Department of History
University of California, Irvine
Instructor: Dr. Barbara J. Becker
Al'-Arjuzat fi' t-tibb
(Poem on Medicine)
by 'Abu 'Ali al-Husain ibn 'Abd Allah ibn Sina,
known to Europeans as Avicenna (c.980-1037)
Preface in Prose
The Sheikh, the Prince of Physicians, 'Abu 'Ali al-Husain ibn 'Abd Allah ibn Sina stated:
It was customary for philosophers and men of knowledge of ancient times to serve kings, amirs, caliphs, viziers, judges and jurists by drawing up for them writings in prose and poetry, volumes consecrated to the arts and sciences and especially medical poems.
As for physicians, they often write poems in rajaz and make collections which permit us to distinguish the eloquent man from the one who is not, the skillful from the incompetent. Thus, it is that kings became acquainted with the precepts of medicine and philosophical methods.
I have seen that in certain countries medical art did not promote discussion meetings, nor polemics, as much in hospitals as in schools; I have seen people, unprovided with a scientific foundation, without any idea of its laws and deprived of any ethical formation, busy themselves with medicine without having studied it. Thus, men without thorough knowledge have pushed themselves forward and have considered themselves teachers. Now, I cast myself upon the footsteps of the ancients and the philosophers and I have served his Excellency, our Majesty the Vizier, the Jurist, the Judge, the Illustrious, whose position is exalted (may Allah prolong his life, allow his power and his glory to continue and overthrow his jealous subjects and his enemies); I have served him with this 'Arjuzat , a poem which deals with every part of medicine.
I have divided this 'Arjuzat in a remarkable manner; I have dressed it with a complete raiment and adorned it with a gown of beauty.
It is drawn up in a very simple style, in convenient versification, so that it may be easy, less difficult to understand.
When Our Majesty looks at it with all his acuteness of mind and it takes a place among his books in a small form, he will make use of it in order to acquire this magnificent science. Then, he will know how to discern the true practitioner from the despicable mob, the apprentice from the perfect savant, and the erudite from the blockhead.
I beseech Allah to help me in one of those works which bring us nearer to Him and lift their author to His eyes.
It is from Him that I beg His help and in Him that I place my confidence....
Preface in Verse
...The arts and speech distinguish man from animal. The best of men do good by accompanying it with courteous words, preoccupying themselves with the body, granting to it its rightful mirth. Poets are the princes of the Word; physicians rule over the Body. The eloquence of the former rejoices the soul; the devotion of the latter cures illnesses. In this poem is included all Theoretical and Practical Medicine. And here I am, putting into verse all I know of this science.
Medicine is the preservation of health and the cure of disease which arises from conscious causes which exist within the body.
A first division will be: Theory and Practice. Theory within itself is divided into three sections. There are seven natural components and six vital factors. Indeed, they are found in books. They are the diseases, the symptoms and the causes. Practice is divided into two actions: one performed with the hands, the other with medicine and dietary regimens.
ON THE SEVEN NATURAL COMPONENTS
The elements are the constitutive factors of bodies. The opinion of Hippocrates on the subject of the elements is accurate; there are four of them: water, fire, earth, air. The proof of the accuracy of this notion is that after death, the body returns to them through necessity. Moreover, if it were composed of only a single element, one would not know how to observe any living being touched by illness.
After that, perfect knowledge of the temperaments aids in the treatment of illness. The temperament has four aspects which the physician will separate or join together. It may be warm, cold, dry or moist, expressions perceptible by touch. These qualities are found in the elements [earth, water, air, fire], in the seasons, in the kingdoms [animal, vegetable, mineral], and in places.
The raw material is the primordial constitutive source of bodies. Warmth is in fire and air, cold in earth and water, dryness between fire and earth, moisture between water and air. These qualities are also found in the elements which are of different natures and which make up bodies by their arrangements. These qualities are different in that there will be only one and they group themselves without opposing each other.
We have an idea of the temperament of someone because of this arrangement of elements and thus, we give him the classification of that which predominates. The temperament is said to be balanced when it includes the four qualities. They exist in man according to certain proportions which serve as a pattern and model.
