Voices of Islam (216 page)

However, the main method of treatment associated with the Medicine of the Prophet was with drugs made from plants and herbs, which were known as ‘‘simples’’ in Islamic pharmaceutical vocabulary. Muslim physicians di- vided drugs into two categories: ‘‘simples’’ (
mufradat
) and ‘‘compounds’’ (
murakkabat
). Simples are drugs in their natural state, and which have not been combined with other drugs to make compounds. Each ‘‘simple’’ drug was thought to possess its own nature and interacted with the four elements of earth, water, fi and air, to bring the bodily humors back into balance. The use of simple drugs was thus related both to the temperament of the

Medicine and Healing in Traditional Islam
159

patient and to the temperament of the drug itself, which derived from the nature of its source in a particular plant or herb. The Medicine of the Prophet relied mostly on simples. Knowledge of the nature of simple drugs and their herbal sources played a major role in the traditional pharmacology of medieval Islam. Some modern scholars use the term ‘‘pharmacognosy’’ to characterize this knowledge, because it combined empirical knowledge of the properties of plants with a subtler and more esoteric knowledge of their natures.
17

Another method used in the Medicine of the Prophet was incantation. A tradition that is reproduced in the
Sunan
of Abu Dawud, the
Musnad
of Ahmad ibn Hanbal, and the
Sunan
of Tirmidhi states that a person asked the Prophet Muhammad: ‘‘Oh Messenger of God, do you consider incanta- tions a suitable means of treatment, and are they useful for protection? Do they turn back anything from God’s decree?’’ He replied, ‘‘They are part of God’s decree.’’
18
Even today, many Muslims in traditional communities continue to rely on prayer, fasting, incantations, and the recitation of certain verses of the Qur’an as approaches to healing. In the past, treatments based on the medicinal properties of minerals and plants were supplemented by charms that were based on the science of letters and numbers. Talismans or amulets were often used as alternative forms of treatment in the Medicine of the Prophet.

The underlying philosophy in the treatment of illness as expressed in the Medicine of the Prophet and later in Islamic Medicine was that the body has the power to preserve and restore balance through its God-given power of self-preservation. Therefore, the role of medicine and the physician was to help this power function by removing any obstacles that may be present in the body that obstruct the natural balance of humors and the flow of bodily fl In this view, regaining health is achieved by the body itself and any form of treatment simply helps this process by assisting the natural life force.

THE
HAKIM:
THE ISLAMIC PHYSICIAN

In the early centuries of Islamic history, physicians were usually of Jewish, Christian, or Zoroastrian background. The use of Christians and Jews as physicians continued well into the medieval period. However, Muslims began to enter the profession in the second century of Islam (mid-eighth century
CE
). Eventually, the position of physician evolved into that of the
hakim
(wise person or sage), who was both a physician and a philosopher and often a master of other Islamic sciences as well. Many famous Muslim philosophers were also physicians. These included three of the most famous philosophers in Islam, Muhammad ibn Abu Zakariyya al-Razi (Rhazes,

d. 925
CE
), Abu ‘Ali Ibn Sina (Avicenna, d. 1037
CE
), and Muhammad Ibn Rushd (Averroes, d. 1198
CE
). Theoretical studies of the Medicine of the

160
Voices of Art, Beauty, and Science

Prophet and Islamic Medicine were often taught in a traditional school of higher education, the
madrasa.
Clinical medicine, however, was taught in hospitals, which were often attached to a
madrasa
that specialized in medical subjects.
19
Private instruction was also available, especially in the area of pharmacology.

