Int. Med J Vol 4 No 1 June 2005

TREATMENT OF DISEASE IN AL-TIBB AL-NABAWI

By Dr. Nurdeen Deuraseh[a] [1]

INTRODUCTION

In this article[2], attempts will be made to interpret and evaluate the ahadith of the Prophet (s.a.w) on treatment of diseases[3] which has been practiced since early of Islamic medical history especially during the time of the Prophet (s.a.w) and his companions. We could see that the treatment of diseases in the time of the Prophet (s.a.w) was considered advanced, given the level of scientific knowledge that existed at that time. Although modern treatment of diseases in certain cases is better than the Prophet’s method of treatment of diseases partly due to the fact that the medicine of the Prophet (al-tibb al-nabawi) was not based on experiments but rather on inspiration, experience from the previous culture, and tradition. In many cases, several companions of the Prophet (s.a.w) had successfully carried out preventive medical practices to ward off certain disease. This was done without any knowledge of medicine as practiced today but they merely followed the instructions of the Prophet (s.a.w) relating to the treatment of disease i.e., using a gulp of honey, cupping (hijamah), cauterization (kayy: to burn a wound with hot metal or a chemical to stop the blood or stop it becoming infected), black seed (habbat al-sauda), and camel urine.

IS SEEKING MEDICAL TREATMENT BETTER THAN ABANDONMENT?

In any attempt to discuss the medical treatment in Islamic history, we have to answer before anything else a central question namely ’hal al-tadawi afdal min tarkuhu’: Is seeking medical treatment better than abandonment? In the middle of third century after hijrah and even after, this issue became one of the serious debates and has been discussed widely in Islamic legal literature. In this regard, there are two different opinions of the Muslims in answering the question. These two opinions are based on the ahadith reported by Imam Bukhari (194-256/ 810-870) in bab ma anzala Allah da’ illa anzala lahu shifa’ (chapter on there is no disease that Allah has created except that He also has created its treatment).[4] The first opinion is in favor with Imam Bukhari’s idea that it is better to seek medical treatment. On the other hand, some Muslims especially Sufis might have been inclined to practice tark al-tadawi (abandonment of treatment) as a sign of their piousness.

The first school of thought, which represents the opinion of Imam Bukhari, realized the importance of the art of medicine as a means to preserve the health and restore it, if one falls into illness, into the normal condition. Following the idea of Imam Bukhari, the majority of the Sunni legal schools accepted the use of medicaments because it does not deny the belief of God’s destiny (al-tadawi la yunafi al-tawakkal).[5] For this reason, Ibn Hajr advised a patient to seek relief and healing from any physical or mental ailment by means of medical assistance and treatment; and not only by putting one’s trust in God’s power and mercy. This interpretation was essentially a distraction from the ahadith, although in many cases the Prophet (s.a.w) did not provide specific drug for certain treatment. However, we are responsible to find its cure because Allah (s.a.w) mercifully provides cures for all illnesses except death and old age. Imam Bukhari reported the Prophet (s.a.w) who said: “for every disease there is a remedy, and when the remedy is made apparent the disease is cured by the permission of Allah, the Almighty.” Connecting to this hadith, Imam Bukhari reported that Abu Hurayrah narrated the hadith of the Prophet: “Allah has not created any disease without also creating a medicine or a remedy for it (ma anzala Allah da’ illa anzala lahu shifa’).”[6]

The word al-inzal, (literally means send down), according to Ibn Ahmad al-`Ayni, indicates that disease was sent down by Allah (s.w.t) through the angel (inzal al-mala’ikah al-muwakkilin bi mubasharah makhluqat al-ard min al-da’ wa al-dawa’)[7] and not by supernatural powers, a spirit, a ghost, either because the patient has broken a taboo or otherwise offended a spirit, or simply because he has fallen a victim to the ghost of an un-reconciled dead or to the malice of a demon. After we have heard that disease was sent down by Allah (s.w.t) through angels but patients at all times still have a strong desire to know the meaning of their being sick. Why am I suffering? Why am I sick? Why am I plagued with a gastric ulcer that will kill me? What have I done to deserve such a fate? These are questions the physician today may hear all the time and everywhere. For those who read the hadith “Allah has not created any disease without also creating a medicine or a remedy” ask the question if God is the only one who cures the diseases, so why does God send the disease? The commentators of Sahih Bukhari agreed that God sent down illnesses but they failed to give a detailed explanation why God sent them to people.

They did, however, express some opinions on the matter while discussing various illnesses. Some people believe that an individual is sick as a punishment for having sinned, for having committed an offense against the law of God, especially when an individual is stricken in the organ with which he has sinned. However, Muslims believe that illnesses were not God’s punishment for the believer but it is test him weather he (the patient) appreciates God’s bounty or otherwise. This means that the purpose of sending the disease is to remind the believer that he is a servant who should supplicate humbly to God, the Creator of the entire Universe. As the servant, he has to prostrate himself in front of Him, and seek refuge in Him. If the believer succeeds in fighting disease, then the disease, in this case, is considered as the means to increase his Iman (faith) as the Prophet (s.a.w) said: whatever misfortunes a true believer may have-fatigue, grief, melancholy or worry - are used to redeem his sins.

