Read Avicenna's treatise on chicory. Avicenna as a luminary of Arab medicine. Works on medicine

Here we will talk about general rules science about the pulse, and let’s postpone the specific ones until discussing specific diseases.

We say: each pulsation is composed of two movements and two moments of rest. For the pulse always consists of compression and expansion, and between each two opposite movements there must necessarily be a moment of rest, since one movement cannot be directly connected with another, after it has actually come, the end and limit of its distance. This refers to those phenomena that are explained in physics. And if so, then each pulsation, until it is followed by another, must have four parts: two movements and two periods of rest - the movement of expansion, the period of rest between expansion and compression; the movement of compression and the period of rest between compression and expansion.

The compression movement, according to many doctors, is not felt at all; others, however, consider the compression to be perceptible with a strong pulse because of its strength, with a large pulse because of its height, with a hard pulse because of the strong resistance when palpating, and with a slow pulse because of the length of the period of its movement.

Galen said: “For some time I constantly missed the period of compression, then I began to repeat the probing until I felt its signs, and then, not long later, I perceived it completely. After this, the gates of knowledge of the pulse opened before me, and anyone who probes it as diligently as I do will comprehend what I have comprehended.”

However, if this is the case as they say, then in most cases the compression of the pulse is not noticeable.

The reason why the forearm was chosen to palpate the vessel is due to three circumstances: it is easy to reach, women are not ashamed to show it, it is located opposite the heart, close to it.
The pulse should be felt when the hand is turned sideways, since the hand lying palm down is wider and raised and less long, especially in thin people, and the hand lying palm up is more raised and longer, but less wide.

The pulse should be felt at a time when a person is free from anger and joy, does not make physical effort, does not experience any influences, aggravated satiety or hunger, does not stop his usual lifestyle and does not acquire new habits.
You should first test the pulse of a person who is balanced by nature, in excellent health, in order to compare the pulse of another with it.

The first type is determined by the size of the expansion, the second type - by the quality of the impact of the beating artery on the fingers. The third type is based on the duration of movement time, the fourth type is based on the condition of the artery wall. The fifth variety is based on the degree of emptiness and filling of the pulse, the sixth variety is based on the warmth and coldness of the palpated area. The seventh variety is based on the time of rest, the eighth variety is based on the evenness and unevenness of the pulse, the ninth variety is based on the presence of any order in the unevenness and the absence of any order. The tenth variety in “size” - pulse rhythm.
As for the type of pulse size, it indicates the state of the pulse in its three dimensions, that is, length, width and depth. In this regard, the pulse has nine simple qualities, as well as complex ones that are combined from them.
Nine simple types of pulse - long, short. Balanced pulse; wide, narrow and balanced; low, high and balanced. A long pulse is one in which parts of the pulse are felt to be longer in duration than what you usually feel, either in general, that is, with a truly balanced nature, or usual for a given person, that is, with a balanced nature characteristic of him personally.

You have already learned the difference between these two natures earlier.
A short pulse is the opposite of a long pulse, and a balanced pulse stands between them. By analogy with this, judge the other six varieties.

As for the complex varieties that are combined from these simple ones, some of them have names, and some do not.

A pulse that exceeds the usual one in length, width and depth is called large, a pulse that is inferior to the normal pulse in these three respects is called small; the balanced one stands between them.

A pulse that exceeds the normal pulse in its width and elevation of the artery is called a thick pulse; inferior in these two respects - a subtle pulse; the balanced one stands between them.

As for the variety derived from the quality of a blow to the fingers during the movement of an artery, there are three types of blow: a strong pulse, that is, one that resists palpation when expanding, a weak pulse - the opposite of a strong one, and a balanced one, standing between them.

The variety, taken according to the duration of time of each pulse movement, has three types: fast, that is, one that completes the movement in a short time, slow - the opposite to it, and balanced, standing between them.
The type of pulse, taken according to the quality of the artery, also has three types: soft, that is, one that can easily go inward when pressed, hard - the opposite of it, and balanced.

The type of pulse, taken according to the quality of what the artery contains, has three types: full, that is, when a significant amount of fluid filling it is felt in the cavity of the artery, and not pure emptiness; empty, the opposite of it, and then balanced.

The variety of pulse, taken according to the sensation to the touch, has three types: hot, cold and balanced, standing between them.

The type of pulse, taken according to the duration of the resting period, has three types: a frequent pulse, that is, a pulse with short perceptible breaks between two beats - it is also called “overtaking” and “condensed”, - a rare pulse, the opposite of it - it is also called “ lagging" and "sluggish" and, between them, balanced. This period is determined depending on how the compression of the artery is felt; if the compression is not felt at all, then the period of rest is considered to be the time interval between each two expansions; if the compression is perceptible, then the rest period is determined by the time of the end of both states, that is, if the compression of the artery is noticeable, then the boundaries of the rest period are considered to be the moments of the end of two states: expansion and compression. .
As for the variety taken according to the evenness and unevenness of the pulse, the pulse is either even or uneven. This refers to the similarity of the blow.

Parts of the pulse beats or any one part of the beat converges in relation to five qualities. Large or small, strength or weakness, speed or slowness. Frequency or rarity, hardness or softness. After all, even in the same person, parts of the expansion of the pulse are sometimes faster due to the great excitement of the nature, or weaker due to weakness. If you like, you can expand this reasoning and keep in mind, with regard to the evenness and unevenness of the pulse, not only the three mentioned varieties, but also all other varieties, but the main attention is paid to these three varieties.

An even pulse in general is an even pulse in all the mentioned respects; if it is even in one of them, then it is called an even pulse, only in this respect, so that we can say: “even in strength,” “even in speed.” The same is true for an uneven pulse: it can be uneven in general or in relation to which it is uneven.
As for the category taken according to the presence of order or disorder in the pulse beat, there are two varieties in this category: an uneven, ordered pulse and an uneven, disordered pulse.

Ordered is a pulse whose irregularity maintains a certain order and repeats itself cyclically. An uneven ordered pulse can be of two types: it is either an uneven pulse, ordered in general, when only one irregularity is constantly repeated, or an ordered cyclic one, when there are two cycles of irregularities or more.

