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The Four Humors and the Integrated Universe: A Medieval World View

Marcy has lengthy experience in print and online media, including writing for traditional publishers as well as for self-publication.

What are the four humors?

What are the four humors?

The Four Humors

Medieval man saw the world around him as concrete, literal and integrated. I once had a teacher who described it as an "enchanted" world filled with joyful innocence.

I do not consider a time when the mentally ill were chained to walls or when women were arbitrarily deemed witches and burned at the stake alongside heretics to be "enchanted." Highwaymen raided dark forests and robbed travelers; the plague decimated populations.

It seems more appropriate to describe the Middle Ages as having a world view in which a sense of connectedness between the tangible and intangible created a literalness, an integration, and a sort of structured guideline to coping with life.

An essential component of that worldview was the concept of the four humors. Founded in classical lore, it influenced the Medieval outlook on everything from personality types to the physical description of the heavenly bodies -- and everything in between. Even today, the legacy of the humors influences art, culture and language.

Humor: Originally, Not So Funny.

The word humor meant, originally, "fluid." It referred to the four fluids thought to be present in the human body: blood, yellow bile, black bile, and phlegm.

In an ideal situation, each of the humors was properly balanced. However, should one fluid overpower the others, the body becomes out of balance and causes medical and psychological illness. Personality types, moods, psychosis and sickness were all easily explained by a surplus or lack of a particular humor.

An Ancient Foundation

Early philosophers and scientists believed that four elements comprised everything in the universe -- including man. Those four elements -- fire, air, earth and water -- were associated with physical states, such as hot/cold and dry/moist. Their duality and opposition represented man's own natural balance (or lack thereof).

The Greek philosopher Empedocles (circa 450 B.C.) described these elements in his On Nature and perhaps founded the concept of the four humors. Aristotle later followed Empedocles in fostering the view that the four elements dictated temperament. However, Aristotle offered his own physical basis for the belief (for example, "pneuma" or wind -- air -- created an "inborn heat" that gave life). Aristotle taught that human veins carried blood and air.

Hippocrates (c. 460 - approx. 377 BC) advanced the doctrine of humors in medicine, teaching that an imbalance of the humors was the cause of illness. As he put it in On the Constitution of Man. The Four Humours, Part IV:

When all of these elements are truly balanced and mingled, he feels the most perfect health. Illness occurs when one of these qualities is in excess or is lessened in amount or is entirely thrown out of the body. Because when one of these elements is isolated so that it has no balance, by one of the others, the particular part of the body where it is supposed to make balance naturally becomes diseased.

The widely influential court physician Galen (private physician to emperor Marcus Aurelius) expanded the theory of the humors into that of four temperaments. He described them as the choleric (hot / dry), melancholic (cold / dry), sanguine (warm / moist), and phlegmatic (cold / moist). Galen also ascribed to each temperament or humor physical attributes from hair color, complexion and physique to the psychological attributes associated with each fluid. Galen believed every food corresponded to humor, with some foods producing bilious blood, phlegm or pure blood. The influence of Galen's teachings carried on for centuries: even prominent Swiss psychiatrist Carl Jung later based his theories on Galen's classification of personality types.

Oh, Those Literal-Minded Medievals!

We who dwell in modern times are are such figurative creatures. It is a luxury to be symbolic rather than literal. If someone tells us their doctor has bled them dry, we know without asking that they're complaining that their medical bills have been outrageous. Our counterpart from the Middle Ages, though, might truthfully say that someone was bled dry by a doctor -- since bleeding a patient was a common way of treating many disorders. Often, the patient died. Sometimes, the blood loss was a contributing factor or direct cause.

If someone describes a person or animal as being "hot-blooded" or "cold-blooded" we know they're referring to personality type, not that someone's blood truly was boiling as they grew angry -- or that it was icy cold as they did something cruel. Our Medieval forefathers, though, believed blood did grow hotter or colder. It was a very literal time.

We speak of being in ill humor and we know it refers to a bad mood. Our Medieval ancestor, however, would know that ill humor meant that the fluids of the body -- the humors -- were quite literally causing us to be mentally or physically ill. That's precisely why their physician might bleed a patient. It would release the excessive humor causing the imbalance.

