A multi-disciplinary review on the diagnostic significance of body organ morphology in different body conditions (health and disease)

INTRODUCTION

Understanding human health, personality, and function has been largely based on body composition. The term "body physique" refers to the structural and compositional characteristics of the human body that represent its potential and overall appearance.¹ From ancient times, diverse systems of medicine have tried to define and interpret physique to explain variances in health, temperament, and disease susceptibility. Physical and physiological variations in Unani medicine are based on the theory of Mizāj, or temperament.^2,3-5

According to Ayurveda, Prakriti types are constitutional frameworks that determine bodily features and susceptibility to diseases.⁶ According to traditional Chinese medicine, the body physique is classified on the basis of harmony and balance of yin and yang, Qi and blood with in the body.⁷ However, modern medicine uses observable parameters like somatotype to analyse the body physique.

Understanding the relationship between body composition and health outcomes is essential for promoting preventive healthcare, personalized treatment, and healthy lifestyle practices. Body physique reflects an individual’s nutritional status, physical fitness, and susceptibility to disease.⁸ For instance, low muscle mass may indicate malnutrition or reduced physical strength, whereas excessive body fat particularly central obesity is strongly associated with metabolic and cardiovascular disorders. Assessment of body composition therefore assists healthcare professionals in designing individualized interventions related to diet, exercise, and medical management.

Moreover, the study of body physique serves as an important bridge between traditional holistic medical systems and modern evidence-based science. The present review aims to explore the concept of body constitution through a comparative analysis of Unani, Ayurveda, Chinese, and contemporary scientific perspectives. By identifying both common principles and unique contributions of these systems, the study seeks to develop a systematic and integrated understanding of human physique that aligns traditional medical wisdom with current scientific knowledge.

METHODS

A comprehensive literature review was conducted, and analyzing manuscripts, textbooks and research articles of Unani, Ayurveda, Chinese and Modern scientific research to explore the concept of body physique or body constitution. Classical Unani texts e.g., Al-Qānūn fi’l Ṭibb, Kāmil al-Ṣanā’a al-Ṭibbiyya, Dhakhīra Khawārizm Shāhī, Kitāb al-Mi’a, Kitāb al-Mansuri, Kitāb al-Murshid, Moojizul Qanoon, Firdaws al-Ḥikma fi’l Ṭibb, Kitāb al-Kulliyāt, Kulliyāt Nafisi, Kitāb fi’l Mizāj, Kulliyāt Qānūn, etc. were the main source of information. A search was conducted on PubMed, Google Scholar, ScienceDirect, ResearchGate and Scopus, using keywords such as body physique, Mizāj, Unani Medicine, Ayurveda Medicine, Chinese Medicine, prakriti, somatotypes. Relevant research articles of Ayurveda, Chinese and Modern Medicine were also examined to better understand the concept of body physique or body constitution.

BODY PHYSIQUE

Body physique refers to the overall physical structure, shape, size and composition of an individual's body.¹ Which are influenced by genetic factors, bone structure, muscle mass, fat distribution, and lifestyle. Individuals may naturally differ in body build, with some having broader, muscular frames and others possessing slimmer physiques. Although nutrition, physical activity, and daily habits can modify physical appearance to some extent, the fundamental body structure is largely genetically determined. Body physique is an important indicator in health and disease assessment, as a well-developed physique is often associated with greater muscular strength and better physical fitness.⁹

TYPES OF BODY PHYSIQUE

The word of body physique is commonly used to categorize and describe different body types based on observable characteristics. Typically, body physique is classified into three broad categories, i.e. fatty, lean and moderate.⁹ Traditional systems offers a comprehensive information regarding the physique types i.e. Unani Medicine classification described body physique on the bases of Mizaj, Ayurveda on Doshas (Vata, Pitta, Kapha), and Chinese medicine classification based on yin-yang theory. American psychologist William Herbert Sheldon’s somatotypes classification also provides additional information on how different factors contribute to the overall physical form of an individual.^6,10-13 Overview of the body physique classifications as per Unani, Ayurveda, TCM and modern medicine are presented in the schematic diagram (Figure 1).

