The seventh and last art mentioned in the fourth book of the Canon of Medicine by Ibn Sina is assigned to the theme of "zina", that is beauty and physical appearance. It consists of four articles dealing with appearance, beauty and hair and body care, as well as skin diseases and their treatment. Subjects such as obesity and emaciation that affect the appearance, and preventive methods and measures for all of these, are also discussed.
Professor Nil Sari*
Table of contents
The seventh and last art mentioned in the fourth book of the Canon is assigned to the topic of "zina" ("ziynet" in Turkish), that is physical appearance. It consists of four articles. Although the term "zina" calls to mind ornament and ornamentation, when we take a look at the text in the Canon, we may observe that it deals with appearance. That is to say the hair and body care; as well as skin diseases and their treatment. What is more, it also refers to subjects such as obesity and emaciation that affect the appearance, and preventive methods and measures for all of these are discussed.
This article is based on the Turkish version of the Canon . It is important to note however, Mustafa b. Ahmed b. Huseyin of Tokat, who translated it into Turkish, in the 18th century, often used medical Arabic terminology and some idioms that may not be found in most contemporary Ottoman dictionaries. It is a literal translation, yet most of the terms of Arabic origin that are found in it have different meanings from those of today. For this reason, in order to comprehend thoroughly the medicine of Ibn Sina, we must first perform an exhaustive study of the meanings of the medical terms used in the medical literature of the period. Only after this may we wholly understand the old medical texts. If we cannot aptly comment on the theories regarding the etymology of illnesses or, in other terms, the "philosophy of medicine", I believe that it will be impossible to thoroughly comprehend ancient medicine.
In the first article of the chapter on "zina" matters about hair (sha'r) are studied, where all knowledge on hair, beard etc. are discussed under the title sha'r (hair).
What are the states of hair? In short, these are, respectively, the growing of hair and its "substance" or "factor" (jawhar), measures to be taken in order to prevent the shedding of hair and beard; getting the hair grow plentifully, suggestions on how to make strands thicker, softer and grow longer; besides the measures to be taken in dressing it, such as getting it smooth or curly, methods for changing the colour of the hair, for example, darkening it, dyeing it red, brown, etc.
All matters on the growth of hair, its illnesses, and treatment are explained according to humoral theory. It is difficult however to understand the medical meanings of some of the terms. Similar to other topics, this point is of importance in "zina." For instance, the growing of hair depends on an agent (factor) called "buhâr-i duhânî" (meaning smoky or dry vapour), which is the substance (jawhar) of the hair. That is to say, the growing of hair, its abundance and thinness are connected with an agent (jawhar) referred to as "buhâr-i duhânî". This smoke collects in the pores of the skin; sometimes hair grows with the help of other smokes. The surface from which hair grows is likened to the deciduous trees with fatty leaves. Akin to these, the place from where hair grows is greasy.
When studying hair diseases, the lack or scarcity of hair, beard or body hair (butlan-i sha'r) are primarily discussed. Sometimes the lack of hair is due to a "substance" (matter, madde) and sometimes due to a factor in the place of hair growth. The substance affecting hair is "blood." The cause of decreasing blood is an object (matter, nesne) which retains blood for a long time. Something connected with the "substance" which changes the character of the blood is, also, another cause of the lack or scarcity of hair.
Hair also lessens when the agent (jawhar), which is the active cause, growing hair (buhâr-i duhânî) decreases.
Scarce hair and the lack of beard in children and women is explained as follows: According to this theory, in children and women the "moist vapour" (ebhire-i ratbe) is more than the "dry vapour" (buhâr-i duhânî); and since the dry vapour, which is the agent of growing hair, is less in children and women they have little bodily hair and they cannot grow beards. Here, I liken the "dry vapour" to the masculine hormone (testosterone) and the "moist vapour" to the female hormone (estrogen). Without any technical facilities, Ibn Sina explained his successful observations by means of the medical theories of his period.
