UNDERSTANDING THE THEORY BEHIND GRAECO-ARABIC MEDICINE.
A Brief Description of the Philosophical Foundations of Graeco-Arabic Medicine.
Man has been attempting to understand the world they live in since time immemorial, as such knowledge has the promise of providing power and control over one's environment and perhaps even one's fate. Today's perceptions of the world around us are based as much on our cultural perceptions as they are based on "scientific concepts". In the past however, there have been other ways of looking at the world, and the Graeco-Arabic traditions, which sprang from the wisdom of classical Greece, was one of those ways. It must be remembered that these Graeco-Arabic traditions were a part of civilised Europe from the 5th. century BC until the dawning of the scientific age and are still a cultural part of many peoples' lives in the Middle East and Indian subcontinent. So let us explore this fascinating alternative world view.
The Four Elements.
In ancient Greece the material universe was considered to be composed of four basic elements: Fire, Air, Water and Earth. There was also a fifth, energetic but invisible element, which permeated all space. This was known as the Prima Materia (Prime Matter) or Aether. Aether was seen as the foundation substance of the four material elements, which during creation of the material universe, had first been transformed into Fire, then into Air, then Water and finally into Earth. Thus Fire was considered to be the most energetic of the elements, while Earth was considered the least energetic. Nevertheless, all matter was considered to contain energy in some form, with the energies of non-living objects being of a "grosser" and less refined nature and those of living creatures being of a much more refined and complex nature. Living creatures had a metabolic turnover of this energy and therefore needed an ongoing supply, which they could obtain from the "pneuma" or vital energy present in the air around them, and also to some extend from the food they ate. Thus human beings were considered to be composed of four material elements: Fire, Air, Water and Earth and to contain a vital force or energy called pneuma. Health was believed to depend on the presence of a proper balance of the four elements and the correct energetic activity of pneuma.
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The Four Qualities.
The understanding of natural systems was further enhanced by a system of four qualities: Warmth, Dryness, Coldness and Moisture. Each of the four elements expresses two of those qualities, which thus links the elements. Fire is considered Dry and Warm, Air is Warm and Moist, Water is Moist and Cold and Earth is Cold and Dry. In addition, the attributes of each element and each quality are further expanded by a system of correspondences that relate to heavenly bodies, the seasons, daily time periods, climatic influences, the properties of food and medicines, components of the body, physiological functions, disease symptoms and many other objects and phenomena. For example, Spring is regarded as belonging to the Air element because it is Warm and Moist, Summer belongs to the Fire element because it is Warm and Dry, Autumn belongs to the Earth element because it is Cold and Dry and Winter is considered to belong to the Water element because it is Cold and Moist. Correspondences are important in Graeco-Arabic Medicine, as they facilitate the observation of relationships and interactions in the natural world and provides a simple, but effective system of diagnosis and treatment, that can be truly considered holistic because it takes into account every factor of human experience.
Graeco-Arabic Physiology - or how the body functions.
In Graeco-Arabic medicine, pneuma is the fundamental energy of all life. With each breath, pneuma is taken into the lungs together with air and from there enters into the blood vessels, to be transported to vital organs such as the heart, liver and brain, where it is transformed into a living vital energy called "Thymos".
The second most important source of life are the Humors, which are vital essences that also course through the blood vessels. The Humors are manufactured in the liver from nutrients that have been extracted by the digestive system from food and liquids.
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The Four Humors.
