Iranian traditional medicine

Iranian traditional medicine (ITM) (Persian: طب سنتی‌ ایرانی, romanized: tebbe sonnati-e irāni), also known as Persian traditional medicine, is one of the most ancient forms of traditional medicine.
ITM is grounded in the concept of four humors: phlegm (Balgham), blood (Dam), yellow bile (Ṣafrā') and black bile (Saudā'). The four humors concept is based on the teachings of Rhazes and Avicenna into an elaborate medical system.
Some scholars believe that efforts for revitalizing ITM in recent years have shaped two main attitudes: evidence-based medicine, and quackery. While many academics use evidence-based scientific measurements (for example, various studies have been conducted and reported on the effect of traditional Persian medicine formulas on the SARS-CoV-2 and these treatments have been studied in various clinical trials in Iran), there is also a pseudoscientific stream in the modern academia.
Globally, this medicine reached its peak in Iran, concurrent with polymaths such as Muhammad ibn Zachariah al-Razi, Ibn Sina and Esmaeil Jorjani. Ancient Iranian Medicine, the basic knowledge of four humors as a healing system, was developed by Hakim Ibn Sina in his medical encyclopedia The Canon of Medicine.
According to a definition given in one of the first Iranian medical textbooks called Hidayat al-Muta'allemin Fi al-Tibb (translated as 'A Guide to Medical Learners'), written by Al-Akhawyni Bokhari in the 10th century, medicine is a technique of scientifically maintaining the health of human beings, and restoring it when it deteriorates.
ITM strongly focuses on prioritizing health maintenance and disease prevention over treatment.
Herbs, spices and plant extracts for traditional Persian medicine are often sold in a kind of specialized shop called an attari. Operation of such a drug store is regulated by the government.
The lifestyle rules in ITM are focused on six core principles, known as Setah Zaroriah in Persian. Nutrition, environment, physical activity, sleeping patterns, emotions, and ridding the body from waste materials, are the six fundamental and guiding principles behind the ITM lifestyle. It is believed that health is found in recognizing one's temperament, or physical and mental characteristics, and using this information to guide your lifestyle.
ITM is a holistic medicine based on individual differences, a concept known as "Mizaj", or temperament. It is a set of physical and mental characteristics, defined by certain symptoms in the body and mind. According to ITM, everybody has a definite Mizaj which determines all physical or mental characteristics. Generally, Mizaj represents the excess or lack of warmness and humidity in one's body, and is classified into four qualities: warmness (Persian: گرمی , transliteration: garmī), coldness (Persian: سردی , transliteration: sardī), dryness, and wetness. Mizaj is a spectrum, and some have warmer Mizaj than others. No two individuals have exactly the same Mizaj, but they can resemble one another to some extent. It is believed that Mizaj is determined in the embryo. Consistently, the parents' Mizaj can also be a determining factor in the child's Mizaj.
While the Mizaj is forming, one or two of the four qualities can become dominant and determine the main Mizaj. Therefore, the tempers are classified into nine categories: warm, cold, wet, dry, warm and dry, warm and wet, cold and dry, cold and wet, and moderate—where none of the qualities are dominant.
There are no absolute good or bad temperaments, and as long as they are within their normal ranges—reflected in physical and mental health—they are in a balanced, or normal, state. As each person's Mizaj differs from others, peoples' lifestyles will be different; this is the main essence of ITM in maintaining health and treating illnesses.
By adopting the kind of lifestyle that fits their Mizaj, one should try to keep the inherent warmness and humidity of their body in certain range, as per their main Mizaj, and avoid possible "mal-temperament".
Mizaj is not just confined to human beings. Every object, situation, and state in the world has a special and defined Mizaj.
The tempers, or amzajeh, are classified into nine categories: moderate, warm, cold, wet, dry, warm and dry, warm and wet, cold and dry, cold and wet.
Some identifying behavioral and physical characteristics help to determine one's temperament.
All organs and body tissues have a specific Mizaj.
Colors have temperament, meaning that they can reveal an object's temperament, or intensify the temperament of an individual.
The color yellow is the symbol of a warm and dry temperament, and red represents warm and wet Mizaj. On the other hand, dark colors such as black, grey, and brown symbolize cold and dry Mizaj, and bright colors such as white and blue are the symbols of cold and wet Mizaj.
Warm colors are signs of warmness and can increase the temperature in a confined area. These colors are associated with danger, threat, warning, and movement. They can increase the metabolism in the body and put it on alert.
Therefore, those with cold Mizaj who normally have a slow metabolism and feel sluggish should use warm colors for their clothes and houses, while people with warm Mizaj should do the reverse. People with a warm temperament who are normally vibrant, brisk, lively and stressed should avoid using warm colors, and use cool colors such as white, blue, and light green. Such cool hues can bring about a more passive reaction in the brain and can make a person feel pleased and relaxed. Accordingly, cool colors are not ideal to people with a cold temperament.
