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Paper by Prof Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard(, DrPH (Harvard) Professor of Epidemiology and Islamic Medicine Universiti Brunei and Visiting Professor of Epidemiology at the Faculty of Medicine Universiti Malaya at Dhaka on 30th March 2007. WEB: http://omarkasule.tripod.com
ABSTRACT
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 characterized by being value-based, by being holistic under the tauhidic paradigm, and by conforming to the 5 purposes of the Law, maqasid al shariah. The Qur’an and sunnah have guidelines for the treatment and cure of diseases. The appeal of the concept of Islamic medicine is set to grow phenomenally in the next 20 years. This growth will be driven by two main forces: defining Islamic alternatives in many fields of endeavor and general dissatisfaction with modern scientific medicine because of over-emphasis of technology over the human dimension. The Islamic approach to medicine has reintroduced the human element in medicine without denying the benefits of modern medical technology. Islamic hospitals and Islamic faculties of medicine are being built. The Islamic health care industry is expected to experience phenomenal growth. The strict and exclusive monotheism of Islam is a basis for a global perspective in medicine and will help make Islamic medicine a global player not limited by geography or ethnicity.
1.0 THE ISLAMIC MEDICINE MOVEMENT
1.1 Definition of Islamic Medicine as Paradigms and Values
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. 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 is called Islamization of Medicine. 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 objective, universal, value-based, and excellent for all.
1.2 Impact of Islamic Medicine
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.
1.3 The Motivation Behind Islamic Medicine: Conceptual and Moral Problems
European[i] 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. There is no consideration of balance and equilibrium in selecting treatment modalities with the result that an unacceptably high number of patients are being treated for side effects of modern therapeutic agents. Too much narrow specialization leads to lack of a holistic approach to the patient. The physician behaves as a technician 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. Secularized medicine has no consistent set of ethics leading to malpractice, fraud, and bias in research. Accepting only empirical knowledge and negating other sources of knowledge had also created new problems. By denying a religious and moral dimension, European medicine operates in a presumed moral vacuum. It is a gross mistake to attempt to solve social and medical problems of a moral or spiritual nature by use of technology.
2.0 TAUHID AS THE BASIS FOR A GLOBAL OUTLOOK IN MEDICINE
2.1 Basic Tenets of ‘Aqidat Al Tauhid
Islam is strictly and exclusively monotheistic. Judaism is also monotheistic but in practice negates monotheistic universality by being an ethnic faith. Christianity has a qualified monotheism. That leaves Islam with absolute monotheism that translates directly into universal social behavior and social organization. The essence of monotheism, tauhid, is the oneness of the creator, wahdaniyyat al llaah.[ii] Belief in the oneness of the Creator-God, tauhid al rububiyyat, explains the harmony and coordination in the universe created by one God. Tauhid al uluhiyyat implies worship of one God alone. Worship of only one God implies following the Creator’s physical and social laws that make life on earth successful.
2.2 Implications of Tauhid
The concept of wastiyyat motivates the need for moderation and not doing anything in excess. The concept of shumiliyyat extends the tauhidi principle by requiring an overall comprehensive bird’s view of the disease and treatment situation.
3.0 PURPOSES OF THE LAW AS THE ETHICO-LEGAL BASIS OF MEDICINE
3.1 The Theory of Maqasid Al Shariah
Islamic Law has 5 main purposes. Ethical practice of medicine fulfills and does not contradict those purposes. They are: protection of life, hifdh al ddiin; protection of life, hifdh al nafs; protection of progeny, hifdh al nasl; protection of the intellect, hifdh al ‘aql; and protection of wealth, hifdh al maal.
3.2 Protection of Diin, hifdh al diin
Protection of diin essentially involves ‘ibadat in the wide sense that every human endeavor is a form of ‘ibadat. Thus medical treatment makes a direct contribution to ‘ibadat by protecting and promoting good health so that the worshipper will have the energy to undertake all the responsibilities of ‘ibadat. The principal forms of physical ‘ibadat are the pillars of Islam: prayer, salat; fasting, siyaam; and pilgrimage. A sick or a weak body can perform none of them properly. Balanced mental health is necessary for understanding ‘aqidat and avoiding false ideas that violate ‘aqidat.
3.3 Protection of Life, hifdh al nafs
The primary purpose of medicine is to fulfill the second purpose of the shariah, the preservation of life, hifdh al nafs. Medicine cannot prevent or postpone death since such matters are in the hands of Allah alone. It however tries to maintain as high a quality of life until the appointed time of death arrives. Medicine contributes to the preservation and continuation of life by making sure that the nutritional functions are well maintained. Medical knowledge is used in the prevention of disease that impairs human health. Disease treatment and rehabilitation lead to better quality health.