Although the above evidence seemingly represents Islamic medical teaching, there were Muslims who doubt the permissibility of the use of medicaments. It is very regrettable that some of them were of the opinion that medical treatment is permissible but its abandonment is better. They understood that the use of medicine is an act incompatible with qadar (belief of God’s destiny). They argued that the preference to use medicine was an expression of one’s distrust in Allah (s.w.t). In their opinion, it was only Allah (s.w.t) who directly caused health and illness, and therefore, He alone cures disease. We are not surprised when we were told that Ahmad b. Hanbal (d. 240/855), for example, was reported to have expressed an opinion that medical treatment is permissible, but its abandonment is better. Similarly Rabi‘ah al-`Adawiyyah, the well-known woman Sufi, does not regard treatment of disease as essentially a demand of Islam. In one story, when Rabi‘ah al-`Adawiyyah was asked to pray to Allah (s.w.t) to ease her suffering, she replied that: Do you not know who has willed my suffering? Is it not Allah? If you know this, then why do you ask me to pray for what contradicts His will.[8]

IS HEALING IN THREE THINGS?

In several authentic ahadith, the Prophet (s.a.w) advised a patient to use three methods of treatment of disease, which are still alive in many countries.  They are a gulp of honey (al-`asal), cupping (al-hijamah) and cauterization (al-kayy). Imam Bukhari, in his Kitab al-Tibb (book of medicine), Bab al-Shifa fi Thalatha (chapter on healing is in three things) mentioned three ahadith. Two of them were reported by Ibn `Abbas and another was reported by Jabir b. Abd Allah. The first hadith is: “Healing is in three things: a gulp of honey, cupping, and branding with fire (cauterizing), however, I forbid my followers to use branding with fire (cauterization) (al-shifa fi thalatha: sharbat `asal, wa shartah mihjam, wa kayyah nar, wa anha ummati `an al-kayy).” The second hadith is “Healing is in three things: cupping, a drink of honey and cauterization (branding with fire) but I forbid my followers to use cauterization (al-Shifa fi Thalatha: fi Shartati Mihjam, aw Sharbat Asal, aw Kayy bi Nar, wa Anha Ummati an al-Kayy).” The third hadith is: Jabir bin Abdullah (r.a) reported that he heard the Prophet (s.a.w) said: "If there is any healing in your medicines, then it is in cupping, a drink of honey or branding with fire (cauterization) that suits the ailment, but I don't like to be (cauterized) branded with fire."[9]

After understanding the meaning of the above ahadith, Ibn Hajr reminded us that the treatment of disease does not predestine only three methods of healing namely a gulp of honey, cupping, and branding with fire (cauterizing). In trying to answer the question, why did the Prophet (s.a.w) mention only three methods of healing?, Ibn Hajr clarified that the Prophet (s.a.w) mentioned only three methods of healing mainly because they were usul al-`ilaj, the principle of treatment of disease. In addition, it was widely known among the Arab at that time. It is possible that this belief was the result of Muslim’s discoveries during that time that the cause of disease was mainly blood (damawi) or yellow bile (safrawi) or black bile (sawdawi) or phlegm (balghi).[10] In the light of this theory, they viewed the nature of disease in terms of philosophy and looked upon it as a disturbance in the equilibrium of the body’s blood, yellow bile (safrawi), black bile (sawdawi) and phlegm (balghi). Thus, the disease, which is caused by one of these three, should be treated either by hijamah (taking the impure blood from the body) or honey. If we failed to treat a disease by the mentioned method, then, it must be treated by cauterization or surgery as in our time. The latter could not be more than a last option to which physicians had to consider when a gulp of honey, cupping and dietetic and pharmaceutical treatments failed.

When we ponder this method of treatment of disease, one finds that the treatment of disease, in the time of Prophet (s.a.w), was basically according to the nature of disease and to know its treatment, they were advised to know its cause and symptom (ma`rifatuhu bitahqiq al-sabab wa al-alamah). That is why before commenting on the method of healing as highlighted in the hadith, Ibn Hajr had to clarify two types of diseases namely material disease (mard madiyyah) and non material disease (mard ghayra madiyyah). The former is referred to the disease caused by hotness (al-hararah), coldness (al-buruudah). The latter is divided into wet (rutbah), dry (yabisah) and compound (murakkabah). The non-material disease, according to Ibn Hajr, is treated by what has been said in the hadith “fever is from the heat of Hell, so abate fever with water.”[11]

In the light of this evidence, we feel much more confident to say that the body and the soul of mankind have the possibility of being healthy or sick, and balanced or imbalanced. Imbalance of the body is like fever, headache and other physical illnesses, while that of the soul is like anger, anxiety, sadness and similar symptoms. The former diseases should be treated through the medical methods involving the use of honey, cupping and cauterization, while the latter should be treated by spiritual methods of treatments. In certain cases, one was encouraged to use the spiritual treatment rather than physical treatment for many reasons. First, in seeking to be healed from the disease of the body, the patients bear the bitterness of medications, the suffering of cauterization as well, as spending large sums of money for medical treatment and care. On the other hand, the care and refinement of the soul which is far more important, is more pleasant and rewarding and less costly to treat and restore.[12] Secondly, if the disease was caused by the Jinn and evils, therefore, the ordinary medical therapies were insufficient. Instead, it has to be cured by giving the effort that may help to end the evil spirit’s influence i.e., by strengthening faith in God. This is because, if a persons’ soul was fortified with strong faith, the evil spirits could not easily influence a Muslim. In other words, the spiritual disease appeared as a result of the lack of faith and misery of the soul. In this case, the spiritual disease has to be cured by spiritual treatment.

