THERAPEUTIC MANAGEMENT OF THE SANGUINE HUMOR AND TEMPERAMENT


Introduction and General Considerations


The Phlegmatic Temperament is dominated by the Water element and its basic qualities of Cold and Wet.  In contrast to the fiery Choleric Temperament, in which energy releasing catabolic metabolism is predominant, the Phlegmatic metabolism is the most anabolic and energy conserving of all the Four Temperaments.  The Phlegmatic Temperament is dominated by the Phlegmatic Humor, which is an umbrella term for all the watery, clear fluids of the body – not just phlegm and mucus, but also plasma, lymph, interstitial fluid, cerebrospinal fluid and synovial fluid.  The Phlegmatic Humor is also called the Serous Humor, after blood serum.  In a nutshell, the basic functions of the various Serous or Phlegmatic fluids of the body are to nourish and moisten the organism on a very deep and fundamental level; to lubricate the body’s moving parts, reducing friction; to purify the body and flush out toxic wastes; and to cool down excessive heat generated in the body, somewhat like the radiator fluid in an automobile.  The Phlegmatic Temperament is sometimes called the Lymphatic Temperament, since lymph is a very important serous fluid.


Because the Phlegmatic Temperament is Cold, all the physiological and metabolic processes tend to operate very slowly, at a very low level of energetic output; the digestive and metabolic fires of the organism operate at very low levels, and the whole Phlegmatic habit is generally slow and sluggish.  Because the vital fires of the organism tend to function at low levels, this allows the Water element and its dampness, moisture and wetness to prevail, predisposing Phlegmatic individuals to phlegm congestion, edema, lymphatic congestion and stagnation, water retention, and the like.  Because the catabolic metabolism of the body operates at such a low level in Phlegmatic individuals, they frequently suffer from a deficiency and hypofunction of endocrine glands like the thyroid and the adrenals.  Consequently, the main emphasis or thrust of therapeutic management for the Phlegmatic Temperament is on stimulating the vital forces of digestion, circulation and metabolism.  Subsidiary to this, fluid metabolism is improved and excess fluids are drained from the body, and various “spinoff” conditions arising from a slow metabolism, like obesity, high cholesterol and high blood sugar, also need to be managed.

 

The Difference Between the Phlegmatic Humor and the Phlegmatic Temperament


Having a Phlegmatic Temperament is a constitutional condition or state of being that necessitates the following of certain guidelines for health maintenance and disease prevention involving diet, exercise, lifestyle, herbs and supplements, bodywork, etc… in order to maintain an optimal state of health and well being.  The Phlegmatic humor is the dominant humor of those with a Phlegmatic Temperament, who tend to suffer more than others from aggravations and imbalances of that humor, but under the right causes and conditions, those of any temperament or constitutional makeup may suffer from excesses and aggravations of the Phlegmatic humor.  And so, while having a Phlegmatic Temperament is a normal constitutional state of being, excesses and aggravations of the Phlegmatic humor are a form of pathology. 

 

The Nature of the Phlegmatic Humor, and Its Management


The Phlegmatic Humor is the most indolent and passive of all the Four Humors, being Cold and Wet in its basic qualities, and will spontaneously become excessive and aggravated whenever the body is invaded by Cold natured pathogenic factors, or the digestive and metabolic fires of the body get too low.  For example, when you get a chill, one of the first things that happens to many people is that they develop sniffles, a runny nose, phlegm congestion in the lungs, and other signs of an aggravated Phlegmatic Humor.  The same goes for consuming cold foods and/or drinks – the aggravation of phlegm and dampness is pretty immediate, especially in those whose systems are already cold and sluggish, or in some way vulnerable or predisposed to Phlegmatic excesses.  And so, one of the best ways to guard against excesses and aggravations of the Phlegmatic Humor, or to lessen their impact when they do happen, is to strengthen the digestive and metabolic fires of the body, and the vital forces of circulation, metabolism and immunity. 


