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The Four Humours of Ancient Greek Medicine

Ancient thought in modern practice


This last week I’ve been reading all about the practice of ancient Greek herbal medicine – doesn’t quite beat a good crime thriller with a mega twist at the end (saving that for a holiday) but it still floats my boat for sure.

We all know that herbalism is rooted in ancient practice, and today the well-recognised ancient traditions of Ayurveda and Traditional Chinese Medicine are very much at the core of modern herbal practice. Some would say, though, that it all started with ancient Greek herbalism, and their practice of working with the ‘four humours’, or ‘humors’, depending on how you want to spell it, which are: blood, phlegm, yellow bile, and black bile. No longer mainstream theories, but still a fascinating underlying foundation to modern medical and herbal practices of today.

From Aristotle to Hippocrates, Theophrastus to Dioscorides, there are still many well-preserved texts by ancient Greek doctors, philosophers and botanists that continue to support our understanding of the connection between us and the natural world.

Agreed, ancient Greek practice isn’t as well known today compared to the ancient herbalists of India or China, but it were definitely instrumental in establishing the practice of modern medicine. We’ve all heard of Hippocrates (460-370 BCE), known as the father of modern medicine, with his Hippocratic Oath continuing to bind modern-day physicians to the “First do no harm,” mantra.

Hippocrates was also instrumental in developing the theory of the four humours from the Greek word chymos or ‘bodily fluid’, which helped ancient healers effectively explain disease with appropriate recommendations. This became a practice that would survive well into the Middle Ages (Galen, 165-175/2003).

4th century BC Hippocrates also seems to be behind a major cultural shift which took place in ancient Greece - instead of seeking cures from the gods and goddesses (who were often blamed for illness and to whom the sick begged for forgiveness), people began focusing more on medicine, philosophy, and the natural sciences for greater understanding of how the body worked.

People slowly began to realise that sickness was no longer thought of as a price paid for a mortal sin but more about imbalances in the body from a variety of factors, including diet, social class, environmental cleanliness, and the state of one’s mental health.

For the first time in history, healing started to emerge as the combination of philosophical thought, understanding the body as a microcosm of the universe, and a bit of knowledge about the cosmos, with Hippocrates at the forefront of a new medical concept that would forever bear his name. Those immortal gods were gradually replaced with scientific medical theories, including the four humours, all of which relied heavily on the power of plants.

Like many ancient systems of medicine, the humours integrated an understanding of disease, psychology, habits, and personalities, and yes, there were astrological connections as well 😉 They determined if one of the three standard practices for balancing the body – inducing vomiting, diarrhoea, or bloodletting – was appropriate for an individual, using herbs as the foundation for supporting the body.

The humours would be commonly practiced for the next 2,500 years and would later be revived by Greek physician and philosopher Galen (130-210 AD), who swore by their validity in his extensive writings, which became the dominant practice well into the Middle Ages. Shakespeare even referred to them in his Julius Caesar when Brutus exclaims to Cassius: “Must I give way and room to your rash choler? Shall I be frighted when a madman stares?”. Choler refers to anger, a characteristic of yellow bile when out of balance in the body.

How The Four Humours Relate to Herbalism

As with the ancient practices of China and India, the four humours are best understood not necessarily via tangible modern explanations, but through recognising invisible characteristics, i.e. energetics, elements, temperament, as well as an understanding of the natural world. To be an effective herbalist meant understanding imbalances in an individual’s specific experience in their natural, environmental setting.

The concept of the four humours still relate to qualities understood by herbalists today: the four natural elements – air (blood), water (phlegm), fire (yellow bile) and earth (black bile), as well as the four energetics – hot, cold, dry, and moist. This method opened up the understanding of ‘health’ not previously known in ancient times.

Here’s the text on The Four Humours – understanding the concepts of each humour helped ancient herbalists categorise sickness and identify the proper herbs for the individual, much like we do today. These characterisations of conditions and temperaments also resemble the Ayurvedic doshas (energies) of pitta, vata and kapha, which some scholars suggest were influenced by the theory of humours. Similarly, the four humours loosely correspond to the wheel of Traditional Chinese Medicine.

NB - please don’t ask me what relevance the Astro and Planet connections are as this is way beyond my spiritual abilities 😉


Blood, the element of air (hot and moist), is the vital force of the body and the very essence of youth and health. Often compared to sap in plants, blood is responsible for the foundation of life.

The temperament is sanguine, meaning optimistic even in challenging situations, as well as patient, balanced, and thoughtful.

