Humours and their Legacy in Early Buddhist Medicine

At the end of the 20th century, Hippocratic medicine--which developed at the cross-roads between the occidental and oriental civilisations--acts as a link, a bridge and a symbol for the need to combine both the experience of traditional (Eastern) and the trends of modern (Western) medicine. Hippocratic medicine is one vital pathway to the proper study of the evolution of the medical art. Not only is it the beginning of the art and science of medicine, but modern medicine can still learn from the Hellenic medicine of ancient Greece. Hippocratic medicine is both an antidote to an overconcentration and overemphasis on medical technology and a stimulus to more humane technical achievements. Hippocratic bedside examination has not died, but is merely pushed aside temporarily by modern technology. The fact that ancient Hellenic medicine was based on the coexistence of both Asclepian (traditional) and Hippocratic (rational) medicine on the island of Kos reveals and symbolises the necessary coexistence and cooperation of both systems, a synthesis of their concepts being essential to solve the problems threatening the future of humankind. Hellenic medicine serves to highlight that the parallels between Asclepian and Hippocratic medicine are closer than medical historians usually realise, and that alternative medicine may function in a complementary way to conventional primary medical care.

The study of ancient Greece is essential for the proper understanding of the evolution of modern Western medicine. An important innovation of classical Greek medicine was the development of a body of medical theory associated with natural philosophy, i.e. a strong secular tradition of free enquiry, or what would now be called "science" (Eπiστnμη). Medical education rests upon the ancient Greek foundations and its history remains a fascinating topic for modern physicians and medical teachers. As Drabkin so eloquently noted half a century ago: "the history of medical education will show how lasting was the influence of the ancient system of medicine, not only in its substantive contributions, but in its devotion to reason, in its attitude toward the relation between science and the medical art, in its concept of disease and classification of diseases, in its ethical attitudes and standards and in countless other ways".1 MEDICAL EDUCATION THROUGH "MAGIC" AND "RELIGION" In prehistoric times, magic and religion were a fundamental part of the healing practice. Therefore, the first primitive medical practitioners were witch doctors or sorcerers. Through a gradual process that lasted for centuries, superstition and religion were replaced by rational inquiry and explanation. At its beginnings, ancient Greek medicine was undoubtedly influenced by neighbouring regions such as Babylonia and Egypt or even more distant civilizations such as India and China.2 As medical practice was tied to magic and religion, so too was medical education symbolized in myth. Thus, the first Greek medical teacher was probably Chiron (Xípωv), the human-horse mythological figure. According to Homer, Chiron taught Asclepius the secrets of the drugs that relieve pain and stop bleeding. Chiron was so famous in his era that the sons of many noble families, including Jason (Iáσovαò), Achilles (Aχiλληαò) and other Homeric heroes, became his apprentices and lived with him during early adolescence studying philosophy and the sciences, including medical arts. Among his teachings the "techni" (τéχvη) (art) of caring for the ill and injured was included.3 Asclepius (Aσκληπióδ) was the God of Medicine in Ancient Greece and he was worshiped in hundreds of temples (Asclepions) throughout Greece. The remains of such shrines may still be seen at Epidaurus (Eπíδαvpoò), Cos (Kώ;ò), Athens (Aθηvα), and elsewhere. Asclepions (Aσκληπieíα) were founded at the 6th century B.C. and served as mysticistic centers of medical education for selected "godly blessed" priests. Patients visiting these sacred sanctuaries were treated by a healing ritual known as incubation, or temple sleep. They slept overnight in the dormitory, or abaton (áβατo), and were visited in their dreams by Asclepius and his daughters Hygeia and Panacea or by one of his priests, who gave them divine advice and inspiration. They reported their dreams to a priest the next morning. The pilgrims were either spontaneously healed or the priest prescribed a cure based on their dream. Evidently, the temple healers relied largely on the use of psychological methods, i.e. suggestion through the use of charms, rituals and incantations, but they also employed physical means, some if which were genuinely efficient. Thus, the temple patients were also offered hydrotherapy and enjoyed theatre, music, poetry and a good diet. It must be emphasized that the temple physicians of Asclepions differed from lay medical practitioners and there is no evidence that they acted as tutors to lay physicians. Patients who visited the Asclepions and treated by the ritual therapeutics were usually cases that were given up as incurable by lay medicine.4 Asclepius' legacy was bequeathed by his sons and students Podaleirius (IIoδαλpípeioò) (Internist) and Machaon (Mαχαóv) (Military surgeon) who also appeared in the homeric epics (8th century B.C.). It is notable how the passing of medical knowledge from generation to generation in Ancient Greece is so characteristically reflected in the Asclepius' family. Even Aclepius' father, Apollo, was originally considered the God of Medicine before inheriting his mantle to his sons. With the passage of time, the influence of superstition and religion on medicine steadily decreased until the boundary of rationality and magic was demarcated by the arrival of Hippocrates' rational medicine.5 However, it appears that, despite the occasional competitive bouts between these