or spiritual problem.
• Determining the patient’s temperament. The patient’s tempera-
ment predisposes him or her towards specific disorders. How
ever, the Tibb practitioner should differentiate the patient’s
symptoms from aspects of the patient’s temperament which
may appear contradictory or ‘out of sync’ with his or her
temperament. For example, the phlegmatic patient with severe
AIDS will most likely appear emaciated.
• Lifestyle assessment. This involves drawing up a ‘risk profile’
for the patient, based on his or her lifestyle. It includes informa-
tion on both the major and minor Lifestyle Factors. This identi-
fies which of the Lifestyle Factors has been the cause(s) of the
imbalance in qualities or humours. This applies particularly to a
patient’s daily diet, what exercise and rest are taken regularly,
sleep behaviour and how effective is the elimination of natural
wastes.

STEPWISE DIAGNOSTIC PROCEDURE

This following diagram describes a stepwise diagnostic procedure

which includes history, complaints, signs & symptoms, and current
treatment, temperamental evaluation as well as lifestyle assessment.
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Table 12: Stepwise diagnostic procedure

After completing the temperamental/lifestyle and background assess-

ment within the context of the signs and symptoms, a differential di-

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agnosis in relation to the qualities, humoral imbalance, pathway type

(whether acute or chronic) is established.

In order to arrive at a final diagnosis, a physical examination, together

with in-house tests (BP, blood glucose, chol, urine etc.) is completed.
If necessary, external tests, (lab, scans, sonar etc.) are requested.
From the above, and within the context of differential diagnosis, a final
diagnosis can be reached confirming the quality/ies associated with
the illness condition/s, the humoral imbalances as well as the affected
systems/organs.

Additional guidelines for accurate diagnosis:

In order to achieve an accurate diagnosis, the following needs to be
taken into account.

• Incorrect information. The practitioner should be aware that in-

correct information may be proffered by the patient for
personal or other reasons. A common example is the amount
and frequency of a patient’s alcohol consumption. Another
example relates to a patient’s smoking habits.
• The patient’s emotional state. The practitioner should take
note of both positive and negative emotions.
• The patient’s stress level. The practitioner should enquire
about stressful life events, both major and minor.
• The patient’s transition stage. The practitioner should note
whether he or she is an adolescent, experiencing a mid-life
crisis, or is menopausal, for example.
• Possible connection between symptoms. Sometimes one
symptom is a reflection of another. Backache is a good
example, as it may not only be a symptom of a spinal disorder,
but of an abnormal menstrual cycle, kidney infection and even
cervical cancer as a worst case scenario.
• The patient should be assessed, not the symptoms, treating
the patient is more important than quantifying the signs and
symptoms.

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• The patient’s personal opinion. This often reveals clues about

its origin. It could, for instance, disclose triggers and
aggravating factors, the organs affected, and possibly humoral
imbalance. A recurrent headache, for example, may be
associated with poor digestion, or emotional pressure.
• The patient should be observed. Whilst listening, note the
facial colouring, texture and complexion, features of the face
and body, speech characteristics, and general body language.
• Other information. The patient should be asked unobtrusively
for more details of his condition or opinion, without interrupting
the flow.

Throughout the above approach the role of physis should be consid-

ered, to ensure that an accurate diagnosis is made. The signs and
symptoms may at times be a healing response, or an attempt to limit
damage to tissues and organs.

Labelling illnesses
Signs and symptoms and what they represent as well as the illness
conditions in Tibb differs from Western medicine, in that Tibb views
them as reflective of an imbalance at a qualitative or humoral level.
For practical purposes, the terminology used for signs and symptoms
and the associated illness conditions, should include both the Tibb in-
terpretation (qualities/humours) and also in line with current Western
terminology, using ‘labels’ of illnesses within the Western paradigm.

PULSE ANALYSIS

Overview. Pulse diagnosis, like tongue diagnosis, is an age-old tech-

nique which enables the practitioner to deduce valuable information
about the inner workings of the patient’s body. In effect it lets the
practitioner “judge the internal from the external”. Pulse and tongue
diagnosis are also important in identifying qualities. Pulse diagnosis
has been extensively used not only by Tibb practitioners but also by
practitioners of Ayurveda and Chinese Medicine. In addition, it has
been used to identify the organs or systems of the body that may not
be functioning efficiently.
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Pulse diagnosis is a valuable and time proven diagnostic tool, used

for many centuries in the practice of Tibb. The procedure is highly
flexible, requires no investment in equipment, facilities or laboratory
support, and for the practitioner, improves in value with training and
experience. For the patient, pulse diagnosis is painless, non-invasive,
requires little in the way of personal preparation (no fasting; no pre-
medication) and does not incur the substantial costs invariably asso-
ciated with technology-based investigations.

Development of pulse analysis. Ibn Sina, the ‘Prince of Medicine’,

devised the form of pulse study which became known as Tibb pulse
diagnosis. It was based on what was known at the time in his region,
Persia, but incorporated elements from pulse techniques applied in
neighbouring areas. Tibb pulse diagnosis therefore has some fea-
tures in common with other systems, but differs in others. Specifically,
Tibb pulse diagnosis is based upon the concept of humours and the
qualities associated with the pulse. The Tibb pulse diagnosis, in terms
of complexity, falls between the simple form, using only a couple of
parameters, and the highly complex version, which entails many years
of study and experience.

Physiology of pulse analysis. According to Tibb, every cell in the

body sends its own unique signal to the heart via the bloodstream.
The response of the heart is carried in the arterial bloodstream as a
carrier frequency – the pulse – which can be decoded by analysing
the pulse.
The pulse is a series of pressure waves within an artery brought about
by contractions of the heart – specifically, the left ventricle. The pulse
corresponds exactly to the heart beat and heart rate, and is calculated
as the number of beats per minute. It is easily detected on arteries
which cross bones near the surface.

There are several factors which provide the inherent pulse:

• The vital power of the heart itself;
• The elasticity of the artery;
• The resistance to the flow of the pulse.

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Changes in the pulse can be brought about by numerous non-clini-

cal factors – age, season, changing temperament, bathing, exercise,
sexual intercourse, pregnancy, foods, intoxicants, medicines, emo-
tional states, pain, habits, infections, and others.

Each pulse beat consists of two movements, and two pauses:

Expansion pause contraction pause

Pulse evaluation is quite complex, and requires extensive person-

al instruction in order to fully master it. Developing sensitivity to the
subtle sensations and elements of the pulse needs much time and
practice. The basic text on pulse analysis runs into many volumes.
The sensitivity of the examiner’s fingertips needs to be enhanced by
training and application of oils. Pulse diagnosis is much older than
urine analysis in Tibb, and more generally practiced. It is remarkably
accurate in allowing the physician to recognise the site, severity, and
intensity of a number of internal disease conditions.

Pulse taking technique

To fulfil its potential as a valuable diagnostic tool, pulse diagnosis re-
quires experience, skill and intuition.
The main pulse points used are:

• The radial pulse – where the radial artery crosses over the
radial bone in the wrist;
• The carotid pulse – where the carotid artery crosses the
spine in the neck.

The carotid pulse is not used in Tibb medicine for several reasons.
For example, it is less sensitive than the radial pulse; it provides less
information; it can be muffled or diminished by the presence of fatty
tissue; and it can deprive the brain of blood if applied too enthusiasti-
cally.

What the pulse determines. Pulse analysis requires skill, a degree

of intuition, and becomes more effective with experience. For best

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results, time, effort and patience are needed in pulse analysis. Prepa-
ration of the patient is a very important preliminary to pulse analysis.
The outcome of what can be achieved from pulse diagnosis depends
on whether the Tibb practitioner adopts the relatively simple six pa-
rameter method, or the very complex specific organ based determina-
tion.

Parameters used in pulse diagnosis

There are six different parameters used in pulse analysis – depth,
width, length, strength, texture and rate.
Different qualities in patients are revealed by different features of the
pulse parameters. Different zones of the fingertips reflect disorders in
specific organs or systems of the body.

Pulse depth. The depth of a pulse means the level at which the pulse
is felt, either when gently laying on the fingers, or when exerting some
pressure on it. The depth of a pulse is further described according to
where it is felt between the surface skin and the inside wrist bone.
• If little or no pressure is needed to feel the pulse, the pulse
is called a superficial pulse. Sometimes the pulse can be seen
when viewed in good light. The pulse in this case is also superfi-
cial. The feeling of this pulse has been described as a piece of
wood floating on water.
• If the fingers need a lot of pressure to feel the pulse, and is
only felt when pressing down about two-thirds down to the wrist
bone, then the pulse is a deep pulse.
• In between these two levels there is the intermediate pulse.
• The depth of a patient’s pulse reveals possible imbalances in
his or her qualities.
• A superficial pulse – indicates dryness.
• A deep pulse – indicates moistness.

Pulse width. The width of a pulse is a measure of the diameter of an

artery. It does not measure the length of pulse under the three finger
tips.
• If the artery is very full and large in diameter, the pulse is
called wide.
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• If the artery is thin and small in diameter, the pulse is called fine.
• An in-between pulse is neither wide nor fine.
• The width of a patient’s pulse reveals possible imbalances
in his or her qualities:
A wide pulse – indicates moistness;
A fine pulse – indicates dryness

Pulse length. The length of a pulse refers to the distance immedi-

ately below the fingers where the pulse can be definitely felt.
The length of the pulse is defined as:
• Short – one finger;
• Medium – two fingers;
• Long – three fingers.

The length of a patient’s pulse reveals possible imbalances in his or

her qualities:
• A long pulse – indicates heat;
• A short pulse – indicates coldness;
• A moderate pulse – indicates a balance of heat and coldness.

Pulse strength. The strength of a pulse is a measure of the force with

which the patient’s pulse ‘hits back’ at the practitioner’s fingers.

The strength of the pulse is defined as:

• Forceful – a strong pulse;
• Forceless – a weak pulse;
• Medium strength – in between the strong and weak pulse.

Describing the strength of a patient’s pulse is largely a matter of the

broad experience gained by the practitioner.
The strength of a patient’s pulse reveals possible imbalances in his or
her qualities:
A forceful pulse – indicates heat;
A forceless pulse – indicates coldness.

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Pulse rate. This measures the beats per minute of the patient’s pulse.
This measurement should be made over at least 15 seconds, and
preferably 30 seconds, to avoid an inaccurate figure. The average
pulse rate in the resting adult is 60 to 80 beats per minute. However,
this rate may be increased markedly by exercise, emotion, blood loss
through injury, and illness. Generally, the pulse in a female is several
beats per minute higher than a male of the same age and body mass.
The basic descriptions for the patient’s pulse rate are:
• Slow – below 60 beats per minute;
• Average – between 60 and 85 beats per minute;
• Fast – above 85 beats per minute.

The patient’s pulse rate reveals possible imbalances in his or her

qualities:
• A slow pulse – indicates coldness;
• A fast pulse – indicates heat;
• A balanced pulse – indicates that the qualities are normal.

Pulse texture. This refers to the feeling of softness or hardness of

the patient’s radial artery wall. This characteristic is also called ‘com-
pressibility’. Pulse texture can also be described as pulse tension; just
as when an elastic band is stretched it is tense, and when it is resting
it is flaccid. A similar analogy is provided by a guitar string – when
stretched or tense then a vibrant sound is heard, whereas when re-
laxed no real note is forthcoming.

The basic descriptions for the patient’s pulse rate are:

• Hard – the pulse feels taut and stretched, and difficult to
compress. This indicates an excess of dryness;
• Soft – the pulse feels flaccid or relaxed, and easy to compress.
This indicates an excess of moistness;
• Balanced – the pulse feels ‘just right’ .

Describing the texture of a patient’s pulse is largely a matter of the

broad experience gained by the practitioner.

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Pulse parameters and associated qualities

The parameters associated with qualitative states are listed below.
Hot & Moist Moist & Hot
Pulse texture – Fast Pulse texture – Soft
Pulse depth – Intermediate Pulse depth – Deep

Cold & Moist Cold & Dry

Pulse depth – Deep Pulse depth – Superficial
Pulse rate – Slow Pulse texture – Hard
Pulse texture – Soft Pulse rate – Moderate to
slow

Dry & Hot Hot & Dry

Pulse depth – Superficial Pulse strength – Forceful
Pulse width – Fine Pulse rate – Rapid
Pulse strength – Forceless Pulse depth – Superficial

Identifying affected organs & systems from pulse

Pulse diagnosis also enables the identification of a patient’s organs
and systems that are not functioning optimally. This identification is
done by assessing the position of the pulse on each of the three fin-
gers at a specific area, or zone, as indicated in the diagram – see
Annexure 3.

Each of the practitioner’s finger pads – distal (index), middle and

proximal (ring) – is divided into five zones. Each zone is associated
with a particular organ or system. Every zone is allocated a different
number:

Distal pulse – from zones 01 to 05

Middle pulse – from zones 06 to 10

Proximal pulse – from zones 11 to 15

Each of the 15 zones indicates the organ/s and/or system/s that are
affected or not functioning optimally.
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Relationship between pulse sites and humoral balance. Most of

the illnesses identified on the distal pulse are linked to an excessive
or abnormal state involving the melancholic humour. That is, exces-
sive dryness.

Most of the illnesses identified on the middle pulse are linked to an

excessive or abnormal state involving the bilious humour. That is,
excessive heat.

Most of the illnesses identified on the proximal pulse are linked to an

excessive or abnormal state involving the phlegmatic humour. That is,
excessive moistness.

Method for determining the zone. Focus on the distal finger first, with
the two other finger tips away from the patient’s wrist. Determine which
zone the pulse beat falls into. Note this zone. Repeat the exercise, but
using the middle and proximal fingers instead.

TONGUE DIAGNOSIS

Background. Inspecting the tongue and analysing its appearance

and texture is an age-old procedure which is common to many forms
of traditional medicine. It has been used in Tibb for centuries. It is a
useful technique to employ, mainly because it can confirm a provi-
sional diagnosis arrived at via other techniques. Tongue diagnosis
is a rapid, painless and cost-effective technique, requiring little if any
preparation.

Tongue analysis is valuable for two reasons: (a) the tongue is a reli-
able indicator of the patient’s current illness; (b) it lets the practitioner
identify imbalances in the patient’s qualities.

The tongue as a hologram. According to holographic theory the

tongue symbolises the entire body, in the same way as the sole of
the foot does in reflexology and the iris of the eye in iridology. Differ-
ent areas of the upper surface of the tongue which are visible to the
practitioner represent or symbolise correlating body organs and organ
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systems. For example, the inner central region represents the organs
of digestion – namely, the stomach, spleen and pancreas. The tip of
the tongue symbolises the heart and head. The full symbolic map of
the tongue can be seen in the diagram below.

Tongue diagnosis is more relevant to the upper part of the body, which
includes the heart, head or stomach. Also, as the tongue is itself in
the upper part, it is more effective and reliable in diagnosing patient
disorders affecting this region.

Structural features. There are five features of the tongue which are
useful in diagnosis:

Shape
• This should pick up any abnormalities.
• Is the tongue normal in shape?
• Or is it short or long?
• Is it thin or swollen?
• Does it show signs of damage (for example, teeth-marks)?
• Are there any cracks or fissures? If so, where are they, and
how long and deep?

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Colour
• Is the colour first seen the true colour of the tongue – or only
that of the coating?
• Are the sides of the tongue pale, normal or red? Or, as some-
times occurs, pale blue, purple, crimson or even black?

Coating thickness and colour

• Is it white, yellow or somewhere between?
• Or, as it sometimes is, very dark, even black?
• Is the coating thick, or is it possible to see the tongue through
the coating?
• Does the coating cover all or part of the tongue’s upper surface?

Moisture content
• Is there a thin layer of moisture or saliva covering the tongue?
• Or is the tongue visibly dry?

Movement
• Is there any trembling visible?
• Does the tongue look stiff?
• Does the tongue deviate to one side?

Tongue abnormalities and related qualities. The physical dimen-

sions, coating, movement and colour of the tongue reveal valuable
information about the patient’s state of health.

Body shape
• If the tongue is swollen, then there is an excess of the quality
moistness.
• If the tongue is thin, then there is probably an excess of the
quality dryness.
• If there are racks in the tongue, this could be due to an excess of
the quality heat. This feature, however, may be hereditary.

Tongue colour
• If the tongue is pale in colour, then there is an excess of coldness.

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• If the same tongue is pale and moist, then a Cold & Moist
condition is suggested.
• If the same tongue is pale and dry, then a Cold & Dry condition
is suggested.
• If the tongue is red in colour, then an excess of heat is indicated.
• If the same tongue is free from a coating, then a Dry & Hot
condition is suggested.
• If the same tongue has a yellow coating, then a Hot & Dry, or
Hot & Moist, condition is suggested.
• If the tongue is purple, then poor blood circulation, or stagnant
blood flow, is indicated. This can be present in the local area,
or due to a systemic problem.
• If the same tongue is a bluish purple, then the poor circulation
is due to coldness.
• If the same tongue is a reddish purple, then the poor circulation
is due to heat.
• A crimson tongue suggests a severe Dry & Hot condition.

Tongue coating
• If the tongue colour is yellow, then a build-up of heat is
suggested.
• If there is a non-transparent white coat, then a build-up of cold-
ness is suggested.
• If there is a thick white coat, a Cold & Moist conditions, or an
accumulation of phlegm is suggested.
• If the whole tongue has a thick white coating, excessive
moisture in the brain is suggested.

Tongue movement
• If the tongue deviates or leans to one side, then this suggests
that a transient ischaemic attack (TIA), stroke, or paralysis
such as hemiplegia has occurred recently.
• If the tongue is stiff, then severe heart disease is probably
present.
• If the tongue continually trembles, then the patient may be
suffering from anxiety (especially if it is dry and red) or weak

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digestion (especially if it is pale and moist).

• Tongue abnormalities and organ disorders. The tongue offers
clues to disorders in specific organs.
Liver and gall bladder
• The tongue is swollen, with red spots. A Hot & Dry disorder is
present.
• The tongue has an orange tinge. A Dry & Hot, or Cold & Dry
disorder is suggested.
The tongue is purplish in colour, or has purple spots. A Cold &
Dry disorder is present.

Heart
• The tongue has a red tip. A Dry & Hot disorder is suggested.
• The tongue has purple spots. A Cold & Dry disorder is
suggested.

Lungs
• The tongue has a shallow dip on it. This suggests chronic lung
disease.
• The tongue has purple spots. A Cold & Dry disorder is
suggested, perhaps blood stasis in the upper limbs.

Stomach, spleen and pancreas

• Cracks are evident on the tongue. An excessive dryness is
suggested, possibly due to diabetes.
• There is a lack of coating on the tongue. This suggests both
excess heat and dryness.
• The tongue has a yellow coat. This suggests a Hot & Dry, or
Moist & Hot, disorder.
• The tongue has a glossy coating. This suggests an excessively
dry condition, indicating severe weakness of the digestive sys
tem.
• The area of the tongue showing an abnormality may also
offer clues regarding the patient’s state of health. If the
posterior (back) part of the tongue is covered in a thick, moist
white or yellow coat, then a Moist & Hot or Cold & Moist

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disorder is suggested. In particular, a disorder of the kidneys,

urinary bladder or large intestine is likely to be present.

URINE EXAMINATION

Background. Urine analysis provided the original Tibb practitioners

with valuable information on disorders of the hepatic and uro-genital
systems. However, with the advent of advanced diagnostic technolo-
gy, urine analysis today provides comprehensive information instantly
by using the appropriate diagnostic tools, such as urine sticks.

Parameters. According to Ibn Sina the following qualities or

parameters can be observed in a sample of urine:

Colour Quantity
Odour Clarity/turbidity
Texture Specific gravity
Sediment Acidity (pH)

Table 13: Features of urine analysis and its link to qualities.

