Elizabethan dramatists are known for their fascination with the medical lore of their day, which was based on the ancient Greek teaching that each person has a constitution that is predominated by one or two of four humors. According to Hippocrates and Galen, some people are dominated by the hot and dry, or choleric humor; some by the hot and moist, or sanguine humor; others by the cold and moist, or phlegmatic humor; and still others by the cold and dry, or melancholic humor (Lewis 169). Each of the four humors corresponds to one of the four elements, one of four life stages, and one of the four seasons: choler is associated with fire, young adulthood, and summer; sanguine with air, childhood, and spring; phlegm with water, old age, and winter; and melancholy with earth, middle age, and autumn (Lewis 169-70, Hedley). Disease, according to this system, is caused by an imbalance or excess of humors, and physicians would prescribe herbs, changes of diet, or bloodletting in order to heal patients by bringing their humors back into balance (Culpeper 11). Ben Jonson and George Chapman wrote entire plays which center around the theme of humoral imbalances, and which are known as humoral comedies (Hunter 282). Although Shakespeare’s interest in early modern medicine may not be quite as overt as that of some of his colleagues, his plays are nevertheless peppered with references to the four humors.

One writer maintains that “there are far fewer phlegmatic leading characters in Shakespeare’s plays than there are sanguine, melancholic, and choleric. Besides Falstaff…they usually function in the subplot of the comedies…in tragedies they may appear in short scenes of comic relief” (Ekstrom). This statement is not accurate, and is based on a superficial understanding of the phlegmatic temperament. In addition to laziness and slow movement, phlegm is associated with characteristics such as prevarication, cowardice, avarice, and, most significantly, madness. Ophelia, Richard II, and Malcolm are all Shakespeare characters who suffer from a surfeit of phlegm. Ophelia is subjected to external pressures which intensify her imbalances, the subjects of Richard II rebel because of his phlegmatic imbalance, and Malcolm receives good advice and is eventually able to overcome his phlegmatic imbalance. Understanding phlegm can help students of Shakespeare understand the plots involving these characters with more clarity.

According to an exhibition created by the U.S. National Library of Medicine, “madness of the kind Ophelia suffers after her father’s death and Hamlet’s rejection of her would have been understood as a drying and overheating of the brain” (“Melancholy Virgins”). There is no source given for this assertion, and it is contradicted by Nicholas Culpeper’s translation of Galen’s Art of Physick, in which hot and dry brains are understood to be clear and clever—the main drawback of having a hot and try distemper in the brain is chronic insomnia: “we shall first give the indications of a hot and dry Brain…they have excellent quick and nimble Wits, they watch much…” (Culpeper 21). In his discussion of brains, Galen attributes symptoms of madness exclusively to the distemper of a hot and moist brain: “[people who suffer from hot and moist brains] cannot keep themselves awake neither can they sleep quietly, but are molested with Dreams, and troubled with foolish imaginations, so that many times they think they see the things they see not, and hear the things they hear not, especially if the Brain offend more in heat than it doth in moisture” (Culpeper 23).

At first, it might appear as if Galen is saying that madness is caused by an excess of the hot and moist sanguine humor, or blood. This is surprising, however, because many medieval and early modern texts indicate that blood is associated with disease less than any of the other humors are—Chaucer even says that blood is “natures friend” (Lewis 171). One of Giovanni Maciocia’s modern textbooks on Chinese medicine can help to clarify the Galenic conception of madness:

When the mind is obstructed, there is a certain loss of insight, resulting in confused thinking, irrational thinking and behavior and, if there is also Heat, manic behavior. In extreme cases, obstruction of the Mind leads to the psychosis seen in bipolar disorder and schizophrenia. However, it is important to realize that obstruction of the Mind occurs in a wide variety of degrees and having the Mind obstructed does not…mean mental illness in every case.

