INSIGHTS INTO AVICENNA'S KNOWLEDGE OF GASTROINTESTINAL MEDICINE AND HIS ACCOUNT OF AN ENEMA DEVICE

Avicenna (980-1037 AD), also known as Sheikh or-Raeis, was an Muslim philosopher, physician, surgeon, astronomer, politician, encyclopedist, and mathematician. Avicenna's writings comprise of five books, know as the Al-Qanun fi al-Tibb (The Canon of Medicine) and the canon covers a wide variety of medical issues. This canon of medicine was the main reference for medical education in Western countries up until the 16th century and in the Middle East until the 19th century. Several chapters of the 3rd book of the Canon are devoted to a detailed description of gastrointestinal diseases including bowel obstruction, hemorrhoids anal fissures, perianal fistulas and perianal itching. Additionally, that same volume contains an illustration of an enema device. The aim of this paper was to present a brief review of Avicenna's 11th century views on bowel obstruction and to present his description of an enema device that has remained relatively unnoticed until now. Finally, this article illustrates similarities between Avicenna's explanation and modern medical science that celebrate Avicenna as an important contributor to medieval knowledge on gastrointestinal diseases, the science of which has been passed on to later generations.

AVICENNA'S MEDICAL DIDACTIC POEM: URJUZEHTEBBI

Historical research shows that many physicians experienced in medical sciences are also talented in art, literature and poetry. Avicenna was a sage who was skilled in poetry in addition to philosophy and medicine. He wrote two different types of poetry: those meant to be enjoyed for their literary qualities of novelty and imagination, and his didactic Urjuzeh. Didactic poems are different from poetry evoked by imagination and feeling. In didactic poetry, the poets want to learn science and philosophy, whether spiritual, ethical or practical to the readers. Rhyme and poetry were often used for scientific writing in Avicenna's era, and were considered a method for memorizing scientific information and raising students' interest in difficult scientific concepts. Verse was used to simplify the didactic content, ease memorization and make difficult scientific issues more attractive. In medieval Persia, students of medicine had learned the basics of philosophy before starting medical courses. Poetry could help the students memorize the poem itself in combination with its meaning, in a way that was better and easier than prose. Avicenna's masterpiece, UrjuzehTebbi, comprises a perfect course in traditional Persian medicine in rhyming text written in Arabic. This great work was translated into Persian at the research centre for traditional medicine and history of medicine. We hope that the Persian translation of Urjuzeh Tebbi will allow students and experts to better appreciate the role of didactic poems in compiling and transmitting the concepts of Iranian medicine.

Clinical stories and medical histories recorded by Rhazes (865-925), the Iranian-Islamic physician in the medieval period

Recording medical histories of patients is not a new issue in clinical medicine. However, the method practiced by the Iranian chemist physician, Rhazes, in the ninth century A.D is incredible. Rhazes has written several textbooks in clinical medicine, but a particular one, "Clinical Stories and Medical Histories" (Qesas va hekayat al-marazi), is a classical case book describing precise clinical courses of thirty three patients. Each chapter includes a title, the name and demographic data about a patient, his/her history of present illness, past medical and family history, findings of physical exam, impression and interventions by the physician, including pharmacological or surgical management. The reasons for each decision made by Rhazes as well as the outcomes are clearly discussed. This book review will shed light on the unknown medical practice methods in Islamic-Iranian golden era.

MANAGEMENT OF ANOREXIA IN ELDERLY AS REMARKED BY MEDIEVAL PERSIAN PHYSICIANS

Normal ageing is often accompanied by loss of appetite and decrease in food intake. Weight loss of senescence is called anorexia of ageing. As an outstanding scientist and physician of Traditional Persian Medicine, Avicenna has introduced an unconventional approach to seniors. He also believed that the elderly should consider special schemes in order to maintain their health. These schemes include consideration of nutrition, mental states, sleep, bathing, and physical activities, and even choosing some appropriate hobbies. The elderly should consume foods and fruits with laxative and stool-softening properties to prevent constipation. They would also do better to decrease the amount of food eaten at meals, but at the same time increasing the number of meals to compensate for low food intake. Moreover, they should maintain their vital force and avoid any activities that tax the body. Furthermore, considering the principles of hifz-al-sehah can help secure long and healthy lives for the elderly.

