Avicenna: The Canon of Medicine and the Rules for Testing Drugs

Table of Contents

1. Deep-Dive Articles
2. 1. Who Avicenna Was
3. 2. The Canon on One Page
4. 3. Seven Rules for Testing a Drug
5. 4. The Natural Sources: Opium, Saffron and Willow
6. 5. Timeline at a Glance
7. 6. Later Significance
8. Key Research Papers
9. Connections
10. Featured Videos

Deep-Dive Articles

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1. Who Avicenna Was

Avicenna was born at Afshana, a village near Bukhara, the capital of the Samanid dynasty in what is now Uzbekistan. The traditional birth year is 980, though the historian Dimitri Gutas argues that it was probably some years earlier. His father, a native of Balkh, was a Samanid official. Persian was his native language, but like most scholars of his world he wrote most of his scientific and philosophical work in Arabic.

Most of what is known about him comes from a short autobiography, written down by his lifelong pupil Abū ‘Ubayd al-Jūzjānī, who added a biography of his later years. By his own account he had memorised the Quran by about ten, studied logic with a tutor, then read geometry, astronomy, natural science and medicine largely on his own; he described medicine as one of the easier sciences and said he began treating patients while still young. At about seventeen he was called to treat the Samanid ruler Nūḥ ibn Manṣūr, and as a reward was allowed to read in the palace library.

The Samanid state collapsed in 999, and the rest of his life was spent moving between courts: Gurganj in Khwarazm, Gorgan, Ray, Hamadan — where he served the Buyid ruler Shams al-Dawla as vizier, went into hiding after his patron’s death and spent about four months imprisoned in the fortress of Fardajan — and finally Isfahan, from about 1024, under ‘Alā’ al-Dawla. He is believed to have written about 450 works, of which around 240 survive, some 40 of them on medicine. His great philosophical encyclopedia, The Book of Healing, was written in the same years as the Canon. He died at Hamadan in 1037, of the colic that had troubled him for years, and is buried there; a later epithet calls him the “Prince of Physicians.”

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2. The Canon on One Page

The Canon was begun at Gurganj, continued at Ray and finished at Hamadan in 1025. It was not the first great Arabic medical encyclopedia — al-Rāzī and ‘Alī ibn ‘Abbās al-Majūsī came before him — but historians describe it as the clearest and best-ordered summary of the medical knowledge of its time: the medicine of Galen, set inside the natural philosophy of Aristotle. Galen is cited about 300 times, and Avicenna, while respecting him, rejected some of his pharmaceutical opinions and physiological views.

The five books are:

1. General principles — elements, humours and temperaments, anatomy, the causes and signs of disease, the preservation of health and general treatment. Regimen and diet come first; medicines are turned to when these fail.
2. Simple drugs — general rules for judging medicines, then an alphabetical list of about 800 simples. Each entry gives the drug’s name, how to recognise a good specimen, its primary qualities (hot or cold, wet or dry), its general actions, its uses arranged by type of disease, and possible substitutes.
3. Diseases organ by organ, from head to toe.
4. Diseases of the whole body — fevers, poisons, wounds, fractures, hygiene and cosmetics.
5. Compound drugs — a formulary of about 650 preparations (theriacs, electuaries, syrups), drawn from Greek, Arabic and Indian sources, compared and judged, with Avicenna’s comments on which had proven themselves in experience. The earliest known copy of this book is dated 1052.

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3. Seven Rules for Testing a Drug

In Book 2, in a chapter on knowing the potency of drugs through experiment, Avicenna wrote that experience leads to certain knowledge of a medicine’s strength only when certain conditions are met. Paraphrased, the seven conditions are:

1. The drug must be free of any acquired quality — not altered by heat, cold or storage beside other substances.
2. It must be tried on a single disease, not a composite one.
3. It must be tried on two contrary conditions, to tell whether it acts on the disease itself or only on a symptom.
4. Its strength must match the strength of the disease; the trial starts with the weakest dose and increases it gradually.
5. The time it takes to act must be observed; an immediate effect points to action on the disease itself.
6. Its effect must be the same in all or most cases; otherwise it is accidental.
7. The experiment must be made on the human body, because a drug may act differently in an animal.

