PhD, Associate Professor E.L. Panova1
PhD, Associate Professor Y.G. Grigoryan1
PhD, Associate Professor K.V. Bogatyreva1
1Sechenov First MSMU under Ministry of Health of Russia (Sechenov University), Moscow
Keywords: health, physical practices, disease, Hippocrates, Galen, ancient medicine.
Background. The origin of modern health concepts with their priority to physical practices appears to be largely in the ancient Greek secular medicine and health philosophy generated by the unique and fertile ancient Greek culture of that time with its pioneering health ideas. Fundamental concepts of the ancient rational medicine with the focus on the ‘health ethos’ rather than specific health disorders and therapeutics – were dominant in the western medical traditions till the early XX century [9, p.195]. These concepts were most clearly and comprehensively formulated in the heritage of Hippocrates (circa 460 –370 years B.C.) and Galen (129–200 years B.C.), two great ancient medics and philosophers.
Objective of the study was to explore the role and effects of physical practices in concepts of Hippocrates and Galen, ancient Greek health philosophers.
Study findings and discussion. Rational concepts of human nature and health were conceived in the ancient Greece as a result of the fast progress in the local philosophy and world outlooks [7, p.216]. The first natural philosophers (Thales, Anaximenos, Heraclitus, Democritus and some others) in their search of the general logics of the key natural processes arrived to the idea of the material/ substantial unity of the world – assumed to be composed of a few primary substances/ elements in their interrelations. The pre-Socrates thinkers differed in their concepts of the qualities and quantities of the primary substances the world is composed of although all of them shared the idea of a genuine balance of the world elements and driving forces. These natural philosophical constructions (on the natural/ human macrocosms being harmonic and proportionate, on the elementary substances etc.) formed a basis for the ideas of human nature and health developed and tested by the ancient Greek medicine. The first fully-fledged theoretical constructions were preceded, however, by ideas on the healthy lifestyles and regimen that were first conceived and developed by the popular Pythagorean philosophical school. Pythagoras believed that all diseases and health disorders are due to disharmonies in the primary elements and their qualities rather than a divine providence. Therefore, the medical practices should be geared, in his opinion, to restore the harmony and restore the balanced healthy state by a variety of specific tools and procedures including healthy daily regimen; healthy diets; optimal sleep-and-wakefulness habits; intellectual and musical practices; and obligatory physical practices (long daily walking, jogging, wrestling, discus throwing, fist fights etc.) [11, p. 113].
Many researchers tend to believe that it was the ideas on healthy daily regimen advanced by the Pythagorean philosophical school that formed a basis for the Hippocrates’ school of dietetics i.e. teaching about a healthy lifestyle [6, p. 150]. Only a small part of the works by great Hippocrates, one of the leaders of the famous Koss medical school, has reached us in the famous ‘Hippocrates Collection’, although the available scientific evidence show that most of the tests in the collection were written by other authors. Still the manuscripts of the Koss medical school are rather unusual in terms of their strictly analytical style, well-though structure and determination to give a logical grounding for every statement. The treatise “On Human Nature’ believed to be written by Hippocrates or one of his close followers spells out, among other things, the key provisions of the humoral theory that interprets a human body as a vessel containing blood, phlegm, black and yellow gall viewed as the four main bodily fluids. The theory further assumes each of these fluids (humors) being connected with and controlled by the relevant cosmic element/ substance having two prevailing qualities: blood relates to air (with its warmth and moisture); phlegm to water (cold and moisture); black gall to earth (cold and dryness); and yellow gall to fire (warmth and dryness). Individual health was believed to depend on the balance of the above four fluids and their qualities in human body that may be undermined by effects of many internal (age, gender) and external (season, climate) factors.
Furthermore, the ‘Hippocrates Collection’ gives a first historical and basically scientific analysis of healthy lifestyles in the section ‘On Diets’ that gives a special priority to healthy diets and habitual physical exercises critical for health protection and improvement purposes [3, p. 442]. Hippocrates in his health concept underlines the importance of due balance and measure for any healthy lifestyle that need be designed so as to avoid both fatigue and inactivity. Physical inactivity, as stated by the author, results in emasculation, over-moistening and, hence, health imbalances. Furthermore, Hippocrates classified physical practices into the natural (unspecific physical activity, walking etc.) and forced/ specific, with the latter interpreted as the discretional body development physical activity. ‘Straight run’ and ‘circular run’ were believed to warm up the body and release the bodily moister; whilst ‘run with hoop’ was recommended for the speed building and body-shaping purposes. Wrestling and rubbing were believed to warm up, expand pores and facilitate the muscular mass building process [3, p. 476]. On the whole, forced physical practices were recommended as a powerful tool to warm up, improve the tonus and facilitate excretion of excessive moisture. They were assumed to be balanced by the counteracting sleep, outdoor recreation, modest nutrition etc. A dietetics-aware person was recommended to keep in balance and reasonably combine these alternatively acting elements. This vulnerable balance, in view of Hippocrates, could be easily disrupted by excessive physical workloads on the whole and sports in particular. Hippocrates qualifies the health disorder due to excessive physical practices as a disease triggered by ‘the exercises in excess of nutrition’ rather than an over-fatigue [3, p. 484].
