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MichaelAli published a new article : THE BASIS OF TIBB MEDICINEIntroduction.
Avicenna begins The Canon with a definition of the science of medicine:
Medicine (tibb) is the science by which we learn the various states of the
human body in health and when not in health, and the means by which health is
likely to be lost, and when lost, is likely to be restored. In other words,
medicine is the art whereby health is conserved and the art whereby it is
restored after being lost. Avicenna
insists that the human body cannot be restored to health unless the causes of
both health and disease are determined. In categorising the causes, he states
that a complete knowledge may be, and should be obtained of the causes and
antecedents of a disease, provided, of course, such causes exist. Sometimes these
causes are obvious to the senses but at other times they may defy direct
observation. In such circumstances, causes and antecedents have to be carefully
inferred from the signs and symptoms of the disease. Hence, a description of
the signs and symptoms of disease is also necessary.
There are four causes: material, efficient, formal and final:
The Material Causes.The material cause (maddi) is the physical body which is subject to
health and disease. This may be immediate and involve the organs of the body
together with their vital energies, or remote as involving the humours, or
remoter than these, by involving the elements which are the basis for both
structure and change (or dynamicity). Things which thus provide the foundation
of health and disease, get so thoroughly altered and integrated that from an
initial diversity there emerges a holistic unity with a specific structure and
a specific type of temperament.
The material cause then, is the physical body, as viewed from the traditional
perspective. It consists of the organs, the vital energy (thymos), the humours
and the elements.
The Elements.The primary constituents of the human body are "the elements."
They are the basic building blocks for the science of medicine.
The four elements - Earth, Air, Fire and Water - are the simplest building
blocks of all that is material, including our bodies. Each of these has two
qualities: Earth is dry and cold; Water, cold and moist; Air, hot and moist;
and Fire is hot and dry.
The elements also have special relationships to each other: Earth is contrary
to Air and Water to Fire. Union between the elements is possible because Water
serves as a link between Earth and Air and Air as a link between Water and
Fire.
The elements, like musical tones, possess an inclination not only to ascend and
descend, but also to move in a circular direction. Each element is joined by
one of its qualities to that which is below and by the other to that which is
above it.
Water to Earth beneath by coldness and to Air above by moisture; Air to Water
beneath by moisture and to Fire above by heat; Fire to Air beneath by heat and
to Earth toward which it declines by dryness; Earth to Water above by coldness
and to Fire towards which it declines by dryness.
Two of the elemental qualities are active and two passive. Active are hot and
cold. Passive are dry and wet. An ideal combination of elements exists when
each one is on an equitable basis with the other.
Quality results from the opposing qualities of the elements, a mixture of hot,
cold, wet and dry. Balance comes when the strength of primary qualities are
equal and represent an average of these qualities. In medicine, balance does
not depend upon the qualities and elements being exactly equal, but upon them
being "equitable," meaning that the quality and quantity of the
elements are distributed in such a manner that the resulting pattern or
equilibrium of the body as a whole or of its parts is the one most appropriate
for that person.
The proportion in which the elements are united with the body has an influence
upon action. Slow and heavy movement signifies a predominance of cold and
dryness (Earth); fearfulness and sluggishness, of cold and wetness (Water);
cheerfulness, of heat and wetness (Air); and sharp, angry violence, of heat and
dryness (Fire).
All living beings consist of elemental qualities which are interwoven into
their physical process. If something changes at an elemental level, something
must have changed in the physical process. The two stand to each other in the
strict relationship of cause and effect.
The phenomena of the external world and, in traditional medicine, the inner
world, also consist of the elements and their qualities. Different elemental
qualities are always based on the different properties of the elements (higher,
lower, lighter, heavier, colder, hotter, etc.). The distinguishing
characteristic of the elements is that they differ like two colours, red and
green, and like two shades of a single colour, light and dark blue or like the
shapes rough and square. The properties of the elements distinguish them from
one another and at the same time orders them in definite ways.
The dynamic quality of the elements is that they have direction. The elements
attract and in turn are attracted and are therefore directional forces.
Elemental motion has its origin not in their different properties but in
differences of dynamic quality as conveyors of motion.
The Humors.The humours are the vital essences of the body. These humours affect the
function of the body and are themselves influenced by physical functions.
Food and drink are transformed into innate heat through the digestive process.
The humours arise in the second stage of digestion in the liver. This process
produces four humours which sustain and nourish the body and move through the
channels or meridians: sanguineous (blood), serous (phlegm), bilious (choler,
yellow bile) and atrabilious (melancholy, black bile); which correspond
respectively to Air (hot and moist), Water (cold and moist), Fire (hot and dry)
and Earth (cold and dry). The humours are subject to variation in quantity and
to variation in degree of purity.
