Hippocratic dietetics

Text : Marie Josèphe Moncorgé. Translator: Bruce Lee


According to Hippocratic dietetics, digestion implies cooking of food inside the body.

Universe consists of 4 elements:

Air Fire Earth Water

There are 4 qualities:

hot cold dry moist

Combination of elements and qualities results in 4 humours and 4 temperaments:

element quality humour temperament
Air hot and moist blood sanguine
Fire hot and dry yellow bile choleric or bilious
Earth cold and dry black bile melancholic or atrabilary
Water cold and moist phlegm phlegmatic or lymphatic

According to Hippocratic dietetics

One must have a balanced diet during different seasons to remain healthy. For this, some doctors recommend eating food that corresponds to one's temperament. Moreover, according to other doctors, one must eat food that is contrary to one's temperament.

For example, according to Tacuinum Sanitatis (11th century Arabic text that was translated to Latin in the 13th century), robust red wine (hot and dry at 2nd degree), as well as hare meat (hot and dry at 2nd degree) are recommended for aged, phlegmatic and melancholic persons who are of cold nature. On the other hand, fresh fish (cold and moist at 3rd degree), plums or pears (cold at 1st degree and moist at 2nd degree) are more suitable for those who are choleric and sanguine, as well as to young whose temperament is hot.

Hippocratic physician mistrusted raw fruits and vegetables: he recommended cooked food.
Healthy lifestyle: eat, drink and live with moderation. Get enough physical exercises, rest, sleep and breathe clean air.

More about: 1) Introduction --- 2) History: Antiquity --- 3) History: Middle ages --- 4) Theory of temperaments --- 5) Cuisine

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1 - Introduction

The old Hippocratic dietetics lasted for over 2000 years. It is an empirical (based on actual measurement, observation or experience rather than on theory) medical knowledge that was rejected after the arrival of medical chemistry on scene: it seemed that the discovery of vitamins, glucides or lipids and now, cholesterol, Omega 3 or free radicals had put an end to these beliefs of yore definitely.

However, later Hippocratic dietetics, which is a learned medical doctrine, became part of popular culture. It survived in some culinary practices (eating melon with raw ham at the beginning of a meal, pears in wine as a dessert, drinking liqueur at the end of a meal) or in some dietary advices of our grandmothers (do not drink while eating). One also finds a modernised presentation of Hippocratic beliefs with some theorists who believe in healthy and vegetarian food.

Our civilisation was deeply marked by the Hippocratic theory of temperaments. There are many telltale signs in the present-day language. In fact, one acts according to Hippocratic medicine, unknowingly, when one defines someone as "dry" or "hot", when one feels "melancholic", or when one reacts with "phlegm".

Will the present trend of Chinese and Ayurvedic dietetics, who are its cousins and are as old as it is, give it a new life?

For all these reasons, Compare diet considers that it is important to inform you about Hippocratic dietetics.

-> 2) History: Antiquity --- 3) History: Middle ages --- 4) Theory of temperaments --- 5) Cuisine

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2 - Some history: during Antiquity

In Greece

Greek dietetics was born as a result of meeting of observations of physicians (medical doctors) and pre-Socratic philosophers. Between 6th and 4th century B.C., the first Greek philosophers wondered about the origin of things: What is the basic ingredient of all the things? Some replied that the basic ingredient was water; others thought that it was air, while still others considered fire or earth to be the basic ingredient of all the things. Physicians, who were disciples of Pythagoras, summarised and stated 4 basic ingredients of things: Water, Earth, Air, Fire. They went on to develop the concept of a system of dual opposition of the universe: hot/ cold, dry/ moist, bitter/ sweet. It is the balance of these principles that results in and keeps one in good health. The unbalance or predominance of one causes disease and then death. They claim, even before the physician Hippocrates, the importance of diet, lifestyle, environment and climate in order to understand and prevent diseases.

