Paper Presented at the Joint 1st Annual Scientific Congress of the Islamic Medical Association and Network of Indonesia (IMANI), the 2nd Islamic Hospital Consortium Meeting, the Annual Scientific Meeting of al-Islam Hospital Bandung, and the Islamic Development Bank Meeting on Funding Socialization held at Horison Hotel Bandung on 18-20 February 2005 by Professor Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH & DrPH (Harvard) Deputy Dean Faculty of Medicine UIA Malaysia http://omarkasule.tripod.com
ABSTRACT
Islamic medicine like Islam is a universal concept that can embrace diverse medical systems if they conform to Islamic criteria. It is not valid to confine the concept of Islamic medicine to prophetic medicine, tibb nabawi, or traditional Muslim medicine systems like the unani medicine of South Asia. Islamic Medicine is defined as medicine whose basic paradigms, concepts, values, and procedures conform to or to do not contradict the Qur’an and Sunnah. It is not specific medical procedures or therapeutic agents used in a particular place or a particular time. Islamic Medicine is universal, all-embracing, flexible, and allows for growth and development of various methods of investigating and treating diseases within the frame-work described above. Any system of medicine that fulfils the criteria mentioned above can qualify to be called Islamic medicine. Any system of medicine can be Islamized to become Islamic medicine. Pre-Islamic Arabian medicine was Islamized in the form of tibb nabawi. Greek medicine was partially Islamized to become traditional Islamic medicine that survives today as tibb unani in South Asia. Scientific medicine practiced in Indonesian hospitals today can be Islamized by removing un-Islamic philosophical values, concepts, and practices so that it can become part of the spectrum of accepted Islamic medicine.
1.0 INTRODUCTION
Confusion about the definition of Islamic medicine has been a leading problem over the past 20 years. This confusion took on a practical dimension when Islamic hospitals were established in the past decade and a question arose on what type of medical system they would offer. Some have called for use of only the Prophetic medicine as the only valid Islamic medicine. Others are of the opinion that traditional medicine such as the unani system of South Asia is the true expression of Islamic medicine. Some in both camps have even called for abandoning scientific medicine practiced in most hospitals today as ‘un-Islamic’.
The confusion is both semantic and conceptual. The semantic confusion is between the adjectives ‘Islamic’ and ‘Muslim’. ‘Islamic’ refers to values, ideals, guiding principles, and application of the Qur’an and Sunnah. ‘Muslim’ refers to people, institutions, and practices of communities that self-identify as Muslim and need not be perfect followers of all Islamic ideals. An ‘Islamic’ community is defined as one that strictly adheres to all aspects of Islamic Law. A ‘Muslim’ community is defined as one consisting of people who self-identify as Muslims but have varying degrees of adherence to the Law. Thus Islamic Medicine the ideal is not the same as Muslim medicine, which is the actual historical or contemporary reality of Muslim societies.[2]
This paper describes the process of Islamization behind tibb nabawi and tibb unani. The process was completed and was perfected in tibb nabawi but was partial in tibb unani. The paper also attempts to clarify conceptual confusions about Islamic medicine and provide a practical definition for it. This comprehensive definition would include all medical systems that confirm to Islamic criteria. The paper also argues that contemporary scientific medicine can be Islamized.
2.0 PROPHETIC MEDICINE, tibb nabawi
Tibb Nabawi refers to words and actions of the Prophet with a bearing on disease, treatment of disease, and care of patients. Thus also included are words of the prophet on medical matters, medical treatment practiced by others on the prophet, medical treatments practiced by the prophet on himself and others, medical treatments observed by the prophet with no objections, medical procedures that the prophet heard or knew about and did not prohibit, or medical practices that were so common that the prophet could not have failed to know about them.
Tibb nabawi is not one monolithic or systematic medical system. It is varied and circumstantial. It covers preventive,[3] curative,[4] and spiritual[5] approaches to disease. It integrates mind and body, matter and spirit.
Tibb nabawi is in essence a result of Islamization of pre-Islamic Arabian medicine in Hejaz. Tibb nabawi has several sources: revelation, wahy (Qur’an[6] and sunnah[7]), empirical experience of the prophet, folk medicine of that time in the Arabian peninsula, and medical knowledge of other communities that could have been known in Makkah or Madinah at the time of the prophet.
The spiritual remedies as well as general guidelines on preventive medicine in tibb nabawi are applicable to all places, all times, and all circumstances. The specific physical remedies of tibb nabawi were specific for place, population, and time but could be generalized after empirical research.
Tibb Nabawi is part of the open and flexible part of the shariah: The flexible part has general principles from the Law-giver but the practical applications are open to the human effort of ijtihad. These applications will of necessity vary by place and time. Thus the general principles of tibb nabawi are applicable at all times and places but the specific remedies do change with change of time and place based on the level of scientific knowledge and technological capabilities.
The scope of tibb nabawi is not inclusive of all branches of medicine. Tibb Nabawi as reported to us did not cover every conceivable disease at the time of the Prophet neither can it cover all ailments today or in the future in various parts of the world. This is easy to understand from the context that although the Prophet practiced medicine, his primary mission was not medicine and he was not a full-time physician. The hadiths of the Prophet should not be looked at as a textbook of medicine. They should be used for the diseases that they dealt with. The proper way to get additional medical knowledge is through research and looking for signs of Allah in the universe.[8]
Tibb nabawi is valid, effective, and useful. Whatever the Prophet said or did was true because he never uttered any untruth.[9] There is however considerations that prevent us from direct and automatic application of remedies of tibb nabawi to contemporary conditions. If the diagnosis of a disease and all the circumstances surrounding it are exactly like those at the time of the Prophet, then we have no hesitation in saying tibb nabawi should be used. In reality changes (in disease pathology, in the genetic pool of the patients, in the genetic pool of the medicinal plants, in weather and climatic conditions, and in meanings terms referring to diseases or treatment modalities) preclude automatic application of remedies as reported in the hadith. We can therefore conclude that the teachings of tibb nabawi can only be a foundation to guide and to encourage scientific research for remedies that are suitable for our times.