Illness results when there is either a quantitative or qualitative change of a
humour. In a "normal" state, the humours are assimilated by the organs
and completely integrated into the tissues. In an "abnormal" state,
which is due to improper digestion, the material is unsuitable for assimilation
and must therefore be eliminated by the body. Surpluses may be eliminated by
exercise, bathing, coitus, purges and laxatives.
- The
sanguineous humour (blood), which is of a balanced nature, is hot and moist, sweet
and red, and exceeds the other humours in proportion to quantity. It
imparts strength and colour to the body and engenders the drives. Located
in the heart, it relates to the Zodiacal constellations of Leo, Aries and
Sagittarius. - The
phlegm humour or serous humour, is next to blood as far as the relative quantity
present in the body is concerned. This humour is watery, cold, moist and
white and moderates the strength, heat and thickness of the blood, nourishes
the brain, and moistens and nourishes the moving parts of the body. If an
abnormality of blood arises, heat will dissolve the phlegm humour into
blood. Cancer, Pisces and Scorpio are the Zodiacal signs relating to this
humour. - The
bilious humor, is less plentiful in the body than either blood or phlegm. Its
quantity is hot and dry, yellow or red and bitter. A part of it passes
from the liver to the gallbladder and another part flows from the liver
with other humours. This humour moderates moisture and provides a
penetrating quality to the blood so that it may enter more readily into
every tissue of the body. The bilious humour prevents the body from
becoming heavy, sleepy and dull. It penetrates and opens passages and
sustains those components of the body in which the fiery element
predominates. Zodiacal signs of the bilious humour are Gemini, Aquarius
and Libra. - The
atrabilious humour’s quality is earthy and gross, thick, black and sour. A part of it
is separated out by the spleen and a part remains within the blood. This
humour feeds the bones, the spleen and other parts of the body which are
gross or "melancholy" in nature. It tempers the two hot humours
(sanguineous and bilious) and restrains the vaporous volatiles that arise
from blood. The atrabilious humour thickens the blood and thus prevents it
from flowing too freely through the veins and arteries. The Zodiacal
relationship of this humour is with Taurus, Virgo and Capricorn.
Variability of the Humors.The humors vary considerably as regards their quantity and quality.
The sanguineous rules from 3 am to 9 am; the bilious from 9 am to 3 pm; the
phlegm humour from 3 pm to 9 pm and the atrabilious humour from 9 pm to 3 am.
The sanguineous humour increases in spring. The heat of summer opens the pores,
dissolves excess humours and reduces them, and causes the vital breath to
escape from the body when exhaling, together with moisture and vapours. During
this time, the bilious humour is dominant. Autumn tends to generate the phlegm
humour. During winter the humours thicken, the sinews are contracted and the
natural heat is directed inward. The atrabilious humour increases and makes
people sluggish.
The activity of the elemental qualities (cold and heat) tends to determine
which type of humours are most likely to form. When the amount of heat present
is in balance, the sanguineous humour will be formed; when heat is in excess,
the bilious humour forms; when there is such an excess of heat that oxidation
occurs, the atrabilious humour forms. When the amount of cold present is
balanced, the phlegm humour forms; when there is an excessive amount of cold,
congelation becomes dominant and the atrabilious humour forms.
The Temperaments.The natural predominance of a given humour in the human body provides
specific characteristics of physique and behaviour.
Those dominated by the sanguinious humour are cheerful, courageous, kind and
ingenious. Their blood, if of good quality, gives them a keen wit.
As a person accumulates fat, the amount of Phlegm present relative to blood,
increases. Domination of the phlegm humour is present in people who are
generally lazy, given to pleasure, and who are sleepy, idle, dull witted, heavy
and slow. They love rich foods and drink.
Those with a predominance of the bilious humor are easily provoked, given to
treachery and vehement in action; fierce when attacking, but inconstant in
maintaining the assault; inclined to envy, pride, extravagance and
vindictiveness. If there is corruption of the bilious humour, they tend to
be subject to abnormal desires and terrible nightmares.
Those dominated by the atrabilious humour are difficult, obstinate, suspicious,
sorrowful and given to terrifying impulses.
The natural predominance of a given humour in the human body provides
specific characteristics of physique and behaviour.
The Psychic Faculties.There are three faculties (Avicenna: souls) within man, the vegetable,
animal and rational. All of which fulfil their own functions. The more refined
the mixture of the humours, the greater is the perfection of the faculties and
the more complete the integration of the soul. Health means the harmony and
total balance of the humours (eucrasia - Classical Greek.), while illness
represents a disruption of the normal balance of the constitution.
