Notes on humors

According to the Hippocratic-Galenic medicine, four humors rule the human body:

  • Bile (or Yellow Bile), corresponding to the Fire element, responsible for all the caloric activities of the human body, both in a physiological sense (e.g., body heat) and in a pathological sense (fever, inflammation, etc.);
  • Blood, corresponding to the Air element and to the physical blood;
  • Phlegm (also called Pituita or Lymph), corresponding to the Water element, responsible for everything that is fluid in the body (body fluids, lymph, blood plasma, synovial fluid, cerebrospinal fluid, etc.)1;
  • Melancholia (also called Black Bile), corresponding to the Earth element, responsible for everything that is hard and structured (bones, teeth, but also growths, polyps, stones, tumors, etc.).

Heat and body fluids are governed by Yellow Bile and Phlegm respectively. When there are no further specifications, the terms “heat” and “fluids” can be used, in this text, to indicate the corresponding humor.

The functioning of the whole body is governed by the mixing (crasia) of such humors: if the ratio between the humors is proper (we speak of eucrasia), the body functions at its best and the health is guaranteed; if they are blended improperly (we speak of discrasia), illness results.

A humor is defined correct when both its “quantity” and its “quality” are proper; when it prevails over the others, generating dyscrasia, it is said that it is superabundant, and when its quality is not appropriate it is said that it is corrupt. We say in general that a humor is perverse when it is overabundant or corrupt. In this text, in order to facilitate comparisons between different systems of medicine, we resort to an extension with respect to the classical conception and define a humor as “perverse”:

  • when its “quantity” is not optimal, that is, it is excessive (superabundant humor) or deficient (deficient humor) with respect to the condition of eucrasia (the classical theory allows only excess; deficiency is due to the prevalence of another humor with opposite qualities), or
  • when its “quality” is different from the physiologically appropriate one (corrupt humor)2.

An excess of heat in the body can overheat and “cook” the humors, altering their characteristics. Phlegm thickens and becomes more viscous, giving rise to the so-called thickened Phlegm. If the excess heat is important or lasts for a long time, all humors can end up “burning” (in this case we call them adust humors). When burned, humors always produce Melancholia. Unani-Tibb medicine provides four types of perverse melancholia produced by the combustion of humors: malankholia damvi, produced by the combustion of Blood; malankholia safravi, produced by the combustion of Yellow Bile; malankholia balghami, produced by the combustion of Phlegm (generally due to fermentation) and malankholia saudawi, produced by the combustion of “correct” Melancholia.

Phlegm is cold in the first degree and damp in the second and is a mobile and flowing humor. When coldness becomes excessive, however, the Phlegm can thicken and become viscous (cold indeed makes viscous), producing once again thickened Phlegm.

Phlegm itself, when it accumulates and stagnates for any reason (for example due to a lack of heat or an excess of Tension, see below), generates, by “compression”, secondary heat that can condense the humor and make it viscous.

Furthermore, in nature stagnant dampness favors fermentation and putrefactive processes, especially when there is concomitant heat. Also in the human body an accumulation or stagnation of Phlegm may cause the onset of fermentation or putrefaction (phenomena that today’s medicine generically indicates as infections), which are certainly supported by the natural heat of the body and by any secondary heat generated by compression of the Phlegm. Moreover, the fermentation and putrefaction generate further secondary heat3. All these phenomena are characterized by the coexistence of perverse dampness and heat, even if, to be more precise, they should be described as due to the presence of pathological dampness associated with a certain degree of perverse heat (it is therefore more correct to think of them as due to “heated” humidity rather than moist heat). From a clinical point of view, the disorders characterized by this humoral picture include the phenomena known as putrefaction4 which are manifested by the emission or collection of purulent material, often even hardened (e.g., abscesses)5.

The conditions described so far (thickened phlegm, adust humors, putrefaction) are perverse not due to an incorrect quantity of the humors, but because of their “bad” quality.



