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A Reconstruction of the Hippocratic Humoral Theory of Health Author(s): W. Balzer and A. Eleftheriadis

A Reconstruction of the Hippocratic Humoral Theory of Health Author(s): W. Balzer and A. Eleftheriadis

Source: Journal for General Philosophy of Science / Zeitschrift für allgemeine

Wissenschaftstheorie, Vol. 22, No. 2 (1991), pp. 207-227 Published by: Springer

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A RECONSTRUCTION OF THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

W. BALZER andA. ELEFTHERIADIS

SUMMARY.

sponding

is laid

The

The

of

model

underlying

the

hippocratic

is reconstructed

and

historical

in which

out,

'descriptive'

and

part

the presentation

hippocratic

structure

the

of

basic

theories,

aetiology

the model,

humoral

theory

is worked

of

of

model

as

contrasted

to

on

global

net

specializations

of

'therapeutical'

in general.

humoral

theory,

as

structuralist

well

in precise,

as

the

terms.

corre

Stress

philological

the

the

different

particular

theories,

derivations

diseases

are

are

metatheoretical

are

exemplified

suppressed.

described

as

features

and

stated

Key

words:

medical

theory,

turalism,

model

theory.

theoretical

medicine,

humoral

pathology,

axiomatization,

struc

INTRODUCTION

This paper presents a logical reconstruction

of the four humores

cular

account

First,

of what

in the Corpus The paper It is intended account

may

be called

Hippocraticum,

Hippocraticum,

emends

and

to serve

of

this

the theory

in parti

the

as

laid

down

in the work

given

a

'Nature

of Man'.1

1991).

simplifies

in (Eleftheriadis,

and

several

theory

purposes.

is given

consistent,

comprehensive

in axiomatic

from the original hippocratic texts, nor by mere philological

studies:

to be eliminated. Reconstruction

to the historical material

form.

have

This

cannot

be

achieved,

links

of

to be

course,

by mere

abstraction

or

historical

gaps

to be filled,

However,

as

in

historical

we

missing

close

this

introduced,

We

concentrating

want

which

the

inconsistencies

tried

to

stick

on the Corpus

to

go

the

fill

a

model

into

would

resulting

involves

construction.

of

on

do

not

our

model

presenting

as possible,

paper

we

Hippocraticum2.

philological paper of its own. Rather,

as well as some derived meta-theoretic

as possible.

Second,

all

in general

plifies

and

'derivations'

concentrate

features in a way as clear and precise

humoral

theory

exem

essential

to empirical

theories

now

one

proper

known

under

the

label

hand

this

shows

that

empirical

application

theories.

of

the

the

as

successful

we

want

to make

clear

features

which

have

been

according

to the general

approach

in fact,

this

to

may

that Hippocratic

regarded

meta-theory

On

regarded

further

of

'structuralist'

theories,

the

other

theories.3

be

a

medical

On

hand

yields

structuralist

Thirdly,

discussion

meta-theory.

this

work

is

intended

on

the methodological

as

status

a

contribution

to

of medical

theories.4

the

continuing

The

example

Journal

?

for

General

Philosophy

of Science

22:

1991 Kluwer

Academic

Publishers.

Printed

207-227,

in theNetherlands.

1991.

208 W. BALZER AND A. ELEFTHERIADIS

studied

is, hippocratic

exemplifies

all

humoral

the properties

theory

has

to

of

be

empirical

regarded

theories

as

an

in general,

empirical

proper.

of

Moreover,

in Sec.

theories

in the natural

IV, an

sciences

important

is pointed

distinction

out

and

to the

exemplified.

