Where Do the Words Choleric, Sanguine, Phlegmatic, and Melancholic Come From?

The four words we use today to describe a temperament (choleric, sanguine, phlegmatic, melancholic) come literally from the four bodily fluids ancient medicine used to explain human health.

Their journey into our vocabulary has four stages: the Hippocratic physicians, who spoke of humors; Galen, who spoke of temperaments; Kant, who turned them into character types; and Eysenck, who translated them into measurable dimensions.

Hippocrates and the medicine of the four humors

Hippocrates, considered the father of medicine, lived in the fifth century BC and stood out for one specific idea: disease didn’t come from supernatural causes or divine punishment, but from the body’s own nature.

The clearest formulation of the four humors appears in the Hippocratic treatise On the Nature of Man, written around 400 BC and often attributed to Polybus, Hippocrates’ son-in-law. According to that text, the body contains blood, phlegm, yellow bile, and black bile, and health depends on the balance among them. When the body vomited, coughed, or sweated, it was supposedly trying to get rid of an excess of one of those fluids.

Each humor was also linked to two qualities (hot or cold, dry or moist), to a season of the year, and to one of Empedocles’ four elements: blood with air and spring; yellow bile with fire and summer; black bile with earth and autumn; phlegm with water and winter. It was a complete system for ordering the world, and the body was one part of it.

In the Hippocratic texts, however, the humors mainly explain health and disease. The idea that the dominant humor defines a person’s character came later.

Galen: from humors to temperaments

The decisive step was taken by Galen of Pergamon, a second-century Greek physician who worked in Rome. In his treatise On the Temperaments he speaks of krasis, mixture, which was translated into Latin as temperamentum: the proportion in which the qualities combine in each body.

Galen described nine temperaments, not four: one balanced, four with one dominant quality, and four with two. And he linked those mixtures to dispositions of mind: an excess of black bile, for example, to sadness and fear.

The four-type version that has come down to us, each with its dominant humor and its psychological portrait, is a later simplification. It took hold in the medicine of late antiquity and the Middle Ages, which passed it on for more than a thousand years until it became everyday language.

The etymology, word by word

Each of the four temperaments still carries in its name the trace of the humor that gave rise to it:

• Choleric, from the Greek kholé (yellow bile): in the classical scheme, a fiery, energetic, irritable person, quick and intense in their reactions.
• Sanguine, from the Latin sanguis (blood): an optimistic, sociable, easygoing person with a light, contagious manner.
• Phlegmatic, from the Greek phlegma (phlegm): an unhurried, calm person, with a composure that other temperaments can mistake for indifference.
• Melancholic, from the Greek melaina kholé (black bile), the humor ancient theory placed in the spleen: a reflective, sensitive person with a tendency toward sadness.

The same source gave us expressions we still use without a thought for anatomy: being in a good or bad humor, being cold-blooded, or choler as an old word for anger.

Kant: the temperaments as character types

In 1798, Immanuel Kant devoted a chapter of his Anthropology from a Pragmatic Point of View to the four temperaments. Kant no longer believed that blood or bile explained anything; he used the names as psychological descriptions.

His contribution was to put them in order. He distinguished two temperaments of feeling, the sanguine and the melancholic, and two of activity, the choleric and the phlegmatic, and within each pair one was marked by liveliness and the other by slowness. It was an early attempt to explain the four types from a few underlying dimensions, instead of treating them as four unrelated boxes.

Eysenck: the bridge to modern psychology

The idea of dimensions was developed in the late nineteenth century by Wilhelm Wundt and taken up in the twentieth by psychologist Hans Eysenck. Eysenck, who measured personality with questionnaires and statistical analysis, found that the four classical portraits fit into the quadrants formed by two of his dimensions, extraversion and neuroticism (or its opposite, emotional stability):

	Stable	Unstable
Extraverted	Sanguine	Choleric
Introverted	Phlegmatic	Melancholic

It’s a coincidence with a basis. The ancient physicians got the cause completely wrong, because humors don’t explain character, but they had observed people well: sociability and emotional reactivity are still two of the most important axes for describing personality, and both are part of the Big Five model.

The supposed Aztec typology

In his popular book Omgiven av idioter (2014; in English, Surrounded by Idiots), Swedish consultant Thomas Erikson claims that the Aztecs used a classification of temperament based on four elements (fire, air, earth, and water), similar to the Greek one, and that they left carvings depicting it.

Erikson cites no source for that claim, and our editorial team has found no historical documentation to support it. Mexica cosmology did organize the world into four directions and told of a succession of eras or suns, but no personality typology follows from that. The prudent course is to treat it as an unverified anecdote, not as a historical parallel.

From humor to color: the line that runs to today

The underlying idea, four broad ways of reacting to the world, outlived the collapse of the medical theory that produced it and resurfaced in 1928 in Emotions of Normal People, by psychologist William Moulton Marston.

Before that, Marston had researched a very different field: as we tell in the article about the early lie detector he also invented, his first work linked blood pressure to lying.

Marston didn’t start from Hippocrates. His four categories, which he called Dominance, Inducement, Submission, and Compliance, came from crossing two axes: whether a person perceives their environment as favorable or unfavorable, and whether they respond to it actively, trying to change it, or passively, adapting to it. But the architecture, four types born from the crossing of two dimensions, is the same one Kant and Eysenck saw in the classical temperaments.

Today that idea survives, without bile or phlegm, in the language of colors popularized by writers on the DISC model: red, yellow, green, and blue. If you’re wondering which one fits you best, the DISC 4 Colors test shows you in a few minutes.

Sources

• Hippocrates (attributed to Polybus). (ca. 400 BC). On the Nature of Man. Hippocratic Corpus.
• Galen. (2nd century). On the Temperaments (De temperamentis).
• Kant, I. (1798). Anthropologie in pragmatischer Hinsicht (Anthropology from a Pragmatic Point of View).
• Eysenck, H. J. (1967). The Biological Basis of Personality. Charles C. Thomas.
• Erikson, T. (2014). Omgiven av idioter. Hoi Förlag.
• Marston, W. M. (1928). Emotions of Normal People. Kegan Paul, Trench, Trubner & Co.