Belief in the Four Humors Continues


The four humors and the importance of keeping them in balance
in order to maintain good health was the most influential of the
theories that were passed down from the Greeks and Romans; it
was actually a dominant factor in medicine until the 19th century.
A physician or healer was to assess the basic composition of each
sick person and then establish a method to rebalance the patient’s
humors for better health. The factors that could affect humoral
balance ranged from diet and the environment to the position of
the stars.

The humors that constituted this theory were blood, phlegm,
yellow bile, and black bile, and each had a very specific influence
on the body noted as follows:
Blood: The qualities of this humor were hot and wet, and
people who fell within this category were thought to be
sanguine (in Latin sanguis means “blood”) or have hopeful
personalities. People who were thought to be dominated
by this humor had ruddy, healthy complexions and
were considered cheerful, warm, and generous. Medieval
books usually portrayed a nobleman in this category
because the ideal nobleman was expected to possess these
qualities.
Phlegm: The qualities of a person who was categorized as
being dominated by phlegm were cold, wet, and slow to
anger but also sluggish and dull. Generally speaking,
phlegmatic people were considered detached and cool,
and in medieval times it was the merchant who best fit
this category.
Yellow bile: The qualities related to yellow bile were hot
and dry. An excess of yellow bile (choler) was thought
to make a person irritable. Thin people were categorized as choleric because of being in a state of constant agitation.
Knights were frequently the symbols of those with
yellow bile.
Black bile: Cold and dry were the elements related to black
bile. The person with too much black bile was gloomy,
depressed, and melancholy (this word is derived from
the Greek words melanos meaning “black,” and chole
meaning “bile”). The person with black bile was usually
cowardly, pale, and covetous of others. The pasty-faced
scholar was generally the symbol of this personality.
Galen’s analytical system for assessing and balancing the four
humors became a lasting part of medical teachings: For example,
too much phlegm caused lung problems, so physicians needed to
find ways to rid the body of phlegm. These adjustments were usually
achieved through diet, medicines, and bloodletting. Galen also
taught that each humor connected with two of the four primary
qualities of hot, cold, wet, and dry. To restore the balance of the
humors, he recommended a system of opposites. Fever was treated
with something cold, weak people were given difficult exercises
to build up strength, and those with chest weakness were told to
perform singing exercises, for example.
Galen differed from Hippocratic practice in one aspect of treatment:
While Hippocrates felt that balance needed to be achieved in
the body overall, Galen introduced the concept that balance could
be reached organ by organ. This allowed physicians to develop
organ-specific remedies, and this philosophy had a powerful influence
on medicine.
To devise ways to maintain humoral balance, a physician or
healer needed to maintain an almost encyclopedic understanding
of how various aspects of life were categorized. Food, weather
conditions, the seasons, and what people wore were all thought to
affect humoral balance. For example, wool clothing was identified
as warm and dry; winds from the north were classified as quite
cold and somewhat dry. Spring was viewed as moist, and winter
was cold.
While much of this belief
offered very little in the way
of the power to heal, most of
it was harmless, and occasionally
it was helpful because the
method encouraged preventive
health care. The followers
of the humoral theory did
not like waiting for a person to
get sick and then deal with it.
They viewed good health as an
ongoing effort that needed to
be tended to regularly. Medical
advice usually included recommendations
on diet, bathing
(in hot, warm, or cold water,
depending on the physician’s
diagnosis of the patient’s humoral balance), proper environment,
rest, and exercise. The dietary recommendations may have promoted
better health simply by introducing greater variety into the
diet, and being reminded to wear warm and dry, heavy clothing
when the north wind blew was not a bad thing. Though medieval
people were seriously misguided about much of their knowledge
concerning the workings of the body and the way the human body
fights off disease, some of the early efforts at maintaining good
health were steps in the right direction.
The humoral theory included the use of certain medications,
and these were usually compounded from vegetable matter, most
commonly from herbs. (For more information on this, see chapter
3, “Diagnosis and Treatment.”)

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