ANORECTAL DISEASES IN AVICENNA'S "CANON OF MEDICINE"

Although the development of modern medicine has helped us detect and treat diseases better than in the past, especially in the field of surgery; the history of medicine may be a trigger that can help us use neglected aspects of prior knowledge for the advancement of modern-day science. Since historical papers that have specifically focused on anorectal diseases are rare, but those that exist contain brief discussions in this field, the current study aims to present a detailed review of Avicenna's approach to anorectal diseases. Therefore, we reviewed On the Diseases of the Anus, the 17th chapter of the third volume of the Canon of Medicine written by Avicenna, and compared his views on the classification and diagnosis of, and the approach to anorectal diseases with that of modern proctology. Avicenna discussed in detail about anorectal diseases such as hemorrhoid, fissure, perianal abscess and fistula, rectal prolapse, fecal incontinence, and pruritus ani. In addition, we introduce herbs which Avicenna used to treat these diseases. Our findings show that Avicenna's views on the classification and diagnosis of, and the approach to anorectal diseases have few fundamental differences with modern medicine. In addition, the pharmacological effects of some of the herbs that were recommended by Avicenna, and are used in current medicine are proven. Thus the Medieval knowledge can be further scientifically investigated to develop new therapeutic options for anorectal diseases.

THE ORIGIN OF THE CONCEPT OF NEUROPATHIC PAIN IN EARLY MEDIEVAL PERSIA (9TH-12TH CENTURY CE)

Neuropathic pain is supposed to be a post-renaissance described medical entity. Although it is often believed that John Fothergill (1712-1780) provided the first description of this condition in 1773, a review of the medieval Persian medical writings will show the fact that neuropathic pain was a medieval-originated concept. "Auojae Asab" [Nerve-originated Pain] was used as a medical term in medieval Persian medical literature for pain syndromes which etiologically originated from nerves. Physicians like Rhazes (d. 925 CE), Haly Abbas (d. 982 CE), Avicenna (d. 1037 CE), and Jorjani (d. 1137 CE) have discussed multiple aspects of nerve-originated pain including its classification, etiology, differentiating characteristics, different qualities, and pharmacologic and non-pharmacologic treatments. Recognizing medieval scholars' views on nerve-originated pain can lighten old historical origins of this concept.

BORZOUYEH, AN ANCIENT PERSIAN PHYSICIAN WHO FIRST REPORTED UTERINE CONTRACTIONS IN NORMAL VAGINAL DELIVERY

During the final hours of pregnancy, uterine contractions cause the foetus to move through the birth canal and leave the mother's body. Haly Abbas (died 982-994 CE), is believed to be the first writer to explain the role of these contractions. However, this concept had in fact been described in the text titled Bab-e-Borzouyeh, written four centuries earlier by the physician Borzouyeh (Perzoes in Latin) as a prologue to his translation of the Indian collection of fables known as the Panchatantra. Because Haly Abbas probably had access to ancient Persian medical texts, the earliest report of uterine contractions may need to be re-attributed to this earlier author.

Mercury and sulphur among the High Medieval alchemists: from Rāzī and Avicenna to Albertus Magnus and pseudo-Roger Bacon

This essay challenges the often expressed view that the principles of metals, namely mercury and sulphur, were generally viewed by alchemists as being of a 'metaphysical' character that made them inaccessible to the tools and operations of the laboratory. By examining a number of Arabo-Latin and Latin alchemical texts in circulation before the end of the thirteenth century, the author presents evidence that most alchemists of the period considered mercury and sulphur to be materials subject to techniques of purification in the same way that naturally occurring salts and minerals could be freed of their impurities or dross. The article also points to the immense influence of Avicenna and Albertus Magnus in formulating the theory that mercury and sulphur were compounds of different materials, containing both fixed and unfixed components. Finally, the author briefly examines the relationship between this materialist approach to the principles and the chymical atomism of early modern authors who were deeply aware of medieval alchemical literature.

Differentiation between seizure and hysteria in a tenth-century persian text: Hidāyat of al-Akhawayni (d. 983 AD)

Although hysteria is associated largely with the nineteenth century, we find the subject treated in a tenth-century Persian medical text, the Hidayat al-Muta`allemin Fi al-Tibb [A Guide to Medical Learners] by al-Akhawayni Bukhari (d. 983 AD), a prominent physician in the Persian history of medicine. In this article, we discuss al-Akhawayni's views on seizure and hysteria and his differentiation between the two conditions, and we place it in a historical context.

