INTRODUCTION TO THERAPEUTICS IN GREEK MEDICINE
The Art of Healing
In his first Aphorism, Hippocrates gives us a sobering overview of medicine, or the Art of Healing:
Life is short, the Art long; opportunity fleeting, experience perilous, and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.
Life is short, the Art long. The Art of Medicine is the sum total of all healing knowledge gathered by mankind down through the ages. What any individual physician, during his short lifespan, can hope to master and achieve, when compared to the totality of the Medical Art, is puny by comparison. The physician's knowledge and expertise in the Art of Healing, however great, must be tempered by this perspective, which induces a sense of humility and respect.
Opportunity fleeting. The time frame or window of opportunity within which the physician's medical intervention can do the most good is fleeting and transitory at best. The physician must seize the moment when the time is ripe for healing and intervention; likewise, he must also know when the time is not ripe, and when to refrain. The physician must learn how to work with the cycles of Nature to optimize the efficacy of his healing interventions.
Experience perilous. Medicine is a practical art whose value or efficacy must be judged by its results. The march of medical progress down through the ages has been wrought at a high price of much trial and error. Because errors or mistakes in medicine can be costly, even fatal, the aspiring physician apprentices himself to a master physician to be schooled by him, both theoretically / didactically as well as practically / clinically, in his school, or tradition, of healing. Schools or traditions of medicine exist to minimize this perilous aspect of experiential trial and error, and to benefit from the accumulated knowledge and experience of previous generations of physicians.
Judgment difficult. Judgment, or the process of diagnosis which provides the key to treatment, is the heart of the Medical Art. But disease and pathology can often be insidious, obscure, or covert, and difficult for the physician to elucidate and ferret out. Similarly, the pros and cons of various treatment options to be considered aren't always that clear cut. Prioritizing attainable short and long term healing goals for the patient is also not always such an easy thing to do.
The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants and externals cooperate. This is also a tough job. The physician must be a great manager and coordinator - the orchestrator and director of the healing process, and be all things to all people, as the situation demands.
To the patient, the physician must be a mentor and guide, a coach and motivator. He must also have a deep understanding of the patient's innate psychology and temperament, and do whatever it takes to get the patient to comply and follow through with the treatment.
The physician must also be skillful and effective in instructing and managing the nurses, or attendants, in their ministrations to the patient. And, as much as is possible, he should also make sure that the external environmental conditions are optimum for healing and recovery.
Healing with Contraries
In Greek Medicine, the usual way of treating disease is through the use of medicines and treatments that are contrary in nature to that of the disease or disorder. Hippocrates explains:
Diseases which arise from repletion are cured by depletion; and those which arise from depletion are cured by repletion; and in general, diseases are cured by their contraries.
- Aphorisms II : 22
Excesses must be drained or purged; deficiencies must be supplemented by what is missing. Fevers must be quelled and cooled down; chills must be dispelled with heat and warmth. Roughness and dryness must be smoothed and moistened. Excess wetness and moisture must be dried up and dispersed. Blockages and obstructions must also be dispersed.
In supplementing deficiencies, we must seek out and use medicines and treatments that will provide the desired quality or nutritional factor that is lacking. The principle here is:
Like increases like.
In correcting imbalances, we must seek out and use medicines and treatments that are contrary in nature to that of the imbalance. The principle here is: Opposites balance. Furthermore, while being contrary in quality, medicines or treatments for correcting imbalances must be similar in degree to the severity of the imbalance; otherwise, we run the risk of either underdoing the correction and leaving some of the original imbalance behind, or of overdoing the correction and creating a new imbalance that is contrary in nature to the first. We need just the right touch.
In removing or purging excesses, congestions and obstructions, we must know and make our treatment appropriate to three factors:
1) What is in excess, causing the congestion and obstruction;
2) Where in the body the excess, congestion or obstruction is;
3) How much, or how severe, is the congestion or obstruction.
We must use medicines and treatments that specifically address all three of these above factors if we are going to be successful:
You wouldn't use a medicine to purge phlegm if blood or bile was the congesting or obstructing factor.
You wouldn't use a medicine to purge the head if it was the bowels that suffered from excess or congestion;
You wouldn't use the Sword of Damocles to clip off a tiny hangnail. In all cases, the medicine or treatment must be appropriate and well-matched to the degree or severity of the disorder.
