International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Review article: Critical Evaluation of Avicennian Cardiac Drugs in the Contemporary Research Syed Ziaur Rahman1, S. M. Mubashir1, S. H. Zahid Jamal1

Abstract: Lots of clinical and experimental research work had been done to screen the cardiac drugs mentioned by Ibn Sina (980-1037) for their efficacy and safety. Similarly, annotated bibliography of his other works such as major philosophical work (Kitab Shifâ), major medical work (Qanun fil Tibb), minor collective works on logics, poetry, physics, psychology, chemistry-magic, mathematics, music, astronomy, metaphysics, Quranic exegesis, mysticism, ethics, politics, prophecy, etc. and critical editions in almost all languages had been prepared and arranged, which includes publications and references in all major languages. But, to the best of our knowledge, no critical descriptive study has ever been done so far to evaluate the scientific report on all 63 cardiac drugs mentioned in his another famous work, Kitab-al Advia Al Qalbia. There is a need to comment on these drugs on the basis of clinical and experimental study regarding the utility of Ibn Sina’s cardiac drugs. Some of these drugs could be found safe without any reported adverse reactions. Such drugs with safe profile need to be further explored, to select promising and accessible drugs. If toxic effects are reported, then the flagging of such drugs and its present position in clinical utilization should be delineated. The present paper deals and discusses the cardiac drugs described by Ibn Sina in the contemporary research after extensive literature review and meta-analysis. The present work, therefore, provides a useful resource to enable a thorough assessment of the profile of Ibn Sina’s Cardiac drugs that have cardioprotective activity. Keywords: Ibn Sina, , Cardiac drugs, Advia Qalbia, Risalahal-Adwiyah al- Qalbiyah

International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 257-266 DOI: http://dx.doi.org/10.31344/ijhhs.v4i4.210

Introduction: Avicenna’s description of cardiac diseases and AbūʿAlī Ibn Sīnā (980-1037AD) was a their psychiatric impact was logically presented genius polymath of his times. He was regarded perhaps for the first time in the history of medicine. as most significant thinker and writer of medieval Avicenna was the first to describe carotid sinus age indeed of entire history. He wrote around hypersensitivity, which presents with vasovagal 250 books, including 150 on philosophy and 40 syncope. He was a pioneer in pulsology and the on medicine. The Book of Healing and Canon first correct explanation of pulsation was given by of Medicine was standard medical texts at Avicenna, after he refined Galen’s theory of the many Medieval European Universities and pulse. Besides, he discussed the action of available remained in use as late as 1650. His another drugs on the heart in details and mentioned their booklet, Risalahal-Adwiyah al-Qalbiyah (A tract indications and contraindications. In conclusion, on Cardiac Medicine) was the first systematized Avicenna made important contributions to book on individual cardiac drugs, in which he cardiology2. discussed 63 cardiac drugs claimed to be beneficial Cardiac diseases are the important cause of for heart ailment as well as for psychiatric morbidity and mortality in the world. Despite of ailments1. tremendous development in the field of cardiology,

1. Department of , Jawaharlal Nehru Medical College, Muslim University, Aligarh 202002, India

Correspondence to: Syed Ziaur Rahman, Department of Pharmacology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India email:[email protected]

257 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Ischaemic Heart Disease is still posing a challenge with drugs for heart ailments as an independent to medical fraternity. It is a general perception work. Ibn Sina had not only laid the foundation of that concept of cardiac diseases did not exist in Pharmacology of Cardiac system, but gave a lead old literature. Contrary to it, concept of cardiac to discuss Pharmacotherapy of Cardiac ailments. disease prevailed since ancient period. Most of the He provided proper understanding about the Unani Scholars enumerated the full description anatomy, physiology, mechanism of contraction of cardiac diseases in their treatises. Risalah al- and relaxation, the concept of pathophysiology Adwiyah al-Qalbiyah is one of the important of heart diseases, the parameters of diagnosis lexicon written by Ibn Sina which encompasses and its management. He also suggested various all the aspect of cardiac diseases including drugs psychical states such as anger, anxiety, joy, grief, and their pharmacological actions. vindictiveness and other feelings are governed As per the introductory part of the tract, it reveals by the structure of heart, constituents of blood that it was written at the instance of al-Said Abu and other humours as well as pneuma. He was al-Hasan in whose house Ibn Sina stayed after probably the first physician, who correlated heart he was freed from the imprisonment in Fardjan with psychological states. Fort. According to Qifti and the writer