So, for example, there may be one cycle and another, different from it, but they always return together, one after another, as one cycle, and a disordered, uneven pulse is something the opposite of this.

If carefully examined, it turns out that this ninth variety is actually a kind of eighth variety and fits into the category of uneven pulse.

You should know that the pulse has a certain musical nature. As an art of music, it is perfect due to the combination of sounds in a certain ratio of sharpness. Also, the gravity and tact circles of the magnitude of the time intervals separating the blows on the strings are the same as the quality of the pulse beats.
The relationship between the speed and frequency of their tempo is a rhythmic relationship, and the relationship between their qualities in terms of strength and weakness and merit is a kind of combinational relationship.
Just as the tempos of the beat and the dignity of sounds are consonant and sometimes dissonant, so the irregularities of the pulse are ordered and sometimes disordered.

And I will also say that the ratios of the qualities of pulse beats in terms of strength and weakness and in merit can be consistent, or they can be discordant and even dissimilar, and then this goes beyond the category of determining any order of pulse irregularities.

Galen believes that the tangible virtue of the ratio of the rhythm of the pulse is the dignity expressed by one of the following ratios found in music, which were mentioned above. This may be the ratio of “a whole to a whole plus five,” that is, the ratio of a triple value to an ordinary value, for such a ratio is the ratio of a double value to an ordinary value with the addition of half of the double value. This is what is called a “relationship with five.” Either it can be a "relation with the whole", that is, a doubling, or a "relation with five", that is, an increase by half, or a "relation with four", that is, an increase by one third; or an increase of one quarter. Further change in value is no longer felt.

I think it's very important to establish this relationship by feel. This is easiest for a person who, by profession, is accustomed to dealing with degrees of time and relationships of sounds and has the ability to study music theoretically and compare what has been done in practice with what is known from theory. Such a person, when he pays attention to the pulse, will perhaps feel these relationships by touch.

I will also say: highlighting a special category of ordered and disordered pulse, which is one of the ten categories, although useful, is incorrect when dividing, because this category fits into the category of uneven pulse and is, as it were, one of its types.

If the sensation is not able to establish all these values, then this “variety” is determined by comparing the values of the ratio of time, the dilation of the arteries to the time passing between two dilations, and in general the ratio of the period of movement to the time of rest.

Those people who introduce into this area a comparison of the time of movement with the time of another movement and the time of a period of rest with the time of another, a period of rest, introduce one area into another.

However, such an introduction is also permissible and not impossible, but it’s just not good.
The rhythm of the pulse is a quality to which we apply the mentioned musical relationships. We say: the pulse is either of a good rhythm or of a bad rhythm. There are three types of bad rhythm pulse. One of them is the pulse of a changing rhythm and a transitional rhythm, that is, a pulse whose rhythm is a rhythm inherent in an age adjacent to the age of the owner of the pulse being studied; Thus, children have the rhythm of the pulse of young men.

The second type is a pulse that is distant in age, such as when children have the rhythm of the pulse of old people, and the third is a pulse that goes out of rhythm, that is, a pulse that is different in its rhythm from the pulse of any age. If the pulse goes out of rhythm, it often indicates a significant health disorder.

Keywords

CANON OF MEDICINE / AVICENA / HISTORY OF CARDIOLOGY / PULSE CHARACTERISTICS/ THE HISTORY OF CARDIOLOGY / PULSE CHARACTERISTICS / AVICENNA / THE CANON OF MEDICINE

annotation scientific article on veterinary sciences, author of the scientific work - Glyantsev Sergey P., Magomedova Suikanat M.

Chronologically, the doctor of the Middle Ages closest to our time, who compiled a lengthy doctrine of the pulse, was who lived in 980–1037. the largest physician in the Arab world, Abu Ali Ibn Sina (Avicenna). The authors analyzed the doctrine of the pulse and the diagnosis of diseases according to its characteristics in Avicenna’s description from the point of view of cardiology of the 21st century and proved the hypothesis of the significance of the doctrine of the pulse of ancient doctors for their modern colleagues. The source (basic material) and methodological approach for the study was the analysis of the main work of the greatest physician of the Middle Ages Avicenna (980–1037) “The Canon of Medical Science” and two modern clinical manuals on the propaedeutics of internal diseases, their historical medical analysis and comparison of the doctrine of the pulse described by Avicenna with the provisions set out in the manuals beginning of the XXI century. It has been established that in the Middle Ages, much more sophisticated methodological techniques were used to diagnose pulse conditions in certain diseases than in our time. For example, doctors of that time, describing a four-beat pulse wave, were able to examine each of the beats separately. The analysis showed that the main provisions of the doctrine of Avicenna’s pulse have survived to this day. Similarities and differences in the understanding of certain types of pulses and their causes are revealed. At the same time, some concepts have become a thing of history, while others were much more sophisticated than modern concepts, which can be explained by the significance of pulse diagnostics in ancient times. As part of the study, it was concluded that the creative heritage of the brilliant doctor of the past has not yet lost its relevance and should be taken into account in the modern study of the types and causes of cardiac rhythm and conduction disorders.

Doctrine about Avizen's pulse: look from the present

The most chronologically close to modern doctor of Middle Ages who compiled detailed doctrine of pulse was the greatest physician of Arabian world Abu Ali Ibn-Sina (Avicenna) who had lived in 980–1037. The authors studied the doctrine of pulse and diagnosis of diseases using the characteristics of Avicenna’s description in the context of XXI century cardiology and evidence of hypothesis about the importance of ancient physicians’ pulse doctrine for their contemporary colleagues. As the source (reference material) and methodological approach for the study was selected analysis of the main lifework of the greatest physician of Middle Ages Avicenna (980–1037) “The Canon of medicine” and two contemporary clinical guidelines on internal diseases propedeutics, historical medical analysis and comparison of Avicenna's doctrine of pulse with statements outlined in the guidelines of the turn of the XXI century. It was established that in Middle Ages to diagnose pulse state associated with some or other diseases there were used far more sophisticated techniques than today. For example physicians then could study every tact separately describing four-tact pulse wave. The analysis shows that the main statements of Avicenna pulse doctrine are extant. Similarity and differences in comprehension of some or other pulse types and their reasons were revealed. At the same time some concepts were gone and others were far more sophisticated than contemporary conceptions which could be assignable to pulse diagnosis in old time. In the frame of the studies carried out there was concluded that the artistic legacy of the genius physician of the past did not lose its relevance up to now and should be considered when studying contemporary types and reasons of rhythm disturbances and heart conductivity.