The Mind is obstructed by Phlegm or by Blood Stasis… (Chinese Medicine 447-48)

Fascinatingly, both Maciocia and Galen associate symptoms of psychosis with “heat.” Maciocia does not say that obstruction of the mind can be caused by the presence of blood, but he does say that it can be caused by the faulty movement of blood, and that it can also be caused by excess phlegm. That is, Maciocia says that madness can be caused by a problem with either of the two moist humors, and that mania occurs when heat is added to the mixture. Maciocia’s assertion that phlegm by itself can cause confused and irrational–but not psychotic or manic–thinking is exactly paralleled by Galen’s description of cold and moist brains:

The Brain afflicted with cold and moist distempers, moves a man to an inexpungable desire of sleep, and when he is awake, his Brain is so muddy, and his Senses so dull, that he can do nothing that will get him honor here, nor make him famous another day…his Head is full, though not of Wit… (Culpeper 25)

Before her madness, Ophelia is certainly not sanguine. The sanguine humor is associated with merriment, love, and courtesy; taciturn and docile, Ophelia unquestioningly obeys her father’s instructions to give up her lover, Hamlet, presumably without giving any kind of explanation to the latter (Culpeper 52-53, Hamlet. 2.1). Afterwards, she wordlessly agrees to be a tool in her father’s plot to trick Hamlet into betraying motivations which he is trying to hide (Ham. 3.1). Ophelia’s pre-madness behavior is in keeping with Culpeper’s description of the “dull” and “cowardly” phlegmatic temperament (Culpeper 57).

When Ophelia is subjected to emotional stress, her dull, phlegmatic behavior is replaced by manic psychosis. Laertes believes that her madness is caused by her grief for Polonius:

O heavens! Is’t possible a young maid’s wits

Should be as mortal as an old man’s life?

Nature is fine in love, and where ‘tis fine,

It sends some precious instance of itself

After the thing it loves. (Ham. 4.5.3037-41)

According to Maciocia, emotional stress causes Qi to rise, which in turn produces heat (“Empty Heat”). In the West, Galen introduced similar ideas about the effects of intense emotions on physical and mental health (“The Balance of Passions”). The specific image that Laertes is conjuring with “nature is fine in love” is Aristotle’s image of a flame burning upwards because it is lighter than the air around it: when a person experiences intense love, Laertes says, part of that person’s essence actually leaves his or her body and goes to the object of the love. Since Polonius is dead, Ophelia’s wits have flown to heaven with him. Whether it is called “rising Qi” or the “fineness of love,” what we have here is heat originating in emotion combining with Ophelia’s phlegmatic temperament to produce madness.

When he learns that Ophelia has drowned herself in her madness, Laertes says, “too much of water hast thou poor Ophelia,/ and therefore I forbid my tears” (Ham. 4.7.3335-36). This strange and sad pun could be understood in two ways, both of which are probably intended by the poet. Ophelia has, of course, drowned in water, and Laertes does not want to “add” to the water that drowned her, by crying. The other meaning of the pun is that Ophelia has been overcome by water internally—she has succumbed to an excess of phlegm, by dully sabotaging her own happiness by her obedient behavior before her father’s death, and by going mad after his death. Excessive crying is a pathology which, like dullness and madness, is also associated with phlegm, and Laertes is saying that, in honor of Ophelia, he will resist phlegm (Chinese Medicine 460).

In a note to his translation of Galen, Culpeper observes that a truly well-tempered man is “as rare as a phoenix” (Culpeper 12). In the English histories, perhaps more than in his other plays, Shakespeare focuses on the humors, contrasting a series of distempered kings with the perfectly tempered Henry V, who corresponds to Culpeper’s phoenix. Richard II is Shakespeare’s phlegmatic English king. Richard never becomes quite as mad as Ophelia does, but his characteristic indecision, rapid shifts in mood, and tendencies towards suspicion and tearful emotional outbursts betray a phlegmatic mind that is somewhat disturbed by heat.

