The History and Theory of The Temperaments in Islamic Medicine

“Lo! In the creation of the heavens and the earth, and the difference of night and day, and the ships which run upon the sea with that which is of use to men, and the water which Allah sendeth down from the sky; thereby reviving the earth after its death, and dispersing all kinds of beasts therein, and (in) the ordinance of the winds, and the clouds obedient between heaven and earth: are signs (of Allah’s sovereignty) for people who have sense” (Sura’tul Baqarah, 2:164).

According to Avicenna, Allah has made all kinds of people as well as all kinds of beasts and they can be roughly categorized into four types. In fact, as far back as Hippocrates in 450 BC, the idea that people could be categorized according to “types” was very popular and was used as a key to self-development, relationships, job choice, and even health care and maintenance. Hippocrates, and later Avicenna, defined these types as sanguine, choleric, melancholic, and phlegmatic and taught how each type could live a healthier and more personally rewarding life. As Muslims, we can use this insight to help our community grow together, to nurture family relationships, to inspire self-improvement and to heal ourselves.

Physically, the sanguine element has historically represented the nutritive aspect of metabolism; the choleric element, the stimulating and heating aspect; the phlegmatic element, the fluid, cooling and purifying aspects; and the melancholic element, the coagulating, solidifying, drying and concentrating aspects.

A quick definition of each temperament personality usually notes its reaction to stimuli in their environment. Thus, the sanguine temperament is marked by quick but shallow, superficial excitability; the choleric is characterized by a quick but strong and lasting reaction; the melancholic temperament is defined by his slow but deep response and the phlegmatic is famous for his slow but shallow excitability. The first two are extroverts and the last two are introverts.

In the Qur’an, Allah describes man as being created from water (32:8), which is cold and wet; earth (3:59), which is cold and dry; clay (7:12), which is cold and wet; and a sounding clay (55:14), which is hot and wet as it is transformed or hot and dry as it is beaten by the wind.

Although the terms used in the Qur’an vary from the terms used by temperamental “healers” during the time of Prophet Muhammad (SAW), the elemental qualities of man remain consistent. Thus, the sanguine element corresponds to the hot and wet sounding clay as it is transformed; the choleric element corresponds to the hot and dry sounding clay as it is beaten by the wind; the melancholic element corresponds to the cold and dry earth; and the phlegmatic element corresponds to the cold and wet water (or raw clay). Although Allah has created each person to have all of these elements, practitioners of temperamental healing have observed that each person usually contains a predominate element.

The opposing idea that all people are alike is a twentieth century idea stemming from the ‘democratic’ idea that if we are all going to be free and equal that we must also be alike. Many popular books on the modern market propel this idea even farther. Books like ‘The McDougall Plan’, ‘The Zone’, and ‘The Atkin’s Diet’ all claim that their diets are the best for everyone and largely discredit any claims that different diets may benefit different types. Furthermore, most discipline books recommend raising children using only one form of discipline and most self-help books recommend that their method is the “one and only” way to success. On the other hand, books like ‘Eat Right 4 Your Type’, ‘Between Heaven and Earth’ (a book on Chinese Healing) and ‘The Medicine of The Prophet’ each emphasize the importance of recognizing people’s health needs according to their various types. The beauty of an Islamic society is that it allows equality but does not define equality with being alike. For example, in the Qur’an it says:

(9:71) And (as for) the believing men and the believing women, they are guardians of each other; they enjoin good and forbid evil and keep up prayer and pay the poor-rate, and obey Allah and His Apostle; (as for) these, Allah will show mercy to them; surely Allah is Mighty, Wise.

(9:72) Allah has promised to the believing men and the believing women gardens, beneath which rivers flow, to abide in them, and goodly dwellings in gardens of perpetual abode; and best of all is Allah’s goodly pleasure; that is the grand achievement.

The fallacy of equality through being alike is extremely evident in the women’s movement of the 1960’s and 1970’s that sought to create equality of the sexes by turning women into men. This failed because women and men are unique. They can only be equal if they work to improve their unique qualities within their own functional boundaries. In much the same way, the theory of temperament states that people in general must also function within their own boundaries and type. Rather than struggling to become something they are not, or abusing others because they are not as they expect them to be, people must develop themselves and appreciate others according to the gifts Allah has given them.

