Greek Herbal Medicine: The Four Qualities and the Four Degrees by Matthew Wood

Greek Herbal Medicine: The Four Qualities and the Four Degrees by Matthew Wood

Intro: The following is an excerpt from the Spring 2012 issue Plant Healer, herbalist Matthew Wood’s excellent explanation of the basics of Greek Herbal Medicine, a predecessor to subsequent Western herbal healing traditions.  This never before published work is an example of the contributions Matt has been making to Plant Healer Magazine through his regular column, and to our contemporary herbal community. Matthew is also teaching on related subject matter at this year’s Traditions in Western Herbalism Conference in the lakes region of northern Arizona!

–Kiva Rose and Jesse Wolf Hardin

Greek Herbal Medicine: The Four Qualities and the Four Degrees

by Matthew Wood

Excerpted From the Summer Issue of Plant Healer Magazine

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Wild Black Cherry, Prunus serotina, ©Kiva Rose

The Galenic system of herbalism is based on the energetics of the four qualities (hot and cold, damp and dry) and their subdivision into four  degrees or grades. Over the centuries the original meanings of the qualities and degrees have been forgotten so that today it is almost impossible to understand the Greek system at first glance.

How could this be the case?  Remember that the Greeks didn’t have thermometers they couldn’t measure temperature or humidity in an objective way.  They had no idea what  heat  or  damp,  therefore they understood them by what they did.  Thus, example, heat is that which  purifies  a substance so that impurities are driven away (this is how we might think of fever), or which mixes substances so that they become one substance in nature (like cooking ingredients together in a soup).  This may not seem like a very important distinction at first, but it becomes much more important as the properties of heat are divided into  degrees.

We also don t understand degrees as the Greeks did.  We look upon degrees as a system of measurement of intensity or space or time, like numbers on a thermometer or around a circle.  For the Greeks, on the other hand, degrees were divisions and each division was completely different in nature.  Thus, for example, heat in the first degree opens pores, heat in the second degree thins fluids, in the third degree it warms and in the fourth it burns.  Furthermore, the second degree includes the first and fourth includes them all.  Thus, the degrees are really more like what we would call  grades.   Like grades in a school one is either in one grade or another and the fourth grade builds on and includes the properties or lessons of the third, second, and first grades.

We would tend to think of heat in the third degree as slightly warmer than heat in the second degree, but this is not what the Greeks meant. Warmth was only one of four major qualities or grades of heat.  How were they to discuss the smelting of iron ore versus the burning of wood if they didn’t have a system of measurement?  Melting ore to purify out the metal seemed to them to be a type of thinning.  The ancients could not measure the difference on a thermometer so instead they observed the actions of heat: opening, thinning, warming, and burning, and arranged them in ascending intensity.  The grades of the qualities therefore refer to actions, not measurements.

And yes, these  actions  are more or less the origins of what we call  actions  in herbalism today.  Thus, remedies cooling in the first degree are  refreshments  (this is now a food, not a medicine), coolants in the second degree are  refrigerants,  those of the third degree are  sedatives  (they not only reduce fever but sedate the mind).  Those of you who learned your medical lessons from Granny on The Beverly Hillbillies will know that  vapors  are caused by excessive heat agitating the nervous system and are treated by cooling medicines.  Herbs cold in the fourth degree so benumb consciousness that they are anodynes like opium.

If we multiple each of the four qualities by the four grades we will arrive at a total of sixteen actions, some of which are still used by herbalists today, some not.

We herbalists are the heirs of magnificent traditions.  We have the dozen or so great American Indian female remedies from the Natives of this continent (black and blue cohosh, wild yam, trillium, raspberry, true and false unicorn root, etc.)  We also preserve the ancient Greek system of energetics in our herbal actions, though we have lost the thread leading back to the energetic system that spawned them.