This is the humour of regeneration and is supported by herbs that are either cooling and drying to help regulate blood, such as stinging nettle (Urtica dioicia) and yarrow (Achillea millefoliium), or herbs that are warming and moistening to nourish and increase blood flow, such as chamomile (Matricaria recutita), and hawthorn (Crataegus spp.).

Humour – Blood

Element – Air

Energetics – Hot and moist

Season – Spring

Characterisation – optimistic, even in difficult circumstances

Taste – Sweet

Colour – Red

Age – Infancy

Organ – Heart

Astro Signs – Gemini, Aquarius, Libra

Planet - Jupiter


Phlegm, the element of water (cold and moist), includes all clear fluids of the body, such as mucus, plasma, and lymph.

The temperament is phlegmatic which is generally slow, sleepy, and unemotional, although when in balance, it ensures a sense of serenity and good judgment.

Herbs that support this imbalance include pungent, stimulating, and aromatic herbs, such fenugreek (Trigonella foenum-graecum), bay laurel (Laurus nobilis), fir (Picea abies) and thyme (Thymus vulgaris).

Humour – Phlegm

Element – Water

Energetics – Cold and moist

Season – Winter

Characterisation – unemotional and stolidly calm

Taste – Salty

Colour – White

Age – Old age

Organ – Brain

Astro Signs – Cancer, Scorpio

Planet - Moon

Yellow Bile

Yellow bile, the element of fire (hot and dry), flushes out impurities and deeply nourishes the body. It reflects the principle of digestion and transformation. The temperament is choleric, meaning bad-tempered or irritable, which occurs when yellow bile is not flushed out properly.

Herbs that support an imbalance in this humour include plants with bitter qualities, which stimulate digestion while cooling and detoxifying the body.

Black Bile

Finally, Black bile, and apparently not easily translatable from ancient Greek texts. However, what can be translated shows the element of earth (cold and dry), with a ‘retentive and solidifying force on metabolism and bone building’. It can be expressed as the dried blood found in faeces, very dark urine, serious fevers caused by malaria, or as constipation, bloating, and arthritis.

The temperament is melancholy from έλας / melas, ‘black’ and χολή / kholé, ‘bile’, or the feeling of pensive sadness.

To quote Hippocrates, “Grief and fear, when lingering, provoke melancholia.” (Hippocrates, 185/1931). Nervine, carminative, and antispasmodic herbs, including lemon balm (Melissa officinalis), rosemary (Rosmarinus officinalis), and lavender (Lavandula officinalis) balance these conditions. A healthy balance of this humour is thought to ensure ‘thoughtful introspection’.

Humour – Black Bile

Element – Earth

Energetics – Cold and dry

Season – Autumn

Characterisation – Melancholic, pensive sadness

Taste – Sour

Colour – Black

Age – Adulthood

Organ – Spleen

Astro Signs – Taurus, Virgo, Capricorn

Planet - Saturn

To conclude ...

I found it rather awesome that regardless of how the different ancient civilisations developed their systems of medicine, many of their concepts overlap – the origins of wellness and the use of herbs travelled across both time and distance.

The principal of Hippocrates’ four humours he developed all those thousands of years ago still remains to this day; regardless of whether we follow the herbal practices of ancient Greece, China, or India doesn’much - what matters is that this was the foundation of our modern practice to understand the complexities of health.

Our ancient teachers were pretty spot on all those millenia ago 😉

Lots of references here …

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Arikha, N. (2007). Passions and tempers: A history of the humours. Retrieved from https://www.passionsandtempers.com

Galen (2003). Galen: On the properties of foodstuffs (O. Powell, Trans.). Cambridge, England: Cambridge University Press. (Original work published 165-175 CE)

Gill, N.S. (2019). Hippocratic method and the four humors [Blog Post]. Retrieved from https://www.thoughtco.com/four-humors-112072

Hippocrates (1931). Hippocrates: Volume IV (W.H.S. Jones, Trans.). Loeb Classical Library. (Original work published ca. 185 BCE).

Liddell, H.G., Scott, R., Jones, H.S., & McKenzie, R. (1940). A Greek-English lexicon. Oxford, England: Clarendon Press.

McKeown, J.C. (2017). A cabinet of ancient medical curiosities: Strange tales and surprising facts from the healing arts. Oxford, England: Oxford University Press.

Osborn, D. (2015). Principles of treatment [Blog Post]. Retrieved from http://www.greekmedicine.net

Porter, R. (1997). The greatest benefit to mankind: A medical history of humanity. New York, NY: W.W. Norton. Exploring the practice of ancient Greek herbal medicine as The Greek Herbalist.