Being so passive and indolent in nature, the Phlegmatic Humor can linger in the body for a long time, and while it is there, it can impede or obstruct many vital processes, such as digestion, respiration, circulation, etc…  Although the Phlegmatic humor is generated in the stomach, mainly through a cold and deficient fire of pepsis, one of its main secondary accumulation sites is in the lungs and respiratory tract, and in the head and sinuses.  If Phlegmatic excess and aggravation gets severe and chronic, morbid or superfluous phlegm can infiltrate from these primary accumulation sites into virtually anywhere in the organism.  Signs of morbid phlegm infiltration include phlegm congestion, slow or sluggish digestion, mental dullness, torpor, clear or white fluid exudations from the skin or the bodily orifices, excessive tearing or salivation, somnolence, and a slow metabolism.  In the course of its long stay within the organism, phlegm can undergo many abnormal changes and transmutations.  Colds and upper respiratory tract infections can come along periodically, especially in those who have developed morbid aggravations and accumulations of phlegm, to rid the respiratory tract of these accumulations. 


The primary way we deal with morbid excesses and aggravations of phlegm is to change our dietary habits to stop eating foods that aggravate phlegm; this is like turning off the water faucet to keep the bath tub from overflowing.  Then secondly, we use herbs, medicinal substances and therapies that are heating and drying in nature to dissolve, concoct, and expel phlegm through the power of contraries.  Of course, phlegm and mucous secretions are just one part of the Phlegmatic Humor, but they are nevertheless a very important part, in that excesses and congestions of phlegm will cause or aggravate excesses and congestions of the other clear fluids of the Phlegmatic Humor.  Although, from a strict anatomical and physiological standpoint, these are different fluids, still, they are all interconnected, primarily due to the fact that they share the same basic Cold and Wet nature and temperament.  Therapeutically, herbs and medicinal substances that eliminate or metabolize various fluids of the Phlegmatic Humor, whether it be phlegm, lymph, etc… are all warming and drying in nature, and stimulate circulation and metabolism.

 

Dietary Therapy and the Phlegmatic Temperament


Since the Phlegmatic Temperament is Cold and Wet in its basic qualities, the first principle of dietary therapy for the Phlegmatic Temperament is to greatly reduce or eliminate one’s intake of cold, wet foods like raw foods, juices, smoothies, yogurt, dairy products, ice cold drinks, etc…  Secondarily, foods that generate a lot of phlegm should be avoided; these are principally dairy products, refined sugar and starches, and glutinous or starchy foods.  These dietary constituents not only generate phlegm, but they also slow down the metabolism and predispose one to conditions like obesity and type 2 diabetes, and indulging in them is like a vicious circle. And thirdly, pungent, warming spices should be consumed as condiments on a daily basis to stimulate the vital forces and fires of digestion, circulation and metabolism; these spices include Ginger, Garlic, Horseradish, Radishes, and Peppers of various kinds.  The more Phlegmatic you are in your constitutional makeup, the more strictly these guidelines should be followed.


When it comes to vegetarianism, those of a Phlegmatic Temperament can go either way, as there are pros as well as cons for this type of a dietary approach.  Generally speaking, vegetarian foods are lighter and easier to digest, and contain more roughage and fiber, which is remedial for the heaviness, sluggishness and congestion that Phlegmatic individuals tend to suffer from.  “Keep it light” is a good dietary maxim for Phlegmatics to follow.  Factors that weigh against a purely vegetarian diet, and favor the inclusion of a small or modest amount of meat and animal foods in the diet are that a little lean, high quality meat in the diet tends to stimulate the metabolism and the endocrine glands that regulate it, and this is a good thing for Phlegmatics.  In stimulating the endocrine glands, glandular and organ meats are especially valuable.  But all in all, the ideal Phlegmatic diet should be kept light, plant based and easy to digest, while still incorporating foods, like pungent spices and small doses of lean, quality meats if desired.  Phlegmatics should also keep their food portions sensible, and not overeat.


