It is well recognized by contemporary historians that the ancient Greek—and to some extent Roman—intellectual heritage of the West would have been almost totally lost were it not for the integrating and synthesizing Arab genius within the Islamic world.¹ In this regard, one must marvel at the Arabs’ level of care and precision in “first collecting, then translating, then augmenting, and finally codifying the classical Greco-Roman heritage that Europe had lost.”² However, “so many people in the West wrongly believe that Islam acted simply as a bridge over which ideas of Antiquity passed to mediaeval Europe. Nothing could be further from the truth, for no idea, theory, or doctrine entered the citadel of Islamic thought unless it became first Muslimized and integrated into the total world-view of Islam.”³

Unani Medicine: Comparisons and Contrasts with Other Health Care Systems

Apart from Unani medicine’s introduction onto the stage of world history as a legitimate synthesis—in time and space—of primarily Greek and Islamic civilizational influences, there is yet another dimension to Unani medicine that is often overlooked and yet of great significance. Along with the great medical traditions of other civilizations of the past, like the Ayurveda of Hindu India or Traditional Chinese Medicine, Unani medicine continues to be preserved and persevere, especially in the face of modern cultural trends in many nations that have moved towards changing the old guards of ancient medicine for the shiny hopes and promises of a new system of powerful drugs, “healing steel,” and high-tech diagnostic tools and machinery. Unani medicine is still practiced today as an organic, living, breathing, whole system of health care helping millions of people around the world (especially in the Indian subcontinent, Pakistan, Afghanistan, Persia [Iran], China, Indonesia, Malaysia, Bangladesh, Sri Lanka, South Africa, and certain sectors of the Middle East [such as Saudi Arabia, Kuwait, and Dubai]).

Furthermore, Unani medicine historically had the opportunity, capacity, and satisfaction of embracing the numerous folk medicines that existed within the borderlands of the Islamic world, from the traditional use of herbal remedies in ancient Palestine to the folkloric ore-based therapeutics of the people living on the high plateaus of the Himalayan Hindu-Kush mountains.

Unani medicine also shares medical theories, philosophies, cultural identity, and spiritual insights regarding human health and disease with ancient systems of medicine, such as Hindu India’s Ayurveda and Traditional Chinese Medicine, because its knowledge and wisdom hail from the traditional Eastern “Orient,” while contrasting tremendously with the single system of contemporary medicine that one could say belongs to the world of the modern Western “Occident.”^* This is what led Hakim Chishti (an American researcher and practitioner of the science and art of Unani medicine) to present a very thoughtfully indexed comparison between all of these healing systems (as found on http:/www.unani.com whose general points are in Table 49-1).

TABLE 49-1 Comparing the Three Great Traditional Healing Systems with Modern Western Medicine^*

History

Contributions and Influences from Antiquity

There were a variety of strands of medicine that came together at the crossroads of Islamic history that proved to be of tremendous significance for the birth of Islamic medicine and for Unani medicine in particular.⁴

First, there was the synthesis of the ancient sciences (including medicine), of Egyptian and Mesopotamian civilizations in Greek life and thought, centered in Alexandria. Only in the light of recent archeological and anthropological discoveries have we discovered the high level of scientific sophistication that was present in these two kingdoms. The medical knowledge attributed to these earlier civilizations became forged in the fire of the Greek intellect into an even more systematic model of diagnostics and therapeutics.

Secondly, the main centers of Greco-Hellenistic learning were pushed further East as a result of a decline of intellectual energies due to shifting political and economic realities constantly confronting and fracturing Western Christendom. This encouraged two other civilizations to take up the reins of transmission of essential elements of Greek knowledge: Persian and Harrānian (i.e., Sabaean). The Sabaeans were independent heirs to the Babylonian and Greek scientific estates through their reliance upon the wisdom contained in Hermeticism and Neo-Pythagoreanism. Also, it was in the city of Jundishapur that the Persians vivified the sciences coming out of India and China.

