THERAPEUTIC MANAGEMENT OF THE MELANCHOLIC HUMOR AND TEMPERAMENT
Introduction and General Considerations
Being Cold and Dry in nature, the Melancholic Temperament is the complementary opposite in its basic qualities to the Sanguine Temperament and its dominant humor, Blood, which is the essence of life and health. Therefore, the Melancholic Temperament is generally considered to be the most problematic of all the Four Temperaments, and the one most prone to pathology and disease. The dominant humor of the Melancholic Temperament, Black Bile, has no clear equivalent in modern medicine, and is rather problematic as a pathophysiological entity as well; the best you can do is to say that, according to Greek Medicine, Black Bile is a sediment of normal Blood, which contains various factors involved in the assimilation of vital minerals like calcium, as well as platelets, fibrin, and various other factors involved in wound granulation, scar tissue formation, and the maintenance and repair of the dense, solid earthy parts and tissues of the body, such as bone and connective tissue. Black Bile is also intimately involved in gastrointestinal functions such as the awakening of the appetite and the formation / solidification of the stool; it also thickens the blood and aids in its clotting where necessary. As the metabolic agent of the Earth element, Black Bile has a thickening, condensing effect on metabolic processes, and a Retentive virtue. Black Bile is also intimately involved in the formation of the hard, dense, solid structures and tissues of the body, such as bones, cartilage and connective tissue, as well as the nerves; all these parts of the body are Cold and Dry in nature, like Black Bile, and are prominent in those of a Melancholic Temperament.
The list of pathologies and conditions that those of a Melancholic Temperament are potentially prone to is quite long: a delicate, colicky digestion with pronounced gas, distension, bloating, constipation and irritable bowel; nutrition and assimilation disorders and anemic conditions; nervous and neuromuscular conditions, and neuraesthenia; arthritis and rheumatism; tremors, tics and spasms; insomnia and sleep disorders, and much, much more. The outlook may appear to be quite bleak at times for the Melancholic individual, but with a moderate and disciplined diet and lifestyle, sensible eating, exercise and sleeping habits, and proper relaxation and stress management, Melancholic individuals can go on to live quite healthy and productive lives, in spite of their relatively more sensitive and delicate state of health. They just need to be more acutely aware of their physical and health limitations, and strive to live within them.
The Melancholic Humor versus the Melancholic Temperament
Even though those of a Melancholic Temperament may be more prone to various types of pathology and disease than the other temperaments, it is not in itself a pathological state, but is rather a constitutional nature or state of being; having a Melancholic Temperament, like having any other temperament or constitutional makeup, necessitates certain preventive measures in terms of diet, exercise, lifestyle and hygiene if one is to maintain an optimal state of health and well being. Although those of a Melancholic Temperament are more prone to excesses and aggravations of Black Bile, or the Melancholic humor, than those of other temperaments, under the right causes and conditions, those of any temperament or constitutional makeup can experience excesses and aggravations of the Melancholic humor and its associated pathological conditions.
Psychological Understanding and Management of the Melancholic Temperament
Of all the Four Temperaments, the Melancholic is the most complex and difficult to understand, just as it may be said that its opposite yet complementary temperament, the Sanguine, is probably the easiest. Introverted, withdrawn, reflective, philosophical, stoic, and studious are all words that come to mind, as are other words like analytical, sensible, practical and pragmatic. The earthy Melancholic mind likes to stick to the hard facts and evidence, and may be quite hardheaded and left brained; a lack of vision and inspiration to see possibilities beyond the hard realities of life can also make them rather boring types and party poopers, or bookish nerds who tend to be withdrawn and misanthropic. Melancholic individuals also tend to accumulate a lot of stress, and are prone to being constant worryers, with nervousness and anxiety being prominent; therefore, the Melancholic Temperament is also known as the Nervous Temperament. With their love of the real and the plain, Melancholic individuals tend to be efficient, diligent and hardworking, and are generally reliable, responsible salt-of-the-earth types.