ACCORDING TO CONVENTIONAL MEDICINE

In 1940s, American psychologist William Herbert Sheldon correlated different body types with distinct human temperaments.^12,14,15 Sheldon identified the following somatotypes in his theory of somatology:

Endomorph

Individuals characterized by a high amount of fat on their bodies, resulting in a round and plump appearance. Endomorphic body types have a soft and flabby physique, aligning with a personality marked by laziness and a preference for pleasure. They are relaxed, food lovers, comfort lovers and sociable.^12,14,15

Mesomorph

Individuals who do not have an excess of fat on their bodies but instead have well-developed and prominent muscles. Mesomorph characterized by a firm and muscular physique, corresponding to an assertive and ambitious personality. They are bold competitive, adventurous, and courageous.^12,14,15

Ectomorph

Individuals characterized by a minimal amount of fat on their bodies, resulting in a lean and thin physique. Ectomorphs have a thin and frail body, associated with a shy and nervous personality. They are self-conscious, self-centred, introvert, socially anxious and prefer privacy.^12,14,15

It's important to note that Sheldon did not believe individuals belonged strictly to one type, instead, rating people on these three body types and assigning them a somatotype.^12,14,15

ACCORDING TO UNANI MEDICINE

The Ancient Unani Scholar Masīḥī's categorization provides a solid framework for understanding human physique. According to the Masīḥī, the body physique is divided into five types¹¹:

Uboolat (fatty)

In this state, the body appears overweight, resulting from an excess of either muscle or fat. Excess of muscle is due to excessive heat and moisture, while an excess of fat is linked to an excess of cold and moisture.¹¹

Qazafat (lean)

In this state, the body appears thin, whether due to lack of muscle or due to lack of fat. Lack of muscle is caused by excessive coldness and dryness, while lack of fat is linked with excessive heat and dryness.¹¹

Saqafat (weak)

In this condition, the body exhibits signs of weakness. This state is due to heat or moisture or combination of both.¹¹

Kasafat (strong)

In this condition, the body is strong due to coldness or dryness or a combination of both. The solidity and hardness of the body indicate coldness and dryness.¹¹

Mu’tadil (moderate)

In this condition, the amount of muscle and fat on the body is moderate.¹¹

Among these, (Overweight, Lean and moderate) are directly related to body built, while the categories i.e. strong and weak, concerned with body strength. These two categories provide an understanding of body strength or weakness based on the prevailing internal conditions. Other than Masihi most of the ancient Unani scholars defined body physique into three types i.e. overweight, lean and moderate.¹⁴

RELATIONSHIP BETWEEN MIZĀJ AND BODY PHYSIQUE

An individual’s body physique is largely influenced by personal temperament as well as the environmental and climatic temperament of the geographical region in which they live. Variations in climate, lifestyle, and environmental conditions contribute to differences in body build and physical characteristics among populations across different parts of the world.¹⁰ All human beings can be divided into four groups according to the temperament: Ḥārr-Raṭb, Ḥārr-Yābis, Bārid-Raṭb and Bārid-Yābis.¹⁷ Here's a detailed description of Temperament and body physique relationship.

Hot and moist temperament

The physical appearance of individuals with this temperament is characterized by a muscular build; there is an abundance of muscles in the body due to the dominance of Ḥarārat (heat) and Ruṭūbat (moisture). As we know, energy and matter are essential for the growth and development of any living organism. According to Unani theory, heat performs the role of energy, while moisture acts as matter, and together they ensure the proper nourishment and development of the body organs.