Using these measures of kind, part and degree, the physician or therapist works to undo or reverse the damage that the disease process has created, to lead the patient back from a state of disorder, or disease, to one of order, or health.
Healing with Similars
Practitioners of homeopathy are fond of quoting Hippocrates' dictum, Similia similibus curantur, or, "Let like cure like." They claim that it proves that Hippocrates was basically homeopathic in his approach.
But the truth is that although there is a place for treatment by similars in Hippocrates' system of therapeutics, the general rule was treatment by contraries. To ripen a boil or abscess to draw out pus and hot, purulent toxins, for example, plasters of heating and stimulating vesicants and counterirritants are applied topically.
Cleansing versus Building
If the patient is clearly suffering from a deficiency disorder, then we must obviously supplement and build. Conversely, if a patient is clearly suffering from plethora and excess, we should purge, or cleanse the offending matter.
But many patients are suffering from a little of both - excess and deficiency. Then, what do you do?
In these cases, Greek Medicine gives initial preference to cleansing. Hippocrates states:
In bodies not properly cleansed, the more you nourish, the more you injure.
- Aphorisms II : 10
In bodies whose vital channels have become clogged with toxic and morbid matter, these same vessels cannot carry nutrients to the tissues for proper assimilation. So, these nutrients just wind up stagnating and putrefying, injuring us and making us sick.
A couple of analogies here would make things clearer: A full cup cannot hold any more water; it must first be emptied to receive more. A slate with writing scribbled all over it must first be wiped clean before any new writing can be made intelligible on it.
The cleansing can be mild and gentle; it need not be radical purgation. When the necessary cleansing has been accomplished, the patient's natural appetite and sense of wellbeing will return of their own accord. Then is the time to start a regimen of rebuilding.
Strong purgatives should not be used unless there's an acute or severe condition of excess that must be purged. Those who are relatively healthy and balanced will be made ill by the use of purgatives, declares Hippocrates. Purgatives should also be matched in strength to the innate strength and vitality of the patient. Never use a stronger purgative or cleansing agent than is necessary to do the job.
An initial period of cleansing is not generally recommended for those in a very frail, emaciated or delicate state of health, however. These people need mild and gentle herbal tonics and dietary therapy to make them constitutionally stronger and resilient enough to undergo a cleansing regime.
Even where a regime of rebuilding, or recruitment, is clearly indicated, the physician, as the servant of Nature, cannot be too reckless or hasty. Hippocrates says:
Those bodies which have been slowly emaciated should be slowly recruited; and those which have been quickly emaciated should be quickly recruited.
- Aphorisms II : 7
Acute cases of depletion should be replenished quickly. Someone suffering from acute dryness and dehydration, for example, should be fed with a rehydrating solution or herbal decoction immediately.
The same thing can also be said about cleansing or purgation. Slow, gentle cleansing while allowing the organism to detoxify gradually, in stages, is best for toxicity and plethora of long standing. Acute conditions of toxicity and congestion call for quick, decisive cleansing and purgation.
In cleansing or rebuilding, the physician simply mirrors or reverses, in a similar manner, the natural processes that led the patient into the disorder.
Basic Differentiation of Therapeutic Modalities
In Greek Medicine, there are six major therapeutic modalities, or pathways to healing:
1) Dietary Therapy
2) Hygiene and Lifestyle Modification
3) Medicines, or Pharmacotherapy
4) Physiotherapy, or Bodywork
5) Hygienic Purification Therapies
6) Surgery, or Structural Modification of the Body
These six modalities of treatment are arranged in a natural priority, or hierarchy. Dietary therapy is the gentlest, safest and least invasive; first, do everything you can to cure or ameliorate the condition through dietary means. Last on the list comes surgery, which is generally used as a last resort when all else fails.
These six modalities also fall into two distinct trinities, or triads, of therapy. The first three modalities are all administered by the patient himself in accordance with the physician's instructions. The last three are usually administered directly to the patient by the physician or therapist.
Of the first triad of therapies, to be administered by the patient himself under guidance from the physician, dietary modification comes first, supported by changes in lifestyle and hygiene habits. Only when these are insufficient should supplements and herbal medicines be resorted to.
