Module 9 Tibb Principle: How Illnesses Develop
Learning Outcomes:
- The Tibb principles allow for a comprehensive understanding of how illnesses develop.
- Most illnesses result from an imbalance at a temperamental or humoral level, beyond the ability of physis to restore homeostasis.
- Accumulation of abnormal excess humours are an important consideration in how illnesses develop.
In this video, Prof. Bhikha discusses how the Tibb principles of physis, temperament, humours and lifestyle factors allow for a comprehensive understanding of how illnesses are caused.
Introduction
The Tibb principles of creation, qualities, physis, temperament, humours and lifestyle factors allow for a comprehensive understanding of not only health maintenance but also interpreting how illnesses are caused. Tibb recognises that illnesses do not just happen but are the result of causes that can be identified.
Principle of Cause and Effect
Hippocrates established the scientific basis of health and disease when he hypothesised the principles of ‘cause and effect’. The case study below highlights that most illness conditions can arise from different causes.
Mr. Robert M. aged 55, somewhat overweight, smokes 30 cigarettes a day, drinks quite heavily at weekends, exercises very occasionally, and is a mild type 2 diabetic. One day, after a difficult time in the office, and when having an argument with his daughter in the evening, he suffers a non-fatal heart attack.
Was it the emotional stress brought about by his confrontation with his daughter? Was it the atherosclerotic plaque (humoral imbalance) in his coronary artery, preventing adequate blood flow to the heart muscle? Was it a blood clot, formed in the leg, but carried to the heart by the bloodstream, where it became stuck in an artery? Was it his inactive lifestyle (Lifestyle Factors)? Was it his genetic composition (temperament)? There is, in this case, a series of possible causes, any one of which could be responsible for his heart attack.
The above scenario illustrates that most causes of illnesses are linked to the Tibb principles of Humours, Temperament and Lifestyle Factors, beyond the ability of Physis to restore homeostasis.
Illnesses are reversible
From the above it is evident that most illnesses have identifiable causes, and therefore should have a possible cure, dependent on a person’s age, state of health, extent of damage (organs/tissues), and compliance to treatment. In addition, as mentioned in the Module on Physis, that after the approximate age of forty (40) the ability of physis to restore homeostasis becomes weaker. This could invariably lead to illness conditions especially chronic conditions manifesting itself. Tibb therefore maintains that most illness conditions acquired after normal healthy birth, should be reversible up to an approximate age of 40.
Temperament: Predisposition to illness conditions
The Tibb principle of ‘temperament’ describes how the dominant quality associated with an individual’s temperamental combination, provides valuable insight into the predisposition to illness conditions. For example, an individual with a dominant sanguinous and a sub- dominant phlegmatic temperament, having an overall quality of moistness will invariably be predisposed to illness conditions being associated with the quality of moistness, as in type 2 diabetes. Similarly, someone with a dominant melancholic and sub-dominant bilious temperament will be predisposed to osteoarthritis, associated with qualities of dryness and cold.
This link between the dominant quality and the predisposition to illness conditions having a similar quality, has been extensively researched at the Tibb Treatment Centres in Cape Town. The research confirmed that the quality/ies associated with the illness condition/s always includes the dominant quality of an individual’s temperamental combination. However, in chronic conditions, associated with the elderly, and due to the weakening of physis, other qualities may also be linked to the illness conditions.
Age and Gender: Predisposition to Illness Conditions
Whilst a person’s temperament is fixed, the different stages of a person’s life from infancy to old age influence disease conditions that a person may be inclined to – during infancy and early childhood most illnesses are associated with moistness (phlegm disorders, vomiting, diarrhoea etc.), teenagers or early adulthood with heat (acne, inflammation) and late adulthood with dryness (osteoporosis). Gender also influences predispositions as females are more moist than males.
The influence of age and gender on the predisposition to illness conditions has been highlighted during the Covid-19 pandemic, wherein research confirmed that children, young adults and females were less at risk whereas males, especially the elderly were more at risk after being infected by the virus.
Qualities associated with illness conditions
Most, if not all, illness conditions begin with an excess of one of the four qualities of heat, coldness, moistness, and dryness, as well as a second associated quality. An example of this is the common cold which typically develops in the cold season of the year. If this cold imbalance is not corrected, colds and flu like symptoms develop and are often associated with an increase in mucous production like a runny or congested nose, productive cough etc. Therefore, colds and flu are associated with qualities of coldness with moistness. Similarly, constipation is linked to qualities of dryness with coldness as intestinal motility slows and the level of fluid is low resulting in the formation of dry, hard, dehydrated stools.
