The Melancholic humor, or black bile, is the humor most prone to aggravation and pathology.  In fact, the very word "melancholy" is almost synonymous with morbidity.
     Even normal black bile, due to its inherent nature and temperament, is the humor least conducive to the optimal health and nutrition of the organism, even though it does have necessary physiological and metabolic functions to perform.  And morbid forms of black bile are even more deleterious in their effects than the morbid forms of other humors.  Since black bile is the most effete of all the humors, its pathologies almost always involve excess, with deficiency only a minor consideration. 
     In its pathologies, a distinction must be drawn between black bile in its subtle, vaporous aspect, also known as the Nervous humor, and black bile in its gross humoral aspect, also known as melancholy, or the Melancholic humor:
     The Nervous humor, in addition to being Cold and Dry, is also light, subtle and mobile; its pathologies are mainly psychic, nervous, spasmodic, convulsive and neuromuscular.
     The Melancholic humor, in addition to being Cold and Dry, is also heavy, dense, gross and binding, being the metabolic agent of the Earth element.  It is mainly concerned with pathologies affecting the digestion, metabolism and nutrition of the organism, particularly the bones, joints and connective tissue.

Melancholic Excess, or Plethora

     Since black bile is the humor most inherently prone to aggravation and pathology, all excesses of it, whether in its normal or morbid forms, are quite undesirable.  You could say that the difference between quantitative and qualitative plethoras of black bile isn't as great as with the other humors.  Even so, with morbid black bile, the pain, stiffness, hardness, obstruction, reflux symptoms and waste retention will be more severe, since black bile in its morbid forms is a slow acting poison to the whole organism.  Since plethoras of black bile are very commonly seen, the physician must thoroughly familiarize himself with their various clinical manifestations.
     Causes:  The possible causes of Melancholic plethora are many and varied.  These causes may be environmental, dietary, hygienic or lifestyle related.
     Environmental causes of Melancholic plethora are mainly cold, dry or windy weather and climactic conditions.  This kind of weather often prevails in the fall, and is worse at high altitudes.
     The dietary causes of Melancholic plethora are many, and include not only what is eaten, but how it is eaten and prepared.  Cold or icy food and drink, dry or stale foods, excessive consumption of raw or astringent foods, and certain foods like beans or some nuts, are big culprits.  For more details, please review the relevant pages on diet in the Hygiene and Therapies sections. 
     Poor eating habits also aggravate Melancholy.  These include starvation diets, irregular eating habits, as well as irregular food intake in terms of quantity.  Eating hurriedly or on the run, as well as eating when upset or anxious, will also aggravate Melancholy.
     Irregular or disordered living habits also aggravate Melancholy.  These include: staying up too late at night, overwork, excessive or prolonged stress; distraction or multitasking; excessive sexual indulgence, and physical overexertion.  Not drinking enough fluids leads to dryness, which also aggravates Melancholy.
     An unbalanced emotional life can also aggravate Melancholy, which is virtually synonymous with dark, morose emotions.  Excessive grief, loneliness or alienation are the most common offenders; an attitude of excessive caution, prudishness, cynicism or misanthropy will also favor plethoras of Melancholy, as will trauma and shock, either physical or psychological.
     Accumulation Sites:  Excessive black bile first builds up in its storage receptacle, the spleen.  From there, it spills over into the stomach and/or large intestine, both of which are adjacent to the spleen, to cause the various digestive complaints for which black bile is known: indigestion, sour stomach, gas, distension, bloating, colic and constipation.  From the digestive tract, excess black bile starts to invade the deeper organs and tissues of the body. 
     From the stomach, duodenum and small intestine, black bile invades and congests the gall bladder and hepatic portal system, and then the liver, from where it can spill over into the chest, throat and hypochondriac region under the ribs.  From the colon, black bile penetrates into the bones and joints of the sacrum, lower back and pelvic girdle, bringing degenerative arthritic changes to these areas before moving on to affect the whole musculoskeletal system.  Melancholy as the light, mobile Nervous humor has a tendency to rise upwards to affect the head and mind, and also floats outwards to affect the peripheral nerves, joints, muscles and articular structures; cramps, twitches, spasms and shooting pains are common.
     Signs and Symptoms:  The cardinal signs and symptoms of Melancholic plethora are many and varied, and are as follows:
     Mind:  Nervousness, anxiety, moodiness, depression.  Lonely, alienated, morose.  Cynical, misanthropic.  Fearfulness or shock without a cause.
     Head:  Spaciness, lightheadedness, vertigo.  Nervous exhaustion, neuraesthinia, insomnia.  Tinnitus, ringing in ears.  Dizziness.
     Mouth and Throat:  Bittersweet or astringent taste in mouth and throat.  Dark brownish sputum or tongue coat.  Dry mouth and thirst.  Globus hystericus:  the feeling of something being stuck in the throat.
     Chest:  Stuffy chest, constricted breathing.  Pain, fullness or distension in the hypochondriac area under the ribs.  Tender, painful breasts.
     Hepatobiliary:  Enlargement of liver and spleen.  Jaundice with dark or dull yellow complexion.  Portal congestion and hypertension.  Biliary congestion, blockage, dyskinesia. 
     Digestion:  Irregular, erratic or perverted appetite; nervous eating and food cravings.  Poor appetite, anorexia.  Nervous or sour stomach; epigastric pain and distension, indigestion.  Gastrointestinal griping and colic; intestinal obstruction.  Abdominal distension, gas, bloating, flatulence.  Constipation with hard, dry stools; tenesmus. 
     Blood:  Poor circulation, cold hands and feet.  Dark, thick blood, tendency to form clots and embolisms. 
     Skin:  Dull yellow or dark, swarthy complexion.  Cold, dry, rough skin.
     Musculoskeletal:  Arthritis and rheumatism; neuromuscular complaints.  Stiff, aching, arthritic joints; lumbago and sciatica.  Tingling and numbness in the extremities.  Tremors, tics, cramps, spasms. 
     Male:  Nervous sexual dysfunction, performance anxiety.  Sexual exhaustion and prostration. 
     Female:  Irregular menses, dysmenorrhea with painful spasmodic cramping.  Premenstrual mood swings, food cravings.  Scanty, dark thick menstrual flow with clotting.  Insufficient lactation.
     Urinary:  A nervous, agitated or sensitive allergic bladder.  Thin, clear urine; can be dark or turbid.
     Pulse:  A weak, thready pulse. 
     Dreams:  Dreams of gloomy, dark places; fearful nightmares.
     It is highly unlikely that anyone will experience all these signs and symptoms simultaneously.  But the more of them you experience, and the more intense they are, the more severe the plethora of black bile.  Also, the organs and parts of the body affected will give you an idea of where the excess black bile and melancholy have accumulated.

