Chapter 12. Avicenna
Yes, I will definitely start with him. Just like everyone else, I had been familiar with his name since childhood. Avicenna – that’s how the Europeans pronounce it, but it actually sounds different – Ibn Sina. I must admit that I only remembered him vaguely. He was famous for something in the old days. It seemed he had been a physician, and I think a poet, as well, but I wasn’t terribly interested. However, Doctor Umarov once told me, “If you want to learn the principles, read Ibn Sina. You should also read about him to understand what a great physician he was.”
I began to read, and I haven't been able to stop reading.
Most of all I was struck by Ibn Sina’s personality, his outstanding talents, broad knowledge and industriousness. That amazing person was, I can say, my countryman – he was born in 980 not far from Bukhara. As a young man, he mastered almost all the sciences known in his time. He was a philosopher, a poet, a musician, a teacher, a physicist, a mineralogist… and this list is incomplete! But after much study, he dedicated himself primarily to developing medicine. In that field, Ibn Sina was a follower of the physicians of antiquity, and first among them, Galen, a famous Roman doctor. To be precise, he used Galen’s papers for his studies and he shared his views. Many believed that the multi-volume work “The Canon of Medicine” by Ibn Sina was a very detailed interpretation of the theory and practice of Galen. In fact, “The Canon,” encompassed the best of Galen’s teachings, but also expanded them and dug deeper into the subject. His work was so profound that “The Canon” remained the principal guidebook and the foundation for medical teaching by European physicians at all European universities for six centuries.
Another few centuries passed, and the natural sciences made great advances (aided, of course, by Ibn Sina’s work). Medical researchers, equipped with ingenious devices, seemed to have learned everything possible about the human organism, about the processes that maintained life and health. New theories based on objective data arrived to supplant Ibn Sina’s ideas, which hadn’t been supported by biology, chemistry, or electronics, but he had achieved icon-like status. He was a radiant image, although rarely do European physicians open his books today.
However, Eastern and Tibetan medicine treats the heritage of this great teacher quite differently. Its practitioners still adhere to Ibn Sina’s views and widely use his system of treatment, practical advice, and diagnostic methods. Eastern physicians became convinced over time of what a wonderful clinician he had been, how profound and distinctive his thinking was, how he adjusted his theoretical assumptions with practice. And some of his ideas even outperformed the teachings of the twentieth century.
Ibn Sina approached the most important scientific theories particularly closely in his teaching about mizaj.
At first, I couldn't understand what mizaj was. It seemed either awfully primitive or incredibly complicated. I read and reread, going back to the same pages and lines over and over… and it finally began to make sense.
The Arabic word mizaj literally means a proportionate blend. But, as a notion, it’s much broader. It encompasses the natural, most important qualities of an organism. In that sense, the idea of mizaj can be applied to any object in the real world.
Hippocrates and Galen considered the correct blend of the four primary elements and four humors, which they believed made up the human organism and every living thing. Hot, cold, moist, and dry are the qualities that make up mizaj.
Ibn Sina recognized that theory, but, as it turned out, he had reached extraordinary profundity in its interpretation. Mizaj is the temperament that emerges as the result of interaction between opposing qualities “when they stop at a certain limit," he wrote. But since the variety of quantitative ratios of elements, which blend in a body is essentially unlimited, the mizaj of each person is uniquely individual.
Unbelievable as it is, it was precisely in his teaching about mizaj that Ibn Sina anticipated one of the principal notions of the theory of complex systems, in other words, the basis for cybernetics, the science that created the powerful computer civilization of our times.
Scientists call this basic notion "homeostasis," which literally means balance – not the static balance of rest, but rather a dynamic one. In other words, if a system is in a state of balance, or homeostasis, its constituent parts can move actively, radiate and absorb energy, and exchange information with each other and with the surrounding world. At the same time, the system doesn’t “swing back and forth.” It is in a state of balance and is protected from any extremely rapid change. Its life can be endless, of course, as long as nothing throws it out of balance, out of homeostasis.