Examples of qualities associated with illness conditions with the dominant quality/ies underlined.
| Colds & Flu | Cold & Moist |
| Osteo-arthritis | Cold & Dry (worse in Winter) |
| Hyperacidity/ulcers | Hot & Dry (from spicy foods) |
| Osteoporosis | Cold & Dry (old age – brittle bones) |
| Diabetes type 2 | Moist & Hot (excess carbohydrates) |
| Asthma (phlegm related) | Moist & Cold |
Pathology
Pathology is the study of the processes by which diseases develop. In Western medicine, pathology is concerned with the causes, signs and symptoms and diagnosis of a disease – the focus is on evaluating the pathological processes (either with blood tests, X-rays/CT scans, in relation to the signs and symptoms, as well as structural changes (tissues/organs) in the patient.
In Tibb, pathology begins when the ideal state of the humours in relation to the ideal qualitative state required by an individual’s temperamental combination is changed to an extent that physis is not able to restore balance or homeostasis.
The pathological processes recognised in Tibb are:
- A sudden change or excess in qualities from lifestyle factors
- An accumulation of excess or abnormal humours
- Infectious agents – exposure to bacteria or virus
- Unwanted side effects of conventional medication
Sudden change or excess in qualities
Example of a sudden change in qualities from lifestyle factors is – if an individual goes from a warm environment out into the cold without being warmly dressed, he/she will most likely experience symptoms of the common cold – runny nose, watery eyes, and shivering. Similarly, if an individual partakes in spicy foods that he or she is not accustomed to, they will start perspiring.
Examples of an excess of qualities is when an individual has not slept for more than 24-48 hours or if a person who is not accustomed to outdoors, spends long hours on a hot day. This exposure to an excess of qualities may lead to fatigue, headaches etc.If these negatively influencing factors are removed, then physis is able to overcome this sudden or excess change in qualities and restore health. Illnesses in this category are mostly self-limiting conditions such as the common cold, mild diarrhoea, indigestion, and headaches.
Accumulation of excess or abnormal humours
This pathological process takes place over a period of time, resulting from poor management of lifestyle factors especially diet. Additionally, poor elimination is a major cause.Hippocrates believed that,
“All living organisms grow at the expense of the environment – taking what is necessary to survive (food, oxygen, etc…) and rejecting what is unnecessary/harmful (toxins, carbon dioxide, negative emotions, etc…). It is the effective digestion and elimination of this environment that constitutes health – if not results in disease”
Hippocrates used the word “pepsis” to describe digestion and elimination of the environment (lifestyle factors), highlighting that poor elimination will result in a build-up of excess or abnormal humours beyond the ability of physis to cope with. The term “dyspepsia” is still commonly used for ‘indigestion’ – however Hippocrates used the word pepsis, not only referring to indigestion (gastrointestinal tract) but also digestion and elimination of the Tibb Lifestyle Factors.
Our normal ageing process also takes its toll on our bodies as research has shown that chronic illnesses increase from the age of 40 onwards from the accumulation of humoral imbalances especially from an excess or abnormal humour.
The elimination of excess or abnormal humours is an important consideration in the management and treatment of illness conditions.
Infections
Tibb has a different viewpoint on infection than Western medicine. Without today’s advanced technology, Tibb physicians were unable to detect and identify disease-causing agents such as viruses, bacteria, fungi, etc. However, they were aware of the nature of infection or as they termed it, putrefaction. They knew that there was something in the air or water that was responsible for causing specific ailments like tuberculosis, pneumonia, and meningitis. Tibb considers that any ailment which we succumb to, as a result of infection, is only possible when our inner healing power of physis, is weakened and overwhelmed.
Infective micro-organisms will only thrive, multiply and infect our body when a change in the humoral balance provides a fertile and welcoming medium for them. This explains why some people are susceptible to bacterial infection and others not.
Unwanted effects of conventional medication
The use of conventional drugs, to deal with common acute ailments like pain, headache, insomnia, and bacterial infection, is widespread. However, many individuals will be affected by side effects in the short term (stomach upsets, dizziness, and nausea, for instance) or even longer-term adverse reactions (like increased risk of diabetes, asthma, and hypertension). These days, patients increasingly seek healthcare advice for illness conditions which result from the long-term use of Western medication. This is often aggravated when additional drugs are required to deal with side effects and adverse reactions.
When individuals take an ACE inhibitor to lower high blood pressure, they sometimes develop a chronic irritating cough. Alternatively, when a diuretic is prescribed for oedema or raised blood pressure, gout may develop. This is then treated with allopurinol, which in turn brings on further side effects. Each time a person takes a new medication, the side effect profile increases.
In summary, the Tibb philosophical principles, based on the temperamental and humoral theories of Hippocrates, Galen and Ibn Sina allow for a comprehensive understanding of identifying the causes of most illness conditions.
References
- Bhikha, R. (2006). 4 Temperaments 6 Lifestyle Factors. Ibn Sina Institute of Tibb, South Africa.
- Bhikha, R and Saville, J. (2014). Healing with Tibb. Ibn Sina Institute of Tibb, Roodepoort, South Africa
- Miraj, S., et al. (2016). Scientific correlation between dystemprament in Unani medicine and diseases: a systematic review. Electronic Physician, 3240-3247. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5217817/