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Theory of Temperaments (Mizaj)
Another area which merits
attention is the theory of Mizaj. It is often translated in English as Theory of
Temperaments. But this causes much confusion. The Mizaj is a metabolic constitution and
behavioral pattern of an individual. By a careful history and bedside examination a Hakim
can classify patients into four broad classesDamavi, Balghami, Safravi and Saudavi. In a
small experiment at Bombay, four young Hakims independently assessed the Mizaj of 40
persons and there was 90 per cent agreement among them indicating that Mizaj can be
assessed easily with little training. We also noted that during the year, 70 per cent of
our patients belonged to Balghami Mizaj though in general population they are no more than
30 per cent. Does this mean that persons of Balghami Mizaj are more prone to chronic
diseases? Identification of diseaseprone population is of cardinal importance in
successful prevention of disease. If research in this area proves fruitful, our limited
resources will be used more effectively by concentrating attention on the segment of
population which is most susceptible.
There are other attributes to
Mizaj like hot, cold, moist and dry. These attributes are applied to diseases and drugs
also. The study of these factors helps to choose proper remedies for individual patient.
It is only when a remedy is chosen with due consideration to these attributes that best
therapeutic results can be expected. If the attributes of the drug do not match those of
the patient and the disease, not only the effect may not be adequate but sideeffects may
also occur. In modern medicine sideeffects to drugs occur in five to 15 per cent of the
patients but there is no way of predicting which patient may get adverse effect, except in
few cases like hemolytic anemia in G 6PD deficiency. Would it be possible to assign Unani
attributes to modem drugs also? In that case do the sideeffects occur because the
attributes of the drug do not match those of the Mizaj of the patient? If this can be
demonstrated, it would be possible to identify the patients likely to get sideeffects to
certain drugsa great advantage for modem medicine. In that case modem medical education
will do well to incorporate study of Mizaj into its curricula.
The Temperaments There are nine kinds of temperaments: eight are called nonequable and one is called equable. Equable means "balanced" or "existing in a state of balance." Of the eight nonequable, four are single: hot, cold, wet, and dry; and four are compound: hot and dry, hot and wet, cold and dry, and cold and wet. The temperament is that quality which exists by the mutual interaction of the four primary qualities residing within the elements. In other words, blood is characteristically hot and moist. Now, some conditions may arise--such as prolonged sleep or exposure to cold--by which the basic quality of heat may be dissipated, which would allow moisture to build up. Such an event would result in various signs occurring within the body or its organs or parts. Thus, the physician, seeing the evidences of excess heat and other signs, would characterize the imbalance as a cold intemperament of the blood, and he would devise a treatment to correct this primary, single intemperament. There is a constant interaction among the elements, a rising and falling of influence, and seldom, if ever, do they actually maintain a strictly balanced point. It is well known that while the so-called normal temperature of the body is 98.6 degrees Fahrenheit, the actual temperature of the body fluctuates throughout the course of a day by several degrees. If you were to record your own body temperature at intervals, you would discover that it is lower in the morning and higher at or just after noon. Each part of the body has been evaluated and assigned its own characteristic temperament, ranging through degrees of heat, cold, wetness, and dryness. Table 2 summarizes these temperaments. Degrees Of Inherent Temperament Heat (1 :Hottest)
Coldness (1 = Coldest)
Moisture (1 =Moistest)
Dryness (1 =Driest)
Likewise, the seasons and other factors have characteristic temperaments, as related in Table 3. Imbalance of Temperaments Let us now consider how these temperaments interact to affect health. In the Unani system, the first diagnostic feature we look for is an intemperament of a particular organ or system. There are four main intemperaments: 1. Hot intemperament: hotter than it should be, not moister or drier 2. Cold intemperament: colder than it should be, not moister or drier 3. Dry intemperament: drier than it should be, not hotter or colder 4. Moist intemperament: moister than it should be, not hotter or colder These four intemperaments are never static, for they are constantly changing and interacting. For example, if a temperament becomes hotter than it should be (hot intemperament), it quickly drives off moisture, which will also lead to a dry intemperament, resulting in a compound intemperament. Thus, there are four compound intemperaments, which occur when the initial simple intemperament persists to the point of affecting a second quality of the innate balance. These four compound intemperaments are: hotter and moister than it should be; hotter and drier; colder and moister; and colder and drier. (Obviously, an intemperament cannot be hotter and colder or drier and more moist.) In addition, an intemperament is classified as being either qualitative or material. It is qualitative if it does not affect an organ directly (as with a fever), material if the intemperament invades a part of the body and causes change (e.g., invades the colon by excess mucus due to intemperament of the phlegm humor). Thus there are a total of sixteen intemperaments, or modes of classifying intemperaments. An intemperament is measured by the observable signs occurring in the body or a bodily part. The temperaments are held in place, or kept balanced, by the existence of four humors. Heating & Cooling In Unani system of medicine, drugs, like other substances, besides being endowed with their own properties are also termed as hot, cold, dry and moist. This means that after being acted upon by gastric juices and undergoing a series of biochemical changes, they produce perceptible degrees of heat, cold, dryness and moisture in the body. Hence the dominant quality of a drug coupled with its specific pharmacological action counteracts the opposite abnormal quality in the body or any of its organs, or subsides, evacuates, alters, strengthens or tones up as the case may be. To some it may look like a mere supposition but observation is the backbone of all scientific convictions and here there is no dearth of that. The correlation between chemical structure and pharmacological action, possible interpretation of attributed temperaments to drugs and their mode of action on the human body might some day be put on scientific footing. As Dr. Salimuzzaman observes the drugs claimed to be heating and drying are found to be alkaloidal in character. On the other hand plant products which are described as cooling mostly contain a carboxyl group, e.g. citrus and sour fruits. Similarly, the presence of an active constituent with organically combined sulphur contributes towards the heating quality of the drug and the presence of terpenic body makes the drug cooling. However there might be exceptions and to several drugs this hypothesis may not apply. Because the temperamental quality and the action of the drugs (which has a history of clinical observations of hundreds of years) are logically interrelated. A drug which is cooling is mostly astringent and a heating drug is stimulant, vasodilator, deobstruent and tonic and so on and so forth. Signs of Imbalanced Humors & TemperamentsAlteration in Quantity of Humour: Red face Alteration in Quality of Humor: Poor vision Excess of Heat: Feelings of uncomfortable heat Excess of Cold: Weak digestion Excess of Moisture: Puffiness Excess of Dryness: Dryness and roughness of skin
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