The Canon of Medicine
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The Canon of Medicine (Arabic: القانون في الطب al-Qānūn fī al-Ṭibb) is an encyclopedia of medicine in five books compiled by Persian philosopher Ibn Sīnā (Avicenna) and completed in 1025. It presents a clear and organized summary of all the medical knowledge of the time. It is a "magisterial exposition of Galenic medicine", although while Avicenna accepted Galen's evidence on anatomical matters he preferred Aristotle's theories where they differed from Galen. It served as a more concise reference in contrast to Galen's twenty volumes of medical corpus. As part of the Arabic translation project Ibn-Sina drew on various sources in the writing of his Canon an important one being the extensive pathology text from Chinese medicine called the Zhubing Yuanhuo Lun written in about 610 by Chao Yuan-fang. Ibn-Sina also drew on the early Chinese pulse diagnosis classic text the Maijing by Wang Shu-hu which was written in circa 310.
Originally written in the Arabic language, the book was later translated into a number of other languages, including Persian, Latin, Chinese, Hebrew, German, French, and English with many commentaries. The Canon is considered one of the most famous books in the history of medicine.
The word Canon in the title derives from the cognate Arabic original Qanun (the English word "canon" comes from Latin canōn, from Ancient Greek κανών (kanón, "measuring rod, standard"), while the Arabic word qanun comes directly from the same Ancient Greek root). The Canon of Medicine remained a medical authority for centuries. It set the standards for medicine in Medieval Europe and the Islamic world, and is Avicenna's most renowned written work. Qanun was used at many medical schools; at University of Montpellier, France, it was used as late as 1650. The Canon was used as a medical textbook through the 18th century in Europe. It is used in Unani (Ionian) medicine, a form of traditional medicine practiced in India.
George Sarton wrote in the Introduction to the History of Science:
"One of the most famous exponents of Muslim universalism and an eminent figure in Islamic learning was Ibn Sina, known in the West as Avicenna (981-1037). For a thousand years he has retained his original renown as one of the greatest thinkers and medical scholars in history. His most important medical works are the Qanun (Canon) and a treatise on Cardiac drugs. The 'Qanun' is an immense encyclopedia of medicine. It contains some of the most illuminating thoughts pertaining to distinction of mediastinitis from pleurisy; contagious nature of phthisis; distribution of diseases by water and soil; careful description of skin troubles; of sexual diseases and perversions; of nervous ailments."
- 1 Influence in Europe
- 2 Overview
- 3 Book 1 Part 1
- 3.1 Thesis I Definition and Scope of Medicine
- 3.2 Thesis II The Elements or Cosmology
- 3.3 Thesis III The Temperaments
- 3.4 The Humours
- 3.5 Anatomy or "The Members"
- 3.6 General Physiology
- 4 Book 1 Part 2
- 5 Book 2 Materia Medica
- 6 Book 3 Special Pathology
- 7 Book 4 Special Diseases Involving More Than One Member
- 8 Book 5 Formulary
- 9 See also
- 10 Notes and references
- 11 External links
Influence in Europe
The Qanun was translated into Latin as Canon medicinae by Gerard of Cremona. (Confusingly there appear to have been two men called Gerard of Cremona, both translators of Arabic texts into Latin. Ostler states that it was the later of these, also known as Gerard de Sabloneta, who translated the Qanun (and other medical works) into Latin in the 13th century.) It became increasingly influential through the medieval period, and was a main text in university courses by 1340. Its encyclopaedic content, its systematic arrangement and philosophical marrying of the medicine of Galen with the theory of science of Aristotle helped it become one of the pre-eminent works in the medical literature of Europe. The Canon's influence declined in the 16th century as a result of humanists' preference in medicine for ancient Greek and Roman authorities over Arabic authorities, although others defended Avicenna's innovations beyond the original classical texts. It fell out of favour in university syllabi, although it was still being taught as background as late as 1715 in Padua.
The first three books of the Latin Canon were printed in 1472, and a complete edition appeared in 1473. In the last 30 years of the 15th century it passed through 15 Latin editions. It was one of the most frequently printed medical books of the 15th and 16th centuries. In recent years, a partial translation into English was made.
The book explains the causes of health and disease. Ibn Sina believed that the human body cannot be restored to health unless the causes of both health and disease are determined. He defined medicine (tibb) as follows:
"Medicine is the science by which we learn the various states of the body; in health, when not in health; the means by which health is likely to be lost; and, when lost, is likely to be restored. In other words, it is the art whereby health is concerned and the art by which it is restored after being lost."
