Walk along the narrow twisted alleyways of a Middle Eastern souk, or marketplace, past the displays of wicker baskets, abas, knives and gold jewelry. Eventually you’ll round a corner and be pleasantly overwhelmed by the sights and smells of herbs and spices piled high in the stalls and shops. Bright orange saffron, terra-cotta cinnamon, dark green thyme and dozens of other herbs weave a carpet of diverse patterns, while the sweet odors of cloves and cardamom waft through the air.
In the Middle East, herbs are not only used to flavor food. Many also are used as medicine, based on recipes and formulas derived from careful observation and experimentation performed more than a thousand years ago by Islamic scientists and scholars. In fact, without the work of medieval Muslim pharmacists, much of what we take for granted in Western medicine might have been lost forever.
From the Arabian Sands
In the middle of the seventh century, Europe was mired in intellectual stagnation. Barbarians from Germany and Asia had destroyed libraries and, with them, irreplaceable manuscripts collected over centuries. The achievements of a thousand years of Hellenistic civilization in the arts, sciences, and humanities had been erased in a few short decades of destruction.
During this time, European medicine was severely restricted and conducted in an atmosphere where pain, suffering, and illness were seen as expressions of Divine will and beyond human intervention. Hospitals offered compassion, but little else, and the Church outlawed surgery. The works of Aristotle, Galen, Hippocrates and Dioscorides were unknown. What passed for scholarship consisted of written commentaries on the works of illustrious predecessors who couldn’t be challenged or questioned.
For Europe it was the Dark Ages. But while Europe lost, and then forgot, its intellectual heritage, a new force emerged from the sandy wastes of the Arabian Peninsula.
The spread of Islam was a great historical watershed, one that continues to reverberate thirteen centuries after the cry of the first muezzin, the Muslim caller of daily prayer. In less than a century, the Muslims, driven by passion and fervor, swept aside the Byzantine empire, overthrew the centuries-old Persian dynasty, and reached into India and France, beginning an unprecedented era of growth in all branches of learning.
By the tenth century, a single language linked people from northwestern India to the south of France, and Arabic became to the East what Latin and Greek had been to the West—the language of literature, the arts and sciences, and the common tongue of the educated.
A New Way to Heal
Medicine was the first of the Greek sciences to be studied in depth by Islamic scholars. During the ninth century and into the tenth, the spiritual head of Islam, Harun al-Rashid (of Arabian Nights fame), and his son, al-Ma’mun, sent embassies to collect Greek and other scientific works from throughout the region. These were taken to the “House of Wisdom,” where the entire body of Greek medical texts, including all the works of Galen, Oribasius, Paul of Aegina, Hippocrates, and Dioscorides, were translated into Arabic—manuscripts so important that one of the translators was paid for each translation by its equivalent weight in gold.
But translation was only a first step. Hellenistic, Persian, and Indian concepts fell on fertile Islamic minds, whose perception of medicine and illness differed from that of their European contemporaries. God did not punish sins by inflicting illness on his subjects. Rather, sickness was the result of bodily imbalances, and these imbalances could be restored if the physician were competent enough. Muslim physicians believed that preserving health was the goal of medicine, and if health were lost, medicine should help restore it.
The Muslim physicians’ resulting contributions form a lengthy list, including the development of medical school, medical licensing, cataract surgery, discovery of the circulation of the blood, the idea of infectiousness, the concept of quarantine, the development of pharmacy as an institution and hundreds more.
Part of the Plan: Herbal Remedies
The search for cures in the natural world stemmed directly from the Prophet Mohammed, who taught that “God has provided a remedy for every illness.” Mankind, Mohammed said, must seek out those remedies, learning to use them with skill and compassion.
Islamic knowledge of medicinal substances was originally based on the 500 substances described by the first-century Greek physician Dioscorides in his De Materia Medica, a reference book that is still used today. To this book, Muslim scholars added herbs that grew on the Arabian Peninsula and those imported from India, Persia, and China.
Islamic medical texts usually had at least one section on herbs and other natural remedies, and another consisting of instructions for compound remedies, with descriptions of the geographical origin, physical properties, and methods of application. Many formularies were composed as larger independent collections of simples (single herbs with medicinal value) and compound recipes. Some were written specifically for use in hospitals.