This change took place in the second half of the seventeenth century, at least in Anglo-American medicine.  In 1654, Nicholas Culpeper still understood the meaning of the four grades of the qualities, even though he used astrology instead of Galenic medicine.  Without doubt, he had been trained in them as an apothecary s apprentice.  Yet in 1689, in his terrific analysis of tastes, actions, properties, and pulses, John Floyer understood the degrees as we would today, as intensifications in taste, sensation, and degree on the thermometer, not as different actions.

The Four Qualities

The four qualities trace back to Aristotle and here is what he said about them:

Hot is that which associates things of the same kind. . .  while cold. . . associates homogeneous and heterogeneous things alike.  Fluid is that which, being readily adaptable in shape, is not determinable by any limit of its own, while dry is that which is readily determinable by its own limit, but readily adaptable in shape (Aristotle, quoted by Mure, 1964, 73).

In Aristotelian philosophy and Greek Medicine hot and cold are considered  active  because they have the power to act, while damp and dry are  passive  because they are acted upon.  This takes some thought to appreciate.  To get water to move takes an outside force.  The same is true for a stone.  Thus, damp and dry are  passive.   Heat, on the other hand, can move objects.  For this reason, treating the temperature was more important than the humidity.

Descriptions of the four qualities are based on William Salmon (1709, v), and include some quotations from him.  For a list of the symptoms of the four qualities refer to The Traditional Healer by Hakim Chishti (1980).



The positive property of heat is to remove inessential and foreign material in order to purify and restore the essence or constitutional type.  Heat does this by opening up channels and pores to remove impurities, thinning stagnant humors and fluids to allow them to run off through the opened channels, burning up (metabolizing) impurities and toxins, and increasing the internal fire of digestion and metabolism to drive waste materials out of the body, at the same time providing life forces, nutriment, air, and water to feed the tissues.

Warming Medicine: The ancients considered the living body to be warm in the first degree when it was in health.  Thus, such remedies “are hot in the first degree, are of equal heath with our bodies, and they only add a natural heat thereto, if it be cooled by nature or by accident, thereby cherishing the natural heat when weak, and restoring it when it is wanting” (Culpeper, 1989, 207).

The layout of the first three degrees of heating medicines teaches us that there is an inner fire in the body, constantly driving out impurities towards the periphery (the channels of elimination), and that this fire keeps the fluids thin and moving and the pores and channels open.  Thus, there are three stages in which cold overwhelms the body: first blocking the external pores, second thickening the fluids to obstruct the internal pathways, and third lowering the inner flame of life.  Note that when a body is cold in the third degree, or needs remedies warm in the third degree, heat symptoms or putrefaction can appear due to accumulation of waste products.

Agents hot in the fourth degree combat foreign growth processes that have overwhelmed the self-governing mechanism of the body, or the basic essence or type.  This includes primarily cancer and growths.

First Grade. These remedies “abate inflammations and fevers by opening the pores of the skin” (Culpeper, 1981, 207), to let out chill and blockage that has invaded the body, returning it to its normal temperature.  These remedies are primarily relaxing diaphoretics such as chamomile, agrimony, peppermint, spearmint, catnip, calendula, peony, and lobelia.

Second Grade. These agents not only open the pores, but dissolve   rough humors  and  obstructions,  so that the fluids can be allowed to flow out through the open pores.  These remedies are primarily warming bitters: fennel, elecampane, frankincense, galangal, calendula, and nutmeg.

Third Degree. These medicines open the pores, liquify fluids, and raise the inner heat to drive obstructions and chills to the surface and out through the pores.  They “help concoction,” that is, cooking in the stomach, warm and comfort the viscera, and “keep the blood in its just temperature” (Culpeper, 1989, 207).  Thus, they fight putrefaction and plague, and can induce fever in order to cleanse the body.  These remedies are primarily  antiseptics  and  stimulants.   Asarum, cumin, ginger, hyssop, pennyroyal, black pepper, rue, cayenne, savin, southernwood, calendula, elecampane, wild marjoram.

