Medicine

Dermatology

Beauty, Hair and Body Care in the Canon of Ibn Sina

Professor Nil Sari*

Table of contents

1. Introduction

The seventh and the last art 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 get a look at the text in the Canon, we see that it deals with appearance, that is to say, the care of hair and body; as well as skin diseases and their treatment; and also subjects such as obesity and thinness 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 [1]. But, Mustafa b. Ahmed b. Huseyin of Tokat, who translated it into Turkish, in the 18^th century, often used medical Arabian terminology and some idioms that are not found in most of the Ottoman dictionaries. It is a literal translation, but most of the terms of the Arabian 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, first of all we must perform an exhaustive study of the meanings of the medical terms used in the medical literature of the period. Only after this, we can properly understand the old medical texts. If we cannot comment properly the theories about the etymology of illnesses or, in other terms, the "philosophy of medicine", I believe that it will be impossible to comprehend thoroughly the old medicine.

2. Hair care

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, having the threads get thicker and softer and grow long; 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, turning it to red, brown, etc.

All matters on the growth of hair, its illnesses, and treatment are explained according to the humoral theory. But it is difficult to understand the medical meanings of some of the terms. Just as in the 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) called "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. Just as these, the place from where hair grows is greasy.

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Figure 1: A drawing of Ibn Sina.

When studying hair diseases, first of all the lack or scarcity of hair, beard or body hair (butlan-i sha'r) are discussed. Sometimes the lack of hair is due to a "substance" (matter, madde) and sometimes to a factor in the place of growth. The substance affecting hair is the "blood." The cause of the decreasing of 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 don't grow beard. 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 had to explain 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) are absorbed and as a result in those who are in the state of convalescence lessens the nutrition nourishing the hair and therefore the hair falls off and does not grow; just as in the case of plants growing when watered, drying off in draught.

In those who are castrated, hair will not grow and this is also acquired. Those castrated are similar to women in "moistness" and "coldness". Since no sperms are produced in them, the "innate moistness" accumulates and cools the body. In those castrated, only a very small portion of their moistness decomposes, and since those decomposed and since those decomposed are very thin, they are excreted through the pores. Because of this, in those castrated bodily hair does not grow. Today we know that in the castrated the testosterone secretion decreases.

Hair of those who continually cover their head also gets thinner, which is an acquired state.

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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 baldness results from the deficiency of the matter (substance), which means that the matter is insufficient.

There are three basic reasons for the failure of the 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 stay there.

3. The "matter" of hair is spoiled, consequently it acquires a quality not suitable for the growth of hair.

The factors causing baldness are discussed as follows. Baldness (sal') develops faster in people with a "hot temperament." Since the pores dry in man with a "hot temperament", they tend more to grow bald. It is hard to cure scarcity of hair in such people, because of the hotness of their humour. But those with a predisposition for baldness have a lot of bodily hair on their chest and other parts of their bodies.

Baldness 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.

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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).

But, sometimes some substances (madde) penetrate into the place where hair grows from, but these substances expand, the pores and therefore hair doesn't grow. This state dominates in those who do not have beard and whose other hair easily come off their roots.

In those who have the "moistness" (rutubet, a kind of hormone?) in their temperament suitable to become the "substance" (madde) of the hair, this affects the healing of baldness. For instance, in this kind of a castrated man beard can grow and in women, baldness 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 before 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 the falling of hair. 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. The hair and beard of people who suffer from this disease fall.

The hard and the cartilaginous character of the places of hair, eyebrows and eyelashes grow from tend to hold hair. Since the skin of Abyssinians and Negros is hard, baldness is rarer in them. Since the hardness of their skin hold their hair firmly, it is hard to pull their hair off, and because of the same reason, they have thin hair.

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Figure 4: An illustrated page of the Canon in 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).

As we have seen above, after having discussed the causes of the scarcity or lack of hair and its symptoms, medicine that protects hair and heals the diseases concerning hair are dealt with and these are collected under the title "medicine protecting hair."

The principles of healing are based on the humoral theory. The medicine that protects hair must have the "attractive" pleasant temperature (hararet-i latîfe-i jazzabe) and the "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 ill of them have astringent effects and that drags having astringent effects are in the same time used externally in healing wounds. I wonder if doctors in history had observed that drugs affecting as astringents also carried the characteristic of healing external wounds and they group them under the title drugs with "the astringent force" (quvva-i kâbiza).

3. Drugs protecting the hair

"As", "habbu'1-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". Or, "shecere-i bezir-i ketan" is burned with its seeds and the hair is rubbed with its oil; "cevz-i kusuru muhreki" is mixed with "duhn-i as" and "Sarab-i kabiz" and rubbed on the hair, especially of children.

