Claudia De Rosa
I do anatomize and cut up these poor beasts, he said to Hippocrates, to see the cause of these distempers, vanities, and follies, which are the burden of all creatures. – Democritus, from The History of Melancholy
When today’s doctor prescribes an antibiotic to fight infection, he is trying to put the patient’s body back in balance. While the drugs and medical explanation may be new, this art of balancing bodily fluids has been practiced since Hippocrates‘ day. In the Hippocratic corpus (believed not to be the work of a single man of that name) disease was thought to be caused by isonomia, the preponderance of one of the 4 bodily humors:
- Yellow Bile
- Black Bile
Four humors matched the four seasons
- Autumn: black bile
- Spring: blood
- Winter: phlegm
- Summer: yellow bile.
(See: Hippocratic Diseases by Season)
Each of the humors was associated with one of the four equal and universal elements (earth, air, fire, and water) posited by Empedocles:
Aristotle, who used the image of wine to expose the nature of black bile. Black bile, just like the juice of grapes, contains pneuma, which provokes hypochondriac diseases like melancholia. Black bile like wine is prone to ferment and produce an alternation of depression and anger…. -From The History of Melancholy
- Earth: black bile
- Air: blood
- Fire: yellow bile
- Water: phlegm
Too much earth made one melancholic; too much air, sanguine; too much fire, choleric; and too much water, phlegmatic.
Too much Earth: Melancholic
Too much Air: Sanguine
Too much Fire: Choleric
Too much Water: Phlegmatic
Finally, each element/humor/season was associated with certain qualities. Thus yellow bile was thought of as hot and dry. Its opposite, phlegm (the mucus of colds), was cold and moist. Black Bile was cold and dry, while its opposite, blood was hot and moist.
Black Bile: Cold and Dry
Blood: Hot and Moist
Phlegm: Cold and Moist
Yellow Bile: Hot and Dry·
As a first step, the prudent Hippocratic physician would prescribe a regimen of diet, activity, and exercise, designed to “void the body of the imbalanced humor.” According to Gary Lindquester’s “History of Human Disease,” if it was a fever — a hot, dry disease — the culprit was yellow bile. So, the doctor would try to increase its opposite, phlegm, by prescribing cold baths. If the opposite situation prevailed (as in a cold), where there were obvious symptoms of excess phlegm production, the regimen would be to bundle up in bed and drink wine.
If this didn’t work the next course would be with drugs, often hellebore, a potent poison that would cause vomiting and diarrhoea, “signs” the imbalanced humor was eliminated.
We might assume such Hippocratic ideas sprang from speculation rather than experimentation, but observation played a key role. Furthermore, it would be simplistic to say ancient Greco-Roman doctors never practiced human dissection. If nothing else, doctors had anatomical experience dealing with war wounds. But especially during the Hellenistic period, there was extensive contact with the Egyptians whose embalming techniques involved removing bodily organs. In the third century B.C. vivisection was permitted in Alexandria where living criminals may have been put to the knife. Still, we believe Hippocrates, Aristotle, and Galen, among others, only dissected animal bodies, not human.
So man’s internal structure was known primarily through analogy with animals, inferences from the externally visible structures, from natural philosophy, and from function.
Such ideas might seem far-fetched today, but Hippocratic medicine was a great advance over the supernatural model that had preceded it. Even if individuals had understood enough about contagion to realize rodents were involved somehow, it was still the Homeric Apollo, the mouse god, who caused it. The Hippocratic aetiology based on nature permitted diagnosis and treatment of symptoms with something other than prayer and sacrifice. Besides, we rely on similar analogies today, in Jungian personality types and ayurvedic medicine, to name two.
These men demonstrated that when the nutriment becomes altered in the veins by the innate heat, blood is produced when it is in moderation, and the other humours when it is not in proper proportion. -Galen On the Natural Faculties Bk II
In traditional medicine practiced in Greco-Roman civilization and in Europe during the Middle Ages (at least until the Renaissance), humorism, or humoralism, dictated that the four humours were special fluids associated with the four basic elements of nature, that were thought to permeate the body and influence its health. An imbalance in the distribution of these fluids was thought to affect each individual’s personality. The concept was developed by ancient Greek thinkers around 400 BC and was directly linked with another popular theory of the four elements (Empedocles). Paired qualities were associated with each humour and its season.
