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Constitutional Medicine – Constitution and Temperament

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Renowned Homeopath David Little offers an excerpt from his Homoeopathic Compendium of 6 Volumes, the result of his many years of experience and study. A treasure of knowledge for any student or practitioner.

From: The Homoeopathic Compendium by David Little. Excerpt from Volume V : Constitution, Temperament and Maps of Consciousness – Chapter 1 : Constitutional Medicine http://friendsofhealth.com/


Constitutional Medicine starts with an exposition of the teachings of Hippocrates on constitution and temperament and explains the system used by the Greek naturalist to assess the most common genotypes. The text examines the use of the classical four temperaments (choleric, phlegmatic, sanguine and melancholic) in Homœopathy and the materia medica. It reviews statements on the relevance of various constitutions by Hahnemann, Boenninghausen, Hering, Jahr, Kent, Allen, Roberts and Whitmont. It also provides a discussion of aphorism 5 of the Organon and its importance in the study of the whole human being and its relationship to environment.


The Hippocratic Corpus

Hippocrates was born on the island of Cos around 460 BC. In the apocryphal biography the Father of western clinical medicine was born into a medical family that traced its lineage to Asclepius and Hercules. He placed great emphasis on the innate constitution of human beings because it intermingles with and conditions all responses to environment. In The Nature of Man Hippocrates discusses the make-up of the human constitution and how it interacts with nature as a whole. He recorded many of his clinical observations of the effects of environment, food, and water on the human constitution in his famous work Air, Water and Places. He followed the Pythagorean system of primordial homœomeries, which are the similar archetypal qualities that constitute all phenomena.

The Pythagoreans called these unchanging roots the immaterial ether and the four physical elements composed of air, fire, water and earth. Hippocrates carefully avoided the intellectual debate about which one of the five elements was the primary power. He was more interested in the direct observation of the five elements and four humours in the constitution of his patients and their symptomatology.

Hippocrates summed up much of his clinical philosophy in the first paragraph of Aphorisms of Hippocrates with the epigram: “Ho bios brachys, he de techne makre (L. Ars Longa — Vita Brevis).” This statement may be translated as “Art is Long — Life is Brief”. The old master wrote that it takes a long time to develop the true arts while life passes quickly, crisis is fleeting, experience is perilous, and decisions are difficult. The healing artist must do what is correct according to their ethics and understanding as well as seek the cooperation of the patient, assistants, family and friends. They should do everything in their power to make the external circumstances harmonious so that the goal of true health may be accomplished. For these reasons, the practitioner should approach the study of Homœopathy with sincerity and great perseverance.

In the course of one’s career one will face many serious situations involving difficult decisions that can only be made properly with experience. The task is not easy, the situation multifaceted, and the responsibility great. Even when one conceives a plan it is sometimes difficult to get the full assistance of the patient and their family. The healing artist should be willing to be with the patient and their family at difficult times like birth, accidents, misfortunes, illness and death. They must be a combination of minister, counselor, and psychologist as well as medical practitioner.

Hippocrates was extremely practical in his approach to clinical medicine. He based his system on the observation of Physis, the living power of nature found in the human organism. He was well aware of the healing properties of similars. In the Organon Hahnemann quoted Hippocrates’ “remarkable words” (in On the Place of the Things which Regard Man, Basel: Froben, 1538, page 72) as an example of ancient Homœopathy.

Disease is born of like things, and by the attack of like things people are healed…

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Introduction, page 57.

One of the most important teachings of Hippocrates is the doctrine of the aetiological constellation and interdependent origin. Most disease states do not have one single isolated factor that can be called its sole cause. A mixture of susceptibility, virulence, exposure and time and circumstances is involved in most illnesses. Every human being possesses an innate predisposition and a certain amount of vitality that may be utilized in the form of adaptation energy. A person’s essential susceptibility is based on the nature of their congenital constitution and natural temperament as well as the amount of exposure to mental and physical stress at any given time. For this reason, Hippocrates taught that all diseases are constitutional in nature and only become local as the last resort to promote crisis.

