Introduction to Mizaj

What is the Mizaj ?

In modern medicine, it is well known that healthy individuals have different physical and mental characteristics and there is genetic variation within races and between them. This can also be deduced from the point that different paraclinical findings and anthropometric indices have a wide normal spectrum in the healthy individuals. Most of the traditional medical schools such as Traditional Chinese Medicine (TCM), Ayurveda and specially Persian (Unani) Medicine (PM) have based their diagnosis and treatment decisions on the discrimination of these differences. Nowadays, conventional medicine is also going towards the personalized medicine and paying attention to individual differences in the pathogenesis, progression of diseases and response to therapeutics, for example, pharmacogenetics that tries to classify individuals according to their possible response to a medicine and other particular contexts such as metabonomics and nutrigenomics are new promising areas of the personalized medicine. The school of PM that originated from the ancient Persian civilization was established upon the basic concept of mizaj (temperament). According to this, each person has a unique characteristic named mizaj which is recognized and classified by his or her morphological, physiological and psychological features. In PM a person is considered to be in a healthy state when his or her mizaj keeps its balance and most of the diseases occur when the mizaj becomes imbalanced. It is believed in PM that the number of mizaj equals the number of living individuals in the world. Since numerous number of mizaj may be imagined, the leading figures of PM have divided all kinds of mizaj into nine major groups for easy assessment. These nine groups may be imagined as the sectors of a two dimensional spectrum of different degrees of warmness and wetness. These sectors include one central equable region and eight circumferential non-equable regions which consists of four simple (Warm, Cold, Moist, Dry) and four combined mizajes (Warm and Moist, Warm and Dry, Cold and Moist, Cold and Dry). In the context of this opinion each member of these groups is susceptible to certain diseases related to his or her mizaj and may need different treatments for the same disease and even different life style recommendations for the health care and disease prevention. In other words the mizaj acts as a guiding force for maintenance and preservation of individuals’ health, for example, an individual with cold and moist mizaj is recommended to have more physical activity than warm and dry. Individuals are sorted into these nine major groups of mizaj by the use of mizaj identification criteria. Avicenna (Ibn Sina, 980-1037 A.D.) the famous Iranian scientist, defined these criteria and described the indices of each criterion in his medical book “The Canon of Medicine”. Most of these indices are qualitative and their discrimination capabilities have not been assessed.

What is Persian Medicine ?

Overview of Persian Medicine

Global attention to traditional medicine

Since the last few decades ago, the World Health Organization (WHO) has considered the development of traditional medicine in order to implement the slogan “Health for all by the year 2000 A.D.”.

The decision was based on two foundations; first, lack of access of a great number of people

(up to 80% in some counties) to primary healthcare and second, dissatisfaction from the outcomes of treatments by modern medicine, especially in relation to chronic diseases and

the side effects of chemical drugs.

In 2002 AD, WHO has described traditional medicine in more details as: “Traditional medicine is a comprehensive term used to refer both to TM systems such as traditional Chinese medicine, Indian Ayurveda and Arabic-Unani medicine, and to various forms of indigenous medicine. Traditional medicine therapies include medication therapies- if they involve use of herbal medicines, animal parts and/or minerals-and non-medication therapies if they are carried out primarily without the use of medication, as in the case of acupuncture, manual therapies and spiritual therapies.

In recent decades, the World Health Organization has presented written programs to member countries for the systematic evidence based development of traditional medicine, the latest of which is the 2012-2023 strategy. Today, many countries around the world have put evidence-based development of traditional and complementary medicine on the agenda of their governments.

Brief history:

The Persian Medicine (PM) is a school that views the world as a good and seeking discipline created by the wise and omniscient Almighty.

PM consists of the sum total of all the knowledge and practices used in diagnosis, prevention

and elimination in Persia from ancient times to present. It is based entirely on practical experience and observations passed down from generation to generation.

PM roots back to over 8000 yr B.C. and it is a branch if not the root of the so called Arabic-Unani medicine as quoted by Cyril Elgood, the English medical historian, was more advanced than that of Assyria and it is not too bold to go even further and claim that

the Persians taught the Greeks the elements of that system of medicine, which has been known ever since as Greek(Unani) medicine.

According to Ibn Khaldoon, Among Persians, rational sciences had a high status. Such sciences had a vast scope since Persians’ governments were majestic and long-lasting. Words have it that after Darius’ murder by Alexander and the occupation of Kelikiyeh, and access to the countless Persian books and sciences, such sciences were passed to the Greeks.