Over the past 20 years scientific research has been undertaken on 2 remedies of tibb nabawi: the black seed (nigella sativa) and honey. Motivation for medical research is found in both the Qur’an[10] and sunnah.[11] Studies of nigella sativa (animal laboratory and clinical on in humans) have investigated its chemical and pharmacological properties.[12] Studies have also been undertaken on the following effects of nigella sativa: anti-pyretic,[13] analgesic,[14] cardiovascular,[15] neurologic,[16] reproductive,[17] respiratory,[18] hematological,[19] allergic,[20] Immunologic,[21] anti-inflammatory,[22] metabolic,[23] diuretic[24] anti-microbial,[25] anti-fungal[26] and anti-helminthic.[27] It has been found to play a role in protection of tissues against toxic damage as well as repair and healing of injured tissue.[28] It also has anti-neoplastic[29] and anti-oxidant activity.[30] Studies have also demonstrated low toxicity of nigella sativa[31] which explains its popularity and widespread use over many centuries and in many countries.
.
Research on honey has covered the following aspects.
This intense research activity testifies to what we said above that tibb nabawi is dynamic and can grow and its remedies should be subjected to modern research for best effect.
We can conclude from the discussions above that tibb nabawi is a valid medical system whose general principles are eternal but whose practical remedies need to be subjected to research in order to know how best to use them in the modern era. Tibb nabawi is part of a wide spectrum of medical systems that fulfill Islamic criteria. It is not valid to confine the term Islamic medicine to tibb nabawi standing in isolation.
3.0 TRADITIONAL MUSLIM MEDICINE
Traditional Muslim Medicine developed during the Abbasid era and spread to all parts of the Muslim world and survives today in some places for example as tibb unani medicine in South Asia. It was in essence Islamization of medical knowledge and practice then prevalent in West Asia. Pre-Islamic roots of medicine are found in ancient Egyptian,[32] Babylonian,[33] Chinese,[34] Indian,[35] Syriac,[36] Persian,[37] Arabian,[38] and Greco-Roman,[39] and Byzantine[40] civilizations.
In the early period (0 – 132 H) the prophet’s teachings gave a big impetus to medicine. He taught that there were two branches of knowledge: ‘ilm al abdaan & ilm al adyaan. He taught that the body had rights and had to be cared for. He also taught that the intestine was the abode of disease and prevention was the head of all medicine. He taught a lot about personal and environmental hygiene. He practiced medicine and urged his companions to seek cures for their diseases.
The Abbasid Period (132 H – 656H) was the golden era of Muslim medicine. The most important impetus and momentum for inquiry and scientific exploration from the golden era of the Prophet and the Khulafa al Rashidiin. Favorable political circumstances also played their role.[41] The first 3 centuries of this period were an era of translation of foreign sources (Greek, Syriac, Hindi, Persian) into Arabic.[42] The next 4 centuries were an era of original research to add to and enrich the translated material. Thus the age of translation was soon followed by the age of innovation because Muslims were no longer passive consumers of knowledge; they started adding to it and enriching it. This was followed by development of medical institutions such as hospitals, medical colleges, public health, licensing and regulation of medical practitioners.[43]
Muslims made many practical contributions to medical knowledge and in diverse fields such as anatomy,[44] physiology,[45] infectious diseases,[46] public health,[47] blood circulation,[48] psychiatry,[49] metabolic and endocrine diseases,[50] allergy,[51] dietetics,[52] pharmaceuticals,[53] ophthalmology,[54] anesthesiology,[55] obstetrics,[56] general surgery,[57] traumatology and orthopedics,[58] wound treatment,[59] urology,[60] gastro-enterology,[61] plastic surgery,[62] ear, nose, and throat,[63] dentistry,[64] cauterization,[65] tumors,[66] and neuro-surgery.[67] Muslims also pioneered hospitals[68] and medical colleges.[69] Muslim physicians also produced major medical writings.[70]
Muslim contribution to methodology was of far greater and more lasting impact than the practical contribution. Dr Jalal Musa[71] after a detailed study of the work of Ibn Sina and al Razi concluded that early Muslim physicians used the empirical methodology.
Following the golden era of medicine of the Abbasid state, there was general decline in medicine in West Asia due to 2 main factors: (a) general political and social decline before and following the Mongol invasion and destruction of Baghdad and (b) negative consequences of Greek philosophy.[72] Isolated efforts continued but the rapid growth of the earlier times did not exist. Some Muslim scholars preserved the knowledge they had and passed it on to Europe[73] where its impact lasted several centuries and formed the basis for the contemporary scientific medicine. Others spread the knowledge to other parts of the Muslim world to become the traditional or folk medicine of many Muslim communities. The most famous of these is the unani system of medicine practiced in South Asia.
Accounts of the historical development of unani medicine over 5 centuries in South Asia have been published.[74] Unani medicine as practiced today retains some elements of the medicine developed in the Abbasid era. It has also developed by incorporating knowledge from South Asia and by results of empirical research and experience.
Unani medicine has become professionalized.[75] It is widely used in South Asia.[76] It has its own hospitals, medical colleges, and professional bodies. South Asian governments recognize it as an integral part of the national health care system.
In the recent years a lot of research has been carried out on various remedies of unani medicine. Pharmacological properties of unani therapies have been investigated scientifically.[77] Unani medicine has been tested and used for treatment of the following conditions: cancer,[78] cataract,[79] conjunctivitis,[80] diarrhea,[81] urinary stones,[82] and leprosy.[83] Also studied are metabolic,[84] diuretic,[85] and immunologic[86] effects of various unani remedies. Unani remedies have also been investigated for effects on tissue repair and healing,[87] effects on sexual behavior[88] and effects on stress.[89]
Unlike the case with tibb nabawi, the process of Islamization of traditional medicine in the Abbasid era was not perfected. Medicine practiced in the Abbasid and subsequent eras had some elements of what we would define as Islamic medicine but cannot be claimed to be the sole expression of Islamic medicine. It was basically Greek medicine to which Muslims added their own observations. The Abbasid period in which the medicine developed had already deviated from the ideals of the first Muslim state established at Madinah by the prophet and continued until the end of the khilafat rashidat. Some of the leading physicians of the time were greatly influenced by Greek philosophy that embodied within it several un-Islamic tenets.[90] We can therefore conclude that the early medicine was one of traditional medicine of any Muslim society and cannot be called the sole expression of Islamic medicine.
