Abstract Herodicus (fifth century BC) is the first

person in the history of medicine who actually com-

bined sports with medicine. He used to be a sports

teacher, who later studied medicine and managed to

succeed Euryphon in the medical school of Cnidos, one

of the most prominent in ancient Greece together with

its neighbor medical school of Cos (Hippocrates’

home). In Cnidos Herodicus formed his own theoreti-

cal perspective of medicine. He considered, namely,

bad health to be the result of imbalance between diet

and physical activity and for this reason he recom-

mended strict diet, constant physical activity and reg-

ular training. He believed that this combination was

the ideal way to maintain good standards of health and

he applied this type of treatment method to his pa-

tients. Unfortunately, Herodicus’ works are lost today.

However, excerpts of his medical system, which can be

traced in ancient texts, support the fact that Herodicus

can be considered as the father of sports medicine.

Keywords Sports medicine Æ History of medicine ÆPhysical activity Æ Herodicus Æ Training Æ Diet

Introduction

Herodicus, a Greek physician lived and practiced

medicine in the fifth century BC. However, it seems that

there are two men, both doctors who have been living

in the same period in the extended region of ancient

Greece, that bear the name ‘‘Herodicus’’. The exis-

tence of the second one became known only in 1893

when the codex Anonymus Londiensis, which included

the first history of medicine, was found and published

[7]. In this text, a ‘‘Herodicus of Selymbria’’ (Anony-

mus Londiensis: 9.20) and a ‘‘Herodicus of Cnidos’’

(Anonymus Londiensis: 4.40) are mentioned one after

the other. This is the reason that some scholars be-

lieved that actually there were two different men.

Nevertheless, a more careful examination of the

information that codex Anonymus Londiensis and

other ancient sources, can lead us to the conclusion

that they refer to one and the same person. Firstly,

these two Herodicus were not only contemporaries,

but also shared the same medical theories. More spe-

cifically, they both recognized that the primary cause of

diseases is the lack of balance between movement and

nutrition. Moreover, according to the medieval lexicon

of Suda, ‘‘Herodicus of Selymbria’’ was the teacher of

Hippocrates (Hippocrates, doctor from Cos... his first

teacher was his father and after him Herodicus of

A. D. Georgoulis Æ I.-S. Kiapidou Æ L. VelogianniOrthopaedic Sports Medicine Center of Ioannina,Department of Orthopaedic Surgery,University of Ioannina, P.O.BOX 1330,Ioannina 45110, Greece

N. StergiouHPER Biomechanics Laboratory,University of Nebraska at Omaha,Omaha, NE 68182, USA

A. BolandMassachusetts General Hospital,Sports Medicine/Shoulder Service,Yawkey Center 3G, Suite 3200, 55 Fruit Street,Boston, MA 02114, USA

A. D. Georgoulis (&)P.O. BOX 1330, Ioannina 45110, Greecee-mail: oaki@cc.uoi.gr

Knee Surg Sports Traumatol Arthrosc (2007) 15:315–318

DOI 10.1007/s00167-006-0149-z

123

SPORTS MEDICINE

Herodicus, the father of sports medicine

Anastasios D. Georgoulis Æ Irini-Sofia Kiapidou ÆLamprini Velogianni Æ Nicholas Stergiou ÆArthur Boland

Received: 17 March 2006 / Accepted: 23 March 2006 / Published online: 2 September 2006� Springer-Verlag 2006

Selymbria...) [1]. Despite the fact that modern scholars

disagree on the truth of this statement (most of them

accept it as it is given [8, 10, 12, 14, 18, 21], but there

are those who react with skepticism [5]), there is

obviously a connection between Hippocrates and He-

rodicus, since central hippocratic doctrines can be

found in Herodicus’ claims. At the same time, it is

known that Hippocrates spent a few years in Cnidos

before he started his career in Cos. This can be an

additional argument for recognizing that the two He-

rodicus are actually one.

Among the medical schools which existed in ancient

Greece during the time of Hippocrates, those of Cni-

dos and Cos were the most prominent [11, 13, 24].

Cnidos was a colony of the Spartans (the residents of

the ancient Greek city of Sparta from southern

Greece) and an important port situated in the penin-

sula of Caria in the south-east part of Asia Minor,

opposite to the island of Cos. On this passage between

the Middle East and ancient Greece, Euryphon foun-

ded the first important medical school and began a

tradition of medicine separating it from magic and

mythology.