Faculties of Persian Medicine

Persian medicine is a part of the culture and history of ancient Persia and Today the Islamic Republic of Iran is moving towards discovering its useful medical treasures to share with mankind all over the world and to take its role in the worldwide move towards integrative medicine. In this path the some Iranian Universitis of Medical Sciences and Health Services has established the first Persian Medicine academic centers.

The Faculties of Persian Medicine has officially started with its first students in 2007 from four universities namely Tehran, Shaheed Beheshti, Shahed and Iran Universities of Medical Sciences in order to teach Persian Medicine with most unity and discipline by the help of the famous and specialist masters of the field from all over the country. In the following years, the growing trend of establishing Persian Medicine schools expanded so that by 2021, about 20 departments and faculties have been formed in major Iranian medical universities.

In this year of 2009, by the help of God; the Persian Medicine and the Traditional Pharmacy

departments are subsequently going to have their 3rd and 2nd PhD degree students.

Future Hopes for PM

Persian medicine has the advantage of being considered as part of the culture, therefore; bypassing cultural issues that may affect the practice of medicine. On the other hand, it can be used in conjunction with and as an aid to the conventional medicine. In accordance with the WHO’s strategy, the old but useful remedies should be integrated in the conventional medicine for the benefit of humanity as the Last testament, the Holy Quran, states: “The scum

fades away and that which is for the good of mankind remains on the earth”.

The Structure of PM at a Glance

Considering the definitions given by the WHO, the PM can be divided into two sections:

A-Written Traditional Medicine & B- Verbal Traditional Medicine.

The Persian Medicine has two main branches, namely a theoretical branch and a

practical branch which each also branch into sub-branches as follows:

1. The theoretical branch of PM: This branch is a science which discusses the status and changes of the human body and the causes and signs of health and disease.

2. The practical branch of PM: This branch is also a science, although it may remind us of practical procedures but it is really the science of how to keep health and how to bring it back after the occurrence of diseases.

The Seven Natural Affairs

In the PM, physiological functions of the human body are considered to be based on seven

factors, known as “Umoor-e-Tabee-e-ya”. These are as follows:

I. Elements [Arkan]

II. Temperament [Mizaj]

III. Humors [Akhlat]

IV. Organs [Azaa]

V. Spirits [Arwah]

VI. And VII. Faculties or Forces [Quwa] and

Functions.

Prevention, Diagnosis and Treatment

PM has given more attention and importance to the prevention of disease rather than its cure.

Maintaining health was so important that the main duty of the physicians were to keep people

healthy and to treat them if they became sick. There are six factors, which are essential for the maintenance of good health, which is referred to as: Setteh-e-Zarurieah. These essential

factors are as follows:

1. Air

2. Food and Drink

3. Sleep and Wakefulness

4. Evacuation and Retention

5. Body movement and Repose

6. Mental movement and Repose

Modes and Strategies of Treatment in PM

The imbalance in body Mizaj and humors leads to the onset of disease condition as

it was previously mentioned. Therefore, treatment is based on the correction of temperament

and humors to achieve a balanced state. Every humor has a specific temperament as described earlier. So, the drug used for the treatment should possess the opposite temperament than that of the diseased humor, resulting in normalization of the temperament. A disease, which is cold in nature, can be cured by a drug, which has hot temperament and so on. It should be noted that not all the diseases in the PM are treated based on the Mizaj, because there are three forms of disease according to PM:

1. Dystemperaments (Su-e-Mizaj) (distortion of the Mizaj of a single organ up to the whole body)

2. Dysfigurements (distortion of the anatomy or the structure of an organ)

3. Dysconnections (distortion of the correlation and connection between organs)

The Dystemperaments (Su-e-Mizaj) are the ones mostly treated by correction of Mizaj and the two latter are mostly treated by special drugs or manipulation especially including surgery.

PM physicians have mentioned four modes of treatment:

1. Correction of the six essentials (Tadbir ba Sitteh-e-Zarurieah)

2. Diet therapy (Tadbir ba Ghaza)

3. Pharmacotherapy (Tadbir ba Dawa)

4. Manipulation or physical therapy (Aamale yadaavi)

These modes might also be considered as levels of treatment, where if a level fails or is inadequate the next level is considered.