The Concept of Temperaments in Traditional Persian Medicine

Abstract

Temperament is a key concept in comprehending the fundamentals of traditional medicine, based on
which individuals are classified as healthy and ill. This principle plays an important role in determining
ways to maintain good health and also in treating diseases. Recently receiving increasing attention in
conventional medicine, the trend has progressed towards treating the individual rather than the illness in
general. Accordingly, s tudies have been conducted to inves tigate the relationship between temperament
and proteomes in the human body. This article is an attempt to review the definition and classification of
temperament, its modifying factors, and categorization of dys temperaments as discussed in Traditional
Persian Medicine references. Clarifying this concept has a vital role in health recognition and maintenance,
treatment of diseases as well as in traditional medicine s
tudies.

Full text

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*Corresponding author: Mahdi Alizadeh Vaghasloo
Department of Traditional Persian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
Email: m-alizadehv@sina.tums.ac.ir
Tel: 021-88990837-105
Introduction
Complementary medicine is considered as an
acceptable, ecient method to treat diseases in
accompaniment with conventional medicine;
the position of which has been promoted in the
recent years [1]. As demons trated in a s tudy in
the US (2002), 62% of adults use at leas t one al-
ternative medicine method per year [2]. Also, a
high percentage of people in Asian and African
countries benet from complementary medicine
for treatment [3]. One of the important roles of
the health care sys tem is to create equality in
access to treatment services for all members of
the public. Moreover, an essential role of so-
cial jus tice is to promote health in all divisions
of the society with priority of prevention over
treatment or health promotion [2]. This issue is
crucially important and sys tematic in alterna-
tive medicine, especially in Traditional Persian
TRADITIONAL AND INTEGRATIVE MEDICINE
Trad Integr Med, Volume 2, Issue 3, Summer 2017 Review
The Concept of Temperaments in Traditional Persian Medicine
Laila Shirbeigi1, Azadeh Zarei1, Ayeh Naghizadeh1, Mahdi Alizadeh Vaghasloo1*
Traditional & Integrative Medicine
1Department of Traditional Persian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences,
Tehran, Iran
Received: 23 Jul 2017 Accepted: 6 Aug 2017
Abs tract
Temperament is a key concept in comprehending the fundamentals of traditional medicine, based on
which individuals are classied as healthy and ill. This principle plays an important role in determining
ways to maintain good health and also in treating diseases. Recently receiving increasing attention in
conventional medicine, the trend has progressed towards treating the individual rather than the illness in
general. Accordingly, s tudies have been conducted to inves tigate the relationship between temperament
and proteomes in the human body. This article is an attempt to review the denition and classication of
temperament, its modifying factors, and categorization of dys temperaments as discussed in Traditional
Persian Medicine references. Clarifying this concept has a vital role in health recognition and mainte-
nance, treatment of diseases as well as in traditional medicine s tudies.
Keywords: Temperament, Traditional Persian Medicine (TPM), Avicenna, Mizaj, Blood Production
and Dis tribution Doctrine
Citation: Shirbeigi L, Zarei A, Naghizadeh A, Alizadeh Vaghasloo M. The Concept of Temperaments in Traditional Persian Medicine.
Trad Integr Med 2017; 2(3): 143-156.