Avicenna regarded the causes of good health and diseases to be:
- The Material Causes
- The Elements
- The Humors
- The Variability of the Tumors
- The Temperaments
- The Psychic Faculties
- The Vital Force
- The Organs
- The Efficient Causes
- The Formal Causes
- The Vital Faculties
- The Final Causes
The Qanun distinguishes mediastinitis from pleurisy and recognises the contagious nature of phthisis (tuberculosis of the lung) and the spread of disease by water and soil. The Qanun considered important factors in health were air (including breathing but also "bad" air); food and drink; movement and rest; sleep; bowel and urinary health; and emotions. The Qanun 's Materia Medica lists 800 substances, and the Formulary lists recipes for 650 compound drugs from various sources, with Avicenna's comments on different recipes and his views on the effectiveness of particular drugs. He recommended the testing of a new drug on humans to determine its effectiveness, cautioning against testing on animals because of the risk it would affect animals differently from humans.
Book 1 Part 1
Book 1 is made up of six theses which give a general description of medicine in general, the cosmic elements that make up the cosmos and the human body, the mutual interaction of elements (temperaments), fluids of the body (humours), human anatomy, and physiology.
Thesis I Definition and Scope of Medicine
Avicenna begins part one by dividing theoretical medicine and medical practice. He describes what he says are the "four causes" of illness, based on Aristotelian philosophy: The material cause, the efficient cause, the formal cause:
- Material Cause Avicenna says that this cause is the human subject itself, the "members or the breath" or "the humours" indirectly.
- Efficient Cause The efficient cause is broken up into two categories: The first is "Extrinsic", or the sources external to the human body such as air or the region we live in. The second efficient cause is the "Intrinsic", or the internal sources such as our sleep and "its opposite-the waking state", the "different periods of life", habits, and race.
- Formal Cause The formal cause is what Avicenna called "the constitutions ; the compositions". According to Oskar Cameron Gruner, who provides a treatise within Avicenna's Canon of Medicine, this was in agreement with Galen who believed that the formal cause of illness is based upon the individual's temperament.
- Final Cause The final cause is given as "the actions or functions".
Thesis II The Elements or Cosmology
Avicenna's thesis on the elements of the cosmos is described by Gruner as "the foundation of the whole Canon". Avicenna insists here that a physician must assume the four elements that are described by natural philosophy (see Classical elements), although Avicenna makes it clear that he distinguishes between the "simple" element, not mixed with anything else, and what we actually experience as water or air, such as the sea or the atmosphere. The elements we experience are mixed with small amounts of other elements and are therefore not the pure elemental substances. The "light" elements are fire and air, while the "heavy" are earth and water. Ibn Sina (Avicenna) goes on to describe each of the four elements in detail.
- The Earth Avicenna upholds Aristotelian philosophy by describing Earth as an element that is geocentric. The Earth is at rest, and other things tend towards it because of its intrinsic weight. It is cold and dry.
- The Water Water is described as being exterior to the sphere of the Earth and interior to the sphere of the Air, because of its relative density. It is cold and moist. "Being moist, shapes can be readily fashioned (with it), and as easily lost (and resolved)."
- The Air The position of Air above Water and beneath Fire is "due to its relative lightness". It is "hot and moist", and its effect is to "rarefy" and make things "softer".
- The (sphere of the) Fire Fire is higher than the other elements, "for it reaches to the world of the heavens". It is hot and dry; it traverses the substance of the air, and subdues the coldness of the two heavy elements; "by this power it brings the elementary properties into harmony."
Thesis III The Temperaments
The Canon of Medicine divides the thesis on temperaments into three subsections; a general overview, one based on members of the body, and temperaments based on age.
I The Temperaments (General description)
The temperaments are reported to be the interaction between the four different element's qualities, such as the conflict between dryness, wetness, cold, and hot. Avicenna suggests that these qualities battle between each other until an equilibrium state is reached and this state is known as the temperaments.
The Canon also adopted the ancient theory of Four Temperaments and extended it to encompass "emotional aspects, mental capacity, moral attitudes, self-awareness, movements and dreams." It summarized Avicenna's own theory of four temperaments in a table presented as follows:
|Morbid states||inflammations become febrile||fevers related to serious humour, rheumatism||lassitude||loss of vigour|
|Functional power||deficient energy||deficient digestive power||difficult digestion|
|Subjective sensations||bitter taste, excessive thirst, burning at cardia||Lack of desire for fluids||mucoid salivation, sleepiness||insomnia, wakefulness|
|Physical signs||high pulse rate, lassitude||flaccid joints||diarrhea, swollen eyelids, rough skin, acquired habit||rough skin, acquired habit|
|Foods & medicines||calefacients harmful, infrigidants beneficial||infrigidants harmful, calefacients beneficial||moist articles harmful||dry regimen harmful, humectants beneficial|
|Relation to weather||worse in summer||worse in winter||bad in autumn|
- The Eight Varieties of Equipoise
Canon describes humans as having eight different "varieties of equipoise", or differing temperaments. The temperaments fall under two categories; In relation to beings other than men and in relation to the individual himself.
