Melancholic or Sanguine? Why the Four Humors Matter Today

The Humoralism theory of medicine was invented and studied by Hippocrates, and it remained the dominant medical theory until the 1800's. This theory postulated that four humors inside the human body — yellow bile, black bile, phlegm, and blood — were responsible for a person's physical appearance, personality, temperament, mental health, and physical health.

Before humoralism became the dominant way people viewed all types of illness, supernatural theories were the main way to think of illness. Prior to Hippocrates' scientific-leaning theory, demonic possession was the main cause of illness, and mental illness in particular, and the main modes of treatment were prayer and exorcism.

The choleric temperament was believed to be caused by too much yellow bile. Those with too much yellow bile were what we now think of as "type A." They were leaders, yet they were prone to anger, impatience, and irritability. They were bold and fearless. On a darker note, they were also prone to extremism and fanaticism.

The melancholic temperament was believed to be caused by too much black bile. Those individuals with too much black bile had the "most problematic" temperament for the society of ancient Greece because they were the opposite of how people in ancient Greece were expected to be. People with melancholic temperaments were practical and realistic yet prone to depression and moodiness. They were also described as reflective and philosophical.

As the name implies, the phlegmatic temperament was believed to be caused by too much phlegm. People with phlegmatic temperaments were what we would think of today as "type B" personalities. They were described and good-natured, patient, and compassionate. They were laid-back, but sometimes prone to "sluggishness." People with a phlegmatic temperament were often the most religious and devoted individuals.

The sanguine temperament was believed to be caused by too much blood. This temperament was thought to be the ideal during the time of Hippocrates. People with a sanguine temperament were sociable and light-hearted, sensual and romantically-inclined. This temperament was also the most likely to be conformist and conventional. This is often considered an ideal temperament in today's society, as well.

All four of the temperaments occurred because it was believed the person had too much of one of the humors. To diagnose this imbalance, according to Hippocrates, one had to the most scientific approach people had seen at that point in history. Hippocrates observed the person to see what behaviors they exhibited, and he made a set of notes. This is quite similar to the way medical and psychological professionals assess patients and clients today.

The treatment for out-of-balance humors was to achieve balance again. The first step of was to change the affected person's diet, fitness practice, hygiene, and climate. If this was unsuccessful in balancing the humors, the second step was to try medication. However, these "drugs" were often poisonous, and would make a person violently ill. The symptomatic illness was then used as confirmation that the humors were trying to balance again.

Though they seem fantastical today, Hippocrates' theory of the four humors was the first big step away from supernaturalism and mysticism and toward real science. The methods Hippocrates and his followers used were more humane, although still not laudable, treatments of the mentally ill. Exorcisms were replaced with things like diet and lifestyle changes and less traumatizing physical treatments like bloodletting.

We can still see some pieces of the Humoralism in medical and psychological practice today. Hippocrates' idea that a balanced life is crucial to a person's physical and mental well-being is well-proven and widely embraced in Western medicine — medical doctors suggest diet changes for certain conditions and mental health professionals suggest exercise to help manage conditions like depression and anxiety. These are often the first corrective steps before the health professional prescribes medication.