Throughout medical history there has been a great debate about which comes first in importance, constitutional susceptibility or the pathogens that cause disease. This question was at the root of the disagreement between Claus Barnett and Louis Pasteur. Barnett felt that the host constitution was the prime factor in disease whereas Pasteur placed more importance on the role of the pathogen. Many people carry the streptococcus bacteria yet remain healthy under normal circumstances. If they are subjected to excessive mental or physical stress many of them are likely to develop symptoms. Other individuals are very susceptible to streptococcus and will become seriously ill if sufficiently exposed. Some people will never suffer from streptococcus under any circumstances. What is the true cause of the disease then?

Hippocrates placed the most emphasis in the congenital constitution although he did not deny the influence of external stress factors and pathogens. Toward the end of Pasteur’s life he realized that Barnett’s view was more correct. The fundamental cause of disease is so closely related to the predispositions of the constitution that it is impossible to ignore its primacy. Great physicians like Hippocrates, Paracelsus, and Hahnemann were well aware of the importance of the constitution in the art of healing.

Definition of Constitution and Temperament

Hippocrates introduced the tradition of studying the constitution and temperament into clinical medicine more than 2,500 years ago, which makes it one of the oldest living traditions in western medicine. The term constitution is derived from the Latin noun, constitutio, which means an arrangement or physical make-up and the verb “constituere”, which means to establish or constitute. To constitute means to establish, to create, to set up, to form, to make up, to appoint, to give being to, etc. The term, constitution, may be defined as an act of creating or constituting; the way something is made up or formed; the rules and regulations governing an organization; the principles, laws and personal rights on which a state is founded; the physical make-up, state of health, nature of the temperament, etc.

When the term, constitution, is used specifically as a medical term it relates to the make-up, nature, qualities, health and condition of the physical body and the mental temperament. Constitutional means that which affects the whole; the inherent natural make-up or structure of a person or thing; the way something is arranged in reference to its composition, construction or nature; that which relates to the physical and mental health or make-up. The term, constitution, is closely related to the word, diathesis, which means an inherited or acquired constitutional disorder. Therefore, there may be inherited and acquired dispositions and diseases that affect the whole constitution.

Hippocrates observed diseases from the vantage point of constitutional syndromes, and their symptom pictures, rather than by pathological names alone. He carefully studied the physical constitution and its relationship to the mental disposition while recording the effects of stress and pathogens on his patients. Through observation Hippocrates recorded the predispositions and symptoms of his patients according to the most common biological types called the four temperaments. Hippocrates called these constitutions the choleric, phlegmatic, sanguine and melancholic temperaments. The essential qualities of the four temperaments and four humours are related to the four archetypal elements of earth, water, fire and air. The doctrine of the four temperaments is closely linked with the tradition of the vital airs and the humoural physiology.

Modern science says that 80% of the human body is composed of humoural fluids, which are the medium of life. A humour in the classical context is defined as a fluid of the animal body, especially the four that are considered in Hippocratic physiology to determine temperament or the disposition of mind. This is the basis of defining the word, humour, as the specific temperament or state of mind. This is the root of statements like “she is in bad humour” and “he has no humour” or “they are out of humour”.

The four major animal fluids are the bilious (bile), pituitious (clear fluids), sanguineous (red blood), and atrabilious (blackbile) humours. Each of these four humours has a particular mood, atmosphere and quality. The earthy yellow bile is angry, dry and hot, the watery pituitous phlegm is weepy, moist and cold, the fiery sanguine blood is passionate, hot and moist and the airy black atrabile is melancholic, cold and dry. A derangement of these humours produced by inner or outer causes generates a specific syndrome of signs, befallments and symptoms.

Hippocrates also taught that diseases could be caused by disturbances of the three vital factors; the vital breath, air or wind as well as heat and cold. Diseases of the vital airs produce nervous disorders, difficulty breathing, lack of coordination, alternating states, wondering pains, shaking, spasm, hiccups, constipation, belching, gas, etc. Diseases of cold produce chill, trembling, low body temperature, poor circulation, low energy, hypofunction, excess mucus, excess fluids, etc. Diseases of heat produce fever, thirst, dryness, plethora, excess energy, hyperfunction, rashes, pimples, boils, etc. Although the physiological concepts of the four humours and three factors may seem outdated, their related clinical pictures are still very accurate. This is because the ancient homœomeries are symbols for archetypal energy patterns that have been observed for millennia.