Before 700 BC the Greek medical philosophy included only three humors: Sanguis or Blood, Phlegm and Choler or Bile, and was in many ways very similar to the ancient Ayurvedic traditions that still exist in modern India. By the time of Hippocrates (460-370 BC), the father of modern medicine, the traditions had been modified by adding another Humor, namely Melancholer or the Black Bile Humor. The addition of Black Bile had been primarily instigated by great philosopher Thales (640-546 BC), who had been educated in ancient Egypt and who wanted to make the Greek traditions line up better with the ancient Egyptian medical concepts. This addition of Black Bile however, had the useful outcome that the four Humors now lined up perfectly with the four elements. From now on the four Humors were: Sanguis or Blood, which belongs to the Air element and is Warm and Moist; Phlegm, which belongs to Water and is Cold and Moist; Choler or Yellow Bile which corresponds to Fire and is Warm and Dry and Melancholer or Black Bile which corresponds to the Earth element and is Cold and Dry. These Humors control the metabolism of the body and affect the function of every part. Thus health can only exist when the Humors are of the right consistency and exist in perfect balance. Any deviation from this, particularly if continued for some time, results in disease. Humors can be adversely affected by many factors, such as organic malfunction, unseasonal weather, bad air, a poor diet and an inappropriate lifestyle.
Click on this button for a table of the Correspondences of the Elements
According to Graeco-Arabic Medicine, there is a natural tendency for the body to restore Humoral quality and balance if this becomes disturbed in some way. This takes place in three distinct stages:
- The body changes the proportions of the Humors and commences to generate heat (a fever) in order to "boil off" the affected Humor or Humors. This process is called "coction". Usually some discharge will be seen during this time, which represent the removal of the affected Humor(s) by the body. For example, there may be a discharge of blood or phlegm from the nose; there may be vomiting and/or diarrhoea, or there may be changes to the consistency of the urine and excessive perspiration.
- This first stage eventually culminates in a crises, which often manifests as the high point of the fever, at which time a turning point is reached and one of three things will occur .....
- i. A sudden discharge takes place and the disease terminates abruptly, ii. the disease slowly fades and health returns gradually or iii. death occurs.
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The Law of the Naturals.
Graeco-Arabic medicinal philosophy also encompasses an underlying physiological model, that explains how the human body functions. This is called the Law of the Naturals, because these represent natural inherent functions that operate autonomously within the body. According to this model, physiological functions may be classified into two broad aspects or 'Virtues': The Principal Virtue, which is protective, progressive and procreative, and the Administering Virtue, which controls the physiological functions of the body including the digestion, absorption and utilisation of nutrients. These two Virtues in turn generate and are closely linked with three "Primary Faculties" which act within the human being, and make a person what they are, namely: The Vital Faculty, The Natural Faculty and the Psychic Faculty. These three Faculties work in close cooperation; therefore when one faculty is affected, the other two faculties will also be affected in some way. How strongly these Faculties affect each other is dependent upon two factors: 1. The 'sensitivity' of the individual and 2. the nature of the causative agent.
- The Vital Faculty generates and controls the motive energy or Life Force, which was called 'Thymos' by the Classical Greeks.
- The Natural Faculty represents the instinctive and involuntary functions, such as hunger, digestion and growth; it arises in the liver where it generates the four humors.
- The Psychic Faculty is the balancing faculty, it represents the conscious and unconscious mind, and arises in the brain.
Click on this button for Diagrammatic Representation of the Law of the Naturals
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The Vital Faculty.
As we have seen, the Vital Faculty controls Thymos. This is an important function, as Thymos needs to be modified continually to deal with the needs of the body and to enable the individual adapt to external influences. Thymos in turn consists of three distinct energies, which are called the three Pneumas.
The generation of Thymos takes place as follows: Pneuma is taken into the lungs with inspired air, from where it is transported by the great blood vessels to the heart. There it is mixed or "churned" with the humors present in the blood and is transformed into the primary form of "living" pneuma or Thymos called "Vital Force". The Vital Force, which is closely related to the functions of the Vital Faculty, is a very refined form of energy and is thus able to penetrate into every bodily tissue.
When the Vital Force enters the liver, it is further mixed with the Humors and forms a secondary, less refined form of Thymos, the Natural Force. The Natural Force is in turn distributed from the liver throughout the body by means of the blood. The Natural Force is associated with cellular nutrition and growth and is closely related to the functions of the Natural Faculty.
