The Four Temperaments or the Four Humours by Hippocrates: a global approach fo better patient care.

Ladies and gentlemen, dear colleagues, I am very pleased to be here this year in London, to share our experience and our research on nature’s path.

This is the first time that I am holding a conference in English,
To prepare for this presentation, I have expressed my four temperaments…so I will adapt and do my best ! Thanks Anne-Marie for this challenge.

Firstly, I was Phlegmatic when I had to show determination and loyalty to my ideas.
Then, Melancholic to summarize my thoughts and go straight to the point.
Choleric to handle my presentation the best I can and probably Sanguine when I’ll be having a good time with my friends and colleagues in about 30 minutes !

Nature’s path is the path I took last week in a preserved valley in the French Alps where
I was leading a group of students through the wonders of nature.

During those 3 days of discovery, I was deeply connected to the origins of our tradition, thanks to both nature and the elements. Let me explain.

Sturdy, solid and mineral is the Earth on which I feel safe and nourished.
Waterfalls, torrents, rivers and lakes give life to Water. Water sustains life, transports, cleanses, purifies, and adapts itself to any shape.

Air reveals itself as the wind, breezes or storms. It is so unpredictable and travels so fast, carrying pollen and seeds like so many other messengers.

And finally, Fire, as the sun warming us up and allowing every living-being on Earth to spread and transform

The Ancients (Our ancestors) were closely connected to the elements and to their manifestation in the four realms which are mineral, vegetable, animal and human.
Regardless of the continent and throughout the ages, every tradition goes back to the elements in their traditional medicine. Nature is a combination of four elements which rarely express themselves in a balanced way.

Each living being has these four elements deep inside them and each species has them in varying proportions.

Ayurvedic medicine, which is one of the most ancient systems of healing, distinguishes three temperaments. They are called The Doshas and they are a combination of the five elements.
Vata is composed of both air and ether. Pitta : fire and water and Kapha : water and earth.
Imbalance among these temperaments may cause illness

Taoïsm is based on the theory of the Five Elements and the Five Movements. 
Traditional Chinese Medicine considers that each element expresses itself through the behaviour of an individual, sometimes in excess or a lack of, determining thereby their temperament.

Closer to us, Arabic Medicine carried on the teachings of Hippocrates and Galen for centuries, influencing medicine throughout the Mediterranean Basin.

In Traditional European Medicine and since the time of Greek Antiquity, it was very common to link the elements to physiological and behavioural disorders.
This Medicine was influenced by Far East, Sumerian and Egyptian civilizations.

In « Timaeus », Plato introduces the four elements when describing the Creation of the World.

Aristotle said that the elements were mutually interchangeable. So, air and fire are « hot », water and earth « cold », water and air « wet » or humid and fire and earth « dry ».

The elements are not separated but deeply connected by properties allowing each element to transform into another.

This is a dynamic that reflects the movement of life.

According to his theory of the four elements, Hippocrates explains that diseases were not caused by some supernatural power as people thought at the time. He developed the theory of the four humors establishing a link between each human body fluid and one element. This theory of the humors is still used today in naturopathic medicine and must not be forgotten. It is the core of our global and holistic way of healing.

In biology, we talk about body fluids and homeostasis. Body fluid balance is constantly maintained by the human body with extraordinary accuracy. The environment, biology and of course psychological and emotional states deeply affect this balance.

Hippocrates, father of medicine, was a fine observer of nature and of human behavior. He suggested a link between each humor : phlegm, blood, yellow bile and black bile – the latter being probably hormones, and one specific element.
He observed in his patients differences in behaviour and reactions as well as particular tendencies towards certain illnesses with a link to the energy of one of the four elements. From these observations comes the theory of the temperaments carried on by Galen and applied to pathologies.

