The History of Healing

The medical and veterinary essays, prescriptions and expressions mentioned in "Dinkart" (from Sassanid period) are very interesting.  Iranian scholars initially compiled some medical books in the Syrian or Pahlavi languages, which later were narrated in Arabic.  Among such books are books on veterinary, agriculture, diseases, and treatment of gab-birds, training and education of children.

In the mid-Sassanid era, a strong wave of knowledge came to Iran from the west in the form of views and traditions of Greece which, following the spread of Christianity accompanied Syriac, the official language of Christians as well as the Iranian Nestorian script.  A book is left by Paulus Persa, head of the Iranian Department of Logic and Philosophy of Aristotle, written in Syriac.  During Sassanid period Jundishahpour, located east of Susa, southeast of Dezful and northwest of Shushtar, became a center of medical science and its fame lasted for several centuries even after the advent of Islam in Iran.

A fortunate incident for pre-Islamic Iranian science during the Sassanid period was the arrival of eight scholars from Greece who sought refuge in Iran from Roman Emperor, Justinian.  These men were the followers of Neoplatonic School.  King Anushiravan had many discussions with these men and especially with the one named Priscianus.

Islamic medicine and its allied subjects such as pharmacology, surgery, and the like, drew their spiritual sustenance from the message of Islam and received their nourishment from the rich soil of Graeco-Alexandrian, Indian and Persian medicine.  The result was the creation of an extensive field embracing nearly every branch of the medical sciences, some fourteen centuries of history and a vast geographical area stretching from southern Spain to Bengal.  In this particular field nearly all the regions of the Islamic world made some contributions.  Nearly all traditional sources mention that the first Muslim physicians was a Companion of the Holy Prophet Mohammad, Harith Ibn Kaladah, who had studied at Jundishahpour and had carried out a discourse with the Sassanid king Anushiravan on questions of health.  He later returned to Medinah where the Holy Prophet Mohammad sent to him many patients for treatment.  Despite this very early contact of Islam with schools of medicine of foreign origin, during the earliest period, Arab Muslims themselves didn't pursue this field.  Nearly all of the early physicians were Christians, Jews, or Persians.  Muslims had conquered both Jundishahpour and Alexandria while they were both functioning as centers of medicine.  Especially the former being in fact at the height of its activity, competent physicians were available to them from the earliest years of the Islamic era.

The principal of the balance between the natures and the humors became easily a part of the Islamic view of nature.  Because it was a particular instance of a universal principal enunciated by Islam and forming one of the cardinal aspects of its view of the cosmos and of human's situation within it.  From the metaphysical and cosmological points of view, the principal of Islamic medicine are deeply rooted in the Islamic tradition, although this medicine itself came into being as a result of the integration of several older traditions of medicine of which the most important was the Greek.  The aspects of the Divine Law concerning personal hygiene, dietary habits, ablutions, and many other elements affecting the body are again related to medicine.  Esoteric teachings concerning the soul in its relation to the body, body as the 'temple of spirit' again creates a link between medicine and various aspects of the teachings of Islam.

The theory of Islamic medicine is related inextricably to the whole of Islamic metaphysics, cosmology and philosophy.  Because the object of medicine, namely human, is a microcosm who recapitulates within himself the whole of existence and is in fact the key to an understanding of existence.  Islamic physicians saw the body of human as an extension of his soul and closely related to both the spirit and the soul.  Moreover, it was especially concerned with the inter-penetration and inter-relation of cosmic forces and the effect of these factors upon human.  Muslim physicians remained also fully aware of the 'sympathy' between all orders of existence and the mutual action and reaction of one creature upon the other.  They therefore, envisaged the subject of medicine, namely human, to be related both inwardly through the soul and spirit and outwardly through the grades of the macrocosmic hierarchy to the Principle of cosmic manifestation itself.  They sought the principles of medicine in the sciences dealing with principle and its manifestations, namely metaphysics and cosmology.

The Muslims did adopt much of Greek medicine, especially its theory.  But this adoption was possible only because of the traditional nature of this medicine and its concordance with the Islamic conception of the universe.  Muslims considered the origin of this science to be prophetic and sacred, related to the Abraham prophetic chain which the Muslims considered to be their own.  The rapid assimilation of Greek medical theory into the Islamic perspective is due most of all to this latent possibility within the Islamic perspective itself.  Also the close relation between the ideas of the harmony of parts Hippocratic and Galenic medicine and the concept of balance and harmony so central to Islam.

As far as the general theory of Islamic medicine is concerned, its basis rests upon the two cardinal doctrines of all traditional cosmologies, namely the hierarchic structure of the cosmos and the correspondence between microcosm and the macrocosm.  As for the specific field of medicine itself, it is with the four elements and the four natures that it usually begins its theoretical discussion.  It leaves the relation between the natures and the elements, the materia prima and form and the imposition of form upon matter to general works on natural philosophy.  Concerning the elements and the natures, it must be remembered that in medicine, they must not be thought of as simply the fire, air, water, and earth found in nature, nor the cold, heat, dryness and humidity human feel during the various seasons of the year.  The same thought that applies in medicine also applies in physics and alchemy. 