Text of scientific work on the topic “The Doctrine of Avicenna’s Pulse: A View from the Present”

HISTORY

TEACHING ABOUT AVICENA'S PULSE: A VIEW FROM THE PRESENT

S. P. Glyantsev*, S. M. Magomedova

FSBI Scientific Center for Cardiovascular Surgery named after. A. N. Bakulev" (director - academician of the RAS and RAMS L. A. Bockeria) RAMS, Moscow

Chronologically, the doctor of the Middle Ages closest to our time, who compiled a lengthy doctrine of the pulse, was who lived in 980-1037. the largest physician in the Arab world, Abu Ali Ibn Sina (Avicenna).

The authors analyzed the doctrine of the pulse and the diagnosis of diseases according to its characteristics in Avicenna’s description from the point of view of cardiology of the 21st century and proved the hypothesis of the significance of the doctrine of the pulse of ancient doctors for their modern colleagues.

The source (basic material) and methodological approach for the study was the analysis of the main work of the greatest physician of the Middle Ages Avicenna (980-1037) “The Canon of Medical Science” and two modern clinical manuals on propaedeutics of internal diseases, their historical medical analysis and comparison of the doctrine of the pulse described by Avicenna with provisions set out in the guidelines of the early 21st century.

It has been established that in the Middle Ages, much more sophisticated methodological techniques were used to diagnose pulse conditions in certain diseases than in our time. For example, doctors of that time, describing a four-beat pulse wave, were able to examine each of the beats separately.

The analysis showed that the main provisions of the doctrine of Avicenna’s pulse have survived to this day. Similarities and differences in the understanding of certain types of pulses and their causes are revealed. At the same time, some concepts have become a thing of history, while others were much more sophisticated than modern concepts, which can be explained by the significance of pulse diagnostics in ancient times.

As part of the study, it was concluded that the creative heritage of the brilliant doctor of the past has not yet lost its relevance and should be taken into account in the modern study of the types and causes of cardiac rhythm and conduction disorders.

Key words: history of cardiology, pulse characteristics, Avicenna, Canon of Medicine.

The authors studied the doctrine of pulse and diagnosis of diseases using the characteristics of Avicenna’s description in the context of XXI century cardiology and evidence of hypothesis about the importance of ancient physicians’ pulse doctrine for their contemporary colleagues.

As the source (reference material) and methodological approach for the study was selected analysis of the main lifework of the greatest physician of Middle Ages Avicenna (980-1037) “The Canon of medicine” and two contemporary clinical guidelines on internal diseases propedeutics, historical medical analysis and comparison of Avicenna's doctrine of pulse with statements outlined in the guidelines of the turn of the XXI century.

It was established that in Middle Ages to diagnose pulse state associated with some or other diseases there were used far more sophisticated techniques than today. For example physicians then could study every tact separately describing four-tact pulse wave.

The analysis shows that the main statements of Avicenna pulse doctrine are extant. Similarity and differences in comprehension of some or other pulse types and their reasons were revealed. At the same time some concepts were gone and others were far more sophisticated than contemporary conceptions which could be assignable to pulse diagnosis in old time.

In the frame of the studies carried out there was concluded that the artistic legacy of the genius physician of the past did not lose its relevance up to now and should be considered when studying contemporary types and reasons of rhythm disturbances and heart conductivity.

Key words: the history of cardiology, pulse characteristics, Avicenna, the Canon of medicine.

Chronologically closest to ours, the Authors analyzed the doctrine of diagnostic

time by a doctor of the Middle Ages, the composition of diseases and conditions of the body according to the characteristics

who gave a lengthy doctrine of the pulse was the living theristician of the pulse in the description of Avicenna with precision

in 980-1037 the largest doctor in the Arab world in the field of modern cardiology. I will put forward-

Abu Ali Ibn Sina (Avicenna). that hypothesis about the enduring significance of the teaching

* Correspondence address: e-mail: [email protected]

ANNALS OF ARRHYTHMOLOGY, No. 4, 2012

about the pulse for modern cardiology. The source (basic material) was Avicenna’s “Canon of Medical Science” and modern textbooks. As a methodological approach, a historical and medical analysis of the “Canon” and a comparison of its provisions with the ideas of modern propaedeutics of internal diseases were used.

Avicenna considered the forearm to be the main area for studying the pulse. Apparently, it was about the radial artery, where the pulse is still studied today. In addition, he taught how to feel the pulse in a state of mental and physical rest, when a person is not full or hungry, does not experience external influences and leads a normal lifestyle. But Avicenna and modern authors consider the reasons for the vibration of the vascular wall differently. In the Middle Ages, it was believed that the arteries contained air (pneuma), and the pulse was nothing more than “the movement of blood vessels,<...>to “cool” the pneuma with a breath of air”1. Modern cardiologists understand the pulse (from the Latin pulsus - beat) as jerky vibrations of the arterial walls associated with the contractile activity of the myocardium. It is curious that by the “beat” of the pulse, Avicenna did not mean expansion (filling) of the vessel, as is now believed, but compression, because it was believed that “pneuma” was attracted by compression of the artery, and not by its stretching.

“...Each pulsation [Avicenna distinguished] 4 parts: 1) the movement of expansion; 2) a period of rest between expansion and contraction; 3) movements of compression and 4) a period of rest between compression and expansion.” It is no coincidence that in those days the pulse was felt not with two or three, as now, but with four fingers, each trying to catch one of the parts of the pulse. Moreover, if the “values of the ratios” of these four periods of time of movement and rest were equal, then they spoke of an even pulse with a good rhythm, similar to music. If not, then such an uneven pulse had a bad rhythm.