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Concept of temperaments L. Shirbeigi et al.
Medicine (TPM). Meanwhile, complementary
medicine also plays an important role in reduc-
ing treatment cos ts. TPM is considered a rich
and known source in the healthcare eld of
medical his tory to the point that in a period of
his tory, it has been used as an educational refer-
ence even at universities in European countries
[4]. TPM, being comprehensive in the elds of
prevention, disease control and treatment has
rich and ecient advice on lifes tyle, providing
natural, safe and low-cos t treatments [5]. De-
spite numerous similarities in terms of disease
descriptions, symptoms, and involved organs,
TPM has special and fundamental concepts that
are not considered in conventional medicine.
Temperament is a key basic factor in traditional
schools of medicine applied in conceptualizing,
diagnosing and treating diseases. This concept
is generally accepted in conventional medicine
in the form of individual dierences in various
physical, mental and personality traits among
individuals [6]. Although genetics and patho-
physiology have sugges ted some hypotheses for
these variances [7, 8], the reason for such dier-
ences is s till unclear. In Islamic literature, bio-
diversity is known to be a gift dedicated by the
creator that not only displays his knowledge and
ability in creation but also benets to correlate
and keep creations dependent on each other
through their dierent needs and capabilities
and thus enabling the formation of ecosys tems
and especially human social relationships and
societies [9, 10]. It seems that unders tanding
the concept of temperament will greatly help
unders tanding these dierences [11, 12]. Dis-
similarities in body reactions agains t a pathogen
and response to treatment arise from this con-
cept. For this purpose - since 1950 continued up
to present - many s tudies have been conducted
in order to provide new models for tempera-
ment [13-15]; and to build new approaches to
conventional medicine with respect to it [16].
Despite the popularity of these s tudies in con-
ventional medicine, the use of temperament
has s till remained limited to psychiatric and
psychological scopes. Moreover, conventional
medicine has also recently replaced the use of
“a similar treatment for all individuals aected
by a certain disease” with “personalized medi-
cine” [17], a principle cons tantly practiced by
TPM physicians as a treatment based on tem-
peraments. Due to the fundamental importance
of temperament in TPM, introducing and den-
ing the concept of temperament becomes man-
datory for ecient use of the knowledge and
recommendations of this medical school. The
aim of this s tudy is to describe the concept of
temperament and its classication from the per-
spective of TPM mas ters.
Methods
To accurately comprehend the concept of tem-
perament and its classication, we searched the
electronic version of selected main resourc-
es of TPM by the Farsi/Arabic equivalent for
temperament, termed “Mizaj”جازم . In order to
recognize the classications lis ted in the s tud-
ied books, the searched contents were read,
reviewed and classied in a table consis ting
of denitions, categories, temperament of age,
temperament of gender, temperament of sea-
sons, temperament of waters, temperament of
winds, temperament of cities, temperament of
body organs and temperament causes.
In this s tudy, ten main books of Persian Medi-
cine sages of 10th-19th centuries who have
written their books in Arabic or Farsi were
used. These ten books included “The Canon of
Medicine” (Avicenna, 11th century), “Hidayat
al-Muta`allemin Fi al-Tibb” (Abu Bakr Rabee
Ibn Ahmad Al-Akhawyni Bokhari, 10th centu-
ry), “Mofarah Al-Gholoob” (Muhammad Akbar
ibn Mir Hajji Muhammad MuqimArzani, 18th
century), “Kāmil al-ṣināʻah al-ṭibbīyah” (Ali
Ibn al-Abbas al-Majusi, 10th century), “Zakhire

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Concept of temperaments L. Shirbeigi et al.
Khwarazmshahi” (Ismail Gorgani, 12th century),
“KholasatAlHekma” (Aghili, 18th century), “Ki-
tab al-Mansouri  al-Tibb” (Abu Salih al-Mans-
ur Al-Razi, 10th century), “Bahr Al-Jawaher”
(Heravi, 16th century), “Exir Azam” (Nazem Ja-
han, 19th century), “Al-Shamil  al-Tibb” (Ala-
al-din abu Al-Hassan Ali ibnAbi-Hazm al-Qarshi
al-Dimashqi, 13th century).
Results
Exploring the equivalent word for temperament,
which is “Mizaj”

in the above mentioned
selected Arabic and Persian TPM references,
we reached the following classication of data:
Denition of Temperament
In Persian Medicine, the four classical elements
of earth, water, air and re are the cons tituents
of creation on earth. The names are only sym-
bols to resemble and bring to mind the physical
characteris tics of each by comparing it with an
external examinable object. These philosophi-
cal elements being considered non-degradable
into a dierent subs tance are therefore not com-
parable with elements of the periodic table and
thus yet to be discovered.
These four elements have four natures of warm-
ness, coldness, dryness and wetness [18]. In
fact, “elemental re”