of Tatimma In the second chapter, he described simple and Siwan al-Hikma, this treatise was composed compound drug remedies of heart diseases, when Ibn Sina came to Hamadan after the year but before that, he gave a general classification 405AH/1014 AD3. of drugs to indicate the group to which each of “The treatise on cardiac drugs” or “Risalah al- the described cardiac drugs belonged. These Adwiyah al-Qalbiyah”, is one of Avicenna`s categories consist of stimulants, diuretics, and important medical books on simple and cooling agents. In this book, 63 simple and 17 compound medicines used in the treatment of compound drugs in the form of electuaries, cardiac diseases. He compiled this book in 16 crushed medicaments, pills, tonic and syrups chapters. First 13 chapters are dedicated to basic derived from the vegetable, mineral and animal discussions about conditions related to heart and kingdoms are discussed explaining how they act on some cardiac disease. In these chapters, Avicenna the heart among other things, through mentioning describes the physiological mainly cardiac causes their place in the aforementioned classification. of different emotional states and application of Furthermore, he described the dosage and strength pharmacotherapy to manage them. Chapter 14 of each drug and application techniques5. consists of 63 detailed monographs on simple Among the diseases of the heart mentioned in this cardio-active drugs and their therapeutic effects. treatise are: difficult breathing or “Tawahhush”, Final chapters appertain to compound cardiac palpitation or “Khafaqan”, syncope or “Ghashy”5,6 remedies4.Before Ibn Sina, no physician had dealt and heart weakness or “Za`af al-qalb”. with drugs for heart ailments in an independent Moreover he has described the relation of some work. Ibn Sina had not only laid the foundation psychological diseases like depression, stress, and of arranging simple drugs by describing only anxiety to cardiovascular function. He adds that: cardiac medicines but had given the proof of “Because the heart is the chief and noble organ, it his intellectual ingenuity and medico-technical is necessary that the physician should treat it after creativity by selecting the most important organ, careful consideration and with a firm will. It is the heart and its novel association with psyhe. necessary that he should have faith in the success The treatise is not confined to medicine only. of his course of treatment. The temperament of the Nine of its chapters deal with psychology which patient is considered of fundamental importance give details about pneuma (Ruh), its kinds, in the treatment of heart diseases and if there is seat, and its extrovert and introvert states. The any disharmony or imbalance of any kind, it remaining ten chapters relate to medicine. The should be treated”. book is of great value from the standpoint of In the words of Avicenna, “the heart is the origin therapeutics as it throws light on such drugs of vital spirit (Pneuma)” which “itself is the source that are used to tone up heart and thereby treat of emotional states such as happiness, grief, fear maladies of mood and personality. Ibn Sina and anger”. Therefore, the quantity and quality of extended the list of cardiac drugs after observing vital spirit plays an important role in existence of his own experience and taking lead from Galenic such mental states. In other words, large amounts Medicine. Before, Ibn Sina, no physician had dealt of vital spirit, its moderate viscosity and excessive

258 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 glitter can give rise to extreme happiness whereas Another thought-provoking issue in this small quantities of a viscose vital spirit can book is specificity or “khasiyyat”. It is a cause grief and unhappiness. A large amount of pharmacodynamical concept that describes a drug vital spirit itself originates from moderation in action that cannot be explained by four qualities blood volume and viscosity and thus, happiness. of . In other words, it is a Moreover, a viscose, turbid and very hot-tempered mechanism of drug action other than hotness, blood can result in grief while a thin and hot blood coldness, moistness and dryness. For example, induces anger via their effect on the vital spirit7. scammony (Convolvulus scammonia L.) resin, has Avicenna also made a connection between the hot and dry temperament but it induces expulsion ability of remembrance and the heart. Accordingly, of the yellow bile, which itself is hot and dry, from cardiac drugs mostly improve memory and mental the body and this is contradiction. Many cardiac function. As an example, in a monograph dedicated exhilarants act in such way. Such specific action to emblicmyrobalan he stated, “Since it is a are due to the form (Surah Naviyah) as each object beneficial cardiac drug due to its cleansing effects, is defined not only by its substance and substantial emblicmyrobalan strongly improves memory and qualities of hot, cold, dry and wet (the aristotelian mental ability”8. ‘hyle’) but also by its form (cf. Aristotelian Generally, drugs with following effects are ‘hylomorphism’) beneficial for the treatment of heart