Temperamental Portraits

What did Hahnemann mean by the "phlegmatic temperament"? To understand this one must study the teaching of Hippocrates and Hahnemann very closely. The data on the Hippocratic temperaments represent 2,500 years of continuous clinical observation. The homoeopaths of the 19th century were very familiar with the Hippocratic canon and most knew the constitutional temperaments. The archetypal images of the four temperaments and humours are still in use even in the modern English language. For instance, the word "temperamental" still means to be very sensitive or overly emotional. At the same time to be in "good" or "bad humor" denotes a happy or distressed state of mind. A person may also be "full of humor" or "humorless" depending on the nature of their personality or mood.

Somebody may be referred to as being in a "dark mood" or to be "melancholic" when he or she is depressed. The word, melancholic, is derived from the word "black" (melan) and the term "bile" which denotes a dark humour or inwardly sullen state of mind. We also say that some people have a "bitter temperament' or while others have a "sour disposition". To be bitter is defined as a state of intense antagonism or hostility whereas to be sour is defined as being austere, morose, or peevish. These states are associated with the choleric and melancholic humour. Terms like these have their roots in the tastes of the four humours i.e., bitter (bile), sweet (blood), salty (phlegm), and sour (atrabile). To be "jaundiced" not only means to turn yellow because of excess bile but also to be prejudiced, envious and resentful. To "turn white" is a common expression associated with a state of fear. To "see red" means to be violently enraged which is related to the term "sanguinary" which means to be ready to shed blood. To feel "blue" is defined as being depressed in spirits, dejected or melancholic. These terms are closely related to the colors of the four humours, yellow (bile), white (phlegm), red (blood), and atrabile (blue-black).

All of these terms are based on the doctrines of the ancient Greeks and the nature of instinctive, innate body language. The Hippocratic theory of temperaments is closely related to the psychological and the physiological functions of the psycho-neuro-endocrine system (PNE) and morphological structures. The intrinsic connection between constitutional development and the neuro-endocrine secretions are well known in modern medicine. Nevertheless, the 2500-year-old Hippocratic system is still much more advanced in its observations of human temperament. The following rubrics are part of a collection taken from traditional sources and a clinical study spanning more than a decade.

The Phlegmatic Temperament (Mental rubrics-Spirit and Emotional Character)

The water element is related to the emotional sensitivity and gives a person an ability to have deep feeling tones. This is why the phlegmatic temperament is psychic, sympathetic, mediumistic, and empathetic. When they are in "pleasant humour" they are imaginative, sensitive, artistic, romantic, sentimental and sympathetic. They are gentle, sweet, mild, and timid and have a receptive, yielding disposition with a tendency to try to please everyone. They like comfortable, safe situations and when they are with friends they come out and can be quite playful, frivolous, and jovial and like to tease.

Their strengths are that they are very sensitive, imaginative, sympathetic, adaptable, peaceful, tolerant, gentle, placid, soft, receptive, considerate and calm.

Their weaknesses are that they become easily attached and are prone to be sad, tearful, indecisive, vulnerable, unsure, fearful, timid, envious, hesitant, changeable, submissive, indifferent, silent, reticent, unforgiving, mournful, pitiable and stubborn.

Under stress phlegmatic types easily become tearful, fearful, sentimental and very moody. The phlegmatic type experiences changeable moods that come in waves and tides like an emotional ocean where one moment they seem happy and the next sad. Their emotional state changes like the phases of the moon. When their mental skies are cloudy they rain down a shower of tears that gives them a sense of relief and allows them to return to bright sunny clarity. They may cry for happy or sad reasons, and sometimes, for no reason at all! If they are under prolonged stress they become sad and withdrawn as if a dark cloud has settled over them and they become shy, inward and dreamy.

Phlegmatics make very strong emotional connections with their loved ones and sexual partners, and suffer greatly from loss if these relationships do not work out. They suffer deeply from a sense of abandonment if they feel they are not appreciated and are easily hurt.

They are < worse when exposed to too much excitement, over stimulating environments, and when forced to do things in a hurry. In their own private way they can be stubborn, irritable, and they easily suffer from inward grief with silent peevishness. They are prone to passive aggression.

As the individual breaks down under stress the phlegmatic temperament becomes more insecure, indecisive, cold, careless, listless, apathetic and suffers from nervous exhaustion. They may even become completely dull, blank, slow and stupid and appear like an idiot.