Of the second triad of therapies, to be administered by the physician or therapist, massage, physiotherapy and bodywork come first, and is often used as a preparatory measure for deeper forms of cleansing.
The dual therapies of oleation, or massage with medicated oils, and sudation, or sweating, are the basic modalities used to loosen and dislodge toxins from their deeply embedded, impacted state as a preparatory measure for flushing them out of the organism with the deeper hygienic purification therapies. This is what Hippocrates is referring to when he declares:
When one wishes to purge, he should put the body into a fluent state.
- Aphorisms II : 9
Detoxification through the hygienic purification therapies is one of the core therapeutic objectives of Greek Medicine, and can accomplish many healing miracles when appropriately done on those who have been properly prepared for it. The six hygienic purification methods are:
1) Sudation (sweating)
2) Diuresis (urination)
3) Emesis (vomiting)
4) Purgation (of the bowels)
5) Derivation (drawing out toxins through the skin)
6) Venesection (bloodletting)
And last on the list is surgery, to be done as a last resort only when all else fails. However, there are some conditions, usually involving trauma, injury or disfigurement, in which surgery is the essential first line of treatment.
Modern medicine has glorified surgery as the crowning achievement of the medical art. And so, surgery is most highly developed in modern medicine, and is excellent in cases where it is absolutely necessary. However, a lot of needless, unnecessary surgery is done as a lucrative "quick fix" substitute for more natural, traditional and slower methods of healing.
Hippocrates once stated that sometimes it's more important to know what kind of person has a disease than what kind of disease a person has. By this, he was referring primarily to considerations of the person's constitutional nature and temperament. The concept of the Four Temperaments forms the basis of all constitutional notions of diagnosis and treatment in Greek Medicine, which enables the physician to treat the patient, and not just the disease.
Because of individual differences of constitutional nature and temperament, no two people will manifest the signs and symptoms of a given disease in exactly the same way. Neither will they respond in exactly the same way to a given medicine or treatment regimen for that disease.
Each of the Four Temperaments responds differently to the various therapeutic modalities offered by Greek Medicine. And so, I have included in this section articles with general tips and suggestions for the therapeutic management of each of the Four Temperaments.
But there are other factors to consider besides just the constitutional nature and temperament of the individual. Greek Medicine, as a holistic healing system, recognizes that no one exists in a vacuum; each individual lives in a dynamic interplay with his/her environment.
In an aphorism regarding dietary therapy, Hippocrates enumerated what these other factors were that must be taken into consideration:
Something must be conceded to habit, to season, to country, and to age.
To Habit: This refers to the patient's particular habits of eating, living, activity, sleep and rest. The patient's daily habits in each of these areas has a profound influence on his state of health, and are often indicators of his constitutional nature and temperament. Accordingly, they must be duly considered by the physician in designing a treatment strategy that the patient is most likely to follow.
To Season: The various seasons of the year all have their characteristic influences on the patient's health and manifestation of disease signs and symptoms, due to their inherent nature and temperament. These seasonal influences have been discussed elsewhere in this website, in the Basic Principles and Hygiene sections.
To Country: Each kind of country, or natural environment, will have its characteristic temperament and influence, and will affect how the seasons manifest and express themselves throughout the course of the year. Does the patient live in an arid desert or in a humid marshland? In a sunny subtropical or Mediterranean environment , or in a cold, dry, windswept alpine one? The influence of the patient's natural environment will certainly affect the course of his/her therapy.
To Age: The various ages of the human lifespan can be likened to the various seasons of the year. This has been discussed in the Basic Principles section. In youth an individual is more Sanguine in nature than he will ever be; in Middle Age, he is at his most Melancholic. Such are the general rules and tendencies, of which, of course, there will be various and sundry individual variations.
Adjusting the Four Humors
Humoral imbalances are common. When a humor gets out of balance, the whole metabolism of the body is thrown off, and multiple signs and symptoms, many of which are seemingly unrelated, can appear in various parts of the body. And so, correcting underlying humoral imbalances can alleviate many health problems and complications.
Humoral imbalances can be of several different types, with each type indicating a certain basic therapeutic approach to restore balance:
The humor can be in excess or plethora, which can be either localized or systemic. In these cases purgatives, or cleansing agents specific to the offending humor, are indicated.
The humor can be altered in temperament or corrupt in quality. This calls for medicines and treatments that purify and correct the qualitative corruption or morbidity of the humor.
