"Causes and Treatment of Diseases" – that's the German translation of Causae et Curae, the main medical work by the Benedictine abbess Hildegard of Bingen. If you want to understand what Hildegard medicine is at its core – her view of people, illness, and healing – you need to know this book. It's the key to everything else: her herbal recipes, her dietary teachings, her doctrine of temperaments, her perspective on body and soul.
This article guides you through the origins, structure, and content of Causae et Curae, explains its adventurous history of transmission, and shows what this 12th-century work still has to say today.
What you'll learn in this article
| Topic | Content |
|---|---|
| Name & Title | What Causae et Curae means – and what other names the work has |
| Origins | When and how the work was created; its relationship to the Physica |
| Transmission | Why it was almost lost – and how it was saved |
| The 6 Books | Structure and content in detail |
| Hildegard's Doctrine of Disease | Four elements, four humors, temperaments – the medical worldview |
| Physica vs. Causae et Curae | How the two main works differ |
| Modern Significance | What remains – and what should be viewed critically |
Name, Title, and Alternative Names
Causae et Curae is Latin and literally means "Causes and Remedies" – or more freely, "Causes and Treatment of Diseases." That's exactly the title of the authoritative modern German translation by Prof. Ortrun Riha (Beuroner Kunstverlag, 2011/2012): "Origin and Treatment of Diseases".
The work is also known by two other names in the historical record: Liber compositae medicinae (Book of Compound Medicine) – that's what the canonization protocol from 1233 calls it, the first historical document that explicitly attributes the work to Hildegard. And originally, together with the Physica, it formed a single work called Liber subtilitatum diversarum naturarum creaturarum – "The Book of the Secrets of the Various Natures of Creatures."
Origins: When did Hildegard write Causae et Curae?
Hildegard's medical and natural history works were written between about 1150 and 1160 – while she was abbess at Rupertsberg near Bingen. They were the result of decades of observation: Hildegard treated sick sisters, received the ill who came to her, studied healing attempts, and recorded her findings – dictated to her secretary Volmar.
Important to understand: Causae et Curae is not a visionary work. It's not one of those writings like Scivias, where Hildegard wrote down divine revelations. Medical historians classify it as practical, everyday knowledge of nature and healing from the Middle Ages – as the personal compilation of knowledge by an exceptionally observant woman of the 12th century, shaped by the monastic medicine of her time, ancient humoral theory, and her own clinical perspective.
Originally, Causae et Curae and the Physica formed a single large work. The split into two independent books happened early in the 13th century – so still during the lifetimes of many who personally knew Hildegard. The exact reason is unclear. Possibly, the division matched their different practical uses: the Physica as a reference for herbs and remedies, Causae et Curae as a theoretical foundation of medicine.
The adventurous history of transmission: Almost lost, rediscovered in the 19th century
This is one of the most fascinating stories in medieval medical history: Causae et Curae survives today thanks to a single manuscript.
While the Physica was still relatively widespread in the Middle Ages (five versions are known, the first printed edition appeared in 1533 in Strasbourg), Hildegard's medical teachings were largely forgotten after her death. It's missing from the Rupertsberg Giant Codex – the complete edition of Hildegard's works, compiled during or shortly after her lifetime. No medieval library catalog listed the work, and no monastery made copies.
What remains: An almost complete copy from the 13th century, which at some point made its way to Denmark and is now in the Royal Library of Copenhagen. It's supplemented by the so-called "Berlin Fragment" (Staatsbibliothek Preußischer Kulturbesitz, Ms. lat. qu. 674), which fills a gap in the doctrine of elements at the end of the first book.
It wasn't until the mid-19th century that the botanist Carl Jessen rediscovered the Copenhagen codex. Jean-Baptiste Pitra and Paul Kaiser published excerpts; Kaiser published the first complete edition of the Latin text in 1903 (Teubner, Leipzig). The first complete German translation appeared in 1933 by Hugo Schulz. The current critical edition is by Laurence Moulinier (Akademie Verlag Berlin, 2003), and the modern standard translation is by Ortrun Riha (Beuroner Kunstverlag, 2011) – published by the Abbey of St. Hildegard Eibingen.
