Humoral Systems

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Humoral Systems

Many idioms and metaphors in the worlds' languages show evidence of a strong semantic connection between temperature, health and emotions. In Swedish, for instance, the idiom reta gallfeber på någon ('tease someone into a state of bile-fever') means making someone very angry. Today, the knowledge of what a bile-fever is, is lost on the majority of the Swedish speakers – but the origins of this, and many other similar expressions, can be found in the Hippocratic Humoral System. As we shall see, similar systems, and similar expressions, can be found in various languages and cultures across the globe – and it is the aim of this introduction to show the striking similarities and fascinating differences among these systems.

What is a Humoral System?

Humoral comes ultimately from Latin hūmōrālis; moisture, bodily fluid. In English the term itself remains as indicating an emotional state - one can be in a good humor or in a bad humor. In Swedish, similary, one can be på glatt humör (in a good temper) or på dåligt humör (in a bad temper). The expression han har ett riktigt humör (he has a real humör) is best translated into English as he has a real temper: where temper, of course, in connected etymologically to temperature.

These expressions entered the European languages together with the Greek humoral theory of medicine - often called the Hippocratic Humoral Theory, because its first known proponent was Hippocrates (ca. 460 BC – ca. 370 BC). Up until the 18th century, the Hippocratic Humoral System was the most important part of the medical paradigm - and at its heart was the idea that the body has four humors, (four fluids) - hot and cold, moist and dry. Any illness is the result of these humors being out of balance with each other.

A humoral belief system thus attributes intrinsic qualities of Heat and Coolness (and possibly Dryness and Moisture) to a number of disparate phenomena. Most typically, diseases and foodstuffs are labeled as either Hot or Cool. A central tenet of all Humoral Systems seems to be the quest for balance – a harmonious system is one that is neither Hot nor Cold.

Two prevailing principles can be found in the Humoral systems of the world – that of Selective Use of Opposites and that of Avoidance of Extremes. Cool diseases are cured by warm foodsstuffs or heating, and Hot diseases are cured by cool foodstuffs or reduction in temperature. Certain people can by nature, or the specific phase in their lives they are in (puberty, pregnancy, old age, female or male) be too Hot or too Cool – a state which must be guarded against: too much or too little heat are both dangerous.

The simplest Humoral Systems have only two labels – Hot or Cool – and little to indicate a logical pattern one could follow to understand and predict which diseases or foodstuffs gain which label. The more elaborate systems have many different degrees of Heat or Cold (Foster 1987 p.368), and not only diseases and medicine, but also people, seasons, temperaments, deities and time periods can be classified into this system – creating a complex world in which the intrinsic heat quality of all these factors interact to produce the current (good, bad or neutral) situation and affecting everything from health to climate. (Matthews 1983, p.827)

” various cultural contexts, the Hot/Cold dimension has been used to organize and order not only notions of health, but also parts and states of the natural environment, the ritual environment, social status, ritual status, and world view. Hot/Cold symbolic projective systems have been used to express a fundamental cosmological duality... and to distinguish between dangerous and sacred states, including illness, in which the social being is in touch with cosmic power.” (Messer 1981).

Is there only one Humoral System – or are there many?

There are four major Humoral systems that can be distinguished according to Foster (1994): the Greek Hippocratic system, the Indian Ayurvedic system,the Chinese traditional system and the South American system.

There is an ongoing scholarly debate about how these systems are historically connected. There are those (such as Messer 1981) who claim that there is strong evidence for at least some of these systems having arisen independently of each other - and only later on started reinforcing one another. The idea of ordering the world into dichotomies, based on the globally essential distinction between hot and cold, would account for the independent rise of the systems. Most importantly, the South American system, with its geographical distance to the others, may be established. Others, such as Foster 1994, argue that all the systems, including the South American, stem from the same historical root - representing a pervasive and useful cultural idea that is easily spread from one area to others.

The Hippocratic Galenic (or Graeco-Persian-Arab) System

The so called Hippocratic System was not invented by Hippocrates, but his writings are our first ”fairly certain” reference to humoral medicine. The system is further explained in Galen's writing (ca. AD 100) (Anderson 1987).

