Available online 12 June 2015
Open Access
Review Article
The value of Avicenna's heritage in development of modern integrative medicine in Uzbekistan
- Open Access funded by Korea Institute of Oriental Medicine
- Under a Creative Commons license
Abstract
The
heritage of Abu Ali al-Husayn ibn Abd Allah ibn Sina (known in Europe
as Avicenna, hereinafter referred to as Avicenna; around 980–1037 ce)
has been used in the practice of doctors of various specialties in the
treatment of various diseases for several centuries. Extensive clinical
experience accumulated for a long time is actively used in modern
medicine. Avicenna has had an invaluable contribution to world medicine.
He is the largest representative of advanced sociohumanitarian ideas
among the peoples of Central Asia. He was a philosopher and physician,
scientist and mathematician, poet, and specialist in literature. The
rich heritage of the scientist takes a worthy place in the history of
medicine in particular, and world civilization in general. Avicenna
introduced the main contribution to the treasury of the universal
culture by his work in medicine. Avicenna brought together the
achievements of Hippocrates (c. 460–370 bce), Galen (c. 130–200 ce),
and Egyptian, Persian, and Indian healers, and supplemented them with
own research results, brilliant discoveries, and hypotheses. Avicenna
left many works, among them the especially popular Canon of Medicine.
He paid great attention to the prevention of diseases rather than their
treatment, which is important today. In his works he gives advice on
the use of herbal medicines and biologically active points for various
diseases. This article highlights some topical issues of multifaceted
heritage of Avicenna for modern medicine and identified promising areas
for the development of integrative medicine in Uzbekistan.
Keywords
- heritage of Avicenna;
- integrative medicine;
- oriental Medicine;
- traditional medicine
1. Introduction
At
the present stage of the medical development, the treatment of disease
can be achieved with a combination of modern classical methods of
treatment with the most effective methods of Oriental medicine.
Integrative medicine—combining traditional and folk direction—is a
medicine of the future. An ideal image of the integrative physician has
long existed in the history of mankind. Hippocrates, Paracelsus,
Avicenna, and others are its real incarnation. Progressive
representatives of the Uzbek medicine obtained from folk medicine
experience all the best, rational (especially relating to medicinal
plants), and preparation into pills, and injected them into the practice
of scientific medicine.
Avicenna was a physician of the Middle Ages. In his functional encyclopedia Canon of Medicine,
he summarized many centuries’ experience of Greek, Indian, and Central
Asian medicine and medicine of other peoples of the Middle Ages, as well
as pharmacology, pharmacy, and pharmacotherapy. Many medicinal plants
described by Avicenna are firmly established in the practice of
traditional medicine in many countries, and—some of them—even in
scientific medicine.
Western
medicine considers external factors as the cause of the disease, such
as viruses and bacteria, whereas oriental medicine considers the nature
of diseases through internal factors such as the weakening of the
protective function of the body. Therefore, the main method of treatment
is destruction, prevention of external factors in Western medicine, and
the strengthening of internal defense response in oriental medicine.
In
Uzbekistan since 1996 the departments of the folk medicine have been
organized in all medical schools where senior students receive primary
knowledge on treatment methods of traditional medicine. Currently, the
total load on traditional medicine for students is 76 hours, including
6 hours of lectures, 54 hours of practical exercises (9 day cycle), and
16 hours of individual work. Particular attention is paid by students to
acquiring practical skills in the application of oriental medicine in
emergency cases.
The
Department of Traditional Medicine of the Tashkent Medical Academy (TMA)
annually holds a faculty in training professors, associate professors,
and assistants of other medical schools of the country. In 1997, at the
First Tashkent State Medical Institute (now TMA) the center of the
Oriental Medicine of the Republic of Korea was opened according to the
international program of KOICA, which is the base of traditional
medicine of the TMA.