'normal'

that

theory

form

I. THE BASIC PICTURE

According in the human

'power'

perfect

to

'The Nature

body

whose

is decisive

these

of Man'5

of

four

humores

or

cardinal

'bulk'

fluids

exist

and

state

'mixture'

and

duly

bulk,

depends

on

(krasis),

(plethos) he enjoys the most to one another are

perfectly

(dynamis)

health

when

of

Thus

humoral

only

and

for health

elements

power

health

are

and

disease.6'

proportioned

on

and

when

three

in respect

mingled'.7

compounding,

a person's

state: first,

in case

third,

humoral

state

of

may

they

characteristics

of

the humores;

'qualitative

in the

of

his

body's

can

the humores,

This

in every

the

that

and

it depends

they

the mixture

Second,

to obtain

his

health

of

obtain

are mixed.

intensity'

their quantities

humoral

it makes

up

condition

the person

be

exposed

so

that

the

of

have

'right measure'.

is not

the

same

body8,

obtains

ideal mixture-balance

individual,

special

in

the

standard

special

health.

(eukrasia)

of

this

destroy

nature

If

which

of

intense

a person's

standard

we

say

Now

is eukratic.

to causes

one

either

more

the person

in some

out which

the optimally

humores

the

increases

and

than

others,

consists

of equilibrium

or mixture

so

of

at

these

typification

of

being

kind

present

of

only

body

four

for

four

elementary

dry.

Yellow

is warm

and

bile

moist,

'carrier'

may

be

(cpopefc)

present

is

their corresponding

proportioned

or

is

is

in finding

isolated

lack

humoral

or

state,

the four

becomes

sense.

of

qualitatively

The

person

have

their

a chemical

humores

by

different

it, or

humor,

then becomes

run out

quantities,

sick.8 Therapy

of

their range

qualities,

was

a

not

rough

available

or

'juices'

every

is reserved

it. Not

with

and

the

the humores

increasing

and

in diminishing

or

that

equilibrium

is restored.

Of

course,

the notion

of

times

(about

450

BC),

so

directly

observable,

 

in the body,

liquid

being

is regarded

yellow

of

them:

These

four

qualities

warm

of

and

phlegm

of

two

produced

as

substance

represent

liquids

leaving

this

label

phlegm.

and

connected

cold,

moist

moist,

each

the

qualitatively

a different

black

are

bile,

bile,

humores

blood

intimately

warm,

the

dry,

human

black

body:

bile

and moist.

We

intensities

ad

is cold

say

and

that

blood

is cold

humor

is the

qualities

qualitative

(dynamies).9

These

the quantities

in different

dregees10,

they vary with

humores.11

Concerning

representations

a

representation

that

the different

seem

would

quantities

from

and qualities of the humores numerical

a modern

standpoint.

However,

such

the

historical

still was

used

today

background. in its process to

of

represent

We

have

formation,

qualitative

natural

conflict

with

to be aware

the concept of a real valued function

the concept

of a quality

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

209

orderings

did

not

exist.

Furthermore,

no

strict

ways

of measuring

the quantities

the

the

qualities

were

known,

and

no

humores

were

made.

Consequently,

mixture

and

equilibrium

remain

attempts

very

at measuring

of

the hippocratic

qualitative.

formulations

There

concerning

'more

or

is only

less'

of

of

-

some

humor

or

For

these

treatment

these

our

models

clarifying

some

we

quality

avoid

in accordance

with

yields

a

what

and

could

stick

be observed.

reasons

notions

treatment

comprise

the

numerical

qualities.

representation

This

to a qualitative

complication

of view,

The

attempts

ond,

change

basic

the

at

(health)

of humores

in our

two parts.

concept

provides

over

of

a

a

time,

disequilibrium

and

an apparent

point

part which

Sec

may

equilibrium

the

latter may

of

however,

reconstruction.

From

and

logical

'more basic'.

is less complicated,

First,

state

there

of

of

is a statical

certain

how

how

equilibrium

how

or health.

factors

dynamical

the states

may

change

part

of a pearson into

picture

and

consequently

and

(illness),

be

treated.

 

II.

PRIMITIVES AND POTENTIALMODELS

The

central

<

notion

^>

of

a

humor

of

humor.

represent

set D

of

and

four

and one

we

by

a weak

order,

and

i.e.

by

a

structure

^ on

such

weak

D

D,

consisting

is

transitive,

for

a

reflexive,

The

abstract

for moist-dry.