Islamically speaking, to distinguish the unani system from any other traditional system of medicine. Its name unani (Arabic for Greek) betrays its Greek roots. Arabs, Muslims and Indians added to it and developed it to what it is today. It is not known to all Muslim societies. Some of the beneficial medicinal plants will not grow in other parts of the Muslim world. It is confined to a particular time and particular place. Islam and Islamic Medicine must be suitable for every place and every epoch. There is therefore no reason to label Unani Medicine as ‘Islamic’. It is Muslim medicine.
4.0 TOWARDS A DEFINITION OF ISLAMIC MEDICINE
The contemporary Islamic revival in general has led to a search for an expression in medicine as in other areas of life. The Islamic revival in medicine[91] has necessitated a clear and practical definition of Islamic medicine.
Another impetus for defining Islamic medicine has been the need to Islamize modern scientific medicine practiced in most hospitals of the Muslim world. Muslims have no major problems with the science and technology of modern medicine because these are based on empirical research and are an intellectual heritage of all humanity including major contributions by Muslims in the past and in the present. The practice of medicine that has been transplanted into the Muslim world by Europeans is associated with several conceptual,[92] ethical,[93] moral,[94] and methodological problems.[95] These problems arise from the associated European world-view, philosophy of life, and values that is not in accord with the Islamic ‘aqiidah. Muslims accept scientific medicine but they want substitute European philosophical values for Islamic values. This cannot be done unless Islamic Medicine is defined clearly.
Islamic Medicine is defined as medicine whose basic paradigms, concepts, values, and procedures conform to or to do not contradict the Qur’an and Sunnah. It is not specific medical procedures or therapeutic agents used in a particular place or a particular time. Islamic Medicine is universal, all-embracing, flexible, and allows for growth and development of various methods of investigating and treating diseases within the frame-work described above. This definition calls for basic transformation of current medical systems. Islamic Medicine thus becomes the result of an Islamic critique and reformulation of the basic paradigms, research methodology, teaching, and practice of medicine. This process of conceptual transformation, also called Islamization of Medicine, is described below. The end-result of the Islamization process will not be a medical system for Muslims only but for the whole humanity because Islam is a set of universal and objective values. Islamization is not theologizing, localizing of parochializing medicine but making it excellent for all.
The above-mentioned understanding of Islamic medicine is gradually changing the practice of medicine in the ummat. Islamic hospitals and clinics are being established in many Muslim and non-Muslim countries. There is increasing research inspired by the Islamic medicine movement. Medical faculties are being established on the same philosophy. In years to come, Muslim physicians will be able to make a marked impact on mainstream medical practice by introducing Islamic values to it.
Islamic medicine is the ideal. The process of Islamization of medicine can move current medical practice towards the ideal. Islamic medicine is ahead and not behind us. We have work hard to be able to reach it. That is the challenge to the Islamic Medicine Movement over the next 20 years.
NOTES
[1] This paper was first presented in July 1995. Its present format reflects developments and maturation in the author’s thought over a decade of involvement in the Islamic Medicine Movement
[2] (Kasule 1980)
[3] Most of tibb nabawi is preventive medicine which is a very advanced concept given the level of scientific knowledge at the prophet's time and certainly must have been divinely inspired. Some of the preventive measures taught by the Prophet were: dietary guidelines, physical exercise, quarantine for epidemics, hijr sihhi, forbidding urination in stagnant water, use of tooth stick, siwaak, precautions in the house at night against accidental fire and pests, leaving a country because of its water and climate, marriage and mental health, marriage and sexual health, dietary control to avoid excesses, cleanliness and avoiding filth.
[4] Ibn Qayim al Jawziyat in his book al tibb al nabawi listed many diseases with their recommended treatments. Some diseases in tibb nabawi are treatable by natural remedies for example fever, humma; bowel movements, istitlaq al batan; dropsy, istisqa; wounds, jarh; epilepsy, sar’a; sciatica, ‘irq al nisa; temperaments, tabau’; skin itch, hakk al jism; pleurisy, dhaat al janb; headache and hemicrania, sidau and shaqiiqat; inflammation of the throat, ‘adhrat; enlargement of the heart, al maf’uud; ophthalmia, al ramad; catalepsy, khudran al kulli; pimples, bathrat; skin eruptions, awraam; food poisoning, sum; witchcraft, sihr; and head lice. He also mentioned other diseases with their diverse treatments like plague, leprosy, eye diseases, throat and tonsils, diarrhea, abdominal disease, fever, plague, snake bite, scorpion bite, food contamination by a fly, headache, nose bleeds, teeth, cough, dropsy, sprain, fracture, bite by rabid dog, and the evil eye. He mentioned several general medical treatments like honey, al 'asal; cold water for fever, al mau al barid; diet, ghadha; milk, al laban; camel milk; and camel urine. The black seed, al habba al sauda, was especially emphasized. Among surgical treatments mentioned were cupping, al hijaam; cauterization, al kayy; and venesection with cauterization, qatiu al uruuq wa al kayy.
[5] Study of tibb nabawi reveals that there are spiritual aspects of healing and recovery. Salat, dua, tilawat al Qur’an, and dhikr, and dhikr play a central role. Psychosomatic diseases could respond to spiritual approaches. The use of ruqyat falls between physical curative and spiritual cures. The physical curative part of ruqyat can be understood in modern terms in the way the psyche can modulate immune mechanisms that protect against disease.
[6] The Qur’an talks about physical ill health (2:196, 24:61, 48:17, 2:184-5, 4:43) and mental ill-health/diseases of the heart(10:57, 2:10, 74:31, 24:50, 22:53, 33:32). The Qur’an itself is a cure (17:82). It contains dua for good health as well as guidances on specific therapy such as honey (16:69), eating only hood halal food, avoiding unhealthy haram food (2:168, 2:172-173, 6:145-146, 16:114-115, 5:2, 5:4-5), and not in eating excessive amounts of food (7:31). Medical guidelines in the Qur’an are more appropriately related to general principles of a balanced life style that the Qur’an enunciated rather those specifics of medicine. Scientific explanations for Qur’anic verses related to medicine (such as contagion, adwah; alcohol, creation, and saum) or establishing medicinal value of plants (zaitoon, tiin, dates, milk, and fruits) usually lacks scientific rigor or accuracy and has created more confusion than clarity. It can also mislead some people into thinking that they know the full reasons behind a certain Qur’anic injunction based on scientific medical evidence. Unless clearly stated in the Qur’an itself or by authentic sunnah, the reasons behind Qur’anic injunctions are unknowable to us with certainty. All we can do is research and make Ijtihad; we could be right or wrong. We must have the humility to realize that we may not reach the whole truth and the scientific explanations that we propose may be wrong or may be only part of the explanation.
