Humorism

ET

Phlegm
Water

LD

Black Bile
Earth

O
H

Blood
Air

Y
R

Yellow bile
Fire

Essentially, this theory holds that the human body is lled

with four basic substances, called humors, which are in
balance when a person is healthy. All diseases and disabilities supposedly resulted from an excess or decit of
one of these four humors. These decits were thought
to be caused by vapors inhaled or absorbed by the body.
The four humors are black bile, yellow bile, phlegm, and
blood. Greeks and Romans, and the later Muslim and
Western European medical establishments that adopted
and adapted classical medical philosophy, believed that
each of these humors would wax and wane in the body,
depending on diet and activity. When a patient was
suering from a surplus or imbalance of one of these
four uids, then said patients personality and or physical health could be negatively aected. This theory was
closely related to the theory of the four elements: earth,
re, water and air; earth predominantly present in the
black bile, re in the yellow bile, water in the phlegm,
and all four elements present in the blood.[6]

This article is about humors in ancient and medieval A humor is also referred to as a cambium (pl. cambia or
medicine. For the modern theory of temperament, see cambiums).[5]
Four Temperaments. For humors in Ayurvedic medicine,
see Ayurveda.
Humorism, or humoralism, is a system of medicine 1 Four humors

The four humors

Paired qualities were associated with each humor and

its season. The word humor is a translation of Greek
,[7] chymos (literally juice or sap, metaphorically
avor). At around the same time, ancient Indian
Ayurveda medicine had developed a theory of three humors, which they linked with the ve Hindu elements.[8]

detailing the makeup and workings of the human body,

adopted by the Indian Ayurveda system of medicine,
Ancient Greek and Roman physicians and philosophers,
positing that an excess or deciency of any of four distinct bodily uids in a person known as humors or
humours directly inuences their temperament and
health. The humoralist system of medicine is highly individualistic, for each individual patient was said to have
their own unique humoral composition.[1] Moreover, it
resembled a holistic approach to medicine as the link between mental and physical processes were emphasized
by this framework.[2] From Hippocrates onward, the humoral theory was adopted by Greek, Roman and Persian
physicians, and became the most commonly held view of
the human body among European physicians until the advent of modern medical research in the nineteenth century. The concept has not been used in medicine since
then.[3][4]

The following table shows the four humors with their

corresponding elements, seasons, sites of formation,
and resulting temperaments alongside their modern
equivalents:[9]

1.1 Blood
The blood was believed to be produced exclusively by the
liver.[10][11]:103-105

1.2 Yellow Bile

The four humors of Hippocratic medicine are black

bile (Greek: , melaina chole), yellow
bile (Greek: , chole), phlegm (Greek: ,
phlegma), and blood (Greek: , haima), and each corresponds to one of the traditional four temperaments.

Excess of yellow bile were thought to produce aggression,

and excess anger reciprocally gave rise to liver derangement and imbalances in the humors. The English word
bilious (peevish; irritable; cranky) derives from this
1

conception, as does the meaning of gall as exasperation or impudence, and the Latin word cholera, derived from the Greek khol, which was passed upon several Romance languages in words meaning anger such
as colre (French) and clera (Spanish).

1.3

Black Bile

humours were based upon the observation of blood clotting in a transparent container. When blood is drawn in
a glass container and left undisturbed for about an hour,
four dierent layers can be seen. A dark clot forms at the
bottom (the black bile). Above the clot is a layer of red
blood cells (the blood). Above this is a whitish layer of
white blood cells (the phlegm). The top layer is clear
yellow serum (the yellow bile).[20]

The word melancholy derives from Greek

(melaina khol) meaning 'black bile', from the be- 2.2
lief that an excess of black bile caused depression.