HONEY: HEALING FOR MEN (SHIFA’ LI AL-NAS)

In Islamic medical system, as in most other medical systems, honey is considered a healthy drink. We are not surprised that Imam Bukhari entitled chapter four of his Kitab al-Tibb (book of medicine) as “al-Dawa’ bi al-Asal wa Qawlihi Ta`ala ‘Fihi Shifa li al-Nas (treatment with honey and the statement of Allah: where is healing for men).” At this place, Imam al-Bukhari mentioned three ahadith on honey together with its value, which is emphasized in many verses of the Quran. In Surah al-Nahl verses: 68-69, Allah (s.w.t) describes honey as Shifa’ li al-Nas: “And thy Lord taught the Bee to build its cells in hills, on trees, and in (men's) habitations; Then to eat of all the produce (of the earth), and find with skill the spacious paths of its Lord: there issues from within their bodies a drink of varying colors, wherein is healing for men: verily in this is a sign for those who give thought.”

In view of this benefit, it is worth mentioning one of the most well known hadith in regard to the medical benefits of honey mentioned by Imam Bukhari in his Sahih Bukhari in Kitab al-Tibb (book of medicine), Bab al-Dawa bi al-Asal waqawl Allah Ta`ala fÏhi Shifa li al-Nas (chapter on treatment with honey and the statement of Allah: where is healing for men). The Prophet (s.a.w) said: “A man came to the Prophet and said: "My brother has some abdominal trouble." The Prophet (s.a.w) replied to him "let him drink honey." The man came for the second time and the Prophet replied to him, 'let him drink honey." He came for the third time and the Prophet replied, "let him drink honey." He returned again and said, "I have done that”. The Prophet (s.a.w) then said, "Allah has said the truth, but your brother's abdomen has told a lie (sadaqa Allah wa kadhiba Batn Akhika). Let him drink honey. So he made him drink honey and he was cured.”[13]

From the above hadith, the treatment of disease was very simple. May be because the Prophet (s.a.w) knew what made the patient sick because he was aware of the well-known method of treatment of diarrhea.[14] In that time, diarrhea was treated by making the patient vomit or by giving him laxative medicine to increase the flow by taking honey. In relation to this, the hadith is concerned about a man who came to the Prophet (s.a.w) and said that his brother was suffering from dysentery (istatlaq al batn).[15] To cure this disease, the Prophet (s.a.w) recommended honey. He came back and reported honey had done no good to his brother. The Prophet (s.a.w) was again advised to take honey. He came back the third and also the fourth time and said he had seen no improvement. The Prophet (s.a.w) said: “The statement of God is true and the stomach of your brother lies (sadaqa Allah wa kadhiba Batn Akhika).”[16] Apparently, the brother’s patient claimed that he had followed the instructions of the Prophet (s.a.w), but with no good results. Thus, we cannot conclude the discussion on this hadith without giving a few words about the meaning of the saying of Prophet (s.a.w): “The statement of God is true and the stomach of your brother lies (sadaqa Allah wa kadhiba Batn Akhika).”

It is important to understand the hadith especially the Prophet’s statement, “The statement of God is true and the stomach of your brother lies.” Before we give correct interpretation of this statement, there are two major remarks, which derive from the hadith that we have to put into consideration. First, the Prophet (s.a.w) was aware of the disease and the cure that was suitable for the patient since he was sure of the benefit of honey for the patient. It is the nature of honey to expel whatever is left of whatever has collected in the stomach and the intestines. Secondly, the Prophet (s.a.w) instructed the patient to take honey for many times to make sure it may cure the disease. The patient should not lose patience for his suffering of illness because sometimes certain diseases take many years to cure or could take at least months.[17]

Now, after making remarks on the above hadith, it is worth give the view of commentators in regard to the saying of Prophet (s.a.w): “The statement of God is true and the stomach of your brother lies.” Some of them, i.e., Ibn Mas`ud, Ibn `Abbas, al-Hasan and al-Qadi `Ayyad, viewed that honey is not only the factor of healing because all are connected with God who is a Healer (huwa al-shafi). This means that, in any medical treatments, doctors are only attempting to cure; it is Allah who cures, Allah Huwa al-Shafi. This interpretation is a reminder that men should not be arrogant by attributing cure to themselves and not to Allah (s.w.t). Thus, if we relate this idea with the statement,” the statement of God is true and the stomach of your brother lies,” we may conclude that sometimes the measures that humans take to cure a disease may not be sufficient on their own to alleviate and ease the condition; it is Allah’s divine intervention and mercy that brings about the complete cure.[18]

Of course, there is no sharp different between the above view with the following. It is equally obvious that the commentators of hadith seem to agree that the hadith referred to a particular kinds of stomach disease namely diarrhea. It mostly occurred when mucus (a liquid produced in parts of body such as in nose) clings to the bowels and interferes with the process of absorption. With this illness, it is honey that expels the excess moisture. Moisture is driven out and is expelled downwards when honey is eaten. In Umdah al-Qari, Ibn Ahmad al-`Ayni recognized that drinking honey may open up the obstructions of the blood vessels, dissolve the excessive food by evacuating the stomach and intestines, and clear the chest and the liver.[19] Furthermore, al-Baghdadi was of the opinion that honey, which contains a variety of sugars and minerals, is good to purify what in the veins and stomach. Consequently, it has a potential to make blood circulate better and provide more air to areas of the body such as the brain.[20]

It is clear from the above discussion that we cannot understand the Prophet’s prescription of honey as the way for treatment of disease unless we know what disease he was fighting. It is necessary to define what type of diarrhea the patient had before giving honey. In relation to this, al-Kahhal b. Tarkhan, an earlier author of the medicine of Prophet (al-tibb al-nabawi), had written that the Prophet (s.a.w) was well aware that diarrhea was caused by indigestion (tukhma) resulting from overeating. Thus, he gave the correct treatment by asking the patient to drink honey. The reason the Prophet had said the patient’s stomach lied was that he knew that the dosage had not been sufficient, because it had not stopped the diarrhea and the Prophet (s.a.w) wanted to stress that honey was the correct cure but in this case it had to be administered several times.