In everyday language, being hot-blooded means having a quick temper and a strong personality.
But, the word « temperament » refers to the humors the Ancients first brought to light, referring to the link between our inherent biological inner state and our behaviour.
We sometimes hear : « I am nervous » ; « My blood is boiling » or « she or he is good humoured » and so on…

One’s temperament is not only a temporary reflection of an emotional state nor the strongest personality trait. It is, as Hippocrates believed, a wide open book on the inner nature of each one of us.
Nature, influenced by genetic inheritance, defines and characterizes us from the beginning of life.

But we must also consider Nurture as the influence of external and environmental factors that shape us through life.

Each element, by its nature, defines one temperament and the predominant bodily fluid.


Given this, we see the following:

Water, cold and wet, manifests in phlegm and that reveals the « Phlegmatic » personality type
Air, hot and wet, manifests in blood and reveals the « Sanguine » personality type
Fire, hot and dry, manifests in bile and that reveals the « Choleric » personality type
Earth, cold and dry, manifests in « black bile », an ancient term used for hormones and that reveals the « Melancholic » personality type

The SLIDE representation summarizes those temperaments in a very schematic way.

Based on the Hippocratic Temperaments, Dr Louis Coman, French Doctor and father of morphopsychology, introduces on a « rational » basis the theory of expansion and contraction.

This theory explains the interaction and the links between the environment, morphology and the psyche. The shape of the body and particularly facial features reflect life forces that shape the human-being by expansion or contraction, according to the environment in which an individual evolves and adapts itself.

So, in that way, the Phlegmatic and the Sanguine tend to « dilate » (body and face) and appear to be shorter and wider whereas the Choleric and the Melancholic tend to « contract » and are taller and thinner.

Physical features are rather stable but the behaviour of an individual is constantly evolving, going from one temperament to another without significantly modifying the physical appearance.
An extreme dilated individual cannot dramatically change into a bean stalk.

(SLIDE Laurel / HARDY)

The theory of the temperaments offers a natural evolution that reflects the movement of life, from birth to death.
Each temperament is related to a specific stage of life.

Childhood is a stage of growth and expansion and it is related to the Phlegmatic. This temperament « goes with the flow » , like water, and adapts itself to any situation.

Adolescence is closer to the Sanguine personality-type and is still in dilatation. The Sanguine is sociable, « out going », unstable and volatile like air.

Adulthood is related to the Choleric personality-type and is more retracted.
This temperament tends to build its own future, take up challenges, like the energy of fire that spreads so easily.

Old-age is close to the Melancholic personality type who retreats into him or herself, into his mind and into his cave…in the Earth. He tends more towards self-reflection, introspection and wisdom.

But, reality is quite often more complex.

For instance, an individual can, for a long period of time, express the Sanguine personality-type. They will be very social, chatty and belong to a group of people. Sometimes called the « eternal adolescent » they will hardly experience other temperaments.

We are always influenced by a fundamental temperament that characterizes us.
Sometimes, a temperament fades away and leaves room for other temperaments according to life events (happy or stressful) that we experience. The temperament is the mirror of the energy in which we find ourselves at a certain point in time and on which we rely in order to adapt.
I am talking about physiological and psycho-emotional adaptations.

As we are most likely conditioned by the family environment and its « temperamental » characteristics, we tend to focus on one particular energy at the expense of another throughout the different stages of our lives. But it is also possible to develop other potential resources that we have within us in contrast to what is familiar or because we need to adapt to a particular situation.
So, thinking and self-reflection call upon the energy of the Melancholic personality type whereas sociability and communication characterize the sanguine personality-type.

Those two different energies may be necessary at some point in life.

It is this temperamental changing? dynamic that shapes and colors our existence.
The temperament is not static. It is an ever-changing dynamic that manifests itself sometimes in excess or in deficiency.

When one temperament dominates, we consider that the capacity to adapt has been used too often.
Firstly, the behaviour of the individual is disturbed and then, an imbalance in the organic functions appears without causing any illness. It is a shift towards homeostatic imbalance and dysfunctioning that we consider, in naturopathic medicine, as the warning signs of illness.
It is essential, in our practice, to observe those warning signs and make necessary changes to avoid a shift in the « terrain » (at least one French word!), the fundamental constitution of a person.

