Two terms, hūṣu and huṣṣu, often precede a well-known expression for anxiety, hīp (GAZ) libbi (ŠA₃) “Heartbreak”, but despite their frequent distribution with Heartbreak, their meanings remain unclear. In his brief study of Heartbreak in connection with epilepsy, Stol notes that this variation occurs only occasionally in the medical corpus; however, Heartbreak is always preceded by one of these terms in “strictly literary texts”, including prayers (Stol 1993: 30). This brief note will address previous interpretations of hūṣu and huṣṣu and, in relation to their regular concurrence with Heartbreak, will point out some nuances that may shed light on their meaning and usage.

When preceding the expression hīp libbi, the term huṣṣu (usually written as huṣṣa or huṣṣi) seems to be in apposition to the expression that follows, possibly in a hendiadys construction, whereas the term hūṣ, when preceding the expression, stands in a genitive relationship as the regens in the construct state. The CAD translates hūṣu as “a physical pain” and “an emotional hurt”, and a philological note appended to the entry suggests that originally, it was “probably a hendiadys construction denoting a specific abdominal pain” (CAD H 260). Geller gives a more specific explanation of hūṣu as “a type of stomach cramp” (Geller 2010a: 151). Von Soden treats hūṣu and huṣṣu/a/i together in a single entry in AHw where hūṣu/huṣṣu in the phrase hu-uṣ(-ṣu/ṣa/ṣi) hīpi libbi is translated as “Leibschmerzen”, or stomach-ache (AHw 361). Von Soden's entry in AHw treats huṣṣu and hūṣ as different forms of the same noun, which I follow here.

The addition of this term has been interpreted as a stylistic, rather than semantic, choice. Stol explains the presence or absence of hūṣ or huṣṣa in medical texts as a stylistic scribal feature and adds that a Neo-Babylonian medical commentary (GCCI II 406: 10-11) shows that later scribes no longer understood the meaning of the word (Stol 1993: 30 n63). The Neo-Babylonian commentary in question is intended to clarify the following line in Tablet 13 of the Diagnostic Handbook: [DIŠ ...] ^⌜hu^⌝-uṣ-ṣa GAZ ŠA₃ TUKU.MEŠ-šu ŠU ^dXV – ŠU [...] “[If ...] he perpetually has huṣṣa, Heartbreak, (then it is) Hand of Ištar, Hand of [...]” (Diagnostic Handbook 13: 161').

The relevant lines of the Neo-Babylonian commentary elaborate on huṣṣa and a perhaps related term, ṣâlim (< ṣâlum “to fight, object; quarrel”, CAD Ṣ 89):

While the above translation is only tentative, these lines may provide some useful information about the term huṣṣa and should not be dismissed as evidence of scribal confusion simply because their meaning eludes modern scholars.

The first excerpted line seems to equate huṣṣa with something that is burning. It is worth noting that the heart and innards can be the subject of kabābu “to burn” in a transitive usage, as in an incantation whose goals include preventing the heart from burning the supplicant: ŠA₃-ba la i-kab-ba-ab-ka “so that your heart may not burn you” (KAR 238 r. 14). Similarly, a report from an āšipu includes this symptom (Thompson 1900: 235 A 13 [83-1-18, 232]).

To return to the commentary, huṣṣa is then further elaborated by ṣâlim “quarreling”. In fact, the noun ṣaltu “quarrel, disagreement, affray” (CAD Ṣ 86-87), which derives from the same root as the verb ṣâlu, frequently appears with Heartbreak in therapeutic texts and incantations. For example, in an anti-witchcraft ritual addressed to Marduk, the symptomatology section pairs Heartbreak with ṣaltu “strife” as follows: hu-uṣ GAZ ŠA₃ TUKU.TUKU-ši ina E₂ ṣal-tu ina SILA pu-uh-pu-uh-hu-u₂ GAR-šu₂ “he continually has hūṣ (of) Heartbreak; in the home there is strife, in the streets, quarrelling” (AMT 21/2 read with BAM 3, 232: 17; Abusch and Schwemer 2011: Text 8.6; cf. Stol 1993: 29 for more references). Thus, the relationship between ṣâlu/ṣaltu and a term that regularly precedes Heartbreak is not entirely random. The lines in the commentary may thus elaborate huṣṣa as a condition or symptom that figuratively burns and relates to – perhaps, causes or is caused by – strife and quarrelling. The meaning of huṣṣa may have in fact been known to the later scribes and, by extension, its use in medical therapeutic texts and other material, was a semantic, rather than stylistic, choice that modified or in some way clarified the type or intensity of Heartbreak being experienced.

Furthermore, the commentary does hint at a meaning that accords with one conceivable, though debatable, interpretation of the term huṣṣu. The term may be understood as deriving from the same root as the verb huṣṣum “to anger, harrass, irritate, trouble”, a D stem of the hypothetical root *h-'-ṣ whose basic stem would have the meaning “to be angry”. J. L. Boyd (1983) offers an interpretation of this verb in a letter from Šamaš-hazir to Hammurabi concerning legal contestations over a field (TCL 7, 58). Boyd's interpretation pivots on the reading of the verb in line 15: i/uh-ta-na-AZ-x understood by him as uh-ta-na-as-^⌜si^⌝, a Dtn of *hiāṣum with a possessive suffix. He draws supporting data for this meaning from parallel roots in other Semitic languages, ancient and modern (see Boyd 1983: 246). While Boyd's interpretation is far from certain and the reconstruction of the root *h-'-ṣ is open to speculation, his brief article does offer a meaning of huṣṣa that seems to correspond to its usage with hīp libbi.

Following this interpretation of the verb huṣṣum, a noun derived from the same root would have a related meaning, such as “anger, irritation”. Is it possible that the meaning of “pain” for hūṣu and huṣṣu derives from the fact that pain causes anger or irritation, and vice versa? Logically and semantically, the two are related. This meaning further coheres with the distribution of the terms hūṣ and huṣṣu with Heartbreak. As noted above, the terms regularly precede hīp libbi in non-medical texts, but not in medical therapeutic texts (Stol 1993: 30). It is perhaps to be expected for more lyrical and subjective genres to include a word that decribes pain or anger, whereas the more scientific and objective genres would omit this aspect in favour of the more straightforward term for the condition of Heartbreak.

As noted at the start of this note, there is still no consensus on the meaning of hūṣ or hūṣṣa. In most occurrences with Heartbreak, these two terms seem to refer to an emotional pain, perhaps akin to anger or irritation, that would be expected to accompany an anxiety state. It is further possible that the emotional pain described by these terms should not be separated from the physiological pain that it may give rise to. Given the consistent overlap in the libbu's function as a physical organ and as the seat of thought and emotion, the association of this anger-related pain with the heart and belly may locate the experience of discomfort or distress caused by anger or anxiety in this region of the body.