As for that word "physician," it originates from the word "physic" -- again, a reference to the physical world and the elements. Early physicians were expected to understand the laws of the universe and physics and to apply them to the healing sciences, just as "chemists" (the equivalent of today's pharmacists) were expected to understand alchemy and chemistry, and to apply those equally to dispensing healing remedies.

Doctors and chemists of the Middle Ages were well versed in astrology, the elements, and the connectedness of all physical things. It's no wonder that the lines between science and mysticism were often indistinguishable; the physical world was seen to have powers and properties that even today influence our superstitions, our figures of speech and even many "New Age" healing practices.

The Ptolemaic Universe and its Influence on Medieval Thought

Ptolemy, the influential Greek astronomer from the second century A.D., is credited with the description of the universe that informed the Medieval world view. He proposed that the earth was the center of the universe and must, necessarily, be fixed and unmoving. He proposed that all heavenly bodies were physically fixed to crystalline spheres.

The Ptolemaic Universe had a profound influence on the Medieval world view. Not only did people see our earth as the center of the universe (which had significant theological and philosophical implications), but the literal thinkers of the Middle Ages saw the parts of the universe as being permanently and tangibly connected to one another. Where we might speak poetically of stars suspended in the sky, the Medieval astronomer was seeing stars fixed to that sky.

Andrew Borde's 1542 Diagram Depicting the Universe

Andrew Borde's 1542 Diagram Depicting the Universe

The Integrated Universe

Thus, Medieval man saw the universe -- and its many wondrous components -- as being both physically and symbolically connected. Man, God and nature were believed to be integrated. In Medieval thought, God dominates nature (the mineral, vegetable and animal kingdom) and man is the ape of Nature.

Medieval thinkers loved charts and illustrations showing the relationships of all physical things. Andrew Borde's diagram of the universe from the 1542 "The First Book of the Introduction to Knowledge" is an excellent example. In thirteen rings that radiate outward from the center (Earth), it depicts the structure of the universe. Based, of course, on the Ptolemaic universe, Earth is encircled first by Air, then Fire. Next, the heavenly bodies: Moon, Mercury, Venus, the sun, Mars, Jupiter, and Saturn appear. The stars are depicted in the eighth ring, illustrated by the astrological symbols for the constellations; this is "The Circle of the Fixed Stars." They are encircled by the Crystalline Heaven, which is surrounded by the First Movable (or Primum Mobile) sphere, and finally -- on the outermost ring -- is the Empyrean sphere (highest heaven) aka, "The Abitation of the Blessed." The metaphysical concept of "heaven on high" as a place for good souls to ultimately reside was very much a part of the Medieval belief in a physical heaven fixed above all other parts of the universe.

Each planet has an affiliation with a disposition, a specific complexion, and an associated metal. Borde is kind enough to note them for most of the planets. As such, you can see that man felt very connected with their astrological sign, the nature of the planets, and the rest of the physical world around them. It is understandable that someone might thus describe it as "enchanted" -- although I still argue it is an inappropriate word choice.

Borde's Seven Medieval Planets and Affiliated Metals, Complexions and Nature

Above are the associations between the seven medieval planets (remember that Earth was considered the center of the universe, not a planet) as diagrammed by Andrew Borde, 1542.

Heavenly BodyMetalComplexionNature







~ Not Stated ~

~ Not Stated ~





















The Four Humors or Complexions

Now we get to the really interesting stuff. The word "humor" or "humour" is from the Latin humor meaning, surprisingly, moisture. That's why the word was applied to the body's fluids. As mentioned above, these four fluids, thus four humors, were blood, phlegm, yellow bile (called "choler") and black bile (called "melancholy"). People were believed to have a humor that predominated, and their personalities, complexions and health were tied to the attributes of these humors. These dispositions or complexions were sanguine, phlegmatic, choleric and melancholy. People were considered true to type. The well-balanced individual, though, had an equal amount of each humor.

Medieval author Geoffrey Chaucer, in arguably the liveliest romp through Medieval literature, The Canterbury Tales, often notes which "humor" his pilgrims bear. Of the Franklin he wrote, "of his complexioun he was sangwyn" referring to the sanguine humor; the Reeve, a "sclendre colerik" man (slender choleric). Each of his pilgrims were true to their humor -- which, in the Medieval world, they must be -- just as they were true to their astrological sign and their physical appearance.