II

Determining the temperament is not an easy task since several aspects of an individual must be taken into account.

It would be simplistic to determine the temperament through facial features and body shape. (as is quite often done)
This would reduce an individual to a set of characteristics determining his or her temperament for good.

However reality is quite different.
In order to evaluate a person’s temperament we need to focus on :

Vital energy or guiding force
Behaviour
Capacity to adapt
Emotional states (expressed or repressed)
Psyche (particularly psychic construction)

And of course

Morphology, linked to physical aspects
Organic and physiological weaknesses

Let’s now focus briefly on the main characteristics of each temperament :

The Phlegmatic personality type.

The phlegmatic person is associated with Water. It is a cold and wet temperament (as described in Taoïsm)
Phlegmatic individuals are very sensitive to the cold. Childhood is the stage of development in which they evolve best.
They are rather stocky (which does not mean they are small… but the overall silhouette is short)
Also, the physical body predominates. They tend to gain weight easily and are often struggling with water retention. Their flesh is quite soft, their cheeks are chubby and their face is round.
Their hands are thick and their handshake is rather soft and cold.
In France, we always kiss our friends and family on the cheek to say « Hi ! » so handshaking is quite difficult to analyze … but usually we don’t kiss our patients on the cheek !

Let’s go back to our Phlegmatic with the blank stare and the vague look on his face.
The Phlegmatic’s gestures and flow of speech are quite slow.
The choleric personality type can be easily annoyed by the slowness of the phlegmatic personality type as we shall see later.

For the phlegmatic person, the digestive system functions slowly with microbiota disbiosis due to enzymatic hyposecretion which leads to absorption disorders.

Fluid stagnation generates a humoral excess load with organic waste as the result of the break down of carbohydrates and lipids causing mucositis. For the phlegmatic person, energy and effort are both constant. Phlegmatic people are quiet individuals. They are followers rather than leaders. We can count on them as they are loyal friends and partners. Stability in affection is more important for them than material stability and they won’t take much risk in their lives. They think things through and may take time to make a decision but when they do they never change their mind.

They are easy-going but easily influenced by others. They don’t express their emotions and do not talk much about their feelings. When they don’t feel well, they tend to repress feelings such as frustration, sadness, anxiety or injustice.
They suffer from a rather passive sexuality and a low libido.
Their energy is Yin and the kidney and bladder is their weakest system.
The Phlegmatic often says : « It’s fine by me ! »


The Sanguine

The Air element characterizes the Sanguine who is unstable and constantly changing.
Its nature is « hot » and « humid ». Sanguine individuals are warm and they always need air.
If you sleep with a Sanguine partner or find yourself in an unventilated room with a Sanguine, you’d hear them say :«  Oh it is so hot in here ! » and they would open the window or turn the air con on even if it’s wintertime and freezing outside.

But the phlegmatic and the melancholic can’t stand that at all !
The Sanguine dresses lightly even in winter. They look plump but tonic, Caucasian type. The skin complexion is rather rosy, almost red with large and chubby hands. The handshake is pleasant, generous, hot and humid.
The cardiovascular and metabolic system is rather weak. Food excess may cause cholesterol and tryglycerides. The pancreas may dysfunction as well with insulin resistance and diabetes. Body fluids are prone to be overloaded and in particular the blood which becomes thicker and produces metabolic wastesuch as mucositis that can be gotten rid of or not.

As long as they are happy with a situation or with their relationships, they are rather adaptable.

Very sociable, this temperament is in search of bonding, contact and belonging through which they build their personality.

Adolescence is the period of life where they feel at their best. During this period the need for belonging is most important.

Throughout their lives, they will seek eternal adolescence and the need to belong. They are warm and caring towards others but they are also inconsistent and it is difficult to count on them even if their feelings are true…today.. But tomorrow is another day!

They are often anxious or worried. They often express their feelings openly, words beyond their thoughts. Their sexuality is quite important for them. They are in search of pleasure and they have a high libido.
Their energy is rather Yang. Heart/Small Intestine is their weakest system in Traditional Chine s Medicine.

