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Al-Razi on Hay Fever


In the golden age of Islamic civilization, Muslim scientists contributed to sciences such as chemistry, biology, mathematics and medicine. Allergy or sensitivity which is called a modern disease was original described by one of the outstanding Iranian physicians nearly 1000 years ago - Mohammed bin Zakariya
al-Razi.

Al-Razi was born in 865 AD in Ray, south of Tehran, which is now a suburb of Tehran in Islamic Republic of Iran. He studied music, literature, philosophy and chemistry in the city of his birth and only studied medicine relatively late when he was 30 years old. He was asked to run a hospital in Ray and later on in Baghdad. He was renowned as an acute clinical observer. In this later years he became blind and died in 925 AD.

Razi achieved fame in the later part of the first millennium because of his authorship of the Alhawi Book, latinized as Liber Continens as well as the ninth book of Ketab of Mansori, latinized as Nonus Almansoris in which he specifically discusses what we would now call clinical pathology. He also described smallpox and measles in his treatise De variolis et Morbillus.

His interest in what we now know as hay fever and catarrh was stimulated by the symptoms of his philosophy teacher, Abi-Zaid Ahmad bin Sahl Al-Balkhi, who suffered sinus pain and catarrhal inflammation every year during the `time of the flowering'. This report was not published separately but was mentioned by Ben Sharabeyun ben Ibrahim in his unique book Alfosool Al-Mohimah Fee Tib Al-Umah (Important Chapters in Public Medicine) (Figure 1). The report by Razi is the Codex Huntingdonianus 461 (foll. 78b3-80b8) in the Bodleian Library in Oxford.

The book Kitab Alfosool Al-Mohi-mah Fee Tib Al-Umah, (Important Chapters in Public Medicine) is a compendium in 43 sections containing extracts from al-Razi, Ibn Sina, also known as Avicenna, [folios 91a-118a], Rufus of Ephesus [folios 38b-5a] and Hunayn ibn Ishaq [folios 52b-63a]. There is only one incomplete copy of this book extant, and its exact date of publication is not known. Since Bin Sharabeyun ben Ibrahim referred to Avicenna (Abu Ali-Sina died in 1037 AD), the date is thought to be in the first half of the 11th century.

Razi wrote one of the chapters of this book about allergic symptoms. Razi clearly relates the symptoms to flowers and a particular time of year. He also suggests some non-pharmacological treatments for the condition, which may have helped his teacher during the pollen season, but these may not be so acceptable to the modern sufferer.


Seasonal allergic rhinitis (hay fever) is considered a disease of the post-industrial revolution era. Clinical reports of patients are readily available from the 19th century starting with John Bostock's description of his own summer symptoms. Also patients with `rose catarrh' are described in the 16th and 17th century. Prevention and treatment of hay fever were rare in the first millennium:

1565 The best-known early reference is to Botallus who noticed that headache, sneezing and itching of the nostrils could be set up by the odour of roses.
1691 De Rebecque describes his own hay fever, which consisted of symptoms of a cold during the summer months, specifically during the rose season.
1695 Riedlin who de-scribes one of his friends with `coryza a rosarum odore'again linking hay fever with roses.
1819 John Bostock who describes his own symptoms of seasonal allergic.
1873 The actual cause of the seasonal symptoms was later elucidated by Blackley.

It is Razi who we think was the first to describe the treatment of hay fever in its full clinical form and suggest remedies (prior to 925 AD) almost nine hundred years before Bostock, having been prompted by the symptoms of his philosophy teacher.


Razi's paper

Al-Shahid bin al-Hossein al-Balkhi wrote a letter to Razi (865-925 AD) asking about the reason of the illness of Abu-Zeid bin Ahmad bin Sahl al-Balkhi al-Katib. Razi replied to him:

'In the name of God, the Beneficient, the Merciful"

`I understood all that you asked about his illness, as to the cause of the disease and why it becomes worse during pollinisation (Spring season) when the smell Of flowers' amplifies the illness. So I shall concentrate on the prophylaxis and treatment of the disease very briefly (Figure 2).

Figure 2: This is a portion of the original Arabic manuscript of Razi written ca. 925 AD. The first part implied an understanding of hay fever one thousand years ago. `In the name of God, the beneflcient, the merciful. Al-Shahid ben al-Hossein al-Balkhi wrote a letter to Razi (865-925 AD) asking about the reason of the illness of Abo-Zeid ben Ahmad ben Sahl al-Balkhi al-Katib. Razi replied to him: `1 understood all that you asked about his illness, as to the cause of the disease and why it becomes worse during pollinisation (Spring season) when the smell of flowers amplifies the illness. So I shall concentrate on the prophylaxis and treatment of the disease very briefly'. The complete manuscript was translated into English from the original Arabic text for the first time by G.A. Bungy et al.