How does the agent (jawhar) of hair decrease? Sometimes it is acquired and sometimes it is hereditary. It is acquired during convalescence, since in chronically and emaciating (degenerating) diseases the "moistness" (rutûbet) is absorbed and as a result in those who are in the state of convalescence lessens. Thus, the nutrition nourishing the hair causes the hair to fall off and does not grow; just as in the case of plants growing when watered, dying off in draught.
Regarding those who are castrated, hair will not grow. Those castrated are similar to women in "moistness" and "coldness". Since no sperm may be produced in their genitalia, the "innate moistness" accumulates and cools the body. In those castrated, only a very small portion of their moistness decomposes, and since the moisture that decomposes is very thin, it excretes through the pores. Owing to this, those castrated may find bodily hair does not grow. Today it is established that if castrated, testosterone secretion decreases.
Hair of those who continually cover their head also gets thinner.
Figure 2: Illuminated opening of the first book of the Kitab al-Qanun fi al-tibb (The Canon on Medicine) by Ibn Sina. Undated, probably Iran, beginning of 15th century. (Source).
Hereditary scarcity of hair is seen in baldness, called sal'. Such hair loss results from the deficiency of the matter (substance), which means that the matter is insufficient.
There are three basic reasons for the failure of hair growth:
1. The "matter" of hair will not diffuse (penetrate) into the place where hair grows from.
2. The "matter" will penetrate into the place where hair grows from, but it will not remain there.
3. The "matter" of hair is spoiled, consequently it acquires a quality not suitable for the growth of hair.
The factors causing hair loss are discussed as follows. Baldness (sal') develops faster in people with a "hot temperament." Since the pores dry in men with "hot temperaments", they tend to bald prior to others. It is hard to cure scarcity of hair in such people, because of the hotness of their humour. However, those with a predisposition for baldness have a lot of bodily hair on their chest and other parts of their bodies.
Hair loss develops because of the obstruction and blocking of the pores. For instance, scars of old wounds prevent hair growth. Baldness, called aqra' develops in this way.
Figure 3: First page of the Latin translation of the Canon: Liber Canonis, de Medicinis Cordialibus et Cantica, iam olim quidem a Gerardo Carmonensi ex arabico in latinum conversa (Source).
Yet, on occasion some substances (madde) penetrate into the place where hair grows from, these substances then expand the pores and therefore prevent hair from growing. This state dominates in those who do not have beards alongside those whose remaining hair is easily uprooted.
With regards to those who have "moistness" (rutubet, a kind of hormone) in their temperament, the "substance" (madde) of the hair is more able to feel the preventitive effects of healing from baldness. In this instance, the castrated man may be able to grow a beard and in women, hair loss can be healed.
But when the "substances" of hair are spoiled, in other words, when the "malign humour" (habîs hilt) develops, the growth of hair is inhibited (hindered). This is what happens in "dâü'l-hayye" and "dâü's-sa'leb" and in worn away chronic ulcers. This is the case in some types of baldness (kar').
Although it is hard to cure baldness, it can be cured in some cases. That is, if measures are taken prior baldness develops, it can be prevented or its occurrence may be delayed.
As we have seen, several different terms, such as " sal'", "kar'", "asla'", "akra'" and "dâü's-sa'leb" are used to desribe baldness or hair loss. As it is understood from the term itself, "dâü's-sa'leb" is an illness (alopecia areata: porrigo decalcans), as a result of which baldness (asla') takes place. Thus, the bodily, head and beard hair of people who suffer from this disease sheds.
The hard and cartilaginous character of the places of which hair, eyebrows and eyelashes grow from tend to hold hair. Since the skin of people of African-Carribean origin is firmer, baldness is rarer in them. Hence, the firmness of their skin holds their hair securely and it is hard to pull their hair out. It is due to this same reason that people from African-Carribean origin tend to have thinner hair.
Figure 4: An illustrated page of the Canon in a Hebrew translation. The miniatures shown here are the three basic stages of a physician's visit with a patient: the examination of the patient, the consultation with attendants, and possibly a written prescription or treatment procedure. (Source).