is extremely
warm and then dry, while “elemental air”



is mos tly mois t and then warm, “ele-
mental water”

extremely cold and
then mois t, and nally the “elemental earth”

is extremely dry and then cold. The
contact of these elements with each other fol-
lowed by interactions between their opposing
qualities, ultimately results in a compound with
a new homogenous quality or “Mizaj”

,
meaning temperament [19]. It is therefore no-
table that temperament may be considered as a
coordinate in a two dimensional quality spec-
trum plane with two axes of hotness and wet-
ness (Figure 1). There are an innite number of
temperaments in the universe per all living and
non-living creatures, since the elements may
combine together in innitive patterns of pro-
portion.
Causes of Temperament
According to the sages, four factors are required
for the appearance of any phenomenon in the
universe. These four factors or causes include:
1. Material cause
2. Agent cause
3. Formal cause
4. Final cause
To make it clear with an example we might
consider a carpenter - the agent cause - that
works on wood - the material cause - to build a
wooden desk - the formal cause - for s tudents
to s tudy on, in the library which is the nal
cause and purpose.
In summary, the material cause of human tem-
perament is food. Human food includes ani-
mal meat and plants, which are also made up
of the four “philosophical elements”. The tem-
perament’s agent cause is the innate heat or the
“Haar” [ 20]


, and its formal cause,
the nine types of temperaments. “Issuance of
activities” comprises the ultimate cause of tem-
perament, and in human beings is classied into
two categories of physical and mental actions
and reactions. In other words, food is changed
by the “Haar” to suitable blood that nourishes
the tissues and gives them their optimum quali-
ty composition or temperament. A suitable tem-
perament provides conditions for proper physi-
cal and mental actions and reactions [21].
Classication of Temperaments
Temperament is divided into two categories by
a reasonable classication [22]:

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Concept of temperaments L. Shirbeigi et al.
1. Moderate Temperament

2. Non-Moderate Temperament


Moderate temperament is also classied into
groups of true moderate

and med-
ical hypothetical moderate


. In
the true moderate temperament, the quantity of
opposite qualities is considered equal. This type
of moderate temperament does not exis t in real-
ity, because the qualitative potency of dierent
elements is not the same in similar quantities
and thus, equalizing the quantities imbalances
the qualities and vice versa; therefore, the qual-
ity and quantity of a compound cannot be ad-
jus ted to yield a truly moderate temperament.
Despite the notion that the true moderate tem-
perament does not exis t, a physician needs a
miles tone to es timate the amount of deviation of
a temperament from desirable coordinate in the
quality spectrum. Taking into account dierent
populations, the sages have considered several
hypothetical moderate temperaments, which
are mainly the modal points of each population.
These eight temperaments are categorized into
four pairs as follows [22]:
A. Typical Moderate Temperament
Typical moderate temperament is classied as
the following:
1. External typical moderate temperament

  
): the temperament of man-
kind compared to other creatures, like inanimate
objects, plants and animals, which is usually de-
ned by their eect on the human body when
consumed, or applied externally (Figure 1).
Figure 1: The schematic position of the human temperament in respect to other creation in the coordinate plane of tem-
peraments (The external typical moderate temperament)