The genes of the paternal and maternal lineages and the natural qualities of the incarnate soul produce the innate constitution. Positive and negative hereditary tendencies contribute to the make-up and function of the inborn constitution and natural temperament. The inherent constitution and temperament compose a functional polarity that is closely aligned with inherited predispositions. These predispositions are natural tendencies that condition the desires and aversions of the individual and their reaction to their environment. The interdependence of the physical constitution and mental temperament is as inseparable as the vital force and the essential Wesen. These are complementary opposites that make up one whole called a human being.

The root derivation of the word temperament is the Latin, temperamentum, which means a proportioned mixture or state with respect to the combination or predominance of internal humours, qualities and climates. An innate temperament is an inborn constitution that permanently affects a person’s psychological and physiological make-up and vital functions. The ancient Greeks taught that the four temperaments are associated with a preponderance of one of the four humours i.e., yellow bile, phlegm, blood and blackbile. These constituents affect the state of the constitutional equilibrium, the nature of its predispositions, and the make-up of the humoural types i.e., the choleric, phlegmatic, sanguine, and melancholic temperaments.

Our generation has advanced the study of psychology related to Homœopathy but Hahnemann understood several aspects of constitution and temperament that are little known in contemporary practice. An investigation of the constitution and temperament is closely related to the study of inherited and acquired diatheses. A diathesis, the Greek word for disposition, is a particular condition or bodily habit that predisposes a person to a particular disease state. The term, temperament, has a number of definitions that were interrelated in the ancient healing arts.

  1. Temperament is a proportioned mixture; a state with respect to a combination or predominance of specific qualities; internal constitution or natural state; mood and disposition; a type of physical and mental organization.
  2. Temperament is a person’s natural character or disposition that governs the way they behave, think and act.
  3. When temperament is used classically it refers to the four Hippocratic constitutions, i.e., the choleric, phlegmatic, sanguine and melancholic temperaments, which are based on mixtures of bile, phlegm, blood and blackbile.
  4. Temperament may be used to describe a sensitive, creative, excitable and emotional personality (to be temperamental).
  5. The word, temper, comes from the Latin, temperare, which means to mix in due proportion. When it is used as a noun it means a mixture or balance of different or contrary qualities; the constitution of the bodily temperament; a disposition; a habitual or actual frame of mind; characteristic state of the psyche, mood or humour. It also means a state of composure and self-control (even-tempered) or the lack of composure and loss of control (losing one’s temper); a state of anger and rage (bad-tempered) or ill humour, irritability, peevishness (out of temper). The verb, temper, means to mix in due proportion; to modify by blending of a mixture; to moderate; to soften something; to make something less severe or rigid; to adjust; to tune; to attune; to adjust the mood or temperament; to bring to a favorable state of mind.
  6. The word, distemper (Fr. destemprer, to derange) means a mental or physical ailment. In Shakespearean English this word was used to describe a person’s unpleasant behavior (a distempered mind) or a liver condition from drinking (distempered liver), etc. Distemper is still used to describe a number of infectious diseases of animals, especially a particular viral infection in dogs.
  7. Temperament is a musical term for a system of compromise in tuning that allows for the adjustment of the intervals between notes so an instrument can be played in any key. An equal temperament is a system of tuning in which notes are tuned in twelve equal intervals called the chromatic scale. An octave is a series of eight notes between the first and eighth note of a major or minor scale, e.g., from a lower C to a higher C.