Every man, in whom the qualities are not in equilibrium and which lead him towards one extreme, is not void of the others because of that, but they do not exist in comparable proportion. He carries the classification of the dominant one: he is said to be of a given temperament of fire, earth, water or air. Behold medical nomenclature!...
The body is made up of humors of different colors and of different temperaments. They are phlegm, yellow bile, blood and black bile.
Natural phlegm is tasteless and mixed with cold; there is a variety known under the name of glassy, thick and of a cold temperament; another is sweet which is not void of warmth; there is also one called salty which leans towards warmth and dryness; another is acid and is the coldest; it is found in the sick stomach.
Yellow bile allows several shades; one is known under the name of smoky; another is like the verdigris and the leek, which is the healthiest; another is like egg yolk and is not unhealthy; still another is a reddish color and is found in the gall bladder. Warmth is attributed to all.
It is likely that the seat of black bile is in the spleen.
The origin of the blood is in the liver; the veins transport it throughout the entire body. There is also some blood in the heart; it has a warm, moist character. The nature of the blood is perplexing; otherwise, it is not normal. It results from the mixture and the combustion of other humors.
The essential organs of the body are four in number; the others are only ramifications of them.
The skin, flesh, different kinds of glands are the agents of the functions of the body. The bones, membranes, ligaments are the supports and protection of it. So that form and constitution be perfected, there are auxiliary organs of the principal one. The fingernails are tools for the extremities; hair eliminates the residues and ornaments the body.
The natural spirit is formed from a perfect and unspotted vapor. The animal spirit which is found in the heart maintains life. The vital spirit has the brain for a substratum and matures in the meninges. These different varieties are perfected in the cerebral convolutions; that is, likewise, the seat of feeling and thought. Each one of these spirits has strictly its own properties.
There are seven forces in human nature, different in appearance:
There are nine properties in the soul. Five of them are related: hearing, sight, smell, taste, and touch in its entirety; one goes to the nerves; through it man moves his joints; another represents objects as seen in a mirror; another governs thought; the last, memory.
Conditioned by forces, actions are equal in number to the former....
ON THE SIX NECESSARY FACTORS
The sun influences the air: this is true for the seasons and for the phases of the moon. It acts on climates with which we have already dealt.
The atmosphere changes its condition under the influence of the stars at their rising and setting. When the sun draws near, it puts fire into the air, whence shooting stars. It is similarly true that after this star has disappeared, the atmosphere has already become cool. If stars of evil omen appear, they decree death for men. If, on the contrary, they are of good omen, they determine absolute health.
If a town is built upon a mountain, it is cold because of this. In a flat, low area, it is warmer; facing the south, it is warmer when the wind blows from the south. When back to back with the mountains on the south side, the north wind will chill it. Facing the west, its air will be heavier; contrariwise, on the east, the air will be lighter.
The seas have an opposite influence. That is what scientists have reported. Winds modify the atmosphere just as do the phases of the moon. The south wind possesses warmth and moisture for which reason it spoils things easily. The north wind possesses coldness and dryness; it brings on a cough. The east wind possesses warmth and tenuity; the west wind, coldness and heaviness.
Each region is moist in which soil is wet and around which marshes are found. If there are fresh water lakes around the town, it is moist. On the contrary, the air is dry in the vicinity of rocks and salty terrains.
The residence provided with numerous openings receives all winds; it is very cold in winter, very warm in summer. It is just the opposite for a subterranean residence....
II. Food and Beverage
Be aware that it is food which ought to cause growth. For adults, it replaces instantly that which, being dissolved in the body, would decrease in quantity. The most commendable is the one which forms a pure blood when being transformed; for example, a good loaf of semolina, the meat of young chickens. Likewise, the vegetable beet agrees with sick people. Among foods certain ones are thick; example: semolina and two-year-old lambs with flavorful meat. The fish caught in rocky waters is a thick food which agrees with people who have to work hard. Among foods, there are some which, by themselves unpleasant to taste, are useful such as mustard, onion and garlic. In reality, they generate yellow bile; they are sometimes used as medicine. There are some which produce black bile and may make certain people sick; for example, old goats, old bulls, bread made from wheat with its impurities; that is dangerous. There are also those which create phlegm; for example, large fish and milk.