Wherever the physician was taught, he was required to develop certain personal characteristics in order to practice his craft. The following is a description of the attributes of a physician from the famous work,
Chahar Maqala
(Four Treatises):

The physician should be of a tender disposition and a wise nature, and excelling in acumen, this being a nimbleness of mind in forming correct views; that is to say, a rapid transition to the unknown from the known. No physician can be of a tender disposition if he fails to recognize the nobility of the human soul; nor can he be of a wise nature unless he is acquainted with logic, nor can he excel in acumen unless he is strengthened by God’s aid. He who is not acute in conjec- ture will not arrive at a correct understanding of any ailment, for he must derive his indications from the pulse, which has a systole, a diastole, and a pause inter- vening between these two movements.
20

The well-known
Ethics of the Physician
(
Adab al-Tabib
), by Ishaq ibn ‘Ali al-Ruhawi, gives directives on medical ethics and what today would be called ‘‘bedside manners.’’ Ruhawi discusses what the doctor should ask of the patient and the nurse, what the patient may conceal from the physician, and what the physician should inform the patient under his or her treatment. The contemporary Islamic scholar Seyyed Hossein Nasr sums up the attrib- utes of the traditional Islamic physician in the following way: ‘‘The physician was expected to be a man of virtuous character, who combined scientifi

acumen with moral qualities, and whose intellectual power was never divorced from deep religious faith and reliance upon God.’’
21

The Egyptian writer Suyuti refers to many traditions that showed that in the time of the Prophet Muhammad, women were permitted to give medical treatment to men, even though they were not close relations. Some of these traditions are recorded in the reliable collection called
Sahih Muslim,
such as when one woman reported: ‘‘We journeyed with the Prophet Muhammad in seven raids. I traveled in the rear with the baggage. I prepared their food and I treated the sick and wounded.’’ Another tradition recounts: ‘‘The Prophet once made a raid and took with him Umm Saylam, and with her came the womenfolk of the Helpers. They used to carry round the drinking water and treat the wounded.’’
22
Imam Ahmad ibn Hanbal (d. 855
CE
) said that it was lawful for a male physician to examine a woman, even though she was not a relative, and even in forbidden places.
23
Suyuti similarly said that it was lawful for a woman to look at the forbidden parts of a man in case of necessity. He then concludes his section by saying, ‘‘If a man dies among

Medicine and Healing in Traditional Islam
161

women or a woman dies among men, the women are allowed to wash the corpse of the man and the men that of the woman.’’
24

The job of the Islamic physician is to learn to read the signs of imbalance in both its empirical and its qualitative aspects. Whereas the empirical aspects of systemic imbalance appear in the sensible world and allow direct observation and experimentation, the qualitative aspects can only be known indirectly by the effects that they produce. Whereas empirical knowledge speaks through the signs of outer forms and observed reality ‘‘on the horizons,’’ the qualita- tive dimension of knowledge speaks through signs of meaning that appear more subtly, within the nature of the patient himself or herself. In the words of the Holy Qur’an: ‘‘We shall show them our signs on the horizons and within themselves until it becomes manifest to them that it is the Truth’’ (Qur’an 41:53).

ISLAMIC MEDICINE: THEORY

Islamic Medicine deals with the inborn nature of the patient in an attempt to maintain health and restore the person to health whenever the inner equi- librium of the patient is lost. The work of the physician is to achieve a dynamic balance between all aspects of the human person. This approach is holistic in theory, practice, diagnosis, and treatment.
25
Ibn Sina (Avicenna), the famous Islamic philosopher and physician and the author of the influen- tial textbook
al-Qanun fi al-Tibb
(The Canon of Medicine), defines medicine as the branch of knowledge that deals with the states of health and disease in the human body for the purpose of employing suitable means for preserving or restoring health. According to Ibn Sina and other traditional physicians, the theory of Islamic Medicine is divided into four parts: the constitution of the patient, the state of the body of the patient, the etiology of disease, and symptoms or signs of disease in the patient.

The Constitution of the Patient

The constitution of the patient has seven components: (1) the four elements and their qualities, (2) temperament, (3) the four humors, (4) the fundamental organs, (5) the souls, (6) the faculties, (7) the functions of attraction and repulsion.

The Four Elements and Their Qualities

The concept of the four elements was inherited by Islamic Medicine from the Greek medical tradition, through the translated works of Hippocrates, Dioscorides, and Galen.
26
The four elements are earth, air, fire, and water. Earth and water are heavy, and air and fire are light. The heavy elements are

162
Voices of Art, Beauty, and Science

considered strong, negative, passive, earthly, and female. The light elements are weak, positive, active, heavenly, and male.