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Concept of temperaments L. Shirbeigi et al.
1. Internal typical moderate temperament


is the mos t moderate temper-
ament within the human population (Figure 2,
person “e”).
Figure 2: Subdivisions of the human temperament based on the residential population of each climate zone
B. Guild (Cas te) Moderate Temperament
Guild moderate temperament consis ts of the fol-
lowing:
1. External guild moderate temperament

  
refers to the mos t mod-
erate tempered human guild in comparison to
the temperament of people outside that class;
for example, it has been claimed by Avicenna
- the mos t famous worldly wide known Mus-
lim Iranian polymath and TPM physician - that
the mos t moderate temperament belongs to the
residents of the equator followed by residence
of the moderate climate zone [22]. It is deduc-
ible that the temperament of people living in the
tropical regions above and below the equatorial
region is therefore warmer than those living in
the equator or the moderate zone (Figure 2).
2. Internal guild moderate temperament


: refers to the temperament
of the mos t moderate person within each class
(guild); therefore, every guild of people has
its own moderate temperament representative,
which has the modal temperament of that guild
(Figure 2, person “b” in the seventh region, per-
son “e” in the equator or the forth region and
person “h” in the second region). However, this
representative may not be the healthies t person
in that climate, since in a tropical climate for
ins tance, such a moderate person (Figure 2, per-
son “h”) is more susceptible to hyperthermia
than a much colder tempered person from the
same guild (Figure 2, person “g”).
C. Individual Moderate Temperament
Individual moderate temperament comprises of
the following:

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Concept of temperaments L. Shirbeigi et al.
1. External individual moderate tempera-
ment
 
refers to the
temperament of a person in a guild who is fur-
thes t from being aected by the quality sur-
rounding the guild, which means he or she is
closer to the “Internal typical moderate tem-
perament”, i.e. person “e” in Figure 2. Such a
person in a tropical climate is considered rela-
tively cold tempered in that climate (person “g”
in region two) and will not shift towards a hot
dys temperament as easily as others of the same
guild. Being closer to temperate in a warm cli-
mate makes this person healthier in such zones.
By the same reasoning, person “c” in region sev-
en is protected from hypothermia or other cold
tempered diseases than the modal person “b” in
the same region who had the label of “Internal
guild moderate temperament” of that region.
2. Internal individual moderate temperament
 
refers to the tem-
perament of a person in his bes t s tate of temper-
ament in comparison to other s tages of his/her
lifetime (persons marked with “T” in Figure 5).
D. Organ Moderate Temperament
Organ moderate temperament includes the fol-
lowing:
1. External organ moderate temperament


refers to the skin especial-
ly that of the ngertips, which is assumed to
have the mos t moderate temperament in com-
parison to other organs.
2. Internal organ moderate temperament

  
refers to the normal and
optimal temperament of each organ in an op-
timum s tate compared to other s tates of the
same organ; for example, the middle set brain
and heart in Figure 3. The eight other brains
and hearts illus trated around but inside the cir-
cles are non-moderate but healthy organs and
the eight brains and hearts drawn outside the
circles are dys tempered diseased organs. Each
of these seventeen temperamental locations of
heart, brain or any other major organ has been
addressed in the literature by a short lis t of signs
and symptoms in order to be discriminated from
the res t.
Figure 3: The comparison and dis tribution of temperaments of the heart and brain as an example in the coordinate plane
of organ temperaments

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Concept of temperaments L. Shirbeigi et al.
Non-moderate temperament (Figure 4) includes
eight types, consis ting of four singular (warm,
cold, wet, and dry) and four combined (warm-
wet, warm-dry, cold-wet, cold-dry) types. A
singular temperament implies that classical el-
ements have reacted together in a manner that
only one quality has overcome to reveal its
feature, while a combined temperament indi-
cates that the reactions between elements has
occurred in such a way to reveal two qualities
simultaneously. As demons trated in gure 4,
there may be many people, and therefore, an
innitive number of temperaments in between
these representatives. However, to facilitate the
diagnos tic process, the two dimensional spec-
trum of normal temperaments is practically
grouped into nine sections or groups of consid-
erably similar clinical manifes tations.
Figure 4: The eight non-moderate temperament groups and the one moderate temperament group of humans in the
coordinate plane of normal human temperaments
Temperament of Age and Sex
The life years of human beings are divided into
four categories of childhood and adolescence,
youth, middle age and old age from the perspec-
tive of philosophers and sages. They believed
that the body resembled a lantern burning with a
liquid fuel, where the burning ame corresponds
to the innate heat or “Hararat-e-Gharizi”


