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Paper Presented by Professor Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine at Universiti Brunei Darrussalam at the Annual Health Islamic Conference held at Faculty of Medicine University of Indonesia Jl Salemba Raya No 6 Jakarta Pusat held on 3-5 February 2006 and organized jointly by Forum Ukhuwah Lembaga Dakwah Facultas Kedoketran se-Indonesia and Forum Studi Islam Kedokteran Universitas Indonesia.
A. BASIC CHARACTERISTICS OF PROPHETIC MEDICINE
Definition: 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 practised 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. The prophet's medical teachings were specific for place, population, and time. They however also included general guidance on physical and mental health that is applicable to all places, all times, and all circumstances. Tibb nabawi is not one monolithic or systematic medical system as some people would want us to believe. It is varied and circumstantial. It covers preventive medicine, curative medicine, mental well-being, spiritual cures or ruqyah, medical and surgical treatments. It integrates mind and body, matter and spirit.
Search for cures: 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. Al Habba al Saudaa was recommended by the Prophet as a general treatment and has been studied extensively. Another implication of this hadith is that seeking treatment does not contradict qadar (pre-determination). Thus both the disease and its treatment are part of qadar.
B. SOURCES OF TIBB NABAWI
Pre-Islamic Arab Medicine: Tibb nabawi has several sources: revelation, wahy; empirical experience of the prophet, folk medicine of that time in the Arabian Peninsula and it is possible that some medical knowledge of other communities could have been known in Makka or Madina at the time of the prophet.
The Qur’an: a source of tibb nabawi: Tibb Qur’ani refers to verses of the Qur’an that relate to diseases of the body and the mind and their treatment. The Qur’an talks about physical ill health[1] and mental ill-health/diseases of the heart[2]. Ultimate cure of diseases is from Allah[3]. The Qur’an itself is a cure[4]. It contains supplications for good health as well as guidances on specific therapy such as honey[5], eating only hood halal food avoiding unhealthy haram food[6] and not in excessive amounts[7]. The Qur’an has many medical teachings that could be called Tibb Qur’ani. Tibb Qur’ani is more appropriately related to general principles of a balanced life style that the Qur’an enunciated rather that specifics of scientific explanations for Qu’ranic verses related to medicine (such as contagion, adwah; alcohol, creation, and saum) or establishing medicinal value of plants (zaitoon, tiin, dates, milk, and fruits) mentioned in the Qur’an as food but not as cures. Such an approach usually lacks scientific rigor or accuracy and have creates 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. The Qur’an is not a textbook of medicine but a book of moral guidance. It contains basic information and guidance on medical matters leaving the room open for humans to undertake research and fill in the details. Confining medicine to only the teachings in the Qur’an would make it very limited because the Qur’an is very selective in coverage of details leaving the field open to humans to observe, search for an understand Allah’s signs on earth. Such constraints on the concept of Islamic Medicine would also discourage further research and scientific exploration.
Hadith as a Source of Tibb Nabawi
The following were the forms of prophet’s medical teachings: words of the prophet on medical matters, medical treatment practiced by others on the prophet, medical treatments observed the prophet with no objections, medical procedures that the prophet heard/knew about and did not prohibit. 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 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.
Hadiths on physical remedies are either wahy or based on empirical experience. In most cases we cannot distinguish between the two sources 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]. Thus hadiths that are not specifically wahy are not binding, ghair mulzimat. However all hadiths on spiritual cures of disease are wahy and are binding, mulzimat.
