Unani temperament (Mizaj) and the four humours explained

If you read about Unani medicine, two words appear again and again: humours and temperament. This review explains both, using descriptions from the Ministry of Ayush ^[1], the Central Council for Research in Unani Medicine, or CCRUM ^{[3, 4]}, and the US National Center for Complementary and Integrative Health, or NCCIH ^[5]. These are traditional ideas. This article does not say that any Unani practice can treat a disease.

1. Introduction

The Ministry of Ayush describes Unani medicine as a system whose basic framework follows the Hippocratic theory of four humours, which holds that a disturbance in the balance of humours is linked with disease ^[1]. Within this framework, the Ministry names temperament, or Mizaj, as a core principle of the system ^[1].

In Unani texts, the word "humour" does not mean a mood. It means a fluid substance of the body. The word "temperament" is not just personality. It is a traditional way of grouping people, foods and medicines by their qualities.

2. The four humours (Akhlat)

The Ministry of Ayush describes the four humours as the liquid fundamental substances of living things, with the ability to support life processes such as life itself, nutrition, growth, sensation, movement and reproduction ^[1]. They are:

• Blood (Dam)
• Phlegm (Balgham)
• Yellow bile (Safra)
• Black bile (Sawda)

Unani theory holds that the humours are in a balance in a healthy person, and that a disturbance in the balance is associated with disease. The aim of treatment, as the Ministry describes it, is to restore that balance ^[1]. Please note that these four terms are not the same as modern laboratory terms. For example, "bile" in Unani theory is a traditional concept, and it should not be read as a blood test result.

3. The four temperaments (Mizaj)

The Ministry says temperament classes people, diets and drugs into four qualitative types ^[1]:

1. Hot and dry
2. Hot and wet
3. Cold and wet
4. Cold and dry

A person's temperament is commonly named after the dominant humour. The four named types are sanguineous (Damwi), phlegmatic (Balghami), choleric (Safrawi) and melancholic (Sawdawi) ^[1]. A CCRUM journal issue uses the same four patient types, in the forms Damvi, Balghami, Safravi and Saudavi ^[2].

The idea of temperament is also used in naming people. The Ministry's list of types shows that a person described as sanguineous is understood to have blood as the dominant humour, a phlegmatic person phlegm, a choleric person yellow bile and a melancholic person black bile ^[1]. In everyday speech these words are often used as personality labels, so the Unani meaning should not be mixed up with the modern one.

Foods and drugs are also described as having temperaments, which can be related to the person's own ^[1]. The Ministry's description of the system adds that a shift away from the normal temperament is considered the origin of disease, and that treatment uses medicines and diets of the opposite temperament to move it back ^[1]. This is the system's own logic, and it is not a statement that the method has been shown to work for any condition.

4. How temperament is used in advice

CCRUM's public guidance on immunity says that its lifestyle advice should be individualised according to temperament, gender, age, region, season and occupation ^[3]. CCRUM's overview of Unani therapeutics states that medicines are chosen according to the patient's temperament, and that this is said to speed recovery and reduce the chance of drug reactions ^[4]. That is a statement by the source about how the system works. Independent proof of it is not given on that page.

In practice, this means that two people with the same complaint may be given different diet and lifestyle advice by a Unani practitioner. It also means that general internet lists of "foods for your temperament" should not be treated as personal advice.

A worked example in plain words

Suppose a Unani practitioner describes a food as "cold and wet". In this vocabulary that is a quality of the food, as the tradition sees it, and not a nutrient or a calorie count. The practitioner may then think about whether the person's own temperament is already cold and wet or hot and dry, and may suggest foods of the opposite quality. This is only an illustration of how the system reasons. It is not a menu, and nobody should change their diet from this example. Foods also affect blood sugar, blood pressure and medicines in ways that are measured by modern science, so your doctor needs to know about any special diet you follow.

5. The role of the body's own healing power

Besides humours and temperament, the Ministry describes a guiding power, Medicatrix Naturae (Tabiat Mudabbira-i-Badan), said to control body functions, provide resistance against disease and help natural healing ^[1]. It is part of the explanation Unani gives for why balance matters.

6. Safety, evidence and special groups

NCCIH advises people to look for scientific evidence rather than personal stories, advertisements or word of mouth, and notes that while some approaches have good evidence of safety and effectiveness, many questions remain unanswered ^[5]. Keep this in mind when you read about humours or temperament online.

CCRUM's immunity guide says to consult a registered Unani physician before using any recommended measures, and says one named compound preparation is not recommended for people with diabetes ^[3]. NCCIH advises discussing any approach with your health care providers before you decide ^[5]. If you are pregnant, are caring for a child or an older person, or have a long-term condition, this is especially sensible, so speak to your own doctor before changing your diet or taking any traditional medicine.

7. When to see a doctor

Do not use your temperament type, or an online quiz about it, to decide whether symptoms are serious. See a doctor if you have symptoms that are new, severe, getting worse or not explained. Tell your doctor about any Unani food plan, medicine or procedure you use, because some products can interact with medicines ^[6].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Four humours and four temperaments are the core vocabulary of Unani medicine, described by the Ministry of Ayush as the framework behind its view of health and disease. They guide how Unani advice is individualised, but they are traditional ideas that sit beside, not in place of, medical tests and your doctor's care.