The four humors, which are blood, phlegm, yellow bile, and black bile are composed of the elements and natures.  The humors form the foundation of animal activity and the body of all animals including human is comprised of them.  They mix together to form the temperament of each individual.  In fact each person possesses a unique temperament, as do the organs of his body based upon the particular combination of the humors comprising his constitution.  Moreover, the harmony of the humors tends is in each case towards a particular type of imbalance.  Some tends to be phlegmatic, others melancholic, etc.  Also each temperament possesses its own heat in addition to the innate heat, which everything possesses.

Neither the humors nor their mixture is the cause of life.  They are only the vehicles, which make possible the manifestation of life.  The Muslim physicians believe in the spirit (Rouh).  It descends upon this mixture of the humors and which is the subtle body standing intermediate between the physical body comprised of the humors and the force of life, which comes from the world above.  The more refined the mixture of the humors the greater the perfection and the more complete and perfect the possibility of receiving the soul.  Moreover, in each human, health means the harmony of the humors and illness the disruption of the balance of the constitution.  Of course the harmony is never perfect in any person, but relative to his own constitution, health means the re-establishment of the balance of the humors.

Beside the internal causes of health, Muslim physicians believed that six external factors are essential and must be presented to guarantee the health of the patient.  These were usually called the 'Six Necessities' and are as follows:

 1)      Air (including the effects of various climates, soils, etc.).

 2)      Food (including times of meals, what should be eaten and drunk and their amount, etc.).

 3)      Bodily rest and movement (including exercise).

 4)      Sleep (including the time and duration of sleep).

 5)      Emotional rest (including the question of which emotional states help or harm health).

 6)      Excretion and retention (including the effects of sexual intercourse).

The traditional physician who usually knew his patient well sought to restore health not only by examining internal problems but also by studying all the different external factors listed here.  To discover the one or several causes which had disrupted the harmony of the humors within the body and the environment.  These causes can range from having eaten the wrong food to emotional strain.

The external world of human is also comprised of the elements possessing various natures.  There is a constant action and reaction between the total external environment of human and the humors.  Each climate causes the people living within it to have a different type of temperament from people of another climate.  Likewise, racial heredity, age, sex, and many other factors influence the temperament.  Moreover, all the food and drugs that human consumes possesses various natures in different degrees.  Then a question of living in harmony within oneself and with the environment, taking into full consideration what one eats and drinks in view of each person's particular inner constitution.  There is a vast cycle comprising the individual, the air, water, soil, etc., about him.  The food and water he eats and drinks and even cosmic forces further removed from him, including the stars.  The substances surrounding man, such as wood, brick, metal, influence his health to some degree.  Most physicians believed in astrological correspondences and took them into consideration in their treatment of both psychological and physical ailments.  Some wrote of the special influence of certain minerals or plants upon various physical forces within the body.  Special ailments and numerous treaties exist where tables are given to show these relations. It is primarily the human and secondary his physician responsibility to discover the nature of his temperament.  The tendencies within human constitution to move away from the state of harmony, and the means necessary to re-establish the harmony which is synonymous with health through diet, hygiene, public health, medicament, exercise or other factors.  This type of treatment is of course distinct from recourse to prayer, fasting, litanies and use of certain traditional sciences connected with the 'therapeutic' power of various verses from the Holy Book, Quran.  Altogether the relation between medicine and all the forces which belong to the worlds above nature forms an essential aspect of Islamic medicine and no amount of criticism by modern physicians can obliterate this fact.  Moreover, this aspect of Islamic medicine containing knowledge of the relationship between the microcosm and other orders of reality is an essential aspect of it.  Modern medicine is completely alien to this knowledge, although many people are seeking to discover today through whatever means they find at their disposal.

Abu Bakr Mohammad Ibn Zakariya al-Razi (864-930 A.D.) was born at Ray, Iran. Initially, he was interested in music but later on he learnt medicine, mathematics, astronomy, chemistry, and philosophy from a student of Hunayn Ibn Ishaq, who was well versed in the ancient Greek, Persian and Indian systems of medicine and other subjects.  The practical experience gained at the well-known Muqtadari Hospital helped him in his chosen profession of medicine. At an early age he gained eminence as an expert in medicine and alchemy, so that patients and students flocked to him from distant parts of Asia.

