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Tibb Principle: How Illnesses Develop



Tibb recognises that illnesses do not just happen but are the result of identifiable cause/s. 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. Gain insight into the pathological processes that result in the disruption of homeostasis which lead to the development of disease.

Principles in Tibb

The principles in Tibb are an assimilation of the philosophies of Hippocrates, Galen and Ibn Sina. These concepts not only allow for a comprehensive understanding of health promotion, but also provide valuable insights into the causes, pathological processes, management and treatment of illness conditions.

Tibb Principle: How Illnesses Develop

The Tibb principles of Creation, Qualities, Physis, Temperament, Humours and Lifestyle Factors as described in the links of the Principles in Tibb, 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 cause/s 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.

What caused Robert M’s 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.

Interestingly, 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 link 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 philosophy 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

As mentioned in the link on “Temperament”, 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, 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 – especially from infancy to adulthood, has been confirmed in the research conducted at the Tibb Treatment Centres in Cape Town.

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.

Listed below are some examples of qualities associated with illness conditions with the dominant quality 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 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 i.e. the focus is on evaluating the pathological processes (either with blood tests, Xrays/CT scans, in relation to the signs and symptoms, as well as structural changes (tissues/organs) in the patient.

Unlike Western medicine, pathology in Tibb 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/homeostasis.

Pathological processes in Tibb

By means of a) sudden change or excess in qualities from lifestyle factors; b) From an accumulation of excess or abnormal humours; c) From infectious agents – exposure to bacteria or virus; d) Unwanted side effects of conventional/Western medication.

a) Sudden change or excess in qualities

Example of a sudden change in qualities from lifestyle factors –  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/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 negative influencing factors are removed, then Physis is able to overcome this sudden/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.

b) Accumulation of excess/abnormal humours

This accumulation of excess/abnormal humours takes place over a period, resulting from poor management of the Lifestyle Factors especially diet. In other words, 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 ( which in essence are the Tibb Lifestyle Factors), highlighting that poor elimination will result in a build-up of excess/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 digestion/elimination of the Tibb Lifestyle Factors.

On top of this, our normal ageing process also takes its toll. Research has shown that chronic illnesses increases from the age of 40 onwards from the accumulation of humoral imbalances especially excess/abnormal melancholic humour.

The elimination of excess or abnormal humours is an important consideration in the management and treatment of illness conditions.

c) 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 well 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, or Physis, is weakened and is 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 are not.

d) Unwanted effects of conventional/Western medication

The use of conventional drugs to deal with common acute ailments like pain, headache, insomnia and bacterial infection is widespread. However, many individuals are affected by side effects in the short term (stomach upsets, dizziness and nausea, for instance) or 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.

For example, when individuals take an ACE inhibitor to lower high blood pressure, they sometimes develop a chronic irritating cough. Another example is 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.

From the above discussion on How Illnesses Develop there is no doubt that unlike in Western medicine where the causes of many illness conditions are unknown, the Tibb philosophical principles allows for a comprehensive understanding of identifying the cause/s of most illness conditions, based on the temperamental and humoral theories of Hippocrates, Galen and Ibn Sina.

Once again it needs to be noted that most illness conditions have been successfully diagnosed and treated for hundreds of years based on the philosophical principles of Tibb.