The four humours, their corresponding elements, seasons and sites of formation, and resulting temperaments alongside their modern equivalents are:
It is believed that Hippocrates was the one who applied this idea to medicine. “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 (131-201 AD) and was decisively displaced only in 1858 by Rudolf Virchow’s newly-published theories of cellular pathology. While Galen thought that humours 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 humours. 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 humours formed.
The imbalance of humours, or “dyscrasia”, was thought to be the direct cause of all diseases. Health was associated with a balance of humours, or eucrasia. The qualities of the humours, in turn, influenced the nature of the diseases they caused. Yellow bile caused warm diseases and phlegm caused cold diseases.
In On the Temperaments Galen further emphasized the importance of the qualities. An ideal temperament involved a balanced mixture of the four qualities. Galen identified four temperaments in which one of the qualities, warm, cold, moist and dry, predominated and four more in which a combination of two, warm and moist, warm and dry, cold and dry and cold and moist, dominated. These last four, named for the humours with which they were associated that is, sanguine, choleric, melancholic and phlegmatic, eventually became better known than the others. While the term “temperament” came to refer just to psychological dispositions, Galen used it to refer to bodily dispositions, which determined a person’s susceptibility to particular diseases as well as behavioural and emotional inclinations.
The four temperaments (Clockwise from top right; choleric; melancholic; sanguine; phlegmatic).
Sanguine indicates the personality of an individual with the temperament of blood, the season of spring (wet and hot), and the element of air. A person who is sanguine is generally optimistic, cheerful, even-tempered, confident, rational, popular, and fun-loving. They can be daydreamy to the point of not accomplishing anything and impulsive, acting on whims in an unpredictable fashion. This also describes the manic phase of a bipolar disorder.
Choleric corresponds to the fluid of yellow bile, the season of summer (dry and hot), and the element of fire. A person who is choleric is a doer and a leader. Many great charismatic, military and political figures were cholerics. On the negative side, they are easily angered or bad tempered.
In folk medicine, a baby referred to as “cholic” is one who cries frequently and seems to be constantly angry. This is an adaptation of “choleric,” although no one now would attribute the condition to bile. Similarly, a person described as “bilious” is mean-spirited, suspicious, and angry. This, again, is an adaptation of the old humour theory “choleric.”
The disease Cholera gained its name from choler (bile).
Melancholic is the personality of an individual characterized by black bile; a person who was a thoughtful ponderer had a melancholic disposition. Often very kind and considerate, melancholics can be highly creative – as in poets and artists – but also can become overly obsessed on the tragedy and cruelty in the world, thus becoming depressed. It also indicates the season of autumn (dry and cold) and the element of earth. A melancholy is also often a perfectionist, being very particular about what they want and how they want it in some cases. This often results in being unsatisfied with one’s own artistic or creative works, always pointing out to themselves what could and should be improved.
This temperament describes the depressed phase of a bipolar disorder.
A phlegmatic person is calm and unemotional. Phlegmatic means pertaining to phlegm, corresponds to the season of winter (wet and cold), and connotes the element of water.
While phlegmatics are generally self-content and kind, their shy personality can often inhibit enthusiasm in others and make themselves lazy and resistant to change. They are very consistent, relaxed, and observant, making them good administrators and diplomats. Like the sanguine personality, the phlegmatic has many friends. But the phlegmatic is more reliable and compassionate; these characteristics typically make the phlegmatic a more dependable friend.
Within an individual, the phlegmatic personality is considered to be compatible with the sanguine and melancholic traits — the melancholic personality is too perfectionist, and the choleric is too controlling. Combinations of two incompatible traits may be evidence of masking.
When the theory of the temperaments was on the wane, many critics dropped the phlegmatic, or defined it purely negatively as the absence of temperament. This, however, made it available for the German philosopher Immanuel Kant to reclaim as the temperament appropriate to freedom and virtue. In five-temperament theory, the classical Phlegmatic temperament is in fact deemed to be a neutral temperament, whereas the “people-liking introvert” position traditionally held by the Phlegmatic is declared to be a new “fifth temperament”
Methods of treatment like blood letting, emetics and purges were aimed at expelling a harmful surplus of a humour. They were still in the mainstream of American medicine after the Civil War. Other methods used herbs and foods associated with a particular humour to counter symptoms of disease, for instance: people who had a fever and were sweating were considered hot and wet and therefore given substances associated with cold and dry.
