Lesson: Cravings, Temperament & Treatment Discomfort

Course: Traditional Islamic Medicine (Tibb Nabawi) — Practitioner Track
Instructor: Dr Feroz Osman‑Latib

Learning Objectives

By the end of this lesson, students will be able to:

1. Explain why patients often crave foods that match (rather than balance) their temperament (mizaj).
2. Differentiate between constitutional temperament and current disease state.
3. Identify how habit, culture, environment, and stomach heat shape cravings and aversions.
4. Clarify the hot/cold and dry/moist qualities of common food groups (meat, spices, fruits) and frequent misclassifications.
5. Recognize patterns of stagnation and blood/Yin/fluid deficiency in hot‑dry (choleric) and cold‑dry (melancholic) patients.
6. Apply practical tools—history taking, decision trees, and protocols—for diagnosis and treatment planning.
7. Counsel patients about treatment discomfort, motivation, and adherence from an Islamic ethic.

Key Terms

• Humoral Theory / Mizaj: Hot, cold, moist, dry qualities shaping constitution and disease.
• Choleric: Predominantly hot & dry; prone to stagnation, irritability, and dryness.
• Melancholic: Predominantly cold & dry; prone to poor circulation and deficiency.
• Stagnation: Impaired movement of Qi/energy and blood; manifests as cold extremities, tension, dull aches.
• Diaphoretic: Induces perspiration, thereby producing a cooling effect despite hot quality (e.g., many spices).
• Stomach Heat: Local heat in the stomach that drives counter‑intuitive cravings (e.g., cold foods/ice‑cream) yet worsens the root pattern.

Big Idea: Why We Crave What Harms Us

Principle: Humans do not reliably crave what balances them. Cravings reflect:

• Early taste‑imprinting & culture (family cuisine, ethnic staples, community norms).
• Environmental influence (season, climate). Environment is often stronger than medicine or diet in how a person feels.
• Functional qualities beyond temperature/moisture (e.g., spices are diaphoretic—cooling by sweat).
• Organ‑level states (e.g., stomach heat; liver stagnation).
• Addictive taste loops (coffee, sugar, ultra‑processed foods).

Clinical takeaway: Do not equate cravings with needs. Diagnose the constitution and the disease state, then treat accordingly—even if the patient finds it uncomfortable.

Treatment Discomfort: A Feature, Not a Bug

• Reality: Corrective treatment is often against the nafs and initially uncomfortable. Patients are in their state because liked habits outweighed balancing ones.
• Role of the practitioner: Normalize discomfort; set expectations; use graded exposure; pair new foods/therapies with trusted tastes; build rituals.
• Islamic lens: Remind of sabr, stewardship of the body (amanah), and seeking balance as part of ihsan.

Food Qualities: Correcting Common Errors

1) Meat

• General quality: Warm/Hot & Moist. It builds blood.
• Clinical signs of insufficient meat/nourishment: Dark peri‑orbital circles, fatigue, pallor, low resilience; common in those avoiding red meat.
• Forms: Fresh stews, bone broth, slow‑cooked—blood‑building. Dried meats (biltong/jerky) are drier in form, but still nourishing when digested.

2) Spices

• General quality: Hot & Dry. Yet many are diaphoretic → induce sweating → net cooling effect in hot climates.
• Historical role: Antimicrobial, anti‑parasitic (e.g., garlic, ginger) where water quality/food storage were poor.

3) Fruits

• General tendency: Cold & Moist.
  • Exceptions/nuance: Dates (often warm), mango less cold than citrus, etc.
  • Citrus: Can provoke loose stools, mucus, post‑nasal drip in some → functionally moistening.

4) Dry vs Moist — a practical cue

If you can squeeze it and it exudes fluid → moist. Peppercorns/herb seeds → typically dry. But final classification also depends on what it does in the body (e.g., coffee’s long‑term drying effect).

Culture & Environment: Two Heavyweights

• Culture: Early‑life exposure sets taste. Asian subcontinent cuisines normalize chilli/garlic/ginger → adults continue to prefer hot & dry foods independent of mizaj.
• Environment: Seasons and climate drive behavior and mood. Spring produces natural uplift and motivation; winter correlates with low mood. Patients in cold, rainy regions often dislike cold/moist therapies because these increase stagnation.

Pattern Focus

A) Choleric (Hot‑Dry) — “Stuck heat over dryness”

Core vulnerabilities:

• Stagnation (shoulders/neck tension, cold hands/feet from poor distal perfusion).
• Dryness (skin, bowels, irritability).

Why they avoid cold/moist: Cold worsens stagnation → heavier limbs, fog, aversion to cooling herbs/foods.

Non‑food ‘blood‑movers’:

• Massage (highly preferred; immediate relaxation via improved perfusion).
• Dry cupping (hijama without bleed); movement/exercise; heat application (judicious).

Food & routine points:

• Maintain adequate meat/broth to build/transport blood.
• Use spices strategically; don’t rely on heat alone to move blood.
• Hydrate oils internally/externally (e.g., tahini, nuts/seeds; castor or sesame oil to skin as needed).

B) Melancholic (Cold‑Dry) — “Low fire, low flow”

Core vulnerabilities:

• Poor circulation; coldness; dryness.

Why coffee feels good (short‑term): Immediate surge of heat → better circulation/alertness. Long‑term: Drying, worsens baseline pattern.

