A N T O N I O A L O N Z O RESEARCH ESSAY

HIST-A394-002 MEDICINE IN THE ANCIENT AND MEDIEVAL

WORLDS | 30 NOV 09

Physic in Galen and the Greek World : A

Delineation of Theory and Approach

The endless endeavor to render κόσμος kosmos of the χάος chaos started in
Greece with Thales’s based-on-water cosmology, and his followers’ : Anaximenes’ air and
Anaximander’s the indefinite. A century later Alcmaeon exposed the physic 1 of the four
nervous juices, the humors or χυμοί chymoi, and postulated the “alteratives”—moisture,
aridity, heat, and algidity—which are responsible for variation of the στοιχειώματα
stoicheiomata (sc. the elements) and therefore different forms.2 I will attempt to
represent humoral and coincidental medical theories rationally paradigmatically in this essay
in order to impart a simple framework that is not linguistically immediate; for this same
want of immediacy if one happens to stumble upon an old text on physic, one will find
reading it proves to be like either learning a new language or, unfamiliar with the inherent
rationality of physic, talking to an unforgivably imaginative intellectual or even a sciolist.

On Humoral Theory, Pneuma, Pepsis, and Treatment

The basis of humoral theory is this condition in nature called κρᾶσις krasis—the
formative tempering of the stoicheiomata and alteratives—the reason the φύσις

physis can raise organ and bone from blood and stretch our flesh without rupture.

As for the actual substance of the coats of the stomach, intestine, and

uterus, each of these has been rendered what it is by a special

alterative faculty of Nature [φύσ.]; while the bringing of these together,

the combination therewith of the structures which are inserted into

them, the outgrowth into the intestine, the shape of the inner cavities,

1Physic is an archaic word for medicine that connoted “a τέχνη”—an art, craft, or practical science. (I will use physic to refer to
the medical art being proposed in this essay and also to old medicine in general.) It is derived from φύσις, a tentative idea in
phyic. The different uses of φύσις are perhaps too numerous and diverse to reconcile, but the word when it appears in the
context of itself and not third-party phraseology usually can be averaged as the nature of a system, i.e. of the human composition,
of the human race, etc. A certain continuity persists. I will promote φύσις as informed by Hippocrates, Galen, and related
sources. | For a detailed account of its uses in different schools of thought cf. Beardslee, The Use of ΦΥΣΙΣ in
Fifth-Century Greek Literature.
2 The humors, our chymical components the cardinal chymoi, “‘that which is contained’ [consist of] the blood [sc.
hæma or sanguine], pituita [sc. phlegm or phlegma], yellow bile [sc. bile, choler, or cholë], and black bile [sc. atrabile or
melancholë] : of these the first is red, humid, sweet, and hot [warm]; the second white, humid, saltish, adhesive, and cold; the
third yellow, dry, bitter, and adhesive [and warm]; the fourth black, cold, dry, and adhesive : the proximate cause of disease he
[Hippocrates] supposed to consist in deficiency or excess of any of these elements. . . or an excess or defect of the secondary
qualities of sweetness, sourness, &c.” (Scott, “History of Medicine,” 222.)
 and the like, have all been determined by a faculty which we call the

shaping or formative faculty; this faculty we also state to be artistic

[τέχ.]—nay, the best and highest art—doing everything for some

purpose, so that there is nothing ineffective or superfluous, or capable

of being better disposed.3

The τέχνη techne or art of φύσις, of nature, is as essential to physic as κρᾶσις is

to humoralism—quintessential—for (as a definition) physic is the τέχνη of imitating nature

in her craft : her physicking, or doctoring; accordingly, “the importance of Hippocratic

medicine is not found in the pathological doctrines which it developed; it lies rather in the

skill of the physician to adapt his opinion on the course of the disease and its cure to the

‘Physis’ of his patient.”4 We define one’s φύσις (any organism’s φύσις) as one’s complex

idiosyncratic physiological character, inborn, lifelong-maintained, one’s composition, one’s

defining framework, one’s individual infrastructure, this thing that subsists essentially in

induplicability that explains one’s unique responses, one’s adaptability and debilities, to

external and internal stimuli.

Φύσις is often described as the body’s demiurge—a notion best thought of if we keep

to the definition of demiurge in the older dictionaries which themselves keep to the Greek

predecessor δημιουργός demiourgos, meaning artist, craftsman, artificer, architect, or

mechanic; and better understood still if we include the meaning of the political δημιουργός

—that magisterial position of the poleis—which is suggestive of the physis’ duty as

longterm physiological overseer, the body’s nature-given physician.