3.4 Protection of Progeny, hifdh al nasl
Medicine contributes to the fulfillment of this function by making sure that children are cared for well so that they grow into healthy adults who can bear children. Treatment of infertility ensures successful child bearing. The care for the pregnant woman, pre-natal medicine, and pediatric medicine all ensure that children are born and grow healthy. Intra-partum care, infant and child care ensure survival of healthy children.
3.5 Protection of the Mind, hifdh al ‘aql
Medical treatment plays a very important role in protection of the mind. Treatment of physical illnesses removes stress that affects the mental state. Treatment of neuroses and psychoses restores intellectual and emotional functions. Medical treatment of alcohol and drug abuse prevents deterioration of the intellect.
3.6 Protection of Wealth, hifdh al mal
The wealth of any community depends on the productive activities of its healthy citizens. Medicine contributes to wealth generation by prevention of disease, promotion of health, and treatment of any diseases and their sequelae. Communities with general poor health are less productive than healthy vibrant communities.
4.0 MEDICAL GUIDELINES IN THE QUR’AN AND SUNNAH
4.1 Qur’anic Medicine
The Qur’an is a book of moral guidance that provides general principles that guide the development of knowledge in various disciplines. It therefore does not go into details about disease. The Qur’an is itself a cure.[v] Honey is described in the Qur’an as a cure.[vi] The Qur’an described disease in prophet Ayyub (PBUH) and its eventual cure.[vii] The Qur’an describes how Isa cured chronic diseases.[viii] Humans try, but it is Allah who cures, allah huwa al shafi.[ix]
4.2 Prophetic Medicine
We find more details about medicine in the hadiths of the Prophet. Bukhari in his Sahih narrated 129 hadiths directly related to medicine. He devoted two books to medicine: kitaab al tibb and kitaab al mardha. There are many other hadiths in Bukhari indirectly related to medicine. Other books of hadith also narrate more hadiths with relevance to medicine. Scholars have collected these hadiths together and some have related them to available medical knowledge. Among these authors are: Abu Nu’aim (d. 430 AH), Ibn Qayyim al Jawziyat (d. 751 AH), and Jalaluddin al Suyuti (d. 911 AH). There are also more recent writings as articles and books.
The prophet Muhammad (PBUH) said in an authentic hadith that Allah did not reveal any disease, bau, without also revealing its cure, dawau.[x] Humans are encouraged to seek treatment, al hatthu ‘ala al dawaa.[xi] Some people may know the cure and others may ignore it but it nevertheless exists. 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. Al Suyuti listed preventive medical measures such as food and exercise. Other preventive measures taught in hadith include: quarantine for epidemics, hijr sihhi, forbidding urination in stagnant water, bawl fi mai raqid, use of tooth stick, siwaak, precautions in the house at night to prevent fire and pests, and leaving a country because of its water and climate.
Study of tibb nabawi reveals that there are spiritual aspects of healing and recovery. Prayer, dua, recitation of the Qur’an, and remembrance of Allah play a central role. Psychosomatic diseases could respond to spiritual approaches. Curative medicine involved prophetic teachings about treatment of wounds, use of honey and the black seed for several ailments. The use of ruqyat (surat al fatiha, al mu’awadhatain) falls between physical curative and spiritual. The curative part of ruqyat can be understood in modern terms in the way the psyche can modulate immune mechanisms that protect against disease.
In his book, A Tibb al Nabawi, Imaam Ibn al Qayim mentions many medical conditions for which the Prophet provided guidance. He interpreted the hadiths using the available medical knowledge of his day. This book needs rewriting and it will look very different if written interpreting the prophetic traditions using today's medical knowledge. Diseases in tibb nabawi treatable by natural remedies were listed as: 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.
Ibn al Qayyim also mentioned other diseases 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.
4.3 Spiritual modalities of treatment
Among spiritual approaches to disease management is use of dua from the Qur’an[xii] and hadith as ruqiy. Dua was reported to have been used for madness, dua min al junoon[xiii] and for fever.[xiv] The formulas for ruqy reported from the prophet, al ruqiy al ma’athuur, consist of the following chapters of the Qur’an: al fatihat, al falaq, al naas, ayat al kursi, and the various supplications reported from the prophet, dua ma’athurat. The Qur’an is the best medicine.[xv] Dua is medicine.[xvi] Asking for protection from Allah, isti’adhat, is medicine. A strong iman and trust in Allah, tawakkul, play a role in the cure of diseases. Salah is a cure.[xvii] The spiritual approach to cure is mediated through the physical processes. Psychosomatic processes affect the immune functions and other metabolic functions of the body. A believer who is spiritually calm will have positive psychosomatic experiences and not negative ones because he or she will be psychologically healthy and at ease. Faith can change the very perception of disease symptoms. Pain is for example subjective. A believing person who trusts in Allah may feel less pain from an injury than a non-believer with the same injury.