different types of healers, the Asclepian temple physicians generally existed side by side, in uneasy proximity, throughout the centuries with the Hippocratics until the formers' practice was eventually perceived as a pagan rite and thus rejected by early Christianity. MEDICAL "CRAFTSMEN" AND THE MENTORING OF MEDICINE IN ANCIENT GREECE The division between medicine as a "science" and medicine as an "art" is an ancient one. The ancient Greeks frequently contrasted the non-scientific practitioner to the theoretically grounded physician/philosopher. According to Plato, a medical apprenticeship that was based only on observation and experience was routine and impersonal in comparison to those physicians who strived to make the understanding of nature fundamental to their art and teaching.6 It appears that the majority of medical practitioners did not concern themselves with biological theories and philosophy. However, the few that did care about the nature of health and the underlying anatomic and physiological changes behind a particular disease, were considered the leaders of their profession.5 Greek doctors usually practiced privately but were occasionally employed by a city-state as public health officers who treated citizens without charge. These state-salaried physicians were supported by a special tax called "iatrikon" (Iαtpiκóv) and sometimes received additional benefits including tax reductions, free pass to recreational centres and statues erected in their honour. Such state participation in citizen health care is evidenced throughout antiquity and began as early as the 6th century B.C. However, no evidence exists that these civic physicians were involved in medical education or that special taxes like the "iatrikon" were used to finance public medical education. Various texts from the Hippocratic Collection help us understand Greek medical practice during the antiquity. A surprisingly large part of medical practice of that period seems to reflect the physician's insecure position. Thus, a good diagnostician aimed to impress the patient and win his confidence. The practice of prognosis was also an important proof of competence and a valuable psychological tool in gaining the patients' trust. On the other hand, physicians tended to decline cases that were obviously incurable in order to avoid any loss of reputation. To ensure that physicians would not amass too much wealth, they were advised to adjust their fees to each patient's means and, when necessary, treat them without payment. While some doctors were permanent residents in a particular city, a large number travelled from place to place searching for a living in response to the demand for doctors and seeking to possess intimate knowledge of the ailments peculiar to each region.5 No system of formal medical education or any curriculum program that issued diplomas to successful medical students existed in the classical antiquity. Even the first centres of medical excellence such as Cos and Cnidos and, later on, the museum of Alexandria (Aλεξávδpiα) did not provide any legally recognized certification or formal system of teaching. On the other hand, physicians who were associated with one of the major medical schools were probably more in demand compared to their less prestigiously educated peers. The passing on of knowledge through mentoring was highly regarded in the Greek antiquity from as early as Homer's (Oμηpoò) time.7 Accordingly, medical knowledge was bequeathed from father to son or to the physician's assistant via a master-apprentice relationship: the apprentice learned by observing and assisting his master curing patients.8 Such medical education was fundamentally practical. The student learned to take detailed medical history from the patient, his relatives or friends, catalogue observable regularities, and accordingly formulate rational hypotheses, explanations and treatments. He was trained to properly use his senses of observation, hearing, smelling, palpating and carefully examine the patient's pains, mental state, position in bed, fever, breathing, and excretions (urine, feces and sweats). The patient's pulse was also examined but its profound diagnostic significance was not elaboratively catalogued at these times. Practical experience was an essential component of the medical craft taught to the apprentice. As was noted in the Hippocratic texts: "He who aspires to practice surgery must go to war". A competent student would also attend the patient as a nurse in serious cases. Good students would complement such practical work with the study of books (e.g. the Hippocratic Collection, Dioskorides' book of herbals and drug preparation) in order to combine knowledge with experience and obtain self confidence and autonomy. The quality of training depended on the master's skills and the student's prowess. The length of education depended on the depth of the apprentice's studies and on his intellectual skills and competence.1 In theory, medical training was open to every man. Of course, the aspiring physician required a master willing to train him and the successful medical protégée required certain characteristics, including above-average intelligence and a firm grasp of reality. But in principle, the pursuit of medical knowledge in ancient Greece was unrestrained. Evidently, medical practice retained a very "free market" approach throughout the ancient world. The Babylonians characteristically presented their sick at the market place in search of those persons who could advise and/or treat the disease. In line with this attitude, no legally recognized method existed to prevent amateur and inadequately trained physicians or various kinds of quacks from practicing in Greek antiquity. One established himself as a doctor not by presenting his training certifications but by vigorously defending the reputation he acquired in practice and by carefully