Many mainstream Americans have difficulty using this valuable system of healing because they cannot get beyond the idea that “everyone must be the same to be equal or right”. Many Christian writers have also explored the temperaments, however, they are largely rejected by the church because many church authorities do not leave room for Christians to learn outside their religion. The authorities of the church say that since it is not written in the Bible it cannot be true. Even so, a number of modern writers have gained much popularity in the past ten years for their spiritual insights into the classical temperament system. Some of these writers are even claiming that the system of temperaments is inherently Christian, although the Muslim physicians were the ones to cultivate and perfect the system. These writers are: Tim LaHaye, (Spirit-Controlled Temperament (1967); Transformed Temperaments (1971); and Why You Act the Way You Do (1984)), and Florence Littauer, Charles Stanley, Larry Burkett and John G. MacArthur.

As Muslims we are uniquely suited to gain from the scientific research in this field as the prophet Muhammad gives us permission to, “Seek knowledge from the cradle to the grave… even as far as China” and also emphasizes the uniqueness of the individual within the equality of the society. In other words, Islam has no problem accepting the idea and usefulness of the system of temperaments.

Some of the most prominent Muslim scientists, such as Avicenna explored the theory of temperaments in great detail and an entire field of Islamic Medicine called Unani Tibb, is devoted to healing through the temperaments. Healing through temperaments was popular at the time of the prophet and some of the methods the prophet mentions in the Hadith such as cupping and cautery were popular “balancing” methods in this field of medicine. In addition, the hadiths frequently refer to the ‘hot’ and ‘cold’ qualities of foods, which was another tool used by this healing system.

Avicenna developed his theories based on the Hippocratic definition of the four humors which existed in the body called black bile, phlegm, blood and yellow bile. Before Hippocrates, however, the ancient Greeks had at least three humors they worked with which very much resemble the present day Ayurvedic system of temperament and healing. The idea of four humors, though, most likely originated with Hippocrates, who observed upon examining blood that the red portion of fresh blood is the blood humor, the white material mixed with blood is the phlegm, the yellow-colored froth on top is the yellow bile, and the heavy part that settles down is the black bile (sauda).

Avicenna developed this Hippocratic method even farther when he stated that intercellular and extracellular fluids were secondary humors and that the origin and action the four humors or essences (Arabic: akhlat) and their ultimate fate in the digestive process are affected by diet. Avicenna defines the elements as simple substances which provide the primary components of the human body. Although he also recognized the substances of blood, black & yellow bile and phlegm, he also correlated these to the four elements of earth, air, water and fire and assigned these four elements temperamental qualities of cold, hot, moist and dry. He also pointed out that although there is a close association between a body fluid and its humor, the humor is considered separate and independent of the body fluid.

Other Arab Muslim Physicians who used the theories of temperament are Abu Bakr Muhammad Zakariya Al Razi (865AD), Ibn Qayyim Al-Jawziyya (1292), and Jalalu’d-Din Abd’ur-Rahman ibn Bakr as-Suyuti (1445). All speak extensively in their works on the humors and how a practitioner can heal the sick through balancing of the humors.

Plato(340), Aristotle (325) , Adickes (1907), Spranger (1914) , Kretchmer (1920), Fromm (1947), Meyers (1955) and Keirsey (1987) have all explored the four temperaments in their own way as well. Even Winnie The Pooh explored the temperaments using Pooh as an example of the melancholic, Rabbit as the choleric, Tigger as the sanguine and Eeyore as the phlegmatic type.

Islamic Unani Tibb Medicine was formed by refining the theories of Hippocrates, Avicenna and later Arab physicians even farther. Unani Tibb recognizes the four humors, the corresponding elemental qualities and temperamental qualities. However, Unani Tibb further divides the human being into 2 ‘virtues’ and 3 ‘faculties’. Using the four element system, Unani Tibb recognizes that each human is made up primarily of the progressive and procreative virtue and a second, physiological virtue. They also define people as being divided into corresponding and interactive faculties which are called: the vital faculty which is akin to the spiritual side of a person, the natural faculty which is akin to the physical being of a person and the psychic faculty, which has little to do with “psychic” ability, but actually relates to the conscious and unconscious mind. It is believed that a person is born into a certain temperament though their physical and mental qualities, but by using all the faculties, especially the spirit.



Please give us a call at

Newsletter Sign-Up

* Email
* = Required Field