By the start of the ninth century, pharmacy was a profession practiced by highly skilled specialists called saydalani who were required to pass licensing examinations and monitored by the state. The dispensing of medication was remarkably exact—Arab pharmacists used balances that were accurate to 0.3 mg. In their laboratories, the saydalani evaporated, filtrated, crystallized and distilled raw drugs, mixing them with syrups, gums and fruit rinds when necessary to improve taste.
A Pharmacy Full of Herbal Medicines
Arab pharmacists introduced many new drugs to clinical practice, including senna, camphor, sandalwood, musk, myrrh, cassia, tamarind, nutmeg, cloves, aconite, ambergris and mercury. The saydalani also developed new ways of administering drugs—ointments, conserves, elixirs, pills, confections, tinctures, suppositories, inhalations, syrups and juleps and pleasant solvents such as rosewater and orange-blossom water—always providing carefully detailed instructions in the formularies.
They used scientific principles to determine which herbs to administer and thoroughly studied the actions of medicinal plants, often drawing upon careful experimentation on humans while meticulously recording their observations on potency, dosage, and possible toxicity. Their collections of case histories were then studied in medical schools.
Because Arab pharmacopoeia came from so many sources—as far afield as China, Southeast Asia, the Himalayas, southern India and West Africa—it was enormous. In his second volume of the Canon of Medicine, Ibn Sina (a.d. 980–1037, also known as Avicenna) describes 235 remedies, of which 97 still appear in the official British Pharmacopoeia, as well as 760 medicinal plants and their uses. Ibn Sina also laid out the rules that are the basis of clinical trials today.
Islamic pharmacists responded by devising a reliable preparation to temper the herb’s ferocity but retain its potency.
Medicinal Forms
Like most medieval medicine, the Islamic viewpoint was an outgrowth of Galen’s Humoral Theory and focused on the need to balance the humors, or bodily fluids.
Cathartics, purges and laxatives were considered essential to this goal. The most popular herb—an enduring favorite today—was senna, a low bush with small yellow flowers, greenish yellow leaves, and fat seed pods. The leaves have a distinctive smell, and the infusion made from them has a nauseatingly sweet taste; taken alone, the infusion does indeed produce nausea. The Arabs calmed both taste and effect by adding aromatic spices.
The Arabs also introduced manna and tamarind as safe, mild and reliable laxatives. Scammony, a climbing plant of the morning glory family that has thick roots with medicinal value, was a controversial herb in Europe, where some practitioners declared its violent laxative action unsafe to use under any conditions, while others said they could not function without it. Islamic pharmacists responded by devising a reliable preparation to temper the herb’s ferocity but retain its potency. They did this by first boiling the scammony root inside a fruit called a quince; the scammony was then discarded and the quince pulp mixed with the soothing, gooey seeds of psyllium. The preparation was known as “diagridium.”
Formulation developed into an art involving many steps and ingredients. Ar-Razi, Islamic medicine’s greatest clinician and most original thinker, combined bitter almonds with an ounce of raisin rob, or pulp, to treat kidney stones. For the same ailment, a clinician named Haly Abbas recommended boiling jujubes, fruits of sebesten, white maude, and seeds of smallage, fennel, caltrop and thyme.
The Simples
In addition to compounds, the Arabs valued hundreds of simple herbal remedies. They used sesame oil to relieve coughs and soften rawness of the throat. Juice from the stalk and leaves of the licorice plant was considered good for respiratory problems, swollen glands, and clearing the throat, whereas the root was used to treat foot ulcers and wounds.
Cardamom was believed to cool the body and aid digestion; it has endured as a principal ingredient in Arabic coffee. Cumin was, and still is, used as an antiflatulent and to relieve stomach cramps. Fennel was used to prevent obesity.
Myrrh, primarily known in the West as a gift from one of the Three Wise Men, was highly valued for its medicinal properties as an astringent and was also used to treat dyspepsia, chronic bronchitis, leukorrhea and as a topical application in gum disease. In fact, it is a primary ingredient in many commercial mouthwashes today.