When he disembarks from his Irish voyage, King Richard is elated, and, weeping, proclaims his feelings of joy, which he follows immediately with expressions of vindictiveness:

…I weep for joy
To stand upon my kingdom once again.

Dear earth, I do salute thee with my hand…

Yield stinging nettles to mine enemies

And when they from thy bosom pluck a flower,
Guard it, I pray thee, with a lurking adder
Whose double tongue may with a mortal touch
Throw death upon thy sovereign’s enemies. (Richard II 3.2.1411-30)

He follows these with declarations of confidence and invulnerability:

So when this thief, this traitor, Bolingbroke,
Who all this while hath revell’d in the night
Whilst we were wandering with the antipodes,
Shall see us rising in our throne, the east,
His treasons will sit blushing in his face,
Not able to endure the sight of day,
But self-affrighted tremble at his sin.
Not all the water in the rough rude sea
Can wash the balm off from an anointed king; (R2. 3.2.1455-63)

However, as soon as, in the same scene, King Richard learns of the execution of his favorites, he despairs:

No matter where; of comfort no man speak:
Let’s talk of graves, of worms, and epitaphs;
Make dust our paper and with rainy eyes
Write sorrow on the bosom of the earth,
Let’s choose executors and talk of wills:
And yet not so, for what can we bequeath
Save our deposed bodies to the ground?
Our lands, our lives and all are Bolingbroke’s,
And nothing can we call our own but death
And that small model of the barren earth
Which serves as paste and cover to our bones. (R2. 3.2.1554-64)

Hazlitt has pointed out that the king’s speech and behavior are often characterized by cowardliness and a failure to properly assess reality—he “is always lamenting the loss of his power which he has not the spirit to regain” (Hazlitt). If King Richard’s confusion and wild mood swings are not signs of actual madness, they are, at the very least, characteristic of a mind that is somewhat obstructed, and also touched by heat.

A Lutheran minister in the late nineteenth century gave a series of sermons on the spiritual side of the four humors, in which he describes the positive and negative tendencies of the phlegmatic:

If the choleric temperament is the grandest, and the sanguine the most amiable, the phlegmatic is the most practical of all…As of the other temperaments, so of this also, sin has taken hold…[The phlegmatic’s] practical activities excite in him sins of avarice and gain, rudeness and vindictiveness, deceit and cruelty, envy and suspicion. (Arndt 35)

This catalogue of phlegmatic sins corresponds remarkably well with Richard II’s behavior before Bolingbroke’s rebellion. Richard cruelly and rudely calls his dying uncle, John of Gaunt, a “lunatic lean-witted fool” (R2. 2.1.799).  Immediately after John of Gaunt’s death, the king avariciously seizes all of his uncle’s possessions, effectively disinheriting Bolingbroke. (R2. 2.1.847–49). The pretext of Bolingbroke’s successful rebellion is, of course, Richard II’s unjust pillaging of Bolingbroke’s inheritance. Bolingbroke at first convinces King Richard’s loyalists to join him by pointing out that

My father’s goods are all distrain’d and sold…

What would you have me do? I am a subject,

And I challenge law; attorneys are denied me;

And therefore, personally I lay my claim

To my inheritance and free descent. (R2. 2.3.1289-94)

Earlier in the play, after many lines of ridiculous indecision, Richard’s overly suspicious tendencies (and weak wits) lead him to banish both Mowbray, who is loyal to him, and Bolingbroke, who is ambivalent towards Richard (R2. 1.3). This is not an advantageous political tactic—Richard permanently exiles a potentially valuable ally, while further alienating a potential dangerous enemy. Richard’s actual death is unnatural, but the poor choices which lead up to it can, at least in part, be attributed to his phlegmatic temperament.