Fresh river waters preserve their original moisture. They cause the elimination of residues and carry nourishment within the vessels. The best is rain water for it contains nothing harmful. Among all waters certain ones have lost their primitive qualities and have assumed those of the substance which is mixed in it. Wine, date wine and milk nourish the body. There are some which lend their temperament to the body; for example, oxymel when it is assimilated.
III. Sleep and Wakefulness
Sleep is the rest of the forces of the body, motor as well as sensory. In reality, it warms the interior, whence more complete digestion of food. However, if it is prolonged, unhealthy humors fill the interior of the head. It moistens the body, relaxes and destroys the warmth which enlivens it. The state of moderate wakefulness causes the senses to function; it makes them active; it gives energy in action and thus, rids the body of its residues; but if it is prolonged, it becomes a restlessness which generates affliction and sadness; in reality, it debilitates the soul and the body, alters the complexion and the colors, makes the eyes sunken, disturbs digestion, lessens judgment and is emaciating.
IV. Movement and Rest
Among physical exercises, there are some moderate ones; it is to them that one ought to devote himself. They balance the body by expelling residues and impurities and are factors of good nutrition for adults and of happy growth for the young. Unmoderated exercise is an overload, alters the forces of the soul, leads to lassitude, consumes natural warmth, empties the body of its moisture, weakens nerves through the violence of pain and causes the body to age before its time. There is no illusion about prolonged rest: no advantages in its excess; it fills up the body with noxious humors and it does not place it in a state from which to benefit from its nourishment.
V. Elimination and Obstruction
The body needs elimination for all its organs and for the brain. Phlebotomy and drugs, taken in the spring, are very useful for people. The emetic ought to be administered in the summer and the black bile expelled in the autumn. Gargle and cleanse your teeth in order to have your dentition and palate clean. Provoke urines; otherwise, fear dropsy. Expel the menstrua under pain of putrefaction. Use the purgative because with that, you will avoid the colic. Make use of baths in order to carry away impurities. Do not be slothful to make the residues come out of the pores and to rid the body of its uncleanliness. Allow sexual relations for young people: through them they will avoid masturbation. On the other hand, forbid them for the weak, old and debilitated people. Promise gout and pains for those who cohabit after the meal. The abuse of intercourse weakens the body and gives as a reward all kinds of illnesses.
Rage causes warmth; sometimes it brings on illnesses. Fright brings on cold; sometimes it is such that it causes death. A great joy makes the body prosperous. There are some noxious ones which generate too much obesity. Sadness may be fatal to the emaciated; it is useful for those who wish to lose weight....
ON ABNORMAL FACTORS
The causes are divided into external -- those which reach the surface of the body -- for example, fire or snow, a blow suffered, a split made by jumping, and into internal -- which are of different kinds -- for example, decomposition which brings on the so-called putrid fever. There are also antecedent causes which correspond to every state of retention in the body.
Certain illnesses are recognized through what the body produces, by what supervenes in it, by what is expelled: sputum, stools, sweat, urine. A normal function may be disturbed in three different manners: weakness, complete arrest and alteration. Each one has its own explanation. Weakness of function; example, for sight it is the decrease in light perception; the arrest of that function is blindness; alteration of function consists in seeing that which does not exist. Judge all organ disturbances by analogy with this example.
Symptoms are obtained through the physical examination of the body at certain moments. There are some visible ones, such as jaundice and edema; there are some perceptible to the ear, such as the gurgling of the abdomen in dropsy; the foul odor strikes at the sense of smell; for example, that of purulent ulcers; there are some accessible to taste, such as the acidity of the mouth; touch recognizes certain ones: the firmness of cancer!
Symptoms obtained from the products eliminated from the body are accessible to the five senses. Urine may be red or black. Sputum may be bloody or frothy. There are some which signify an expulsion: flatulence, sneezing, hiccoughs. Vomitus may be acid, bitter or astringent. If urine is fetid, that indicates an ulcer of the bladder. As for sweat, it may be cold, thin or viscous. These symptoms are signs of illness for the patient and also are indications for the physician. I have summarized them above and now am going to delve into the details.
Every symptom has a value in the past, present and for the future. Example of past symptoms: the moisture of perspiring. By itself one of these signs is inadequate and cannot sway our opinion. That which indicates something of the present and of the future is absolutely necessary and serves as a foundation for our medicine. Among the symptoms, there are generalized ones and localized ones. I shall speak of the latter further along in the section on "Practice."