The following are examples of compound drugs (preparations) used for protecting hair and growing new hair instead of the fallen hair:
"Habbü'1-âs", "afs" and "emlec" are cooked in "dühn-i verd" or "dübn-i âs."

Another compound drag is composed of "âs'in varak-i ratbi", "laden" "avsec", "ezraf-i serv" and "habbü'1-âs." These drugs are pounded. The preparation is mixed with olive oil and the head is wrapped (treated) with it.

Afterwards, medicine for protecting eyebrows, getting the hair grow long, preventing baldness and shedding of hair, is given. After these, topics about beautifying and dressing hair: 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 kind of a group of skin diseases (lichen).

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Figure 5: The drawing of Ibn Sina on a Libyan stamp.

4. Skin care

In the second article, the skin is dealt with in its characteristics of colour and it is introduced describing the factors that lead to changing the colour of the skin.

The sun, cold, the wind, old age, bathing rarely, having too salty food, the changing of blood into bile (according to the humoral theory) darkens the colour of the skin.

The following are the factors that cause the skin to grow pale:

Illnesses, anxieties ("gumflm"), hunger, too much sexual intercourse, severe pain, too hot weather, drinking of stagnant water [2], eating "nânhuvah", having vinegar continually, drinking cumin [3] and geophagia cause the skin to grow pale. It's also stated that geophagia blocks the lumen of the blood vessels; consequently blood does not reach the skin. Here the disease Pica, is discussed. It's remarkable that Ibn Sina observed the relation between geophagia and anemia [4].

There are several types of drugs preserving the colour of the skin and it is introduced describing the factors leading to changing the colour of and brightening the skin. All drugs attracting the "blood" and "spirit" (ruh) [5] to the skin give colour to it, makes it pinkie, cleanses and shines it.

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 the "fine blood" ("dem-i rakik") or the "good blood" ("dem-i ceyyid"): Chickpea (nohud), soft boiled egg, broth of meat (bouillon), sweet basil (reyhan) and a drink made from sweet basil and figs etc. When these are eaten, they are turned into the "fine blood" which penetrates into the skin and act as beautifiers of the colour of the skin.

Dried figs and normally ripe, but not overripe fruit (busr) especially dates are useful in improving the colour of the skin of the convalescent. These increase the amount of the "fine blood" (dem-i latif) and the natural body temperature (hararet-i gariziyye).

2. Some objects (eshya) such as "itrifîl-i sagîr" and "helilec murebbai" beautify the colour of the skin by the clearance of the blood.

3. Objects such as "haltit, fulful, karanfil, su'd" beautify the colour of the skin by diffusing the blood in the body and skin. Since these are stimulants, they attract the blood outwards and dilate the blood vessels (vasodilators). These are added to meals and eaten together.

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Figure 6: The drawing of Ibn Sina on a Polish stamp.

Later, topics such as, protecting skin from sunshine, weather and cold; the treatment of sunstroke; the cure of pock marks from smallpox; skin diseases which change the colour of the skin, such as "bahak" (vitiligo) and "baras" (achromic leprosy), the differences among them and their treatment are discussed. For instance, it's said that "bahak" occurs on the skin but "baras" penetrates into the "flesh."

5. Skin diseases

The third book is on the skin diseases that cause blisters, pimples, pustules, boils, furuncles, ulcers etc.

One of the most important skin diseases with sore blisters (büsûru karhiyye) is "sa'fe" (tinea). "Sa'fe" begins with slight itching blisters (büsûr-i mustahike-i hafife). These blisters are scattered on different parts of the body. Afterwards crusty red boils (kuruh-i hushk rîshte) form. Sometimes these suppurate and excrete pus. This is called "shir-benc" and "moist sa'fe" (sa'fe-i ratbe).

The cause of sa'fe is again explained in terms of the humoral theory. According to this, the malign (redie), acute (hadde) and irritating (ekkale) "moistness" (rutubet) diffuses in the blood.

Sometimes this "bad moistness" mixes with the bad, dense (crude) humors (ahlât-i galîze-i redîe). These get together and form a swelling (teverrum) and mix and dissolve the fine humour (hilt-i rakîk).

Sometimes the "dry kûbaiyye" (kûbaiyye-i yâbise) occurs and this type gets worse suddenly in winter, but disappears (heals) quickly. The cause of the "dry kûbaiyye" is too much black bile (hilt-i sevdâvi) mixing with the "acrid moistness" (rutubet-i hirrîf), diffuses to the skin, spoils and erodes it.

After having discussed the types of "sa'fe" and having given their method of treatment, the disease "kubâ" (impetigo) is studied. In the Turkish version of Canon it is said that "kubâ" means "temregi", (lichen). But "temregi" may probably be identified as a different illness. "Kubâ" differs from "sa'fe" in some minor points. It is more similar to "dry sa'fe" (sa'fe-i yabise) than the other types. The "dry sa'fe" is a very 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.