As the Vital Force enters the brain, it is collected and transformed into a third form of Thymos, which is called the Animating or Nerve Force. The Nerve Force is distributed from the brain by means of the nerves and controls body movements and the functions of the sense organs. The Nerve Force is closely associated with the Psychic Faculty.
As all three forms of Thymos are imprinted by the quality of the Humors during their generation, there is a close interrelationship between the nature and quality of Thymos and the nature and quality of the Humors. A balance of one encourages a balance in the other. Conversely an imbalance in one will also affect the other. To maintain the balance of Thymos and the Humors, is the role of the Vital Faculty, which controls the generation and quality of Thymos. The Responsive Aspect of the Vital Faculty senses the properties that have been acquired by Thymos from its interactions with the Humors and this information is then carried to the Active Aspect of the Vital Faculty, which then modifies Thymos in order to maintain or re-establish physiological homeostasis.
When the Vital Faculty is balanced, good quality Thymos will be generated. As Thymos generates the emotions, good quality Thymos will tend to generate positive emotions, such as: caring, courage, gentleness, hope, humour, joy, trust, etc. Interestingly, good emotions are also seen to affect the Responsive Aspect of the Vital Faculty in a positive way, which means that good emotions will in turn tend to improve the quality of Thymos.
If, however, the Vital Faculty is not in balance, a poor quality of Thymos is generated, which will give rise to such negative emotions as: despair, fear, grief, hatred, jealousy, obstinacy, sadness, vengefulness, worry, etc. These negative emotions will in turn weaken the Vital Faculty, thus interfering with the quality of the four humors and setting the stage for the development of chronic and degenerative disease. In some cases the quality of Thymos is so severely affected by humoral or physical abnormalities or by negative emotions, that the Vital Faculty is unable to restore complete normalcy. Then the affected Thymos will have an adverse effect on most or all of the humors at the same time. This will manifest as a disease or condition that has seemingly unrelated symptoms or abnormalities that occur at the same time in various parts of the body.
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The Natural Faculty.
The four Humors, Sanguis (Blood), Phlegm, Choler (Yellow Bile) and Melancholer (Black Bile), are generated in the liver from Thymos and from the nutrient components of ingested food and beverages. This generation of four Humors, is controlled by the Digestive Function of the Administering Aspect of the Natural Faculty. It must be remembered, that although there is a clear association between a body fluid and a Humor of the same name, the Humor is to some extent separate and independent of the body fluid. Thus the Sanguis or Blood Humor represents the nutritive aspect of metabolism, Choler or Yellow Bile the stimulating and heating aspect of the metabolism, Phlegm the fluid, cooling and purifying aspects of the metabolism and Melancholer or Black Bile the coagulating, solidifying, drying and concentrating aspect of the metabolism. There is a strong relationships between a body fluid and its associated Humor; thus an abnormality or imbalance in a Humor will also cause changes in the composition and properties of its associated body fluid.
Humors are generated in the following manner:
Food and liquid enters the mouth,and are broken down in the stomach, by the process called 'coction'. From there they enter the small intestine, where the nutritional components are absorbed and enter into the circulation. All non-nutritional components are passed along by the small intestine to the large intestine, from where these are excreted as faeces. The nutritional components, apart from dissolved fats, enter directly into the liver, where they are transmuted into useful components and non-useful by products. The type and quantity of useful and non-useful components is determined by the food eaten, and the quality of digestion. Fats remain suspended in the body fluids and are eventually deposited in the tissues or are removed from the main blood circulation and broken down by the liver. Thymos, which has been derived from Pneuma, interacts with the nutrients in the food to generate the metabolic fire 'Ignis', which in turn provides energy for the coction which occurs in the process of digestion and in metabolic combustion. There are three steps of coction:
Click on this button for a Diagram of the Generation of the Four Humors
- The digestive process in the stomach.
- The generation of the Humors in the liver.
- The metabolic activity in the body tissues that generates heat and produces growth.