Fourth Degree. Medicines that raise blisters, corrode, and burn the skin.  The more gentle ones (rubifacients) are used to stimulate blood flow to areas that are emaciated, paralyzed, understimulated, or undernourished, while the more severe ones (esxharotics) are used to burn away and remove foreign growth processes that have overwhelmed the self-protective agencies of the body ““ warts and cancers.  Nettle, black mustard, garlic, onion, savory, and chelidonium.



As a positive force in the body, cold keeps different parts, tissues, organs, spirits, and mental faculties integrated into a functional whole.  Remember that cold, according to Aristotle, binds together things compatible or incompatible.  Thus, when cold is lost the different parts of the body start to go their separate ways.

Cooling Remedies: “Observe, that those medicines that are called cold, are not so called because that they are really cold in themselves, but because the degree of their heat falls below the heat of our bodies, and so only in respect of our temperature are said to be cold” (Culpeper, 1981, 207).

Cooling medicines were once very important since there was no refrigeration in ancient times.  At the very minimum, they were used simply to cool people off on hot summer days.  However, cooling medicines do much more than this.  They are not only refrigerant  (cold in the second degree), but sedative.  They settle the spirits and nerves, like when boiling water is settled by turning the heat down.  In fact, cold medicines were used to settle “vapors,” which were an old way of describing hysteria, nervousness, convulsions, and other conditions where the energy seemed to be rising up out of control.  Very much the same concept is found in Chinese medicine, were stones, shells, and heavy medicines are used to weigh down the spirit, so that it doesn t fly up and create problems.  Note that  hysteria  (from the Latin word for uterus) refers both to feelings out of control and uterine spasms.

First Grade. Agents cold in the first degree are suited to heat that has not yet settled.  The person only feels stuffy and bothered, as on a hot summer day.  Thus, medicines cold in the first degree “qualify the heat of the stomach, cause digestion” and “refresh the spirits” (Culpeper, 1981, 208).  This is the origin of salads, which are found in European and Middle Eastern cooking, but not traditional in India and China.  Fresh vegetables and fruits are considering cooling enough to refresh on a hot day.  This is also the origin of soda pops.  Even today one can still obtain rose water and orange petal drinks in the Middle East which are used to cool on a hot day.  The Anglo-American version of this drink was  switchel,  made from vinegar, sometimes with ginger and molasses.  Most fruits qualify here.  Rose hips and petals, peach fruit and leaf, lemon, lime, orange petals (not the fruit), strawberry, blueberry, elderberry rob, lemon balm, cherry juice, domestic lettuce, cucumber, parsley, tomato, etc.

Second Grade. In this degree the heat has become inflammatory, so that agents cold in the second grade “abate inflammation” (Salmon, 1709, v).  These are what we would today call  anti-inflammatory.   The old herbalists termed these agents  refrigerant.   Examples include lemon, commonly used in  fever drinks,  elder flower and berry, lemon balm, rose hips and petals, peach leaf, wild cherry bark, strawberry, yarrow, etc.

Third Degree. These agents bring down excessive sweating caused by heat out of coontrol, hold back matter from discharge, bring the blood back down from the head, and keep the vapors from rising, which reduces mental restlessness, vertigo, and fainting.  Thus, they are suited to conditions in which heat is driving the fluids actively out of the body and raising vapors upwards to agitate the mind and brain.   Examples include lemon balm, yarrow, lavender, poppy flowers, and rosehips.

Fourth Degree. These medicines cause unconsciousness or diminish consciousness; hence they are used in extreme pain, morbid vigilance, ravings, and violent delirium.  These are mild to powerful sedatives or poisons such as wild lettuce, opium, and hemlock.



The dry quality, for Aristotle, does not just dry out and desiccate substances, but hardens them and gives them the structure necessary to have boundaries and separation from the rest of the world.  The ability to hold anything inside the body is due to the dry faculty.  Thus, in the first degree dryness protects the exterior from outside influences, while in the fourth it hardens.

