In Greek Medicine, once disorders and pathologies start to affect the Four Humors, they pass from the realm of the exogenous and superficial into that of the endogenous and self-generated.  All humoral disorders involve the digestive process of pepsis, and hence the nutrition and metabolism of the organism, which is the domain of the Natural Faculty.
     The Four Humors are more gross and material than the qualities or temperaments, which exist on a subtle energetic level.  Being more solid and substantial, the humors hold the temperaments in place, and affect the organism on a deeper level. 
     Being generated by and subject to the process of pepsis, which is basically digestion and metabolism, change and transformation, humoral disorders typically go through a process of change or metamorphosis as the offending morbid humors are ripened, or concocted.  This is in stark contrast to the typical pattern for dystempers, which is generally more static and linear, worsening or alleviating in direct proportion to the resurgence or subsiding of the offending exogenous qualities or influences.


Humoral Disorders and Pepsis

     Since the liver concocts the chyle into the Four Humors through the process of pepsis, it is to this process of pepsis that we must look to understand humoral disorders.  Basically, the process of pepsis is like cooking; to generate balanced, healthy humors, we must cook them just right, with just the right amount of metabolic heat. 
     If the metabolic heat is too low, the humors are undercoooked, which is like half-baked bread, being partially raw.  Generally, undercooking the humors tends to generate too much phlegm and not enough blood. 
     If the metabolic heat is too high, the humors are charred and burned, producing a kind of morbid, toxic ash, which is highly toxic to the organism.  This charring process is sometimes called oxidation.  The end product is most commonly morbid, toxic forms of black and yellow bile.
     The metabolic heat that concocts the humors can also be erratic and deranged, fluctuating wildly between the extremes of hypo-pepsis and hyper-pepsis.  This creates a similar derangement of the Four Humors, combining raw residues with toxic ash.
     The Four Humors, like any other part or component of the body, can be subjected to exogenous dystempers, with cold congealing them, heat hyperexciting their movement, dryness thickening them, and moisture or wetness diluting or attenuating them.  But true humoral disorders set in the moment that the process of pepsis which generates and metabolizes the Four Humors becomes unbalanced or deranged.


Types of Humoral Disorders

     In the differentiation of humoral disorders, the most basic distinction we must make is between quantitative disorders and qualitative disorders of the humors.  Simple quantitative disorders involve only an alteration or imbalance in a humor's quantity, whereas qualitative disorders also involve some morbid alteration of a humor's texture, composition or consistency. 
     Quantitatively, an excess or buildup of a certain humor, either locally or systemically, is called a plethora.  Conversely, there can also be a deficiency of a certain humor; for example, a deficiency of blood is known as anemia.  If a humor is not only quantitatively in excess, but also altered or morbid in quality as well, it is called a qualitative plethora.
     Qualitatively, there are various kinds of changes or alterations that a humor can undergo.  The chief ones are as follows:
     In terms of texture and consistency, a humor may be too thick and viscid, or it may be too thin and attenuated.  Humors that are too thick and congealed tend to have slow or impeded circulation, whereas those that are too thin tend to seep out of their proper channels and vessels too easily, or not nourish sufficiently. 
     Although normal, healthy humors do mix and mingle, they always maintain their own distinct identity and functional integrity.  Morbid, toxic humors can lose this purity and integrity and amalgamate, or bond with other humors, to the mutual disabling and detriment of all humors involved. 
     Putrefaction is the rotting or spoiling of a humor, much like food spoils on a hot summer day.  It happens when excessive moisture and stagnation within a humor allows a foreign heat or metabolism to take over; usually, an innate weakness of host metabolism and immunity is also involved.  Nowadays, putrefaction would be called sepsis or infection; a common symptom or side effect of putrefaction is pyrexia, or fever, with different types of fevers resulting, depending on the particular humor involved. 