So mizaj and homeostasis, in Ibn Sina’s interpretation, are essentially the same. We must also remember that he meant that the active, quick, dynamic system was in balance (“interaction of opposite qualities as they stop at some limit”). Naturally, Ibn Sina's reasoning was based on different concepts. He couldn’t create the mathematical system used in this modern-day theory or describe homeostasis in modern terms. But on the whole, his theory was very similar to the theory of homeostasis. There is a scientific term used to define the similarity found in comparisons between modern and ancient scientific theories.
The term is isomorphism.
It refers to the way one and the same theory is formulated with reference to different subjects. For instance, every high school student knows that numbers and dots on a straight line are more or less the same. Even though arithmetic and geometry are different subjects, any arithmetical result can be “drawn” geometrically, and any geometric drawing can be written down arithmetically. A mathematician would express it this way: the theory of actual numbers and the theory of dots on a straight line are isomorphic. So, the principles of mizaj formulated by Ibn Sina explaining the balance among principal qualities and the theory of homeostasis are isomorphic.
And the great scholar knew nothing about integral elements of the complex system! Such notions as information, information channels, and entropy didn’t exist in his time. However, the intellect, sagacity and intuition of this genius opened up the truth to him. All that was multiplied by his colossal experience. Eastern physicians maintain that not everything has been learned from that experience, and many things are either not sufficiently used or simply forgotten.
According to the ancient knowledge, which Ibn Sina adhered to and developed in “The Canon,” the world consisted of four elements: Earth (hard body), Water (liquid), Air (gases) and Fire (energy, heat). Each of them had its own quality – it could be dry or moist, hot or cold. According to Ibn Sina, these elements never existed in their pure form, but rather in different combinations in which one of them would prevail, and as a consequence its “essence prevailed.”
The four elements enter our organism with food and breath. Mixed and digested in the intestines and the liver, and then in blood vessels and other organs, they turn into humors: phlegm (jelly-like substances); blood (not yet mature enough to be absorbed by other organs); yellow bile (bile pigment of blood); and black bile (the heavy sinking part of blood). There is also surplus remaining, which is then removed from the body via urine, excrement, and sweat. Humors, the ancients thought, were formed thanks to heating. For instance, different cells in a liver have different temperatures. The fluids begin to mix, and their proper mixing produces mature blood, which organs are capable of absorbing. Ibn Sina called that blood “so perfect that it deserved praise.”
Perpetual movement of humors, their penetration into all parts of the body, metabolic nourishment of organs and tissues, removal of unnecessary substances – all of that maintains life. Fine, so what causes diseases? There are many reasons, for instance, even an insignificant deviation from the norm while humors are being produced and mixed (let’s say a surplus or insufficient amount of one or another combination of elements). Whenever there is a deviation, it means the mizaj is disrupted. That is the early stage of a disease. It’s very important to catch it while it’s still possible to restore balance in the organism, changing a regime of nutrition or a way of life, in a word, that have caused changes. If the early stage of a disease is missed and causes are not established, a disease will develop, becoming more complicated and causing more harm.
At this point, it’s appropriate to turn to another part of Ibn Sina’s teaching, about the integrity of the organism, the indisputable connection and interaction of all organs. They make one common chain in which, as in a chain of electric devices, the breakdown of one device (one organ) may lead to countless consequences – distortion of signals, in a word, the incorrect functioning of other organs, and to “a short circuit.” This is my comparison, may the great Ibn Sina forgive me, but it seemed appropriate here.
A wise physician draws a conclusion. The symptoms of a disease, which sometimes directly indicate trouble with one or another organ, may be the consequence of a disease of quite a different organ. There can be many consequences, and the one that caused a disease, that was its source, may not reveal itself right away. But it’s necessary to search for it and treat it, to treat precisely the organ that was the first to be affected. If it is restored, the consequences will disappear. If the consequences are “treated, the symptoms of a disease will temporarily become dull and will later return with greater force."
