THERAPEUTIC MANAGEMENT OF THE CHOLERIC HUMOR AND TEMPERAMENT
Introduction and General Considerations
The Choleric Temperament has the nature of its associated element, Fire, and is Hot and Dry in its basic qualities. The dominant humor of the Choleric Temperament is the Choleric or Bilious humor, or Yellow Bile. In Unani Medicine, Yellow Bile is called Safra. Fire is the most Yang natured element, and the greatest emitter of light, heat and energy; it is also dynamic, volatile, spreading, penetrating, transforming and consuming. The Fire element is behind the principle of catabolic metabolism, which burns or consumes substance to produce and release energy. The Fire element is also behind the digestion of food, which Greek Medicine calls pepsis; in other words, digestion is the process in which the body uses some of its own Metabolic Heat and energy to "cook" or concoct the raw nutrient juices of food and drink and transform them into the Four Humors, which then feed the whole organism. It is like a smelter's or refiner's fire, which transforms the raw ore and distills the precious metal of nutrient essence from it. Embodied in the Yellow Bile humor is this fiery principle of digestion, transformation and pepsis.
Those of a Choleric temperament are fiery, high energy people with a high level of Fire and Metabolic Heat in their bodies, which can manifest in a number of ways. Their digestions are sharp and quick, and they have a predisposition towards strong febrile and inflammatory reactions. Choleric individuals can either manifest a lot of heat in their bodies, which shows up as redness and a ruddy complexion, or they may produce a lot of Yellow Bile, which predisposes them to a sallow complexion. They tend to be active, dynamic and sportive, having lean, wiry, muscular physiques, driving themselves hard to get the most that they can out of life, and quickly grow impatient when anyone or anything gets in their way. Their Hot, Dry natures makes their skin warm, rough and dry to the touch, and makes muscles, veins and tendons well defined. Choleric individuals tend to be intense, with a fiery sparkle in their eyes.
Because Choleric individuals are so fiery, intense and high powered, the therapist's main objectives in treating them can be summed up as putting out the fire, in various ways; defusing, diverting and channeling their excess and pent-up energy into constructive avenues of relaxation and stress management when and where appropriate or necessary; and showing him or her how to properly manage their aggressive drive and pick and choose their battles wisely. This can apply just as much in a general sense, when it comes to the game of life, as it can in the management of one's health and well being.
The Choleric Temperament versus the Choleric Humor
Having a Hot, Dry, fiery Choleric temperament is a more or less permanent constitutional condition that those who are born with this temperament have to deal with, and make allowances for, in their basic regimen of health, hygiene and lifestyle. However, under the right conditions, those of any temperament or constitutional type or makeup can suffer temporarily or periodically from acute or acquired aggravations of the Choleric humor. However, those who are, constitutionally speaking, of a Choleric temperament are more prone to aggravations of their dominant Choleric humor than are those of different constitutional makeups. We must discern between having a Choleric temperament, which is primarily a constitutional condition, and not necessarily pathological in nature, and various pathological aggravations of the Choleric humor that can arise from time to time in those of any constitutional makeup, and not confuse or conflate the two.
Psychological Understanding and Management of the Choleric Temperament
Choleric individuals are dynamic, high powered people. They are pushing to the limit to cram as much excitement and intensity into their life as they can, and are not inclined to wait around for it. Feeling an abundance of energy and inspiration, they are the pioneers, the free wheelers, the idea people, the brilliant, insightful creative movers and shakers who glow in the dark. Yellow Bile, their dominant humor, being hot, caustic, stimulating and provocative in nature, makes them bold, ambitious and audacious, courageous and proactive as their basic default state of spirit and being. When it is aggravated and unbalanced, the negative emotions associated with the Choleric humor include anger, frustration and irritability, as well as jealousy and envy. Anger, frustration and irritability arise when the tremendous energy and drive they feel within has not been properly and wisely channeled, or runs into obstacles; rechannel the energy and you usually resolve these problems. Jealousy and envy are particularly destructive Choleric emotions that can "eat you up" from within; this can even manifest psychosomatically in chronic inflammation, ulcers, or even malignant growths; the solution is to redirect that inner dissatisfaction towards solving a worthy problem that can be resolved, but this is often easier said than done.