 It seems quite certain that honey is the most suitable prescription for the patient as mentioned in the hadith. If someone today is facing a similar problem, can honey be used effectively? This needs clarification and understanding the other part of hadith, “fihi shifa li al-Nas (in it (honey) is healing for men).” This is because some people believe that honey is beneficial for all kinds of diseases and for all people. To answer this claim, Ibn Hajr clarified that the statement, “fihi shifa li al-Nas”, did not mean that honey is suitable to use for all people because the words “li al-Nas” designated that honey was only suitable for “some people” and not for “all people”. This means that honey is possibly harmful for some people who live in hot regions.[21] In other words, honey cannot be a cure for all kinds of disease.

CUPPING (AL-HIJAMAH)

In a number of medical systems, from Greek to Malay traditional medicine, illness was believed to be caused by harmful and dirty blood and that treatment must take out the dirty blood. Under this influence, people believed that wherever any part of the body, from head to toe, became ill, hijamah can be used as the right measure of treatment. Therefore, if we wish to know the history of treatment of disease in the light of al-Tibb al-Nabawi, we must study hijamah because it was widely practiced by the Prophet (s.a.w) and his companions and this method of healing is still alive in many Muslim countries.

We were told that the Prophet (s.a.w) and his companions always had practiced al-hijamah in several occasions from the time he was at home to the time that he was in the state of Ihram. It is very regrettable that we do not have very clear rational explanations why cupping was so popular in the time of Prophet. One fact is nevertheless clear that hijamah is very easy to practice, just using a jar or a similar material. A jar is attached to the skin surface, so that the dirty blood, air, toxic and other harmful substances flow to the surface of the skin into the jar. Thus harmful substances may be removed from the body. The dwellers of the Arabian peninsular and countries with hot climate are the most suitable people to be cupped. This is because the blood of people who dwell in that region is thinner (raqiq) and is drawn closer to the surface of the skin (tamil ila zahir al-abdan). [22]

As we expected, many ahadith would be recorded in Kitab al-Tibb of Sahih Bukhari. They were recorded from chapter eleven to chapter fifteen of kitab al-tibb. One of these five chapters is Bab al-Hijamah min al-Da’ (cupping as a treatment for disease). In this chapter, Imam Bukhari mentioned that Jabir bin 'Abdullah narrated that he visited al-Muqanna while he was ill.  Jabir said, "I will not leave till he gets cupped, for I heard Allah's Apostle saying, "There is healing in cupping." Second, Imam Bukhari reported that Allah's Apostle was cupped on the middle of his head at Lahy Jamal on his way to Mecca while he was in a state of Ihram. Thirdly, Imam Bukhari reported that: “Allah's Apostle was cupped on his head. Lastly, al-Bukhari reported that the Prophet commanded cupping to be used and said: “There are no remedies comparable to cupping and blood letting.” [23 

While interpreting the above ahadith, there are two general remarks that we may make. First, there is no specific time to practice cupping because the Prophet (s.a.w) was cupped at day and night and sometime during Ihram. However, we have to keep in mind that if blood cupping is done in the wrong place and times or when it is not needed, then it weakens the faculties and it removes both healthy humors as well as harmful ones. That is why medical doctors advise, for safety purpose, that cupping should be avoided by those who are suffering from enteritis, those on the road to recovery, those who are very old, those with a weak liver or stomach, those who suffers from palsy of the face or feet, and women who are pregnant or who have just given birth or who are menstruating.

Secondly, it seems quite certain that the Prophet (s.a.w) was cupped on his head. That is why Imam Bukhari entitled one of the chapters of his kitab al-tibb as al-hijamah ala al-ra`s (cupping on the head). In truth, the view that headache was caused by dirty blood in the head was widely spread among the ancient people, and sucking of harmful blood was therefore a chief method of treatment. We are not surprised to hear that the Prophet (s.a.w) was cupped on his head to treat headache and similarly when a man who complained to the Prophet (s.a.w) about a pain in the head, the Prophet (s.a.w) recommended him to get cupped.[24]

With advance of methods of treatment, people have observed that the use of leeches, as a means of sucking blood from the affected parts of human body, was similar to cupping (hijamah). In other words, the use of leeches and other modern methods of healing can be regarded as a substitute for cupping. In Graeco-Arab medicine, leech-therapy occupied an important place. Ibn Sina and al-Baghdadi, for example, wrote specific section to leech in their al-Qanun fi al-Tibb and al-Mukhtarat fi al-Tibb respectively. According to Ibn Sina, the application of leeches is more useful than cupping in letting off the blood from deeper parts of the body. Treatment by the use of leeches is desirable in skin disease. For al-Baghdadi, the use of leeches was the best way for skin disease, wet and chronic ulcers. Leeches are also used for reducing the weight of fat and fleshy people. They can be used repeatedly, but one should be aware of the risk of cross-infection. Leeches may also be used as a means of cleaning the tissues especially after micro-surgical operations. Since there is possibly risk over using leeches, al-Baghdadi and other Muslim physicians suggested that the leech has to be cleaned. The dirt or dust clinging to a leech should be wiped off before application. When leech has sucked out the blood and tends to drop down, salt should be sprinkled on the affected part of the human body.[25] The following are al-Baghdadi’s words: ‘When they are to be used, they should be kept away for a day and then applied. If a leech does not stick, fresh blood should be poured or thoroughly smashed and pounded clay sprinkled over the affected part and if the affected part is free of any wound, the part should be rubbed till it becomes red’.