There are still remnants of the theory of the four humours in the current medical language. For example, we refer to humoral immunity or humoral regulation to mean substances like hormones and antibodies that are circulated throughout the body, or use the term blood dyscrasia to refer to any blood disease or abnormality. The associated food classification survives in some apparently illogical adjectives that are still used for food, as when we call some spices hot and some wine dry. When the chilli was first introduced to Europe in the sixteenth century, dieticians disputed whether it was hot or cold.
The theory was a modest advance over the previous views on human health that tried to explain in terms of the divine. Since then practitioners have started to look for natural causes of disease and to provide natural treatments.
A few psychologists use the four-temperament model even today, some also recognizing twelve mixtures of the four temperaments: Mel-Chlor, Chlor-San, San-Phleg, Phleg-Mel, Mel-San, Chlor-Phleg; and the reverse of these: Chlor-Mel, San-Chlor, Phleg-San, Mel-Phleg, San-Mel, and Phleg-Chlor. These represent people who have the traits of two temperaments. The order of temperaments in these pairs was based on which temperament was the “dominant” one (this is usually expressed by percentages). A person can also be a blend of three temperaments.
In Steiner (Waldorf) education and anthroposophy, the temperaments are used to help understand personality. They are seen as avenues into teaching, with many different types of blends, which can be utilized to help with both discipline and defining the methods used with individual children and class balance. The Unani school of Indian medicine, still apparently practiced in India, is very similar to Galenic medicine in its emphasis on the four humours, and in treatments based on controlling intake, general environment, and the use of purging as a way of relieving humoral imbalances.
Mappa mundi’s applications to homeopathy
Hahnemann was the first physician to fully integrate into medicine the innate constitution, the spiritual, mental and emotional temperament, the instinctive vital force, inheritance, predispositions, single and multiple causations, susceptibility, infection, acute and chronic miasms as well as the complete objective signs, coincidental befallments and subjective symptoms. Hippocrates is normally thought of as the father of constitutional medicine but Hahnemann brought this study to its perfection in Homoeopathy.
The healthy state represents a harmonious tuning of all vital operations (§9). Disease is the mistuning of this harmonious tone by a dissonant dynamic influence (§11). It is the disease-tuned life force that manifests as the essence of the disease-Gestalt through the totality of the symptoms (§12). Homoeopathic remedies cure through their power to similarly alter the tuning of the human condition (§19). The primary action of a homoeopathic remedy over-tunes the disease and elicits a secondary healing response that retunes to the state of harmonious health. This is the Esse of Hahnemann’s treatment method.
The Spiritual-Bodily Organism
Throughout Hahnemann’s writings he uses the phrases, the unity of life, the complete whole, laws of the organic constitution, our living human organism, the bodily constitution, temperament, the make-up of the body & soul, the spiritual-bodily organism, etc.
In the German text Hahnemann used the term, beschaffenheit (make up), which is usually translated into English as the word “constitution”. This, however, does not reflect all the usages of the German term. This term can be used in a variety of ways that have nothing to do with the human constitution. The root word “schaffen” means “to do, to make, to work”. Beschaffen is a verb that means, “to procure, make something available”, and as an adjective it means, “constituted”.
In Aphorism 81 of the German Organon Hahnemann uses the term “angebornen Koerper-Constitutionen”, which means the congenital bodily constitution. The genetic constitution represents the essence of the paternal and maternal lineages. This represents the inherited diathetic constitution and temperament including all its predispositions. The interdependence of the mind/body constitution is as inseparable as the link between the essential nature and the instinctive vital force. One does not appear without the other. Such relationships are called functional polarities and complementary opposites. This bipolar phenomenon is innate in nature.
Homoeopathy views the spiritual-bodily organism as a highly potentized essential being with spirit, mind, vital force and body. This synergy of natural forces composes a whole human being, which is more than the sum of its parts. Hahnemann integrated the ancient Hippocratic teachings on temperaments, physis, diathetic constitutions and miasms into Homeopathy and brought them up to date for his time. References to this subject can be found throughout Hahnemann’s writings and the Paris casebooks.
Although modern Homoeopathy has greatly expanded the psychological aspects of our materia medica few persons understand how Hahnemann used the terms constitution and temperament and their practical ramifications in the clinic. To appreciate this material the homoeopath must be familiar with the medical history of the vitalist lineage and its greatest practitioners as well as Hahnemann’s original works. This dynamic view of mind/body constitution has its roots in Pythagoras, its trunk in Hippocrates, its branches in Paracelsus, and its fruit in Hahnemann. This fruit carries the seeds for a new generation of healers and will be part of De Medicina Futura.