In this text, for the exclusive purpose of simplifying any comparisons between different systems of medicine (for example, Chinese and humoral), we add the pseudo-humor Tension6, which is responsible for the “functionality” of the whole body or its parts (e.g., the organs). In this sense, it corresponds to the Qi of Chinese medicine but also to other concepts, such as that of the Four Virtues (attractive, retentive, alterative and expulsive) of organs according to Galen (see for example [Giannelli]) and it can also be related to the vasoconstriction and vasorelaxation conditions of Physiomedicalism and to Matthew Wood’s Constriction and Relaxation tissue states [Wood].

Tension, defined as a pseudo-humor because it is not contemplated by the classical humoral theory, can be thought of as formally derived from Fire to which a sort of “constraint”, “limitation”, or “obstacle” has been applied. Like Fire, in fact, it is a form of “energy”, mobile in itself and activating; but whereas Fire tends to move only upwards and centrifugally, thus expanding indefinitely, the movement of Tension is more “structured” and so to speak “oriented” towards specific, defined forms and modalities. We can therefore see it as a kind of Fire to which a structuration (element of “terrestrial” nature) has been applied.

We can resort to an image taken from everyday life as an example. If we pour water on the fire, the latter goes out and the water disperses or evaporates. If we place a hard (i.e., cold and dry) element above the fire (for example, a terracotta or metal container) which prevents the water to directly “mix” with the fire, we are able to let the water heat up without dispersing, and to use it warm for specific purposes (for example, to cook food). By applying a cold and dry “obstacle” (the container) to the fire, we “functionalize” the heat that otherwise would disperse or make the water disperse or evaporate.

Tension can therefore be described, in a humoral sense, as derived from a sort of “functionalization” of Fire by a factor (a principle rather than a material cause) of a cold and dry nature. For this reason Tension is hot and dry, with a lower degree of heat than Fire (because of the cooling due to functionalization).

Even Tension can be correct or perverse and, in the latter case, it can be perverse both in quantity (excess or deficit of Tension) and in quality (think for example of the Qi ni, or counterflow Qi, of Chinese medicine). Given the correspondence, described above, of Tension with Qi, the various manifestations of perverse Tension will typically have a more or less specific correspondence in Chinese medicine (for example, “Tension deficiency” corresponds to “Qi deficiency”). In general, Tension imbalances correspond to Qi imbalances and/or to “Wind” (intended as a pathogenic manifestation).

An imbalance in Tension can also affect other humors, potentially making them perverse. For example, an excess or a stasis (stagnation) of Tension can prevent the body fluids from being moved correctly, generating stagnation of Phlegm and/or Blood; Tension stagnation can generate “compression” which in turn can produce heat (Chinese medicine speaks, for example, of “implosion of stagnant Qi” which generates Fire, understood here not as the element but as a specific manifestation of heat).




Luigi Giannelli, “Medicina Tradizionale Mediterranea”, Ed. Tecniche Nuove (2006)


Matthew Wood, “The Earthwise Herbal – A Complete Guide to New World Medicinal Plants”, North Atlantic Books (2009)


1 In this sense, it is conceptually different from the Phlegm of Chinese medicine, which corresponds specifically to the thickened Phlegm of humoral medicine when it is located in the upper part of the organism.

2 Melancholia, for example, can be in excess with respect to the physiological condition of eucrasia (generating excessive structures) or in deficit (generating deficient constructions), but it can also be generated by the combustion of humors by heat (see below); in the latter case, it is always perverse (therefore it is perverse in quality rather than in quantity). In classical humoral medicine these three conditions are usually not so sharply distinguished from each other.

3 The fermentation and putrefaction processes are generally exothermic or generate a “hot” response from the human body..

4 Corresponding to the toxic heat of Chinese medicine. This condition also includes diseases characterized by macular or maculopapular eruptions (e.g., exanthematous diseases).

5 The conditions known as Dampness/Heat in Chinese medicine (which include, for example, problems often related to the urinary tract or gallbladder, some cases of jaundice, etc.) also fall within this picture.

6 Name borrowed from Matthew Wood’s tissue states model [Wood].


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