Historians note that the rules were taken partly from Galen. Sajadi and colleagues, writing in the Annals of Internal Medicine in 2009, called the passage “the earliest known treatise related to clinical trials”; Nasser, Tibi and Savage-Smith, writing in the same year, observed that the seventh rule remains very relevant given how often animal and human results disagree. The rules are conditions for careful observation on patients. They contain no control group, no randomisation and no blinding, and there is no record that Avicenna conducted a trial in the modern sense — the deep-dive article sets each rule beside the modern idea it most resembles.

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4. The Natural Sources: Opium, Saffron and Willow

Almost every medicine in the Canon came from a plant, a mineral or an animal. Modern reviews, most of them written by historians and pharmacologists in Iran’s schools of traditional Persian medicine, have gone back to individual entries and compared them with what later pharmacology found. Their conclusions are the authors’; they describe what Avicenna listed and what laboratory and clinical studies have since examined.

• Opium (afyūn, from the opium poppy, Papaver somniferum). His entry describes effects on pain, sleep, cough, the gut, thinking and breathing, and calls opium a potential poison; Heydari and colleagues found that most of these effects were later confirmed.
• Mandrake, henbane and opium in surgery. Aziz and colleagues describe their use for pain relief and sleep before operations in the Canon. All three are poisons.
• Saffron (Crocus sativus). The Book 2 monograph lists uses that Hosseinzadeh and Nassiri-Asl compare with modern work on its constituents crocin, crocetin and safranal.
• Heart remedies. His separate treatise on cardiac drugs discusses about 50 plants; a 2017 review singles out saffron, cassia cinnamon, pomegranate, basil, cardamom, lemon balm and emblic (amla) as the ones with the most modern research behind them.
• Pain and inflammation. Mahdizadeh and colleagues list willow, turmeric (curcuma), garlic and opium among the analgesic and anti-inflammatory substances of the Canon. Willow bark is the plant source of salicin, the ancestor of aspirin.

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5. Timeline at a Glance

• About 980 — born at Afshana near Bukhara (the traditional date; some historians place it earlier).
• About age 17 — treats the Samanid ruler Nūḥ ibn Manṣūr and gains the palace library.
• 999 — collapse of the Samanid state; around this time he leaves Bukhara for Gurganj in Khwarazm.
• 1012 — leaves for Gorgan, where al-Jūzjānī becomes his pupil.
• About 1014 — physician at Ray to the Buyid ruler Majd al-Dawla.
• 1015 — moves to Hamadan; vizier to Shams al-Dawla until the ruler’s death in 1021, then hiding and imprisonment at Fardajan.
• About 1024 — moves to Isfahan under ‘Alā’ al-Dawla.
• 1025 — the Canon of Medicine is completed.
• 1037 — dies at Hamadan.
• 12th century — Gerard of Cremona translates the Canon into Latin at Toledo.
• 1309 — earliest evidence of the Canon in a university syllabus, at Montpellier.
• 1472 — first Latin printing (Book 3); about a dozen complete editions follow before 1500.
• 1527 — Paracelsus burns a copy of the Canon in the Midsummer bonfire at Basel.
• 1593 — the Arabic text is printed in Rome.
• 1712–1715 — Morgagni still lectures on Book 1 at Padua.

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6. Later Significance

Translated into Latin as Canon medicinae by Gerard of Cremona at Toledo in the twelfth century, the Canon became a set text of European medical schools. It appears in the Montpellier syllabus in a papal bull of 1309, was firmly established in university teaching by 1340, and lecture material on it is first mentioned at Paris in 1330; German universities followed the Parisian model. Scholars such as Dino del Garbo and Gentile da Foligno wrote long commentaries on it, and the Latin translation fixed anatomical terms still in use. In the Islamic world more than two dozen Arabic commentaries were written between the twelfth and fourteenth centuries, among them those of Fakhr al-Dīn al-Rāzī and Ibn al-Nafīs.

The printing press spread it further: fourteen more complete Latin editions appeared between 1500 and 1608, a Hebrew version was printed at Naples in 1491–92, and the Arabic text was printed at Rome in 1593. Renaissance humanists, preferring the Greek originals, attacked the Arabic textbooks, and in 1527 Paracelsus burned the Canon at Basel — a gesture the historian Ullrich Weisser describes as by no means typical of the age. In the second half of the sixteenth century the Canon gradually left the syllabus at most European universities, though individual professors still taught it as late as 1670 and it remained a set text at Padua, Valladolid and Salamanca into the eighteenth century. The physician William Osler later called it the most famous medical textbook ever written.