In summary, the “scientific knowledge that originated in India, China, and the Hellenistic world was sought out by Arab and Muslim scholars and then translated, refined, synthesized, and augmented at different centers of learning, starting at Jundishapur in Persia around the sixth century—even before the coming of Islam—and then moving to Baghdad,^* Cairo, and finally Toledo and Cordoba, from whence this knowledge spread to Western Europe.”²

The Torchbearers of Islamic Medicine

With the advent of the Islamic spiritual tradition, one must mention the intellectual power and genius found in the physicians of Islam. For if history did not give birth to these giants in the field of medicine, one cannot really speak in the present tense at all of contemporary Unani medicine, let alone its subtle historical influences upon the character of modern conventional medicine.

Ibn Ishāq (Johannitus Onan), 809-873 AD

Hunayn ibn Ishāq al-Ibādi was “the greatest of all translators of this period … [and] an outstanding physician of his day. [He] often translated texts from Greek into Syriac. At other times he would translate directly from Greek into Arabic.”⁴ He was “reputed to have been paid for his manuscripts by an equal weight of gold. He and his team of translators rendered the entire body of Greek medical texts, including all the works of Galen, Oribasius, Paul of Aegin, Hippocrates, and the Materia Medica of Dioscorides, into Arabic by the end of the ninth century. These translations established the foundations of a uniquely Arab medicine.”²

Post-Avicennan Medicine

Egypt and Syria: Ibn Nafīs

Ibn Nafīs was born in Damascus and died in Cairo in the twelfth century AD. Ibn Nafīs has only recently gained fame as the rightful discoverer of pulmonary circulation, which was mistakenly thought to have been identified in the 16th century by Michael Servetus. There have been several studies in recent years that incontestably demonstrated that Ibn Nafīs discovered the lesser circulation of the blood before Servetus. See A.O. Soubani’s “The Discovery of the Pulmonary Circulation Revisited,” in which this medical doctor and researcher pooled together and summarized a host of earlier literature regarding this hallmark of medical subjects.^4,⁷

Spain and Morocco: Al-Zahrāwī (Albucasis) and Ibn Rushd (Averroes)

Abu al-Qāsim al-Zahrāwī (976-1013 AD) is considered to be the greatest surgical figure in Islamic medicine. He was also original in this medical arena in inventing and manufacturing the requisite surgical instrumentation that did not exist, or existed previously in very crude form only, to conduct operations as painlessly and effectively as possible. Some of these instruments of surgery have not changed significantly in design for over 1,000 years. A more comprehensive sketch of the significance of Albucasis in the field of surgery can be found in Kasule.⁸

Abu al-Walīd Muhammad ibn Ahmad ibn Muhammad ibn Rushd ⁹ (1126-1198 AD) was born in Cordoba, where he trained in law and philosophy, although he made his living as a physician. He wrote his Kitāb al-Kulliyyāt (the Latin translator’s Colliget, The Book of General Principles) in which he covered the whole field of medicine in abridged form.

The Eastern Lands of Islam, Persia, and India: Al-Jurjāni, Nurbakhski, and Dara Shukūh

Isma‘īl Sharaf al-Dīn al-Jurjāni followed Avicenna by one generation, producing the most important medical encyclopedia in the Persian language, the Zakhira-i Khwarizmshahi (Treasury Dedicated to the King of Khwarazm). The size, as well as the style of the work, places it between Avicenna’s Canon and Rhazes’ Continens.

Muhammad Husayni Nurbakhski was a physician of fifthteenth century Safavid, Persia, who wrote a large medical work entitled The Quintessence of Experience. He was the first person to identify and treat several common diseases, including whooping cough.

The sixteenth and seventeenth centuries were the major centuries in which Islamic medicine spread into India and came to be known as al-Tibb al-Yunānī (Unani medicine). One of the major patrons of the medical arts in India during this time was Dara Shukūh, a Mogul prince who was also a Sufi and a student of the Vedanta. Ayn al-Mulk al-Shirāzī was responsible, at least in large part, in composing The Medicine of Dara Shukūh, which is the last great medical encyclopedia written in the world of Islam.