Malcolm, another phlegmatic prince, has a happier fate. He is an interesting foil to Macbeth: while Macbeth is an ambitious man of action who commits murder in order to gain a throne to which he has no claim, Malcolm is too cowardly to lawfully defend his right to the throne. He runs away to England as soon as he sees that his father has been murdered, and he does not voluntarily come back (Macbeth 2.3). As mentioned earlier, cowardice is typical of the phlegmatic temperament. Also noteworthy is Malcolm’s speech when he is confronted by Macduff—Malcolm’s descriptions of his own vices are striking:

It is myself I mean: in whom I know
All the particulars of vice so grafted
That, when they shall be open’d, black Macbeth
Will seem as pure as snow…

…there’s no bottom, none,
In my voluptuousness…
With this there grows
In my most ill-composed affection such
A stanchless avarice that, were I king,
I should cut off the nobles for their lands,
Desire his jewels and this other’s house:
And my more-having would be as a sauce
To make me hunger more; that I should forge
Quarrels unjust against the good and loyal,
Destroying them for wealth… (Mac. 4.3.1901–39)

When Malcolm is shamed into going with Macduff, he confesses that his previous confessions were false:

I put myself to thy direction, and
Unspeak mine own detraction, here abjure
The taints and blames I laid upon myself,
For strangers to my nature. (Mac. 4.3.1981-84)

The audience, which knows about Malcolm’s timidity from previous scenes, cannot be very surprised by Malcom’s retraction and explanation that his previous confessions were untrue; it can, however, be amused by his phlegmatic temperament, manifested both by the underlying cowardice and by the details of his first speech, which obviously has very little connection to reality. It can also be amused by his pliability and rapid shift in purpose, both of which are characteristic of the phlegmatic temperament as well. This scene is one of the few scenes of comic relief in Macbeth—Malcolm is a sort of Jos Sedley character. In the end, Malcolm fares better than Ophelia and Richard (and Jos Sedley) do: Macduff functions as a sort of a doctor, who, by example, nudges Malcolm out of his mild distemper and encourages him to be brave.

While, as we have seen, certain individuals have constitutions that are phlegmatic, there are also classes of people which are thought to be more phlegmatic than other classes of people: as mentioned earlier, the old and senile are especially associated with phlegm. So are women. In King Lear, Goneril discusses her father’s behavior with Regan:

The best and soundest of his time hath been but
rash; then must we look to receive from his age,
not alone the imperfections of long-engraffed
condition, but therewithal the unruly waywardness
that infirm and choleric years bring with them.

When the heat of King Lear’s choleric temper combines with the phlegm of his years, it can be expected that the result will be an “unruly waywardness,” or a sort of madness.

Like the elderly, women are, to a certain degree, more associated with the two moister humors than men are. I hope to discuss the importance of the sanguine humor as it pertains to Shakespeare’s women in another blog post. The most obvious connection between women and phlegm, which is one that comes up in countless plays, is the constant reiteration of the rule that women are more likely to cry than men are. Ironically, this idea is usually mentioned when a man is crying, or when a woman is not crying (as far as I can remember).  The full version of Laertes’s speech about crying for Ophelia is one example:

Too much of water hast thou, poor Ophelia,

And therefore I forbid my tears. But yet

It is our trick. Nature her custom holds,

Let shame say what it will. When these are gone,

The woman will be out.—Adieu, my lord.

I have a speech of fire that fain would blaze,

But that this folly doubts it.

Another example is Hermione’s explanation for her lack of tears when her husband falsely accuses her of committing adultery:

Good my lords,
I am not prone to weeping, as our sex
Commonly are; the want of which vain dew
Perchance shall dry your pities: but I have
That honourable grief lodged here which burns
Worse than tears drown…

That is, Hermione is an exceptional woman who does not cry, because she has a masculine choleric temperament, as evidenced by the burning action of her grief.