The cities of Cnidos and Cos were politically con-

nected to the city-band of Exapolis and together with

other cities in the area had as political and cultural

center the Temple of Apollo near to Cnidos [16]. The

myth says that after the fall of Troy Asclepius’ son

Podaleirios moved to the peninsula of Caria, where he

married a local princess and set a new city named

Syrnos. Eventually his descendants, the Asclepiads, left

this city and went either to Cnidos or to the island of

Cos, where they passed the medical education from

father to son. Among the Asclepiads of both cities was

an obvious connection and this is an additional argu-

ment for the existence of close communication be-

tween Cnidos and Cos [15].

Collaboration and exchange of ideas, in parallel of

course with scientific competition, can be traced in the

relationship between the two nearby medical institu-

tions. Despite the fact that doctrines of these two

schools show more similarities than differences, there

are some significant odds. The physicians of Cnidos

gave great importance in taking the medical history of

the patient and they also developed the process of

differential diagnosis. In their descriptions of diseases,

they were the first to differentiate the areas of symp-

tomatology, aetiology, therapy, and prognosis. Unfor-

tunately, only fragments are known today of these

medical theories.

There is no doubt, however, that the great person-

ality of Hippocrates shadowed both schools. This

is why remarkable doctors such as Euryphon and

Herodicus are rarely noticed by current scholars, al-

though according to Sigerist [23], both these two heads

of the school of Cnidos were outstanding physicians

beyond any doubt.

Short biography

Herodicus appears to have been born in the fifth cen-

tury BC in Selymbria of Thrace. The fact that this city

was an old colony of Megara, situated on the north

shore of the see of Marmara, is responsible for his

name ‘‘Megareus’’ (of Megara) in Greek documents

(Platon, Protagoras [3], 316.d.9–316.e.1: Herodicus of

Selymbria, primarily of Megara, who is still alive [It

means contemporary with Protagoras and Socrates,

whose discussion recreates Platon] and a great sophist).

Later, he studied and worked as a doctor-physician and

dietician in Selymbria, in Megara, and other cities of

ancient Greece, such as Athens. In addition, he was

educated as a physical educator, which allowed him to

better understand the role of exercise and balanced

diet in medicine. Considering the fact that during his

time physical educators did not allow physicians to visit

the gymnasiums and as a result physicians did not

understand the world of sports, Herodicus had the

unique chance to combine both areas: sports and

medicine. He was effective in this endeavor and he

formulated his own theoretical perspective of medicine

which he applied to his patients. Given the fact that

they, as warriors who often participated to battles,

were interested in keeping a good physical shape,

welcomed Herodicus’ strict principles and discipline

approach to health. Herodicus emphasized the rela-

tionship between sports and health and he even lived

by example as we will see below.

His theoretical perspective

The founder of the school of Cnidos, Euryphon was the

first to believe that diet has an important role in health

[7]. According to him, the excrements which arise in

abdomen after bad digestion are spread through the

body, they reach the brain and eventually result in

illness. On the contrary, when the abdomen is empty,

the digestive system works properly and people enjoy

good health (Anonymus Londinensis: 4.31–40) [9].

Influenced by this hypothesis, Herodicus formulated

his own theoretical perspective (Fig. 1). He believed

that food products are not correctly digested when

people consume food without corresponding motion.

Incorrect digestion can result to byproducts which

316 Knee Surg Sports Traumatol Arthrosc (2007) 15:315–318

123

generate two types of ‘‘bodily liquids’’: a sharp and a

bitter. The type of disease that results depends first on

the dominance of one bodily liquid over another (i.e.,

homeostatic imbalance) and secondly on location and

organ, where bodily liquids congregate. Namely, there

is a difference if the redundant bodily liquid is located

at the brain, the liver, or the spleen (Anonymus Lon-

dinensis 4.40–5.34) [9]. The sharp and bitter bodly

liquids are identical with the phlegm and bile, which

constantly in later medical theories are considered to

be pathogenic factors. Herodicus’ theory of ‘‘two

bodily liquids’’ belongs to the fundamental medical

doctrine from which the dominative ‘‘doctrine of four

bodily liquids’’ came. [19].

