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Background material for a faculty development program by Professor Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard)
5.0 ALIMENTARY SYSTEM, maidat
5.1 FOOD AS RIZQ
Food is needed for energy, growth, repair, and maintenance of the body. The Qur'anic term rizq means sustenance. It refers to food useful to the body. Rizq is from Allah alone and He provides for all. The alimentary canal is a tube outside the body in direct contact with the external environment. Some food ingested at the mouth exits at the anus without entering the body. Digested food is absorbed by the intestines to enter the internal environment. The alimentary canal has a role in balancing the internal and external environments. It takes material from the environment, processes it, and returns it to the environment. Human appetite for food (a requirement for survival) is so strong that prayer is delayed when food is presented.
Nutritional habits reflect underlying visions, beliefs, and cultural experiences. The alimentary system can be looked at as the final pathway for human corruption because food security is the underlying but often unstated purpose behind crime, corruption, treachery, amassing of wealth, aggression, and many other transgressions. Believer eat to get energy for ‘ibadat; non-believers may eat for enjoyment or to get energy for evil. A believer is satisfied with less food than a non-believer. The search for food and its ingestion is part of ‘ibadat. The human is rewarded for efforts to feed himself or herself. The ‘ibadat aspect is emphasized by the fact the feeding starts with the basmalah and end with the hamd. Fasting of Ramadhan is one the major acts of obligatory physical 'ibadat. It serves the functions of cleansing and protecting the body.
5.2 DIGESTION AND ABSORPTION:
Digestion takes place in the mouth, the stomach, and the intestines. The prophet taught measures to prevent oral infections: rinsing the mouth after a meal and use of the tooth-pick. He taught stopping to breathe during drinking because of deglutition apnea. The Qur'anic term batn refers to the whole gastro-intestinal tract or the whole internal cavity and not only the anatomical stomach. Humans have to eat at intervals because of limited internal food storage. The limited storage enables them to engage in 'ibadat and other activities of human civilization without having to eat continuously. Besides its digestive function, the stomach acts to warn humans of impending starvation by its hunger pangs. The Qur'an mentioned the intestine as being destroyed by bad food.
5.3 ELIMINATION
The alimentary system separates the nutritious food to be absorbed from the non-nutritious one to be eliminated as waste. It protects the environment by detoxifying ingested toxins or detoxifying metabolic products before elimination into the ecosystem. Feces are considered filth (najasat) largely because of their content of infective and toxic material. Proper disposal of excreta at both the individual and community levels is a mark of civilizational development. Islam started with a revolution in hygiene by teaching proper toilet etiquette and cleaning with water in both wudhu and ghusl. Hygiene is a pre-requisite for many humans to live together (civilized existence) because it prevents infectious and toxic disease.
5.4 MATABOLISM
The complex human food in all its varieties is in the final analysis reduced to a few chemical compounds after digestion (amino acids, glucose, and fatty acids). They are all finally reduced to Acetyl CoA that enters the Krebs cycle. The main purpose of the metabolic processes is to generate energy from food. The liver is the chemical intermediary between the alimentary system and the rest of the body. It is responsible for maintenance of the body's chemical and metabolic homeostasis. It is the great factory involved in both anabolism and catabolism. The liver is also the great protector of the body by detoxifying toxic substances from the alimentary tract.
5.5 GIT and NUTRITIONAL DISORDERS
The diseases of over-nutrition are obesity, diabetes mellitus, ischemic heart disease, and atherosclerosis. The prophet taught the rule of the thirds as a guide for food intake: one third for solid food, one third for water, and one third empty[1]. He taught that Muslims do not eat until they are hungry and when they eat they do not fill their belly. Ibn al Qayim defined three levels of food: necessary, hajat, sufficient, kifayat, and excess, fadhlat. The necessary is for maintenance of life and health. The sufficient is for psychological satisfaction. The excess is harmful. Obesity is a result of excessive intake without matching physical exercise. In a hadith reported by Aisha, the prophet described obesity as one of the signs of social degradation.
6.0 URO-GENITAL & CARDIO-RESPIRATORY SYSTEMS
6.1 EXRETORY SYSTEM, jihaz bawli
The excretory system consists of the kidneys, the ureters, the bladder, and the urethra. The system forms and voids urine and ensures fluid and electrolyte balance. It ensures homeostatic control of the body by controlling and maintaining the volume, pH, and ionic composition of plasma. The kidney is the most important organ in homeostasis fulfilling the physical laws, sunan al kawn, relating to equilibrium and balance, tawazun & i’itidaal. Urine is filth, najasat. The Law teaches the importance of avoiding being soiled by urine and teaches measures to safeguard against urine. Washing of hands and the external excretory organs is required after urination. The use of the right hand is forbidden in the toilet because it is the hand used to eat. The urine of breast-feeding infants is treated differently from that of adults in washing. The urine of female infants is also treated differently from that of males. Urination on the street or public places is forbidden.
