Review
Management of stroke as described by Ibn Sina (Avicenna) in the Canon of Medicine

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Abstract

Stroke or cerebrovascular accident (CVA) is caused by a disturbance of the blood supply to the brain and an accruing loss of brain function. The first recorded observations were in 2455 BC and it has been studied intensely by ancient physicians throughout history. In the early medieval period, Ibn Sina (980–1025 AD) called stroke sekteh and described it extensively. Some of Ibn Sina's definitions and his etiology of stroke are based on humoral theories and cannot be compared with medical current concepts, but most of his descriptions concur with current definitions. This review examines the definition and etiology, clinical manifestations, prognosis, differential diagnosis, and interventions for stroke based on Ibn Sina's epic work, Canon of Medicine. The pharmacological effects of medicinal herbs suggested by Ibn Sina for stroke are examined in light of current knowledge.

Introduction

Stroke or cerebrovascular accident is a disruption of the blood supply to the brain and an accruing loss of brain function. It can occur because of lack of blood flow (ischemia) caused by thrombosis or arterial embolism or by hemorrhage [1]. Stroke can cause significant physical, mental, and emotional problems in the life of patients [2].

Cerebrovascular disease is the second most common cause of death and the primary cause of disability worldwide [3]. About 80% of all stroke deaths in the world occur in developing countries [3], where the chance for a positive outcome is not favorable: people are not well-informed about prevention and the clinical manifestations of stroke [4]. Mortality rates are higher and more patients are younger adults in the labor force [5]. In addition, post-stroke care is much less well-organized [3].

Patients in developing countries are more likely to resort to traditional medicine as the sole or complementary therapeutic option [6]. Critical reappraisal of traditional sources of medical information can be a post-modern approach to finding new solutions for old problems.

Traditional Persian medicine (humoral medicine) is one of the oldest paradigms of medicine. In early medieval times (Islamic period), Muslim physicians (mostly Persians) flourished. Their methods were based on ancient Persian, Indian, and Greco–Roman medical knowledge and from experience [7], [8], [9], [10]. This form of medicine spread gradually throughout the world. Ancient Persian and Islamic medical treatises such as Ibn Sina's Canon of Medicine written in 1025 AD, Razi's (Rhazes) Continens Liber written circa 960 AD, and Complete Book of the Medical Art by al-'Abbas al-Majusi (Haly Abbas) circa 970 AD were taught and used in western and eastern universities and medical centers until the 17th century [11], [12], [13].

During the Renaissance, in the transition from humoral medicine to more current paradigms of medicine, many traditional practices from ancient times fell out of favor or were forgotten [14]. A review of historical manuscripts on medical science suggests that approaches and medication developed over centuries of human experience have the potential to improve modern medical approaches and practice. Such a review, if done using a modern scientific approach and evaluation, can find novel avenues for further investigation from the writings and knowledge of pioneers in medicine. It also helps document the course of medical sciences throughout history.

This study is a review of the opinions about stroke of Ibn Sina (Avicenna), a foremost pioneer of neurology and cardiology. Ibn Sina's definition of stroke and his diagnosis and suggestions for treatment are summarized. His treatment approaches and definitions are compared with current terminology and the pharmacological effects of herbal medicines he suggested for stroke are considered. This review provides an avenue to examine knowledge and treatment of stroke in the early medieval period.

Section snippets

Historical perspective

Ancient people were familiar with the manifestations of stroke. A document found in the tomb of the vizier Weshptah, an official of the 5th dynasty (2455 BC) in Egypt, describes stroke [15]. Also, It has been described in records from the Middle East by Persians and Assyrians as long as 2600 years ago [16]. The oldest scientific documented definition of stroke in a medical manuscript dates back to Hippocrates (460–370 BC) [17]. In the 4th century BC, the Alexandrian anatomists Erasistratus and

Ibn Sina

Ibn Sina (980–1032 AD) was a great influence on the progress of medicine in early medieval times [23]. He was born in Afshaneh in the northwest of ancient Persia. He became a physician when he was only 16 years old. He also was an expert in astronomy, philosophy, and many other branches of science. He wrote more than 400 books and treaties about these sciences, especially on medicine. His Canon of Medicine was in use as a medical text in Europe until the 17th century AD [11].

Current

Stroke in Canon of Medicine

Ibn Sina's categorization of stroke (as the term of sekteh) [34], [35] in Canon of Medicine is described herein.

Discussion

Although some of Ibn Sina's explanations for the definition and etiology of stroke are based only on humoral theories and cannot be explained using current medical concepts, most of his descriptions are very similar to modern definitions of stroke. It can be said that he explained the definition and causes of stroke in the language of his era. His discussion of the collapse of the brain and carotid arteries as causes of stroke, his close description of hemorrhagic and ischemic strokes, and the

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