1.4

HISTORY

Greek medicine

Phlegm

Phlegm was thought to be associated with apathetic

behavior, as preserved in the word "phlegmatic"
/gmatk/.[12]
The phlegm of humourism is far from the same thing
as phlegm as it is dened today. Nobel laureate Charles
Richet MD, when describing humorisms phlegm or pituitary secretion in 1910 asked rhetorically, this strange
liquid, which is the cause of tumours, of chlorosis, of
rheumatism, and cacochymia - where is it? Who will ever
see it? Who has ever seen it? What can we say of this fanciful classication of humours into four groups, of which
two are absolutely imaginary?"[13]

History

Although advances in cellular pathology and chemistry

discredited humoralism as a scientically acceptable theory by the nineteenth century, the theory had dominated
Western medical thinking for more than 2,000 years.[3][4]
Only in some instances did the theory of humoralism
wane into obscurity. One such instance occurred in the
sixth and seventh centuries in the Byzantine Empire when
traditional secular Greek culture gave way to Christian
inuences. The use of Humoralist medicine continued
during this time, however, its inuence was diminished
in favor of religion.[14] The revival of Greek humoralism,
owing in part to changing social and economic factors,
did not begin until the early ninth century.[15] Use of the
term in modern times is pseudoscience.[16]

2.1

Origins

The four temperaments (phlegmatic; choleric; sanguine; melancholic).

See also: Ancient Greek medicine

Hippocrates is the one usually credited with applying this
idea to medicine. One of the treatises attributed to Hippocrates, On the Nature of Man describes the theory as
follows:
The Human body contains blood, phlegm, yellow bile and black bile. These are the things
that make up its constitution and cause its
pains and health. Health is primarily that state
in which these constituent substances are in
the correct proportion to each other, both in
strength and quantity, and are well mixed. Pain
occurs when one of the substances presents either a deciency or an excess, or is separated
in the body and not mixed with others.[21]

The concept of four humors may have origins in Ancient

Egyptian medicine[17] or Mesopotamia,[18] though it was
not systemized until ancient Greek thinkers[19] around
400 BC directly linked it with the popular theory of the
four elements: earth, re, water and air (Empedocles).
Although the theory of the four humors does appear in
Fhrus (1921), a Swedish physician who devised the some Hippocratic texts, some Hippocratic writers only
erythrocyte sedimentation rate, suggested that the four accepted the existence of two humors, while some even

3
refrained from discussing the humoral theory at all.[22]
Humoralism, or the doctrine of the four temperaments,
as a medical theory retained its popularity for centuries
largely through the inuence of the writings of Galen
(129201 AD) and was decisively displaced only in 1858
by Rudolf Virchow's newly published theories of cellular pathology. While Galen thought that humors were
formed in the body, rather than ingested, he believed that
dierent foods had varying potential to be acted upon
by the body to produce dierent humors. Warm foods,
for example, tended to produce yellow bile, while cold
foods tended to produce phlegm. Seasons of the year,
periods of life, geographic regions and occupations also
inuenced the nature of the humors formed.
The imbalance of humors, or dyscrasia, was thought to
be the direct cause of all diseases. Health was associated
with a balance of humors, or eucrasia. The qualities of the
humors, in turn, inuenced the nature of the diseases they
caused. Yellow bile caused warm diseases and phlegm
caused cold diseases.

is transmitted from the heart to the organs

through the arteries. At rst, it [proper soul]
enters the master organs such as the brain, liver
or reproductive organs; from there it goes to
other organs while the nature of the soul is being modied in each [of them]. As long as
[the soul] is in the heart, it is quite warm, with
the nature of re, and the softness of bile is
dominant. Then, that part which goes to the
brain to keep it vital and functioning, becomes
colder and wetter, and in its composition the
serous softness and phlegm vapor dominate.
That part, which enters the liver to keep its vitality and functions, becomes softer, warmer
and sensibly wet, and in its composition the
softness of air and vapor of blood dominate.
In general, there are four types of proper
spirit: One is brutal spirit residing in the heart
and it is the origin of all spirits. Another as
physicians refer to it is sensual spirit residing
in the brain. The third as physicians refer to
it is natural spirit residing in the liver. The
fourth is generative i.e. procreative spirits residing in the gonads. These four spirits
go-between the soul of absolute purity and the
body of absolute impurity.