Qualities Normal Quantity Odour pH Specific Abnormality
colour gravity
Cold & Dry White or Oliguria Bad +/- <5 > 1.030 None noticed
greyish-
red
Hot & Dry Dark Oliguria Strong 5 - 6 > 1.030 Pain, burning,
yellow proteinuria,
haematuria
Dry & Hot Reddish Oliguria Bad < 5 > 1.030 Proteinuria,
yellow haematuria
Hot & Moist Golden Polyuria Less 6 - 7 1.015- Dysuria,
yellow 1.030 nocturia
Moist & Hot Whitish Polyuria Less ≥ 7 < 1.015 Bedwetting,
yellow nocturia
Cold & Moist White / Polyuria None > 7 < 1.005 Nocturia,
transpar- bedwetting,
ent incontinence
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Listed below are illness conditions linked to qualitative imbalances:

• Oliguria: an abnormally small amount of urine is produced (as

in kidney disease). This is indicative of heat/dryness.
• Polyuria: frequent and large amounts of urine are produced
(as in diabetes). This is indicative of moistness.
• Proteinuria: the appearance of protein in the urine (as in
kidney damage). This is indicative of dryness/heat.
• Haematuria: the appearance of blood in the urine (as in
kidney injury). This is indicative of dryness/heat.
• Dysuria: pain or difficulty in passing urine (as in urinary tract
infections). This is indicative of heat.
• Nocturia: urination at night (as in diabetes). This is indicative
of moistness.

People with different temperaments have different urinary features.

The different urinary parameters can reveal underlying clinical
disorders.

STOOL ANALYSIS

Background. Stool, or faeces, is the semi-solid waste material elimi-

nated through the rectum and anus. It is formed in the colon. The
stool consists of (a) the undigested residue of food, mainly cellulose;
(b) gut bacteria; (c) various secretions, especially mucus; (d) bile pig-
ments, (e) varying amounts of water, which give the faeces its liquid,
semi-solid or solid consistency. The basic principles of stool analysis
revolve around the physical features of the faecal mass. The typical
colour of normal faeces is due to the presence of the bile pigments,
namely, bilirubin and biliverdin. The different shades of the faecal co-
lour are due to the relative proportions of these two bile pigments.

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Table 14: Characteristics of normal stool

Characteristic Normal stool

Colour Yellowish brown

Odour Not overtly offensive

Viscosity / texture Soft, homogenous

Quantity Depends on food intake

Frequency of bowel Regularly; once or twice daily

movement

Features. Normal faeces should be passed (evacuated) relative-

ly quickly, without irritation or subsequent irritation, and without too
much wind (flatus), foam, or any blood (melaena).

Stool characteristics often vary according to the temperament of the

patient:

• Cold & Dry – hard to black-grey; sometimes with a bad odour;

sometimes tainted with fresh blood.
• Dry & Hot – low in quantity; hard; sometimes ball-like; black
ish-brown; sometimes reddish-yellow; constipation often
present; sometimes bleeding present with the stool; offensive
odour.
• Hot & Dry – dark yellow to reddish in colour; occasional
diarrhoea or mucus.
• Hot & Moist – yellow; loose to normal; sometimes burning;
loose stool
• Moist & Hot – very pale to light yellow; sticky; mucus and
phlegm present; soft texture; excessive in amount; long time to
eliminate.
• Cold & Moist – light colour, occasionally black brown to black;
soft; diarrhoea often present; frequently constipated.

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Disease indicators. There are a number of disorders which can be

identified from the properties of faeces:

Clinical abnormality Cause according to Tibb Humoral imbalance

Constipation Due to dryness Cold & Dry, and
Dry & Hot
Diarrhoea Due to moistness Moist and Hot, and
Cold & Moist
Dysentery Due to heat Hot & Dry, and
Hot & Moist

CHAPTER REVIEW

The Western system of medicine is supported and underpinned by

a highly specific, unambiguous and uncompromising agenda which
barely acknowledges and invariably excludes traditional or alternative
healing paradigms. The system is maintained through a stringent, un-
deviating curriculum in Western medical schools, and by post-gradu-
ate education and specialisation programmes. One of the important
differences between the Western system and Tibb relate to diagnostic
theory and practice.

This chapter on the principles and techniques of Tibb diagnosis pro-

vides insight into the relevance of both the temperamental and hu-
moral theories in diagnosis. The introduction of specific diagnostic
techniques used in Tibb, such as pulse and tongue diagnosis, is an
added dimension that can assist in conducting an effective diagno-
sis. This is often used together with current Western diagnostic tech-
niques.

Diagnosis: The objectives of diagnosis in Tibb are to (a) determine

the patient’s temperament; (b) the nature of the humoral imbalance;
(c) the body tissues or organs affected by the disorder; and (d) the
specific pathway that the patient’s disorder is following. It involves
initially assessing the personal and family history, patient complaints,
the presenting signs & symptoms and current treatment. Determining
the patient’s temperament is the next step, followed by an inspection
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of the patient’s lifestyle factors. In addition, diagnosis also notes pa-

tient input, and acknowledges intuition. Viewing the patient holistically
and interacting with the patient – listening to the patient, discussing
the problem – is very important in Tibb diagnosis.

Tibb diagnostic techniques interpret the qualities and humoral imbal-

ances observed, which provide information regarding the pathological
processes affecting different body organs and functioning systems.
However, Tibb doctors do, if necessary, call upon pathological and im-
age testing for confirmation. They avoid blanket tests, as is often the
case in Western medicine.

Diagnostic techniques: The initial physical examination in Tibb di-

agnosis includes (a) visual inspection, or direct observation, of the
patient’s frame, gait, complexion and skin texture, speech and body
language; (b) palpation, or carefully feeling parts of the body using
the hands or fingertips; (c) percussion, or tapping different parts of the
body, and sensing the resulting vibrations to detect fluid accumula-
tion; (d) auscultation, or listening with a stethoscope, to body sounds
produced in different parts of the body; and (e) articulation, or assess-
ing the range of movement of the spinal joints and the joints of the
extremities.

A component of Tibb diagnosis is concerned with the possible build-

up of humoral imbalances in specific parts of the body which could
conceivably lead to blockages in flow. This is often the case in injury
or deterioration of anatomical structures.

The main diagnostic techniques in Tibb involve the pulse, tongue,

urine, and, to a lesser extent, the stool. Tibb diagnosis can also bring
in Western techniques, such as biopsy, laboratory assays and
urinalysis.

Pulse diagnosis: The pulse is the outcome of the vital power of the
heart, the elasticity of the artery, and the resistance to blood flow.
Pulse diagnosis is a valuable and time proven diagnostic tool, used

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for many centuries in Tibb practice. It lets the practitioner “differenti-

ate the internal from the external”. Pulse diagnosis provides exten-
sive information on the temperament of the patient, and can identify
the organs or systems of the body that are not functioning efficiently.
From the patient’s perspective, pulse diagnosis is cost-effective, pain-
less, non-invasive, and requires little in the way of personal prepara-
tion. For the practitioner it is highly flexible, requires no investment in
equipment, facilities or laboratory support, and improves in value with
both training and experience.

Tongue diagnosis: The tongue can be regarded as a hologram of the

whole body. Different areas of the upper surface of the tongue which
are visible to the practitioner represent or symbolise the patient’s body
organs and organ systems. Tongue analysis provides an indicator of
the patient’s current illness and imbalances in the patient’s qualities.
There are five features of the tongue which are useful in diagnosis:
shape, colour, coating, moisture content, and movement. The tongue
offers clues to disorders in specific organs.

Urine & stool examination: Urine examination provides useful in-

formation on the hepatic and uro-genital systems. It makes a link be-
tween the nature of the patient’s urine and qualitative balance. Differ-
ent disorders are related to changes in the features of the patient’s
urine. Stool analysis relates to the physical features of the faecal
mass. There are several disorders which can be identified from the
properties of faeces.

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CHAPTER 5: THERAPEUTICS IN TIBB

INTRODUCTION

Therapeutics is the division of medicine that deals with the dif-

ferent approaches to the treatment (therapy) of illnesses in order
to heal them, or prevent their recurrence.Technological and clini-
cal advances over the past fifty years have resulted in tremen-
dous changes in the realm of therapeutics. In the time of Hip-
pocrates, Ibn Sina and Galen, the key focus of treatment was to
assist Physis in the patient’s healing process. It was acknowl-
edged that the illness was brought about by poor pepsis (Greek:
digestion). That is, the inefficient or delayed elimination of toxins from
the body was responsible for the occurring illness. The therapeutic
process therefore centred largely on the elimination of toxins resulting
from improper pepsis, which had developed during the pathological
processes of humoral imbalances within the body.

The practice of Western medicine today, because of available tech-

nology and pharmaceutical drugs, focuses largely on removing the
effects of the accumulation of humoral imbalances within the patient,
which usually manifest as physical and/or mental symptoms. Western
pharmaceutical agents are generally designed to oppose the symp-
toms associated with these humoral imbalances. Also, surgical pro-
cedures, such as bypass surgery most often deal with the structural
changes in organs and tissues that have developed.

Whilst there is undeniably a degree of success associated with these

procedures, a different approach intended to prevent the accumula-
tions of toxins in the first place is of special significance in the thera-
peutic processes in Tibb. The use of medication (pharmacotherapy)
is only one of the many therapeutic options in Tibb. These includes
Lifestyle Modification and Emotional Support, incorporating dieto-
therapy, exercise, breathing, meditation, and counselling; as well as
eliminative therapies such as sneezing, enema, purgation, massage,
somatic balancing technique, and therapeutic cupping.

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Even though modern medicine is increasingly recognising the impor-

tance of a holistic approach to medicine, invariably most illnesses
are treated within the Western medicine paradigm, through the use
of symptom-suppressing medication, or with surgery. However, the
Tibb approach to treatment avoids aggressive, intrusive and invasive
methods that is aimed at addressing not only the symptoms but also
the causes of disease. Tibb stresses the importance of making appro-
priate therapeutic choices depending on the imbalances at a temper-
amental, qualitative, humoral, functional or structural level. It further
recognises that treatment for many illnesses is aimed at elimination,
as it accepts the Hippocratic principle of pepsis. It also recognises the
role of Physis and the body’s healing processes, and how Tibb thera-
peutics should support and enhance the Physis response.

This chapter aims to provide insights into the rationale, application and
clinical benefits of the multifaceted therapeutic interventions available
to the Tibb practitioner. Mention will also be made of surgical tech-
niques which were developed during Tibb’s watch, and eventually be-
came the standard in Western medicine as practiced over the last few
centuries. Tibb, therefore, has been at the forefront in developing a
wide spectrum of healing techniques, which are now largely accepted
in clinical circles, either as stand-alone procedures, or as part of the
emerging healing paradigm of Integrative Medicine.

Therapeutics in Tibb can be divided into four categories:

• Pharmacotherapy: The use of herbs and other natural
ingredients to treat ailments.
• Lifestyle modification and emotional support therapy:
This includes changes to the behaviour of the patient through
dietotherapy, physical exercise, breathing, meditation and re
laxation, visualisation, colour therapy, music therapy, psycho-
therapy and counselling, aromatherapy.
• Eliminative (Regimental) therapies: This includes eliminative
techniques such as sneezing, emesis, perspiration, hydrothera-
py, diuresis, enema, purgation, massage, somatic balancing
technique, leeching (hirudotherapy), venesection and cupping.

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• Surgery: Used extensively for amelioration of eye problems,

cauterisation of haemorrhoids and wounds, excision of
malignant masses, [This topic will not be covered in depth in
the book.]

This chapter on Therapeutics will focus on the theoretical aspects of

the various therapeutic options and not on the practical application of
the different therapies.

DEFINITIONS AND DESCRIPTIONS

Therapeutics is the division of medicine which deals with

the different approaches to the treatment (therapy) of illnesses in
order to heal them, or prevent their recurrence.
Allopathic simply means allo-(opposite) medical practice. The term
has, however, been co-opted by Western medicine to mean conven-
tional medicine, as opposed to homeopathic medicine. However, for
much of the world’s non-Western population this does not apply.
Medicine. The word ‘medicine’ is derived from the Latin medere, to
heal. A medicine is a substance, mostly taken internally, used for the
alleviation or removal of disease; or the art and science of preserv-
ing health and curing or alleviating disease. It is distinguished from
surgery and obstetrics. The term ‘medicine’ has the same meaning
in both Tibb and Western medical care.
Western medicine refers to the medical paradigm practiced
predominantly in the North Atlantic nations, but also in developing
countries where it is also known as orthodox medical practice.
A drug in this chapter refers to a synthetic or semi-synthetic sub-
stance used in Western medicine to prevent, treat or diagnose ill-
nesses. It excludes recreational or illegal (‘street’) drugs or herbal
remedies.
Surgery is the branch of healing that treats injuries, trauma, internal
malfunctions or structure-related diseases by planned operation on
the body, or manipulation of a specific part thereof.
A physician is someone versed in, or practicing, the art of healing,

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including medicine and surgery. The term is derived from the Greek
physis, nature.
A doctor is a healthcare practitioner qualified in the art and science
of medicine or surgery. The term is derived from the Latin docere, to
teach.
Pharmacotherapy. The treatment or prevention of disease
(e.g., diabetes) or the symptoms of an illness (e.g., menstrual ill-
nesses) through the use of drugs or herbal remedies.
Pharmacology is the science of the properties of drugs and other
active agents such as herbs, extracts from animal material and min-
erals, and their effect on the body.
A pharmacopoeia is a book, database or other record which con-
tains a list of drugs which are used in medical treatment. It includes
details of their contents, formulation, methods of preparation, dos-
ages, standard of purity, shelf-life and storage conditions.

COMPARISON: TIBB AND WESTERN MEDICINE

There is increased awareness worldwide that the clinical signs and

symptoms that accompany a particular ailment or disease cannot sim-
ply be dealt with by taking medication, especially prescription drugs.
Although initially successful, the dosage of the drug most often has
to be increased to counteract a diminishing efficacy. In addition, other
drugs may have to be added into the treatment regimen in order to
increase effectivity of the drug, or to deal with the side effects that
invariably accompany long-term usage.

A person with constant or frequent headaches, for example, cannot

be treated effectively by simply taking analgesics. These may be ef-
fective, but they only deal with the symptom of the illness, not the
cause. Sooner or later the patient’s stomach, liver and kidney will
succumb to the impact of long-term exposure to the very active, and
unnatural, ingredients which are present in most analgesic products.
(The difference between Tibb and Western medication will be elabo-
rated under the section on Pharmacology).

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Patients are increasingly seeking health solutions that address the

root causes of their health condition, as well the symptoms. Once the
causes have been accurately identified, most individuals would like to
be actively involved in restoring harmony for optimum bodily function-
ing.

It should be stressed that treatment of the symptoms of an illness is

by no means wrong or misguided. What would be wrong would be to
think that by suppressing the symptoms we have dealt with the prob-
lem itself.

From the Tibb perspective, if a person suffers from an illness, then the
healing process should relieve the patient of any troublesome symp-
toms as quickly as possible, then identify and remove the causes
of the illness, restore the ideal humoral and temperamental balance,
and finally, increase the strength of the vital organs and tissues, to
ensure efficient functioning and prevent recurrence.

When treating illness by the Western medicine route, it is often only at

the second and third stages, where there may already be functional
and structural damage, that the illness is actually identified, and clini-
cal intervention initiated.

From the Tibb perspective, an illness can be stopped before it mani-

fests into a full blown disease. Moreover, when the illness is investi-
gated, whether at the humoral, functional or structural stages, treat-
ment will take into account the Lifestyle Factors that are involved in
the onset and progression of the illness.

In Tibb, treatment consists of restoring internal homeostasis to the

patient’s humoral qualitative state, as well as renewing the ideal tem-
perament at every level (cell, tissue, organ and total system), depend-
ing on the underlying disturbance in the body. This leads to improved
functional activity, then to repair of any resulting tissue or organ dam-
age.

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PHYSIS AND THE BODY’S HEALING PROCESSES

Before we examine Tibb therapeutics, we will revisit the central role

of Physis in the healing process. The recognition of the role of Physis
will make us appreciate the rationale behind the modes of therapeu-
tics practiced in the Tibb system of medicine.

Throughout our life, we are constantly exposed to innumerable hostile

external forces and internal changes that can result in injury or cause
illness by attacking and overcoming our immune system. These not
only disturb our internal harmony, but activate our Physis, which has
a predominant role in the defensive and reparative processes. Physis
contributes to the body’s self-regulatory mechanisms, and encour-
ages self-repair in the body. As part of this, we have a range of very
elaborate mechanisms of self-repair. These are highly effective in
counteracting those forces that create illness and cause injury. They
are our self-healing systems – our built-in ability to maintain health
and combat illness. Historically, the human race has not always had
access to medical help in dealing with the myriad of diseases that be-
set us, so self-healing mechanisms are extremely important as part
of our genetic make-up.

The body’s capacity for self-healing is evident at all levels of complex-

ity in the human being. The following examples amplify this point:
• At the sub-cellular level, our genetic material, DNA, is frequently
exposed to damage from environmental radiation, dietary toxins,
and toxic chemicals. This damage could have disastrous conse-
quences for our body. Luckily, we are equipped with highly effi-
cient mechanisms which repair this damage, and ensure the ac-
curate transfer of information from one generation to the next.
• At the cellular level, the membrane surrounding all living cells
in the human body is constantly being scrutinised for structural
damage. If any is detected, it is repaired if possible, or other
wise the damaged area of the membrane is replaced. This
healing system is a spontaneous, continually operating ex-
pression of the cell’s Physis. By performing continuous
maintenance, the cell’s internal harmony is preserved.
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• At the tissue level, the same self-healing characteristics are

evident, although more complex in nature. We are all familiar
with the healing of skin wounds. The process is a sequence
of activities in the area surrounding the wound. Initially, white
blood cells are immediately attracted to the wound, in order to
counteract infection. This is followed by an inflammatory
response to clear the damaged area of tissue. Later, cell
proliferation begins in earnest, sealing up the wound with new
tissue.
• At the organ level, an example of Physis ability to repair is
indicated in the human liver is capable of regenerating a large
proportion of itself if removed or damage by viruses, toxins or
chemicals.
• At the structural level, when the musculoskeletal system is
negatively affected from poor posture and/or fatigue, Physis
will attempt to compensate posture by movements such as
stretching.

The human body, therefore, is capable of self-healing at all levels of

functional and structural organisation, from the sub-cellular to the en-
tire body’s organ systems. We have a wide range of mechanisms to
achieve and maintain our own bodily health.

In the practice of Tibb, any illness that is acquired after birth can be
completely reversed, depending on the extent of tissue or organ dam-
age, the age of the patient, the ability of Physis, patient compliance to
treatment and the Lifestyle or Lifestyle Factors.

“For every disease there is a cure” [Diocles]

As we are only too well aware, this process is more readily achieved
in the young than in the old. The older the patient, the longer the struc-
tural damage will take to correct. Alas, in some patients the structural
damage may have gone too far, and lasted too long. In this case,
effective treatment may take a long time to reverse the structural
damage.

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THERAPEUTIC GUIDELINES FOR CLINICAL DISORDERS

Many clinical disorders are associated with either an excess of one

or more basic qualities or with an accumulation of humours, both nor-
mal and abnormal, treatment is therefore aimed at assisting Physis
in restoring qualitative or humoral balance, and where necessary to
remove blockages to flow and restore continuity between different
structural and metabolic systems within the body.

By applying the insights gained from Tibb, the healthcare practitioner

aims to restore health comprehensively and permanently, thus avoid-
ing relapse or recurrence of the disorder.

The approach in therapeutics is to take into account that the Pathway

to illnesses is either via a qualitative route (Pathway 1) or humoral
imbalance (Pathway 2). This approach determines whether the clini-
cal condition is due to a (a) qualitative, (b) humoral, (c) functional, or
(d) structural imbalance. It also recognises the progress of the condi-
tion, and whether the disorder can be readily reversed. It is therefore
necessary to address whichever imbalance is deemed responsible
for the disorder, and then to counter the imbalance be it qualitative or
humoral, or both. In addition the presence of infection needs to be
taken into account.

Tibb clearly realises that treatment cannot be solely directed at target-

ing isolated tissues, organs or systems of the body. It acknowledges
the existence of a ‘network’ between the many components of the hu-
man body, and recognises this in its therapeutic approaches.

Treatment of multiple symptoms – one underlying cause

Patients commonly present with multiple symptoms which are regu-
larly considered as separate, individual illnesses by western medi-
cine. For example, a phlegmatic/sanguinous patient presenting with
sinus congestion, frontal headaches, indigestion, amenorrhoea, and
depression would be considered as having multiple conditions with
unrelated symptoms by virtually all conventional medicine practitio-

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ners. By contrast, a Tibb practitioner will conclude that these symp-

toms are all signs of an excess of the phlegmatic humour.

Treatment of conditions due to sudden change/temporary ex-

cess in qualities
As most acute conditions will be the result of a qualitative imbalance
(heat, cold, moistness and dryness), it is necessary to identify the
quality responsible for the signs and symptoms associated with the
illness.