Receptacles and Accumulation Sites for the Humors

     Each humor, according to its nature and temperament, as well as its physiological functions, has certain parts of the organism where it likes to reside, to which it has an affinity.  These are the receptacles and accumulation sites for the Four Humors.  These receptacles and accumulation sites are as follows:
     Blood:  Heart, blood vessels and capillaries (receptacle); liver, spleen, pancreas, uterus.
     Phlegm:  Lymph nodes and vessels (receptacle); stomach, lungs, respiratory tract; brain, head and cranium; sinuses, veins, spleen.
     Yellow Bile:  Gall bladder (receptacle); liver, spleen, stomach, duodenum, small intestine, capillaries
     Black Bile:  Spleen (receptacle); veins of hepatic portal system, stomach, large intestine; bones, joints and connective tissue; peripheral nervous system; liver and hypochondriac region. 
     When a humor gets excessive or aggravated, it first builds up in its receptacle, and then in its accumulation sites.  As pathology progresses, the excessive or aggravated humor will overflow these accumulation sites, and can spread to invade any part of the organism.  However, an aggravated humor prefers to gravitate towards an organ, tissue or body part whose inherent nature and temperament gives it a special affinity for, or vulnerability to, the humor in question.
     As you may have noticed, some deep internal organs, like the liver and spleen, are accumulation sites for multiple humors.  This is due to the important and central role they play in the physiology, metabolism and nutrition of the organism.


Diseases of the Four Humors

     Each of the Four Humors has certain diseases and disorders that are commonly associated with it.  If one looks at these diseases and disorders, one can see that they often involve the humor's receptacles and accumulation sites:
     Blood:  Heart disease, angina, high blood pressure; nosebleeds, hemorrhage and bleeding disorders; congested, sluggish liver and spleen; uremia and gout; high cholesterol, diabetes; amenorrhea or suppressed menses; dysmenorrhea, or painful menstruation, often with clotting; menorrhagia, or excessive menstrual bleeding; rashes and skin disorders.
     Phlegm:  Atonic dyspepsia, gastric atony; coughs, colds and lung congestion; asthma, chronic bronchitis, respiratory allergies; nasal allergies and sinusitis; somnolence and lethargy; lymphatic congestion and obstruction; swollen or tender lymph nodes; water retention, swelling and edema; leucorrhea and white vaginal discharges.
     Yellow Bile:  Jaundice and fatty liver; hepatitis; biliousness and biliary congestion; gall stones, cholecystitis, biliary dyskinesia; gastric and duodenal ulcers; gastritis, hyperacidity and acid reflux; chronic inflammatory conditions, bursitis, tendonitis; rheumatoid arthritis, gingivitis, headaches, migraines, photophobia.
     Black Bile:  Constipation, colic, irritable bowel; anorexia, poor appetite; nervous or sour stomach, chronic or indolent gastroduodenal ulcers; portal congestion or hypertension; veinous blood congestion, clots and embolisms; tremors, tics, neuralgias, neuraesthenia; nervous, spasmodic and neuromuscular disorders; seizures and convulsions; arthritic and rheumatic disorders; abnormal growths and hard tumors; splenic disorders; intestinal obstruction.
     In three of the Four Humors, certain patterns in tthe genesis or origin of humoral disorders and their subsequent spread can be seen:
     Phlegm tends to initially accumulate and get aggravated in the upper digestive tract, starting with the stomach, then spreading to the lungs, chest and respiratory tract; throat, esophagus and pharynx; and finally, the head, nose and sinuses.
     Yellow Bile tends to initially accumulate and get aggravated in the middle digestive tract, starting with the liver, gall bladder and hepatobiliary system, and then the stomach, duodenum and small intestine. 
     Black Bile tends to initially accumulate and get aggravated in the bowels and lower digestive tract, producing constipation, gas, colic, bloating and irritable bowel.  The stomach and hepatic portal system are subsidiary focus areas.  All these intial accumulation sites are adjacent to the spleen, which is the storage vessel or receptacle for black bile. 
     The three humors that are most likely to cause imbalances in the digestion, metabolism and nutrition of the organism all start their pathological proliferation from different parts of the digestive tract.  This fact emphasizes the primary importance of maintaining sound, balanced pepsis and digestion in the prevention of humoral diseases.
     The fourth humor, blood, is more generalized and systemic in its accumulation patterns, lacking any particular localization in the digestive tract.  This is because blood is the essence of life and health, and the bottom line in the overall nutrition of the organism.