cultivating the confidence of his clients. The physicians' fierce competition with other healers, his conscience, and the patient's demands for efficacy were his only restrictions and incentives for self-improvement. The only possible evidence of completed medical training and qualification may have been the Hippocratic Oath, as well as attendance to one of the major medical schools. It may be strange that the ancient Greek civilization, with all its sophistication, failed to establish any means of protection from ignorant and potentially dangerous physicians. But one needs to remember the distinct features of ancient Greece that could explain why this system persisted and even how it could work adequately for so many centuries. The Greek region was literally fragmented into hundreds of independent city-states and this hindered any possible attempt of a unified professional evaluation policy. Therefore the ancients had to rely on the self-policing apprentice system by which Greek medical education was organized. Each of the masters, who were successful and experienced physicians, would take care in recruiting, selecting and training their apprentices and carefully monitor their progress to ensure the quality of their education, which was important to reputation of the master as well as the student. THE ROOTS OF RATIONAL MEDICINE First medical schools The first medical schools were founded in Greece and in the Southern Italy (Magna Grecia) regions of Sicily and Calabria. In the classical antiquity, medical "schools" were essentially schools of thought formed by an influential medical practitioner and his followers. There were no academic buildings dedicated to medical training. The "school" was essentially realized wherever its adherents would gather. With the coming of the 5th century B.C. the most famous of such centers were Cos, where Hippocrates (Iππoκpáτηò) was born, and Cnidus, situated just opposite of Cos on Asia Minor. These ancient Greek states developed medical schools that served as hallmarks of medical education. The doctors associated with these schools shared knowledge and certain medical practices; medical students retained a master-apprentice relation with their teachers and observed their masters treating diseases and prescribing measures such as good diet, exercise, and herbal remedies. Aspiring surgeons were trained as assistants to a military surgeon accompanying troops on a campaign. The instruction was of course very informal and there was no established certificate of the student's right to practice.1 Hippocratic medicine Hippocrates was born in about 460 B.C. on the island on Cos, an island of the coast of Asia Minor in the Dodecanese (Δωδεκávησα), where he developed his immensely influential rational school bringing about the transition from empiricism to scientific medicine in antiquity. During his lifetime, Hippocrates was undoubtedly the most renowned physician and teacher of medicine. Soranus stated that Hippocrates traced his descent and medical knowledge from his father Heraclidos (Hpáκλεiδoò) and Asclepius. He practiced medicine in his birthplace of Cos but also ventured in other parts of Greece including Athens, Sicily, Alexandria, Cyrine and Cyprus; he died in Thessaly at an advanced age in about 377 B.C. Although Hippocrates is widely considered the father of medicine and well-known scribes such as Plato and Aristotle have documented a number his achievements, there is little knowledge about his actual life and biography. There is even a possibility that Hippocrates was actually not one but many men of the same name.9 Whether Hippocrates was one man or several, the works attributed to him mark the stage in Greek medicine where physicians were encouraged to offer rational explanations concerning the cause and character of disease and health, instead of superstition and magic. Hippocrates' rational medicine was notably based on common sense and substituted divine intervention in favour of a profound, practical philosophy. Hippocrates is thought to have originated the concept of the "four humours" (plegm, yellow bile, black bile and blood) in medical physiology. The humoural doctrine stated that good health was the result of the harmonious equilibrium and blending of the four humours. Thus, disease was explained as the consequence of humoural imbalance. Relative excess of each humour resulted in particular personality types. An abundance of blood, yellow bile, black bile or phlegm was respectively associated with the sanguine, phlegmatic, choleric and melancholic temperaments. Hippocratic medicine notably emphasized maximum conservation in all medical treatments according to the famous Hippocratic motto: "to help or at least to do no harm". Hippocrates put more emphasis on diet and recommended a restricted use of drugs, which is to be expected if one considers that the rational medical use of herbs required a thorough systemization of the botanical world that would only be achieved a century after Hippocrates' death by Theophrastus (Teófpασtoò). Hippocrates also knew well how to describe a disease clearly and concisely and recorded treatment outcomes, both failures as well as successes.9 He also introduced the first concepts of medical ethics contained in the Hippocratic oath which still serves as the ethical nucleus of today's physicians.10 Hippocratic medicine gave emphasis on the patient rather than the disease and concentrated on experience and on the visual aspect of observation rather than theory. On the other hand, Cos' rival school, Cnidus, focused on a reductionist conception of disease, similar to the modern approach. However, Hippocrates' school achieved more wealth and recognition because it focused on the patient, while the school of Cnidus concentrated on studying the disease in the absence of the necessary technical instruments and general scientific infrastructure that