Avicenna distinguished 9 varieties (categories) of a smooth, rhythmic pulse2: 1) by the magnitude of the expansion; 2) by the quality of impact (compression); 3) by time of movement; 4) by condition (artery wall); 5) according to the degree of emptiness and filling (arteries); 6) by warmth and coldness (of the palpated place); 7) by rest time; 8) by evenness and unevenness; 9) by the presence of order (or disorder) in the irregularity (“size” of the pulse).

The pulse value was understood as its length, width and height, which together gave 9 simple

2 In the future, we will denote the names of the varieties (categories) of pulse in boldface font.

by Avicenna, and in bold italics - modern ones.

types of pulse: 1-3) long (long), balanced (normal length) and short; 4-6) wide, balanced (normal width) and narrow; 7-9) tall, balanced (normal height) and low. Today it is difficult to give an analogy to these characteristics, and in order to feel them, a modern cardiologist needs to strain his imagination and become a little philosopher.

Combinations of simple types of pulse values constituted its complex varieties. Thus, a pulse exceeding the usual one in length, width and depth was called large, and a pulse inferior to the usual one in these respects was called small. The pulse between them was considered balanced. Accordingly, today a thread-like pulse (pulsus filiformis) has been added to the large (pulsus magmus) and small (pulsus parvus) pulses, and the magnitude of the pulse evaluates the degree of tension in the artery wall and its filling with blood. Avicenna called a wide and high pulse thick, a narrow and low pulse thin. Regular (balanced) was in between. Already from these characteristics it is clear how intellectually sophisticated the diagnosis of pulse conditions was at that time.

According to the quality of the blow, a strong pulse was distinguished, hitting the fingers when palpating and slightly pressing the artery, the opposite, weak, and normal, balanced (middle between them).

Based on the time of movement, Avicenna distinguished between fast, slow and balanced pulses. These types of pulse: fast (pulsus celer), slow (pulsus tardus) and dicrotic, or double (pulsus dycroticus), observed with a decrease in the tone of the peripheral arteries and preservation of the contractile function of the myocardium, have survived to this day.

The condition of the artery wall, according to Avicenna, was characterized by a soft pulse that easily disappeared with pressure, a hard pulse, and a balanced pulse. Nowadays, these characteristics correspond to pulse tension, which combines the quality of the pulse beat and the condition of the artery wall: tense, or hard (pulsus durus), and relaxed, soft (pulsus mollis) types of pulse.

According to the degree of filling of the artery, the pulse can be: “full, that is, when a significant amount of fluid filling it is felt in the cavity [artery], and not pure emptiness, empty, the opposite of this, and then balanced,” taught Avicenna3.

3Note that according to this characteristic, the “beating vessel” - the artery - must contain liquid (blood), and not air. We believe that Avicenna read about this from Galen. But he wrote about this in passing, as if by the way, without drawing the reader’s attention to it.

Today, cardiologists determine the filling of the pulse depending on the change in the diameter of the artery during the passage of the pulse wave: the pulse is full (pulsus plenus) and empty (pulsus vacuus). This characteristic, taken in conjunction with the pulse voltage, means its value.

According to the doctor’s sensations, the pulse was “hot, cold and balanced, [standing] between them.” In modern cardiology there are no analogues to these types of pulses.

There are interesting types of pulse according to the duration of the resting period: “frequent, that is, [a pulse] with short perceptible [breaks] between two beats, it is also called overtaking and compacted, and rare, the opposite of it, or lagging and sluggish, and between them - ordinary, balanced". Avicenna’s technique for identifying the periodicity of the pulse was perhaps the most sophisticated: “This period [is determined] depending on how the compression [of the artery] is felt; if the compression is not felt at all, then the period of [rest is considered] the period of time between each two expansions; if the compression is perceptible, then [the period of rest is determined] by the time of the end of both [states].”

Modern cardiologists distinguish between a rare pulse (less than 60 beats per minute, pulsus rarus, or bradis) and a frequent pulse (more than 90 beats per minute, pulsus frequens, or tachis). In Russia, the first condition is called bradycardia, and the second - tachycardia. In Ukraine they talk about brady- and tachysphygmia.

According to the evenness and unevenness of the beat, “the pulse is either even or uneven.<...>An even pulse is an even pulse in all [mentioned above] respects; if he is equal in one of them, then he is called equal only in this respect. : “even in strength”, “even in speed”. An uneven pulse is the same: it can be uneven in general or in that in relation to which it is uneven.”

In our understanding, an even pulse is rhythmic (pulsus regularis), and an uneven pulse is arrhythmic (pulsus irregularis). Avicenna divided the latter into uneven ordered and uneven disordered (disorderly).

"Irregularity of the pulse in many parts of one beat" was manifested either in the arrangement of parts of the artery, or in the movement of its parts. “The unevenness in the arrangement of the parts of a vessel is the unevenness in the relation of the parts of the vessel to the direction; since there are 6 directions, there are as many irregularities 4. Irregularity in the movement [of the pulse] is manifested either in speed and slowness, or

4Perhaps we are talking about the directions “up - down”, “right - left”, “forward - back”.

in lag or advance, that is, when a part [of a vessel] moves ahead of time or later [than it should], or in strength and weakness, or in large or small magnitude, and all this occurs either in an even order or in an uneven order, increasing and decreasing, and takes place either in two parts, or in three, or in four.

As for the unevenness of the pulse in one part [of one beat], this includes [the pulse] intermittent, returning and continuous.

Intermittent is a pulse that is interrupted in one part of the beat by a true interruption, and the ends of the part of the beat separated by the interruption diverge in relation to speed, slowness and mutual similarity. Returning is one when a large pulse becomes small in one part, then gradually returns [to its original value]. The same kind of pulse is fused, when one beat due to unevenness is similar to two beats or two beats are similar to one beat, since they merge. A continuous pulse is one in which the unevenness [increases] continuously and no boundary is felt in the transition from speed to slowness, and vice versa, or to balance, or [to unevenness] from balance in these two respects, or [the transition] from large or small dignity, or from balance to some other quality to which a transition [is possible].