Metaphysical and Philosophical Foundations

Unani medicine’s philosophical underpinnings are tied to the Islamic spiritual tradition. The true and original meaning of the word “philosophy” as “philo-sophia” (love of wisdom) has only accidental affinities to what is termed philosophy in the modern lexicon today. Traditional philosophy as philo-sophia was, and still is, tied to a spiritual vision of humanity and the cosmos.

Epistemology and Ontology

Epistemology and ontology deal directly with the nature of knowledge—what something “is,” how it is obtained, and its methods of utilization—and the study of existence or “being.” Because Unani medicine is rooted in the Islamic tradition, it is from this spiritual source where one must search for the answers to the questions regarding its theories on knowledge and existence.

Within the Islamic, as well other traditional religious worlds, knowledge has a definite hierarchical structure.^* This hierarchy maintains the essential links that exist between Heaven and Earth, between God and humans. First, there exists an acknowledgement of a presiding Divine Knowledge (i.e., God as Wise and All-Knowing). Following this is the knowledge found in Revelation (i.e., a perfect dispensation from Heaven that enlightens the human intellect).^† As this revelatory knowledge sparks the heart’s depths, it necessarily begins to involve the mind–intellect in its quest for knowledge of this earthly domain (‘ilm al-dunya), this physical world.

Ontologically, the “being-ness” of humanity is intimately connected with the Being of God. God is seen as the Supreme Being Alone, without whom nothing can rightfully claim existence for itself. Thus, God’s Being is termed Wājib al-Wujūd (“Necessary Being”). In this light, humanity—and everything else in the world of forms—is seen as “borrowing” its existence from the indispensable nature of Divine Being.

Cosmology and the Human Microcosm

The basic cosmologic premise in Islam, as well as in other traditions such as Hinduism, Christianity, and Judaism, is that the Absolute Truth of Divinity (al-Haqq) manifests Itself in the world of forms and within the human heart in a process called the “arc of descent.”^‡ There is in response to this arc of descent of the Divine a reciprocal “arc of ascent” of the human spirit.¹⁰ These adwār (“arcs” or “cycles”) of descent and ascent relate directly to the interdependence of all things on all levels of existence. Everything in creation is perceived as acknowledging, in one form or another, the all-pervading Divine Presence. From the traditional view, the human being is seen as the most concentrated theophany (i.e., a locus of Divine Presence in the world of forms), especially as it concerns the qualities of an active intellect and free will. According to the Hermetic dictum, “As Above, so too below,” the human being acts as a mirror to the Divine. Furthermore, the Sufis (the mystics of Islam) have a popular saying that addresses this reality on the cosmic scale: al-insān qawn saghīr wa ’l-qawn insān kabīr (“Man is a small universe and the universe is a large man”).

The guiding principle of the dynamic interplay between the Divine Order and the rest of creation is called Tawhīd (“the principle of Divine Unity”). All traditional sciences agree that there exists a dependence of creation on the Divine, an interdependence between all forms in the cosmos, and an intradependence of all elements within each specific form. There is an obvious analogy to the profound knowledge found in that sacred oriental symbol of the Tao’s Tai Chi (“Supreme Principle of Unity”) with the complimenting and harmonizing forces of Yin and Yang. This is also known in Islamic cosmologic language as al-wahdah fi ’l-kathrah wa ’l-kathrah fi ’l-wahdah (“the one in the many and the many in the one”).

Unani medicine bases its medical theories of diagnosis and treatment upon this specific understanding of the intradependent relationships that exist between the four humors as it concerns the subtle (latīf) aspects of human physiology and spiritual psychology.^*

Teleology and Spiritual Correspondences

The teleologic component of Unani medicine’s philosophy entails extracting “meaning” and “purpose” as it relates to the realities of creation and the human experience. To what end is human life? What is the goal of all of creation? Is there a plan of purpose that governs the created order and all of its particular elements?

The Qur’ān explicitly states that inna li ’Llāhi wa inna ilayhi rāji‘ūn (“Verily we belong to God, and to Him is our return”). The human race hurls itself forward, in time and space, toward an inevitable reunion with its Creator. It is this understanding of the nature of things that permits traditional Hakīms (the “doctors” of the Unani medical tradition) to find solace in the fact that every patient is ultimately a patient at the doorsteps of the Divine Doctor.