Treatment for these conditions is thus aimed at targeting the quality

responsible for the illness by restoring the qualitative imbalance with
therapeutic options, be they lifestyle modification or pharmacotherapy
that will be opposite to the quality which is the cause.

The treatment approach is in the true allopathic tradition, as

mentioned by Al-Jawyziyya:

“... repelling harmful effects of the cold with the hot, the hot with
the cold, of the moist with the dry and the dry with the moist...
Each quality withstands the opposite and its fierceness is
repelled by the other quality. This is the basis of all treatment,
and a basis for the preservation of health; even more, the whole
science of medicine makes use of this principle...”

The above strategy should provide relief. Once the qualitative imbal-
ance is restored, Physis would then be capable of healing the ailment.

Treatment of conditions associated with humoral imbalances

Within the context of an individual and Lifestyle Factors, varying de-
grees of excess/abnormal humours always exist in the body. As long
as the body is not overburdened with the wrong diet and other fac-
tors resulting in humoral imbalances, Physis has the capacity to deal
with these abnormalities. It is only when excess or abnormal humours
reach a level beyond the ability of Physis to rectify that they start
manifesting themselves into disorders.
The humoral imbalances are dealt with through the processes of con-
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coction and elimination. Concoction means “to prepare by mixing to-

gether”, in this case it refers to, “the adjusting a physical substance to
make it suitable for expulsion from the body”.

Hakim Chishti, in his “Traditional Healers Hand Book”, describes the

concoctive and eliminative process as being two separate processes.
Chishti explains that the humours first have to be concocted or rip-
ened, after which the concocted humours need to be eliminated with
appropriate laxatives. The approximate concoctive period for the bil-
ious humour is 3 to 8 days; the phlegmatic humour is 17 to 30 days,
and the melancholic humours from 40 to 90 days, using medication,
lifestyle changes and other therapeutic measures.

However there are a number of arguments against these periods of

concoction:

• Firstly, Physis is constantly working to concoct and eliminate

excessive or abnormal humours – an on-going process.
• Secondly, the various abnormal states of the different humours
will require different degrees or periods of concoction. For
example, a salty phlegmatic humour, which needs thicken-
ing, may require a few days to concoct compared to a
calcerous phlegmatic humour which may take longer, possibly
even months, to soften, in readiness for elimination.

At the Tibb Medical Centre in Cape Town, research conducted with

herbal infusions, formulated to facilitate the concoction and elimina-
tive processes have shown positive results in patients with excess/ab-
normal sanguinous, bilious, phlegmatic melancholic humours within a
few days/weeks. This highlighted the continuous attempt of Physis to
restore homeostasis.

The research has also provided guidelines when treating illnesses as-
sociated with humoral imbalance:
• Avoiding all factors that can produce/increase the humoral
imbalance. For example if the condition is linked to the excess

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phlegmatic humour, Cold & Moist foods should not be

consumed.
• Attending to the patient’s painful or life threatening symptoms
such as pain, fever or hypertension.
• Assisting Physis in the concoction and elimination of excess/
abnormal humours with appropriate therapies and/or
medication.
• If necessary prescribe medication/tonics together with lifestyle
modification to support the affected systems associated with
chronic conditions.

Treatment of conditions arising from loss of continuity

In Chapter 3 – Pathology; illnesses arising from a loss of continu-
ity were described. These manifest either from the accumulation of
abnormal humours, or from physical trauma which result in tissues
and organs damage, or from internal blockage to humoral transport
and distribution. These clinical conditions require eliminative thera-
pies such as therapeutic cupping and massage, or somatic balanc-
ing techniques to assist Physis in returning the person to a state of
dynamic continuity.

Treatment of multiple chronic conditions

Often patients will present with multiple conditions with more than
one imbalance and also having opposing qualities. This is especially
common in older patients. For example, a patient with primary hyper-
tension associated with an excess sanguinous humour (Hot & Moist)
qualities can present with osteoarthritis, which is normally indicative
of excess/abnormal melancholic humour (Cold & Dry qualities).
In this scenario the following is recommended:
• Evaluating the patient holistically is essential as attention has
to be given to which condition is the more serious:
hypertension will take priority over osteoarthritis.
• Treatment for hypertension could continue systemically with
appropriate medication, and if necessary cupping.
Osteoarthritis can be treated locally with cupping, massage,
and suitable medication.

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• However, if both conditions are associated with differing

excess or abnormal humours, these need to be concocted and
eliminated. The humour with the shortest period will be
concocted and eliminated first.

Treatment of infections
As mentioned in the Pathology chapter, infection due to micro-organ-
isms is only possible when an imbalance occurs at the humoral level,
beyond the ability of Physis, via the immune system, to restore ho-
meostasis. This imbalance provides a suitable “environment” in the
body’s tissues and fluids for the microbes to multiply and prosper. The
approach therefore is not only targeting the infectious agent, but also
aimed at strengthening the immune system as well as addressing the
humoral imbalance. As all humoral imbalances qualities associated
with them, this needs to be addressed. The following protocol applies:

• Assisting Physis, by strengthening the immune system with im-

mune booster medication, with ingredients that have anti-bacteri-
al and anti-viral properties.
• Qualitative lifestyle adjustments to oppose the quality associ ated
with the humoral imbalance. Special emphasis needs to be
placed on ensuring that the humoral imbalance is not further
aggravated with food and drink that will produce/ increase the
humour.

The above strategy should overcome the infection. However, in

severe life-threatening infections, the use of antibiotics should be
considered.

Consideration of the Lifestyle Factors

Treatment will only be comprehensive and long-lasting if it includes
the appropriate Lifestyle Factors which ultimately address the under-
lying cause of the problem. This approach must be applied for the
total duration of the treatment.

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Other factors in Therapeutics

• Do not inflict pain, or otherwise harm the patient, either directly

or indirectly, regardless of the treatment protocol that is recom-
mended. This includes the use of the Lifestyle Factors, dietother-
apy, and therapies such as cupping and massage.
• The Tibb practitioner is a teacher. (The word ‘doctor’ also means
teacher). He or she has a duty to inform and educate the patient,
as a fundamental part of patient empower-ment. The Tibb prac-
titioner is expected to educate the patient in healthcare matters,
so that optimal health can be achieved.
• The whole person should be treated in the recognition that
ailments have physical, mental, emotional and spiritual dimen-
sions. The practitioner should direct therapy appropriately at
these.
• The practitioner should direct treatment at identifying the
underlying causes, then dealing with them appropriately.
Therapy should not aim at solely suppressing the immediate
symptoms.
• The practitioner should be aware of the healing crisis that mani-
fests during treatment for a number of diseases. The patient’s
symptoms may in fact deteriorate briefly before the healing pro-
cess begins in earnest.
• When applying treatment bear the following in mind:
a) Begin treatment early.
b) Start with powerful remedies if there is a risk of rapid
deterioration.
c) Maintain treatment until the disorder clears up.
d) Avoid foods which are difficult to digest.

PHARMACOTHERAPY
Pharmacotherapy is without a doubt the most important therapeutic
option for the treatment of the majority of most disorders. The use
of herbs and other natural products goes back as far as civilisation
itself. In the search for food, and to cope successfully with suffering,
humans learnt to distinguish between plants which were useful as

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food, and those with healing properties. Some plants became widely
used as food, whilst others showed benefit in people suffering from
various ailments and injuries. This mutually advantageous relationship
between the plant kingdom and humankind has resulted in many
plants being used as valuable remedies.

“God in his infinite goodness and bounty hath by the medium of

Plants, bestowed almost all food, clothing and medicine upon
man” [Gerarde’s Herbal (1636)]

Pharmacotherapy has been around for thousands of years. Virtually

every society and culture has adopted it in one form or another. Even
today, in spite of the massive inroads achieved by Western medicine
and synthetic drug usage, around 80% of the world’s population uses
herbal medication to a greater or lesser extent. It was only with the
arrival of the first industrial revolution in the 18th Century and the
advent of Western medicine in the 20th that herbal medicine was
progressively relegated to a minor role, especially in the developed
world.

Pharmacy in ancient times

It is generally accepted that our civilisation dawned in the Middle East

region, ten to twelve thousand years ago.
A holy book, the Avesta, describes three types of medicine – incan-
tations, surgery, and the use of medicinal plants. Healers of the time
considered that for every disease there is a plant to remedy it. In
the Avesta seventy categories of remedies were identified, all derived
from plants.

In Assyria and Babylonia three thousand years ago, a detailed phar-

macopoeia of more than 2000 plants and animal derivatives was cre-
ated.

In Ancient Egypt, medicine was highly specialised, using cures that

were simple, natural, adapted to the patient, and which were used
empirically; that is according to past clinical and cultural experience.

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In fact, until quite recently most of the knowledge and use of herbs
could be traced directly back to the ancient Egyptians, whose priests
were skilled in phytotherapy.

In early India, the four pillars of medical treatment were: the healer,
the patient, the nurse and the remedy. To the healer, “for a remedy
to be considered a real pillar on medicine, it should compose of
plants grown in excellent soil, picked on a good day, and should be
administered in the proper dose at the right time”.

In China several centuries ago, there was a very rich medical tradition
based upon more than 8000 pharmaceutical formulations. One
pharmacopoeia in particular recorded more than 1870 substances,
around 1070of which were herbal in origin.
In Persia, a thousand years or so ago, Ibn Sina (980-1030 CE), one
of the major luminaries of Tibb, detailed the vast range of herbal and
non-herbal remedies available at the time. This was presented in one
of the five volumes of his monumental opus, the ‘Canon of Medicine’.

Much of the information contained in the Canon draws on several

sources, especially Greek texts of the philosopher-physician Di-
oscorides (40-90 CE). Translated into Arabic, these texts were the
way Ancient Greek knowledge was conserved; otherwise it would
have been lost completely. Later, the Arabic was translated back into
other languages, most specifically, Latin. This enabled the teaching
of Ibn Sina and the ancient Greek and Roman medical pioneers to be
restored and shared throughout the Western World. Other physicians,
especially Al-Rhazi (854-925 CE), Al-Zahrawi (936-1013 CE) and Al-
Biruni (973 – 1050), also contributed significantly.

At the time, the cataloguing of traditional remedies into pharmacopoeias

was carried out in various regions, with detailed explanations of how
they exerted their beneficial actions on the basis of their intrinsic
qualities, their practical usage, and any unwanted effects that could
be expected. Herbal remedies shown to be therapeutically effective
have retained their place in health practices, whereas those that failed
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to deliver clinically have generally fallen by the wayside.

Eventually the entire body of Arabic medical knowledge and tradition
was introduced into Europe by Christian doctors returning from the
Crusades. Indeed, during the Middle Ages trade in herbs became a
substantial and lucrative international commerce.

In the late 11th century the first European medical school was set up
in Salerno, Italy. The teaching syllabus was firmly based on the teach-
ings of Hippocrates, Galen and Ibn Sina, and relied extensively on Ar-
abic translations. Other medical schools followed soon after: Montpe-
lier in France, and Bologna and Padua in Italy, for instance. Arguably
the best-known advocate of Western holistic medicine was Nicholas
Culpeper (1616-1654 CE), a 17th century herbalist and astrologer. His
medicine was essentially that of Hippocrates, Galen and Ibn Sina,
and this was subsequently used throughout Europe until the end of
the 19th century.

Pharmacotherapy of herbal remedies

When the normal and natural harmonious state of the body is dis-
turbed, then a clinical disorder is likely to develop. In this situation,
Tibb, and many other modalities, aim to remove the cause of such
disharmony by selecting one or more therapeutic options. Amongst
these interventions, the rational and systematic use of herbal rem-
edies to restore health and invigorate the body is most commonly
adopted.

Pharmacotherapy with natural ingredients especially herbs has

invariably been the first line of treatment of physical and mental
disorders and the restoration of optimum health. Extracts from
different parts of a herb such as the roots or leaves are used, but
not isolated as specific, individual chemicals. The concept of a single
active ingredient, which is proposed by Western medicine, is rejected
by Tibb, because different phytochemicals present in many herbal
extracts will interact to enhance the desired therapeutic effects and
minimise toxicity.

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A great deal is known about the pharmacological actions of a few

traditionally popular herbs, such as garlic, ginger and turmeric,
because they have been used for a long time. The efficacy of these
and many other individual herbal and other natural remedies has
been established empirically over time, through extensive clinical
experience and observation. However, the modes of action of many,
if not most, effective herbs have yet to be elucidated.
As the use of herbal remedies expands globally, the demand for better
understanding of their pharmacological action is escalating. Many
have now been identified, confirmed and documented. Garlic, for
example, has multiple clinical benefits, confirming what has long been
known by pharaohic Egyptian, ancient Greek and other healthcare
practitioners.
Modes of action
Thanks to increased interest and improved technology, the modes of
action of many categories of plant constituents have been recently
uncovered. These include amongst others, alkaloids, anthocyanins,
anthraquinones, cardiac glycosides, cyanogenic glycosides,
coumarins, flavonoids, minerals, mucilage, phenols, saponins,
tannins, vitamins, volatile oils etc.

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Some of these findings are elaborated in the table below:

Table 15: Categories of active plant constituents

These possess a vast range of activities including

analgesic (opioids), anti-cholinergic (atropine), anti-
Alkaloids
parasite (quinine), anti-cancer (vinca alkaloids), anti-
asthma (ephedrine), anti-hypertensive (reserpine).
These possess laxative and anti-inflammatory action,
Anthroquinones with potential antimicrobial, anti-tumour and immune-
modulatory activity.
E s s e n t i a l These are the basis of aromatherapy with many
oils therapeutic actions.
These possess anti-inflammatory, anti-oxidant,
Flavonoids anti-viral, cardio-protective, anti-cancer and other
activities.
Hepatoprotective, anti-inflammatory, anti-cancer,
Glycosides
wound healing, cardiac tonic and other activities.
Anti-inflammatory, anti-oxidant, demulcent and anti-
Mucilages
tussive activity
Phenolic
Anti-septic and anti-inflammatory properties
compounds
These are plant steroid glycosides which interact with
human cell membranes, affecting their permeability.
Saponins
They possess immuno-modulatory, anti-tumour
properties and influence hormonal activity.
These affect Ca2+ availability in smooth and cardiac
cells, have anti-hypertensive potential, and exhibit
Tannins
anti-initiating and anti-promoting activity in tumour
formation.
Terpenoids have membrane depleting properties
on the lipid bilayer of bacteria and therefore exert
Terpenoids
antimicrobial properties via a membrane disruption
mechanism
Vitamins and Most plants have a range of vitamins and minerals
Minerals which contributes to a person’s daily requirements.

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Each of these categories has a wide range of pharmacological actions,

and many overlap in terms of their activity. In addition, most herbs
contain not only one but usually several active ingredients under the
same category. Listed below are examples of a few common herbs
which contain some of the above categories, bearing in mind that
each category may have several active ingredients:
• Garlic contains flavonoids, alkaloids, saponins, tannins and cardiac

glycosides.

• Ginger contains phenolic compounds, flavonoids, alkaloids,

glycosides, saponins and tannins.

• Basil contains terpenoids, alkaloids, flavonoids, tannins, saponins

and ascorbic acid.

The many categories (together with the different active ingredients

within a category), contained in a single herb allows for a wide range
of pharmacological activity, across multiple physiological systems of
the body – cardiovascular, digestive, respiratory, etc. They not only
address the signs and symptoms of the illnesses associated with
the different systems, but also restore homeostasis at a cellular/sub-
cellular level. In addition to their active constituents, medicinal herbs
also contain numerous metabolic precursors in the form of primary
constituents, such as carbohydrates, fats and proteins, as well as
secondary metabolites. The therapeutic benefits these collectively
confer are unbelievably complex and pose formidable challenges to
pharmacological research. Even with the technological advancements
of today there is a very limited understanding of how the body’s
genetically programmed in-built wisdom, that is, physis, operates.

The wide range of active substances present in herbal remedies,

whether administered singly or in combination, acts positively on
several clinical disorders, which on first appearance appear unrelated
etiologically.

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Garlic, for example, has proven benefits in patients suffering from

multiple clinical disorders. In the past it was extolled as an invigorating
heart tonic, as a reliable laxative, and as a topical anti-microbial agent.
More recently, its ability to reduce raised blood pressure, prevent
stroke, lower cholesterol, control inflammation, counteract skin and
intestinal infections and possibly reduce tumour progress has been
confirmed.

The basis for these claims lies in the active substances found in
garlic, which contains several sulphur-containing substances, such
as allicin, as well as numerous representatives from Table 15 above.
Individually, any one active substance from garlic most likely has a
narrow spectrum of clinical activity. However, collectively they act
holistically on several disorders which are seemingly unrelated to
each other.

Another example is Cannabis sativa. Many well-controlled human

studies confirm that this plant confers numerous and wide-ranging
medicinal benefits. Cannabis contains numerous active agents, such
as tetra-hydro-cannabinol (THC) and its many variants. Individually,
one active agent may have only one limited pharmacological effect.
However, when several are combined, they act holistically on several,
often unrelated, physiological and metabolic disorders.

Specific cannabinoids, plus one or more active agents from table 15

(above) act collectively in the nervous system, and so exhibit potent
analgesia, ease depression, reduce anxiety and relieve symptoms
of multiple sclerosis. Those afflicted by Alzheimer’s dementia may
also benefit. Other components are effective on the digestive tract
in easing irritable bowel syndrome (IBS), stimulating appetite, and
counteracting nausea. Yet other cannabis components offer promise
in opposing tumour development.

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The Development of Western pharmacology

As a genuine scientific discipline, Western pharmacology is little more
than 150 years old. It emerged as an independent science in its own
right following advances in chemistry, physiology and biology in the
late 19th and early 20th centuries, mainly in the West. It is a broad
science of the biological properties of natural substances, synthetic
chemicals and drugs, and their effects on the body’s structure, func-
tion, and metabolism. Modern pharmacology emerged out of two
distinct lines of scientific endeavour: (a) identification, extraction and
modification of active ingredients found in plants, such as quinine and
aspirin; and (b) the application of powerful techniques in synthetic or-
ganic chemistry, as with beta blockers, benzodiazepines and cancer
medication.
Subsequent advances led to the isolation, purification and utilisation
of active substances from medicinal plants, such as quinine, and
several alkaloids, such as morphine, extracted from opium collected
from poppy plants. Further advances in synthetic chemistry lead to
the synthesis of new-to-nature derivatives, which were considered
less toxic and more predictable in their pharmacological activity. For
example, a basic chemical process, acetylation, is used to convert
morphine to heroin, and salicylic acid to aspirin.

Further advances in organic chemical synthesis supplied a steady

stream of new chemical entities, many of them with significant
marketable pharmacological activities. Barbiturates, for instance,
appeared in 1902, to be superseded fifty years or so later by the
benzodiazepines. The sulphonamides were introduced in 1935,
followed by penicillin in 1942, the corticosteroids in 1952, and the
phenothiazines in 1957. Since this era, the number of new chemical
entities introduced into the practice of Western pharmacotherapy is
virtually incalculable.

Research and development of Western drugs was initially conducted

mainly in academia. The first universities to study pharmacology as a
discrete life science were in Dorpat, Estonia (1847) and Michigan, USA
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(1890). Schmiedeburg, a student of another pioneer, Buchheim, now

regarded as the true founder of Western pharmacology, published the
first scientific text, Outline of Pharmacology in 1878. Abel researched
adrenaline, histamine, and insulin during the period 1897 to 1926, and
his student Reid-Hunt discovered acetyl choline in 1906. However,
due to financial constraints, academia could no longer continue
researching and developing new drug entities, and this eventually led
to the formation of commercial companies dedicated to discovering,
characterising and developing new pharmaceutical products. The
pharmaceutical industry – ‘Big Pharma’ – was born in the 1930s.