"Causae et curae is now the best-known and most widely read work of Hildegard of Bingen. In this fascinating treatise on healing, the great Benedictine presents a comprehensive picture of healthy and sick people and shows concrete ways to a wholesome order and way of life."
– From the foreword of the Abbey of St. Hildegard Eibingen to the edition by Ortrun Riha (Beuroner Kunstverlag)
Structure: The six books of Causae et Curae
According to the structure of the standard edition by Ortrun Riha, the work includes 492 sections in six books:
| Book | Title (according to Riha) | Sections | Main Content |
|---|---|---|---|
| Book I | The Order of the World | 1–55 (55 sections) | Cosmology, creation story, four elements, the place of humans in the cosmos, doctrine of the four humors, doctrine of temperaments, sexual pathology, E |
With 297 sections in the second book alone, the actual study of diseases is the heart of the work—and at the same time, the most practical part. Here, Hildegard describes symptoms and treatments systematically by body region, starting with the head.
The Worldview of Causae et Curae: Macrocosm and Microcosm
Why does a book on healing begin with the story of creation and the order of the universe? For a modern reader, that might seem odd. For Hildegard, it was absolutely logical—and that's the key to her way of thinking.
Hildegard's medical worldview rests on a single fundamental idea: Humans are an image of the cosmos—a microcosm within the macrocosm. Just as the world is made up of four elements (fire, air, water, earth), so too is the human made up of four corresponding bodily humors. Health is the harmonious balance of these humors; illness arises when one humor dominates and pushes out the others.
Hildegard puts it this way—loosely quoted from the first book of Causae et Curae:
"Just as [the world] is made up of four elements, so [the human] is made up of four humors (temperaments), and in a specific mixed ratio. That's why the ancients connected humans with the structure of the world, since in Greek the world is called 'cosmos', but humans are called 'microcosmos', that is, little world."
This way of thinking wasn't invented by Hildegard—it comes from ancient medicine, especially Galen and Hippocrates, passed down through Arabic and early medieval writings. Hildegard's achievement was to fill this traditional system with her own observations, connect it with her mysticism, and translate it into the language of the 12th century.
The Four Elements and Their Effects on Humans
| Element | Quality | Effect on Humans (according to Hildegard) | Bodily Humor / Phlegm Type |
|---|---|---|---|
| Fire | warm, dry | Body warmth, vision | dry phlegm (siccum) |
| Air | warm, moist | Breath, hearing | moist phlegm (humidum) |
| Water | cold, moist | Blood, mobility | frothy phlegm (spumaticum) |
| Earth | cold, dry | Tissue, bones, upright posture | lukewarm phlegm (tepidum) |
The balance of these four humors—in Hildegard's own terminology, which differs slightly from classical ancient humoral theory—results in health. An excess (abundantia) of one component leads to coagulation of the humors (coagulatio) and thus to illness: physically, mentally, or emotionally.
The Doctrine of Temperaments: Hildegard's Own Development
This is where Hildegard's intellectual independence really stands out. Ancient medicine recognized four temperaments (sanguine, choleric, melancholic, phlegmatic). In Causae et Curae, Hildegard describes 14 character types—separately for men and women—and connects these with specific tendencies toward certain illnesses.
According to Hildegard, each type has a characteristic tendency toward certain ailments, behaviors, and also certain virtues or vices. This is early psychosomatics: for Hildegard, character and physical constitution are inseparably linked. If you know yourself—your type, your humors, your inclinations—you can prevent illness. This approach is still the truly modern element in Hildegard's overall medicine today.
The Second Book: The Systematic Study of Diseases
With 297 sections, the second book is the core of Causae et Curae. Hildegard systematically works her way through the human body—from top to bottom. What she describes here is the first comprehensive disease classification in a work written in the German-speaking world during the Middle Ages:
Head and Sense Organs: Headaches, ear disorders, dental diseases, eye ailments, nasal conditions—each with cause and treatment.
