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The Theory of Humors
in Unani Traditional Medicine

    The idea of humors originated with Hippocrates, who observed upon examining blood that the red portion of fresh blood is the blood humor, the white material mixed with blood is the phlegm, the yellow-colored froth on top is the yellow bile, and the heavy part that settles down is the black bile (sauda). This theory was further refined by Galen, to the extent that he held that all diseases were the result of irregular or improper distribution of the four humors.

    Avicenna agreed that these four components are the primary humors, but he added that the intracellular and extracellular fluids in the tissues are secondary humors. According to Avicenna, the four primary humors are derived from the digestion of food and are utilized as nutrient components for the growth and repair of the organs and to yield energy for work. The humors have a normal state as well as abnormal varieties. The worst abnormal humor is black bile, which is believed to be responsible for cancerous growth. It is a toxin.

    The origin and action the four humors or essences (Arabic: akhlat) and their ultimate fate in the digestive process are presented in the accompanying illustration.

    A humor exists in a kinetic state, at all times adjusting and interspersing with the body fluids, tissues, and parts.

    The humoral theory presupposes the presence of four humors-Dam (blood), Balgham (phlegm), Safra (yellow bile) and Sauda (black bile)- in the body. The temperaments of persons are expressed by the words sanguine, phlegmatic, choleric and melancholic according to the preponderance in them of the respective humors blood, phlegm, yellow bile and black bile. The humors themselves are assigned temperaments: blood is hot and moist, phlegm cold and moist, yellow bile hot and dry, and black bile cold and dry.

    Every person is supposed to have a unique humoral constitution which represents his healthy state. And to maintain the correct humoral balance there is a power of self-preservation or adjustment called Quwwat-e-Mudabbira (Vital Force) in the body. If this power weakens, imbalance in the humoral composition is bound to occur. And this causes disease. In Unani Medicine, great reliance is placed in this power. The medicines used in this system, in fact, help the body to regain this power to an optimum level and thereby restore humoral balance, thus retaining health. Also, correct diet and digestion are considered to maintain humoral balance.

    All four of these humors arise at the site of the liver, in quantity or predominance according to the nature of the foods eaten and the degree of completeness of their digestion. The blood humor comes into being first and is formed of the choicest parts of nutrients. Second, the phlegm humor arises and accompanies the second-level digestion nutrients. The yellow bile is composed of the third stage of digestion nutrients, which are the coarser and less refined parts, and the black bile is composed of the least digestible and usable parts of nutrients. Each of the four humors has its own characteristic temperament, in accord with the system it regulates. Thus, the blood humor is moist and warm (like blood itself), phlegm humor is cold and moist, yellow bile humor dry and cold, and black bile warm and dry. One humor predominates in each individual.

    During the early stages of the Renaissance, the humoral concept of disease was attacked violently and discarded by many. But later, new factors came to light that reawakened interest in humoral medicine. Landsteiner and Garrod began scientific inquiry into humoral theory in 1901, and since then the scientific community has devoted a watchful eye on humoral developments. One of the limitations of this research and attention has been the tendency to consider humor and body fluid as one and the same. While humors share some aspects of nature with body fluids, they are not identical. Urine, for example, is a body fluid but not a humor. The humor associated with the blood and called "sanguine" is not identical with blood drawn by venesection. Nor is the phlegm of the phlegm humor the same as mucus or lymph or phlegm, although it shares some characteristics with them. Dr. Cameron Gruner, a medical doctor who performed exhaustive research into humors, called them "quasi-material;' I call them "semigaseous vapors."

The Origin and Fate of the Four Bodily Humors

Mouth takes in food and drink

First digestion

To Stomach
Usable parts are acted upon by
digestive fluids. (Unusable parts go
to large intestine and are
emitted as excrement.)

To Small Intestine
Becomes chyme by mixing with
digestive juices and fluids of meal.
(Travels through mesenteric veins, portal vein.)

To Liver

Second digestion

(Hot & Moist)

Superior nutrients are taken in via
bloodstream to heart and dispersed to
cells via general bloodstream.

Third digestion

Less choice parts become

(Cold & Moist)

Normal digestion converts into mucus,
saliva, and gastric and intestinal mucus.
Abnormal digestion causes excess mucus,
classified as sweet, sour, thick, thin, etc.

Remaining nutrients become

(Hot & Dry)

Normal bile is formed in liver, affects
blood, and acts in small intestine.

Abnormal humor causes destructive changes in bile.

Sediments of precipitates of digestive nutrients become

(Cold & Dry)

Normal humor affects spleen and blood,
and mixes with phlegm humor.

Fourth digestion

Abnormal humor is passed out as ash
or admixes with blood humor and other
humors, producing morbid conditions.

The Process of the Four Humors of the Body

    The invention of the microscope has taken us away from the source and origin of the problems associated with disease. For example, most physicians would attribute an infection to one or more bacteria and will produce actual living specimens of those bacteria which they say caused such and such an infection. From the Unani Unani point of view, the deviation from the normal state of the humor provided a suitable environment for the bacteria to grow to larger than normal populations. While admitting the existence of the bacteria, the Unani scientist must look deeper to the cause of the imbalance in the humor and its characteristic temperaments. Thus, the mode of current medical practice that "attacks" the red- and white-cell-forming organs does not take into account the fact that blood itself is living and not simply a conglomerate of chemical components.

    Thus in Unani, the dictum "Health is a harmony of the humors" is the only valid point of view if one desires to cure the cause of the disease. Chemical destruction of the abnormal growth of microscopic life may result in a temporary decline or total eradication of the population of microorganisms, but if the imbalance of the humor is not corrected, the disease will recur or will arise in another place in the body. More important, the dramatic effects of the chemical drugs themselves on the humors result in new imbalances, as evidenced by the many so-called side effects of drugs.

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