Phlegmatic Bodily Constitution (Generals)

In the Hippocratic tradition the seat of a phlegmatic's inner energy is in the cool moist fluids of the brain and pituitary gland and its influence spreads through the lymphatic channels and the veins and has its outer lower seat in the lower abdomen. The negative pole of the "natural forces" that governs the anabolic processes of nutritional transformations and the generative seed rules the phlegmatic constitution. They rule the lymphatic system level of the five-fold defense mechanism and often suffer from autointoxication due to imbalances of the toxin-antitoxin axis.

The body of the phlegmatic temperament is large boned, well rounded, and has soft tissue with flaccid muscles that tire easily.

They easily suffer from water retention that makes them look and feel heavy, fleshy and fat. They easily put on weight on the hips, sacrum and thighs.

The phlegmatic temperament moves with leisurely graceful motions and has difficulty doing things quickly because rapid motion makes them feel confused.

Under continual stress the phlegmatic constitution suffers alternating emotional states, and becomes tired, weak, slow, chilly, and prone to edema.

The phlegmatic constitution has a round face, soft features, and deep watery eyes that swim with emotion. The sclera and the iris of their eyes often have grayish white spots and the iris may show a white ring around its outer edge. This ring like effect is called a lymphatic rosary in iridology.

The face of a phlegmatic is round with soft, oval features and is often slightly bloated. Their skin is commonly cold, moist, whitish, pale, pasty and translucent with blue and green veins showing through.

They are < worse from cold food and drinks.

The phlegmatic type may like open air because it stimulates them but they do not like cold wind. They have a tendency to cold clammy perspiration that may be < aggravated by emotions.

All complaints are < worse by cold, cloudy weather, winter and dampness, and are better > in warmer, dry climates and warm influences. They also can be worse < cold and heat as their temperature control is extremely unstable.

They suffer from skin diseases that are accompanied by swelling and clear discharges that may change from bland to more irritating clear or white secretions. They also have a tendency to form lesions with white scales.

A phlegmatic type usually feels cold easily and is < worse by cold, damp environments and cold food and drink. Correspondingly, phlegmatic types are > better warm drier environments and warm food and drinks.

The tongue of a phlegmatic is pale, swollen and may be watery or coated with a white coating.

The phlegmatic pulse is usually slow, soft, wide and slippery. It is strong in the first phases of an illness but it becomes weak and stagnates as a disease becomes chronic.

The hands of the phlegmatic temperament are cold, thick, soft, humid, swollen, and plump and their skin is white, pale and puffy.

Their fingers are often short with thick tips and the joints are reasonably lax. The nails of the phlegmatic are often wide, white, pale, and soft and the moons are not very predominant.

When they shake hands their palm feels soft, wet, and cold, and their grip is weak. Phlegmatic women tend to hug softly and often do not offer a kiss as a greeting. If they do kiss, it is usually on the cheek, which causes them to blush and look sideways.

Von Grauvogl called them the hydrogenoid type because of their tendency to hold water weight and to be < worse by damp cold atmospheres, watery foods, or living near bodies of water.

Physiognomists of the past have called the phlegmatic constitution such names as the venous, lymphatic, abdominal and thymus types.

Morphologically speaking, Sheldon considered these constitutions to be pure endomorphs because of their large organs and lack of somatic structures. For this reason he called them the viscerotonic persons.

In Danielopolu's system the phlegmatics are called vagotonic persons because they have overactive parasympathetic nervous systems that suppress the function of the sympathetic nervous system. This is related to many of their predispositions to hypofunction, coldness, slow metabolism, water retention, weight gain, etc.

Phlegmatic Predispositions (Diathesis and miasms)

The phlegmatic temperament is prone to water retention, cold stomachs, insufficient secretion of digestive juices (such as hydrochloric acid), poor assimilation, anemia, and flatulence.

The phlegmatic temperament is prone to poor circulation, lymphatic stagnation, non-inflammatory swollen glands, watery swelling, autointoxication, glandular swellings, increased mucus and serous secretions and watery discharges of clear or whitish color.

They have a tendency toward hypo-pituitary, hypothyroid, low blood pressure, slow metabolism, low temperature, and lack of energy.

The phlegmatic has a tendency to disorders of the genito-urinary system and their urine is frequent, pale and in larger quantities.

Their arthritic problems manifest with cold white swellings that are < cold and damp and often better > warm applications and dry weather.