2. Scientific heritage of Avicenna
Avicenna
was a great scholar of Central Asia, the founder of the world of
medicine. He was born in the village Afshona near to Bukhara (in Bukhara
region, current Uzbekistan). According to ancient sources, he was
credited with ∼470 works ranging in size from a single sheet to 20
volumes in 29 fields of study, 23 in Persian, others in Farsi and
Arabic—the language of science and literature of the time. Many of them
are lost forever, and only 274 survive and have been preserved.1
In the judgment of Professor U.I. Karimov, the fullest and sufficient
bibliographic source is the work of Iranian scientist Jahji Mahdavi
(1954) Catalogue of manuscripts of products of Avicenna, which
includes 242 works of Avicenna divided into two groups: (1) undoubtedly
by Avicenna; and (2) attributed to Avicenna or representing parts of
separate compositions of the scientist. 2
Avicenna
summarized the scientific achievements of his time and developed them
further in encyclopedic works on philosophy, logic, mathematics,
astronomy, physics, mineralogy, jurisprudence, linguistics, and
musicology. However, Avicenna acquired most fame as a physician,
pharmacist, and scientist.3
The Avicenna era—the era of the Samanid dynasty, the heyday of science,
culture, and Bukhara, according to many historians—“became a place of
greatness, the sanctuary of the kingdom, the dawning-place of stars in
the center of literature and scientists of the time.” From a very young
age Avicenna showed his exceptional intellectual abilities, studying
medicine and philosophy, and had an interest in the works of Aristotle.
It is noteworthy that at the age of 16 years he became a famous court
physician who healed the Emir of Khorasan.
Avicenna
grew up in Bukhara, the capital of the Samanid dynasty, whose rule
extended to the territory of Maverannakhr and Khurosan in 892–999 ce,
and Maverannakhr is the territory of modern Uzbekistan. Desire “to
untangle the knot of death”—to unravel the secrets to defeat the
ailments do everything possible to make life easier for people—moved
Avicenna when he created his major work on medicine: Al-kanun-fi-t-tibb (Canon of Medicine).
This work, written in 1013–1021, brought him fame for centuries and is
considered the foundation of medicine, not only in the Islamic world,
but also in Europe. This is truly a medical encyclopedia, in which a
logical harmony outlines everything that relates to the prevention and
treatment of disease. It is the most important work in his era and
incredibly raised a high level of medical science, and 100 years after
the death of Avicenna was widely recognized in Western Europe. Within
650 years this book had become a handbook for doctors and was equal to
half of the curriculum of medical schools in the world.
Canon of the Medicine consists of five books:
- •
- The first book is devoted to medicine theory, disease prevention, and treatment.
- •
- The second book is devoted the doctrine about simple medicines and ways of their action.
- •
- Separate illnesses and their treatment are described in the third book.
- •
- The fourth book is devoted to surgery, doctrine about fevers, etc.
- •
- Complex medicines and poisons are described in the fifth book.
Drugs (Al-Adviyat al kalboya)
was written during the first visit to Khamadan. The work presented in
detail the role of the heart in the emergence and manifestation of air,
especially the diagnosis and treatment of heart disease. Removing harm from manipulation by various fixes, errors, and warnings (Daf al kulliya an al-abdon al insoniya bi-tadorik anvo khato an-tadbir), Poem on the medicine (Urdzhusa fit-tib). Urdzhuza (Al urdzhuza fi-t-tibb) - this work is in second place after the Canon of Medicine in content and coverage of the material. The doctrine about Misadgi is the base of Avicenna's concepts about health and illnesses, and on all systems of its medical sights. The term Misadgi (Arab) means proportional mixture. Its equivalent in Russian is nature. In ancient time and the Middle Ages medical views on fervor, coldness, dryness, humidity are based on the doctrine of Misadgi concepts. Echoes of this doctrine remain in traditional (Eastern) national medicine in Central Asia. 2
In Treatise on the Pulse (Risolai nabziya),
Avicenna developed the whole doctrine of pulse diagnosis: “Pulse may be
wavy and spindle-shaped, two-shock, long, trembling, short, small,
slow, ant, soft, intense nervous, low, ramp, full, empty.” In addition
to the above described characteristics of pulse and 10 more of its
varieties, Avicenna also described in detail the 15 different natures of
pain, 20 species of urine, differentiated three types of jaundice, and
in practice used in various types of operations such as lithotomic
section, cesarean, hernia repair, and reduction of dislocations and
fractures under anesthesia. Thus, all medical manipulations used by
Avicenna even today have not lost their value.
2.1. Avicenna and modernity
In the third book of Canon of Medicine,
Avicenna describes the diseases of internal organs, in particular a
detailed description of symptoms of gastritis and gastric ulcer, close
to the modern description, i.e., vomiting, pain, heartburn, and, in some
cases, bleeding. To determine the place of ulceration, Avicenna
localized the pain and time of their arrival, as he said the pain occurs
when the food reaches the ulcer. Also, he used oral health as an
indicator of disease of the gastrointestinal tract.
In
modern medicine, diagnosis of chronic gastritis and gastroduodenal
ulcers, is realizing not only with symptom complexes of diseases
described by Avicenna, but with modern methods causative disease
pathogenesis.
