Become Your Own Doctor

Lost Secrets of Humoral Healthcare Revealed

John Hunt Publishing Ltd.

Contents

When "Alternative" Medicine was Mainstream

There was a time when the practice now known as "alternative" medicine was, in fact, mainstream. Everyone from highly qualified doctors to amateur healers, and from clerics and high-ranking lords to lowly peasants, understood the needs of the body in terms of its relationship with the environment; and people who kept diaries and notebooks were convinced that humoral-based medicines worked very well indeed. In order to comprehend the workings of this system we need to start by briefly looking at the history of humorism. In this chapter I look at its roots and revival in Renaissance Europe and reveal some of the reasons for its enduring resilience in the face of challenges from those who thought the answer to humanity's health problems lay in taking chemicals and minerals orally, and in applying them externally to treat skin complaints. I describe the nature of humorism, the humoral body and medicine, and reveal why, for centuries, humoral treatments were so important in maintaining good health and preventing illnesses.

Before more "scientific" ideas were adopted by doctors, starting with the chemical and mechanical body theories forwarded by pioneers such as Swiss alchemist Paracelsus – which supposedly necessitate the use of chemicals, minerals and distillates to cure illnesses introduced to the body – our ancestors up until around the mid-1600s clearly understood wellbeing in quite another way. Prevention and cure of illnesses that originated within the body, learned people knew, was part of the same package that had at its core respecting the so-called "non-naturals." These are breathing in high-quality, non-polluted air; regular and timely evacuation of bladder and bowel; correct and adequate exercise; sleeping soundly; avoiding perturbation of the mind such as stressful thoughts and bad dreams; and, most importantly – because it was clearly understood that food is medicine – eating and drinking the right foods in the right quantities at the right time. Thus, lifestyle is key; and, as physician James Hart who in 1633 wrote a book called Klinike observed, this means eating humorally balanced meals. Hart was just one of many doctors who thought along these lines, for this theory had become established among medical experts and accepted by the public who applied this wisdom at the point of treatment. So where did the ideas come from?

They appear to have been known and used by people living in ancient Greece and classical Rome, but they are probably rooted in much earlier civilizations. This can be seen in the works of two ancients: Claudius Galen, a well-respected physician and philosopher who was born in Turkey and lived in Greece, Alexandria and Rome between AD 130 and AD 210; and "the father of Western medicine" Hippocrates who lived in Greece six centuries earlier. Even in Hippocrates' time, which was four hundred years before Jesus was born, there was nothing new in humoral medicine, for this insightful and well-informed Greek physician – who bequeathed to us the still-important Hippocratic Oath – insisted that his medical knowledge was ancient even at that time. Thus, it is probable that humorism was received indirectly from exceptionally knowledgeable sages inhabiting Mesopotamia in the earliest of times – wise men who also passed down to us advanced mathematics, accurate astronomy, writing, accountancy, recordkeeping, libraries, law-making and rules for living a harmonious life within the framework of civic society.

During the Renaissance period in Europe (circa 1300 to 1650) there was a revival of interest in all things Greek and Roman, and this included art, architecture, literature and science – including medicine. Thus, the works of Galen and Hippocrates came to occupy a central position in the medical theories of late medieval and early modern physicians. Given that the Roman Empire was centered in the country that is now known as Italy, it is perhaps unsurprising that this country's humanist scholars were at the cutting edge of reviving and analyzing classical teachings. It is equally unsurprising to find the main Renaissance medical training facility here. Prior to Montpellier in Southern France becoming the main European center for medical students, the School of Medicine at Salerno, close to Naples in Southern Italy's Campania region, was the distinguished medical teaching facility. So much so that it attracted scholars from all over Europe. Here students learned about the theories of great thinkers who had lived in the dim and distant past – how best to cure illnesses, and even how to help prevent them from occurring in the first place – and, with critical eyes, they adapted them to suit their own environmental conditions and relatively modern ways of life. It was largely the words of wisdom of these Southern European scholars that informed the writings of medical practitioners in Northern Europe, Britain and, subsequently, North America.

So what was the nature of this medical knowledge that was readopted by physicians in the Middle Ages? Doctors based their advice on the firm belief that good health depends on achieving a fine balance between the four humors present in the body. These are black bile, yellow bile, phlegm, and "particles" located within blood. Any imbalance, no matter how small, results in the body becoming too dry or damp, or too cool or warm. This imbalance, they showed through observation and experimentation, can then cause mental or physical health problems. The rationale of doctors' convictions was clear: because all organic matter contains the same humors, but in different forms and amounts, it logically follows that each type of food has its own specific humoral properties. These humors are transferred to the body when the food is eaten, so a diet that improves one's health can be selected. There is no need for chemically produced medicine, experts understood, because food is medicine. Illnesses accordingly require short-term dietary adjustment; and books called "dietaries," written by doctors and pharmacists, served as useful guides to healthful living.

