Biomedicine

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Biomedicine

Biomedicine (also referred to as Western medicine, mainstream medicine or conventional medicine) is a branch of medical science that applies biological and physiological principles to clinical practice. Biomedicine stresses standardized, evidence-based treatment validated through biological research, with treatment administered via formally trained doctors, nurses, and other such licensed practitioners.

Biomedicine also can relate to many other categories in health and biological related fields. It has been the dominant system of medicine in the Western world for more than a century.

It includes many biomedical disciplines and areas of specialty that typically contain the "bio-" prefix such as molecular biology, biochemistry, biotechnology, cell biology, embryology, nanobiotechnology, biological engineering, laboratory medical biology, cytogenetics, genetics, gene therapy, bioinformatics, biostatistics, systems biology, neuroscience, microbiology, virology, immunology, parasitology, physiology, pathology, anatomy, toxicology, and many others that generally concern life sciences as applied to medicine.

Overview

Biomedicine is the cornerstone of modern health care and laboratory diagnostics. It concerns a wide range of scientific and technological approaches: from in vitro diagnostics to in vitro fertilisation, from the molecular mechanisms of cystic fibrosis to the population dynamics of the HIV virus, from the understanding of molecular interactions to the study of carcinogenesis, from a single-nucleotide polymorphism (SNP) to gene therapy. 

Biomedicine is based on molecular biology and combines all issues of developing molecular medicine into large-scale structural and functional relationships of the human genome, transcriptome, proteome, physiome and metabolome with the particular point of view of devising new technologies for prediction, diagnosis and therapy 

Biomedicine involves the study of (patho-) physiological processes with methods from biology and physiology. Approaches range from understanding molecular interactions to the study of the consequences at the in vivo level. These processes are studied with the particular point of view of devising new strategies for diagnosis and therapy.

Depending on the severity of the disease, biomedicine pinpoints a problem within a patient and fixes the problem through medical intervention. Medicine focuses on curing diseases rather than improving one's health.

In social sciences biomedicine is described somewhat differently. Through an anthropological lens biomedicine extends beyond the realm of biology and scientific facts; it is a socio-cultural system which collectively represents reality. While biomedicine is traditionally thought to have no bias due to the evidence-based practices, Gaines & Davis-Floyd (2004) highlight that biomedicine itself has a cultural basis and this is because biomedicine reflects the norms and values of its creators.

Molecular biology

Molecular biology is the process of synthesis and regulation of a cell's DNA, RNA, and protein. Molecular biology consists of different techniques including Polymerase chain reaction, Gel electrophoresis, and macromolecule blotting to manipulate DNA.

Polymerase chain reaction is done by placing a mixture of the desired DNA, DNA polymerase, primers, and nucleotide bases into a machine. The machine heats up and cools down at various temperatures to break the hydrogen bonds binding the DNA and allows the nucleotide bases to be added onto the two DNA templates after it has been separated.

Gel electrophoresis is a technique used to identify similar DNA between two unknown samples of DNA. This process is done by first preparing an agarose gel. This jelly-like sheet will have wells for DNA to be poured into. An electric current is applied so that the DNA, which is negatively charged due to its phosphate groups is attracted to the positive electrode. Different rows of DNA will move at different speeds because some DNA pieces are larger than others. Thus if two DNA samples show a similar pattern on the gel electrophoresis, one can tell that these DNA samples match.

Macromolecule blotting is a process performed after gel electrophoresis. An alkaline solution is prepared in a container. A sponge is placed into the solution and an agaros gel is placed on top of the sponge. Next, nitrocellulose paper is placed on top of the agarose gel and a paper towels are added on top of the nitrocellulose paper to apply pressure. The alkaline solution is drawn upwards towards the paper towel. During this process, the DNA denatures in the alkaline solution and is carried upwards to the nitrocellulose paper. The paper is then placed into a plastic bag and filled with a solution full of the DNA fragments, called the probe, found in the desired sample of DNA. The probes anneal to the complementary DNA of the bands already found on the nitrocellulose sample. Afterwards, probes are washed off and the only ones present are the ones that have annealed to complementary DNA on the paper. Next the paper is stuck onto an x ray film. The radioactivity of the probes creates black bands on the film, called an autoradiograph. As a result, only similar patterns of DNA to that of the probe are present on the film. This allows us the compare similar DNA sequences of multiple DNA samples. The overall process results in a precise reading of similarities in both similar and different DNA sample.

Biochemistry

Biochemistry is the science of the chemical processes which takes place within living organisms. Living organisms need essential elements to survive, consisting of carbon, hydrogen, nitrogen, oxygen, calcium, and phosphorus. These elements make up the four big macromolecules that living organisms need to survive- carbohydrates, lipids, proteins, and nucleic acids.

Carbohydrates, made up of carbon, hydrogen, and oxygen, are energy-storing molecules. The simplest one of carbohydrates is glucose, C₆H₁₂O₆, is used in cellular respiration to produce ATP, adenosine triphosphate, which supplies cells with energy.

Proteins are chains of amino acids that function to contract skeletal muscle, function catalysts, transport molecules, and storage molecules. Proteins can facilitate biochemical processes, by lowering the activation energy of a reaction. Hemoglobins are also proteins, that carry oxygen to the cells in an organisms body.

Lipids, also known as fats, also serve to store energy, but in the long term. Due to their unique structure, lipids provide more than twice the amount of energy that carbohydrates do. Lipids can be used as insulation, as it is present below the layer of skin in living organisms. Moreover, lipids can be used in hormone production to maintain a healthy hormonal balance and provide structure to your cell walls.