The most
common chronic diseases of the digestive system are pathology of the
stomach and duodenum (gastritis, gastro, and ulcer). As a result of the
pathological process local immunity is disturbed, destroying the
microecological structure of the stomach and intestines, leading to a
vicious circle of inflammation of the mucous membrane of the digestive
system.
Scientific novelty
of the research is to develop ways of acting to the biologically active
points of the human body. Patients with diseases of the gastrointestinal
tract were examined. Of these, one group of patients received drug
therapy and a second group of patients was treated with acupuncture.
2.2. Diseases of the gastrointestinal tract in the Canon of Medicine and the current state of the issue
In his book Canon of Medicine,
Avicenna provides data on diseases of the stomach and intestines as a
reaction of the organism to changing environmental conditions and
violation of specific forms of adaptability of the organism. The
interaction of the organism with the environment, heredity, and changing
its reactivity should be considered in judgment about the cause and the
origin of diseases of the digestive system. To maintain this harmony,
Avicenna recommended foods for certain persons who have close relatives
in the past who suffered from disorders of the stomach and intestines to
avoid disturbing the relationship between nutritional factors, the
intestinal flora, and intestinal motility. To maintain this harmony
Avicenna recommended that patients eat a mixed food (animal and plant).
He also attached great importance to the rhythm of the food: “You do not
need to feed once too much, and little by little better feed and
multiply.”
The
problem of the gastrointestinal tract is one of the complex problems of
the modern medicine. Relevance of the research is one of the most
important problems of modern gastroenterology. Gastrointestinal disease
is a multifactorial chronic relapsing disease with different course and
dynamics.
2.3. Avicenna about certain issues of drug therapy
In the Canon of Medicine, the second and fifth volumes are devoted to issues of drug therapy. In the second book (Simple Medicines),
811 means of vegetative, animal, and mineral origin with instructions
of their action, ways of application, gathering, and storage rules are
described. The fifth book is the Pharmacopoeia, which outlines
the methods of manufacturing and application of medicines of difficult
structure (powders, broths, juice, infusions, ointment, syrups, jam,
oil, etc.).
The second book of Canon
consists of 811 articles, 520 of them devoted to herbs, 31 to the
products received from them, and 215 to animal and mineral origin
products and the medical products received from them. Approximately 40%
of the herbs described in Canon can be found in tropics and are not grown in Uzbekistan.
According to the Uzbek researcher, Professor H.M. Komilov, of 520 plants described in Canon
as medicinal, 178 can be found in Uzbekistan, including 100 in the wild
and 68 cultivated for various purposes. Among 52 plants listed in Table 1,
25 (48%) have applications in modern medical practice; for 14 (27%),
this has partially proved to be true, and for 13 kinds conformity is not
established.
- Table 1. List of herbs from the heritage of Avicenna used by scientific medicine at present
1. Acorus calamus L. 27. Hyosciamus niger L. 2. Allium cera L. 28. Hypericum perforatum L. 3. Allium sativum L. 29. Inula helenium L. 4. Althaea officinalis L. 30. Linum usitatissimum L. 5. Amygdalus communis L. 31. Mentha piperita L. 6. Anethum grareolens L. 32. Oryza sativa L. 7. Armeniaca vulgaris Lam. 33. Pastinaca sativa L. 8. Artemisia absinthium L. 34. Peganum harmala L. 9. Artemisia vulgaris L. 35. Persica vulgaris Mill. 10. Berberis vulgaris L. 36. Pimpinella anisum L. 11. Brassica juncea L. 37. Plantago major L. 12. Brassica oleracea L. 38. Poligonum avicularae L. 13. Calendula officinalis L. 39. Poligonum hydropiper L. 14. Carum carvi L. 40. Populus nigra L. 15. Chamomilla recutita L. 41. Prunus domestica L. 16. Corechorus olitorius L. 42. Rhus coriaria L. 17. Coriandrum sativum L. 43. Ricinus communis L. 18. Cucurbita maxima Duch. 44. Rosa canina L. 19. Datura stramonium L. 45. Rubia tincorum L. 20. Daucus carota L. 46. Silybum marianum Gaertn. 21. Driopteris filix mas L. 47. Taraxacum officinale Web. 22. Equisetum arvense L. 48. Tribulus terrestris I. 23. Ficus carica L. 49. Trigonella foenumqraecum L. 24. Foeniculum vulgare Mill 50. Triticum vulgare Vill. 25. Glycyrrhiza glabra L. 51. Tusilago farfara L. 26. Gossipium herbaceum L. 52. Urtica dioica L.