In the beautifully interrelated world of the Middle Ages, the physical world was orderly. Illnesses, like humans, winds and planets, had humors and elements associated with them. Chaucer describes the Physician in the Canterbury Tales as knowing "the cause of every malady, were it of hot, or cold, or moist, or dry, and were engendered, and of what humor."

Each humor was also associated with a wind (north, west, east, south); a season (remember, for every thing there is a season!); a stage in man's life; and one of the four elements: earth, fire, air and water.

Handy Reference Chart: The Four Humors

HumorBody FluidElementWindSeasonLife Stage


Yellow bile




Old Age








Black bile




Manhood / Prime of Life







T. Walkington's Diagram from "The Optic Glass of the Four Humors," 1639.

T. Walkington's Diagram from "The Optic Glass of the Four Humors," 1639.

The Choleric Humor

The humor ruled by the malevolent Mars, and associated with Aries, Leo, and Sagittarius, the choleric disposition is a hot - dry humor. Its element is ignis, fire. Choleric individuals are passionate, fiery and irascible. It's an angry sign -- and as a hot humor, it makes sense that we refer to people as "hot-tempered." The choleric man was considered "all violent." A Medieval illustration of the four humors depicted the choleric man beating his wife.

Yellow bile was the fluid of the choleric complexion. Since bile is linked to jaundice, and one's humor was reflected in one's complexion, the choleric individual was seen to have a yellowish complexion.

Its season is aestas -- summer. Appropriately, its life-stage is juventus: the prime of life, manhood. Favonius, the wind associated with the choleric disposition, is the west wind (also known as Zephyrus or the zephyr).

The Sanguine Humor

From the Latin word "sanguis" for blood, the sanguine humor is a happy humor. The humor of benevolent Jupiter, the sanguine complexion is associated with Gemini, Libra and Aquarius. Its element is air (appropriate for the lightness of being associated with the sanguine). It's a hot-moist humor.

People of the sanguine humor boast a ruddy complexion, rosy cheeks and perhaps a red nose -- just as one would expect since blood is their fluid. The humor is associated with joviality and good cheer. Medieval man believed the sanguine person was fond of "mirth and music, wine and women." Hot-blooded, lusty lovers were sanguine.ts life stage is youth (adolescentia) and its season is ver, spring. The Latin word ver also means youth.

It was believed the humor blood dominated the body from midnight until six a.m.

The Melancholy Humor

The humor of the malevolent planet Saturn, the melancholy complexion is associated with Cancer, Scorpio and Pisces; its element is earth (terra), and its wind is aquilo, the north wind. Its season is hyems -- winter (Latin hyemare) -- and its corresponding age of man is senectus, old age or dotage. The melancholy humor is cold-dry, as is appropriate for a "cold" temper -- one of sadness rather than spark. Just as we use the term melancholy to describe a depressed, blue individual, the Medieval man saw the melancholy personality type as brooding and contemplative. One Medieval illustration showed the melancholy man as playing a lute, the instrument of the bards -- melancholy types, of course, preferred poetry to parties.

The humor of the melancholy complexion was black bile. Not surprisingly, in the Middle Ages, an excess of black bile was thought responsible for mental illness. Suffering "dark thoughts?" It must be the black bile.

The benevolent moon.

The benevolent moon.

The Phlegmatic Humor

The humor of the benevolent and kindly moon, the phlegmatic complexion is associated with Taurus, Virgo and Capricorn. It is the humor associated with water and as such is a cold-moist humor, dominated by phlegm. Its wind is Eurus, the east wind, and it is the humor of autumn. The phlegmatic individual is unemotional, even apathetic, consistent with a "cold" temper. The phlegmatic person may be easy-going or simply uninterested. They were thought of as "given to sloth" (laziness) by the Medieval man. Phlegmatic individuals would have a pale (but not sallow) complexion.

As the humor associated with the moon, the phlegmatic complexion is linked to the metal silver. It is the humor that corresponds to the life stage of childhood.

Excerpt: The Four Ages of Man

The English-born Puritan American poet Anne Bradstreet (1612 to 1672) authored a poem, The Four Ages of Man, that concisely sums up the four humors and the corresponding life-stages and temperament. Excerpted here are but a few lines of the lengthy work:

Childhood, and Youth, the Manly, and Old-age.

