Home 
Contact 
Profile 
Videos 
Background material for a faculty development program at the Faculty of Medicine King Fahad Medical City on 6th April 2010 by Professor Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard)
NB: PLEASE READ AND CORRECT ANY MISTAKES IN SCIENTIFIC FACTS
INTRODUCTION: READING THE 2 BOOKS
The purpose of this workshop is to discuss the Islamic epistemological perspective of basic medical sciences. A medical scientist is led to appreciate the signs of the Creator, ayat al allah, from the book of empirical scientific observation, kitaab al kawn, alongside appreciating the signs of the Creator from the book of revelation, kitaab al wahy. From this he / sje can reach a synthesis of reading the two books together, al jam'u bayna al qira atain, which will be the summit of knowledge, understanding, and wisdom
This paper will attempt to present a joint reading of the 2 books focusing on the following phenomena: (a) perfection, optimality, and incomparability of Allah's creation in anatomy, physiology, and biochemistry (b) Phenomena of control in anatomy, physiology, biochemistry as manifestations of underlying laws and integration of the organism (c) homeostasis as a manifestation of the concepts of mizan, wasatiyah, tadhafu’u, and e’itidaal and interaction with the environment. A follow up workshop will discuss each of the organ systems to complete the picture.
1.0 PERFECTION, OPTIMALITY, INCOMPARABILITY OF ALLAH'S CREATION
1.1 CONCEPTS
Allah’s creation is perfect. Allah is the best creator, ahsan al khaliqin[1]. He perfected everything He made, kamal al khalq[2]. He made humans in the best image, ahsan suurat[3]. The process of perfection went through four stages: creation, khalq; making due proportions, taswiyat[4]; balancing, ta‘adil[5]; and making the best image, taswiir[6]. The biological perfection was created and not evolved. Every living and non-living things was created perfect de novo. All what Allah created has a purpose[7]. This applies to the whole organism or its constituent tissues and cells. Order, nidhaam; harmony; and perfection, kamaal, are part of pre-determination, qadar, and are not accidental. Denying the existence of a creator is an intellectual and mental aberration that is incompatible with logic because perfection and harmony could not arise by chance. The constant physical laws, sunan al kawn[8], operate in both inanimate and biological systems. Every human is unique and is different from everybody else, a testimony to the power of the Creator. The human is created in the best and optimal fashion, ahsana taqwiim[9] and all biological systems are optimal. Change is governed by natural laws, sunan llah. There is a balance between constancy and change. The Qur’an challenged humans and other creations to create the like of Allah’s creation and proved them incapable of facing the challenge[10]. Cloning, genetic engineering, and selective breeding are not de novo creations and can not be compared to Allah’s creations. No human or any other being can create new life, ‘ajz al shuraka ‘an al khalq[11]. Human actions are imperfect.
1.2 MANIFESTATIONS: ANATOMY
Perfections of perfection and optimality are found in all medical disciplines. In anatomy, for example, parity, al zawjiyat, in general[12], parity of gender[13], parity of organs[14], symmetry, both circular and lateral symmetry, laterality of left and right[15], adaptation of structure to function, consistency and predictability, and orderly change (staged, anticipated, and protective measures against mistakes).
1.3 MANIFESTATIONS: PHYSIOLOGY and BIOCHEMISTRY
Manifestations of perfection and optimality in physiology, biochemistry, & pharmacology are: the human organism functioning as a single entity[16], correlation between structure and function, repeatability / replicability, specificity, specialization, complementality, co-operation, a hierarchy of importance, information processing / perception, reserve capacity in organs, and compensation for overload.
The complex human organism has few basic building blocks: amino acids, monosacharides, and fatty acids.
The discovery of the periodic table of elements is one of the strong indicators that there is order in the universe.
Metabolism of new synthetic molecules is a miracle of creation that needs appreciation. The finding that synthetic molecules can be metabolized by the biological systems indicates the existence of a unifying scheme of creation based on sunan al laahi fi al kawn.
1.4 MANIFESTATIONS: BIOSTATISTICS AND EPIDEMIOLOGY
Manifestations of perfection and optimality in biostatistics and epidemiology are consistency & predictability, inference and causality, and probability.
