Treatment Must Follow the Temperament (مزاج mizāj ): Ibn Sina’s Golden Rule and Modern Neurocognitive Insights
- Qaisar J Qayyum MD
- Sep 30
- 11 min read
Updated: Oct 16
Author: Dr Qaisar J. Qayyum, MD — Chief Editor, Noor Journal of Complementary and Contemporary Medicine (NJCCM); Clinical Assistant Professor of Medicine, Oklahoma, USA.
Abstract
Alzheimer’s disease now affects one in nine adults over 65 years in the United States [4]. Long before modern disease labels, classical Unani (Yoonani یونانی) physicians articulated universal therapeutic principles for all illnesses. Central among these is that treatment must fit the individual’s temperament, not merely the diagnosis. Ibn Sina taught, “Treatment must follow the temperament” [1], and Hakim Nuruddin ؓ stated, “True treatment consists of removing the causes in accordance with the temperament” [3]. These maxims capture a timeless truth: two people may share the same disease, yet each requires management tailored to his or her unique mizaj (temperament).
This paper (Part 1) aligns Unani (Greco–Arabic) theory with modern neurocognitive and biochemical evidence. It explains the four temperaments, their physiological parallels, and how personalized medicine today echoes what Unani Hikmat established a millennium ago.
Introduction
“It’s far more important to know what person has the disease than what disease the person has.” — Hippocrates (حکیم بقراط, PMC3296331)
Unani medicine (al-tibb al-yoonani) evolved from Greek, Arabic, and Persian scholarship, an integrated system where healing is guided by mizaj (temperament). The concept was introduced by Galen (Jalinoos جالینوس), refined by Ibn Sina (Avicenna), and later reinterpreted by Indian–Persian sages including Hakim Nuruddin ؓ, whose Bayaz-e-Nuruddin serves as a bridge between classical theory and modern practice.
In this approach, treatment must correspond to the individual’s internal balance of hot–cold and moist–dry qualities through carefully selected remedies, diet, and lifestyle suited to their unique mizaj (temperament). By aligning therapy with the patient’s inherent state, the physician minimizes adverse effects and identifies the most effective medicinal agents for restoring balance and function.
Modern neuroscience is rediscovering this truth through the lens of genetics, biochemistry, and stress physiology: mizaj is the phenotype of the genotype — a dynamic expression of constitutional and environmental interaction.
The Golden Rule of Hikmat
Ibn Sina (Avicenna), al-Qanun fi’l-Tibb (The Canon of Medicine):
“Treatment must follow the temperament.” [1]
Hakim Nuruddin ؓ, Bayaz-e-Nuruddin:
“اصل علاج تو ہے کہ ازالہ اسباب حسب مزاج کیا جاوے”
“True treatment consists of removing the causes in accordance with the temperament.” [3]
This principle underscores a fundamental reality: disease may be universal, but healing must be individualized. Personalization, not uniformity, is the essence of medicine, classical or modern.
Philosophy of Integration: Hikmat and Modern Science
Classical physicians of Hikmat (Unani medicine) such as Ibn Sina and Hakim Nuruddin ؓ taught through observation and reasoning, not blind imitation. Their concept of mizaj (temperament) explained individual differences in health and healing. Today, modern neuroscience and biochemistry describe similar ideas through genetics, inflammation, and neurohormonal balance. Our purpose is not revival for its own sake, but selective adoption of principles that remain physiologically sound and clinically verifiable.
When interpreted through evidence-based understanding, Hikmat offers a framework for truly personalized medicine, one that treats causes, respects individuality, and unites body, mind, and spirit.
Author’s Clinical Observation and Experiment
As part of an exploratory n-of-1 observation on cognitive performance, I conducted a self-experiment using a natural formulation derived from culinary and traditional principles. The intervention consisted of a mixture of approximately ½ tablespoon Kashmiri chili powder (≈2 g), ½ tablespoon organic apple cider vinegar (≈5 g), and ½ tablespoon local raw honey (≈12 g), administered once daily. This initial dose produced noticeable mental clarity and improved alertness without any discomfort. To explore potential dose–response effects, the amount was tripled to roughly 1½ tablespoons of each component (≈6 g chili, 15 g vinegar, and 36 g honey). Within 24 hours, this higher dose produced transient retrosternal spasmodic discomfort, prompting emergency evaluation.
