The Development of Arab Medical Sciences (2/2)

The development and the recognition of the independent, academically oriented status of pharmacy as a profession charged with the preparation of safe and effective drugs started in Baghdad during Al-Mamun’s caliphate (813–833). The main objectives of pharmacists were directed not only toward the translations and interpretations of accumulated data on natural product-based drugs, but increasingly toward the search for the potential of natural products as sources for new drugs, and they even started to elucidate physicochemical properties of these products. Drugs were classified according to their effects on the human body, for example, diuretics (promote urination and thus expel toxins), expectorants (remove mucous accumulation), topical antiseptic cleansers, stimulants (prescribed to increase blood flow and raise energy level), tonics (general strength building and disease prevention), analgesics and anesthetics, digestive aids, and oral health agents. Pharmacists, or saydalaneh in Arabic, managed to introduce a large number of new drugs to clinical use, including senna, camphor, sandalwood, musk, myrrh, cassia, tamarind, nutmeg, cloves, aconite, ambergris, and mercury. They also developed syrups, juleps, and pleasant  solvents such  as  rose  water  and  orange  blossom  water  as  means  of administering drugs. The first pharmacy shop was apparently in Baghdad, founded in 762, and medicines were manufactured and distributed commercially, and then dispensed by physicians and pharmacists in a variety of forms: ointments, pills, elixirs, confections, tinctures, suppositories, and inhalants. Saydalaneh were required to pass examinations and be licensed and were then monitored by the state [1–18].

As discussed in detail, the selection of potential natural products as sources for new drugs was based on traditional knowledge developed in the pre-Islamic era based on a long history of trial and error, and then by theoretical and practical knowledge introduced by Islam. These include natural products mentioned in the Holy Qur’an or in the Hadith of the Prophet (Peace be upon him), notably honey, milk, dates, black seeds, olive leaf, and olive oil. In addition, theoretical and practical knowledge developed in other medical systems, which became available to Arab-Islamic scholars after the translation of foreign scripts, played a central role in developing new medicines. The works of Galen, Hippocrates, and the Indian physicians Sushruta and Charaka were translated into Arabic. Arab-Muslim physicians developed hundreds of new natural product-based remedies. They were not guided by a long history of trial and error, but mainly by scientific methods, which led to the development of evidence-based medication. Avicenna discussed in his book, on simple drugs (materia medica), the nature and quality of drugs (see Chapter 7), and the way that compounding them influences their effectiveness. He stated “You can tell the potency of drugs in two ways, by analogy and by experiment. We say experimenting leads to knowledge of the potency of a medicine with certainty after taking into consideration certain conditions.”

Arab–Islamic medicine considers all components of existence with equal importance, from breath and body to the soul and matter; both spiritual and physical health is treated equally. Hence, the body should be treated as a whole and not just as a series of organs and tissues. Physicians noted that there are individual differences in the severity of disease symptoms, and in the individual ability to cope with disease and healing. Hippocrates thus laid the foundations of the modern theory that thoughts, ideas, and feelings, which he proposed to originate in the brain, can influence health and the process of disease. Rhazes supported this concept by his recommendation: “The physician, even though he has his doubts, must always make the patient believe that he will recover, for state of the body is linked to the state of the mind.” Later on, Avicenna who defined medicine as “the science from which we learn the states of the human body with respect to what is healthy and what is not; in order to preserve good health when it exists and restore it when it is lacking” supported the views of Rhazes. He stated that “We have to understand that the best and most effective remedy for the treatment of patients should be through the improvement of the power of the human body in order to increase its immune system, which is based on the beauty of the surroundings and letting him listen to the best music and allowing his best friends to be with him.”

It is now clear that the mind and the body interact, influence, and regulate each other. The perception of stress can lead to production of “stress hormones” as well as mediators of the immune system, for example, cytokines and free radicals. Stress hormones act in a feedback pathway to regulate their own production and the production of certain immune products. These immune products act on the brain to modify behavior and the ability to perceive and to respond to stressful challenges by inducing lethargy, fever, and nausea.

Based on the recommendations of Rhazes and Avicenna, patients were treated through a scheme starting with physiotherapy and diet, and if this failed, drugs were used. Rhazes’s treatment scheme started with diet therapy; he noted that “if the physician is able to treat with foodstuffs, not medication, then he has succeeded. If, however, he must use medications, then it should be simple remedies and not compound ones.” Drugs were divided into two groups, simple and compound drugs. Physicians were aware of the interaction between drugs; thus, they used simple drugs first. If these failed, compound drugs consisting of two or more compounds were used. If these conservative measures failed, surgery was undertaken.

The Greek and Roman humor theory of the human body or humoralism had a great influence on the development of the Greco-Arab medical system. Hippocrates was the first who applied this idea to medicine and it became strongly accepted in the medical canon through the influence of Galen. The humoral theory was adopted and further developed by Arab-Muslim physicians and it became the most commonly held view of the human body among European physicians until the advent of modern medical research in the nineteenth century [1–8]. Chapter 7 provides an overview of method of therapy used in Greco-Arab and Islamic medicine.