Chest and Internal Organs: Lung and heart diseases are treated less extensively; more detail is given to stomach, liver, kidney, and bladder diseases as well as stone ailments.
Metabolism and Blood: For metabolic disorders, Hildegard especially highlights the role of blood as a "distributor"—an observation that points in the right direction, even if the physiological explanation remains medieval.
Fever and Skin Diseases: Hildegard distinguishes skin diseases as leprosy, rash, and boils, and describes the course and treatment of fever.
Gout and Joint Disorders: Covered in detail, since gout was the quintessential medieval common disease. Hildegard's approaches—changes in diet, certain herbs, warmth—are basically in line with modern recommendations for lowering uric acid.
Not described: surgical procedures for bone fractures or injuries. That wasn't Hildegard's field—and not part of monastic medicine in her time either.
Recipes, Prognoses, Moon: Books III to VI
Books III and IV, with a total of 108 recipe sections, are what practical Hildegard medicine still uses most directly today. Here you’ll fin
which contain specific preparation instructions for herbal applications, tinctures, ointments, and teas—many of which are identical or related to recipes also found in the Physica. Interesting: Book IV also includes notes on animal diseases and agriculture—a sign that Hildegard wrote her knowledge for the entire monastic community, not just for human medicine.Book V (Prognoses) contains rules that a medieval physician could use to estimate the course of an illness—a kind of checklist of clinical signs. Book VI (Moon) deals with the influence of the moon’s phases on health, illness, and healing treatments—a concept that was universally widespread in medieval medicine and lasted well into modern times.
Physica vs. Causae et Curae: How do the two main works differ?
| Physica (Liber simplicis medicinae) | Causae et Curae (Liber compositae medicinae) | |
|---|---|---|
| Latin title | Liber simplicis medicinae | Liber compositae medicinae |
| Content focus | Natural history: plants, animals, stones, metals, elements—with medicinal uses | Healing arts: origins of illness, pathology, therapy, recipes |
| Structure | 9 books, encyclopedic by kingdoms of nature | 6 books, from cosmology to practice |
| Transmission | 5 manuscripts + fragments; first printed edition 1533 | 1 main manuscript (Copenhagen) + 1 fragment |
| Medieval impact | Moderate, but documented (Speyer Herbal, Garden of Health 1485) | Virtually none—fell into obscurity |
| Character | Reference work, herbal manual | Theoretical foundational work of medicine |
| Current relevance | Basis for practical Hildegard applications (herbs, spices, stones) | Basis for understanding Hildegard’s views on illness and humanity |
| First modern German translation | Ortrun Riha, Beuroner Kunstverlag 2012 | Ortrun Riha, Beuroner Kunstverlag 2011 |
Simply put: If you want to know what Hildegard recommended for which plant, read the Physica. If you want to understand why Hildegard thought the way she did—what shaped her view of people, illness, and healing—read Causae et Curae.
Authenticity and authorship: What research says
An honest introduction can’t avoid this question: Are Causae et Curae really entirely by Hildegard herself? The answer from medieval studies is nuanced.
Since the original manuscripts haven’t survived and all existing copies are from the 13th century or later, most researchers today believe: The works are essentially by Hildegard, but may have been edited, supplemented, or altered by scribes. Medical historian Laurence Moulinier, who published the critical edition in 2003, writes: The nature and content of the work are “overwhelmingly Hildegard’s.” Medical historian Klaus-Dietrich Fischer considers the authenticity beyond doubt, since Hildegard’s way of thinking and style are so distinctive that no reasonable doubt about her authorship can exist.
Confirmed by external sources: The writings are mentioned in Hildegard’s Vita, written shortly after her death, and appear in the canonization records of 1233—under the alternative title Liber compositae medicinae.