Counsel: Replace reliance on coffee with movement, massage, broth, red meat, warmth, regular daylight.

Special Topics

1) Stomach Heat & Ice‑Cream Craving

• Cold/moist constitutions can develop stomach heat → crave ice‑cream. Short‑term relief; later headache, cough, bloating, thirst, diarrhea.
• Counsel tactic: If socially compelled to partake, follow with hot tea—but emphasize it’s compensatory, not curative.

2) Hypothyroidism — Treat the Pattern, Not the Label

• Patients with the same label may be cold‑moist or cold‑dry.
• Approach: Determine mizaj; correct deficiencies (blood/fluids), warm gently, address digestion; long‑standing cases require habit change + herbs + nourishment.

3) Drug‑Induced Presentations

• Prednisone overuse → rapid weight gain, edema; can mask a choleric constitution under a phlegmatic appearance.
• Fat‑burner/kidney strain history → rebound weight and fluid dysregulation.

Diagnostic Workflow

1. Anchor in Constitution (does not change):

• • Body shape & lifetime pattern carry the most weight.

1. Map the Current State (does change):

• • Edema? Dark circles? Cold extremities? Tension lines? Tongue/skin feel? Bowel patterns?

1. History Deep‑Dive:

• • “When did this begin? What changed then?” (illness, pregnancy, medications, stress, climate move).

1. Food Journal & Timing:

• • Morning vs evening digestion; tea near meals (iron chelation), coffee use, spice load.

1. Environment Audit:

• • Season, home/office temperature, humidity, outdoor time, sunlight.

Red Flags (refer/modify plan): Sudden edema, chest pain, syncope, progressive neuro deficits, severe GI bleed, major mood collapse.

Treatment Planning

Core Principles

• Treat stagnation first in hot‑dry: massage/dry cupping + movement; avoid heavy cooling early on.
• Replete blood/fluids in dry types: red meat, bone broth, oily seeds/nuts, regular meals—especially morning when digestion is strongest.
• Respect treatment discomfort: dose changes; start low, go slow; pair with spiritual counsel.

Food Strategy

• Blood‑building: Red meat (beef/lamb), organ‑supported broths; eggs; black tahini; nuts/seeds.
• Stagnation‑moving: Warming spices in moderation; ginger/garlic when appropriate; soups/stews; gentle heat.
• Moisture support: Broths, stewed fruits (if indicated), oils; avoid excessive coffee/strong diuretics.
• Irritant control: Limit ultra‑processed foods, sugars, frequent coffee; separate tea from iron‑rich meals by 2–3 hours.

Non‑Food Therapies

• Massage (highly indicated for cholerics)
• Dry cupping
• Walking & rhythmic movement
• Sleep regularity & daylight exposure
• Breathwork & dhikr for nervous system tone

Counseling Scripts

Normalizing Discomfort:
“Balanced treatment often feels unfamiliar. Your body is used to one pattern. With Allah’s help, small steady changes will reset the pattern and the discomfort will pass.”

Culture‑Sensitive Reframe:
“You can keep the flavors you love. We’ll adjust quantity, timing, and add blood‑building foods so your body feels better without losing your cuisine.”

Environment Reframe:
“Cold weather is pushing you toward stagnation. Let’s add movement and massage now, and we’ll re‑balance cooling foods when spring returns.”

Case Sketches

1. Hot‑Dry Teacher with Cold Feet & Shoulder Tightness

• • Craves chilli; hates cucumber/mint.
  • Plan: Massage weekly x 4, daily brisk walks, broth + red meat breakfasts, moderate spice, skin oiling; no iced drinks at night.

1. Cold‑Dry Accountant on 4 Coffees/Day

• • Feels great after coffee then crashes; dry skin/constipation.
  • Plan: Step‑down coffee; replace with morning walk + broth; sesame oil rub; stew dinners; space tea 2–3 h from meals.

1. Cold‑Moist Young Mother with Stomach Heat & Ice‑Cream Habit

• • Post‑ice‑cream cough/headache/bloat.
  • Plan: Remove nighttime ice‑cream; soothe stomach heat; warm soups; ginger as indicated; hot tea only short‑term when socially compelled.

Practical Tools

A) Decision Tree

1. Are extremities cold + muscles tense? → Think stagnation → massage/move first.
2. Dark circles/fatigue/pale tongue? → Think blood deficiency → meat/broth in mornings; separate tea.
3. Craves matching temperament foods? → Check culture/habit/environment → change context before chasing cravings.
4. Label like ‘hypothyroid’? → Re‑assess mizaj → treat pattern.

B) History Checklist

• Lifelong body type & childhood appetite
• Key turning points (illness, meds: prednisone, fat‑burners)
• Climate moves; seasonality of mood/energy
• Breakfast pattern; tea/coffee timing; spice load
• Bowel/urine/sweat profile; skin moisture
• Sleep, stress, movement, massage tolerance

Action Items for Students

1. Take a 7‑day food/climate/mood journal on yourself and one volunteer patient.
2. Run the history checklist; draft a working mizaj and current pattern.
3. Choose one non‑food mover (massage or walking) and one blood‑builder (broth/meat breakfast) for each case; report outcomes next session.

“Allah ﷻ created balance in all things; our task is to recognize the pattern of imbalance and return to a state of balance relative to the mizaaj with wisdom and patience. ان شاء الله ﺗﻌﺎﻟﯽٰ ”