Listed below are some chemically based synthetic Western drugs used
in conventional pharmacotherapy, sourced from medicinal plants:

Table 16: Western drugs used in conventional pharmacotherapy

Botanical Active Desired activity

Deadly night-
shade Low heart rate and heart
block; pupil dilation in eye
Atropine
surgery; antidote for some
[Atropa bella- poisons;
donna]
Indian snakeroot
Anti-psychotic; anti-hyperten-
Reserpine
[Rauvolfia sive;
serpentina]
Ephedra
Stimulant; decongestant;
Ephedrine
appetite suppressant
[Ephedra sinica]
Tea bush Bronchodilator in asthma;
[Camellia Theophylline heart stimulant; nervous
sinensis] system stimulant

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Madagascar peri-
winkle
Vinblastine Vin-
Anti-cancer agent
cristine
[Catharanthus
roseus]
Coffee bush
Nerve stimulant; exercise re-
Caffeine
covery; hair growth stimulant
[Coffea liberica]
Pacific yew
Paclitaxel Anti-cancer; Kaposi sarcoma
[Taxus brevifolia]
Anti-tussive; (poss.) anti-can-
Poppy Noscapine cer activity
[Papaver
somniferum] Morphine Relief from moderate-severe
pain
Autumn crocus Anti-gout, anti-inflammatory
[Colchicum Colchicine agent; (poss.) anti-cancer
autumnale] activity

Basic theory

Western synthetic drugs generally act to either stimulate or depress

normal body biochemical and physiological functions. They may act
systemically and non-specifically upon all cells within the person’s
body, as with chemotherapy. Alternatively, the drug may exert its effect
locally in specific cells or tissues, or upon the affected organ alone, as
with the proton pump inhibitors.
Furthermore, the drugs may exert their action on the surface of the
cell, or on membranes, ion channels or other structures within the
cell. They may also act by inhibiting key enzymes in a biochemical
cascade within a membrane or organ which are essential for regulatory
or metabolic performance.
Pharmacological studies revealed that minute amounts of specific
substances could have extensive effects on the body’s physiological
systems, and slight changes in their chemical structure would result in
radically different responses. The structure of the cell responsible for
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the effect was termed the receptor. This was viewed as a biological
switch, activated or blocked by specific chemicals.
Langley (1852-1926) originally introduced the concept of the drug
receptor, visualising it as a switching mechanism which could be
turned off and on by specific drugs. From this time onwards, many
pharmacologists in various countries, such as Dale (1875-1968),
Loewi (1873-1961), and Ahlquist (1914-1983) were involved in the
rapid progress of Western pharmacology.
The receptor theory was the impetus to development of numerous
drugs, which stimulate, inhibit or block these receptors as a prelude
to pharmacological action. Western drugs have also been developed
which inhibit the passage of electrolytes and neuro-hormones across
cell membranes. The table (below) lists a selection of chemically
based synthetic drugs based on the receptor theory:

Table 17: Pharmacological action of Western drugs based on the

receptor theory
Site Action Examples Clinical usage
Treatment of
Membrane Dopamine agonists Parkinson’s disease
Stimulation
receptor Beta agonists Bronchodilators for
asthma
Lowering high blood
Membrane Beta blockers pressure
Inhibition
receptor Anticholinergics Treatment of mental
disorders
Treatment of
Membrane Serotonin re-uptake depression
Blockage
receptor Dopamine re-uptake Anti-psychotic
medication
Angiotensin Blood pressure
antagonists reduction
Key enzymes Inhibition
ATP Proton pump Reduce stomach acid
inhibitors secretion
Lowering of blood
Membrane Calcium antagonists pressure
Blockage
channels Anaesthetics Paralyse nerve
transmission

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As the body’s metabolic and physiological processes are highly com-

plex, tightly regulated systems under the control of physis, interfer-
ing with a particular process may achieve a desired clinical outcome,
but have unintended consequences elsewhere in the body. There is
therefore no doubt that Western drugs based on the receptor theory
will manifest as early side effects, later as adverse drug reactions,
and sometimes as toxic effects on, for instance, foetal development.
The unavoidable consequences of drugs based on the receptor theo-
ry, working against physis, are shown in the following examples:
A receptor inhibitor drug is the proton pump Inhibitor omeprazole
(Nexium) – which opposes the cellular mechanism responsible for
the production of gastric hydrochloric acid. By working against physis
(as hydrochloric acid is necessary for digestion), food is incompletely
digested, leading to side effects and complications, such as leaky gut
syndrome, constipation, osteoporosis.
A receptor blocking drug is the beta blocker atenolol (Tenormin). With
age, inadequate diet and a poor diet a person’s blood circulation is
unbalanced, resulting in a decrease in peripheral blood flow and an
increase in blood pressure. Atenolol blocks the beta receptor site in
the heart muscle. It also blocks beta receptor sites in other tissues and
organs, resulting in side effects like bronchospasm, confusion and
depression centrally. The real underlying problem is not addressed
properly, and other problems are created. Not only is the underlying
problem of hypertension addressed, additional side effects are
created.

Stimulating drugs are dopamine agonists such as bromocriptine

(Parlodel). In Parkinson’ disease there is a progressive loss of the
neurotransmitter dopamine, so conventional treatment often involves
administering a dopamine agonist. Side effects like hypotension, con-
fusion and heart rhythm disturbances often ensue.
Listed below are the short- and long-term side effects of some cat-
egories of Western drugs.

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Table 18: Short- and long-term Adverse Drug Reactions of some

Western drugs
ADR Type
Common Uncommon Chronic use Late developing Long term
Drug
Abdominal Dizziness Hepatitis Raised
Anti-retrovirals Liver failure
pain Headache Alopecia cholesterol
[Protease
Diarrhoea Insomnia Anaemia Ingrown nails
inhibitors]
Flatulence Mood swings Rash Gynaecomastia

Anti- Persistent
Headache Hyperkalaemia
hypertensives cough
Hypotension Dizziness Renal
[ACE Congenital
Fatigue impairment
inhibitors] abnormalities

Anti-asthma Effects on the Deterioration of

drugs Tachycardia lung function
[Bronchodilators]
heart

Anti- Hypertension
Eye damage Peptic ulceration Osteoporosis
Hyperglycaemia
inflammatories Depression Hypogonadism Skin damage
Diabetes mellitus
[Corticosteroids] Anxiety Hypothyroidism

Safety of Tibb and other herbal remedies

There may be many different activities present in a single herb or, as
with many herbal remedies, a combination of several herbs working
in combination or synergistically for optimum effect.

In Tibb, physis is responsible for maintaining homeostasis between

the many physiological and metabolic functions operating within
and between the various body systems. With today’s technological
advancements we know that these functions, are carried out by
various neurotransmitters, enzymes, hormones, cytokines and other
signalling factors which communicate through receptor sites – all
under the control of physis. Collectively they act holistically on several
disorders, which may at times be seemingly unrelated to each other.

This can be illustrated by inspection of Rauwolfia serpentina.

Rauwolfia contains many different phytochemicals, including

glycosides, flavonoids, tannins and alkaloids, of which more than
50 have been identified. When using the whole plant, high blood
pressure is effectively lowered by the major active alkaloid, reserpine.
However, there are other alkaloids within the plant which also exert

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distinct pharmacological actions; adrenergic blocking activity (from

ajmalicine), antiarrhythmic activity (from chandrine), and hypnotic
activity (from yohimbine). In addition, the herb contains the alkaloid
rauwolfine, which increases blood pressure, thus preventing blood
pressure from dropping too low. When reserpine alone is used it is
effective in reducing blood pressure. Unfortunately, there are several
possibly serious side effects such as depression, nausea, headaches
and dizziness. This has led to the use of reserpine being severely
restricted in clinical use. If the whole plant is used, very few if any
side effects result, highlighting the safety of using the whole plant as
opposed to isolated active ingredient.

Whilst the above example highlights the side effect associated with a
potent medicinal herb such as Rauwolfia serpentina, the same ratio-
nale may well apply to herbal supplements such as curcumin (sourced
from turmeric) - obviously to a lesser extent.

Pharmacotherapy in Tibb
Pharmacotherapy in Tibb is intricately linked to its fundamental phil-
osophical principles and is consistent with the temperamental and
humoral theories. Over the centuries, these principles have enabled
Tibb practitioners to understand the nature, relevance and practice
of aetiology, pathology, diagnosis and treatment. Tibb pharmaco-
therapy aims to (a) eliminate the causes; (b) normalise the humoral
balance; and (c) restore qualitative harmony to tissues and organs.

Whilst there have been numerous compilations of Tibb pharmaco-

peia’s over the past centuries, Volume 2 of Ibn Sina’s Canon of Medi-
cine is still the most comprehensive. It describes more than 670 in-
gredients, mainly herbs, but also a number of animal and mineral
ingredients. Staple foods such as grains, bread, milk, honey, dates
and beans are also included. This volumes highlights the following
features:
Temperament. The temperament/quality of ingredients in Tibb is
as important as their pharmacological actions. For example, garlic,
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fenugreek and cinnamon are described as having Hot and Dry

qualities. Coriander, borage, cardamom are Cold and Moist; basil and
tamarind are Cold and Dry; and agrimony, ginger and black pepper
are Hot and Moist.
Properties of drugs. Ibn Sina described the pharmacological action
of specific drugs in relation to their physical properties, and their
effect on humours. These include their potential for coagulation or
dehydration, whether they are heavy or light, dense or tenuous,
viscous or mucilaginous, oily or viscous, and also whether they are
fragile in nature.
Degrees of activity. Ibn Sina categorised ingredients into four
degrees of activity, or Orders, depending on their overall effect on
the human body. They take into account: (a) The potency of the
substance’s pharmacological action; and (b) The intensity of the
quality or temperament associated with the specific ingredient.
• Ingredients in the first Order: These include pharmaceutically
active foods (nutriceuticals) and dietary ingredients. They have
only a minor pharmacological action but do contribute to health
maintenance and the healing process e.g. quince, almonds,
coconut.

• Ingredients in the second Order: Have a definite pharmacological

action which is exerted as long as the active ingredient circulates in
the bloodstream. Adverse effects may arise from these ingredients,
especially in the elderly and children, e.g. agrimony, cinnamon and
ginger.

• Ingredients in the third Order: Have the capacity to overwhelm

the functions of the body. Large dosages of products containing
these ingredients can lead to serious side effects e.g. lobelia and
artemisia.

• Ingredients in the fourth Order: Are highly potent, potentially

toxic and possibly life-threatening, as they can either increase or
decrease the functions of the body beyond the extent that supports
life. Products containing these ingredients are always administered

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with other agents, which act to reduce their toxicity e.g. arsenic,
opium and cannabis.

• For the maintenance of health: Ingredients from the first Order and
to a certain extent the second Order should be selected.

• For the treatment of most conditions: Ingredients from the second

and third Orders should be selected.

• For the treatment of very serious conditions: Ingredients from the fourth
Order may be selected, especially if the condition is potentially life
threatening. However, they should not be used for extended periods.

Differences between Tibb pharmacotherapy and other herbal

medication

In addition to the qualitative and humoral imbalance associated with

an illness condition, another important difference between Tibb phar-
macotherapy and other disciplines is the temperament or quality of
the medication.

For example, the pharmacological action of Commiphora mukul is

often included in cough and colds formulations, as it counteracts the
specific symptom of runny nose; however, it also has Hot & Dry quali-
ties which oppose the Cold & Moist symptoms.

This is a general rule in Tibb pharmacotherapy that the medication’s

temperament is opposite to the qualities associated with the condi-
tion. In fact, the term ‘allopathic medicine’ (allo: Greek, opposite) origi-
nates from this understanding. That is, both the pharmacological ac-
tion and temperament of the medication are important in relation to
the clinical features associated with the ailment. This awareness of
the importance of a medication’s temperament or quality in relation to
the disease’s qualities is unique to Tibb herbal products.
The Tibb approach therefore offers a rational approach to therapy. It
logically and systematically describes the wide range of pharmaco-
logically active drugs, whether derived from plant, animal or mineral
sources. It includes (a) the drug’s action in redressing any qualitative/
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humoral imbalance underpinning the clinical disorder, and (b) the de-
gree of effect, or potency, which it exerts.
Differences between Tibb and Western medication

There are real, substantial and clinically important differences

between Tibb pharmacotherapy and Western pharmacological drug
treatment. The main features are:

• Holistic approach. Tibb embodies a holistic approach, based on

the temperamental and humoral theories in its application of phar-
macotherapy. The herbal remedy ingredients possess many ac-
tive constituents (alkaloids, saponins etc.) which work at the cel-
lular and humoral level, supporting, protecting and enhancing the
body’s vital physiological and biochemical processes. Essentially,
Tibb adopts a multi-targeted approach.
• Natural form. New-to-nature, synthetic chemicals, which comprise
many Western drugs, have a specific but limited pharmacologi-
cal action, which is to interfere with normal physiological and bio-
chemical processes, so disturbing inner homeostasis. Tibb herbal
remedies, on the other hand, act at three levels.
• Firstly, they help to restore qualitative, humoral and tempera-
mental balance, which has been upset during disease or disor-
ders such as fatigue and IBS.
• Secondly, they act pharmacologically on specific physiological
and metabolic processes, by interaction with receptor mecha-
nisms.
• Thirdly, they regulate internal body processes, by working with
physis. In doing so they enhance inner healing.
• Spectrum of action. Tibb herbal remedies, being based upon the
whole plant, contain not only the active component, but also its
precursors and its metabolites. These collectively ensure smooth
pharmacological action and avoid excessive effects on basic me-
tabolism. However, Western medication usually has a single, major
effect, with little control exerted over the prevention of excessive
action. 215
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• Multiple actions. One agent alone may be able to attenuate

specific symptoms in a disorder arising from a single cause, as
many Western drugs successfully do. However, many disorders,
especially those of a chronic nature, are the result of disharmony
arising from multiple causes. In these cases, a herbal remedy
with several different modes of action is more likely to be
successful in ameliorating the symptoms of the disorder
• Synergy. The active components present in a herbal remedy act
in synergy. Experience and observation strongly suggest that
the general pharmacological response to a herbal combination
is not based solely on one active component, but on the overall
synergistic activity arising from several compounds. This property
is very important when the disorder is so severe or intractable
that no single ingredient is sufficiently effective. Western drugs,
on the other hand, are usually given in combination to either
boost the desired effect by acting on different physiological
mechanisms, or so that one component drug counteracts the side
effects of the main drug.
• Metaphysical action. Unlike Western medicine, which acts
purely in the physical dimension, Tibb herbal remedies claim to
exert a proportion of their effect in the metaphysical context.
• Side effects. Because of the above differences, Tibb medication,
has a limited side effect profile compared to Western drugs.

Combining Tibb medication with Western drugs

For various reasons there has been a substantial increase in the con-
sumption of herbal remedies in recent times. They are often com-
bined with one another, and are commonly used simultaneously with
Western drugs, taken for a wide range of acute, chronic and recurring
disorders.
As there is a significant and increasing number of people taking herbal
remedies simultaneously with Western drugs, there is a distinct and
real possibility of herb-drug interaction, analogous to the Western
drug-drug interaction that is now well established and extensively doc-
umented. 216
 THERAPEUTICS IN TIBB

The original indication that an herbal agent could interact significantly

with the action of a Western drug was the observation, 20+ years ago,
that the consumption of grapefruit juice markedly reduces the metabo-
lism of the immunosuppressant ciclosporine in patients following trans-
plantation. We now know that the metabolic enzymes (comprising the
cytochrome P450 system) of the patient’s liver were being inhibited, so
higher levels of the active drug were being maintained for a longer pe-
riod of time.
The herbal component does not combine with a drug to form a toxic
intermediary. In most cases changes to the absorption of a drug, or
its metabolism within the body, is most likely the basis for interaction.
Several herbs can induce or inhibit enzymes, resident in the liver or
intestinal tract walls, which are responsible for drug metabolism. These
enzymes, mainly of the cytochrome P450 type, are made less effective,
so the level of non-metabolised drug rises within the systemic blood
circulation, and clearance of the unchanged drug and its metabolites
is reduced.
The interaction of herbs and drugs is only to be expected; if a herb trig-
gers a pharmacological response, then it could conceivably interfere,
to a greater or lesser extent, with a Western drug’s activity. This has
important ramifications for drug therapy, as many people are taking
not one, but several, potent Western drugs. The potential for herb-drug
interaction is therefore immense when the number of herbal products
coming into popular use is considered.
The mechanisms by which a herbal product interferes with a
drug, or vice versa, are not fully understood in most cases. There
are, however, a number of possible activities which explain
the interaction; these are divided into pharmacokinetic and
pharmacodynamic interactions.

Pharmacokinetic interaction
Inhibition of absorption. The herb or drug acts on the other active
agent to reduce or minimise its absorption. A number of agents have
been identified:

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• Pectins, resins, tannins may bind to certain antibiotics, preventing

unimpeded absorption of the drug.

• Garlic (Allium sativum) interacts with several drugs, by reducing

their absorption into the body.

Enhancement of absorption. This is usually the result of increased

gastric emptying or shorter gut transit time.
• Laxatives can increase these processes.
• Certain saponins can increase gastric emptying, so enhancing the
rate of gastric emptying.

Increase in drug metabolism. The herbal product promotes

an increase in metabolic enzymes in the liver, so boosting the
breakdown or elimination of drugs.
• St John’s Wort reduces the plasma concentrations and increases
clearance of a wide range of drugs.

• Echinacea affects the metabolic clearance of caffeine and certain

anti-anxiety drugs.

Binding of drug by the herb component. Some antibiotics are

chemically bound to certain botanical substances. This prevents or
inhibits absorption through the intestinal wall, as the drug-herb complex
is either too big to absorb, or too poorly soluble in the intestinal fluid.

Pharmacodynamic interaction
Electrolyte depletion. Laxatives and diuretic drugs can reduce
sodium and potassium levels in the body, and so lead to adverse
cardiac effects.
The pharmacological effect is intensified. Certain herbs have
specific pharmacological effects. If a drug is being co-administered,
an additive or perhaps synergistic effect can arise.
• Hypoglycaemic drugs and herbal products used to treat diabetes
may act together.
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• Herbs which contain the alkaloids caffeine and ephedrine, or

similar, may increase nerve stimulant drug action.
Herbal medicine is one of the oldest forms of medicine used for the
treatment of physical as well as psychological maladies. The spe-
cific mechanisms of action of many of these remedies are undergoing
rapid and accelerating study, with the objective of ensuring that their
clinical effects are maximised. Today, production methodology and
extensive research studies ensure that herbs and other components
used to make herbal medication are stable, well formulated and safe
when administered to the patient. Herbal products exert their benefi-
cial action in numerous pharmacological routes, many only recently
discovered.
Despite the massive inroads made by modern Western medicine,
herbal and natural therapies are experiencing a revival in usage,
partly as a result of extensive research in their modes of action and
clinical efficacy. Another notable reason for this renewed interest and
increasing demand is due to the side effects often associated with
Western medication.

Western drugs exert their effects in only a limited number of ways.

They stimulate, or inhibit, or otherwise interfere with the functioning
of drug receptors; or reduce the activity of certain enzymes involved
in key biochemical or metabolic processes; or they affect cell
membrane permeability to certain ions. In contrast, herbal remedies
differ in their mechanism of effect as they contain a wide range of
active agents, their precursors and metabolites, which allow for
close regulation of physiological and biochemical processes.
Most herbal products have been around for millennia, and the
efficacy of individual formulations has been established empirically
by extensive clinical experience and by observation. Whilst some of
the pharmacological actions of herbal medicines have been clearly
detailed and identified through time and tested use and recently
through technological advancements; there are many others of
which we only have an inkling of modes of action.

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In Tibb, Pharmacotherapy is without a doubt an important

therapeutic option, based on the fundamental principles
embedded in the temperamental and humoral theories. Ibn Sina’s
pharmacopoeia laid the foundations for Tibb pharmacology, allotting
each herb to one of four categories, or orders, of clinical efficacy
and patient safety. In addition, unique to Tibb as compared to other
herbal remedies is the concept of qualities in relation to illness
conditions.

Tibb Pharmacotherapy makes available to the intricate wisdom of

physis, many active constituents within herbal formulations, thereby
allowing the body’s intrinsic healing ability to restore homeostasis at
the temperamental and humoral level - ‘treatment comes from the
outside healing comes from within’.

LIFESTYLE MODIFICATION AND EMOTIONAL SUPPORT

THERAPY

The modern Western way of life leads inexorably to the accumulation

of toxins in the body. These can be natural, as in people suffering from
constipation or poor eating habits; or they can be artificial, due to the
build up of ‘new-to-nature’ chemicals in the air we breathe, the water
we drink, and the food we consume. As we noted earlier, Hippocrates
introduced the concept of pepsis, whereby the body preferentially se-
lects the parts of our daily food and drink that the body can use, and
rejects the constituents which are of no immediate benefit. These are
eliminated from the body as natural waste. An additional aspect is
that healing in many cases with lifestyle modification and emotional
support therapy can be reasonably carried out by the person experi-
encing ill-health, without recourse to the intervention of a healthcare
professional. This form of personal empowerment is a very important
aspect of Tibb.