- A. In relation to beings other than men
i. "the equability of the temperament seen in man as compared with other creatures"
ii. the temperament of other human beings
- Avicenna describes a hot versus cold / moist versus dry equilibrium between the members of the human body. The heart, for example, is hot and must be in equilibrium of other cold parts of the body such as the brain. When this equilibrium between these members are achieved, the person is considered to be in "ideal equability." 
iii. external factors "such as race, climate, atmosphere"
- This third gauge for temperament assumes that each race has their own equilibrium. As an example he says, "The Hindus, in health, have a different equability to the Slaves, and so on." Avicenna explains that the differing climates contribute to differing temperaments among the races.
iv. in relation to extreme climates
- B. In relation to the individual himself
v. "as compared to another person"
- Although Avicenna had listed the fifth mode "as compared to another person", he seems to contradict that statement by explaining that every individual has a temperament that is unique to themselves and unlike anyone else.
vi. comparison of the individual himself
vii. comparing one member of the body with another member of the body
- The Canon here makes the distinction of the members into categories of their individual "moistness", "dryness", "hotness", and "coldness".
viii. comparison of a member to itself
The Canon continues to explain the sun's position in relation to ideal temperament and the role that climate and human skin play. Organs are nowhere near ideal in temperament, but skin comes the closest. Avicenna says that the hand, especially the palm and the tip of the index finger, is the most sensitive of all and attuned to tactile contact. Medicine is described as "hot" or "cold", not based upon its actual temperature but with regard to how it relates to the temperament of the human body.
The Canon then describes when temperaments are unequal, in other words, illness. Avicenna separates these into two categories, which are fairly self explainable within the context of what Ibn Sina has already defined as the temperaments.
- A. Simple "intemperaments"
i. Hot temperament (hotter than normal) ii. Cold temperament (colder than normal) iii. Dry temperament (drier than usual) iv. Moist temperament (more moist than usual) 
- B. Compound "intemperaments"
The compound intemperaments are where two things are wrong with the temperament, i.e. hotter and moister; hotter and drier; colder and moister; colder and drier. There are only four because something cannot be simultaneously hotter and colder or drier and moister. The four simple temperaments and four compound intemperaments can each be divided into "Those apart from any material substance" and "Those in which some material substance is concerned", for a total of sixteen intemperaments. Examples of the sixteen intemperaments are provided in the "third and fourth volumes."
II The Temperament of the Several Members
Each member of the body is described to be given each its individual temperament, each with its own degree of heat and moisture. Avicenna lists members of the body in "order of degree of Heat", from hottest to coldest.
- the breath and "the heart in which it arises"
- the blood; which is said to be generated from the liver
- the liver; "which may be looked upon as concentrated blood."
- the flesh
- the muscles
- the spleen
- the kidneys
- the arteries
- the veins
- the skin of the palms and soles
Then a list is given of coldest members to hottest.
- serious humour
- the hairs
- the bones
- the cartilage
- the ligaments
- the tendon
- the membranes
- the nerves
- the spinal cord
- the brain
- the fat
- the oil of the body
- the skin
- serious humour
- the serious humour
- the blood
- the oil
- the fat
- the brain
- the spinal cord
- the breasts and the testicles
- the lung
- the liver
- the spleen
- the kidneys
- the muscles
- the skin
Finally, a list is given in order of dryness
- the hair
- the bone
- sereous membranes
- motor nerves
- sensory nerves
III The Temperaments Belonging to Age
The Canon divides life into four "periods" and then subdivides the first period into five separate categories.
The following table is provided for the four periods of life:
|Period||Title||Name||Year of Age|
|I||The Period of Growth||Adolescence||Up to 30|
|II||The Prime of Life||Period of beauty||Up to 35 or 40|
|III||Elderly life||Period of decline. Senescence.||Up to about 60|
|IV||Decrepit Age||Senility||To the end of life|
Avicenna says that the third period shows signs of decline in vigor and some decline in intellectual power. In the fourth period, both vigor and intelligence decline.
