for 1st year medical students on 27th April 2001
A. CURE OF DISEASE
ANY DISEASE IS POTENTIALLY CURABLE
Every disease has a treatment (KS p. 338). The prophet Muhammad (PBUH) said in an authentic hadith that Allah did
not reveal any disease, bau, without also revealing its cure, dawau, (MB #1962, KS338). Humans are encouraged to seek treatment, al hatthu ‘ala al dawaa (MB#1962, KS
p. 338). The Qur’an described cure, shifa (p 637 , 5:110, , , 10:69, 17:82, 26:80, 41:44). The Qur’an
is itself a cure (17:82). Honey is described in the Qur’an as a cure (16:69). Some people may know the cure and others
may ignore it but it nevertheless exists. The Qur’an described disease in prophet Ayyub (PBUH) and its eventual cure
(21:83-84, 38:41-44). The Qur’an described how Isa cured chronic diseases (,
CURE IS FROM ALLAH:
Humans try, but it is Allah who cures, allah huwa al shafi (p 1105 21:83-84,
26:80, 38:41-42). Humans should not be arrogant by attributing cure to themselves and not Allah. In the same way humans cannot
refuse to take measures to cure disease claiming that Allah will take care of it. 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. Disease treatment is part of qadar (KS P. 338). Seeking treatment
does not contradict qadar or tawakkul.
Disease treatment ispart of qadr.
The principle that applies here is reversal of qadar by another qadar (rad al qadr bi al qadr).
B. PREVENTIVE MEDICINE, tibb wiqa’i:
PREVENTIVE MEDICINE IS A PRO-ACTIVE MEASURE.
The Qur’an has used the concept of wiqaya in many situations to
refer to taking preventive action against entering hell-fire, wiqaya min al naar( ), against punishment, wiqaya min al adhaab
(p 1316 2:201, 3:16, 3:191, 3:34, 13:37, 40:7, 40:9, 40:21, 44:56, 52:18, 52:27, 70:11), against evil, wiqaya min al sharr(p 1316 86:11), against greed, wiqaya min al shuhhu (p 1316 59:9, 64:16), against bad acts, wiqayat min
al sayi’at (p 1316 40:9, 40:45), against injury/harm, wiqayat min al adha,
(p 1316 16:81), against jealousy, wiqayat min al hasad), against oppressive rulers,
wiqaya min al taghoot (p 1316 3:28), against annoyance, wiqayat min al adha (p 1316 16:81),and against heat, wiqayat min al harr (p 1316 16:81). Prevention is therefore one of the fixed laws of Allah in the universe, sunan llah fi alkawn. Its application to medicine therefore becomes most obvious.
PREVENTION AND QADAR
Disease could be prevented before occurrence or could be treated after occurrence. The concept of prevention, wiqayat, does not involve claiming to know the future or the unseen, ghaib, or even trying to reverse qadar. The human using limited human
knowledge attempts to extrapolate from the present situation and anticipates certain disease conditions for which preventive
measures can be taken. Only Allah knows for sure whether the diseases will occur or not. The human uses knowledge of risk
factors for particular diseases established empirically to predict disease risk. Preventive action usually involves alleviation
or reversal of those risk factors. For example stopping cigarette smoking can prevent lung cancer and ischemic heart disease.
Obeying fire regulations can prevent fire accidents. Careful driving prevents road traffic accidents and trauma. Immunization
prevents viral and bacterial infections.
THREE LEVELS OF PREVENTION
The concept of prevention can be understood at three levels. Primary prevention aims at making sure the disease
does not occur at all. Secondary prevention aims at limiting the impact of the disease once it has occurred; this is usually
by attempting to detect the disease early and instituting necessary treatment. Tertiary prevention aims at mitigating the
long-term sequelae and complications of a disease. Prevention also involves avoiding any act that can hurt good health or
destroy life, halaak (p 1261 4:176 … 67:28). There are activities that promote
good health and are part of preventive medicine because they put the body in the best possible status to be able to fight
and overcome any disease that occurs. Examples of such activities are: physical exercise,rest and recreation, diet, dhikr llah,happy marriage and good family life.
C. CURATIVE MEDICINE, tibb ‘ilaji:
Every disease has a cure that must be searched for and used (MB 1962). Curative medicine may be invasive or non-invasive.