, and the liquid to the innate mois ture or
“Rotoobat-e-Gharizi”

It is noted
in the literature that throughout life, the innate
mois ture eventually decreases by factors like
consumption, consequently leading to a decline
in the innate heat. This change in the amount
of mois ture and heat, changes the body temper-
ament gradually during lifetime; therefore, the
body will have a certain temperament in each
age period. Childhood and adolescence - from
birth to age thirty - have a warm and mois t
temperament. The innate heat in children-from
birth until the end of growth- is similar to youth,
while the amount of mois ture is greater due to
the need for growth and development [23]. This
excess mois ture masks the intensity of heat in
contras t to the youth period, including ages 30
through 40. The mos t moderate temperament in
contras t to other periods of life belongs to the
youth [22], who have a warm and dry moderate

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Concept of temperaments L. Shirbeigi et al.
temperament. By the onset of middle age (40 to
60), the innate mois ture and subsequently the
innate heat begin to decline more evidently and
this decreasing trend continues to the old age
(after age 60), and the body will experience a
cold and dry temperament. In this period of life,
the temperament of the main organs reaches its
coldes t and dries t s tate; but despite this dryness,
an accumulation of harmful mois tures may oc-
cur in some elders resulting in the “Bad-An-
basht Syndrome” discussed in previous articles
[24] and thus, symptoms of coldness-wetness,
ins tead of coldness-dryness develop in these in-
dividuals. In gure 5, a schematic model of the
eect of age on temperaments is illus trated, with
the temperaments color coded. It is shown that
the closer to the center circle, the more temper-
ate and healthy a person will be in a certain age
(persons marked with “T”).The opposite is true
for the persons marked with “D”, who are more
deviated from the central circle of the spectrum
making them susceptible to a dys temperament
with the same quality of the direction of devi-
ation. For example, in childhood, a warm-wet
tempered baby – marked with “D” in the far
right side of the diagram- is more susceptible
to a warm and wet tempered disease like dia-
per rash especially at the warm-wet season of
spring. This is because warmness and wetness
accumulate much more than physiologically
tolerated in such a situation. The uncertainty
and diversity shown at the old age in the far left
side is due to the various amounts of unsuitable
mois ture deposition in this age group leading to
the cold temperament of the elderly to be ac-
companied by varying degrees of dryness and
wetness. As s tated in TPM references, there are
certain laws on the temperaments of men and
women. In all classes of organisms, including
humans, the temperament of the male is slightly
warmer and drier than that of the female, and
the female’s temperament is somewhat colder
and wetter [21, 23].
Figure 5: Schematic model of the eect of age on temperaments (“T” marks the mos t temperate person in each age group;
“D” marks the person mos t vulnerable to dys temperament in each age group. Red is for warm-wet temperament, yellow
is for warm-dry temp., pink is for moderate temp., green is for cold-dry temp., blue is for cold-wet temp)