Foster (1994) describes the Hippocratic system as recognizing four primary elements: fire (Hot), earth (Dry), water (Moist) and air (Cold) - these primary elements were, in pairs, responsible for the four humors, or bodily fluids, that, properly balanced, assured the health of the individual. The four humors also corresponded to four temperaments and the four seasons:

Yellow bile - Hot/Dry - bilious (choleric, ill-tempered) - summer

Black bile - Cold/Dry - melancholic (melancholic, thoughtful) - autumn

Phlegm – Cold/Moist - phlegmatic temperament (calm, composed, sluggish, apathetic) - winter

Blood – Hot/Moist - sanguine temperament (ruddy, cheerful, optimistic) - spring

All diseases had their source in an imbalance of the four bodily fluids – or, in other words, in an imbalance in the elements. In this system, there is not only a temperature scale, but also a wetness scale – though this appears in other systems as well, the temperature dimension seems to be the most fundamental one.

From sometime before Hippocrates' time to the 18th century, the Humoral system of diseases and cures was the prevailing paradigm within which all doctors were trained. Today, it still leaves traces in the European languages in the form of idioms.

The four temperaments (Clockwise from top right; choleric; melancholic; sanguine; phlegmatic). Image of woodcut from 18th century text by Johann Kaspar Lavater. Public Commons Licence.

The Ayurvedic System of India

The first sure evidence of an Indian Humoral System appears in the 2nd century BC (Anderson 1987 p.331) – this opens up the possibility of influence from the Graeco-Persian-Arabic system, though it could also have an independent origin. (Wandel et al 1984).

According to the Ayurvedic theory, within the human body there are three intrinsic forces at work – the three dosas fire, air and water. When the body is in perfect health, the dosas are invisible, but when the balance is disturbed they manifest as the products of disease: phlegm, swellings, inflammation, bleeding and the like. As Beck (1969) points out, these dosas are also connected with seasons, diseases, colors, religious power and many other factors.

The Vata dosa is comprised of wind (but also ether). It is cold, light, rough, mobile, subtle, clear, dry and astringent.

The Pitta dosa is connected with fire. It is very intensive and hot.

Kapha dosa is a combination of earth and water. It is slow, heavy, cool, dense etc. and is primarily based in the stomach.

The level at which people actually use the Ayurvedic system varies – often the system in use seems to be a simplified version, such as the one presented in Beck (1969) which uses only a hot-cool distinction.

The Ayurvedic sages Nagarjuna and Agatsaya. This file is licensed under Creative Commons Attribution ShareAlike 2.0

The Chinese System

Anderson (1987) claims that the first sure evidence of a Chinese humoral system dates from the 6th century AD, when T'ao Hung-ching re-edited the classical herbal book She Nun Pen Ts'ao Ching. In Chinese traditional medicine, the four qualities Hot, Cold, Wet and Dry are central. They are associated with the concepts of yin (Cold, moist, dark, female) and yang (Hot, dry, light, male). As with the other systems discussed above, too much yin or yang should be avoided, and the cure lies in the treatment by opposites – in fact, as can be seen in the well-known yin-yang symbol, in the heart of yin lies yang, and vice versa.

The formal Chinese system is very elaborate, connecting the yin and yang in the human body with yin and yang forces in the cosmos.

The Yin-Yang symbol. GNU Free documentation Licence

The diffusion of the three systems

As said above, there is an ongoing debate on whether the different humoral systems of the world have a single origin, or different origins. Regardless of ones position in that debate, it is clear that the systems have influenced each other. Foster (1994) discusses the diffusion of the three Humoral systems and notes that they have all spread widely:

”During the past two millennia the three humoral systems have followed rather different courses. Ayurveda became the principal medicine of India, Nepal, and Sri Lanka, with influences radiating eastward into Burma and, to some extent, Malaysia.

Chinese medicine diffused to Korea and Japan, and southward into Thailand and adjacent areas, where it shared the field with Ayurveda and Greek humoral pathology, intrusive with the Moslem eastern expansion following the death of Mohammed. Ayurveda and traditional Chinese medicine continue to be very important not only as the basis of a great deal of popular medicine but also as a literate tradition, formally taught in government-supported schools in India, Nepal, and China.

Greek humoral medicine has diffused far more widely: under the Muslims, eastward through Iran, Afghanistan, Pakistan, India, Bangladesh, Malaysia, and parts of Indonesia, and westward to Europe, Latin America, and the Philippines. In India it is known as Unani ("Ionian") medicine and, like Ayurveda, it is formally supported by the Indian government in Unani training centers.”

The South American System – native or imported?

Do the three old world Humoral systems come from the same origin – and which was this? - or have they sprung up locally by simply providing a logical, binary way of simplifying the complex and threatening world of foods and diseases? Most of the discussion around this is centered on the Humoral system(s) of South America – it is the one studied most in detail, and its clear geographical separation from the other Humoral System areas makes it ideal for this kind of study. If it is possible to prove or disprove that the South American system has arisen locally, it will give important input in the discussion about the origin of the old world systems.