The first: son unto Phlegm, grand-child to water,

Unstable, supple, moist, and cold’s his Nature.The second: frolic claims his pedigree;

From blood and air, for hot and moist is he.

The third of fire and choler is compos’d,

Vindicative, and quarrelsome dispos’d.

The last, of earth and heavy melancholy,

Solid, hating all lightness, and all folly.

A Medieval Prescription for Imbalanced Humors

Have you found yourself in ill humor? The 1484 Latin poem Regimen Sanitatis Salernitanum not only offered a great deal of medical and lifestyle advice, but proposed this to restore a choleric or phlegmatic man's balance:

If unto choler men be much inclined,

'Tis thought that onions are not good for those,

But if a man be phlegmatic (by kind)

It does his stomach good as some suppose:

For ointment juice of onions is assigned,

To heads whose hair falls faster than it grows:

If onions cannot help in such mishap,

A man must get him a Gregorian cap.

And if your hound by hap should bite his master,

With honey, rue and onions make a plaster.

As with many physicians of the time, the author of The School of Salerno (the English name for the Latin verse cited) attached significance to the alignment of the heavenly bodies during treatment of disease. As with all good Medieval practitioners, he was well versed in astrology and suggests best results will be obtained by bleeding a patient in September, April or May (except on May first or the last day of April or September. He points out you should not eat a goose on those days, either.) Why? He explains that the moon is most influential in those months.

Should you decide to be bled, by all means do it in April, May or September -- but avoid those "black-out" days!

The (Somewhat) Enlightened Paracelsus

Medieval doctor Paracelsus (1493 to 1541) was, in many ways, the archetypal physician of the Middle Ages. He had faith in alchemy and some believed he owned the Philosopher's Stone. In his travels, he delivered dramatic presentations filled with gimmicks. However, Paracelsus turned away from (and openly mocked) the concept of the four humors. Nonetheless, he believed in ens astrale -- the stars' influence -- as one of five influences on human health. He was bound by the world view of the time yet foreshadowed the Renaissance and the advent of modern medicine and pharmacology.

Paracelsus, although oft-persecuted during his time, is still credited by some as "the father of chemistry."

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Share Your Thoughts!

Marcy J. Miller (author) from Arizona on April 16, 2014:

Dolores, thank you! I believe there is more of the Medieval in us today than we'd like to think; I see many parallels with our contemporary culture -- for example, the public "shaming" of people by sentencing them to holding up signs in public is reminiscent of the stocks in the town square where tomatoes could be thrown at the "guilty" party as the townspeople laughed. So many of today's "New Age" views and beliefs are straight out of the 1400's. Soon, if I get the latest batch of research done, I'll be publishing my hub on augury and auspices -- another mystical practice from the Middle Ages that still lives on in superstition. Intriguing stuff!

You made me chuckle to think, "Today is the New Medieval!" as I ponder how the future will muse at our own weird and wonderful ways!

Best -- Mj

Dolores Monet from East Coast, United States on April 16, 2014:

Congratulations on your hub of the day. And no wonder, this was fascinating. I love how the word "humor" has changed over the years. And how astrology seemed to have such influence on science. When we look into Medieval times, they seem so strange and even silly. But it makes me wonder how, in a thousand years, those people will look at us.

Marcy J. Miller (author) from Arizona on April 08, 2014:

Hi, Stephanie! Thanks greatly for your comment and congrats. It is interesting how the four personalities certainly seem to apply to people around us -- I know I fit into one of the types rather well.

Best -- MJ

Marcy J. Miller (author) from Arizona on April 08, 2014:

Kimberly, thank you for your kind words! I really appreciate them. What a wonderful surprise it was to see HOTD when I checked in this afternoon!

Best -- MJ

Marcy J. Miller (author) from Arizona on April 08, 2014:

Thank you so much, Lisa! It's a fascinating subject. I love how classical and medieval history influence our language today in ways we often don't realize!

Best -- MJ

Lisa Chronister from Florida on April 08, 2014:

This is so interesting, and well written. I am intrigued and must find out more now! Thank you for sharing, I voted up.

