The traditional diagnosis and treatment of respiratory diseases: a description from Avicenna's Canon of Medicine.

This article presents selected text on respiratory medicine from the famous book of medicine, Al-Qanun fi al-Tibb (the Canon of Medicine) by Avicenna (981-1037 AD), which was taught for 600 years as a standard text of medicine across medieval Europe. The authentic manuscript of the Canon of Medicine is located in the Central Library of the Tehran University of Medical Sciences, and the section on respiratory diseases was studied for the most relevant information - information that would be informative and interesting for present day physicians and pulmonologists. The results of the analysis are presented in the article. Respiratory diseases are discussed in depth in volume 3 of the Canon of Medicine. Avicenna discusses in detail the functional anatomy and physiopathology of the pulmonary diseases that were known in his time. He also describes the signs and symptoms of various respiratory diseases and conditions in the five chapters of volume 3 (breathing, voice, cough and hemoptysis, internal wounds and inflammations and principles of treatments) that are remarkably similar to those of modern pulmonary medicine. In addition, the herbal and nonherbal treatment of respiratory diseases and their signs and symptoms, mentioned in volume 2 of the Canon of Medicine, is also presented. In the time of Avicenna, the presentation of respiratory diseases, their treatment and their prognosis was much different than in modern times. There was more reliance on history, physical examination (which was mostly based on visual observation), individual variation, environmental factors, diet, and so on, for diagnosis and treatment. Nevertheless, going through a popular historic text such as the Canon of Medicine adds to our knowledge of the developments in the area of respiratory medicine at the time of Avicenna.

Pulmonary hypertension.

The modern era in cardiopulmonary medicine began in the 1940s, when Cournand and Richards pioneered right-heart catheterization. Until that time, no direct measurement of central vascular pressure had been performed in humans. Right-heart catheterization ignited an explosion of insights into function and dysfunction of the pulmonary circulation, cardiac performance, ventilation-perfusion relationships, lung-heart interactions, valvular function, and congenital heart disease. It marked the beginnings of angiocardiography with its diagnostic implications for diseases of the left heart and peripheral circulation. Pulmonary hypertension was discovered to be the consequence of a large variety of diseases that either raised pressure downstream of the pulmonary capillaries, induced vasoconstriction, increased blood flow to the lung, or obstructed the pulmonary vessels, either by embolism or in situ fibrosis. Hypoxic vasoconstriction was found to be a major cause of acute and chronic pulmonary hypertension, and surprising vasoreactivity of the pulmonary vascular bed was discovered to be present in many cases of severe pulmonary hypertension, initially in mitral stenosis. Diseases as disparate as scleroderma, cystic fibrosis, kyphoscoliosis, sleep apnea, and sickle cell disease were found to have shared consequences in the pulmonary circulation. Some of the achievements of Cournand and Richards and their scientific descendents are discussed in this article, including success in the diagnosis and treatment of idiopathic pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, and management of hypoxic pulmonary hypertension.