[7] Hadith is the second source of tibb nabawi. The total number of hadiths on medicine is about 300; many do not reach the degree of hasan. Bukhari in his Sahih narrated 129 hadiths directly related to medicine. He devoted two books to medicine: kitaab al tibb and kitaab al mardhah. There are many other hadiths in Bukhari indirectly related to medicine. Other books of hadith also narrate more hadiths with relevance to medicine. Hadiths on physical remedies are either wahy or based on empirical experience. In most cases we cannot distinguish between the two types unless there is a specific indication that wahy is involved such as in the hadith of using honey in treating an abdominal ailment of a brother of a companion.
[8] (2:164, 3:190, 10:5-6, 30:20-27, 39:59, 51:20-23)
[9] The ijtihad of the prophet even in worldly matters was protected, ma'suum. The Qur'an and hadith have records of divine intervention to comment on the prophet's ijtihad on worldly matters such his advice on some aspects of agriculture that he later withdrew. Thus the record of authentic hadith that we have is valid whether in 'aqidat or worldly matters. The attempt to distinguish between the medical teachings of the prophet-messenger and as a human living in Arabia at a particular historical epoch is not easy and is of no practical significance. As part of respect for the Prophet we follow him even in human matters that were not within the direct purview of wahy because he was a human model of perfect behavior.
[10] The Qur’an is not a textbook of medicine but is a book of moral guidance. It contains basic principles and guidance on medical matters leaving the room open for humans to undertake research and fill in the details.
[11] The Prophet enunciated a basic principle in medicine that for every disease there is cure (ma anzala allahu daa; illa anzala lahu shifa'a- Kitaab al Tibb, al Bukhari). This is an impetus for us to look for remedies. Thus the prophetic medical tradition does not stop at only the medical teachings of the prophet but goes beyond to encourage humans to search and experiment with new treatment modalities. This implies among other things that prophetic medicine is not static. There is room for growth and even breaking new ground.
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[29] Gali-Muhtasib H, Diab-Assaf M, Boltze C, Al-Hmaira J, Hartig R, Roessner A, Schneider-Stock R.. Thymoquinone extracted from black seed triggers apoptotic cell death in human colorectal cancer cells via a p53-dependent mechanism. Int J Oncol. 2004 Oct;25(4):857-66.; Awad EM. In vitro decreases of the fibrinolytic potential of cultured human fibrosarcoma cell line, HT1080, by Nigella sativa oil. Phytomedicine. 2005 Jan;12(1-2):100-7.; Badary OA, Al-Shabanah OA, Nagi MN, Al-Rikabi AC, Elmazar MM.. Inhibition of benzo(a)pyrene-induced forestomach carcinogenesis in mice by thymoquinone. Eur J Cancer Prev. 1999 Oct;8(5):435-40.; Badary OA, Gamal El-Din AM.. Inhibitory effects of thymoquinone against 20-methylcholanthrene-induced fibrosarcoma tumorigenesis. Cancer Detect Prev. 2001;25(4):362-8.; Farah IO, Begum RA. Effect of Nigella sativa (N. sativa L.) and oxidative stress on the survival pattern of MCF-7 breast cancer cells. Biomed Sci Instrum. 2003;39:359-64.; Kumara SS, Huat BT.. Extraction, isolation and characterisation of antitumor principle, alpha-hederin, from the seeds of Nigella sativa. Planta Med. 2001 Feb;67(1):29-32.; Mabrouk GM, Moselhy SS, Zohny SF, Ali EM, Helal TE, Amin AA, Khalifa AA. Inhibition of methylnitrosourea (MNU) induced oxidative stress and carcinogenesis by orally administered bee honey and Nigella grains in Sprague Dawely rats. J Exp Clin Cancer Res. 2002 Sep;21(3):341-6.; Salim EI, Fukushima S. Chemopreventive potential of volatile oil from black cumin (Nigella sativa L.) seeds against rat colon carcinogenesis. Nutr Cancer. 2003;45(2):195-202.; Salomi MJ, Nair SC, Panikkar KR. Inhibitory effects of Nigella sativa and saffron (Crocus sativus) on chemical carcinogenesis in mice. Nutr Cancer. 1991;16(1):67-72. Salomi NJ, Nair SC, Jayawardhanan KK, Varghese CD, Panikkar KR. Antitumour principles from Nigella sativa seeds. Cancer Lett. 1992 Mar 31;63(1):41-6. Swamy SM, Huat BT. Intracellular glutathione depletion and reactive oxygen species generation are important in alpha-hederin-induced apoptosis of P388 cells. Mol Cell Biochem. 2003 Mar;245(1-2):127-39. ;Worthen DR, Ghosheh OA, Crooks PA. The in vitro anti-tumor activity of some crude and purified components of blackseed, Nigella sativa L. Anticancer Res. 1998 May-Jun;18(3A):1527-32. Iddamaldeniya SS, Wickramasinghe N, Thabrew I, Ratnatunge N, Thammitiyagodage MG.. Protection against diethylnitrosoamine-induced hepatocarcinogenesis by an indigenous medicine comprised of Nigella sativa, Hemidesmus indicus and Smilax glabra: a preliminary study. J Carcinog. 2003 Oct 18;2(1):6.