« Carpe Diem » is their philosophy.

The Choleric personality type

The element fire is related to the choleric temperament. Its nature is hot and dry.

They are rather slender and they tend to retract . Their face is square, angular and tonic.

If they belong to the Caucasian type, the true choleric has a rather olive complexion. 
Their hands are rather long with a firm, dry and strong handshake that could crush your hand. Their eyes are sharp and bright. Their liver is the weakest organ. Their metabolism suffers from biological disorders such as cholesterol, triglycerides and transaminases.
Acidifying elements in tissues are the result of the acidification in the body.
This may be taken care of thanks to physical activity and a healthy lifestyle.
This temperament is hardly adaptable and it seeks to be in control of situations. Everything must be planned and mastered. Choleric personality types are leaders, they build and they always have ongoing projects.

However, they do not always finish them, they tend to delegate to others but this is not easy for them to do so. Also, they don’t like to waste time and they always plan their holidays like they do plans at work. Sometimes it is exhausting for their friends and family.

Their sexuality is planned as well which does not leave room for surprise and creativity. Their libido is quite good but they can easily turn it into physical and mental energy. They are determined and combative. Emotions such as anger, resentment, jealousy, anxiety and suspicion mostly define the choleric.

Their incessant need for control helps them evacuate anxiety.
You may have understood that the choleric is a real go-getter. Their energy is clearly yang +++ compared to the sanguine. Physical activities help them unwind and remove stress and fatigue.

The Liver and gallbladder is the weakest system. « I’m in control » would be their punch line/key words.

The Melancholic

Now I am going to talk about the melancholic personality type who is connected to the Earth element. Their nature is cold and dry and they tend to be very sensitive to the cold. Physically they look tall and thin and retracted with a triangular face (pointing down).

The forehead is prominent and it is a sign of intellectual capacity. Their hands and the fingers are rather long. The handshake is dry and cold and not very pleasant. The look on their face seems anxious and inquiring. Sometimes both at the same time.
The weakness in this temperament is the neuroendocrine system. Psychological disorders, degenerative diseases or hormonal imbalance are very common in this temperament.

The emunctory organs tend to close. Acidosis is intensified and it is characterized by the crystallization of organic acids. They accumulate and fix in the body, developing sclerosis or calcification.

The melancholic temperament is introverted and thoughtful. These individuals are self-centered and do not show interest in others. Also, they tend to lock themselves up, think, inquire and ask specific questions on many different subjects. The melancholic has doubts and it is very difficult for this person to make a decision.

They think and plan before they act. They can be helpful advisors for the choleric who will act without thinking.

Melancholics are calm and quiet followers and deeply introspective. It is the least adaptable temperament. Their social life is very limited as it is hard for them to make friends. (other than if they share the same hobbies)

They need to master and control their lives. The main emotions are melancholy and sadness but fear, injustice and frustration are also present.

The melancholic temperament reveals itself in the last stage of life when the individual takes a step back and evaluates what is important in life.

Either melancholy and regret overtake them or wisdom and fulfilment rise to the surface.

The melancholic is inclined to spirituality. Their relationship with others is not their priority and sexuality is sometimes missing in their lives. It is more of an obligation than a pleasure.

The energy of the melancholic is weak so they tend to save it and use it rather for mental activities than physical ones.
Their nature is Yin, cold and dry. The Lungs and Large intestine is their weakest system.

« I’ll think about it » are the key words of this temperament.


Each of one us has a fundamental temperament but we mostly find temperament combinations or blends such as Phlegmatic/Sanguine, Sanguine/Choleric or Choleric/Melancholic with a better balance but a great complexity.

This is the richness of the human-being.

III

Over the 25 years of my clinical practice, I have always worked with the four temperaments.
Indeed, they allowed me to assess the « terrain » of an individual and prevent them from developing towards serious illness using personalized patient care.

