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HISTORY OF MEDICINE
Year : 2013  |  Volume : 14  |  Issue : 3  |  Page : 155-158  

Sphygmology of Ibn Sina, a message for future


1 Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator; Students Research Committee; Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2 Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator; Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator; Department of Traditional Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Date of Web Publication28-Jan-2014

Correspondence Address:
Mohammad M Zarshenas
Department of Traditional Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, PO Box: 71345-1583
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1995-705X.125934

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   Abstract 

Sphygmology is a 2000-year-old method that is still used in some traditional medicine systems, mainly Iranian, Chinese and Ayurveda. Ibn Sina is one of the most popular physicians in the history of Sphygmology, who had made great contributions to this method, but few meticulous studies have been made on his concepts. In this article, his standpoints on Pulsology are studied. Ibn Sina has mentioned 10 parameters for pulse palpation, and 13 compound pulses, as well. Besides, some pulse patterns applicable for differentiating similar diseases have been introduced. Nowadays some concepts on pulse patterns, such as pulse change in sleep and pregnancy have been studied; but unfortunately many of the ideas on Pulsology have not yet been examined. Sphygmology, as an accessible and inexpensive means, having a substantial diagnosis yield, has been accepted by the people since its rise, and its development over centuries ago. Although some new instruments have been innovated, which can measure different parameters of pulse, yet sphygmology can be one of the most commonly usable diagnostic methods in future, not only applicable by cardiologists but also by all the physicians.

Keywords: Avicenna, Ibn Sina, pulse, pulsology, sphygmology


How to cite this article:
Zarshenas MM, Abolhassanzadeh Z, Faridi P, Mohagheghzadeh A. Sphygmology of Ibn Sina, a message for future. Heart Views 2013;14:155-8

How to cite this URL:
Zarshenas MM, Abolhassanzadeh Z, Faridi P, Mohagheghzadeh A. Sphygmology of Ibn Sina, a message for future. Heart Views [serial online] 2013 [cited 2018 Aug 14];14:155-8. Available from: http://www.heartviews.org/text.asp?2013/14/3/155/125934


   Introduction Top


Since the 1950s, physicians were not aware of the impact of blood pressure on the body's mechanism and its relation to diseases. [1] But in many traditional systems of medicine, Pulsology was primarily considered in physical examination and clinical practices, [2] having been applied by ancient Arab, Chinese, Egyptian, Greek, Indian, Iranian and Tibetan medical practitioners. [3] The history of Pulsology goes back to long years ago, [4] probably formed in China during almost 6 th century. [5]

The relation between heartbeat and peripheral pulse was first described by the Egyptians. [6] Tibetan, on the other hand, had their own exclusive experiences, besides being affected by Chinese medicine. [7] Existing air in the arteries, was believed by the Greeks, to have effect on pulse. [1] Pulsology in Ayurveda, influenced by Greco-Islamic medicine is one of the main diagnostic means. [8] Persian practitioners gathered their findings of sphygmology from other leading sources of medicine and developed them. [9] Later on, around the 16 th century, "Joseph Struthius Polonus" presented pulse graphic form for the first time in the history of medicine. [10]

Ibn Sina (called Avicenna in Europe) was one of the most outstanding scholars dealing with Pulsology. [11] Therefore; this manuscript was prepared to bring Ibn Sina's concepts into view, in respect with his findings in the field of Sphygmology.