could carry out its ideas the School of Cnidus ceased to exist, whereas that of Hippocrates flourished. The conflicting philosophies of medical education and the different interpretations of the nature of medicine (medicine as science versus medicine as art) raged on for several centuries until the unifying influence of Galen's (ταληvóò) (129-200 A.D.). Theories and research became the standard system that was passed on to later ages all the way to the 16th century. Medical education through the Hippocratic collection It is possible that Hippocrates was the author of only some, or even none, of the texts that comprise the Hippocratic Collection (Corpus Hippocraticum), a compilation of over 70 medical treatises that are traditionally attributed to him. Hippocrates' students and his two sons, Thessalus and Draco, were the successors of the Hippocratic tradition and a large part of the Hippocratic Collection, including the Oath, was written by them. The Hippocratic tradition became the accepted standard for medical education and these texts were taught in universities throughout most of the ancient West and during the Renaissance until the 19th century. The Hippocratic collection contained a series of aphorisms, among which is the well-known "Life is brief, art is long, opportunity is fleeting, experience is fallacious, judgement is difficult" (often shortened to the Latin tag, "Ars longa, vita brevis"). These passages are the foundation of Hippocrates' philosophy and lay much stress to careful, repetitious thought before a medical intervention. Such aphorisms are followed by case histories, summary accounts of the climatic conditions, brief comments on diseases, symptoms and prognostic indications, many of which remain valid.9 Post-Hippocratic era In the following century the work of Aristotle (Apτστéληò), regarded as the first great biologist, incalculably influenced medicine. Aristotle was a student of Plato at Athens and tutor to Alexander the Great (Mέγας Aλέξαvδρoς). His interests and studies included the entire world of living things. He was the founder of comparative anatomy and embryology and his work influenced scientific and medical thinking for the next 2 millennia.5 Following Aristotle's time, the centre of Greek culture shifted to the Egyptian city of Alexandria. The famous medical school of Alexandria was established in about 300 BC and replaced Cos and Cnidos as the foremost centre of medical excellence. Its two founders and best medical teachers were Herophilus (Eρóφιλoς), who is known as the first anatomist in history, and Erasistratus (Eρασίστρατoς), whom some regard as the founder of physiology. Medical studies at this great school were based on a more professional tutorship by its renowned teachers supplemented by practical apprenticeship under one of these physicians. Thus, the earlier periods' master-apprentice relationship was gradually replaced by that of professor-student. Due to this notable change in the character of medical education, large numbers of students were tutored by fewer professors. This university atmosphere did not in itself preclude clinical instruction and bedside teaching. It did however introduce a new non-professional direction for medical education in the sense that some students studied biology and medicine not for the purposes of professional practice but as part of scientific and philosophic exploration. This division of studies probably depended on each student's social status, with the more wealthy protégées generally preferring to focus on an academic approach to medicine. There were also certain individuals who studied almost every possible subject matter (polymaths). Such an endeavour to encompass all knowledge would have been incompatible with a busy medical practice. The tripartite division of medical education can be seen from as early as Aristotle's time described as "the physician who is a craftsman, the scientific physician, and the man who has studied medicine as part of his education".1 The museum of Alexandria continued as a centre of medical teaching even after the Roman Empire had attained supremacy over the Greek world. The medical education of women Women in Greek antiquity avoided examination and treatment from male physicians, a fact that often hindered successful treatment. This should not come as a surprise considering that ancient Greek women were taught from a young age to be ashamed of their bodies. Before the 5th century B.C. childbirth was almost exclusively entrusted to female kin and neighbours who had themselves given birth. Some of these women stood out because of their skills and became known by the title of "maia" (Mαία) or "midwife". Most midwife practitioners were usually trained from other midwives. The story of Agnodice (Aγvoδίκη), who according to myth was the first female to achieve the role of physician despite this being forbidden by law, has been cited by many Western midwives during the Renaissance in an attempt to medicalize childbirth. It seems that there were women in ancient Greece who studied medicine serving alongside leading male physicians and practiced obstetrics and gynaecology. As of yet there are few data regarding the involvement of women in general medical practice other than gynaecology.1,5,11 CONCLUSION Medical education in ancient Greece closely mirroring the evolution of ancient Greek though originates from magic and religion which is gradually superseded by more objective and leading to the Hippocratic rational medicine that with the of of ancient medical education such as the reputation system of medical education and practice may be peculiar But on these ancient can also the fundamental concepts that to modern practice. In a world that was by the first great medical schools a more ethical practice to their students and these were and by the today's medicine. than two to the of modern medical education.