'degrees'

We

a relation

four

two

which

connected.

qualities

we

introduce

into

orders,

orders,

one

one

each

for warm-cold,

comprise

Though

Hippocrates

always

the

We

two

keeps

the

four

qualities

the humores

qualities

seperate,

each

nothing

into

one

gets

lost

opposite

of

according

pair to the following

respective

list:

abbreviate

by

combining

weak

order.

(1)

hx = yellow

bile,

h2 = black

bile,

h3 = blood,

hA = phlegm,

and

for

we

i =

denote

1, 2,

3,

the

ht = <11 four humores.

corresponding

ht

weak

orders

Index

in the

form

<|

| ht\

|,<,->,

always

4,

so

\ |,^,>.

Similarly,

/ in the following

orders

for

will

the qualities

range over

these

are denoted

by

-

(2)

ql

where

each

ql

range

over

1,2

order

in terms

the two weak

temperature,

has

in the

of ^

the

q2 = moisture

q 2 = m o i s t u r e
q 2 = m o i s t u r e
q 2 = m o i s t u r e
q 2 = m o i s t u r e

form

ql

=

<|

^||

As

b iff

usual,

a ^

|,^'*>,

and

a)

index

equivalence

i will

b

always

strict

(a <

b

following.

by:

(a ?

we

b and

define

b ^

and

iff

and

(a <

and

A

not

b ^

person

a)).

at

of

humoral

its humores,

degrees

each

the

time

eight

(two

for

whether

the

humores

are

has

degrees

each

a distinct

of

the

humor),

in mixture

or

state

comprising

the

four

degrees

qualities

and

So

one

not.

corresponding

further

item

each

state

s(t)

to

these

indicating

at

time

t

is a

13-tuple

1y(/)=<Cz1,

,z4,z5,

,z8,Z9,

,z12,z13Z>

210 W. BALZER AND A. ELEFTHERIADIS

where

zx,

,zA

are

degrees

the

signs V

quality

q1,

z9,

,zn

(for separated)

St

= \W\\\ ^ = ||Ail|x

of

the

degrees

and

'?1 s'

humores

of

quality

(for not

hu

,hA,

q2,

and

separated).

separated).

^Hl<72ll4,

x||A4||.

SQ =

StxSw

z5,

,zs

z13

are

is one

Defining

and

degrees

of

the

of

two

each

such

Elements

states.

state

is

of

SH we

an

will

element

of

the

'state

call

humoral

states,

space':

SH

and

elements

x

Sq

of

Sq

X

{s, ?\s}.

qualitative

Whereas

the

the

information

equilibrium

two

sets

and

that

humores

of quantitative

the

are

in mixture

by

and of qualitative

primitives.

symbol'?15',

We

use

POSCS^

the notions

of

equilibrium

qualities

the corresponding

BALCSg

of

is expressed

the humores

afford

further

to contain

equilibrium

intensities,

exactly

those

(7roo6rrjTa)

respectively.

tuples

and

These

The

assignment

of degrees

by two functions 0,:

""** 11<72lI ?t(u)

=

11h{\ |U

that

vmeans

of

degrees

balanced

two notions

qualities

are

of

U|

|hA\\ -

the humoral

which

with

have

are

in quantitative,

humoral

respect

a rather

to

their

theoretical

qualitative

status.

to degrees

of

humores

\ \ql\ | and &w: 11hx\ | U

degree

u

'has' degree

is captured

U

11hA\\

v of quality

(e.g.

v means

ql

a given

that

of

blood

has

a

certain

degree

assign

,%t(zA),

central

and

=

degree

the

temperature),

v

of

quantity

qualitative

of 0t

states

and

0W:

,^w{zA)>.

theoretical

over

0w(w)

humoral

a

degree

core

defined

{zx),

u has

to

with

q2. Further

to

humoral

more,

states.

In

employ corQ can be

core

addition

(zl5

to

there

we

function

explicitly

,z4)

these

are

=

<0/

the help

^w{zx),

for

the

the

notions

concept

time.

of

equilibrium,

others

concerning

description

First,

of

course,

time

itself

is needed.