Ordered is a [pulse] whose irregularity preserves a certain order and [repeats] cyclically. [An uneven ordered pulse] can be of two types: it is either an [uneven pulse], generally ordered, when only one irregularity is [constantly] repeated, or an ordered cyclic one, when there are two cycles of irregularities or more.

So, for example, there may be one cycle and another, different from it, but only they [always] return together, one after another, as one cycle, and the [uneven] disordered [pulse] is something the opposite of this. If we carefully examine, it turns out that this ninth variety [is actually] like a kind of the eighth variety and fits into the [category of] uneven [pulse].”

The modern physician cannot fail to be amazed by the ability of his medieval colleague to distinguish the irregularities of the pulse in one, two, three or even four parts of one beat. In other words, doctors of that time could perceive changes in the pulse by time, strength or magnitude in each of the four parts of the pulse wave!

The uneven pulse is more reminiscent of the modern arrhythmic pulse and its many varieties, but to establish that they understood

ANNALS OF ARRHYTHMOLOGY, No. 4, 2012

ancient doctors under one definition or another is not so simple.

Thus, “an intermittent pulse is [such] an uneven pulse when: a) you expect movement, but immobility occurs, [or] ... b) you expect immobility, but movement occurs.” Apparently, what we have in front of us is nothing more than ventricular and atrial extrasystoles. Ventricular extrasystole may also include intermittent pulse.

A pulse that is uneven in movement resembles an alternating, or intermittent, pulse observed with myocardial damage, which is characterized by a combination of large and small pulse waves. A returning pulse can mean a paradoxical pulse or a pulse with respiratory arrhythmia, a continuous pulse can mean bigeminy or the already mentioned dicrotic pulse, and a continuous pulse looks like atrial fibrillation.

It is curious that by the rhythm of the pulse, medieval doctors did not understand exactly the same thing as today’s doctors. In their understanding, the pulse was considered rhythmic, described by the first seven of the 9 categories described above, which corresponded to the laws (harmony, rhythm, tempo, timbre) of music and corresponded to the age of the person who possessed it. About the same as the timbre of our voice corresponds to our age. At the same time, Avicenna gave priority to comparing the pulse with music to Galen.

A rhythm that corresponded to age was considered good, and one that did not correspond was considered bad. Avicenna distinguished three types of pulses with a bad rhythm: “...a pulse of a changing and shifting rhythm is a pulse whose rhythm is a rhythm inherent in an age adjacent to the age of the owner [of the pulse under study]; Thus, children have the rhythm of the pulse of young men. The second type is the pulse of a distant [age] rhythm, for example, when in children [we find] the rhythm of the pulse of old people; and the third is a pulse that goes out of rhythm, that is, a pulse that is not similar in its rhythm to the pulse of any age. If the pulse goes out of rhythm, it often indicates a significant disorder [of health].” These concepts are certainly interesting, but currently have only historical significance. Among them were the following:

“The pulse of a gazelle is one that beats unevenly in one part of the stroke, when [that part] is slow, then breaks off and [then] rushes.” What is this? Paroxysmal tachycardia?

“Wavy [pulse] - uneven in relation to the large and small size of parts of the vessels or in their rise and width and in the advance and lag at the beginning of the movement of the pulse if there is softness in it. It is not very small, it has some

different width and resembles waves following one another in a row, differing in the degree of rise and fall, speed and slowness.” This pulse resembles the one described above, which is uneven in movement and, as we have already said, is similar to an alternating one.

“The worm-shaped pulse is similar to the [wavy], but only very small and very frequent.”

“An ant pulse is very small and even more frequent. The unevenness of the worm-shaped and ant pulse in relation to rise, advance and lag appears to the touch more clearly than the unevenness in relation to width; the latter may not even appear at all.” It is possible that the worm-like and ant-like pulses are today called filamentous.

“Sawtooth pulse. It is similar to the wavy one in terms of the unevenness of the parts in relation to the rise and width and in relation to the advance and lag, but it is only hard, and although there is hardness, its parts are not equal in hardness. The sawtooth [pulse] is fast, frequent and hard, its parts vary in the amount of expansion, hardness and softness.” It is difficult to find a modern analogy for this pulse and the next two.

“Mouse tail. This is a pulse whose irregularity gradually changes, from decreasing to increasing or from increasing to decreasing. Mouse tail is sometimes observed in many strokes, and is sometimes felt in several parts of one stroke or in one. The most characteristic unevenness [for him] is that associated with size, and sometimes it relates to speed and slowness, weakness and strength.”

“Spindle-shaped pulse. It is a pulse that goes from decreasing to some limit of increasing, then continually retreats back until it reaches the original limit of decreasing. The result is two “mouse tails”, converging at the largest ends.”

“Two-beat pulse. Doctors differ in their opinions regarding this [variety]: some of them consider [two beats] to be one beat of the pulse, uneven in relation to leading and lagging, while others say that it is two beats following each other without interruption. But, in general, the time between them is not such as to accommodate the compression [of the artery] and then the expansion.” When you read this, the first thing you think about is bigeminy.

“Pulse with interruptions” and “pulse falling in the middle [pulsation]” have already been mentioned. The difference between the “pulse falling in the middle” and the pulse of the “gazelle” is that with the pulse of the “gazelle” the second beat arrives before the end of the first, and with the “pulse falling in the middle” [the second] beat occurs during a pause, after end of per-

wow. All these arguments again and again speak of the now lost sophistication of the pulse diagnostic technique that the ancients possessed.

“The pulse is convulsive, trembling, vibrating, which looks like a thread being twisted and twisted. It falls into the category of irregularities in terms of lead and lag, position and width.”

“A pulse tense as a string is a type of vibrating pulse. Cases of a tense, vibrating and “leaning to one side” pulse most often occur in “dry” diseases.”

Thus, even a simple enumeration (and we have not analyzed everything) allows us to identify about 60 characteristics of the pulse that were distinguished by medieval doctors. Of these, about 20 have survived to this day. The exact concepts of some others have been lost. Perhaps forever. Avicenna called the reasons that determine the nature of the pulse (that is, its overall characteristics) restraining. In his opinion, there were three such reasons:

1. “The animal force that moves the pulse, which is located in the heart.”