AL-KAYY: BRANDING WITH FIRE (CAUTERIZATION)

Al-Kayy is another method of treatment of disease at the time of Prophet (s.a.w) and even after.[26] In the time of Prophet, al-kayy (a hot metal) was used as a way to burn a wound to stop bleeding or infection[27]. The question now arises, is it forbidden (haram) to use al-kayy for medical purposes? If not, why did the Prophet discourage his Ummah to use cauterization even though he had known that it might give many medical benefits? While commenting the ahadith on al-kayy, some commentators of Sahih Bukhari like Ibn Hajr al-`Asqalani, Ibn Ahmad al-Ayni and al-Qastalani had attempted to give the reasons behind the wisdom of the Prophet (s.a.w)’s words “I forbid my followers to use (cauterization) branding with fire (‘wa `anha `an ummati an al-kayy’)” as recorded in the following ahadith: The Prophet (s.a.w) said, "If there is any healing in your medicines then it is a cupping operation, or branding (cauterization), but I do not like to be (cauterized) branded."[28] In another version, Imam Bukhari reported that the Prophet (s.a.w) said, "Healing is in three things: cupping, a gulp of honey or cauterization, (branding with fire) but I forbid my followers to use cauterization (branding with fire)." [29

Though some commentators of hadith understood that the Prophet (s.a.w) prohibited his followers to use cauterization, however, Ibn Hajr did not interpret the words “wa anha an ummati an kayy (I forbid my followers to use cauterization)” as prohibition (al-nahy) but abhorrent or undesirable (makruh). He argued that it is undesirable to use cauterization if it may cause pain and menace to the patient.[30] It is quite reasonable to accept this reason because by nature cauterization (al-kayy) may cause the patient pain and menace and produce side effects. This is the reason the Prophet (s.a.w) did not like al-kayy (cauterization) as the right method of healing.

In order to give further evidence that cauterization is not prohibited in Islam, Ibn Hajr quoted the hadith which was reported that the Prophet (s.a.w) had himself cauterized the wound of Sa`d b. Mu`ad[31] and also the wound of As`ad b. Zararh in order to stop bleeding (anna al-nabiy (s.a.w) kawa As`ad b. Zararh min syawkihi).[32] Also, Ibn Hajr mentioned that Ibn `Umar (r.a) used to use cautery for treating facial palsy. This is according to the report of Abu Zubayr who said: “I saw Ibn Umar one day branding the forehead of a man who had a slight facial palsy.” From all these evidence, Ibn Hajr concluded that the prohibition against utilizing cautery applies for as long as complete trust in Allah (s.w.t) is lacking. During the Prophet’s time, there were people who thought that it is cauterization itself which cures the affliction. In other words, they believed that if cautery had not been used, then the patient would have perished. This kind of cauterization practiced, according to Ibn Hajr, is prohibited. On the other hand, cautery is permitted when it is perceived as being the appropriate means to affect a cure, but not the essential cause of the cure because Allah (s.w.t) alone cures and grants good health and not cauterization. This means that humans try, but it is Allah who cures, Allah huwa al Shafi. Humans should not be arrogant by attributing cure to themselves and not Allah (s.w.t). Of course, humans cannot refuse to take measures to cure disease claiming that Allah (s.w.t) will take care of it. This is because it is true that Allah cures but in some cases that cure operates through the agency of humans. Sometimes the measures that humans take to cure a disease may not be sufficient on their own to alleviate the condition. It is Allah’s divine intervention and mercy that brings about the complete cure.[33]

Ibn Ahmad al-`Ayni viewed the hadith, i.e., healing is in three things: cupping, a gulp of honey or cauterization, (branding with fire) but I forbid my followers to use cauterization (branding with fire), as preference from one thing over another. This means that as long as medicine conceived disease in terms of philosophy and looked upon it as a disturbance in the equilibrium of body’s humors, cauterization could not be more than a last resort to which physicians had recourse when treatment by honey and cupping failed. In this case, the Prophet (s.a.w) preferred honey and blood letting over cauterization and it does not mean that cauterization is prohibited (haram) in medical treatment. [34]

Although al-Qastalani was aware that Ibn Hajr and al-Ayni’s interpretation of the hadith are in harmony with Islamic law, he, in his Irshad al-Sari li Sharh Sahih al-Bukhari, did not hesitate to add that al-kayy was not like other ways of treatment as far as side effects are concerned. Cauterization (al-kayy), it might lead to medical benefits and harmful side effects as in the case of al-khamr (intoxicating drink) which according to the Qur’an might have both beneficial and harmful consequences for mankind, but the harmful ones are more.[35] Al-Dhahabi took a similar attitude to the tradition concerning the prohibition of cauterization. He claimed that the cautery of bleeding wounds was permissible especially when it was known to be the best possible cure for a particular illness but it was forbidden as a preventive measure.

Those who say that cauterization is forbidden in medical treatment base their opinion mainly on the hadith related by Ibn `Abbas that the Prophet (s.a.w) said: “If the cure ultimately depends on either scarification, or drinking honey or cauterization with fire, then I absolutely forbid cauterization.” It is regrettable that this school of thought does not give further explanation and justification of the hadith.