Where possible non-invasive approaches are preferred because invasive disease treatment whatever its nature involves some
element of risk to the patient. This risk is higher the more invasive the treatment modalities are. A non-invasive approach
that aims at helping or assisting the body to fight the disease is the best. Many physicians forget the tremendous potential
that the body has to take care of itself and cure disease with the help of Allah. Medical treatment in most cases should be
supportive to the body’s natural healing processes. The body’s defenses against foreign bodies are in the immune
system that may be humoral or cellular. Given the chance to fight back, the body is able to repair damaged tissue with time.
Present-day hospital medicine has a long history. For millenia the home has been the site of treatment. Increasing
sophistication of medical treatment eventually led to opening hospitals. The first hospital in Europe
was Hopital de Dieu opened in Paris in 600 AD. The first Muslim hospitals, bamirstans, were opened before that. For a long time hospitals were looked at as places
where people went to die and not places for recovery. The bad reputation arose from the fact that most of those who went to
hospitals did not return. The situation has now improved. With available medical technology the hospital makes a major difference.
D. MODALITIES OF TREATMENT
Among spiritual approaches to disease management is use of dua from
the Qur’an (17:82) and hadith as ruqiy (KS p. 504). The Qur’an is the
best medicine (KS p. 338). Dua is medicine (KS p. 338). Asking for protection from
Allah, isti’adhat, is medicine (KS p. 338). A strong iman and trust in Allah, tawakkul, play a role in the cure of diseases.
Salat is a cure (KS p. 338).The spiritual approach to cure is mediated through
the physical processes. Psychosomatic processes affect the immune functions and other metabolic functions of the body. A believer
who is spiritually calm will have positive psychosomatic experiences and not negative ones because he or she will be psychologically
healthy and at ease. Faith can change the very perception of disease symptoms. Pain is for example subjective. A believing
person who trusts in Allah may feel less pain from an injury than a non-believer with the same injury.
Among physical approaches to disease management are: diet, natural agents (chemical, animal and plant products),
manufactured chemical agents, surgery, jiraha, and physical treatment e.g. heat.
Physical approaches can reverse disease pathology, mitigate its effects or just stop farther progression. All therapeutic
agents and procedures are allowed unless they contravene a specific provision of the law. This provides a wide scope for the
practice of medicine. Bad medicine is forbidden (KS p. 341). Bad medicine causes more harm than benefit. While seeking treatment,
the moral teachings of Islam must be respected. The end never justifies the means. Haram material is not allowed as medicine
except in special circumstances where the legal principle of necessity, dharurat, applies.
Alcohol is for example not an accepted cure for any disease; it is actually itself a disease.
The side effects of medication must be considered alongside the benefits. The discovery of antibiotics and other
powerful agents and procedures effective against disease has changed the face of medical care for the better in the past 50
years but has brought with it many iatrogenic problems. They are always associated with side effects or unwanted effects that
a good physician should be aware of and should look out for. These problems are two-fold: (a) introduction of new molecules
in drugs into the body and the environment. The long-term effect of such ‘unnatural’ molecules is not known. (b)
Invasive technology makes drastic changes to human anatomy and physiology with its long-term consequences still unknown. Some
of the harm in medicine arises from the manner of their use. The practitioners of homeopathic medicine rightly criticize allopathic
medicine for its aggressive approach that is associated with many side effects and unwanted effects in the long and short
terms. Homeopathic medicine, practiced in some societies and thought to have fewer side effects, is clearly less effective
for most conditions.
Harmful treatments are not allowed in situations in which the cure is worse than the disease. Choice of what treatment
modality to use should involve a careful weighing of benefits and possible harm or injury. It is a principal of Islamic Law,
sharia, to give priority to preventing harm over accruing a benefit. The equilibrium
between benefit and harm of treatment modalities should be looked at using three Islamic principles: tauhid, wasatiyyat, & shumuliyyat. The concept of tauhid motivates
looking at the patient, the disease, and the environment as one system that is in equilibrium; thus all factors that are involved
with the three elements are considered while making decisions. The concept of wastiyyat
motivates the need for moderation and not doing anything in excess. The concept of shumiliyyat
extends the tauhidi principle by requiring an overall comprehensive bird’s view of the disease and treatment situation.
Evil people use pharmacological agents for bad and selfish reasons for example in altering people's minds to deliberately
MULTIPLE/COMBINATION OF SPIRITUAL AND PHYSICAL:
There should no dichotomy between spiritual and physical modalities of treatment. Both approaches should be used
for the same condition; they are complementary. Each cures the disease each using a different pathway. There is no contradiction
but there is always synergy. It is a mistake to use one and reject the other.