Nucleic acids are used to store DNA in every living organism. The two types of nucleic acids are DNA and RNA. DNA is the main genetic information storing substance found oftentimes in the nucleus, which controls the processes that the cell undergoes. DNA consists of two complementary antiparallel strands consisting varying patterns of nucleotides. RNA is a single strand of DNA, which is transcribed from DNA and used for DNA translation, which is the process for making proteins out of RNA sequences.

Five temperaments

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Five_temperaments 

Five temperaments is a theory in psychology, that expands upon the four temperaments proposed in ancient medical theory. 

The development of a theory of five temperaments begins with the two-factor models of personality and the work of the late William Schutz, and his FIRO-B program. It is a measure of interpersonal relations orientations that calculates a person's behavior patterns based on the scoring of a questionnaire. Although FIRO-B does not speak in terms of "temperament", this system of analysis graded questionnaires on two scales in three dimensions of interpersonal relations. When paired with temperament theory, a measurement of five temperaments resulted.

History and the ancient four temperaments

Five Temperament theory has its roots in the ancient four humors theory of the Greek Historian Hippocrates (460-370 BC), who believed certain human behaviors were caused by body fluids (called "humors"): blood (sanguis), [yellow] bile (cholera or Gk. χολη, kholé) black bile (μελας, melas, "black", + χολη, kholé, "bile"); and phlegm. Next, Galen (131-200 AD) developed the first typology of temperament in his dissertation De Temperamentis, and searched for physiological reasons for different behaviors in humans. In The Canon of Medicine, Avicenna (980-1037) then extended the theory of temperaments to encompass "emotional aspects, mental capacity, moral attitudes, self-awareness, movements and dreams."

This is also related to the classical elements of air, water, earth, and fire; as sanguine, phlegmatic, melancholic, and choleric, respectively. They made up a matrix of hot/cold and dry/wet taken from the Four Elements. There were also intermediate scales for balance between each pole, yielding a total of nine temperaments. Four were the original humors, and five were balanced in one or both scales.

Nicholas Culpeper (1616–1654) disregarded the idea of fluids as defining human behavior, and Maimonides (1135–1204), Immanuel Kant (1724–1804), Alfred Adler (1879–1937), and Ivan Pavlov (1849–1936) all theorized on the four temperaments and greatly shaped our modern theories of temperament. Hans Eysenck (1916–1997) was one of the first psychologists to analyze personality differences using a psycho-statistical method (factor analysis), and his research led him to believe that temperament is biologically based.

Development of related "two factor" models and the regaining popularity of the ancient temperaments

Simple emoticons of the five temperaments: sanguine (top right), choleric (bottom right), melancholy (bottom left), and phlegmatic (centre), with the new temperament supine (top left) and phlegmatic blends in between.

From the beginning, with Galen's ancient temperaments, it was observed that pairs of temperaments shared certain traits in common.

• sanguine quick, impulsive, and relatively short-lived reactions. (hot/wet)
• phlegmatic a longer response-delay, but short-lived response. (cold/wet)
• choleric short response time-delay, but response sustained for a relatively long time. (hot/dry)
• melancholic (also called melancholy) long response time-delay, response sustained at length, if not, seemingly, permanently. (cold/dry)

Therefore, it was evident that the sanguine and choleric shared a common trait: quickness of response, while the melancholy and phlegmatic shared the opposite, a delayed response. The melancholy and choleric, however, shared a sustained response, and the sanguine and phlegmatic shared a short-lived response. That meant that the choleric and melancholy both would tend to hang on to emotions like anger, and thus appear more serious and critical than the fun-loving sanguine, and the peaceful phlegmatic. However, the choleric would be characterized by quick expressions of anger, while the melancholy would build up anger slowly, silently, before exploding. Also, the melancholy and sanguine would be sort of "opposites", as the choleric and phlegmatic, since they have opposite traits. 

As the twentieth century progressed, numerous other instruments were devised measuring not only temperament, but also various individual aspects of personality and behavior, and several began using factors that would correspond to the delay and sustain behaviors; usually, forms of extroversion and a developing category of people versus task focus (eventually embodied as agreeableness). 

Examples include DiSC assessment system and Social styles. In both of these, the four behaviors or styles resembled the key characteristics of the ancient four temperaments: the choleric's extroversion and seriousness; the melancholy's introversion and seriousness; the sanguine's extroversion and sociability, and the phlegmatic's peacefulness.

As personality typing increased, Christian writer and speaker Tim LaHaye helped repopularize the ancient temperaments beginning in his books.

Another addition to the two factor models was the creation of a 10 by 10 square grid developed by Robert R. Blake and Jane Mouton in their Managerial Grid Model introduced in 1964. This matrix graded from 0 to 9, the factors of concern for people and concern for production, allowing a moderate range of scores, which yielded five "leadership styles". The Thomas Kilmann Conflict Mode Instrument (TKI) used a version of this with assertiveness and cooperativeness as the two factors, and an intermediate score in both scales likewise resulting in a fifth mode directly in the center of the grid.

The FIRO-B connection

FIRO-B was another such two-factor system, originally created by Dr. Schutz in 1958, using the same scales corresponding to extroversion/introversion and people/task focus. The difference now was that there were three such matrices. These three areas of interaction are Inclusion, Control, and Affection. Note that these areas include the two familiar scales: how you want to relate to others (called "expressed behavior"), and how you want them to relate to you (called "wanted behavior"). Scores in these scales range from 0 to 9. In 1977, "locator charts" were produced for each area by Leo Ryan, providing a map of the various scores, following the Managerial Grid model; with unofficial names assigned to different score ranges. 

