Disorders of Temperament

     In Greek Medicine, the simplest types of pathology are dystempers, which are disorders or imbalances of temperament.  Simply put, one or more of the Four Basic Qualities - Hot, Cold, Wet or Dry - overwhelms the body's defenses and homeostatic mechanisms, and gains entry into the organism as a whole, or localizes itself in a certain part of the body.
     A dystemper, in its most basic form, is simply succumbing to an exogenous environmental influence, or getting "under the weather".  One may get a cold from catching a chill, or experience a bout of rheumatism from cold, damp weather. 
     Dystempers are rather simple, straightforward affairs; the stronger the offending environmental influence gets, the stronger become the signs and symptoms of the dystemper.  Conversely, when the offending influences subside or abate, the dystemper is also alleviated, and one experiences relief. 
     Dystempers may affect any organ, tissue, or part of the organism, and that includes any one, or more, of the Four Humors.  But even if they affect a humor, a dystemper of a humor isn't the same as a genuine humoral disorder; the humor's substance or essence hasn't become affected, and the metabolism and generation of the humors remains balanced and intact.  Also, humoral disorders progress and work themselves out through complex, dynamic metabolic processes of transformation and ripening, or maturation, which are absent in simple dystempers.


Qualities and Dystempers

     Simple dystempers involve only a single quality: heat, coldness, dryness or moisture.  They can also vary in degree or severity, which will make a difference in how they affect the organism.
     The two primary dystempers are heat and coldness, or chill, because they involve the two primary or active qualities of Hot and Cold.  They're primary not just because they're the most important; they also have the power to precipitate changes in the other two qualities - dryness, and wetness - as well. 
     Moderate heat simply increases the quality of heat in the organism, whereas extreme or severe heat will also lead to dryness and dehydration.  Moderate coldness, or coolness, simply cools down the organism, whereas extreme coldness also precipitates moisture. 
     Of the two primary dystempers, coldness or chill is usually considered to be the most deleterious in its effects, because Cold is basically inimical to life.  All living organisms generate a metabolic or innate heat; dead bodies are cold and lifeless.
     The two secondary dystempers are dryness and wetness, or moisture.  They can exist in relatively pure form, but are often seen paired up with either heat or coldness.  For example, the heat of an arrid desert is usually dry heat, whereas the heat of a tropical swamp or jungle would usually be humid or damp heat.  Similarly, the coldness of a high mountain ridge is most likely to be dry, whereas that of a subarctic marsh or peat bog is most likely to be moist or damp. 
     In addition, there's a fifth quality or exogenous pathogenic factor that often figures into dystempers: Wind.  Wind is rarely found alone, and usually teams up with one or two of the other four qualities as the motive force that penetrates the body's external immune defenses and drives the others in.
     A dystemper enters the organism by overwhelming its immune defenses and upsetting its homeostatic mechanisms.  But what is pathogenic and overwhelming for some may not be so for others; it's all relative.  One's inherent vulnerability to any given influence or potential dystemper depends on two basic factors:  one's constitutional nature and temperament, and any acquired conditions or imbalances of humor or temperament that one may be suffering from. 
     For example, those of a Phlegmatic temperament, with a preponderance of coldness and moisture in their constitutional makeups, will tend to be more vulnerable to dystempers of cold and/or dampness.  Frequent indulgence in cold, damp things, like ice cream or cold, iced drinks will also make one more vulnerable to dystempers of coldness and dampness, regardless of one's constitutional makeup. 
     Coldness and dampness exert a Phlegmatic influence, whereas heat or warmth and moisture exert a Sanguine influence.  Heat and dryness exert a Choleric influence, whereas coldness and dryness exert a Melancholic influence.
     In therapeutics, practitioners of Greek Medicine are always careful to choose treatments or medicines whose natures are opposite yet complementary, or remedial, for both the patient's constitutional nature and temperament, as well as any acquired disorders or imbalances that may exist.  Otherwise, a poorly chosen treatment or remedy can just as easily create a new dystemper or imbalance, leading to further complications.


Dystempers of the Four Humors

     The organism as a whole, as well as its constituent parts, responds to, and is affected by, dystempers.  And that includes the Four Humors.
     Perhaps the clearest and most obvious example is the way that cold dystempers cause an increase in, and congestion of, phlegm.  This reaction is very common, and many people experience sneezes, sniffles or runny noses, as well as coughs and lung congestion, right after catching a chill. 
     But in simple dystempers, these humoral reactions are very transient and short term.  Once the exogenous pathogenic factor or influence has been expelled and balance or homeostasis is restored, the humors return back to normal. 
     Only when dystempers become chronic or entrenched do they start to cause pathological changes in the humors.  Disorders and imbalances of the metabolism also set in, and the generation of the humors becomes unbalanced or impaired.


