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Home , Myrrh, Prophetic medicine

LEGACY OF Folk Medicine In The Arabian Gulf

– Written by Alan Weber, Qatar

The number of healers practicing ‘folk’ or practices based on the theories, beliefs ‘traditional’ medicine in the Arabian Gulf is and experiences indigenous to different unknown, but is probably substantial based cultures, whether explicable or not, used they used on the number of published case reports in the maintenance of health, as well as in from hospitals that have treated patients the prevention, diagnosis, improvement or and the antibiotic with complications from improperly carried treatment of physical and mental illnesses. out folk medical practices or poisonings The terms complementary/alternative/ tree Myrrh from plant or heavy metal-based . non-conventional medicine are used Folk or can be loosely interchangeably with traditional medicine and defined as the medicine that was used before in some countries”1. Although the World the of modern Western allopathic or Health Organization believes that the evidence-based medicine in the late 19th efficacy and safety of traditional medicine century. The World Health Organization has been confirmed through long practical officially endorses traditional medicine experience and Western pharmaceuticals and complementary and alternative are unaffordable in many parts of the world, medicine (TM/CAM), which it defines as the World Health Organization nevertheless “the sum total of the knowledge, skills and endorses more regulation, standardisation

92 and testing of traditional medicine to Image: Cupping horns increase safety and to understand its used in Egypt in the 16th century. Found in mechanisms of action. Medicina Aegyptiorum. Traditional medicine was the dominant medical system in the Gulf in the pre-oil era. The Arabian Mission of the Dutch Reformed Church in America was active in establishing modern medical care in the region, first by building a hospital in Basra in 1892 and then expanding into Bahrain when evangelist Samuel Zwemer invited Drs Sharon and Marion Thoms to set up practice there2. In 1903, the Arabian Mission built the Mason Memorial Hospital in Manama, Bahrain (still operating as the American Mission Hospital). Shortly after its establishment, a deadly epidemic of smallpox followed by another epidemic of plague broke out in Bahrain and rumours circulated that the Christian missionaries had poisoned the wells. Dr Sharon Thoms died in 1913 in while trying to establish a hospital in Muscat. Due to the lack of development in Oman because of the collapse of its slave trade in the 19th century and the late discovery of oil, folk medicine was the only option for the majority of patients up until the 1960s3. In Qatar, the first modern hospital was built in Doha in 1950 since periodic visits from the British government doctor in Bahrain were not sufficient for Qatar’s health needs4. From the 1930s to 1960s, all of the Gulf nations, using their newly acquired oil wealth, developed a modern health infrastructure first run by symptomology, aetiology, diagnosis and The two greatest practitioners of Islamic Egyptian, Indian, Pakistani, European and prognosis to medicine and they used opium medicine were Abu Bakr Muhammad bin American personnel and later by their own and the antibiotic tree resins Myrrh and Zakariya al-Razi (Rhazes) and Abu ‘Ali al- medical graduates trained abroad or in their Frankincense5. In fact, the southern region Husayn ibn ‘Abd Allah ibn Sina (Avicenna). newly established medical schools. of Oman and were the largest Rhazes’s Kitab al-hawi al-Kabir (Latin: Liber The sources of folk medicine in the Gulf producers of these highly coveted aromatic continens) and Avicenna’s Qanun fi al-Tibb are various. First, some of the indigenous gums, harvested from the Boswellia spp. and (Latin: Liber canonis totius medicinae) were plant remedies used today by native spp. trees and large quantities both used extensively as medical textbooks Bedouins were probably discovered by were exported to Egypt, Mesopotamia in the East and in Western universities until accident or by observing animals and and later to Greece and Rome6. Myrrh and the end of the 17th century. birds, which are known to self-medicate by Frankincense are still used extensively in Two other notable figures in the Islamic purposefully selecting and eating medicinal the Gulf as an internal medicine or burned medical tradition are Ibn Rushd (Averroes), plants. Nomadic tribes and settled coastal as to purify the air. Most of these a Cordoban philosopher and physician who Arabs in the Gulf may also have had access gums are produced in Oman, Yemen and wrote the medical encyclopaedia Kulliyat to Sumerian, Akkadian and Babylonian . (Latin: Colliget) and another Andalusian medicine since both the Dilmun (modern Second, there is a learned, scholarly physician Abu al-Qasim Khalaf ibn al- Bahrain or eastern Arabia) and the Al ‘Ubaid tradition of Persian and Arabic Islamic Abbas Al-Zahrawi (Albucasis), whose (modern Iraq) civilisations were active in medicine based on clinical observation monumental book Al-Tasrif introduced the area. ‘Ubaid pottery was uncovered and critical synthesis of the ancient Greek new surgical techniques and instruments at Ras Abruk in Qatar in the 1970s. The medical tradition of , Hippocrates, specially designed by him. Closely related Akkadians introduced the concepts of Soranos, Oribasius and Paul of Aegina. to Islamic medicine is Unani Tibb, which