4.4 Physical modalities of disease treatment
Ibn al Qayyim mentioned three therapeutic modalities used in Prophetic medicine: natural, spiritual, mixture of natural and spiritual. The physical treatments mentioned were honey, al 'asal; cold water for fever, al mau al barid, diet, ghadha, milk, al laban, camel milk, camel urine, cupping, al hijaam, cauterization, al kayy, venesection with cauterization, qati’u al uruuq wa al kayy;. The black seed, al habba al sauda, was especially emphasized.
Among physical approaches to disease management is: diet, natural agents (chemical, animal and plant products), manufactured chemical agents, surgery, jiraha, and physical treatment e.g. heat. Physical approaches can reverse disease pathology, mitigate its effects or just stop farther progression. All therapeutic agents and procedures are allowed unless they contravene a specific provision of the Law. This provides a wide scope for the practice of medicine. Bad medicine is forbidden.[xviii] Bad medicine causes more harm than benefit. While seeking treatment, the moral teachings of Islam must be respected. The end never justifies the means. Haram material is not allowed as medicine except in special circumstances where the legal principle of necessity, dharurat, applies. Alcohol is for example not an accepted cure for any disease; it is actually itself a disease.
Harmful treatments are not allowed in situations in which the cure is worse than the disease. Choice of what treatment modality to use should involve a careful weighing of benefits and possible harm or injury. It is a principal of Islamic Law, shariah, to give priority to preventing harm over accruing a benefit.
Evil people use pharmacological agents for bad and selfish reasons for example in altering people's minds to deliberately cause harm.
4.5 Prohibition of shirk in seeking cure
Shirk arises when humans seek and expect cure of disease from anything other than Allah. Manifestations of shirk practices in disease treatment include: amulets, tamaim; divinations, kahanah; and worshipping or asking cure from humans called saints, awliyaa, by visiting their graves. Other superstitious practices usually associated with shirk are: claiming knowledge of the unseen and claiming supernatural powers by any human. Many people with disease conditions resort to shirk practices due to misguidance by shaitan. These practices nullify ‘aqidat al tauhid because they attribute disease and its cure to other than Allah. They also distract from seeking true treatment based on rational scientific medicine. Patients delay coming to hospital and by the time they come the disease is too advanced for easy cure.
Involvement of jinn and shaitan: Jinn possess power that is used to misguide and give credibility to shirk and superstition. The jinn do not know the unseen.[xix] A good Muslim should not be involved with jinns and should ask Allah for protection against them.[xx]
A fortuneteller, kahin, is a liar who pretends to know the future or the unseen and provides information to the gullible clients. The prophet forbade consulting fortunetellers, al nahyu ‘an hawlaan al kaahin, al nahyu ‘an istishaarat al kaahin.[xxi] Fortunetellers are able to convince their clients about supernatural knowledge because of assistance by shaitan that listens to people’s secrets and informs the fortuneteller, istishraaq al shaitan al sama’u.[xxii]
Astrology, tanjim, is the belief that movement of planets, stars, the sun, and the moon can affect peoples’ lives. The astrologer uses these phenomena to make predictions about disease or its cure. The astrologer, munajjim, is a liar because he or she is trying to appropriate Allah’s prerogative of knowing the unseen, ghaib. Astrology was forbidden by Islam, al nahyu ‘an al tanjiim.[xxiii]
Divination, tatayyur was mentioned in the Qur’an.[xxiv] Divination is foretelling the future using several techniques such as horoscopes, astrology, geomancy (use of figures or lines), crystal gazing, possession by a spirit that answers specific questions, pyromamcy (divination by fire), hydromancy (divination by water), cleromancy (divination by lots), somatomancy (divination based on body appearance), phenology (divination by features of the head), and oneiromancy (interpretation of dreams). Augury is divination of the future by observation of natural phenomena in plants, animals, or inanimate objects to see omens (divinatory signs). What is surprising is that spread of modern science based on empiricism has not done away with the superstition of divination. It is also surprising that those who consult diviners do not test the predictions of the diviners but just believe them or ignore them and never reach the conclusion that diviners do not know or just guess.