They are prone to taking cold with watery discharges and chilliness and flushes of heat. They easily accumulate water in the lungs and have much phlegm and mucus that produces complications.

Tendency toward urinary infections (acute miasms), NSU, frequent urination and yeast infections with watery milky discharges.

The sycotic miasm tends to produce an abundance of phlegmatic humours and the phlegmatic temperament.

Now we can see that the phlegmatic temperament represents a portrait of a group of individuals who share similar natural traits and reactions to environment as well as predispositions toward certain signs and symptoms. This system includes mentals and generals, thermals, desires, aversions, sensations, modalities and pathological generals as well as particular symptoms of the regions of the body. It also assesses the vitality of the life force as well as the inherited and acquired miasms, predispositions and diathesis.

One can see that this system of constitution and temperament is much more advanced than any modern constitutional concepts (glandular and morphological types which have few symptoms) as it employs similar data to Hahnemannian Homoeopathy. Thus the ancient wisdom of Pythagoras and Hippocrates has found its home in the medicine of the future, Homoeopathy.

Phlegmatic Remedies

The phlegmatic, leuco-phlegmatic temperament as well as the lymphatic and hydrogenoid constitution is ruled by the same element (water). These constitutions are reflected in a group of well-proven remedies. It is easy to see the similarities between this phlegmatic constitution and Pulsatilla. It is also similar to well known remedies such as Agnus cast.. Aloe, Asterias rubens, Ammonium carb., Calc carb., Capsicum, Carbo veg., Cyclamen, Dulcamara, Graphites, Hepar sulph, Mercurius, Natrum carb, Natrum chlor, Natrum sulph., Sepia., Thuja., etc..

The carbon group of mineral remedies are very similar to the phlegmatic temperament, leuco-phlegmatic and lymphatic constitutions. Such remedies include Am-carb., Calc-carb., Carbo-v., Graphites, Kali carb., Natrum carb, etc.. The Natrums also have a tendency to phlegmatic states Nat-c., Nat-chlr, Nat-m., Nat-s. The Ammoniums, and Antimoniums also are similar as demonstrated by Am-c., Am-m., and Ant-c., Ant-t., Animal remedies include Asterias Rubens, Calcarea, Sepia (water creatures) and Apis. Many anti-sycotic remedies also are similar as there is a connection between phlegmatic states and sycosis. Here you find Agnus Cast., Thuja, Asterias rubens, Natrum sulph., Calc carb., etc.. Plant remedies include Aloe, Dulcamara, Pulsatilla, Cyclamen, Thuja, etc. Here is a repertory rubric with sources for the phlegmatic temperament and lymphatic constitutions.

*Reputed Remedies for the Phlegmatic Temperament and Lymphatic constitution*. h=Hering, k=Knerr, l= Lilienthal, c=Clark, a= H.C. Allen, bk=Boericke, bh=Bhanja.

agar., agn-c. (h), aloe. (h, a, k, bk), alum., am-c. (c), am-m. (a, k), anthr. (h), apis. (h), all-c. (bk), ant-c. (f), ant-t. (h, a, k), aran. (f), ars. (c), asaf. (h), ast-r. (a, h), bad., (f), bapt. (a, h), bar-c. (f), bell. (a, k, h), bov. (f), calad. (h, c, k, bh), calc-ars., Calc. (a, c, k, h), cann-i. (h), Caps. (a, c, h), carbo-an. (f), carbo-v. (f, l), cast. (c), caust. (h), chel. (h), chin. (k), cinnam. (h), clem. (k), cocc. (k, h), colch. (l), cycl. (h, c), cupr. (f), dig. (h), dros. (hm), Dulc. (k, a. c), ferr. (h), ferr-p. (h), graph. (f), hep. (h, k, a), hydr. (f), kali-bi. (k), kali-br., kali-c. (f), kali-chl. (f), kali-i (f), kali-n., (f), kalm., kreo. (k, c, bh), lach. (c, k), led. (k), lyc. (l, h), mag-m. (f), mag-s. (f), mang. (f), med. (f), merc. (k, l, h), Mez. (h, c, k), Murx., Nat-c. (c, k, bh), nat-chl. (bk), nat-m. (f, k), nat-n. (f), nat-s. (f), nit-ac. (f, l), nux-m., nux-v. (h), op. (k. h), petr. (f), phos. (l), phos-ac. (h), plat. (k, h), Puls. (h, k, a, c), rhus-t. (f, l), sabad. (j). sabin. (f, h), sars. (c), Sep. (c, k), seneg. (k, c, l, h), sil. (f), spig. (c), spong. (f), stann. (h), stront-c. (f), sul-ac. (k), sulph. (k, h), thuja. (a, f, k), tub. (f), ust. (c), vario, (f).

