Expert Understanding of Body Functioning and Illness
The traditional therapists (matabibu , sing. tabibu ) understand the basic cause of most illness to be an imbalance among the four characters or elements (matabia , sing. tabia ) that they take as fundamental to the body's functioning. This disruption is always due to improper diet, although other factors can exacerbate or lessen the disruption. The only effective treatment of the illness that inevitably results from disruption is understood to be dietary change supplemented by medicines, most of them compounded from herbs. The new diet and the medicines are aimed at reinstating the body's essential elementary balance and thereby restoring health.
The fact that the beliefs and values described in this section are shared among experts and not at all among the overwhelming majority of the community is crucial to an understanding of the cultural dynamics in this domain. Most community members have consulted "herbal doctors" (as I will henceforth call matabibu) several times or more, but this cannot be attributed to even sketchy knowledge of the basis for this medical view. Traditional medical care may be slightly less expensive than care from a university-trained physician, but many Swahili can well afford Western-type care. Although the basic understandings in Western medicine are shared no more than are those of traditional medicine, most people utilize Western medicine rather often. In fact, as an estimate, I would say that a majority of the community uses Western medical services more than traditional ones, even though most people use both.
Fundamentally, the "balance theory," as it can be called, followed by herbal doctors holds that the proper balance of the body's four elements, hot and cold and wet and dry, is indispensable to health. Illness results should any of the elements fail to make its appropriate contribution to the body's operation.
A number of the herbal doctors and expert laymen commented on the fact that the understandings concerning illness they follow come from outside their own society. Many attribute them (correctly) to the early Greeks and, more specifically, to the well-known second-century physician, Galen, who is called "Galeni" in Swahili. The Mombasa Swahili, like their fellow ethnics up and down the East African coast, see themselves as part of the great, worldwide Muslim civilization, and a number of them, including many herbal doctors, know that the cultural heritage of this civilization includes the view of illness held in their own group. The view that balance theory is shared by other Muslim peoples in other areas of the world is, of course, correct (Temkin 1973). There are differences between the Swahili view of balance theory and the same basic theory as held in other Muslim groups (see, e.g.,
Good 1977), but the existence of similarities and a recognized relationship is worth noting.
All the Swahili herbal doctors save one learned their profession in apprenticeships, most commonly with their fathers. The one who has formal schooling went to a Muslim institute in Lamu where he received a certificate for "general studies." He has far more elaborate offices than other herbal doctors, charges higher fees than they do, and told me that a group of visiting American physicians gave him $500 for a one-hour lecture on his approach to medicine.
Body Functioning and the Bodily Elements
According to the herbal doctors, the body's functioning is to be understood according to what I have called balance theory. Their main attention to discussing body functioning is focused on the four elements (also referred to by English-speaking informants as "complexions" and "characters"): "cold" (baridi ), "hot" (hari ), "dry" (yabisi ), and "wet" (rughtba ). In Swahili belief, the same four elements are present in everyone, but there are important differences among people in their relative amounts and in the balance among them.
Each of the elements is centered in a particular part of the body and is associated with a bodily fluid. Hari (hot) is centered in the liver and is associated with blood. People with a predominance of hari tend to be hopeful and courageous in disposition. Hari is more powerful in men than in women and more powerful during youth than in old age. Women rarely get diseases caused by an excess of hot because their menstrual flow protects them from this excess by lessening the blood supply when they are young. When they are old enough for their menstrual flow to stop, they are protected by their advanced age, with its diminution of hot. Men, however, are quite susceptible to hot diseases until aging brings about a lessening in their natural tendency to hotness and makes them more susceptible to diseases of excessive cold as women are all their lives.
Baridi (cold) is in the lungs and is associated with phlegm. People with a predominance of phlegm are inclined to be sluggish, dull, and impassive. Cold is more powerful in women than in men and in old age more than in youth.
Unlike the case for cold and hot, there is no association between gender and the rughtba (wet) and yabisi (dry) elements, but wet is associated with youth and dry with old age. Wet is associated with yellow bile and is located in the bile sac. A person with a preponderance of wet is likely to be proud, quick tempered, and generally given to anger.
Dry is in the spleen and is associated with what the Swahili call maji ,
which is the word also used to refer to water. However, informants specifically deny that this "water" is the lymph that fills blisters, and it is a near certainty that it is the "black bile" Galen associated with the spleen as opposed to the yellow bile he associated with the liver and bile sac (Siegel 1968:258). Those in whom dryness predominates are commonly moody, depressive, and suspicious.