The Excess of heat amount (within the normal limits) in the body inhibits the accumulation of fat, as the active cause for fat accumulation is Burūdat (coldness). Consequently, individuals with this temperament don’t tend to be overweight and usually maintain a muscular physique.^17–19

Cold and moist temperament

The physical look of individuals with this temperament is characterized by a fatty build; there is an abundance of fat in the body due to the dominance of Burūdat (coldness) and Ruṭūbat (moisture). Dasūmat (viscous substances) in the blood is the madi (material) cause for excess fat production, while the Fā‘ili (active) cause is Burūdat (coldness), which promotes the solidification and deposition of these fatty substances. As a result, individuals possessing such a temperament are more prone to weight gain and obesity.^3,11,17,20

Hot and dry temperament

The physical expression of individuals with this temperament is characterized by a thin build, which means the amount of muscle and fat in their body is less. In this type of individuals, there is excess of Ḥarārat (heat) and Yubūsat (dryness). Because, there is no excess material causes to produce muscle and fat. But there must be some musculature in them due to the heat. The body tabiyat make some arrangements for the necessary musculature with the help of available material.^11,17–19

Cold and dry temperament

The physical appearance of individuals with this temperament is characterized by a thin build. Due to the excess coldness and dryness, there is very low amount of muscle and fat in the body. According to the concept, heat acts as a source of energy, while moisture serves as the material basis for tissue formation. When both heat and moisture are present in minimal quantities, the production and development of muscles and fat occur in very small amounts. According to the Ibn Sīnā, the thinnest people are those who have Bārid Yābis temperament.^3,11,17,20 Figure 2 shows the relationship between Mizāj (Temperament) and different body types.

MIZĀJI TRAITS

Each individual is distinct from the others due to his unique and distinct specific physical characteristics and mental makeup. This individuality is associated with the Mizāj (body temperament) that every person possesses from birth which leads to variations in the functions and traits, emphasizing the distinctiveness and diversity of human characteristics.^3,10 Ibn Sina's explanation of the Ajnās 'Ashara (ten determinants) in al-Qanoon fi Tib serves as a framework for the compilation of these traits. Through This framework, the unique traits associated with different Mizāj become more understandable.3 Here, we have given a brief overview of traits according to different Mizāj.

Traits of sanguineous (Ḥārr Raṭb Mizāj) personality

Individuals with this temperament are characterized by their predominant Ḥarārat and Ruṭūbat, exhibit a balanced state and superior qualities in comparison to those individuals who have different temperaments. Heat plays a vital role in all biological processes, it promotes and accelerates various bodily functions such as growth, digestion, and metabolism. The body utilizes more nutrients, which facilitates blood production, organ growth, and the development of robust organ structures due to this temperament. People with a hot and moist temperament have more muscle than fat. They have good appetite, balanced and sound sleep, and a strong ability to make judgments. They get trouble with hot things. They feel comfort with cold and dry things and in cold weather the vital functions are further facilitated by Mizaji Ruṭūbat.^3,10,16,20

Traits of bilious (Ḥārr Yābis Mizāj) personality

Individuals with this temperament are characterized by their predominant Ḥarārat and Yubūsat, so they exhibit distinct signs of heat and dryness. In contrast to other people, these people naturally produce more Ṣafrā' (yellow bile) and comparatively a more quantity of Bilious humour in their blood. That’s why; they have strong and slender bodies. They get trouble with hot things and find comfort with cold things. Most suitable season for them is winter. These people have Ḥarārat in their Mizāj, which accelerates the body functions and enhance the metabolic rate. The morbid matters early evacuated from the body so they are very much safe from the diseases caused by morbid matters.^2,3,10,16,21

Traits of melancholic (Mizāj Bārid Yābis) personality

Individuals with this temperament are characterized by their predominant Burūdat and Yubūsat, so they exhibit unique characteristics with their temperamental qualities. In terms of other people, they are usually the thinnest and weakest because of their Mizāj. Their bodies have less fat and flesh due to the lack of heat and moisture, which makes their bones and joints more prominent. Their digestive system is weak, making it difficult for them to digest dense, hard, and large quantities of food. When they get older, usually past 40 or 50 years old, the lack of heat and moisture in their bodies causes their organs and faculties to weaken quickly. Lack of heat and moisture promotes the aging and physical decline process, weakening organs and decreasing vitality.^2,3,10,16,21