Ibn Sina

Ibn sina
, being a Persian physician, was one of the most famous scientists and medical practitioners in his era and centuries after that. The golden epoch of Islamic medicine (9-12 th century AD) has been arguably affected by his medical knowledge. [12] His main book "Canon of Medicine" was one of the standard medical textbooks for almost 600 years in medieval, and the grandest in medical history. [13],[14] The 1 st and 3 rd volumes of his encyclopedia contains sections on cardiology and blood pressure. [11],[15] "Kitab al-Adviyat al Qalbiye", meaning book on drugs for cardiovascular diseases is the other work of Ibn Sina, which encompasses his opinions, experiments, treatments and methods applicable to overcome cardiovascular diseases. [16] Furthermore, he wrote a Persian treatise on Sphygmology, named "Resaleye Ragshenasi" or the Pulsology treatise. [17]

Ibn Sina's contribution to sphygmology

As a definition, movement of the vessels is called "Pulse". Each pulse consists of four parts: Two movements and two pauses. The first movement is the expansion movement and the second one is the pause after the expansion movement, which is the rest phase between expansion and contraction. The third part is the contraction movement, and the fourth part is the pause after the contraction movement, which is a rest phase between contraction and expansion. [18]

For the proper way to examine the pulse, four fingers (having a better sensation along the artery), should be applied, excepting the thumb in that it has a strong pulse itself. Pulse (as a regular beat that can be felt as heart pumps blood around the body) is easily examined by touching the patient's wrist, regarding the fact that the patient may feel uncomfortable when exposing her chest to the physician for measurement of her heart's pulsation.

There are other factors influencing the accuracy of pulse examination, among which is the increased pulse width and height, achievable when the patient's forearm is near and vertical to the body. Pulse examination results can also be affected by emotional or physical strain of the healthy persons. Both empty and full stomach can interfere with the accuracy of the examination. Furthermore, results of pulse examination of a patient under imbalanced temperament should be checked with the results derived when the patient is in a healthy situation.

Pulse detection is based on expansion degree, impact of pulse beat on fingers, duration of movements, structure of artery, emptiness or fullness of artery, hotness or coldness of pulse feeling, duration of the rest period, similarity or dissimilarity of pulse and finally pulse rhythm. Expansion movements are usually felt by the physician's finger, but it may not be felt when the pulse is weak. The contraction movement is too difficult to distinguish, so most of physicians cannot feel it. However it may be determined in thin and soft bodies. Therefore, most of the pulse signs can be determined in the expansion movement. [18],[19]

According to Ibn Sina's reports, 10 parameters (called Ajnas-e-nabz) are applied for detecting the pulse namely size (meghdaar), fastness or slowness (sorat, ebtaa), strength or weakness (ghovvat, za'af), shortness or length of pulse intervals (tavaator, tafaavot), softness or hardness (emtelaa, khala'a), similarity or dissimilarity (estevaa, ekhtelaaf), regularity or irregularity in diverse pulses (nezaam, gheir-e-nezaam) and harmony related to musical nature of the pulse (vazn). [18] The description of these parameters is represented in [Table 1]. Remarkably the combination of two or more of these parameters results in compound pulses (nabz-e-morakkab). Thirteen different kinds of compound pulses, such as massive pulse, deer pulse, wavy pulse, vermicular pulse and serrate or saw-like pulse have been mentioned by Ibn Sina.[17]
Table 1: The description of main pulse parameters

Click here to view


According to Avicenna's concepts; the pulse variation is related to sex and age. Pulse of the male is massive, strong and slow, while that of the female is weak and fast. During the growth period, pulse is massive and very soft, while through the youth it will be massive and fast. On the other hand, in the middle age, pulse changes to thin and moderate. Moreover, pulse of the elders becomes thin, slow, different and soft. [18]

Ibn Sina mentioned that different physiological conditions could affect pulse parameters. He mentioned that pulse is massive, fast and frequent when stomach is full. Sport and physical exercise will modify the pulse. During the pregnancy period, pulse is bigger than in the other periods, yet being fast, frequent and massive. Along the end months of pregnancy, especially when approaching the labor phase, pulse becomes thin, weak, fast and frequent. Inflammation changes the pulse to saw-like one. Anger makes it massive, tall, fast and frequent, while distress makes it thin, weak, slow, and different. [18],[19]