It makes sense now why Galen would add a third component to the Aristotelian

model of the element air’s, or πνεύμα pneuma, animating properties in the body. This

Galeno-Aristotelian principle of life is triune, consisting of πνεύμα ψυχικὸν pneuma

3 Galen, On the Natural Faculties, 86, 88.

4 Pagel, Prognosis and Diagnosis, 387.
psychikon, πνεύμα ζωτικὸν pneuma zotikon, and πνεύμα φυσικὸν pneuma
physikon. The former two correspond to mind and body; pneuma physikon or

natural air refers to vegetation.

Air is hæmatic, the element belonging to the blood humor, αἵμα haema—the
humor from which φύσις erects the human form. Both Aristotle and Galen contended that

the pneuma psychikon is a hæmic exhalation that having risen to the head accounts
for the thought process. Blood, the nutritive ὕλη hyle substance of the body, is

manufactured in the liver from χυλὸς chylos chyle—a sustenate juice procured of

foodstuffs in πέψις pepsis, digestion. Galen locates his æry agent of vegetation the

pneuma physikon in the abdomen where, by merit of innate heat (v.i.), pepsis
occurs.

Πέψις, a word that means digestion, boiling, and cooking, was originally posited by

Hippocrates and is the same process of depuration that corresponds to (his ruminations on)

the ἀκμή acme or height of disease. That is, the fever—if there is a fever—the supposed

point of κρίσις krisis at which point a decisive boiling-off of the affected humors occurs,
and remaining excesses and recrement are sent to the emunctories and discharged via

hæmorrhage, vomitus, diarrhea, urine, and sweat. Πέψις is a three-step process : (1) The

first phase is called “crudity”; it is simply a precondition to pepsis; it is a state of

“suspension” or lingering of noxious liquors or, if the toxin is undigested food, this condition

is called ἀπεψία apepsia; (2) within the capacity of the φύσις, there is chymical
mollification—humoral softening— : a ripening, nourishing, or maturation of the peccant

humors already alluded to : those serous juices in ἀπόκρισις apokrisis, separated from

κρᾶσις, are warmed in this innate heat–directed maceration; this phase is called πεπασμός

pepasmos or coction; (3) lastly, in the event of krisis, there is a fervid expulsion of

superfluities, or, in the event of λύσις lysis, there is gentler mewing of the excesses. The

other possibility occurs when φύσις-the-physician localizes the peccancies in a tumor,

abscess, or pimples.
 These measures of chylosis, coction, and krisis would be impossible without the

agency of innate heat, a component of this vitalic pneumatic-hæmatic order which we have

been discussing, usually referred to as ϑέρμον ἔμϕυτον thermon emphyton in

Aristotelian terms. Innate heat is the biological “continuer”; it is useful to compare it to the

universal principles Heraclitus’ πῦρ αἰείζωον and the stoic ἡγεμονικόν hegemonikon.5

The concept of πέψις factors into the emblematic semeiotics of Hippocrates as the

basis of his “critical days” theory that figures the days on which kriseis are most likely to
occur. Prognosticating the nature of an approaching krisis enabled him to treat a patient

on the spot. The humoral-qualitative pathology that gained Hippocrates’ advocation led to

the fabrication of a juicy therapy bent on aligning the animal affluxes : there emerged a

pharmacopœia of stypics and phlegmagogues, cholagogues and melanagogues, purgatives

and fumigants, and a meticulous alterative-conscious treatise on dietetics (hygienics).

Foodstuffs possess δυνάμεις dynameis (v.i.), and those of particular sweetness or

alkalinity, etc. are the most potent. Hippocrates effectively canonized ϕλεϐοτομία

phlebotomia as a major implement in physic for coming centuries.

In prognosis Hippocrates looked for σημεῖα semeia signs in urine, stool,

expectorations, and in the physiognomy and tongue in order to profile the patient’s

δύσκρατος dyskratos φύσις (sc. dyscratic or ill-tempered physis). And understanding

then the nature or φύσις of the disease, he proceeded with the proper treatment. Rather

5 Cf. Allbutt, “The Innate Heat,” 216-225 : “Thus Empedocles, Anaximenes, Diogenes of Apollonia, Heraclitus,
taught that fire was the finest and subtlest air, such as was around the sun; and, still more definitely, that there was a
something creative between air and fire, a demiurgic, essence, a dynamic stuff, a spirit of motion and heat—to use
Bacon’s words, ‘The spirits of the animals and vegetables are compounded of an aery and flamy pneumatic body.’” |
It is informative here to mention the Platonic and Gnostic notions of their demiurge that is the creator of this world
of the senses (a world that for Plato is in imitation of the greater Idea, and for the Gnostics is a product of a
demiurge that could not imbue humans with a true πνεύμα, soul, and so gave us this lower one that is tempted by
the senses); the important thing here being the continuing warranted by the demiurge.
than combating the arising symptoms Hippocrates aimed to treat the διαϑέσεις

diatheseis or susceptibilities of the patient’s φύσις to the influence of the disease’s.6