Ayurveda (means the science of life in Sanskrit) developed in India during the same period: an art of living, a philosophy and a system of medicine that developed a similar theory. There were neither any direct contacts between Indian and Greek physicians nor direct borrowing of texts but rather indirect contacts through Persians (Darius, who conquered the Indus valley, had Greek doctors). In fact, one observes certain resemblances between Greek and Indian system of medicine concerning the theories of temperaments. Indian theories are so found in the treatise of Winds of Hippocrates and in Plato's Timaeus. Links between Hippocratic dietetics and Ayurvedic dietetics (in French).


Since 4th century B.C., Hippocrates and his disciples had been advising about diet, sexual life, bathing, physical exercises according to age, place where one lives and season. It continued to be cited throughout the western world until 19th century.

Hippocratic physicians recognize 4 fluids or humours: blood whose nature is hot and moist, yellow bile whose nature is hot and dry, phlegm (or pituita) whose nature is cold and moist and black bile (or melancholy) whose nature is cold and dry. Modern medicine contests the existence of this last humour. Health is presented as the right balance of temperaments. Therefore, it is necessary to have a life-style and a diet that help one in maintaining this balance or that compensate the unbalances related to seasons or patients' age.

Symbolic meeting of Galen and Hippocrates

Hippocrates' successors developed the theory of Hippocratic temperaments: sanguine, choleric or bilious, melancholic or atrabiliary, phlegmatic or lymphatic.

Symbolic meeting of Galen and Hippocrates

During Antiquity in Rome

Claude Galen (or Claudius Galenus in Latin) was a Greek physician of the Roman emperor Marcus Aurelius (1st century A.D.). He wanted to "complete" the work started by Hippocrates. He took over and developed the theory of temperaments by introducing graduations and combinations. Galen classified foodstuff and medicines on a scale with 4 degrees. For example, pepper is hot at 4th degree; bitter almond is hot at 1st degree and dry at 2nd degree. Galen created a coherent and beautiful system. He tried to find pleasure in symmetry rather than in scientific observation of facts.

1) Introduction <- To -> 3) History: Middle ages --- 4) Theory of temperaments --- 5) Cuisine

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3 - Some history: In Middle Ages

After the fall of Roman Empire, the ancient medical tradition survived only during Byzantine Empire. Then, the theological disputes of Christian Church in 4th and 5th century favoured the exile of many cultivated people who were driven out of Constantinople. They went to Syria and Persia where they brought ancient culture and manuscripts with them.

In Baghdad and in Arab-Andalusia

The caliphs of Baghdad (especially Al-Mansur, 754-775) of the Abbasids dynasty were attracted by the ancient culture. They drew the intellectuals towards "the House of Wisdom" (Bait al-hikma) where they created a library that was similar to the one in Alexandria. Thus, they attracted philosophers, geographers, translators and physicians to their court who first studied Aristotle, Plato, Hippocrates and Galen and later translated their works into Arabic. The translators of Hippocrates and Galen were Nestorian Christians. Some Nestorians are also physicians such as Jibrail ibn Bokhticho who was personal physician of Haroun al-Rachid (the Baghdad caliph of Thousand and one nights).

Between 9th and 13th century, Arabic, Jew and Persian physician-philosophers studied ancient texts, compared them with the Indian know-how (the abbasid caliphate was spread from Indus to Spain before being destroyed by the Mongolians in 1258), carried out their own researches and published them in Persian, in either Baghdad or in Andalusia. Some of these are Rhazes (~860-923, who was also called Arab Galen), Abulcasis (936-1013), Avicenna (980-1037), Averroes (1126-1198), Maimonides (1135-1204), etc...

The Book of properties of foodstuff (Kitâb Khawâss al-aghdhiya), written by Nestorian Yuhanna ibn Masawaih called Mesue the Elder, is the first book of Arabic dietetics. It was written in Baghdad in 9th century and was inspired from a book written by Galen: Properties of foodstuffs. Later, it was used as a model for many Arabic treaties of dietetics.

Regimen of health was integral part of therapeutic tools used by Arabic medicine. On their part, the physicians of arabo-muslim world took over Hippocrates' theory of temperaments and Galen's classification of foodstuff and medicines according to degrees.

Secret of secrets

Secret of secrets, arabic text dating back to the end of 10th century that was wrongly attributed to Aristotle, provides dietary advices including a diet according to season. It was translated to Latin around 1230 and influenced the form of first European Regimen sanitatis including the Regimen of the body of Aldebrandin de Sienne (chapter on physiognomy).