Choleric individuals are out to pack in as much excitement, activity and intensity into life as possible - which can often get them into major problems. They are attracted to extreme sports, often involving thrill and speed, but if they are not mindful of their own physical limitations or handicaps, they can injure themselves badly - or worse. This thrill seeking, and the quest to feel all-powerful or larger than life can also lead them to crave and abuse certain types of drugs, most notably "uppers" or stimulants, as well as alcohol. They can also be drawn to abuse these substances due to an inner sense of boredom or ennui from lives that may be too routine or predictable. Such thrilling diversions can also be a form of escapism when they appear to be helpless to resolve some very real and major problem in their lives, or some unpleasant memory, issue or troubling emotion that is eating them up inside. Choleric individuals are also prone to depression as well, often from repressed anger that is directed inwards towards themselves; in this they need to learn self forgiveness, and to stop being too hard on themselves. Choleric individuals who are depressed or driven towards substance abuse may also be their own worst critic, especially when their lives don't measure up in some way to the high standards and ambitions they have set for themselves.
Choleric individuals are rigorous and demanding; therefore, the physician or therapist needs to give them definite and immediate results. Even if the final healing goal or objective is not achieved right off the bat, if the doctor or therapist can produce some real, concrete, verifiable results in short order, they will win the Choleric individual's confidence, trust and commitment; if not, the Choleric individual will simply move on to the next doctor or therapist who looks promising. Choleric patients can be filled with excitement and enthusiasm for the course of treatment at the beginning, but once they start to get results, and to feel better, they may "burn out" and forget to follow through with the treatment until healing and recovery are complete; if this is the case, the physician needs to remind them once again of their original healing objectives, and how far they actually need to go, and what needs to be accomplished, before they can be reached and fully realized. The Choleric individual may also be looking for the magic pill or treatment that will give them the greatest high or "buzz" and forget to do the more boring or routine things that need to be done as part of the overall course of treatment. Choleric patients also need a challenge, as well as results - the doctor or therapist can put things to them in the most stark and blatant terms, and if the challenge is clearly and boldly outlined, the Choleric patient will usually take up the gauntlet, and get on board with the program.
Managing Choleric Fire and Bile through Diet and Proper Pepsis
Yellow Bile, which is the dominant humor in those of a Choleric temperament, is the very embodiment of the fiery principle of pepsis, or digestion and transformation. With the fiery Yellow Bile humor at the heart of their very nature and temperament, proper dietary management and therapy is essential to keeping their process of digestion and pepsis well regulated and controlled for optimum health and well being. In order to do this there are two main dietary objectives that need to be attained: First, the dominant Choleric humor needs to be put into proper quality, krasis and balance by avoiding foods and drinks that put it out of balance, especially unhealthy fats and oils, like hydrogenated trans fats and oxidized, rancid oils, including various foods, like old, stale nuts and seeds, in which they might be found; heavy meats, especially red meat, and greasy or fried foods are also major culprits. Secondly, Choleric individuals need to eat a diet rich in cooling, cleansing, alkalizing and anti-inflammatory fresh fruits and vegetables; especially valuable are fresh fruit, as well as green, leafy vegetables, especially cooling, bitter greens like lettuce, endive, artichoke and dandelion.
Rancid or oxidized fats and oils corrupt Yellow Bile, making it even hotter and dryer than it needs to be to do its job, thickening it and making it even more corrosive and caustic; they also generate toxic, oxidized forms of Yellow and Black Bile that act as slow poisons to the entire organism. Not eating enough fresh fruits and vegetables will make the body too acid, which also increases or aggravates the caustic, corrosive effect of Yellow Bile. In a healthy, balanced individual whose system is clean of toxins, even if he or she be of the Choleric temperament, sour foods like citrus fruits and vinegar will not be too problematic, but if the Choleric humor is toxic or aggravated, these foods will cause reactions of undue acidity, irritation or inflammation. Since relatively few individuals are truly balanced and free of toxins and acidic residues, most Choleric individuals should avoid overindulging in sour, acidic foods, and may find certain ones problematic.