Ibn Sina believed that Pulsology is not only applicable for cardiovascular diseases, but also for other diseases. Moreover he indicated that pulse can be a diagnostic factor in different diseases. In this regard, for many diseases, pulse can help the physician to make a differential diagnosis for similar disease. As a whole, Ibn Sina described more than 50 types of pulses in different diseases and comprehensively explained the effects of variety of conditions on the pulse such as the environment, food, drink, physical exercise, pregnancy, sleep, waking, pain, temperature and various emotional states, such as anger, grief and fear. [19],[20] Different periods of life have its own influences on the pulse. Ibn Sina divided the life to four main periods, namely: Growth period (age 0-29), youth (30-39), middle age (40-60), and geriatric (over 60). In this regard he indicated a specific pulse for each of these periods. The musical character of the pulse was also attended by him, by virtue of his hidden talent of poetry. [6] According to Avicenna's idea, sleep, as the natural state of resting the mind and body, affects pulse as it continues. To begin with, the pulse gets gradually and increasingly shorter, weaker, and thinner; then it gets bigger and stronger as sleep prolongs. [18]

Based on Ibn Sina's opinions, disorders related to the central nervous system or those that affect the cardiovascular, gastrointestinal or respiratory system, obviously change the pulse parameters. For instance, patients suffering from a kind of psychos (Sabaaraa) have hard and thin pulse. Convulsion causes elevated, or dropped pulse, and paralysis changes it to weak, and irregular; while pulse of the patient suffering from delirium (Sarsaam) is thick. [19],[20] Ibn Sina mentioned that in palpitation, generally, size, speed and pulse intervals enlarge. In hepatic inflammation the pulse would become wavy. In pleurisy (Zaat-ul-Janb) the pulse is saw-like and sometimes hard. Pneumonia makes wavy and soft pulse. [13] In Anasarca (Estesghaa-e-Lahmee) the pulse is soft and wide, and in Tympanites (Estesghaa-e-Tablee) it is long and strong. [21],[22] There is a pleasing story told by Ibn Sina about diagnosis of love disorder. He mentioned that pulse resulted from love disorder will be different in frequency. [23]

In his "Canon of Medicine", he mentioned that pulse is just one factor among other means of illness detection. He used pulse as a prognostic and diagnostic factor and also for differentiating the types of illnesses. He was able to diagnose diseases only by feeling a patient's pulse. [11]

Ibn Sina was a meticulous clinical observer, yet skillful in physical examination and history taking. He has brought together his own experiences, and adding to them the teachings of his predecessors to form a comprehensive work for the use of the future generations. He was the first physician to have a correct explanation of pulsation. [11] The importance of pulse to Ibn Sina was so extended that he issued a specific treatise on it, and some poems relating to Pulsology. [24]


   Discussion Top


Most of the people in the world accept that Pulsology has roots in their cultures. This method is still used by traditional medical practitioners in India, China, and Iran, persistent over 2000 years since its emergence. Such a long persistence could be a valuable proof, confirming the desirable efficiency of this method. It is an inexpensive, fast, painless, precise, convenient and non-invasive method, including important information, and reflecting body health state.

Today, investigations have been made on assessing the pulse, heart rate, and blood pressure, related to the diseases and physiological conditions, some of which may confirm Avicenna's concepts in Pulsology. Ibn Sina0's idea that pregnant women have fast and frequent pulse [18] has been proved by Smith, et al. in a research on heart rate and pregnancy. [25] According to Rossi, et al., heart rate and blood pressure increase during gastric distension (fullness of stomach), [26] which is in line with Avicenna's concepts. [18]

Despite the limited numbers of references on Pulsology in the modern medicine, however, recently Van Tellingen reported that some traditional pulse parameters, such as slow or quick and hard can be distinguished by modern instruments. [2] We have another report showing that pulse rate in males is slower than in females. [27] There are some evidences about higher blood pressure in the summer than in the other seasons, [28] which is in conformity with Ibn Sina's ideas in this respect. [18] Investigations confirms the impact of anger on blood pressure and heart rate, [29] which is in compliance with Ibn Sina's views of the fact that anger affects the pulse. [18],[19]