2. “An instrument, that is, a beating vessel.”

3. “The need to reduce heat.”

Let's consider these provisions. In Avicenna’s understanding, the main driving cause of the pulse was in the heart (according to Galen - “vital spirit”5) and was transmitted to the arteries to cool the pneuma located in them. From a modern point of view, the conditioning of the pulse by heart contractions should be considered true, as well as the influence of the arterial wall on the speed of the pulse wave. Note that it arose at the beginning of the twentieth century. The “teaching of the peripheral heart,” whose apologist in Russia was S. P. Botkin’s student M. V. Yanovsky, basically repeated the ideas of the ancients about the independent contraction and relaxation of arteries.

As for “warmth,” if by it we mean body temperature, which affects the pulse rate, then the third reason for the variety of pulse is quite reasonable. Only the cause was confused with the effect: Avicenna believed that the pulse quickens in order to reduce body temperature, and we believe that fever causes tachycardia.

5 One of the three spirits that ensure the vital functions of the body. It entered a person with inhaled air, was transported by arteries and endowed the person with life (soul - breath - life). The second spirit - the animal - penetrated the body aerophagically, was in the liver, spread through the veins and ensured the growth of organs and body parts. The third spirit - the plant spirit - was located in the ventricles of the brain, penetrating there with the air inhaled through the nose, distributed throughout the body by nerves and was in charge of our motor activity.

Various combinations of these three reasons, as well as some external, “optional” ones, led to one or another type of pulse.

A large pulse in Avicenna’s view corresponded to great “animal strength” (healthy myocardium - author’s note), soft vascular walls and the “need for cooling” (during fever - author’s note). A small pulse indicated weakness of animal strength (heart failure. - Author's note). If the wall of the vessel was hard, and “the need for cooling is insignificant,” then the pulse became even smaller. In other words, which is absolutely true, a small pulse was observed both in atherosclerosis and in cardiac weakness.

And here is how Avicenna explained the cause of tachycardia: “If the need for cooling is great, the vital force is significant, but the hardness of the vascular wall does not allow the pulse to become large, then it must become fast in order to quickly make up for what it missed, did not become large (here and further italics are ours. - Author's note). If the strength is weak, then it is not possible to either increase the pulse or create speed in it, and it must inevitably become frequent in order to make up with frequency what it missed without becoming large and fast. Numerous frequent strikes replace one large full blow or two quick strikes. "

Avicenna wrote that the pulse is fast and frequent even when normal size The strength in the heart and fairly soft vessels increases the need for greater cooling of the pneuma (for example, during fever). The pulse becomes rare when the need for cooling the pneuma disappears, for example, with severe general cooling, “extreme loss of strength” or “approaching death.” Brilliant observation!

Among the reasons leading to weak pulse, Avicenna named “insomnia, exhaustion, excessive physical work.” The pulse becomes hard “during crises as a result of the body’s strong fight against the disease and the resulting tension in the organs, aimed at reflecting the disease.” A soft pulse occurs with “moisturizing factors, such as dropsy or bathing.” His next observation is remarkable: “The causes of irregular pulse include overflow of blood vessels. , this phenomenon is eliminated by bloodletting.” Let's pay attention to this. After all, on the one hand, it turns out that the treatment of paroxysmal tachycardia in aortic disease with bloodletting was known long before Avicenna. But, on the other hand, from this observation it follows that, according to the author, the arteries could contain both pneuma and blood! But if she

ANNALS OF ARRHYTHMOLOGY, No. 4, 2012

was there, then how did it get there if, according to the ideas of anatomists of that time, the arterial and venous systems did not communicate with each other? In this case, did not Avicenna (following Galen!) admit the possibility of blood getting from the right heart to the left?

If this is so, then his following words become clear: “. especially if such a pile-up (that is, a mixture of blood and pneuma. - Author's note) occurs close to the heart (our italics - Author's note).”

An interesting remark of the great doctor about the appearance of interruptions (extrasystoles) and even fluttering of the pulse when the stomach is full. Another reason for an intermittent pulse is “exhaustion of strength” (physical and mental fatigue. - Author’s note) and “some sudden phenomenon to which the nature and soul immediately turn” (physical and mental excitement and tension, causing the appearance of ventricular extrasystoles - Author's note).

Above we suggested that the worm-like and ant-like types of pulse are today interpreted as filamentous. We find confirmation of this from Avicenna: “The reason for these types of pulse is such a great weakness of strength (possibly low cardiac output - author’s note) that slowness, frequency and unevenness are combined in the parts of the pulsation.”

Avicenna’s remarks about the pulse during physical activity are interesting. Since the body (and, accordingly, the pneuma) warms up when moving, the pulse becomes large, strong, fast and frequent. After all, “hot air” needs to be cooled. With prolonged or heavy load (overwork), the pulse becomes small and weak, remaining fast and frequent, and with excessive load and severe fatigue it turns into a worm-shaped pulse. The load that leads a person to death makes the pulse ant-like (thread-like).

What we have before us is nothing more than a kind of pulse stress test of the “dark” Middle Ages.

The analysis showed that the main provisions of the doctrine of Avicenna’s pulse have survived to this day. At the same time, some concepts have become history, and other techniques were much more sophisticated than modern ones, which can be explained by the meaning of the pulse in ancient times.

Avicenna studied the characteristics of the pulse depending on the “vital force” located in the heart (the modern analogue is cardiac output), the state of the vascular wall (elastic - dense - hard), the level of metabolism (human body temperature), gender, age, temperament, place of residence a person, the quantity and quality of food he eats, as well as changes in heart rate caused by sleep and wakefulness, pain, pregnancy, the presence of cancer, emotional (for example, love) experiences, and approaching death. He also described the features of heart rate changes with increasing physical activity. To a certain extent, this can be considered the concept of modern stress tests.

As a result of the study, we can conclude that the “cardiological” legacy of the brilliant doctor of the Middle Ages not only has not lost its relevance, but should also be taken into account in the modern study of the problem of cardiac rhythm and conduction disorders.

