Galen's Viewpoint about Classification of Health States.

Priority of health preservation and disease prevention to disease treatment is clear. During years, numerous studies with various aims have been done in relation with classification of health states based on some classification systems in order to determine level of healthiness among different groups of people. However it is thought that the need to classify interventions emerged for the first time in 1971, study of ancient medical sources results in getting some interesting things else. This study done through Qualitative research method on "Resale fi Hefzossehhat"authored by Galen, discusses about Galen's viewpoint about classification of health states.

Introduction

Priority of health preservation and disease prevention to disease treatment is clear and there are numerous studies about parameters which affect healthy life (1–4). Researchers try to find each factors which could affect the health and also quality of life within different groups of people; for example, Khodaverdi et al. studied about relationship between health Related quality of life (HRQOL), motor ability and weight status in children (5); and Pipat Luksamijarulkul explained some parameters which may be considered as “risks” for healthiness(6). In addition, during years, numerous studies with various aims have been done in relation with classification of health states based on some classification systems in order to determine level of healthiness among different groups of people (7–12).

Some important systems for classification of health states include The World Health Organization Family of International Classifications (WHO-FIC) (13) and the Classification and Measurement System for Functional Health (CLAMES) (14). WHO has developed two reference classifications, which can be used to describe the health state of a person at a particular point in time (13). Diseases and other related health problems are classified in the 10th revision of International Classification of Diseases (ICD-10) (13, 15); Functioning and disability are classified separately in the International Classification of Functioning, Disability and Health (ICF) (13, 15). The International Classification of Health Interventions (ICHI) is under development (13). CLAMES is a generic tool developed by the Health Analysis and Measurement Group of Statistics Canada to quantify the health-related quality of life associated with diseases and injuries. This system permits comparable description and classification of health states covering a broad range of severity levels and symptoms. It is used to compare the impact of disease or injury in a population, monitoring of population health over time, and to identify disparities among socio-demographic groups (14). However it is thought that, the need to classify interventions emerged for the first time in 1971 only for surgical procedures and then, for other subjects in medicine about 1989 (13), study of ancient medical sources results in getting some interesting things else. One of these interesting data is Galen’s viewpoint about classification of health states. Galen (129–210 AD), pupil of Hippocrates, was a famous ancient physician who wrote some books and lectures in medicine some of which have been translated to English. George Rosen has recommended Galen’s Hygiene to all public health workers (16).

This study discusses about Galen’s viewpoint about classification of health states.

Materials and Methods

Qualitative research, phenomenology type, is the method of study. Qualitative research is regular, continual and synchronized gathering and analyzing of meanings in order to get a new and general cognition from a principle subject; and its aim is creation of a substantive or tentative theory and making complexities of a subject clear (17–21). In qualitative research few samples are chosen but they are studied deeply (21). To do this study, initially, Galen’s books, essays and articles were searched by researches electronically. The electronically advanced searches about “Galen and Health” and “Galen and Hygiene” result in finding the book “A translation of Galen’s hygiene (De sanitate tuenda)” translated by ROBERT MONTRAVILLE GREEN, which has been taken under consideration by some researchers (16, 22). Unfortunately, this book was not available electronically so, searching within library in department of Traditional medicine in Tehran university of medical sciences was done and researchers found an Arabic essay from Galen about health preservation entitled: “Resale fi Hefzossehhat” which means: “Essay in health preservation” (23). It may be the essay, which Jack W Berryman has talked about it in his article where he said: “On Hygiene contains the best collection of Galen’s views on exercise and health” (24); but electronically searching about this essay had no result. According to study’s aim, subjects were gathered from Galen’s book, “Resale fi Hefzossehhat”, as sample of study, through manual searching; then, subjects were classified and read out repeatedly according to qualitative research method, so main themes were created and “content analysis” was used for data analysing. Qualitative content analysis is defined more widely by some researchers to include techniques in which the data are analyzed solely qualitatively, without using of counting or statistical techniques (18, 19).

Results

Two main themes were found after reviewing data, which are introduced as the most important principles to preserve health. The first is “Good Food Digestion” (GFD), and the second is “Enough Waste Defecation” (EWD). GFD is created because of four parameters observations include:

1- Food with appropriate quality: The foods which their temperament is similar to body temperament, for example, warm temperament foods are appropriate for warm temperament body.

2- Appropriate quantity of food: The quantity of food in which individuals do not sense heaviness in their stomach.

3- Appropriate time for eating food: 12 hours after pervious eating of food, is the best time to eat again.

4- Observing a set sequence for different food in one turn: Eating various foods in one set should be according to turn; for example, a laxative food should be eaten before other types of food.

To get EWD, in the first step, everybody should pay attention to his/her level of exercise and bathing. Because of each of them, some specific wastes are defecated. The second step is using substances or drugs which help to defecate wastes through urine or stool, and drugs which eradicate obstruction and make tracts clean completely.

According to these two principles, people are divided to four groups as regards level of healthiness so each group should obey specific orders in order to preserve healthiness or return it if it has been lost. This division is shown in Table 1.

Table 1:

Galen’s classification for level of healthiness

Group	Level of healthiness	Body status	GFD	EWD	Orders
1	Healthy person	Normal	Yes	Yes	Don’t need to any drugs
2	Incomplete Healthy person	Normal	No	No	Need to some drugs to complete wastes defecation
3	Incomplete Healthy person	Weak in some chief organs1	Yes	Yes	Need to some drugs to reinforcement weakened organs
4	Not to health	Weak in some chief organs	No	No	Need to strong drugs to both complete wastes defecation and reinforce weakened organs

Discussion

Data analysis shows that according to Galen’s classification, people are divided to 4 levels of health; each level can be determined through two parameters include Good Food Digestion with 4 nutritional rules and Enough Waste Defecation with confirming on exercise and bathing. Today, some parameters have been known to determine level of health for example, there are two attributes used in CLAMS for classification of health states include: Core attributes which include: Pain or Discomfort, Physical Functioning, Emotional State, Fatigue, Memory and Thinking, Social Relationships; and Supplementary attributes which include: Anxiety, Speech, Hearing, Vision, and Use of Hands and fingers. Each of these parameters may be divided to some components for example fatigue is divided to 4 levels (14). Therefore, Statics Canada has defined 5 levels of perceived health include: 1 Excellent; 2 Very good; 3 Good; 4 Fair; and 5 Poor (25).

In a paper, “Motion and rest: Galen on exercise and health”, Jack W Berryman explained Galen’s viewpoints about health especially through exercise and he indicated that according to Galen’s viewpoints, to get good condition, as a kind of excellence of health, exercise and nutrition are necessary (24). However, he did not say anything about classification of health levels and only indicated to “good condition” as kind of excellence of health. As a conclusion, Galen had considered nutrition and exercise as a component of two important principles, Good Food Digestion and Enough Waste Defecation, for wellbeing as similar as modern medicine (26–28). In addition, he paid attention to defecation of different wastes from body and bathing so that according to Galen’s viewpoint, having good digestion and enough defecation result in healthiness in different levels.

1According to medieval medicine, some organs are more important than others named as “Chief organs” including Heart, Brain, Liver, Ovary, Testis and Stomach (29, 30).

Ethical considerations

Ethical issues (Including plagiarism, Informed Consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc) have been completely observed by the authors.