Susceptibility of diseases in different Mizāj

Temperament differences of every individual play an important role in determining susceptibility to various diseases.¹⁰ Unani physicians have observed that people with specific temperaments are more prone to specific diseases. Such as people with Mizāj Ḥārr Raṭb are more susceptible to conditions that are related to extreme heat or moisture, whereas people with Mizāj Bārid Yābis are more prone to conditions associated with cold or dryness. Thus, persons with different Mizāj are predisposed to different diseases in different ways, especially at various stages of life and in different climates.³ A brief description of various temperaments of individual and how susceptible they are to common illnesses is provided in the Table 1.

ACCORDING TO AYURVEDIC MEDICINE

In Ayurveda, individuals are classified into distinct body types known as Prakriti, and one such classification involves the dominance of the three doshas: Vata, Pitta, and Kapha.⁶ The characteristics of these body types are due to predominance of respective Dosha in each individual. Figure 3 shows three different body types which are classified by ancient scholars of Ayurveda.

Vata prakriti

In this prakriti, vata dosha is dominant. Vata dosha is characterized by properties such as dryness, lightness, mobility, roughness, coldness, and swiftness. Individuals with vata prakriti have a small body frame or slender body, slim physique and low body weight. They have dry, rough and thin skin. They have dry, brittle and frizzy hairs. They are vibrant, talkative, sensitive, imaginative, and quick to respond. They have clear and alert mind. They are susceptible to Osteoarthritis, Osteoporosis, Fractures, Dental Cavities, Calcium deficiency, Diseases related to the intestine, Splitting of hair, hair fall, Nail disorders, chipping of nails, Underweight, and malnourishment etc.^27,28

Pitta prakriti

In this prakriti, pitta dosha is dominant. Pitta dosha is characterized by properties such as heat, sharpness, and liquidity. Individuals with Pitta prakriti generally have a medium build or muscular body and moderate body weight. They have warm skin, lustrous complexion, good concentration, large bones, wide shoulders and narrow waist. They are more prone to Acidity, inflammatory conditions, Early ageing, Premature greying of hair, Skin diseases, wrinkles, pimples, Bleeding disorders, Hemorrhoids and Varicosities etc.^27–29

Kapha prakriti

In this prakriti, kapha dosha is dominant. Kapha dosha is characterized by properties such as heaviness, softness, coldness, and greasy. Individuals with Kapha prakriti typically have a large body frame and tend to be overweight. They have a wide waist and a large bone structure. They are relaxed, compassionate, emotionally steady and loyal in comparison of other body types. They have good memory and good stamina. They have tendency to allergies, dullness, fatigue, oversleep and overweight. They are more prone to Obesity, Hypothyroidism, Diabetes, Poly Cystic Ovarian Syndrome, Atherosclerosis, Menstrual irregularities, Disorders related to sedentary life.^6,13,29,30

ACCORDING TO TRADITIONAL CHINESE MEDICINE

As per traditional Chinese medicine, the unique character that is compatible with nature and social environment is known as body constitution. It develops during all the stages of life and reveals a person’s susceptibility to diseases, metabolism and response to stimuli. Consideration of body constitution is an important process for diagnosis and treatment.

Body constitution can be very helpful for disease prevention and maintain a healthy lifestyle.^31–33 The China Association for TCM classified body physique or body constitution into nine types, namely the Balanced, Qi-stagnation, Blood stasis, Qi-deficiency, Yin-deficiency, Yang-deficiency, Phlegm-dampness, Damp-heat and Inherited special (Figure 4).^34,35 Among them, balanced type of constitution is a neutral type, while the rest are biased and unbalanced types.^31,34 There are nine constitutional types.