     Heat, or a Hot dystemper, is when the body as a whole, or any part thereof, attains a state of heat which is beyond that which is natural or inherent to it.  Moderate or natural Innate Heat is generated by all living organisms. 
     In the broadest, most basic sense, excess heat is excess energy or activity - physical/kinetic, or metabolic.  Quite often, the body, or certain parts thereof, will feel hot or feverish to the touch.  Redness, soreness, irritation and inflammation are all signs of heat, as are a rapid pulse and an elevated body temperature. 
     The most obvious cause of heat is hot weather or hot environments.  A hot, sunny summer day, a sun-baked desert, or sweltering tropical heat.  Everyone knows that extreme heat like this can lead to secondary fluid loss and dehydration, so one must keep hydrated and drink plenty of fluids.
     Other forms of heat exposure can also create Hot dystempers.  Examples are overexposure to a hot fire, a hot oven, or excessive immersion in a hot bath. 
     Physical activity and exercise are also heating, and moderate but persistent overindulgence in physical exercise and activity can aggravate excessive or unnatural heat in the body.  Physical activity to the point of utter exhaustion, however, will dissipate heat and lead to cold. 
     Psychic movement, or e-motion, is also a potent generator of heat.  Anger and passion are heating in nature, as is worry, or even joy or euphoria.  Eating, or ingesting nourishment, in moderation, also exerts a heating influence, as it stimulates the activity of digestion and metabolism.  The organism also acquires the caloric heat generating potential of the foods consumed.  Overeating to the point of gluttony, however, depresses circulation and metabolism, and is cooling.
     Infection and sepsis, or what Greek Medicine calls putrefaction, also generates heat, since it is the invasion of an exogenous microbe and its foreign heat, or metabolism, into the body.  In addition, the organism manifests additional heat in exerting the immune force and reaction necessary to expel the invader. 
     Secondary heat or fever can also be generated as a defensive reaction of the organism to an invading cold or chill.  In these cases, there is usually the paradoxical, simultaneous experience of both chill and fever. 
    Excessive heat can accumulate if the normal means and channels for its dispersal and release are blocked or lacking.  Perhaps the most common cause of this kind of heat is obesity, in which a heavy layer of insulating fat allows excessive heat to accumulate from what for an ordinary person would be very light activity, and no problem at all.  Also, if the pores are closed due to excessively tight or dry skin, the normal release of heat through perspiration, both sensible and subtle, or insensible, will be blocked, allowing heat to build up. 



     Greek Medicine considers cold to be more dangerous and harmful to the organism than heat, because cold is basically inimical to life.  Cold cramps and constricts, and depresses vital life functions like circulation, metabolism and digestion.
     Most people vastly underestimate the insidious nature of cold, how much damage it can do, and how long it can linger in the organism.  By the time most people finally succumb to a chill and come down with a cold, they have usually forgotten or discounted their initial exposure(s) to cold, which have greatly weakened their resistance.  Perhaps the most frequent offender is ice cold drinks, followed by ice cream.  These things particularly need to be watched in cold weather, or when the seasons are changing.  In cold weather, hot drinks should be taken, not cold ones.
     In addition to prior exposure, one's constitutional nature and temperament determines how vulnerable one is to the ill effects of cold.  In general, those of a hot, Choleric temperament are least vulnerable to cold, followed by those of a warm Sanguine temperament.  Those of a Melancholic or Phlegmatic temperament are most vulnerable to the ill effects of cold. 
     Moderate coldness and dryness, as often prevails in the fall, most easily aggravates melancholy.  Severe or extreme coldness, or coldness and dampness, as often prevails in the winter, tends to aggravate phlegm.
     In the head and cranium, cold can cause headaches, earaches; stuffy, runny or congested nose; and tearing eyes.  In the throat, cold can cause sore throat and hoarseness.  In the chest, cold can cause coughing and lung congestion.  In the stomach and GI tract, cold can impair digestion, cause gurgling in the stomach and/or intestines, as well as stomachache, indigestion, abdominal cramping and diarrhea.  In the kidneys and urinary tract, cold can cause urinary debility and frequent or urgent urination, as well as renal or urinary colic.  In the female reproductive organs, cold can cause menstrual cramps.  In the musculoskeletal system, cold can cause or aggravate arthritic and rheumatic conditions. 
     Even those of a hot Choleric temperament aren't immune to the ill effects of cold.  In such individuals, exposure to cold may trigger reactions of what could be called rebound heat as the organism over-reacts.  Colds initially caught due to a chill can later manifest a fever as well as the organism struggles to throw off the chill; paradoxically, the victim feels simultaneous chills and fever.
     Cold is, above all, a phenomenon of extremes, and extremes of many kinds will eventually lead to cold.  Extreme sedentariness and inactivity will lead to cold, as will somnolence, but also will extreme physical activity and exertion carried to the point of utter exhaustion.
     Similarly, eating and nourishment are basically heating, in that they stimulate digestive and metabolic activity.  But overeating far beyond one's digestive capacity, as well as eating too many cooling, heavy or phlegm-forming foods, stifles the digestive and metabolic fires of the organism, leading to a cold condition.
     The same goes for immersion in a hot or warm bath.  Moderate immersion kindles and cherishes the Innate Heat of the organism and warms up the body.  But overimmersion for extended periods of time over-relaxes the pores and disperses the Innate Heat through too much sweating, leaving the body cold.
     If the humors get too thick, aggregated or congealed, circulation will be impeded and the Innate Heat will be suffocated, resulting in cold.  Cold is also a leading cause of thickening and congellation of the humors.  And so, the effect can become the cause, and vice-versa.
     The cardinal signs and symptoms of coldness are: fatigue and low energy; a pale complexion; feelings of chill, coldness, or being cold to the touch; an aversion to cold weather; closed pores, goose flesh, and a cessation of perspiration, both sensible and insensible; a slow and/or deep pulse; and cold hands and/or feet.
     In diagnosing a cold condition, a further distinction should be made as to whether it is of excess or deficiency.  Excess cold conditions tend to be more acute, caused by the invasion of exogenous, superfluous cold pathogenic factors into an otherwise healthy organism.  With deficiency cold, which tends to be more chronic and atonic, the core problem is an inherent weakness or deficiency of the Innate Heat of metabolism, which allows cold to dominate by default.  