In Greek humoural theory, the colour white was associated with phlegm, which is synonymous with mucous and was thought to be a primary element like gall, in explaining disease; 'phlegmatic' was a meaningful diagnostic term in Greek medicine. In Greek medicine 'wind' ( pneuma ) or breath ( physa ) was vital in circulating throughout the body, and if any part of the body was cut off from this breath, paralysis resulted. One treatise in the Hippocratic Corpus, On Breaths , argues that all diseases are caused by winds in the body. The Akkadian disease name zikurrudu is borrowed from the Sumerian term zi.kur.ru.da, which has been interpreted in various ways and is understood as the disease brought on by black magic and witchcraft. A literal translation for zikurrudu is 'breath cut off', and may well correspond to the cutting-off of pneuma in Greek medicine. Keywords: Babylonian medicine; breath; Hippocratic medicine; phlegm; zikurrudu

The XIth International Hippocrates Colloquium focused on the contexts in which the Hippocratic texts were written and read. The organiser, Philip van der Eijk, chose this broad theme in order to encourage contributions from a wide range of disciplines. The proceedings, divided into five sections, open with a study of the notion of cause in the contemporary works of historians (Thucydides and Herodotus) and medical writers by Jacques Jouanna, who usefully reminds the reader that comparisons across genres should not always be conceived in simplistic terms of influences. The remainder of the first section, devoted to the epistemological context of Hippocratic medicine, is heavily centred on the much-studied treatise On ancient medicine, although Daniela Fausti examines some more neglected texts in her study of the use of signs in prognostication. The second section, exploring the social context of Hippocratic medicine, includes some of the most innovative essays of the volume. Maria Elena Gorrini offers an impressive study of the archaeological evidence for healing cults in Attica. She stresses that these cults developed contemporaneously with ‘Hippocratic medicine’, often used the same methods of healing, and were not in strict opposition—she shows how medical doctors made dedications to the God Asclepius. Julie Laskaris also investigates the links between religious and Hippocratic medicine, focusing on the use of excrements and kourotrophic milk (the milk of a woman who has borne a male child) in the Hippocratic gynaecological recipes. She suggests that the use of kourotrophic milk shows the influence of Egyptian medicine, which made use of the milk of the Goddess Isis feeding her son Horus. In incorporating that ingredient in their pharmacopoeia, the Greeks misunderstood or ignored the Egyptian ritual connotations of kourotrophic milk. Finally, in her contribution on the largely unknown treatise On the organ of sight, Elizabeth Craik ventures the hypothesis that this text was composed by someone whose first language was not Greek, maybe someone from Egypt. The third section explores the links between “Hippocratic” and “non-Hippocratic” medicine, that is, the medicine expounded in the writings of inter alia Aristotle (Frederic le Blay), the Anonymus Londinensis (Daniela Manetti), and Theophrastus (Armelle Debru). The fourth section, devoted to the linguistic and rhetorical context of Hippocratic medicine, is—unfortunately—the shortest. Detailed linguistic and literary studies can yield important information on the socio-cultural context in which the Hippocratic texts were produced, as shown most prominently by Tim Stover's study of discursive practices and structural features exploited in Prorrhetic 2. Through the use of particular rhetorical features, the author of Prorrhetic 2 produced a protreptic text destined to win over a clientele of pupils in the context of competition between medical practitioners. The final section, focusing on the later reception of Hippocratic medicine, opens with a study of the medical papyri from the Egyptian village of Tebtunis by Ann Hanson, and is followed by essays on the reception of Hippocratic theories by later medical authors, such as Celsus (Muriel Pardon), Aretaeus (Amneris Roselli), and Galen (Ivan Garofalo). The division of the proceedings into sections is at times artificial, and it is regrettable that the section on the epistemological context is so centred on On ancient medicine; but altogether this volume testifies to the very positive evolution of Hippocratic scholarship in recent years. Hippocratic scholars are no longer afraid to use archaeological and papyrological evidence; they study linguistic features in innovative ways; they do not shy away from neglected texts such as Prorrhetic 2, Internal affections and On the organ of sight (as shown by the index of passages cited); and they fully embrace the possibility that Greek medicine was influenced by Egyptian medicine. In short, Hippocratic scholarship has truly become interdisciplinary.