[30] Badary OA, Taha RA, Gamal el-Din AM, Abdel-Wahab MH. Thymoquinone is a potent superoxide anion scavenger. Drug Chem Toxicol. 2003 May;26(2):87-98.; Burits M, Bucar F. Antioxidant activity of Nigella sativa essential oil. Phytother Res. 2000 Aug;14(5):323-8.; Kanter M, Meral I, Dede S, Gunduz H, Cemek M, Ozbek H, Uygan I. Effects of Nigella sativa L. and Urtica dioica L. on lipid peroxidation, antioxidant enzyme systems and some liver enzymes in CCl4-treated rats. J Vet Med A Physiol Pathol Clin Med. 2003 Jun;50(5):264-8 and J Vet Med A Physiol Pathol Clin Med. 2003 Sep;50(7):383.; Khan N, Sharma S, Sultana S. Nigella sativa (black cumin) ameliorates potassium bromate-induced early events of carcinogenesis: diminution of oxidative stress. Hum Exp Toxicol. 2003 Apr;22(4):193-203. Ramadan MF, Kroh LW, Morsel JT. Radical scavenging activity of black cumin (Nigella sativa L.), coriander (Coriandrum sativum L.), and niger (Guizotia abyssinica Cass.) crude seed oils and oil fractions. J Agric Food Chem. 2003 Nov 19;51(24):6961-9. Suboh SM, Bilto YY, Aburjai TA. Protective effects of selected medicinal plants against protein degradation, lipid peroxidation and deformability loss of oxidatively stressed human erythrocytes. Phytother Res. 2004 Apr;18(4):280-4. El-Saleh SC, Al-Sagair OA, Al-Khalaf MI. Thymoquinone and Nigella sativa oil protection against methionine-induced hyperhomocysteinemia in rats. Int J Cardiol. 2004 Jan;93(1):19-23.
[31] Zaoui A, Cherrah Y, Mahassini N, Alaoui K, Amarouch H, Hassar M. Acute and chronic toxicity of Nigella sativa fixed oil. Phytomedicine. 2002 Jan;9(1):69-74.; Tennekoon KH, Jeevathayaparan S, Kurukulasooriya AP, Karunanayake EH. Possible hepatotoxicity of Nigella sativa seeds and Dregea volubilis leaves. J Ethnopharmacol. 1991 Mar;31(3):283-9.;
[32] The practice of embalming the dead gave Egyptians a lot of knowledge about anatomy. They also developed various medical and surgical modalities
[33] The Babylonians knew nasal tamponade for bleeding and cataract couching. They used blood-letting as a treatment. They knew circumcision and we learn from the sunnat that the great patriarch Ibrahim (PBUH) was circumcised.
[34] Ancient Chinese medicine was well developed. The Chinese developed acupuncture and several medical procedures. Sa’ad Ibn Abi Waqqaas the commander of the conquest of Qadisiyyat (13H) and the founder of the city of Kufa (18H) was sent by Othman Ibn Affan on a diplomatic mission to China 620-640 M and is reported to have lived in the Chinese city of Canton. Thereafter contacts between Muslims and Chinese increased. A Chinese physician came to Al Razi (d. 313 AH/925 M) and requested to study under him for 1 year. He learned Arabic and translated medical books into Chinese. Muslims were in contact with Chinese physicians who visited Central Asia such as Yuan Chwang 630-645 M and I Tsung 675-685 M.
[35] Surgical knowledge in India was very advanced and many surgical instruments were developed. Indian medicine reached Baghdad both directly and indirectly, through Persia. Muslims entered Sindh in 15H/637M led by the Omayyad military leader Muhammad Ibn al Qasim; a long period of contact with Indian medicine, trade and cultural exchange ensued. In the Abassid era the ruling Barmaki family were interested in Indian culture especially its medicine. Yahya bin Khalid al Barmaki, vizier of Harun al Rashiid, sent missions to India to learn its medical knowledge. He also invited Indian physicians to Baghdad. Some Indian medical texts were translated into Arabic in Baghdad. Indian physicians worked in Baghdad. Abubakr al Razi in his book ‘al Hawi’ depended a lot on Indian medical knowledge.
[36] Syriacs translated Greek medical books into their language and subsequently into Arabic. Among the Syriac translators were: Sarjus al Ras’ani (d. 536M), Job of Edessa or Ayyub al Rahawi (d. 832M), and the famous Hunain Ibn Ishaq (d. ). In the Abassid era many translations were from Greek to Syriac and then to Arabic and not directly Greek to Arabic. The Syriacs not only translated but also wrote books making their own contributions for example Sarjus al Ras’ani wrote ‘al isatisqau’ and Ayub al Rahawi wrote ‘Fahas al bawl’.
[37] When Alexander of Macedonia defeated Persia, he spread Hellenic civilization including its medicine. Greek knowledge was translated first into Persian then into Arabic. Hereafter many translations of medical works were made from Persian to Arabic especially at the time of the Abbasids. Persian influence was very strong at the Abbasid court in many areas including medicine.
[38] Medical knowledge in the Arabian Peninsula before Islam was the folk medicine found in all human communities. We know a lot about the nature of this medicine from the many authentic hadiths on Tibb al nabawi. The prophet’s medicine was in most cases the medicine practiced in Hejaz at that time. Pre-Islamic Arabs used cupping, hijamat; cautery, kayy, and branding with fire, wasm. They used a wide variety of herbal medicine. Among medical practitioners in the pre-Islamic era were: Ibn Huzeem, Nadr Ibn Harith, and Ramtha al Tamiimi. The harsh environment, isolation in the desert, the nomadic Bedouin life, and general illiteracy explain the low level of medical knowledge among Arabs before Islam. They sometimes confused medical practice with sorcery and magic.
[39] Greek medical knowledge was picked up by the Romans and was spread in West Asia by the Byzantines. Claudius Galen (130-201 BC), a famous skilled Roman military surgeon, had great impact on Arab medicine He closely followed Hippocrates. His writings were compiled by the Byzantines and were eventually translated into Arabic. Muslims learned a lot from Galen but also had access to other Greek sources. Muslims played a big role in preserving early Greek medical knowledge, improving and enhancing it, and eventually passing it on to Europe during the renaissance.
[40] The Greek-speaking multi-national Byzantine Empire, with its capital at Constantinople in West Asia, lasted over 1000 years after the fall of Rome and acted as a bridge to transfer Greek knowledge to West Asia and North Africa. The Byzantines compiled Greek knowledge from Hellenic and Roman books. The University of Alexandria was the center of this activity. It continued functioning after the Muslim conquest of 642M and lasted until 719M.
[41] Pax Islamica over a wide multinational empire with relative stability the general conditions of peace allowing movement of people and ideas across the expanse of a large empire. The political leaders encouraged as well as patronized learning and science. They bought books and imported scientific brains.
[42] Al Ma ‘amun established Bayt al Hikmat which undertook translations of Greek knowledge. The process of translation strengthened Arabic as a language of science. The translators had to arabize many technical terms, ta’ariib al mustalahaat. Greek tenets and ideas were Islamized for example translators would use alternative words in the place of pig and alcohol.
