Bull. Ind. Inst. Hist. Med. Vol. XXII pp 111 to 120

THERAPY AND MEDICAMENTS BY IBN AL-NAFIS

SAMIR YAHIA EL-GAMMAL'~

ABSTRACT

Ibn AI-Nafis was one 01 the head physicians in Egypt and an outstanding and

brilliant philosopher of the 13th century A.D. He devoted all his life to his studies inmedicine and anatomy. He began his research work with explaining the compilationsof othe- physicians then turned his way, and began writing his own books based on hispe-sonal experiments on human bodies and animals, and could come to his own conclu-

sions about the mechanism of action of the different organs. He also tried his best topresent medicine to the common people as simple as possible. He described many formsof dietary food, best drugs to use etc. He gave specified new nomenclature and defini-tions to drugs also. Thus his life was filled with scientific activity specially medicine

arid helped in directing it to the right and true path which guided the European scientiststo follow his ideas and to discover more about it.

Alaa EI Din Ali ibn Abi Al-HazrnIbn AI-Nafis Al-Our ashi (or Al-Oara-shi) ... known as Ibn AI- Natis, wasone of the head physicians in Egyptand an outstanding and brilliantphilosopher of the 13th century A.D.He was born in Damascus, Syria in1207 A.D. studied medicine in theBimarestan (hospital) of lbn Zanki inDamascus as a pupil to the physicianAI-Dekhwaar, and later to OrnranAl-Isvae!i. He migrated to Cairo,Egypt during the rule of the AyyubidKing Al-Karnel, and worked as a phv-

sician in the Hospital AI-Naseri (builtby the King AI-Naser Salah AI-Din(Saladin). Later on, he became chiefphysician at the Bimarestan AI-Man-souri which was built by the KingAI-Mansour Qalawoun in 1285 A.D.When he died, in 1288 A.D. hedonated his house and books to thishospita I.

Ibn Al-Nafis devoted all his lifeto his studies in medicine and ana-tomy, did not get married, was verymodest in scientific vanity, was busy

":Pharmacist. Rc;cearcher in the His io r v of Medicine & Pharmacy,

POBox No. 136. Ma adi. Cairo. ~=UYrt.

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in discussing the intellectual andscientific persons at his home mostof the day and night. His genius mindwas not due to, as many of his criticsand opposition declared, that he knewby heart all of the medical works ofAvicenn a. but in fact that he correctedmany of Galen's and Avicenn a'sbooks in medicine and therapy, andso could discover the lesser bloodcirculation (i e. from the heart to thelungs) .

All physicians of lbn Al-Natistime took for granted, the theoriesconcerning the physiological functionof the body organs which were men-tioned by Galen, and afterwards, byAvicenna, without doubting in itscontents, ... except Ibn AI-Nafis, whoconsidered Hippocrates... that greatGreek physician as more accuratethan anyone who came after him.He wrote a book explaining the textsof Hippocrates called 'Sharh KotubAbiqrat', and commented on it. IbnAl-Nafis. althoujjh denied stronglythat he was practising dissection,yet his accurate interpretations andfindings about the passageof the blood in the heart and thefunction of the veins in it, proves theopposite. He corrected that Galenmentioned about the presence ofminute pores through which, theblood passes from the right cavity ofthe heart to the left cavity, andexplained that the passage of bloodfrom the right cavity is done throughthe pulmonary artery to the lungs,

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where it mixes with air, then returnsfrom the lungs to the left cavitythrough the pulmonary vein, wherethe 'spirit' is produced, then runsfrom the heart to the tissues. (thegreater blood circulation i.e. the returnof the blood from the tissues back tothe right cavity of the heart was notknown untill William Harvey in 1616and Marcello Malpighi in 1661 could,through the use of a microscope ofviewing the mi nute capillaries res-ponsible for that).

lbn Al-Nafis. mentioned also that,there must be inside of the humanheart, another cavity where the bloodgets ready for us admixture with theatmospheric air i e. the air can notmixes with bloed in its coarse state.This cavity lie ; in the right cavity ofthe heart, and when the blood getssofter in this cavity in contact withair, then it passes to the left cavitywhere the spirit is born, but since thewall between the two cavities isimpermeable, and has no apparentexit, as some people has thought, andalso no invisible exit as Galenthought, because the body ofthe heart is so thick and the valvesare also impermeable, then the bloodmust pass through the pulmonaryvein to the luriqs where it stays till itmixes with the air and gets rid oflighter matter then passes to thepulmonary vein till it reaches theleft cavity of tho heart after beingadmixed with the air and becomesuitable for the 'spirit' to be created ...what is left in the blood of coarser

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matter, is used by the lungs for itsnourishment.