Avicenna divides the beginning stage of life in the following table, according to Oskar Cameron Gruner's edition of the Canon of Medicine:
|First||Infancy||The period before the limbs are fitted for walking|
|Second||Babyhood||The period of formation of the teeth. Walking has been learnt, but is not steady. The gums are not full of teeth.|
|Third||Childhood||The body shows strength of movement. The teeth are fully out. Pollutions have not yet appeared|
|Fourth||Juvenility. "Puberty"||The period up to the development of hair on the face and pubes. Pollutions begin.|
|Fifth||Youth||The period up to the limit of growth of the body (to the beginning of adult life). Period of athletic power.|
Avicenna generalizes youth as having a "hot" temperament, but comments that there is controversy over which periods of youth are hotter. The general notion that youth are "hot" in temperament is due to youth's supposed relationship to members of the body that are hot. For example, blood was considered "hot" as was mentioned earlier, therefore youth is assumed to be hot partially due to blood being more "plentiful" and "thicker", according to Avicenna. Evidence for youth having an excess of blood is suggested by Avicenna's observation that nose bleeds are more frequent within youth. Other contributing factors are the youth's association with sperm and the consistency of their bile. Further description of youth in regards to heat and moisture is given with respect to sex, geographical location, and occupation. The Canon says, for example, that females are colder and more moist.
The Canon of Medicine is based upon the Four Humours of Hippocratic medicine, but refined in various ways. In disease pathogenesis, for example, Avicenna "added his own view of different types of spirits (or vital life essences) and souls, whose disturbances might lead to bodily diseases because of a close association between them and such master organs as the brain and heart". An element of such belief is apparent in the chapter of al-Lawa", which relates "the manifestations to an interruption of vital life essence to the brain." He combined his own view with that of the Four Humours to establish a new doctrine to explain the mechanisms of various diseases in another work he wrote, Treatise on Pulse
“From mixture of the four [humors] in different weights, [God the most high] created different organs; one with more blood like muscle, one with more black bile like bone, one with more phlegm like brain, and one with more yellow bile like lung.
[God the most high] created the souls from the softness of humors; each soul has it own weight and amalgamation. The generation and nourishment of proper soul takes place in the heart; it resides in the heart and arteries, and is transmitted from the heart to the organs through the arteries. At first, it [proper soul] enters the master organs such as the brain, liver or reproductive organs; from there it goes to other organs while the nature of the soul is being modified in each [of them]. As long as [the soul] is in the heart, it is quite warm, with the nature of fire, and the softness of bile is dominant. Then, that part which goes to the brain to keep it vital and functioning, becomes colder and wetter, and in its composition the serous softness and phlegm vapor dominate. That part, which enters the liver to keep its vitality and functions, becomes softer, warmer and sensibly wet, and in its composition the softness of air and vapor of blood dominate.
In general, there are four types of proper spirit: One is brutal spirit residing in the heart and it is the origin of all spirits. Another – as physicians refer to it – is sensual spirit residing in the brain. The third – as physicians refer to it – is natural spirit residing in the liver. The fourth is generative – i.e. procreative – spirits residing in the gonads. These four spirits go-between the soul of absolute purity and the body of absolute impurity.”
What a Body Fluid is and How Many Kinds There Are
The Canon defines a humour as "that fluid, moist 'body' into which our aliment is transformed", and lists the four primary types of fluids as sanguineous, serous, bilious, and atribilious. The secondary fluids are separated into "non-excrementitious" and "excrementitious".
The Four Body Fluids or Humours Proper
The sanguineous humour
Avicenna calls this humour "the most excellent of all" the humours. This section describes blood and compares its healthy states with its unhealthy states. Avicenna describes healthy blood as "red in colour, has no unpleasant odour, and has a very sweet taste." Abnormality of the blood stems from a change in temperament or an unhealthy humour has polluted it.
The serous humour
The serous humour is described as a sweet fluid that is cold and moist in relation to blood and bilious humours. Serous humour resembles blood and is necessary for body tissues for two reasons: to provide the tissue with nutrients as an auxiliary and to keep the bones and tissues moist.
The bilious humour
The atribilious humour
Anatomy or "The Members"
In his thesis on "The Members", Avicenna explains that the humours help to make up the members of the body, gives a general description and how to repair them.
Some are "simple members" or "elementary tissue" such as bone, cartilage and tendons. Some are "compound members" such as the heart, the liver, and the brain. He also categorizes these into vital organs and auxiliary organs.
Avicenna continues to classify the organs by different systems. "According to actions" organizes members by what they do. "According to their origin" classifies members by assuming that each member originates from the blood or from male or "female sperm".