Foster (1987) discusses the various arguments for and against the "Old World" or "New World" theories of the origin of the South American Humoral System. The ”Old World” theory claims that the Humoral System was brought to South America by the European conquerors, while the ”New World” theory claims that the tradition is a local one that was later reinforced by the Spanish humoral medicine.

Foster (1987, 1994) claims that the Humoral Systems have a single origin, somewhere between India and Greece and before the 5th century BC. The Hippocratic system, the Ayurvedic system and the Chinese system are all in a geographical continuous area, where other forms of cultural diffusion is known to have taken place. In the 15th, 16th and 17th century Humoral Medicine was the basic foundation upon which the education of doctors was based – and this was carried over to South America, and taught in the first universities and the first religious seminar schools.

Foster (1987) further claims that local Humoral ethnomedicine was very limited – in part based on linguistic evidence: the names of illnesses, cures and Humoral terms (Hot, Cold etc.) are almost exclusively Spanish. Indigenous groups sometimes use indigenous terms, but Spanish-speaking ethnic groups seem to never use indigenous terms. Also, as would be expected were the ”Old World” Theory true, mestizo populations (from a mixed European and South American origin) seem to have greater knowledge of the Humoral system than do indigenous ethnic groups.

The major arguments of the proponents of a New World origin of the South American Humoral systems are as follows (derived from Foster 1987):

  • There is no dry/wet dimension in South America – if the system was imported from Europe, why did it disappear?
  • Humoral medicine is present in groups with very little contact with the outside world and it seems unlikely that they would have been influenced by the conquerors.
  • South American Humoral systems that involve a Hot/Cold distinction do not restrict themselves to foods and illnesses, but encompass minerals, heavenly bodies, supernatural being and the like. Since European Humoral theory and practice are restricted to medicine, they cannot explain the New World universality.

Messer (1987) gives the following example from the Aztec mythology for how Hot and Cold is associated with cosmological concepts.

Father - Mother

Heavens - Earth

Shining - Dark

Vital - Humid, water, wind

Fecund - Fecund, but also associated with death

Hot - Cool

Messer is a proponent of the ”New World” Theory and argues, largely based on the last point outlined above, that there is clear evidence that there was a very important Hot-Cold distinction in place long before the Europeans came to South America.

Most linguists will lack the anthropological training to clearly find fault or clear positive evidence for either stance based on anthropological findings– our contributions must be in the linguistic area. But should the evidence favor a New World origin for the South American Humoral systems, this might give evidence for a globally widespread, possibly universal, use of cultural metaphores for HEAT. Should the evidence favor an Old World origin, we are instead presented with a fascinating story of how powerful the cultural metaphors are, and how widely they can diffuse.

It is also possible to take a middle road, acknowledging points from both sides: no one disputes that HEAT metaphors were not important in the New World, the anthropologists argue about how important they were. They were clearly mixed with European metaphors to some extent. This makes it clear that the Cold-Hot dicHotomy is widespread and pervasive, and well worthy of study.

Are the concepts Hot and Cold central in Humoral Systems?

There seem to be several concepts in the major Humoral systems outlined above – hot, dry, cold and moist, entangled and connected with issues such as gender and elements such as ether and the like. Yet it seems as if most articles on Humoral systems focus on the Hot and Cold dichotomy. The reason for this (Anderson 1987 p.335) might be that while the old scholarly texts from Europe, India and Asia show very complex interactions between not only Hot/dry/Cold/moist but also seasons, age and temperaments, the system that is actually in use today by the common people in South America and Asia is far simpler. Messer (1987 p344) agrees, saying that ”...the Hot-Cold opposition may be a universal primordial opposition, like male-female, which is likely to be seized upon in all cultures as 'good to think' and therefore, good to classify with. Second, even where elaborate 'elite' or scholarly formulations of Hot-Cold exist in combination with other elements, humors and correspondences, the 'common people' may conflate or simplify such scholarly complexity into just the two terms, Hot and Cold.” The widespread cultural idiom of Hot/Cold can perhaps be likened to the gender system imposed on many languages, or the animate-inanimate distinction. Foster (1987 p380) also concurs, saying that a stripped down system – getting rid of the dry/wet distinction – is what developed in South America.

Anderson (1987 p334) points out that a binary encoding is the easiest way to encode data. ”Adding a wet/dry dimension increases the complexity of the system, apparantly enough to cause most people to simplify it down to the hot/cold or wet/dry dimension alone”. The author further cites the Aymara people of Bolivia as an ethnic group that have gotten rid of the hot/cold distinction but kept the wet/dry – my literary overview suggests that this is very rare.