Also, lbn Al-Natis was awarethat the nourishment of the heartcomes from the blood passing throughthe heart veins, where he mentionedthat the blood in the right ventricleof the heart is not suitable for itsnourishment. The heart gets its foodfrom the blood that passes in itsveins.

He also corrected what Avicennahad quoted from Galen about theheart cavities, when he mentionedthat the heart has three ventricles,and this is not ture. because the hearthas only two ventricles, one of themis filled with blood which is the rightor.e. and the other is filled from thespirit, i.e. the left one, and thereexists 110 passage between those twoventricles, or else the blood couldpass to the {Jlace of the spirit and sodestroys its nature, and the anatomyof such organ shows how wrong theyare.

This explanation of the lesserblood circulation was mentioned inIbn Al-Nafiss book entitled 'Tashreeh/\I-Qanun Ii lbn Sino' (Anatomy ofAlOanun by Aviccnna), which is hismost important compilation (thisvolume was not discovered untill1921 in Berlin, and so the real valueof Ibn ll.l- Naf iss discovery of thistheory was recently known). In fact,the discovery of the lesser bloed

circulation dates back to the ancientEgyptians, who, through their dissec-tion of both the human bodies andthe animals, could discover manyanatomical features and physiologicalproperties of the different organs, asevidenced by the contents of EdwinSmith Surgical papyrus (1550 B.C.),where mention of the heart and itsfunction in blood circulation waswidely known to most surgeons.The Greeks quoted much from theancient Egyptian anatomy andphysiology, specially that of the heart,and so appeared in Hippocrates'sworks, and later in the theories ofErasistratos, that great Alexandriananatomist and physiologist at thefamous Mauseion of Alexandria,Egypt where he performed hisexperiments in its medical school onhumans and animals speciallymonkeys (3rd century B.C.). Theseinformations about the heart and itsfunctions were familiar to Gres kphysicians including Galen, whoseworks were translated into Arabc.after being translated into Coptic,Syriac and other languages. Thusthe Arab-Islamic scientists, altertranslating most of the Greek medicalvolumes, could benefit from it a Iand distributed it through all of thenew Islamic empire. The British physi-cian and physiologist Wi\l;am Harvey(1578-1657 A.D), could rediscoverthis lesser blood circulation in 1616,and opposed and corrected many ofthe opinions of Galen, Vese lius.Servetus (a Spanish physician, 1511-

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1553 A. D. who also rediscovered thatpart of the blood runs in the lungs),Columbus, Cesalpinus and others.Harvey found that the heart muscleacts as a muscular pump and theblood is pushed to the lungs throughthe veins and arteries. .

Ibn AI- Nafis began his researchesby explaining the compilations ofother physicians, such as that ofAvicennas Oanun. Hunain Ibn Ishaq's'AI- Masaa'el'. Hippocrates's materiamedica, Galen's anatomy .. and others,then turned his way, and beganwriting his own books based on hispersonal experiments on humanbodies and animals, and could cometo his own conclusions about themechanism of action of the differentorgans he examined.

His own compilations were:1. Sharh Mufradat AI-Qanun (Expla-nation of the simple drugs inAl-Oanun by Avicenna), and also anabridged form.

2. Tafasir AI-Elal wa Asbab AI-Amra ad (Explanation of the diseasesand their causes).

3. Sharh AI-Hedayah fil Tibb(Explanation of the Salvation inMedicine).

4. AI-Shamel fil tibb (Comprehen-sion in Medicine), which he intendedto be in 300 volumes, but could notwrite except 80.

5. AI-Muhazzab fil Kohl (The Refinedbook in Ophthalmology).

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6. AI-Mukhtaar min AI-Aghzia(Selection from Foods).

7. Sharh Tashrih lbn Sina (Explana-tion of Avicenna's anatomy).

8. AI-Resalah AI-Kameliah fil SirahAl-Moharnrnadiah (Kamel's Treatiseon Mohammad's Biography), wherehe mentioned once more the role andfunction of the heart, lungs andpuimonary blood circulation (Lesserblood circulation), and also thefunction of the different human bodyorgans, and the way each operates.