The Melancholic nature is most characteristic of the phase of life called middle age. Gone are the debonair, carefree pleasures of youth, and the soul is weighted down with earthly cares and responsibilities; above all, an abiding sense of the seriousness of life prevails. With this maturity, a sense of wisdom dawns, in spite of the nostalgic longing for the spontaneity and sensual indulgence of youth. Nevertheless, there's a lot that the Melancholic Temperament can learn from the Sanguine in order to regain a better sense of equilibrium and balance: to lighten up, don't take things so seriously, and learning to enjoy life more; and to reach out to others for fellowship and camaraderie, and for help and assistance, and sharing life's heavy load. This also helps the therapist understand how to work with and motivate those of a Melancholic Temperament - to get them to have hope, try new things and change their old set ways, to be able to see and visualize new possibilities for healing and regeneration. Melancholics also need to learn how to abandon their worries and doubts long enough to give the physician's healing medicines and therapies time to work. Try it, you'll like it! Once this is done, and the hard evidence of healing and recovery starts to come in, Melancholic individuals can apply their tremendous discipline and dedication to following the treatment regimen through to its conclusion.
Dietary Management of Melancholic Health and Pepsis
The delicate, colicky Melancholic digestion and pepsis are notoriously difficult to treat and manage, and Melancholic individuals tend to have more food sensitivities, and are less tolerant of dietary abuses, than any of the other Four Temperaments. The strength and efficiency of their pepsis and Digestive Fire tends to fluctuate up and down in accordance with their mental and emotional states, and appetite usually follows in similar fashion, with nervous eating and cravings, as well as periods of poor appetite and anorexia being common. Due to the Retentive Virtue of Black Bile, digestion and GI function tends to be nervous and colicky, with gas, distension and bloating, constipation and irritable bowel being common; intestinal probiotic flora and immunity also tend to be weak and unstable as well. Because Black Bile, the dominant humor in those of a Melancholic Temperament, receives the poorest and coarsest share of nutrients from food and drink, and is contrary in its basic qualities to the flourishing, nourishing Sanguine humor, Melancholic individuals need to take care to eat an adequately nourishing diet, having a sufficient amount of rich, unctuous, nutritious foods within a diet that is basically sound and balanced, and above all, Blood needs to be adequately nourished. Because meat tends to generate a generous supply of Blood, Melancholic individuals generally have the hardest time of all the Four Temperaments when it comes to being vegetarian; they usually do well with a small or moderate amount of meat in their diet. Raw food diets are also not recommended, due to the coldness and problematic pepsis of the Melancholic temperament, which the subtle astringency of raw foods also aggravates. Because blood sugar levels can be as unstable as digestion and pepsis in Melancholic individuals, and because they are prone to anemia and other nutritional deficiencies that can drain their energy levels, Melancholics often experience the craving for sweets and starches as comfort foods, or to give them quick bursts of energy - this should be avoided, since it is no substitute for sound nutrition.
Since the Retentive Virtue of Black Bile predisposes Melancholic individuals to colic and gastrointestinal problems, they need to take care of their digestion and intestinal function on a daily basis, first and foremost through the food they eat. They need to get a good amount of fiber and bulk in their diet, and need to cook with a generous amount of aromatic, carminative herbs and spices, like Basil, Cumin, Dill, Sage, Fennel, Coriander, etc... A tea made from equal parts of Cumin, Coriander and Fennel seeds is a very soothing after dinner drink to ease Melancholic GI problems, and de-bittered Aloe Vera juice from the health food store also works very well for this purpose. Supplementation with probiotics and colostrum, as well as the making of salted bran pickles to nourish the beneficial lactic acid bacteria in the gut all help. Because the Melancholic Temperament is Dry in nature, drinking an adequate amount of water and fluids is a must.