For pharmacology its lasting interest lies in three things: an organised materia medica of hundreds of natural drugs described by their properties, a formulary that weighed recipes against experience, and a short list of conditions for testing a medicine on patients that still reads, a thousand years later, like an outline of careful drug research.

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Key Research Papers

1. Nasser M, Tibi A, Savage-Smith E. Ibn Sina's Canon of Medicine: 11th century rules for assessing the effects of drugs. J R Soc Med. 2009;102(2):78-80. PubMed PMID: 19208873
2. Sajadi MM, Mansouri D, Sajadi MR. Ibn Sina and the clinical trial. Ann Intern Med. 2009;150(9):640-3. PubMed PMID: 19414844
3. Shoja MM, Rashidi MR, Tubbs RS, Etemadi J, Abbasnejad F, Agutter PS. Legacy of Avicenna and evidence-based medicine. Int J Cardiol. 2011;150(3):243-6. PubMed PMID: 21093081
4. Zargaran A, Mehdizadeh A, Zarshenas MM, Mohagheghzadeh A. Avicenna (980-1037 AD). J Neurol. 2012;259(2):389-90. PubMed PMID: 21887514
5. Sadeghi S, Ghaffari F, Heydarirad G, Alizadeh M. Galen's place in Avicenna's The Canon of Medicine: Respect, confirmation and criticism. J Integr Med. 2020;18(1):21-25. PubMed PMID: 31787564
6. Heydari M, Hashempur MH, Zargaran A. Medicinal aspects of opium as described in Avicenna's Canon of Medicine. Acta Med Hist Adriat. 2013;11(1):101-12. PubMed PMID: 23883087
7. Aziz E, Nathan B, McKeever J. Anesthetic and analgesic practices in Avicenna's Canon of Medicine. Am J Chin Med. 2000;28(1):147-51. PubMed PMID: 10794127
8. Hosseinzadeh H, Nassiri-Asl M. Avicenna's (Ibn Sina) the Canon of Medicine and saffron (Crocus sativus): a review. Phytother Res. 2013;27(4):475-83. PubMed PMID: 22815242
9. Sobhani Z, Nami SR, Emami SA, Sahebkar A, Javadi B. Medicinal Plants Targeting Cardiovascular Diseases in View of Avicenna. Curr Pharm Des. 2017;23(17):2428-2443. PubMed PMID: 28215156
10. Mahdizadeh S, Khaleghi Ghadiri M, Gorji A. Avicenna's Canon of Medicine: a review of analgesics and anti-inflammatory substances. Avicenna J Phytomed. 2015;5(3):182-202. PubMed PMID: 26101752
11. Arráez-Aybar LA, Bueno-López JL, Raio N. Toledo School of Translators and their influence on anatomical terminology. Ann Anat. 2015;198:21-33. PubMed PMID: 25667112
12. Fancy N. Verification and Utility in the Arabic Commentaries on the Canon of Medicine: Examples from the Works of Fakhr al-Dīn al-Rāzī (d. 1210) and Ibn al-Nafīs (d. 1288). J Hist Med Allied Sci. 2020;75(4):361-382. PubMed PMID: 32974673

PubMed Topic Searches

1. PubMed: Avicenna Canon of Medicine
2. PubMed: Ibn Sina drug testing
3. PubMed: Avicenna materia medica
4. PubMed: Avicenna medicinal plants

Further Reading

• Gohlman WE (ed. and tr.). The Life of Ibn Sina: A Critical Edition and Annotated Translation. Albany: State University of New York Press; 1974.
• Siraisi NG. Avicenna in Renaissance Italy: The Canon and Medical Teaching in Italian Universities after 1500. Princeton: Princeton University Press; 1987.
• Encyclopaedia Iranica, “Avicenna”: ii. Biography (D. Gutas); x. Medicine and Biology (B. Musallam); xiii. The influence of Avicenna on medical studies in the West (U. Weisser). iranicaonline.org

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Connections

• Pharmacology: Notable Doctors
• Avicenna: Life and Times
• The Canon of Medicine: Five Books of Medieval Medicine
• Avicenna’s Seven Rules for Testing Drugs
• Opium, Saffron and the Long Life of the Canon
• Dioscorides: De Materia Medica
• Paracelsus: The Dose Makes the Poison
• William Withering: Foxglove and Digitalis
• Saffron
• Willow Bark
• Turmeric: History and Traditional Use
• Chronic Pain: History and Discovery

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