Stages and Progression of Humoral Pathology

     Humoral pathology is not static, but progresses through several different distinct stages.  A thorough understanding of these stages and how they progress is necessary to properly understand humoral pathology. 
     Basically, there are two different ways of looking at this progression, each with a different model or schema of subdividing or delineating the stages of humoral disorders.  Each is equally valid, and has its own distinct strengths and virtues.
     The first model is the six stage progression.  It starts out with a buildup or accumulation phase, which may hardly be noticed by the individual.  The offending humor is slowly accumulating or getting aggravated, but has not yet reached critical levels that challenge the organism's physiology, metabolism and homeostatic mechanisms.
     Next comes the provocation stage, or the acute crisis.  The offending morbid or superfluous humor has built up to critical levels, which now threaten the organism's physiology, metabolism and homeostatic mechanisms.  The signs and symptoms of an acute crisis manifest as the organism struggles to throw off the offending morbid or superfluous humor.
     If the healing and catharsis that comes with the acute crisis is successful and complete, the organism returns to a state of health and regeneration as balance and homeostasis are reestablished.  If this healing and catharsis does not occur, or if it is only partial or incomplete, a subsequent stage of spreading or metastasis, which can also be seen as a submergence, ensues.  The humoral imbalance or pathology spreads beyond the initial accumulation site(s) to affect the organism on a deeper and more systemic level. 
     Morbid or superfluous humors circulating freely throughout the organism tend to gravitate to, or concentrate themselves in, weak spots or defective parts of the body, which could be called Achilles' heels.  Often, these weak spots are sites of an old illness, injury or deformity.  This stage of pathogenesis is called deposition, or entrenchment.  It must be remembered that morbid humors, like any other pathogenic factor, are basically opportunistic in nature, and will strike at the weakest point. 
     After deposition comes the stage of manifestation, in which the classical signs and symptoms of a serious or chronic disease make their initial appearance.  This stage, in which pathology is already quite advanced, usually follows quite quickly after deposition or entrenchment.
     A serious disease or disorder, after it has persisted for a while, often generates spinoffs or complications.  And so, complication is the final stage in this six step progression of pathogenesis.  The original serious or chronic disease could be likened to a tree, with the complications being like the fruit that the tree bears. 
     The second model or perspective on pathogenesis is simpler, and consists of only four stages.  Actually, these aren't so much stages as they are the various forms or manifestations that a disease can take.
     First, there is acute disease, which roughly corresponds to the second acute crisis stage of the previous six stage model.  The signs and symptoms of an acute disease are strong and vehement, as the organism struggles vigorously and decisively to throw off the offending pathogenic humor or factor.  Of course, acute disease presupposes that there has already been an initial latent accumulation stage that has precipitated the acute crisis.
     Then, there is subacute disease, in which the organism's struggle to throw off the offending pathogenic humor isn't quite so vigorous and vehement as it was in the acute stage.  Actually, the word "acute" means sharp; in the subacute stage, the organism's symptom-generating responses have become more dulled and subdued.  Usually, subacute disease manifestations were preceded by one or more initial acute episodes; now, the organism's defensive responses have become weakened.  The "sub" in subacute can also indicate a submergence or spreading of the offending humor or pathogenic factor to affect the organism on a broader, more systemic level.  Subacute disease roughly corresponds to the spreading or metastasis stage of the six stage model.
     If subacute disease is not resolved, it becomes chronic disease.  In chronic disease, the organism has resigned itself to living with the offending humor or disorder, and various physiological, metabolic or immunological mechanisms and functions have become compromised to accommodate the pathology.  In the initial stages of chronic disease, these changes or compromises are mostly functional, but as chronic disease progresses, they become increasingly structural and organic.  Chronic disease roughly corresponds to the manifestation stage of the six stage model. 
     Finally, pathology enters the degenerative disease stage.  Degenerative disease is characterized by degenerative organic or structural changes in the organs and tissues which are often irreversible.  The existence of degenerative disease illustrates an important principle of humoral physiology and pathology:  Since all the body's organs and tissues are formed and generated from the Four Humors, the continued presence of corrupt or morbid humors, if not corrected and resolved in a timely manner in the earlier stages of pathology, will eventually lead inevitably to degenerative changes in the organs and tissues.  Morbid humors generate morbid changes in the organs and tissues.  In the final complication stage of the six stage model, degenerative changes are usually present.  When these degenerative changes preclude any hope for survival, the degenerative disease becomes terminal. 