1. Dietotherapy

“Leave your drugs in the chemist’s pot if you can heal the patient
with food” [Hippocrates] 220
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Rationale
The rationale behind dietotherapy is to advice on appropriate foods
that restore humoral and qualitative harmony. This is achieved with a
diet that has qualities opposite to the signs and symptoms associated
with the illness. Disorders associated with a combination of qualities
are mostly acute conditions which arise from a qualitative imbalance,
or Tibb’s Pathway 1).

Dietotherapy is used to counter sudden qualitative changes by con-

suming foods that restore the balance of qualities. An example is
treatment of the acute disorder the common cold, which is qualita-
tively Cold & Moist. Consumption of hot chicken soup, and hot honey
and ginger drinks is traditionally used to balance the sudden qualita-
tive distortion of the disorder. The patient is also advised to abstain
from foods that will aggravate the disorder, such as cold or iced drinks
and dairy products.

This approach applies equally to chronic disorders such as diabetes,

which is a qualitative imbalance in moistness. The Tibb recommended
treatment includes Hot & Dry and Cold & Dry foods and drink, which
help normalise the humoral balance.

Guidelines for dietotherapy

Limit intake of food during disorders. This is achieved by reducing
the number of meals, or by limiting the size of the meal. Furthermore,
emphasis should be more on the value of nutritious foods.

Influence of temperament on dietotherapy. The temperament of an in-

dividual should also be taken into account when applying therapy. For
example, in treating a melancholic/bilious patient’s arthritis (a Cold &
Dry disorder) which has an overall quality of dryness, changes to the
diet should be aimed at increasing moistness. In the same vein, a
melancholic/phlegmatic patient, having an overall quality of coldness,
his/her arthritis will be more as a result of excess cold, therefore life-
style factors should be aimed at more heat.

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Categories of food. The overall qualities of food categories, such as

proteins (which lead towards dryness), carbohydrates (which lead
towards moistness) or fats (which lead towards heat) also need to
be taken into consideration. For example, disorders characterised by
dryness (that is, Hot & Dry or Cold & Dry disorders) should limit the
intake of proteins, and those with an overall quality of moistness (Hot
& Moist – Cold & Moist disorders) should avoid carbohydrates.

The qualitative nature of different foods. Although both mutton and

bananas are qualitatively Hot & Moist, one is a meat and the other a
fruit. The qualitative effect of these foods will therefore differ. This is
because the overall quality of meat has more dryness, compared to
fruits, which have more moistness.

Metabolism of foods. All foods and drinks undergo the processes of

digestion and metabolism. The efficiency of metabolism therefore
needs to be taken into account, because the strain on the digestive
system varies from food to food. For instance, the energy and time
required to digest fruits is much less than for meats.

Temperature of food. The qualitative effect of the temperature at which

food and drink is consumed has a particular influence. A good exam-
ple is water. When consumed at room temperature it has a moderate
cooling and moistening effect. However, when consumed chilled, cold
water will have a cooling effect, whilst ice will have a drying effect.

Constituents of food. The nutritional constituents contained in differ-

ent foods need to be taken into account. They have, for instance,
different amounts of calories, vitamins and minerals, and white flour
provides far less nutritional value than oats, which has the same Hot
& Moist quality.

By-products of food. The end result of the foods consumed once me-
tabolism and digestion have occurred is relevant. For instance, the
link between unsaturated fats and the increase in cholesterol levels,
or the increased production of uric acid after consuming red meat,
should be taken into consideration.
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The taste of food. Another consideration is that taste is indicative of

the qualities of foods. For example, consuming sour foods lead auto-
matically towards dryness and coldness.

Seasonal changes. The season during which dietary changes are

recommended has an effect. For example, foods with heating quali-
ties will have a greater influence when consumed during summer as
opposed to winter.

2. Physical Exercise

The therapeutic benefit of reasonable, controlled and regular exercise

is well documented.

Physical exercise is invaluable in aiding numerous chronic clinical

conditions, from hypertension and lipid disorders, to osteoporosis and
digestive disorders.

Rationale
From a therapeutic point of view, movement results in an increase
in heat quality, whereas rest results in the opposite. The rationale
behind the benefits of physical exercise and rest should be seen in
this context. Exercise as a therapy is used to augment heat and dry-
ness qualities. Success or otherwise depends on the intensity of the
exercise. The higher the intensity, the greater is the amount of heat
generated. Light exercise such as walking and moderate aerobics is
generally suitable for all types, and beneficial in most disorders.
Clinical application
When physical exercise is used for therapeutic benefit, the healthcare
professional needs to take into account:
• The qualities (especially the dominant ones) associated with the
illness. For instance, ailments associated with heat are adversely
affected by strenuous or excessive exercise.
• The motivation of people of different temperament towards exer-
cise as therapy. Phlegmatic people, for example, are not gener-
ally inclined to exercise regularly, whereas those of a melanchol-
ic temperament might be more enthusiastic.
223
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• The patient’s practicality or suitability to follow an exercise

programme. Factors such as occupation, lifestyle circumstances,
age, extent of illness and even emotions have to be considered.

3. Breathing and Meditation

Breathing, meditation and mind-body integration exercises are cur-

rently in vogue. Their benefits though, are undisputed, especially in
the stressful and pollution riddled climate we live in. Faulty breathing
is known to underlie the onset and development of a number of clini-
cal disorders.

Breathing

“Air is the source of life, and also provides the source for the acti-
vation of energies to form body fluids and maintain life” [Ibn Sina]

Rationale
The fundamental purpose of breathing is to provide the lungs with
a constant supply of air from which the essential oxygen can be ab-
sorbed into the blood and circulated to all the body’s tissues and or-
gans. Breathing exercises are beneficial for all types of illness. In fact,
conscious breathing exercises coupled with other therapies such as
meditation and colour visualisation affect mood and emotions signifi-
cantly. The main outcome is the relaxation effect, which aids the re-
covery process significantly. Controlled relaxation and breathing oxy-
genate the body, improves circulation and further provides benefits
similar to the state of sleep, which has a cooling and moistening ef-
fect. The added benefit is that the effect produced from these exer-
cises increases stimulation of Physis through active focus on healing.

Breathing directly influences our body’s the unconscious (autonomic)

processes. Unlike other functions of the autonomic nervous system,
breathing is the one over which we can exert conscious control. In-
adequate breathing adversely affects aerobic respiration, which is the
main driving mechanism for the body’s energy provision. An optimum
oxygen level is especially beneficial to our brain cells. Regular, con-
224
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trolled breathing exercises programs our subconscious to breathe

correctly, even when we are not aware of it.

Poor breathing adversely affects Physis function. Inspiration of air

which is inadequate in volume, or oxygen-poor, or laden with toxins
inevitably leads to metabolic disharmony, resulting in a wide range of
ailments.

Several traditional healing paradigms, such as yoga, use breathing

techniques to aid healing and improve health. Western medicine now,
belatedly, recognises this and often advises better breathing as sup-
portive therapy.

The benefits of improved breathing technique are well documented.

They range from relief of chronic headache and tiredness, to reduc-
tion in blood pressure and heart rate, to alleviation of anxiety and
sleep disorders. The focus of breathing exercises, of which Tibb has
several, is to restore overall calmness, control, focus and stability –
that is, internal harmony or homeostasis. The persons most likely to
benefit from improved breathing are those of a bilious or melancholic
temperament.

Meditation
Meditation is both a form of mental therapy for stress-related disor-
ders, and a means of calming the mind.

Meditation has been used for centuries in the East, and more recently
in the West, as an effective approach to spiritual enlightenment. It is
an integral part of Ayurvedic medicine, Yoga, and T’ai Chi.

Rationale
Many emotional ailments originate from stress and the emotional
trauma arising from the times in which we live. Materialism, informa-
tion overload, the inordinate demands of consumerism, lack of reli-
gious conviction and spiritual awareness, the socio-economic chal-
lenges that confront us, etc., all have major health implications, and
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play havoc with our emotions. Meditation in one form or another is a

time honoured method for dealing with such stress.

It requires no special equipment, and can be practiced in any suit-

able time and place. It allows a person to redress where a person’s
thoughts and emotions negatively control daily behaviour.

During meditation, alpha waves are produced in the brain, which in

turn encourage the parasympathetic section of the autonomic ner-
vous system to prevail. This leads to the suppression of the ‘fight,
fright, flight’ response, and the attainment of profound rest. At the
same time, the brain and mind become more alert and vigilant. Lac-
tate is a substance produced by anaerobic metabolism of glucose
in the skeletal muscles. During states of anxiety and stress there is
a substantial rise in the level of lactate in the blood. Meditation has
been shown to reduce these levels markedly.

Emotional disorders are predictably the outcome of the constant strain

on the brain and peripheral nervous system. This leads to disorders
associated with the brain and the nervous system.

Clinical application
Meditation beneficially affects muscle tone, breathing efficiency, brain
activity and problem solving. Physiologically it reduces stress hor-
mone levels, elevated blood pressure and heart rate, and generally
improves blood circulation. People with hypertension and headaches
related to poor blood supply to the scalp often benefit.
Meditation can affect a person’s mental well-being. Anxiety, self-pity,
low self-esteem, feelings of inadequacy, for example, often benefit
from regular meditation sessions.

Another positive effect is that prescription drug use is reduced dramat-

ically. When combined with breathing exercises, the benefit is raised
significantly. The most appropriate breathing exercise in meditation is
a Slow and Deep Breathing which elicits a calming effect.

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4. Visualisation
This technique applies imagination to create a sense of well-being,
encouraging the replacement of negative attitudes and behaviour
with positive ones.

Rationale
Visualisation has been applied therapeutically in the East for millen-
nia. More recently in the West it has been used in conjunction with
bio-feedback and other relaxation techniques. It affects the cerebral
cortex of the brain, which is involved in information processing. In
particular, it influences the right hand side of the brain, which is con-
cerned with imagination, creativity, and intuition, as opposed to the
left hand side, which is more concerned with logic, mathematics and
language. It may also involve the pituitary gland, so exerting a hor-
monal effect.

Clinical application
Experience of visual techniques has shown that they beneficially af-
fect chronic pain, high blood pressure, skin disorders such as eczema
and depression. People with unwanted habits, such as smoking, ex-
cessive drinking, and overeating, also derive benefit.

5. Colour therapy

Colour therapy is a type of holistic healing that uses the visible spec-
trum of light and colour to affect a person’s mood and physical or
mental health.
Rationale
Colour affects mood and influences behaviour, and a person’s choice
in colour points to their particular temperament. The theory of colour
therapy (chromotherapy) states that all matter, including living tissue,
is composed of energy. Each particle vibrates at its own specific fre-
quency. A deviation from the respective frequency is believed to cause
either depletion or excess of the ideal frequency, resulting in disease.

In Tibb the frequencies can be compared to the qualities of heat,

moisture, coldness and dryness. Tibb understands the influence of
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qualities in relation to temperaments, which places emphasis on the

quality of the colours and its relation with the temperaments, as well
as its corresponding effects on the body by the autonomic nervous
system.

Clinical application
Colour therapy often benefits those with mental problems, specifically
depression, anxiety and eating disorders. Emotional problems, such
as certain phobias, post-traumatic stress disorders and skin condi-
tions like eczema, dermatitis and, psoriasis also respond.

6. Music Therapy

The rhythms and harmonies of music exert a powerful impact on our

senses.

Music (or Sound) Therapy involves the sharing of musical experi-

ences between the patient and therapist, or as an adjuvant for home
therapy.

Rationale
Music, rhythm and sound have long been associated with healing.
Unfortunately, the use of music as a healing option has been some-
what subdued by Western medicine, which questioned its scientific
basis. However, recent research has revealed that it is a valuable op-
tion when treating mental and emotional disorders. Music is a means
of resolving inner conflicts, and restoring personal confidence and
self-esteem. It can be considered an ‘ice-breaker’ for other therapies,
such as psychotherapy.

Tibb recognises that attitudes and responses to music vary consider-

ably, as part of a person’s temperament. Some are deeply affected,
whilst others are not. The rationale behind the use of music therapy
is associated with the effect of different types of music on both a per-
son’s temperament and the clinical disorder being treated. A person
with a bilious temperament responds differently to certain types of
music compared to someone who is phlegmatic. The effect of music
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on the patient’s qualitative balance needs to be taken into account

when applying music as a treatment. For example, a person with a
Cold & Dry condition should avoid listening to music that is sad or
depressing, as it will aggravate the disorder.

Clinical application
Actually making music lets a person express a spectrum of emotions,
ranging from joy and tranquillity, through to anger and frustration Mu-
sic therapy seems to be particularly valuable in treating numerous
disorders as well as specific groups of patients. They include children
with behavioural, sensory and learning difficulties which prevent the
child freely expressing him- or herself. People with severe mental and
emotional problems generally respond positively, as do the elderly,
aged and terminally ill. Others who benefit are those who are grieving,
mothers-to-be, and physically challenged people.

Conducted by a qualified therapist, music therapy is completely safe.

Treatment is most beneficial if there is a good relationship between
patient and therapist, as the experience is designed to help the pa-
tient reveal deep, submerged conflicts and stress-related problems.

7. Psychotherapy and Counselling

This therapeutic approach describes a number of techniques which

help patients to deal with mental and emotional disorders.

Rationale
Emotions are our natural way of expressing our reaction to changes
in our internal or external environment. All emotions, from happiness,
gratification and euphoria to anger, worry, sadness, shyness, fear,
and crying, have an effect at psychological and spiritual levels.

The humoral link to psychological problems is of special significance

in Tibb. The brain is qualitatively moistness (phlegmatic) which can
be imbalanced through increased moistness (phlegmatic) or dryness
(melancholic) disorders.

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The potential role of spiritual healing should be considered by the

healthcare worker, and perhaps included in the treatment. Appropri-
ate treatment needs to be selected depending on the patient’s reli-
gious conviction, the putative cause of the problem, and the symp-
toms presented.

Different temperaments are inclined to different emotional states. De-

pression is common in melancholic people, and anger and aggres-
sion in bilious people, for example. Likewise, sanguinous people are
often troubled by anxiety and depression, and phlegmatics by fear
and panic attacks.

Clinical application
Psychotherapy and counselling benefit those with mental ailments,
especially depression, anxiety and eating disorders; emotional prob-
lems, such as phobias and post-traumatic stress disorder; and skin
conditions like eczema, dermatitis and psoriasis.

8. Aromatherapy

This therapeutic technique uses oils topically, either alone or in com-

bination with therapeutic massage, to alleviate numerous chronic dis-
orders.
Plant essences have been used for thousands of years for healing
purposes, and there has been a recent reawakening of interest in
aromatherapy. Essential oils are used in a variety of ways, and often
as part of massage therapy. Over fifty individual oils are used in Aro-
matherapy.

Rationale
Essential oils are synthesised in many plants, shrubs or trees. Their
role is to protect the plants, etc., from grazing animals, parasites and
microbes, and from the encroachment of other plants. Specific plant
oils provide therapeutic benefits, and often having antiseptic, antimi-
crobial, sedative and tonic properties.

Tibb recognises the role of essential oils, Eucalyptus and rosemary

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oils are known to be effective nasal decongestants. Sage has a ben-

eficial effect on blood circulation.

Essential oils help restore Physis or harmony to the person, thus en-
hancing the body’s natural defences such as the immune system.
Aromatherapy therefore benefits numerous ailments affecting differ-
ent parts of the body.

Knowledge of the qualitative nature of the oils is important to the prac-

titioner. Common aromatherapy oils, together with their qualities, in-
clude: rosemary and eucalyptus (Hot & Dry), lavender and chamomile
(Dry & Hot), peppermint and clary sage (Hot & Moist), Ylang-ylang
and coriander (Cold & Moist), grapefruit and rose (Cold & Dry).

Clinical application
Applying essential oils is gentle, and suitable for people of all ages,
and generally free of adverse reactions if used properly. However,
pregnant women should exercise caution with this treatment.

Aromatherapy is effective in treating stress related symptoms such

as insomnia and anxiety. It also benefits people with gout or arthri-
tis, such as painful limbs, muscles and joints, respiratory complaints,
burns, rashes, and infections of the mouth, throat and urinary tract.

Aromatherapy has proven beneficial in chronic disorders. It has been

found to have prophylactic properties – that is, it may prevent the de-
velopment of certain disorders.

ELIMINATION

In Tibb, true healing can only happen when the elimination of waste,
toxins and excess/abnormal humours are effectively dealt with, either
through natural or induced modes of elimination.

Natural modes of elimination

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These include the following:

• Respiration – the elimination of carbon dioxide and other toxic
gases through the lungs.
• Defaecation – the passing of stool, the residue of digestion, via
the lower digest tract. The liver is the main organ involved in
this process, working together with the gall bladder.
• Urination – the excretion of urine from the urinary bladder.
• Perspiration – excretion via the skin, removing toxins dissolved
in the sweat and sebum.
• Menstruation – the periodic discharge of blood and fragments
of the endometrium lining via the vagina.
• Emotional routes – excitement, anger, worry, sadness and fear
play a part in the elimination of toxins from our body.

There are other natural mechanisms by which unwanted materials are

rejected by the body. These include: coughing and sneezing, vomit-
ing, flatulence, tears, ear wax, and ejaculation.

Body temperature and elimination

An infant’s average body temperature is slightly higher than that of an
adult. This higher body temperature is necessary to process all the
by-products emerging from the infant’s rapid growth. As a result, the
infant experiences a whole range of elimination episodes – vomiting,
diarrhoea, fever and sweating, and frequent urination.

Another example is the body’s immune system. This works best at

a temperature which is higher than normal. The body’s natural re-
sponse is thus fever when the immune system is hard at work to ward
off infection or re-establish homeostasis. Unfortunately, many disor-
ders which present with fever as a symptom tend to be treated with
potent antipyretics. The temperature is lowered, but at the expense of
the body’s built-in defence mechanisms.

Induced modes of elimination

Induced modes of elimination also known as regimental therapies,
are supervised therapies for removing toxins and excess or abnor-

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mal humours which may be present at a vascular level or have been

incorporated into body tissues. These therapies assist Physis in re-
storing homeostasis and maintaining continuity between the different
physiological systems.

The science and art of medicine which is essential for the elimination
of excess/abnormal humours has been extensively elaborated on by
Ibn Sina.

Ibn Sina’s guidelines on elimination. According to Ibn Sina, elimi-

nation procedures not only dislodge or divert the diseased matter
from the site of illness, but also direct this matter to the appropriate
exit routes for elimination.
From Ibn Sina’s ‘Canon of Medicine’, the following guidelines are
noted:
• Elimination procedures vary in their degree of harshness. Pur
gation is harsher than laxatives are.
• Some elimination procedures benefit from the use of herbs
during the concoctive and eliminative process.
• Main organs and tissues should not be risked by using potent
drugs.
• Organs that are diseased or dysfunctional should be treated
more carefully.
• Medicines or herbs which are irritant or injurious should be
avoided.
Examples of these principles in practice are:
• Purgatives and enemas attract diseased matter towards the
intestines, from where they are expelled in the faeces.
• Sneezing originates in the upper respiratory tract, diverting
toxins, microbes etc. towards the nostrils for expulsion.
• Diuretics divert toxic material towards the kidneys, where it is
removed via the urine.
• Perspiration, massage and cupping direct toxins, etc., towards
skin for elimination in the sweat.

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Factors affecting elimination efficiency. The principles of evacu-

ation embrace several aspects of the patient. Factors to be evalu-
ated before applying an eliminative procedure include the patient’s
temperament, age and sex. Also important are the patient’s lifestyle
quality, physique, overall health state and presenting symptoms. The
practitioner will also assess the nature of the humoral imbalance to
be eliminated.

INDUCED MODES OF ELIMINATION

The main induced modes of elimination are:

• Sneezing • Diuresis • Somatic balancing technique

• Emesis • Enema • Leeching (hirudotherapy)
• Perspiration • Purgation • Venesection
• Hydrotherapy • Massage • Cupping

1. Sneezing

The nose is the gateway to the brain and to consciousness.

Rationale
Medication, as nasal drops/oils, sprays or snuffs, given to induce
sneezing, cleanses accumulated phlegmatic humour and wastes
from the head, face and neck. Induced sneezing also improves mem-
ory and eye sight, and voice quality. Medication administered nasally
helps to correct disorders affecting the cerebral, sensory and motor
functions.