Greek medicine is an important aspect of Greek culture. The Greeks were the first to put forward rational systems of medicine which resulted in a radically new conception of disease, accounting for causes and symptoms in purely natural terms. Greek rational medicine reached a climax in the third century BC at Alexandria, where medical anatomical researchers attained levels of accuracy and sophistication largely unsurpassed in Western culture until the 16th century. In the past this subject has been difficult to study because of the inaccessibility of source material, which is highly diverse, widely scattered, frequently unedited, and at times fragmentary. The aim of this book is to help to resolve this problem by providing a collection and translation of some of this material and assembling it in an accessible form.

Reviewed by: Ancient Medicine from Mesopotamia to Rome by Laura M. Zucconi Jessica Wright Ancient Medicine from Mesopotamia to Rome. By Laura M. Zucconi. Grand Rapids, MI: William B. Eerdmans Publishing Company, 2019. Pp. xxii + 432. Hardback, $110. ISBN 978-0-8028-6983-8. Ancient Medicine from Mesopotamia to Rome makes a significant intervention in the field of ancient medicine by decentering Greco-Roman sources and casting its geographical and cultural frame to focus on Mesopotamia, Egypt and the Levant. Through this approach, Zucconi is able to avoid the standard account of ancient medicine as naturalistic by definition, a perspective that is all but inevitable when taking the Hippocratic Corpus as a starting-point, as is usually the case. The book comprises nine richly documented chapters, each focusing on healing practices in specific regions or cultures of the ancient Near East and Mediterranean: Mesopotamia, pre-Ptolemaic Egypt, Canaan (including Phoenicians and Israelites), the Hittites, Classical and Hellenistic Greece, Ptolemaic Egypt, Italy (Etruscan and Roman), Second Temple Judaism and Persia. Each chapter, with the exception of Chapter 7, on Hellenistic medicine, follows an identical structure that encompasses general context (e.g. geography, politics), healing practices (e.g. diagnostic tools) and technical knowledge (physiology, anatomy, nosology). This approach reflects Zucconi’s explicit incorporation of a medical anthropological paradigm, which treats medicine as a cultural practice that can therefore be best understood within its social and cultural contexts. It also enables Zucconi to successfully demonstrate a central argument of the book, which is that each of the chapters “represents a local manifestation of a wider ancient medical culture” (1). That is, healing practices vary across the cultures and regions of the ancient Mediterranean, but all of them share core principles and ideas. One important implication of this argument is that Hippocratic medicine is just one local manifestation of a widespread and varied medical culture, and should no longer be treated as a kind of unique or miraculous predecessor to modern biomedicine. A distinctive strength of Ancient Medicine is that Zucconi offers a guide to archaeological and textual evidence for medicine in each of the cultures that it examines. Zucconi provides useful bibliographical information (for example, the different series of tablets that provide the basis for our understanding of Mesopotamian healing practices) and also critiques historical and existing practices of organizing and interpreting these sources. This both opens up a set of scholarly resources and establishes a basis for Zucconi to critically examine how expectations about what counts as ancient medicine have influenced the [End Page 255] organization and interpretation of sources. The critique centers especially around scholarly projection of the modern categories “magical” and “scientific” onto ancient texts. As Zucconi demonstrates repeatedly, ancient healing practices incorporated natural and supernatural elements. A clear example that she provides is the analysis of the “scientific” prescription of drugs through the lens of healing ritual: an oral rite, a physical rite, a charged substance. As Zucconi shows, drugs may operate as charged substances within the ancient context, but be interpreted in scientific terms as pharmacological substances by modern scholars. Zucconi amply demonstrates that distinctions between science, magic and religion, are unhelpful for the study of medicine in the ancient Near East. Zucconi’s reframing of ancient medical cultures is in part a strategy of names and renaming: Chapter 4, for example, details in large part with ancient Israelites and the Hebrew scriptures, but is titled “Canaanite Medicine,” and therefore both includes the Phoenicians and points the reader’s attention to all of the other Canaanite communities for which we have little evidence. Chapter 9, titled “Etruscan and Roman Medicine,” inevitably focuses on Latin texts, since Etruscan material is limited. The chapter on Ptolemaic Egypt, following closely after chapters on Classical Greek and Hellenistic medicine, deals similarly with the legacy of the Greek medical tradition, albeit within the Egyptian context. This difficulty in actually dislodging the centrality of Greece, Rome and Israel reflects the imbalance of extant sources. Yet, Zucconi’s strategy is successful in drawing the reader’s attention to the many, varied medical cultures that are obscured by the traditional lens. It also establishes groundwork for broadening the study of ancient medicine to include...

