Galenic Constitutions

Galenus of Pergamum

In History and Philosophy of Herbal Medicine over the last couple of weeks, we have been looking at the Galenic concepts of constitutions: the choleric, sanguine, melancholic and phlegmatic temperaments. These constitutions are based on the classical idea that you can group people according to their physical, mental, emotional and spiritual characteristics, and that such groupings can be used to give you information about the patterns of health and disease likely to be seen in people from each group. We have been trying to guess how Galen might have classified each member of the class. (“I’m not fat, I just have a phlegm imbalance”)

These ideas obviously have problems when you try to apply them in the modern day. For example, the old descriptions of each temperament carry some rather sweeping value judgments – who would have wanted to be one of Culpeper’s melancholics with their tendency to be “lumpish…envious, fretful, obstinate in opinions…mistrustful, suspicious…”(Tobyn, 1997)

However, as a practising medical herbalist, I do frequently find myself thinking about whether such archaic concepts could be useful when trying to understand the problems of the patients that I see in my practice. Perhaps this is entirely anachronistic- am I taking concepts that can only be understood when embedded in their historical context and trying to stretch them to the modern day where they don’t belong?

But there are other ways of looking at this. John Tosh (2006) describes one use of history as being ‘an inventory of alternatives….History reminds us that there is usually more than one way of interpreting a predicament or responding to a situation, and that the choices open to us are often more varied than we might have supposed.’

In the current paradigm of conventional medicine, questions about how to group and classify people in broad terms of their physical, emotional, mental and spiritual characters, and then to link these classifications to patterns of ill-health are rarely considered, except perhaps in psychiatry. Perhaps this is because such questions are not really amenable to scientific method and so it is easier to just ignore their existence. Kuhn (1996) suggests that one way of defining each historical phase of a science is by the set of questions that are considered worthy of study. In which case, it would seem that these questions are amongst the ones that are currently excluded from medical science. What would happen if we started trying to answer them again?


  • Tobyn, G. (1997) Culpeper’s Medicine: a Practice of Western Holistic Medicine. Shaftesbury: Element Books
  • Tosh, J. and Lang, S. (2006) The Pursuit of History, 4th Edition. Harlow : Pearson Education Ltd
  • Kuhn, T.S. (1996) The Structure of Scientific Revolutions. Chicago: The University of Chicago Press
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3 Responses to Galenic Constitutions

  1. Sarah Golding says:

    Julian Barker says that it was Avicenna who was the first to convert the humours into temperaments and then relate them to types of sanguine, choleric etc; Or have I misunderstood him?

    • Robyn James says:

      I’ve only ever consulted secondary sources on this and it’s certainly true that some of them say Avicenna although I’d forgotten that Julian was one of them. More of them say Galen, so I’ve gone with that so far, but with a mental note to track it down one day!

  2. hypericum says:

    I’ve just written a report on a patient who exactly fits the phlegmatic constitution as described by Conway citing Eysenck

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