Schutz was emphatic that all FIRO scores in themselves "Are not terminal — they can and do change", and that they "Do not encourage typology" (and thus contradicted the notion of inborn temperament). However, the four ancient temperaments were eventually mapped to the FIRO-B scales, including the three separate temperament grids for individuals' scores in each area. 

A Melancholy tends to be an introverted loner, and in the area of "control" such a person would exhibit a low need to control others, and also have a low tolerance of control by others (i.e. "dependency"). In the areas of inclusion and affection, such people would display a low need to include or be close to others, and a low need to be included by others. 

A Choleric, however, is an extroverted "leader"-type who, in the area of control, has a high need to control others, but a low tolerance of others controlling him. He also has a high need to include or be close to others, but a low level of "responsiveness" (used as another term for "wanted" behavior) to them. He tends to be a "user", and only relates to people according to his own terms, which are usually goal-oriented.

A Sanguine is an extrovert who has a high need to include and be close to others, but unlike the Choleric, the Sanguine genuinely likes being around people just for the sake of socialization. The Sanguine also "swings" between both control and dependency.

From four to five

The low scores in both "wanted" and "expressed" would correspond to the Melancholy. A high score in "expressed" with a low score in "wanted" corresponds to Choleric. A high score on both scales corresponds to the Sanguine.

So the temperaments were divided between introverts, extroverts, and in the other dimension, "relationship-oriented", and "task-oriented". In the older model, the fourth temperament, Phlegmatic, had generally been regarded as "introverted" like the Melancholy, yet more "agreeable", like the Sanguine. For example, the "slow response/short-lived sustain" of the original conception, where it shares one factor with the Sanguine, and the other with the Melancholy. In the other instruments using people/task-orientation, the type that holds the corresponding place in respect to the other types (such as Social Styles' "Amiable" or Adler's "Leaning") is also generally correlated with the Phlegmatic in comparisons.

However, while the Phlegmatic is not as extroverted as the Sanguine and Choleric, nor as serious as the Melancholy and Choleric; he is neither as introverted as the Melancholy, nor as relationship-oriented as the Sanguine. This created a problem whereby a "middle-of-the-road" temperament was needed to complete the list of temperaments. A new temperament was created as a neutral, balanced temperament. However, the new temperament's lack of expression and personality was similar to the Phlegmatic, so the traits the Phlegmatic and the fifth temperament shared were removed from the Phlegmatic, and the remaining traits were renamed to Supine while the fifth temperament became known as the Phlegmatic.

Comparison of fifth temperament to the phlegmatic

The Phlegmatic also is peaceful at heart, and is one reason the Phlegmatic had held the place in the older four temperament model the Supine holds in the five temperament model. The difference is that the Supine is more "needy" for acceptance (or control) from people, yet less able to initiate and express this need to them than the Phlegmatic. Supines are often frustrated because they expect people to know they want interaction, while the Phlegmatic expresses a moderate need, and wants only the same moderate amount in return.

Four temperament theories such as LaHaye's often depict the Phlegmatic as being very fearful (according to LaHaye, "he is a worrier by nature", which is what "keeps him from venturing out on his own to make full use of his potential)."

Driving needs

Each of the four corner temperaments has a driving need that energizes its behavior. 

For the Melancholic, the motivation is fear of rejection and/or the unknown. They have a low self-esteem and are perfectionists.

The Supine also has low self-esteem, but is driven to try to gain acceptance by liking and serving others.

The Sanguine is driven by the need for attention. They try to sell themselves through their charm, and accept others before others can reject them. If they are nevertheless rejected, their self-esteem crashes, but they will regain the confidence to keep trying to impress others.

The Choleric is motivated by their goals, in which other people are tools to be used.

The Phlegmatic's lack of a motivation becomes their driving need: to protect their low energy reserve.

Humorism

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Humorism 

 

Humorism, or humoralism, was a system of medicine detailing the makeup and workings of the human body, adopted by Ancient Greek and Roman physicians and philosophers.

Origin

The concept of "humors" (i.e. chemical systems regulating human behaviour) became more prominent from the writing of medical theorist Alcmaeon of Croton (C. 540–500BC). His list of humours was longer than just four liquids and included fundamental elements described by Empedocles, such as water, air, earth, etc. Some authors suggest that the concept of "humours" may have origins in Ancient Egyptian medicine or Mesopotamia, though it was not systemized until ancient Greek thinkers. The word humor is a translation of Greek χυμός, chymos (literally juice or sap, metaphorically flavor). However much earlier than this, ancient Indian Ayurveda medicine had developed a theory of three humors, which they linked with the five Hindu elements.

Hippocrates is the one usually credited with applying this idea to medicine. In contrast to Alcmaeon, Hippocrates suggested that humours are the vital bodily fluids, such as blood, yellow bile, phlegm and "black bile" (he probably referred to blood composites in patients with bleeding internal organs). Alcmaeon and Hippocrates posited that an extreme excess or deficiency of any of the humours bodily fluid in a person can be a sign of illness. Hippocrates and then Galen suggested that a moderate imbalance in the mixture of these fluids produces temperament (behavioural) type. One of the treatises attributed to Hippocrates, On the Nature of Man, describes the theory as follows:

The Human body contains blood, phlegm, yellow bile and black bile. These are the things that make up its constitution and cause its pains and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with others.