Amulets / talisman are objects thought to bring good fortune or to prevent disease. They may be natural or man-made. They may be of plant or animal origin. Some are made of stone or metals. They are thought to have magical powers. Talismans are forms of shirk, al tamaim shirk[xxv] and it is offensive to carry them, karahiyat haml al tamaim.[xxvi] There is no difference in prohibition between talismans from the Qur’an and those from other sources. There are people who hang amulets, azlaam, on their body for protection instead of relying on Allah.[xxvii] Such actions are very demeaning to humans. How can a human who possesses an intellect rely for protection on a small object that he manufactures himself and hangs around his neck?
4.6 Medicine and Pre-determination, qadar
Disease treatment is part of qadar.[xxviii] Seeking treatment does not contradict qadar or tawakkul. Disease treatment is part of qadr. The principle that applies here is reversal of qadar by another qadar, rad al qadr bi al qadr. Disease could be prevented before occurrence or could be treated after occurrence. The concept of prevention, wiqayat, does not involve claiming to know the future or the unseen, ghaib, or even trying to reverse qadar. The human using limited human knowledge attempts to extrapolate from the present situation and anticipates certain disease conditions for which preventive measures can be taken. Only Allah knows for sure whether the diseases will occur or not. The human uses knowledge of risk factors for particular diseases established empirically to predict disease risk. Preventive action usually involves alleviation or reversal of those risk factors. For example stopping cigarette smoking can prevent lung cancer and ischemic heart disease. Obeying fire regulations can prevent fire accidents. Careful driving prevents road traffic accidents and trauma. Immunization prevents viral and bacterial infections.
5.0 THE ISLAMIC HEALTH INDUSTRY: PROSPECTS AND CHALLENGES
5.1 The Islamic Medicine Alternative
The appeal of the concept of Islamic medicine is set to grow phenomenally in the next 20 years. This growth will be driven by two main forces. The first one is the general process of defining Islamic alternatives in many fields of endeavor. For example Islamic banking has expanded to all countries of the world being recognized and catered for by the Bank of England and virtually all banking giants that are not in any way describable as Muslims. Many of these banks have set up special accounts and special windows to handle Islamic banking and the industry is worth billions with the prospect it shall soon be worth trillions.
5.2 Dissatisfaction
The second driver is the general dissatisfaction with modern scientific medicine. This dissatisfaction is evidenced by the phenomenal growth of alternative traditional of complementary (TCM) medicine. The disadvantage of the TCM movement has been denying a large number of patients the powerful curative modalities of scientific medicine. People turn away from scientific medicine not because of its technology but because of its lack of a human dimension. The growing popularity of Islamic medicine is that it has reintroduced the human element in medical practice without missing out on the benefits of modern medical technology. This popularity is witnessed by building of Islamic hospitals in many parts of the world. The medicine practiced in these hospitals is as modern as is found in the best medical centers in New York and London but has the added value of a human dimension that gives patients so much satisfaction. It is for these reasons that we have included some elements of Islamic medicine in the undergraduate medical curriculum to prepare our students to be players in an industry that is billed to grow phenomenally in subsequent years.
6.0 THE CHALLENGE OF GLOBALIZATION
6.1 Lizard Hole Phenomenon
Prof Malik Badri talked about the Lizard Hole phenomenon based on the hadith of the prophet that Muslims in later times would follow non-Muslims like lizards follow one another into lizard holes.[xxix] Creators of lizard holes want to retain intellectual leadership and initiative. They create new lizard holes so fast that they do not have enough new ideas for them. Old ideas have to be recycled and labeled as new ones using different terminology and words. Globalization is one of the lizard hole phenomena that is as old as human history but is being presented today as a new phenomenon and as an addition to the lizard holes that Muslims are being persuaded to enter. Since we know it is old and not new we should spent time examining it critically instead of just entering the lizard hole.
6.2 Globalization Before the 15th Century of Hijra
Globalization is not new. The inhabited world has always been global. Humans created from Adam and Hawa have walked on their feet to far corners of the world where humans live today. The evidence for these wide-scale human movements is still preserved for us today. Physical anthropologists can trace the spread of humans by studying physical and genetic characteristics along the routes of migration. Cultural anthropologists can make similar studies using linguistic tools. Thus humans before and after history have been moving around and interacting with one another genetically, culturally, politically, religiously, and commercially.
6.3 Globalization in the 15th Century of Hijra
Globalization in the 15th century H differs from ancient globalization in having faster communication and movement. Ancient communication was 2-way with mutual influence on one another. Modern globalization is one-way transfer of information and culture from the industrialized countries to the less industrialized. Economically cheaply-priced raw materials flow from the less industrialized countries to the more industrialized while fewer economic benefits flowing in the opposite direction.