[43] During the early Abbasid era, many measures of public health significance were undertaken. The Abbasid Minister Ali Ibn Isa asked the court physician Sinaan Ibn Thabit to organize regular visiting of prisons by medical officers. The first hospital was built by Harun al Rashiid in Baghdad. Khalifah al Mansur instructed his physician Isa bin Yusuf to examine all physicians to determine those who were competent; those who were successful were allowed to continue their work and the unqualified were expelled.
[44] Muslims largely depended on the writings of Galen. They however made their own observations and corrected many mistakes made by Galen. Al Razi encouraged dissection and al Zahrawi insisted on knowledge of anatomy before any surgery.
[45] Muslim physiological knowledge was influenced a lot by the Greek theories of the 4 elements and the 4 humors These Greek ideas had one very important and true concept, the idea of balance, which is the forerunner of the modern physiological concept of homeostasis. Most of the details were however found by later research to be untrue and were discarded. Muslim physicians knew the heart as a mechanical pump. They had ideas about food digestion
[46] Al Razi was aware of air-borne infection when he made an experiment to determine the site of a new hospital in Baghdad by putting meat in the air and waiting to see the site where it putrefied soonest. Al Razi in his book, Kitaab al judri wa al hisbat described the symptoms of smallpox and measles. The concept of contagion was known as early as the time of the prophet. Al Majuusi described contagious diseases like leprosy, elephantiasis, phrenitis, and trachoma. Ibn al Khatib and Ibn Khatimat described the symptoms of plague. Ibn Khatima had mentioned minute bodies causing disease in the 14th century CE.
[47] The following wrote about public health: Qusta bin Luuqa, Ishaaq bin Omran, Ibn al Jazzaar, Ibn Sina, Fakhr al Ddiin al Razi, and Ibn al Quffi.
[48] Ibn Nafees al Nafees described pulmonary circulation centuries before its ‘discovery’ by William Harvey.
[49] Depression melancholia was related to organic factors. It was also realized that it could be caused solely by psychological factors. The symptoms of depression were described very well.
[50] The symptoms of diabetes mellitus were described well. Urine examination was a very advanced art
[51] Al Razi described rhinitis due to plant exposure centuries before similar descriptions by Europeans
[52] Muslims knew that diet is a method of treatment. The following wrote on diets: Hunain Ibn Ishaaq, Muhammad bin Zakariyyah al Razi, and Ibn Zuhr.
[53] Muslims knew both simple and compound drugs. Among those who wrote about drugs were: Abu daud Sulaiman bin Hasan al Andalusi known as Ibn Juljul in the 4th century H / 10th century M; Ibn al Jazzaar, Ibn al Raihan al Biruni, Abi Obaid al Bakri, Ibn Baja al Idrisi, and Abd al Latif al Baghdadi.
[54] Ibm Hytham (965-1040 CE) in his book 'Kitaab al Manadhir' disproved the extromission theories of Euclid and Ptolemy and instead advocated an intromission view. He described the optic pathways and the point-to-point projection of the visual world into the brain. He described how eye movements helped in visual perception. He also realised that several processes were involved in conscious visual experience. Jurjani (5th century H) wrote about ophthalmology in his book 'Nur al ‘Uyuun'. Al Zahrawi described many extra-ocular operations. Al Zahrawi described the posterior displacement of the lens in cataracts. He also discovered many instruments such as: hooks, eye speculum, conjunctivae scissors for removal of panus, perforator and depressing needles for cataract surgery. Al Razi recommended tearing the capsule of the lens if it cannot be displaced and Ibn Sina described various needles that can be used for this. Ali Ibn Isa was another ophthalmologist who wrote the book 'Tadhkirat al Kahaliin'. Both Al Razi and Ibn Sina described a procedure for operative decompression of glaucoma.
[55] Al Zahrawi performed many of his operations under anesthesia: opium or mandragora.
[56] Al Baladi (circa 380 H) wrote a complete discourse on midwifery called ' Kitaab Tadbir al Habala'. Al Zahrawi described normal and abnormal presentations and described instruments for craniotomy to deliver a dead fetus in case of obstruction. He also developed a vaginal speculum.
[57] The main contributors were: Ibn Zuhr, al Shirazi, Ibn Dhahabi, and al Zahrawi. The book al Tasrif by Al Zahrawi took 30 years to compile in 30 volumes. The last volume deals with surgery and is one fifth of the whole book. The volume on surgery is divided into three sections: (a) cauterization in 56 chapters (b) incisions, perforations, wounds & wound healing in 93 chapters (c) bones setting and joints in 36 chapters. The book contains anatomical details. It covered all branches of surgery. The book was used as a standard text in Europe and was translated into Latin in the 12th century M. Al Zahrawi performed thyreidoctomy in 952 M. Al Razi was the first to use gut sutures for intestinal repair. Al Zahrawi is also reported to have used catgut and cotton sutures. Al Zahrawi recognized pain as a symptom and not a disease. Among operations performed by Al Zahrawi and described in his writings were: tracheostomy as an elective procedure and bandaging techniques. Al Zahrawi has 11 inventions credited to his name such as use of the syringe for bladder irrigation, the vaginal speculum, and plaster for bone setting. Al Jurjani (d. 1136 M) described the relation between goitre and exophthalmos
[58] Al Zahrawi and al Quff described treatment of bone and joint trauma. Zahrawi wrote about osteomyelitis, amputations, and ostotomies for un-united fractures. He cautioned against above-knee and above-elbow amputations.
[59] The main contributors were: Ibn Sina, Al Zahrawi, Ibn Rushd, and Al Razi. Al Zahrawi taught the following methods of arresting hemorrhage: digital pressure, tourniquet, sponges, cauterization, hypothermia, ligation of bleeding vessels by sutures of thread. He also advised against tight bandaging. Al Zahrawi emphasized the importance of cleanliness in would treatment. Ibn Sina mentioned dry dressing. Al Zahrawi wrote about the drainage of abscesses describing in detail the site and shape of the incision, packing of the wound, excision of the skin edges, use of slow decompression of large cavities, dependent and counter drainage.
