Humorism

Humoral pathology (from the Greek-Latin humor: 'moisture', 'bodily fluids', 'bodily fluids'), also known as humoral theory, is a theory of disease developed in antiquity and valid until the 19th century. The correct mixture or composition of bodily fluids is a prerequisite for health, but their imbalance or faulty composition or damage can cause disease.

The basis for this was the (four-)sap theory (also: Vier-Säfte-Lehre, Viererschema), a generally accepted medical concept from antiquity to the 18th century, which was first developed in the Corpus Hippocraticum (including in De aeribus [...] and De natura hominis, "On the Nature of Man"; around 400 BC) to explain general bodily processes and as a concept of disease. After the founding of cellular pathology by Rudolf Virchow in the 19th century, it was scientifically outdated in the etiological and therapeutic ideas in physiology and medicine.

The origins of the four-fluid theory probably already existed in ancient Egypt, but certainly in the elemental theory of Empedocles (490-430 BC). In the 5th century, Zeno of Elea then assigned the primary qualities of hot, cold, moist and dry to the four Empedoclean basic elements of fire, earth, water and air.

Polybos, the alleged son-in-law of Hippocrates, is considered the founder of humoral pathology. The theory was further developed and brought together with ancient ideas by Galen, who combined it with the theory of temperaments. He further subdivided the primary qualities, the excessive or insufficient expression of which can cause disease (for example, too much "cold" or great "heat"), (for example, "moist in the third degree" or - for example, in relation to the rose - "cold in the first degree"). The application of remedies was also based on the primary qualities ("warm/cold", "dry/humid") that had been valid in medicine since Galen until modern times. Thus, in the system of humoral pathology, there are those that should warm, cool, dry or damp and thus counteract the opposite pronounced diseases. Galen wrote down the whole concept in its final form. Galenos' teachings were refined once again in the 11th century by Avicenna in his Canon of Medicine.

According to the humoral pathological concept, yellow bile (cholera, colera), black bile (melancholia, melancolia), blood (sanguis) and phlegm (phlegma, flegma) were assumed to be the life carriers in the body. These four juices (Leibessäfte, also Leibesfeuchten, Latin humores) would thus be spread throughout the body via the blood and also via the nerves. The area of digestion was treated in more detail by the theory of digestion.

Humoral pathology in Hippocrates and Galen

Hippocrates

Primary qualities of the juices
	warm	cold
dry	Yellow bile	Black bile
damp	Blood	Slime

In many writings of the Corpus Hippocraticum (as an author, for example, the Hippocrates student Polybos is mentioned), the idea can be found that the human body contains juices that influence his constitution and his state of health depending on their mixture (Krasis). If the juices are mixed correctly (eucrasia) the person is healthy, a disturbance of the mixture (dyscrasia) means illness. In some scriptures, however, only two humors are mentioned, in others up to five. A basic form of the four-fluid doctrine, which was later formulated by Galen, can be found, for example, in the "Hippocratic" writing On the Nature of Man from the end of the 5th century, which is attributed to Polybos. Polybos or Hippocrates writes: "[...]. The body of man contains within it blood, phlegm, yellow and black bile; they constitute the nature of his body, and because of them he feels pain and is healthy. Now he is healthy especially when these substances in their mutual action and in their quantity have the right proportion and are best mixed [...]." Accordingly, already in Hippocrates, the four juices correspond to four organs, which are considered the "source" of the respective juices. The juices are described by qualities of warmth and moisture (cf. table on the right) and fluctuate with the seasons, so that in each season one juice predominates: Phlegm in winter, Blood in spring, Yellow Bile in summer, and Black Bile in autumn. In addition, we can also find the beginnings of an assignment of the humors to four phases of life, but not yet to the temperaments.

Galen

Galenos of Pergamon (ca. 130-200 AD), who summarized the entire medical knowledge of his time and followed the ideas of the Hippocratics and Aristotle (De gen. et corr. II,3), who had also assigned a primary pair of qualities to each of the elements, wrote down the doctrine of humoral pathology in a systematic form and connected the four humors blood, yellow bile, black bile and phlegm, among others, with the four phases of life and the four (Empedoclean) elements air, fire, earth and water.