The fact that the Swahili refer to the elements by the same names used for physical qualities of temperature and moisture might lead to the incorrect inference that they are, in fact, directly connected with these qualities. This mistaken idea might be strengthened by the fact that the hot element affects the body, for good or ill, most readily in the summertime, while the cold element is most effective in the winter. In fact, season is understood to affect body functioning indirectly by the influence of ambient temperature on how food is digested. Thus, the cold element tends to dominate the body in the winter and hot in the summer because the foods promoting hot are more effectively assimilated in the summer, while those promoting cold are more effectively assimilated in the winter.
In addition to variations due to sex and age, each individual has his or her own particular balance, which is significantly different from all others. A fanciful balance rendered, strictly for purposes of illustration, in numerical values for the elements might be 3:1/2:2 for one person, while another might be 1:3/3:1. One consequence of these differences is that individuals not only differ in character as a result of the different weightings of the elements in their balances but they are also more or less healthy depending on how stable their balances are. Differences in predisposition to particular diseases and kinds of diseases result from the same individual variations in balance.
When the influence of one or more of the elements becomes excessive, an imbalance occurs and is manifested as an illness. Only reestablishing the individual's customary elemental balance will end the illness. Although the season of the year has an indirect effect on the balance of elements, only aging, sex, food, and drink affect it directly.
The Classification of Food and Drink in the Balance System
All food and drink is classified according to the four elements, or a combination of them, according to the way they affect the body rather than to the nature of the foods themselves. Thus, ice is not cold; it is dry since it contributes to the operation of the element that is given that name. Honey, even if it is taken directly from the refrigerator, is hot because of the nature of its contribution to body functioning.
Edible substances, in the Swahili view, can have another property in addi-
tion to the four components of the body's elemental balance, and this is being either "heavy" or "light." This dimension appears to be similar to another aspect of Galen's system. Galen, like his Swahili successors, believed that in addition to the four primary "qualities," there were "secondary qualities" that modified the primary qualities. As Siegel, an authority on Galen, puts it, "Galen regarded all parts of the body as a combination of primary qualities, but modified by the addition of secondary qualities. Thus, the blood is red; bile is bitter and yellow, and because of some other secondary quality each exhibits a varying viscosity" (ibid., 147).
In Swahili understandings, "heavy" foods facilitate the effect of, say, cold less than "light" foods do. For some foods, being heavy or light is an inherent property. Others, including most meats, are neither heavy nor light in themselves but can become either depending on how they are prepared and on how long they have been stored.
The classification of foods and drinks in this system is exhaustive, with previously unknown foods or drinks being classified by their observed effects on those who ingest them. Most foods are classified according to being either cold or hot and also according to being either wet or dry. Some foods, however, are so strong along one of the dimensions (hot or cold or dry or wet) that their standing on the other is negligible. Cold and hot are more powerful in their effects on the body than dry and wet, with hotness being a definite cause of dryness (i.e., if there is enough hotness, wet foods will be converted to dry), and excess cold can cause otherwise dry foods to produce the reaction of wet ones. Neither dry nor wet, however, can produce either hot or cold. Despite this, wet and dry must be in balance quite as much as hot and cold must be, if illness is to be avoided.
A few common foods and their classifications can serve as illustrations of the system:
Corn: cold and dry, light in the stomach
Wheat: cold and dry, heavy in the stomach
Millet: hot and wet, heavy in the stomach
White beans: dry and cold, heavy in the stomach
Red beans: hot and dry, heavy in the stomach
Goat meat: hot and dry
Fruit: all fruits having juice are hot and wet, heavy in the stomach
Since foods are classified according to how they affect the body, it is not surprising that their classification changes as the food substances do. Thus, many foods are understood to change their effects with time, so that fresh cow's milk is hot and wet, but if it stands for some time, it becomes cold
and wet, and if allowed to sour it is only wet without cold. Rice is hot, but if it is stored for a year or so it becomes dry. In the winter, bananas are hot and wet but in the summer cold and wet.
Similarly, the state, including size, or age of the source of a food is understood as affecting the food's influence on the body and therefore the food's classification. So, for example, the meat from immature chickens, that is, from hens that have not yet laid eggs and roosters that have not yet crowed, is hot, moderately wet, and fairly light in the stomach, but when the birds are older, their meat is hot, dry, and heavy in the stomach. In the same way, the flesh of large fish is understood to contribute to the hot element in the body but that of small fish to the cold. Even within the same food, the constituents can have different elemental standings, if these are taken to have different effects on the body. Thus, the whites of eggs are cold and wet, while the yolks are hot and wet.