It is interesting to think about the connection between crying and phlegm. Tears are mostly water of course, and phlegm is the watery humor. “Wet brains” and obstruction of the mind may be relevant here as well: Hermione calls tears “vain dew,” implying that crying is a pointless and irrational act. The Greeks, of course, believed in the intellectual superiority of men over women, but men cry in Greek poetry nevertheless (I wonder whether men ever cry in Greek plays, though?). It seems to be the case that, at some point, Greek medical ideas became tied in with Greek philosophical ideas, and the taboo against male tears materialized. The idea that an emotional shock could produce a temporarily wet brain, which would involve temporary mental obstruction, fits with Galen’s general theory that emotions have effects upon physical health. The biological fact that men cry less often than women do must have, at some point, been linked to the fact that women were generally thought to be constitutionally wetter, which in turn was associated with the fact that women were thought be less intelligent.

While madness is not thought of as a monocausal disease in traditional medicine, phlegm is often considered to be a factor (Chinese Medicine 448). Whenever madness or other classic symptoms of phlegm—such as avarice or cowardice—arise in an early modern play, it is always worthwhile to consider whether the character in whom the symptom manifests may be a distempered phlegmatic. Distempered phlegmatics do have major parts in Shakespeare’s plays, and understanding the unique humor and pathos which Elizabethan audiences would have associated with their predicaments can increase a modern reader’s appreciation of the plays.


Works Cited


Arndt, Frederick. “The Phlegmatic Temperament.” The Homiletic Review, Volume 47. Funk and

Wagnalls Company, 1904, pp. 34–38.

Culpeper, Nicholas, ed. and trans. Galens Art of Physick. By: Galen. Peter Cole, at the Sign of

the Printing Press in Cornhill, 1652.

Ekstrom, Nelly. “The Humours in Shakespeare.” Wellcome Collection.

wellcomecollection.org/articles/the-humours-in-shakespeare/. Accessed 3 Dec. 2017.

Hazlitt, William. “Henry VI in Three Parts.” Characters in Shakespeare’s Plays.

ebooks.adelaide.edu.au/h/hazlitt/william/characters-of-shakespeares-plays/chapter17.html. Accessed 3 Dec. 2017.

Hedley, Christopher. “Which Humour Are You?” Henriette’s Herbal Homepage.

https://www.henriettes-herb.com/articles/hedley-humours.html. Accessed 16. Jan 2018.

Hunter, G.K. English Drama: 1586-1642: The Age of Shakespeare. Clarendon Press, 1997. Print.

Lewis, C.S. The Discarded Image: An Introduction to Medieval and Renaissance Literature.

Cambridge University Press, 1964.

Maciocia, Giovanni, “Empty Heat.” Maciocia Online.

maciociaonline.blogspot.com/2012/06/empty-heat.html. Accessed 3 Dec. 2017.

Maciocia, Giovanni. The Practice of Chinese Medicine. Churchill Livingstone Elsevier, 2008.

“Melancholy Virgins: The Case of Ophelia.” And There’s the Humour of It: Shakespeare and

the Four Humours. U.S. National Library of Medicine. http://www.nlm.nih.gov/exhibition/shakespeare/hamlet.html. Accessed 3 Dec. 2017.

Shakespeare, William. “History of Richard II.” Open Source Shakespeare.

https://www.opensourceshakespeare.org/views/plays/play_view.php?WorkID=richard2&Scope=entire&pleasewait=1&msg=pl. Accessed 3 Dec. 2017.

Shakespeare, William. “The Tragedy of Hamlet, Prince of Denmark.” Open Source Shakespeare.

http://opensourceshakespeare.org/views/plays/play_view.php?WorkID=hamlet&Scope=entire&pleasewait=1&msg=pl. Accessed 3 Dec. 2017.

Shakespeare, William. “The Tragedy of Macbeth.” Open Source Shakespeare.

https://www.opensourceshakespeare.org/views/plays/play_view.php?WorkID=macbeth&Scope=entire&pleasewait=1&msg=pl. Accessed 3 Dec. 2017.

“The Balance of Passions.” Emotions and Disease. U.S. National Library of Medicine.

https://www.nlm.nih.gov/exhibition/emotions/balance.html. Accessed 3 Dec. 2017.

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