diseases: Accumulating excessive black bile in 1. Exhilarants e.g. saffron Crocus( sativus L.) cardiovascular system is a major risk factor for 2. Attenuant agents (drugs which decrease heart diseases. So drugs like common polypody the viscosity of blood) e.g. common rue (Polypodiumvulgare L.) and dodder (Cuscuta (Rutagravolens L.) epithymum Mur.) which eliminate black bile from 3. Fragrant drugs e.g. cinnamon (Cinnamomum cardiovascular system are of value in management zeylanicum Blume.) of such diseases. On the other hand, to improve 4. Antidotal agents e.g. zedoary (Curcuma blood flow in capillaries such as the small branches zedoaria (Bergius) Roscoe) of coronary arteries, the body needs yellow bile. 5. De-obstruents e.g. white behen Yellow bile is hot and dry and has the ability to (Centaureabehen L.) reduce the viscosity of blood. If the level of the 6. Astringents e.g. thorny bamboo (Bambusa yellow bile in the blood is lowered for any reason, arundinacea Retz.) the blood viscosity will increase, and as a result, 7. Anger-inducing drugs e.g. pot marigold blood flow will decrease. (Calendula officinalis L.) In some cases cardiac drugs act through inducing 8. Drugs having specificity or “khasiyyat” i.e. anger. These kinds of drugs tone the heart by not acting because of a general property. abrupt warming of blood and make it thinner. Pot Exhilarants are important cardiac medicines marigold is a typical example for this. The use that can equilibrate the viscosity, warmness of fragrant drugs such as lemon balm (Melissa and quantity of vital spirit in order to treat heart officinalis L.) and cinnamon, as cardiac tonics to diseases. These drugs act with several mechanisms alleviate heart diseases is another interesting issue. including: In fact, aromas are intensely harmonious with the 1. Increasing the amount of vital spirit and vital spirit and thereby, can tone it. expanding its volume e.g. wine Avicenna`s book would be a precious source 2. Increasing the glitter of vital spirit e.g. pearl of novel hypotheses for further researches on and silk psychosomatic aspects of cardiovascular diseases 3. Preventing the consumption of vital spirit as well as phytopharmacological studies on e.g. Chebulic myrobalan (Terminalia cardioactive medicinal plants. chebula Willd. ex Flem.) Aims of the Study: 4. Making the temperament of vital spirit well- The aim of the present study is to make a balanced e.g. rose water comprehensive notes of all publications done in 5. Toning the vital spirit e.g. basil (Ocimum any language on each 63 cardiac drugs described basilicum L.) by Ibn Sina in his monograph Risalahal-Adwiyah 6. Preventing gases originated from black al-Qalbiyah (Treatise on Cardiac Drugs) and to bile to approach the vital spirit e.g. bogloss evaluate critically all 63 drugs by clinical and (Anchusaitalica Retz.) investigational parameters singly or in combination

259 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 of these 63 drugs. of automated importing, and Mendeley in PDF Methodology: management. Ultimately, the choice of a RMS To fulfill the objective of the above project, we should reflect the user’s needs and work habits. did thorough critical literature review of scientific works of all 63 cardiac drugs using following Reference management is one of the most methods: complicated aspects of being a researcher. The 1. Reference management software (RMS) tedium of formatting references based on a variety for making online bibliography and list of of citation styles has made the reference manager references, an essential tool for scholars at all levels. The 2. Literature search through various search variety of reference manager available makes it engines, difficult to know which tool to select. Although 3. Field work and there are a number of reference manager on the 4. Communication with experts. market. Reference managers serve a variety of Soundness of the methodology and techniques functions: to be employed therein: 1. Import citations from bibliographic databases Literature reviews are important information and websites sources for any researcher while doing meta- 2. Gather metadata from PDF files analytical study with limited time to keep up with 3. Allow organization of citations within the the rapid increase in primary research. However, reference manager database their validity depends on their methodological 4. Allow annotation of citations soundness. The present work reviewed 5. Allow sharing of the reference manager research articles both clinical and non-clinical database or portions thereof with colleagues (experimental) works of cardiac drugs mentioned 6. Allow data interchange with other RM by Ibn Sina. Apart from these two main reviews, products through standard metadata formats we also included review articles, case-reports (e.g., RIS, BibTeX) and suggestions by other scholars. In our study, 7. Produce formatted citations in a variety of authors’ positions, structured papers published styles in indexed journals were more important and 8. Work with word processing software to reliable. These reviews would adhere to structured facilitate in-text citation scientific principles similar to what was used