Kimberly Lake from California on April 08, 2014:

Excellent hub, very interesting. Well written and absolutely engaging. Voted up, interesting, pinned. Congrats on Hub of the Day!

Stephanie Bradberry from New Jersey on April 08, 2014:

Excellent write-up about the humors.

Congratulations on your Hub of the Day.

I always found the study of the humors rather interesting. It amazes me that so many people can "fit" into four categories.

Marcy J. Miller (author) from Arizona on April 07, 2014:

Met2014, it appears to me that the word humor as we now most commonly use it, meaning in the comical sense, was a gradual transition. Shakespeare used it often to refer to a fancy or a mood in the late 1500's; in the mid-1600's it was commonly in use to describe whimsy or fanciful subjects, and it wasn't until the early 1700's that the first written usage appeared where "humor" was clearly intended to be funny or satirical. In 1709 Shaftess wrote an "Essay on Wit and Humour" that would indicate it was used to describe jocularity. Jonathan Swift also used "humor" in more of a satirical sense not long thereafter -- and satire is a springboard for comedy.

As for "humorous," before it became commonly used, the words "humourish" and "humoursome" were widely used but with a slightly different meaning. They described someone fanciful, moody or prone to strange imagination. Eventually, as humor became more widely adopted for things which are funny, it seems that the word "humorous" began to squeeze our "humourish" and "humoursome" from our language, and humor became not so negative in its connotation.

Thank you for visiting and commenting! I appreciate receiving a question on the subject!

Best -- MJ

met2014 on April 07, 2014:

Can you describe when the word use of Humor and Humorous transitioned to our current use? I have heard the history before, and like your description, and it made me wonder when the transition of the word use happened and how it happened.

Marcy J. Miller (author) from Arizona on March 20, 2014:

Julie, I am very much looking forward to your Salem hub -- and others. The plague was a force with devastating social and cultural consequences, including persecution of the Jewish people, that still affect modern culture. Thank you for your insightful thoughts.

Best -- MJ

Elizabeth from The US of A, but I'm Open to Suggestions on March 20, 2014:

I look at the plague in terms of much broader implications. I have found in my own study and research that the plague directly feeds into the widespread success (if success the word for such a horrible atrocity) of the various inquisitions across Europe, which directly feed into the witch hunt craze, responsible for the needless murder and torture of thousands of innocent people. Compared to Europe, Salem was tiny - but the acceptance of spectral evidence and the backwards nature of the trials themselves is incredibly disturbing. Our modern minds can't truly comprehend such a thing happening, but complacency is one of those things that enables bad things to repeat themselves. I've read the Black death before, but I will need to read it again soon. I will have to check out the other book that you referenced. Thanks for the tips. I will be posting a hub about Salem in the upcoming weeks, the result of my final paper for my current class.

Marcy J. Miller (author) from Arizona on March 19, 2014:

Julie, have you read Philip Ziegler's The Black Death? It's an outstanding, scholarly, comprehensive study of the plague during the Middle Ages. I referred to it yet again this afternoon while finishing this hub. I'm so glad someone else gets enthusiastic over the plague! (Does that sound a bit odd? You know what I mean.)

I have to confess to superficial knowledge of Salem, despite having visited it years ago. Sitting just inches away from me on my desk, however, is "Magic in the Middle Ages" by Richard Kieckefer -- something you might also find as interesting as I do. I'm kicking around the idea of a hub on Margery Kempe -- what do you think?

Best -- MJ

Elizabeth from The US of A, but I'm Open to Suggestions on March 19, 2014:

I've been reading the transcripts of Salem for the past the weeks for my current American history class and is fascinating. History is my passion, and it's not a passion many people share. I know way too much about the bubonic plague for my own good, but someone has to, right?

Marcy J. Miller (author) from Arizona on March 19, 2014:

Julie, thank you so much! I had a remarkable Medieval Literature professor, Dr. Sigmund Eisner, in college. He instilled a great love of the Medieval history and literature in me. I can still hear his voice reciting "Beowulf" (in Old English) all these many years later.

I appreciate your visit and your comment.

Best -- MJ

Elizabeth from The US of A, but I'm Open to Suggestions on March 19, 2014:

as a history student, this hub was awesome. I love reading whatever I ca about the Medieval period, and my concentration is on European History. Voted up.