From the above analysis, I think it would be a great mistake to prohibit the cauterization today. If it is forbidden in Islam, the surgery should be also forbidden. Therefore, it is right to conclude that it is perfectly correct to recommend al-kayy (cauterization) as the method of treatment of disease when all other remedies i.e., a gulp of honey and cupping have failed. In other words, it is fully permitted when there is no other alternative or no other remedy has proven successfully. In this case, there can be no objection to using cauterization so long as it is done cautiously and we remain aware of its negative effects.

HABBAT AL-SAUDA’ (BLACK SEED)

In studying the history of pharmacy and pharmacology in Islamic medical tradition at the time of the Prophet, we must always remember that the advice and the practice of the Prophet (s.a.w) in relation to drugs and medicine are followed widely by his followers partly because they believed that what had been said and acted by the Prophet (s.a.w) was inspired by God. One of the very important sayings and advices of the Prophet (s.a.w) for his Ummah is about the black seed (al habbat al-sauda’), a healing for all diseases except death. It was reported by Imam Bukhari in his Kitab al-Tibb that the Prophet (s.a.w) said: "There is healing in black seed for all disease except death (fi al-habbat al-sauda’ shifa min kulli da’ illa al-sam)."[36]

Is true that black seed is healing for all diseases except death? This question arose after we found in many cases that patients who took the black seed (habbat al-sauda’) were not cured. So, why did the Prophet (s.a.w) said that black seed is healing for all illness except death? It is worth highlighting the interpretation of Ibn Hajr in order to answer the question. Ibn Hajr quoted the idea of al-Khatabi and Ibn al-Arabi. The latter interpreted the hadith by comparing the medical benefits of black seed with the benefits of honey which, according to the Quran is shifa` li al-nas (healing for men). In this regard, Ibn Hajr explained that the word shifa li al-nas, does not mean that black seed (habbat al-sauda’) may cure all illness of all peoples. Rather, its medical benefits are many to the extent that its medical benefits are universally accepted simply because most of cultures from the past up to the present accept its medical benefit. Universal acceptance of the benefits of the black seed does not mean it can be used as a cure for all disease.[37] In other words, the medical benefits contained in the black seed are numerous. It cannot cure all diseases because disease cannot be cured except with the permission of Allah (s.w.t) as He said: “It destroys everything by the permission of its Lord (tudammir kullu syai’n bi amr rabbiha).”[38]

The above discussion reveals to us that the correct religious analytical concept of “a cure for every illness except death” has its limitations, as the limitation of the benefit of honey where Allah (s.w.t) says: “in it, there is cure for people.”[39]

In the light of this argument we feel much more confident in considering black seed (habbat al-sauda’) as a cure for every illness except death because discoveries of habbat al-sauda as a cure for illness was not made by the Prophet (s.a.w) alone. The medical benefit of habbat al-sauda were acknowledged by ancient civilization since over 3,000 years. This does not mean that Prophetic medicine should not be given the credit it rightly deserve. In explaining ahadith in relation to habbat al-sauda’, Ibn Sina in his masterpiece al-Qanun fi al-Tibb (Canon of Medicine), admitted that the black seed is a natural remedy for maintaining and storing body heat and dryness. This is very important since a reduced metabolic rate (internal body heat) is the cause of most illnesses but we have to be cautious that if the body loses too much energy, it also loses its ability to fight off toxins, leading to a greater chance of contracting illness. There are many diseases for which the black seed has been successfully been as a treatment.

In the light of the above discoveries, many physicians believe that there are many diseases that can be treated successfully with the black seed. Significantly, black seed (habbat al-sauda’) is a safe and effective herb that can be used by almost anyone. No side effects are caused when the right dose is correctly applied. Its benefits are obtained through consistent use. However, it is recommended that the treatment be supervised because black seed does lower blood sugar levels.

THE URINE OF CAMELS

Imam Bukhari made special chapter on camel urine in his book of medicine named “Bab al-Dawa’ bi Abwal al-`Ibl (treatment with the urine of camels)”. The camel is among the animals mentioned in the Qur’an as a miracle of God. In surah 88, verse 17, Allah (s.w.t) says: "Do they not look at the Camels, how they are made?". When pondering this verse, one finds that studies about the nature of camel have a certain importance as the first step to know its medical benefits. Naturally, the camel lives in the desert and in a hot climate. That is why it was created with the ability to store water in its body.  It does not overheat and can withstand water loss. It stores fats in the hump for use in times of food and water deprivation. Modern medicine has taken a very clear stand when it accepts that the camel is free from foot and mouth disease viruses as a result of its immune system. Recently, discoveries in medical science published in the British Institute of Biology’s Magazine, say that the small size of camel antibodies would also allow them to penetrate deep into human tissue and cells that would not be otherwise accessible. Camel antibodies, by being transported from the desert sands into the laboratory test tube, have the potential to be a vital weapon against human diseases.