Cardiac workup—including ECG, cardiac biomarkers, and echocardiogram—was normal. A consulting cardiologist (with background in South Asian therapeutics) attributed the episode to gastric irritation from the combined chili–vinegar acidity rather than a cardiac cause. The reaction resolved completely with Pepcid Complete (famotidine + antacid), confirming a gastrointestinal origin and establishing this as the upper safe limit for this formulation.
This clarified an important point: individuals with Balghami (cold–moist) or Sawdawi (cold–dry) temperaments—where metabolism is sluggish or mucosal sensitivity heightened—may react adversely to acidic preparations despite their benefits in others. Future formulations and studies will omit vinegar or strongly acidic components to improve tolerability across temperament types.
The aim was to assess subjective changes in alertness, mental clarity, and overall cognitive function following short-term exposure to mild thermogenic and antioxidant agents.
The working hypothesis was that mild neurostimulation from spice could activate cranial-nerve pathways, improving alertness and memory through adaptive neuroprotection, as suggested in studies linking capsaicin to neurogenesis and antioxidant effects.
Initial outcome: noticeable mental clarity and reduction in “brain fog.”
Adjustment phase: After initial subjective improvement, the dosage was deliberately increased to explore the upper tolerance range and potential dose–response relationship. Within 24 hours, transient retrosternal spasmodic anginal discomfort developed, prompting emergency evaluation. Cardiac workup, including ECG and biomarkers, echocardiogram was normal. A consulting cardiologist (with training in South Asian therapeutics) attributed the symptoms to gastric irritation from the combined chili–vinegar acidity, rather than a cardiac cause.
The reaction resolved completely with Pepcid Complete (famotidine + antacid), confirming a gastrointestinal origin and establishing the upper safe limit for this formulation. This clarified an important point: individuals with Balghami (cold–moist) or Sawdawi (cold–dry) temperaments, where metabolism is sluggish or mucosal sensitivity heightened, may react adversely to acidic preparations despite their benefits in others. In future formulations and experiments, vinegar and other strongly acidic components will therefore be omitted to ensure broader tolerability across temperament types.
This observation highlights a deeper truth about the philosophy of healing: that effective treatments often already exist within traditional or natural frameworks but are overlooked in favor of newer, more commercial options. Given the prevailing trend of monetization in modern medicine, new treatments may not be pursued unless they promise significant financial returns. As a result, potentially beneficial remedies are sometimes ignored simply because they do not fit the economic model of profitability.
At this juncture, it is worth recalling a timeless medical principle beautifully expressed in the ḥadīth of the Holy Prophet ﷺ:
The Prophet (ﷺ) said, “There is no disease that Allah has created, except that He also has created its treatment.”— Sahih al-Bukhari, Kitāb al-Tibb (Book of Medicine), Hadith 5678 https://sunnah.com/bukhari:5678
Comparable intuitions appear across several ancient healing traditions, each reflecting the recognition that nature carries within it both ailment and remedy. Hippocrates taught that “Nature itself is the best physician,” suggesting that the forces which disturb balance also contain the potential for its restoration. The Charaka Saṃhitā of Ayurveda records that “for every disease, there grows a herb that can cure it,” affirming divine provision through natural design. Likewise, the Huangdi Neijing of Chinese medicine describes health as harmony between yin and yang, where imbalance inevitably evokes its counterbalance. Even the Hebrew Scriptures (Ezekiel 47:12) echo this notion, describing leaves “for healing.”
Yet, the ḥadīth of the Holy Prophet ﷺ transcends these intuitive philosophies. It frames healing not merely as a natural reciprocity but as a deliberate act of Divine wisdom, that for every illness permitted to exist, its cure was created within the same framework of mercy and balance.