Although the theory of the four humors does appear in some Hippocratic texts, some Hippocratic writers only accepted the existence of two humors, while some even refrained from discussing the humoral theory at all. Humoralism, or the doctrine of the four temperaments, as a medical theory retained its popularity for centuries largely through the influence of the writings of Galen (129–201 AD). Hippocrates theory of four humours was linked with the popular theory of the four elements: earth, fire, water and air proposed by Empedocles but this link wasn't proposed by Hippocrates or Galen who referred primarily to bodily fluids. While Galen thought that humors were formed in the body, rather than ingested, he believed that different foods had varying potential to be acted upon by the body to produce different humors. Warm foods, for example, tended to produce yellow bile, while cold foods tended to produce phlegm. Seasons of the year, periods of life, geographic regions and occupations also influenced the nature of the humors formed. 

The four temperaments as depicted in an 18th-century woodcut: phlegmatic, choleric, sanguine and melancholic.

The imbalance of humors, or dyscrasia, was thought to be the direct cause of all diseases. Health was associated with a balance of humors, or eucrasia. The qualities of the humors, in turn, influenced the nature of the diseases they caused. Yellow bile caused warm diseases and phlegm caused cold diseases. In On the Temperaments, Galen further emphasized the importance of the qualities. An ideal temperament involved a balanced mixture of the four qualities. Galen identified four temperaments in which one of the qualities, warm, cold, moist or dry, predominated and four more in which a combination of two, warm and moist, warm and dry, cold and dry or cold and moist, dominated. These last four, named for the humors with which they were associated—that is, sanguine, choleric, melancholic and phlegmatic, eventually became better known than the others. While the term temperament came to refer just to psychological dispositions, Galen used it to refer to bodily dispositions, which determined a person's susceptibility to particular diseases as well as behavioral and emotional inclinations.

Disease could also be the result of the "corruption" of one or more of the humors, which could be caused by environmental circumstances, dietary changes, or many other factors. These deficits were thought to be caused by vapors inhaled or absorbed by the body. Greeks and Romans, and the later Muslim and Western European medical establishments that adopted and adapted classical medical philosophy, believed that each of these humors would wax and wane in the body, depending on diet and activity. When a patient was suffering from a surplus or imbalance of one of these four fluids, then said patient's personality and or physical health could be negatively affected.

Four humors

Even though humorism theory had several models that used 2, 3 and 5 components, the most famous model consists of the four humors described by Hippocrates and then developed further by Galen. The four humors of Hippocratic medicine are black bile (Greek: μέλαινα χολή, melaina chole), yellow bile (Greek: ξανθη χολή, xanthe chole), phlegm (Greek: φλέγμα, phlegma), and blood (Greek: αἷμα, haima). Each corresponds to one of the traditional four temperaments. Based on Hippocratic medicine, it was believed that the four humors were to be in balanced proportions with regard to amount and strength of each humor for a body to be healthy. The proper blending and balance of the four humors was known as ‘eukrasia’. Imbalance and separation of humors leads to diseases.

Galen recalls the correspondence between humors and seasons in his On the Doctrines of Hippocrates and Plato, and says that, "As for ages and the seasons, the child (παῖς) corresponds to spring, the young man (νεανίσκος) to summer, the mature man (παρακµάζων) to autumn, and the old man (γέρων) to winter". Galen also believed that the characteristics of the soul follow the mixtures of the body but he does not apply this idea to the hippocratic humours. He believed that the phlegm did not influence character. Here is what he says in his On Hippocrates’ The Nature of Man: “Sharpness and intelligence (ὀξὺ καὶ συνετόν) are caused by yellow bile in the soul, perseverance and consistency (ἑδραῖον καὶ βέβαιον) by the melancholic humour, and simplicity and naivety (ἁπλοῦν καὶ ἠλιθιώτερον) by blood. But the nature of phlegm has no effect on the character of the soul (τοῦ δὲ φλέγµατος ἡ φύσις εἰς µὲν ἠθοποιῗαν ἄχρηστος).” He further said that blood is a mixture of four elements: water, air, fire, earth. 

These terms only partly correspond to the modern medical terminology, in which there is no distinction between black and yellow bile and phlegm has a very different meaning. It was believed that these were the basic substances from which all liquids in the body were made. Robin Fåhræus (1921), a Swedish physician who devised the erythrocyte sedimentation rate, suggested that the four humours were based upon the observation of blood clotting in a transparent container. When blood is drawn in a glass container and left undisturbed for about an hour, four different layers can be seen. A dark clot forms at the bottom (the "black bile"). Above the clot is a layer of red blood cells (the "blood"). Above this is a whitish layer of white blood cells (the "phlegm"). The top layer is clear yellow serum (the "yellow bile").

Many Greek texts were written during the golden age of the theory of the four humors in Greek medicine after Galen. One of those texts was an anonymous treatise called On the Constitution of the Universe and of Man, published in the mid-nineteenth century by J.L. Ideler. In this text the author establishes the relationship between elements of the universe (air, water, earth, fire) and elements of the man (blood, yellow bile, black bile, phlegm). He said that:

• The people who have red blood are friendly, they joke and laugh around about their bodies and for their appearance they are rose tinted, slightly red, and have pretty skin.
• The people who have yellow bile are bitter, short tempered, daring. They appear greenish and have yellow skin.
• The people who are composed of black bile are lazy, fearful, and sickly. They have black hair and black eyes.
• Those who have phlegm are low spirited, forgetful, and have white hair.

Blood

The blood was believed to be produced exclusively by the liver. It was associated with a sanguine nature (enthusiastic, active, and social).

Yellow bile

Excess of yellow bile was thought to produce aggression, and reciprocally excess anger to cause liver derangement and imbalances in the humors.

Black bile

The word "melancholy" derives from Greek μέλαινα χολή (melaina kholé) meaning 'black bile'. Depression was attributed to excess or unnatural black bile secreted by the spleen.