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Concept of temperaments L. Shirbeigi et al.
Temperament of Seasons and Places
According to TPM references, each season of
the year has a particular temperament. The tem-
perament of spring, which is the mos t moderate
season, is warm and wet, while the summer is
warm-dry. The temperaments of autumn and
winter are cold-dry, and cold-wet respectively
[25]. Even regional winds have their own tem-
perament according to the latitude and longitude
of each location and the geographical positions
of mountains and the sea. This means that their
temperaments may change the temperaments
of the living organisms especially humans and
shift them towards their own [26]. For exam-
ple, a hot weather, climate or wind may warm
up the temperament of people exposed to them.
These climatic eects may not be very intense
due to the defensive mechanisms of intelligent
and warm blooded human beings as they may
change their clothes or environment intellectu-
ally or their blood circulation physiologically.
As pointed out briey before, the sages have
divided the northern and southern hemispheres
each to nine latitudinal regions s tarting from the
narrow equatorial region to the hot 1s t-3rd hot
regions corresponding with the modern tropi-
cal zone, the forth region or the moderate zone
and nally, to the5th-7th cold regions, leaving the
nonresidential polar regions unnamed. In gure
6, a rough correlation has been shown between
the conventional and traditional classications
[27] of the global regions.
Figure 6: A comparative schematic illus tration of the conventional and traditional classications of the global regions
Although there are disagreements in dierent
books about the mos t moderate geographic area
and despite Avicenna’s opinion on the rs t zone
being the mos t moderate, some believe this to
be true about the fourth zone [21], modern geo-
graphical evidence demons trate that the narrow
equatorial belt has the mos t suitable climate for
life. Due to a moderate heat and mois ture, this
well-nourished area hos ts an incredible plant
and wildlife ecosys tem in the form of the trop-
ical rainfores ts all around the globe (Figure 7).

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Concept of temperaments L. Shirbeigi et al.
Temperament of Colors
According to TPM sages, the four humors of
blood, phlegm, yellow bile and black bile have
specic temperaments. These humors each have
their own specic color. The red color, as blood
humor, has a warm and wet temperament, and
the color yellow, as yellow bile humor, has a
warm and dry temperament. White, similar to
phlegm humor, has a cold and wet tempera-
ment, while black, like black bile humor, has a
cold and dry temperament [21].
Temperament of Organs
As discussed previously, each body organ has
a specic temperament at which it will have its
bes t function. The sages consider man’s skin
as the mos t moderate organ, and describe the
temperament of other organs compared to this
organ [28]. For example, the heart and the liv-
er have the warmes t, and the bone, the coldes t
temperaments. Other examples are hair, being
the dries t and fat, being the wettes t organs [26].
Indeed, body organs have a composite tempera-
ment; for ins tance, the bone has a cold-dry tem-
perament, while adipose tissue has a cold-wet
temperament. Avicenna notes that although the
three vital organs - the brain, the heart and the
liver - are warm and wet generally due to be-
ing the container and source of the spirits and
the “Haar”, but in comparison to each other the
brain is cold-wet, the liver warm-wet, and the
heart warm-dry [22]. The paradox of a cold ver-
sus warm temperament for the brain has been
previously discussed by colleagues [29]. In re-
cent s tudies the brain excluding the cerebellum
has been shown to have approximately four
times more non-neural cells [30]. It seems that
the core of the functioning brain, which is prac-
tically comprised of neurons, has a hot temper-
ament but the dominant glial cells, the myelin
and the cerebrospinal uid are cold-wet, which
may have a function of cooling and feeding the
hot core.
Figure 7: Tropical rainfores ts around the world located on the equatorial line are mos tly surrounded from the north and
south by tropical hot dry deserts (with permission from kids.mongabay.com)

