According to Walter Gratzer, the study of nutrition probably began during the 6th century BC. In China, the concept of Qi developed, a spirit or "wind" similar to what Western Europeans later called pneuma. Food was classified into "hot" (for example, meats, blood, ginger, and hot spices) and "cold" (green vegetables) in China, India, Malaya, and Persia. Humours developed perhaps first in China alongside qi. Ho the Physician concluded that diseases are caused by deficiencies of elements (Wu Xing: fire, water, earth, wood, and metal), and he classified diseases as well as prescribed diets. About the same time in Italy, Alcmaeon of Croton (a Greek) wrote of the importance of equilibrium between what goes in and what goes out, and warned that imbalance would result disease marked by obesity or emaciation.