Phlegm

Phlegm was thought to be associated with apathetic behavior, as preserved in the word "phlegmatic". The phlegm of humorism is far from the same thing as phlegm as it is defined today. The French physiologist and Nobel laureate Charles Richet, when describing humorism's "phlegm or pituitary secretion" in 1910, asked rhetorically, "this strange liquid, which is the cause of tumours, of chlorosis, of rheumatism, and cacochymia—where is it? Who will ever see it? Who has ever seen it? What can we say of this fanciful classification of humours into four groups, of which two are absolutely imaginary?"

Humor Production

Humors are produced via digestion and are the final products of hepatic digestion. Digestion is a continuous process taking place in every human being and it can be divided into four sequential stages. The gastric digestion stage, the hepatic digestion stage, the vascular digestion stage, and the tissue digestion stage. Each stage digests food until it becomes suitable for use by the body. In gastric digestion, food is made into chylous which is suitable for liver to absorb and carry on digestion. Chylous is changed into ‘chymous’ in the hepatic digestion stage. Chymous is composed of the four humors: blood, phlegm, yellow bile, and black bile. These four humors then circulate in the vessels. And in the last stage of digestion, tissue digestion, food becomes similar to the organ tissue that it is destined for.

If anything goes wrong leading up to the formation of humors, the humors will not be in good condition. From the kind of food that goes into the body to the proper organ functioning is necessary in the production of good humor. The stomach and liver have to function normally in order for proper digestion. If there are any abnormalities in gastric digestion the liver, blood vessels and tissues can not be provided with the raw chylous and that can cause abnormal humor and blood composition. A healthy functioning liver is not even capable of converting abnormal chylous into normal chylous and then normal humors. 

Humors are the end product of gastric digestion but they are not the end product of the digestion cycle so an abnormal humor produced by hepatic digestion will lead to affect other organs that are working towards the digestion of the food in the digestion cycle.

Unification of humorism with Empedocles model

Empedocles's theory suggested that there are four elements: earth, fire, water, and air; with earth producing the natural systems. Since this theory was influential for centuries, later scholars paired qualities associated with each humour as described by Hippocrates-Galen with seasons and "basic elements" as described by Empedocles.

The following table shows the four humors with their corresponding elements, seasons, sites of formation, and resulting temperaments:

Humour	Season	Ages	Element	Organ	Qualities	Temperament
Blood	spring	infancy	air	liver	warm and moist	sanguine
Yellow bile	summer	youth	fire	gallbladder	warm and dry	choleric
Black bile	autumn	adulthood	earth	spleen	cold and dry	melancholic
Phlegm	winter	old age	water	brain/lungs	cold and moist	phlegmatic

Influence and legacy

Islamic medicine

Medieval medical tradition in the "Golden Age of Islam" adopted the theory of humorism from Greco-Roman medicine, notably via the Persian polymath Avicenna's The Canon of Medicine (1025). Avicenna summarized the four humors and temperaments as follows:

Avicenna's (ibn Sina) four humors and temperaments

Evidence	Hot	Cold	Moist	Dry
Morbid states	Inflammations become febrile	Fevers related to serious humor, rheumatism	Lassitude	Loss of vigour
Functional power	Deficient energy	Deficient digestive power	Difficult digestion
Subjective sensations	Bitter taste, excessive thirst, burning at cardia	Lack of desire for fluids	Mucoid salivation, sleepiness	Insomnia, wakefulness
Physical signs	High pulse rate, lassitude	Flaccid joints	Diarrhea, swollen eyelids, rough skin, acquired habit	rough skin, acquired habit
Foods and medicines	Calefacients harmful, infrigidants[25] beneficial	Infrigidants harmful, calefacients beneficial	Moist articles harmful	Dry regimen harmful, humectants beneficial
Relation to weather	Worse in summer	Worse in winter		Bad in autumn

Perso-Arabic and Indian medicine

The Unani school of medicine, practiced in Perso-Arabic countries, India, and Pakistan, is based on Galenic and Avicennian medicine in its emphasis on the four humors as a fundamental part of the methodologic paradigm.

Western Medicine

The humoralist system of medicine was highly individualistic, for all patients were said to have their own unique humoral composition. From Hippocrates onward, the humoral theory was adopted by Greek, Roman and Islamic physicians, and dominated the view of the human body among European physicians until at least 1543 when it was first seriously challenged by Andreas Vesalius. Vesalius mostly criticized Galen's theories of human anatomy and not the chemical hypothesis of behavioural regulation (temperament). However, some believe that theory of humours was cast into the underside of science in 1628 by the findings of William Harvey (also criticising mostly anatomy theory of Galen) and by Rudolf Virchow's theories of cellular pathology in 1858.

The four humors and their qualities

Typically "eighteenth-century" practices such as bleeding a sick person or applying hot cups to a person were, in fact, based on the humoral theory of imbalances of fluids (blood and bile in those cases). Ben Jonson wrote humor plays, where types were based on their humoral complexion. Methods of treatment like bloodletting, emetics and purges were aimed at expelling a surfeit of a humor. Other methods used herbs and foods associated with a particular humor to counter symptoms of disease, for instance: people who had a fever and were sweating were considered hot and wet and therefore given substances associated with cold and dry. Paracelsus further developed the idea that beneficial medical substances could be found in herbs, minerals and various alchemical combinations thereof. These beliefs were the foundation of mainstream Western medicine well into the 17th century. 