The generation of the four humors produces waste products that must be eliminated. These wastes often contain some of the humors or humoral components that are superfluous to the body. There are four elemental wastes:
Each of these four wastes has their own natural channels of elimination. Waste heat is eliminated through the skin, waste air and gasses through the lungs, waste water through the kidneys and bladder and waste solids through the bowel. When there are abnormal humors, the body attempts to rid itself of these by increasing their rate of generation in the liver and by passing them out in larger quantities than usual, in exhaled air, through the faeces or in the urine. This produces observable changes in the excretions. Abnormal humors can also become admixed with the Sanguis Humor and/or other Humors to produce morbid conditions in the body, or in the case of the Melancholer Humor may be retained in the body to settle in or on tissues.
- Waste heat – fire - from coction
- Waste air and gasses which have had their vital substance, Pneuma, removed
- Waste fluids – water
- Waste solids – earth
There are other functions of the humors, these include:
Sanguis Humor – Provides motive energy of the body. Stimulates the logical faculty.
The receptacle for this humor is the veins and arteries.
Phlegm Humor – Has expelling properties, its role is to expel substances that not required by the body, such as by-products of infections and toxins.
The Phlegm Humor controls the Choler Humor and has a beneficial cooling and moistening effect on the heart.
It strengthens the function of the lower brain and the emotions, but has an adverse affect on the intellect.
It also maintains proper fat metabolism and the balance of body fluids, electrolytes and hormones. The receptacle for the Phlegm Humor is the lungs.
Choler Humor – Closely associated with the nervous system and acts to increase its rate of function. Choler clarifies all humors and has a warming effect on the body. Choler also stimulates the intellect and increases physical and mental activity and courage. Its receptacle is the gall bladder.
Melancholer Humor – Consists of two parts, a thick earthly aspect, which is the coldest part and which is prone to coagulation, and a more fluid, vaporous substance that is also called Atrabile. Atrabile has the propensity to ascend and affect the brain. When Atrabile exists in normal quantities, it stimulates the memory and makes the nature homely, practical, pragmatic and studious. If however Atrabile becomes excessive, it can cause the condition called melancholy. The coldest part of the Melancholer Humor is adherent and viscous and if not eliminated properly, can settle on or in tissues, thus causing morbid deposits, which can form tumours. The spleen removes the Melancholer from the blood and body fluids and is the receptacle of Melancholer.
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The Psychic Faculty.
The Psychic Faculty performs three functions: It controls behaviour, generates voluntary movement and produces sensations. It has two aspects: The Intellective Aspect, which is associated with the Principal Virtue and the Sensitive Aspect which is associated with the Administering Virtue. The Intellective Aspect consists of three functions: Imagination, Judgment and Memory. Imagination is considered to resides in the forward part of the brain, and to be warm, dry and active in nature; while Judgment resides in the middle part of the brain, is warm and moist in nature and provides the logical and reasoning capacity; and Memory resides in the hind part of the brain, and is cold, dry and melancholic in nature. The Imagination is always active, and never rests, while the Memory is active during waking, but only spasmodically active during sleep. Thus, when the person sleeps, Judgment sleeps also and dreams arise from a combination of the action of the Imagination, and of the intermittent action of the Memory. The second part of the Psychic Faculty is the Sensitive Aspect. This again consists of two functions: The Common and the Particular. The Common Function unites the senses and the Intellective parts together, and is often referred to as the 'Common Sense'. It resides in the outer part of the brain. The Particular Function consists of the five senses of perception vi: Sight, Hearing, Olfaction, Taste and Feeling. Sight resides in the eyes, and is cold and moist and Phlegmatic in nature; hearing resides in the ears, and is cold and dry and Melancholic in nature; olfaction resides in the nose, and is warm and dry, and Choleric in nature; taste resides in the tongue and is warm and moist and Sanguine in nature; and feeling resides primarily in the skin, but it is really in every organ and every part of the body; its nature is composed of all four elemental qualities, namely: Warm, Moist, Cold and Dry.
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The Four Temperaments.