Genome-wide association and linkage analyses localize a progressive retinal atrophy locus in Persian cats

Hereditary eye diseases of animals serve as excellent models of human ocular disorders and assist in the development of gene and drug therapies for inherited forms of blindness. Several primary hereditary eye conditions affecting various ocular tissues and having different rates of progression have been documented in domestic cats. Gene therapy for canine retinopathies has been successful, thus the cat could be a gene therapy candidate for other forms of retinal degenerations. The current study investigates a hereditary, autosomal recessive, retinal degeneration specific to Persian cats. A multi-generational pedigree segregating for this progressive retinal atrophy was genotyped using a 63 K SNP array and analyzed via genome-wide linkage and association methods. A multi-point parametric linkage analysis localized the blindness phenotype to a ~1.75 Mb region with significant LOD scores (Z ≈ 14, θ = 0.00) on cat chromosome E1. Genome-wide TDT, sib-TDT, and case-control analyses also consistently supported significant association within the same region on chromosome E1, which is homologous to human chromosome 17. Using haplotype analysis, a ~1.3 Mb region was identified as highly associated for progressive retinal atrophy in Persian cats. Several candidate genes within the region are reasonable candidates as a potential causative gene and should be considered for molecular analyses.

Al-Akhawayni and the early descriptions of meningitis

Abubakr Rabi-ibn Ahmad Akhawayni Bukhari, also known as Al-Akhawayni, was a Persian physician who lived in the Near East during an age in which medical knowledge blossomed in the Islamic world. This era, the "Islamic Golden Age," extended from the tenth to the twelfth centuries AD. During his lifetime as a physician, Al-Akhawayni was famous for his expertise in medicine, including disorders that would be considered neurological today. In his extant book Hidayat al-Muta`allemin fi al-Tibb [A Scholar's Guide to Medicine], he provided an early description of what is probably meningitis. He illustrated the membranes surrounding the brain tissue in detail and described manifestations resulting from their inflammation.

Insights into Avicenna's contributions to the science of surgery

An influential Persian scholar of the Islamic Golden Age of Medicine (from the ninth to the twelfth centuries AD), Ibn-e Sina (AD 980-1037), also known by the Latinized name Avicenna, is best remembered for his contributions to various aspects of medicine, particularly surgery. In fact, the art of surgery was a major focus of his attention and practice, and one to which he devoted several chapters of his main medical encyclopedia, Al-Qanun fi al-Tibb (The Canon of Medicine). This article presents a brief review of Avicenna's life, introduce his textbook of medicine, and present his significant contributions to the science of surgery.

The bezoar stone: a princely antidote, the Távora Sequeira Pinto Collection-Oporto

Bezoar stones, once used as universal antidotes and panaceas, but currently regarded as costly and useless medicines of the past, are a major milestone in the history of toxicology. Arabic physicians had been using bezoars in medicine from the 8th century onwards. In the 16th century, the Portuguese controlled bezoar trade from India, and the Portuguese doctors Garcia de Orta, Amatus Lusitanus, and Cristobal Acosta introduced the medicinal use of Oriental bezoars to European medical literature. Some criticism aside, leading European doctors prescribed bezoars mainly as powerful antidotes. Five bezoars that now adorn the Távora Sequeira Pinto Collection in Oporto testify to the allure and glory of bezoars at the height of their golden age, when they equalled the splendour of gems and noble minerals that dominated the Eastern and Western lithotherapy.The end of the 18th century marked the end of ancient panaceas. This article focuses on the therapeutic and apotropaic use of bezoars.

[Herodotus on the adventurous career of the famous Greek physician Democédes]

In the latter half of the sixth century BC the physician Democédes left Croton, a Greek settlement in Southern Italy, in order to practice and gain an income and perhaps fame. He first arrived in the island of Aigina, where he soon became very famous and was offered a substantial fee for serving the inhabitants of the island. He then moved to Athens and after a year he became physician to the tyrant Polykrátes of Samos. When the tyrant was murdered, he was enslaved by the new ruler, but he too was killed. Finally Democédes fell into the hands of the Persian king, Dareios the first, still fettered as the other slaves. When the king sprained his ancle seriously, his Egyptian court doctors were helpless. Someone knew that Democédes was a skillful physician, so he was sent for and appeared in chains and rags. After having cured the king he was very generously rewarded. Democédes only wanted to go back to Hellas, but the king would not let him. Later Democ,des cured the favourite wife of the king, Atossa, of an abscess of the breast. Democédes persuaded her to encourage the king to send a scouting expedition including Democédes to Greece in order to prepare for war. Democédes managed to escape from the ship and after some further troubles he succeeded to remain in his native town of Croton. The story contains many folkloristic motives and is certainly not historically correct. But it is well known that young Greek doctors often travelled around as Democédes did and that Greek doctors came to replace their Egyptian colleagues at the courts of the local rulers. Herodotus wrote down the adventures of Democédes about one hundred years after they may have taken place, and this simple fact probably accounts for some of the dramatic details of the story. The tale of Democédes illustrates the interests of Herodotus and of Hippocrates too in foreign people and the reasons why the Greek of the fifth century were so successful compared to others. Here Democédes triumphs over his Egyptian colleagues and he escapes from his Persian guards when back in Italy. But Democédes also shows virtues worthy of a true Hippocratic doctor. He saves his Egyptian colleagues from being crucified, applies a gentle treatment curing the king's strained ancle, promises the queen not to reveal anything about her ailment, and points out that he will not ask for an indecent reward for curing her of the abscess.

