Humoral medicine is based on the interrelationship between the four elements present in the cosmos and the four temperaments based on these elements, present in human beings (Tobyn 1997). Biomedicine, the prevalent medical model has molecular biology as its basic scientific discipline and has a Cartesian conviction that human illness can be described in physicochemical and quantified terms (Engel 1981 and Pellegrino 1974). Humoral medicine believers appear to use subjectivist philosophy where the knower and known are interrelated, whereas Biomedical health professionals seem to use an objectivist philosophy with a positive epistemology (Wilson 2000).
The earliest views on the nature of disease, its cause and its cure by eradicating the cause, stem from the fact that during the early history of mankind, religion, philosophy and medicine were a single discipline (Cohen 1981). Humoral medicine is also based on the philosopher Aristotle’s theory of four elements and their relationship to physical universe; and was the medical system prevalent for 2000 years (Cohen 1981 and Thiessen 1934). At that time it provided the explanation for some diseases as rheumatism (a flow of abnormal humours) and melancholia (the depression caused by an excess of black bile) (Cohen 1981 and Tobyn 1997). The Heart in humoral medicine was thought to be the organ of coordinating sensory and motor activity (Quin 1992) and Galen believed that the veins originated in the liver (Woolley 2004). However, the discovery of the anatomy of heart, the increasing use of autopsy methods and the introduction of microscope slowly replaced the humoral description of the phenomena of human body along with some erroneous knowledge like the anatomy and physiology of heart (Thiessen 1934).
This lead Tobyn to reason about two crucial imperfections in the knowledge of humoral medicine from a modern point of view: the lack of knowledge of the circulation of the blood at the time, and of bacteria as the causes of infections (Tobyn 1997). In Humoral medicine the concept closest to bacterial infections can be explained by ‘Putrefaction. “Putrefaction occurs when excess moisture in the body dampened the innate heat and allowed the body to be governed by an extrinsic or foreign heat” (Tobyn 1997). The process of putrefaction was known for centuries but the organism responsible could only be seen after the development of microscope. Since then Biomedicine can also clearly show the causative association of pathogens in diseases; like Mycobacterium in Tuberculosis, Plasmodium in Malaria and amoeba in Amoebic dysentery (Haslett 2000). In such cases it is evident that humoral medicine is limited by the lack of evidence and unable to explain such scenarios. Biomedicine, on the other hand relies heavily on evidence-based practice which Hampton calls an opinion-base medicine. Hampton further states that clinical trials have so many limitations that their relevance to an individual patient and they being the basis for their medical treatment must be regarded with caution (2002).
Biomedicine claims to understand the structure and function of the heart and the anomalies originating from them, yet heart disease is the number one killer in the UK (DOH 2002). Biomedicine is highly sophisticated in its understanding of infective organisms and the ways to treat them with anti-infective agents such as penicillin. However, the recurrence of infections and the resistance of micro-organisms to these drugs is on the increase (Singh 2004). Biomedicine has been able to eradicate the poliomyelitis virus from most of the countries and consequently the incidence of Polio has decreased but incidence of other infections like AIDS is on the rise (DOH 2005) and AIDS is believed by some to be a mutant form of STIs (HPA 2004). Sexually transmitted infections/diseases (STI) are less prevalent than before but there has been a recent upsurge in STIs (HPA 2004). In spite of its unprecedented diagnostic tools and treatment strategies in treating infections or heart disease Biomedicine does not seem to be efficient in upholding the wellbeing of the patients and in reducing the incidence and the recurrence of these diseases.
Biomedicine is also being criticised for its dualistic approach (Eisenberg 1977, Engel 1981, Helman 1985 and Finkler 1994). With its reductionist principles, Biomedicine can explain the course of some somatic diseases like Diabetes Mellitus in minute details (Engel 1981) but is finding it difficult to explain mental conditions like Schizophrenia. Also, it is unable to understand the recurrence of some diseases particularly in some patients. Due to such incapacities it is starting to focus its attention on patient-practitioner relationship and the principles of psychoneuroimmunoendocrinology, psychosomatic medicine and biopsychosocial medicine (Cassell 1978, Siegler 1981 and Stewart et al 1995). These doctrines have started to help biomedicine in explaining many behavioural, mental, psychological and recurrent conditions (Donovan 1988). There seems to be a historical tendency to divide patients/people into categories whether they are 4 temperaments of humoral medicine, 3 Ayurvedic doshas (Lad 2002), 8 Jungian personality types or 4 endocrinological personality types (Donovan 1988). These concepts; of personalities or constitutions of people and treating the ‘whole’ person, which have always been an integral part of humoral medicine, seem to form the basis of psychoneuroimmunoendocrinology and psychosomatic medicine.
In addition to the two inherent deficiencies, the knowledge of structure of the heart and the bacteria, there are limitations in the way humoral medicine is taught, learnt and practiced nowadays. While doing her degree in Western Herbal Medicine this author has experienced the lack of incorporation of humours in the teaching schedules. Not uncommonly the practitioners themselves do not understand the preamble to the theory of elements and the humours and the way to amalgamate these in their practice. In order to understand these complex theories one will have to understand the philosophical and cultural ideas of the people and the practitioners of the time of their inception because as Klienman says, our illnesses are culturally constructed (1978). The socio-cultural-economic environment we live in and the diet we consume now, is different from the past days of humoral medicine and will thus affect the way this ideology will be applied in a clinical setting in today’s healthcare scenario.
It is appropriate to say here that both Humoral medicine and Biomedicine have their limitations, but Biomedicine being the medicine of the era is not scrutinized as rigorously as humoral medicine. After studying and comparing the limitations of both Humoral Medicine and Biomedicine it can be safely concluded that the study of Humoral Medicine is neither pointless nor misleading. It may be that we need to find a way to return to the concept of “lion heart” (Hillman) but now with an understanding of the “mechanical heart”. We must construct and move the medical paradigm towards a horizon of pluralistic healing, where Humoral Medicine and Biomedicine work together towards a common goal and that is the HEALTH of a patient (Thomasma 1984 and Maretzki 1985).
PS: List of references is available for anyone interested.