Islamic simples also included a variety of analgesics. Ranking them according to their potency, Ibn Sina’s Canon lists opium poppy, two other varieties of poppy, mandrake, henbane, black nightshade and lettuce seed as effective pain relievers.
Aconite, which, Ibn Sina cautioned, could also be used as a poison, was prescribed for rheumatism, gout, whooping cough, asthma and fever. Cloves were used for toothaches and to control vomiting. The medieval Arabs were the first to use cassia and appreciated its mild laxative action, which made it a popular herbal remedy for young children and the elderly. Caraway oil, which remains a common herbal remedy, was taken to aid digestion. Boiled thyme was prescribed for colds and in its natural form was considered a treatment for indigestion and tooth pain. Baked with bread (Arabs spread thyme mixed with a small amount of olive oil on half of the dough, which is then folded and baked), thyme remains a common breakfast herb valued for its breath-freshening qualities.
Muslim doctors employed walnut oil for stomach and kidney ailments, “especially for the well fed,” according to Ibn Sina. Abu Mansur described sweet almond oil as “good for opening the bowels and useful for pains affecting the stomach, kidney, liver, chest and lungs.” Infusions of absinthe were used to treat diabetes, African rue was used for headaches, and pomegranate peels were placed on skin ulcers. These are only a few of the herbs that Arabs valued and recognized for their healing properties and as buffers and vehicles for making medicines more palatable.
An Ancient Tradition Survives
Arab pharmacology was not only extensive but also the strongest empirically based biological science. Ibn Sina’s Canon laid out the basic rules of clinical drug trials, ones that are still followed today: A drug being tested must be pure, and it must work on all cases of the disease. Testing in humans, with careful notation of the drug’s effectiveness under different conditions, was the necessary final step. Observation and experimentation were the sole determinants of the value (or lack of value) of a potential treatment.
Not surprisingly, when Europe began to stir from a thousand years of intellectual slumber, it turned to the Islamic world. It was no coincidence that Salerno, Europe’s first great medical center, was close to Arab Sicily, or that the first outstanding medical university, Montpellier, was located in southern France, near the Andalusian border.
The returning Crusaders introduced to Western practice the entire Arab materia medica, including herbs that today are known mainly as food flavorings, such as nutmeg and saffron.
Arabic pharmacology formed the basis of Western prescriptions until well into the nineteenth century before being abandoned in favor of synthetically produced drugs. Until that time, Arabic medicine was used by millions of people in Africa, Asia and Europe, both in home remedies and as a systematized branch of medical practice.
Respect for natural remedies is still strong in the Islamic world. Muslims, whether city folk or desert-roaming Bedouins, continue to view nature as the mother of all treatments, firmly convinced that it provides therapies for nearly all illnesses and diseases. Recently, in Abu Dhabi, capital city of the United Arab Emirates, UAE president Sheikh Zayed Bin Sultan Al Nahyan established the Zayed Foundation for Research and Traditional Medicine. The foundation conducts biological research on the active components of natural medications such as plants and herbs. Treatment is also offered at the foundation, along with the production of natural pharmaceuticals—a 1,300-year-old tradition that continues to grow.
Resources
Aqrabadhin of Al-Kindi. Translated by Martin Levey. Madison: The University of Wisconsin Press, 1966.
Kamal, Hassan. Encyclopedia of Islamic Medicine. Cairo: General Egyptian Book Organization, 1975.
Levey, Martin. Early Arabic Pharmacology. Leiden, Netherlands: E. J. Brill, 1973.
Savage-Smith, Emilie. Islamic Culture and the Medical Arts. Bethesda, Md.: National Library of Medicine, 1994.
Siddiqi, Muhammad Zubayr. Studies in Arabic and Persian Medical Literature. Calcutta: Calcutta University Press, 1959.
Usama, Ibn Shuraik. Sunna Abu-Dawud, Book 28, No. 3846 (part of the hadith, a narrative record of the sayings of Mohammed and his companions).
David Tschanz lives with his family in Saudi Arabia, where he is an epidemiologist with Saudi Aramco. Tschanz holds master’s degrees in epidemiology and history, and writes frequently about the history of medicine. This is his first article for Herbs for Health.