In On the Temperaments, Galen further emphasized the

importance of the qualities. An ideal temperament involved a balanced mixture of the four qualities. Galen
identied four temperaments in which one of the qualities, warm, cold, moist or dry, predominated and four
more in which a combination of two, warm and moist,
warm and dry, cold and dry or cold and moist, dominated. These last four, named for the humors with which
the four humors and temperaments in a
they were associatedthat is, sanguine, choleric, melan- He summarized[23]
table
as
follows:
cholic and phlegmatic, eventually became better known
than the others. While the term temperament came to
refer just to psychological dispositions, Galen used it to
refer to bodily dispositions, which determined a persons 3 Inuence and legacy
susceptibility to particular diseases as well as behavioral
and emotional inclinations.
3.1 Medicine
Typically eighteenth-century practices such as bleeding
a sick person or applying hot cups to a person were,
in fact, based on the humor theory of surpluses of uSee also: Medicine in medieval Islam and Unani
ids (blood and bile in those cases). Ben Jonson wrote
humor plays, where types were based on their humoral
In Islamic medicine, Avicenna (9801037) repeated the complexion. Methods of treatment like bloodletting,
ancient theory of four humours in The Canon of Medicine emetics and purges were aimed at expelling a harmful
(1025):
surplus of a humor. Other methods used herbs and foods
associated with a particular humor to counter symptoms
of disease, for instance: people who had a fever and were
From mixture of the four [humors] in difsweating were considered hot and wet and therefore given
ferent weights, [God the most high] created
substances associated with cold and dry. Paracelsus furdierent organs; one with more blood like
ther developed the idea that benecial medical substances
muscle, one with more black bile like bone,
could be found in herbs, minerals and various alchemical
one with more phlegm like brain, and one with
combinations thereof. These beliefs were the foundation
more yellow bile like lung.
of mainstream Western medicine well into the 1800s.

2.3

Islamic medicine

[God the most high] created the souls from

the softness of humors; each soul has it own
weight and amalgamation. The generation and
nourishment of proper soul takes place in the
heart; it resides in the heart and arteries, and

Central to the treatment of unbalanced humors was the

use of herbs. Specic herbs were used to treat all ailments
simple, common and complex etc., from an uncomplicated upper respiratory infection to the plague. For example, chamomile was used to decrease heat, and lower

REFERENCES

excessive bile humor. Also, arsenic was used in a poultice ance between food and physical activity.[25] The conbag to 'draw out' the excess humor(s) that led to symp- temporary view of a healthy lifestyle in Western culture
toms of the plague. Philip Moore, who wrote on the hope emphasizes the historically inuential concept of balance.
of health, and Edwards, who wrote Treatise concerning
the Plague discuss how these herbs are helpful in curing physical disease. They also discuss the importance
4 See also
of maintaining an herb garden.
The Unani school of medicine, practiced in PersoArabic countries, and in India and Pakistan, is based on
Galenic and Avicennian medicine in its emphasis on the
four humors as a fundamental part of the methodologic
paradigm.

Four Temperaments
Five Temperaments

Three Doshas of Ayurveda

There are still remnants of the theory of the four humors
Wu Xing (Five Elements of Chinese philosophy)
in the current medical language. For example, modern
medicine refers to humoral immunity or humoral regulation when describing substances such as hormones and
antibodies that circulate throughout the body. It also uses 5 References
the term blood dyscrasia to refer to any blood disease or
abnormality. The associated food classication survives
in adjectives that are still used for food, as when some Notes
spices are described as hot, and some wines as dry.
When the chili pepper was rst introduced to Europe in [1] Bynum, edited by W.F.; Porter, Roy (1997). Companion
Encyclopedia of the History of Medicine (1st pbk. ed. ed.).
the sixteenth century, dieticians disputed whether it was
London: Routledge. p. 281. ISBN 978-0415164184.
hot or cold.

3.2

Culture

[2] Bynum, edited by W.F.; Porter, Roy (1997). Companion

Encyclopedia of the History of Medicine (1st pbk. ed. ed.).
London: Routledge. ISBN 978-0415164184.

Theophrastus and others developed a set of characters

based on the humors. Those with too much blood were
sanguine. Those with too much phlegm were phlegmatic.
Those with too much yellow bile were choleric, and those
with too much black bile were melancholic. The idea
of human personality based on humors contributed to
the character comedies of Menander and, later, Plautus.
Through the neo-classical revival in Europe, the humor
theory dominated medical practice, and the theory of humoral types made periodic appearances in drama.

[3] NY Times Book Review Bad Medicine

Because people believed that the quantity of humors

in the body could not be replenished, there were folkmedical beliefs that the loss of uids was a form of death.