All of the above definitions have relevance to the healing arts. As a general term, temperament means the mood, disposition, demeanor or the emotional tone of a person. When the word, temperament, is used specifically it refers to the four major and twelve mixed constitutional temperaments. One must remember, however, that there are innate and temporary temperaments in the Hippocratic tradition. A temporary temperament is a transient state that affects the intellect, emotional disposition, mood, composure and/or the vital physiological functions. An innate temperament is the inborn make-up of the bodily constitution and mental character that conditions the structure of the psyche and soma. It is possible for an individual to have both innate and acquired mistunements of the constitutional temperament in layers that form complex disorders.

The physical constitution and mental temperament is the meeting point of the collective (prenatal-inherited) and individual (postnatal-acquired) aspects of human experience. In the ancient Greek tradition the terms constitution and temperament are interchangeable because of the intimate link between the physiological make-up and the innate personality. In physical terms this demonstrates the connection between the functions of the brain, nervous system and glandular secretions and how they affect the body and mind simultaneously. Following in the footsteps of Father Hippocrates, the great Paracelsus asked healers to return to the root of a problem if they wished to cure disease.

No knowledge is perfect unless it includes an understanding of the origin — that is the beginning; and as all man’s diseases originate in his constitution, it is necessary that his constitution should be known if we wish to know his diseases.

Constitutional Medicine, with special reference to The Three Constitutions of Dr. Von Grauvogl; J. H. Clarke, Title Page.

In Search of the Lost Chord

In the 6th century BC Pythagoras discoursed on the music of the spheres, which is applicable to the microcosmic and macrocosmic worlds. He opined that the universe produces a series of vibrations resembling a sequence of notes that makes up various scales and melodies. For example, the Sun, Moon and the planets all have their own vibratory tones that create the music of the solar system. These ideas are in harmony with the concepts of modern physics, which has confirmed this hypothesis in many ways. The use of the spectrometer and radio telescopes has shown that each heavenly body has its own frequencies of light and sound that offer much information about their construction. It was said that an advanced Pythagorean master could “hear” the sound of these celestial vibrations during meditation and receive knowledge about their origins.

Temperament means tuning in both a musical and medical sense. The musical definition of equal temperament is the tuning of an instrument into a scale of 12 semi-tones that make up the harmonic structure of western music. On the basis of the 12-note chromatic scale, Pythagoras developed the lyre and the 8-tone Ionian mode that composes the major scale. The chromatic scale forms the background for different combinations of 8 notes that are the source of the 7 melodic modes of classical music. These modes originated in the ancient Mediterranean world where music was an integral part of the healing arts. They are called the Ionian, Dorian, Phrygian, Lydian, Mixolydian, Aeolian and the Locrian modes.

According to the ancients, the 12 constellations of the zodiac are similar to the 12 semi-tones of the chromatic scale and the 7 visible planets (Mercury, Venus, Earth, Mars, Jupiter, Saturn, Sun and Moon) are similar to the 7 notes at the root of all melodies. This universal temperament is reflected in the human organism as the 12 parts of the zodiacal being expressed by the 12 astrological signs. Each of these signs rules a part of the body. Aries rules the head; Taurus the throat, Gemini the lungs; Cancer the breast; Leo the heart; Virgo the abdomen; Libra the kidneys; Sagittarius the hips and thighs; Capricorn the knees; Aquarius the calves; and Pisces the feet.

The 7 notes of the scale are related to the 7 vital centers (gonads, adrenals, pancreas, thymus, thyroid and parathyroid, pituitary and pineal glands) and the 7 major nerve centers (coccygeal plexus, sacral plexus, solar plexus, cardiac plexus, carotid plexus, cavernous plexus, cerebrum). The brain, lungs, heart, liver, spleen, kidneys, stomach and intestines are called the vital organs because the rhythm of life depends on them. Each nervous center, gland and organ must function in harmony for the individual to be healthy and happy. Even the word, organism, has the “obsolete” definition of a musical instrument showing the link between the human constitution and musical terminology.

Thus one can see that in the music of life the tone, rhythm and harmonies of the human organism are all interrelated. The four modes that provide classical music with its moods or atmospheres are intimately related to the nature of the four temperaments. These are risoluto (resolute-choler), mesto (melancholic-atrabile), giocoso (playful-sanguine) and tranquillo (peaceful-phlegmatic). Each of these modes induces a particular feeling tone that reflects the moods and atmospheres associated with the four constitutional temperaments.