Historically, the use of ‘snuffs’ was a common practice. In fact the cus-
tomary response of ‘bless you!’ to a person who sneezes is reflective
of the importance of sneezing as a blessing for good health.

Clinical application
Several ailments, mainly of the upper respiratory tract, respond posi-
tively to sneezing. They include nasal allergies, polyps and sinusitis,

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and loss of smell (anosmia). Other disorders not directly linked are
certain headaches, trigeminal neuralgia and Bell’s palsy.

2. Emesis

Emesis, or vomiting, is the reflex action by which the stomach con-

tents are expelled through the mouth.

Emesis can be induced by certain irritant substances such as ipecac,

mustard and salt. It is valuable when there is congestion in the lungs,
which causes repeated attacks of bronchitis, cough, cold or asthma.
The objective of this therapy is to induce vomiting to get rid of the
excess phlegmatic humour. Emesis is common in infants to eliminate
the phlegm from the stomach and lungs.

Rationale
Tibb considers that vomiting purifies and invigorates the stomach. It
is also useful in sharpening eyesight, and helps to eliminate head-
aches. Emesis is applied when there is an accumulation of abnormal
humours, especially the phlegmatic in the stomach and respiratory
organs. Ghee, a clarified butter/oil combination, has traditionally been
used as an emetic, as it avoids oesophageal corrosion. Hippocrates
recommended that vomiting should be induced on two consecutive
months, after meals.

Clinical application
Inducing vomiting can help alleviate a number of ailments which affect
the upper respiratory and digestive tracts. Allergic rhinitis, congestion
of the nasal passages and sinuses, infections, especially coryza, and
phlegmatic asthma often respond. Digestive ailments characterised
by a build-up of phlegm, such as chronic indigestion and tonsillitis will
likewise improve.

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3. Perspiration

Perspiration is the process by which toxins are eliminated through the

skin.

Rationale
The skin is the largest organ in the body. Perspiration leads the hu-
mours to fluidity, making it easier for them to flow out of the system. It
opens up the pores and rids the body of impurities through the sweat
glands.

Types of perspiration
There are two types:
• Insensible perspiration – the formation of sweat that evaporates
almost immediately from the skin, so is not visible;
• Sensible perspiration – sweating which is visible on the skin as
drops of liquid.

There are several ways of inducing perspiration. Steam baths (Turk-

ish; hammam) and sauna are popular methods, with intense physical
exercise and the use of hot packs or insulated blankets as common
alternatives.

Heat is the main quality associated with perspiration. Depending on

the method used (sauna or steam), the extent of loss of moisture can
be beneficial or harmful. Steam baths can be of benefit in most disor-
ders, whereas saunas should be used with caution in qualitatively Dry
& Hot and Hot & Dry disorders.
Clinical application
Sensible perspiration is most effective in removing toxins, both natu-
ral and synthetic. Steam or Turkish Baths are recommended when
problems arise from impurities in the body, such as drug or anaes-
thetic gas residues. Profuse sweating by these means helps to carry
impurities out through the pores of the skin. This type of perspiration
may also be a short-term answer to water retention in the body.

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Several ailments benefit from induced perspiration, including skin

disorders such as psoriasis, obstruction of sweat and sebum ducts
which lead to body odour, and undue fever. Some symptoms of arthri-
tis, especially body aching, often benefit.

4. Hydrotherapy

Hydrotherapy is the use of water for health promotion or treatment

of diseases, with variations of temperatures, pressure, duration, and
site.

Hydrotherapy has been used for many centuries, especially in Greek,

Roman and Arabic communities.

Rationale
Hot water dilates blood vessels, so increasing blood flow to the skin
and muscles. At the same time it reduces the flow of blood to the in-
ternal organs. It soothes and relaxes. Cold water constricts the flow
of blood to the skin and muscles, but increases blood flow to the in-
ternal organs. It also inhibits the biochemical reactions responsible
for uncontrolled inflammation. Cold water stimulates, easing muscle
tension and spasms. Hydrotherapy has a generally positive effect on
Physis, so has a general tonic effect on people who practice it.

Clinical application
Hydrotherapy improves blood circulation so increasing oxygen and
nutrient flow. It boosts the immune system in its efforts to combat tox-
in accumulation so benefiting patients with a wide range of ailments,
from acne to arthritis, and sleep disorders to headaches. It is very ef-
fective in dealing with stress-related disorders of the mind and body.

5. Diuresis

Diuresis is the increased excretion of urine via the kidneys.

The processes which lead to diuresis are helpful in eliminating abnor-

mal bilious humour and wastes from the liver and circulation through
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Rationale
The use of natural diuretics such as tea or spring water reduces the
risk of kidney stones forming. In Western medicine there is a large
number of synthetic diuretics which are administered for the treat-
ment of oedema, heart failure, hypertension and other Cold & Moist
disorders. However, the relatively rapid loss of fluid can lead to elec-
trolyte imbalance, especially loss of the mineral potassium. These
often result in muscle cramps, and sometimes heart arrhythmias.

Clinical application
A number of common kidney-related ailments respond favourably to
diuresis. Amongst these are hypertension, peripheral oedema, the
nephritic syndrome, renal calculi, kidney infection and urinary tract
infection.

6. Enema

An enema is a volume of fluid which is infused through a tube via the

anus into the rectum.

An enema contains soap, sesame or olive oil, and is used to dislodge

impacted faeces which form in severe cases of constipation.

Rationale
An enema cleanses accumulated toxins, especially those associated
with the melancholic humour, from the lower digestive tract Regular
enemas of this type are thought to reduce the risk of colon cancer
developing. Enemas are used for various specific reasons, and are
especially good for melancholic disorders.

Clinical application
As an enema has a preponderant local action, the ailments which re-
spond are those originating in the lower digestive tract, such as irrita-
ble bowel syndrome, severe constipation and colitis. Other disorders
which may respond are backache and sciatica, and a regular enema
is often of value in reducing unwanted weight gain.
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Enemas are more suitable when purgation is not ideal and where
faecal obstruction exists in the colon. Enemas should not be given to
someone with digestive or respiratory disorders or to young children.

7. Purgation

Purgatives, aka laxatives or cathartics, act to increase the frequency

of bowel movement, or encourage the formation of a softer or bulkier
stool.

Rationale
Purgation helps the body move undigested dietary material more ef-
fectively, so preventing the occurrence of blockage as ileus or convol-
vulus. The time of exposure of the inner lining of the lower intestine to
toxins for abnormally long periods is reduced.
Purgation is the cleansing of excess of three humours - bilious, phleg-
matic and melancholic – from the tissues, plus the purification of the
blood toxins. A number of different herbs can be used as purgatives.
Commonly used natural purgatives are aloe vera, jelapa, senna and
its derivatives, milk of magnesia, ispaghula husk, and other bulking
agents. When taking these agents, it is important to adhere to a re-
stricted diet. Purgation can be done twice a year whereas the use of
laxatives which is less harsh should be done at least once a month.

Strength of the purgative

• For bilious disorders, the purgative should be light.
• For melancholic disorders, the purgative should be moderate.
• For phlegmatic disorders, the purgatives should be moderate to
strong.

Clinical application
A number of ailments respond favourably to purgation. They include
skin disorders such as vitiligo and psoriasis, digestive complaints like
constipation and hyperacidity, and anal fissures.

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8. Massage

Massage is the therapeutic hands-on manipulation of the muscles

and other soft tissues of the body.

“The way to health is to have a scented bath and an oiled mas-

sage every day” [Hippocrates]

Massage has been practiced in the Middle and Far East for at least
5000 years, and is arguably the oldest therapy known. The relaxing
and healing powers of massage have been well documented. It first
relaxes, then stimulates, and finally invigorates both the mind and the
body. It confers both physiological and a psychological benefits.

Rationale
Constant manual pressure on the skin transfers deep into the body’s
tissues, affecting blood vessels and lymph channels. It also affects
nerve fibres, so influencing the nature and number of messages
which are being transmitted to the brain. Deeper pressure stimulates
systemic blood circulation and the digestive system. Massage also
influences immune functioning.

Tibb recognises the importance of touch in the care of the body. It ac-
cepts that massage therapy is able to support and enhance Physis in
its healing role. The focus of massage is removal of accumulated tox-
ins and/or qualities of coldness and moistness that have penetrated
the tissue or muscle area.
Tibb advocates the use of botanic oils in therapeutic massage. They
are chosen not only on the basis of their pharmacological activity but
also on their heating, cooling, drying and moistening qualities. Differ-
ent oils possess different pharmacological actions (see aromatherapy
section). The qualities possessed by these oils vary widely. Olive oil,
for example, is Hot & Moist, whereas sesame oil is Cold & Dry. Com-
bining different oils changes their qualitative nature, so the massage
therapist matches the oil used to suit the patient’s temperament and
presenting disorder.

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Treatment is aimed at alleviating symptoms and restoring the quali-

tative imbalance underlying the ailment. As well as the patient’s ail-
ment, the massage therapist considers the patient’s temperament,
age and sex, and the type of massage indicated.

Clinical application
Massage provides many benefits, as it leads to a better functioning
Physis. These benefits the whole body: they occur across the spec-
trum of physiological systems. Improved blood and lymph circulation
usually leads to less spasm and tension, and better skeletal muscle
tone, Troubling headaches often resolve, as does peripheral oedema.
There is a significant calming of the mind, which improves sleep
quality.
The skin, not surprisingly, responds well to regular massage. The
sweat and sebaceous gland function better, the build-up of dead sur-
face tissue is reduced, and the formation of subcutaneous adipose
tissue is reduced. Overall, cosmetic improvement leads to a healthier
appearance and increased self-esteem.

9. Somatic Balancing Technique

“Get knowledge of the spine, for this is the requisite for many
diseases”. [Hippocrates]

Hippocrates realised that spinal alignment problems could develop

into chronic ailments. He confirmed this observation with a primitive
thermal scanning technique using mud, noting which areas of the skin
dried first. From this he deduced which spinal level controlled a par-
ticular internal organ.

Rationale
It was only in the mid-1900s that Dr Andrew Taylor Still, the ‘Father
of Osteopathy’, took this further, and described in considerable de-
tail the functional relationship between the patient’s spine and his or
her internal organs. His therapeutic technique of Somatic Balancing,
which is consistent with Tibb philosophy, gently readjusts the spine,

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pelvis and limbs, so releasing both physiological and physical block-

ages that have developed due to humoral imbalances. This allows
Physis to re-establish “continuity” and restore health. Tibb considers
the Somatic Balancing Technique as one of the established elimina-
tive therapies.

Clinical application
Different vertebrae are associated with different internal organs. For
example, the thoracic T3 vertebra is linked to the lungs, bronchial
tubes, pleura and chest, whereas lumbar L2 vertebra is linked to the
appendix, abdomen and upper leg. Further examples are shown in
the table:

Table 19: Relationship between vertabrae and specific ailments

Spinal Vertebra Part of Body Some ailments resulting

Region No. served from dysfunctional
(selected) imbalance

Cervical C1 Head, face, Headaches, insomnia,

C6 sympathetic hypertension, Cough, stiff neck,
NS inflammation of tonsils
Neck, tonsils,
shoulders
Thoracic T1 Arms, hands, Asthma, dyspnoea, pain in
T6 oesophagus hands and arms
Stomach Digestive disorders: Indiges-
tion, heartburn
Lumbar L1 Large Constipation, diarrhoea, some
L5 intestine hernias, Leg cramps, cold feet,
Lower legs, swollen ankles
ankles, feet
Sacral --- Pelvic girdle, Disorders of lower body, spine
buttocks deformities

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Spinal Vertebra Part of Body Some ailments resulting

Region No. served from dysfunctional
(selected) imbalance

Coccyx --- Rectum, Haemorrhoids, pruritus

anus

As this technique will restore continuity between the nervous and other
systems it will benefit conditions of the musculoskeletal system, such
as lower back pain, sciatica, tendonopathies, fibromyalgia, whiplash
injuries as well as conditions such as asthma, gastrointestinal distur-
bances, menstrual irregularities, and migraine.

10. Leeching (hirudotherapy)

Hirudotherapy is the clinical, controlled use of leeches, applied to re-

move blood where it has accumulated under the patient’s skin and
mucous membranes.
Also known as leeching, hirudotherapy has been used for millennia
for bloodletting, and in the treatment of a wide range of ailments. Hip-
pocrates used it to treat various disorders such as thrombosis, which
were related to an imbalance of the sanguinous humour, and Galen
was himself an enthusiastic hirudotherapy practitioner for pain relief.
The technique is now experiencing a revival in its practice, especially
for treating post-surgical complications, osteoarthritis of the knee, and
for cosmetic improvement.

Rationale
The leech used, Hirudo medicinalis, is a species of small parasitic
worm, with blood suckers at each end. Its saliva contains a natural
anti-coagulant (hirudin) which prevents the formation of blood clots
(thrombosis). This makes it particularly effective for removing coagu-
lated blood which has pooled under the skin and mucous membranes.

Clinical application
Together with cupping and venesection, hirudotherapy is one of Tibb’s
major eliminative therapies.
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As a method of bloodletting, it is used to restore humoral harmony

where an excess of blood is the underlying problem, for instance cer-
tain types of headache. Leeches are particularly effective for removing
blood which is denatured, so are used for the relief of haemorrhoids
and to improve cosmetic appearance by clearing black eye shadows.
In practice they are applied to the skin and mucous membrane. Hiru-
dotherapy is now extensively used following micro-surgery to restore
blood flow in blocked blood vessels. Although usually well tolerated,
the technique can cause local inflammation and infection.

11. Venesection

Venesection, aka phlebotomy, is the removal of venous blood from

the circulatory system via surgical incision or puncture of a vein, usu-
ally in the brachial flexion of the arm, in order to remove excess blood.
It is used for the treatment for certain blood disorders, diagnosis
and blood donation.
Venesection has been practiced by almost all cultures and societ-
ies at some point in their medical history. It is based on beliefs about
health and disease originally held by the ancient Greek philosopher/
clinicians. They thought that many diseases were caused by an over-
abundance, or plethora, of the dominant sanguinous humour, and
these plethoras could be treated by reducing food intake, induced
vomiting and venesection.

Venesection was very popular from ancient times until well into the
nineteenth century, and considered to be part of the treatment for
practically every ailment. It subsequently became less popular, large-
ly due to controversy about the amount of blood removed.

Rationale
The practice is based on the humoral theory. Blood is equivalent to the
sanguinous humour, and derived from the food and drink consumed.
When the four humours are in balance, then good health prevails.
Conversely, if out of balance, then diseases will develop. Venesec-
tion was therefore a logical way of restoring humoral balance. After it
was carried out, measures were taken to promote inner healing, with
supplements and herbs. 244
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Clinical application
Venesection is generally practiced by a skilled surgeon to reduce
pathologically high haemoglobulin levels, polycythaemia vera, or to
treat the hereditary iron storage disorder, haemochromatosis. It is a
preliminary procedure before infusing therapeutic fluids, certain drugs
and ‘cleansed’ blood. In general surgery it is routinely employed as
part of catheterisation and cardiography. If the patient is too young,
old, or weak to tolerate venesection, wet cupping is often used in-
stead.Therapeutically, donating blood at least yearly appears to lower
the risk of a heart attack, as it reduces raised blood pressure. As a
technique used today it is effective, works rapidly, and has minimal
side effects such as dizziness and tiredness.

12. Cupping

Background
Therapeutic cupping (aka fire cupping) is the practice of applying a
partial vacuum by means of heat or suction in bell-shaped vessels
(suction cups) to specific and different parts of the skin. The tissues
beneath the cup swell and drawn up into the cup, so increasing blood
flow to this area. This draws impurities and toxins away from the near-
by tissues and organs towards the surface for elimination. The time
the suction cups are left in place varies according to the patient’s age
and physical constitution, and the medical disorder being treated.

“Cupping is the most helpful act for human beings to cure them-
selves with” [Prophet Muhammad [PBUH]

Historical development of cupping

Cupping has been practiced since ancient times, at least 2500 years.
It was applied by the Babylonians, the Egyptians in Pharaonic times,
and by the early Chinese. In these times, cupping was carried out
using bamboo tree sections, bulls’ horns or metal cups. Air was re-
moved originally by sucking, and later by burning tapers or cotton to
remove air enclosed in the cup.

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Hippocrates describes cupping in his Guide to Clinical Treatment, and

recommended it for the treatment of angina, menstrual disorders and
numerous other ailments. Later, Galen was a committed practitioner
of the procedure.

After a long period of decline in its use, cupping was revived in the
Islamic age. Strict adherence to rules of application was demanded,
with close attention paid to the practical process, timing and the na-
ture of the patient’s disorder.

In Europe, cupping was advocated by many medical pioneers, includ-

ing Paracelsus and Ambrose Paré. This technique has been used by
practitioners of Western medicine for many centuries to treat a range
of diseases.
Traditional healers in many parts of the world use cupping or versions
of it. Some healers in North America use sea shells instead of cups,
and others use buffalo horns. In parts of Europe, Asia and Africa hol-
low animal horns are used effectively as cupping devices.

Types of cupping

There are two major forms of cupping:

Dry cupping: The practice of applying a cup under partial vacuum to

specific parts of the body. In this procedure no blood is drawn. This
procedure always precedes wet cupping.

Wet cupping: The skin immediately below the cup is cross-cut lightly
several times – lacerated – so that blood may actually be drawn by
the vacuum from the skin into the cup.

The time the suction cups are left in place varies according to the pa-
tient’s age and physical constitution, and the medical disorder being
treated.

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Dry cupping is always used before wet cupping is considered. Wet

cupping is only applied when repeated use of dry cupping has proven
to be ineffective clinically. The use of whichever form of cupping is at
the discretion of the practitioner.

Cupping and Traditional Chinese Medicine

Chinese healers describe the process of cupping as directing the chi
energy to flow towards the cupping area and promote healing. Cup-
ping warms local tissue and promotes the free flow of Chi energy and
blood, so dispelling cold and dampness. Cupping also stimulates acu-
puncture points, and releases biological opioids called endorphins.

“When energy flows, illness goes” [Chinese aphorism]

Cupping therapy has been further developed as a means to open

the meridians of the body. Meridians are the conduits through which
energy flows to every part of the body, so reaching all tissues. Many
healers consider cupping as the best way of opening those meridians.

In practice, cupping is used to treat Bi syndrome caused by wind and

dampness, resulting in pain from musculo-skeletal, respiratory and
gastrointestinal disorders. Cupping is often combined with bloodlet-
ting for joint trauma.

Rationale
Tibb accepts cupping as one of the oldest and most effective methods
of mobilising toxins from the body’s tissues and organs. It supports
its use in treating the pain and discomfort of disorders of the lungs
and other internal organs, muscle spasms, joint pains, and numerous
other ailments.

Cupping assists Physis in the healing process by drawing inflamma-

tion and pressure away from the vital organs, especially the heart,
brain, liver, lungs and kidneys, towards the skin. Increasing blood cir-
culation to the area where the cup is placed improves nutrition flow to
that particular region.

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Clinical application
The clinical benefits of cupping have been extensively researched
and documented. The benefits of cupping continue for several days
after the procedure. It demonstrates extended action.

Cupping acts in support of a number of organ systems:

• The liver – by increasing blood perfusion, so helping remove the

metabolic load imposed by the disease.
• The immune system – by acting on the blood-forming (reticulo-
endothelial) system to help it oppose the actions of invading
microbes.
• The nervous system – by helping to reverse ischaemia, which
can lead to circulatory disorders in the brain, such as memory
disturbances, epilepsy and emotional disorders.
• The renal system – by helping to reverse the ischaemia which
underlies many kidney disorders.

Cupping is performed on the skin surface, so has little direct influence

on the arterial blood supply. However, it does influence the lymphatic
and venous systems, which contain ‘used’ blood and toxins.

As cupping acts to support and enhance Physis, the list of disorders

which benefit from the technique is comprehensive, ranging from mi-
crobial infections, musculoskeletal and circulatory disorders, diges-
tive system ailments, skin lesions and malfunctions of the endocrine
system.

SURGERY

Historical background

In the Egypt of the Pharaohs (1,600 BCE), major operations are not
mentioned, although simple surgical procedures treating fractures
and joint dislocations for example, were carried out routinely. Circum-
cisions and the removal of eye cysts or tumours were recorded as per-

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formed with a range of bronze practical instruments. Good recovery

was claimed, as the wounds were often cauterised and treated with
herbs such as willow, which has antiseptic and analgesic properties.