Nowadays modern physicians have found that some pulses stand as clues to direct the diagnosis of diseases. Severe aortic stenosis may be associated with a week and delayed pulse; a bifid systolic pulse can be produced in some obstructive cardiomyopathies; a bounding pulse indicates a large stroke volume with a rapid fall-off, occurring in hyperkinetic states, such as fever, anemia and thyrotoxicosis. [30]

Furthermore an instrument has been made, which automatically identifies human pulse signals, and recognizes depth, frequency, rhythm, strength and shape of the pulse. [4]

In ancient medical systems, various parameters for pulse sensation were being used, where today modern medicine pays little attention to such parameters. As a whole, Pulsology or Sphygmology is highly desirable as a tool, with sense and simplicity, inexpensive, and accessible leading to substantial diagnostic yield. [2] Knowledge of past scientists and scholars, namely Ibn Sina is still of great help towards medical diagnosis. Henceforth, as a recommendation, it is worth to rehabilitate the traditional knowledge on Pulsology of Ayurveda, Persian, Greek and Chinese medical systems, in such a way to be rendered applicable not only by traditional medical practitioners, but by all the other physicians as well. The success of such rehabilitation, will in near future, be a great contribution to cardiologists as well as to all other physicians in different fields of medicine.

 
   References Top

1.Hajar Albinali HA. 4,500-year voyage: From pulse tension to hypertension. Heart Views 2005;6:124-33.  Back to cited text no. 1
    
2.van Tellingen C. De pulsibus-or sense and simplicity in daily medical practice. Int J Cardiol 2010;142:201-6.  Back to cited text no. 2
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3.Bedford DE. The ancient art of feeling the pulse. Br Heart J 1951;13:423-37.  Back to cited text no. 3
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4.Wang H, Zhang P. A model for automatic identification of human pulse signals. J Zhejiang Univ Sci 2008;9:1382-9.  Back to cited text no. 4
    
5.Nejat S, Stolt C. The Importance of the pulse as presented in Al-Qanun f′it Tibb by Ibn Sina (Avicenna): A review. Türkiye klinikleri J Med Ethics Law Hist 2003;11:221-5.  Back to cited text no. 5
    
6.Hajar R. The pulse in antiquity. Heart Views 1999;1:89-94.  Back to cited text no. 6
    
7.Zhen Y. On the differences and similarities of pulse-taking between TCM and Tibetan medicine. Zhonghua Yi Shi Za Zhi 2000;30:237-9.  Back to cited text no. 7
    
8.Chaturvedi GN, Singh KP. Impact of Ibn Sina on pulse examination and materia medica of medieval period of Ayurveda. Indian J Hist Sci 1986;21:358-62.  Back to cited text no. 8
    
9.Lad V. Secrets of the pulse: The ancient art of Ayurvedic pulse diagnosis. Delhi: Motilal Banarasidas; 2005.  Back to cited text no. 9
    
10.Grzybowski A, Sak J, Pawlikowski J. 500 th anniversary of the birth of the precursor of modern cardiology: Josephus Struthius Polonus (1510-1568). Cardiol J 2011;18:581-6.  Back to cited text no. 10
    
11.Celik T. Time to remember Avicenna for his contribution to pulsology. Int J Cardiol 2010;144:446.  Back to cited text no. 11
    
12.Zargaran A, Mehdizadeh A, Zarshenas MM, Mohagheghzadeh A. Avicenna (980-1037 AD). J Neurol 2012;259:389-90.  Back to cited text no. 12
    
13.Hashemi SM, Raza M. The traditional diagnosis and treatment of respiratory diseases: A description from Avicenna′s Canon of Medicine. Ther Adv Respir Dis 2009;3:319-28.  Back to cited text no. 13
    