[6] Wittendor, Alex (1994). Tyge Brahe. G.E.C. Gad. p45

The humors can be found in Elizabethan works, such as

in Taming of the Shrew, in which the character Petruchio
pretends to be irritable and angry to show Katherina what
it is like being around a disagreeable person. He yells at
the servants for serving mutton, a choleric food, to two
people who are already choleric.

[4] [ https://books.google.com/books?id=t8UfI3BH78wC&
lpg=PA204&dq=medical%20dictionary%
20humorism&pg=PA204#v=onepage&q&f=false
Humoralism entry], p 204 in Websters New World
Medical Dictionary, 3rd Edition. Houghton Miin
Harcourt, 2009 ISBN 9780544188976
[5] Burton, Bk. I, p. 147

[7] http://www.perseus.tufts.edu/cgi-bin/ptext?doc=
Perseus%3Atext%3A1999.04.0057%3Aentry%3D%
23115103
[8] Magner, A History of the Life Sciences, p. 6, at Google
Books
[9] Keirsey, David (1998). Please Understand Me II: Temperament, Character, Intelligence. Del Mar, CA: Prometheus
Nemesis Book Company. p. 26. ISBN 1-885705-02-6.

Foods in Elizabethan times were all believed to have an

anity with one of these four humors. A person showing
signs of phlegmatism might have been served wine (a cho- [10] Medical Blood Page accessed Feb 15, 2015
leric drink and the direct opposite humor to phlegmatic)
[11] Byron Good. Medicine, Rationality and Experience: An
to balance this.

Anthropological Perspective Cambridge University Press,

The concept of balance in health, a key feature in the hu1994 ISBN 9780521425766
moralist theory, is still prevalent in modern Western culture. The dietary guidelines put forth by the United States [12] <http://www.oed.com/view/Entry/142540>; accessed 27
May 2012.
Department of Agriculture recommend nding a bal-

[13] Charles Richet, MD, Professor of Physiology, University

of Paris. Ancient Humorism and Modern Humorism.
Delivered at the International Congress of Physiology
held in Vienna, September 27th to 30th 1910, as reported on page 921 of the British Medical Journal of October 1, 1910 http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2336103/pdf/brmedj07876-0001.pdf
[14] al.], Lawrence I. Conrad ... [et (1998). The Western medical tradition, 800 BC to AD 1800 (Reprinted. ed.). Cambridge: Cambridge University Press. p. 100. ISBN 9780521475648.
[15] al.], Lawrence I. Conrad ... [et (1998). The Western medical tradition, 800 BC to AD 1800 (Reprinted. ed.). Cambridge: Cambridge University Press. p. 101. ISBN 9780521475648.
[16] Williams, William F. (December 3, 2013). Encyclopedia
of Pseudoscience: From Alien Abductions to Zone Therapy.
Routledge. ISBN 1135955298.
[17] van Sertima, Ivan (1992). The Golden Age of the Moor.
Transaction Publishers. p. 17. ISBN 1-56000-581-5.
[18] Sudho, Karl (1926). Essays in the History of Medicine.
Medical Life Press, New York. pp. 67, 87, 104.
[19] Hippocrates (c. 460 c. 370 BC): in Hippocratic Corpus,
On The Sacred Disease.
[20] Hart GD (December 2001). Descriptions of blood and
blood disorders before the advent of laboratory studies.
Br. J. Haematol. 115 (4): 71928. doi:10.1046/j.13652141.2001.03130.x. PMID 11843802.
[21] Chadwick, edited with an introduction by G.E.R. Lloyd
; translated [from the Greek] by J.; al.], W.N. Mann ...
[et (1983). Hippocratic writings ([New] ed., with additional material, Repr. in Penguin classics. ed.). Harmondsworth: Penguin. p. 262. ISBN 978-0140444513.
[22] Lindberg, David C. (2007). The Beginnings of Western
Science : the European Scientic Tradition in philosophical,
religious, and institutional context, prehistory to A.D. 1450
(2nd ed. ed.). Chicago: University of Chicago Press.
ISBN 978-0226482057.
[23] Lutz, Peter L. (2002). The Rise of Experimental Biology:
An Illustrated History. Humana Press. p. 60. ISBN 089603-835-1.
[24] Infrigidate - ''The Free Dictionary''".
tionary.com. Retrieved 2012-01-11.

