The Hippocratic Humoural Theory: A Proper Philosophical and Historical Context

Richard G. Parker
Issue XIV - May 9, 2003
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The Hippocratic humoural theory of disease remains one of the most important, and often  misunderstood concepts in the Hippocratic Corpus.  It is a theory that has been the subject of much undeserved criticism by some of today’s medical historians and physicians.  

In coming to a proper understanding of it’s historical significance, it is important to emphasize that the doctrine of the humors is the first time that direct observation of disease processes
and a natural metaphysics are integrated to formulate a rational and naturalistic conception of medicine. 

Anaximander (c. 610-510 BCE) was, together with Thales, one of the
first philosophers--he used direct first-hand observation of reality and logical argumentation to develop a rational conception of existence.  Anaximander’s theories about the nature of reality centered on the idea of *opposites* with existence representing a type of balance between opposing forces.  Later thinkers re-formulated and essentialized Anaximander's theory of opposites as being four in number:  hot, cold, moist and dry.  

Empedocles (fl. 450 BCE), like Anaximander, developed an ontological view of existence based on observing natural phenomena and rational argumentation.  For Empedocles, the four opposing
powers of hot, cold, moist and dry were qualities associated with four fundamental elements of existence:  fire, air, water and earth.  

In the Hippocratic Treatise
Ancient Medicine these four philosophical opposing powers and elements are substituted with four bodily fluids:  phlegm, blood, yellow bile and black bile.  Disease, in essence, becomes a state in which one of these four bodily fluids (humours) overpowers the others.  Some thinkers who were more influenced by Empedocles (whose interests included not only philosophy, but medicine as well) never modified the latter's original formulation, but simply retained the original philosophical idea of fire, air, water and earth as the fundamental components of the body with disease being an excess of one over the other(s). 

There are three points which are important in developing an accurate and proper historical context in which to understand the significance of the Hippocratic humoural theory: 

1)  The humoural theory is based on direct, first-hand observation of natural phenomena.  Hippocratic physicians carefully observed the natural progression of disease in their patients and made inductive inferences from these observations.  In fact, three of the most common ailments that ancient Greek physicians must have seen in their practices--chest problems (or infections, presumably bronchitis and pneumonia) with symptoms such as productive cough (phlegm), malaria, with its concomitant vomiting (yellow and black bile) and traumatic injuries with their resultant hemorrhage (blood)--were the likely concretes from which the four humours were induced. 

2)  The theory of humours is the first theory which attempts to
integrate a natural theory of metaphysics (Anaximander's theory of opposites and Empedocles' theory of fundamental elements) with empirical first-hand observations of disease.  This is a very significant development, since it essentially marks the origin of the integration of Western medicine with early Greek naturalistic science which was in its infancy at that time as well. 

3)  The pathogenesis of disease is beginning to be understood
not in terms of mystical and inexplicable unnatural causes (demons, gods, etc.), but rather as an interplay between natural processes within the body which follow the same laws as the fundamental constituents of all of existence.  As such, disease processes, like all natural processes, can and must be understood using the same observational methods and are subject to the same rigorous rational analysis applied to all natural phenomena. 

In short, mystical superstition has successfully been replaced by a naturalistic theory.   

The theory of humours is frequently discounted today because it was fallacious in factual details.  While it is true that the humoural theory was
centuries later proven to be false, this critique suffers from historical context dropping and obfuscates the essential characteristic of the humoural theory--the differentiation of a medicine which seeks natural causes for illness vs. one that is essentially mystical. 

In formulating a proper context in which to understand the significance of the humoural theory, it is important to understand what preceded it and what it successfully separated Western medicine from--a primarily mystical approach to disease which was characterized by the worship of gods, the fending off of evil demons and subjective dreams.   

The humoural theory of disease, in essence, marks the beginning of a rational
pathophysiology.  As such, it deserves respect for what it actually represents and what it accomplished--the origins of a scientific methodology in Western medicine which successfully separated medicine from the primitive mysticism which preceded it.


"Anaximander."  The Internet Encyclopedia of Philosophy.

"Empedocles."  The Internet Encyclopedia of Philosophy.

Jones, W.H.S.  Hippocrates vol I.  Loeb Classical Library.  Cambridge, MA:

Harvard University Press, 1984.

2003 Richard G. Parker, MD.  All Rights Reserved.

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