It is essential, in our pratice to consider the temperament in order to adjust our strategy.
The teaching that I provide in my naturopathy school, Aesculape, insists on this idea.

The temperaments are rooted in tradition but still very much compatible with our modern vision and our knowledge of biology and physiology.

Depending on the prevailing temperament, we will choose specific diets and health practices to balance the temperament.

For instance, when the Phlegmatic personality type is particularly dominant, we observe a stagnation in the internal environment (such as stasis, lymphatic overload, blood congestion, oedemas…) and digestive disorders. The recommendations we give would aim at reducing high-water-content foods (such as fruits or raw vegetables). The Fire Element would also help make improvements by stimulating the lymphatic system using warming spices and herbal remedies and drying techniques such as sauna (which is warm and dry).

The temperaments, as you can see here (slide), are based on a logical dynamic and movement that follows the nature of the element with its corresponding temperament.

On the upper left, the Phlegmatic, dilated, wet and cold (Water element)
On the lower left, the Sanguine, dilated, wet and hot (Air element)
On the lower right, the Choleric, retracted, dry and hot (Fire element)
And finally on the upper right, the Melancholic, retracted, dry and cold (Earth element)

The temperaments are also based on the natural evolution, from birth to death, going from a liquid environment ( for example, the amniotic fluid of the mother), in a movement of adaptation and expansion, to a rather dry, retracted and concentrated environment.

We always use this grid to evaluate the temperaments. Their proportion (physical or behavioral) determines the diagram that will help establish a strategy and offer individualized care.

Here (slide) you can see that the predominant temperament is the Choleric, then the Sanguine and very slightly the Melancholic. The Choleric is over manifesting here through an excessive behavior, anxiety, anger, control, joint pain and metabolic disorders (such as disturbed hepatic function)

The strategy consists in balancing the Choleric temperament (fire) using the opposite element on the grid corner, which is here the Water Element (on the upper left). The Choleric temperament is reaching the center, balance is gradually restored and physical and mental conditions are improved.

The opposite element, on the corner of the diagram, will always balance a temperament that is overly dominant.

As you can see here (slide) :

The Phlegmatic (water) is balanced with Fire
The Sanguine (air) is balanced with Earth
The Choleric (fire) is balanced with Water
The Melancholic (earth) is balanced with Air

To illustrate that, let me me talk about Virginie, one of my patients.

As soon as Virginie steps into my office, she lets me know that I am 6 minutes late.

This young 32-year-old woman looks rather slender and elegant.

Her handshake is firm and she stares at me as if she were reading my thoughts and analyzing the situation. Physically she looks tonic with well-defined arm muscles.

Her face is rather retracted with prominent cheek bones and chin.
She sits up straight without touching the back of the chair. Her flow of speech is rapid and she uses precise words. Also, she looks alert and quick-witted.

She has been very keen on sports since childhood but today she suffers from joint pain.
Chronic tendinitis, persistent back pain and lumbago (7th and 8th dorsal vertebrae) are slightly relieved by osteopathic manipulation.
She takes anti-inflammatory pain relievers but she doesn’t tolerate them well.
Today she wants to find real solutions « to control » her lifestyle and her diet.

Her joint disorders started at the age of 15 when she started swimming at school.
Training was very intense and so was the school rhythm.
And she was fine with that. « Just another challenge ! » she says.

She runs her own business and still does some work out.
She goes running for 30 to 40 minutes every day and also goes to the gym 2 or 3 times a week despite her pain. She says that it is really important for her balance.
« Physical exercise helps me reduce stress and fatigue » she says.

Virginie knows how to control her emotions. She can feel exasperation, anger or impatience but she never expresses those emotions. She would rather control and repress them.
She can’t relax, let go and appreciate the present moment.
Whether she is with friends or family she is always on alert.