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Figure 7: Dar al-Shifa (Hospital) and patients inside (Sivas, Turkiye).

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". When the blisters are scratched, a serous fluid secretes.

There is also a "dry" (yâbis) type of "kubâ", which is produced from the matter turning phlegm (balgam) into "the 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" [6]. Still another kind of kubâ is one that does not form a scab.

In short, there are different kinds of kubâ, some of which develop rapidly and spread all over the body (sat), some do not spread (vâkif); while others appear later (hadis); and still others are chronic (muzmin).

In the Turkish text, kubâ is termed as "temriye" (lichen); yet, as we have already seen, various skin diseases are mentioned under the title of kubâ; and the descriptions being very different from those of today, we are not able to specify the clinical tables.

Kubâ is treated according to its etymology. In kubâ, primarily the "dense- matter" (galîz madde) occurs, later on the "thin and inflammable matter" (madde-i hârre-i rakîka) develops; or kubâ appears as a result of the prevalence of one of the two matters. For treatment, mixtures to remove the causes are prepared and measures expected to remove the cause that is predominant are preferably taken. Appying leeche (irsal-i alak), administering enema (tenkiye) and the water of cheese (mâ-i cübn) do well.

Moistening (rutubetlendirmek) is useful for healing. Here is the prescription for dressing the wound: 1 dirhem of sabr (washed); and 3 ûkiyye of reyhan (cooked). If the disease is in the early phase and mild, some of the simple drugs (mufred devalar) are to be administered are the following:

Hummâz, utrûc, zamk-i arabî (with vinegar), zamk-i levz (with vinegar), asel lebeni (with vinegar), hardal (with vinegar), mâ-i kibrit, mâ-i mâlih, zebedü'1-bahr etc.

Besides the simple ones, many compound drugs are prescribed. Here is an example: 1 dirhem zac, 1 dirhem kibrit, 1 dirhem sabr, and 1 dirhem zamk. , These drugs are rubbed (tilâ) with vinegar.

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Figure 8: Ibn Sina drawing by A. Suheyl Unver. (Source).

In the third article, besides the examples given, other skin diseases such as blistered skin diseases, itching and its treatment, corn and getting cornified, skin fissures (fissures in lips), feet and between fingers; fissures and wounds resulting from lying in bed too long; bad smells radiating from skin and urine etc. and their treatment; getting lousy and its treatment are dealt with.

6. Emaciation

In the fourth article, with which the topic "zina" is completed, subjects related with the body and limbs are studied.

Primarily, the aim is the treatment of emaciation (izâleaü'l-hüzal). To achieve this the causes of emaciation are determined, which are the following:

1. Failing to take fattening food or eating too much "mülâttif" (attenuant) food that causes one to get skinny. Although we cannot describe the "delicious food" (latîf gida) specifically, we can get an idea of it from the examples of "delicious food" (latîf gida) found in the old medical manuscripts. According to these manuscripts most of the vegetables, broth, yolk of the egg, radish, mustard, liver, piecles etc. are delicious (latîf) food. Indeed, these are foods that do not cause to grow fat [7].

2. Blood attracting the food that do not produce "clean blood" (dem-i zekî).

3. Insufficiency of potential energy (quvvat) contained in food.

4. Digestion or the "attractive force" (quvva-i câzibe) [8] may be inefficient. These forces weaken because of the corrupted (fesâd) humor (mizac). Usually the corrupt humor causing weakness is the "cold" humor (mizac-i barid). The cause of the weakness of the attractive force is "extreme inactivity" (kasrat-i sukûn); for when one is too much inactive the "attractive force" gets calm and dormant. This condition is observed more frequent in those who have the habit of activating their function of attracting food by their own "attractive force" with the help of exercises, this is, sports. If such people remain in continuous inactivity, however moderate, (mutedil) the food they eat may be, the "attraction of food" by the attractive force weakens. Here the importance of sports is mentioned in the terms of feeding.

5. Splenomegali and resulting pressure on the liver is a cause of emaciation. As a result of spleenomegali, attraction of spleen is higher, compared to that of the liver. The liver organizes inefficiently the food that diffuses in the body. This pressure causes liver to weaken and the "food" that flows out of the liver is insufficient. The loss of weight is related to the disturbance of the liver.

6. Helminths consume the food that's to be used by the body.

7. Humours block the pores.

8. For some other reasons the pores and canals in the body being blocked food can not diffuse' property into the organs consequently and the food can not spread all over the body and emaciation results. The agents that cause the pores to be stopped consist of "heat, cold and dryness."

9. Eating soil is a cause for emaciation.

10. Too much dissolution of the food (kesret-i tahallul): The food reaches the organs properly, yet undergoes too much dissolution there. (This reminds us of the catabolism and metabolic reactions.) In heavy sports (riyazât-i seriâ), anxiety (hümûm), worries (gumûm) and consuming diseases, emaciation develops.