What can be Hot or Cold?

According to Narayanan (forthc.) the things that are classified as Hot or Cold crossculturally are:

edibles, diseases, characteristics of people, emotions, colors, characteristics of abstract processes and events. (In the last category he probably includes temporal events such as seasons.)

As Messer (1987) and Beck (1969) point out, deities and other mythological creatures can also be labeled as Hot or Cold.

A series of lists drawn from a handful of surveyed articles (see the references at the end of this document) of things and their temperature-labels can be found here - showing examples of hot and cold foods, diseases, plants and behaviors in different cultures.

According to Anderson (1987) Humoral lists from an Oaxacan Community in Mexico are strikingly similar to Chinese lists: my own attempts at finding similarities among foodstuffs have not turned up many similarities, though, admittedly, I have a very limited number of languages to compare.

Why can some things be labeled Hot and Cold (such as diseases) in many different cultures while other types of things (cloud formations) do not seem to be included in the temporal systems? Why are some diseases hot, while others are cold? And is there a connection between Hot behaviors, hot foods and hot diseases?

There are many different theories about why certain foodstuffs and diseases are labeled as hot or cold. Quite often, anthropologists can formulate theories that explain and predict the labeling in their study area, but universal rules have yet to be discovered.

Messer (1981 p137) is of the opinion that one of the types of reasoning behind Hot/Cold classification is how the object affects health – if one is a hot person, a bad food (that is not already by cultural, traditional consensus labeled as one or the other), is often labeled as Cold, and vice versa.

Messer is not the only one to hold that disease is the central tenet of all humoral systems: Anderson further finds that the Chinese focal cool condition for disease, (i.e excess of coolness leading to problems) was symptoms of general malnutrition characterized by low intake of protein, calories and iron. The focal hot conditions most typically are either minor viral ailments or avitaminoses (especially of A and C).

Since the high-protein, high calorie foods that are often considered Hot are just the thing to cure malnourishment, this proves the systems validity, just as it is proven when vitamine-rich Cool vegetables are given for the Hot condition.

Pool (1987) has the theory, based on data from India, that Hot diseases share the physical and physiological characteristics of prototypically Hot substances – ”boiling” skin (i.e sores) etc, and that Cold diseases display opposite characteristics. Messer (1987), Beck (1969) and Pool (1987) have found instances where Coldness is seen as something attacking/affecting the body from the outside, whereas Heat is seen as coming/arising from within the body.

Pool's ideas are close to Narayanan's (forthc.) who believes that the Hot/Cold systems of the world can all be explained and predicted by an Idealized Cognitive Model, detailing what happens to a prototypically Hot substance (it boils, changes color) etc. This is then metonymically and metaphorically extended to cover non-boiling things as well.

Matthews (1983) presents a very convincing quantitative study from Oaxaca, Mexico, wherein she shows that foodstuffs are classified according to three axes that all have Cold on one end of the scale and Hot on the other. The axes are Danger, Illness neutralization and Healthfulness. Not all foodstuffs have classifications on all the three, or any of the three, axes. Foods that can be dangerous have a Danger classification – it can be Hot for foods that cause digestive disorders such as gas, diarrhea or heartburn, and Cold for foods that cause stomach distension and bloatedness. Foods that can be used to neutralize the heat or coolness in an individual are classified on the Neutralization axis. Healthy people have a stable Hot/Cold balance, but sometimes people are born abnormally Hot or Cold, and there are also certain points in life where everyone is susceptible to Humoral imbalance – such as adolescence, menstruation or pregnancy. This imbalance is then corrected by eating the right kind of food. Excessive or abnormal sexuality is also seen as something that can be neutralized in this way – too sexually active people are too Hot, and people who do not marry or are not interested in sex are seen as too Cold.

Foods that can cure illnesses have a classification on the Healthfulness axis. Hot foods cure Cold diseases and Cold foods cure Hot diseases.

Matthews found that people classified foods differently depending on which function they filled. Onions are Hot on the Danger axis, but Cool on the Neutralization axis, for instance. Foods that were classified as Hot (or Cold) on all three axes were rarely or never up for discussion – they were simply Hot (or Cold). The same was true of foods that were classified as Hot (or Cold) on only one axis. People were more likely to disagree on the classification of foods that had conflicting definitions on different axes (like the onions above), and on foods that had no definitions as Hot or Cold on any axis. I have found no research that has attempted to apply these three axes, or even the theory of different axes, to other ethnic communities and languages.