Samuel Hahnemann used temperamental portraits that include both positive natural qualities during the time of health compared with the negative changes brought on by diseases. He utilized such constitutional information within the totality of symptoms when prescribing his homoeopathic remedies. The Hofrath gives a complete portrait of Pulsatilla in the *Materia Medica Pura, 3rd edition, 1833, page 345. This example includes the use of classical temperaments.
“The employment of this, as of all other medicines, is most suitable when not only the corporeal affections of the medicine correspond in similarity to the corporal symptoms of the disease, but also when the mental and emotional alterations peculiar to the drug encounter similar states in the disease states to be cured, or at least in the temperament of the subject of treatment.
Hence the medicinal employment of Pulsatilla will be all the more efficacious when, in affections for which this plant is suitable in respect to the corporeal symptoms, there is at the same time in the patient a timid lachrymose disposition, with a tendency to inward grief and silent peevishness, or at all events a mild and yielding disposition, especially when the patient in his normal state of health was good tempered and mild (or even frivolous and good humouredly waggish) It is therefore especially adapted for slow phlegmatic temperaments; on the other hand it is but little suitable for persons who form their resolutions with rapidity, and are quick in their movements, even though they may appear to be good tempered.
Hahnemann’s picture includes attributes of the natural constitution (timid lachrymose disposition, slow phlegmatic temperament), positive natural traits during a time of health and happiness (good tempered, mild, good humouredly waggish) and negative emotions brought on by disease (inward grief, silent peevishness). This portrait includes natural, positive and negative qualities. As one can see from the above quotes this information was included within the totality of the symptoms.
Pulsatilla is “adapted for slow phlegmatic temperaments”, while on the other hand it is less suitable for those who “form resolutions with rapidity’ and are “quick in their movements”. Such data establishes constitutional portraits as well as the use of temperamental counter indications as elimination rubrics. Pulsatilla is rarely indicated in those constitutions that make quick resolutions or move rapidly because this remedy does not normally suit that type of patient. This temperamental picture demonstrates several of the essential elements of the Pulsatilla proving. This demonstrates that Hahnemann was the first to open the field of investigation into constitution and temperament in Homoeopathy.
Physiognomy and Temperaments
The use of Hippocratic temperaments (choleric, phlegmatic, sanguine and melancholic) expands the study of constitution in Homoeopathy because it includes physiognomy and the natural groupings of human beings into four major and twelve minor mind-body types. This 2, 500 year old system is the oldest living tradition in western medicine. These classical methods offer much insight into the nature of the innate constitution and temperament as well as potential diathesis toward particular signs, befallments and symptoms. Physiognomy is defined as:
“Physiognomy, the art of judging character from the appearance, esp., from the face; general appearance of anything; character, aspect-Greek- physiognomy, a shortened form of physiognomoni-physis, nature, gnomon-onos, an interpreter.”
A homoeopathic physiognomist is an interpreter of natural temperament, heredity, predisposition, miasms and constitutional diathesis, as well as the present state of the spirit, mind and body. Let us look at the definition of the key terms, temperament, and constitution. What does temperament mean? The word temperament has different levels of meaning depending on usage.
Temperament from Latin, temperare; to temper, restrain, compound, moderate.
Temperament means a state with respect to a predominance of qualities; an internal constitutional state; a natural disposition; a proportioned mixture of qualities. Specifically it refers to the Hippocratic temperaments, the choleric or bilious, phlegmatic, sanguine and melancholy constitutions.
Temper-noun; a mixture or balance of contrary qualities; the constitution of the body and/or mind; a natural temperament; an innate or acquired disposition; a frame of mind; a mood; composure; to exert self control; to be uncontrolled, a fit of anger.
Temperament is also a musical term for a system of compromise in tuning. An equal temperament is a system of tuning by which the octave is divided into twelve equal intervals. The octave is a system of eight notes that make up the major or minor scale. The twelve note series of tones is called the chromatic scale.
Constitution, temperament, the spiritual body organism, the make up of the soul and body are synonyms for the living whole represented by a complete living human being. It is interesting to see that these major terms also have musical definitions. Even the word ‘organism’ is an archaic name for a musical instrument. The organism (musical instruments) supports the temperament (division of 12 notes of the chromatic scale-natural qualities), which is tuned (German-stimmung-tuning, voice, pitch and mood) by the vital force.