In the thesis on General Physiology or "The Faculties of the Body", Avicenna separates life into three different categories: Vegetable, Animal, and Human. He contrasts Galen's view that the brain is the "chief seat of sentient life" with Aristotle's view that the heart is the source of all the body's faculties, saying that if physicians considered the matter carefully they would agree with Aristotle that the heart was the ultimate source of all the faculties, even if (for example) the brain is where the rational faculty manifests itself.
Book 1 Part 2
Writings on anatomy in the Canon are scattered throughout the text in sections regarding to illnesses related to certain body parts. The Canon included numerous discussions on anatomy and diagrams on certain body parts, including diagrams of the cranial sutures.
The Canon was one of the Muslim medical encyclopedias of the period which distinguished anatomy "from other aspects of medicine by its need for a different methodology".
"As for the parts of the body and their functions, it is necessary that they be approached through observation (hiss) and dissection (tashrih), while those things that must be conjectured and demonstrated by reason are diseases and their particular causes and their symptoms and how disease can be abated and health maintained."
Book 2 Materia Medica
Book 2 (the Materia Medica) of the Canon lists about 800 "simple" substances alphabetically that were used by doctors of the time. The substances are simple in the sense of not compounded with other substances. Plants, animal substances and minerals are included. Book 5 (the Formulary) lists 650 compound drugs, attributing them to various Arabic, Indian and Greek sources. Avicenna added his own comments, highlighting differences between recipes from different sources, and sometimes giving his own recipe. He also gave his opinion of the effectiveness (or ineffectiveness) of some remedies, and gave details of where particular ingredients came from and how they were prepared. He favoured proven remedies which had been tested through experience, cautioning that compounds could have unexpected or much stronger effects than might be expected from the effects of the individual components.
- "The drug must be free from any acquired quality"; for example from being exposed to heat or cold or stored in close proximity to other substances.
- "The experiment must done on a single, not a composite condition"; in other words it should not be tested on a patient who has complex or multiple illnesses.
- "The drug must be tested on two contrary conditions"; a drug may act directly on a disease but also it may be effective against a different disease by relieving its symptoms.
- "The quality of the drug must correspond to the strength of the disease...it is best to experiment first using the weakest [dosage] and then increase it gradually until you know the potency of the drug, leaving no room for doubt."
- "One should consider the time needed for the drug to take effect. If the drug has an immediate effect, this shows that it has acted against the disease itself."
- "The effect of the drug should be the same in all cases or, at least, in most. If that is not the case, the effect is then accidental, because things that occur naturally are always or mostly consistent."
- "Experiments should be carried out on the human body...the quality of the medicine might mean that it would affect the human body differently from the animal body..."
Book 3 Special Pathology
Book 3 is arranged from head to toe covering the function and diseases of each organ.
Book 4 Special Diseases Involving More Than One Member
Book 4 covers diseases that affect the whole body like fevers.
Book 5 Formulary
Book 5 covers compound drugs.
- Ibn al-Nafis
- Abu al-Qasim al-Zahrawi
- Medical literature
Notes and references
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- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. pp. 59–60. ISBN 0-404-11231-5.
- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. p. 60. ISBN 0-404-11231-5.
- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. pp. 59–61. ISBN 0-404-11231-5.
- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. pp. 62–63. ISBN 0-404-11231-5.
- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. p. 63. ISBN 0-404-11231-5.
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- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. pp. 67–68. ISBN 0-404-11231-5.
- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. p. 68. ISBN 0-404-11231-5.
- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. p. 69. ISBN 0-404-11231-5.
- Avicenna, Ibn Sina; Laleh Bakhtiar (1025). Canon of Medicine (2nd ed.). New York, NY: AMS Press, Inc. pp. 69–74. ISBN 0-404-11231-5.
- Mohammadali M. Shojaa, R. Shane Tubbsb, Marios Loukasc, Majid Khalilid, Farid Alakbarlie, Aaron A. Cohen-Gadola; Tubbs, RS; Loukas, M; Khalili, M; Alakbarli, F; Cohen-Gadol, AA (29 May 2009). "Vasovagal syncope in the Canon of Avicenna: The first mention of carotid artery hypersensitivity". International Journal of Cardiology (Elsevier) 134 (3): 297–301. doi:10.1016/j.ijcard.2009.02.035. PMID 19332359
- "Aliment: something that nourishes; food". Aliment
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- The Canon on Medicine, United States National Library of Medicine.
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- Mona Nasser Aida Tibi, Emilie Savage-Smith; Tibi, A; Savage-Smith, E (2009), Ibn Sina's Canon of Medicine: 11th century rules for assessing the effects of drugs, Journal of the Royal Society of Medicine 102 (2): 78–80, doi:10.1258/jrsm.2008.08k040, PMID 19208873
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