Drying Remedies: “Drying medicaments are such as make dry the parts overflowing with moisture,” writes Salmon (1709, v).  “Drying medicines consume the humours, stop fluxes, stiffen the parts, and strengthen nature,” writes Culpeper (1989, 208).  These remedies are primarily astringents that contain fluids and restore prolapse, or alkaline remedies that remineralize the electrolytes in water.

First Grade. Medicines dry in the first degree are said to “comfort and strengthen nature” (Salmon, 1709, v).  This means they close the pores and keep the body from being attacked by cold during the winter.  I only know the American Indian remedies used in this way: sumach, witch hazel, comptonia, and ledum. Note that remedies warm in the first degree open pores while those dry in the first grade close them or keep them closed.

Second Grade. Agents in this degree not only strengthen nature but astringe tissues to increase the tone, so that they do not collapse.  These would be astringents such as sumach, witch hazel, oak, raspberry leaf, blackberry leaf, lady s mantle, and horse chestnut.

Third Grade. In this degree medicines not only strengthen nature and increase the tone of the tissue but stop the discharge of fluids.  These are astringents such as yarrow, water lily, blueberry leaf, and sumach. Care should be taken to use astringents that have an affinity to stopping blood flow rather than powerful astringents that merely pucker the tissues closed.

Fourth Grade. Agents dry in the fourth degree not only strengthen nature, bind the tissues, and stop discharges, but  harden  the tissue to resist consumptions “where great fluxes of the bowels have” occurred, or where the lungs are subject to unstoppable catarrhs and bleedings.  They “stop catarrhs, and all fluxes of blood and humors, are highly stiptick, and dry up a super-abundancy of moisture.”  Examples include rose petal and yarrow. The famous  rose petal conserve  of Avicenna was used for tubercular bleeding and expectoration.



The damp quality is that which allows substances to move through one another without friction, it is the lubricating substance.  As a substance is thinned it becomes more “damp.”  Moistening agents not only increase fluid but are nourishing because food has to travel through fluids (water and oil) to get to the tissues and feed them.

Moistening remedies: These moisten the surfaces, add dampness to the internal organs, move water into dried out, hardened tissues, bring nourishment into the body, dilute or thin fluids to move out stuck deposits of water, and make  slippery.

First Grade. Agents damp in the first degree act on the mucosa of the respiratory tract to  smooth the roughness of the windpipe,  and reduce coughing.  These remedies are  demulcents  or  mucilages.   Here we would place violets, water lily, marshmallow root, slippery elm, comfrey, and fenugreek.

Second Grade. Medicines damp in the second degree act on the mucosa of the digestive tract to loosen the belly, lubricate the passages, and promote elimination.  They do not purge by catharsis but by moistening the stool.  They also make the womb  slippery  to promote fertility and passage of the baby.  I would extend this category from mucilages to fixed oils or nutritive oils and nutritive tonics and foods.  Slippery elm, fenugreek, burdock, American ginseng, and some of the Chinese sweet tonics.

Third Grade. Agents damp in the third degree moisten the body and “relax parts contracted or hardned.”  These are the  emollients.  Many of the mucilages are emollient.  Examples include marshmallow root, comfrey, and fenugreek, but we would also think of mullein.

Fourth Grade. These agents move the stool when it is stuck or remove water through the bowels when the kidneys are deficient.  They are purgatives, hydrogogues, and cathartics.  Examples include yellow dock root, rhubarb root, cascara sagrada, senna, and poke root.



“Temperate medicines are such which work no change at all, in respect to heat, coldness, dryness, or moisture.  And these may be temperate in some respect” and not in another.  For example: “1. As being neither hot nor cold, and yet may be moist or dry.  2. As being neither moist nor dry, and yet may be hot or cold.  Their use is, where there are no apparent excesses of the four other qualities; to preserve the body temperate, conserve Strength, and restore decayed Nature” (William Salmon, 1709, v).

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