I have personally confirmed many of the above remedies in the clinic. Others are more experimental. The grades are based on the number of homoeopaths who offered references in materia medica and the clinical experience of the author (DL). Here are a few examples of the corresponding rubrics in the Homoeopathic Materia Medica.

1. Aloe

(H. C. Allen) Adapted to indolent "weary' persons; averse to either mental or physical labor; mental labor fatigues. Old people, esp. women of relaxed, phlegmatic habit. Extreme prostration, with perspiration. (Hering) Phlegmatic, indolent; Women of relaxed phlegmatic habit. Prolapsus uteri.

2. Asterias Rubens

(Phatak) This remedy produces disturbances of the circulation, with pulsations and congestion, in head, womb, chest etc. It has a decided action on female organs. Cancer; of mammae. Flabby lymphatic constitution. Left-sided symptoms. (Boericke) A remedy for the sycotic diathesis; flabby, lymphatic constitution, flabby with RED face. (Hering) Sycosis. Flabby, lymphatic constitution. [red starfish (red face)-lives at the bottom of the sea (lymphatic phlegmatic fluids), cancer of the mamma (water, cancer rules the breast).

3. Calcarea Carbonate

(H. C. Allen) Leuco-phlegmatic, blond hair, light complexion, blue eyes, fair skin; tendency to obesity in youth. Psoric constitutions; pale, weak, timid, easily tired when walking. Disposed to GROW FAT, corpulent, unwieldy. Children with red face, flabby muscles, who sweat easily and take cold readily in consequence.

(Hering) Pale, leucophlegmatic, weakly timid persons. Scrofulous constitution, with pale face, rather fair complexion and disposition to corpulence. More frequently indicated with the young; cannot be often repeated with the old, unless higher potencies are used. Diseases of children, especially during dentition. Children and sucklings become thick and gross, as if fat, but are pale and unhealthy. Leucophlegmatic temperament in childhood. Dentition. Fair, plump children. Crusta lactea. Urticaria, etc. Children: self-willed; fair, plump; fat, flabby, with red face, sweat easily, and readily take cold; large heads and abdomens, open fontanelles and sutures, and crooked legs.

4. Dulcamara

(H. Allen) Adapted to persons of phlegmatic scrofulous constitutions; restless; irritable. Catarrhal rheumatism or skin affections, brought on or aggravated by exposure to cold, damp, rainy weather, of sudden changes in hot weather. Increased secretion of mucous membranes; perspiration being suppressed from cold. These are all phlegmatic symptoms. (Hering) Phlegmatic, torpid, scrofulous patients, who are restless and irritable; take cold in cold damp changes. Dark hair: skin delicate, sensitive to cold; liable to eruptions from being exposed to cold.

5. Natrum Carb

(Hering) Leucophlegmatic constitutions, with aversion to open air and dislike to exercise, physical or mental.

6. Pulsatilla

(Hering) Persons of indecisive, slow, phlegmatic temperament; sandy hair, blue eyes, pale face, easily moved to laughter or tears; affectionate, mild, gentle timid, yielding disposition. Especially suitable for slow, phlegmatic, good-natured, timid people; for women, and especially during pregnancy. Sandy hair, blue, eyes, pale face, inclined to grief and submissiveness. Often indicated with women and children. Women inclined to be fleshy, with scanty menstruation.

7. Thuja

(H.C. Allen) Adapted to the hydrogenoid constitution of Von Grauvogl, which is related to sycosis, as effect is to cause. Thuja bears the same relation to the sycosis of Hahnemann-fig warts, condylomata and wart-like excrescences upon mucous and cutaneous surfaces that Sulphur does to psora or Mercury to syphilis. Acts well in lymphatic temperaments, in very fleshy persons, dark complexion, black hair unhealthy skin. (Hering) Hydrogenoid constitution; this constitution is distinguished from the oxygenoid and the carbo-nitrogenoid, in that it is more hygroscopic i.e., it possessed an increased capacity to contain water; hence, rain, cold, damp weather, baths, and food that increases the number of molecules of water in the system, aggravate the symptoms of the hydrogenoid constitution. Strumous and sycotic persons. Lax muscles; light hair; children.