153
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Concept of temperaments L. Shirbeigi et al.
Table 1. Avicenna’s quote from Galen about the temper-
ament sequence of bodily materials, tissues and organs.
(Avicenna’s commentaries on some organs have been
numbered in the table and discussed in the text)
Warm to
moderate
Cold to
moderate Dry to moderate Wet to
moderate
Spirit and heart1Phlegm Hair Phlegm
Blood Hair Bone Blood
Liver Bone Cartilage Parietal fat
Meat2Cartilage Ligament Visceral fat
Muscle2Ligament Tendon Brain
Spleen Tendon Aponeurosis Spinal cord
Kidney3Aponeurosis Artery Breas t
Artery4Nerve Vein Tes ticles
Vein4Spinal cord Motor nerve Lung5
Skin Brain Sensory nerve Liver
Visceral fat Skin Spleen
Parietal fat Kidney
Skin Muscle
Skin
Avicenna, quoting the above mentioned se-
quence of temperaments from Galen, points out
several items which may decode the source of
temperament formation. These issues are as fol-
lows [22]:
1. The hottes t materials in the body are the
“Haar” or the soul, the heart and then the
blood.
2. Meat is generally known to be warmer than
the muscle because it is considered as coag-
ulated blood, but in the muscle it combines
with the cold tempered – hard dense - nerves
and tendons so the muscle does not receive
as much warmness and wetness of blood.
1. The esh of kidneys being harder and dens-
er than liver, meat, muscle and spleen is
considered to receive less blood and thus
less warmness.
2. The veins containing mos tly blood and less
spirit or “Haar” are also known to have a
colder temperament than the arteries.
3. The primary ins tinctive temperament of ev-
ery organ is similar to what it feeds from.
Accumulation of was te products in the or-
gan may change this temperament and result
in a secondary acquired one. For ins tance,
the lungs primarily feed on the hottes t part
of the blood mixed with bile but may be
inltrated with excess damp due to vapors
rising from lower body parts, or discharges
spilling from upper parts of the body. This
may result in a very wet dys temperament,
making the lungs susceptible to damp dis-
eases such as as thma.
It is deducible from the above items that blood,
the soul originating from it, the heart pumping
them throughout the body, and the amount of
their penetration in dierent tissues and organs
dedicate a diverse combination of warmness
and wetness and thus temperaments to tissues.
Food and Drugs Temperament
Food and drugs also have temperaments; for ex-
ample, white mulberry has a warm and wet tem-
perament, while watermelon is cold-wet. Rasp-
berries have a cold and dry temperament and
mango has a warm and dry temperament [31].
The actions of drugs or food-drugs in the human
body are categorized into three levels, namely
“primary”, “secondary” and “tertiary” acts. “Pri-
mary” and “secondary” actions aect almos t the
whole body, whereas the specialized minor “ter-
tiary” actions are related to a particular organ.
“Primary” actions are general actions attributable
to the direct eect of the four qualities like heat-
ing, cooling, wetting and drying eects.
“Secondary” eects are semi-general actions de-
riving from indirect eects of the four qualities,
like the closure of pores due to coldness, or loos-
ening of tissues as a result of heating or wetting.
“Tertiary” actions are related to the specic
s tructure of the drug and its anity to a specif-
ic organ with the tendency to receive and show
the eects of that drug. This action is a concept

154 Traditional & Integrative Medicine 2017, Vol. 2, No. 3
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Concept of temperaments L. Shirbeigi et al.
similar to the modern molecular ligand-receptor
reaction.
The rs t two eects may be directly or indi-
rectly jus tied by the simple or compound tem-
perament of the drug’s particles. For example,
chamomile is warm and dry, and therefore not
only fairly heats the body by its primary eect
but also opens the enclosed pores and fenes tra-
tions of the body and loosens hardened materi-
al; acting as a diuretic, antispasmodic and anti-
catarrh and etc. secondarily.
The potency of drugs is described in a degree
scale from one to four, based on the amount of
deviation they impose on the temperament of a
temperate body in vivo. Each degree is subdi-
vided to three levels adding up to overall twelve
subdegrees of temperament. Thus, the more
warmer or colder the drug becomes, the more it
is displaced towards the third level of the forth
degree - the twelfth subdegree - which makes it
more eective in changing the temperate body
towards hotness or coldness respectively, and
also more potent to cause side eects and even
lead to toxicity if consumed in high doses [22].
Discussion & Conclusion
Temperament or “Mizaj” is a key concept in
TPM, evidences for which have been demon-
s trated in proteomics s tudies carried out by our
colleagues [32].
It is dened as the nal homogenous quality de-
rived from the interactions of contras ting quali-
ties - warmness, coldness, wetness and dryness
- of the four philosophical elements when they
combine with each other to form the compound
materials of the universe.
Accordingly, everything including food and
drug and even conditions like the climates and
weather has its own temperament determined
by the change it imposes on the temperament of
human beings. Due to this eect, their temper-
aments can be used to maintain health or treat
diseases in dierent individuals, particularly in
relation to personalized medicine [33].
Based on the denitions, we come to the con-
clusion that moderate temperament is a person’s
temperament being in the range of health where
all his body organs are in their bes t condition.
In fact, in a moderate temperament, the accura-
cy and perfectness of actions issued by the or-
gans, and generally, by the whole body remains
relatively s table in dierent situations. In con-
tras t, displacement of a temperament from its
moderate center toward the edges of the quality
spectrum make the person susceptible to a dys-
temperament or “Su-e-Mizaj”