In light of this principle, it may be reasoned that the cure for every disease has existed since the very inception of that disease, both created within the same divine framework of balance and reciprocity. The true role of the physician and researcher, therefore, is not to wait for future invention, but to rediscover and apply time-tested remedies from historical knowledge, until a better, safer, or more refined one becomes available, a prospect increasingly limited by high cost of development and commercial priorities that favor profitability over genuine therapeutic discovery.
Hence, one formula cannot fit all; treatment must always respect mizaj. Until modern medical science looks deeper into this philosophy, true success in healing may continue to elude us, and medicine will keep failing many whom it aims to serve.
Temperaments and Their Scientific Echo
Temperament | Qualities | Classical Description | Modern Correlates |
🟥 Damawi (دموی) | Hot & Moist | Cheerful, sociable, energetic; forgetfulness from distraction, not decay [1] | Attention lapses ↔ working-memory overload [5] |
🟦 Balghami (بلغمی) | Cold & Moist | Sluggish, pale, sleepy; prone to true memory loss [2] | Metabolic-inflammatory profile (insulin resistance, raised CRP/IL-6) [11] |
🟨 Safrawi (صفراوی) | Hot & Dry | Ambitious, restless, weakened by stress [1] | Elevated cortisol, sympathetic over-activity, stress-induced hippocampal damage [7, 13] |
⬛ Sawdawi (سوداوی) | Cold & Dry | Thoughtful, anxious, perfection-seeking [4] | Depression-related hippocampal atrophy, rumination, serotonin imbalance [9, 10] |
Biochemical markers, such as cortisol, bilirubin, fasting glucose, CRP, and IL-6 — support that mizaj correlates with specific neuroendocrine and inflammatory profiles. What Unani called temperament aligns with modern “endophenotypes” in dementia research.
Mizaj Is Not Limited to Alzheimer’s
While this study centers on memory and cognition, mizaj underpins all bodily and psychological states. The same constitutional tendencies explain differential susceptibility to metabolic syndrome, cardiovascular disease, anxiety, and depression. Modern complementary medicine thus mirrors Unani’s call for personalized healing.
Diagnosing Mizaj and Cognition
A. Temperament Indicators (Simplified Overview)
Category | Damawī (Hot + Moist) | Balghamī (Cold + Moist) | Ṣafrāwī (Hot + Dry) | Sawdāwī (Cold + Dry) |
Body & Color | Reddish tone, warm skin | Pale, cool, soft | Lean, yellowish | Dark, dry |
Energy | High, steady | Low, slow | Quick, tense | Variable, weak |
Digestion | Strong | Sluggish | Acidic | Sensitive |
Mood | Cheerful, sociable | Calm, steady | Driven, impatient | Cautious, analytical |
B. Cognitive Screening Tools
Participants in Part 2 of this project are encouraged to complete one of these tests at baseline and repeat it after 4–6 weeks of temperament-guided therapy.
Test | Purpose (Lay Summary) | Access |
MoCA – Montreal Cognitive Assessment | Detects early memory loss and executive issues. | |
SLUMS – St Louis University Mental Status Exam | Screens for mild cognitive impairment or dementia. | |
M@T – Memory Alteration Test | Quick 10-minute screen for early Alzheimer’s. |
Validated Tools for Mizaj Assessment
Tool | Population / Setting | Key Features | Access / Reference |
Mojahedi M, et al. (2014) — Reliability and Validity Assessment of Mizaj Questionnaire (Iran Red Crescent Med J. 16(3):e15924)* | Adults (general) | 10-item validated self-report; establishes hot/cold and wet/dry traits. | |
Salmannezhad H, Mojahedi M, et al. (2018) — Design and Validation of Mizaj Identification Questionnaire | Adults | Detailed scoring for compound temperaments. | |
Akhtari M, Mojahedi M, et al. (2024) — Elder Mizaj Questionnaire (60+) | Older adults | Tailored to geriatric use; reliable for dementia studies. | |
CCRUM “Know Your Mizaj” (Govt. of India) | General public | Official AYUSH screener mapping classical Unani axes. |
Discussion:
Tradition Meets Modern Science
Classical Type | Modern Parallel | Key Insight |
Damawi | Attentional lapses, multitasking fatigue | Working-memory overload, dopamine balance [5] |
Balghami | Metabolic sluggishness | Insulin resistance, “Type 3 diabetes” hypothesis [11] |
Safrawi | Stress-driven burnout | Cortisol excess, hippocampal injury [7, 13] |
Sawdawi | Mood-driven decline | Depression and hippocampal shrinkage [9, 10] |
Thus, what in Unani medicine once called “imbalance of humors” is now measurable in biomarkers and neuroimaging.