Of course there is never perfect harmony, as living things are always in a
state of dynamic equilibrium in which one state of imbalance counteracts
another state of imbalance; therefore health means the re- establishment of the
balance of the humors relative to an individual’s own constitution and
environment. Diagnosis for such disorders as fever are, in fact, based on
searching in order to discover in which way the humours have become unbalanced.
In diseases that are associated with clear symptoms, diagnosis is made from the
most notable sign or signs of the disease, and a disease will often receive its
name from the main signs associated with it.
The Vital Force.The vital force (breath - Avicenna, pneuma or thymos - Classical Greek.)
acts as the link between the body, soul and spirit. It is the role of the vital
force to maintain a perfect equilibrium within the elements of the body, and
between the elements of the body and the environment.
The left side of the heart is hollow in order to serve both as a storehouse of
the vital force, as well as the place of manufacture of the vital force. The
vital force in turn enables the soul to convey its directions to the body and
its components. In the first place the vital force is a rallying-point for
the vital faculties (of the soul), and in the second place it is an emanation
that penetrates every tissue of the body. The vital force is generated from the
more refined aspects of the humors and out of vital heat, while the tissues
themselves are produced from the coarser and earthy aspects of these humours.
In other words, the vital force is related to the refined particles as the body
is related to the coarser particles of the same humours.
There are three aspects or spirits to the vital force, the natural spirit, the
animal spirit and the vital spirit. Each of these three aspects has its own
place and function and each has its own particular temperament.
Although the body consists of several organs, there is one from which they all
originally arose. As to what this organ actually was, there are various
opinions. The fact remains that one organ necessarily came to light before
other organs could arise out of it. Exactly the same is true in the case of the
vital force, there is one single vital force that accounts for the origin of
the other vital energies. This vital force, according to the most important
philosophers, arises in the heart, passes thence into the principal centres of
the body, lingering in them long enough to enable them to impart to it their
respective temperamental properties. While it remains in the cerebrum it
receives a temperament that enables it to respond to the impulses of sensation
and movement; in the liver, it receives the drive of nutrition and growth
(vegetative drives); in the generative glands it acquires a temperament that
enables it to respond to the impulse of generation (reproduction).
Thus the vital force has three components:
- The
vital spirit, which is hot and dry, has its centre in the left ventricle of the
heart, preserves life, causes the body to grow, move and reproduce, and
travels through the arteries. - The
psychic spirit, which is cold and moist, has its centre in the brain, causes
sensation and movement, travels through the nerves and is the source of
movement and reason. - The
natural spirit, which is hot and moist, has its centre in the liver, is concerned
with the reception of food, growth and reproduction and travels through
the veins.
The Organs.The humors are the constituent elements from which the organs of the
body are formed, just as the humors are derived primarily from the
inter-combination of nutrients and the nutrients are primarily composed of a
combination elements.
The organs are divided into two types: simple organs, which have homogeneous
parts such as flesh, bones and nerves, and compound organs such as the hands
and face. The organs are the servants of the mind and are the instruments by
which the mind can control the body.
The primary elemental quality of an organ is based on its nutrient while its
secondary quality is determined by what it excretes.
- Hot
organs consist of vital force; blood; and tissues of the heart, liver,
flesh, muscle, spleen, kidneys, breasts, testicles, muscular coats of
arteries, veins, and of skin of the palm. - Cold
organs consist of phlegm; and tissues such as hair, bones, cartilage,
ligaments, serous membranes, nerves, spinal cord, brain, solid and liquid
fats and skin. - Moist
organs consist of phlegm; blood; and tissues such as sold and liquid
fats, brain, spinal cord, breast, testicles, lungs, liver, spleen,
kidneys, muscles and skin. - Dry
organs consist of tissues such as hair, bones, cartilage, ligaments,
tendons, membranes, arteries, veins, motor nerves, heart, sensory nerves,
and skin.
The Efficient Causes.
The efficient causes (failiya) are capable of either preventing or
inducing change in the human body. They may be external to the person or be of
internal origin. External causes are: age, sex, occupation, residence and
climate and other agents which effect the human body by contact, whether
contrary to nature or not. Internal causes are sleep and wakefulness,
evacuation of secretions and excretions, the changes at different periods of
life in occupation, habits and customs, ethnic group and nationality.
The efficient causes are clear and vary with each individual. Whereas the
elements, humors, vital force and organs are all inherent and from nature, the
efficient causes are acquired and develop out of the nurturing process.
The Formal Causes.There are three formal causes (suriyah): temperaments (mizajat), the
faculties or drives (qawa) which emerge from it, and the structure.
Temperament arises from the elements and humours and it determines the way in
which the individual functions. Each kind of living creature, as well as every
organ of the body, has its own temperament which is perfectly suited to its own
functional requirement. Some are more hot, others more cold, others more dry
and others more moist.
The temperament is "equable" (balanced or in eucrasia - Classical
Greek) when the contrary qualities are in perfect equilibrium, and out of
harmony or "inequable" when the temperament tends toward a particular
quality.
Therapeutics, then, are based on the principle of providing treatments or
medicines that have the opposite quality to the excess of the imbalance. That
is, "cold" diseases can be cured by "hot" remedies and vice
versa.
It is worth remembering that when a medicine is referred to as being temperate
(balanced - Avicenna), it does not mean that its temperament is the same as of
a human being, or that it is even similar to it, for it would then be like a
human being. It merely means that such a medicine, after having been acted upon
by the innate heat [metabolised], fails to produce any material change in the
normal state of the body, and that its pharmacological actions remain within
the limits of the normal human temperament. In other words, when this medicine is
given to a normal person, it does not produce any appreciable change or
imbalance in the body.
When it is said that a medicine is hot or cold, it does not mean that the
physical quality of the medicine is particularly hot or cold or that it is
colder or hotter than the human body. It just means that such a medicine, when
ingested or applied, produces a greater amount of heat or cold than what was
originally present in the body. A medicine which, for example, is cold for a
human being may be hot for a scorpion, while a medicine which is hot for the
human being may be cold for a serpent. In fact it may also mean that the same
medicine may be less hot for one person than for another. This is the reason
why physicians are advised to change their medicine when it fails to produce
the desired result.
The growth and decay of the human body is dependent upon the human temperament.
Growth depends upon the heat contained in the inherent generative energy, which
is gradually used up. Meanwhile, the moisture lessens in quantity and quality,
thus preserving the innate heat at a constant level up to the old age.
Ultimately, however, the moisture of the body comes to an end, and the innate
heat is extinguished, thus causing the death to which everyone is destined and
the timing of which depends upon the original temperament of the human body.
The uniqueness of the temperament of each individual indicates that each
individual is a microcosm that represents a world of its own, which is not
identical with any other microcosm. Yet, the repetition of the same basic humours
in each constitution bears out the fact that each microcosm presents a
morphological resemblance to other microcosms.
Moreover, there is an analogy between the human body and the cosmic order, as
shown by the correspondence between the humours and elements. There is in the
Hermetico-alchemical natural philosophy, which has always been closely tied to
Graeco-Arabic medicine, which represents a basic doctrine of the correspondence
between all the various orders of reality: the intelligible hierarchy, the
heavenly bodies, the order of numbers, the parts of the body, the letters of
the alphabet which are the "elements" of the Sacred Book, etc. The
seven cervical and the twelve dorsal vertebrae correspond to the seven planets
and the twelve signs of the Zodiac, as well as to the days of the week and the
months of the year; and the total number of discs of the vertebrae, which are
considered to be twenty-eight, to the stations of the moon. There is,
therefore, both numerical and astrological symbolism connected with medicine.
Thus these correspondences and "sympathy" (sympathia - Classical
Greek) between various orders of cosmic reality, form the philosophical
background of Graeco-Arabic Medicine.
The Vital Faculties.The body also possesses vital faculties or drives, from which originate
the functions of various organs. The major faculties are:
- the
vital faculty (hayawaniyah), which is responsible for preserving the integrity
of the vital force, sensation, and movement of the heart; - the
natural faculty (tabiiyah), which governs the nutritive powers of the liver and
the reproductive powers of the generating organs; and - the
animal faculty (nafsaniyah), which controls the brain and the rational faculty.
The ability of the different components of the body to function as one
entity arises from the vital faculty, which provides the body with its inner
force. The vital faculty is that which appears in the vital force at the very
moment at which the vital force develops out of the rarefied particles of the
humours.
There is a relationship between the human body as a whole and its component
parts; the whole being is active in any part or components, while any part or
component continually demonstrates its relationship to the whole. Whenever we
encounter a phenomenon that shows this kind of relationship between its
totality and its component parts, we may assume that there is an ordered action
of forces that underpins its existence. This is the role of the faculties which
we can only know through their effects, as it works through the physical body
without ever being confined by it.
(Special note: according to some of Avicenna’s other writings, the
faculties represent the natural laws inherent in the elements, humors and in
the vital force. In the true Hermetic tradition, Avicenna sees these natural
laws as embodying a component of Divine creative perfection, which to him
explains the tendency inherent in natural systems to direct themselves towards
a point of balance or equilibrium.- P.H.)
The Final Causes.The final causes (tamamia) are the actions or functions. They can only
be understood from a knowledge of both the faculties or drives (qawa) and the
vital energies (arwah) that are ultimately responsible for them.
- The
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