The esoteric traditions often used numerology to hold information symbolically. The important numbers in this series are 3, 4, 7 and 12. They are related to the 3 vital forces, the 4 elements and 4 temperaments, the 7 vital centers and the 12 mixed temperaments. In aphorism 9 Hahnemann wrote that in the healthy human state the spirit-like “vital force” is the dynamis that enlivens the “material organism” and keeps all parts in “harmonious vital operations” so that the “indwelling rational spirit” can use this “healthy instrument for the higher purposes of our existence”. This passage reflects the trinity of the psyche, vital force and physical constitution, which synergistically act to produce the harmonious human temperament (scale of life).

The Pythagoreans also taught that the vital forces, organs and tissues within the human body have their own vibratory tones, which could either be in tune or out of tune with the state of health. To have tone is to be harmonious and to be off tone means a state of dissonance or discord. People still speak in terms of feeling “in tune” or “out of tune” in modern English. A person may have a “bad temperament” or be “off key” meaning that they are out of tune. Doctors often talk about “toning up the system”, which means to bring the organism to a higher state of health. They refer to the constitution, nervous system, muscles and tissues as “lacking tone” when a person is ill. Tone is also the root of the word “tonic”, meaning a medicine used to induce a better state of health and increased vitality.

Even when we want to know what a person feels about something we ask, “How was their tone?” It is common to speak of various emotional states as having different “feeling tones” in relationship to a person’s emotional moods. The terms organism, having tone, lacking tone, tonic, being in tune, being out of tune, temperament, harmony, discord, mood, atmosphere, rhythm, pulse, beat and timing are common in music as well as medicine. All of these usages are part of instinctive body language although the origin of the words has been long forgotten.

The meanings of these terms are also related in German. Langenscheidt’s German-English, English-German Dictionary defines the English word Temperament as Charakter [character], Laune [temperament] and Stimmung [tuning]. Therefore, the words tuning and mistuning have their common source in the ideas of temperament and character, which is related closely to mood and disposition. The root of the German word Stimmung is stimmen, which means to be right as well as tune and is closely related to the word, Stimime, which means voice as well as vote (voicing one’s opinions). Stimmung can mean the correct tone, being in tune, the right pitch, a good atmosphere, a nice mood and a pleasant air or aura. In harmony with the original Pythagorean use of musical terms in the healing arts, the German words, Stimmung and Verstimmung, were translated as tuning, tunement, mistuning and mistunement in the Kunzli and O’Reilly editions of the Organon.

Verstimmung may be defined as mistuned, mistunement, untuned or mistuning but it also means deranged, upset, distressed, disturbed, disordered as well as ill humored, feeling bad or being in a negative mood, etc. When speaking in general about the whole state of health as related to the constitution, temperament, psyche, vital force, nervous system, bodily condition and vitality one may think in terms of “tone” and feeling “in or out of tune”, but when speaking of the specific organs like the liver and stomach, one thinks in terms like “my liver feels disordered” or “my stomach is upset”.

Therefore, to always translate Verstimmung as mistuning may be awkward in places and appear strange in some contexts. This has led some to object to the use of tuning and mistuning in association with the vital force but these individuals are not aware of the links between the vital pneumatic forces, the human temperament, tone, tuning and mistuning in medical history. The idea of tone, tunement, pleasant mood, good humour, balanced atmosphere and strong aura has been associated with harmonious health since the time of the ancient Greeks. Tone represents a state of balance, harmony and homeostasis (Gk. a similar state). The nervous system, muscles and tissues have their tone and a lack of tone in the nervous system, muscles and tissues is equated with disease. In aphorism 88 Hahnemann uses the term Gemueths-Stimmung, the tuning of the emotional disposition, which relates to the mood of the emotional temperament. Many of these terms are still in common use in modern medicine although their original source has been lost in the mist of time.