for The originality of the work primary research articles. To the best of our knowledge, no critical Data extraction technique would be based on descriptive study has ever been done so far to the current software that would help in making evaluate the reports on all 63 listed cardiac drugs bibliography and for preparing list of references. mentioned by Ibn Sina in his book, Al-Advia Al This meta-analytic review is more reliable for Qalbia especially in the areas of clinical and non- accessing all possible databases. Just to give an clinical (experimental) areas, their effectiveness example, reference management tool ‘Software and availability in the market. The pharmacology Mendely’, can access at least 20,000 databases of these drugs has to be established using modern including all main database such as PubMed, methodology and techniques in order to assess Cochrane, Embasse, University Libraries, etc. their value. The reliability of the sources on which the Observation: research is based: Both empirical and theoretical work of all 63 Reference management software (RMS) is listed drugs is spread over in the form of clinical, widely used by researchers in the health and experimental and theoretical research work natural sciences. Librarians are often called upon for the last millenary. This includes in vivo / in to provide support for these products. Studies vitro experiments, review articles, case-reports suggest that RMSs software such as EndNote, and propositions by many scholars, scientists, CiteULike, RefWorks, Mendeley, and Zotero, physicians and researchers. This meta-analytic in terms of features offered and the accuracy of review is more reliable as it accessed all possible the bibliographies that they generate. RefWorks databases including translation of classical generated the most accurate citations. The other manuscripts in different languages. RMSs offered contrasting strengths: CiteULike in Translations of Risalah Advia Qalbia: simplicity and social networking, Zotero in ease The original work of Ibn Sina is in Arabic language 260 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 and available at Mashhad (Iran), Istanbul (Turkey), Notes by S. Hussein Razavi Burqa, I, Tehran Leiden (The Netherlands), Escorial (Spain), 2004. British Museum Library (England), Raza Library 6. Arabic text was published by Astanah-i Quds-i Rampur (India) and Bankipur Library (India). But Radawi, Mashhad (Iran). this work was translated into many languages. 7. O. C. Gruner, the famous physician translated Many authors provided a list of translation of these it (De ViribusCardis) into English and 9,10 original manuscripts in different languages , but incorporated it into his A Treatise on the Canon not the whole complete list as given below: of Medicine, published by Luzac & Co. London, The first translation was done in Latin (1482). The 1930 (pages 123 to 125, and 534 to 552) other translations are as follows: 8. Hakim Abdul Lateef. KitabulAdviya Qalbiya 1. First translation in Latin by Arnold of (Urdu Translation), Iran Society Calcutta, Villanove (d. 1310 or 1313 A.D.) was 1954 carried out in 1312 and published under the 9. Hakeem Abdul Hameed. Avicenna’s Tract title “Cardiac Remedies, the VerbusCardis”. on Cardiac Drugs and Essays on Arab Second was in 1482 (“De Medicines Cardiotherapy (English). Karachi, Hamdard Cordialibus”). Another translation was Foundation, 1983 rendered into Latin by Alpagus in 1520 10. Hakim Mohammad Said. Greco-Arab Conepts AD and was published under the title on Cardiovascular Diseases (English). “Medicumenta Cardialis”. Karachi, Hamdard Foundation, 1983 2. Turkish translation with the title “Buyuk 11. Hakim Syed Zillur Rahman, Persian translation Truk Filosof vetibustadi Ibni Sina of al-Adwiyah al-Qalbiyah of Ibn Sina. Stud Sasiyetiveeserlerihakkindatelkikba” published Hist Med Sci. 1993; 12(1-2):43-57 in Roman script from Istanbul (Turkey) in 12. Hakim Syed Zillur Rahman, RisalaAdviya 1937. The collection includes the following Qalbiya (Persian), Muslim University Press, three works of Ibn Sina: “Al-Adwiyah al- Aligarh, 1996. It is critically edited text of Qalbiya”, “Hai b. yaqzan” and “Risalah fi Persian translation of KitabulAdviya Qalbiya Mahiya al-Huznwa Aasbabihi”. by an Indian physician, Hakim Ahmadullah 3. A facsimile reproduction of the text of Khan. The edition is based on three Indian the manuscript (preserved in Tashkent) extant manuscripts as mentioned above. with translation and commentary by H. Cardiac Drugs in Formulations Hikmatullaev in Uzbek published from Tashkent in 1966 AD. In , although the general preference is for single drugs, compound formulations are 4. ‘Tafrih al-Qulub’ the name of Persian also used in the treatment of various complex version and done by Indian physician and chronic disorders11. Ibn Sina’s cardiac drugs Hakim Ahmadullah Dehlavi. The copies are used in various formulations such as ‘Dawaul of these manuscripts preserved in four Misk Motadil Sada’, ‘Safoof Daroonaj’, ‘Khamira libraries of India viz Nizamia Tibbiya Abresham Sada’, ‘Khamirah Aabresham Ood College (Hyderabad), Asafiya Library Mastagi Wala’, ‘Khamirah Aabresham Sada’, (State Government