Even if contemporary medicine doesn't consider the teaching of elements and humors to conform to what has been later established, Ibn Sina’s assertion about the interaction of organs, their inter-influence, is fully recognized. And it is being corroborated more and more. However, medical practice, for some reason, overlooks it more and more frequently. Physicians in the most specific fields – oncology, cardiology, neurology, urology, dermatology, etc., –concentrate on diseases of only those particular organs that are within their specialization without trying to search for the initial causes of diseases. Why? I don’t understand. Is it narrow-mindedness, work overload, commercial norms? There are many possible explanations, but they cannot justify the fact that this most important thing, without which it is impossible to treat a disease, is neglected.
I’ve already written about the way Doctor Umarov found the initial cause of Mama’s disease – the old trauma to the uterus. Too much time had been lost; the process had spread too far. By the time we met him, her liver had also been harmed. The doctor had to start treating her liver first, and though it was impossible to stop the disease entirely, the efforts of Doctor Umarov helped Mama to live. And regular doctors only threw up their hands, surprised by Mama’s survival.
I can also write about myself…
I had symptoms of cold a few years ago. I had a runny nose, teary eyes, and difficulty breathing. And it went on and on. I was exhausted and decided to see a doctor. He referred me for allergy tests. Treacherous allergies were found and treatment was recommended – pills, injections. I took the pills and had the injections, but the results were insignificant. What a persistent ailment that allergy turned out to be.
But then Tabib Umarov arrived, and he diagnosed me in his usual way, using my pulse. He discovered that, owing to intense stress, the connection between my heart and lungs had been corrupted. In other words, my lungs had not been providing enough oxygen to my blood, and that affected my mucus membranes, among other things. That was the source of my pseudo-allergy.
Such conditions – they can be called background allergies – are often taken for allergies to plants, food, dust – anything. But they are secondary factors, even if an allergy has been found. And it is necessary to treat the initial cause. And that’s what Doctor Mukhitdin did. He managed to make me feel much better.
I don’t dare judge the extent to which the achievements of Eastern medicine depend on the fact that it still considers the four elements and humors the basis for the existence of life. But we can easily see that they are sufficient for an Eastern doctor to understand what goes on in an organism. It’s necessary to add their constant desire and ability to find an initial cause of a disease, their approach to the human body not as a set of mechanical parts, but as the most complex, active, continually changing, sensitive organism, all of it guided by the mind and spirit. It’s the approach that is used in practice – this is what I want to emphasize.
But that’s not all, far from all. Eastern medicine is famous nowadays, above all for its wonderful practical achievements in pulse diagnostics and herbal treatments.
Chapter 13. The Story a Pulse Can Tell
We were sitting around the dinner table, this time not in hospitable Namangan but at our house in New York. The doctor had agreed to tear himself away from his endless work for a week to visit the city of skyscrapers. He had many impressions, but he wasn’t as amazed at our city as we had expected. It turned out that Mukhitdin had traveled to more than 70 countries for medical visits. He visited some of them quite a few times, so he had something to compare New York with. He had been all over Europe, Asia, and the Far East. He had visited Israel. One could call him a Royal Doctor, for when he went to Saudi Arabia for hajj during Ramadan, he examined all the king’s retinue on his first visit. And when he arrived in Moscow, he was taken straight from the steps of the plane to the homes of the highest officials in Russia. Mukhitdin mentioned that in passing, without bragging, though it certainly was something to brag about.
Yura and I (for he naturally came to see his old friend) asked him which of his trips was most memorable.
"The voyage across the ocean," he answered, "on the ship Academician Boris Petrov.”
That’s how we learned of another interesting event, and only because we asked the proper question. It turned out that as early as 1986 the Ministry of Health had invited 30 scientists to make a voyage to visit different countries of Europe and America. Doctor Umarov was one of those invited.
"It was a very interesting trip," Mukhitdin was telling us. "We happened to arrive in Athens during the annual medical conference. We were there while they were discussing which of the Greek physicians should be awarded the Hippocrates Prize for best doctor of the year. Then I was asked to work a bit – to check the health of the participants in the conference by their pulse – and after they confirmed that my diagnoses were correct, they suddenly told me that I deserved the prize … a great honor, particularly for a foreigner."