He also tried his best to presentmedicine to the common people assimple as possible, so as the greatermajority of them could know thedifferent body organs and theirfunctions. Also, he pushed greatlythe development in medicine whenhe fascilitated the treatment for thesick people, modified the healingprocedures, and the regulation of thepatient's diet in the first place ratherthan to depend on drugs alone.

So, in the other abridged book onAI-Qanun of Avicenna 'MouqazAl-Oanun Fil Tibb' (Abridged AI-Qanun), he described many forms ofdietary food, best drugs to use etc..thus arranged it accordir.qlv to fourarts;1. The two important rules in practi-sing medicine i.e. scientifically andpractically.

2. Simple and compound drugstotether with food.

Therapy and Medicern mt s bv /bn Ai-Netts=Et Gamma/

3. Specific diseases of each organ,causatio n, diagnosis, and tre atrnent.

4. Diseases that occur in a definiteorgan than the other, causation, signsand treatment.

Concerning the therapy using drugs,Ibn Al-Naf is mentioned that they aregoverned by three laws:1. Selection of the specific drugafter knowing the illness, using it asan antidote.

2. Selection of the amount andmode of action of the specific drugusing the way of assumption regar-ding the nature of the diseased organ,the severity of the disease, patient'sage, his habits, season, occupation,country, facial features and his bodystrength.

3. Recognition of the exact time thedisease has occured.

Ibn AI-Nafis recommended theuse of bathing the patient before andafter taking the treatment, and warnedagainst eating after the drug has beenadministered or else the potency ofthe drug will decrease, since the bodywill be busy with digesting the food.

He also recommended the use ofvenesection, cautery since it willpurify the blood, cures headaches(meaning high blood pressure).intentional vomiting twice monthly,avoiding constipation due to 'l azinessof the intestines by using purgativesin upgrading potencies, keeping care

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not to use one drug repeatedly for alonger period lest the body getsaccustomed to it, and if the patientCan take food instead of any drug, itis strongly advisable.

Concerning simple drugs, IbnAl-Nafis recommended the intake ofa single moderate one, as much aspossible, instead of using compounddrugs such as the Tiryaques, in whicheach component acts separately andindependently on the body organsproducing harmful side effects. Healso showed that the effect of thedrug may be shown through externalapplication such as bandages orinternal one like orally.

He explained also that the forceof action of the drug could beidentified through two channels; thefirst is experirnentallv while thesecond is done by sequence ... andconcluded that experimentation is farmore better. Also, the way the drugacts can be known whether the effectis slow or fast.

Ibn AI- Nafis also gave specified newnomenclature and definitions todrugs, such as :1. The Condensed drug; that whichdoes not dissolve rapidly inside thebody (AI-dava-al-kaseef).2. The Brittle drug; that whichpulverise easily by any slight pressure(AI-dava-al hash).3. The Nice drug; that which dis-solves rapidly inside, due to the

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body's own temperature (AI-dava-al-latee!) .4. The Sticky drug; that whichseparates when gets over stretched( AI-dava-al-Iazij).5. The Solid drug; that which liqui-fies while being firm and in piece( A/-dava-al- jamed).6. The liquid drug; that whose partsfall down easily (AI-dava-al-sael).7. The Salivary-like drug; that whichseparates into parts when infused,forming a sticky-product (AI-dava-al-luabi) .8. The Greasy drug; that whichforms a greasy interior (AI-dava et-dahani) .

9. The Desiccating drug; that whichabsorbs water when gets in contact,showing no visible traces (AI-dava-al-munashshifi) .

10. The Soothing drug; that whichmakes the component thinner(Ai-dava-al-muiattif) .

11. The Decomposing drug; thatwhich fascilitates the evaporation ofthe component t At-aev e-et-mebtits .

12. The Polishing drug; that whichremoves the sticky liquids from theorgan (AI-dava-al jali).

13. The Harshening drug; that whichchanges the surface of the organdifferently after being in contact witha sticky material (AI-dava-al-mukha-shshin) .

14. The Opening drug; that whichgets out the material which blocks

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down the vessel (AI-dava-al-rnufa-tthih) .