It is obvious that Herodicus attached great impor-

tance to physical activity. He declared that sufficient

physical activity and proper diet are vital to maintain

good standards of health (Anonymus Londinensis:

9.20–36.) [9]. The restoration of a natural life was

thought to be the basis for the healing of disease, which

appears only as a result of a wrong way of life. It is very

interesting to notice here that lack of physical activity

and improper diet, have been implicated with numer-

ous health problems in our present societies. Eventu-

ally Herodicus invented his own medical system, which

first of all included a strict diet, consisted of grains and

other foods generally regarded as unappetizing. His

medical theory embodied also exhaustive training as a

treatment method. Socrates in Platon’s Phaedros [2]

(227.d.2–5) admits that he was so pleased by the words

of his interlocutor, that even ‘‘if Phaedros took the

road to Megara, reached the city walls and turned

back, as Herodicus did, he would follow him’’.

According to the commentary of Hermias in this ab-

stract of Platon’s [6] (24.25–30) ‘‘Herodicus the doctor

used to train himself outside the city walls, starting

from a certain distance, not very far away, but sym-

metrical. He was walking till the walls and then

returning, and he did that many times’’.

However, Herodicus sometimes followed this line of

thinking to extremes and his instructions for a healthy

life were quite complex. Thus, some ancient authors

criticised him for being obsessive with his treatments.

For example, the writer of Epidemics [17] (: 6.3.18)

notes that ‘‘Herodicus have killed fever patients by

running exercises, many bouts of wrestling and vapour

baths.’’ Platon in Res Publica [4] (: 406.a.4–b.8) criti-

cizes also his method to mix gymnastic training with

medicine. It seems that the same opinion was shared by

Aristotle in Rhetorica [20] (: 1361b 4–6): ‘‘many men

are in good health, for example Herodicus, but no one

would congratulate them on their health, because they

abstain from all or most human pleasures.’’ However,

Herodicus persistency may be what separated him

from others.

Despite the negative criticism, Herodicus had

achieved significant results with his methodology. His

theoretical perspective was greatly influenced from the

philosophy of Pythagoras, but no one can verify today

if Herodicus was actually a student of Pythagoras; text

tradition of ancient sources is disorderly and full of

gaps [22].

It is also obvious that his theory of the homeostasis

of the two liquids influenced later Hippocrates, who

developed the theory of the homeostasis of the four

liquids. Under this perspective one can says that He-

rodicus was a pioneer in setting the basis of the

explanative westernized medicine.

Conclusion

Herodicus was a sports medicine doctor, one of the

oldest of Cnidos’ medical school, who is known to us by

name. He combined his knowledge of physical educa-

tion and medicine to develop new treatments that

could benefit his patients. He formulated his own

medical theory and he applied his ideas to his patients.

His methodology is clearly relevant for our times since

we have finally realized the importance of physical

activity and proper diet to healthy living. He may be

the first doctor that suggested patients to get off their

Theory of Herodicus

Nutrition Imbalance Physical activity

Byproducts of bad Digestion

acute chronic

Sharp bodily liquid Bitter bodily liquid

Homeostatic imbalance

Congregation in Organs(Brain, liver, spleen etc)

Disease

Theory of Herodicus

Nutrition Imbalance Physical activity

Byproducts of bad Digestion

acute chronic

Sharp bodily liquid Bitter bodily liquid

Homeostatic imbalance

Congregation in Organs(Brain, liver, spleen etc)Congregation in Organs(Brain, liver, spleen etc)

DiseaseDisease

Fig. 1 Herodicus’ theoretical perspective

Knee Surg Sports Traumatol Arthrosc (2007) 15:315–318 317

123

beds and start moving after an injury. This is common

practice today since we try to minimize bed rest.

Everyone had to recognize the value of the treatises of

Herodicus. They were taken under consideration from

doctors of that time and the years after [19]. His theory

for the explanation of the diseases through the

homeostasis of the two liquids makes him a pioneer.

Unfortunately, his works are lost and only excerpts of

his theories and concepts can be traced today in an-

cient sources. There is no doubt, however, that Hero-

dicus influenced directly the medical history by

proposing the use of diet, training and physical activity.

He has set the basis not only of sports medicine, but of

all medicine in every field.

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