2.0 CONTROL
2.1 CONTROL IN ANATOMY
There is centralized master control of physiological functions mediated by the pituitary gland, the hypothalamus, and the CNS. This control has a genetic basis in the form of DNA. DNA has 6x10e9 bits of information called codons. These represent 10E7 genes. Each gene codes for one protein molecule. Command and control in physiology relate very well to the integrative concept of tauhid. For efficiency there must be a controlling center otherwise contradictions from many un-coordinated centers of control will lead to failure. An orderly and harmonious universe cannot have more than one master. Examples of control are the integrity of DNA despite continuous mitosis, normal cell growth, control of embryological development
2.2 CONTROL IN PHYSIOLOGY, BIOCHEMISTRY
Examples of control are control of balance (fluids, electrolytes, iron, acid-base, heat energy, and temperature). There is balance between entropy (disorder) and order, between coagulation and fibrinolysis, between sympathetic and parasympathetic systems, between left and right brain hemispheres, between anabolism and catabolism. Chemical reactions tend to an equilibrium as defined in the Hasselbach-Henderson law. Phenomena of control manifest as control of the heart beat, control of vomiting, control of swallowing, control of coughing, control of gagging, control of posture, control of micturition, control of defecation, control of lactation, control of parturition, control of cell membrane permeability, control of genetic expression, and control of hormonal receptors. Phenomena of periodicity manifest as cycling of matter between organic and inorganic and the circadian rhythm. Constancy and predictability are the basis for diagnostic tests and drug action. These phenomena of control and return to an equilibrium state all indicate underlying fixed laws, sunan, in the human organism.
3.0 HOMEOSTASIS, ‘i’itidal
3.1 THE QUR'ANIC CONCEPT OF THE GOLDEN MEAN
Four Qur’anic concepts relate to the golden mean: mizan[17], wasatiyah[18], tadhafu’u[19], and e’itidaal[20]. The concept of mizan refers to balance. The concept of wasatiyyat refers to the center. Concept of tadafu’u refers to action and reaction. The concept of i’itidal refers to equilibrium.
The human body is in harmony with its internal and external milieu. The internal and milieu and the external milieu are themselves in harmony. There is equilibrium between the internal and external environments.
Tauhid is related to homeostasis. Tauhid implies that the whole cosmos and what it contains have one deliberate creator. The contents must relate to one another in some harmonious way. It is unthinkable that the one creator could create systems that are contradictory to one another. The harmony must however be looked at in a dynamic way. Because there are constant changes, there must arise from time to time contradictions in the state of flux. There must therefore exist mechanisms for restoring the status quo after the changes have been accomplished. Homeostasis restores the normal state once it has been disturbed.
Feed-back may be positive or negative. Negative feed-back operates in homeostasis when deviations from the norm are detected by specialized sensors and compensatory changes are triggered to restore the status quo. Positive feed-back is a very dangerous concept. If a change occurs, positive feed-back will reinforce it in a cyclic way that causes more of the same until all homeostasis is lost. The base-line is not constant. It changes with the environment and time. Variation can be within the range of normality or outside the range of normality. Change may be temporary or permanent. Sleep and fatigue are temporary. Lameness and blindness are permanent changes.
3.2 CARDIO-VASCULAR HOMEOSTATASIS:
The control centers are in the spine, medulla oblongata, or the cortex. The input is from baro-receptors, chemo-receptors, cerebellum, and cerebrum. The output is through the autonomic nervous system to the heart and blood vessels. The hormonal factors involved are autocoids, adrenal medulla catecholamines, adrenal cortical hormones, and vasopressin. Oxygen and carbon dioxide have a direct effect on the smooth muscles of the pre-capillary sphincters of arterioles. Kidney auto-regulation also keeps blood flow at a constant rate. The integrated control of cardiac output depends on sympathetics, catecholamines, and increased venous return.
3.3 RENAL EXCRETORY HOMEOSTATASIS:
The kidney maintains plasma osmolality by ultra filtration followed by selective tubular reabsorption.
3.4 RESPIRATORY HOMEOSTASIS
Neural and chemical mediators are involved in respiratory control. The respiratory rate is controlled by the respiratory center, stretch receptors in the lungs, peripheral chemoreceptors, and central chemo-receptors. The diaphragm and the intercostals are responsible for respiratory movements.
3.5 GIT HOMEOSTASIS
There is balance of glucose, lipids, and nitrogen. Glucose is the final pathway of carbohydrate metabolism. The level of glucose in the blood is finely controlled. Glucose balance depends on dietary intake, rate of entry into cells, and the homeostatic activity of the liver. There is a balance among glycolysis, gluconeogenesis, and glycogenolysis. The level of free plasma fatty acids is finely controlled. It is increased by lipolysis. It is decreased by incorporation into lipoproteins, binding to albumin, and deposit as triglycerides. Plasma cholesterol is also kept in balance. It is increased by dietary intake, liver synthesis through a negative feed-back control, and breakdown of lipid stores. It is removed through feces and bile salts. Intake of nitrogen is dietary. The output is by excretion is in the form of excretion as urea and ammonia; about 80% of the ingested nitrogen is excreted as urea.