Excessive food intake weighs a Phlegmatic person down, and increases torpor and sluggishness.  It can also increase the risk of obesity and certain anabolic disorders like high blood sugar and type 2 diabetes, as well as high triglycerides and cholesterol, which those with a slow Phlegmatic metabolism are so prone to.  Since the Phlegmatic pepsis and digestion also tends to be slow and sluggish, many Phlegmatic individuals may find that they do better eating only two meals a day instead of three.  Although the usual pattern is to combine both breakfast and lunch together into a mid-morning brunch, the same thing can be done with lunch and dinner – combining the two together into a late afternoon meal.  Dinner can be skipped altogether, especially if one has had a late lunch, or eaten very lightly; “Eat like a pauper for dinner” is another good dietary maxim for Phlegmatics to follow.  Dinner, if it is eaten, should be had at least three hours before bedtime. 


Considering the slowness of the Phlegmatic digestive system, and their propensity for putting on weight, another key dietary principle also presents itself:  Eat a diet rich in the protective, catalyzing micronutrients – vitamins, minerals, enzymes and phytochemicals – while being light in the macronutrients – carbohydrates, fats and heavy proteins.  This will go a long, long way towards preventing many of the metabolic disorders that are so common in Phlegmatics.  In addition, such a diet will curb the Phlegmatic individual’s craving for junk foods that go overboard  on the macronutrients, while scarcely providing any micronutrients at all, since these foods are usually craved, not only as comfort foods, but also to provide a quick burst of energy to offset the devitalization brought about by chronic deficiencies of these micronutrients.  Vitality levels can also be maintained by avoiding foods that are unduly cooling, like beef, lettuce, cucumbers, melons, and tropical fruits, while emphasizing warming, stimulating foods.

 

Psychological Understanding and Management of the Phlegmatic Temperament


A good understanding of the basic psychological nature of the Phlegmatic Temperament can be had by first recognizing it as being the contrary, or complementary opposite, of the Choleric Temperament.  Whereas Cholerics are feisty and audacious, angry and irritable, Phlegmatics are basically placid, calm, and good natured; it takes a lot to upset or anger a Phlegmatic individual, and they have a relatively long fuse.  Whereas Cholerics are adventurous and independent, Phlegmatics tend to be passive, emotional and into bonding on a deep, sentimental level.  Cholerics are gifted with great objectivity and insight, but Phlegmatics, being so emotional and sentimental, are also quite subjective in their thinking.  Cholerics tend to be dynamic, proactive, demanding and impatient, but Phlegmatics are as patient as the day is long, and full of faith and trust.  Whereas the Choleric mind is sharp and penetrating, the Phlegmatic mentality is often dull, lethargic and passive. 


Because of this dullness and lethargy, many see the basic Phlegmatic mindset as being one of placid indifference, even bordering on numbness.  In a way, this is kind of like the psychological parallel to the Phlegmatic’s slow, lethargic metabolism and physiological processes.  Whereas the Choleric mind identifies strongly with the Élan Vital and the thrill and intensity of the Life Force coursing through its veins, the sluggish, lethargic Phlegmatic has these vital forces operating at such a low, slow level that he or she can hardly feel them at all.  And the more the Phlegmatic humor is aggravated and congested within the Phlegmatic individual, the more this sluggishness, lethargy and indifference will be felt.  Although the Melancholic Temperament is the most famous for its bouts of depression, every temperament but the Sanguine is vulnerable to its own particular kind of depression.  The Phlegmatic variety of depression is feeling so heavy, lethargic and indifferent to life that it’s a tremendous burden just to carry on. 


For the physician or therapist, the big problem is how to adequately motivate the Phlegmatic individual to get him or her to follow through with the treatment plan.  Pointing out the dire or unfortunate consequences of inaction and no follow through may motivate some.  For others, the idea of spouses, family members and loved ones is a big motivating factor, seeing as how important sentimental and family ties are to them.  For some, it helps to make it personal – that the physician or therapist is counting on them to follow through with the course of treatment.  And as with the Sanguine temperament, it is important to emphasize the payoffs of a greater feeling of wellbeing and aliveness after the healing is complete; and it is also important to make them aware of the successful attainment of intermediary milestones along their healing journey, even holding their hand and taking the baby steps with them until their confidence and motivation increase.  Obesity in Phlegmatics is often a form of psychosomatic body armoring; as the armor / excess weight is shed, pound by pound and piece by piece, suggestive techniques can be used to remind them that, at each step, there is a heightened feeling of aliveness. 