[60] Al Zahrawi described bladder irrigation. He also developed original methods of lithotromy for impacted stones. He introduced a fine drill into the urethra and was rotated gently to break up the stone into small pieces that could be washed away by the urine. He also wrote about using a bladder sound to locate bladder calculi, control of post-operative hemorrhage, and removal of clots from the bladder.
[61] Al Zahrawi used stomach tubes. He described paracentesis for ascites and intra-peritoneal abscesses. He mentioned use of trocar and cannula to drain liver abscesses. He also described the use a heated cautery to open liver abscesses. Ibn Zuhr (1113-1162 M) was the first to describe in detail the distinction between gastric ulcer and gastric malignancy. Ibn Sina wrote about colitis and its management by diet, drugs, and enema. Abu Imran Musa bin Maymun (1135-1204 M) wrote about hemorrhoids and the role of diet and surgery in their treatment. Mohammad bin Mahmood Al-Qusum (circa 1525 M) in his book ' Zad al Masir fi 'Ilaj Bawasir' wrote about treatment of piles. Ibn al Quff wrote about complications of hemorrhoidectomy and post-operative anal stricture. Al Zahrawi originated cauterization treatment of fistula-in-ano and was aware of the complications of this treatment.
[62] Al Zahrawi described the cauterization treatment of harelip. He wrote that the edges must be freshened first before cautery.
[63] Al Zahrawi discovered the guillotine method of tonsillectomy as well as the complications of the operation. He described the tumors of the tonsil. Among discoveries attributed to al Zahrawi are: use of special osteotomies for nasal operations and polypectomy, use of a marine sponge with an attached string for removal of foreign bodied from the throat, removal of foreign bodies from ears, treatment of nasopharyngeal tumors by repeated excision and cauterization.
[64] Ibn al Quff described making artificial teeth from bone. A Zahrawi described several dental operations: wiring of loose teeth, extraction of roots of broken teeth and broken pieces of the mandible by use of special forceps.
[65] Thermal and chemical cauterization for syphilitic lesions were described by Ibn Sina
[66] The main contributor was Abdul Malik Ibn Zuhr (d. 484 H). Al Zahrawi and Ibn Sina recommended wide excision including healthy tissue in removal of tumors. Use of cautery and drugs in treatment of tunors was also described.
[67] Both al Zahrawi and Ibn Quff described in detail the various intra-cranial and extra-cranial hemorrhages due to arrow wounds and their respective treatments. Al Zahrawi described symptoms and signs of skull fracture. He also described the depressed fracture in children and recommended treatment by removal of a bone. In cranial operations, the drill may accidentally perfotate the delicate intra-cranial structure; Al Zahrawi developed an instrument to prevent this accidental penetration. Al Zahrawi's craniotomy operations were remarkably like modern ones; using burr holes with a linking cut between them allowing to raise part of the cranial vault. Al Zahrawi described paralysis due to injury of the spinal cord. Haly Abbas described several types pof fractures: simple, comminuted, displaced, and hairline. Ibn Sina classified fractures of the skull into two types: closed fractures and open fractures. He described treatment of skull wounds by relieving hematioma or removing pieces iof bone that culd hurt the brain. Al Baghdadi described the depression fracture found in children. He also described meningoceles that remained after skull surgery and appeared during coughing. Samarkandi described treatment of brain edema following skull trauma and its relief using dehydration, venesection, and enema.
[68] The Persian word bimaristan was used to refer to hospitals and is literally translated as the house of the sick. The first hospital in Islam was the hospital tent that the prophet ordered erected in the mosque of Madinah during the battle of the confederates and Rufaidat used it to treat the wounded. The complete bimaristan was established in 88H for the lepers and the blind by the Omayyad Khalifat al Waliid bin ‘Abd al Malik. There were general bimaristans as well as specialized ones for prisons and schools. There were bimaristans for isolating patients who mad or those with chronic diseases like leprosy. The army has mobile bimaristans. Hospitals were built in Baghdad, Cairo, Andalusia, and Damascus. Bimaristan al Adudi al Kabir was opened in Baghdad in 982 M. Bimaristan al Nuri al Kabir was established in Cairo in 160 M. The Salahi and Mansuri hospitals were built in Cairo and the Nuri hospital was built in Damascus. Muslim hospitals had separate sections for each type of disease. They had gardens. Fans were used to cool the hospital. Cleanliness was observed by workers in all areas of the hospital especially the kitchen and the pharmacy. Daily clinical rounds were carried out. Patients were given some money on discharge.
[69] Mosques were first used for medical education for example Omar bin al Mansur (d. 824H) taught medicine at the Tulinid mosque, al jami’u al taaluuni, in Egypt. Abu Ja’afar al Mansur established Bayt al Hikmat in Baghdad that had become by the time of Ma amuun a research center in which medical books were translated. Among schools of medicine was the school of Abu Bakar bin Fuwruk al Asbahani (d. 406H). The Wazir Nidhaam al Mulk (408-486H) established medical schools in Iraq and Khurraasaan. Medical schools were also established at bimaristans such as the school of the al Muqtadiri Bimaristan in Baghdad established in 306H. Out of concern for proper medical education, Khalifah al Muqtadiri ordered in 319H that nobody would be allowed to practice medicine unless examined by Sinan bin Thaabit bin Qurra.
[70] Major writings by muslim physicians: Al Qanun Fi Al Tibb was written by Abu Abdullah Ali Al Hussein Bin Abdullah Ibn Siina. Al Hawi was written by Muhammad Ibn Zakariyyah Al Razi, Kitaab Al Manadhir was written by Ibn Haytham. Al Tasrif was written by Al Zahrawi. The book al Tasrif that took 30 years to compile is in 30 volumes. The last volume deals with surgery and is one fifth of the whole book. The volume on surgery is divided into three sections: (a) cauterization with 56 chapters (b) incisions, perforations, wounds & wound healing 93 chapters (c) bones setting and joints 36 chapters. The book contains anatomical details. It covered all branches of surgery. The book was used as a standard text in Europe and was translated into Latin in the 12th century CE. Al Kafi was written by Abu Nasr Ibn Al Ayn Zarbi. Al Umdat Fi Sinat Al Jarahat was written by Abu Al Farag Ibn Al Kufi (1233-1286 M). The book consists of 20 maqalas of which maqala 17 is devoted to traumatology while maqala 19 discusses surgical problems and their treatment from head to foot. Al Jirahat Al Kaniya was written by Sharaf Al Dddiin Ali. Kamil Al Sinaet Al Tibiyyat was written by Ali Ibn Abbas. Kitaab Al Kulliyaat was written by By Ibn Rushd. Kitaab Zad Al Musafir Wa Quut Al Hadhir was written by Abu Yafar Ahmad Ibn Ibrahim Ibn Abi Hadir Al Jazzan. The Ten Articles on the Eye was written by Hasan Ibn Ishaq. A Manual for the Oculist was written by Ali Ibn Isa. Al Taysir Li Man Ajaza ‘An Taliif was written by Abu Al Qasim Al Zahrawi. Kitab Al Shamil was written by Ibn Nafiis. Kitaab al Dhakhiirat was written by Ismail al Jarjani in Persian.