The Choleric temperament is Hot and Dry, so eating a diet of lots of Cold, Wet foods, like juices, shakes, yogurt, smoothies, etc..., which can be problematic for the Cold natured temperaments, is actually good for them; they also need to keep well hydrated and drink a lot of water and fluids. Choleric individuals have a strong digestive Fire, which is powerful and efficient at extracting the vital nutrients out of food. Because of their powerful digestions, and because fresh fruits and vegetables have such a beneficial cooling, moistening and alkalizing / detoxifying effect on their bodies, Choleric individuals usually have no problem being vegetarian, and actually thrive on such a diet, provided it is sound and balanced. If Choleric individuals do not pay heed to the basic dietary recommendations here, they are prone to problems with stomach hyperacidity, acid indigestion and bilious problems, but if they follow the dietary guidelines given here, their digestions will become calm and balanced, and the hyperactivity of the Digestive Fire that they are prone to can be brought under control - and, in turn, more deep seated systemic Choleric imbalances may be healed.
Choleric individuals can have a hard time taming their taste buds, and often crave spectacular taste sensations, like flaming hot sauces, spicy chillies, or delectably tart and tangy sauces and dips, not to mention alcohol and vinegar. Ironically, these are the very types of tastes, spices and condiments that can make an irritable, hyperacidic Choleric digestion, or indigestion, even further aggravated and out of balance. In a more in balance Choleric individual, who has his Digestive Fire under better control, these cravings are easier to handle or avoid, and are less of a problem. It's a similar situation with salt and salty foods; a craving for them is a good barometer indicating the degree to which the Choleric humor is abnormally aggravated, especially in Choleric individuals, as the former is directly proportional to the latter. Excessive salt intake aggravates inflammation, both acute and chronic; it also negatively impacts the liver and bile metabolism, as well as kidney function, and can drive up blood pressure. Salt is one of the strongest aggravators of the Choleric humor that there is.
Exercise and Lifestyle Guidelines for the Choleric Temperament
Unlike the colder natured Phlegmatic or Melancholic temperaments, Choleric individuals are not loathe to exercise; in fact, they like to remain active and on the go. The main problem is that, due to their driven personalities and their competitive natures, they may push themselves too hard in exercise and fitness regimens, and wind up injuring themselves. Because the Choleric Temperament is Hot and Dry, getting enough fluids and hydration during a workout is essential, and muscular cramps and strains can be an issue. A few minutes of easy stretching prior to a workout to warm up, as well as after a workout to cool down, should be heeded, and undue stiffness and tension in the muscles, tendons and joints may be a problem if this advice isn't followed, particularly in older Choleric individuals. As I said before, the Choleric individual should be mindful of any physical limitations or handicaps they might have, and not exceed them when they exercise, or they run the risk of injury. In all fitness and conditioning regimens, a tolerance and capacity for exercise and physical activity needs to be built up slowly and gradually, but impatient Cholerics may not always heed this advice.
Anger and stress management, and learning how to control one's temper, can be another problem area that Choleric individuals need to focus on. Meditation and yoga are helpful calming and stress relieving activities to engage in that have helped many Choleric individuals cool down and find peace within. Doing some yogic relaxation and deep breathing exercises right before bedtime, and/or massaging one's temples and feet with soothing medicated oils often helps greatly in the relaxation and cool-down process, and will aid sleep. Another thing that will aid sleep, which is often problematic with Cholerics, is taking care to eat dinner early, at least three hours before bedtime, or to eat a light dinner, seeing as an overloaded GI tract with too many stimulating and Choleric aggravating foods will disturb sound, peaceful sleep. Eating fast food on the run will also aggravate and unsettle the Choleric digestion, and should be avoided.
In their home and family lives, and in their intimate relationships, many Choleric individuals can often have a problem with excessive intolerance or quickness to judge or criticize others, and the "blame game" can be very big with them. They need to learn to be more tolerant and accepting of others, and more forgiving of themselves to ensure domestic peace and tranquility within the home and family unit. Still others with a Choleric temperament that is immature or unbalanced may be perennial dreamers or pioneers, and great ones to launch some bold, exciting new venture, but not very good on the follow through, and bringing things to completion. These problems and imbalances are usually amenable to counseling for those Cholerics who are willing to be helped and guided.