If a Humor is dominant for many years, the physiology and psyche of the person will gradually change to mirror the qualities inherent in that Humor. Thus there are four basic temperaments or classifications which relate to the four Humors: The Sanguine (from sangui=blood), the Choleric (from choler or bile, yellow bile), the Phlegmatic (from phlegm), and the Melancholic (form melan or black, black bile) temperaments. These temperaments traits than an individual acquires during their life due to environmental and lifestyle factors and therefore represent phenotypes. The tendency to develop a given temperament varies from individual to individual and depends upon their genetic or inherent predisposition.
Sanguine Temperament – Belongs to Air element, it is typified by a fair with ruddy complexion, full muscular development, large full veins and a large pulse. These are confident, positive people who are rarely anxious. They are very prone to involve themselves with physical excesses and as a result they often suffer from injuries and their sequels. This type has also been called the 'Muscular' temperament.
Phlegmatic Temperament – Belongs to Water element and displays a fair complexion, light hair, general softness and laxity of tissues and a pulse that is soft and wide. Because of the excessive metabolic activity of immune system, heat tends to be drawn inwards and the exterior is cold; hence people of this types tend to feel the cold the acutely. The Phlegmatic type is slow and sluggish, apathetic and not readily excited, and easily becomes flabby and overweight. This type has also been called the 'Lymphatic' temperament.
Choleric Temperament – Belongs or Fire element and is characterised by a slim build and by much nervous activity. These are passionate people, quick to become excited or angry and just as quick to forget their excitement. They live on their nerves and because of this they are susceptible to brain and nervous disorders. Their pulse tends to be sharp and quick. The skin in this type appears yellowish, and this temperament occurs often in those with brown hair. This type has also been referred to as the 'Nervous' temperament.
Melancholic Temperament – Belongs to Earth element and usually has a darkish complexion and appears emaciated. Their tissues are hard and dry and their pulse is narrow and thready. This temperament is prone to frequent spells of pessimism, a gloomy state of mind with much depression and moroseness.
Understanding the theory of the temperaments is important because: i. certain signs may be normal in one temperament but abnormal in others, ii. certain conditions occur more commonly in certain temperaments and iii. the suitability of a treatment or a medicine or of the dose of medicine may vary depending on the temperamental type.
Click on this button for a table of the Qualities Associated with the Temperaments
When attempting to determine a person's temperament, it will be observed that four temperaments are primary and manifestation of intermediate forms or combinations of two or more temperaments are the rule rather than the exception. This was observed by Galen, who recognised that opposite qualities such as Warm and Dry (Choleric) and Cold and Moist (Phlegmatic) can exist together in a dynamic equilibrium in a living entity with separate structures. He considered that a compound temperament may develop from the exposure by a person to climatic extremes, or may be due to environmental reinforcement of qualities already present in the inherent constitution. Galen formulated the eight compound temperaments.
Click on this button for a table of the Qualities of the Eight Compound Temperaments
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A Dystemper is a deviation from the normal physiological response, metabolic balance or temperament of an organ, body part or of the body as a whole, due to an adverse effect from an abnormally Warm, Dry, Moist or Cold quality, which has disrupted the functions of the Humors and produced an abnormal response of Thymos. There are four Dystempers:
Dystempers may be distinguished from purely Humoral diseases because they produce specific and persistent symptoms that do not seem to progress or change in any way, and which are predictable in that they are generally aggravated or ameliorated by specific environmental factors, while Humoral disease generally present as a series of sequential symptoms that tend to move towards a healing crisis, or, in chronic states will present a set of symptoms that appear and then diminish or disappear, only to reappear in a periodic sequence that is unrelated to environmental factors. Below are set out some symptoms commonly associated with Dystempers.
- The Warm or Hot Dystemper. This may be caused by:
- excessive activity
- excessive anger
- anxiety or worry
- excessive environmental heat
- deficient elimination
- burning up of metabolic ash
- active putrefaction
- too much warm or hot foods, such as hot spices.
- The Moist Dystemper. This may originate from;
- excessive eating or drinking
- too many moist foods
- exposure to too much dampness
- lack of activity.