Accomplished, qualified medical professionals understood clearly that choosing the right diet was central to maintaining good health; but they also knew that the other "non-naturals" (lifestyle choices) helped. Then as now, sufficient rest, good-quality sleep, sufficient exercise and stress management were considered important under the humoral philosophy; thus books known as "regimen manuals" were also published. These were more comprehensive. Some dietaries and regimen guidebooks were written for the benefit of medical scholars. These contained in-depth advice in technical language; examples include Gualtherus Bruele's Praxis medicinae (1628) and Dr Thomas Moffett's Healths Improvement (1655). Shorter books written in simple terms were aimed at unqualified people who had an interest in healthcare. An example of these is Philip Moore's The Hope of Health (1564). Both dietaries and regimen guidebooks usually contain gender- and age-specific advice; and, because specific foods are key to adjusting health, all of them include sections on foods' humoral properties.

What are these properties? Each person and each type of food was known by medical experts to be comprised of the two basic humoral qualities – namely heat and moisture. One can be either temperate (neutral), hot and dry, cold and dry, hot and moist, or cold and moist. Furthermore, heat and moisture each have nine stations (known as "degrees"); these range from hot in the fourth degree (very hot) through temperate to cold in the fourth degree (very cold), and the same for moisture (very dry to very moist). Thus a person or type of food can occupy any one of 81 stations (9 × 9). In addition to the "temperate" stations where there is no excess in heat or cold, or no superfluous dryness or moisture, there are 16 shades of hot and dry (4 × 4), and 16 each of cold and dry, hot and moist, and cold and moist. In practical terms – expressed somewhat simplistically – food additives with opposing humoral properties to the main ingredient can help to neutralize a dish, and a meal with opposing humoral properties to its consumer can be eaten to help rectify his or her humoral imbalance.

It is important to realize that when doctors discuss humoral "heat" and "moisture," they are not referring to physical temperature, or to dryness or dampness in the sense that you can feel it. If this was the case a freshly cooked joint of beef taken straight out of the oven would be humorally "warmer" than a refrigerated joint of lamb. It is not. Similarly, one might expect hard cheese to be humorally "dryer" than cream cheese. Again, this is not the case. As doctors explain, it is all about humors – and these are discussed at length below.

In addition to informing their readers about the benefits of certain foods, and about the harm they can do, some dietaries even subdivide each degree into three further parts. With the seasons of the year and climatic conditions also affecting a person's humors, this level of detail helps to fine-tune the body as and when required.

So what do ancient and Renaissance medical experts mean when they write about "humors"? And how are humors understood to affect health? Sir Thomas Elyot, a renowned sixteenth-century scholar who had a thirst for knowledge and a keen interest in medicine, describes them in this way: The blood humor holds a pre-eminent position over the other three. Because it is moderate in heat and moisture, it preserves the body. Distemperature of blood occurs when one, or more, of the other three humors either becomes excessive or mixes with (and pollutes) the others. Another humor is in phlegm. There are, he said, two sorts of phlegm – natural and unnatural. Natural phlegm is cold and moist, white and tasteless. Containing mainly water, it is produced when digestion is slow and partial. Thus, the goodness cannot be converted to heat-generating blood. Natural phlegm is fine when the right quantity is in the body, but too much of it can result in illness. Unnatural phlegm is that which is mixed with, and has been texturally altered by, other humors. Its characteristics typically are these: colorless, green or chalky; it is thick, slimy and viscose; it is cold; and it is either salt or sour. Again, too much of this unnatural humor is dangerous.