After having discussed the causes of the scarcity or lack of hair and its symptoms Ibn Sina precedes to discuss medicine which protects and heals hair from diseases under the title "hair protecting medicine."
The principles of healing are based on humoral theory. The medicine that protects hair must have an "inviting" pleasant temperature (hararet-i latîfe-i jazzabe) and a "retaining (astringent) force" (quvva-i kâbiza). When we study the drags for protecting hair, the names of which are given below, we note that almost all of them have astringent effects that is longlasting. Having astringent effects also aid the external healing of wounds. Whether doctors in times past had observed that astringents are effective drugs, as they have characteristics which externally heal wounds and grouped them under the title "the astringent force" (quvva-i kâbiza), is yet to be revealed.
"As", "habbu'l-as", "laden", "emlec", "halilec-i kabilf", "murr-u sabir", "barsiyavugan", "afs" (sometimes useful owing to it's astringent effect). "Filzaharac", especially used with "Sharab-i kabz" (astringent syrup); or "duhn-i as", "duhn-i mastaki" is used with "ma-i as" and "varak-i azad diraht usaresi". Alternatively, "shecere-i bezir-i ketan" is burned seeds which release oil, this oil may then be rubbed in to the hair; "cevz-i kusuru muhreki" is mixed with "duhn-i as" and "Sarab-i kabiz" and rubbed in the hair, especially of children.
The following are examples of compound drugs (preparations) used for protecting hair and new hair growth as opposed to hair loss:
"Habbü'l-âs", "afs" and "emlec" are cooked in "dühn-i verd" or "dübn-i âs."
Another compound drug is composed of "âs'in varak-i ratbi", "laden" "avsec", "ezraf-i serv" and "habbü'l-âs." These drugs are initially pounded in to a powder. The preparation is them mixed with olive oil and the head is wrapped (treated) with it.
Ibn Sina later mentions medicine for protecting eyebrows, aiding the hair to grow longer, preventing baldness and hair loss. Topics on beautifying and dressing hair follow, including; curling, smoothing, softening hair; preventing hair from turning grey; vitalizing hair, applying henna; dying hair to black, yellow or lightening the colour of hair. The first topic ends with the description and cure of the disease "huzaz". The Ottoman dictionaries give "huzaz" as "konak", (scurf) but "huzaz" may be a group type dedicated to skin diseases (lichen).
In the second article on beauty, Ibn Sina deals with skin, the characteristics of colour and introduces the describing factors that lead to changing the colour of the skin.
The sun, cold, wind, old age, bathing rarely, consuming too much salty food, the changing of blood into bile (according to humoral theory) are all factors which Ibn Sina outlined darkened skin colour.
The following are factors which Ibn Sina indicated cause skin to become pale:
Illnesses, anxieties ("gumflm"), hunger, too much sexual intercourse, severe pain, exceedingly hot weather, drinking stagnant water, eating "nânhuvah", taking vinegar regularly, consuming cumin in liquid form  and geophagia . Ibn Sina's continues to state that geophagia blocks the lumen of the blood vessels; consequently preventing blood from reaching the skin. Here the disease Pica is also discussed. It is noteworthy to also mention that Ibn Sina observed the relation between geophagia and anaemia .
Ibn Sina subsequently introduces several types of drugs which aid the preservation of skin colour by describing the dynamics leading to change and/or the brightening of skin. All drugs attracting the "blood" and "spirit" (ruh) give skin colour - making it pinkish, cleansed and glowing.
There are three ways in which blood is attracted to the skin:
1. Some drugs ("eshya") beautify the colour of the skin by producing and increasing the amount of blood. The following produce "fine blood" ("dem-i rakik") or "healthy blood" ("dem-i ceyyid"): Chickpea (nohud), soft boiled egg, meat broth (bouillon), sweet basil (reyhan) and a drink made from sweet basil and figs. When these food stuff are consumed, they develop into "fine blood" which penetrates into the skin and act as beautifiers of skin colour.