Central to the treatment of unbalanced humors was the use of herbs. Specific herbs were used to treat all ailments simple, common and complex etc., from an uncomplicated upper respiratory infection to the plague. For example, chamomile was used to decrease heat, and lower excessive bile humor. Also, arsenic was used in a poultice bag to 'draw out' the excess humor(s) that led to symptoms of the plague. Philip Moore, who wrote on the hope of health, and Edwards, who wrote Treatise concerning the Plague discuss how these herbs are helpful in curing physical disease. They also discuss the importance of maintaining an herb garden. Apophlegmatisms, in pre-modern medicine, were medications chewed in order to draw away phlegm and humours.

Although advances in cellular pathology and chemistry criticized humoralism by the seventeenth century, the theory had dominated Western medical thinking for more than 2,000 years. Only in some instances did the theory of humoralism wane into obscurity. One such instance occurred in the sixth and seventh centuries in the Byzantine Empire when traditional secular Greek culture gave way to Christian influences. Though the use of humoralist medicine continued during this time, its influence was diminished in favor of religion. The revival of Greek humoralism, owing in part to changing social and economic factors, did not begin until the early ninth century. Use of the practice in modern times is pseudoscience.

Modern use

There are still remnants of the theory of the four humors in the current medical language. For example, modern medicine refers to humoral immunity or humoral regulation when describing substances such as hormones and antibodies that circulate throughout the body. It also uses the term blood dyscrasia to refer to any blood disease or abnormality. 

The concept of humorism was not "definitively demolished" until 1858. There were no studies performed to prove or disprove the impact of dysfunction in known bodily organs producing named fluids (humors) on temperament traits simply because the list of temperament traits were not defined up until the end of 20th century.

Culture

Theophrastus and others developed a set of characters based on the humors. Those with too much blood were sanguine. Those with too much phlegm were phlegmatic. Those with too much yellow bile were choleric, and those with too much black bile were melancholic. The idea of human personality based on humors contributed to the character comedies of Menander and, later, Plautus. Through the neo-classical revival in Europe, the humor theory dominated medical practice, and the theory of humoral types made periodic appearances in drama.

The humors can be found in Elizabethan works, such as in Taming of the Shrew, in which the character Petruchio pretends to be irritable and angry to show Katherina what it is like being around a disagreeable person. He yells at the servants for serving mutton, a "choleric" food, to two people who are already choleric.

Foods in Elizabethan times were all believed to have an affinity with one of these four humors. A person showing signs of phlegmatism might have been served wine (a choleric drink and the direct opposite humor to phlegmatic) to balance this.

Pharmacognosy

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Pharmacognosy 

 

Dioscorides’ Materia Medica, c. 1334 copy in Arabic, describes medicinal features of various plants.

Pharmacognosy is the study of plants or other natural sources as a possible source of drugs. The American Society of Pharmacognosy defines pharmacognosy as "the study of the physical, chemical, biochemical and biological properties of drugs, drug substances or potential drugs or drug substances of natural origin as well as the search for new drugs from natural sources".

Description

The word "pharmacognosy" is derived from two Greek words: φάρμακον pharmakon (drug), and γνῶσις gnosis (knowledge). The term "pharmacognosy" was used for the first time by the Austrian physician Schmidt in 1811 and 1815 by Crr. Anotheus Seydler in work titled Analecta Pharmacognostica. 

Originally—during the 19th century and the beginning of the 20th century—"pharmacognosy" was used to define the branch of medicine or commodity sciences (Warenkunde in German) which deals with drugs in their crude, or unprepared, form. Crude drugs are the dried, unprepared material of plant, animal or mineral origin, used for medicine. The study of these materials under the name pharmakognosie was first developed in German-speaking areas of Europe, while other language areas often used the older term materia medica taken from the works of Galen and Dioscorides. In German the term drogenkunde ("science of crude drugs") is also used synonymously. 

As late as the beginning of the 20th century, the subject had developed mainly on the botanical side, being particularly concerned with the description and identification of drugs both in their whole state and in powder form. Such branches of pharmacognosy are still of fundamental importance, particularly for pharmacopoeial identification and quality control purposes, but rapid development in other areas has enormously expanded the subject. The advent of the 21st century brought a renaissance of pharmacognosy and its conventional botanical approach has been broadened up to molecular and metabolomic level.

In addition to the previously mentioned definition, the American Society of Pharmacognosy also defines pharmacognosy as "the study of natural product molecules (typically secondary metabolites) that are useful for their medicinal, ecological, gustatory, or other functional properties." Other definitions are more encompassing, drawing on a broad spectrum of biological subjects, including botany, ethnobotany, marine biology, microbiology, herbal medicine, chemistry, biotechnology, phytochemistry, pharmacology, pharmaceutics, clinical pharmacy and pharmacy practice.

• medical ethnobotany: the study of the traditional use of plants for medicinal purposes;
• ethnopharmacology: the study of the pharmacological qualities of traditional medicinal substances;
• the study of phytotherapy (the medicinal use of plant extracts); and
• phytochemistry, the study of chemicals derived from plants (including the identification of new drug candidates derived from plant sources).
• zoopharmacognosy, the process by which animals self-medicate, by selecting and using plants, soils, and insects to treat and prevent disease.
• marine pharmacognosy, the study of chemicals derived from marine organisms.

Biological background

The carotenoids in primrose produce bright red, yellow and orange shades

All plants produce chemical compounds as part of their normal metabolic activities. These phytochemicals are divided into (1) primary metabolites such as sugars and fats, which are found in all plants; and (2) secondary metabolites—compounds which are found in a smaller range of plants, serving a more specific function. For example, some secondary metabolites are toxins used to deter predation and others are pheromones used to attract insects for pollination. It is these secondary metabolites and pigments that can have therapeutic actions in humans and which can be refined to produce drugs—examples are inulin from the roots of dahlias, quinine from the cinchona, THC and CBD from the flowers of cannabis, morphine and codeine from the poppy, and digoxin from the foxglove.

