Fever and pain are the two most common--and for most people, alarming--signs of imbalance in the body. Fever, technically speaking, can be a very slight elevation above the "normal" temperature of 98.6º Fahrenheit, or a raging, fearsome soaring up over 105º. Temperatures above 106.5º are quite rare and usually occur only in conjunction with some form of injury to the brain. Fevers are usually preceded by chills, a mechanism the body uses to prod the thermal regulators into action to raise the temperature.

    Orthodox medicine divides fevers into two basic types: those of known causes and those of unknown causes. But whatever the cause, the best course of treatment is not always to cut short the fever, because this strange and unusual heat is a valuable indicator of bodily functions.

    Pain is a rather different topic. Western medicine views it almost exclusively as a symptom of some form of physiological disruption of function. Of course, the pain associated with a broken bone obviously derives from the violent break in the continuity of the limb. But the other forms of pain--abdominal cramps, headaches, lower back pain, "growing" pains, and similar discomfort--are generally treated symptomatically; that is, a drug is administered to shield the body's pain sensors and bring relief. For very deep, acute pain, some palliation may be necessary. But for the slight pains of the head, back, and abdomen, Unani has some very interesting insights into their origin. Let us now observe the Unani perspective on these two phenomena of fever and pain.

    Fever is an unnatural heat that arises from the heart, according to Unani. Some biologists may wish to disagree, saying that the heart is merely a muscular pump with no other functions. However, scientists at Cornell University Medical College recently reported the discovery of biologically powerful substances in the heart and noted that they "probably act as hormones." Dr. John H. Laragh, a Cornell researcher, revealed that one of the substances Was a compound, named auriculum, that acted as one of the most powerful diuretics known. From the Unani viewpoint, any excessive decline in moisture would cause a rapid increase of heat: in other words, fever. Similar discoveries about unusual functions of the heart have been reported by physicians in Japan and Canada.

    According to Unani, fevers are divided into three classes. Those that originate in the spirit are called ephemeral fevers; those that originate in the humors are called putrefactive fevers; and those that occur in principal organs are called hectic fevers.

    Ephemeral fevers have many causes: external exposure to extremes of heat or cold, or bathing in very hot or cold water; things ingested, such as heating foods, hot beverages, and hot medicines; and things that cause excessive motion, either of the body (sports) or of the spirit (anger and grief).

    Ephemeral fevers are often emotion-related and are generally classified according to their mental signs, such as mental, angry, joyous, painful, fainting, hungry, solar, heating, water, and so on.

    The ephemeral fever usually lasts only twenty-four hours, and the temperature is consistent, not rising. There is no sign of infection. The remedy is to remove the mental or spiritual cause and try to reduce food intake as much as possible, but inducing vomiting is not advised. Mild pain relievers and warm baths often prove soothing.

    If an infection is present, there will often be a foul smell to the urine and feces. This kind of fever needs medical attention and possibly treatment by antibiotics. The signs of fever due to typhus infection (transmitted by animals) are excessive perspiration, nosebleed, asthma, great hunger, incessant sneezing, and fainting.

    Putrefactive fevers have five causes: (1) overabundance of humors, (2) thickness of humors, (3) stickiness of humors, (4) obstruction of humors, and (:5) the putrefaction that happens to humors when they remain too long without circulating and lack ventilation.

    Hectic fevers also often arise from emotions--grief, worry, fear--but there are other causes that dry the body excessively while at the same time heating it. These fevers may also be caused by certain chronic diseases, very heating diseases, hot tumors, and similar conditions.

    Fevers are said to be either continuous or intermittent. A continuous fever begins at one point and continues either to rise or to decline, or else it begins at one point and continues, neither increasing nor decreasing. With an intermittent fever, the temperature rises, then falls, then rises again. Continuous fever occurs when putrefaction is occurring inside the blood vessels, whereas intermittent fever is a sign that putrefaction is occurring inside one of the principal organs.

There are four general types of putrefactive fevers:

    Permanent fever is due to putrefaction of blood (including bacterial infections) and is continuous.

Al-ghabb is due to putrefaction of yellow bile humor and alternates one day on, one day off.

Balgham (phlegm) is due to putrefaction of phlegm humor and appears daily.