Each season has a defining temperament, so individuals should take special measures depending on the seasons.
The amount of warmness and humidity fluctuate over days and nights, therefore different temperaments form: morning is cold and wet, before noon is warm and wet, the afternoon is warm and dry, and evening and night are cold and dry. The various Mizaj of the day and night are the reasons behind mood swings and pain or discomfort varying during the day and night.
Flavors have temperaments and accordingly would cause warmness, coldness, dryness and wetness in the body. One can determine the Mizaj of a food item or a drink by taste alone.
Tasteless food items, also called watery, are cold and wet. Every insipid food item such as lettuce, dairy products such as yogurt, and citrus fruits, which are not very sour or sweet are cold and wet.
Sourness is cold and dry and causes dryness and coldness in the body as well. Vinegar and pickled vegetables, sour fruits or sour juices, and kashk are all cold and dry.
Salty, bitter and spicy flavors which are usually used to give foods a special taste are warm and dry, although spicy foods are warmer and dryer than bitter and salty foods respectively.
Sweetness is warm and wet and most food items (including main dishes and high-calorie food) are classified in this group.
People with cold and dry Mizaj should avoid consuming sour foods and drinks or they can develop conditions such as dry skin, depression, and weakness.
The same goes for people with other temperaments, for instance, people with warm and wet Mizaj should cut back on sweet foods, people with warm and dry Mizaj should avoid using too much spice and salt, and people with cold and wet Mizaj should use dairy products, water and citrus fruits cautiously.
Each climate has its own unique temperament. In general, polar regions, mountainous areas with rocky landscapes, sandy grounds, and north winds, are cold and dry. Salt marshes and deserts are warm and dry. Coastal areas are cold and wet, while the tropics are warm and wet.
In Iran, southern, some eastern and mostly central areas which get the most sunlight and low humidity are warm and dry. Coastal areas in southern Iran and northern Iran (only during hot seasons) are warm and wet. Western and northwestern areas which are dominantly mountainous are cold and dry and coastal areas in northern Iran (except for warm seasons) are cold and wet.
The house orientation, whether the house is south-facing, north-facing, or built underground, determines the house temperament. North-facing houses (in Iran) with less sun exposure, underground houses, or houses built in damp and humid places are cold and wet or cold and dry. But south-facing houses which get enough sunlight and are built in warm places are normally warm and dry.
Even winds can develop a distinguishing temperament in an area. Winds blowing from northern and north western areas in Iran are cool and can cause a cold temperament, while winds blowing from southern areas are warm and develop a warm and wet temperament. Western and eastern winds are moderate and will not change the temperament very much.
The type of soil of an area is also important. Areas with loamy and clay soil which have great potential of retaining water are wet, while areas with chalky or sandy soil, composed of large particles which prevent it from retaining water, are warm and dry.
Any changes in the psychiatric condition affect a human's temperament to some extent. The longer the conditions are, the more dramatic and lasting the effects are. On the other hand, changes in one's temperament can influence psychiatric condition as well.
By releasing the heat from inside the body to the surface and vice versa, and by absorbing heat from the body's surface, such psychiatric conditions can cause warmness or coldness in the body.
Anger and excitement increase warmness and dryness in the body, and are the signs of dry and warm Mizaj, as someone with warm and dry Mizaj is more likely to get angry or excited. People who consume too much warm and dry food may be affected by anger and excitement more often.
Pleasure and worry are warm and wet, while fear, horror, and depression can be a result or sign of cold and dry—or in some cases cold and wet—Mizaj.
In order to maintain mental health one can both practice self-control and seek professional help. But adopting a lifestyle that suits one's Mizaj by consuming foods and drinks in accordance with their temperament is very important for good mental health.
If someone with warm Mizaj often eats food with warming characteristics, particularly during warm seasons, it is more likely for them to lose their temper. So in order to remain healthy, both physically and mentally, one should firstly reconsider and reform his or her lifestyle and diet, and then seek professional help or study more deeply about the situation.
Moderate exercise increases the heart and breathing rate, excretes sweat which then evaporates off of the skin, and reduces stress. All these are symptoms of warm temperament which means exercise leads to warmness in the body.
High-intensity exercise drives the body to excessive coldness and weakness, and after heavy exercise the heart rate takes much longer to return to its base level, which is not healthy.
On the contrary, lack of movement slows the metabolism, and drives the temperament to coldness and wetness which is accompanied by weakness, lethargy, obesity, and puffiness.
Compared to light and mental exercises such as swimming and chess, vigorous and outdoor exercises such as football and running have a warmer and drier temperament.
