Ibn Sina was to the Arab world what Aristotle (384-322 b.c.) was to ancient Greece.

He was a scholar not only in medicine but in law, mathematics, physics, and
philosophy. The name Avicenna, as he was known in Europe, is a Latinized form of
his Arabic name.

His great work, the Canon of Medicine was written before his twenty-first birthday.
At more than one million words long, it represents a comprehensive collection of all
existing medical knowledge during his time. He summarized Hippocrates (460-377
b.c.), Galen (130-200), Dioscorides (40-90), and late-Alexandrian physicians,
adding Syro-Arab and Indo-Persian knowledge along with his own notes and
observations. He tried to put anatomy, physiology, diagnosis, and treatment into
proper categories. The work is not only a systematic digest of all
medical information, but is clearly arranged, organized, and written. As a result, Ibn
Sina's work became preferred to those of Rhazes (865-923), Ali ibn Abbas Maliki,
and even Galen.

The five books of the Canon of Medicine are organized with summaries and
comments. Book One begins with the general principles of humors. Ibn Sina
elaborates on the versatility of the humoral theory and how it fits into the four
elements, four ages of man, and the four temperaments. He then moves on to
anatomy, physiology, hygiene, etiology (the origin of diseases), and symptoms and
treatments of disease.

Book Two deals with materia medica, or pharmaceuticals. He details all

known information on the physical properties of simple drugs and discusses how to
collect and preserve herbals. In a separate section he lists 740 different types of
medicinals.

Book Three zeroes in on specific diseases that he catalogs from head to toe. He
outlines the etiology, symptoms, diagnosis, prognosis, and treatment of each one of
these diseases.

Book Four tackles conditions that affect the entire body, including fevers, infections,
ulcers, abscesses, pustules, fractures, and injuries. Avicenna also discusses poisons
and includes a section on anorexia and obesity.
Book Five ends with a discussion of compound drugs, using terms like theriacs,
electuaries, emetics, pessaries, and liniments, along with their medical uses.

In its basic conception the Canon follows Galen in the ancient tradition of elements
and humors. The elements are air, water, fire, and earth. The theory of the four
humors includes blood, phlegm, choler or yellow bile, and melancholy or black bile.
However, Ibn Sina incorporated many observations not found in Galen's.

Ibn Sina's original contributions recognized the contagious nature of phthsis and
tuberculosis, the distribution of diseases through soil and water, and the interaction
of mind and body. He suggested a treatment for lacrymal fistula and introduced a
medical probe for the channel.

He also stressed the importance of prevention. Discussing diet and the influence of
climate and environmental factors on health, the book also discusses rabies,
hydrocele, breast cancer, tumor, labor, and treatments for poisons. He showed the
difference between meningitis and the meningismus of other acute diseases. Other
conditions he described include chronic nephritis, facial paralyses, ulcer of the
stomach, and types of hepatitis and their causes. He discussed in great length the
dilation and contraction of the pupils and how they were used in diagnosis, as well
as the six motor muscles of the eye and the function of the tear ducts. Noting the
contagious nature of some diseases, he attributed this to "traces" left in the air by the
sick person.

In addition to a description of 740 medicinal plants and drugs made from them, he
laid out a series of basic rules for clinical drug trials, many of which continue to
serve as the basis of modern clinical trials. Ibn Sina stipulated that: 1) The drug must
be pure and must not have anything that would lessen the quality; 2) The drug must
be used on a "simple" disease, not one with several complications (Today, this is
called targeted treatment);
 3) The drug must be tested on at least two different types of diseases, as sometimes
a drug cures one disease by the essential quality and cures another by accident (Ibn
Sina was proposing the parameters for a controlled experiment); 4) The quality of
the drug must correspond with the strength of the disease (This is based on the Greek
view that the "heat" of some drugs is less than the "coldness" of certain diseases, so
they would not have an effect on them); 5) The observation of the time must be
recorded so as not to confuse with natural healing; 6) Several trials must be made
and the effect of the drug deemed to be consistent, otherwise the effect may be
considered an accident; 7) While animal testing on a lion or horse may begin the
experiment, it must be tested on the human body, as reactions on an animal may not
be the same as the effect on man.