Al-rub' is due to putrefaction of black bile humor and alternates one day on, two days off.

    The alternating cycles of the intermittent fevers are due to the ease or difficulty in collecting, refining, and expelling the matter of the humors. The time between the appearances of the temperature of fever is called rigor. The time when the fever is apparent is called paroxysm. If a fever does not follow one of the three stated modes (daily, one day on and one day off, or one day on and two days off), it is because more than one humor is affected or more than one kind of imbalance or disease process is going on.

    The nature of the paroxysm is altered by the strength of the patient (the stronger the patient, the shorter the paroxysm), the nature of the residues being eliminated (the thicker and colder, the longer the paroxysm), and the constitution of the patient (the hotter the constitution of the patient, the shorter the paroxysm).

    Hectic fevers are of three types: (1) those due to reduction of moisture in small vessels; (2) those in which moisture is fully dissipated and the heat fills the empty spaces caused by the absence of moisture; and (3) those in which the moisture of the organs is used up by the fever and the heat of the organs themselves adds to the fever.

    It is important to know the origin of the cause of a fever. Fever is said to originate in the spirit, the humors, or the principal organs. Thus, if it originates from causes that heat the spirit (e.g., exposure to hot external temperatures), spreads from the spirit to the organ moistures, and then, after drying them up, heats the principal organs, it is still called ephemeral fever, because that is its point of origin. Likewise, if its course originates in a moisture that putrefies, then heats the spirit, then attacks the principal organs, it is called putrefactive fever, for that is its origin. The cause will be found at this point of origin, even though some treatment may be used to alleviate symptoms that arise in other parts.

    Hectic fevers are called either tertian or quatrain. The whole cycle of the tertian fever lasts forty-eight hours, with the interval (period without fever) lasting approximately thirty-six hours and the paroxysm lasting twelve hours.

    A pure tertian fever usually does not last more than one week. This is usually caused by the yellow bile humor becoming too cold and moist. If there is constipation, the superfluous matters are inside the veins and not in the principal organs. Food should be withheld as much as possible on the days the fever returns. If the person feels cold and trembles, give him or her oxymel (1 teaspoon honey with 1 tablespoon vinegar) with warm water. This will help purge the yellow bile. If the person vomits, it is a sign of healing. When the fever comes down, put the person's feet in a warm-water bath and massage them, which will help the fever descend from the head. Diuretics may be given, but no laxatives. If there is an abundance of mucus, use less cooling herbs and foods, but if the phlegm is "salty;' use only cooling herbs and foods.

    The quatrain fever has a cycle of seventy-two hours, the paroxysm lasting eighteen, and the pause lasting fifty-four hours.

    There is no one specific treatment for each of these fevers, because each person would have to be evaluated in terms of age, temperament, vitality, season, and so forth. However, it is very useful to identify the origin and type of fever so that one can coordinate all diet and herbal medicines so as not to confuse the body in what it is trying to accomplish.

    A general advice for returning fevers is to reduce food and water, especially cold water, on the day the fever returns. Avoid all fruits and foods that produce flatulence, and everything that is hot and dry in temperament. The humor should be purged, according to the signs of imbalance or the features of the fever (see Chapter 9).

    Pain is usually thought of by physicians as a sign or signal of some "deeper" causative factor. But to the patient, it is the primary ailment. In fact, pain is the symptom that most often causes a patient to seek help from a physician. The symptom of pain may be the cause of a disorder, because persistent pain impairs vitality; in this sense, pain is a disease.

    Most people suffer predominantly from two kinds of pains: those of the abdomen and those of the head. Western medical texts list almost forty different diseases of which headache is one of the main symptoms. But headache can also be a temporary sensation due to fatigue or stress. (I will exclude discussion of pain associated with accidental injury, for its causes are self-manifest, and emergency medical treatment is indicated in every case.)

    Pain can be a symptom of conditions varying from a slight change in mood to terminal cancer of the colon. But the sensation of pain frequently appears long before an organ or internal system is degenerated to a terminal state. Yet most people try to dodge the signal offered by pain, masking it with aspirin and other remedies. This is unfortunate, because often years and years pass during which these signs are covered up, while the disease expands and ultimately becomes difficult to cure; and even if it can be, the procedures are gruesome.