That’s how we began to talk about pulse diagnostics, not right away but after our other guests had left. That conversation, which I had been dreaming of for many months, became very serious and important for me.
The thing is that, thanks to meeting the doctor, I had touched upon the secret of the pulse code, and it excited me more and more. After I had obtained a copy of Ibn Sina’s works, I read the part of the “Cannon” entitled “The Science of the Pulse” with the greatest interest. I couldn’t stop wondering how Ibn Sina had managed to write so simply, understandably and interestingly about such complex things.
Pulses came to life on the pages of the book. They sang, and I listened to their music. It seemed to me that I could visualize an artery in which life was pulsating rhythmically… Here, under one of the pulse reading positions on the wrist – and there are six of them – a frightened “gazelle” galloped by. And here “the tail of a mouse” wagged. The mouse itself couldn’t be seen. It was hiding behind a bush. And a bit farther on, a piece of soil rose forming a tiny mound. It was “a worm” that crawled, wiggling its rings. And here was a strange little creature, obviously sick, it trembled, wriggling like “a twisted thread.”
You can imagine all of that so vividly while reading the book. But how can you hear it? How can you decipher it? Why are those signals so different? Why… I didn’t finish the sentence, understanding that I was asking Mukhitdin too many questions. I suddenly remembered a boy whom I had seen in Namangan, in Mukhitdin’s office. He was sitting next to me by the window, that dark-complexioned little Uzbek boy, gazing steadily at the doctor who was feeling the pulse of a young woman, obviously his mother. He wasn’t just watching; he was feeling the pulse on his own hand and moving his lips. He was certainly a doctor at that moment and wanted to know as badly as I did what the tabib could hear.
Mukhitdin, as if he had read my thoughts, smiled and put his fingers on my wrist. He pulled a sheet of paper toward him and picked up a pencil with his other hand. The zigzag of a sinusoid began to appear on the paper. “Each twist is the surge of an artery,” I thought. Then a second sinusoid appeared on the paper followed by a third.
"All these show your pulse," Mukhitdin said. "I listen to these three spots. The first one," he pointed to the upper sinusoid with his finger, "tells me about the functioning of your heart, colon and stomach. The second one…"
That was a lecture given with a demonstration of the method, a lesson that was long and at the same time extremely concise and brief. Many books are dedicated to the functioning of the pulse in the Chinese system of pulse diagnostics, which is very similar to the Eastern system. So, was it possible to talk even about the basic points in one evening?
But I still learned a lot that night.
Apart from simple “indices,” – rhythm, frequency, force of a strike, angle of decline, flexibility of arteries, etc. – the pulse has many other, more complex features that help one to diagnose. The doctor told me about some of them.
An artery didn’t just expand and contract. Each of its movements varied. Surges occurred, and it was necessary to know how “to hear” them with the tips of one’s fingers. Eastern physicians believed that an artery could have up to 16 surges from the moment of shrinking to full expansion, and return to the initial point. Doctor Mukhitdin could feel seven. His pupils, after they completed their studies, three. We people who aren't trained can feel only the last splash at the moment an artery relaxes close to the skin.
What do these surges tell physicians? What do they transmit and how?
According to Eastern and Chinese medicine, every living thing has energy that operates at different frequencies and spreads along different channels. That energy is called the life force. (Ibn Sina called it the pneuma.) It circulates through a body along certain meridian just as invariably as blood through blood vessels. There are twelve basic and two auxiliary invisible energy channels, or meridians, in one’s body. Each of them has a name that corresponds to the dominant organ through which that meridian runs. They all cross the body along certain curves and either start or end in different areas of the head, feet or hands.
That energy, the pneuma, controls the functioning of the principal organs and systems of the organism. It must flow unhindered along the meridians to maintain our organs in normal condition. But if its flow is hindered, unbalanced, or if it charges an organ insufficiently, diseases arise. There are many reasons why the energy state of a meridian may deviate from the norm. It can be an imbalance of humors, stress, or… but that deserves a separate explanation.