The notion of forcing “heroic” measures upon the sacred human frame is problematic to the philosophical principles upon which Unani medicine is based. This is not to say that surgery and trauma care are perceived in a negative light in Unani medicine. Rather, the question is really one of proportions. The traditional Tabīb (“man of medicine,” or physician) always has an eye to the Divine within the human temple. This is really a cultivated virtue that the hakīms practice as part of their art to remain true to the doctrine that “God is everywhere present”; that in keeping with the wisdom of Plato, it is the “eye of the soul” that witnesses “tō Agathōn” (“the Supreme Good”). Therefore, any decision made by a hakīm must include an analysis of risks-to-benefits within the larger ethical framework of the Divine’s presence in human life. As a prayerful supplication of Ali, the son-in-law of the Prophet Muhammad and the spiritual pole of Shiite Islam, says: Yā man Ismuka dawā’, wa dhikruka shifā’ (“Oh Ye whose Name is a sacred medicine, and in whom remembrance of Thee [dhikruka] is a healing balm …”).

Unani Medical Theory in Principle

Vis Medicatrix Naturae

It is only with the “eye of the heart” (‘ayn al-qalb’) that the doctors of Unani medicine are able to gain proper intuition of vision concerning the state of the jism al-latīf (the “subtle body”) of the patient in whom is found the flowing, dynamic streams of the humors. It is at the level of the subtle body that the hakīm desires to enliven the self-healing power, the vital force, or the vis medicatrix naturae to affect a change in the patient’s being in the direction of health and wellness. It is this particular “organizing principle” (al-quwwa al-mudabbirah), as a component of the hidden physiology of the subtle body, that affects a harmonizing reaction in the face of “disease” or illness. One may perceive the Vis as being the thread that holds the fabric of the human body, mind, and soul together in close conjunction with the spirit. This is the general medical theory of the “healing power of nature” that Unani medicine posits as a guiding principle upon which is built more complex specific understandings of human health and disease.

A Personal Thought on the Invisible Vis or Quwwa

I believe that we encounter many opportunities in life that allow us to witness obvious demonstrations of the vis medicatrix naturae. An everyday example of the obvious workings of the Vis is seen when someone gets a paper cut. Many of us have had this experience and have considered it a very irritating situation. However, if we look carefully at what is actually happening, we cannot but assume that the “natural healing instinct” in the human body, when undergoing injury or trauma, is to mobilize mechanisms that will allow for self-preservation and homeostasis, and not disorder. Why should the body even mobilize these mechanisms to begin with? We know to a great degree the science behind these mechanisms, but what we do not know is why these mechanisms should initiate such a nonentropic response. This is still a mystery.

As simple as a paper cut is, it is usually followed by a natural biochemical and physiological inclination towards wound healing (homeostatic repair). We usually never see a paper cut to a finger progressively develop into an open wound, fester with pus and infection, turn gangrenous or necrotic, die, and then have the finger be amputated; this is simply not the natural instinctual response of the human body. In actuality, what we do see happen is the influence of this organizing principle—call it what you may: qi, prana, vis, quwwa, ki, etc.—leading the organism’s biochemistry towards a prolife, healing homeostasis, and not a death-inducing “diseased” chaos or disturbance.

There is yet another common example that relies heavily on the signaling of this “power” or “quwwa” for healing, and that is surgery. How many times have we heard what surgeons say after surgery? It usually goes something like “Well, it’s now up to the patient to heal” or “I’ve done all I can, the rest is up to the patient” or “I look forward to seeing you in 1 week in order to see how your hand is healing.” What do statements like this really mean? I believe that what is actually being invoked is a subconscious acknowledgement of and reliance upon the Vis. However, because the language of modern conventional medicine does not give this ever-present healing power a name, it is vicariously mentioned under ambiguous terms, phrases, and allusions. All other traditional systems of medicine in the world have a name for this “elephant in the room,” as a distinct reality.