Now the question arises: Why did the Prophet ask some people from `Urayna who found Madina noxious (ijtawaw) to drink camel urine? This advice becomes one of the most controversial issues in the medicine of the Prophet. It is impossible to answer the question with any degree of certainty. All we can do is to give medical benefits of camel urine as mentioned in ahadith of the Prophet (s.a.w). Obviously, there are many ahadith mentioning the benefits of camel urine in the different versions. All these ahadith are focusing on the Prophetic prescription to the `Urayna Bedouins, who came to Madinah and found it noxious to the point they became jaundiced and their bellies became swollen. In this regard, Imam Bukhari reported: Narrated Anas (r.a): The climate of Medina did not suit some people, so the Prophet ordered them to follow his shepherd, i.e. his camels, and drink their milk and urine (as a medicine). So they followed the shepherd and drank camel milk and urine till their bodies became healthy.[40]

It is very regrettable that we do not find clear comments either in Ibn Hajr’s Fath al-Bari nor Umdah al-Qari of Ibn Ahmad al-Ayni, whether camel urine was good for treatment of disease or otherwise. However, Muhammad al-Akili, while translating Ibn al-Qayyim’s al-Tibb al-Nabawi, was of the opinion that the words "their urine (abwaliha)” in all the ahadith of Prophet (s.a.w) is a copyist's mistaken rewording of the word "alba'niha”. Even this view has no foundation in whatsoever in the books of ahadith, however, he argued that the word abwaliha (their urine) is so rare in the ahadith. It seems that abwaliha (their urine) looks so much like al-baniha, "their milk". Many Muslim scholars are of the opinion that it would be  a mistake to accept al-Akili’s suggestion because the compilers of ahadith are unanimous on the abwaliha wording. Even it is so rare in the ahadith, the Muhaddithin did not mind because they were aware that camel urine had a history of medicinal use among desert Arabs with which majority of the early scholars seemed familiar. Al-Shawkani in his Nayl al-Awtar admitted that there was, in the urine of camels and their milk, a cure for those with decaying stomach (al-dharibati butunuhum). The decaying of the stomach was defined as "a disease of the stomach that prevents it from digesting aliments." Similarly, Dawud ibn `Umar al-Antaki (d. 1008) in his Tadhkirat Ulil-Albab wal-Jami` lil-`Ajab al-`Ujab (Memorandum Book for Those Endowed with Hearts and the Encyclopedia of Wonders) said: Urine differs according to its animal of origin but it all tends to heat and dryness provided it does not come from an animal devoid of bile such as the camel. In the latter case, its dryness is minimal because it is devoid of salinity since nothing breaks down salinity, with water, other than the bile. All urine types dispel the effects of diseases, cure the eye and the ear, chronic cough, difficulty in respiration, the spleen, and uterine pains, especially aged and/or congealed. The most effective types are human urine then camel’s urine.

CONCLUSION

The study of health and medicine in the early Islamic tradition is extremely interesting and is important for various reasons. First, it throws light on the conditions of Muslims at the time of Prophet (s.a.w) and his companions on how they prevented and treated disease. However, in our time, we are not obliged to use the ancient method of treatment or drugs without empirical research because of changes in medicinal plants and environment as well as the meaning of linguistic terms. The conditions for which these remedies were prescribed in the first century of hijrah may not be exactly the same as the conditions we are dealing with today. Therefore, if we wish to have a complete account of the medicine of the Prophet (al-tibb al-nabawi), we shall not be satisfied by referring to the writing of traditionalist scholars in the past without referring to the new discoveries made by the researchers after the demise of Prophet (s.a.w). Further, it is true to say that the health and medicine in Islamic tradition from the time of Prophet (s.a.w) until the decline of Islamic civilization are mainly rooted in the Qur’an and Ahadith of the Prophet (s.a.w), although the Islamic medical system came into being, especially during the Abbasid period, as a result of the integration by Muslims of several older traditions of medicine, most importantly Greek.

This leads us to conclude that medicine of the Prophet not only refers to what was been practiced in the time of the Prophet but also what was practiced in the subsequent eras (Khulafa’ al-Rashidin, Umayyad, Abbasid, and Othman) and what is practiced in modern times as long as it does not contradict the concept of Oneness of Allah (al-Tawhid). This means that Muslims today are not obliged to follow the medical system, which, had been practiced in that period because of different circumstance surrounding a certain disease. Of course, if the diagnosis and all the circumstances surrounding a certain illness episode today are exactly like those at the time of the Prophet, then we have no hesitation in saying that what had been prescribed in al-tibb nabawi should be used. However, in actual practice it is difficult to ascertain that the conditions are the same. Changes in disease pathology, the genetic pool of patients and medical plants, weather and climate conditions are among many variables that may make a particular remedy recommended by the Prophet not appropriate for a medical condition today despite the disease being called by the same name. We are afraid that using tibb nabawi that was appropriate in the past for a condition today that is different is like using the right drug for the wrong disease.


 

[a] Universiti Putra Malaysia  


 

[1] This article is part of my “Health and Medicine in the Light of the Book of Medicine (Kitab al-Tibb) in Sahih Bukhari”. It was prepared while I was a Visiting Fellow at the Oxford Centre for Islamic Studies (OCIS). I would like to express my deepest thank to the Director of OCIS, Dr. F.A Nizami for giving me the golden opportunity to conduct my research at the Centre as well as for the funding that I received from the Centre. Similarly, I wish to express my gratitude to the Vice Chancellor, the Dean of Faculty of Human Ecology and the Head of the Department of Government and Civilization Studies, Universiti Putra Malaysia, for their moral support, encouragement and understanding. Currently, the author is a Senior lecturer in the Department of Government and Civilization Studies, Faculty of Human Ecology, University Putra Malaysia (UPM), 43400 UPM, Serdang, Selangor, Malaysia.

[2] Abbreviation: SB= Sahih Bukhari of Muhammad b. Isma`il al-Bukhari (194-256/ 810-870); UQ= Umdah al-Qari Sharh Sahih Bukhari by Badr al-Din `Ayni
     (762-855/1361-1452),
25 vols. (Beirut: Dar Ihya’ al-turath al-`Arabi, n.d); FB= Fath al-Bari fi Sharh Sahih Bukhari by  Ibn Hajr  al-`Asqalani (773–852/1372-
     1449),
13 vols. (Beirut: Dar al-kutub al-`ilmiyyah, 1989).