She is on a high-protein diet and she eats lots of dairy products (cheese after every meal…)

Virginie is on a high-protein diet, she eats many dairy products (cheese after every meal…ok we are in France but this is not a good reason !) cooked vegetables and very little fruit and raw vegetables. (Less than once a day)
She drinks mineral-rich water and has a preference for salty food (she uses refined table salt) and spices. She drinks more than four coffees a day, does not drink alcohol and doesn’t like deserts.

Her digestive system works properly. Diuresis is almost at 1liter every 24 hours. During the day urine is dark yellow and it gets even darker after physical activity. She sweats with little effort, also at night mostly when she has eaten animal proteins for dinner. Her skin is rather dry. She wakes up between 2 to 3 a.m 4 to 5 times a week when the liver and gallbladder meridian is most active. She is sensitive to strong smells with feelings of nausea. Windy days increase this condition showing a higher liver sensitivity.

Virginie demonstrates a typical Choleric temperament.

The choleric temperament is over manifesting here ( I cannot describe the whole clinical case during this lecture) but this is certainly the reason why her joint pain keeps getting worse. The main strategy aims at balancing the temperament by using the water element and cold.

I suggested she modify the following points :

Firstly, her lifestyle, by balancing her physical activities by getting back into swimming (not competitive)

Walking or running by the seaside.

And praticing derivative baths ( 3 to 4 times a week at least )

Then her diet by increasing her intake of fruit and raw vegetables  :

Introducing cold and wet foods such as avocados, apricots, pineapples, cherries, mushrooms (raw or cooked), lemon and lime, clementines, cucumber, pickles, marrow, aubergine, crab, crawfish crayfish ?, chicory, spinach, strawberries, raspberries, passion fruit, guava, sprouted seeds, yam, kiwi fruit, lettuce, corn, mango, melon, millet, blueberries, nectarine, watermelons, peaches…

Drinking low mineral bottled water with mineral content of 250 to 500 ppm.

Prefering steaming to stir-fry.

Changing salt quality and reducing salt intake.

Reducing acidic foods (dairy and proteins at dinner time)

Reducing warming spices and replacing them by sweeter aromatic plants.

A specific protocol using plant therapies and minerals was recommended on a two-months basis:

Aromatherapy and olfactotherapy (using relatively low doses):

Mentha x piperita (peppermint) in the morning
Rosmarinus Officinalis verbenone in the evening

Two drops of each essential oil to take orally and to inhale
For 21 days, 2 times a day

Those essential oils contain ketones and aldehydes which have anti-inflammatory properties and help balance the Fire element in the Choleric temperament.
According to Mr Pierre Franchomme’s referential chart, they are considered as hypothermal and hydrophilic molecules.

Gemmotherapy (using buds or young shoots 1/10th dilution)

Ribes Nigrum Bud 1/10th dilution
(Blackcurrant)
40 drops a day
For 21 days, 2 times a day

These recommendations help support adrenal and renal functions and evacuate acids.

Mineral supplies

Phosphorus and calcium intakes are essential to balance an overly acidic terrain (from mineral loss due to acidosis)

Schussler’s mineral salt remedies help restore a balance:

Calcarea Phosphorica 6th D (decimal)
3 tablets a day for 60 days

Bach Remedies help restore emotional balance

In this case I used the « Holly » remedy since anger was the most predominant emotion at that time. In traditional Chinese medicine (TCM) anger slows down the liver function which is a very sensitive organ for the Choleric temperament.

3 drops morning and evening for 21 days

One and a half months later, changes were pretty clear.
Pain (mostly tendonitis) completely disappeared and back pains improved after two months.
Virginie’s behavior changed. She was more in search of pleasure than control.
Also, she started mindfulness meditation and learned how to let go easily.
Her health condition stabilized over the following months.
Virginie succeeded in balancing her choleric temperament leaving more room for the Sanguine (ie: pleasure) and the Melancholic (i.e. introspection)
Although we made use of the water element, the Phlegmatic temperament did not manifest itself.
Water element was used as a leverage to help Virginie find a new temperamental balance.

Over the last 25 years of clinical practice spent observing my patients, I have been able to note how individual recommendations and advice given in relation to a particular personality type truly made a difference in terms of results in the long term.