In the time of Hippocrates, one of the early pioneers of Tibb medi-

cine, major surgery as we know it today was rarely if ever carried out
because of the risks involved. The non-availability of anaesthesia,
surgical techniques and instruments, infection control and pain relief
militated against extensive surgery. Even so, minor surgery was car-
ried out quite routinely, especially in and after the many periods of
conflict and natural disaster, where the need for surgical intervention
was immediate and urgent.

“What medicine will not cure, the knife will cure; what the knife
will not cure, the cautery will cure; what the cautery will not cure,
may be considered incurable” [Hippocrates]

Amputations of wounded or gangrenous limbs, for example, were car-

ried out using techniques and instruments which were still available
many centuries later. Cauterisation of open wounds was also widely
used.

Routine surgery with ligature and cautery for haemorrhoids and open
wounds was commonly carried out. Operations were supported by
the liberal use of honey, wine and vinegar, the application of plants
such as laurel and olives, as well as the use of frankincense and
myrrh. Post-operative care was reasonably high, even by our pres-
ent day standards. Certain invasive procedures, such as draining the
chest of someone with emphysemia or pleurisy, were carried out, as
was the removal of malignant or benign tissue masses.

Apart from Hippocrates and the physicians of his school on Cos, such
as Praxagoras, others were also noted to have performed surgical
procedures. They included Erasistrasus and Herophilus, who helped
reveal the mysteries of the human anatomy.

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Galen, several centuries later, drew much on the ideas and experi-
ence of Hippocrates. He specialised in the subject of anatomy. Major
advances in this area were made, though not all of them were that ac-
curate, as history would later prove. No notable advances in surgical
techniques were made as he was prohibited from study of the human
body for theological reasons.

In the time of the Golden Age of Muslim culture, the practice of medi-
cine and surgery assumed a central role. Over a few centuries, Islam-
ic physicians and surgeons assiduously developed a vast and com-
prehensive Materia Medica. In a dynamic climate of receptiveness
to new concepts and techniques, major advances were made in the
understanding of the human body in sickness and in health, and also
in the practical aspects of surgery. These advances were fortuitously
aided by the novel introduction of hospitals, which allowed surgery to
be conducted in a sanitary, pleasant and safe environment, thus en-
couraging better recovery and recuperation.

Abu al Qasim al Zahrawi is to this very day recognised as a valuable

contributor to the theory and practice of surgery. He is considered as
the greatest medieval surgeon, and regarded as the “Father of Sur-
gery”. His epochal encyclopaedic book, Kitab al-Tasnif, was the basis
for the resurgence of surgical practice, and his influence in, for exam-
ple, techniques and instruments in ophthalmologic practice, persists
to this day. The Latin translation of this book was highly influential in
reviving surgical practice during the European Renaissance, and of-
fered a valuable and reliable reference work for several centuries.

Al-Zahrawi invented numerous advancements in surgical instruments

and described in detail the operations in which they could be used.
Common disorders like cataracts and trachoma became treatable
with these new techniques and instruments. Many authorities affirm
that the contributions of this pioneer were the impetus to have routine
surgery taken away from the grasp of charlatans and amateurs, and
established its true place in rational medicine.

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Other important contributors to advancements in surgery were Ibn Al-

Haitham and Haly Abbas, whose texts on various diseases amenable
to surgery were the standard reference books in the West until recent
times.

Two surgical interventions which were routinely carried out in the

Golden Age and continue to this day are cauterisation and therapeu-
tic cupping. Although the underlying concepts behind the techniques
remain the same, both have been modified to reduce the incidence of
unwanted consequences such as infection and excessive pain.

A major limitation to surgery in ancient times was the real and severe
risk of post-surgical infection. This threat limited surgery to amputa-
tion following severe trauma, bone-linked disorders such as fractures,
and life threatening conditions like kidney stone. Surgeons in the
Golden Age acknowledged these obstacles, and dealt with them in
several ways. One was scrupulous attention to cleanliness, cleaning
the operating field with herbal agents like rose water, various resins,
vinegars and medicinal wine. Frankincense and myrrh were popular
as aids in surgery, as was the use of opium and digitalis as painkillers
and hemlock as an anaesthetic.

Unfortunately not much progress has been made in Tibb as far as

surgery is concerned, compared to the significant progress made in
Western medicine. Could this possibly be because of Western medi-
cine’s disregard to the Hippocratic principles of “pepsis” which has
resulted in an accumulation of toxins/humoral imbalances resulting
in blockages, abscess, growths and various other structural changes
requiring surgical intervention.

TIBB AND INTEGRATIVE MEDICINE

Overview
There has been a huge cultural shift worldwide in the way people
view healthcare, and this has given rise to Integrative Medicine (IM).
This is a holistic form of healthcare that combines complementary

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and Western medicines in the treatment of acute, chronic, and recur-

ring disorders. As well as the physical aspects of the patient, it is also
concerned with the psychosocial and spiritual dimensions. IM merges
Western and complementary diagnostic procedures as a preliminary
to therapy. Treatment deals initially with the presenting symptoms,
largely by use of Western drug therapy, and subsequently addresses
the underlying disorder by applying selected forms of complementary
medicine. Tibb is a well-established healing system which has tradi-
tionally been practiced widely in many countries. It is ideally situated
as a partner for Western medicine for a number of reasons: it focus-
es on supporting inner self-healing processes; it advocates realistic
lifestyle-linked changes in behaviour; it involves the patient in both
diagnosis and treatment; and it can provide a number of therapeutic
options of proven efficacy. Furthermore, it is consistent with Western
medical therapy, as they both share a common ancestry. IM is espe-
cially effective in dealing with chronic, refractory or recurring disor-
ders. It focuses on support and stimulation of the person’s Physis, the
body’s innate healing mechanisms, rather than just alleviating symp-
toms of the disorder. It achieves this by combining realistic lifestyle
changes, individualised therapies and selected herbal therapy. Active
involvement and motivation of the patient is a key factor in accurate
diagnosis and successful therapy, and in achieving and maintaining
optimum health.

Description
IM critically selects the best, scientifically proven therapies from both
Western and complementary systems for the treatment of both chron-
ic and acute clinical disorders.

“The deliberate practice of medicine that selectively incorporates

concepts, values and practices of complementary, alternative
and orthodox medicine into comprehensive diagnosis and treat-
ment plans”. [Dr Andrew Weil]

The primary function of IM to the patient is the prevention of disease.

An important element to the healing process is that it is patient, not

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disease, centred, so a partnership between the patient and the prac-

titioner is desirable. In turn, the practitioner should be aware of best
available clinical practice, and of the relative contribution that both
medical paradigms are capable.

The increasing application of IM

For several years there has been a discernible move away from West-
ern medicine towards the so-called alternative and complementary
medicine (CAM). There are a number of reasons for this disillusion-
ment with Western medicine. The cost of Western medicine has been
escalating significantly; the adverse drug reactions encountered by
the patient; the poor quality of the doctor/patient interaction; the ac-
ceptance that behaviour modification is a plausible option in treating
chronic disorders; the general movement towards more natural, less
harmful way of healthcare.

As a result of this movement, a great deal of interest in CAM theory

and practice has developed. Traditional therapeutic and healing sys-
tems, such as Ayurveda, Tibb and Chinese Herbal Medicine, and more
recent arrivals, such as homeopathy and chiropractic have emerged
into the mainstream. Aspects of CAM therapy, such as acupuncture,
hydrotherapy and herbalism now enjoy widespread application.

Features
IM focuses on improving the patient’s health or maintaining wellness,
rather than just alleviating the presenting disease. Furthermore it ac-
cepts that the patient’s Physis is a potent natural self-healing mecha-
nism which restores stability, or homeostasis, and that this should be
supported and stimulated, not inhibited or ignored, as it often is in
Western medicine. It also acknowledges that the patient’s emotions,
mind, spirit and even community, as well as his or her body, also have
a significant part to play in the healing process, recuperation from ill-
ness and health maintenance.

Diagnosis in Integrative Medicine

By applying the philosophical principles of Tibb, especially tempera-

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ment and humours, to the diagnostic capabilities of Western diagno-

sis, we are able to not only measure the changes but to also under-
stand why the changes occur. With today’s technology, functional and
structural imbalances in clinical conditions, together with their associ-
ated symptoms, are easily diagnosed and have been appropriately
identified and labelled.

For example, Tibb diagnosis explains why hepatitis is associated with

the qualities of heat and dryness, why the symptoms of colds and flu
are associated with Cold & Moist qualities, and why the symptoms of
insomnia, dry cough and constipation are linked to excessive dryness.

Integrative Medicine in clinical practice

IM adopts natural, minimally invasive procedures wherever possible,
especially for chronic or recurrent disorders. It uses procedures, both
Western and complementary, which are proven effective on an empir-
ical or scientific basis, and backed up by acceptable clinical practice.
It recognises the pre-eminence of Western medicine in the treatment
of acute, emergency and life-threatening disorders. In addition, it ac-
cepts the major role of complementary medicine in chronic and recur-
ring diseases, and disorders brought about by an imprudent lifestyle.

Tibb as a partner for Integrative Medicine

Tibb is well placed as the complementary component in the partner-
ship with Western medicine, as it provides a wide range of lifestyle
adjustments (particularly diet and exercise), habit changes, pharma-
cotherapy and physical practices which have proven health benefits.
Addressing the causes of chronic disorders has always been a cen-
tral tenet of Tibb. For example, a recent study confirmed the benefit
of lifestyle adjustment – specifically diet and exercise – to the marked
improvement of patients exhibiting unequivocal signs and symptoms
of the metabolic syndrome. Hypertension, dyslipidaemia, obesity and
glucose intolerance were significantly reduced by lifestyle changes
carried out by the subjects. Tibb restores to medicine the precepts
and practice of Hippocrates and Ibn Sina that have been largely dissi-

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pated in the past 300 years or so, beginning with Descartes, and end-
ing with the doctrine of specific aetiology. Another factor in favour is
the similarity of Tibb to Western medicine, in that it is more ‘metabolic’
orientated, rather than ‘energy’ orientated, as is the case with some of
the traditional Eastern systems of medicine.

CHAPTER REVIEW

Therapeutics in Tibb can be divided into four categories: pharmaco-

therapy, lifestyle modification, eliminative therapies, and surgery. This
chapter deals with each of these, with particular attention paid to the
Tibb philosophy of temperament, qualities and humours, and the na-
ture and contribution by Physis.
The treatment of illness via Western medicine differs from the Tibb
approach in that most conditions are dealt with by taking medication,
which in many cases results in troublesome side effects. These then
often require yet more drugs to deal with the side effects that invari-
ably occur in the longer-term.

In contrast, Tibb treatment aims to restore homeostasis with a wide

range of therapeutic options to restore the patient’s humoral qualita-
tive state, as well as renewing the ideal temperament, depending on
the underlying disturbance in the body’s internal harmony. This leads
initially to improved functional activity, then to repair of any resulting
tissue or organ damage. Tibb treatment also recognises a patient’s
temperament as a key factor in treatment.

Physis and healing: Tibb attaches great importance to assisting our

inner doctor, Physis, in maintaining homeostasis in the body. Physis
is our inborn potential for self-healing, which exists and operates in all
living beings from the sub-cellular level up to the complete functioning
organism. This is achieved by adherence to the Tibb Lifestyle Factors
and avoidance of agents, such as certain Western drugs and prac-
tices, which compromise its full action. All Tibb therapies are geared
to supporting and enhancing Physis in the healing processes, and
avoiding or minimising the actions of certain substances or technique
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which oppose, diminish or ignore its activity.

Therapeutic guidelines: Tibb is an eminently practical healthcare

paradigm. It offers guidelines for the successful application of its vari-
ous therapies, translating its philosophical principles into everyday
practice. It deals specifically with illnesses such as microbial infec-
tions, or those arising from sudden or temporary changes in qualita-
tive and humoral balance. It offers realistic advice on the treatment of
complex illnesses, or where there are multiple chronic conditions.

Pharmacotherapy: Is the treatment of physical and mental disorders

with herbs mainly and their derivatives, but also with animal products
and essential minerals. It is widely practiced form of treatment extend-
ing far back into recorded history. It is probably the most important
therapeutic option today for the majority of the world’s population, ei-
ther as stand-alone therapy, or as part of traditional healing systems.
Herbal medicine was side-lined due to the emergence of synthetic
chemical drugs early in the 20th Century but is now experiencing a
significant revival. It is one of the major Tibb therapeutic interven-
tions, alongside dietary modification, lifestyle adjustment, and physi-
cal therapies. Ibn Sina laid the foundations of Tibb pharmacotherapy,
describing a vast range of effective remedies, and these became the
model for numerous pharmacopoeias. The use of herbal remedies is
expanding rapidly, and demand is increasing, for more information
of their pharmacological action. This is not yet available for many ef-
fective herbs, especially as research in this area poses numerous
challenges not faced by the study of Western drugs. Herbs contain
many active agents, their precursors and derivatives, from alkaloids
to glycosides, and flavonoids to saponins, and often combine several
different plant species, this variety of active agents not only amelio-
rates the signs and symptoms of a disease but help restore internal
homeostasis within the body’s organs and tissues. Tibb pharmaco-
therapy is based on the fundamental principles of the temperamental
and humoral theories and aims to assist physis in restoring qualitative
and humoral imbalances. Herbs in Tibb are characterised into de-
grees of activity, or orders, according to their qualitative nature and ef-

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fect on the patient, a feature which is unique to Tibb. Tibb pharmaco-

therapy differs from its Western counterpart in several key respects.
Western drugs, in many cases are derived synthetically from herbal
extracts, and act according to the receptor theory. Although this al-
lows for a more specific pharmacological action, it does expose the
patient to increased risk of adverse drug reactions. In addition, it fails
to acknowledge physis’ critical regulating and healing roles, and with
many drugs actually oppose and negate them. Tibb herbal remedies,
conversely, act to support and enhance physis. They act holistically
as a result of their natural synergistic and metaphysical properties.
As the mechanisms of action largely differ to those of Western drugs,
Tibb pharmacotherapy allows for effective integration with these for
enhanced clinical effect, although the possibility exists of pharmaco-
kinetic and pharmacodynamic interaction between herb and drug.
Lifestyle modification and emotional support therapy: These gen-
tle, non-intrusive and self-help therapeutic options include dietothera-
py, physical exercise, breathing, meditation and relaxation, visualisa-
tion, colour therapy, music therapy, psychotherapy and counselling,
The rationale and the clinical application of each of these therapies is
dealt with.

Eliminative therapies: Elimination is the process of detoxification of

accumulated waste products, and removal of excess/abnormal hu-
mours from the body. According to Ibn Sina, elimination procedures
not only dislodge or divert the diseased matter from the site of illness,
but also direct this matter to the appropriate exit routes for elimina-
tion. From the Tibb perspective, the correct treatment of disease is
to assist the natural eliminative functions of the body. Ibn Sina pro-
vides detailed guidelines for the elimination of waste from the body,
and qualified these with reasonable safety concerns, especially when
potent drugs are administered. Tibb recognises the role of Physis in
effective, regular elimination, and sees its actions in the light of hu-
moral/qualitative imbalance. The body’s natural elimination routes are
reviewed, especially respiration, urination and perspiration. Induced
modes of elimination including sneezing, emesis, hydrotherapy, di-
uresis, enema, purgation, massage, somatic balancing technique, hi-
rudotherapy, venesection, and therapeutic cupping, is discussed. The
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rationale behind each of these, together with the expected benefits for
the various illnesses, is included. Cupping, for instance, is detailed in
its various formats, its practical application, clinical benefits, target ill-
nesses, and precautionary guidelines. The underlying mechanism of
action is the support of Physis, by restoring the body’s homeostasis,
and normalising temperament, structural and function of the various
systems of the body.

Surgery: Although this aspect of therapy is outside the scope of this

chapter, it should be acknowledged that surgical techniques hold an
important position in Tibb. Amputation and wound treatment were
common practices in ancient Egypt and Hippocratic Greece, and as
anatomical knowledge improved, so surgery advanced. Muslim physi-
cians refined the techniques of, and subsequently developed a range
of surgical operations, especially of the eye. The Latin translation of
Islamic surgeons was highly influential in reviving surgical practice
during the European Renaissance, and offered a valuable and reli-
able reference work for several centuries.

Integrative Medicine: This incorporates elements of complementary

and Western medicine into diagnosis and treatment of diseases. It
focuses on health and healing by supporting the body’s innate healing
abilities. The complementary arm of IM can resort to specific thera-
peutic techniques like acupuncture, or broadly adopt particular medi-
cal paradigms such as Tibb. IM has a role to play in the treatment of
acute disorders, mainly via the conventional, Western, arm of treat-
ment, and chronic disorders, mainly via the complementary route. It
should be considered for the increasingly prevalent chronic diseases
of lifestyle. For a number of reasons Tibb can be regarded as an ex-
cellent partner in IM.

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UK.

262
 ANNEXURE 1

ANNEXURE 1:
ARABIC TRANSLATION OF ENGLISH TERMINOLOGY

Terminology Arabic Terminology

Air Baad / Reeh
Animals-Plants-Minerals Mawaleed-e-Salaasah
Balanced Motadil
Bile Safraa
Bilious Safravi
Canon of Medicine Al - Qanoon Fi - al - Tibb
Carbohydrates Nishastajaat
Cause Sabab
Causes Asbaab
Cold Barid
Coldness Barudat
Disease Maradh
Dry Yabis
Dryness Yabusat
Earth Khaak / Ardh
Elimination Istafraagh
Energies Arwaah
Energy Rooh
Environmental Air Hava-e-Muheet
Faculties Quwaa
Faculty Quwat
Fire Aatish / Naar
Food and Drink Makulaat wa Mashrubaat
Formal Cause Sababe Tammami / Sauri
263
 ANNEXURE 1

Galen Jalinoos
Health Sehat
Heat Hararat
Hippocrates Buqraat
Hot Haar
Humour Khilt
Humours Akhlaat
Imbalanced Ghair Motadil
Inflammation Waram
Lipids Shahmiyaat
Main Organs Aadhaa-e-Raeesah
Material Cause Sabab-e-Maaddi
Melanchole Sauda
Melancholic Saudavi
Metabolic Faculty Quwat-e-Tabiyyah
Moist Ratab
Moistness Ratubat
Organs Aadhaa
Patient Mareedh
Phlegm Balgham
Phlegmatic Balghami
Physician Tabeeb
Physis Tabiyat
Primary Matter Maadda-e-oola
Protein Lahmiyaat
Psychic Quwat-e-Nafsaniyah
Qualities Kaifiyaat

264
 ANNEXURE 1

Quality Kaifyat
Retension Ehtebaas
Sanguine Dam
Sanguinous Damawi
Six Lifestyle Factors Asbab-e-Sittah Zarooriyah
Sleep and Wakefulness Naum-o-Yaqzah
Temperament Mizaj
Tissues Aadhaa-e-Mufradha
Vital Faculty Quwat-e-Haiwaniyah
Vitamins Hayateen
Water Aab / Maa

265
 ANNEXURE 2

ANNEXURE 2:
PERSONALISED LIFESTYLE PROGRAMME FOR
DIFFERENT TEMPERAMENTAL COMBINATIONS

The factors underlying a person’s health and disease are closely linked
to lifestyle. Listed below are eight personalised lifestyle programmes
for the different temperamental combinations. This is in keeping with
Tibb philosophy, namely, giving equal importance to health promotion
and illness management. While the lifestyle programmes are based
specifically on the person’s temperamental combination, the different
stages of his or her life, from infancy to old age, also need to be taking
into account.

Each lifestyle programme includes the following:

• The dominant quality associated with the temperamental
combination,
• Examples of the different lifestyle factors that can increase this
quality,
• The various illnesses that each temperamental combination is
prone to,
• Guidelines on optimum health promotion and maintenance
through lifestyle factors for each temperamental combination.

1. Dominant bilious with sub-dominant sanguinous

This combination has a temperamental quality between bilious (Hot

& Dry) and a sanguinous (Hot & Moist) temperament. This results
in an overall dominant quality of heat, which is common in both the
temperaments.

As heat is the dominant quality associated with this

temperamental combination, an increase in heat from the Six
Lifestyle Factors will negatively affect this individual to the
greatest extent. An increase in moistness and dryness will also
affect, but to a lesser extent, whereas an increase in the quality
of coldness will be beneficial for this person.

266
 ANNEXURE 2

An increase in heat can result from:

Summer - very hot weather and environment - Hot and Dry food and
drink – anger - strenuous exercise - excessive awakening.