The element of earth is located at the center of our existence. It is made of gross matter (
madda
). Because of the inherent weight that this element possesses, it remains at rest while the other elements are pulled toward it by means of attraction. Ibn Sina explained the force of gravity as the ‘‘attrac- tion’’ or ‘‘inclination’’ (
mayl
) of lighter objects toward the heavy earth.
27
The element of earth within our bodies fixes and holds our bodies in place. Its gross materiality forms the building block of the skeleton.

The element of water allows things to be shaped, molded, and spread. It has a tendency to sag or droop and forms the building block of the muscles. The element of air refi es things and makes them lighter so that they can ascend easily. It is the building block of the circulatory system. It is also the building block of the breath (
nafas,
related to
nafs,
‘‘soul’’), as it moves in and out of the physical form of the body, making involuntary movement possible. The element of fire rarifies, refines, and mixes things. It penetrates air and overcomes the coldness of earth and water. It forms the basic building block of the liver.

Each of the four elements has two primary qualities. Earth is cold and dry, water is cold and wet, air is hot and wet, and fire is hot and dry. Many descrip- tions of the four elements can be found in medieval medical and scientifi

texts from the Islamic world. It is clear from all of these texts that the four elements of Islamic Medicine are not what we call earth, air, water, and fire. They are more than the earth we walk on, the air we breathe, the water we drink, and the fire we use to cook our food. Rather, they are manifestations of primary matter, subtle qualities that our bodies contain. The quality of moisture within the elements of water and air dispels dryness and protects things from crumbling; the quality of dryness in earth and air prevents mois- ture from dispersing. The four elements are continuously in motion, making changes within the body. These changes can be either cyclical or progressive. The changes involved in eating food, digesting food, and eliminating waste are cyclical because they are repeated in the same manner. The growth of a cancerous tumor, however, is an example of progressive change because it creates a condition in the body that has not existed before.

Substances (sing.
jawhar
) are either simple or compound. The four elements are simple substances that provide the primary matter for the components of the human body. It is through these four elements and their qualities that bodies gain shape and mass. However, mass needs energy to move. This energy comes from the properties of heat and cold, which act upon the elements in the body. Heat and cold are active properties of energy, while moisture and dryness are passive qualities of matter. Although a person can speak of these qualities separately, in action they are inseparable. For instance, heat provides kinetic energy to the atoms of the body because it possesses both rapid and random motion.

Medicine and Healing in Traditional Islam
163

Temperament

Temperament is unique to each individual. In Islamic Medicine, no two persons can be treated alike medically because they have different tempera- ments. Temperament refers to the metabolic constitution of a person and one’s pattern of behavior. Temperament was thought to be partially dependent on one’s astrological sign or constellation at birth and on one’s place of conception. If the temperament is balanced, there is no need for medical treatment. An illness creates an imbalance in the temperament. There are eight different kinds of imbalance in temperament. Four are simple: an imbalance in heat, cold, dryness, or moisture. Four are compound: an imbalance in the combination of heat and dryness, an imbalance in the combination of heat and moisture, an imbalance in the combination of cold and dryness, and an imbalance in the combination of cold and moisture.

The temperament of a person comes about primarily from the interaction of the qualities of the four elements acting on the components of the body. For example, blood is hot and moist. If a person were to sleep excessively or to become exposed to cold, the natural heat of the blood would dissipate and the result would be too much moisture. The diagnosis of this condition would be an ‘‘imbalance of the hot temperament of the blood,’’ and treat- ment would be given accordingly. The breath, blood, and liver are consid- ered the hottest components of the body. When they are out of balance by being too hot, herbs with the quality of cold are given to restore balance. Hair, bones, and cartilage are considered the coldest components of the body. Oil, fat, and the brain are considered wet components, while ligaments, tendons, and the serous membranes are dry components. A ‘‘hot imbalance’’ is hotter than it should be but not moister or drier. A ‘‘cold imbalance’’ is colder than it should be but not moister or drier. A ‘‘dry imbal- ance’’ is drier than it should be but not hotter or colder. A ‘‘moist imbal- ance’’ is wetter than it should be but not hotter or colder.