The Basis of the Four Temperaments in Medicine - Body of Harmony

The Basis of the Four Temperaments in Medicine

by: Payam Hakimi
April 2025
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The classification of Sanguine, Phlegmatic, Choleric, and Melancholic temperaments originates from humoral theory, which dates back to Ancient Greece and was later expanded in Islamic, Roman, and Medieval European medicine. This system was primarily developed by Hippocrates (c. 460–370 BCE) and later refined by Galen (c. 129–216 CE). It was used as a framework to understand human physiology, personality traits, and disease tendencies for over 2,000 years.

Ancient Origins and Cultural Use

Ancient Greece (Hippocrates, c. 400 BCE)
- Hippocrates proposed that health depended on the balance of four bodily humors: blood, phlegm, yellow bile, and black bile.
- Each humor was associated with specific physical and psychological characteristics.
Ancient Rome (Galen, c. 200 CE)
- Galen expanded on Hippocratic theory, linking the four humors to specific temperaments that determined behavior, health conditions, and disease susceptibility.
Traditional Persian & Islamic Medicine (Avicenna, c. 980–1037 CE)
- Avicenna (Ibn Sina) in his Canon of Medicine further refined the four humors, integrating diet, lifestyle, and emotional well-being into medical practice.
Medieval & Renaissance Europe (c. 1100–1600 CE)
- The four temperaments were widely used in diagnosing and treating illnesses, influencing early psychology, homeopathy, and naturopathy.

The Four Temperaments and Their Associations

Sanguine (Blood - Air)
- Traits: Energetic, social, enthusiastic, optimistic
- Health Strengths: Strong circulation, rapid recovery from illness
- Weaknesses: Prone to overstimulation, high blood pressure, fevers
Phlegmatic (Phlegm - Water)
- Traits: Calm, slow-moving, reliable, introspective
- Health Strengths: Strong immune function, resilience
- Weaknesses: Prone to sluggish digestion, respiratory issues
Choleric (Yellow Bile - Fire)
- Traits: Ambitious, passionate, aggressive, determined
- Health Strengths: High energy, strong metabolism
- Weaknesses: Prone to inflammation, liver disorders, hypertension
Melancholic (Black Bile - Earth)
- Traits: Thoughtful, deep-thinking, anxious, artistic
- Health Strengths: High endurance, strong focus
- Weaknesses: Prone to depression, digestive issues, joint pain

Surviving Influence Today

Though modern medicine no longer follows humoral theory, the four temperaments still influence homeopathy, Ayurveda, Unani medicine, naturopathy, and holistic medicine.
Some psychological models, such as Carl Jung’s personality types and the Myers-Briggs Type Indicator (MBTI), share similarities with this ancient classification.

Oldest Culture Using It

The Ancient Egyptians (c. 3000 BCE) and Mesopotamians had early medical systems that influenced Greek medicine. However, Hippocrates and Galen in Ancient Greece were the first to formally codify the four humors, making Greek medicine the primary source of the temperamental model still recognized today.

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