One interesting thing to note is that the kinds of foodstuffs that people (intra- and intercommunity) disagree about are often the same cross-culturally according to Anderson– usually they are foods that give mixed signals: brightly colored, red fruits are appearance-wise often considered Hot, but if they are watery and sour, that would indicate coolness.

The connection between red and hot temperatures appears in many cultures. In the South of India (Beck 1969) the Red has a close connection with Hot, and White with Cold. Heat and sex also seems to have a cross-cultural significance - as in Southern Indian rituals and traditions where an important historical-literate term is tapas – ritual heat. In the Vedic times, ritual heat can be gained by sacrifice, and can then be used against enemies. Late, tapas described the intense internal flame ascetics could generated by meditation and sexual abstinence. Sex is Hot – control of sex makes one Cool, in a serene good manner.

In Tamil (Beck 1969) paccai refers to fresh, Cool or green things. AvarkaLuku paccai manacu – ”To have a green-Cool heart” is a term of praise. A generous man is called avarKal perun taNmai – meaning that he is ”very Cool”.

Heat is polluted and purity is Cold. Before an important occassion there will be a cooling ceremony, for example the kiraaman caanti ceremony of the Coimbatore area – which means ”cooling the Kiraaman region”. Also, before a couples wedding night a ceremony called caanti kalyaanam is performed, meaning ”cooling nuptial”.


It is not easy to extract knowledge from the huge amounts of information available about Hot/Cold systems around the world. Despite several large surveys (in India, for example, as told in Messer 1981) it has proved difficult to find one single system or set of principles that could underly all the different Humoral systems. Several different theories have been proposed – that all systems are fundamentally based on the physiological sensation of Hot and Cold, that they are based on social interaction and psychological relations (Messer 1981 p.134), that they have their origin in the human need for binary encoding of cultural information (Anderson 1987) or that they are fundamentally based on the physical effects diseases have on the human body, where Hot diseases resemble heat or fire (bubbling, erupting, fevers, red blood) and Cold diseases resemble Cold things (moisture, shivering) and all other classified objects gain their classification by this cultural metaphore or by curing/affecting a Hot/Cold disease or ailment. (Pool 1987)

There is, of course, no reason why all these proposals shouldn't be true simultaneously – that one thing can be classified as Hot and Cold on various axes (physical sensation, social, effect on ailment, resembling a prototype, following a cultural metaphor) and that the end result of its ”humoralness” is an amalgamation of its classification on all these axes. The similarities seen in various cultures could then depend on the shared physiological reality – diseases to which humans are prone cause the body to behave in much the same way irregardless of culture, and fire and Cold weather affect the human body in almost the same way. We would expect certain culturally influenced differences depending on climate for instance – a geoclimatical environment where no one could possibility freeze to death might have different idioms than one where ice and snow is ever present.


Anderson Jr, E. N. 1987. Why is humoral medicine so popular? Social Science & Medicine, Volume 25, Issue 4, 1987, Pages 331-337,

Beck, B 1969. Color and heat in a south indian ritual. Man,4(4), 553-572. (

Foster, G. M Jr 1978. Hippocrates' Latin American Legacy: "Hot" and "Cold" in Contemporary Folk Medicine. In Colloquia in Anthropology (R. K. Wetherington, ed.), 2:3 l9. Dallas: Southern Methodist University and Fort Burgwin Research Center.

Foster, G. M Jr 1994. Hippocrates’ Latin American Legacy: Humoral Medicine in the New World. Langhorne, Pa.: Gordon and Breach Science Publishers.

Mathews H 1983. Context-Specific Variation in Humoral Classification. American Anthropologist. 85:826-847 (

Messer E 1981. Hot-Cold Classification: Theoretical and Practical Implications of a Mexican Study. Social Science Medicine. 15 B:133-145

Messer E 1987. The Hot and Cold in Mesoamerican Indigenous and Hispanicized Thought. Social Science and Medicine. 25:346-399

Narayanan, S forthcoming. The thermal qualities of substance: a cross-cultural account (

Pool, R 1987. Hot and cold as an explanatory model: The example of Bharuch district in Gujarat, India Social Science & Medicine, Volume 25, Issue 4, 1987, Pages 389-399, (

Wandel M, Gunawardena P, Oshaug A, Wandel N. 1977. Heaty and Cooling Foods in Relation to Food Habits in a Southern Sri Lankan Community. Ecology of Food and Nutrition. 14:93-104

-Susanne Vejdemo, 2010

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