6.2 GENITAL SYSTEM, jihaz tanasuli
The Qur’anic term farj is used to refer to the external genitalia of both males and females. External genitalia must be private and are considered part of ‘awrat. The uterus, rahim, had special mention in the Qur’an as the abode of the fetus. Fertilization and growth inside the uterus increase chances of survival of human fetii compared to frogs and fish whose ova are fertilized and grow outside and birds whose fetii grow partially inside. Female reproductive physiology manifests predictable cyclicity that is one of the signs of Allah, ayaat al llaah. The ovarian, menstrual, uterine, and vaginal cycles recur every month for 30-40 years of the woman’s life and are closely related to the human reproductive function. The menstrual flow lasts a few days and recurs in a cycle of 28 days on average. The menstrual cycle manifests one of the sunan of Allah because its duration of 28 days is the same as the duration of the lunar cycle. Menstruation is a normal process at the end of each ovarian cycle. Unlike Yahudiyyat, Islam does not make a menstruating woman a social outcast. Menstruation is a cause of physiological stress therefore fasting or prayers are excused. Copulation is a source of physical pleasure but has a deliberate reproductive function that is considered one of the Purposes of the Law, maqasid al shari’at. The Qur’anic term nutfat or mani refers to the male and female gametes that are the spermatozoa and ova respectively. Sex determination is not random but is determined by Allah. Sexual identity is a result of biology and socialization. Some deviant cultures encourage people of one gender to behave like those of another gender contrary to the teachings of Islam that emphasize very strong gender identity and a sharp demarcation between males and females. There are severe punishments for feminine men, al mukhanathin, and masculine females, mutarajilaat. Homosexuality is also severely punished.
6.3 THE HEART
The Qur’anic term qalb is not used in an anatomical sense. The heart is a pump that provides the energy to drive blood through the circulatory system. Parity of the heart is understandable from the embryological point of view. Separation of the left and right hearts ensures supply of well-oxygenated blood to the tissues. Control of the heart rate is by the electrical conduction system.
6.4 THE BLOOD CIRCULATORY SYSTEM
The prophet mentioned the flow of blood inside the body. Ibn Nafees was the first to describe circulation centuries before European writers. The circulatory system is an illustration of the sunan of equilibrium and control. Blood circulation follows biophysical principles and is another illustration of the unity of creation because physical and biological phenomena follow the same laws, sunan al kawn. The efficiency of the heart’s energy conversion is 20%, better than many machines. Blood flow to the skin increases in hot temperature to release heat. During digestion more blood flows into the GIT. During exercise cardiac output increases ten-fold and work done by the heart can increase 500-fold.
6.5. RESPIRATORY SYSTEM
The Qur’an mentioned the chest, sadr but not as an organ of respiration. The lungs are the main organs of respiration. The lungs provide a big opportunity for exchange between the internal and external environments. The term respiration can be used in 2 different ways to mean ventilation or tissue respiration. Coughing and sneezing expel irritants. In coughing the glottis is closed raising intra-ductal pressure to 100mm of mercury. When the glottis is opened suddenly, a jet of air under high pressure is released accompanied by the familiar sound of coughing. The glottis is not closed in sneezing but pressure still builds up. Sneeze is from Allah. Sneeze in salat is from shaitan. The prophet taught the etiquette of sneezing and yawning. The sneezer should praise Allah. It is obligatory for those present to respond to the sneezer. Respiratory movements have been used over the millennia as indicators of life. The Qur’an describes the last moments as sakrat al mawt as respiration begins to fail.
7.0 LOCOMOTOR and PROTECTIVE SYSTEMS
7.1 LOCOMOTOR / MUSCULO-SKELETAL SYSTEM, ‘idhaam & ‘adhalaat
The skeleton has three main functions of support, movement, and protection. It was mentioned in the Qur’an as bones, ‘adhm. Muscles are mentioned in the Qur'an as meat, lahm. Organs are used for worship, work, aggression, and sinning. Wudhu involves washing exposed organs of the body: the face, hands, forearm, leg, ear, mouth, nose, and hair. The upper limb is for manipulation and is specialized for manual dexterity. The lower limb is for posture and mobility and is specialized for weight bearing and walking. The sophisticated human hand is responsible for the advanced human civilization by making tools. The upper and forearms are levers to position the hand. The human upright posture allows use of the upper limb free for manipulation. Control of posture and movement in humans is very advanced to enable upright walking. The musculo-skeletal system act as levers and pulleys with a mechanical efficiency higher than that of man-made machines. Continuous movement and exercise of the musculo-skeletal system is a physiological necessity for growth in infants and to prevent disuse atrophy. Salat is physical exercise repeated five times a day. The Prophet engaged in physical exercise and Omar Ibn al Khattab encouraged physical sports. Physical exercise is best undertaken while doing some work that is useful for the community. The human facial muscles are used in both verbal and non-verbal communication. Body language and body posture can convey very sophisticated messages and emotions. The vocal apparatus, the mouth, the tongue, pharynx, and the larynx, help in producing noises that may be happiness, anger, or fear. They also produce words that have enabled humans have the most sophisticated language and enable recitation of the Qur’an in a sweet voice.