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means ‘Greek medicine’ in Arabic. Unani guidance of the Prophet (Peace Be Upon Tibb shares its with the same authors Him) concerning the medicine which he used by Avicenna and Rhazes and it is still a used, was treated with, or recommended flourishing tradition in India and Pakistan. to others”8. Ibn Qayyim divided illness the procedure is Both Greek and Islamic medicine shared the into sickness of the body and sickness of fundamental physiological doctrine that the the heart (spiritual illness), which could be often performed body is made up of four balanced humors treated with natural or divine medicines. (phlegm, blood, black and yellow bile) and Unlike modern Western medicine, Prophetic by slitting the skin that curing illness requires returning the and Islamic medicine firmly believed that and sucking out humors to their natural balance through spiritual illness or “sicknesses of the heart”, plant drugs, diet, baths and bloodletting. such as religious uncertainty and doubt blood through a Third, due to the extensive historical and inordinate desire and temptation, trade between India and the Gulf nations, were serious conditions that required cures. hollow horn the Ayurvedic medicine of India can be Several ahadith from and found in various forms in the Arabian Abu Hurayra state that God has sent a cure peninsula, specifically in Oman, such as for every disease, except that of aging and the hot turmeric plasters for skin diseases death. and . has both a folkloric The central core of Prophetic medicine blood pressure and to treat cor pulmonale and written tradition embodied in the revolves around three primary means of and pulmonary oedema, the practice has two encyclopaedias Susruta and Charaka healing: cupping (hijama), (al ‘asl), been abandoned in modern medicine with Samhita, and it also endorsed the idea of and cautery (wasm/kaii/kowie). Al Bukhari one exception: haemochromatosis or iron- the balance of humors or energies (vata, transmits a saying of the Prophet which loading disease is a condition in which toxic pitta and kapha). Although the Portuguese lists these therapies: “Narrated Jabir bin levels of iron build up in the body organs, controlled much of the trade in the Gulf Abdullah: I heard the Prophet saying, ‘If primarily due to an autosomal recessive for nearly 150 years (1507 to 1650) until there is any healing in your medicines, genetic disorder. The only recommended they were expelled from Bahrain, Hormuz then it is in cupping, a gulp of honey or therapy is phlebotomy, the periodic and Oman, they seem to have had little branding with fire (cauterisation) that suits removal of blood which contains large impact on medical practices, even though the ailment, but I don’t like to be branded amounts of iron in the erythrocytes. The military surgeons must have been present (cauterised) with fire” (7.71.587)9. popularity and wide-spread use of hijama to treat the 2000 to 3000 soldiers and sailors in ancient times may be due to the fact stationed at Portuguese forts in the Gulf7. CUPPING that haemochromatosis is one of the most Their medical practices at the time would Cupping or hijama has been carried out common inherited liver diseases, with a have been very similar to Islamic medicine in many civilisations either for the removal prevalence of 1 in 200 to 1 in 500 cases since they were also based on the humoral of ‘bad blood’ or to rebalance the humors in worldwide. In 2011, Zainel at Weill Cornell model and employed bloodletting as a the humoral model of physiology. Hijama Medical College in Qatar summarised the primary therapy, just as the Islamic hakims is based on the Arabic for ‘sucking’, research that suggests that lower levels would use hijama (cupping) to remove since the procedure is often performed of iron, which could be achieved through blood and restore humoral balance. One by slitting the skin and sucking out blood hijama, may decrease the risk of infectious of the reasons that the Portuguese were through a hollow horn10. Heated metal or disease12. interested in the region was trade in glass cups, which create a vacuum as they and medicinal drugs from both India and cool, can also be placed over skin incisions HONEY the Gulf (including the aromatic gums), to draw out the blood and vacuum pumps Honey used as a wound dressing is which later also brought the Dutch, English attached to the cups are sometimes used attested in Egyptian medical papyri. It is also and Ottomans to the Gulf. in modern practice. The practice is still a recommended in the Holy Qur’an and many Finally, Prophetic medicine (Tibb al- popular folk remedy in the Gulf used to written Islamic medical texts for internal Nabawi) represents the most widely treat a wide variety of disorders including use and is widely used in folk traditions. The followed current traditional medical migraine headache, jaundice, stomach oxidation of the glucose in honey creates system in the Gulf. This medical tradition ache, nausea, sprains, muscular pain and hydrogen peroxide, used as an antibacterial derives from passages in the Qur’an, insomnia. At Hamad Medical Hospital in bleach in hospitals, and the high osmolarity and sunna (way of life) of the Prophet Qatar, Dr Hssanien and his colleagues at the of this supersaturated sugar solution also Muhammed. Its continuing high status Hijama Clinic determined in a clinical trial inhibits bacterial growth. Honey found in derives from its religious origins. There are of 86 patients in 2007 that pain was reduced bronze jars in Paestum, Italy, was virtually many written compilations of prophetic for all patients presenting with headache unchanged since its burial 2,500 years medicine, the most famous being Ibn and back pain11. As with many other of the ago, attesting to honey’s ability to retard Qayyim al-Jawziyyah’s Medicine of the traditional treatments in the region, the bacterial and fungal growth. Manuka honey Prophet. Ibn Qayyim was a thirteenth- mechanism of action is not known. harvested in New Zealand and Australia century jurist and expert in hadith. Although there was some interest in contains an unknown phytochemical He defined Prophetic medicine as “the bloodletting in the 20th century to reduce ingested by the bees that increases the