[71] Dr Jalal Musa (1972)
[72] Translating and learning Greek medicine was a double-edged sword. On one hand it led to quick and major development of Muslim medicine. On the other hand it laid the seeds for its downfall by weakening the empirical methodology inspired by the Qur’an. Pre-Islamic bedoin medicine was empirical learning from trial and error. The Qur’anic methodological revolution would have turned it into a progressive evidence-based medical system. The interlude of Greek medicine that relied a lot on philosophical discourse and not practical observation delayed the growth of evidence-based empirical medicine among Muslims. The golden era of Muslim medicine during the early abassid period was due to a combination of translated Greek medical knowledge with the addition of empirical observations by Muslims. However Greek ideas became predominant and squeezed out the empirical and inductive approach taught by the Qur’an. This dealt a death blow to further development of Muslim medicine.
[73] While Muslim medicine was flourishing in West Asia, Europe was in the ignorance and decline of its middle ages. There were three routes of knowledge transfer from the Muslim world to Europe: through Italy, through Andalusia, and by the crusaders. Constantine Africanus (d. 1087 CE) translated the most important medical books from Arabic into Latin. This gave new life to the Salerno (Italy) school of medicine. After him more books were translated. Many medical texts that had been lost in Europe were rediscovered thanks to the translations made by Muslims. Books by Hunain Ibn Ishaaq, al Razi, Al Zahrawi, Ibn Sina, and Ibn Zuhr were translated into Latin and were used in Europe as texts for many years. Europeans came to study at Muslim institutions in Andalusia and took back the knowledge to Europe. Crusaders in the Near East found themselves in a more advanced Muslim civilization and took back many ideas with them to Europe.
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[90] Ibn Sina was referred to as “al muallim al thalith” the third teacher-philosopher after Aristotle and al Farabi. Al Razi was called the physician-philosopher while Ibn Sina was called the philosopher-physician (Najar 1986). . Some were very pious Muslims whereas others, being humans, had their personal weaknesses. Some of the physicians were close to and served the rulers of the time who led regimes that were not fully Islamic. It is noteworthy that the dean of early Muslim medicine, Al Shaikh al Rais Ibn Sina, did not include an Islamic philosophic or ethical dimension when he defined medicine as ‘knowledge of the states of the human body in health and decline in disease: its purpose is to preserve health and restore it whenever it is lost” (Said 1977)
[91] Muslim revival in Medicine started with the commencement of the new hijra century 1400 H/1980M. Medicine in the ummat is passing through a period of revival. There is pride in the past and a determination to excel in the present. This revival is manifesting as seminars, conferences, memorial buildings, books, and publications dealing with Islamic medicine. Islamic Medical Associations have been set up and are operating in the US, S Africa, Pakistan, Egypt, Sudan, and Jordan. Among their activities are: journals, bulletins, conventions, research, direct care services, medico-legal fatwas, advocacy, Islamic clinics and hospitals.
[92] Several conceptual problems can be identified in European medicine. European medicine has some paradigms that we do not accept as Muslims. Death is rejected as a natural phenomenon and resources are wasted in terminal illnesses. Aging is also not accepted as a normal process and research is now being undertaken to reverse its course. There is no balance and equilibrium in selecting treatment modalities. Treatments are selected for their effectiveness against the condition without regard to what other harm they may cause to persons and the eco-system. Some treatments of yesterday are the diseases of today. Too much narrow specialization leads to lack of a holistic approach to the patient. The physician turns a blind eye to moral and social issue of the day that affect the health of his patients and claims that his responsibility is medical care only.
[93] Ethical problems of European medicine are due to its secular basis. The secularized medicine has no consistent set of ethics. Malpractice, fraud, physician misbehavior are common. Materialistic pursuits are predominant. The highly secular environment does not acknowledge a spiritual or a religious dimension in medicine. There are biases in selecting, funding and publication of research. Powerful political, economic forces that reflect the European world-view and philosophy of life are involved. The scientific method and its empirical observation were bequeathed to Europe by Muslims. The Europeans took the letter but not the spirit of the method. They proceeded to misused it by making empirical observation and experimentation the only source of knowledge to the exclusion of revelation.
[94] Moral problems of European medicine arise from its secular outlook mentioned above. European science denies morality as a factor in its work. It operates in a presumed moral vacuum. There is no recognition of absolute morality. It has adopted an even more dangerous concept. The attempt to solve social and medical problems of a moral or spiritual nature by use of technology. Empirical observation is in itself not sufficient to fully describe and understand the human being and his society. Values, motivation, attitudes, beliefs are difficult to measure let alone understand from empirical study. The tools available to the scientist, human senses and instruments, extensions of senses, have an inherent inability to see the whole human picture. Additional guidance and information from the creator, the all-knowing, is needed. Only Allah knows and understands humans fully. Thus knowledge of humans that can come only from revelation must be considered alongside the empirical observations for valid understanding.
[95] Actual experience with European medicine shows that it has problems of objectivity contrary to the claims of its advocates. The scientific method has been directed to parochial and Euro-centric concerns and interests (political, military, economic). The priorities of research and application of knowledge are not based on objective and universal criteria. European epistemology pretends to be universal. In practice it is parochial and reflects the cultural and religious heritage of Europe. Claim of objectivity by European epistemology is not true. Many of the so-called objective empirical observations actually reflect biases and presumptions of the western world-view. Science is fragmented with no overall holistic picture. Narrow specialization has led to rapid advances in scientific research but in the process only the trees are seen but not the forest.