 

Exercise and Lifestyle Guidelines for the Phlegmatic Temperament


A Phlegmatic friend of mine once said to me, “I exercise the option not to exercise!”  That pretty much sums up the Phlegmatic feeling about exercise – What a chore!  Why bother?  Yet getting out of unduly sedentary habits and getting regular exercise, however light or basic it may be, is probably more important for the Phlegmatic individual than for any of the other temperaments.  Getting Phlegmatics to get out there on the court, or the gym or dance floor is quite difficult; as with Sanguines, sports that have a teamwork or social / interactive aspect to them are often more appealing than exercising alone; this is due to the wet or moist nature of the Phlegmatic Temperament, which seeks meaningful contact and bonding with others.  A hike alone may be a chore and drudgery that a Phlegmatic may never undertake, but hiking in a group may be a totally different story, with the other group members urging them on. 


Another approach to exercise that often works well with Phlegmatics is getting them to walk up a flight of stairs instead of taking the elevator, or walking down to the corner store to do some shopping instead of plopping into their car.  Perhaps no other invention in the whole history of human civilization has made man more sedentary in his habits than the automobile.  Exercise that is timed to fulfill a certain practical objective or purpose also works well, too.  For example, a light stroll before dinner will work wonders to awaken the appetite and improve digestion; a similar stroll an hour or two after dinner will also enhance the digestion of one’s food, and release the stresses of the day to prepare one for sleep.  The Phlegmatic individual can get creative in looking for new ways to do their usual chores and errands in a more active and less sedentary way. 


Winter is often a difficult and challenging season for Phlegmatic individuals, for a variety of different reasons.  Naturally, they find winter hard to take, since their inherent coldness and low level of metabolic heat or fire makes them more vulnerable to the effects of external cold than those of other temperaments.  Many Phlegmatic individuals can have a weak or vulnerable lungs and respiratory tract, which is often chronically congested with excess phlegm.  This excess phlegm can also compromise the biological terrain of the lungs and respiratory tract, making it easier for pathogenic bacteria and viruses to gain a foothold and proliferate.  In elderly individuals in the Phlegmatic winter stage of their lives respiratory vulnerability and immune-deficiency can reach critical levels, inviting life threatening conditions like chronic bronchitis and pneumonia.  A phlegm cleansing diet which starts in the fall, and carries over throughout the winter months can often do wonders in reducing the incidence of respiratory infection in vulnerable Phlegmatic individuals.


One of the blessings of having a Phlegmatic Temperament is deep, restful sleep; in fact, the sleep might be too good, and many Phlegmatics have a problem with excessive sleep and somnolence.  Since they would oversleep if left to their own devices, they usually need an alarm clock to wake them up on time.  They should also get to bed at a decent hour to avoid sleeping too late in the day; early to bed and early to rise (within reason!) usually works best for them.  If allowed to oversleep, Phlegmatic individuals often find themselves to be too groggy and sluggish throughout the day.

 

Bodywork and Aromatherapy Guidelines for the Phlegmatic Temperament


Phlegmatic individuals get a lot of benefit from massage because it removes congestion and improves the circulation of their blood and lymph.  And massage works best for them when medicated oils are used which are stimulating and decongesting.  Warming base oils like Olive Oil or Sesame Oil are good, into which stimulating, decongesting aromatic oils like those of Cinnamon, Cloves, Juniper, Bay Laurel, Pine and Fir have been added.  Adding melted resins like pine or fir tree resins also works well, too, as do resins from Balm of Gilead or Poplar buds.  There is an art to making a fine medicated massage oil, which Phlegmatic individuals would do well to learn. 


Another time honored method of aromatherapy that works wonders for relieving the phlegm congestion in their respiratory tracts that Phlegmatic individuals can be prone to is that of the vaporizer.  Inhaling aromatic steam helps to liquefy and loosen congested phlegm in the lungs and respiratory tract of Phlegmatic individuals.  Good aromatic essences to use are those of Eucalyptus, Bay Laurel, Oregano and Fir.  Either a few drops of the essential oil can be put into the pot of simmering water from which the fumes are inhaled, or the whole herb may also be used.  Another therapy that works well to loosen up phlegm congestion in the lungs and respiratory tract is applying an aromatic balm like Vicks Vapo Rub to the chest and ribcage.  One should never underestimate the power of stimulating aromatic essences like these to open up and remove blockages and congestions.