Manuscripts Library and ‘Khamirah Aabresham Sheerah Unnab Wala’, Research Institute, Hyderabad), Salarjang ‘Khamirah Gaozaban Ambari’, ‘Khamirah Museum Library (Hyderabad) and Ibn Sina Gaozaban Ambari Jadwar Ood Saleebwala’, Academy of Medieval Medicine and Sciences ‘Khamirah Gaozaban Ambari Jawahar Wala’, (Aligarh). Two Persian versions are extant ‘Khamirah Gaozaban Sada’, ‘Khamirah Khas’, in the Tehran Libraries of Majlis (scribed in ‘Khamirah Marwareed’, ‘Khamirah Marwareed 1057 AH/1647 AD) and Milli Malik (scribed Ba Nuskha Kalan’, ‘Khamirah Marwareed in 1071AH/1660AD), but the names of their Ba Nuskha Khas’, ‘Khamirah Sandal Sada’, translator are unknown. ‘Khamirah Sandal Tursh Warq-e-Tila Wala’, 5. ‘Daruha-yiqalbi’ - A Persian translation of ‘Khamirah Yaqoot’, ‘Khamirah Yashab’, Al-Adwiat al-Qalbiyya of Ibn Sina by Hakim ‘Khamirah Zamarrud’, ‘Khamirah Zehar Mohra’. Muhammad BaqirMusavi, physician of Sultan In Greco-Arab system of Medicine (Unani), there HusaynSafavi, edited with Introduction and is a school of thought that asserts that Unani drugs 261 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 should be used in formulations to make them more Cardio Protective Activity of Standardized potent, efficacious and safe. Extracts of Unani Medicinal Plants Listed in Scholars like Mursaleenet. al. and Khurshid A Ibn-e-Sina’s Treatise, Planta Medica, 2013; p. Ansari, et. alcompiled a list of a few formulations 102. based on Ibn Sina’scardiac drugs12,13. We found a 10. Ahmad Sayeed, ShabanaRehman, Aftab few publications on scientific relevance of these M Ahmad and, Khalid M Siddiqui, et formulations compared to theses submitted. Below .al. Khamiras, a natural cardiac tonic: An is a list of publications on drug formulations. overview. Journal of pharmacy &bioallied Research Articles on Cardiac Formulations: sciences 2010: 2. 93-9. 1. Mohanty I, Gupta S K, Arya D S. Antiapoptotic MD and PhD Theses and cardioprotective effects of an herbal From our literature review, we found 14 theses of combination in rats with experimental MD (Unani medicine) and 1 thesis of PhD student myocardial infarction. International Journal of (Pharmacy) completed their research work as Integrative Biology, 2007; 1(3): 178. partial fulfillment of their degrees. These theses 2. Tajuddin, Nasiruddin M, Ahmad N. are mainly on compound formulations and given Cardioprotective effect of Unani formulation in below in chronological order. rats. Indian Journal of Traditional Knowledge. 1. Alam M M. Zightud Dam Qawi Ka Tahqeeqi 2007; 6(4): 663. Mutala Aur UskeIlaj Mein Safoof-e- 3. Goyal S, Siddiqui M K, Siddiqui K M, Khashkhash Aur Sharbat-e-Buzoori Motadil Arora S, Mittal R, Joshi S, Arya D S. Ki Ifadiyat Ka Jaizah, Department of Moalejat, Cardioprotective effect of ‘KhamiraAbresham A.K. Tibbiya College, Aligarh Muslim Hakim ArshadWala’ a Unani formulation in University, Aligarh, 1991 isoproterenol-induced myocardial necrosis in 2. Siddiqui M A. Khafqan Ka Tahqeeqi Mutala rats. Exp Toxicol Pathol, 2010; 62(1): 61-74. Aur UskeIlaj Mein Khamira Abresham Sada 4. Ahmad S, Singh M, Parveen R. Validation of Ki Ifadiyat KaJaizah (MD Thesis), Department Cardio Protective Activity of Standardized of Moalejat, A.K. Tibbiya College, Aligarh Extracts of Unani Medicinal Plants Listed in Muslim University, Aligarh, 1994 Ibn-e-Sina’s Treatise, Planta Medica, 2013; p. 3. Ahmad. Iflas-E-Qalb Mein Badranjboya, 102 Abresham Kham Moqarraz AurBisfaij 5. Bafna, P.A. and R. Balaraman, 2005. Fostaqui Ki Ifadiyat KaTahqeeqi Mutala Antioxidant activity of DHC-1, an herbal (MD Thesis), Department of Moalejat, A.K. formulation, in experimentally-induced Tibbiya College, Aligarh Muslim University, cardiac and renal damage. Phytother Res., Aligarh, 1997 19(3): 216-21. 4. Rahman A. Zightuddam QaviIbtidai (Essential 6. Mohanty I, Gupta S K, Arya D S. Hypertension) Mein Itriphal Kishneezi Ki Antiapoptotic and cardioprotective effects of a Ifadiat KaTahqeeqi Mutala (MD Thesis), herbal combination in rats with experimental Department of Moalejat, A.K. Tibbiya myocardial infarction. International Journal of College, Aligarh Muslim University, Aligarh, Integrative Biology, 2007; 1(3): 178. 1999 7. Tajuddin, Nasiruddin M, Ahmad N. 5. Manzar J. Saqoot-E-QalbImtilai KaTahqeeqi Cardioprotective effect of Unani formulation in Mutala Aur UskeIlaj Mein Khamira Abresham rats. Indian Journal of Traditional Knowledge. Sada WaJawahar Mohra Ki Ifadiat KaJaiza 2007; 6(4): 663. (MD Thesis), Department of Moalejat, A.K. Tibbiya College, Aligarh Muslim University, 8. Goyal S, Siddiqui M K, Siddiqui K M, Aligarh, 2000 Arora S, Mittal R, Joshi S, Arya D S. Cardioprotective effect of ‘KhamiraAbresham 6. Faiyaz M. Zof-e-Qalb KaTahqeeqi Mutala Aur Hakim ArshadWala’ a Unani formulation in UskeyIlaj Mein Amla, Gul-e-Gauzaban, Qust isoproterenol-induced myocardial necrosis in Sheerin Aur Sharbat Ansul Ki Ifadiat Ka Jaiza rats. Exp Toxicol Pathol, 2010; 62(1): 61-74. (MD Thesis), Department of Moalejat, A.K. Tibbiya College, Aligarh Muslim University, 9. Ahmad S, Singh M, Parveen R. Validation of Aligarh, 2003