Foods that are unduly drying, astringent, acrid or sour all have a tendency to aggravate pathologies of Black Bile, and condiments that are excessively hot and spicy can, through their hot, irritating nature, also aggravate the Dry quality in Melancholics, aggravating colic, constipation and irritable bowel. Among the most notorious dietary aggravators of the Melancholic humor are beans and nuts that are unduly harsh or astringent in nature, like walnuts and soybeans, as well as lentils; Nightshade vegetables, especially tomatoes and eggplant; and rancid or oxidized fats and oils, as is the case with Yellow Bile as well, since these spoiled oils can lead to chronic inflammation, oxidative stress, and the generation of toxic oxidized forms of Black and Yellow Bile. In addition to knowing what to eat, how you eat, and how much, is also important. Overeating overloads the Melancholic intestines and GI tract, increasing the possibility of colic and dysfunction; nervous binge eating and eating on the run, or at odd hours, is also to be avoided. All in all, the dietary regimen for Melancholics needs to be well balanced and regulated in every respect, with regards to food composition, quality and quantity, as well as eating in a calm, relaxed environment, at regular eating hours.
Exercise and Lifestyle Guidelines for the Melancholic Temperament
Exercise is a good way for Melancholic individuals to reduce their level of nervous stress and tension, as well as to generate mood-lifting endorphins that remedy the bouts of depression that Melancholics can be prone to. Regular exercise, especially before meals, can also stimulate and regulate the finicky Melancholic appetite and digestion. However, the Melancholic individual needs to take his or her exercise in moderate doses, and must not overdo it, or they may be overly tired and devitalized the morning after. Due to underlying chronic nutrient deficiencies, which Melancholics are prone to because of their inefficient digestion and assimilation of nutrients, they may have underlying weaknesses and frailties in their body that they may not be aware of. Due to their withdrawn, introverted nature, Melancholics generally prefer to exercise alone, or to get out in Nature, which really grounds them and gives them a deep seated sense of peace and security.
Indulging in social Sanguine sports activities like team sports or dancing from time to time is remedial for them, and gets them to open up to others. The Melancholic individual tends to view his or her body as a well oiled machine, and is interested in self discipline to attain new levels of efficiency in any sports activity they engage in. Because they are prone to stiffness and tension in their muscles and tendons, bones and joints, stretching before a workout, to warm up, and especially after a workout, to cool down, are essential for them.
In addition to eating at regular hours, and in a calm, friendly and relaxed environment, Melancholic individuals also need to go to sleep at a decently early hour as well, as staying up too late tends to aggravate nervousness and Melancholy, as well as the insomnia that Melancholics are so prone to. Establishing and sticking to a sensible life routine is a must for Melancholic individuals, who thrive under such conditions. Taking the time to engage in relaxation and deep breathing exercises before sleep is also great, as are foot massages with aromatic medicated balms and oils, to encourage deep, sound sleep. Sleeping with a sachet of fragrant Lavender flowers on your pillow is a nice form of aromatherapy to encourage deep, sound sleep as well, as Lavender is soothing and balancing to the Yang and Yin halves of the autonomic nervous system, the Sympathetic and the Parasympathetic.
Bodywork Therapies for the Melancholic Temperament
Melancholic individuals are notoriously prone to neuromuscular, arthritic and rheumatic complaints and disorders, and one of the best therapies for this is Oleation and Massage, which is called Abhyanga in Ayurvedic Medicine. There is something incredibly soothing about oil that remedies and allays aggravations of nervousness and melancholy; the smooth, lubricating unctuousness of the oil is the perfect antidote for the dry, harsh and rough qualities of the Melancholic humor. And the thicker and heavier the oil, the better. Because of the coldness of the Melancholic Temperament, cooling oils like Coconut and Sunflower Seed oils are forbidden; we want warming oils, like Sesame Oil, Olive Oil, or Castor Oil, which is also especially thick, heavy and calming. Into the base oil is usually added small doses of essential oils; aromatic oils that are especially therapeutic for the Melancholic humor and temperament are oils like Lavender, Vetivert, Sage and Jatamansi, as well as oils that are a bit more warming, like Fir, Terebinth and Bay Laurel. Essential oils that are too heating and stimulating, like Cinnamon leaf and Clove, need to be avoided. Oleation and Massage on a regular basis is great for relaxing and detoxifying tired, tense or inflamed muscles, nerves, tendons and joints in arthritic, rheumatic and neuromuscular problems and complaints; it also improves and stimulates the healthy circulation of blood and lymph, and promotes deep, sound sleep; it also stimulates and enhances the detoxification of the entire organism.