Illnesses that this combination will be susceptible are those of the

bilious temperament:
Stress - Migraine - Bronchitis - Hay fever - Nausea – Overactive thy-
roid – Endometriosis

This combination will be inclined to a lesser extent to illnesses of the

sanguinous temperament:
Congestive headache - High blood pressure – Diabetes - Urinary tract
infection - Rheumatoid arthritis - Pre-menstrual tension.

Health maintenance for this temperamental combination:

Positively affected by:
• Fresh air and a cool, properly ventilated environment.
• Including more fruit and vegetables than meat in your diet.
• Increase daily water intake.
• A good night’s sleep (6 to 8 hours).
• A 5 -10 minute relaxation break after lunch.
• Meditation and breathing exercises are helpful, especially during
times of emotional turmoil.
• Exercise in the early morning and late afternoon

Negatively affected by:

• Weather, environment, work and leisure activities that increase
heat and dryness.
• Excessive intake of alcohol, tea and coffee.
• Excessive movement and strenuous exercise.
• Lack of sleep (less than five hours on a regular basis) and late
nights.
• Extreme emotions of anger, excitability, irritability and suppres-
sion of anger.
• An excess of a Hot & Dry diet especially in hot weather.

267
 ANNEXURE 2

Advice: In humid weather it benefits the person to reduce the

intake of Hot & Moist food and drink. The excess humidity can be
counteracted by effectively applying the six factors and by includ-
ing Cold & Moist and Cold & Dry foods.

2. Dominant bilious with sub-dominant melancholic

As dryness is the dominant quality associated with

this temperamental combination, an increase in dryness from
the Six Lifestyle Factors will negatively affect this individual to
the greatest extent. An increase in heat and coldness will also
affect, but to a lesser extent, whereas an increase in the quality of
moistness will be beneficial for this person.

Any change in the ideal level of dryness, especially an increase in

dryness will negatively affect this combination the most. An increase
in heat or coldness also has a negative effect, whilst moistness have
the least negative effect.

An increase in dryness can be as a result of:

Summer - very hot weather/environment - late winter - dry food and
drink – anger – sadness - strenuous exercise - excessive awakening
- irregular elimination of wastes.

Illnesses that this combination will be susceptible to are those of the

bilious temperament:
Stress - Migraine - Bronchitis - Hay fever - Nausea - Overactive thy-
roid - Endometriosis

This combination may also be inclined to a lesser extent to illnesses

of the melancholic temperament:
Insomnia - Osteo-arthritis - Hyperacidity – Constipation - Piles – Flat-
ulence - Colic - Gout

Health maintenance for this temperamental combination: Positively

affected by:
• Fresh air and a cool, properly ventilated environment.
• Including more fruit and vegetables than meat in the diet.

268
 ANNEXURE 2

• Increasing daily water intake.

• A good night’s sleep of 6 to 8 hours.
• A 5 -10 minute relaxation break after lunch.
• Meditation and breathing exercises are helpful, especially during
times of emotional turmoil.
• Exercise in the early morning and late afternoon.

Negatively affected by:

• Weather, environment, work and leisure activities that increase
heat and dryness.
• Excessive intake of alcohol, tea and coffee.
• Excessive movement and strenuous exercise.
• Lack of sleep (less than five hours on a continuous basis) and
late nights.
• Extreme emotions of anger, excitability, irritability, excessive
speech and suppression of anger.
• An excess of a Hot & Dry diet especially in hot weather.

Advice: In late winter and autumn, the intake of Cold & Dry food
and drink should be reduced. The excess cold and dryness is
counteracted by effectively applying the six lifestyle factors and
by including foods from Hot & Moist and Cold & Moist foods

3. Dominant sanguinous with sub-dominant bilious

As heat is the dominant quality associated with this

temperamental combination, an increase in heat from the Six
Lifestyle Factors will negatively affect this individual to the
greatest extent. An increase in moistness and dryness will also
affect, but to a lesser extent, whereas an increase in the quality
of coldness will be beneficial for this person.

Any change in the ideal level of heat especially an increase in

heat will negatively affect this combination the most. An increase in
moist-ness or dryness will also have a negative effect, whilst
coldness will have the least negative effect.

269
 ANNEXURE 2

An increase in heat can be as a result of:

Summer - very hot and humid weather or environment - hot and moist,
to hot and dry, food and drink - anger -strenuous exercise - excessive
awakening.

This combination will be prone to illnesses of the sanguinous tem-

perament:
Congestive headache - High blood pressure – Diabetes - Urinary tract
infection - Rheumatoid arthritis - Pre-menstrual tension

This combination may also be inclined to a lesser extent to illnesses

of the bilious temperament:
Stress - Migraine - Bronchitis - Hay fever - Nausea – Overactive thy-
roid – Endometriosis

Health maintenance for this temperamental combination:

Positively affected by:
• Keeping cool in hot weather and warm in wet weather.
• A diet that contains equal amounts of protein, fruit/vegetables
and salads. Seafood is excellent.
• A 15 to 30 minute morning walk or jog.
• Gardening and aerobic exercises.
• Six to seven hours sound sleep. Early to bed and early to rise
is best for everyone but especially for the dominant sanguinous
temperament.
• A 5 to10 minute relaxation break after lunch.
• Maintaining a high fibre diet for regular bowel movements.
• Increasing water intake for optimum kidney function.
• Cupping or blood donation 2 to3 times a year in summer or
spring reduces excess blood dominance in a sanguinous person.

Negatively affected by:

• Weather, environment, work and leisure activities that increase
heat and moistness - especially in humid weather.
• Inadequate rest and strenuous exercise.
• Sleeping more than 8 hours, or less than 3 hours, a night.
• Worries, anger and excessive excitement.
270
 ANNEXURE 2

• A large intake of white flour products as this will result in irregular

bowel movements. The colon should be kept clean.
• An excess of a hot and moist diet.

Advice: In summer reduce the intake of Hot & Dry food and
drink. The heat and dryness of summer can be counteracted by
effectively applying the six factors and by including Cold & Moist
and Cold & Dry foods.

4. Dominant sanguinous with sub-dominant phlegmatic

As moistness is the dominant quality associated with

this temperamental combination, an increase in moistness from
the Six Lifestyle Factors will negatively affect this individual to
the greatest extent. An increase in heat and coldness will also
affect, but to a lesser extent, whereas an increase in the quality of
dryness will be beneficial for this person.

Any change in the ideal level of moistness especially an

increase, negatively affects this combination the most. An increase
in heat or coldness will also have a negative effect, whilst dryness
will have the least negative effect.

An increase in moistness can be as a result of:

Rainy season, humid weather or environment - hot and moist, to
cold and moist, food and drink - excessive sleep/rest - depression
and fear - lack of exercise.

This combination will be prone to illnesses of the sanguinous tem-

perament:
Congestive headache - High blood pressure – Diabetes - Urinary
tract infection - Rheumatoid arthritis - Pre-menstrual tension.

This combination will be susceptible to a lesser extent to illnesses

of the phlegmatic temperament:
Asthma – Tonsillitis – Sinusitis – Anaemia - Anorexia

Health maintenance for this temperamental combination:

271
 ANNEXURE 2

Positively affected by:

• Keeping cool in hot weather and warm in wet weather.
• A diet that contains equal amounts of protein, fruit/vegetables
and salads. Seafood is excellent.
• A 15 to 30 minute morning walk or jog.
• Gardening and aerobic exercises.
• Six to seven hours sound sleep. Early to bed and early to rise
is best for everyone but especially for the dominant sanguinous
temperament.
• A 5 to10 minute relaxation break after lunch.
• Maintaining a high fibre diet for regular bowel movements.
• Increasing water intake for optimum kidney function.
• Cupping or blood donation 2 to3 times a year in summer or
spring reduces excess blood dominance in a sanguinous person.

Negatively affected by:

• Weather, environment, work and leisure activities that increase
heat and moistness - especially in humid weather.
• Inadequate rest and strenuous exercise.
• Sleeping more than 8 hours, or less than 3 hours, a night.
• Worries, anger and excessive excitement.
• A large intake of white flour products as this will result in irregular
bowel movements. The colon should be kept clean.
• An excess of a Hot and Moist diet.

Advice: In winter reduce the intake of Hot & Moist food and drink.
The coldness and moistness of winter can be counteracted by ef-
fectively applying the six factors to maintain body heat, and by
including Hot & Dry and Cold & Dry foods.

5. Dominant phlegmatic with sub-dominant sanguinous

As moistness is the dominant quality associated with this
temperamental combination, an increase in moistness from the
Six Lifestyle Factors will negatively affect this individual to the
greatest extent. An increase in heat and coldness will also affect,
but to a lesser extent, whereas an increase in the quality of dryness
will be beneficial for this person.

Any change in the ideal level of moistness especially an increase

272
 ANNEXURE 2

in moistness will negatively affect this combination the most. An in-

crease in cold or heat, will also have a negative effect, whilst dryness
and heat will have the least negative effect.

An increase in moistness can be as a result of:

Rainy season, humid weather or environment - Hot and Moist, to Cold
and Moist, food and drink - excessive sleep/rest - depression and fear
- lack of exercise - continuous blood loss.

This combination will be susceptible to illnesses of the phlegmatic

temperament:
Asthma – Tonsillitis – Sinusitis – Anaemia – Anorexia – Low Blood
Pressure

This combination will be inclined to a lesser extent to illnesses of the

sanguinous temperament:
Congestive headache - High blood pressure – Diabetes - Urinary tract
infection - Rheumatoid arthritis - Pre-menstrual tension

Health maintenance for this temperamental combination:

Positively affected by:
• Having only one or two full meals daily. Because of low digestive
ability phlegmatic people should make a habit of eating two main
meals per day, with at least a 6-8 hour gap between meals. If
feeling hungry in-between meals, a little fruit or salad should be
taken. The diet should be high in fibre and protein including
eggs, meat, sea foods and liver. In winter or on cold and rainy
days /nights, cold foods should be taken in smaller quantities as
these increases phlegm.
• Starting the day with a glass of warm water with two tablespoons
of honey. Drink 1 ½ to 2 litres tap water per day but avoid drink-
ing water half an hour before and up to one hour after meals.
• Exercising on a daily basis.
• Breathing exercises for 10 to 15 minutes in the morning.
• At night a 15-20 minute brisk walk after supper is very beneficial.
• Retiring early for the required 8 hours sleep promotes moisture.

273
 ANNEXURE 2

It is also the temperament of phlegmatic people, as they have a

tendency towards excessive sleep.
• Rising before sunrise is advised to avoid an increase of phlegm.
• Additional physical activity to supplement body heat.

Negatively affected by:

• Weather, environment, work and leisure activities that increase
cold and moistness. Because of the low heat, phlegmatic people
are particularly vulnerable to a cold environment as well as cold
and rainy weather. Heat management through proper clothing
and seeking a warm environment cannot be stressed enough.
• Excessive rest and a lack of exercise and movement. Unneces-
sary rest during the daytime should be avoided.
• Sleeping during the day and especially 1 hour before sunset is
very harmful as this aggravates the phlegm and leads to heavi-
ness of the head, sinus congestion and dullness of the brain.
• Fear, shyness and depression are the emotional excesses of
phlegmatic people and should be managed accordingly.
• A diet low in calories and nutritional values, with no proteins and
fats but high in carbohydrates.
• Cold & Moist diet, especially in a cold environment.
• Menstruating women should avoid a cold diet. This also applies
to women who have given birth (1 month post-natal period).

Advice: In winter excess of cold and moistness can be counter-

acted by effectively applying the six factors by including Hot &
Dry and Cold & Dry foods.

6. Dominant phlegmatic with sub-dominant melancholic

As coldness is the dominant quality associated with

this temperamental combination, an increase in coldness from
the Six Lifestyle Factors will negatively affect this individual to
the greatest extent. An increase in moistness and dryness will
also affect, but to a lesser extent, whereas an increase in the
quality of heat will be beneficial for this person.

Any change in the ideal level of coldness will negatively affect this

274
 ANNEXURE 2

combination the most. An increase in moistness or dryness will also

have a negative effect, whilst heat will have the least negative effect.

An increase in cold can be as a result of:

Early/late winter - cold environment - rainy season - cold and moist
food and drink - depression and fear - worries, sadness - excessive
sleep - lack of exercise - continuous blood loss - irregular eating and
sleeping habits - prolonged suppression of natural urges - irregular
elimination of wastes.

This combination will be susceptible to illnesses of the phlegmatic

temperament:
Asthma – Tonsillitis – Sinusitis – Anaemia – Anorexia – Low Blood
Pressure

To a lesser extent this combination may also be inclined to illnesses

of the melancholic temperament:
Insomnia - Osteo-arthritis - Hyperacidity – Constipation - Piles – Flat-
ulence - Colic - Gout

Health maintenance for this temperamental combination:

Positively affected by:
• Having only one or two full meals daily. Because of low digestive
ability phlegmatic people should make a habit of eating two main
meals per day, with at least a 6-8 hour gap between meals.
If feeling hungry in-between meals, a little fruit or salad should
be taken. The diet should be high in fibre and protein including
eggs, meat, sea foods and liver. In winter or on cold and rainy
days/nights, cold foods should be taken in smaller quantities as
these increases phlegm.
• Starting the day with a glass of warm water with two tablespoons
of honey. Drink 1 ½ to 2 litres of tap water per day but avoid
drinking water half an hour before and up to one hour after meals.
• Exercising on a daily basis.
• Breathing exercises for 10 to 15 minutes in the morning.
• At night a 15-20 minute brisk walk after supper is very beneficial.

275
 ANNEXURE 2

• Retiring early for the required 8 hours sleep promotes moisture.

It is also the temperament of phlegmatic people, as they have a
tendency towards excessive sleep.
• Rising before sunrise is advised to avoid an increase of phlegm.
• Additional physical activity to supplement body heat.

Negatively affected by:

• Weather, environment, work and leisure activities that increase
cold and moistness. Because of the low heat, phlegmatic people
are particularly vulnerable to a cold environment as well as cold
and rainy weather. Heat management through proper clothing
and seeking a warm environment cannot be stressed enough.
• Excessive rest and a lack of exercise and movement. Unneces-
sary rest during the daytime should be avoided.
• Sleeping during the day and especially 1 hour before sunset is
very harmful as this aggravates the phlegm and leads to heavi-
ness of the head, sinus congestion and dullness of the brain.
• Fear, shyness and depression are the emotional excesses of
phlegmatic people and should be managed accordingly.
• A diet low in calories and nutritional values, with no proteins and
fats but high in carbohydrates.
• Cold & Moist diet, especially in a cold environment.
• Menstruating women should avoid a cold diet. This also applies
to women who have given birth (1 month post-natal period).

Advice: In late winter and autumn the intake of Cold & Dry food
and drink should be reduced. The cold and dryness of late winter
and autumn can be counteracted by effectively applying the six
factors to maintain body heat and by including Hot & Dry and Hot
& Moist foods.

7. Dominant melancholic with sub-dominant phlegmatic

As coldness is the dominant quality associated with

this temperamental combination, an increase in coldness from
the Six Lifestyle Factors will negatively affect this individual to
the greatest extent. An increase in moistness and dryness will
also affect, but to a lesser extent, whereas an increase in the
quality of heat will be beneficial for this person.
276
 ANNEXURE 2

Any change in the ideal level of cold, especially an increase, will neg-
atively affect this combination the most. An increase in moistness or
dryness will also have a negative effect, whilst heat will have the least
negative effect.

An increase in cold can be as a result of:

Early/late winter - cold environment - rainy season - cold and moist
food and drink - depression and fear - worries, sadness - excessive
sleep - lack of exercise - continuous blood loss - irregular eating and
sleeping habits - prolonged suppression of natural urges - irregular
elimination of wastes.

The illnesses that this combination are susceptible to will be those of

the melancholic temperament:
Insomnia - Osteo-arthritis - Hyperacidity – Constipation - Piles – Flat-
ulence - Colic - Gout

To a lesser extent this combination may also be inclined to illnesses

of the phlegmatic temperament:
Asthma – Tonsillitis – Sinusitis – Anaemia – Anorexia – Low Blood
Pressure

Health maintenance for this temperamental combination:

Positively affected by:
• Breathing exercises in the early morning and late afternoon.
• Protecting against dry weather by applying a moisturizer, cream
or oil (olive oil) to the skin
• A Hot and Moist diet.
• A 10 to15 minute walk after supper.
• Water intake should consist of at least 2 litres a day.
• Exercises like jogging and a brisk walk.
• Change of environment (picnics, etc.) every 2 to 3 months.
• Meditation is very helpful in most melancholic people.
• Getting to bed early, around 22:00 to get 6 to 8 hours sleep.
• A 5 to10 minute relaxing break after lunch.

277
 ANNEXURE 2

Negatively affected by:

• Weather, environment, work and leisure activities that increase
coldness and dryness. In autumn avoid cold nights and the mid-
day heat.
• Dewy conditions, during autumn, late winter and (00:00 - 06:00)
as this aggravates the melancholic humour.
• Too much tea, coffee, sour drinks, artificially flavoured and fizzy
and iced drinks.
• Too little water.
• Eating more cold than warm food. Using frozen of refrigerated
foods and drinks.
• Excessive waking during the night.
• Excessive worries, sadness, loneliness, thinking and being over-
ly philosophical.
• Unnecessary suppression of stools and urine.
• Excessive use of anti-allergic, antipyretics, antihistamines and
other cold and dry medications.
• Excess of Cold & Dry food in the diet.

Advice: In winter reduce the intake of Cold & Moist food and
drink. The cold and moistness of winter can be counteracted by
effectively applying the six factors to maintain body heat and by
including Hot & Dry and Hot & Moist foods.

8. Dominant melancholic with sub-dominant bilious

As dryness is the dominant quality associated with this

temperamental combination, an increase in dryness from the Six
Lifestyle Factors will negatively affect this individual to the
greatest extent. An increase in heat and coldness will also affect,
but to a lesser extent, whereas an increase in the quality of
moistness will be beneficial for this person.

Any change in the ideal level of dryness especially an increase in

dry-ness will negatively affect this combination the most. An
increase in cold or heat will also have a negative effect, whilst
moistness will have the least negative effect.

278
 ANNEXURE 2

An increase in dryness can be as a result of:

Summer - very hot weather/environment - late winter - dry food and
drink – anger – sadness - strenuous exercise - excessive awakening
- irregular elimination of wastes.

The illnesses that this combination are susceptible to will be those of

the melancholic temperament:
Insomnia - Osteo-arthritis - Hyperacidity – Constipation - Piles – Flat-
ulence - Colic - Gout

This combination may also be inclined to a lesser extent to illnesses

of the bilious temperament:
Stress - Migraine - Bronchitis - Hay fever - Nausea – Overactive thy-
roid – Endometriosis

Health maintenance for this temperamental combination:

Positively affected by:
• Breathing exercises in the early morning and late afternoon.
• Protecting against dry weather by applying a moisturizer, cream
or oil (olive oil) to the skin.
• A Hot and Moist diet.
• A 10 to15 minute walk after supper.
• Water intake should consist of at least 2 litres a day.
• Exercises like jogging and a brisk walk.
• Change of environment (picnics, etc.) every 2 to 3 months.
• Meditation is very helpful for most melancholic people.
• Getting to bed early, around 22:00 to get 6 to 8 hours sleep.
• A 5 to10 minute relaxing break after lunch.

Negatively affected by:

• Weather, environment, work and leisure activities that increase
coldness and dryness. In autumn avoid cold nights and the mid-
day heat.
• Dewy conditions, during autumn, late winter and (00:00 - 06:00)
as this aggravates the melancholic humour.
• Too much tea, coffee, sour drinks, artificially flavoured and fizzy
and iced drinks.
279
 ANNEXURE 2

• Too little water.

• Eating more cold then warm food. Using frozen of refrigerated
foods and drinks.
• Excessive waking during the night.
• Excessive worries, sadness, loneliness, thinking and being
overly philosophical.
• Unnecessary suppression of stools and urine.
• Excessive use of anti-allergic, antipyretics, antihistamines and
other cold and dry medications.
• Excess of Cold & Dry food in the diet.

Advice: In order to maintain the adequate moistness of the body,

water intake should be increased to 3 litres per day in spring
and summer, with the inclusion of Hot & Moist and Cold & Moist
foods.

280
 ANNEXURE 3

ANNEXURE 3: PULSE DIAGNOSIS

AFFECTED ORGANS/SYSTEMS

281