We can of course apply a standard protocol in naturopathy, which tends often to be symptomatic, when we think strictly in terms of the illness or a dysfunction, which obtains results over the short term.

Obviously, patients sometimes have difficulties in persevering because improvements to their condition don’t always come about rapidly. However, when patients accepted to make an effort over a length of time from 2 to 6 months, the results obtained in their general state of being and their emotional well being were deep and lasting.

Before finishing up, I would like to present my findings, which I carried out over the last 6 years of practice with 1250 patients:

Benefits of a temperament strategy in individual naturopathic recommendations for better patient health care over the long term

Methodology
Sample of 1250 patients followed over 6 years.
Adults from 21 to 75 years
Women: 69% Men: 31%
Length of consultation: 50 to 60 minutes.
Consultation tools: Person-centered approach (Carl Rogers) – Transactional analysis – NLP neuro-linguistic programming – Active listening
Other assessment tools used: morpho psychology –Vannier constitutions (Homeopathy) – biological analysis.

Reason for consulting (question asked at beginning of consultation):

• A /To accompany a degenerative illness, auto immune illness or cancer previously diagnosed and medically treated: 58%
• B/ To accompany functional disorders medically treated (metabolic syndrome, high blood pressure, pre-menstrual tension, cholesterol): 17%
• C/ To accompany functional disorders non-medically treated (same as before): 10%
• D/ To accompany an identified psycho-emotional state (excluding psychiatric pathologies): 9%
• E /To accompany a preventative objective: 6% (!) 6% only, it’s a shame, that is meant to be the heart of our practice ☺

If we focus on line A, we see that out of 621 patients (group 1), 361 having a degenerative illness, an autoimmune illness or cancer followed the recommendations specific to their temperament in terms of life style, nutrition, as well as in plant remedies, in aromatherapy, gemmotherapy (plant buds), Schussler mineral salts and Bach Flower remedies.

They were also followed in allopathic medicine and sometimes in psychotherapy. For these patients, the improvement rate to their general state of being (clinical signs, sleep, emotions, functioning of emunctories (our filters and excretory systems), general biological markers, inflammation, immunity) was 72% after 1 year compared to 54 % for group 2 (364 patients) who had rather partially followed the advice or followed it in an irregular way.

Three years later, group 1 had a general state of aggravation of 28% against 42% for group 2. Six years later, the level of state of aggravation was 12% for group 1 against 21% for group 2.

The differences are sufficiently significant between the two groups and in all the categories to underline the necessity of taking into account the temperamental approach in accompanying our patients to better health.

To summarise, I suggest you take away the following points that can be used during a consultation:

• Identify the fundamental temperament and the temperamental dynamic (if expressed)
(Slide)
• Identify a dominant expression of temperament
(Slide)
• Regulate the dominant temperament expressed by using the energy found in the opposite element, and by using the natural tools as reflected in this element (Slide)

Ladies and gentlemen, colleagues, it is time for me to wrap up. I have aimed, during this short presentation, to make you aware of the importance of taking an overall holistic approach to patient care, more in line with the traditional roots of our art, closer to nature’s path.
Health, illness, life and death are all along this journey. The energy making us live or want to live comes from nature and its four elements. Mankind, whether we want it or not, is subject to the laws of nature, we must conform if we want to live in good health, in harmony with our environment and with ourselves.

Our elders observed nature in order to better understand the human race and it is through this magnificent prism of the elements that they better understood the ways of working of mankind as a whole and in all its aspects. Today, we tend to forget this unity of man and the unity of nature as one. We dissect, we analyse, we separate down to the smallest part and we distance ourselves from this overall unity.

Four elements, four temperaments, one common point : energy underlying life. Four elements which find a balance in one single point, could that be the 5th element, the very essence? Love, perhaps?

Thank you for your attention.

Dominick Léaud-Zachoval
Conférence donnée en anglais à Londres – ICNM 2017
International Congress on Naturopathic Medecine