Resolving Humoral Disorders Through Pepsis

     The Four Humors are all generated through the process of digestion, or pepsis.  Every major change or movement of each humor at each stage of its metabolic pathway occurs through the digestive action of pepsis and the metabolic heat.
     And that includes the final elimination or removal of morbid or superfluous humors from the body.  They can't be forcibly extracted or removed; they must first be concocted or ripened through pepsis.  This is like the refiner's or smelter's fire, which separates the dross and impurities from the valuable ore.
     Of all humoral pathologies, blood disorders are the quickest and easiest to ripen and resolve.  That's because blood is the first humor to arise in the Second Digestion, and is quickly generated and re-generated.  Blood takes only a day or so to ripen, two at the most.
     The other three humors all take longer to ripen and resolve.  Yellow bile, being the hottest in temperament, and therefore the most active and volatile, takes only three days to ripen.  Phlegm is next, requiring nine days to ripen and resolve.  Black bile is the slowest and most recalcitrant, requiring a full fifteen days to ripen. 
     The general rule is that a humoral disorder must be treated for at least as many days as it takes that humor to ripen.  The role of the physician in Greek Medicine is to aid and facilitate the organism in the ripening and elimination of morbid or superfluous humors, and in the cleansing and catharsis it wants to accomplish.  Humoral ripening wil tend to be faster in hot weather and slower in cold weather. 
     When morbid or superfluous humors are being ripened and passed off, signs and symptoms of an acute crisis will often occur.  These can include: dizziness, vertigo or headaches; fevers, sweats or hot flashes; coughing or expectoration of phlegm; giddiness, nausea or vomiting; muscular aches, pains or fatigue; boils, blisters, pustules, abscesses and other skin discharges or secretions; diarrhea, soft stools or irritable bowel; and increased urination, often with changes in volume, color, odor, texture, etc...  These signs and symptoms, in the proper circumstances and context, are recognized as the healing crisis in Greek Medicine, which is not something to be suppressed, but rather managed and facilitated in a proper manner. 


Conclusion:  A Humoral Understanding of Pathology

     A humoral understanding of pathology is one of Greek Medicine's most valuable contributions to the art of healing.  A number of previously unexplained mysteries about how the organism responds, in both health and disease, become clear when one understands the physiology and pathology of the Four Humors.
     The Four Humors, being the metabolic agents of the Natural Faculty, follow the workings of Nature within the human organism.  When the physician works with the Four Humors in correcting and facilitating their natural homeostatic and metabolic processes, he is truly working with Nature as a natural healer. 
     Modern medicine has a vast, bewildering array of imposing, polysyllabic disease names.  But Greek Medicine sees behind this perplexing facade to common humoral themes that run through them like universal connecting threads.  The vast multiplicity of diseases stem, by and large, from only Four Humors, which can get deranged, aggravated or vitiated in various ways, to varying degrees, and localize themselves in various organs, tissues or parts of the body.