6.4 The future of Globalization
The laissez-faire attitude to globalization will continue as long as it is comfortably one-way. When demographic, social, economic, and ideological trends start forcing a reversal of the flow of information, culture, ideology, and economic initiative in the opposite direction, industrialized countries will respond by curtailing or shutting down globalizing trends. The first victim of the shut-down will be the internet.
6.5 The challenge of globalization in medicine
Medical knowledge, skills, and technology flow from the industrialized countries. The less industrialized ones are consumers and not producers of medical knowledge. The challenge is to reverse this unhealthy trend by a vigorous research program to be producers of knowledge.
7.0 IBN SINA and THE CHALLENGE OF GLOBALIZATION
Ibn Sina in whose honor this lecture is being given lived at a time similar to our times. Greek knowledge and science were dominant. Ibn Sina studied all the available medical knowledge and went on to research and adds onto that knowledge. He therefore exemplified the ideal we need today. He was a producer and not a consumer of knowledge.
Al Shaikh al Rais Abu Ali Al Hussain Bin Abdillah Bin al Hassan Ibn Sina (370-428 H / 980 – 1037 CE) wrote many books the most famous being al Qanuun fi al Tibb, a 14-volume encyclopedia on disease classification and causes, therapeutics, simple and compound medicines, hygiene, and functions of the body. The book was translated into Latin and had a major impact on western medicine being taught until the 18th century CE. Ibn Sina recognized that TB was contagious. He accurately described the symptoms of diabetes mellitus. He discovered ancylostoma. Besides medicine, Ibn Sina made contributions to science, mathematics, chemistry, and philosophy.
NOTES
[*] Ibn Sina keynote address by Prof Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard(, DrPH (Harvard) Professor of Epidemiology and Islamic Medicine Universiti Brunei and Visiting Professor of Epidemiology at the Faculty of Medicine Universiti Malaya at the 4th Universiti Malaya Medical Center Conference on Medicine from the Islamic Perspective held at the Saujana Subang Malaysia on 24th March 2007
[i] The term European is used here to refer to a distinct culture and world-view based on Greco-Roman and Judeo-Christian traditions. It developed in Europe and was carried by European colonizers, settlers, and rulers all over the world. It is today the dominant culture on the world scene.
[ii] Qur’an 28:70
[iii] Qur’an 4:1
[iv] Qur’an 49:13
[v] Qur’an 17:82
[vi] Qur’an 16:69, 3:49, 5:110, 9:14, 10:57, 10:69, 17:82, 26:80, 41:44
[vii] Qur’an 21:83-84, 38:41-44
[viii] Qur’an 3:49, 5:11
[ix] Qur’an 21:83-84, 26:80, 38:41-42
[x] Bukhari K76 B1
[xi] Tirmidhi K26 B2
[xii] Qur’an 17:82
[xiii] Ahmad 1:302
[xiv] Tirmidhi K45 B36
[xv] Ibn Majah K31 B28
[xvi] Ahmad 2:446
[xvii] Ibn Majah K31 B10
[xviii] Tirmidhi K26 B7
[xix] Qur’an 15:17-18, 34:14, 37:6-10, 67:5, 72:8
[xx] Qur’an 3:36, 7:200, 16:98, 114:1-6
[xxi] Muslim K39 H121
[xxii] Bukhari K59 B6
[xxiii] Ibn Majah K23 B28
[xxiv] Qur’an 7:131
[xxv] Abudaud K27 B17
[xxvi] (KS142)
[xxvii] Qur’an 5:3, 5:90
[xxviii] Tirmidhi K26 B21
[xxix] latatabi’anna sunan alladhiina min qablikum hadhwan al qatra bi al qatra hatta law dakhaluu juhra dhabbi ladakhaltumuuhu qaalu al yahuudi wa al nasaar ya rassula al llaah? Qaala faman? Lata akhudha ummati bima akhadhat al umam qablaha shibran bi shibrin wa diraa’an bi dhiraa’in hatta law minhum man ata umahu ‘alaniyyatan lakaana min ummati man ya ati ummahu ‘alaniyyatan. …. ‘an abi sa’ied al khudhri : latatabi’anna sunan man kaana qablakum shibran bi shibrin wa dhiraa’an bi dhiraa’in hatta law salakuu juhra dhabbin lasalaktumuuhu. Qulna ya rasuul al llaah al yahuud wa al nasaara? Qaala faman?