Galen who lived more than 500 years later than Hippocrates, further developed the health concepts of the latter to substantiate the largely intuitive thinking of his teacher by the new knowledge accumulated by the descriptive anatomy and newborn physiology. As provided by Galen, there are three groups of health aspects/ elements including the health-protection elements; health building (therapeutic) elements; and the disease-prevention elements [8, p.104]. He gave a top priority to the health-protection elements determined by ‘six available factors’ controllable by every human including: air; food and drinks; sleep and wakefulness regime; movement and rest; excretion and retention; and spiritual passions. Galen further states in his works ‘On the Best Construction of Our Body’ and ‘Frasibulus or Does Hygiene Refer to Medicine or Gymnastics?’ that health is rather the special ideal bodily condition achievable by anyone who keeps in balance the ‘six health elements’ rather that only a disease-free individual status [9, p. 195]. He mentions in the ‘Art of Medicine’ that ‘when our body needs movements, physical practices will be healthy whilst rest may provoke diseases; and when it needs rest, it improves health whilst exercises may provoke diseases’ [1, p. 141]. In his treatise ‘On Health Protection’, Galen emphasizes benefits of physical activity for every age group since the trained body better protects its organs from wear and improves their functions by increasing the internal warmth and boosting metabolism to improve digestion and diffusion of every of the four elements [10, p. 210]. Physical practices, however, were recommended to be immediately stopped as soon as the body starts suffer and develop fatigue. It was also mentioned that physical trainings are beneficial only when the bodily movements are symmetrical and harmonic, with neither bodily part working harder than the others.
Galen recommended physical practices with a small ball as the most beneficial for health. As provided in his treatise ‘On Practices with a Small Ball’, such physical exercises help correct imbalances in the body and at the same time prevent the flesh being excessively built up or exhausted. In contrast to many other sports including running, jumping, fist fighting, discus throwing and riding that may end up in injuries and even death, practices with a small ball are harmless and highly healthy. It is well known that Galen served for 10 years as a doctor at gladiators’ stable, and this service only cemented his negative attitudes to professional sports and athletes. In his treatise ‘On Motivations for Medicine’ he accuses athletes of negligence to the key rule of health life formulated by Hippocrates i.e. modesty in every life aspect and element. In the Galen’s opinion, athletes only disfigure their bodies and make harm to their health by the life-long excessive physical practices, overeating and oversleeping [2, p. 155-156].
Conclusion. Rational health concepts by Hippocrates and Galen gave a high priority to physical practices to lay a foundation for dietetics which is the healthy lifestyle science driven by the idea of balance of elements and conscientious health protection and building policies and practices. It was due to the great authority of Galen who was highly gifted as therapist, scientist and philosopher that the health concepts were accepted and advanced to lay a sound foundation for the further health research, protection and improvement methods – still highly valued and applied by the modern health medicine and physical education.
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The article explores the role and benefits of physical practices in concepts of the ancient Greek health philosophy and medicine that were the first in the human history to offer a consistent system of views on the human nature and health. Since the late VII century B.C. the Greek culture had developed a new type of the world outlook absolutely different from the mythological one and based on the following concepts: the world evolves according to the natural laws independent of the gods’ wills; and knowledge of the laws gives the means for a human to control the own life process and change it in some aspects. This new world outlook provided a basis for the first consistent health concepts to outline the health protection and building ways, with the relevant health theories stemming from the new understanding of the human nature. The humoral theory was the most influential at that time. It were the studies of the great ancient therapists including Hippocrates (circa 460 –370 years B.C.) and Galen (129–200 years B.C.), that opened up and crowned a great epoch in the ancient Greek medicine, plus studies of the modern national and foreign scientists that have laid a sound basis for the physical education as a part of the modern dietetics system i.e. the science of healthy lifestyles. The study analyzes the present value of the historical health protection and improvement system developed by the ancient Greek culture. It was found that the health concepts by Hippocrates and Galen laid a sound foundation for the further health research, protection and improvement methods – still highly valued and applied by the modern health medicine and physical education.