 

Herbal Therapies for the Phlegmatic Temperament


The Phlegmatic Temperament is Cold and Wet in its basic qualities, so it does well with herbs and medicinal substances that are warming and drying in nature.  These are mainly hot, pungent herbs and spices: Ginger, Garlic, Horseradish, Peppers, and so on.  Not only will these hot herbs and spices concoct and expel phlegm, but they will also relieve the blockage and congestion that Phlegmatic individuals are so prone to, and stimulate the vital forces of circulation, digestion and metabolism that tend to operate on such a low level in their systems.  This is what is usually meant by stimulant therapy in herbal medicine, not what most people think of as stimulants – empty stimulants like caffeine; these herbal stimulants are much more beneficial.  The main contraindication for the use of these hot stimulant herbs and spices is excessive heat, irritation and inflammation in the body, either acute or chronic, and the secondary dryness that is often seen with it. 


This stimulant method of herbal therapy has a long and time honored tradition behind it.  Galen made ample use of peppers and other heating stimulants to relieve Phlegmatic congestion and blockage.  Ayurvedic Medicine has its formula of Trikatu, or the Three Spicy Herbs: Ginger, Black Pepper and Long Pepper.  In 18th and 19th century America, Thomsonian herbalism made abundant use of heating stimulants like Cayenne (Capsicum anuum), Lobelia (Lobelia inflata), and Bayberry bark (Myrica cerifera).  In heating the body, these hot stimulants will often provoke a sweat, helping to release the pathogenic factors causing colds and flu; they will also heat up the body in cases of acute cold and chill.  Generating heat in the body to raise the circulatory and metabolic rate of the organism to help neutralize and expel toxins and pathogenic factors is probably what inspired Hippocrates to say that, if allowed to generate a fever, he could cure any disease.  Obviously excessive heat, inflammation and dryness in the body is a contraindication for such therapies. 


A milder version of this warming and stimulation can be seen in aromatic herbs.  Aromatic essences, being penetrating and volatile in nature, are great at opening up clogged vessels and passageways, which can often be obstructed by excessive phlegm, either gross or subtle.  Aromatic herbs that are particularly good and useful for relieving cold, sluggish Phlegmatic congestion are Cinnamon (Cinnamomum cassia), Bay Laurel (Laurus nobilis), Fir (Abies picea), Thyme (Thymus vulgaris) and Hyssop (Hyssopus officinalis).  While the hot stimulant herbs burn excess phlegm out of the body, the aromatics gently warm, open, loosen and dissolve the phlegm.  Warming aromatic herbs that ease the cold muscular and rheumatic aches and pains that Phlegmatic individuals are prone to are called anodynes; Cinnamon and Bay Laurel are excellent examples.  There are also super-aromatic substances that “open the orifices” which can even unblock obstructed sensory organs and revive consciousness in case of fainting or syncope; examples would be Camphor (Cinnamomum camphora), or Ammonium Salts (Sal Ammoniac).


Expectorants are herbs that facilitate the expulsion, or expectoration, of phlegm, mainly from the lungs and respiratory tract, but they work to rid other parts of the body, such as the GI tract and stomach, from excess phlegm as well.  Since there are many different types of phlegm in the body, there are many different types of expectorant herbs to treat these different types.  But the best expectorants for relieving phlegm congestion in those of a Phlegmatic Temperament tend to be pungent or acrid in taste, and heating and drying in their overall nature and qualities.  Warming and drying pungent or acrid expectorants usually work by concocting, or metabolizing the phlegm on the spot.  Good examples are Greek Oregano (Origanum vulgare), Fenugreek seed (Trigonella foenum-graecum) and Elecampane root (Inula helinum).  Phlegm that is thickened and toughened by subsequent heat and dryness needs to first be attenuated or liquefied before it can be expelled, and the herbs that do this tend to be soothing, smoothing and moistening, being rather temperate, or even slightly cooling in terms of their temperature.  Examples of these kinds of expectorants are Linden Flowers (Tilia europaea) and Red Clover (Trifolium praetense). 