Introduction: A quintessential element of Hippocratic medicine is treatment of mental diseases which was based on a detailed examination of the symptoms as well as the study of human physiology and final outcome of the diseases which is based on humoral theory. Purpose: The aim of the work is to highlight the contribution of Hippocrates to the study of mental illness based on his theory of humors Methodology: Our study consists of interpretations of the original text of Hippocrates including extensive observations of anatomy and physiology of human body based on humoral theory. Then the information was evaluated on the basis of modern literature in order to establish their validity. A major limitation of the research is the lack of a systemic methodology to screen the Hippocratic corpus for relevant passages which actually requires interdisciplinary research in order to determine which aspects of Hippocratic medicine can be developed. Results: In Corpus Hippocraticum, it is highlighting that maintaining a relative proportion of humors in human body (apart from maintaining health) regulates the human temperament and its behavioral manifestations. Hippocrates, has included in his work observations not only on human physiology and diseases but also studies the environmental and geographical impact on them, thus setting the stage for holistic approaches Conclusion: Summarizing, Hippocratic medicine and particularly his observations on mental disorders provides a clear picture of the methodology used by Hippocrates which can be a guide for the adoption of good practices for contemporary scholars and clinicians on their everyday practice

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The concepts currently operating in much medical microbiome research bear a curious resemblance to an ancient tradition of Western medicine. This tradition, humoral medicine, is concerned with the four humors: yellow and black bile, phlegm, blood. Both humoral medicine and medical microbiome research use notions of imbalance and balance for broad explanations of disease and health. Both traditions also hold that the composition of humors or microbiomes determines bodily as well as mental states. Causality in each system is often conceived teleologically, meaning that humors or microbiomes "function for" the maintenance of the whole. And ultimately, each framework situates the humors or microbiomes in a multilevel interactionist theory that conceptualizes individual health within a broader environmental context. As well as critically assessing the parallels between these systems, this article sketches some explanations of how they may have arisen. The authors also evaluate the implications of these similarities for the future of medical microbiome research and suggest ways in which the field might move forward.

To describe the fortunes of Galen over the centuries is almost to write the history of medicine since his death. Not only did his ideas constitute the basis of formal medicine in Europe at least until the seventeenth century, and arguably until the nineteenth, but as Yunani medicine (i.e. Greek medicine as consolidated and developed by Ibn Sina [Avicenna], d. 1037), they constitute a major medical tradition in the modern Muslim world. Galen's holistic approach can also be found among modern practitioners of complementary medicine, as well as in one branch of Tibetan medicine. Galen's conception of Hippocrates and Hippocratic medicine not only dominated until recently historians' approaches to their medical past but, more subtly, continues to influence modern perceptions of what medicine is and how it should be practised. Galen's ideal of the learned, thinking practitioner still directs our preconceptions of what a doctor should be like, even if his demands for constant training in philosophy and in dissection can be fulfilled only with difficulty. Historians' knowledge of Galen continues to increase, not only because his writings have been studied more closely in the last thirty years than at any time since the seventeenth century, but also because there has been a steady accession of new discoveries, albeit principally in medieval translations rather than in his original Greek. Indeed, modern scholars are more familiar with Galen's works than were their predecessors in Byzantium and all but a handful of experts in the Islamic world.

Starting from the frescoes of the cathedral of Anagni which present an obvious relationship between Hippocrates as Galen's teacher and the medieval image of man's place in the universe dominated by the number four, this paper returns to the origins of this quaternary theory in Hippocratic medicine with the four humors (Nature of Man), then follows its evolution in Galen and finally into late Greek and Byzantine medicine where the quaternary division will have an unprecedented extension, with the four temperaments. In particular, a new piece of evidence from this late period attributed to Hippocrates (the small treatise of Greek Medicine The Pulse and the Human Temperament) appears as the veritable source of the Latin Letter attributed to Vindicianus. Therefore, contrary to what was believed until now, the doctrine of the four temperaments was not elaborated first in a Latin form. Throughout its history, the quaternary theory will remain connected to Hippocrates, but the image and teaching of the Father of Medicine will change as the theory evolves. A second rediscovered treatise of the late period (The Formation of Man) starts with this phrase: 'Words of Hippocrates to Galen his own pupil'. This seems a felicitous commentary to the medical scene in the cathedral of Anagni.