4.0 INTERACTION WITH THE ENVIRONMENT
4.1 CONCEPTS
The miracle of the human body is more startling when seen in its interaction with the environment. The interaction between the internal and external environments is purposive and is not a product of chance. The nervous and endocrine systems ensure that the human body can adjust to rapidly changing circumstances of the external environment. This even includes changes on anticipation of external changes. The interaction between humans and their external and internal environments is part of Allah’s grand design and is not by mistake. This implies that this interaction has to be harmonious and follows the laws of Allah sunan llah fi al kawn. The human body is programmed to interact with the environment in the most efficient way. However humans because of their free will can behave in ways that produce unhealthy interactions. There are some phenomena like disease or drought that may bring adversity to humans. These are part of the grand design to ensure that there are checks and balances in the eco-system that ensure equilibrium. The adversities are therefore not created for punishment of humans. The universe was placed under the humans, taskhir[21], They control and change it as they want. However this control is sometimes not proper resulting into imbalances and problems. The crucial question is to determine what changes are bad because they derange the permanent fixed laws of nature, al sunan. A decision must also be made on what changes must be made for purposes of building a civilization.
4.2 THE PHYSICAL ENVIRONMENT
The human body is able to adapt to all types of physical environments. Human eucaryotic cells are less dependent on the external chemical environment that pro-karyotic cells. They have in a way created their own environment in their internal environment. Human can change environment. Some of the changes are for the good of the eco-system while some others are definitely harmful. Humans can sustain injury from the environment.
4.3 THE BIOLOGICAL ENVIRONMENT
The biological environment consists of parasites, animals, and plants. Humans and parasites have evolved a mutual adaptation. This takes several forms: symbiosis, commensalism, and parasitism. Parasites undergo antigenic change to avoid host immune defences. Plants are a source of food. They are involved in the oxygen, carbon dioxide, and nitrogen cycles that are necessary for human comfort. Human are able to eat some plants or parts of plants for which they have the appropriate digestive enzymes. Plants or parts of plants indigestable by humans still provide human food by being eaten by herbivorous. Under the concept of taskhiir, the earth and its contents were put at the disposal of humans. Taskhiir has its limitations based on the need to establish balance and equilibrium in the eco-system and protect humans from harm. Animals and plants are a source of food. Humans are at the top of the food chain and all food webs.
4.4 MICROBIOLOGICAL ENVIRONMENT
Micro organisms are viruses, prokaryotes, and eukaryotes. Viruses are the smallest infective agents and are obligate intracellular parasites that depend on the host for survival. In prokaryotes DNA is not bound in a membrane and there is no separation between the nucleus and the cytoplasm. Bacteria, spirochetes, mycoplasmas, and rickettsiae are prokaryotes. Eukaryotes have their DNA separated from the cytoplasm. Protozoa, fungi, helminthes, arthropods are eukaryotes. There are 3 basic types of host-parasite relations: symbiosis, parasitism, and commensalism. Vectors transport parasites in disease causation. Parasites have to overcome overcome host resistance and barriers before disease causation. There is a balance sheet between the benefits and harm of microorganisms. There are many Islamic teachings about avoiding infections.
4.5 CHEMICAL ENVIRONMENT
Water is 45-75% of body weight. Tissues consist of inorganic substances, carbohydrates, lipids, and proteins. Elements higher concentration in humans than earth are H, C, and I. Elements the same concentration in humans and human body and the earth are P, S, Cl, K, and Ca. Humans take elements from the earth as food, drink and through respiration. C is the basis of organic compounds. Humans do not release dangerous chemicals into the environment eg ammonia is detoxified and turned into urea. Humans have complicated the simple chemical environment bequeathed to them by producing new chemicals.
[1] (2:138 & 37:125)
[2] (27:88 & 95:4)
[3] (40:64 & 95:4)
[4] 82:7
[5] 82:7
[6] 82:7
[7] (23:115)
[8] 3:137, 4:26, 33:62, 35:43
[9] (95:4)
[10] (7:191 & 25:35-36)
[11] (7:191 & 25:35-36)
[12] (11:40 & 51:49)
[13] (92:3 & 78:8)
[14] (12:84 & 111:1)
[15] (7:17 & 84:7-8)
[16] (MB2018)
[17] 55:7-9, 57:25, 21:47
[18] 2:143
[19] 2:251, 22:40
[20] 82:7
[21] 13:2, 14:32, 14:33, 16:12, 29:61, 43:13