Douglas Graham, M.D., an early-20th-century American physician from Boston, provides his commentary upon the words of Hippocrates as they apply to massage treatments. Graham examines numerous statements by Hippocrates on massage and puts them into a more modern context.

"The wisdom of the ancients appears to great advantage in some of their remarks about rubbing, and it requires years of practical acquaintance with massage in order to fully appreciate them. Thus the aphorisms of Hippocrates (460 to 380 B.C.) on this subject embodied the wisdom of the past and presaged the development of the future to a greater extent than most ancient or modern writers on massage have shown any evidence of understanding. 'The physician must be experienced in many things,' says Hippocrates, 'but assuredly also in rubbing; for things that have the same name have not always the same effects. For rubbing can bind a joint that is too loose and loosen a joint that is too rigid … Rubbing can bind and loosen; can make flesh [here Hippocrates believes that massage can help build muscle tissue] and cause parts to waste. Hard rubbing binds; soft rubbing loosens; much rubbing causes parts to waste; moderate rubbing makes them grow.'"

Graham also writes, "By appropriate massage, passive and resistive movements, atrophied muscles, tendons, and ligaments would have their circulation accelerated and increased, and consequently their nutrition and innervation improved, so that they would become larger and firmer, thus binding closer a joint too lax and making it stronger. By the same means involuntary tension of the muscles, adhesions, effusions, and hyperplastic tissue may be removed, so that a joint stiff from such causes would become more flexible.

"Therefore, the saying of Hippocrates, that anatripsis will bind closer a joint that is too lax and relax a joint that is too rigid, is not so paradoxical as it seems. These remarks also in part refer to the fact that 'rubbing can make flesh and cause parts to waste' in its local application; but in its general application the same effects have been observed and much more fully referred to by S. Weir Mitchell in Fat and Blood, and How to Make Them. People who have a normal quantity of adipose tissue sometimes lose much of it, to their detriment, by the excessive use of massage.

"But even this feature can sometimes be utilized to advantage in cases where fat is super-abundant, soft, and flabby, with a want of tone and tension in the areolar tissue, and in these it will be found that hard rubbing binds. 'Soft rubbing loosens' not only abnormally tough and matted conditions of the skin and superficial fascia, but also involuntary tension of muscles, both of which conditions, if looked for, may often be found generally as well as locally in overtaxed and debilitated people.

"Such a state of these tissues would seem to be a physical expression of too-great mental tension that the patient, like his muscles, is unable to relax. And here comes the necessity of a careful discrimination; for if a patient whose condition corresponds to this should receive such vigorous rubbing as often passes for massage in these days, and the vigor of which would really seem to be necessary to relax the tenseness of the tissues, the trouble would in all probability be aggravated, for reflex action and consequently still greater tension would be excited by the pressure of rough friction and manipulation upon terminal nerve-filaments, which are already in a state of irritation.

"Though it does not appertain to the history of massage, yet it may not be amiss to say here that an admirable preliminary measure in such cases is a warm bath, which is grateful and soothing to the patient, solicits the blood to the surface, softens the cuticle, and removes the epithelial debris, and also relaxes the skin and to some extent the tissues beneath it. 'Moderate rubbing makes parts grow' implies that the tissues to be rubbed are insufficiently nourished, and that if they be immoderately rubbed, their vitality will be lessened, their natural nervous irritability exhausted, and a state of congestion induced highly unfavorable to their proper nutrition.

"These brief sayings of Hippocrates on anatripsis serve partly to show at the same time why he was considered a man of transcendental genius and justly styled the 'Father of Medicine,' who, having raised the art from a system of superstitious rites practised wholly by the priests to the dignity of a learned profession, was then accused by his jealous contemporaries of having made too free use of the writings of others, and of having burned the collection to conceal his plagiarism's. [sic] It was supposed that he had ample opportunity to do this in his capacity as librarian of the famous medical school of Cos, of which he was also chief."

The prevailing medical doctrine of Hippocrates' time was called the humoural theory. This elaborate doctrine, known commonly as the Four Humours, had endured for centuries and was central to the tenets of the Hippocratic Corpus. Based on the four elements of Earth, air, fire and water—and their constituent elements in man, phlegm, blood, yellow bile and black bile, the Four Humours had to be in balance for health to exist. Further, these humours were related to the four seasons and the four elements.

Walter Libby, in his 1922 book, The History of Medicine, offers this composite view, "blood is hot and moist like air, phlegm is cold and moist like water, yellow bile is hot and dry like fire, and black bile is cold and dry like earth ... Similarly in the Hippocratic physiology, health depended on the crasis, or blending, of the four juices of the body. Unless they duly blend, there is a state of dyscrasia, or crudity, the humours, like raw food, acting as irritants. Health must be restored by a process of coction (or pepsis) wherein the internal heat of the body cooks the crude humours.

"Upon this follows a crisis—a separation, or elimination—of the superfluous substance. The elements may be restored to a state of harmony and equilibrium by the remedial power of Nature. It was faith in this vis medicatrix naturae which led Hippocrates to adopt an expectant attitude in the treatment of many of his cases, to abstain at times from surgical interference, and to prescribe drugs and cooling drinks as auxiliaries of Nature in the expulsion of the morbific matter after a fever crisis."

Perhaps this statement by Libby helps bring a better understanding about why Hippocrates believed massage was a valuable therapeutic tool. "Nature acts without masters," wrote Hippocrates. He firmly believed that the body was capable of curing itself, and that disease symptoms, particularly fever, were simply expressions of that capability. The Four Humours remained the mainstay of medicine in Europe for more than 2,000 years after Hippocrates.

The Hippocratic Corpus contains very few references to massage. The treatise on fractures contains only five minor mentions of any of the ancient words usually associated with massage.

Anoint is used three times. First, "The swellings which arise in the ham, at the foot ... should be well wrapped in unscoured and carded wool, washed with wine and oil, and anointed with cerate.” Cerate is an "unctuous substance containing wax and of such consistency that it may be spread easily at ordinary temperature ... and yet not so soft as to liquefy and run when applied to the skin." Second, "and the parts around are to be anointed with white cerate." And third, "To the sore itself a compress, anointed with white cerate, will be sufficient ... "

Rubbed is used in two occasions. First, "And when they are extended, the physician should apply the palms of the hands, and adjust the fractured parts and then having rubbed the parts with cerate, but not in large quantity so that the bandages may not come off, it is to be bound up in this state ... " And second, "But this form of bandaging must not be used unless there be danger of vesications or blackening in the swelling, and nothing of the kind occurs unless the fracture be bound too tight, or unless the limb be allowed to hand, or it be rubbed with the hand, or some other thing of an irritant nature be applied to the skin." The first use of the word "rubbed" is explained as a preparation for applying bandages, to lubricate the skin so that when the bandages are removed they won't stick to the area around the fracture.

These statements are hardly a resounding call for massage as a therapeutic device in the treatment of fractures, as some authors have claimed.

Robert Noah Calvert is the founder, CEO and publisher of MASSAGE Magazine. The material for this column comes from the World of Massage Museum's collection and Calvert's book, The History of Massage (2002, Healing Arts Press).