Medicine rests upon four pillars–philosophy, astronomy, alchemy, and ethics. The first pillar is the philosophical knowledge of earth and water; the second, astronomy, supplies its full understanding of that which is of fiery and airy nature; the third is an adequate explanation of the properties of all the four elements–that is to say, of the whole cosmos–and an introduction into the art of their transformations; and finally, the fourth shows the physician those virtues which must stay with him up until his death, and it should support and complete the three other pillars. Paracelsus
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The four pillars of medicine are philosophical knowledge, astronomy, alchemy, and ethics. The first pillar is philosophical knowledge of earth and water. The second is astronomy, which provides the full understanding of that which is fiery and airy in nature. The third is an adequate explanation of the properties of all four of the elements.

That is to say of the whole cosmos. And finally it shows the physician those virtues which must stay with him up until his death, and which should support and complete the three other pillars.

Source: Paracelsus: Selected Writings

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