Ripe dried figs and other fruit, but not overripe (busr), fruit , in particular dates are useful in improving the colour of the skin of the convalescent. These increase the amount of "fine blood" (dem-i latif) and natural body temperature (hararet-i gariziyye).
2. Some substances (eshya) such as "itrifîl-i sagîr" (clover) and "helilec murebbai" (fruit based gelatine) beautify the colour of the skin by the clearance of blood.
3. Substances such as "haltit (Asafoetida/digestive sedative), fulful (pepper), karanfil (Flos Caryophylli; acts as a stimulant/antiseptic/digestive), su'd (the corm and perfume of Cyperus rotundus " are stimulants which diffuse in the blood. Hence, beautifying the colour of the skin as they attract the blood outwards and dilate blood vessels (vasodilators). These should be added and taken with meals.
Later, topics such as sun and cold protection for the skin, the treatment of sunstroke; the cure of pock marks, skin diseases which alter skin colour such as "bahak" (vitiligo) alongside "baras" (achromic leprosy) and the differences among them along with their treatment are examined. For instance, Ibn Sina is of the opinion that "bahak" occurs on the skin but "baras" penetrates into the "flesh."
The third book explores skin diseases that cause blisters, pimples, pustules, boils, furuncles, ulcers etc.
One of the most pressing skin diseases discussed is that which causes sore blisters (büsûru karhiyye), or"sa'fe" (tinea). Indicators of "sa'fe" include miniscule itching blisters (büsûr-i mustahike-i hafife). These blisters appear scattered on different parts of the body. These blisters then take on a crusty red boil (kuruh-i hushk rîshte) form. On occasion, these suppurate and excrete pus. This is referred to as "shir-benc" and "moist sa'fe" (sa'fe-i ratbe).
The cause of sa'fe is once again outlined in terms of humoral theory. According to this, the malign (redie), acute (hadde) and irritating (ekkale) "moistness" (rutubet) diffuses in the blood.
At times this "unhealthy moistness" mixes with the defective, dense (crude) humours (ahlât-i galîze-i redîe). These combine to form a swelling (teverrum) mix which in turn dissolves the fine humour (hilt-i rakîk).
Occasionally,"dry kûbaiyye" (kûbaiyye-i yâbise) may occur and this type of disease get could get unexpectedly worse in winter, however, it can also heal just as quickly. The cause of the "dry kûbaiyye" is large amounts of black bile (hilt-i sevdâvi) mixing with "acrid moistness" (rutubet-i hirrîf) which diffuses in to the skin, spoiling and eroding it.
After having discussed the different types of "sa'fe" and having specified their method of treatment, Ibn Sina goes on to mention the disease "kubâ" (impetigo). In the Turkish translation of the Canon, it is said that "kubâ" means "temregi"(lichen). However,"temregi" most probably is identified as a different illness altogether. "Kubâ" differs from "sa'fe" in some minor regards. It is more similar to "dry sa'fe" (sa'fe-i yabise) than other types. The "dry sa'fe" is a highly malign type of "kubâ". The cause of "kubâ" is similar to that of "sa'fe", for the cause of "kubâ" is the acute (hadde) and acrid (hirrif) moistness (maiyyet); in "kubâ", also, an amount of matter mixes with the "dense" (galiz) bile matter.
The characteristic of the type of "kubâ" of which the blisters heal quickly is that the thinness (rakîki) of its matter overcomes its thickness (galîz).
There is also a moist (ratb) and bloody (demevî) type of "kubâ" of which if blisters are scratched, a serous fluid secretes.
Additionally, there is also a "dry" (yâbis) type of "kubâ", which is produced from the matter turning phlegm (balgam) into " black bile" (sevda) through combustion (ihtirak).
Another kind of kubâ forms a crust because of the intensity of dryness (shiddet-i yubûset) and the depth of the sore (kesret-i gavr). This kind of kubâ is similar to "baras-i esved" (black leprosy; lepra nigricans) and "hushk-rishte" .
Yet another kind of kubâ is one that does not form into a scab.
In short, there are different kinds of kubâ, some of