The Doctrine of the Seven Naturals

There are hosts of medical systems around the world with their own understanding of what constitutes the primary and basic functional components that cause health to reign or disease to take root, progress, and finally show itself in constellations of signs and symptoms of illness. In Chinese medicine, we have physiologic concepts such as Qi, Blood, Yin, and Yang. In conventional medicine, physiology is dominated with the key concepts of organic issues relating to organ tissue morphology (anatomy) and fluid dynamics (medical biochemistry).

In Unani medicine, these concepts fall under the strict heading of umūr al-tabīiyyah (“principles of natural physiology”), comprised of the “Seven Naturals” that are the pillars and determinants of health. These are as follows:

Forces, drives, faculties, or powers (quwwāt)

Actions or functions (afāl)

Pneuma or spirit substance (rūh)

Elements, Qualities, Properties, and States

The elements are the simple building blocks of matter in nature, including the human body. They are nondivisible, but do have qualities that are both active and passive that determine the states of matter. They are:

Fire (nār), which is hot and dry (hār and yābis): determines energy state.

Air (hawā’), which is hot and wet (hār and ratab): determines the gaseous state.

Water (mā’), which is cold and wet (bārid and ratab): determines the liquid state.

Earth (ardh), which is cold and dry (bārid and yābis): determines the solid state.

These elements do not mean literally clods of dirt, buckets of water, and so forth. “Likewise, the burning fire that we see is not the element fire, which is really the potentiality of fire within the substance.”¹¹

Temperaments

The interplay between the qualities of the elements leads ultimately to a uniform configuration of a temperament. “Each [Temperament] is named after a certain Humor, and is characterized by the predominance of that Humor and its associated basic qualities.”¹² The classical temperaments correlate well to today’s psychological constitutional types: choleric, melancholic, phlegmatic, and sanguine. Imbalances of temperaments cause disharmony, especially on the mental and emotional fronts. The following is a concise, but thorough medical depiction of the temperaments (Table 49-2).

TABLE 49-2 The Four Different Temperaments

Sanguine Temperament
Humor	Blood
Basic qualities	Hot and wet
Face	Oval or acorn-shaped face and head. Delicate, well-formed mouth and lips. Beautiful almond-shaped eyes, often brown. An elegant, swanlike neck.
Physique	In youth, balanced, neither too fat nor too thin. Moderate frame and build. Elegant, statuesque form, with ample, luxuriant flesh. Joints well-formed; bones, tendons, veins not prominent. Can put on weight past 40 years, mostly around hips, thighs, buttocks.
Hair	Thick, luxuriant, wavy. Abundant facial and body hair in men.
Skin	Pink, rosy, blushing complexion. Soft, creamy smooth, luxurious feel. Pleasantly warm to the touch.
Appetite	Quite hearty, often greater than digestive capacity. A predilection for rich gourmet foods.
Digestion	Good to moderate; balanced. Can be overwhelmed by excessive food.
Metabolism	Moderate, balanced. Bowel tone can be a bit lax.
Predispositions	Metabolic excesses of the blood. Uremia, gout, diabetes, high cholesterol. Intestinal sluggishness, putrefaction. Congested, sluggish liver and pancreas. Congested blood, bleeding disorders. Respiratory catarrh, congestion, asthma. Urinary conditions, genitourinary disorders. Excessive menstruation in women. Skin conditions, hypersensitivity, capillary congestion.
Urine	Tends to be rich or bright yellow and thick.
Stool	Well-formed, neither too hard nor too soft.
Sweat	Balanced, moderate.
Sleep	Moderate, balanced, sound. Can be some snoring.
Dreams	Usually pleasant, of a charming, amusing, romantic nature. Travel, enjoyment, games, distractions.
Mind	Faculty of judgment well-developed. A synthetic intellect that likes to see the whole picture. An optimistic, positive mental outlook. Rather conventional and conformist; good social skills.
Personality	Exuberant, enthusiastic, outgoing. Optimistic, confident, poised, graceful. Expansive, generous. Romantically inclined; loves beauty, aesthetics, arts. Sensual, indulgent nature. Sociable, gregarious, light-hearted, cheerful.

