Letter to the Editor: Avicenna's view on the prevention of thrombosis

Abstract

We have greatly enjoyed reading the recently published manu-script by AA. Gooshah et al.[1] who related their view on Avicenna's(Ibn Sina) theory of humors on the prevention of thrombosis. It isinteresting to know that in one of the most prominent figures inthe history of medicine Avicenna himself had comments in hisAl-Qanun on the causes of obstructive cardiovascular diseases[2,3]. But, unfortunately, the inconsistent terms and conceptsfound in this manuscript could result in the miscommunication ofthe readers. In their article, the authors only emphasize Sauda andSafra which have important roles in blood coagulation in the circu-latory system — to decrease blood circulation and cause thrombusformation. In Avicenna's medicine, Sauda clinically divides intotwo categories — normal black Sauda and abnormal Sauda, whereinthe abnormal Sauda usually plays an important role in blood coagu-lation in the circulatory system [4–6].Although there is no concept of thrombosis in the Qanunof Medicine as such and the concept of thrombosis in modernmedicine distinguishes from the concept of obstruction and semi-obstruction by abnormal Sauda which is discussed in thefirstbook of Avicenna's Qanun, some important links could be foundbetween the old and the modern medicines' understanding.In Avicenna's medicine, the human body is composed of fourhumors (blood or Dam,phlegmorBalgham, yellow bile or Safra andblack bile orSauda). These four humors – yellow bile, blood, phlegmand black bile– mutually compensate, balance, control and supporteach other. In normal condition, the Blood is the humor most essen-tial and conducive to vitality and good health. The Blood plays a rolein hilit transportation and metabolism and that all the hilits con-stantly cycle in the blood. The Safra primarily functions to transportthe Balgham and Sauda in the Blood to the smallest parts of thehuman body by increasing the viscosity of the blood, facilitateblood flow in the vessels, inhibit the solidification of the Balgham,Blood and Sauda, and prevent blood stasis. One of the most impor-tant functions of the yellow bile is the suppression of the effects ofthe black bile [5]. The Balgham protects the hilits damaged by theSafra with hot character. It also transports the Sauda through thebloodtothebody'stissuesandorgans,suppliesbodyfluids,moistensandsoftenstissues,andreplacesblood.Itisthelasthilit,savda,whichhelps to maintain the shape of the organ and body.The cornerstone of health is the right ratio and specificbalanceof humors based on their quality and quantity. The disequilibriumof the humors quantitatively or qualitatively causes diseases [6].Avicenna suggests that all four humors are the important factors invessel obstruction (and then thrombus formation) in a differentstage of disease. Again, we should state that according to Avicenna'smedicine, all humors are taking part in the formation of thrombosis.The special treatment by the regulation of these humors could pre-vent thrombosis. Our research studies found that cardiovasculardisease risk factors such as metabolic abnormalities like abdominalobesity, high cholesterol, high blood pressure and high blood glucoseare the parts comprising the Balgham increase syndrome (abnormalBalgham) [7]. The increase of abnormal Balgham would decrease thequantity and quality of the Safra and thus enhance the Sauda's originalability to perform the formation, cohesion and thickening of the blood.The increase of blood viscosity and further atherosclerosis are under-stood as the deposition of abnormal Sauda in arterial walls which nar-rows the blood vessels, reduces circulation, and causes obstructionand semi-obstruction in the vessels [8,9].Itmustberememberedherethat conditions of deficient blood supply to the muscles and tissuesandjointsandtendonsareinfactaSaudacondition,becausewiththeab-senceofwarm,moistBlood,acold,drySaudaconditionwillbeproduced.And so, increasing the circulation and vital blood supply to an organ ortissue of the body is actually an anti-Sauda therapeutic approach.In our clinical studies of coronary heart disease cases and coagu-lation–anticoagulation and fibrinolytic system function disorders,theBalghamsyndromehasbeenpredominated.However,theseverestages of these diseases are clinically connected with abnormalSauda syndrome [5–7]. Based on Avicenna's view, the specific