The humor can be deficient, especially if it is one of the moist, flourishing humors - blood or phlegm / serous fluids. This calls for tonics and restoratives to nourish and replenish the humor back to its optimum level.
The humor can be poorly circulated and distributed throughout the body. In these cases, medicines or treatments that restore proper circulation and metabolism to the affected humor are called for.
Certain articles in this section discuss therapeutic approaches for correcting the various imbalances that can happen to each of the Four Humors.
Constitutional Strengthening and Support
One of the therapeutic approaches that Greek Medicine places a lot of faith in is restorative measures to strengthen and support the basic resiliency and adaptive powers of the patient's physis, or constitution. In direct contrast to the allopathic approach of banishing or eradicating disease, this is the naturopathic approach of strengthening the vital forces of health and recuperation within the organism.
As the righteous forces of the patient's innate constitutional health and vitality are restored, many of his/her various complaints and infirmities will naturally ameliorate or disappear, just as the shadows of night flee before the rising sun. This therapeutic approach is health-specific rather than disease-specific.
In modern holistic medicine, this therapeutic approach is called restorative or adaptogenic. It is based on a natural, wholesome diet in keeping with one's constitutional nature and temperament; health-promoting and stress-busting moderate exercise and fitness regimens coupled with beneficial lifestyle adjustments; and gentle yet effective herbal tonics and superfoods.
Each one of the Four Temperaments, or basic constitutional types in Greek Medicine, has its own typical patterns of breakdown when challenged or under stress, both physical and psychological. These patterns of breakdown then indicate to the physician certain therapeutic approaches for shoring up and restoring constitutional strength and resiliency where it is needed the most.
These restorative constitutional treatments of Greek Medicine later became the basis for the Nature Cure treatments of European health spas. The main objective is to let Mother Nature do the healing, and put back together a broken down constitution as only She knows how.
Therapeutic Goals and Priorities
In Greek Medicine, the usual therapeutic order of business is to work backwards, starting with resolving the most acute and short term manifestations of disease, and gradually correcting, as the means and opportunity present themselves, disease conditions of longer and more chronic standing and duration. The therapist tries to reverse the disease processes that led to the patient's infirm condition.
No one would deny that acute flareups and crises demand the physician's immediate attention. If a fire is burning out of control, the physician must put it out. These acute crisis conditions include fever, acute infections, severe pain, vehement and uncontrolled diarrhea, colic, nausea and/or vomiting; seizures and convulsions; rashes and skin outbreaks; bleeding disorders, inflammatory crises and allergic or autoimmune reactions. These volatile acute conditions must be put under control before the patient's condition is stable enough to work steadily on the more chronic conditions.
These acute outbreaks need not always be from recently acquired conditions. Sometimes, morbid conditions held deeply and chronically within the organism can spawn acute flareups, or eruptions, when the conditions are right.
High on the physician's priority list must also be disease conditions that interfere with the Six Hygienic Factors, or the basic hygienic and lifestyle processes that empower healing and recovery. Conditions that generate acute, severe pain or discomfort, for example, can ruin sleep, which is essential for regeneration and healing.
Beyond these exigencies, therapeutic or healing goals and priorities are fairly flexible, and should be discussed between physician and patient. The patient's healing goals and priorities may not always be in his/her own best interests, however. It's up to the physician to diagnose and point out to his patient the existence of underlying serious or insidious pathologies that demand prompt and aggressive treatment.
Ethics of Treatment: First, Do No Harm
The first ethical rule of treatment in Greek Medicine is: Primum non nocere. This is Latin for "First, do no harm."
Wherever Hippocrates went on his healing ministrations to the ill and infirm, he would try to do good. Or, in cases in which he wasn't convinced that he could do his patient any good, he saw it as the height of medical wisdom and ethical behavior to refrain from doing anything that might harm the patient.
Doing no harm includes not upsetting the delicate balance of the forces of Nature at work in the patient's organism. And so, Greek Medicine is committed to using natural methods of treatment wherever possible, as these are the least likely to disturb the delicate balance of Nature.
The physician of Greek Medicine is the humble servant of Nature, intervening when and where necessary to assist Mother Nature in Her healing work. His ideal and motto is to work with Nature, and not against Her.