Conflict of interest

No conflict of interest is declared.

BIBLIOGRAPHICAL LIST

1. Avicenna. Canon of medical science. Tashkent: Medicine, 1979.

2. Propaedeutics of internal diseases / Ed. N. A. Mukhina, V. S. Moiseeva. M., 2002.

3. Propaedeutics of internal diseases / Ed. N. E. Fedorova and others. Minsk, 2007.

4. Glyantsev S.P. Galen - a pioneer in the description of multiple defects of the interventricular septum // Bulletin of the Scientific Center for Cardiovascular Surgery named after. A. N. Bakuleva RAMS. 2010. T. 11, No. 1. P. 51-57.

Abu Ali Hussein ibn Abdullah ibn al-Hasan ibn Ali ibn Sina known in the West as Avicenna He was born in the city Afshana near Bukhara, August 16 980-died in Hamadan e, June 18 1037 ) - medieval Persian scientist, philosopher and doctor, representative Eastern Aristotelianism. Was a court physician Samanid emirs and Daylemite sultans, was for some time vizier in Hamadan. In total, he wrote more than 450 works in 29 fields of science, of which only 274 have reached us. The most famous and influential philosopher-scientist of the medieval Islamic world

From an early age, the boy showed exceptional abilities and talent. By the age of ten, he knew almost the entire Koran by heart. He was then sent to study Muslim jurisprudence at school, where he was the youngest. But soon even the oldest of the school’s students appreciated the boy’s intelligence and knowledge and came to him for advice, although Hussein had only just turned 12 years old. Later, he studied logic and philosophy, geometry and astronomy under the guidance of the scientist Abu Abdallah Natili, who came to Bukhara. At the age of 14, the young man began to study independently. Geometry, astronomy, and music were easy for him until he met Aristotle's Metaphysics

At the age of 16, Ibn Sina was invited to treat the Emir of Bukhara himself. In his autobiography, Avicenna wrote: “I began studying medicine, supplementing my reading with observations of patients, which taught me many treatment techniques that cannot be found in books.”

After the capture of Bukhara by the Turks and the fall of the Samanid dynasty in 1002, Ibn Sina headed to Urgench, to the court of rulers Khorezm. Here they began to call him “the prince of doctors.” In 1008, after Ibn Sina refused to enter the service of the Sultan Mahmoud Ghaznavi a prosperous life gave way to years of wandering. He wrote some works in the saddle during his long journeys. From 1015-1024. lived in Hamadan, combining scientific activity with a very active participation in the political and government affairs of the emirate. For the successful treatment of Emir Shams al-Dawla, he received a position sight

The encyclopedic work “The Book of Healing” (“Kitab al-Shifa”), written in Arabic, is dedicated to logic, physics, biology, psychology, geometry, arithmetic, music, astronomy, as well as metaphysics. The Book of Knowledge (Danish-name) is also an encyclopedia.

Works on medicine

The main medical works of Ibn Sina:

« Canon of medical science"(Kitab al-Qanun fi-t-tibb) is an encyclopedic work in which the prescriptions of ancient physicians are comprehended and revised in accordance with the achievements of Arab medicine. In the Canon, Ibn Sina suggested that diseases could be caused by some tiny creatures. He was the first to draw attention to the contagiousness smallpox, defined the difference between cholera And plague, described leprosy, having separated it from other diseases, he studied a number of other diseases. There are many translations of the Canon of Medicine into Latin. In the "Canon" two books out of five are devoted to the description medicinal raw materials,medicines, methods of their production and use. Of the 2600 medicines described in the Canon, 1400 are of plant origin .

"Medicines" - written during the first visit to Hamadan. The work details the role of the heart in the occurrence and manifestation of pneuma, features of the diagnosis and treatment of heart diseases.

“On the benefits and harms of wine” is Ibn Sina’s shortest treatise.

"Poem about Medicine"

"Treatise on the Pulse"

"Events for Travelers"

“Treatise on honey vinegar - describes the preparation and medicinal use of mixtures of vinegar and honey of various compositions.

"Treatise on Chicory"

"Blood vessels for bloodletting

Chemistry

In the field of chemistry, Ibn Sina discovered the process of distillation of essential oils. Knew how to mine salt, sulfuric And nitrogen acids, hydroxides potassium And sodium.

The great scientist is also the inventor of the popular Central Asia bowed instrument - gijaka.

In his honor Carl Linnaeus named a genus of plants Acanthus family - Avicennia.

IN Riga, in the park of the hospital complex Gaiļezers, in 2006 a monument to Abu Ali ibn Sina was unveiled

Named after Ibn Sina crater on the moon

The main business of life for Avicenna was medicine. At the age of 16, he was invited to treat the Emir of Bukhara himself. And since then, Ibn Sina was the court physician of many rulers of the East. No wonder his contemporaries called him “the prince of doctors.” Avicenna himself wrote in his biography about his path to medicine: “I began studying medicine, supplementing my reading with observations of patients, which taught me many treatment techniques that cannot be found in books.” Ibn Sina left to his descendants many books on medicine, and his “Treatise of Medical Science” became the second printed book after the Bible and served as a reader for doctors for 600 years. Avicenna's advice on how to live a healthy life, written 1000 years ago, is still relevant in the 21st century.

About physical activity:

“Idleness and idleness not only give rise to ignorance, they are at the same time the cause of illness...

A person who exercises moderately and in a timely manner does not need any treatment aimed at eliminating the disease...

One who gives up physical exercise often wastes away, because the strength of his organs weakens due to refusal to move...

If you engage in physical exercise, there is no need to take medications taken for various diseases, if at the same time you follow all other requirements of the normal regimen.”

About healthy eating:

“The worst food is the one that burdens the stomach, and the worst drink is when it goes beyond moderation and fills the stomach to the top... If you have eaten too much, then the next day you need to remain hungry...

The worst thing is to mix a variety of foods and eat for too long...

The harm caused by a very tasty food is that you can eat too much of it...

Light food preserves health more, but less maintains strength and strength, and heavy food does the opposite...