The third humor is known as choler or yellow bile. This is also of two kinds – natural and unnatural. The former sort is clear red or orange in color, and is hot and dry. It is, Elyot says, "engendered of the most subtle part of matter decoct, or boiled in the stomach, whose beginning is in the liver." This is an important bodily element, but an excessive amount dries the constitution, which is particularly detrimental to the wellbeing of physically active people. Unnatural choler is that which is "mixed or corrupted with other humours," and its characteristics are of four sorts: yellow – being a mixture of natural choler and the phlegm humor, with less heat than pure choler; yellowy orange – being a mixture of natural choler and the humor found in congealed phlegm; a light green sort that originates in the stomach rather than in the liver; and a darker green sort that is poisonous. The humor known as black bile, sometimes referred to as black choler or melancholy, also comes in two kinds. The natural sort, Elyot believed, comes from the dregs of pure blood, and can be recognized by its blackness when "it issueth either downward or upward." It is cold and dry; and although in the right quantity it is essential in maintaining good health, too much of it can induce despondency and can leave the body susceptible to contracting disease. The unnatural kind, which is produced in the body as a result of a corruption of choleric yellow bile, is hotter and lighter. This unnatural bile is particularly dangerous to mental health because it can induce low spirits, despondency and feelings of dejection that can result in depression.

The humoral station of male manual workers is understood to be slightly hot and dry, hence their need to drink copious quantities of fluids. If a man or a woman is overly hot and dry, he or she is said to have a "choleric" complexion. This means that there is too much yellow bile, or corrupted choler, in the body. One of the many signs of this is restlessness; another is feistiness. In order to rectify this condition, and to avoid the possibility of leaving the person susceptible to contracting the sorts of illness described below, he or she would be advised to adjust his or her diet to include more humorally cool, moist ingredients – such as certain types of vegetables or fruits – in order to achieve equilibrium.

In comparison to men, it is understood that women in general terms (although not always) are slightly to the cool and moist of center. Perceived to have thinner bodily fluids than men, and greater quantities of them – hence their ability to lactate and their need to menstruate – they are considered to be relatively calm-headed and can sometimes seem to be a little remote. Whether male or female, these doctors assuredly note, people naturally become humorally cooler in their old age. There are many indicative signs of this – not least of which is their need to wear warmer clothes, and their tendency to be adversely affected by cold weather in the winter. For this reason it is important that seniors should not consume certain foods and drinks that will exacerbate the problem and leave them feeling unwell. If an aged person, or indeed anyone, is cooler and moister than necessary, he or she is said to be phlegmatic. This condition can induce a whole range of maladies, not least of which is mental illness due to excess fluids affecting the brain. Deteriorating health in this case can be prevented, and even reversed, by cooking with well-chosen ingredients which, as we shall see, include substances such as cloves, ginger or nutmeg that are humorally hot and dry.

The body can also be overly warm and moist. This means that it is too blood-rich which makes the patient "sanguine." While some people may consider the plump, ruddy-faced, overly cheerful characteristics of sanguinity agreeable, to others they are undoubtedly irritating; but Renaissance doctors understood that there was a more serious side to this condition. High blood pressure, then as now, was a problem – even if "pressure" was not the term used. A way to combat this potentially dangerous problem is to prepare meals with humorally cool, drying ingredients such as lemon, vinegar or some of the other foods discussed later. Conversely if a person possesses too much black bile, or the wrong kind of this melancholic humor, and is therefore overly cool and dry, he or she requires immediate dietary adjustment of the sort that I will reveal later.

It cannot be overstated that one size certainly does not fit all when it comes to humoral medicine, for the system is inherently individualistic. We have seen that doctors considered laboring men to be on the hot and dry side of center. This requires them to consume specific foods and beverages to prevent illness from occurring and to work effectively. Less active people such as those who sit behind a desk for much of the day, on the other hand, are understood to be closer to midpoint; therefore their bodily requirements are different. Under the humoral system, a more leisurely or studious lifestyle requires the eating of lighter foods that are also relatively low in moisture, coolness and viscosity. The last thing a scholar needs is an excessively phlegm-inducing diet with the resulting impairment to reason and memory.

But whether people work hard for a living or are relatively inactive, medical experts of old knew that humoral complexions and bodily requirements are subject also to climatic conditions. They also knew perfectly well that foods acquire their properties from the environment that surrounds them. Thus, as the body is at one with its natural surroundings, locally produced foods are considered to be the most healthful ones – transferring their humoral properties to the people eating them. To our knowledgeable ancestors this meant that people could safely eat both indigenous plants or animals and those that had been introduced to the region, and had become acclimatized to a particular area over a long period of time. For this reason, olives, dates, figs, citrus fruits, tomatoes and chilies are considered ideal for people living in the Mediterranean basin, the Middle East, and the region described in modern times as the southern United States. For Northern Europeans, and for those living in other cooler places such as Canada, Maine, New Hampshire and New York, temperate and cool-loving plants can just as effectively be used to preserve good health.