Due to the great amount of heat and Fire in their systems, Choleric individuals may not do too well in summer, nor do they usually respond well to hot tropical or desert environments. In addition, hot weather and environments can aggravate the purulent, toxic or septic conditions that they are prone to. They do best in places and climates that are cool and well ventilated. Although Choleric individuals can take it when the air conditioner is turned on full blast, or when they guzzle down gallons of ice water in summer, that may really not be the best thing for their health. In those of a colder temperament, cold foods and climactic influences may penetrate deeper and more insidiously into the organism, but in Hot, Choleric individuals, strong cold influences like these can trigger a backlash reaction of aggravated heat and/or inflammation, as well as possible cramping and spasm due to the cold.
Herbal Therapy for the Choleric Temperament
The most important objective of herbal therapy for Choleric individuals is to keep the digestive and metabolic fires properly under control. The Choleric individual needs first of all to be cooled down, then to be kept adequately moistened and hydrated with herbs that nourish the essence or Radical Moisture, as well as serous body fluids and the Phlegmatic humor, which is the opposite yet complementary counterbalance to the Choleric. Generally, the best herbal taste for doing this is the bitter taste, which is the most strongly cooling and detoxifying taste there is; the astringent taste, which is also cooling in many herbs, comes in a close second, and is also good for cleaning up any morbid corrosive or putrid exudations or discharges that may be present. If chronic fevers, heat or inflammation have secondarily dried up or exhausted the body's reserves of cooling fluids and essence, then moistening demulcents or emollients are quite useful; these are usually of a bland or mildly sweet taste.
When it comes to balancing the Choleric digestion, and putting out flareups of an aggravated Digestive Fire, bitter tonics or aperitifs are the way to go. The old herbalist who once wrote, "Bitter to the tongue is sweet to the stomach." was surely thinking of the Choleric digestion when he wrote this. In addition to having a beneficial soothing, cooling, anti-inflammatory and acid balancing effect on the stomach and its digestive secretions, many, if not most, of these bitter tonics are also cholagogues, which increase the flow and secretion of Bile by the liver and gall bladder. Many of these anti-Choleric and anti-bilious herbs are also yellow in color, which, according to the Doctrine of Signatures, indicates that they are good for regulating and controlling Yellow Bile.
As a prime example of a yellow bitter tonic herb, we have Barberry root (Berberis vulgaris). Its main anti-Choleric bitter principle is the alkaloid Berberine. Another famous bitter tonic herb that contains Berberine, and also another bitter alkaloid, Hydrastine, is Goldenseal (Hydrastis canadensis). In Chinese herbal medicine, there is the herb Coptis or Huang Lian (Coptis chinensis), which means, "Gold Tie", or Goldthread, which is its common English name. All of these have a beneficial anti-Choleric action on the stomach which soothes irritation and inflammation and quells the fires of hyperacidity, as well as improving the flow and secretion of Yellow Bile, or the Choleric humor. Centaury (Erythrea centaureum) is another aperitif or bitter tonic herb that is especially valued in traditional Greek and European herbal medicine for treating Choleric digestive disorders.
Yellow Bile is also the body's own natural laxative, and increasing its flow and secretion can also have a laxative and purgative effect. And so, there is another yellow anti-Choleric bitter tonic, much used in herbal medicine, that is also a good laxative / purgative, especially in larger doses; it is Rhubarb root (Rheum palmatum). Another well-known bitter tonic herb that is also a laxative / purgative in larger doses is Cascara Sagrada (Rhamnus purschiana). Whether the herb is used as a bitter tonic or aperitif or as a laxative / purgative principally depends on its dosage, preparation and administration, as well as its formulation and combination with other herbs.
