Just as the miasma theory of disease wanders in the direction of something useful (germs) before veering off to be totally wrong (bad air), so too does the notion of elemental imbalances contain a grain of truth in a beach of incorrect concepts.
By “elemental imbalances” I mean the various theories — European humorism, Indian Ayurveda, Chinese wuxing, and others — that envision the human body as being made up of a small number of humors, elements, energies, and so forth, with disease arising when one of them becomes too prevalent or too lacking. Not just physical ailments, either; they also diagnosed mental issues such as depression or phobia by these same means. And it’s true, excess and deficiency can indeed cause disease! The latter is more common, I think, resulting in conditions like anemia, beriberi, rickets, or scurvy, but gout is an example of a disease brought on by too much of something (uric acid, in this case).
To be clear, these conditions were recognized by earlier medical theories, and in some cases the treatments were known, even if the mechanisms by which those treatments worked were obscure. The British navy famously figured out that if they made their sailors consume citrus (leading to the nickname “limeys”), then they wouldn’t get scurvy, long before we’d identified vitamin C. On the other hand, some of the treatments were wildly wrong: in seventeenth-century England, physicians knew adolescent girls commonly suffered from anemia (“green sickness”), but figured that problem would be solved by regular deposits of their husbands’ semen once they married.
But when physicians of this type diagnose a patient as having deficiency of something, they aren’t talking about protein or iron or vitamins. They mean an element like earth, water, air, and fire, or earth, metal, wood, water, and fire, or whatever philosophy pertains in their particular culture. Combined with other principles like the Chinese yin and yang or the Ayurvedic doshas, these form elaborate frameworks wherein the component pieces become associated with everything from colors to seasons to flavors to internal organs to deities.
So when it comes time to treat a disease, the answer lies within that framework. You solve the problem by reducing whatever has gotten out of hand or supplying its counter, through a variety of treatment methods. In Europe, imbalances of the four humors (blood, yellow bile, black bile, and phlegm) could be righted through bloodletting, the administration of emetics or purgatives, or cupping — creating suction on the skin, sometimes strongly enough to form a blister or bruise. Traditional Chinese medicine also makes use of moxibustion, burning dried mugwort on the skin.
(By the way, the stereotypical image of European physicians attempting to solve every problem with bloodletting? As near as I can tell, that’s 100% accurate. Even though blood is only one of the four humors, I swear there was no medical issue they didn’t think could be helped by cutting the patient’s arm or sticking a leech on them. Leeches have genuine therapeutic value in a few surgical situations nowadays, but on the whole, bleeding a person only weakens them, at a time when they can least afford it. I’m sometimes amazed the human species survived to the present day, given the things we did to ourselves in the name of healing.)
Treatments of that sort are only one part of the equation, though. Just as important, if not more so, is the administration of medicine designed to restore whatever is lacking or counterbalance an excess. This frequently involves herbs, and those are a complex enough sub-topic that they’ll get their own essay next week, but it’s important to note that the all-encompassing nature of these theories sweeps everything into their orbit, not just what you’d normally think of as “medicine” today.
Which means that curing an imbalance can involve all kinds of approaches. A physician might recommend engaging in or refraining from particular activities; sex is a common target, but they might also address bathing, exercise, sun exposure, meditation, and so forth. Because medicine often ties in with religion, prayers or offerings to the deities that govern the appropriate forces might be called for. And while this was true to a lesser extent in European humorism as well, every book I’ve read that mentions traditional Chinese medicine makes a point of saying that there is not and never has been a clear dividing line there between “food” and “drugs.” Since everything is presumed to exhibit the fundamental characteristics of the cosmos, then anything you consume affects your internal balance.
Part of what makes this kind of approach so attractive is the sheer beauty of it. Our brains like holistic frameworks where everything gets slotted neatly into place and the interactions between them are clearly defined. The wuxing is a gorgeous philosophical structure that not only divides the world into five elements, but arranges them in two separate cycles, the generating (wood – fire – earth – metal – water – wood) and the overcoming (wood – earth – water – fire – metal – wood). It ties in with everything from feng shui to the zodiac to the stages of life to the hours of the day. It’s much more elegant than the lopsided shape of the periodic table of elements.
Unfortunately, anything that tidy also becomes inflexible. If the philosophical principles say X should work, then when it doesn’t work, that isn’t a sign of an exciting new discovery; it’s a threat to the coherence of the whole system, and therefore the problem must lie elsewhere. Everything must be slotted into the available shape, even if that means lopping off bits of knowledge to make it fit, like Cinderella’s sisters trying to put on the glass slipper. And while a work of speculative fiction can create a world in which everything truly does fit and work like it’s supposed to . . . there’s still narrative potential in messing the tidiness up a bit.