Rolfing, or Deep Tissue Massage, also known as structural reintegration, is another great form of massage for those of a nervous or Melancholic Temperament, as they tend to hold deep seated nervous and emotional issues deep within their fascia and connective tissue. With the release of these psychosomatic blockages in the deep tissue will also come emotional releases as well. In fact, there is something deeply healing and therapeutic about the mere phenomenon of human touch for Melancholic individuals, who often suffer from excessive withdrawal, introversion and aloneness. Healing touch imparts human contact and interaction to someone who would otherwise be too lonely and isolated. Melancholic individuals also tend to get too intellectual and into their heads, whereas touching and massage brings them into sensual contact with their bodies. And if they can't get someone else to massage them, self massage is also very therapeutic as an expression of loving and caring for oneself.
Herbal Therapies for the Melancholic Humor and Temperament
Since the Melancholic Temperament tends to suffer from conditions of aesthenia and deficiency, herbal tonics of various kinds come in very handy in conjunction with a balanced, nutritious diet. Since the Melancholic humor is contrary to the Sanguine in its basic qualities, Blood tonics are often useful (see the page on Managing the Sanguine Temperament). Since Melancholic individuals suffer from nervousness, stress and neuraesthenia, herbs to calm and restore balance to the nervous system, called nervines, are also very useful. Since digestive complaints like indigestion, anorexia, colic, gas, distension and bloating are common among Melancholics, digestive tonic herbs that have stomachic, carminative and aperient properties also come in very handy.
The Melancholic Temperament is Cold and Dry; it is also rough, in that it is prone to tension, colic and spasm. Therefore, those of a Melancholic temperament need to steer clear of foods and herbs that are excessively astringent, as the astringent taste is also cooling and drying, and will exacerbate the roughness, colic and spasm that Melancholics are so prone to. In contrast, herbs which are nourishing and moistening, having a smoothing, soothing or unctuous lubricant effect are desirable. Such herbs and medicinal substances are usually either mildly sweet, bland or bittersweet in taste, or they are rich and unctuous. Good examples of rich and unctuous tonic substances would be Ghee, or Clarified Butter; Royal Jelly; Maca; and Bee Pollen. Barring any possible idiosyncratic allergic reactions or sensitivities, these are fine examples of good tonics for those of a Melancholic Temperament.
By all means, wherever the Melancholic or nervous humor is aggravated or excessive, stay away from herbs and substances that are excessively astringent, rough or drying in nature, and stick to medicines that are soothing, smoothing, moistening, lubricating, carminative and antispasmodic in their therapeutic actions and properties. Although mild astringents may come in handy as part of an herbal formulation, the general rule, especially when working with those of a Melancholic temperament, or in situations in which nervousness and melancholy are aggravated, is to stay away from the use of strong astringents or multiple astringents in the same herbal formula. Herbs and medicines that are extremely bitter, especially when used by themselves, or in large doses, untempered by other herbs in an herbal formula, will also provoke nervousness, giddiness and melancholy, especially in those of a Melancholic Temperament.
We have seen how the herbs of choice for balancing pepsis and the raging fires of a Choleric digestion that is out of control are the bitter tonics, or aperitifs (see the page on Managing the Choleric Temperament); bitter tonics, to a degree, and in moderation, can also be useful for balancing the Melancholic digestion and pepsis. That's because Black Bile is, in many ways, like a cooler, more toned down version of Yellow Bile. Whereas aggravations of Yellow Bile tend to create vehement or acute flareups of hyperacidic, inflammatory and ulcerative conditions of the GI tract, aggravations of Black Bile are associated with chronic or indolent acidic, inflammatory or ulcerative conditions of the GI tract. Rancid fats and oils, free radicals and oxidative stress will generate toxic, oxidized corruptions of both Black and Yellow Bile. So, whereas the ideal aperitif or bitter tonic for Choleric digestive upsets is very bitter and cooling, the best bitter tonics for treating Melancholic digestive disorders are only moderately bitter, and also pungent, aromatic or acrid as well. Good examples of bitter tonics for treating Melancholic digestive conditions, which fit this description, include Blessed Thistle (Carduus benedictus), Yarrow (Achillea milfolium), Celandine (Chelidonium majus), and Sage (Salvia officinalis).