The herbs in Table 2
were described by Avicenna and used earlier in scientific medicine, but
for various reasons were excluded from pharmacopoeias and registers;
nowadays, thanks to the creation of medical products with new properties
based on them, they have again come back to medical practice.4
- Table 2. Medical herbs described by Avicenna and used in modern medical products
1. Apium graveolens L. 2. Asparagus officinalis L. 3. Cannabis sativa L. 4. Citrullus colocynthis L. 5. Cydronia oblonga Mill. 6. Ferula assafoetida L. 7. Juglans regia L. 8. Pyrus malus L. 9. Malva silvestris L. 10. Melilotus officinalis L. 11. Mellissa officinalis L. 12. Papaver somniferum L. 13. Petroselinum crispum (Mill). 14. Pistacia vera L. 15. Punica granatum L. 16. Rosa damascena Mill. 17. Sesamum indicum L. 18. Trachyspermum ammi L
To
satisfy the demand on medicinal herbs in Uzbekistan, purposeful
research is being conducted in the following directions: research and
studying of new medicinal herbs to replenish and update of the catalogue
of medical products by more effective and safe domestic preparations;
protection and rational use of medicinal herbs resources; and including
in the culture of valuable herbs to provide needs of pharmaceutical
industry.
There are some
scientific centers of Uzbekistan engaged in research on studying and
introduction herbs used by Avicenna in medical practice, namely:
Institute of Chemistry of Vegetative Substances; Institute of Bioorganic
Chemistry of Academy of Sciences; Uzbek Research
Chemical–Pharmaceutical Institute; Uzbek National University of Mirzo
Ulugbek.; and Tashkent Pharmaceutical Institute.
Avicenna divided all medicines into two groups, ethers and complex. In the second volume of Canon,
he described > 800 simple drugs of herb, mineral, and animal origin;
in the fifth volume he provides information about the complex forms of
drugs (powders, teas, juices, infusions, ointments, syrups, jams, oils,
etc.) and their application for various diseases.
Of
great significance is Avicenna's thought of having a purely individual
approach in the purpose and use of drugs in a particular case. This
statement of Avicenna, innovative for the level of development of
medical science of the period, retains its value now.
Avicenna
highlighted three basic principles of treatment with medication. The
first principle (qualitative) involves selecting drugs whose properties
are opposite properties and disease from the ancient therapeutic
receiving treat the opposite. The second principle (quantitative)
provides quantification of the degree of cuttings Agen heat, cold,
humidity and dryness medication accordingly genus disease. The third is
establishment of the dose of medication.
Avicenna state that special attention should be given to determining the dose (3rd
principle); the physician must use their own experience, tailored to
the affected organ, the individual characteristics of the patient (age,
sex, profession), and various external factors (season, climate,
country, etc.). He wrote: “Quantitative measurement [medicine] in two
ways [i.e. the choice of medication appropriate degree of quality and
proper dose] taken as a whole, made by conjecture using the Healing Art,
[based] on the natural body, the extent of disease and such moments
that require compliance for yourself and congruity; [these moments] are:
sex, age, habit, season, country, occupation, strength, and
appearance.” This principle is particularly progressive, considering
Avicenna during and after the assignment of the case on the basis of:
astrological forecasts, draws from dreams were associated with God's
will.
Medicines, trapped in
the body, according to Avicenna held various transformations, and
influenced each other. It is a value the way of drug administration and
dosage form into which it is introduced into the body. Here, in fact,
Avicenna introduces issues of pharmacokinetics.
Thus,
1000 years ago Avicenna put forward progressive thinking genius doctor
principles that has not lost its relevance and needs to be studied.
3. Conclusion
Some observation stated in Canon
and nowadays forgotten, can become an impulse for new openings in the
field of diagnostics and therapy. Research into medical herbs
recommended in Canon will allow enlargement of the arsenal of
modern therapeutic means. Current studies indicate the relevance and
necessity of deep analysis and study of multifaceted heritage of
Avicenna, which has not lost its value for medical theory and practice,
and from the perspective of integrative medicine.
Taking
into consideration the existing potential in Uzbek organizations
engaging in folk medicine, there is a need to consolidate them to
develop a common strategy and development of the Uzbek integrative
medicine. International cooperation in this area, including with the
Korean Institute of Oriental Medicine will help to create a
science-based Uzbek integrative medicine and the general promotion of
the study of the great scientist Avicenna's heritage.
Conflicts of interest
The author has no conflict of interest.
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