The Four Humours


Claudius Galenus was a Greek philosopher and physician who practiced medicine among the Romans circa AD 160. Galen brought the approach known as Humourism to the mainstream. Humourism is a philosophical theory originating from he Greek philosopher Empedocles who implied that all things are combinations of the four basic elements: earth, water, fire and air.

Earth: cold and dry

Air: warm and wet

Fire: warm and dry

Water: cold and wet

However, Galen like the father of modern medicine, Hippocrates, believed that these basic elements were mirrored in corpus. Hippocrates stated that the qualities of the four elements are reflected in our bodily fluids namely blood, phlegm, yellow bile and black bile. They both set about classifying illnesses in terms of excess of these fluids (Mukherjee, 2010).

Excess blood: prompted inflammation: red, warm, painful.

Excess phlegm: prompted “tubercles, pustules, catarrh and nodules of the lymph” (ibid): cold, white, soggy, heavy.

Excess yellow bile: prompted jaundice: yellow.

Excess black: prompted depression (or melancholy, literally black (melass) bile (khole) and cancer: oily, viscous, dark.

Cancer was believed to be the static form of black accumulating into a solid mass (ibid), whereas depression was viewed as the excess of fluid black bile circulating through the system.

Galen explored this the approach of Humourism further, expanding into a theory of personality. Galen saw a direct relationship between the levels of the humours in the body and the emotional and behavioral inclinations known as temperaments. He described these temperaments as sanguine (blood), phlegmatic (phlegm), choleric (yellow bile) and melancholic (black bile). Imbalances in the humours determined personality as well as susceptibility to certain illnesses. Unfortunately, this interesting yet erroneous belief about illness continued beyond Galen’s death in AD 199. Medicine focused all curative and therapeutic efforts in Galen method. Surgery was thought pointless as the humour would only flow back.
Galen’s falsely held beliefs about anatomy stood uncorrected until Andreas Vesalius’s attempts to confirm his heroes hypothesis disconfirmed it. Due to Vesalius discontent with the state of anatomical training at the University of Paris, he began to his own exploratory autopsies (ibid). These exploratory autopsies on the bodies left at the city gallows and in poorly covered graces, revealed to Vesalius that the possibility of Galen’s theories were non-existent. Blood, yellow bile and phlegm were found aplenty but black bile (the corner stone to Galen’s theory) was no where to be found (ibid). Vesalius’s discoveries and intricate anatomical drawings soon shattered the idea of humourism, opening up the doors to effective treatment.

The theory of Humourism, did not however completely disappear. In fact, in psychology a major theory of personality still owes its root to the Greek physicians.

If one of the humours developed uncontrollably, becoming obviously dominant to the other three humours, the corresponding personality type would also become dominant. As a paradigm, a sanguine person has too much blood and as a result shows characteristics such as cheerfulness and optimism but can be selfish and overconfident. A phlegmatic person suffers from too much phlegm and would be rational and consistent but often slow and quiet. A choleric person suffers from too much bile and would be passionate and energetic but could also be tempered. Finally, a melancholic person suffers from excess bile and would be characterised as the artists, poetic and artistic but often depressed and fearful.

During Galen’s time, the Medieval Ages and up until the Renaissance it was considered accurate that certain people were born predisposed to one of the four temperaments and imbalances could be cured by changes in diet, exercise or the extremes of purging and blood-letting. By the 1500s, hundreds of errors were found in Galen’s work but he would later come to influence Hans Eysenck that concluded that temperaments are in fact biologically based but not through humours. Eysenck identified two personality traits he called neuroticism and extraversion, a nod to Galen.


Collin, Catherine. The Psychology Book. New York: DK Pub., 2012. Print.

Mukherjee, Siddhartha. The Emperor of All Maladies: A Biography of Cancer. New York: Scribner., 2010. Print.