Treatment of gout in a recently published 9th century manuscript of Rhazes

Gout is a common lifestyle disease and was identified by Hippocrates in the fifth century BC although the condition was known ancient Egypt some two millennia earlier. The pharmaceutical suggestions described in a recently edited manuscript, the oldest known medical manuscript of the Arab world, is presented, here for the first time. It is entitled Treatise on Gout by Rhazes, the greatest of Arab clinicians, and was written in the late 9th or early 10th century. Rhazes' pharmaceutics are presented in descriptive tables and their components are also compared with other recipes from manuscripts of the Galen and a recently edited medieval Syrian manuscript of Le Livre des simples (Tables 1-2). It is noteworthy that Rhazes insists that the drugs should be taken before sunrise and at down, showing ignorance of current knowledge of circadian rhythms. This is of interest as arthritis chronotherapy is widely discussed in recent literature.

Herbal medicinal oils in traditional Persian medicine

CONTEXT

In Iran, conventional production methods of herbal oils are widely used by local practitioners. Administration of oils is rooted in traditional knowledge with a history of more than 3000 years. Scientific evaluation of these historical documents can be valuable for finding new potential use in current medicine.

OBJECTIVE

The current study (i) compiled an inventory of herbal oils used in ancient and medieval Persia and (ii) compared the preparation methods and therapeutic applications of ancient times to current findings of medicinal properties in the same plant species.

MATERIALS AND METHODS

Information on oils, preparation methods and related clinical administration was obtained from ancient Persian documents and selected manuscripts describing traditional Persian medicine. Moreover, we investigated the efficacy of medicinal plant species used for herbal oils through a search of the PubMed, Scopus and Google Scholar databases.

RESULTS

In Iran, the application of medicinal oils date back to ancient times. In medieval Persian documents, 51 medicinal oils produced from 31 plant species, along with specific preparation methods, were identified. Flowers, fruits and leaves were most often used. Herbal oils have been traditionally administered via oral, topical and nasal routes for gastrointestinal, musculoskeletal, and neural diseases, respectively. According to current investigations, most of the cited medicinal plant species were used for their anti-inflammatory and analgesic properties.

CONCLUSIONS

Medicinal oils are currently available in Iranian medicinal plant markets and are prepared using traditional procedures for desirable clinical outcomes. Other than historical clarification, the present study provides data on clinical applications of the oils that should lead to future opportunities to investigate their potential medicinal use.

Al-Akhawayni's description of pulmonary circulation

Since antiquity, heart function and the mechanism of blood circulation within the human body have been the focus of attention of scientists from different parts of the world. Over the passage of time, the theories and works of these scientists have resulted in the achievement of today's knowledge of circulation. The medieval Persian scholar, Al-Akhawayni Bukhari (?-983AD), is among the physicians who investigated both the anatomy and the physiology of the human body. Al-Akhawayni describes the mechanism of pulmonary circulation in his only extant book, "Hidayat al-Muta`llemin fi al-Tibb" (A Scholar's Guide to Medicine) with which he made a contribution to the development of knowledge regarding this mechanism in the medicine of the Islamic world. In this paper, Al-Akhawayni's viewpoints on anatomy and the function of the heart, its related vessels, and also pulmonary circulation will be briefly discussed.

In commemorating one thousandth anniversary of the Avicenna's Canon of Medicine: gastric headache, a forgotten clinical entity from the medieval Persia

Although the connection between head and stomach and hence the condition known as "gastric headache" was well known to the ancients, it has received little attention since the early 20th century. Herein, we review the teachings of the medieval Persian physicians about the gastric headache along with the related signs, symptoms, types and causes. The medieval Persian scholars adopted the main ideas of the gastric headache from predecessors in the ancient Greece and Rome, added substantial sub-categories and details to the earlier descriptions and therapeutic options. The medieval Persian physicians' contributions to the concept of gastric headache influenced beyond doubt the later accounts of this condition.