- The Cold Dystemper. This may be caused by;
- excessive ingestion of cold substances
- debilitating activity or excessive inactivity
- chronic fevers
- slowing of elimination of the humors due to their thickening and coagulation.
- The Dry Dystemper. This may be originate from;
- fasting and starvation
- deficient fluid intake
- excessive activity
- excessive exposure to drying environments
- excess drying foods, such as salt, vinegar or alcohol, or habits such as smoking tobacco.
- acute conditions that have turned chronic due to the drying up of the secretions.
Click on this button for a table of the Signs and Symptoms of the Dystempers
- Symptoms of a Warm Dystemper:
- flushed complexion
- unpleasant sensation of heat
- easily fatigued
- excessive thirst
- irritation or burning in epigastrium
- bitter taste
- fever causes great discomfort
- increase in perspiration
- increase in mucous production
- aversion to hot foods
- craving for cold foods
- hot weather aggravates
- feverish symptoms
- Symptoms of a Moist Dystemper.
- an excessively moist and soft skin
- puffiness of the tissues
- weak digestion
- excessive salivation
- thin catarrhal conditions
- puffy eyelids
- tendency to loose stools
- chronic ulceration
- much need for sleep
- wet weather aggravates
- Symptoms of a Cold Dystemper:
- pale complexion
- desire for heat
- craving for hot spices
- thick catarrhal discharges
- accumulations of toxins and metabolic by-products
- weak joints
- cold weather aggravates
- Symptoms of a Dry Dystemper:
- rough and dry skin
- desire for moistening foods and drinks
- dried and hardened phlegm
- aversion to drying foods
- dry weather aggravates
Compound Dystempers can also exist and in fact are quite common. For example, a Dry Dystemper can be associated with a Warm Dystemper and a Cold Dystemper can exist together with a Moist Dystemper. Clearly a Cold and a Warm Dystemper cannot exist in the same place at the same time because these are opposing qualities, the same applies to Moist and a Dry Dystempers. As we have seen above however, different and opposing Dystempers can exist at the same time in different parts of the body or body organs.
Dystempers are usually associated with an underlying debility and are for this reason normally treated with strengthening foods and tonic remedies that have the opposite quality to that of the Dystemper. For example, a Warm Dystemper is treated with Cold foods and remedies, a Dry Dystemper with Moist foods and remedies, a Moist Dystemper with Dry foods and remedies and a Cold Dystemper with Warming foods and remedies. If a Dystemper is present in an area or organ of the body, medicines that target that area or organ are used.
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Traditionally Graeco-Arabic Medicine considers that all disease processes are due to an imbalance in the four Humors, or at the very least implicate the four Humors. When such an imbalance occurs, the person is said to be in 'bad humor'. The aim is always to find the cause of the underlying disruption of the Humor or Humors and whenever possible give this the main attention. The cause may be due to external factors, such as an injury, infection, exposure to poisons, incorrect diet, inclement climate, etc., or due to internal factors such as improper digestion, organic malfunction, a Dystemper, disturbed emotions, etc., or may be due to a combination of these factors.
Signs of Humoral Diseases.
The celebrated English herbalist, Nicholas Culpeper (1616-1664 AD.) practiced according to the principles of Graeco-Arabic Medicine, as generally was the case with every physician in his day.
Click on this image for more information on Nicholas Culpeper
In his book "The Complete Herbal and English Physician Enlarged", he expounded on the matter of the symptoms of Humoral abnormalities as follows:
- Sanguis Humor: "Signs of Blood abounding: the veins are bigger (or at least appear so), and fuller than ordinary, the skin is red, and as it were swollen, pricking pains in the sides, and about the temples, shortness of breath, headache, the pulse great and full, urine high coloured and thick, dreams of blood, etc."
- Phlegm Humor: "Signs of Phlegm abounding: sleepiness, dullness, slowness, heaviness, cowardliness, forgetfulness, much spitting, much superfluities at the nose, little appetite to meat and as bad digestion, the skin whiter, colder and smoother than it was want to be; the pulse slow and deep, the urine thick and low coloured, dreams of rain, floods and water, etc."