Secret of secrets

In Mediaeval Christian Europe

The know-how of oriental physicians was translated to Latin by translators such as Constantine the African (1015-1087) or Gerard of Cremona (Gerardo da Cremona, in Italian) (1114-1187). Taqwim as-sihha (table of contents of Health) written by Ibn Butlan (Christian physician trained in Baghdad who died around 1068) is one of the most famous books of dietetics that were brought in to the Christian West. Latin translation of this manuscript is known as Tacuinum sanitatis. It was translated in the court of Manfred of Sicily, son of Emperor Frederick II Hohenstaufen (who reorganised the teaching of medicine in the School of Salerno)

The Christian physicians in turn took over and developed the dietetics' know-how of Hippocrates, Galen and their Arabic, Jew or Persian heirs. The School of Salerno was handed over the task of popularising and disseminating this knowledge throughout the Christian West through its book Medicine according to Salernitan regimen of health (1060: Flos medicinæ vel regimen sanitatis Salernitanum).

Many books of dietetics called the Regimen of health (Regimen sanitatis) are based on the texts of School of Salerno, comment or elaborate on these texts.

For example, Catalan physician Arnaud de Villeneuve (or Arno de Vilanova, 1235-1311) spoke Latin, Arabic and Hebrew. He taught in the University of Montpellier and treated popes and kings. During last days of his life, he took refuge in the court of Frederick II in Sicily in order to escape the accusations of heresy levelled against him by the Church. He wrote many Regimen sanitatis in Latin: regimen of health that comment on the prescriptions of the School of Salerno. In the beginning of 17th century, his work was still referred to and commented on in the books of dietetics such as Thresor de santé (Treasure of Health).

1) Introduction --- 2) History: Antiquity <- To -> 4) Theory of temperaments --- 5) Cuisine

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4 - The Theory of temperaments

Hippocratic medicine believes that digestion is cooking of food in the stomach. Hippocratic physicians think that most of the diseases originate from problems of digestion. Diet is proposed in order to maintain or restore the balance of humours.

In Hippocratic Dietetics there are pairs of opposition between raw and cooked, hot and cold, dry and moist, bitter and sweet.

Like earthly bodies made of 4 elements, Air, Fire, Earth, Water, human bodies are made of 4 fluids, called humours: blood, yellow bile, black bile, phlegm (or lymph). Each of these humours brings together two of the 4 fundamental forces (qualities): heat, cold, dryness and moistness. Each of them becomes dominant during each of the four seasons and each of the four ages of life.

The quaternary system combining elements, humours and qualities is represented in this fashion:

Oldcook: Medieval dietetics - The diagram of the theory of humours and 4 elements

Theory of humours

The blood, which corresponds to Air, is both hot and moist. This element dominates childhood, spring, and gives a sanguine temperament, inclined towards pleasure. The yellow bile, also known as "choler", hot and dry, dominates youth, summer, and gives a choleric temperament, full of Fire. Autumn, cold and dry, is the season corresponding to adult life, dominated by the Earth and its correspondent, the black bile. The adult temperament is melancholic or atrabilary, which is the Greek word for black bile. And winter is the time of Water, cold and moist, and corresponds to old age. Older people are phlegmatic or lymphatic, dominated by the phlegm (or lymph).

hot cold dry moist

Combination of elements and qualities results in 4 humours and 4 temperaments:

element quality humour temperament
Air hot and moist blood sanguine
Fire hot and dry yellow bile choleric or bilious
Earth cold and dry black bile melancholic or atrabilary
Water cold and moist phlegm phlegmatic or lymphatic

Sanguine, choleric, melancholic, phlegmatic

Each person is born with a dominant temperament that is the distinct sign of his character. A sanguine person can be recognised by his complexion that is somewhat reddish, his vigour and stoutness. A choleric individual has yellowish complexion, a dry and nervous body. The melancholic person is grey and rather thin. Someone who is phlegmatic will be rather thin and limp with a pale complexion.