Choleric Temperament
Humor	Yellow bile
Basic qualities	Hot and dry
Face	Broad jaw. Sharp nose, high cheekbones. Sharp, angular facial features. Reddish face common. Sharp, fiery, brilliant, penetrating eyes and head.
Physique	Compact, lean, wiry. Good muscle tone and definition. Prominent veins and tendons. Broad chest common. An active, sportive type. Weight gain usually in chest, arms, belly, upper body.
Hair	Often curly. Can also be thin, fine. Balding common in men. Blonde or reddish hair common.
Skin	Ruddy or reddish color if heat predominates; sallow or bright yellow if bile predominates. Rough and dry, quite warm.
Appetite	Sharp and quick. Soon overcome by ravenous hunger. Fond of meat, fried foods, salty or spicy foods, alcohol, intense or stimulating taste sensations.
Digestion	Sharp and quick. Tendency towards gastritis, hyperacidity, acid reflux. When balanced and healthy, can have a “cast iron stomach,” able to digest anything.
Metabolism	Strong, fast, active; catabolic dominant. Strong innate heat of metabolism. Liver and bile metabolism can be problematic. Digestive secretions strong, bowel transit time short. Adrenals, sympathetic nervous system dominant. Strong inflammatory reactions.
Predispositions	Fevers, infections, inflammation. Hives, rashes, urticaria. Fatty liver, bilious conditions. Hyperacidity, acid reflux, inflammatory and ulcerative conditions of middle GI tract. Headaches, migraines, irritability. Eyestrain, red sore eyes. Purulent conditions. High cholesterol, cardiovascular disorders. Gingivitis. Bleeding disorders from excess heat, choler in the blood. Hypertension, stress.
Urine	Tends to be scanty, dark, thin. Can be hot or burning.
Stool	Tends towards diarrhea, loose stools. Can have a yellowish color, foul odor.
Sweat	Profuse, especially in summer, or with vigorous physical activity. Strong body odor. Sensitive to hot weather, suffers greatly in summer.
Sleep	Often fitful, restless, disturbed, especially with stress, indigestion. Often tends to wake up early or in the middle of the night.
Dreams	Often of a military or violent nature. Dreams of fire, red things common. Fight or flight, confrontation.
Mind	Bold, daring, original, imaginative, visionary. Ideation faculty well-developed. Brilliant intellect, sharp penetrating insight. The idea man who prefers to leave the details to others.
Personality	Prone to anger, impatience, irritability; short temper. Bold, courageous, audacious, confrontational, contentious. Dramatic, bombastic manner; high powered personality. The rugged individualist and pioneer; thrives on challenge. The fearless leader. Seeks exhilaration, intense experiences. Driven, “Type A” personality. Prone to extremism, fanaticism.

Melancholic Temperament
Humor	Black bile
Basic qualities	Cold and dry
Face	Square or rectangular head and face. Prominent cheekbones, sunken hollow cheeks common. Small, beady eyes. Teeth can be prominent, crooked or loose. Thin lips.
Physique	Tends to be thin, lean. Knobby, prominent bones and joints common. Prominent veins, sinews, tendons. Muscle tone good, but tends to be stiff, tight. Rib cage long and narrow, with ribs often prominent. Can gain weight in later years, mainly around midriff.
Hair	Color dark, brunette. Thick and straight. Facial and body hair in men tends to be sparse.
Skin	A dull yellow or darkish, swarthy complexion. Feels coarse, dry, leathery, cool. Calluses common.
Appetite	Variable to poor. Varies, fluctuates according to mental or emotional state.
Digestion	Variable to poor; irregular. Digestion also varies according to mental or emotional state. Colic, gas, distension, bloating common.
Metabolism	Often slow. Can also be variable, erratic. Prone to dehydration. Nervous system consumes many nutrients, minerals. GI function variable, erratic; digestive secretions tend to be deficient. Blood tends to be thick. Nutritional deficiencies can cause a craving for sweets, starches. Thyroid tends to be challenged, stressed.
Predispositions	Anorexia, poor appetite. Nervous, colicky digestive disorders. Constipation. Spleen disorders. Nutritional and mineral deficiencies, anemia. Blood sugar problems, hypoglycemia. Wasting, emaciation, dehydration. Poor circulation and immunity. Arthritis, rheumatism, neuromuscular disorders. Nervous and spasmodic afflictions. Dizziness, vertigo, ringing in ears. Nervousness, depression, anxiety, mood swings.
Urine	Tends to be clear and thin.
Stool	Can either be hard, dry, compact; or irregular, porous, club-shaped. Constipation, irritable bowel common.
Sweat	Generally scanty. Can be subtle, thin, furtive, indicating poor immunity. Nervous stress can increase sweating.
Sleep	Difficulty falling asleep, insomnia. Stress, overwork, staying up late aggravates insomnia. Generally a light sleeper.
Dreams	Generally dark, moody, somber, disturbing. Themes of grief or loss common.
Mind	An analytical intellect; detail oriented. Efficient, realistic, pragmatic. Reflective, studious, philosophical. Retentive faculty of memory well-developed. Thinking can be too rigid, dogmatic. A prudent, cautious, pessimistic mental outlook.
Personality	Practical, pragmatic, realistic. Efficient, reliable, dependable. A reflective, stoic, philosophical bent. Can be nervous, high strung. Frugal, austere; can be too attached to material possessions. Serious, averse to gambling and risk taking. Can be moody, depressed, withdrawn. Can easily get stuck in a rut. Excessive attachment to status quo.