Moisture, or Dampness

     The human body is about 70 percent, or over two-thirds water.  Water is essential for life, but when the water level in the body gets even one or two percentage points over normal, moisture or dampness sets in and begins to get problematic, causing signs and symptoms.
     Above all, dampness or moisture is heavy, slow and sluggish; it lingers, and is hard to disperse.  It tends to sink to the lowest point, and seep downwards.  Dampness also makes things soft and soggy, and makes the tone of the muscles and tissues too lax.  Its sluggishness tends to obstruct proper circulation, digestion and metabolism.
     If moisure and the stagnation it brings become chronic, toxicity and turbidity start to set in.  Cloudiness, murkiness, stickiness and a foul or foetid odor start to appear.  In Greek Medicine, stagnant moisture or dampness is the most common cause of putrefaction, which modern medicine calls sepsis, or infection.
     Moisture or dampness is of many different kinds, and has many different causes.  Wetness, being a secondary or passive quality, is often seen as being a consequence of extreme cold in the Phlegmatic disposition.  Yet dampness can also combine with heat, or be fairly neutral or temperate in terms of hot or cold. 
     Eating and nourishment are basically moistening in nature.  Through digestion and metabolism, the nourishing moisture of food and drink is transformed and assimilated into living tissue.  Eating too many moistening foods, or overeating beyond one's digestive capacity, are common causes of the accumulation of excess dampness, as is taking a warm or hot bath immediately after eating.
     Deficient or obstructed circulation is another common cause of dampness, which will build up precisely where proper circulation and drainage are lacking.  In this, dampness is often seen in conjunction with cold, which also obstructs or slows down proper circulation.
     The retention of secretions or waste matter which should be evacuated is also a common cause of excess dampness.  Closing of the pores, which blocks perspiration, also leads to the accumulation of dampness.  Excessive sleep and rest are also unduly moistening.  Living in damp, marshy, musty or mildewy environments can also cause the accumulation of excess dampness.
     The signs and symptoms of excess dampness are many; the most common and important ones are:
     Lassitude, listlessness, and undue heaviness of the head and limbs.
     Swelling, water retention and edema.
     Excessive or abnormal secretions or exudations.
     Excessively soft, moist, tender or clammy skin.
     Soft, loose, or watery stools; stools that are smelly, foetid, gassy or burning (damp heat).
     Dizziness and vertigo with a heavy head.
     Phlegm congestion and/or discharge.
     A thick, turbid tongue coat; a soft, soggy pulse.
     Itching and pruritis of the skin (damp heat). 