Each type of temperament is attracted by foodstuffs that correspond to it. Sanguine person will love meat in gravy, wines that are hot and moist like him. Choleric will favour grilled meat, spices, hot and dry food. The melancholic will prefer "roots" pulled out of earth that is their reference point. When phlegmatic individuals will eat soup, raw vegetables. As is the case today, there were disputes between medical centres. After Avicenna, Aldobrandini of Siena recommends similar principles: those with hot temperament are to eat stuff whose nature is hot and those with cold temperament are better off if they eat cold foodstuffs. However, many physicians recommend the opposite by suggesting that one attains a balance by correcting the temperament: the cholerics with hot temperament must eat cold and moist food.

The food balance

However, according to Galen and physicians who were disciples of Hippocrates, balanced diet was usually obtained by combining for example a cold and moist food-item with a hot and dry one's, such as mushrooms cooked with pepper or garlic. Older people with cold temperament will drink more wine that is supposed to be hot as compared to younger ones whose temperament is generally hot and sanguine.

Maintaining the balance is a sign of good health and it implies a system of compensations that are evaluated according to season, breath and direction of air. This is the reason why diet can vary according to seasons: in winter, one must eat as much as possible; drink as little as possible and this drink could be wine that must be diluted as little as possible. One can eat bread, roasted meat and fish but vegetables are not much recommended. This diet will keep the body hot and dry. In summer, the diet will consist mostly of soft cereals, boiled meats, raw or boiled vegetables. One can drink a lot of wine diluted with water. This summer diet will keep the body cool because hot and dry season increases the body temperature. In spring and autumn, the diets will be adapted to these seasons. In all cases, the Hippocratic physician will recommend cooking (coctio in Latin) of foodstuffs as he mistrusts consumption of raw fruits and vegetables (as is the case in Chinese dietetics).

A lifestyle

Bath in Middle Ages

Make use of baths in order to remove impurities.

Poeme of medicine, Avicenna

The mediaeval dietary prescriptions are quite simple and full of common sense as far as health practices are concerned: eat, drink and live with moderation in order to preserve one's health. Dietary excesses or excesses in terms of sentiments (anger, sadness, melancholy, overstress, Arnaud de Villeneuve speaks of accidents of soul) are harmful for a correct balance in life. One is advised to do moderate physical exercises, breathe clean air and get enough rest and sleep.

1) Introduction --- 2) History: Antiquity --- 3) History: Middle ages <- To -> 5) Cuisine

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5 - Cuisine as described in Hippocratic dietetics

Diet is important in order to restore the balance of humours. In Arab-Andalusia of 13th century and Christian occident between 14th and 16th century, the master cooks employed by elites knew the values of different food items quite well. They were supervised by physicians who worked for Kings and Princes, and they strived to prepare "balanced" meals that conformed to the mediaeval dietetics by adapting the menus with the season (delicate dishes in summer, heavier meats in winter) and with the temperament of their employer (for example, sanguine or phlegmatic).

They knew how to maintain a balance in a dish by combining hot and dry spices with beef or venison that was colder, by heating a salad with salt and oil, or heating oysters (cold and moist) with fried onion and spices diluted in vinegar (in order to dry these molluscs that were too moist). Poultry meat (delicate dish) is usually cooked with verjuice and this type of dish is adapted to summer. Beef-meat (considered coarser) is usually cooked with vinegar and this type of dish is adapted to winter. These spices are usually absent from the dishes made for those who are sick.

The cookbooks published during this period bear witness to the fact that the master cooks were aware of these dietary principles.

Platine: De Honesta Voluptate

Some cookbooks have an introduction that discusses dietetics: Anonymous Andalousian in Arab-Spain in 13th century, Tractatus de Modo in Italy at the end of 13th century. Some books of dietetics use these recipes: De honesta voluptate (On right pleasure) by Platina published in Italy around 1470, translated to French in 1505, talks about the recipes of Italian master cook Martino.

Illustration à gauche:
copie d'une page du livre de Platine avec des recettes du cuisinier italien Maestro Martino.

In the beginning of 14th century, famous surgeons such as Henri de Mondeville had cookbooks in their library.

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La diététique hippocratique