These days, when we visit a doctor and get prescribed medications, the general concept is that the medications will help to rebalance our systems and return them to normal. While our modern medical practices may differ far from that of the ancient Greeks and Romans, the idea of rebalancing is not so different from what the ancient civilizations believed.
In the times of ancient Greece and Rome, the concept of humorism was used as the main approach to medicine. Physicians believed that the four humors were the metabolic agents of the four elements, and that one had to maintain the right balance of these four humors in their body to obtain perfect health.
It is unknown as to where and when exactly the concept of humorism originated. One of the earliest writings was that of the medical theorist Alcmaeon of Croton in the 6th century BC, detailing a list of more than four humors and associating each with an element, such as earth, air, fire and water. Some believe that the concept of humors predates that to perhaps ancient Egyptian times, although it is generally acknowledged that Greek thinkers were the first to systemize the concept. There was also a similar concept in ancient Indian medicine long before the Greeks, which mentioned three humors linking to the five Hindu elements.
The word “humor” originates from the Greek chymos, which means juice or sap, or flavor in metaphor. Humorism as it was used in medicinal applications can be largely attributed to the work of Hippocrates, who suggested that the humors are the vital bodily fluids, an imbalance of which may be a sign that one is ill.
What are the Four Humors?
The four humors are namely blood, phlegm, yellow bile and black bile, said to be present in the bloodstream of every person in varying quantities. Blood was the Sanguine humor and represented the red, hemoglobin-rich portion of one’s blood. Phlegm, also called the Phlegmatic humor, was the clear plasma portion of the blood. Yellow bile, the Choleric humor, was a residue with a slight yellowish tint. Black bile, the Melancholic humor, was a brownish grey sediment of platelets, normally present in clotting. It is believed that the “black bile” referred to by Hippocrates was the blood composites of those who had internal bleeding.
Hippocrates wrote that the four humors must be in correct proportion to each other, both in strength and quantity, and they must be well mixed. If there was a deficiency or an excess of any one humor, or if one was separated in the body and not mixed with others, then pain would occur.
The four humors were believed to originate in the digestive process. Greek medicine taught that digestion happened in four stages: the first stage, gastric digestion, happened in the gastrointestinal tract, producing chylous and the waste product of stools. The second stage, hepatic digestion, took place in the liver, producing the four humors and eliminating waste products via the bile, sweat and urine. The third stage, vascular digestion, happened in the blood vessels, where nutrients would be fed to the rest of the body and the waste products would be eliminated by sweat and urine. The fourth and last stage of digestion, tissue digestion, happened in the tissues, causing the four humors to become living tissue and eliminating its waste products similarly by sweat and urine.
Moreover, the four humors would be formed in the liver during the second stage of digestion according to a special order. Blood was formed first, receiving the richest share of nutrients and thus being the most plentiful humor. Phlegm would be formed next, receiving the second most abundant share of nutrients. Yellow bile would be formed third, and unlike blood and phlegm which entered the body’s circulation, would mostly be stored in the gall bladder to be used as needed. Black bile was the last to form and would receive the least share of nutrients. An even slighter amount of it would enter the body’s circulation, with the rest being stored in the spleen.
If anything went wrong in the digestive process, the production of humors would potentially become abnormal since the chylous produced by gastric digestion would be abnormal and unable to be converted to normal chylous. As such, people believed that it was important to eat good food and have a healthy stomach and liver.
Humorism was widely written about in the ancient civilization, but it appears that in Hippocrates’ time, the concept of humorism was not of great influence. Some people only believed in the existence of two humors, while others did not discuss humorism at all. It was mostly through the writings of Galen in the 2nd century AD that the four humors took root and gained popularity in medicinal use.
Effect of the Humors on Health
Since it was believed that the humors had to be well balanced for one to be in good health, if an individual was sick, the physicians believed that the person’s humors were imbalanced – a condition called dyscrasia. On the converse, if someone was healthy, they were said to have eucrasia.
The qualities of the humors were said to influence which diseases a person would be afflicted with if they were out of balance. For instance, yellow bile would cause warm diseases and phlegm would cause cold diseases.
Galen thought that humors were formed internally in the body, but that it was possible to influence the production of humors by eating certain foods. He wrote that warm foods would have a tendency to produce yellow bile, while cold foods had a tendency to produce phlegm. The proportion of the formation of one’s bodily humors would also vary depending on the season of the year, period of life, geographic region and occupation.
More Than the Bloodstream
The ancient Greeks and Romans also believed the four humors to represent one’s personality. Hippocrates suggested that one’s temperament or behavioral type was caused by a moderate imbalance in the mixture of humors.
In his writing, Galen also identified four temperaments, each where one of the humors was said to be predominant. It is worth nothing that the definition of temperament was different in that time than it is now. While temperament usually refers to psychological disposition in modern usage, it was used in the past to refer to bodily dispositions in addition to psychological disposition. This meant that people who were more inclined to behave or feel a certain way were usually associated with being more susceptible to the same type of disease or ailment.
As such, if there was a deficiency or an excess of any particular humor, both the person’s personality and physical health were thought to be negatively affected.
In modern medicine, the concept of humorism has largely been criticized and abandoned. However, there are still remnants of the medical concept that had dominated the Western world for over two millennia. Modern medicine uses the term “humoral immunity” or “humoral regulation” to describe substances circulating in the bloodstream that require balance, such as antibodies and hormones. Additionally, the term “blood dyscrasia” is used to refer to any blood disease or abnormality.