15. The Relaxing drug; that whichsoftens the limb with its own heatand humidity (AI dava-af-murakhi).16. The Ripening drug; that whichchanges the form of the mixture andpushes it outside (AI-dava-al-munzij).17. The Digestive drug; that whichaccelerates the ripening of the food.(AI-dava-al-flaz irn).18. The Carminative drug; that whichtenderizes the winds (gases) anddrags them outside (AI-dava-al-muhall il -I il -Ri ah).19. The Dividing drug; that whichdivides the material into small portionsbut still keeping a thick consistency(AI-dava-al-muqatta) .20. The Extracting drug; that whichrnoves the material from its place(AI- dava-al- js zi b) .21. The Pungent drug; that whichdisconnects, through its penetrativepower, the organ attachement inseveral points, which can not be feltindividually but collectively (AI. dava-al-Iaz;) .22. The Warming drug; that whichpulls the blood strongly up to skin,causing a rise in its temperaturegiving it a deeply red colour(AI-dava-al-muhammir) .23. The Scraping drug; that whichattracts externally a pungent acridhumour (AI-dava-al-muhak kite],24. The Ulcerative drug; that whichis concerned with the original humi-

The repv and M;;dicaments by lbn AI-Nafis-El-Gammal

dity and pulls out a bad substancethat ulcerates (AI-dava-al-muqurih).25. The Burning drug; that whichkeeps with its hotness, the softnessof the humours and its ashes(AI-dava-al-muhrique) .26. The Corrosive drug; that whichminimizes the size of a part of theflesh due to its increased ulceration(AI-dava-al-akka/) .27. The Crumbling drug; that whichconverts the solid humour into smallersegments (AI-dava-al-mufatit).28. The Putrefying drug; that whichalters the nature of the spirit andhumidity thus making it unsuitablefor the desired function (AI-dava-a1-

mauffin) .29. The Caustic drug; that whichburns the skin turning it into thestate of melted grease (AI-dava-al-kavi) .30. The Exfoliating drug; that whichexpels the rotten parts (AI-dava-alquashir) .

31. The Tonic drug; that whichchanges the temperament of theorgan thus preventing it from retainingthe excreta (AI dava-al-muquavvi).32. The Restraining drug; that whichis controversary to the extractingdrug (A!-dava-al-radi).33. The Thickening drug; that whichis co ntroversurv to the soothing drug(AI- dava- ,,!- muqel! iz).34. The Unripening drug; that whichis controversary to the digestive drugi At-dev» al-mufaj/lj).

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35 The Soporific drug; that whichrenders, the sensitive or the locomo-tive spirit (soul) or the part thatcan not be affected psvcholoqicallv.completely acceptable (AI-dava· almukhaddir) .

36. The Flatulating drug; that whichpossess excretive humidity that isundecomposable by heat thus forminggases (AI-dava al munaffikh).

37. The Washing drug; that whichcleans through its humidity andflowing power (AI-dava-al-Gassal).

38. The Filthying drug for ulcers;that which slickens them withits humidity (AI-dava-al-musikh-/il-Quruh) .

39. The Slipping drug; that whichliquifies the surface of excreta whichis congested in the tract, thus fascili-tates its expulsion (At-dev e al-muzaliqque).

40. The Smoothing drug; that whichspreads over the surface of a roughorgan, thus hiding its harshness(AI-dava·al-mumallis) .

41. The Drying drug; that whichabolishes the humidity by soothingand disintegrating it (AI-dava-al-mu ja/iff).

42. The Astringent drug; that whichsticks together a\l of the organ'ssegments (AI-dava-al-quabiz).

43. The Squeezing drug; that whichfortifies the astringent effect till itevacuates what is in the organ(AI-da/a-a!· Aasir).

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44. The Blocking drug; that whichbecomes clogged in the tracts due toincreased condensation or stickinessor dryness, thus blocks it (AI-dava-al-musaddid).

45. The Glueing drug; that which isdry with sticky humidity that sticksto the openings and plugs them(AI-dava-al-mugarri) .

46. The Healing drug; that whichdesiccates, making the humiditywhich forms over the cut wound sosticky and hold together (AI-dava·al-mudammil).

47. The Hesh-producinq drug; thatwhich agglutinates the blood thatflows to the cut wound, thus forming

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new flesh t Al-d ev e-et-mumbit-lit-Lahm) .

48. The Sealing drug; that which isapplied over the cut wound to guardagainst sepsis (AI-dava-al-khatim).

49. The Theriaque; that which pre-serves the health and strength of thespirit, thus antagonizes poisons(AI-dava-al-tiryaqueval-fadzahar) .

That was the life of Ibn AI-Nafis,filled with scientific activity speciallymedicine, and helped in directing itto the right and true path whichguided the European scientists tofollow his ideas and to discover moreabout it.

Therapy and Medicaments by /bn A/-Nafis-E! Gamma/

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