262 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 7. Mohsin M. Therapeutic Evaluation of Qalbeen their dissertation work as a part of their research in Ischaemic Heart Disease (MD Thesis), works. These dissertations are mainly on single Department of Moalejat, A.K. Tibbiya drugs. College, Aligarh Muslim University, Aligarh, M. Pharm Dissertation Theses 2004 1. Cardioprotective activity of Terminaliabelerica 8. Aftab B. Clinical Evaluation of Hypertension in isoprenaline induced myocardial necrosis in with Special Reference to Bekh-e-Asrol, Rats by Firoj Alam (2011) under the guidance Kishneez Khushk and Filfil Siyah (MD of H.H. Siddiqui Thesis), Department of Moalejat, A.K. Tibbiya 2. Cardioprotective activity of Nehumbonucifera College, Aligarh Muslim University, Aligarh, rhizomes in isoprotenerol induced myocardial 2005 necrosis in male wistar rats by Rahul Singh 9. Bhat M D A. A Study of Cardiac Dysrhythmia (2011) under the guidance of H.H. Siddiqui with Special Reference to Khamira-Marwareed 3. Cardioprotective activity of Boerhaviadiffusa (MD Thesis), Department of Moalejat, A.K. roots on isoproterenol induced myocardial Tibbiya College, Aligarh Muslim University, necrosis in rats by Vipra Tomar (2011) under Aligarh, 2007 the guidance of H.H. Siddiqui 10. Ahmad S. Evaluation of Khameera Sandal 4. Cardioprotective effect of alcoholic extract of Sada in the Management of Zaghtuddum Cyprus rotundus Rhizome on isoproterenol QaviIbtidai (MD Thesis), Department induced myocardial necrosis in rats by Syed of Moalajat, National Institute of Unani Mehdi Raza (2011) under the guidance of Medicine, Bangalore, 2007 H.H. Siddiqui 11. Arif M. A Clinical Study on Primary 5. Cardioprotective effect of Nardstachys Hypertension and a Comparative Evaluation jatamansi by isoprenaline induced myocardial of Qurs-E-Dawaush Shifa with Amlodipine infarction in Rats by Ameena Khatoon (2011) in Its Management (MD Thesis), Department under the guidance of H.H. Siddiqui of Moalejat, A.K. Tibbiya College, Aligarh Muslim University, Aligarh, 2008 6. Cardioprotective activity of Delphinium denudatum Wall. in isoprenaline induced 12. Rather S A. Study of SuqooteQalbImtilaiand myocardial necrosis in Male Wistar Rats by Therapeutic Evaluation of Safoof Daroonajin Amrita Shukla (2011) under the guidance of its Management (MD Thesis), Department H.H. Siddiqui of Moalajat, National Institute of Unani Medicine, Bangalore, 2011 7. Evaluation of cardioprotective effect of Coleus forskohlii against isoprenaline induced 13. TariqueMahmood, Pharmacological studies myocardial infarction in Rats by Farogh Ahsan on Bombyxmori L. (Abresham) and its (2012) under the guidance of H.H. Siddiqui combinations in the treatment of cardiovascular and Tarique Mahmood diseases (PhD Thesis), Integral University, Lucknow, 2015 8. Effect of Tinosporacardifolia (Guduchi) root extract on cardiotoxicity in streptozocin 14. Siddique Ahmad, Scientific Study of Some induced diabetic rats by Arshiya Shamim Advia-e-Qalbia of Ibn Sina (MD Thesis), (2014) under the guidance of H.H. Siddiqui Department of Ilmul Advia, Faculty of Unani and Tarique Mahmood Medicine, A.K. Tibbiya College, Aligarh Muslim University, Aligarh, 2016 9. Evaluation of cardioprotective effect of leaves of Eclipta alba against isoprenaline induced 15. Sana Nafees, Scientific Study of Some myocardial infarction in Rats by Priya Pathak Unani Cardio-vascular drugs (MD Thesis), (2012) under the guidance of H.H. Siddiqui Department of Ilmul Advia, Department of and Tarique Mahmood Ilmul Advia, Faculty of Unani Medicine, A.K. Tibbiya College, Aligarh Muslim University, 10. Evaluation of cardioprotective effect of Silk Aligarh, 2018 cocoon (Abresham) against isoprenaline induced myocardial infarction in Rats by Ritesh Dissertation Kumar Srivastava (2012) under the guidance From our literature review, we found 12 scholars of H.H. Siddiqui and Tarique Mahmood from Pharmacy discipline (M. Pharm) completed 263 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 11. Evaluation of cardioprotective effect of Tinosporacardifolia against isoprenaline induced myocardial infarction in Rats by NehaKesarwani (2012) under the guidance of H.H. Siddiqui and Tarique Mahmood 12. Effect of ethanolic extract of Terminaliachebula R. against isoprenaline induced Cardiotoxicityby Asma Parveen (2013) under the guidance of H.H. Siddiqui and Tarique Mahmood. Projects on Ibn Sina’s Cardiac Drugs Cardiac Drugs as Single Ingredient 1. “Meta-analytical study of cardiac drugs As reported earlier in the text, the treatise, Risalah described by Ibn Sina (980-1037) in the Advia-e-Qalbia has a description of 63 cardiac contemporary research”, sanctioned by INSA, drugs. Among 63 drugs, 48 are of plant origin New Delhi (Fund value Rs. 4,56,000 for 2017- (76.19%), 8 are of animal origin (12.70%) and 7 2019, SZ Rahman (PI) (11.11%) are of the nature of minerals (including 2. “Comparative study of Nanoformulation 2 metals). of Khamira Abresham with its traditional A large number of experimental research works, formulation against myocardial necrosis and literary reviews have been reported and published associated ailments” sanctioned by Ministry in various journals and books on these 63 of AYUSH, Govt. of India (Fund value of 44 drugs. The present study