We

it by

a

linear

order <T,<

>,

where

T

is supposed

to be

a finite,

represent

non-empty

anti-reflexive

set

(representing

points

of

time)

the maximal

and

<

C

T

x

element

T

transitive, of T with

is

respect

to <,

then

and

by

connected.

denote

T* we

T\

If

t*

is

{t*},

and

for

each

t

e T*

we

denote

by

t+\

the

unique

t'

e T

such

that

t <

/' and

there

are

no

/"

e T

such

that

t<

t"<

f.

The

function

mentioned

then may

be

typified

precisely

by

s:T ?

SHx

SqX

is described

s(t)

{s, ?1

already

s}.

The

?

'observational'

state

of health

of a person

by

a function:

g:T

{healthy,ill}.

Finally,

we

use

a

set F

of

'factors'

and

a

function

a

describing

how

these

factors

affect

the

different

humores,

their

qualities,

and

the

state

of mixture.

We

write

a(tf)=<h,

a,

q,

b,

c>,

to

be

read

as

'at

/, factor

/

affects

mixture

and

ed

by

of

humores

respectively

{s,0},

'greater'

and

^

>,

s

indicates

'/

humor

'smaller'

is

h

in direction

a,

and

'+'

a,

c range

quality

q

in direction

where

c.

b,

'-'

natural

and

in the

the

of

indicate

reading

'0' neutrality.

in the

seperating',

in direction

{+,-,0},

b,

and

D,

sets

{+,-,0}

express

<

we may

directions

the

orderings

Altogether

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

211

define,

in structuralist

format,

the class Mp

of potential

models

as follows.

DI

is a potential exist

x

hl9

,

model

of

h4, q\

q2 and

hippocratic

F,

T, H,

Q,

<

theory

(x

,s,g, POS,

 

and

a

such

that

x=<T,

 

H,

Q,

F, <,s,

g,

POS,

a >

and

 

(1)

<T,

<

>

is a

finite,

linear order

 

(2)

H={hu

,hA]

and

each

ht

weak

order

(3)

Q={<l\

42} and

each

ql

is a finite is a

finite,

weak

 

order

(4)

s:T-+

SHxSQ

x{s, ?i

s}

(5)

(6)

g.T-

POS C

{healthy,111}

SH

 

(7)

BAL C

SQ

(8)

0,:||/*J|U

U||/*4||HI<71II

 

(9)

0W:||/*J|U

U||/*4||HI<72II

(10)

F

is a non-empty

set

(11)

a:TxF-(Hx

{+,-,0}

x

Q

x

{+,-,0}

x

{j,0})

e MS)

BAL,

BAL,

iff

0?

0?

there

%w

%,

We

may

suppose

could

of

the

that

all

orderings

are

were

and

finite

because

limited

so

Q,

and F

that

are

respectively.

over

person

states

factors

the means

only

of

few

differentiating

degrees

by

describes

yields

not. Elements

equilibrium,

and

qualities temperature and moisture,

at what

Each

son, whether

qualities

states

the degrees

be

time,

in antiquity

Elements

qualities

and

qualities

time

may

very of T, H,

factors,

distinguished.

humors,

of

interpreted

Function

time,

while

is healthy

s

g

or

points

humores,

over

and BAL

of

degree

affect

mixture

a direct

0^

to

time,

potential

description

of POS

and

each

and

of whether

be

called

balanced

the

humoral

in intensities,

in quantitative

respectively.

of

(degrees

St

the)

are

effective

per

po

models.

states

humoral

how

model

assign

its corresponding

which

and

a describes

the humores

the concepts

persons

they

their qualities.

to describe

comprises or sick. Different

is no need

necessary

being

one

by different

healthy

there

captured

tential models,

to mention

the person

in the potential

III.

THE

MODELS

In

sets

order

state

are

two

(resp.

to

the

helpful.

axioms

We

<D,

order

characterizing

say

^>

that

a</