- Choler Humor: "Signs of Choler abounding: leanness of body, costiveness, hollow eyes, anger without a cause, a testy disposition, yellowness of the skin, bitterness in the throat, pricking pains in the head, the pulse swifter and stronger than ordinary, the urine highly coloured, thinner and brighter, troublesome sleeps, much dreaming of fire, lightning, anger and fighting."
- Melancholer Humor: "Signs of Melancholy abounding: fearfulness without a cause, fearful and foolish imaginations, the skin rough and swarthy, leanness, want of sleep, frightful dreams, sourness in the throat, the pulse very weak, solitariness, thin clear urine, often sighing, etc."
The signs of the basic Humoral disturbances given above are only part of the picture, as Humoral disturbances tend to occur in four main ways.
Plethora – an excess or over-activity of one or more Humors. Over-activity of a Humor may occur when the body attempts to replace an abnormal Humor or attempts to balance out a Dystemper. In the latter case the body will produce an excessive amount of a Humor that has the opposite quality to the Dystemper present, in an attempt to re-establish physiological homeostasis. Excessive activity of a Humor may be caused either i. Humoral agitation or ii. an abnormal metabolic change in the body towards the quality of that Humor e.g., cold and moist in the case of the Phlegm Humor. Plethora may be chronic, subacute or acute. The removal of Plethora by the body is characterised by three stages:
Plethora is usually treated by methods which calm or assist in the elimination of the affected Humor.
- A basic Humoral change which may be hardly noticed,
- The coction or boiling off of the excess Humor by a fever, and
- The healing crisis, which is seen with the discharge of the excess Humor. This stage is under the right conditions followed by a restoration of health.
Thinning – Thinning of a Humor may be due to a depletion of a Humor through illness or injury, or may be due to an inadequate generation of that Humor by the liver. The latter may be due to a dysfunction in the generation of Humors by the liver which can be caused by a lack of availability of the elements needed for that Humor, which commonly occurs in malnutrition. Thinning of the Humor may also occur if there is an abnormal metabolic change towards the opposite quality of a Humor..Thus a Cold condition can lead to a depletion of the Choler and Sanguis Humor. For example, thinning of the Sanguis Humor is a common occurrence and usually is the result of underlying blood deficiency such as anaemia. Thinning is usually corrected by removing the cause its depletion and by treatments which augment the quality of the Humor.
Thickening – is common in the Melancholer Humor and also readily occurs in the Phlegm Humor in the presence of a Dry Dystemper. The Sanguis and Choler Humors only become thickened if one or more of the following takes place:
The thickening of a Humor is treated by any of the following methods: i. through the removal of any blockage of Thymos, ii. by removing any blockage to the flow of the Humor, iii. by thinning the Humor, iv. by normalising its function or v. by purging the admixed Humor.
- they become admixed with another Humor,
- they become affected by abnormal Thymos, or
- physical structural changes occur which interfere with their normal flow.
Cacochyma – comes from a Greek word that means: 'bad essence'. It refers to the putrefaction of a Humor. Cacochyma can happen to any Humor and is a common cause of both acute and chronic disease. Cacochyma may be due to noxious substances, such as ingested or absorbed toxins, or it can be due to noxious vapours, that is, air that contains disease causing organisms such as bacteria and viruses. Cacochyma can also occur as a result of grossly imbalanced intakes of the essential elements. Autogenic Cacochyma is the admixture of one abnormal Humor with a normal Humor. This type of corruption is a common cause of an underlying weakness that interferes with the natural resistance to noxious substances and the generation of good Thymos. A Humor commonly affected by Cacochyma is the Phlegm Humor. When the Phlegm Humor is affected, expectorated mucous, which is normally tasteless, takes on a specific and abnormal taste. A sweet taste indicates that there is an excess of the Sanguis Humor admixed; a salty taste indicates admixture with Hot Choler; if the taste is sour, there a Cacochyma of Phlegm by moderate Heat; if there is roughness to the taste there is admixture of a small amount of Melancholer with the Phlegm. If the expectorated mucous is watery and tasteless there is a thinning or excess Moisture in the Phlegm, this the coldest Phlegm imbalance. Cacochyma of a Humor can be treated by one or more of the following methods: i. by eliminating exposure to the noxious substance(s), ii. through eliminating the noxious substances(s) through gentle purging, by means of expectorants or by inducing perspiration, iii. by antidoting the noxious substance(s) and counteracting Cacochyma, iv. through improving the quality of Thymos.