The vitalists explained alterations of the life force and the organism in terms of hyperfunction and hypofunction, which are related to overtuning and undertuning. Tonic, sharp and flat notes in music are the tonic state of balance, hypertension and hypotension. Even in common speech one refers to persons as either sharp (bright and energetic) or flat (dull and weak). The Organon uses terms like tune or tone altering (Gr. umstimmen) and over-tuning (Gr. uberstimmen) as well as tuning or toning down (Gr. herabstimmen). Tune altering is a change of a condition; over-tuning means to override something and toning down is the lowering of amplitude or force.

People often speak of a person “changing their tune” when they change their mind and we ask someone to “tone it down” when their voice is too loud. Hahnemann spoke of a homœopathic remedy “over-tuning” (overriding) the natural disease in such a manner that it replaces its affects in the vital force. A homœopathic remedy does not “over upset” the natural disease or “derange down” a condition. In this context these words may be translated in accordance with the original Greek derivations related to the Pythagorean School because they possess additional significance not found in modern language.

When the human organism (the instrument) is tuned in a harmonious natural temperament (scale of adaptation) the person’s constitution is vigorous and their tone, mood, humour, rhythm, timing, air and aura (Gr. Stimmung) are right (Gr. Stimmen). When disease powers mistune the healthy tone of the organism, the vital force (Gr. Lebenskraft) becomes mistuned (Gr. Verstimmung) and the outcome is a disturbed temperament, a weak constitution, poor tone, negative moods, ill humour, broken rhythms, bad timings, an unhealthy air and a weak aura. The teachings of the ancient Greeks hold the keys to understanding the deeper meanings of terms like vital force, tuning, mistuning, constitution, temperament, causation, psora, miasms, suffering and the signs and symptoms. This is one of the reasons why it is important to study medical history.

In aphorism 16 Hahnemann speaks of health as a “harmonious play of life”, which relates to a correct tuning of the life force, constitution, temperament, organs and tissues. Symbolically, it might be said that vital force is the conductor that guides the melodies, rhythms and volumes of the orchestra of the human organism. The vital systems, glands, organs and tissues are like strings, woodwinds, brass and percussion instruments that must work in synchronization. When the conductor is confused and the instruments out of tune the outcome is discord and dissonance. Even if one instrument is not tuned properly, it can throw the entire orchestra out of sync forcing the conductor to focus on the discord and seek to reinstate harmony! The great metaphor of live and health as music is a reflection of Pythagorean harmonics and the music of the spheres.


The term physiognomy is derived from the Greek word, “physiognomoni” (physis, nature and gnomon, an interpreter), which means an interpreter of nature. The art of interpreting nature is based on the principles of similar correspondences and the “as if method”. Physiognomy is the science of judging character from the appearance of an individual. It uses outer observable phenomena as a mirror to understand the inner essence or nature of a person. In the classical Greek system the human constitution is linked symbolically to the four physical homœomeries, earth, water, fire and air. Ether is spiritual in nature and related to the psyche. On this basis, the human genus is classified into four major and twelve mixed temperaments.

About the author

David Little

David Little

David Little was born in the USA in 1948 and has been a student of Homeopathy since the early 1970s. He has studied Homeopathy in the USA and India. His first teacher was the late, great Dr Manning Strahl and he was a colleague of the late Dr Harimohan Choudhury. He started HOE, Homeopathic Online Education in 1999. David Little has recently published The Homoeopathic Compendium, a unique series of textbooks designed to provide a complete guide to Homoeopathy. This monumental work is presented in 6 volumes, with over 4,500 pages. To order online and for more information, including free chapters visit: www.friendsofhealth.com


  • Hi We would love to hear any feedback/comments and thoughts that you might have after reading through this Chapter excerpt from The Homoeopathic Compendium by David Little a special thanks to the HPathy editing team for their help and support in publishing this article.

  • This is like a liberal arts course in homeopathy. It gives perspective on the historical development of medical ideas and then connects all the dots and shows how ideas were derived/developed. It has a wonderful, easy to understand progression that brings the reader along in a logical manner. It seems that nothing is left out. Just as a question would form in my mind, it was answered. It’s just very well written, very accurate and very complete. Thank you!

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