[3]  In Umdah al-Qari Sharh Sahih Bukhari, one of commentaries of Sahih Bukhari, the author defined disease as a condition in which, due to the loss of equilibrium of the natural state,
  
making the organs do not function properly (khuruj al-jism `an al-majra al-tabi`i). Treatment (al-mudawat) is to restore it into the normal condition (radduhu ilayhi) by removing the
  cause of illness. (Umdah al-Qari Sharh Sahih Bukhari by Badr al-Din `Ayni (762-855/1361-1452), 25 vols. (Beirut: Dar Ihya’ al-turath al-`Arabi, n.d); 21: 229).

[4] To give an accurate explanation and interpretation of ahadith in Sahih Bukhari, I will consult many important commentaries of Sahih Bukhari most notably
   Umdah al-Qari Sharh Sahih Bukhari
by Badr al-Din `Ayni (762-855/1361-1452),
25 vols. (Beirut: Dar Ihya’ al-turath al-`Arabi, n.d); Fath al-Bari fi Sharh
   Sahih Bukhari
by  Ibn Hajr  al-`Asqalani (773–852/1372-1449)  , 13 vols. (Beirut: Dar al-kutub al-`ilmiyyah, 1989).

[5] Ibn Hajr, FB, 167.

[6] SB, Kitab al-Tibb, Bab Ma anzala Allah da’ illa anzala lahu Shifa’.

[7]UQ, 21: 229-30.

[8] Fazlur Rahman, Health and Medicine in the Islamic Tradition (New York: Crossroad Publishing Company, 1989; repr., Kuala Lumpur: S. Abdul Majeed & Co, 1993), 49.

[9] SB, Kitab al-Tibb, Bab Shifa’ fi thalatha.

[10] FB, 10: 170, al-Ayni, UQ, 21: 231.

[11] FB, 10: 171.

[12]UQ, 21: 231.

[13]SB, Kitab al-Tibb, Bab al-Dawa bi al-Asal waqawl Allah Ta`ala fihi Shifa li al-Nas.

[14]It is described as frequent and excessive discharging of the bowels producing abnormally thin watery stools, usually as a symptom of gastro-intestinal upset or
    infection.

[15]The disease of the lower intestine caused by infection with bacteria, protozoa or parasites and marked by severe diarrhea, inflammation and passage of blood
   and mucus.

[16]Bukhari, Sahih Bukhari Kitab al-tibb, Bab al-Dawa’ bi al-‘asal.

[17]UQ, 21; 232.

[18]UQ, 21; 233.

[19] UQ, 21: 232.

[20] FB, 10: 172.

[21] FB, 10: 172.

[22] FB, 10: 186.

[23]SB, kitab al-tibb, Bab al-Hijamah min al-Da’.

[24] FB, 10: 187-8.

[25] Al-Baghdadi, Kitab al-Mukhtarat fi al-Tibb, 1: 299.

[26]In relation to this, it is worth to mention that the process of destroying tissue by heating or freezing it is known at the present as electrocautery. It is done by using a small tool 
    which  has an electric current running through it. So that it is able to cauterize or burn the tissue. Normally, this method of treatment, electrocautery, is a safe procedure and is
    routinely used in surgery to burn unwanted or harmful tissue. Sometime, a small electrode is applied to the skin near the surgery site. This is used to collect the electricity from the
    body and safely discharge it back to the machine. A grounding pad is placed on the person's body (usually the thigh) before the surgery starts to protect the patient. Of course, it
   
causes a patient in painful and menace compared to a gulp of honey and cupping.

[27]In relation to this, al-Suyuti was of the opinion that the verb hasama (cut off, terminate) is the synonym of kawa (cauterize). From this point of view, he explained that hasama al-damm 
   anhu bi al-kayy
means qata`a al-damm anhu bi al-kayy that is to stop blood from bleeding by cautery. (FB, 10: 170-1).

[28]SB, Kitab al-Tibb, Bab man iktawa aw kawa ghyrihi wa fadl man lam yaktawi.

[29]SB, Kitab al-Tibb, bab al-shifa fi thalatha.

[30] FB, 10: 170.

[31] FB, 10: 170.

[32] FB, 10: 170, UQ, 21: 231.

[33]FB, 10: 171.  

[34] UQ, 21: 233.

[35] Al-Qastalain, Irshad al-Sari, 12: 413, FB, 10: 171.

[36] Kitab al-tibb, bab fi al-habbat al-suda’. See also another hadith narrated by Khalid bin Sad that: we went out and Ghalib bin Abjar was accompanying us. He fell ill on the way and
   when we arrived at Medina he was still sick. Ibn Abi 'Atiq came to visit him and said to us, "Treat him with black cumin. Take five or seven seeds and crush them (mix the powder
   with oil) and drop the resulting mixture into both nostrils, for 'Aisha has narrated to me that she heard the Prophet saying, 'This black cumin is healing for all diseases except As-Sam.
  `Aisha said, 'What is As-Sam?' He said, 'Death." Again, it was narrated by Abu Hurairah: “I heard Allah's Apostle saying, "There is healing in black cumin for all diseases except
  death."

[37]FB, 10: 178-8; UQ, 11: 237.

[38]Al-Ahqaf (46): 25.

[39]16: 69.

[40]SB, Kitab al-Tibb, Bab al-Dawa’ bi Abwal al-Ibl.