6 Cf. Encyclopædia Britannica, 62-73 for a detailed account of Hippocrates’ physic elaborating on the
abovementioned and specifics on the critical days (when they are), several purgatives (ingredients), etc.
Dynamis and Physis

A δύναμις dynamis is a sort of faculty, and solely so; it does not itself qualify

either as εῖδος eidos7 or matter, yet within matter finds carapace and “capacitates” its

material body qua a teleological circuit—from passivity, and through some conduit of ὕλη

hyle, to a state of (activity) ἐνέργεια energeia, sc. ”dynamic” operation, activity, work.
An example of this carapace-cum-δύναμις involving genetic matter, and the work of the

circuit thence established, from Galen :

In the same way that Phidias possessed the faculties [δυν.] of his art

even before touching his material [ὕλη], and then activated these in

connection with this material [ὕλη] (for every faculty [δύν.] remains

inoperative in the absence of its proper material) [ὕλη], so it is with the

semen : its faculties [δυν.] it possessed from the beginning while its

activities [ἐνέργειας] it does not receive from its material [ὕλη], but it

manifests them in connection therewith. . . . Therefore, in order that it

may not perish, but may become a nature [φύσ.] in place of semen,

there must be an afflux to it of a . . . quantity [of blood] commensurate

with that [amount required by] the semen. . . . Now, it is not for the wax

to discover for itself how much of it is required; that is the business of

Phidias. Accordingly the artificer [semen] will draw to itself as much

7On Εἴδη : Miller, “Dynamis and Physis,” 196 : “As each dynamis or simple substance manifests to the senses a
simple entity of physis by virtue of its various perceptible and concrete effects in the body, the entity may properly
be referred to as an eidos. . . . [or] the "form" of the simple entity as manifested, characterized, and differentiated by
its sensible qualities and observable effects from another simple entity of physis. Thus, "the sweet" is one eidos,
identified and distinguished by its dynamis and all the observable effects of that dynamis from "the acid," which is
also an eidos. "The hot" is also an eidos (even though it is not manifested as an individual substance) because,
although it is always found in koinônia [sc. κοινωνία, communication or relationship] with other eidê, it is still
perceptible and distinguishable from those other eidê by its manifested effects.” | Εῖδος, LIT. “a sight, appearance,
form, figure; sort” (A Lexicon of the Greek Language, 2nd ed.), is where we get our suffix “-oid.”
 blood as it needs. . . [W]e shall ascribe to the semen a faculty for

attracting blood similar to that possessed by the lodestone for iron.8

There are four important things to note in this fragment : (1) The residence of the δύναμις

in its shell the semen is analogous to the residence of the technical faculties “in” Phidias the

sculptor;9 (2) the δύναμις–cum-carapace requires special conditions, menstrual blood, to

act; (3) the semen does not qualify as an organism (sc. nature or φύσις) until it acts—it is

as it does; and (4) neither the vessel nor the δύναμις act out of their own intellect : the duo

siphons the menstrual blood in a manner similar to the attraction possessed by the

lodestone for iron.

Applied to natural processes, this term τέλος telos (see n. 10)—a word used by

Aristotle to mean end-purpose—most essentially predicates the uttermost of the thing (sc.

δύναμις), its finality or ultimacy, its perfection, viz. the entelechy of the thing. We can now

more properly define the ἐνέργεια of δυνάμεις as ἐντελέχεια entelecheia, that is, a

function, activity, action, or operation of an entelechy.

The φύσις that is put in motion by the energeia of a δύναμις or δυνάμεις, as in

the case of the semen when presented with menstrual blood, should be understood as both

the product and conductress of this “dynamism,” both the nature and the naturer,10 so it is

not incorrect to credit the φύσις as an efficient entelechy of the δυνάμεις in a body, disease,

food, etc.