    According to Unani, pain is a sensation produced by something contrary to the course of nature, and this sensation originates in one of two circumstances: (1) a very sudden change in temperament or the bad effects of an imbalanced temperament, or (2) the resolution of an imbalance--that is, a return to health.

    To explain it another way, I might give the example of a person who has had properly balanced humors for years, but whose temperament, owing to a radical change in diet, changes to a hotter or colder character. The sensitive faculties of the body become aware of this change: this is "pain." There is no pain except as the sensation of an opposite force. A temperament that is always unbalanced (chronic) does not produce pain. This is so because, over time, the improper temperament thoroughly destroys the healthy temperament, so that it acts as if it were never there and becomes "used to" the intemperament. Therefore, it neither experiences pain nor becomes aware of it (because there must be a contrariness of forces for pain to be felt).

    The hot, cold, moist, and dry temperaments of the whole person, as well as the specific parts (see Chapter 2), provide a very useful index to understand the nature of imbalances--both their immediate causes and the preexisting dietary indiscretions that led up to full-blown disease states.

    The reason some people suffer more pain than others, often during a similar or identical illness, is due to the relative strength or balance of the innate temperaments of the body parts, and the strength of the force that opposes it. A hot intemperament can cause pain by its own energy, as can a cold intemperament. But a dry intemperament causes pain only as a secondary matter, and a moist intemperament is painless. This is so because heat and cold are active qualities, and dryness and moisture are passive ones. According to Galen, pain is due to one thing only: loss of the proper continuity of temperament. In order to experience the sensation of pain, there must be a rapid coming together or rapid dispersal of particles--the fact of this motion accounts for the painful sensation. For example, viewing some object of extreme blackness can cause pain to the eyes, as can viewing an object of severe whiteness (such as sun-drenched snow). In both cases, it is due to the very compacted nature of the particles of color. The effect of heat is the opposite--the rapid dispersal of particles, which causes pain. This is true of all forms of pain perceived by the senses of touch, taste, smell, and sight.

1. Boring pain is caused by retention of gross matter or gas within the folds of a "hard" organ, such as the colon. The retained matter constantly rubs and pushes against the organ, "boring" it.

2. The pain of compression is produced when fluid or gas is confined in too small a space and causes a squeezing or compression of the tissues.

3. Fatigue pain is caused by excess labor, gaseous substance, a humor under tension (overabundant humor), or a humor of ulcerative properties.

4. Corrosive pain derives from material being trapped between the muscle fibers and their sheaths, stretching it until it disturbs the temperament of the muscle fiber and the muscle itself.

5. Dull pain is from an overly cold temperament, obstruction of pores so that the vital force cannot penetrate into a member, and distension of the cavities of the body.

6. Stabbing pain results when a humor enters between and separates membranes. In some cases the whole body is affected; in others only one member is affected.

7. Heavy pain is due to an inflammation in an organ that has few or no pain sensors, such as the lung, kidney, or liver. The weight of the inflammation added to the organ causes it to drag against adjacent organs and tissues, which experience the pain.

8. Incisive pain is due to a humor of sour quality.

9. Irritant pain occurs when a humor is changed to a harsh or rough nature.

10. Itching pain is due to the bitter, sharp, or salty nature of a humor.

11. Relaxing pain is caused by matters accumulating and stretching the muscle, not the tendons. The pain is due to the belly of the muscle being more lax than that of the tendon.

12. Throbbing pain is due to a hot inflammation.

13. Tension pain is produced by a humor overstretching nerves or muscles.

14. Pricking pain is due to matter entering into an organ for a time, then rupturing it.

15. Tearing pain arises when a humor or gas enters between the bone and the periosteum, or from cold which strongly constricts the periosteum.

    The main effect of pain on the body is that it causes weakness and interferes with the normal functioning of organs. In particular, the lungs are constricted and unable to perform complete oxygenation. The breath becomes either too fast or unnatural in rhythm. Severe pain, such as that of distension (incisive pain), disperses the breath. Any pain in the area of the heart will also disperse the breath. The temperaments become cold because the vitality is lost.

