Four humors

The theory holds that the human body is filled with four basic substances, called humors, which are in balance
when a person is healthy. Diseases and disabilities supposedly resulted from an excess or deficit of one of
these four humors. Disease could also be the result of the "corruption" of one or more of the humors, which
could be caused by environmental circumstances, dietary changes, or many other factors. [7]These deficits were
thought to be caused by vapors inhaled or absorbed by the body. The four humors are black bile, yellow bile,
phlegm, and blood. These terms only partly correspond to the modern medical terminology, in which there is no
distinction between black and yellow bile, and in which phlegm has a very different meaning. These "humors"
may have their roots in the appearance of a blood sedimentation test made in open air, which exhibits a dark
clot at the bottom ("black bile"), a layer of unclotted erythrocytes ("blood"), a layer of white blood cells
("phlegm") and a layer of clear yellow serum ("yellow bile"). It was believed that these were the basic
substances from which all liquids in the body were made.
Greeks and Romans, and the later Muslim and Western European medical establishments that adopted and
adapted classical medical philosophy, believed that each of these humors would wax and wane in the body,
depending on diet and activity. When a patient was suffering from a surplus or imbalance of one of these four
fluids, then said patient's personality and or physical health could be negatively affected. This theory was
closely related to the theory of the four elements: earth, fire, water, and air; earth predominantly present in the
black bile, fire in the yellow bile, water in the phlegm, and all four elements present in the blood. [9]
Paired qualities were associated with each humor and its season. The word humor is a translation of Greek
χυμός chymos (literally juice or sap, metaphorically flavor). At around the same time, ancient
Indian Ayurveda medicine had developed a theory of three humors, which they linked with the five Hindu
elements.
The following table shows the four humors with their corresponding elements, seasons, sites of formation, and
resulting temperaments

Humour Season Ages Element Organ Qualities Temperament

Blood spring infancy air liver moist and warm sanguine
Yellow bile summer youth fire gallbladder warm and dry choleric
Black bile autumn adulthood earth spleen dry and cold melancholic
Phlegm winter old age water brain/lungs cold and moist phlegmatic
Blood
The blood was believed to be produced exclusively by the liver. It was associated with a sanguine nature
(enthusiastic, active, and social)

Yellow bile
Excess of yellow bile was thought to produce aggression, and reciprocally excess anger to cause liver
derangement and imbalances in the humors. [

Black bile
The word "melancholy" derives from Greek μέλαινα χολή (melaina kholé) meaning 'black bile'. Excess of black
bile was understood to cause depression, and inversely a decline of feeling or opinion cause the liver to
produce blood contaminated with black bile

Phlegm
Phlegm was thought to be associated with apathetic behavior, as preserved in the word "phlegmatic".[15]
The phlegm of humorism is far from the same thing as phlegm as it is defined today. Nobel laureate Charles
Richet MD, when describing humorism's "phlegm or pituitary secretion" in 1910 asked rhetorically, "...this
strange liquid, which is the cause of tumours, of chlorosis, of rheumatism, and cacochymia—where is it? Who
will ever see it? Who has ever seen it? What can we say of this fanciful classification of humours into four
groups, of which two are absolutely imaginary?" [16]

History
Although advances in cellular pathology and chemistry discredited humoralism by the seventeenth century, the
theory had dominated Western medical thinking for more than 2,000 years. [5][6] Only in some instances did the
theory of humoralism wane into obscurity. One such instance occurred in the sixth and seventh centuries in the
Byzantine Empire when traditional secular Greek culture gave way to Christian influences. Though the use of
humoralist medicine continued during this time, its influence was diminished in favor of religion. [17] The revival of
Greek humoralism, owing in part to changing social and economic factors, did not begin until the early ninth
century.[18] Use of the practice in modern times is pseudoscience.[19]

Origins
The concept of four humors may have origins in Ancient Egyptian medicine[20] or Mesopotamia,[21] though it was
not systemized until ancient Greek thinkers[22] around 400 BC directly linked it with the popular theory of the four
elements: earth, fire, water and air (Empedocles).
Robin Fåhræus (1921), a Swedish physician who devised the erythrocyte sedimentation rate, suggested that
the four humours were based upon the observation of blood clotting in a transparent container. When blood is
drawn in a glass container and left undisturbed for about an hour, four different layers can be seen. A dark clot
forms at the bottom (the "black bile"). Above the clot is a layer of red blood cells (the "blood"). Above this is a
whitish layer of white blood cells (the "phlegm"). The top layer is clear yellow serum (the "yellow bile"). [23]

Greek medicine
Hippocrates is the one usually credited with applying this idea to medicine. One of the treatises attributed to
Hippocrates, On the Nature of Man, describes the theory as follows:
The Human body contains blood, phlegm, yellow bile and black bile. These are the things that make up its
constitution and cause its pains and health. Health is primarily that state in which these constituent substances
are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when
one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with
others.[24]

Although the theory of the four humors does appear in some Hippocratic texts, some Hippocratic writers only
accepted the existence of two humors, while some even refrained from discussing the humoral theory at all.
[25]
 Humoralism, or the doctrine of the four temperaments, as a medical theory retained its popularity for
centuries largely through the influence of the writings of Galen (129–201 AD) and was decisively displaced only
in 1858 by Rudolf Virchow's newly published theories of cellular pathology. While Galen thought that humors
were formed in the body, rather than ingested, he believed that different foods had varying potential to be acted
upon by the body to produce different humors. Warm foods, for example, tended to produce yellow bile, while
cold foods tended to produce phlegm. Seasons of the year, periods of life, geographic regions and occupations
also influenced the nature of the humors formed.
The imbalance of humors, or dyscrasia, was thought to be the direct cause of all diseases. Health was
associated with a balance of humors, or eucrasia. The qualities of the humors, in turn, influenced the nature of
the diseases they caused. Yellow bile caused warm diseases and phlegm caused cold diseases.