It is possible for those who have got emaciated in a short time, to put weight on in a short time. Those who have got emaciated in a long time however need a long time to put weight on again, because their humours and ability to benefit the greater part of the food is low. (Here again metabolic reactions come to mind).

The reasons why people do not want to be skinny are explained. According to Ibn Sina, the skin of the skinny being too loose, people dislike thinness. Those who are merely skin and bones (mehzfil) are extremely affected from heat and cold. In such people various spiteful resentments (infialat-i nefsaniye), illnesses, fatigue and insomnia are frequently observed.

Here I will skip over thinness and its treatment, which is determined by the cause of it, in order to avoid extending the subject. However, I would like to state that developing different parts of the body such as hands, legs, etc., with the help of massage is discussed, which is remarkable from the point of physiotherapy.

As far as I know, even though fatness was regarded as desirable in those days, Ibn Sina had seen the harmfulness of obesity. Thus indeed Ibn Sina said: "Fatness also does harm. The fat is not like normal people. Yet they do not take it seriously as long as they don't get any harm from it. But one must protect oneself and beware excessive obesity. Although they may not be suffering from fatness and see no harm in it, their healthy may fail unexpectedly. In order to loose weight Ibn Sina advices diet, bathing and intensive sports. Then after this subject, methods for getting some organs such as arms and legs thin are discussed.

Finally, illnesses of the nails are studied. The topic "zina" ends with subjects such as pulling out the nails, protecting of the newly growing nail, blood blister of the nail etc.

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Figure 9: Opening of the chapters of zina in the Canon (Part 7, On Cosmetics) in the edition of Rome 1593, reproduced online by the American University of Beirut. (Source).

7. Conclusions

1. Subjects are essentially classified according to the "symptoms". For example: Shedding of hair, skin-growing pale, getting thin... Thus, some of the skin diseases are discussed in the article on "hair", still another part was studied in the article on "the colour of the skin" and these learning's discourse on this subject excluded from the third article where only skin diseases are studied.

Another classification was made on the organs. The topic zina starts with the head, studying the "hair" and is completed with the foot studying the subject "nail". Only in this way can we explain why nail diseases are discussed just the after the subject obesity and emaciation.

2. The topic zina deals only partly with cosmetics. Especially in the first and second articles, there are formulas for hair and skin care. Besides chapters on other subjects, primarily skin diseases, metabolism and nourishment, haematology, physical therapy is also discussed thoroughly.

I would also like to make it clear that the main goal of Ibn Sina in the chapter on "zina" is not beautifying people. He discussed all subjects from the point of view of medicine and aimed to "cure" these diseases which "spoil the appearance."

3. Many "observations" given under the title "zina" are surprisingly interesting. The subject "Ziynet" dealing with the externally observable symptoms, observation ought to have been easier for physicians. While acquisition of clinical knowledge was good, the etymology of diseases depended on the old theories of medicine, since technical aids were not developed. Physiopathology and the etymology of diseases were explained according to the medical theory based on the humoral theory. Many terms used in the explanations form the medical terminology of the time. Although we know the meanings of these words commonly used in language, their medical meanings are not yet satisfactorily explained. For instance in this text there are several words such as "dem-i rakîk, dem-i latîf, dem-i ceyyîd, dem-i zekî" etc., describing different types of blood, the meanings of which are obscure, especially as medical terms. Although these are considered to be theories or philosophy, I believe that hey are based on medical observations not aided by technology. This is why we associate "buhâr-i duhâni" with male hormone (testosterone) and "ebhire-i ratbe" with female hormone (estrogen).

Drugs are classified in categories according to their effects. While we know what some of these are, the composition of the others has not been found out yet. In the topic, "zina" drugs are considered in categories with certain names according to their effects. For example, in this text, it is interesting to see that while astringent drugs were called "quvva-i kabîza" (astringent agents), they were also used externally to cure hair and skin diseases.

A complete criticism and evaluation of Ibn Sina's medicine will be possible only when the ancient medical terminologies have been interpreted correctly and when their meaning is brought into light.

4. Some definitions we come across in the topic "Ziynet" are worth noting in respect of their similarity with today's medical knowledge; for an example, we can quote the fact that Ibn Sina distinguished vitiligo from lepra.

The chapter "Ziynet" comprises some extremely interesting knowledge; such as geophagia, is an illness discovered and described in the 20^th century, which we find clearly described by Ibn Sina.

Here, I will not quote any other examples in order to avoid stretching the subject. I believe, however, that when we have studied Ibn Sina's Canon as well as the works of the other great names of the old medicine attentively and patiently we shall have to bring about some changes in our learning's and knowledge of the history of the old medicine.

8. Glossary