Fenugreek Seed is an old Greek herb that dates all the way back to Hippocrates; it is probably the ideal expectorant and phlegm reducing herb for the Phlegmatic Temperament.  As an expectorant, it helps to expel phlegm in two different ways: via a pungent / aromatic part that concocts and dissolves the excess phlegm, and via an emollient, mucilaginous part that iiquefies the phlegm to facilitate its expulsion.  Prepared as an infusion, Fenugreek Tea is great for eliminating phlegm from the head, throat and sinuses; as a decoction, it works to eliminate excess phlegm from other parts of the body, like the stomach and GI tract, as well as the liver.  Taken as a powder, the seeds act as a gentle yet reliable superfood and metabolic stimulant that warms and stimulates humoral metabolism in the liver to generate more Blood and less Phlegm, and is also useful in treating high blood sugar as well as high cholesterol and triglycerides; for nursing mothers, it is a powerful galactagogue to improve the generation of breast milk. 


Astringent herbs come in handy in treating those of a Phlegmatic Temperament in many ways.  Due to the excessive moisture and wetness of the Phlegmatic Temperament, muscles, fascia and connective tissue, as well as other tissues of the body, can often be lax or of poor tone, and astringents can help tighten and improve the tone of these loose or sagging tissues.  Secondly, cold damp exudations, either from the skin, or from various bodily orifices like the vagina, can be common in those of a Phlegmatic Temperament, and the drying properties of astringents, especially those that are not too cooling, but are temperate or warming in nature, can be useful in treating these conditions; examples are Lady’s Mantle (Alchemilla vulgaris) and Astragalus (Astragalus membranaceous); these astringent drying agents are also called derivatives.Certain other astringents, like Red Raspberry leaf (Rubus idaeus), Sea Buckthorn berry (Hippophae rhamnoides) or Bayberry bark (Myrica cerifera) can be stimulating tonics that tone and energize the body.


I already mentioned that Fenugreek Seeds were a great tonic to stimulate the metabolism.  The overall metabolism and physiological functioning of the body can also be stimulated via the use of endocrine tonics; for those of a Phlegmatic Temperament, the main endocrine glands that we want to stimulate are the adrenals and thyroid glands.  Good endocrine tonics for the Phlegmatic Temperament include Maca root (Lepidium meyenii), Royal Jelly and Human Placenta.  Stimulating the endocrine system is a good therapeutic strategy for those of a Phlegmatic Temperament, but is most effective only after excess phlegm and fluid congestion is relieved.


Because Phlegmatics are so prone to water and fluid retention, herbal diuretics play an important part in regulating and improving fluid metabolism with them and relieving this fluid accumulation.  Diuretics often work well in combination with warming and pungent herbs to stimulate metabolism; the warming herbs start to metabolize and cast off excess fluids, and the diuretics enable them to finally be eliminated from the body.  Couch Grass (Agropyron repens) is a mild diuretic and antirheumatic that has a long and venerable history of use in Greek Medicine.  Other good diuretics that are suitable for those of a Phlegmatic Temperament are Burdock root (Arctium lappa), Dandelion leaves (Taraxacum officinale), and Pipsissewa (Chimaphilla umbellata). 


Those with a Phlegmatic Temperament are also vulnerable to rheumatic aches and pains, due to the coldness and dampness that tends to accumulate in their bodies, especially in cold, damp weather.  These rheumatic tendencies can be remedied with antirheumatic herbs like Elecampane root (Inula helinum), Angelica root (Angelica archangelica) and Ajwain seeds (Ptychotis ajowain).  Anodyne herbs, which I have discussed earlier, are also useful for warming the body and dispelling cold rheumatic aches and pains. 

 

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 professional.  The reader assumes all personal responsibility and liability for the application of the material contained herein, and is advised to seek out professional medical treatment if his or her symptoms or condition persists or worsens.