Ibn Sina encouraged observation and a close study of the human body; he
condemned conjecture and presumption in anatomy. Some of his observations were
ahead of his time. For example, he observed that the aorta, at its origin, contains
three valves that open as blood rushes into it from the heart during contraction and
closes during relaxation so the blood may go back into the heart. He determined that
muscles could move because of nerves and that pain in the muscles is also due to
nerves. He found that the liver, spleen, and kidney do not contain nerves, but that
nerves are present in the coverings of these organs.

The Canon was translated into Latin as early as the twelfth century by Gerard of
Cremona (1114-1187) and published in Venice in 1493-1495. The Canon became a
standard textbook for medical education in the emerging medical schools of Europe.
The fact that it was reissued 16 times in the last 30 years of the fifteenth century
underscores its influence; 15 editions were in Latin and one in Hebrew. During the
sixteenth century, it was revised more than 20 times. In 1390 Cameron Gruner
translated part of the book into English as "A Treatise on the Canons of Medicine of
Avicenna." From the twelfth to the seventeenth centuries the Canon was the chief
guide to medical science in the West. As the great medical scholar William Osler
(1849-1919) noted, the Canon has remained a medical bible for longer period than
any other work.
Although some of the science of the elements and humors are no longer accepted,
the contributions of Ibn Sina have helped set the standard for current medical
practice. His encouragement of observation is one of the basic tenets of the scientific
process, his description of the anatomy and some of the muscles of the eye are still
used, and his advocacy of trial and control in drug testing forms the basis of modern
pharmacological discovery.

Ibn Sina and his Canon of Medicine has become so important that no discussion on
the history of medicine can be complete without referring to him. He has earned
many honorary titles, notably the "Galen of Islam." His preeminence in the Latin
West was even enshrined by Dante (1265-1321), the fourteenth-century Italian poet,
who ranked Ibn Sina between Hippocrates and Galen.

Nevertheless, some critics have alleged that Ibn Sina stifled independent thought
through his writings. However, some of his treatises and comments are highly
critical of the works of past writers, opening the door for subsequent physicians to
question his own writings and those of other scientific authorities.

Variability of the Humors.

The humors vary considerably as regards their quantity and quality.
The sanguineous rules from 3 am to 9 am; the bilious from 9 am to 3 pm; the
phlegm humor from 3 pm to 9 pm and the atrabilious humor from 9 pm to 3 am.
The sanguineous humor increases in spring. The heat of summer opens the pores,
dissolves excess humors and reduces them, and causes the vital breath to escape
from the body when exhaling, together with moisture and vapours. During this time,
the bilious humor is dominant. Autumn tends to generate the phlegm humor. During
winter the humors thicken, the sinews are contracted and the natural heat is directed
inward. The atrabilious humor increases and makes people sluggish.
The activity of the elemental qualities (cold and heat) tends to determine which type
of humors are most likely to form. When the amount of heat present is in balance,
the sanguineous humor will be formed; when heat is in excess, the bilious humor
forms; when there is such an excess of heat that oxidation occurs, the atrabilious
humor forms. When the amount of cold present is balanced, the phlegm humor
forms; when there is an excessive amount of cold, congelation becomes dominant
and the atrabilious humor forms.

The humors are the vital essences of the body. These humors affect the function of
the body and are themselves influenced by physical functions.
Food and drink are transformed into innate heat through the digestive process. The
humors arise in the second stage of digestion in the liver. This process produces four
humors which sustain and nourish the body and move through the channels or
meridians: sanguineous (blood), serous (phlegm), bilious (choler, yellow bile) and
atrabilious (melancholy, black bile); which correspond respectively to Air (hot and
moist), Water (cold and moist), Fire (hot and dry) and Earth (cold and dry). The
humors are subject to variation in quantity and to variation in degree of purity.
Illness results when there is either a quantitative or qualitative change of a humor.
In a "normal" state, the humors are assimilated by the organs and completely
integrated into the tissues. In an "abnormal" state, which is due to improper
digestion, the material is unsuitable for assimilation and must therefore be eliminated
by the body. Surpluses may be eliminated by exercise, bathing, coitus, purges and
laxatives.