Likewise, when it comes to carminative herbs and spices that are helpful in treating Melancholic digestive disorders, herbs that are slightly bitter and either pungent and/or aromatic are usually the best. Such herbs and spices include Lavender (Lavandula officinalis), Lemon Balm (Melissa officinalis), Rosemary (Rosmarinus officinalis) and Patchouli (Pogostemon patchouli). What most digestive tonics that are good for treating digestive disorders of the Melancholic Temperament seem to have in common are a relaxing or mildly sedative quality that eases and releases locked up nervous tension in the gut. In addition, many of them, like Patchouli, also have a heavy, musky earthy aroma to them.
Bad Temperament of the Liver, Hepatoprotectors and Black Bile
In Unani Medicine, there is a condition known as Waram-e-Kabid, or Bad Temperament of the Liver. It is a condition in which the liver goes into a state of imbalance and dysfunction due to a pathological imbalance of humors within it, and a consequent imbalance in its basic qualities, since the Four Humors hold the Four Basic Qualities in place. Although the liver can suffer from pathological excesses of any of the Four Humors, most typically, it suffers from congestions and excesses of morbid Yellow and Black Bile, especially of the toxic, oxidized variety, which act as a slow poison or irritant to the liver, the digestive system, and the entire organism. Because the liver is the principal organ of the Natural Faculty, which controls the digestive system, and through it the metabolism and nutrition of the entire organism, having a liver that is in balance is very important for keeping the digestive system in optimum health. Conversely, chronic or deep seated humoral imbalances in the liver can have a profound deranging effect on the functions of digestion and nutrient assimilation. And the main therapeutic tools we use to correct Bad Temperament of the Liver are medicinal herbs.
This condition is quite similar to what modern medicine calls jaundice, although pathological imbalances of Black and Yellow Bile can begin to accumulate even in the pre-clinical stage; the earlier these imbalances are caught and treated, the easier the treatment, and the better the outcome. With pathological excesses of morbid Yellow Bile, the complexion is a bright yellow color; with pathological congestions of morbid Black Bile, the complexion is a dull, dark yellow, or a swarthy color. If the whole humoral balance and metabolism of the liver is severely deranged, we have a condition known as cachexia, in which the complexion is an extremely sickly color, often ash grey or greenish. In addition, there will often be fullness or distension under the lower ribs, or the hypochondriac area; since hypochondriac pain and distension is a condition classically associated with pathological aggravations of the Melancholic humor, and the morbid states of mind that go with it, someone who has a morbid preoccupation with feelings of illness and disease is called a hypochondriac.
Luckily, Mother Nature has provided us with some very good medicinal herbs for treating Bad Temperament of the liver; since many of these herbs also protect the liver from various forms of toxicity and help to regenerate liver cells, these herbs are called hepatoprotectors. The sixteenth century English herbalist Gerard lauded the herb Milk Thistle (Silybum marianum) as being one of the best herbs for cleansing the liver of pathological excesses of morbid Black Bile. Today, Milk Thistle seed and its extract, called Silymarin, are recognized as a powerful hepatoprotector, one of the most potent ones known, and numerous clinical research studies have proved its efficacy.
There are many other great liver herbs used in Greek, Unani and Western herbal medicine as well. Chicory root (Chicoryum intybus) is Unani Medicine's premier liver herb and hepatoprotector. It has a stellar ability to correct imbalances in the humoral metabolism of the liver with regular use, even in cases of cachexia and profound derangement of the Four Humors. It is also a mild aperient laxative, a choleretic / cholagogue, which improves bile generation and flow; a mild diuretic that cleanses excess uric acid from the system; and a great alterative or blood cleanser in conditions like diabetes, and chronic skin disorders. Most herb stores in the United States only carry roasted Chicory root, which is used as a coffee substitute, but to get the full hepatoprotective effect, we need to use the raw root.
