Avicenna defines elements as simple substances which provide the primary

components of the human body. The four elements are earth, air, water and fire.
These are symbolic expressions. Because all the elements recognized so far
exceeding 100 should correspond to any of these four elements which virtually
encompass all the known elements of today. These four elements have been
assigned four temperamental qualities viz. hot, cold, moist and dry. With the
existence of the matter in the universe, bodies also gain specific shape, and the
quantum of matter a body contains is its mass. Since the body has to do some work,
it should have energy to do so. Moist or dry states of matter shouId be charged with
heat and cold in the form of energy. In theory mass and energy could be spelled out
distinctly but in practice the two are inseparable. In view of the physical conditions
as they are, we could conclude that heat is in fact the total kinetic energy
possessed by the molecules of the body due to their rapid and random motion.
Aristotle has rightly held the hot and cold as active, and dry and moist as passive
qualities. This concept of element with heat and cold as two opposite types of
energy and dryness and moisture as two opposite qualities of matter is the
fundamental hypothesis which proceeds to explain the complicated phenomenon of
human biology and psychology in physical terms.
The four elements are earth and water (heavy), and fire and air (light). In terms of
qualities, the heavy elements are strong, negative, passive, and female. The light
elements are weak, positive, active, heavenly, and male.
The chart below shows various correspondences for elements.
Season

Spring

Summer

Autumn

Winter

Age

Childhood

Youth

Maturity

Old Age

Region

East

South

West

North

Element

Air

Fire

Earth

Water

Humor

Blood

Yellow Bile

Black Bile

Phlegm

Personality

Sanguine

Choleric

Melacholic

Phlegmatic

Earth is an element usually situated at the center of our existence. In its nature it
is at rest, and because of its inherent weight, all other elements gravitate toward it,
however far away they may be. It is said to be cold and dry in nature, and it appears
so to sight and touch, so long as it is not changed by any other elements. It is by
means of the earth element that the parts of our bodies are fixed and held in place;
thus the outward form of the body is due to the earth element.

Water is a simple substance whose position in nature is exterior to the sphere of

the earth and interior to that of air. Water is cold and moist in temperament,
although only slightly so. Water is easily dispersed and assumes any shape without
permanency. In the construction of "things," the addition of water allows the
possibility of their being shaped and molded and spread out. Shapes can readily be
made from it, and just as easily dispersed. Moisture dispels dryness, the latter being
overruled by the former. Moisture protects dryness from crumbling (as moist earth,
or mud), and likewise, dryness prevents moisture from dispersing. Thus the two
elements of earth and water are interacting and interdependent. Water is, of course,
absolutely essential to life.
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 nature is to make things
finer, lighter, and more delicate and thus more able to ascend into higher spheres.
Air is also the agent by which breath moves in and out of the body and causes or
makes possible the involuntary movements of the body.
Fire is also a simple substance, situated higher than the other three elements.
Fire is hot and dry in temperament, and its role in nature is to rarefy, refine, and
intermingle things. Fire has the power to penetrate and can ride through the
element of air. It has the capacity to overcome the coldness of the two cold
elements, earth and water, and so creates and maintains harmony among the
elements.
Each of the elements has a corresponding humor or essence in the body: Blood
humor relates to air. Phlegm humor relates to water. Yellow bile humor relates to
fire. Black bile humor relates to earth.
The table below summarizes attributes of the elements as they relate to aspects
of human physiology:
Attributes Of The Elements
Earth