Plants synthesize a variety of phytochemicals, but most are derivatives:

• Alkaloids are a class of chemical compounds containing a nitrogen ring. Alkaloids are produced by a large variety of organisms, including bacteria, fungi, plants, and animals, and are part of the group of natural products (also called secondary metabolites). Many alkaloids can be purified from crude extracts by acid-base extraction. Many alkaloids are toxic to other organisms.
• Polyphenols (also known as phenolics) are compounds that contain phenol rings. The anthocyanins that give grapes their purple color, the isoflavones, the phytoestrogens from soy and the tannins that give tea its astringency are phenolics.
• Glycosides are molecules in which a sugar is bound to a non-carbohydrate moiety, usually a small organic molecule. Glycosides play numerous important roles in living organisms. Many plants store chemicals in the form of inactive glycosides. These can be activated by enzyme hydrolysis, which causes the sugar part to be broken off, making the chemical available for use.
• Terpenes are a large and diverse class of organic compounds, produced by a variety of plants, particularly conifers, which are often strong smelling and thus may have had a protective function. They are the major components of resin, and of turpentine produced from resin. When terpenes are modified chemically, such as by oxidation or rearrangement of the carbon skeleton, the resulting compounds are generally referred to as terpenoids. Terpenes and terpenoids are the primary constituents of the essential oils of many types of plants and flowers. Essential oils are used widely as natural flavor additives for food, as fragrances in perfumery, and in traditional and alternative medicines such as aromatherapy. Synthetic variations and derivatives of natural terpenes and terpenoids also greatly expand the variety of aromas used in perfumery and flavors used in food additives. The fragrance of rose and lavender is due to monoterpenes. The carotenoids produce the reds, yellows and oranges of pumpkin, corn and tomatoes.

Natural products chemistry

Digoxin is a purified cardiac glycoside that is extracted from the foxglove plant, Digitalis lanata. Digoxin is widely used in the treatment of various heart conditions.

A typical protocol to isolate a pure chemical agent from natural origin is bioassay-guided fractionation, meaning step-by-step separation of extracted components based on differences in their physicochemical properties, and assessing the biological activity, followed by next round of separation and assaying. Typically, such work is initiated after a given crude drug formulation (typically prepared by solvent extraction of the natural material) is deemed "active" in a particular in vitro assay. If the end-goal of the work at hand is to identify which one(s) of the scores or hundreds of compounds are responsible for the observed in vitro activity, the path to that end is fairly straightforward:

1. fractionate the crude extract, e.g. by solvent partitioning or chromatography.
2. test the fractions thereby generated with in vitro assay.
3. repeat steps 1) and 2) until pure, active compounds are obtained.
4. determine structure(s) of active compound(s), typically by using spectroscopic methods.

In vitro activity does not necessarily translate to activity in humans or other living systems.

Herbal

In some countries in Asia and Africa, 80% of the population relies on traditional medicine (including herbal medicine) for primary health care. Native American cultures have also relied on traditional medicine such as ceremonial smoking of tobacco, potlatch ceremonies, and herbalism, to name a few, prior to European colonization. Knowledge of traditional medicinal practices is disappearing, particularly in the Amazon.

Traditional Tibetan medicine

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Traditional_Tibetan_medicine 

 

Traditional Tibetan medicine (Tibetan: བོད་ཀྱི་གསོ་བ་རིག་པ་, Wylie: bod kyi gso ba rig pa), also known as Sowa-Rigpa medicine, is a centuries-old traditional medical system that employs a complex approach to diagnosis, incorporating techniques such as pulse analysis and urinalysis, and utilizes behavior and dietary modification, medicines composed of natural materials (e.g., herbs and minerals) and physical therapies (e.g. Tibetan acupuncture, moxabustion, etc.) to treat illness.

The Tibetan medical system is based upon Indian Buddhist literature (for example Abhidharma and Vajrayana tantras) and Ayurveda. It continues to be practiced in Tibet, India, Nepal, Bhutan, Ladakh, Siberia, China and Mongolia, as well as more recently in parts of Europe and North America. It embraces the traditional Buddhist belief that all illness ultimately results from the three poisons: ignorance, attachment and aversion. Tibetan medicine follows the Buddha's Four Noble Truths which apply medical diagnostic logic to suffering.

History

As Indian culture flooded Tibet in the eleventh and twelfth centuries, a number of Indian medical texts were also transmitted. For example, the Ayurvedic Astāngahrdayasamhitā (Heart of Medicine Compendium attributed to Vagbhata) was translated into Tibetan by Rinchen Zangpo (957–1055). Tibet also absorbed the early Indian Abhidharma literature, for example the fifth-century Abhidharmakosasabhasyam by Vasubandhu, which expounds upon medical topics, such as fetal development. A wide range of Indian Vajrayana tantras, containing practices based on medical anatomy, were subsequently absorbed into Tibet.

Some scholars believe that rgyud bzhi (the Four Tantras) was told by the Lord Buddha, while some believe it is the primary work of Yuthok Yontan Gonpo (708 AD). The former opinion is often refuted by saying "If it was told by the Lord Buddha, rgyud bzhi should have a Sanskrit version". However, there is no such version and also no Indian practitioners who have received unbroken lineage of rgyud bzhi. Thus, the later thought should be scholarly considered authentic and practical. The provenance is uncertain. 