8 Galen, ibid., 133, 135.

9 Δύναμις connotes something “special” or “peculiar,” as a talent (of Phidias the sculptor) or as in a dynasty (a
term derived from dynamis) an exclusive authority or right. This exclusive specialized own-purpose of a δύναμις
has been called its τέλος, or end-purpose, as in to that end. | To illustrate : Having a τέλος implies that one’s
going-abouts are organized as a function of the doing-of-a-task that may be unknown, and so this τέλος is
independently detrimental to those going-abouts by, so-to-speak, a transcendental nature.
10 Recall that the φύσις is both the demiurge and doctor of the body, the mechanic and physicker (v.s.).
 Dr. W. B. A. Scott of the Homœpathic Review observes that “in other places, he

[Hippocrates] seems to identify this ‘nature’ with the ‘fire’ or ‘heat’ of Heraclitus,” Heraclitus’

πῦρ αἰείζωον (v.s.).11 And Walter observes of Artistotle in The Use of ΦΥΣΙΣ in Fifth-Century

Greek Literature : Wo
rk
bei
ng
do
ne.
Φύσις is used by Aristotle of the universe
Pre as a whole. . .[H]e uses φύσις
sen
of that part of the universe whicht has its moving principle within itself
asp
ect
as distinguished from mathematical . objects and objects of art. . . . “Art
Fu
nct
imitates nature,” [wrote aristotle] ion but only as art makes use of natural
.
objects do the spheres of art andTh nature coincide. . . . [Φ]ύσις is used
e
éla
for the object itself or for the principle
n of motion which is inherent in
vit
al.
that object. In this latter use φύσιςAcomes to mean “life principle” when
ch
used of living beings. Then ἡ φυσικὴ an ϑεωρία [physical or natural
gin
g
theory] or φυσικὴ alone comes to whi be used for the science which treats
ch
ca 12
these objects or discusses this principle.
nn
ot
be
un
der
Clearly the φύσις is something both caused sto (put in motion by the energeia) and
od
as
causative, i.e. efficiently entelechial. We understand a Aristotle’s “science which treats these
su
objects” to be an analog of our physical sciences m but in service of a teleological paradigm.
of
sta
In the introduction of Galen’s On Natural tic Faculties the translator has for the reader’s
par
ts ;
convenience mapped out the “dynamic circuit”: a
co
nst
ant
be
δύναμις ἐνέργεια co ἔργον Wo
mi rk
Wo ng, do
rk ne ne,
to ver fini
be sto she
do ppi d.
ne. ng Pas
11 Scott, ibid., 216. Fut — t
ure at asp
asp lea ect
12 Walter, ibid., 104, 105. st .
ect
. till Str
the uct
ἔργ ure
ον .
is A
rea “th
ch ing
ed. .”
The initiating “future aspect” in the above figure of what one assumes to be a linear

phenomenon is the eyecatcher.13 To reconcile this anomaly Brock mentions that “certain

resemblances between the Galenical and the modern vitalistic views of Henri Bergson may

perhaps be alluded to here” identifying δύναμις as in the likeness of Bergson’s “teleological

aspect.”14 Galen’s term for the “past aspect,” ἔργον ergon15 means literally task, deed, or
labor. In his habit of presenting a sequence of points Galen depicts ἔργον as, for example,

the flesh effected by the creative techne of φύσις, and in the same vain he rationalizes

that “one might, therefore, also speak of the activity [ἐνέρ.] as an effect [ἔργον] of Nature
16
[φύς.].” The significance here is that the ἔργον, an affair of the entelechy-φύσις, is

detrimental to the purpose (sc. the τέλος) of the δύναμις and is therefore entelechial itself.

Hence the circuit metaphor is cleanly extended. Galen seems to advance an Aristotelian

notion in the suggestion that an object, i.e. flesh, contains within it a causative principle of

its own.

It may not be just the diffusion of these foundational ideas of physic that aggravates

the accuracy of their representation in literature and renders such theories perplexing.

There is the incompatibility of the media of modern-day English, stroked as it has been over

the years by the brush of our natural sciences that as a rule depend on the universe being

wholly predictable. Thesauruses that synonymize natural and artless indicate such a cultural

paradigm that would make the paradigm of physic difficult to swallow. We lack the

vocabulary for desultory discussion and rumination on these topics. It takes a bit of thinking

one’s way out of the box by a sort of ἔλεγχος elenchus, the Socratic polemic.
13 The cause and effect of this scenario seems incompatible with that of our physical sciences. A teleological
causality, this sort of attraction to the thing rather than a progression toward it, may be a bit more complicated than
the linear.
14 Galen, Trans. Brock, ibid., xxx.
15 The full textbook definition of ἔργον is LIT. “an employment ; work ; pursuit ; tillage ; agriculture ; economy ;
property ; occupation ; embroidery ; business ; trade ; task ; matter of fact ; subject ; affair ; advantage ; concern ;
operation ; conflict ; war ; exploit ; contest ; work of difficulty ; important action ; a heinous crime ; evil action” : A
Lexicon of the Greek Language, 2nd ed.
16 Cf. Galen, 13. | Note Galen’s signature association of vegetation with φύσις, a demiurgic φύσις.
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