named
as the same exceeding quality. For example, the
excessive use of a cold tempered drug may push
a tempered individual towards the cold edge of
the spectrum causing primarily a cold temper-
ament and gradually a cold dys temperament.
This deviation in temperament leads to dis tur-
bances in mental or physical actions and reac-
tions of the body by activating some and inhib-
iting others [34]. As in the previous example,
the mental and physical actions and reactions
of the body may generally reduce in intensity,
speed and frequency due to coldness.
Large groups of diseases are precipitated by dys-
temperaments aroused in an organ or the whole
human body; therefore, preventing or treating
diseases may be facilitated by recognition and
treatment of the underlying dys temperament.
The temperament and dys temperament of the
whole body or specic organs have been allocat-
ed by the sages with scenarios of symptoms and
signs accumulated during centuries of observa-
tion and clinical experience. The recognition
and discrimination of the dys temperaments are
thus theoretically possible from medical his tory
taking, physical examination and summation of
data. Although this method may lead to a major
and rough classication of people in res tricted
types of dys temperaments, but it is mos tly im-
practical, imprecise and confusing when there

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Concept of temperaments L. Shirbeigi et al.
are compound paradoxical dys temperaments of
dierent organs simultaneously. It is because of
these problems that we have tried to nd a new
- but loyal to the text - model to describe and
discuss the source of dierent and inconsis tent
concurrent dys temperament formation in a sin-
gle individual. Concluding from this research, it
seems that the production of blood and its dis tri-
bution from the heart via the vessels throughout
the body can be considered as an important key
factor in creating and changing the tempera-
ments. In modern physiology, the arterial blood
is known to receive its nutrients and chemical
energy from the liver and the lungs and its pres-
sure and mechanical energy from the heart and
then dis tribute them throughout the whole body.
Similarly, in TPM literature the blood is the ve-
hicle of the “Haar” and heat. The “Haar” itself
is the sum of the liver’s natural spirit and the
heart’s vital spirit [20]. Therefore, the circula-
tion of blood transfers and provides both the
mass and the heat needed for the formation of
temperaments and accomplishment of tissue
functions. It has even been clearly s tated that
the body receives its heat from the circulating
sanguine and bile that are the hot components
of the blood [22].
This issue claries why the organs with more
blood supply, such as the heart and liver, are
considered organs with warm temperaments
and those with lower blood supply, such as
hair and bones, are seen as cold tempered ones.
Through unders tanding these mechanisms in
the human body, a more accurate recognition of
temperaments and its deviations can be made.
The writers of this article aim to emphasize
again the “Doctrine of Priority of Blood Pro-
duction and Dis tribution over the Formation
of Temperaments and Dys temperaments” dis-
cussed in previous articles [35]. This doctrine
may help solve the simultaneous paradoxical
dys temperaments in a particular patient and
may clarify the s teps of treatment by emphasiz-
ing on the management of major shared causes
of blood production and dis tribution ins tead of
simultaneous diverse drug prescription for each
organ dys temperament in an individual. The
dimensions and clinical evidence of the above
doctrine are yet to be discussed in more detail
in future articles.
Conict of Interes ts
None.
Acknowledgments
None.
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