Youthog Yontag Gonopo adapted and synthesized the Four Tantras in the 12th Century. The Four Tantras are scholarly debated as having Indian origins or, as Remedy Master Buddha Bhaisajyaguru's word or, as authentically Tibetan with Chinese origins. It was not formally taught in schools at first but, intertwined with Tibetan Buddhism. Around the turn of the 14th century, the Drangti family of physicians established a curriculum for the Four Tantras (and the supplementary literature from the Yutok school) at Sakya Monastery. The 5th Dalai Lama supported Desi Sangye Gyatso to found the pioneering Chagpori College of Medicine in 1696. Chagpori taught Gyamtso's Blue Beryl as well as the Four Tantras in a model that spread throughout Tibet along with the oral tradition.

Four Tantras

The Four Tantras (Gyushi, rGyu-bzhi) is a native Tibetan text incorporating Indian, Chinese and Greco-Arab medical systems. The Four Tantras is believed to have been created in the twelfth century and still today is considered the basis of Tibetan medical practise. The Four Tantras is the common name for the text of the Secret Tantra Instruction on the Eight Branches, the Immortality Elixir essence. It considers a single medical doctrine from four perspectives. Sage Vidyajnana expounded their manifestation. The basis of the Four Tantras is to keep the three bodily humors in balance; (wind rlung, bile mkhris pa, phlegm bad kan.)

• Root Tantra – A general outline of the principles of Tibetan medicine, it discusses the humors in the body and their imbalances and their link to illness. The Four Tantra uses visual observation to diagnose predominantly the analysis of the pulse, tongue and analysis of the urine (in modern terms known as urinalysis )
• Exegetical Tantra – This section discusses in greater detail the theory behind the Four Tantras and gives general theory on subjects such as anatomy, physiology, psychopathology, embryology and treatment.
• Instructional Tantra – The longest of the Tantras is mainly a practical application of treatment, it explains in detail illnesses and which humoral imbalance which causes the illness. This section also describes their specific treatments.
• Subsequent Tantra – Diagnosis and therapies, including the preparation of Tibetan medicine and cleansing of the body internally and externally with the use of techniques such as moxibustion, massage and minor surgeries.

Some believe the Four Tantra to be the authentic teachings of the Buddha 'Master of remedies' which was translated from Sanskrit, others believe it to be solely Tibetan in creation by Yuthog the Elder or Yuthog the Younger. Noting these two theories there remain others sceptical as to its original author.

Believers in the Buddhist origin of the Four Tantras and how it came to be in Tibet believe it was first taught in India by the Buddha when he manifested as the 'Master of Remedies'. The Four Tantra was then in the eighth century translated and offered to Padmasambhava by Vairocana and concealed in Samye monastery. In the second half of the eleventh century it was rediscovered and in the following century it was in the hands of Yuthog the Younger who completed the Four Tantras and included elements of Tibetan medicine, which would explain why there is Indian elements to the Four Tantras.

Although there is clear written instruction in the Four Tantra, the oral transmission of medical knowledge still remained a strong element in Tibetan Medicine, for example oral instruction may have been needed to know how to perform a moxibustion technique.

Three principles of function

Like other systems of traditional Asian medicine, and in contrast to biomedicine, Tibetan medicine first puts forth a specific definition of health in its theoretical texts. To have good health, Tibetan medical theory states that it is necessary to maintain balance in the body's three principles of function [often translated as humors]: rLung (pron. Loong), mKhris-pa (pron. Tree-pa) [often translated as bile], and Bad-kan (pron. Pay-gen) [often translated as phlegm].

• rLung is the source of the body's ability to circulate physical substances (e.g. blood), energy (e.g. nervous system impulses), and the non-physical (e.g. thoughts). In embryological development, the mind's expression of materialism is manifested as the system of rLung. There are five distinct subcategories of rLung each with specific locations and functions: Srog-'Dzin rLüng, Gyen-rGyu rLung, Khyab-Byed rLüng, Me-mNyam rLung, Thur-Sel rLüng.

• mKhris-pa is characterized by the quantitative and qualitative characteristics of heat, and is the source of many functions such as thermoregulation, metabolism, liver function and discriminating intellect. In embryological development, the mind's expression of aggression is manifested as the system of mKhris-pa. There are five distinct subcategories of mKhris-pa each with specific locations and functions: 'Ju-Byed mKhris-pa, sGrub-Byed mKhris-pa, mDangs-sGyur mKhris-pa, mThong-Byed mKhris-pa, mDog-Sel mKhris-pa.

• Bad-kan is characterized by the quantitative and qualitative characteristics of cold, and is the source of many functions such as aspects of digestion, the maintenance of our physical structure, joint health and mental stability. In embryological development, the mind's expression of ignorance is manifested as the system of Bad-kan. There are five distinct subcategories of Bad-kan each with specific locations and functions: rTen-Byed Bad-kan, Myag-byed Bad-kan, Myong-Byed Bad-kan, Tsim-Byed Bad-kan, 'Byor-Byed Bad-kan.

Usage

A key objective of the government of Tibet is to promote traditional Tibetan medicine among the other ethnic groups in China. Once an esoteric monastic secret, the Tibet University of Traditional Tibetan Medicine and the Qinghai University Medical School now offer courses in the practice. In addition, Tibetologists from Tibet have traveled to European countries such as Spain to lecture on the topic.

The Tibetan government-in-exile has also kept up the practise of Tibetan Medicine in India since 1961 when it re-established the Men-Tsee-Khang (the Tibetan Medical and Astrological Institute). It now has 48 branch clinics in India and Nepal.

The Government of India has approved the establishment of the National Institute for Sowa-Rigpa (NISR) in Leh to provide opportunities for research and development of Sowa-Rigpa.