In order to understand the actions of herbs according to the traditional systems of medicine, we must first master the philosophies and concepts that underlay such traditions. Contemporary medicine is based on a mainly analytical approach and is founded on biochemistry and on the modern concepts of anatomy, physiology and pathology; traditional medicines, instead, were based upon models more or less divergent from the current ones, usually established on an analogical and “energetic” (that is, functional) conceptual framework.
The Chinese and Ayurvedic Medicine are two of the most important systems of traditional medicine of the whole World. Far less known today, but equally important from a historical point of view, was the Hippocratic-Galenic medicine (called this way from the names of the most important “formulators” of the related school of thought), another “energetic” medicine, that was born in Greece and that eventually spread in the whole Mediterranean basin.
The four elements and the four qualities
[Giannelli], [Prioreschi], [Wood], [Wood2]
The ancient Greek medicine of hippocratic derivation, upon which also the Roman (especially that of the so called “Dogmatic School”), Mediterranean and, subsequently, the Arab-Islamic medicines (included Unani, that is today one of the official medicine systems of the Indian Republic) were based, has its roots in the classical and ancient cosmological model of the four elements, postulated by Anaximenes of Miletus (even though it is generally considered as having been formulated by Empedocles) and that has been systematized especially by Aristotle.
The four elements are associated to four elemental qualities: hot, cold, dry, and damp. The latter are not linked to the physical temperature or to the water content of a system, but they are rather immaterial principles that can be described in terms of their “actions”. According to Aristotle:
- Hotness is the principle that associates objects having the same nature;
- Coldness is the principle that associates objects having the same or different nature;
- Dampness is not determined by any intrinsic limit, and it can be easily limited or adapted in form;
- Dryness is determined by an intrinsic limit of its own, but it can’t be easily limited or adapted in form.
Hot and Cold are active qualities; Dry and Damp are passive qualities.
Each quality exercises its own actions:
- Hotness elevates, lightens, expands and dilates, puts in motion, makes it flowing and penetrating, opens;
- Coldness lowers, makes it heavy and viscous, contracts and stabilizes, stops, slows down, prevents penetration, closes;
- Dryness accentuates, thins, sharpens, closes, hardens, pushes toward extremes;
- Dampness moderates, thickens, rounds off, mitigates, softens, liquefies, pushes toward equilibrium.
Each element is characterized by a couple these qualities, put together by complementary (one active and one passive):
- Fire is Hot in the first degree1 (or gradus summus, in medieval texts), and Dry in the second degree (or gradus remissus);
- Air is Damp in the first degree, and Hot in the second;
- Water is Cold in the first degree, and Damp in the second;
- Earth is Dry in the first degree, and Cold in the second.
Elements are original on their own, and so they have not to be thought as “composed” of qualities. They too are to be thought as metaphysical entities which underlie and regulate real phenomena. In the Universe, they tend to stratify according to their density.
The first element is Fire, the lightest and most rarefied, highly diffusive. It represents and animates all the forces which produce movement, expansion and ardor in a violent and uncontrollable way; it heats, dries, thins or hardens (depending on the “substrate” on which it operates), makes it light and penetrating, opens (but can also close, as happens with cautery).
The second one, still light and diffusive but denser than the first, is Air, which represents heat moderated by humidity; it heats in moderation, warms rather than burning, thins, swells, compresses, makes it elastic. It is the most moderate movement, but it can also cause extreme events.
The third, denser but still mobile and flowing, capable of moving only downwards, is Water; it favors flowing, fluidifies, makes soft or flabby, moderates, humidifies and refreshes up to chilling in an energetic way, soaks and impregnates, dulls the senses, makes structures round and flaccid. When coldness prevails over humidity, it can thicken and become viscous.
The fourth Element is the Earth, the densest and heaviest of all, basically immobile; it cools and dries up, makes it hard and rigid, viscous up to solid, closes, tones, “tightens” the structures making them compact and cohesive, coherent, edgy. It crystallizes and structures.
Humors and crasia
In the medical field, the four elements model found its expression in the doctrine of the four humors, reported for the first time in written form by Hippocrates of Kos (about 460-377 BC), and subsequently taken up also by Galen of Pergamum (131-201 AD), who brought this theory to Rome. According to Hippocrates, the four elements “manifest” themselves in the so-called humors, subtle fluids2 present in the body, which determine its physiology and general appearance. The four humors are as follows:
- 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.);
- Melancholia (also called Black Bile or Atrabile), corresponding to the Earth element: it is responsible for everything that is hard and structured (bones, teeth, but also growths, polyps, stones, tumors, etc.).
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 granted; if they are blended improperly (we speak of discrasia), illness results.
Thus, an excess of Yellow Bile produces overheating and inflammation; an excess of Phlegm makes the body heavy and slows it down, causing accumulation and stagnation of body fluids; an excess of Blood produces the so-called “plethora” and a whole series of conditions arising from overabundance of heat and dampness (e.g., putrefactions); an excess of Melancholia produces non-physiological structurations in the body. Also the character and the mood are altered by the crasia.
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)3.
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), 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 heat4. 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 putrefaction5 which are manifested by the emission or collection of purulent material, often even hardened (e.g., abscesses)6.
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.
The schools of Rome
In ancient Rome, different medical schools (or sects) coexisted for some time, the main of which were that of the Dogmatics and that of the Empiricists. The first was based on a medical theory that was essentially Hippocratic, while the second was based mainly on experience, rather than on a formal doctrine.
After the decline of both schools, another was born, that of the Methodists, which was the most important during the imperial era. This school accepted the notion of Atoms and Pores (invisible entities on which all visible reality was founded) of Asclepias’ medicine, but also introduced some new elements, such as the koinotetes, that is, the “common characteristics” shared by the various diseases. Among the common characteristics in question, the most important were the status strictus and the status laxus: the first is a state in which pores are closed (“constricted”) and do not let liquids pass, while the second is the state in which pores are open (“relaxed”) and the flow of fluids cannot be stopped, and so that they flow out freely from the body. Examples of the first state are constipation, anuria and mouth dryness; examples of the second are diarrhea, polyuria and excessive perspiration.
Notes
1 The Quality in the first degree is the one that better defines and characterizes each Element: it’s the Element’s essential Quality and cannot be separated from that element.
2 Humors are to be understood, rather than as physical matters, as subtle “substances”, comparable in some way to the Qi or Xue of Chinese medicine, responsible for the formation of substances and the carrying out of functions. Sometimes the humors have the same name as some body fluids: in this case we can imagine that between the two classes of substances there is a close correlation, since the humors are “generators” of their homonymous physical counterpart, which in turn become transporters of the corresponding humor in the body districts.
3 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.
4 The fermentation and putrefaction processes are generally exothermic or generate a “hot” response from the human body..
5 Corresponding to the toxic heat of Chinese medicine. This condition also includes diseases characterized by macular or maculopapular eruptions (e.g., exanthematous diseases).
6 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.
Sources
[Giannelli] Luigi Giannelli, “Medicina Tradizionale Mediterranea”, Ed. Tecniche Nuove (2006)
[Prioreschi ] Plinio Prioreschi, “History of Medicine”, vol. III: “Roman medicine” (1998)
[Wood] Matthew Wood, “The Practice of Traditional Western Healing”, North Atlantic Books (2004)
[Wood2] Matthew Wood, “The Earthwise Herbal – A Complete Guide to New World Medicinal Plants”, North Atlantic Books (2009)