    Most temporary pains are due to one of two factors: (1) corrupted or overabundant humors, which causes stretching of the tissue fibers or adds excess weight to the organ, or (2) accumulations of gas in the viscera of the stomach, the membranes of nerves or organs, the sheaths of muscles, the subcutaneous muscles (as between the muscles and loose skin), or the internal muscles, such as those of the thorax. Such gas may be dispersed quickly or over time, depending upon the amount of gas, its quality, and whether the affected part is dense or light in structure.

    There are three approaches to the relief of pain. The first is to do something contrary to the cause of the pain--that is, to remove the cause. The second is to use an agent that counteracts the corrupted humor, soothes the body, induces sleep, or dulls the sensitive faculties and lessens their activity. Agents that accomplish this include inebriants, milk, and massage oils (saffron, rose). The third method is to use some agent that completely dulls the sensation in the painful part. All narcotics and sleep-inducing drugs are used in this approach. The first method is the most certain to produce relief.

    In sum, pain is caused by either a sudden change in temperament or a loss of continuity of function. The first class of causes is due to the arising of a hot, cold, moist, or dry intemperament. The second class of causes is the result of deposits of matter or the effect of gas or inflammatory conditions.

    When considering the three choices of treatment, the least favored is to destroy the sensation of the part feeling pain. This destruction of sensation can be accomplished only by making it extremely "cold" or by exposing it to toxic agents (narcotics), which interfere with its functions.

    A basic formula for alleviating pain is to make a poultice of dill seed and linseed oil and place it over the painful part.

    In addition to dill and linseed, other substances that create relief by soothing include chamomile, celery seed, bitter almond, and anything that is hot in the first degree, especially if combined with some glutinous agent such as prunes, starch, saffron, marshmallow, cardamom, cabbage, or turnip. These can be made in decoction (tea) form. The useful oils are rose, violet, saffron, sweet almond, and sandalwood. Laxatives and other forms of elimination must be encouraged, for they will help draw away the cause.

    The most powerful herbal anesthetic medicine is opium. Less powerful agents are deadly nightshade (belladonna), lettuce seed, snow, and ice water. Some herbal agents are unavailable without prescription, and even if obtained, must be used under a physician's direct supervision and should never be self-administered.

    One should always be alert for obvious, external causes of pain that may have been forgotten, such as recent falls (e.g., during epileptic attack or drunkenness), improper posture during sleep, or straining during heavy work. If no such cause can be uncovered, look for the signs of excess in one of the humors.

    A pain may originate from an external cause and then become internal. Drinking very icy water will cause pain in the stomach and liver area. In such a case a full regimen of adjusting humors is not required. A good warm bath and a restful sleep are sufficient. Or one may have indulged in eating too many hot peppers, and a headache resulted. A glass of cold water is enough.

    The remedies selected for pain must be appropriate to the particular condition. Colic may be cured by evacuating the contents of the lower intestine, but the pain may be so severe that more immediate relief is necessary. On the other hand, very rapid relief may be provided only by creating a worse injury than what one was trying to cure. This is the unfortunate result of treatments with many biochemical medicines.

    Judgment and sense must be applied in selecting a course of treatment. If a pain is allowed to increase, it can cause death by destroying innate heat and vitality, interruption of the heart, and so forth. So a judgment must be made of the potential harm that will result by making the organ insensate to pain. For example, the bowels may not be able to function. In this case, one should make the organ insensate, for the immediate danger of death from extreme pain is averted, and other methods may be used to evacuate the bowels.

    A general principle is that internal remedies for pain should not be excessively cold in temperament. All narcotics are extremely cold. Such agents not only decrease the innate heat but also increase the amount of superfluous matter and solidify it and enclose it, making it quite difficult to refine and expel.

    Other methods of relieving pain include walking around for an extended period. The motion softens the tissues and relaxes the body. Music, especially if it is agreeable and softly inclines one to sleep, is a powerful pain reliever. Being intensely engaged in an activity one finds engrossing helps reduce the severity of pain.

    You now should examine all of the other fundamental principles of the Unani system of healing, including the basic temperaments, the humors, the process of digestion, dietetics, and the major signs that indicate the body is well or ill.