Water

Tendency

Spreading

Drooping

Bodily system

Skeleton

Muscles

Excretion

Feces

Urine

Sense

Touch

Taste

Bodily function

Form

Nutrition

Mentality

Torpid

Phlegmatic

Mental State

Obstinancy
Fearfulness

Submission
Affection

Air

Fire

Tendency

To and Fro

Rising

Bodily system

Circulation

Liver

Excretion

Saliva

Sweat, Tears

Sense

Hearing

Smell

Bodily function

Respiration

Digestion, Voluntary

Mentality

Cheerful

Emotional

Mental State

Humor

Weeping, Anger

The terms earth, water, air, and fire do not mean literally clods of dirt, buckets of
water, and so forth. The four elements are sometimes referred to as "primary
matter;" which, when admixed, gives rise to the various forms such as mountains
and rivers. Likewise, the burning fire that we see is not the element fire, which is
really the potentiality of fire within the substance. For example, green wood has the
element of fire within, but this may or may not be brought forth as flames,
depending on whether it is ever ignited. All of the elements bear this relation
between capacity within and reality of form.
Thus all of the concrete objects of this world--from the most immense mountain
to the minutest form of submicroscopic life--are related by the four elements. And
through these same four primary elements, all earthly objects are related to (and
influenced by) the planets and stars of the zodiac (which also have primary qualities
within them).
The movement of these four elements is continually taking place, so that change
is a continuous process within the human body. This change can be either cyclical or

progressive. The cycle of intake and elimination of food is an example of cyclical

change, whereas the growth of a cancerous tumor is an example of a progressive
change. In the Unani system, the monitoring and observation of these changes
becomes an important mode of evaluating precisely what is happening within each
part of the body. Therefore, a method of classifying these changes has arisen, called
temperaments.

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)

1. Breath

6. Spleen

2. Bloodd

7. Kidneys

3. Liver

8. Walls of arteries

4. Flesh

9. Walls of veins

5. Muscles

10. Skin of palms and soles

Coldness (1 = Coldest)

1. Phlegm humor

7. Membranes

2. Hair

8. Nerves

3. Bones

9. Spinal cord

4. Cartilage 10. Brain

5. Ligaments11. Fat
6. Tendons

12. Oil of the body

13. Skin
Moisture (1 =Moistest)

1. Phlegm humor
2. Blood

7. Breasts and testicles

8. Lungs

3. Oil 9. Liver
4. Fat 10. Spleen
5. Brain

11. Kidneys

6. Spinal cord

12. Muscles

13. Skin
Dryness (1 =Driest)

1. Hair

7. Arteries

2. Bone

8. Veins

3. Cartilage 9. Motor nerves

4. Ligaments10. Heart
5. Tendons

11. Sensory nerves

6. Serous membranes

12. Skin

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 & Temperaments

Alteration in Quantity of Humour:

Red face
Full veins
Tightness of skin
Dull movements and gestures
Full pulse
Colored and dense urine
Poor appetite
Feeling of weight in the limbs

Alteration in Quality of Humor:

Poor vision
Dreaming that one cannot speak
Cannot lift a heavy object
Sluggishness
Loss of appetite
Feeling of bearing emotional burdens
In dream, sensation of itching, stinging, burning and smelling foul odors.

Excess of Heat:

Feelings of uncomfortable heat

Suffer greatly from fevers
Easily fatigued
Excessive thirst
Burning and irritation in the pit of the stomach
Bitter taste in the mouth
Pulse weak, rapid and fast
Intolerance of hot foods
Relief and comfort from use of cold foods and things
Suffer greatly in summer
Inflammatory conditions
Fatigue and loss of energy

Excess of Cold:

Weak digestion
Diminished desire for drinks
Laxity of joints
Tendency to phlegmatic type of fevers and catarrhal conditions
Cold things easily upset and hot things are pleasant and beneficial
Suffer greatly in winter

Excess of Moisture:

Puffiness
Excessive salivation (mucous in saliva) and nasal secretion
Tendency to diarrhea and upset stomach
Desire for moist type of foods
Excess of sleep
Puffiness of eyelids

Excess of Dryness:

Dryness and roughness of skin

Insomnia
Wasting
Intolerance of dry type of foods, while moistening foods will give comfort and
pleasure
Suffer greatly during autumn
Hot water and light oils are readily absorbed by the skin