Phlegmatic Temperament
Humor	Phlegm
Basic qualities	Cold and wet
Face	Round face; full cheeks, often dimpled. Soft, rounded features. Double chin, pug nose common. Large, moist eyes. Thick eyelids and eyelashes.
Physique	Heavy frame, stout, with flesh ample and well-developed. Often pudgy, plump, or overweight; obesity common. Joints dimpled, not prominent. Veins not prominent, but can be bluish and visible. Lax muscle tone common. Feet and ankles often puffy, swollen. Women tend to have large breasts. Weight gain especially in lower body.
Hair	Light colored, blondish hair common. Light facial and body hair in men.
Skin	Pale, pallid complexion; very fair. Soft, delicate, cool moist skin. Cool, clammy perspiration common, especially in hands and feet.
Appetite	Slow but steady. Craves sweets, dairy products, starchy glutinous foods.
Digestion	Slow but steady to sluggish. Gastric or digestive atony common. Sleepiness, drowsiness after meals common.
Metabolism	Cold, wet, and slow. Conserves energy, favors anabolic metabolism. Congestion, poor circulation, especially in veins and lymphatics. Kidneys slow, hypofunctioning, inefficient. Adrenals and thyroid tend towards hypofunction; basal metabolism low. Metabolic water drowning out metabolic fire.
Predispositions	Phlegm congestion. Water retention, edema. Lymphatic congestion, obstruction. Poor venous circulation. Gastric atony, slow digestion. Hypothyroid, myxedema. Adrenal hypofunction. Weight gain, obesity. Frequent colds and flu. Chronic respiratory conditions, congestion. Swollen legs, ankles, feet. Cellulite. Poor tone of skin, muscles, and fascia.
Urine	Tends to be clear or pale and thick. Tends to be scanty in volume, with excess fluid accumulation in the body.
Stool	Well-formed, but tends to be slightly loose, soft. Bowels tend to be sluggish.
Sweat	Cool, clammy sweat common, especially on hands and feet. Sweating can be easy and profuse, especially with kidney hypofunction. Sensitive to cold weather; suffers greatly in winter.
Sleep	Very deep and sound. Tends towards excessive sleep, somnolence. Snoring common; can be loud or excessive.
Dreams	Generally very languid, placid. Water and aquatic themes common.
Mind	Tends to be dull, foggy, slow. Slow to learn, but once learned, excellent and long retention. Patient, devoted, faithful. Faculty of empathy well-developed. Sentimental, subjective thinking. A calm, good-natured, benevolent mental outlook.
Personality	Good natured, benevolent, kind. Nurturing, compassionate, sympathetic, charitable. Great faith, patience, devotion; tends to be religious, spiritual. Sensitive, sentimental, emotional, empathetic. Passive, slow, sluggish; averse to exertion or exercise. Calm, relaxed, takes life easy. Excessive sluggishness can lead to depression.