The Concept of Intermediate State of Health Explained by Greek Physician Galen and Its Reflection in Other Traditional and Contemporary Medicines

Abstract

Jalinoos ’s (Galen’s) concept of the intermediate state of health describes a transitional phase between perfect health and illness, where individuals neither enjoy optimal health nor exhibit enough symptoms to be classified as ill. Despite the World Health Organization’s definition of health in 1948, no comprehensive definition has emerged since then, and this intermediate state is largely absent from modern medical literature. This article explores Jalinoos ’s rationale for recognizing the intermediate state or subhealthy state. Today, this concept can be correlated with conditions like prediabetes, prehypertension, and subclinical conditions like metabolic syndromes where a person is neither fully healthy nor ill but has the potential to develop a disease. This narrative review synthesizes existing literature on the intermediate state of health in ancient medicine and its relevance in contemporary medicine. A comprehensive search was conducted across peer-reviewed journals, databases such as Google Scholar, MEDLINE, and PubMed, as well as classical Unani literature. The review highlights that in addition to the binary states of health and disease, a third, intermediate state exists. This is supported by contemporary examples such as prediabetes, prehypertension, and old age aligning with Galen’s original concept. Recognizing this intermediate state can bridge the gap between health and disease. Acknowledging the third state of health is crucial for promoting health maintenance across all states – healthy, ill, or in-between. Populations in this intermediate state require appropriate medical attention, which will only be possible when this concept is fully recognized.