has discussed all these Lacs INR; Principal Investigator Dr. Tariq experimental works in detail and in the light of Mahmood, Lucknow, India) modern parameters. From pharmacological point Conference and Seminars on Ibn Sina’s of view, drugs effective on heart do not act only Cardiac Drugs: on heart per se but on the whole cardiovascular system. The cardiovascular system, also called 1. Many papers were read on Ibn Sina’s Cardiac the circulatory system or the vascular system Drugs during the International Seminar on is an organ class system that permits blood to Life and Contributions of Ibn Sina held at Ibn circulate and transport nutrients, oxygen, carbon Sina Academy, Aligarh during October 25- dioxide, hormones and blood cells to and 27, 2014 (Organising Secretary, Hakim Syed from cells in the body to provide nourishment Zillur Rahman). and help in fighting diseases, stabilize 2. H.H. Siddiqui & Tarique Mahmood, temperature and pH, and maintain homeostasis. “Status of cardiac drugs used by Avicenna”, The present review of 63 cardiac drugs mentioned International Conference on Cardiovascular by Ibn Sina for the treatment of Amraz Qalb Research Convergence, AIIMS, New Delhi, consisted of drugs having either direct action on 17-18 Feb.2012 heart or on the whole cardiovascular system14,15,16. Video Talks on Ibn Sina’s Cardiac Drugs: These drugs were found to have their major action Y. TzviLangermann at Bar Ilan University gave or role on heart or blood vessel, and on those a talk in Rio de Janeiro on July 2017, which he used primarily for cardiovascular disorders as posted to Youtube in the name “Exhilirants, Muqavvi-e-Qalb, Mufarreh-e-Qalb, Muharrik- Illuminants and the repair of the pneuma: Ibn e-Qalb, Musakkin-e-Qalb, Mufatteh-e-Urooque, Sina’s al-Adwiya al-Qalbiyya (https://www. Mudir, etc. This includes the effect as anti- youtube.com/watch?v=Sdb157K4Src). In another hypertensive and anti-hyperlipidemic. The above 2 video, he discussed Ibn Sina’s book on drugs properties Muqavvi-e-Qalb and Mufarreh-e-Qalb appertaining to the heart; the heart is the seat of of 63 drugs could correlated with the mechanism the spirit (ruh, pneuma) which is responsible for of action as cAMP modulators, Na/K-ATPase our emotions. Degraded spirit causes sadness, the Enzyme Inhibitors, peripheral β blockers, calcium suggested here restore happiness. The channel blockers, autacoids, nitric oxide donors, manuscript contains a Hebrew translation with potassium channel openers, centrally acting β numerous glosses receptor agonists, diuretics, in various diseases of (https://www.youtube.com/watch?v=g6wkLFyJTAE). cardiovascular system. 264 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 We analysed thoroughly and critically each 63 Conclusion single drugs individually, which is not possible to There is little doubt that Traditional Medicines provide here because of space. It needs 95 pages have been utilized since antiquity in the health care. meaning thereby it is an exhaustive work prepared However, with the advent of the pharmaceutical with notes, annotations and history. industry early in this century, the popularity of In this study, we discussed cardiovascular activities traditional/herbal medicine declined, in spite of of all 63 drugs mentioned by Ibn Sina in his treatise, the fact that twenty five percent of all prescription Al-Adwiat al-Qalbiyya. A number of the most drugs still contain ingredients isolated from plants. important suggested plants as well as their efficacy The resources now do exist which can help and in clinical studies has been thoroughly evaluated. assist for greater understanding of the ways in Major bioactive compounds identified from these which herbs can facilitate health and restore plants are also discussed. Other scholars also tried balance in disease. to compile similar work17, but it was found either The findings in this study could help in identifying incomplete or focused only on medicinal plants18. many ‘lead drugs’ that could work as a part of A total of 39 different plant parts and their extracts ‘reverse pharmacology’ especially those that have been published to possess cardioprotection showed the effect as β antagonist, Angiotensin II against doxorubicin or isoproterenol-induced Blocker, Calcium Channel Blocker (CCB) and myocardial infarction. Isoproterenol a beta- digoxine like activities. adrenergic receptors agonist causes severe stress in myocardium resulting in the infarct-like lesion Acknowledgement: and produced cardiotoxic effects by elevating The authors are thankful to Indian National the levels of cardiac biomarkers and causing Science Academy (INSA), India for sanctioning changes in ECG. Plant-based medicines with their and providing funds to the project entitled, ‘Meta- antioxidant, antiapoptotic, antihyperlipidemic, analytical study of cardiac drugs described by Ibn platelet antiaggregatory, anti-lipid peroxidation Sina (980-1037) in the contemporary research’ for property provide substantial evidence for the the period 2017-2019 to one of the authors Syed management of Ischemia induced by doxorubicin Ziaur Rahman (PI). The present paper is a part of and isoproterenol. the project.