To cool down acute or chronic heat, fever and inflammation, there are herbs with a febrifugal or anti-inflammatory effect. Perhaps the most famous of the anti-inflammatory herbs are the herbs containing Salicylates, which became the basis for Salicylic Acid, or Aspirin. White Willow bark (Salyx alba) is the herbal source from which Salicylates were first isolated and extracted; the bark is both febrifugal and anti-inflammatory. Other herbs that contain Salicylates include Meadowsweet (Filipendula ulmaria), Birch leaves (Betula alba) and Wintergreen (Gaultheria spp.); the first two have a cooling, anti-Choleric nature and temperament, but the last of these is warming and anodyne. Truly, there are many different kinds of cooling febrifuges and anti-inflammatories in the herbal kingdom, each with its own particular uses and applications.
Aloe Vera is a versatile wonder herb that holds a unique and distinctive place in Greek and Unani herbal medicine, and its medicinal actions and effects depend on how it is prepared and administered, and the dosage, as well as the other herbs it is blended with. The de-bittered Aloe Vera juice that you buy in health food stores is a great drink for quelling excessive or abnormal Choleric inflammation in the GI tract, and through the GI tract, throughout the human organism. As such, it can be a great after dinner drink to soothe the Choleric tummy. But the Aloe plant really shines in the intensely bitter powdered extract of the whole fresh Aloe leaf, which is known variously as Cape Aloes, Socotrine Aloes, or simply Bitter Aloes. It is one of the most potent and far reaching of the bitter tonics in its therapeutic effects, and is alterative, anti-inflammatory, choleretic / cholagogue, depurative, emmenagogue, emollient, expectorant, laxative, purgative and vulnerary. Bitter Aloes has the distinction of being a universal attenuant, having a beneficial thinning and fluidifying action on tough, congealed morbid accumulations of all of the Four Humors, although its main action as a bitter tonic is on bile and the Choleric humor. This sheer therapeutic versatility and universal attenuating action make Bitter Aloes one of the key ingredients in the famous Swedish Bitters, as well as many other traditional Greek and Unani herbal formulas. The universal attenuating action of Bitter Aloes can be directed to a specific humor in accordance with the other herbs it is blended with in herbal formulas; if we want to thin and attenuate the Phlegmatic humor, for example, we combine Bitter Aloes with expectorants and other hot, spicy anti-Phlegmatic herbs to flush excess Phlegm out of the system. Bitter Aloes should not be used by those with an overly weak or devitalized digestion, especially in large doses, since its cooling anti-Choleric action is too strong, but in small doses, and blended or offset with the right formulation of other herbs, Bitter Aloes is a versatile healer that can work wonders.
Soothing Aromatherapy to Defuse Choleric Stress and Tension
Those of a Choleric temperament are high powered people who drive themselves very hard to compete and achieve; in the course of an intense, active life, and the activities of the day, they can accumulate a lot of stress and tension. And so, cooling and soothing aromatic essences and essential oils, properly prepared and applied, can work wonders when it comes to calming and defusing Choleric stress and tension. These essential oils and aromatic essences include those of Aloes Wood (Aquillaria Agallocha), Basil (Ocimum basilicum), Camphor (Cinnamomum camphora), Eucalyptus (Eucalyptus globulus), Jasmine (Jasminum officinale), Peppermint (Mentha piperita), Rose (Rosa damascena), Sandalwood (Santalum album), and Tulsi, or Holy Basil (Ocimum sanctum).
You can use these essential oils in many ways. You can put a drop on a light bulb, to fill the air with its fragrance, or you can put some in an essential oil diffuser. You can even massage these into pressure points on the body. In Chinese medicine, there is Tiger Balm, as well as White Flower Oil; both of these can be used as aromatic embrocations to activate sensitive pressure points on the body. For example, if you should have a headache or migraine, just rub a little of one of these balms or oils into the temples, and watch the pain and tension disperse. These aromatic essential oils cleanse and purify the air of negative or unclean vibrations, and many, like Sandalwood oil and Tulsi oil, can be used as aids to meditation. Sandalwood oil has another interesting application: put a drop or two onto a pustule or acne blister, and it will disappear within minutes - provided you use real, natural Sandalwood oil, and not some synthetic substitute.
DISCLAIMER: The information on this page is for educational purposes only, and is not meant to substitute for personal diagnosis and treatment from a physician or licensed health care practitioner. The reader assumes all personal liability and responsibility for the application of the information contained herein, and is advised to consult with a physician or licensed health care professional should his or her symptoms persist or worsen.