Aphorisms of Moshe chapter 2

The Four Humors

The “four humors” is an ancient theory about the healing of the body. Their earliest mention is in the Sefer Raziel which is attributed to Adam the first man. There is a brief discussion of it in the section of the Zohar called “Raya Mehemna” (רעיא מהימנא - Faithful Shepherd). More recent classics which include it are the Kuzari c.1140 and The Gates of Holiness by Rabbi Chaim Vital (1542 - 1620).

The four humors are emphasized in the Ayurveda texts of India. The main classical Ayurveda texts begin with accounts of the transmission of medical knowledge from the gods to sages, and then to human physicians. Some scholars assert that Ayurveda originated in prehistoric times and if a biblical paradigm is used that would be the ten generations from Adam to Noah. From Hippocrates onward, the theory of the four humors was adopted by Greek, Roman and Islamic physicians, and became the commonly held view of the human body among European physicians until the advent of modern medical research in the nineteenth century. The concept has not been used in medicine since then. Some say that it still has value while others say it is pseudoscience.

Like the physicians of the his day, the four humors were used by Maimonides and he devotes the second chapter of Aphorisms of Moshe to it. The Rambam was not shy about being critical when it was appropriate and as such also wrote a critique on the works of Galen which were the prime medical texts at the time. It is not certain what his point of view would be today. The Rambam would probably like its holistic approach as well as the idea that behavior and health were largely connected.

Maimonides identifies the four humors as blood, black bile, yellow bile, and phlegm. These labels though have wider implications. Black bile would apply to the digestive system. Yellow bile is lymph and seems to apply to the immune system. Phlegm applies to the respiratory system and the brain. Things like the skeletal, muscular, nervous, and reproductive systems can be fit into this model. Other parts of the body would be difficult and may seem forced. However this is not unusual in other religious all inclusive models.

The Rambam explains that other secretions are derived from the four humors which may or may not be healthy. In addition an excess or deficiency of a healthy substance can have an adverse effect on the body or behavior. For example black bile, which is associated with digestion, if in excess or unhealthy can cause hemorrhoids, cancer, leprosy, peeling of the skin, quartan fever (not positively identified but probably malaria), thickening of the spleen, and dementia.

These components have the quality of being either hot or cold as well as being dry or wet. The great Persian physician Avicenna (980 - 1037) focussed on these four characteristics. Hot was associated with feverish inflammations, deficient energy, thirst, and food having a bitter taste. Cold was associated with rheumatism, deficient digestive ability, lack of a desire for fluids, and flaccid joints. Wet was associated with being tired and sleepy, difficult digestion, spitting up phlegm, and diarrhea. Dry was associated with lethargy, insomnia, and rough skin. Changes in diet and various herbs were prescribed to cure maladies associated with imbalances and bad humors.

There were four personality types that corresponded to the four humors and these corresponded to the four elements of antiquity. Blood was associated with a sanguine or cheerful personality and the element of air. Yellow bile or lymph was associated the choleric person, who was angry and dominating and the element of fire. Black bile was associated with a melancholic or depressed personality and the element of earth. Phlegm was associated with being phlegmatic or calm and unemotional, and its element was water.

The four elements in turn correspond to the the four letters of the Tetragrammaton. Fire corresponds to Yud, wind corresponds to Heh, water corresponds to Vav, and earth corresponds to the final Heh. This hints that our health is in the hands of Hashem and the bridge is good character and living in harmony with the nature.

לע"נ הסבתאטויבע בת יואל לייב ז"ל נלב"ע כה שבט תשכגו

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