7.2 SURFACES AND MEMBRANES
The Qur’an described skin as a site of punishment because of the sensory function. It also described psychological and physiological reaction of the skin to mention of the name of Allah. The skin will on the last day bear witness because it is used in sinful activities. The functions of the skin are: protection against mechanical injury, excretion through sweat, sensory input, temperature regulation, immune protection, protection against UV rays. Skin color is controlled by 4 pairs of genes. Chemically and optically, it is the melanin in the epidermis and the blood vessels in the dermis that define skin color. The density of melanocytes in the skin does not differ between darker and lighter races. Darker races have more active melanin production than lighter races. The primary purpose of melanin is to protect the skin against cosmic radiation especially ultra-violet radiation. Skin whorls and patterns are unique for each individual. The probability of two individuals having the same pattern is very low. Serous membranes allow smooth movement of organs and play a role in immune protection. Human nails unlike those of animals do not play a significant role in self-defense against attack. They are however used to scratch the skin and to improve grip for some small objects. Tears, sweat, and sebum play non roles in non specific immune protection. The number, size, and depth of melanin particles determine the color of hair from black to blonde. White hair has no melanin. Red hair has iron-rich pigment. Straightness and curliness of hair of hair depend on the shape of the pit of the follicle (straight sharply curved) or shape of hair shaft (round or oval). The pattern of baldness is under genetic control. Hair is part of female beauty.
7.3 THE ENDOCRINE SYSTEM
Functions of hormones are morphogenesis, hemostasis, metabolic regulation, and functional integration. The human hormonal system plays a major part in the flight/fight preparation. Modern sedentary humans have the same hormonal reactions as ancient hunters bit do not face the same physical stresses and risks. The hormonal cascade refers to the chain of command and control with ultimate central control in the hypothalamus. The flow of information is as follows: environmental signal, CNS, limbic system, hypothalamus, anterior pituitary, target organ, ultimate hormone, and systemic effects. The final hormone acts by negative feed-back on the hypothalamus, pituitary, and even the central nervous system.
7.4 THE IMMUNE DEFENCE SYSTEM
Immune defense is recognition and elimination on non-self (foreign) material. Immune defense may be cellular or humoral. Psycho-neuroimmunological research is uncovering what empirical observation has always shown that psychological factors such as stress affect susceptibility to disease.
7.5 HEMOSTASIS
The Qur’an mentioned blood as ddam. The chief function of blood is transport. It is also a buffer. The purpose of the hemostatic system is to maintain the integrity of the closed circulatory system in case of vessel rupture.
8.0 THE SENSORY SYSTEM
8.1 VISION
Vision is physical or moral. The eye is the organ of vision and emotional expression (sadness, pleasure, beauty, communication). Light is a condition for sight. The sources of light are the sun, the moon, the stars, and lamps. Darkness is either physical or moral. Human vision is limited, can be deceived by a mirage, and has poor speed and size discrimination. Blindness can be moral or physical.
8.2 HEARING
The ear is an organ of hearing. Biaural hearing is a bounty from Allah enabling humans to judge distance. Deafness can be physical or moral.
8.3 CHEMICAL SENSATION
Human smell and taste are weak. Odors may be pleasant or unpleasant. Smell and taste of food are appetizing, stimulates salivary and gastric secretions. Humans cannot smell out enemies but can smell or taste dangerous and discard harmful substances. The poor food discrimination of babies due to poor smell and taste enables them to like a wide range of food. Poor human smell is a bounty because they are spared many bad odors in the environment. Chemical sensations by chemoreceptors and osmoreceptors are useful in homeostasis.