Book Review

The origins of Uyghur medicine: Debates and perspectives

Chinggis Khan created the largest land empire in history, and he and his successors not only united the old land silk routes but produced successor regimes active on water as well as on land. Arabic Medicine was practiced in Turkistan, Iran, the Arabic- and Syriac-speaking Middle East, the Turkish Middle East, Africa, and Spain. Like Chinese medicine, it was humoral, but whereas Chinese medicine received its humoral ideas by diffusion from the West, or through Buddhism, the humoral ideas in Arabic Medicine were inherited directly from the previous cosmopolitan medical system of its region, Greek medicine. The Ayurvedic or Tridosa system is similar to Greek and Arabic humoral medicine, with some significant differences. On the East Asian side is another encyclopedia, this one in Chinese and not Persian, although with Arabic script entries mostly in that language. Medical ideas and systems came from a variety of cultures the Mongols came into contact with as they created their empire.

Hildegard of Bingen (1098–1179), abbess, mystic, physician, poet, and composer, has been the subject of a renaissance of sorts over the past twenty-five years. Historians of medicine and religion, literary critics, musicians, and even new-age medical practitioners have revived the Rhineland abbess as a unique and formidable intellectual figure of the twelfth century. While previous historians of medicine have looked broadly at Hildegard's medical views or narrowly at her pharmacological knowledge of plants, Victoria Sweet provides a solid and fruitful monograph on the connections between humoral theory and practical knowledge in Hildegard's thought. After an initial biographical chapter, which includes a definitive rejection of the theory that Hildegard's mystical visions were caused by migraines, Sweet turns to the impact of the abbess's probable training in horticulture (as monastic infirmarian) on her understanding of the body and humoral theory. Sweet argues that Hildegard's text Causes and cures (c. 1150) was a medical manual for a student infirmarian at her abbey, and as such can allow us to see how “concepts of premodern medicine were understood and used by a particular practitioner” (p. 7). Sweet argues that she is using an “anthropological” approach in this work, investigating the world of her informant, Hildegard the practitioner. This approach is in reality a form of historical analysis that pays close attention to intellectual traditions and wider, symbolic cultural meanings and contexts. Sweet keenly identifies Hildegard's distinct interpretations of such classical medical concepts as the four elements (chapter 3) and the four humours (chapter 4). Most revealing is Sweet's study (chapter 5) of the Hildegardian term viriditas (“greening,” the fertile power of all living things) from the perspective of horticultural and humoral knowledge in medieval thought. Where other scholars search for the symbolic and spiritual meanings of the term, Sweet demands that we take seriously the concrete reality behind Hildegard's notion of viriditas as a form of juice or sap in plants, a liquid which provides both sustenance for the plant and possible pharmacological succour for the ill. While the abbess may have borrowed the term from the theological tradition, she applies it broadly to the idea of fecundity and health in the natural world. The book argues well that Hildegard's views on the body and healing can best be understood by looking at the organic, natural imagery that underlies medieval medical thought. Sweet very nicely places Hildegard's unique vision and all of humoral theory in this context. But the author is less successful in the conclusion, where she attempts to place Hildegard's medical and horticultural ideas in the larger context of pre-Copernican geocentric views of the cosmos. Sweet argues that the crucial image uniting all pre-modern medical concepts is the fixed earth and the temporal changes (in the seasons, qualities, humours, and elements) that ensue as the moving firmament circles it. Hildegard was certainly concerned with the symbiosis of the macrocosm of the world—with its winds and seasonal changes—and the microcosm of the body, but her thought remains markedly anthropocentric rather than geocentric. It is revealing that the only Hildegardian evidence that Sweet supplies comes not from her medical writings but from her mystical and visionary treatises, which did not require strict adherence to natural philosophical or medical views. Most medical theory took into account fluctuations in the environment, but did not reduce health or illness to such shifting contextual factors. The author attempts to create a sense of coherence within a massive body of medical knowledge that resists any single theory, even within the work of a single author. The argument is intriguing and provocative, and requires more elaboration than it receives in the concluding pages of the monograph. None the less, the book's strength lies in its ability to identify a systematic natural philosophy that underlies Hildegard's medical material. Sweet does so by studying Hildegard's views of humours and viriditas, and by revealing the experiential and botanical underpinnings of Hildegard's life and thought. In all of this, Sweet hints at the relevance of Hildegard's medical ideas to the connections between gender, natural science, and medicine.