He was first placed in charge of the first Royal Hospital at Ray, from where he soon moved to a similar position in Baghdad. In Baghdad, he remained the head of its famous Muqtadari Hospital for a long time.  Razi was a Hakim, an alchemist and a philosopher. In medicine, his contribution was so significant that it can only be compared to that of Ibn Sina (Avicenna). Some of his works in medicine earned everlasting fame. Kitab al-Mansoori, which was translated into Latin in the 15th century A.D., comprised ten volumes and dealt exhaustively with Greco-Arab medicine. Some of its volumes were published separately in Europe. His al-Judari wal Hasabah was the first treatise on smallpox and chickenpox, and is largely based on Razi's original contribution.  It was translated into various European languages.  Through this treatise he became the first to draw clear comparisons between smallpox and chickenpox.  Al-Hawi was the largest medical encyclopedia composed by then. Each medical subject contained all the important information that was available from Greek and Arab sources, and he concluded this by giving his own remarks based on his experience and views.  A special feature of his medical system was that he greatly favored cure through correct and regulated food.  This was combined with his emphasis on the influence of psychological factors on health.  He also tried proposed remedies first on animals in order to evaluate their effects and side effects.  He was also an expert surgeon and was the first to use opium for anesthesia. 

In addition to being a physician, he compounded medicines and, in his later years, gave himself over to experimental and theoretical sciences.  He went beyond his predecessors in dividing substances into plants, animals, and minerals, thus in a way opening the way for inorganic and organic chemistry.  By and large, this classification of the three kingdoms still holds.  His contribution as a philosopher is also well known.  The basic elements in his philosophical system are the creator, Satan, spirit, matter, space, and time from ancient Iranian's five principals in which he believed.  He discusses their characteristics in detail and his concepts of space and time as constituting a continuum are outstanding.  His philosophical views were; however, criticized by a number of other Muslim scholars of the era.  He was a prolific author, who has left monumental treatises on numerous subjects.  He has more than 200 outstanding scientific contributions to his credit, out of which about half deal with medicine and 21 concerns alchemy.  About 40 of his manuscripts are still extant in the museums and libraries of Iran, Paris, Britain, Rampur, and Bankipur.  His contributions have greatly influenced the development of science, in general, and medicine, in particular.

Abu Ali al-Hussain Ibn Abdallah Ibn Sina (Avicenna) was born in 980 A.D. at Afshana near Bukhara. The young Bu Ali received his early education in Bukhara, and by the age of ten had become well versed in the study of the Quran and various sciences.  He started studying philosophy by reading various Greek, Muslim and other books on this subject and learnt logic.  While still young, he attained such a degree of expertise in medicine that his renown spread far and wide.  At the age of 17, he was fortunate in curing Nooh Ibn Mansoor, the King of Bukhhara, of an illness in which all the well-known physicians had given up hope.  On his recovery, the king wished to reward him, but the young physician only desired permission to use the uniquely stocked royal library.

He was the most famous physician, philosopher, encyclopedist, mathematician, and astronomer of his time.  His major contribution to medical science was his famous book “al-Qanun,” known as the "Canon" in the West. The “Qanun fi al-Tibb” is an immense encyclopedia of medicine extending over a million words.  It surveyed the entire medical knowledge available from ancient and Muslim sources. Due to its systematic approach, formal perfection as well as its intrinsic value, the “Qanun” superseded Razi's Hawi, Ali Ibn Abbas's Maliki, and even the works of Galen, and remained supreme for six centuries.  In addition to bringing together the available knowledge of the time, the book is rich with the author's original contributions.  His important original contribution includes such advances as recognition of the contagious nature of phthisis and tuberculosis, distribution of diseases by water and soil, and interaction between psychology and health.  In addition to describing pharmacological methods, the book described 760 drugs and became the most authentic materia medica of the era.  He was also the first to describe meningitis and made rich contributions to anatomy, gynecology and child health.

His philosophical encyclopedia “Kitab al-Shifa” was a monumental work, embodying a vast field of knowledge from philosophy to science.  He classified the entire field as follows: theoretical knowledge: physics, mathematics and metaphysics; and practical knowledge: ethics, economics and politics.  His philosophy synthesizes Aristotelian tradition, Neoplatonic influences and Muslim theology.

Avicenna was the most influential of all Iranian philosophers-scientists.  He was educated by his father, whose home was a meeting place for men of learning at that time.  He continued to study logic and metaphysics under some of the best teachers of his day but then continued his studies on his own.  In particular he studied medicine and this was to prove of great value since Avicenna was able to cure a Samanid prince and, as a reward, he was allowed to use the Royal Library of the Samanids, which greatly helped his studies.

Avicenna's two most important works are “The Book of Healing” and “The Canon of Medicine.”  The first is a scientific encyclopedia covering logic, natural sciences, psychology, geometry, astronomy, arithmetic, and music.  The second is the most influential single book in the history of medicine, even considering the writings of Hippocrates and Galen.  It consists of five books as follows:

 1)      General principles of medicine, which includes the philosophy of medicine, anatomy and

           physiology, hygiene, and the treatment of diseases.

2)      Simple drugs.

3)      Disorders of each internal and external organ of the body.

4)      Illnesses, which affect the body in general and are not limited to a single organ or limb.

5)      Compound drugs.

The most widespread of his other medical work was his “Medical Poem” in which the principles of medicine are summarized in poetic form to facilitate their being memorized by medical students.