Disease is the mistunement (verstimmung) of the life force that causes disharmony in the temperament (the scale of notes -the natural qualities) of the organism (the instrument). Is this the Odes of Pythagoras and the theory of life as music? After all, Pythagoras introduced the 7 note major scale (diatonic scale), the five elements (ether, air, fire, water, earth) and the Mappa Mundi (geometric map of the macro & microcosm)) into western culture. These hold the keys to understanding the complete system.
The four major constitutions are called the choleric, phlegmatic, sanguine and melancholic or nervous temperaments. The twelve minor types are mixtures of the major type. They are the cholero-phlegmatic, the sangino-phlegmatic, the nervo-phlegmatic, the phlegmo-choleric, the sanguino- choleric, nervo- choleric, the cholero-sanguine, the phlegmo-sanguine, and the nervo-sanguine, the cholero-nervous, phlegmo-nervous and sanguino-nervous. Each of these temperaments represents a natural grouping of constitutional types that have similar mental and physical qualities.
When temperament is used in a general way it means the mental and emotional disposition, state, mood, composure, etc. There are other references to disposition and temperament in Hahnemann’s writings.
When temperament is used specifically it means the Hippocratic constitutional temperaments, the choleric, phlegmatic, sanguine and nervous melancholic. Hering expanded this temperamental portrait by adding the names of the Hippocratic temperaments and physical descriptions of the patient in the portrait. The source of this information is the observation of the Hippocratic temperaments during the provings and recording which constitutions developed the most characteristic symptoms. This was then combined with clinical confirmations in patients under treatment. Hering created a separate section for constitution and temperament in his materia medica called Stages of Life and Constitution.
In Hering’s 5-point system of grading remedies II (5) is the highest grade, I (4) is the second grade. We find similar rubrics in Allen’s Keynotes under the title “adapted to”. Allen includes temperaments, miasmic tendencies, diathetic constitutions and symptoms in these rubrics. These are all constitutional general rubrics.
The above rubrics are an extension of Hahnemann’s original portrait of Nux Vomica. This temperamental portrait includes natural temperament (bilious, choleric, melancholic, nervous dispositions with their traits), diathetic constitutions (melancholic with venous constitution), mental rubrics (angry, spiteful, impatient, etc), physical descriptions (thin, dark hair), lifestyle (sedentary or great mental exertion), habits, (addicted to wine, coffee, drugs), as well as predispositions to regional symptoms (tendency to hemorrhoids, indigestion, hepatic affections). On this constitutional basis the signs, befallments and symptoms are further investigated for those rubrics that are strange, rare and peculiar to the individual organism (Org. §5.6.7). To utilize this method completely one must understand the teachings of Hippocrates as well as Hahnemann, Boenninghausen and Hering.
Hering’s proving collection and his clinical confirmations are the source of constitutional characteristics such as: Nux Vomica is well adapted to angry, irritable, dark, thin, dry, bilious, choleric persons; Pulsatilla is well adapted to gentle, blond haired, blue eyed phlegmatic temperaments; Phosphorus is well adapted to tall slender persons of sanguine temperament, fair skin, delicate eyelashes, fine, blond or red hair, with quick perceptions, and very sensitive nature; Arsenicum is well adapted to the over anxious, chilly, nervous anxious temperaments. Such symptoms do not automatically lead to remedies by themselves, as they are only part of the totality of the symptoms.
The mappa mundi of phosphorus
VISION: ‘Love my light’
ESSENCE: the bearer of light, conversation, sympathy and affection. Sensitive to you so you are to them. Love me, care for me.
Signature: Phosphorus is the second element in the fifteenth group of the periodic table. It is an essential element for life, necessary in the transfer of energy. Phosphorus ignites into colour flames (entertains and warms).
MAPPA MUNDI: Sanguine, open, fire: Phosphorus is a warm and open, chatting to everyone, seeking to please and be pleased.
Melancholic, closed, air: they often dream of a cooler, quieter place and if they over extend themselves they burn out becoming detached, cold and introverted.
If you are interested in learning more about the Mappa Mundi’s System and its applications to homeopathy, visit firstname.lastname@example.org for upcoming events.or email claudia at
Claudia De Rosa is a Classical Homeopath, qualified Nutritionist and Psychologist.
She is School Director of Vis Vitalis Intl, homeopathic school which she founded in Italy in 2008. She lecturers and runs seminars and events worldwide about newest researches in homeopathy, new methods and materia medica.