From: The Homoeopathic Compendium by David Little. Excerpt from Volume V : Constitution, Temperament and Maps of Consciousness – Chapter 1 : Constitutional Medicine
Constitutional Medicine starts with an exposition of the teachings of Hippocrates on constitution and temperament and explains the system used by the Greek naturalist to assess the most common genotypes. The text examines the use of the classical four temperaments (choleric, phlegmatic, sanguine and melancholic) in Homœopathy and the materia medica. It reviews statements on the relevance of various constitutions by Hahnemann, Boenninghausen, Hering, Jahr, Kent, Allen, Roberts and Whitmont. It also provides a discussion of aphorism 5 of the Organon and its importance in the study of the whole human being and its relationship to environment.
The Hippocratic Corpus
Hippocrates was born on the island of Cos around 460 BC. In the apocryphal biography the Father of western clinical medicine was born into a medical family that traced its lineage to Asclepius and Hercules. He placed great emphasis on the innate constitution of human beings because it intermingles with and conditions all responses to environment. In The Nature of Man Hippocrates discusses the make-up of the human constitution and how it interacts with nature as a whole. He recorded many of his clinical observations of the effects of environment, food, and water on the human constitution in his famous work Air, Water and Places. He followed the Pythagorean system of primordial homœomeries, which are the similar archetypal qualities that constitute all phenomena.
The Pythagoreans called these unchanging roots the immaterial ether and the four physical elements composed of air, fire, water and earth. Hippocrates carefully avoided the intellectual debate about which one of the five elements was the primary power. He was more interested in the direct observation of the five elements and four humours in the constitution of his patients and their symptomatology.
Hippocrates summed up much of his clinical philosophy in the first paragraph of Aphorisms of Hippocrates with the epigram: “Ho bios brachys, he de techne makre (L. Ars Longa — Vita Brevis).” This statement may be translated as “Art is Long — Life is Brief”. The old master wrote that it takes a long time to develop the true arts while life passes quickly, crisis is fleeting, experience is perilous, and decisions are difficult. The healing artist must do what is correct according to their ethics and understanding as well as seek the cooperation of the patient, assistants, family and friends. They should do everything in their power to make the external circumstances harmonious so that the goal of true health may be accomplished. For these reasons, the practitioner should approach the study of Homœopathy with sincerity and great perseverance.
In the course of one’s career one will face many serious situations involving difficult decisions that can only be made properly with experience. The task is not easy, the situation multifaceted, and the responsibility great. Even when one conceives a plan it is sometimes difficult to get the full assistance of the patient and their family. The healing artist should be willing to be with the patient and their family at difficult times like birth, accidents, misfortunes, illness and death. They must be a combination of minister, counselor, and psychologist as well as medical practitioner.
Hippocrates was extremely practical in his approach to clinical medicine. He based his system on the observation of Physis, the living power of nature found in the human organism. He was well aware of the healing properties of similars. In the Organon Hahnemann quoted Hippocrates’ “remarkable words” (in On the Place of the Things which Regard Man, Basel: Froben, 1538, page 72) as an example of ancient Homœopathy.
Disease is born of like things, and by the attack of like things people are healed…
Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Introduction, page 57.
One of the most important teachings of Hippocrates is the doctrine of the aetiological constellation and interdependent origin. Most disease states do not have one single isolated factor that can be called its sole cause. A mixture of susceptibility, virulence, exposure and time and circumstances is involved in most illnesses. Every human being possesses an innate predisposition and a certain amount of vitality that may be utilized in the form of adaptation energy. A person’s essential susceptibility is based on the nature of their congenital constitution and natural temperament as well as the amount of exposure to mental and physical stress at any given time. For this reason, Hippocrates taught that all diseases are constitutional in nature and only become local as the last resort to promote crisis.
Throughout medical history there has been a great debate about which comes first in importance, constitutional susceptibility or the pathogens that cause disease. This question was at the root of the disagreement between Claus Barnett and Louis Pasteur. Barnett felt that the host constitution was the prime factor in disease whereas Pasteur placed more importance on the role of the pathogen. Many people carry the streptococcus bacteria yet remain healthy under normal circumstances. If they are subjected to excessive mental or physical stress many of them are likely to develop symptoms. Other individuals are very susceptible to streptococcus and will become seriously ill if sufficiently exposed. Some people will never suffer from streptococcus under any circumstances. What is the true cause of the disease then?
Hippocrates placed the most emphasis in the congenital constitution although he did not deny the influence of external stress factors and pathogens. Toward the end of Pasteur’s life he realized that Barnett’s view was more correct. The fundamental cause of disease is so closely related to the predispositions of the constitution that it is impossible to ignore its primacy. Great physicians like Hippocrates, Paracelsus, and Hahnemann were well aware of the importance of the constitution in the art of healing.
Definition of Constitution and Temperament
Hippocrates introduced the tradition of studying the constitution and temperament into clinical medicine more than 2,500 years ago, which makes it one of the oldest living traditions in western medicine. The term constitution is derived from the Latin noun, constitutio, which means an arrangement or physical make-up and the verb “constituere”, which means to establish or constitute. To constitute means to establish, to create, to set up, to form, to make up, to appoint, to give being to, etc. The term, constitution, may be defined as an act of creating or constituting; the way something is made up or formed; the rules and regulations governing an organization; the principles, laws and personal rights on which a state is founded; the physical make-up, state of health, nature of the temperament, etc.
When the term, constitution, is used specifically as a medical term it relates to the make-up, nature, qualities, health and condition of the physical body and the mental temperament. Constitutional means that which affects the whole; the inherent natural make-up or structure of a person or thing; the way something is arranged in reference to its composition, construction or nature; that which relates to the physical and mental health or make-up. The term, constitution, is closely related to the word, diathesis, which means an inherited or acquired constitutional disorder. Therefore, there may be inherited and acquired dispositions and diseases that affect the whole constitution.
Hippocrates observed diseases from the vantage point of constitutional syndromes, and their symptom pictures, rather than by pathological names alone. He carefully studied the physical constitution and its relationship to the mental disposition while recording the effects of stress and pathogens on his patients. Through observation Hippocrates recorded the predispositions and symptoms of his patients according to the most common biological types called the four temperaments. Hippocrates called these constitutions the choleric, phlegmatic, sanguine and melancholic temperaments. The essential qualities of the four temperaments and four humours are related to the four archetypal elements of earth, water, fire and air. The doctrine of the four temperaments is closely linked with the tradition of the vital airs and the humoural physiology.
Modern science says that 80% of the human body is composed of humoural fluids, which are the medium of life. A humour in the classical context is defined as a fluid of the animal body, especially the four that are considered in Hippocratic physiology to determine temperament or the disposition of mind. This is the basis of defining the word, humour, as the specific temperament or state of mind. This is the root of statements like “she is in bad humour” and “he has no humour” or “they are out of humour”.
The four major animal fluids are the bilious (bile), pituitious (clear fluids), sanguineous (red blood), and atrabilious (blackbile) humours. Each of these four humours has a particular mood, atmosphere and quality. The earthy yellow bile is angry, dry and hot, the watery pituitous phlegm is weepy, moist and cold, the fiery sanguine blood is passionate, hot and moist and the airy black atrabile is melancholic, cold and dry. A derangement of these humours produced by inner or outer causes generates a specific syndrome of signs, befallments and symptoms.