Books on Tibb Nabawi[9]
Many books have been written about tibb al nabawi down the centuries. Books with the title al Tibb al Nabawi were written by Ibn al Qayyim al Jawziyyat (d. 751H / 1350 M), al Hafidh Abu Abd al llaah Shams al Ddiin Muhammad bin Ahmad al Dhahabi (d. 748H), Abu al Qasim al Husain bin Muhammad bin Habiib al Naisapuuri (d. 206H), Abu al Sunni Abu Bakar Ahmad bin Muhammad al Dainawiri (d. 364H), Abu Nu’aim Ahmad bin Abd al llaah al Asfahani (d. 430H), Abu al ‘Abbaas Ja’afar bin al Mu’utazz al Mustansiri (d. 433H), Dhia al Ddiin Muhammad bin ‘Abd al Waahid al Maqdasi (d. 643H), Shams al Ddiin Abu Abd al llaah Muhammad bin Abi al Fath al Ba’ali (d. 709H), Abu Abd al llaah Muhammad bin Yusuf al Sanuusi (d. 895H), Abu al Hasan Nur al ddiin Ali Bin Muhammad al Jazaar al Masri (d. 914H), Qaysuufi Zaadet Muhammad Badr al Ddiin (d. 1020H), Abd al Waziir al Abhari. Jamaal al Ddiin Daud,
Mukhtasar al tibb al nabawi was written by Jalaluddin al Suyuti. Al Ahkaam al Nabawiyyat fi al sina’at an tibiyyat was written by the physician ‘Ali bin Tarkhaan. Kitaab al tibb fi al hadiith by Abu ‘Ubaid bin al Hasan al Harraani (d. 369H). Al Ahkaam al Nabawiyyah fi al sina’at al tibiyyat by Ali bin Abd al Karim al Hamawi (d. 720H). Al Rahmat fi al Tibb wa al Hikmat by Mahdi bin Ali al Sabiiri (d. 815H), al Sayr al Qawi fi al Tibb al Nabawi by Muhammad bin And al Rahman al Sakhaawi (d. 902H), Al Manhaj al Sawi a al Manhal al rawi fi al Tibb al Nabawi by Jalal al Ddiin Abd al Rahman bin Abu Bakar al Suyuti (d.911H). Al Rahmat fi al Tibb wa al Hikmat by Jalal al Ddiin Abd al Rahman bin Abu Bakar al Suyuti (d.911H). Rawdh al Insan fi Tadaabiir Sihhat al Abdaan by Khair al Ddiin Khidhr bin Mahmud al ‘Atuufi al Murzaifuuni (d. 948H). Al Masaabih al Sunniyyat fi Tibb Khair al Bariyyat by Shihaab al Ddiin Abu al ‘Abbaas Ahmad bin Ahmad bin Salamah al Qalyuubi (d. 1069H). Sihhat Aabaad by Othman Zadeh Taa ib Ahmad (d. 839H). Mukhtasar al Tibb al Nabawi by Mur’ish ZadehQudduus Ahmad Affendi (d. 1265H).
Need for New Books on Tibb Nabawi
In his book, A Tibb al Nabawi, Imaam Ibn al Qayim al Jawziyat 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. With modern medical knowledge we can identify more hadiths with relevance to medicine than was possible in the past.
C. CLASSIFICATION OF TIBB NABAWI:
Preventive Tibb Nabawi
The classification of traditions relating to medicine depends on the state of knowledge and changes with time and place. Jalaluddin al Suyuti published a book on tibb nabawi and divided medicine into 3 types: traditional, spiritual and preventive. 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 (1994) 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: fire & pests, leaving a country because of its water and climate, marriage and mental health, marriage and sexual health, dietary control to avoid excesses[10], cleanliness and avoiding filth. Recitation of the Qur’an has beneficial physiological effects[11].
Spiritual Tibb Nabawi
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. 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.
Curative Tibb Nabawi
Ibn Qayim al Jawziyat listed many diseases with their recommended treatments from tibb nabawi. Diseases in tibb nabawi treatable by natural remedies: 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 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. The medical treatments mentioned were honey, al 'asal; cold water for fever, al mau al barid; diet, ghadha; milk, al laban; camel milk; camel urine. The black seed, al habba al sauda, was especially emphasised. The surgical treatments mentioned were: cupping, al hijaam; cauterization, al kayy; venesection with cauterization, qatiu al uruuq wa al kayy.
D. APPLICATION OT TIBB NABAWI TODAY
General Considerations
There are 3 aspects that we have to deal with regarding modern application of tibb nabawi. (a) is tibb nabawi part of the sharia? (b) what is the scope of tibb nabawi? (b) spatio-temporal changes (c) empirical research on tibb nabawi.
Tibb Nabawi as Part of the Shari’at:
A correct answer to this question requires clarifying the very concept of shariat. The regulations about salat, menstruation, and toilet hygiene are part of the shariat rules that are immutable and there is no dispute about them. There are other regulations about the government, ahkam sultaniyat, that are part of the shariat but that change with circumstances. We can therefore distinguish two parts of the shariat: (a) fixed and immutable and applicable to all places and times and (b) fixed general principles whose details of application change with place and time. If we take the meaning of shariat in (b) above we can conclude that prophetic medicine is part of Islamic shariat that can change and grow using ijtihad and empirical research to apply general shariat principles to changing circumstances.
Scope of Tibb Nabawi
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 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[12].
Spatio-Temporal Changes
Whatever the Prophet said or did was valid and must be followed because he never uttered any untruth even when joking. 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 worldy 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. The question is whether all or some of the tibb nabawi should be used today. 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 actual practice it is difficult to ascertain that the conditions are the same. Changes in disease pathology, changes in the genetic pool of the patients, changes in the genetic pool of the medicinal plants, weather and climatic conditions are among many variables that may make a particular remedy recommended by the Prophet not appropriate for a medical condition today. The circumstances of time and place have changed. Indiscriminate use of the historical remedies could be using the right drug for the wrong disease. There is even a more serious linguistic problem. The meaning of words has changed. What was called fever in the 1st century AH may not be the same as the meaning of the same world today. Even medicinal plants like the black seed may not be exactly the same plant. We can therefore conclude that the teachings of tibb nabawi can only be a foundation to guide and encourage scientific research for remedies that are suitable for our times.