Deficiencies of Black Bile

     Deficiencies of black bile are not so commonly seen.  They can be seen in some women who menstruate excessively, especially when the menstrual blood is an extremely light or bright shade of red. 
     Black bile deficiencies can also be involved in various chronic or congenital bleeding or hemorrhaging disorders, many of which are hereditary or constitutional in origin.  Perhaps the most well-known of these bleeding disorders is hemophilia, which is a total lack of the clotting factors inherent in black bile.  Hemophilia is usually best treated with conventional modern medicine, to replenish the missing clotting factors. 
     Nevertheless, milder states of susceptibility to bleeding and hemorrhage due to thin blood and a deficiency of Melancholic residues in the bloodstream can be treated naturally, with herbal medicines.  These include certain blood tonics, astringents and hemostatics.

Qualitative Disorders of Black Bile  

    Normal black bile is a sediment of blood, and is Cold and Dry; it is also dense and heavy.  Abnormal or morbid forms of black bile can be the charred, oxidized residues of any of the Four Humors, including black bile itself.  As such, these abnormal forms of black bile are all hotter and lighter in temperament than the normal variety, and have a greater penetrating and corrosive power.
     What differentiates these abnormal forms of black bile from oxidized forms of yellow bile is that, in the latter, the oxidized residue, or ash, is admixed with the more rarefied, attenuated form of the humor.  With oxidized black bile, these rarefied portions have already been separated out, leaving behind only the ash-like residue. 
     Although hotter than normal black bile, oxidized black bile isn't as hot and caustic as the oxidized forms of yellow bile.  Whereas oxidized yellow bile produces hotter, more acute irritation, inflammation and ulceration, that produced by oxidized black bile tends to be more indolent and chronic.
     Being lighter than normal black bile, the oxidized form's corrosive influence is subtle, and can penetrate anywhere within the organism.  Morbid black bile can also amalgamate itself to any of the Four Humors, including black bile itself.
     Abnormal black bile can be generated or aggravated due to several different causative factors.  The chief ones are:
     There can be excessive heat in the liver, causing burning, charring or excessive oxidation of the humors.
     The excessive metabolic heat generated by certain types of chronic or extreme fevers, usually involving the liver, can also burn and char the humors.
     The spleen, black bile's receptacle, may be weak and feeble, and unable to adequately contain, ripen or metabolize the humor in both its normal and abnormal forms, allowing excessive amounts of it to spill out into the organism.
     Excessive cold in the body congeals and solidifies the humors and secretions of the body.  Prolonged stagnation, often caused by cold, will also aggravate morbid black bile, and strengthen the deleterious effects of the normal variety as well.
     Stagnation leads to putrefaction.  In many putrefactive processes, the denser residue left behind is usually some form of morbid black bile.
    The various types of morbid black bile are each named after the humor from which they were derived.  Their properties and characteristics are as follows:
     Sanguineous Atrabile is derived from blood, either by oxidation or putrefaction.  When the Sanguine humor putrefies, it generally produces two byproducts: morbid choler, which is dispersed as the lighter, more rarefied portion; and Sanguineous Atrabile, which is left behind as the denser residue.  The charring or oxidation of normal blood will also produce Sanguineous Atrabile as an ash-like residue.  Sanguineous Atrabile tastes salty and faintly sweet; it is only slightly to moderately toxic. 
     Phlegmatic Atrabile is derived from the oxidation of either mucous or serous fluids of varying compositions and consistencies.  It will taste salty if it's derived from watery, attenuated fluids; if derived from thicker fluids, it will taste either acrid or bitter - astringent.  Like Sanguineous Atrabile, the Phlegmatic variety is only slightly to moderately toxic, and generally acts at a slow rate.  It may be found either within the digestive or respiratory tracts, or carried by the circulatory and lymphatic systems to anywhere in the body.