14.Shoja MM, Tubbs RS, Loukas M, Khalili M, Alakbarli F, Cohen-Gadol AA. Vasovagal syncope in the Canon of Avicenna: The first mention of carotid artery hypersensitivity. Int J Cardiol 2009;134:297-301.  Back to cited text no. 14
    
15.Turgut O, Yalta K, Tandogan I. Islamic legacy of cardiology: Inspirations from the holy sources. Int J Cardiol 2010;145:496.  Back to cited text no. 15
    
16.Faridi P, Zarshenas MM. Ibn Sina′s book on drugs for cardiovascular diseases. Int J Cardiol 2010;145:223.  Back to cited text no. 16
    
17.Zareshenas MM, Faridi P, Abolhassanzadeh Z, Mohagheghzadeh A. Ibn Sina′s treatise on pulsology. Int J Cardiol 2011;146:243-4.  Back to cited text no. 17
    
18.Ibn Sina. Rag Shenasi ya Resaleh dar Nabz (Pulsology, or, treatise on pulse). Tehran: Selsele Intisharat-e Anjomane Asare Melli; 1951.  Back to cited text no. 18
    
19.Ibn Sina. Qanoun fi al-Tibb (Canon of medicine). Vol. 3. Translated by Sharafkandi A. Tehran: Soroush (Publisher); 1987.  Back to cited text no. 19
    
20.Avicenna Al Qanun Fil Tibb (Canon of medicine). Vol. 3. English translation by Hameed HA. New Delhi: Jamia Hamdard Printing; 1998.  Back to cited text no. 20
    
21.Ibn Sina. Qanoun fi al-Tibb. (Canon of medicine). Vol. 4. Translated by Sharafkandi A. Tehran: Soroush; 1987.  Back to cited text no. 21
    
22.Avicenna. Al Qanun Fil Tibb (Canon of medicine). Vol. 4. English translation by Hameed HA. New Delhi: Jamia Hamdard Printing; 1998.  Back to cited text no. 22
    
23.Shoja MM, Tubbs RS. The disorder of love in the Canon of Avicenna (A.D. 980-1037). Am J Psychiatry 2007;164:228-9.  Back to cited text no. 23
    
24.Ibn Sina: Urjûzah fî al-tibb. National Library of Medicine [Monograph on the Internet]. Available from: http://www.nlm.nih.gov/hmd/arabic/poetry_2.html . [Last cited on 2012 Aug 4].  Back to cited text no. 24
    
25.Smith SA, Morris JM, Gallery ED. Methods of assessment of the arterial pulse wave in normal human pregnancy. Am J Obstet Gynecol 2004;190:472-6.  Back to cited text no. 25
    
26.Rossi P, Andriesse GI, Oey PL, Wienekea GH, Roelofsb JM, Akkermansb LM. Stomach distension increases efferent muscle sympathetic nerve activity and blood pressure in healthy humans. J Neurol Sci 1998;161:148-55.  Back to cited text no. 26
    
27.Rabbia F, Calvo C, Leotta G, Grosso T, Morello F, Del Colle S, et al. Pulse rate in childhood: Reference limits. Nutr Metab Cardiovasc Dis 2003;13:287-90.  Back to cited text no. 27
    
28.Portela A, Northrup G, Halberg F, Cornélissen G, Wendt H, Melby JC, et al. Changes in human blood pressure with season, age and solar cycles: A 26-year record. Int J Biometeorol 1996;39:176-81.  Back to cited text no. 28
    
29.Goldstein HS, Edelberg R, Meiler CF, Davis L. Relationship of resting blood pressure and heart rate to experienced anger and expressed anger. Psychosom Med 1988;50:321-9.  Back to cited text no. 29
    
30.Libby P, Bonow RO, Mann DL, Libby P. Braunwald′s heart diseases. 8 th ed. Philadelphia: Saunders Elsevier; 2008.  Back to cited text no. 30
    



 
 
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