What Causae et Curae means today—and where to be critical
Medical historian Ortrun Riha, today’s leading translator, has pointed out a tension that shapes how we deal with Hildegard’s work: between the historical text on the one hand, and modern “Hildegard medicine” on the other. Popular ideas of a unified, immediately practical Hildegard healing art ignore the complex history of the texts, their compilation character, and the problems of transmission.
That doesn’t mean Causae et Curae has no value today. On the contrary—it contains insights that go far beyond its own era:
Psychosomatics before the term existed: The link between character, temperament, and physical disposition to illness that Hildegard draws in her teachings on temperaments is a forerunner of what modern psychosomatics only systematically developed in the 20th century. Hildegard’s core idea—that body and soul are inseparable and illness must always be considered on both levels—is timeless.
Holistic approach as a method: Hildegard doesn’t treat symptoms, but people in the context of their lives. Diet, sleep, movement, temperament, season, constitutional type—all of this factors into her diagnosis and therapy. That matches what modern preventive and integrative medicine aim for.
Herbal medicine with substance: Many of the healing plants mentioned in Books III and IV—wormwood, galangal, bertram, fennel, wild thyme—have proven effectiveness according to modern phytopharmacology. The folk medicine Hildegard drew from had, over centuries, empirically discovered what research labs confirm today. You can find more about individual herbs and their effects in our overview of herbs according to Hildegard von Bingen.
What to view critically: Hildegard’s anatomy and physiology reflect the medieval state of knowledge—which means they are, in many ways, incorrect. Her descriptions of bodily fluids, organs, and causes of illness are not modern medicine. If you read Causae et Curae, you’re reading medieval healing knowledge—with all the insights and all the limitations that come with it.
Where you can read Causae et Curae: Editions and translations
| Edition | Language | Special feature |
|---|---|---|
| Ortrun Riha (trans.), Beuroner Kunstverlag, 4th ed. (ISBN 978-3-87071-248-8) | German | Authoritative standard translation; completely newly translated and introduced; published by the Abbey of St. Hildegard Eibingen |
| Laurence Moulinier, Akademie Verlag Berlin, 2003 (ISBN 978-3-05-003495-9) | Latin (critical edition) | Scholarly standard |
Causae et Curae and Hildegard Medicine Today: The Connection
Much of what is practiced today as Hildegard Medicine—the theory of temperaments, the spice blends, fasting cures, herbal preparations—has its theoretical roots in Causae et Curae. The Physica provides the raw materials; Causae et Curae provides the underlying system of thought.
When Hildegard recommends wormwood for bitterness of the mind or galangal for a weak heart, it’s not an arbitrary suggestion—it’s part of a coherent system where the warming quality of galangal restores balance to a body fluid that is too cold and damp. Knowing this system makes the difference between just using individual remedies and truly understanding an entire healing tradition.
You can find more about practical applications from Hildegard’s writings in our articles on Hildegard Medicine, Hildegard Nutrition, and the Hildegard Fasting Cure. Our products—from fasting preparations to Hildegard cosmetics—consistently follow the principles Hildegard set down in Causae et Curae and Physica.
Summary: What you should know about Causae et Curae
| Question | Answer |
|---|---|
| What does the title mean? | "Causes and Remedies" – full German title: "Origin and Treatment of Diseases" |
| When was the work written? | About 1150–1160, alongside the Physica |
| How has it survived? | Almost complete in a single manuscript (Copenhagen, 13th century) + Berlin fragment |
| How many books? | 6 books, 492 sections |
| What is the central theme? | Human as microcosm; illness as imbalance of the four bodily fluids; healing as restoration of order |
| How does it differ from the Physica? | Physica = natural history/herbal handbook; Causae et Curae = medical theory and study of disease |
| Which translation is recommended? | Ortrun Riha, Beuron Art Publishing (4th ed., ISBN 978-3-87071-248-8) |
| Is Hildegard the sole author? | Essentially yes—with possible later edits by scribes; scholarly consensus supports Hildegard’s authorship |