Prophylaxis

  1. It may be useful to avoid heavy meals that give a feeling of fullness arid drowsiness.
  2. DO not sleep immediately after dinner especially of ter drinking a large amount of cold water.
  3. Avoid living in damp and humid places, for example jai Is, tunnels Or damp houses.
  4. Do not expose the patient's head to cold weather espedal ly after catching a cold.
  5. Do not eat food or drink water excessively and do not speak or exhaust yourself with excessive thinking.
  6. Do not fasten your neck button tightly.
  7. Avoid cold showers or submerging your head in cold water. Try to keep the hair short.
  8. Avoid treating hair with oils particularly contractive oils and colours (such as henna)'.
  9. Do not comb the patient's hair too much.
  10. Do not smell strong perfume especially when orig-mating from, e.g. flowers and Shahsafarm which are very pleasant, attractive and beautiful.
  11. Do not smell anything which causes sneezing when the abdomen is full'.
  12. Do not eat anything which may cause sleep such as saffron, mandrake (Loffah), storax (Mai ah).
  13. Do not eat foods which are hard to digest such as peas, fish, chicken, onion, thyme (Korath), garlic, ginger and wine.
  14. Try to lose more weight in the first and middle of the Spring season, try to use agents which are able to remove perspiration (sweating) accumulated inside the body due to:
    (a) overconsumption of foods and drinks;
    (b) oversleeping in houses full of heavy air, too much steam or smoke, as heaviness of the evaporated materials ascend towards the head.
  15. Do not sleep on your back, but try to use the sneezing stimulants by applying some wheat powder to the pa-tient's nose to bring the mucous fluid from the lung to the nose to get rid of it.

Treatment

Clean the running nose frequently. Dissolve some material like camomile, a special type of dessert plant or mentha sativa (Nammam), madder (Fotanj), wormwood plant (Shih), etc. in hot water and breathe their vapours before sleeping which prevents material falling to the chest at the time of deep sleep. This happens especially when one lays down on ones back for a long time. It may cause coughing, tightness of breathing and breathlessness (wheezing), and high body temperature (fever). Meanwhile it should be necessary to take into consideration to dissolve the materials entering into the chest using some dissolving material such as honeydew melon to clean and clear the chest easily and prevent the mucous material from affecting the lung. At the same time, these dissolving drugs will prevent the mucous that was in the nasal area from going inside the chest. If there is too much pressure on the nasal area, the hair of the head should be cut and covered with mustard. Hot materials such as coriander (ash-shonise), onions and mustard should be smelled to create sneezing. The things that strengthen the throat muscle such as cold water are also useful with frequent washing of throat with constant or regular drinking that prevent mucous falling into the chest.

Do not use drinks such as opium liquid or poppy juice (Sharab al-khashkhash), or any drugs and extracted liquid originating from opium or poppy, tragacanth (al-kethira), gum (Samgh), the mucilage of pear seed or the saliva of quince seeds (Lo-abe Habbe Safarjal), Al bazraghatoona, purslane juice (baghlato al-hamgha) or night shade (enab Ath-thalab). If the patient is in trouble due to coughing, using medicines coming from opium-like materials such as morphine, hashish, frankincense (Kondor) and Armenian mud are useful. Massage of the chest will help to moisten the materials inside the chest with oils from plant-like material (Ghyroti) coming from cactus (Khiry) oil or camomile oil and keep the chest warm with hot clothes. Staying in a big house which is protected from cold weather and facing steam from boiling water or a bath with great amounts of steam which encourage the removal of mucous. To dissolve the mucous materials, strengthen the body activity together with the use of medicines such as barley water or a decoc- silver knife is also suggested. More than one patient has tion of water with sugar and honey, cooked figs and raisin, been cured by cutting the blood vessels on the side of foreliquorice (Asl As sons) itself, maidenhair (Par-e-siawoshan) head. This vessel and also other local vessels in the forehead and continuous use of hot water to wash the throat is neces- which are in contact with the bone are not overfull of blood. sary. If the case is more serious, medicine which is extracted The face becomes warmer due to the blood circulation in the from fenugreed (Trigonella foenum-graecum) (Holbah), vessels.

For that group of patients who have got a warm and true horehound or motherwort or marrubium (Farasiion), red face (but excluding the others mentioned above) cutting fig, special date (Earesa), pepper and mustard is good to be the ear for bleeding is more useful. Also eating everything used. If a patient suffers from this disease due to running of which can keep the blood cold and more concentrated is the nose and itching, and a lot of sneezing, he can also use useful. For example, lintus, sour grapes and rhubarb or sorthose medicines which are mentioned above. Furthennore, rel (Rybus). Sometimes patients should keep their heads walking and being in the bath till sweating is also suggested. cold with vinegar and flower oil which is cool upon their use Bleeding by making a small hole in the patients back using a as a piece of ice. This has been tried on the head of a man who was drunk so he suddenly screamed loudly and then became calm. What he felt was a severe cold which entered his head deeply. Then he had a simple cold for one night. This was not a successful treatment for other such patients who were treated similarly by this method not only once but several times. However, severe diarrhoea, walking and fasting were very useful for him.

For those who have a big neck vessel and those who suffer from smelling flowers, it is useful to smell musk, Ele cam pane (Ghost) and colocynth (almor). It is useful to clean inside the nose by inhalation of the lily of the valley (Sown) and frankincense olibanum (Ban).

Thanks to God who is the Just One, and blessings upon prophet Mohammad (peace be upon him) who is the best creation of God and also upon his family and companions, many greetings.

The above article is an adaptation of a summary by Shekoufeh Narmizadeh based on a paper by Dr. Bungy et al published in:
International Archive of Allergy and Immunology
July 1996
Volume 110
Page 219-224

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