The amount of food should be such that it does not burden, does not stretch the ends of the ribs, does not bloat the abdomen, does not growl or float to the top... In addition, it should not be followed by nausea, “dog appetite”, loss of strength, stupor, or insomnia ...

It's better to drink than to overeat...

Be moderate in food - that’s the first commandment. The second commandment is to drink less wine.”

About the dangers and benefits of wine:

“Continuous drunkenness is harmful, it spoils the nature of the liver and brain, weakens the nerves, causes nerve disease, sudden death...

Wine is our friend, but there is deceit in it: Drink a lot - poison, drink a little - medicine. Do not harm yourself with excess, drink in moderation - and the kingdom of life will last...

Wine is your friend while you're drinking, but if you're drunk, it's your enemy. It's snake venom when you're drunk like a fool.

The less often a hand raises the table cup of wine, The stronger it is in battle and the braver and more skillful it is in business.”

About healthy sleep:

“Healthy people need to pay proper attention to sleep. Their sleep should be moderate in duration, not excessive; they should beware of the harm caused by insomnia to the brain and to all their powers...

Sleep strengthens everything natural forces... And excessive sleep produces the opposite of all this. It gives rise to lethargy of mental strength, dullness of the brain and cold illnesses... Tossing about in bed between wakefulness and sleep is the worst of all conditions...

Sleeping on an empty stomach is not good; it weakens your strength. It is also harmful to sleep with a full stomach... For such sleep will not be deep, but restless...

Know that a blanket and a high pillow promote health. In short, the members should be positioned so that the head is higher than the feet...

The most better position during sleep is considered when sleep begins with lying on the right side, and then turns to the left. If sleep begins with lying on the stomach, then this helps digestion well... People who are weak from illness usually sleep on their backs... Such people also sleep with their mouths open due to weakness of the muscles that compress both jaws..."

About healthy housing...

“Whoever chooses a place of residence should know what the soil is like there, what the water is like there... He must know whether this place is exposed to the winds or is located in a basin, and what kind of winds there are - whether they are healthy and cold...

Then the windows and doors should face east and north; and also so that the sun reaches any place in them...

He must find out what the state of the local residents is in terms of health and illness..."

“The main thing in the art of maintaining health is balancing the necessary, general factors. They are:

1) balance of nature,

2) choice of food and drink,

3) cleansing the body of excess,

4) maintaining the correct physique,

5) improving what is inhaled through the nose,

6) adaptation of clothing,

7) balance of physical and mental movement.

The latter includes, to some extent, sleep and wakefulness...”

Works of Avicenna.

The circle of mystical works of Ibn Sina includes

“The Book of Birds”, “The Book of Love”, “The Book of the Essence of Prayer”, “The Book of the Meaning of Pilgrimage”, “The Book of Deliverance from the Fear of Death”, “The Book of Predestination”.

Medicine.

“Canon of Medical Science” (“al-Qanun fi-t-tibb”)

The exact date for the completion of work on "Canon" has not been established. Presumably this is 1020. Translated into Latin, it became widely known in Europe from the 12th century. It was one of the manuals that went through more than thirty editions; it was used to teach medicine at European universities for five centuries. When the printing press was invented, the Canon was among the first printed books, and rivaled the Bible in the number of editions. This is an encyclopedic work in which the prescriptions of ancient physicians are interpreted and revised in accordance with the achievements of Arab medicine. This fundamental work, consisting of 5 volumes, collects information on pharmacology, gives a detailed description of the heart (first principle), liver (second principle), brain (also second principle), refutes the opinion that the source of vision is the lens, and proves that The image of an object is given by the retina. Avicenna establishes the differences between plague and cholera, pleurisy and pneumonia, describes leprosy, diabetes, stomach ulcers, etc. In the Canon, Ibn Sina suggested that diseases could be caused by some tiny creatures. He was the first to draw attention to the contagiousness of smallpox, separating it from other diseases, and studied a number of other diseases.

An experienced surgeon, Ibn Sina gave a detailed anatomical description of man, but his special contribution was the study and description of the activities of the brain.

“Medicines” (“Al-Adwiyat al Kalbiya”) - written during the first visit to Hamadan. The work details the role of the heart in the occurrence and manifestation of pneuma, features of the diagnosis and treatment of heart diseases.

“Removing harm from various manipulations through corrections and prevention of errors” (“Daf al-mazorr al kulliya an al-abdon al insonia bi-tadorik anvo hato an-tadbir”).

“On the benefits and harms of wine” (“Siyosat al-badan wa fazoil ash-sharob wa manofi’ih wa mazorich”) is the shortest treatise by Ibn Sina.

“Poem about Medicine” (“Urjusa fit-tib”).

“Treatise on the Pulse” (“Risolai Nabziya”).

“Events for travelers” (“Fi tadbir al-musofirin”).

“Treatise on Sexual Power” (“Risola fil-l-boh”) - describes the diagnosis, prevention and treatment of sexual disorders.

“Treatise on Vinegar Honey” (“Risola fi-s-sikanjubin”) - describes the preparation and medicinal use of mixtures of vinegar and honey of various compositions.

“Treatise on Chicory” (“Risola fil-hindabo”).

“Blood vessels for bloodletting” (“Risola fil-uruk al-mafsuda”).

“Risola-yi Judiya” describes the treatment of diseases of the ear, stomach, and teeth. In addition, it describes hygiene problems. Some researchers dispute Avicenna's authorship.

"Book of Healing" (Kitab al-Shifa)

Written in Arabic, the encyclopedic work is devoted to logic, physics, biology, psychology, geometry, arithmetic, music, astronomy, and metaphysics.

Read Avicenna's treatise on chicory. Avicenna as a luminary of Arab medicine. Works on medicine

annotation scientific article on veterinary sciences, author of the scientific work - Glyantsev Sergey P., Magomedova Suikanat M.

Related topics scientific works in veterinary sciences, author of the scientific work - Glyantsev Sergey P., Magomedova Suikanat M.

Doctrine about Avizen's pulse: look from the present

Text of scientific work on the topic “The Doctrine of Avicenna’s Pulse: A View from the Present”

Works of Avicenna.

Medicine.