Landmark Commentary
Avicenna on Food Aversions and Dietary Prescriptions Sheldon G. Cohen, M.D.
the earliest of extant medical texts, the Chinese WithYellow Emperor's Classic of Internal Medicine (Huang Ti Nei Ching Su Wen, 2698-2598 B.C.)' and the Egyptian Papyrus Ebers (1500 B.CY the concept that some foods could act as agents of human ills was introduced into the folklore and customs of antiquity. A millennium later, through the writings of renowned physicians of the classical Greco-Roman era, the role of diet received first attention in the shaping of medical practices. Ptecepts were centered on beliefs in the dual effects of foods, the capacity to both endow health and induce disorders through diverse and often opposite actions. The discussions of Hippocrates (460-377 B.CV Celsus (25 B.C.-50 A.D.),4 Dioscorides (fl. 60 A.D.),5 Galen (PO-c. 200)6 and Aretaeus the Cappadocian (fl. second - third centuryf, reinforced and advanced those concepts. Perpetuation of the unquestioned acceptance of the Corpus Hippocraticum and Galen's works, aided by translations from Latin and Greek into Hebrew and Arabic, carried these dicta forward for many centuries thereafter. Concern with the mystiques of food consequently appeared in the writings of the foremost physician teachers in the eighth through twelfth century centers at Baghdad, Cairo, and Persia.8 With the westward spread of Arabic culture,9 inclusion of this material in texts of the newly developing medical schools in
National Institute of Allergy and Infectious Diseases, National Institutes ojBealth, Bethesda. MD 20892
Italy, Spain, and Southern France continued their influence. Another 800 years after Maimonides' (1135 to 1204) Treatises on the Regimens of Health 10 went by before the tools were at hand to enable separation of fact from fancy, to employ objectivity, substantiate hypotheses, or discard conjecture in dealing with evaluation of adverse reactions to foods and food additives. Ultimately unfolding new knowledge applicable to the science and art of medicine established models for the study of clinical expressions of food allergy and intolerances. Initiating these was the scratch test 1 I followed by the technique of passive serum transfer 12 (until recognition of the risk ofIive virus transmission negated its clinical applicability). Beyond reaginic antibody (IgE) mediated hypersensitivity, other prototype demonstrations of adverse food reactions included serologic study for precipitins in an immune complex mediated disorder,'3 measurement of lactase for demonstration of an enzyme deficiency,14 identification of tyramine content as a pharmacologic trigger,15 and the placebo controlled, double-blind ingestion challenge to verify or negate subjective impressions. 16Despite the simplicity and feasibility of readily employed diagnostic studies, there still are critical areas in which diagnostic approaches and management may be clouded by unproved inference, impression, or hypothetical interpretation. In this consideration the insight of an eleventh century Persian physician, clarifying a circumstance even today not always appreciated, provided a lesson that merits remembering. Avicenna (Abu Ali Husayn Ibn - Abdullah ibn - Sina) (980 to 1037) (Figs. I and 2) was born in Bokhora,
Allergy Proc.
199 Delivered by Ingenta to: Guest User IP: 193.9.158.31 On: Sun, 05 Jun 2016 14:26:42 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
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Avicenna on Food Aversions and Dietary Prescriptions Sheldon G. Cohen, M.D.
the earliest of extant medical texts, the Chinese WithYellow Emperor's Classic of Internal Medicine (Huang Ti Nei Ching Su Wen, 2698-2598 B.C.)' and the Egyptian Papyrus Ebers (1500 B.CY the concept that some foods could act as agents of human ills was introduced into the folklore and customs of antiquity. A millennium later, through the writings of renowned physicians of the classical Greco-Roman era, the role of diet received first attention in the shaping of medical practices. Ptecepts were centered on beliefs in the dual effects of foods, the capacity to both endow health and induce disorders through diverse and often opposite actions. The discussions of Hippocrates (460-377 B.CV Celsus (25 B.C.-50 A.D.),4 Dioscorides (fl. 60 A.D.),5 Galen (PO-c. 200)6 and Aretaeus the Cappadocian (fl. second - third centuryf, reinforced and advanced those concepts. Perpetuation of the unquestioned acceptance of the Corpus Hippocraticum and Galen's works, aided by translations from Latin and Greek into Hebrew and Arabic, carried these dicta forward for many centuries thereafter. Concern with the mystiques of food consequently appeared in the writings of the foremost physician teachers in the eighth through twelfth century centers at Baghdad, Cairo, and Persia.8 With the westward spread of Arabic culture,9 inclusion of this material in texts of the newly developing medical schools in
National Institute of Allergy and Infectious Diseases, National Institutes ojBealth, Bethesda. MD 20892
Italy, Spain, and Southern France continued their influence. Another 800 years after Maimonides' (1135 to 1204) Treatises on the Regimens of Health 10 went by before the tools were at hand to enable separation of fact from fancy, to employ objectivity, substantiate hypotheses, or discard conjecture in dealing with evaluation of adverse reactions to foods and food additives. Ultimately unfolding new knowledge applicable to the science and art of medicine established models for the study of clinical expressions of food allergy and intolerances. Initiating these was the scratch test 1 I followed by the technique of passive serum transfer 12 (until recognition of the risk ofIive virus transmission negated its clinical applicability). Beyond reaginic antibody (IgE) mediated hypersensitivity, other prototype demonstrations of adverse food reactions included serologic study for precipitins in an immune complex mediated disorder,'3 measurement of lactase for demonstration of an enzyme deficiency,14 identification of tyramine content as a pharmacologic trigger,15 and the placebo controlled, double-blind ingestion challenge to verify or negate subjective impressions. 16Despite the simplicity and feasibility of readily employed diagnostic studies, there still are critical areas in which diagnostic approaches and management may be clouded by unproved inference, impression, or hypothetical interpretation. In this consideration the insight of an eleventh century Persian physician, clarifying a circumstance even today not always appreciated, provided a lesson that merits remembering. Avicenna (Abu Ali Husayn Ibn - Abdullah ibn - Sina) (980 to 1037) (Figs. I and 2) was born in Bokhora,
Allergy Proc.
199 Delivered by Ingenta to: Guest User IP: 193.9.158.31 On: Sun, 05 Jun 2016 14:26:42 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
I . E
Itt
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