8.4 SURFACE SENSATION
The Qur'an mentioned touch as lams or mass. The skin is a sensory organ. The hand is a sense organ that feels size, shape, and texture. The tactile ability of the hand is the basis of human civilization because it enables manufacture and use of tools. Touch can also be used to show love and intimacy. Earthly pain is less severe than pain in the hereafter. Somatic pain is a bounty for humans as an early warning of tissue injury. It is Allah’s bounty that most visceral pain is not felt. Heat is a punishment in the hereafter, and a discomfort on earth. It is Allah’s bounty to protect humans from heat by clouds and shades. Cold is the opposite of heat. Cooling rain water and cold drinking water are bounties of Allah. Hunger and thirst can be physiological, psychological, and moral. They are a warning to replenish food stocks before depletion and do not always indicate immediate danger or pathology. Diabetes mellitus is associated with hunger and diabetes insipidus is associated with thirst. Moral hunger manifests as loss of control of appetite and not getting satisfied. Hunger is a test and a punishment. There will be no hunger in jannat. The food of the dwellers of hell does not cure or satisfy hunger.
8.5 OTHER SENSORY MODALITIES
It is Allah’s bounty that humans are not consciously aware if visceral, kinesthetic or propioceptive sensation otherwise they would be overwhelmed by information. Allah wanted humans to concentrate on sensory input from the external and not the internal environment. The Qur’an and sunnat have described phenomena of extra-sensory perception (ESP) as inspiration, ilhaam; intuition, hadas; instincts, jibillat; and imagination, khiyaal; telepathy; dreams; and revelation. Scientific understanding of ESP is limited. Only dreams of prophets are true. The Qur’an and sunnat have condemned astrology, foretelling, divination, and sorcery.
9.0 THE NERVOUS SYSTEM
9.1 QUR'ANIC CONCEPTS RELATING TO THE NERVOUS SYSTEM
The Qur’an mentioned the functions of the nervous system (thought, memory, forgetting, and emotions) in association with 4 Qur’anic phenomena (naasiyat, lubb, qalb/nafs, fuaad, and dhihn. Humans have freedom of action on a limited scale.
9.2 STRUCTURE and FUNCTION OF THE NERVOUS SYSTEM
The nervous system consists of the central and peripheral nervous systems. Most physiological functions are autonomic not under conscious cortical control. Human behavior can be explained by the nafs, organic factors (chemical and anatomical), early learning, early conditioning, and socialization. Genetically-determined organic factors of behavior do not excuse humans from accountability because the nafs can override organic factors. Diet and environmental factors may also affect behavior. Humans can artificially change their behavior by using chemicals and intoxicants.
9.3 THE INTELLECTUAL FUNCTION, ‘aql
Intellect, ‘aql, includes conceptualisation and categorization, measuring and counting, concrete and abstract thought, causal reasoning, and problem solving. It cannot reason out all moral issues without guidance from revelation. It is very creative and imaginative. It is the basis of judgment (reconciling apparently contradictory information). It is is needed for sensory perception. It is needed for acquisition of knowledge. It is related to observation The 3 main intellectual processes are understanding, fahm; insight, idraak; and judgment, hukm. Consciousness, shu’ur, is both physical (awareness of the environment) and moral (sensitivity to immoralities in the community). Learning is related to memory and language. Humans think by manipulating verbal symbols. Communication is the basis for growth of civilization, family and social functioning, problem solving, and acquisition of new knowledge. The disorders of the intellect are kufr, shirk, junuun, jahal, and thought disorders (sterile argumentation, doubt, self-delusion, and conjecture).
9.4 MEMORY FUNCTIONS, dhhakirat, hifdh
Humans are capable of great memory but the capacity is not fully used. Short-term memory is recollection of recent events. Long-term is persistent recollection of distant events. Implicit memory is involved skills such as driving, eating, and drinking. There is a neurological basis for memory. Memory capacity can be enhanced by dua, strong motivation, and repetition. Memory can suffer from decay, distortion, confabulation, moral forgetting and physical forgetting. Shaitan is the cause of forgetting, moral and physical. Forgetting as a type of negligence cured by remembrance of Allah, dhikr Allah. Humans are not punished for forgetting. Reminding in a moral sense and the physical sense helps humans remember.
9.5 THE MOTIONAL FUNCTION
The qalb is the seat of emotions. Its emotional states can be expansion, inshiraah; stress, dhiiq; and calmness, tama'aninat. The basic animal drives are hunger, thirst, sex, self-protection & security, sociability, and inner promptings of the nafs. The food and sex drives are the strongest and both are necessary for survival of the human species. Humans have drives more and above the animal drives described above: honor, sharaf; altruism, iithhar, faith, iman, consciousness of Allah, taqwah, seeking the pleasure of Allah, ridhallah; seeking knowledge, talab al ‘ilm; appreciation of esthetic beauty, and self-actualization. Drives are inside and emotions are their external manifestations. Satisfaction of drives is associated with pleasant emotions. Dissatisfaction of drives is associated with unpleasant emotions. Drives cannot be denied or abolished but have to be controlled and channeled. Pleasant emotions are love, hope, elation, tranquility, mercifulness, and empathy. Unpleasant emotions are fear, rage, aggression, enmity, hate, hamm