The Nature Of Disease And The Doctrine Of The Four Humors

The modern physician and patient are especially eager for a precise diagnosis—the ceremonial naming of the disease—but this was of little importance to the Hippocratic physician. His main preoccupation was prognosis, which meant not only predicting the future course of the disease, but also providing a history of the illness. This recital of past and future was a factor in impressing the patient and family with the knowledge and skill of the physician. It also was essential in predicting crises and deaths so that no blame would be attached to the physician if they occurred.

Rather than recording lists of symptoms, without weight or judgment, Hippocratic physicians looked for characteristic patterns of signs and symptoms in order to chart the course of an illness. Diagnostic signs are characteristics of the disease that are not self-evident, but must be specially detected. Only a skillful physician could detect the obscure signs betrayed by abnormal colors, sounds, heat, hardness, and swellings. If further information was needed, the physician could prescribe cathartics and emetics, which were meant to restore balance as well as provide further evidence of the state of the patient's humors.

For Hippocrates, disease was not a localized phenomenon, but a disturbance affecting the whole person through some imbalance in the four humors—blood, phlegm, black bile, and yellow bile. The four humors and the four associated qualities—hot, cold, moist, and dry— in the microcosm or small world of the human body corresponded to the four elements—earth, air, fire, and water—that make up the macrocosm or universe. Various texts in the Hippocratic collection offer observations and theoretical rationalizations concerning the relationship between health and disease and the humors, qualities, and elements, but these explanations are sometimes obscure and inconsistent.

VELLOW BILE (Choleric)

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