A couple of close relatives of Chicory root that also enjoy a prominent place in herbal medicine for correcting imbalances and congestions in the liver, spleen and stomach are Dandelion root (Taraxacum officinale) and Elecampane (Inula helinum). Dandelion root is a great herb for removing humoral obstructions from the liver, strengthening stomach and gastrointestinal functioning, and having a mild aperient laxative effect on the bowels. Elecampane root is quite similar to Dandelion root, but its nature is more warming and stimulating. Elecampane root is indicated in imbalances of the liver and spleen that impair stomach and digestive functioning; besides stimulating and increasing gastric secretions, Elecampane root also dissolves and concocts phlegm, warms the channels and meridians of the body, having an anti-rheumatic effect; and it is also a rich source of Inulin, a special polysaccharide which stimulates both intestinal as well as general immunity. Chicory root and Dandelion root are also rich in Inulin.
Nervines, Mineral Substances and the Healing Alchemy of the Earth Element
The Earth element, which is associated with the Melancholic humor and temperament, has several unique and distinct properties, which are found in medicinal substances that manifest or embody the nature and qualities of Earth. In its basic qualities, the Earth element is cooling and drying; it is also astringent or binding in nature, and rules the processes of condensation, sedimentation, crystallization, etc... Earth is also heavy and dense, having a descending energy that grounds, anchors and stabilizes. Earth is also Fixed and enduring, in keeping with this stability and grounding. Many medicinal substances that embody the healing properties and virtues of the Earth element are actually mineral substances extracted from the Earth.
Talc, or Soapstone, is cooling and drying in nature, and cools, protects and dries moist, hot, irritated or chaffing skin; it is also smooth and lubricating as well. Being an earthy mineral substance, powdered Talc is also heavy, with a sinking energy; that, plus its smoothness, gives it a medicinal use in Chinese medicine for smoothing the descent and passage of kidney stones. If you want to use Talcum powder internally for this purpose, be sure you get some that has not been perfumed.
Clay, or Bentonite, has cooling, drying astringent properties, as well as chelating properties that draw out toxins and bind with them to neutralize them. Clay is a common ingredient of facial masks for cosmetic beauty purposes, as well as for poultices that draw out toxins in eczema, rashes and chronic skin conditions. In addition to Sandalwood oil or paste, Bentonite Clay, prepared as a paste with water, will also dry up and extinguish an acne pustule or eruption.
Smithsonite, a kind of pink or reddish clay-like mineral substance, is the basis for the ever-popular Calamine Lotion, which is very useful for treating all skin conditions characterized by both heat and redness, as well as turbid, yellowish exudations - like the rash caused by Poison Oak or Poison Ivy.
Nervines are mildly sedating or calming herbs that resonate with the Earth element because they have a heavy, descending energy to calm us down, and get us to be more "grounded". That's why we call stimulants "uppers" and sedatives or calming agents "downers". The Nervine herb that probably embodies the healing properties and virtues of the Earth element the most fully is Valerian root (Valeriana officinalis); in addition to being heavy and grounding, Valerian root also has a heavy, earthy, musky aroma as well. Valerian root is probably one of the best known remedies for nervousness and insomnia, but it will also quell and subdue nervousness, stress and tension in other parts of the body as well: the heart, the stomach and GI tract, and the muscles.
Of the other Nervine herbs, Skullcap (Scutellaria spp.) and Hops (Humulus lupus) are more sedating, whereas Bacopa (Bacopa monnieri) and Gotu Kola (Centella asiatica) are more strengthening and restorative to the nervous system. Many of these Nervine herbs have a certain earthy or musky aroma as well, even though it may not be a strong and pronounced as that of Valerian root.
DISCLAIMER: The information contained in this article 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 responsibility and liability for the application of the information contained herein, and is advised to consult with a physician or licensed health care professional if his or her symptoms or condition persist or worsen.