     Choleric Atrabile, or the ash-like residue from the oxidation of the bilious humor, is very corrosive, caustic and toxic.  Oxidized yellow bile has the ash-like residue still mixed in with it, but when this residue is separated out, it becomes Choleric Atrabile.
     Choleric Atrabile has several different varieties.  It can be generated by separating out, or distilling, the ash-like residue from any of the oxidized forms of the bilious humor.  Generally, the more toxic and injurious the morbid choler variety of its derivation, the more caustic and toxic will be the atrabilious residue produced.  Generally, the residues of Leekgreen Bile, Verdigris Bile and Adust Choler are the most caustic and toxic, especially the latter.
     Choleric Atrabile tastes bitter; all its varieties are extremely injurious and toxic.  According to its effects on the organism, and its prognosis and treatment characteristics, Choleric Atrabile is generally divided into three types:
     The first type is more injurious, and decomposes very readily.  However, it is more amenable to treatment than the other forms. 
     Of the two remaining varieties, one is more acrid and injurious; the sooner it is treated, the better.  The other variety of Choleric Atrabile penetrates the tissues less easily, and is more slowly destructive; it's very difficult to disperse, mature or treat with remedial measures.
     Melancholic Atrabile is derived from the oxidation of black bile itself.  If derived from a more watery, attenuated form of black bile, its taste is acrid, like vinegar; if derived from a thicker, denser form, its taste is less acrid, astringent and slightly bitter.  Generally, Melancholic Atrabile is considered to be a slow acting poison except if it is charred pitch black, in which case it is even more toxic.

Clinical Manifestations of Morbid Black Bile  

     Morbid black bile will produce many different signs and symptoms, depending on where it's localized in the organism.  Aggravations of normal black bile will produce mainly functional disorders, but those of abnormal black bile will produce morbid degenerative changes in the organs and tissues as well.
     If localized in the liver, morbid black bile may also affect the head, senses and nervous system.  Mild perturbations will disturb the flow and patency of liver function and impede humor generation, resulting in neurovegetative dystonia, portal hypertension, an irritable liver, hepatobiliary insufficiency, and blood whose full nutritive capacity has been compromised. 
     If these conditions get more chronic and severe, sensory or neurological symptoms may develop, such as neuraesthenia, insomnia, nervousness, anxiety, frequent headaches, hypertension, dizziness, giddiness, nausea, vertigo, red sore eyes, and tinnitus, or ringing in the ears.   With more time and aggravation, full-blown tremors, tics, spasms and even apoplexy, convulsions or syncope may develop.  This is called internal wind or wind stroke, and may presage a cerebrovascular accident.  In all the above liver syndromes, morbid choleric derivations of black bile are the worst offenders.
     Morbid black bile in the stomach and middle digestive tract can produce a nervous or sour stomach, heartburn, perverted appetite and food cravings, poor appetite and nausea, and chronic indolent gastroduodenal ulcers.  In the intestines, it can produce marked colic, gas, distension and pain, irritable bowel, gurgling intestines, and even intestinal obstruction.  With morbid black bile, the obstruction, pain, colic, reflux and dysfunctional symptoms will be more severe.
     In the bones and joints, morbid black bile can produce marked, severe, or even crippling arthritic pains and degenerative changes in the joints and supporting structures.  These arthritic conditions may even have an autoimmune component, as in rheumatoid arthritis.  With simple aggravation of normal black bile, there may be some stiffness or calcification, but the pain will only be moderate, and much less severe.

Putrefaction of Black Bile

     Black bile, like any other humor, can putrefy.  When it putrefies, black bile generates a fever pattern that is one day on, two days off.