The Nutriment Of Hippocrates

The Ionian philosopher Heraclitus, who flourished around 500 B.C., was even in ancient times known for his obscurity and elusiveness.  His well-deserved nickname was “The Obscure,” due to the fact that his elliptical sayings could be variously interpreted.  Yet this was no impediment to his influence; his renown was considerable, and his fame rested on the strength of one book, On Nature.  Time has not preserved it for us intact, but we do have about a hundred short fragments, and these provides us with the rudiments of his thought.

Some of his key precepts were these:  fire is a generative force in nature; there is a duality to all things, so that they may be simultaneously good and bad; and conflict between opposites can lead to a sort of harmony, or balance.  I have lately been reading the medical works of Hippocrates, and find Heraclitan ideas embedded in much of the physician’s thought.  Hippocrates is no dogmatic adherent to one system of belief, of course; as a man of experience and knowledge, he was always careful to promote the value of experimentation and direct observations as prerequisites for informed opinion.  And yet long experience in treating patients must have cause him to reflect on patterns and recurrences.  He must have been impressed by the human body’s attempts to fight off disease and seek an equilibrium between opposing states.  He must have marveled at the operations of the organs, and how they worked together as a harmonious whole.

It is against this backdrop that we must view Hippocrates’s most unusual work, the Nutriment.  It is more philosophy than medicine; in length only around fifteen pages, it is nevertheless a striking example of the aphoristic Heraclitan style.  The general subject of the essay is how the body nourishes and sustains itself; but it touches on many other unrelated subjects as well.  Both food and the human body, says Hippocrates, have a certain innate power (δύναμις); this power can vary depending on external factors (such as climate, environment, and stresses), as well as internal ones (nourishment, digestion, qualities of food and drink).  From this basic principal he derives all kinds of statements and conclusions about the relative nature of all things.  Some of them are maddeningly vague (which, a cynic might say, is most convenient for the author).  I have summarized what I believe are the basic ideas found in his Nutriment, along with illustrative quotations where appropriate.

1.  The form of nutriment varies, depending on the quantity of “moisture” or “dryness” contained in it.

2.   Nutriment is a continuous process, designed to support and prolong the body’s life:

Nutriment is that which is nourishing; nutriment is that which is fit to nourish; nutriment is that which is about to nourish.  (VIII).  [Quotations of Hippocrates trans. by W.H.S. Jones]

3.   Nature is the controlling agent in the health of the body.  A physician’s task is to assist nature in the effort to overcome disease.

4.   The body is an organic whole and must be treated as such:

Conflux one, conspiration one, all things in sympathy; all the parts as forming a whole, and severally the parts in each part, with reference to the work.  (XXIII).

5.   The quantity of one’s food intake should synchronize with the body’s powers of toleration.  In other words, both repletion and depletion should be avoided with regard to food:

It is a great thing successfully to adapt quantity to power.  (XXXV).

6.   Life force is not just for living things.  Even inanimate objects can be possessed of some vital, sustaining power:

Inanimates get life, animates get life, the parts of animates get life.  (XXXVIII).

7.   What is good, and what is bad, are relative and depend on the situation:

Blood is liquid and blood is solid.  Liquid blood is good, liquid blood is bad.  Solid blood is good, solid blood is bad.  All things are good or bad relatively.  (XLIV).

We should emphatically note here that Hippocrates uses this principle in one context only, that of medicine and healing.  He never says, or even implies, that ethics or morals are “relative” or situationally-dependent.  In fact, he states the opposite in his other writings.

8.   There are times when the quality of nutriment, not its quantity, is what truly matters. Large volumes of food and drink do not automatically confer inherent benefit.  On the other hand, there may be times when the reverse is true:

Power of nutriment superior to mass; mass of nutriment superior to power; both in most things and in dry.  (XLVI).

9.   There is a correspondence between end and beginning, such that the end of one cycle should be seen as the beginning of another. Change is the proper state of the universe, in both medicine and in physics:

The beginning of all things is one, and the end of all things is one, and the end and beginning are the same.  (IX).

These, then, are the essential principles found in Hippocrates’s Nutriment.  Without doubt he was a Heraclitan; ancient sources, including Aulus Gellius, ascribe the Nutriment to Hippocrates himself.  And yet the influence of Heraclitus on the course of medical history has not been given its proper due, I think.  The reader’s natural reaction to reading them may be to shrug his shoulders and say, “Of what use are these ideas?  They seem to be so general as to be within the grasp of any person.”  Yet further reflection will show that this superficial view overlooks the profundity of the philosophy expressed.  These are concepts that permeate all life, yet pass unnoticed by us in the hectic flow of our daily struggles.

As we stumble and stagger about our business, we are likely to forget the primacy of such principles as harmony, unity, the duality of all things, and the permanence of nature’s cycles.  Rare it is that we take note of them; even more rarely do we ever make an effort to master them, or to apply them to our personal situations.  But this is the heart of Heraclitus’s, and Hippocrates’s, view of the world.  We spend much time—far, far too much time—seeking to impose our will on external events, racking up huge debts in anxiety, anguish, and distress, without pausing to consider that it is only our own erroneous opinions that may make things “good” or “bad.”  We do not realize that all things move in cycles, and that the end of one cycle is the start of another, and that this new cycle may bring better fortune.  The wise man, then, will wait patiently for his luck to turn, as it always does; and when this happens, he will seize the moment.  As Cicero says in Tusculan Disputations (IV.17):

And so this man, whoever he may be, whose mind is calm with moderation and steadfastness, and who is truly at ease with himself, so that he neither wastes away in anxiety nor crumbles to pieces in fear, nor burns with a thirst for chasing some passion, nor pines away in the ebullience of futile ardor:  this, indeed, is the wise man we are looking for.  [Trans. mine]



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