Unani medicine, owes its origination to Hippocrates (460-377 B.C.) and his numerous followers. Other Greek medical masters, such as Dioscourides and Galen (131-210 AD), who we recognize as the forerunners of Western herbal medicine, are also considered founders of Unani medicine. It has evolved in the Muslim world with the name Hikmat or Unani-Tibb for the past 13 centuries. Its medical practitioners are called Hakims. Unani is an Arabic spelling of Ionian (meaning Greek - al-Yunaan). Medicine in ancient Greece was based on the concept of balancing body humors. They either fell out of balance, which might yield diseases (depending on circumstances), or were restored to balance to heal diseases. The system involved four elements, thus differing from the Ayurvedic system of three doshas and the Chinese system of five elements.

The most influential historical figure in this golden era of Unani medicine was Ibn Sina or Avicenna (980-1037 A.D.). He began studying medicine at the age of 13 and started treating patients three years later. He gained a very good reputation, such that the ruler of the Samanid Empire (in what is now Iran) appointed him as court physician. His most important medical work was The Canon of Medicine (Qunun), which remained a valued text throughout Europe and the mid-East for several centuries after his death.

The original Greek and the resulting Unani systems are based upon:

• The four elements: earth, air, water, and fire
• The four natures: cold, hot, wet, and dry
• The four humors: blood (which is hot/wet), phlegm (cold/wet), yellow bile (hot/dry), and black bile (cold/dry).

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 (translates to spirit). Health was believed to depend on the presence of a proper balance of the four elements and the correct energetic activity of pneuma. 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 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 Greco-Arabic Medicine, as they facilitate the observation of relationships and interactions in the natural world and provide 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.
The second most important source of life is 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.

The Four Humours

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, the traditions had been modified by adding another Humour, namely Melancholer or the Black Bile Humour. 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, unseasonable weather, bad air, a poor diet and an inappropriate lifestyle.

According Unani, 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 Humour or Humors. This process is called “coction”. Usually some discharge will be seen during this time, which represents the removal of the affected Humour(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 crisis, 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.

The Law of the Naturals

Unani 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 ‘Thymus’ 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.

Examination and therapy

Diagnosis is performed by checking the pulse, urine and stool, but takes into account the influence of surroundings and the environment, including air, body movement and repose, sleep and wakefulness and excretion/retention of food and drinks. The interactions of these factors entails in the dominance of one of the humors. Hakims treat the patients holistically, not just physically. The treatment may not necessarily be solely herbal. In many cases minerals (such as gold, silver, sulphur and gemstones) and animal parts (like deer horn, goat testis, deer chicken gizzard e.t.c) are also recruited.

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