In general, from the Iranian traditional medicine point of view, anaerobic exercises which consist of short exertion and high-intensity movements will mostly increase the heat in the body and will not decrease the wetness, so they best suit people with cold Mizaj and do not help in losing weight. On the other hand, exercises which are of light-to-moderate intensity and can be performed for extended periods of time will decrease the wetness and increase the heat in the body and therefore those with warm Mizaj who want to lose weight would benefit from such exercise.
Sleep is a passive, dormant part of our daily lives, while wakefulness is a daily recurring brain state and state of consciousness. Sleep is physical and mental rest, and wakefulness is physical and mental activity.
Therefore, the longer one stays up the drier and warmer their bodies get, and the longer one sleeps the wetter the brain and body gets, so their temperament would drop lower. While one is sleeping the body temperature drops, meaning that the heat moves from the surface of the body. During the day the heat moves to the surface of the body and the body temperature rises.
When one does not get enough sleep the brain and the body get warmer and drier, so in order to control the excessive warmness or dryness in the body one should cut back on warm and dry food. Taking a short nap during the day can also be beneficial.
Those with cold and wet Mizaj should not sleep as much. People with phlegmatic temperament should cut down on food items with a cold and wet temperament, to sleep for shorter periods and not having trouble waking up.
Although each person is born with a fixed and unique temperament, also called their inherent or main Mizaj, with the passage of time the main Mizaj is subject to fluctuation. For example, someone's Mizaj may get drier, but this does not mean that they are suffering mal-temperament.
Taking that into account, in addition to the main Mizaj, one must take note of the temperament of the age to stay healthy.
Disturbing one's inherent or main Mizaj and moving towards excessive warmness, coldness, wetness or dryness, would undermine the persons' health. So one must take immediate action by recognizing the factors causing such symptoms, to prevent them from developing.
In the case where one fails to keep their Mizaj within its normal range for a long period of time, mal-temperament or 'So-e-Mizaj' will strike the body and diseases will progress.
There are cases when the patient is diagnosed with excessive warmness in their bodies. Reasons for this include:
A fast heart rate, breaking out in pimples and mouth ulcers, and sleep deprivation are the side effects of excessive warmness.
Some actions or consuming some food stuff can contribute to excessive coldness in the body. These include:
People with cold Mizaj can be affected by mal-temperament caused by excessive coldness by consuming food with cold Mizaj.
Below is the list of reasons one might suffer conditions of excessive dryness:
Thin people with dry and cold or dry and warm Mizaj are more likely to suffer from excessive dryness.
On the other hand, some actions and eating some foods and drinks can lead to excessive wetness in the body. These include:
Overweight people with wet Mizaj are more prone to suffer excessive wetness.
In Iranian traditional medicine the excess or lack of warmness and humidity define four essential temperaments. These are "warm and wet (sanguine or Damawiy)", "warm and dry (choleric or Safrawiy)", "cold and dry (melancholic or Saudawiy)" and "cold and wet (phlegmatic or Balghamiy)". The terms in the parentheses refer to four groups of material in the body (called "humors" or 'Akhlat') including blood, yellow bile, black bile, and phlegm respectively. Words written in italic show original Persian terms in the ancient literature.
Humors, or 'Akhlat', are liquid humours formed in the liver and gastrointestinal system following digestion.
Afterwards the substances move towards the liver and will be processed again (called the second digestion in traditional medicine) and will form the four liquid humors: blood, yellow bile, black bile, and phlegm.
The gastrointestinal tract, also known as digestive tract, plays an important role in one's health and it is said that all diseases begin in the gut. The four aforesaid humours, or Akhlat, are supposed to supply the cells and the body organs with necessary nutrients.
Therefore, the healthier the humors are, the healthier the body. Selecting healthy foods in accordance with the main Mizaj (temperament) to aid digestion keeps one healthy. Excessive amounts of blood, yellow bile, black bile, and phlegm is rooted from the fact that someone has not stuck to a healthy diet.
In the Iranian traditional medicine 'abstaining' is the best path to effective treatment. According to a saying by Razi, once you are aware of the detrimental effects of a food item you should abstain from it and it is wise "not to choose your desire over your body's comfort".
In ITM everything in this world has Mizaj, and Akhlat are no exception. Akhlat can be also examined according to their warmness and humidity :
"Blood" is the most abundant and most important humor in the body, which is formed by eating food. The humor of "blood" is necessary for growth, especially in children and teenagers, when their growth spurt happens. So they need larger amounts of "blood" by consuming foods which will produce this humor in the body.
A great deal of the bloodstream is made up of the humor of "blood", which is warm and wet.
The recommendations of ITM for preventing eye diseases can be classified with respect to the mechanism associated with the negative effects on eyes: