Hippocratic Medicine and the Four Humors

Who was Hippocrates?

Very little is known for certain about the first physician named Hippocrates. The National Library of Medicine (NLM) says there are considered to have been several, all teachers at the medical school on the island of Cos. [1] From the 5th century BCE, the name came to stand for a way of doing medicine. [1]

The NLM says Hippocrates is generally credited with turning away from divine explanations of illness and using observation of the body as a basis for medical knowledge. [1] In this approach, prayers and sacrifices did not hold a central place, while changes in diet, drugs and keeping the body "in balance" were the key. [1] Greek medicine of this period was practiced in an area that included parts of modern Greece, Turkey, Egypt and Italy. [1]

The Hippocratic Corpus

The "Hippocratic Corpus" is the collection of writings attributed to Hippocrates. It holds about sixty works on diagnosis, epidemics, obstetrics, pediatrics, nutrition and surgery. [1] It was written by several authors, probably over several centuries, and different treatises often give contradictory advice. [1] So "Hippocrates said" is usually shorthand for "a text in this collection says."

A modern historical review of the orthopedic writings in the Corpus describes careful accounts of how to reduce fractures and dislocations, and of how broken bones heal. [2] That shows the Corpus held practical observation as well as theory.

The four humors as a traditional framework

In the humoral theory, the body's four fluids (blood, phlegm, yellow bile and black bile) needed to be kept in balance. [1] Illness was thought to arise when they fell out of balance, and treatment might aim to reduce one humor through bloodletting or purging. [1]

This is a traditional explanation. The humors are not substances that medicine has found to behave this way, and the theory should not be treated as biology. Later writers extended it. One historical review notes that Hippocrates, Aristotle and Galen read cancer through the humoral theory, as an excess of black bile. [3] Another says Hippocrates proposed breast cancer was a systemic disease caused by an excess of black bile, and describes the era as one without a scientifically verifiable understanding of cancer or effective treatment. [4]

Why the theory was set aside

The theory faded over a long time rather than in one moment. One historical review says that Harvey's discovery of the circulation of blood in 1628 destroyed the basis of the humoral theory. [3] The NLM adds that European medicine at first accepted Greek theories as dogma, and that scholars later followed the Greeks' own call to observe the body and began to do their own research. [1]

Bloodletting shows the change clearly. A review in the British Journal of Haematology says phlebotomy was practiced for thousands of years, first for unproven indications, causing great suffering. [5] It says evidence-based use came mainly since the nineteenth century and that it was achieved through audit. [5]

What survives, and what does not

One narrow piece of bloodletting has a modern, tested use. For hemochromatosis, an inheritable condition, an Annals of Internal Medicine review states that early diagnosis and therapeutic phlebotomy improve clinical outcomes. [6] That use rests on modern testing and a diagnosed condition, not on humors, and it is done by clinicians. Do not bleed, purge or fast yourself to "rebalance" anything.

Humoral ideas live on as a framework in some living traditions, including Unani medicine. [7] See Unani Medicine and the history of Unani medicine for how that tradition describes them in its own terms. For the wider question of how old use compares with trial evidence, see historical use vs clinical evidence.

Hippocratic Oath: common myths

The Oath is the best-known Greek medical text. The NLM notes that most modern medical schools do not require it and that it does not explicitly contain the phrase "First, do no harm." [1]

If you are unwell

Humoral language is not a way to judge your own symptoms. For new, severe or worsening symptoms, contact a licensed clinician; in a US emergency call 911. See talking with a health professional.

Related pages

Galen and Galenic medicine, Avicenna and the Canon of Medicine, Western herbal traditions and ancient Greek medicine.