Humorism: the ancient doctrine of four bodily fluids, temperament, and treatment

Hippocrates

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 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:

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.