E. SHIRK IN SEEKING CURE
Shirk arises when humans seek and expect cure of disease from anything other than Allah. Manifestations of shirk
practices in disease treatment include: amulets, tamaim, divinations, kahanah, and worshipping or asking cure from humans calledsaints,
awliyaa, by visiting their graves. Other superstitious practices usually associated
with shirk are: claiming knowledge of the unseen and claiming supernatural powers
by any human. Many people with disease conditions resort to shirk practices due to misguidance by shaitan. These practices
nullify ‘aqidat al tauhid because
they attribute disease and its cure to other than Allah. They also distract from seeking true treatment based on rational
scientific medicine. Patients delay coming to hospital and by the time they come the disease is too advanced for easy cure.
A fortuneteller, kahin, is a liar who pretends to know the future
or the unseen and provides information to the gullible clients. The prophet forbade consulting fortunetellers, al nahyu ‘an
hawlaan al kaahin, al nahyu ‘an istishaarat al kaahin (KS451). The fortuneteller will not enter jannat (KS451). Fortunetellers
are able to convince their clients about supernatural knowledge because of assistance by shaitan that listens to people’s
secrets and informs the fortuneteller, istishraaq al shaitan al sama’u (KS451).
Talismans are forms of shirk, al tamaim shirk (KS142) and it is offensive to carry them, karahiyat haml
al tamaim (KS142).There are people who hang amulets, azlaam, on their body for protection instead of relying on Allah
(p 97 5:3, 5:90). Such actions are very demeaning to humans. How can a human who possesses an intellect rely for protection
on a small object that he manufactures himself and hangs around his neck?
Sorcery, sihr, has many forms, anwaa’u al sihir (KS275) one of them being the evil eye, al ‘ayn
haqq (KS275). The prophet was a victim of sorcery (KS275). Is one the greatest sins in Islam, min akbar al dhunuub al ishtighaal
bi al sihr (KS275). The Qur'an condemns and forbids sorcery in all its forms and manifestations (p 1248 113:4, p 566 2:102,
2:102, 5:110, 6:7, 7:109, 7:112-113, 7:116, 7:120, 7:132, 10:2, 10:76-77, 10:79-81, 11:7, 15:15, 17:47, 17:101, 20:57-58,
2:63, 20:66, 20:69-73, 21:3, 23:89, 25:8, 26:34-38, 26: 40-41, 26:46, 26:49, 26:153, 26:185, 27:13, 28:36, 28:48, 34:43, 37:15,
38:4, 40:24, 43:20, 43:49, 46:7, 51:31, 51:52, 52:15, 54:2, 61:6, 74:24). Sorcery was also forbidden by the sunnat, tahriim
al sihr wa al sha’awadhat (KS274). He who practices sorcery becomes a polytheist, man sahara faqad ashraka (KS275).
Astrology, tanjim, is the
belief that movement of planets, stars, the sun, and the moon can affect peoples’ lives. The astrologer uses these phenomena
to make predictions about disease or its cure. The astrologer, munajjim, is a liar
because he or she is trying to appropriate Allah’s prerogative of knowing the unseen, ghaib. Astrology was forbidden by Islam, al nahyu ‘an al tanjiim
Divination, tatayyurwas mentioned in the Qur’an(p 755 7:131, 27:47, 36:18-19). It is strictly forbidden (KS275).
Involvement of jinn and shaitan: Jinn
possess power that is used to misguide and give credibility to shirk and superstition.
The jinn do not know the unseen (p 289-9 -18, 34:14, 37:6-10, 67:5, 72:8).
A good Muslim should not be involved with jinns and should ask Allah for protection
against them (p 288 , 7:200, 16:98, 114:1-6).
Dreams and their interpretation could lead to shirk. The Qur’an mentioned
dreams during sleep, ru’yat manamiyat (p 516 8:43, 12:4-6, 12:36, 12:43-44,
12:100, 21:5, 37:102, 37:105, 48:27, 52:32). Some forms of dream interpretation, tafsir
al ahlam, are forms of shirk. It is true that humans dream. Most dreams are related to the daily human experiences. Sometimes
because of the state of sleep the facts become distorted such that a person cannot relate the dream or understand it. In such
cases the Qur’an tells us that only Allah knows for sure the correct interpretation of dreams. Limited ability to interpret
dreams was given to some prophets (p 221 12:6, , -37, -49, 12:100-101). Other humans do not this ability. Therefore dreams of ordinary humans should
have no role in the diagnosis, treatment and prognosis of disease.