Ancient Theory of Elements and Humors

In ancient times many physicians based their medical practices on their theory of bodily humors or fluids. In the classic form of the theory physicians regarded health as depending upon the balance of four humors in the body: blood, phlegm, yellow bile (choler) and black bile. Blood was the source of vitality, choler or yellow bile was the gastric juice crucial for digestion, phlegm was a lubricant and coolant, and black bile functioned to darken other fluids.

Hippocrates (460-377) who was one of the originators of the theory of humors, made analogies between these humors and the four elements of external nature. The theory of elements he drew from began with Empedocles (490-430).  Empedocles theorized that everything in the world is made up of four basic elements: fire, air, water, earth. He called these four elements "roots", and associated each with Greek gods Zeus, Hera, Nestis, and Aidoneus. This theory of the four elements became a standard cosmology for the next two thousand years.

Hippocrates’ humors also corresponded to personality types or temperaments of individuals. Each individual was seen to have a unique natural balance or makeup of humors and qualities. A person whose temperament is based on blood is filled with energy. The result is a sanguine personality. Someone with a yellow bile temperament is bilious and choleric, showing a predilection toward anger. A melancholic temperament comes from an abundance of black bile resulting in a predilection toward introspection and sentimentality. And a phlegmatic or passive, calm temperament is associated with an excess of phlegm. Certain temperaments were thought to make one more susceptible to certain diseases, especially if the humors were out of balance.

Weather, temperature, and seasons were thought to influence the balance of humors and in so doing caused different kinds of illnesses. The cold in winters lowered body heat causing phlegm to be produced. This additional phlegm resulted in colds and coughs. In the summer people got hot, resulting in more bile, which in turn caused diarrhea and vomiting. Mania also occurred in summers and was seen as due to bile boiling in the brain.

Elements Seasons Qualities Humors Illness/Symptoms Temperament
Fire Summer Hot-dry Yellow bile Fever, Vomiting, Yellow skin Choleric
Earth Autumn Cold-dry Black bile Dry skin, Vomiting Melancholy
Air Spring Hot-moist Blood Dysentery/Nose bleeds Sanguine
Water Winter Cold moist Phlegm Sneezing/colds Phlegmatic

Nutrition, too, was seen as affecting the balance of these four bodily fluids or humors. Poor diets could result in the body producing too much blood creating sanguineous disorders associated with fever. This may in turn result in a seizure, an apoplectic fit, or mania. Dietary deficiencies could result in blood deficiencies, reducing vitality and leading to fainting, coma and even death.

The four major fluids accounted for various physical features of the body: temperature, color, and skin texture. Blood makes the body hot and wet. Choler or yellow bile was gastric juice. It serves digestion and makes the body hot and dry. Phlegm, a fluid that made up the colorless secretions of the body results in a cold and wet body and serves as a lubricant and coolant. Black bile or melancholy, was a dark liquid almost never found in pure form. Bile caused other fluids to darken such as when the blood, skin, or stools become black. It produced a cold and dry body.

Hippocrates theorized that humors were set in motion inner air and innate heat. They traveled through the veins to different organs of the body. The blood vessels carried air, foodstuffs, and humors. If the crude or morbid foodstuffs did not get digested, or if the inner air became blocked at a specific organ, the humors became unbalanced causing disease.

The role of the physician who followed humor theory was to restore a balance to an imbalanced system. By carefully examining the patient, for instance by looking at his or her urine, inspecting the feces, listening to the patient’s breathing, and asking questions, a doctor could discover whether the humors were in balance. If they were not, the doctor worked to restore the proper balance and remove excess humors. A patient, for example, might be made to vomit, might be heated or cooled, blood might be removed from their body (bloodletting), or their bowels might be purged.

Blood letting, a common practice was done with bleeding cups. A bleeding cup was heated and placed over a scratch. The warmth drew blood to the surface of the skin and out through the scratch. Doctors used bleeding in the spring and summer, when it was thought that people had too much blood. They determined this from observation that people often became hot and red in the summer.

Other humor-based preventions and remedies included dietary changes. For example, to eliminate the excess of blood in the spring, when the weather got hot, people were advised to lower blood-rich foods like red meat.

Humor theory was used by physicians to account for, to diagnose, and to treat speech problems. Speech problems were regarded as humoral disequilibrium. For example, stuttering was due to dryness of the tongue. In this case, Hippocratic physicians prescribed blistering substances to drain away the black bile that they thought were responsible for the dryness.

References on humor theory

Arikha, Noga (2007). Passions and tempers: A history of the humours. NY: HarperCollins.

Finney, G. (1966). Medical theories of vocal exercise and health. Bulletin of the History of Medicine, 5, 395-406.

Mazzio, Carla (2009). The inarticulate renaissance: Language trouble in an age of eloquence. Philadelphia: University of Pennsylvania Press.

Nutton, V. (2005) The fatal embrace: Galen and the history

of ancient medicine. Science in Context, 18, 1, 111-121.

Wollock, J. (1997). The noblest animate motion: Speech physiology and medicine in pre-Cartesian linguistic thought. Philadelphia: John Benjamins Publishing Co.

See the following website table for today’s manifestations of humor theory: Retrieved March 1, 2010.