265 International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 References: 12. Naseer Mursalin, Mohd Anwar and Mohd Yunus 1. Azmi KA, Hussain S. Al-Adwiyah Al-Qalbiyah: Siddiqui, Cardioprotective Drugs with special introduction and commentary. Bull Indian Inst Hist reference to Kitab al Adwiyah al Qalbiyah: A review, Med. 1994; 24(2):127-68. World Journal of Pharmacy and Pharmaceutical 2. Chamsi-Pasha MA, Chamsi-Pasha H. Avicenna’s Sciences 2016; 5 (9): 2453-2462 contribution to cardiology. Avicenna J Med. 13. Khurshid A Ansari and Shahla Nazir. Cardio 2014;4(1):9-12 protective drugs in Unani medicine: A review. The 3. Syed Riaz Ali Perwaz. Ibn Sina’s Medical Works. Pharma Innovation Journal 2014; 3(9): 67-69 Indian Journal of History of Science 1986; 21(4): 14. S. Z. Rahman. First Ibn Sina Memorial Lecture by 297-314 Saiyid Hamid – A report, Newsletter of Ibn Sina 4. Ibn Sina H. Damascus: Al-Maahad al-Torath al-Elmi Academy 2002; 2 (2): 8-9 al-Arabi; 1984. Resalat fi-al-Adviytol Qalbiye (The treatise on cardiac drugs) pp. 221-282 15. Imran Zaheer, Syed Ziaur Rahman, Rahat Ali Khan, 5. Faridi P, Zarshenas MM. Ibn Sina’s book on drugs for MehtabParveen, Mushtaq Ahmad. Evaluation of cardiovascular diseases. Int J Cardiol. 2010;145:223 Analgesic Activity of Extracts of Delphinium 6. Zarshenas MM, Zargaran A. A review on the denudatumin Animal Models: A Dose Dependent Avicenna’s contribution to the field of cardiology. Int Pre-Clinical Trial, Journal of Clinical and Diagnostic J Cardiol. 2015; 182:237–241 Research 2018; 12 (12): FC01-FC04 (ISSN: 0973- 7. Behjat Javadi, Syed Ahmad Emami. Avicenna’s 709X) contribution to mechanisms of cardiovascular drugs. 16. SZ Rahman, RA Khan & A Kumar, Experimental Iranian journal of basic medical sciences 2015; 18(8): study of the morphine de-addiction properties of 721-722. Delphinium denudatum Wall, BMC Complementary 8. Ibn Sina H. Damascus: Al-Maahad al-Torath al-Elmi and Alternative Medicine 2002: 2/6 http://www. al-Arabi; 1984. Resalat fi-al-Adviytol Qalbiye (The biomedcentral.com/1472-6882/2/6 treatise on cardiac drugs) pp. 221–282. 17. Sobhani, Zahra; Reza Nami, Saeed; Ahmad Emami, 9. Syed Riaz Ali Perwaz. Ibn Sina’s Medical Works. Seyed; Sahebkar, Amirhossein; Javadi, Behjat. Indian Journal of History of Science 1986; 21(4): Medicinal Plants Targeting Cardiovascular Diseases 297-314 10. Hakim Syed Zillur Rahman. Risala Adviya Qalbiya in View of Avicenna. Current Pharmaceutical Design (Persian), Muslim University Press, Aligarh, 1996 2017; 23(17): 2428-2443 11. Ahmad, S., Rehman, S., Ahmad, A. M., Siddiqui, K. 18. Syeda Nishat Fathima, Vasudeva Murthy S. Current M., Shaukat, S., Khan, M. S., Jahangir, T. Khamiras, Pharmacological Status of Cardioprotective Plants a natural cardiac tonic: An overview. J Pharm Bio against Isoproterenol induced Myocardial Infarction. allied Sci2010; 2(2), 93-99 Asian J Pharm Clin Res, 2018; 11, (4): 17-27

266