Every general sign refers to noble organs: liver, brain and heart are undeniably the principal ones.
If among the humors the blood carries predominance, sleep and migraine are exaggerated, vessels turgid and red, sometimes thought revolts; there is a heaviness of the head, weakness of sensation, carelessness, warmth to the touch, heaviness of the shoulders, yawning; sometimes heaviness of the flanks; nose bleeding, the desire to stretch out, relaxing of the abdomen, search for a life of well-being, dreams, varied joys, and of all colors, gaiety, longings for phlebotomy, unusual ruddiness of the eyes, furuncles and pustules, dreams of sweet things, a sugar flavor in the mouth, as if the patient had just eaten some, appear. If these symptoms are seen in the spring or during the prime of youth, they indicate diseases of the blood....
If bile is predominant, the shade of the body is yellow, the appetite weak, the mouth bitter. There are gastric burning, vomiting of bile, a powerful diarrhea, restlessness, sunken eyes, dry mouth and tongue. Between times the urine is yellow, the patient has episodes of syncope [fainting], some goose-bumps, is sad, is thirsty without appetite and dreams of flames; his pulse is week, his body febrile. Frequent warm baths are the cause of this state as are sojourns in southern countries, youth and the prolonged misuse of spiced foods, especially in the summer.
If black bile predominates, the body is wan, thoughts sullen, appetite reduced, an acid flavor in the mouth. On examination, anguish, rigidness of the face, pulse firm in its slowness; the patient is constipated, presents black spots, sadness, restlessness without agitation. Urines are white, not very dense, crude; similarly, the stools are not digested. The causes are dry food, anxiety, permanent sadness and misery. In his dreams, the patient sees dangers and completely frightening things. This affects the mature age in autumn, in northern countries and the weakened man.
If phlegm predominates, the head is heavy, the sleep prolonged; there is a laziness of movements, little appetite; plethora is in harmony with the force of the individual; he is slow in his gait, his intelligence is slow, he leans towards an unusual softness, foams, has a swollen face, his shade is dull; the pulse is slow and thick; urine dense, strong and crude; thirst is reduced except when the phlegm is salty or decayed. The cause of this state is cold and moist food, old age, winter, sedentarity, lack of warm baths, sometimes gluttony, the sojourn in a country damp because of its water flow; in his sleep, the phlegmatic person dreams of seas, complains of nightmares and his chyme [digested matter as it leaves the stomach] is not digested well. If you see these exact symptoms, messengers of illness in individuals in good health, endeavor to make them disappear....
V. Duration of illnesses
Every illness has its duration: the short one is called acute; it kills in a short while or ends with a favorable crisis; it matures rapidly; its periods are very close together and teeming in accidents. You will recognize it by the abruptness of its beginning. Then, allow your patient an accommodating diet; do not give him too much nourishment for his strength nor any too small and unsubstantial; otherwise, you will change everything from the beginning and it will not come to an end. On the other hand, let the food be measured wisely for him like provisions for a traveler. If you see any danger signals appear, of malignancy or pain, if the strength of the patient declines, if his reasoning is disturbed, if he raves, if he does not sustain his illness, warn him of his probable death before the end of the development. Be aware that death is foreseen by grievous signs and by bilious manifestations.
There exist illnesses of long duration, called chronic, which only change the organism slowly but which kill by consumption, phthisis, hemorrhage, anemia; they may heal after a long development and end by maturity and dissolution. You will recognize them by the lack of the seriousness of symptoms and by the fact that they are cold; do not feed your patient inadequately: he will lose strength. Between these two kinds of illnesses, there is one of intermediate duration, neither short nor long, for which the diet should be medium in strength and amount.
Be aware that the crisis is a brutal and rapid change which is produced in the course of acute illnesses and means the battle between the latter and the patient. It resolves in a short while, be it death or be it healing. Between the strength of the patient and the illness exists such a violent hostility that it is a veritable war; if the strength has it, the crisis is favorable whence survival and safety; if the illness has the victory, it means death....
Treat your patient with the conduct inspired by the signs indicating death or survival....