     Dryness, as one might expect, has qualities which are contrary to those of moisture, or dampness.  Dryness is light, hard and rough, whereas dampness is heavy, soft and smooth.  Dryness also withers and emaciates.
     Since life needs moisture and fluids to grow and flourish, dryness is basically inimical to life.  Although it could be argued that, due to this fact, dryness is the greater of the two evils, the threats posed to the organism by excess moisture or dampness are almost as bad; the scales of life must be finely balanced.
     Perhaps the most common cause of dryness, and one that is easily remedied or preventable, is insufficient hydration.  Many people simply don't drink enough water and fluids. 
     In terms of environmental causes, a dry weather or climate are the chief concerns; dryness also tends to prevail in the fall.  Extremely hot weather will also disperse or evaporate moisture and cause profuse sweating, thereby leading to dryness.  Paradoxically, exogenous cold can be a cause of dryness if it congeals or prevents the proper circulation and dispersal of moistening humors like blood, phlegm or lymph.
     When it comes to dietary causes, insufficient food and nourishment is the most basic, primal cause of dryness, since food and nourishment are basically moistening in nature.  After this, the excessive consumption of drying foods and medicines, as well as the abuse of harsh laxatives or purgatives, are the chief culprits.  Excessive or violent evacuations, such as diarrhea, is a common and dangerous cause of dryness and dehydration.
     In terms of lifestyle, exercise, activity and wakefulness are drying in nature, whereas their contraries, inactivity and sleep, are moistening.  Excessive exercise, physical activity and wakefulness will lead to dryness.  Melancholic emotions like grief or loneliness are also drying.
     When someone is suffering from dryness, the skin and lips will often be chapped and dry; other possible signs and symptoms include: hollow cheeks and sunken eyes and temples; dry, irritated nasal passages, and possible nosebleeds; extreme thirst and dehydration; dizziness and lightheadedness; a dry, sore throat and a hoarse, scratchy or raspy voice; thick, sticky phlegm that's difficult to expectorate; wasting and emaciation; constipation and dry stools; stiff, popping or cracking joints.  Other bodily secretions and evacuations, like urine, digestive juices or the menstrual discharge in women will often be scanty or deficient; extreme dryness can dry up these secretions altogether.
     Aging is basically a drying out process.  The Radical Moisture starts to dwindle, as do hormonal secretions; the skin starts to thicken, wrinkle and wither like a dried-up prune.  In general, old people have a reduced capacity to assimilate and metabolize vital fluids, and the moist, flourishing Sanguine and Phlegmatic humors are compromised, in both quantity and quality, and lack their original fulness and robustness. 



     Wind can have many manifestations, and assume many forms in the body.  Being light, dry, subtle, rough and mobile in nature, it is most closely associated with the Melancholic/Nervous humor and temperament, and aggravations and disturbances thereof.
     The main characteristic of wind is unnatural or abnormal disturbances or blockages of movement.  These can assume many different forms and manifestations in different parts of the body.  Wind is rarely seen alone, but usually combines with other pathogenic factors.
     Wind often enters the body as an exogenous pathogenic factor.  It can provide the motive force that drives other dystempers like heat, cold, dryness or moisture into the body.  When you catch a chill and come down with a cold, you usually catch a chilly draft.  The organism will become extremely sensitized and averse to the secondary pathogenic factor.  If the Thymos and immunity are strong and robust, wind will close or block the pores, stopping all perspiration, both sensible and insensible; if Thymos and immunity are weak, the pores will be lax and loose, with sweating abnormal or profuse.  Muscular flu-like aches and pains in which wind is prominent will often be subtle, mobile, ephemeral shooting pains.
     Wind is a major culprit in rheumatic complaints, which most typically involve accompanying cold and/or dampness, although heat can also be involved.  Declining Thymos and immunity in the elderly and infirm allows exogenous wind, along with various other pathogenic factors, to penetrate into the bones and joints.
     In the head and cranium, wind can cause dizziness, vertigo, apoplexy, deviations of the eyes and tongue, stoppage of the senses, and even seizures and convulsions.  In the muscles, wind can create twitches, tremors, tics, spasms and palsy.  Internally generated wind can arise from chronic nervous stress and tension, as well as from high fevers, which aggravate the Choleric humor, producing giddiness, nausea and dry heaves as well as the above cardinal signs and symptoms.
     In the internal organs, wind is also called flatus; hence the term flatulence.  Today, it's most commonly called gas.  Flatus is most commonly seen in the hollow visceral organs of the body; these are principally the stomach and bowels, but other hollow viscera, like the bladder or uterus, can be involved as well.
     Wind, or flatulence, in the digestive tract is most commonly associated with nervous, colicky digestive disorders of a Melancholic nature and temperament.  The cardinal symptoms are colic, gas, distension and bloating, which are relieved once the wind is passed.  Eating too quickly, or while stressed, tired or nervous, is a common cause of gas or flatulence; also, some foods, like cabbage or beans, tend to produce lots of gas, as does poor food combining.
     A pressure or distension is felt with wind in other organs, like the bladder, as well as blockages or disturbances of normal organ function.  Once the wind is passed, the symptoms subside, and normal organ function is restored.