Thefreedic-

[25] Dietary Guidelines. Retrieved 10 May 2014.

Bibliography
Edwards. A treatise concerning the plague and the
pox discovering as well the meanes how to preserve
from the danger of these infectious contagions, as
also how to cure those which are infected with either
of them. 1652.

Moore, Philip. The hope of health wherin is conteined a goodlie regimente of life: as medicine, good
diet and the goodlie vertues of sonderie herbes, doen
by Philip Moore.. 1564.
Burton, Robert. 1621. The Anatomy of Melancholy,
Book I, New York 2001, p. 147: The radical or
innate is daily supplied by nourishment, which some
call cambium, and make those secondary humours
of ros and gluten to maintain it [...].

6 External links
BBC Radio4s In Our Time. Episode on the four
humors in MP3 format, 45 minutes.
Article from 'Phisick'. Humoral Theory

7 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

Text and image sources, contributors, and licenses

7.1

Text

Humorism Source: http://en.wikipedia.org/wiki/Humorism?oldid=651973478 Contributors: SimonP, KF, Gabbe, Delirium, JWSchmidt,

Jm34harvey, Furrykef, Altenmann, Geogre, Henry Flower, Pashute, Noe, Factitious, Dbachmann, Furius, Brian0918, CanisRufus, Iamunknown, Polylerus, Palestine-info, Woohookitty, Johan Lont, Mandarax, Cuchullain, Jb-adder, StephanCom, Glenn L, WhyBeNormal,
Eric B, Adoniscik, YurikBot, Luis Fernndez Garca, Pigman, Bill52270, Dialectric, Darker Dreams, Ragesoss, Dhollm, DeadEyeArrow, VAgentZero, JoanneB, Garion96, SmackBot, InverseHypercube, McGeddon, Jagged 85, Dyersgoodness, Paxse, Kintetsubualo,
Swerdnaneb, Armeria, Patriarch, RedHillian, BullRangifer, Lambiam, JoseREMY, Mizushimo, Shn525, RichardF, LaMenta3, Shoeofdeath, Alpha Ursae Minoris, Wolfdog, CmdrObot, Cappycollins, SteveMcCluskey, Mattisse, Oerjan, Mojo Hand, Z10x, NERIUM,
Escarbot, Yomangani, SummerPhD, Spencer, Alphachimpbot, Michig, PhilKnight, Bongwarrior, Neosystems, Dr algorythm, Thompson.matthew, Rickard Vogelberg, Stephenchou0722, Fconaway, Ian.thomson, McSly, Chiswick Chap, Lygophile, BrettAllen, GreenWyvern, Paularblaster, Luminate, Narikha, Jmrowland, Philip Trueman, Fran Rogers, Shadowlapis, Staka, FinnWiki, Bluedenim, Oldag07,
Scleppy, Alexbrn, Mrmorganiser, Maralia, Hordaland, Jpotisch, EPadmirateur, ClueBot, XmaceX, The Thing That Should Not Be,
Abu America, Jdb00, Freebullets, J8079s, Arunsingh16, Jeremiestrother, SamuelTheGhost, Quantum ant, Hans Adler, SchreiberBike,
Versus22, Editor2020, Jytdog, Nicolae Coman, Addbot, Power.corrupts, Jncraton, ThreeOfCups, , Lightbot, Yobot, IW.HG,
AnomieBOT, Jim1138, Materialscientist, Citation bot, Taer9, St.nerol, Abce2, Omnipaedista, M0tty, Sophus Bie, SchnitzelMannGreek,
Paine Ellsworth, Pinethicket, Notedgrant, Skyerise, Pcirrus2, Beyond My Ken, Gatmaster, Syncategoremata, Juan Carlos PS, ,
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Satellizer, Chester Markel, Widr, Helpful Pixie Bot, NotWith, A1candidate, 786b6364, Mogism, Wywin, Epicgenius, Nonsenseferret,
Jayaguru-Shishya, Trippingrabbit, Mehul Suneja, Monkbot, HiYahhFriend, Atgr92, Gracea235 and Anonymous: 188

7.2

Images

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body uids.PNG Original artist: Tom Lemmens
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7.3

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