Balanced

This type is harmonious constitution with the balance of Yin and Yang. Individuals of this type of constitution are physically well, emotionally or mentally stable, and hopeful. They frequently have shiny skin and hair, brilliant eyes, good senses of taste and smell, healthy sleep and appetite, and regular bowel and urine patterns. They are able to adjust to environmental changes.^31,34–37

Qi deficient

These individuals have flabby muscles. They are introverted and shy in nature. Frequently, they have dyspnoea, exhaustion, susceptibility to colds and flu, sweating, and tooth marks on the side of the tongue. They are sensitive to changes in the environment. Individuals typically take longer to recover from infections because their immune systems are not as strong.^31,34–37

Yang deficient

These individuals are usually quiet, introverted, and have flabby muscles. They frequently complain their fatigue, a cold feeling in their stomach, and cold hands and feet. Cold food and cold environments tend to make them uncomfortable. They are vulnerable to health issues like diarrhoea, puffiness, and an excess of secretions from the throat.^31,34–37

Yin deficient

These individuals typically have slender bodies and friendly and impatient nature. They frequently complain of constipation, dry stool, dry mouth, warm palms and soles, and dry nose. They frequently experience discomfort in hot and dry conditions. They are prone to sleeplessness, lethargy, coughing, and certain chronic illnesses.^31,34–37

Phlegm dampness

These individuals are overweight and have a tummy. They have a moderate temper and flexible in nature. They have an oily face, a sticky or sweet taste in the mouth, a thick tongue coating and excessive throat secretion. They are more prone to cardiovascular disorders, metabolic syndrome, and diabetes.^31,34–37

Damp heat type

These individuals have a normal or slender physique. They generally tend to be irritable and short-tempered. They are often seen with an oily face that erupts acne or pimples, a bitter or strong taste in the mouth, unfinished feeling after defecation or dry stools, yellow urine, and a yellow coated tongue. They are sensitive to hot weather. They are more prone to urinary difficulties and skin disorders.^31,34–37

Blood stasis type

Individuals are often forgetful and irritable. Their pale complexion, spots on the face, dark-red lips, dark bags under the eyes, rough skin, an unidentified bruise on the body's surface, and varicose veins are common symptoms. They frequently experience discomfort in cold environment. They are susceptible to bleeding, abnormal growths and painful conditions.^31,34–37

Qi stagnation type

The majority of individuals has slender body. They frequently exhibit emotional instability, depression, or anxiety. They react poorly to stressful conditions, particularly in winter, autumn and rainy on rainy days and in the winter and fall. They are vulnerable to breast lumps, anxiety disorders, depression, and sleeplessness.^31,34–37

Inherited-special constitution type

Individuals with inborn weakness are highly sensitive to medicines, foods, odours, pollen, and other environmental allergens. They frequently complain of runny noses, itching, sneezing, nasal congestion, and even purple marks or patches beneath the skin. People frequently suffer from eczema, asthma, hay fever, and drug allergies. They have a weak response to external factors, and seasonal variations may lead to health issues.^31,34–37

DISCUSSION

Body physique is a key aspect of understanding health holistically in all of these systems. Unani, Ayurveda, TCM and modern medicine all hold the balance of the body is reflected in its exterior form (Physique). Although their classification differ i.e. temperament in Unani, doshas in Ayurveda, constitution in TCM and somatotypes in modern medicine (Table 2), all highlights the importance of balance. All Traditional systems evaluate physique through a wider lens that takes temperament, lifestyle, and environment as factors, in contrast to contemporary biological techniques that measure health through anatomy and biochemistry. This holistic approach provides insights that enhance contemporary preventive medicine and facilitates extremely individualized care.

CONCLUSION

All Traditional medical systems have been aware that a person's physical appearance reveals a lot about their health and personality. Physical form serves as a guidance for internal balance and therapeutic approach in Unani, Ayurveda, TCM, and Modern Medicine. Despite cultural differences, they all agree that maintaining balance between one's body and mind as well as between oneself and one's surroundings is essential to good health. Combining these viewpoints with contemporary research could improve methods for preventative and individualized healthcare. Future studies could examine the relationship between conventional body-type evaluations and contemporary physiological and genetic information, bridging the gap between traditional knowledge and modern medicine.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: None required

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