Noor Journal Mizaj (Temperament) Self-Assessment Form *
(Based on the validated Mojahedi Mizaj Questionnaire, Iran J Public Health, 2014)
Click below to print the form
Basic Information: Name | Age | Gender | Date
Mizaj (Temperament) Self-Assessment
Instructions
Read each statement carefully and mark Yes (✓) if it applies to you, or No (✗) if it doesn’t. At the end, count how many “Yes” responses you gave in each section.The sections with the highest Yes totals define your temperament (for example, Hot + Moist = Damvi).
A. Hot (Garam) vs Cold (Sard)
No. | Statement | Yes | No | Temperament |
1 | I usually feel warm or heat up quickly. | ☐ | ☐ | Hot |
2 | I digest food quickly and feel hungry often. | ☐ | ☐ | Hot |
3 | I prefer cool weather. | ☐ | ☐ | Hot |
4 | I get irritated or excited easily. | ☐ | ☐ | Hot |
5 | I sleep lightly and wake up early. | ☐ | ☐ | Hot |
6 | I usually feel cold, and my hands or feet stay cool. | ☐ | ☐ | Cold |
7 | I digest food slowly and rarely feel hungry. | ☐ | ☐ | Cold |
8 | I prefer warm weather. | ☐ | ☐ | Cold |
9 | I feel tired easily and need more rest. | ☐ | ☐ | Cold |
10 | I remain calm and seldom get angry. | ☐ | ☐ | Cold |
Hot (Yes) ____ Cold (Yes) ____
B. Moist (Tar) vs Dry (Khushk)
No. | Statement | Yes | No | Temperament |
1 | My skin and hair feel soft or oily. | ☐ | ☐ | Moist |
2 | I sweat more than most people. | ☐ | ☐ | Moist |
3 | I have steady physical energy throughout the day. | ☐ | ☐ | Moist |
4 | I sleep deeply and peacefully. | ☐ | ☐ | Moist |
5 | My skin feels dry or rough. | ☐ | ☐ | Dry |
6 | I sweat very little, even in heat. | ☐ | ☐ | Dry |
7 | My lips or joints feel dry often. | ☐ | ☐ | Dry |
8 | I tire quickly or need frequent rest. | ☐ | ☐ | Dry |
Moist (Yes) ____ Dry (Yes) ____
Interpretation
Combination | Temperament | Core Traits |
Hot + Moist | Damvi (Sanguine) | Warm, energetic, sociable |
Hot + Dry | Safravi (Choleric) | Active, decisive, focused |
Cold + Moist | Balghami (Phlegmatic) | Calm, steady, gentle |
Cold + Dry | Saudavi (Melancholic) | Thoughtful, analytical, deep |
Note: This self-assessment is for educational and lifestyle guidance only. For professional evaluation, consult a qualified Unani / Hikmat practitioner.
Prepared by: Dr Qaisar Qayyum, MD. Chief Editor, Noor Journal of Complementary and Contemporary Medicine (NJCCM)
Conclusion
From Galen and Ibn Sina to Hakim Nuruddin ؓ, the guiding principle has remained constant: treatment must follow the temperament. Modern neurocognitive science now validates this ancient wisdom, recognizing that disease pathways vary by constitution, stress biology, and emotional tone.
Unani medicine therefore stands not as an alternative, but as a complementary personalized model, harmonizing spiritual, physical, and neurobiological understanding.