1. The sanguineous humor (blood), which is of a balanced nature, is hot and

moist, sweet and red, and exceeds the other humors in proportion to quantity.
It imparts strength and colour to the body and engenders the drives. Located
in the heart, it relates to the Zodiacal constellations of Leo, Aries and
Sagittarius.
2. The phlegm humor or serous humor, is next to blood as far as the relative
quantity present in the body is concerned.
 3. This humor is watery, cold, moist and white and moderates the strength, heat
and thickness of the blood, nourishes the brain, and moistens and nourishes
the moving parts of the body. If an abnormality of blood arises, heat will
dissolve the phlegm humor into blood. Cancer, Pisces and Scorpio are the
Zodiacal signs relating to this humor.
4. The bilious humor, is less plentiful in the body than either blood or phlegm.
Its quantity is hot and dry, yellow or red and bitter. A part of it passes from
the liver to the gallbladder and another part flows from the liver with other
humors. This humor moderates moisture and provides a penetrating quality to
the blood so that it may enter more readily into every tissue of the body. The
bilious humor prevents the body from becoming heavy, sleepy and dull. It
penetrates and opens passages and sustains those components of the body in
which the fiery element predominates. Zodiacal signs of the bilious humor are
Gemini, Aquarius and Libra.
5. The atrabilious humors quality is earthy and gross, thick, black and sour. A
part of it is separated out by the spleen and a part remains within the blood.
This humor feeds the bones, the spleen and other parts of the body which are
gross or "melancholy" in nature. It tempers the two hot humors (sanguineous
and bilious) and restrains the vaporous volatiles that arise from blood. The
atrabilious humor thickens the blood and thus prevents it from flowing too
freely through the veins and arteries. The Zodiacal relationship of this humor
is with Taurus, Virgo and Capricorn.

The Organs.
The humors are the constituent elements from which the organs of the body are
formed, just as the humors are derived primarily from the intercombination of
nutrients and the nutrients are primarily composed of a combination elements.
The organs are divided into two types: simple organs, which have homogeneous
parts such as flesh, bones and nerves, and compound organs such as the hands and
face. The organs are the servants of the mind and are the instruments by the which
the mind can control the body.
The primary elemental quality of an organ is based on its nutrient while its secondary
quality is determined by what it excretes.

1. Hot organs consist of vital force; blood; and tissues of the heart, liver, flesh,
muscle, spleen, kidneys, breasts, testicles, muscular coats of arteries, veins,
and of skin of the palm.
2. Cold organs consist of phlegm; and tissues such as hair, bones, cartilage,
ligaments, serous membranes, nerves, spinal cord, brain, solid and liquid fats
and skin.
3. Moist organs consist of phlegm; blood; and tissues such as sold and liquid
fats, brain, spinal cord, breast, testicles, lungs, liver, spleen, kidneys, muscles
and skin.
4. Dry organs consist of tissues such as hair, bones, cartilage, ligaments,
tendons, membranes, arteries, veins, motor nerves, heart, sensory nerves, and
skin.

The Vital Faculties.

The body also possesses vital faculties or drives, from which originate the
functions of various organs. The major faculties are:

1. the vital faculty (hayawaniyah), which is responsible for preserving the

integrity of the vital force, sensation, and movement of the heart;
2. the natural faculty (tabiiyah), which governs the nutritive powers of the liver
and the reproductive powers of the generating organs; and
3. the animal faculty (nafsaniyah), which controls the brain and the rational
faculty.
REFRENCES

Clendening, Logan. Source Book of Medical History. Dover: Henry Schuman,

1942.

Khan, Muhammed Salim. Islamic Medicine. London: Routledge & Kegan Paul,
1986.

Porter, Roy. The Greatest Benefit to Mankind: A Medical History of

Humanity. New York: W.W. Norton, 1997.

Pouchelle, Marie-Christine. The Body and Surgery in the Middle Ages. New
Brunswick, NJ: Rutgers University Press, 1990.

Smith RD. Avicenna and the Canon of medicine: a millennial tribute.

West J Med. 1980; 133: 367 370.

Tan SY. Medicine in stamps. Avicenna (9801037): prince of physicians.

Singapore Med J. 2002; 43: 445 446.

Saints and Saviours of Islam. New Delhi: Sarup &

Sons; 2005: 273. Smith RD. Avicenna and the Canon of medicine: a millennial
tribute.
Khan A. Avicenna (Ibn Sina): Muslim Physician and Philosopher of
the Eleventh Century. New York

Parvin M. Avicenna and I: the journey of spirits. Bethesda: Ibex Publishers;

2006: 151 152.

Viseltear AJ. C.-E.A. Winslow and the early years of public health at
Yale, 1915-1925. Yale J Biol Med. 1982; 55:137 151.

Avicenna. The Canon of Medicine of Avicenna [Translated to English

by: Oskar Cameron]. NewYork: AMS Press INC; 1973.