Always the first and most important method of treatment utilised by Practitioner of Graeco-Arabic Medicine is dietary therapy. This is not only a gentle and safe and effective tool when used skillfully, but also provides the means to maintain the balance of "good Humor" once this has been re-established.
Some general rules on correcting Humors.
- The cause of the disease should first be removed; if this is done all other aspects of the disease will vanish.
- A medicine should firstly fit the condition, and secondly fit the quality of the condition, the affected Humor and the quality of the affected organ.
- If there are toxins present in the body always balance with foods and medicines that have the exact opposite quality.
- If toxins have accumulated in the body, first support Thymos to increase physical resistance to the toxin and then gently purge the toxins.
- When eliminating toxins it must be remembered that Sanguis and Phlegm tend to eliminate upwards and Choler and Melancholer downwards.
- Always use the correct elimination procedure and remedy for the affected Humor.
- If the Humors to be eliminated are viscous, avoid sour, drying and astringent remedies and foods, as these will further thicken the Humors and prevent their elimination.
- Care should be taken during pregnancy and breast feeding as many common and normally harmless foods and remedies can have an adverse effect on the child.
- During a crises do not use cooling remedies, unless these are needed to protect against a seriously high fever, as these can drive the Humor back and the condition inward and set the stage for a chronic disease.
- Never give strong medicines if gentle ones will do the job, it is better to take too weak a medicine than one that is too strong.
- When treating any patient always keep in mind Hippocrates' dictum: "Primum non nocere" (first do no harm).
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Finally, Graeco-Arabic Medicine recognises that everyone comes into this world with certain inherent strengths an weaknesses. As such, there have always been attempts to classify individuals according to their inherent constitutional type.
Originally there were four inherent constitutions, which were the same as the four classical temperaments, namely Sanguine, Phlegmatic, Choleric and Melancholic. These were considered to represent an inherent tendency towards one or more specific temperamental states that could be discovered by a careful observance of a person's physical appearance and other attributes. These constitutions were regarded as providing some fundamental measure of the inherent nature and quality of the Thymos, and were therefore seen as having a bearing on the potential overall health and longevity of the person. The inherent constitution was also considered to influence the nature of the Dystempers likely to develop during life.
It was important to the Graeco-Arabic physician to determine wherever possible the inherent constitution of a patient, and this particularly so in the case of treatment of a chronic disease, as it provided a picture of the acquired changes that were likely to be the foundation of the disease or were at the very least an important part of the cause of the disease. It was also important because it was well recognised that truly inherent weaknesses could only be ameliorated and never be cured.
The classification of people into inherent constitutional types became of much greater importance than previously in the 19th. century and reached its height of sophistication towards the beginning of the 20th. century. These developments were primarily driven by the decline in the medical practice of the humoral model, and by scientific discovery of the macro- and micro-nutrient chemicals, which appeared to expand knowledge beyond the simple system of the temperaments, although this information did fit in remarkably well with the metabolic model represented by the functions of the humors.
One of the major researchers in this area was Victor Rocine (1859 - 1943) who by 1908 had developed and implemented a inclusive genotype system of classification which contained twenty distinct inherent constitutional types that correlated perfectly with the classifications of the classical temperaments of Graeco-Arabic Medicine.
Click on this image to read more about Victor Rocine and the Inherent Constitutions
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