The balance of the humours (eucrasia; from Greek eukrasia; Latin bonum temperamentum), which is individually different for each person and, among other things, also dependent on age and season, was, as Polybos had already explained around 400 BC, synonymous with the health of the human being. According to Galen's humoral pathology, diseases arose from disturbances (dyscrasia) of this balance. A dyscrasia could arise from an absence, an excess or a corruption of one or more humors. It is treated by supplying the opposite element: Thus, water extinguishes fire and earth stops wind, i.e., air. Galen emphasized that it was the physician's task to redress an imbalance of the humors by dietetics, medicines, or even surgical measures. In the Hippocratic writings, however, surgery was not yet regarded as a medical discipline, but at best as a manual discipline, as can be seen from the oath. Galen exercised an extraordinary influence into the 19th century, not least because of his rhetorical talent and his convictions.

The great overall scheme of Galen
Item	Body Juice	Primary quality	Color	Taste	Organ	Season	Age	Fever type	Gender
Air	Blood	hot and humid	red	sweet	Heart	Spring	Youth	continuous fevers	(none)
Fire	Yellow Gall	warm and dry	yellow	bitter	Liver	Summer	young man	Tertiana	Male
Earth	Black Gall	cold and dry	black	hot and sour	Spleen	Fall	old man	Quartana	(none)
Water	White Slime	cold and damp	white	Salty	Brain	Winter	Greis	Quotidiana	female

The meaning of the colors and tastes in the Galenic quadruple scheme is later further differentiated by Avicenna (in the 3rd chapter of the 1st treatise of the 2nd book his Canon of Medicine).

Further development to the temperament theory

Galen also assigned temperaments to the four humors. In the philosophical lexicon of Georgi Schischkoff, these are presented as qualities of will and feeling:

Course of will or feeling
	quick	slow
strongly	yellow bile → choleric	black bile → melancholic
weakly	Blood → Sanguine	Mucus → Phlegmatic

Schematic representation of the relationships of elements, cardinal juices, their properties and assignments

Humoral pathology and food culture in the Middle Ages

The medieval understanding of nutrition was largely based on ancient humoral pathology. Humoral pathology thus strongly influenced food culture in the Middle Ages. Foods were classified as "hot" or "cold" and "moist" or "dry." Skilled cooks were expected to combine foods so that these characteristics balanced and complemented each other. In this way the humors of the body were kept in harmony. Cholerics were advised not to over-season their foods. Spices were considered hot and dry and thus support the characteristics of the choleric person. Cholerics who add too much fire are more likely to risk a "heart attack" according to humoral pathology. Fish is "cold" and "moist" and should be prepared in a way that was "drying" and "heating" such as deep frying or baking in the oven, fish seasonings should be "hot" and "dry". Juniper berries have drying and heating properties. Beef is "dry" and "hot" thus "fiery". It is cooked accordingly in water to prevent excess fire. Salads are "cold and moist" foods and add a balancing amount of water. Pork, which is lighter in color, is cooler than beef and "moist" and is better roasted over an open fire; fire is supplied by the method of preparation.

Where medieval recipe collections make suggestions for the use of alternative ingredients, they occasionally give more weight to the classification of foods in humoral pathology than to their taste. Medieval physicians were always at the same time nutritional therapists. The ideal foods were those which were classed as warm and moist, that is, which in the main supplied air element to man. The air element primarily antagonizes the earth element; since very many diseases arise from an excess of earth, of black bile, such a diet is primarily health-promoting. The particular suggestions used to be still adapted to the special needs of the consumer by means of side dishes. The particular dishes should be finely chopped or pureed to achieve a good mixing of ingredients. One dish that ideally met this requirement was blanc manger, which was eaten by the middle and upper classes throughout most of Europe until well into modern times: Chicken breasts were cooked together with rice flour, lard and sugar in a mass of crushed almonds and then pounded and pureed into a paste.