So, each of the three points where one feels the pulse on the wrist offers an opportunity to obtain information about the energy state of one or another meridian.
Of course, it's very difficult to explain how this can be detected by feeling a pulse. It’s only possible to understand the written instructions after one learns how to hear.
By the way, here it’s appropriate to compare some ingenious discoveries of ancient scholars and contemporary science. First of all, modern medical apparatuses confirm that meridians – electronic, thermal and radiation – exist. I’ve read about it recently. Secondly, and no less significantly, it turns out that pulse diagnostics is very reminiscent of research on the so-called “black box” by modern scientists.
The black box, just like homeostasis, is one of the basic notions of the contemporary theory of complex systems. In practice, it is any device whose inner structure we know nothing about. How can one analyze it? Obviously, the only reasonable way is to send it different signals and analyze the answers. In other words, to do what Kozma Prutkov wrote about: “Give a mare a flick on the nose and it will wag its tail.”
Joking aside, it is possible to learn many extremely interesting things about the contents and structure of a black box. Scientists usually send it the simplest signals, the simplest vibrations – a sinusoid. (Remember the sinusoids that Mukhitdin drew on the sheet of paper?) Those signals are distorted inside the black box and turn into complex vibrations before leaving it. Let’s say, if an instrument tuner uses a tuning fork to send a simple signal, or note, to a violin, it will answer him with a more complex sound, since overtones will be added to the note. That’s where a tuner begins his “diagnostics.” By listening to the violin's response, he discovers harmful distortions, analyzes them – why they could have appeared – and then corrects defects in the instrument.
A human organism is also a distinctive black box. It’s extremely complex, unbelievably complex. Today, scientists know how to send numerous signals into it and analyze answers given by the organism. Even thousands of years before our time, the great scholars of antiquity and their ingenious pupil Ibn Sina performed an even greater miracle.
When the heart, our tuning fork, sends blood through the arteries in spurts, the organism affects that flow according to its state of distortion, further complicating the amplitude of vibration of the artery. Ibn Sina, without the benefit of any devices, without the theory of complex systems, received the outgoing signals from the black box, or the beats of a pulse, and learned to decipher them, interpreting the meaning of numerous distortions as a message about different ailments of the organism.
Now, let’s go back to Mukhitdin’s explanations. He told me that the beating of a pulse reaches the upper point, the one where a doctor’s finger is placed, at different angles. Naturally, they all “sound” different. In other words, they carry different information. A combination of such beats spurts in an artery, angles of decline, creates 48 varieties of pulse. When Ibn Sina identified them, he gave them colorful names, such as “mouse’s tail,” “galloping gazelle,” and “crawling worm,” among others.
According to Ibn Sina’s teaching, a disease can occur as a result of excessive heat or cold, in other words, according to contemporary notions, as a result of an exo- or endo-thermal process. The pulse also gives relevant information about this.
And finally, the vibrations of an artery demonstrate which of the four humors is out of balance and is therefore harming one of the organs.
"Do you understand now how many different vibrations of a pulse it is possible to hear?" Mukhitdin asked. He picked up a pencil again. "Let’s multiply all these numbers… Twelve meridians by 48 angles of incidence… by four signals regarding changes in humors… by two temperature indexes… Well? Have you figured it out? Over 4,600 basic, and that's just the basic vibrations…"
A short pause followed. I tried to comprehend what I had heard, tried to imagine…
"That’s not all," he broke through the silence. "That’s not so many. I can distinguish 5,000 pulse vibrations, and my teacher was able to hear about 10,000."
"What about Ibn Sina?"
"I don’t know for sure, but I think about 15,000."
"So, what does it mean? Such an enormous number. Does it give an amazingly precise diagnosis?"
We were standing on the terrace, and Mukhitdin was, as usual, smoking a cigarette.
"You see," he said pensively. "If I can point to the spot where a tumor is with my finger, my teacher could point to its location with the tip of a needle."
“And Ibn Sina?" I thought, but I didn’t ask him about that.