Empirical Research on Tibb Nabawi:
There is a lot of scientific interest in prophetic teachings on medicine. In Egypt for example many institutions are involved in research on traditional remedies: universities, the National Research Center, the Desert Institute, and the Horticultural Department of the Ministry of Agriculture. Many medicinal plants including the black seed have been investigated extensively and have been commercialized[13]. The black seed (nigella sativa) is an example of a prophetic remedy that has been studied extensively by both Muslims and non-Muslims. Animal research has shown that the black seed is a potent anti-hypertensive[14] and respiratory stimulant[15]. It was shown to act against bacterial infection in mice[16]. Al-Awadi et al (1991) studied the effect of a plant mixture including black seed on liver gluconeogenesis in rats with induced diabetes[17]. Salomi et al (1991) studied the inhibitory effects of the black seed on chemical carcinogenesis in rats[18]. Nair et al (1991) studied the modulatory effect of the black seed on toxicity in rats induced by a cis-platinum, a cancer treatment drug[19]. Keshri et al (1995) studied the post-coital contraceptive effects of the black seed in rats[20]. El-Dakhakhny (1965) studied the pharmacological properties of the black seed. Toppozada et al (1965) studied the antibacterial properties of the black seed with clinical applications[21]. El-Fattary (1975) isolated and described the anti-bacterial principles from the black seed[22]. Chakravarty (1993) studied the inhibition of histamine release from mast cells by the black seed[23]. Salomi et al (1992) studied the anti-tumor activity of the black seed[24]. Human studies of the black seed have also been undertaken. Akhtar et al (1991) studied the effect of the black seed on nematode worm infection in children[25]. Haq et al (1995) studied the effect of the black seed on human lymphocytes and polymorphonuclear leucocyte phagocytic activity[26]. Laboratory studies provided scientific support for the traditional use of the black seed and its derived products as a treatment for rheumatism and related inflammatory diseases[27]. The study of the black seed as a medicine has even extended to its side effects since no medicine however useful is free from side effects. Steinmann et al (1997) recorded occurrence of contact dermatitis after topical use of the black seed[28]. Tennekoon et al. (1991) studied the possible hepato-toxicity of the black seed[29]. Dr Ahmad El Kadhi (1986) identified immune enhancing capability of the black seed, garlic, and bee honey and started using them in the treatment of advanced cancer[30].
E. CONCLUSION AND FUTURE CHALLENGES
From the survey above we can conclude that tibb nabawi is an authentic and valid medical system. The general principles of this system are applicable at all times and all places. The specific remedies taught by the Prophet (PBUH) are valid and useful. They however can not be used today without undertaking further empirical research.
FOOTNOTE
1 (2:196, 24:61, 48:17, 2:184/5, 1:196, 4:43)
2 (10:57, 2:10, 74:31, 24:48, 2:48, 74:31, 24:50, 22:53, 33:32, 17:52)
3 (26:80)
4 (17:82)
5 (16:69)
6 (2:168, 2:172-173, 6:118-119, 6:121, 6:145-146, 16:114-118, 5:2, 5:4-6)
7 (5:90)
8 ( )
9 Dr Akmal al Ddiin Ihsan Oglu in Proceedings of the 4th International Conference of Islamic Medicine 9-13 November 1986M pages 159-163.
10 Araf:31
11 ffect of Reciting Qur’an on Physiology by Ahmad al Qadhi Proceedings of the 3rd International Conference of Islamic Medicine 26 September – 2nd October 1984M.
12 (2:164, 3:190, 10:5-6, 30:20-27, 39:59, 51:20-23)
13 (Sayed 1980)
14 (Tahir et al. 1993)
15 (Tahir at al 1993)
16 (Hanafy et al. 1991)
17 Al-Awadi et al (1991)
18 Salomi et al (1991)
19 Nair et al (1991)
20 Keshri et al (1995)
21 Toppozada et al (1965)
22 El-Fattary (1975)
23 Chakravarty (1993)
24 Salomi et al (1992)
25 Akhtar et al (1991)
26 Haq et al (1995)
27 Houghton et al (1995)
28 Steinmann et al (1997)
29 Tennekoon et al. (1991)
30 Ahmad El Kadhi. Use of Natural Immune Enhancers in the Treatment of Far-advanced cancer. Proceedings of the 5th International Conference on Islamic Medicine, Kuwait 1988.