“True treatment consists of removing the causes in accordance with temperament.” — Hakim Nuruddin ؓ
Acknowledgment:
This article was written with AI assistance. All claims are supported by credible, peer-reviewed references, which were validated for accuracy and authenticity. The AI synthesized information were reviewed by authors, ensuring scientific integrity throughout. In the event of any inadvertent errors, the responsibility lies with the AI/authors, and corrections will be made promptly upon identification. I would like to express my sincere gratitude to Dr Tahira Khalid, for her thoughtful review and invaluable feedback, and Dr. Mohyuddin Mirza, Ph.D for his valuable feedback. Their expertise and guidance have played a pivotal role in refining and enhancing this article.
Conflict of Interest Statement:
The author is the developer of a herbal formula and the owner of Dr. Q Formula/Insulinn LLC. However, this affiliation has not influenced the content, analysis, or conclusions of this article
Author’s Note on Scope and Intent:
This article does not advocate the replacement of evidence-based conventional care modalities. All complementary interventions are intended to supplement, not supplant, standard clinical practice, and are implemented within a physician-governed, ethically reviewed, and fully documented medical framework.
References
Avicenna (Ibn Sina). The Canon of Medicine (al-Qānūn fī’l-Ṭibb, English trans. Gruner). Archive.org – Canon of Medicine PDF Internet Archive
Galen. On the Natural Faculties. Project Gutenberg – On the Natural Faculties Project Gutenberg
Biyaz E Nooruddin at Internet Archive — https://archive.org/details/ByazENurudin archive.org
Alzheimer’s Association. 2024 Alzheimer’s Disease Facts & Figures. alz.org/facts
Adam KCS, Mance I, Fukuda K, Vogel EK. The Contribution of Attentional Lapses to Individual Differences in Visual Working Memory Capacity. J Cogn Neurosci. 2015;27(8):1601–1616. https://pubmed.ncbi.nlm.nih.gov/25811710/
Ahn AC, Tewari M, Poon CS, Phillips RS. The limits of reductionism in medicine: Could systems biology offer an alternative? PLoS Medicine. 2006;3(6):e208. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030208
Prasher B, Negi S, Aggarwal S, Mandal AK, Sethi TP, Deshmukh SR, et al. Whole-genome expression and biochemical correlates of Ayurvedic constitutional types. Journal of Translational Medicine. 2008;6:48. BioMed Central https://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-6-48
Akhondzadeh S, Sabet MS, Harirchian MH, Togha M, Cheraghmakani H, Razeghi S, Hejazi S, Yousefi MH, Alimardani R, Jamshidi A, Khani M. Saffron in the treatment of patients with mild to moderate Alzheimer’s disease: A 16-week, randomized and placebo-controlled trial. Journal of Clinical Pharmacy and Therapeutics. 2010;35(5):581-588. DOI: 10.1111/j.1365-2710.2009.01133.x | PubMed
Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease. Archives of General Psychiatry. 2006;63(5):530-538. https://pubmed.ncbi.nlm.nih.gov/16651510/
Koster EHW, De Lissnyder E, Derakshan N, De Raedt R. Understanding depressive rumination from a cognitive science perspective: The impaired disengagement hypothesis. Clinical Psychology Review. 2011;31(1):138-145. DOI: 10.1016/j.cpr.2010.08.005 | PubMed
Fadó R, López-Sanz P, Casado P, Pizarro-Delgado J, Sanz C, Bergantiños-López A, et al. Feeding the brain: Effects of nutrients on cognition. Nutrients. 2022;14(21):4549. https://pmc.ncbi.nlm.nih.gov/articles/PMC9572450/
Genin E, Hannequin D, Wallon D, Sleegers K, Hiltunen M, Combarros O, et al. APOE and Alzheimer disease: Semi-dominant inheritance. Molecular Psychiatry. 2011;16:903-907. https://pubmed.ncbi.nlm.nih.gov/21556001/
*Copyright and Usage Notice
© 2025 Noor Journal of Complementary and Contemporary Medicine (NJCCM).
This form may be used, reproduced, and adapted freely for educational or clinical purposes, provided that proper credit is given as follows:
Source: Noor Journal of Complementary and Contemporary Medicine (NJCCM) — Mizāj (Temperament) Self-Assessment Form, 2025. Developed by Dr Qaisar J. Qayyum, MD.
Commercial use without permission is not allowed.