94 Image: Bloodletting procedure. Found in Medicina Aegyptiorum.

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Images: Cupping cups used in Egypt in the 16th century. Found in Medicina Aegyptiorum. antibiotic properties of the honey. In 2006, Like hijama, it is used on a variety of College of Medicine, King Faisal University, Nzeako and Al-Namaani at Sultan Qaboos ailments including eye problems, headache, Saudi Arabia states emphatically that “the University tested eight commercial honey mental illness, jaundice and even cancer. practice of kaiy is not science-based and is samples purchased in Muscat, Oman and The technique involves heating iron nails or associated with considerable health risks.”16 found that all of them inhibited the growth similarly shaped metal objects and applying of the bacterium Helicobacter pylori which them to very specific cautery points on the causes duodenal ulcers and gastritis13. The body, which are learned by apprenticeship. Herbal medicine (al-tibb al ashab) is authors suggested that honey could be used Cautery has also traditionally been used in also widespread in the Gulf and medicinal in conjunction with the standard antibiotics many cultures to seal and disinfect open plants and spices can be found in many amoxicillin and clarithromycin to eliminate wounds or to lance subcutaneous infections. souqs. The practice is dying out, however, H. pylori. The modern surgical electrocautery knife is as sons are no longer interested in learning Two commercial brands of medical grade based on these principles. Small crescent- their father’s herbal knowledge (which is honey called L-Mesitran and Medihoney shaped cautering irons have traditionally mostly unwritten) and some plants are have been approved in the EU for burn been used to burn off the ingrown eyelashes facing extinction from habitat loss and treatment and wound care. Studies of on the eyelid from trachoma infection. overgrazing of animals. The Qur’an and honey’s effectiveness as a wound dressing The eyelashes, which turn inward due to hadith mention a great number of plants and have had variable results. A meta-analysis Chlamydia trachomatis bacterial infection, of 19 studies on topical use of honey can scrape the cornea and cause blindness. by Jull et al. in 2009 for the Cochrane It is still a common problem in the Gulf Library concluded that “although honey and Africa and now controlled by simple may improve healing times in mild to antibiotics. Patients in the Gulf sometimes Cautery has also moderate superficial and partial thickness visit a mawasmer (cauterer) if conventional burns compared with some conventional therapy has failed. In some parts of Saudi traditionally been dressings, it was found that honey dressings Arabia, the practice is quite common. H.G. used alongside compression therapy do not Watts reported in 1989 that 22% of 298 used in many significantly increase leg ulcer healing at children admitted to King Faisal Specialist 12 weeks. There is insufficient evidence Hospital in Riyadh had been cauterised15. cultures to seal to guide clinical practice for other wound Most allopathically trained physicians in the types”14. Gulf region take a dim view of cautery, since and disinfect open they frequently must treat the unwanted CAUTERY side effects of cautery such as severe wounds Cautery (wasim or kaii in Arabic), is the infection and scarring. Dr K-E. A. Abou- third major therapy of Prophetic medicine. Elhamd of the ENT Department at Al-Ahsa

96 fruits still used in folk medicine, for example stibnite, an ore of antimony (Arabic ithmed) with the cause of poisoning determined dates, fig, pomegranate, colocynth, caper, which is an antibiotic against bacterial to be Bint al Dhahab in 80% of the cases20. fenugreek, aloes, chicory, indigo, senna, infection of the eye, such as trachoma. Neurological damage occurred in 56% of the dill, mustard, olive and truffle17. The most Some kohls also contain borax, a common children. Importation of Bint al Dhahab is prized is black cumin or black seed (habat ingredient in pharmaceutical eyewashes. now banned in Oman. al-barack = ‘blessed seed’) from the Nigella However, studies by Hardy of kohls Despite some undesirable side-effects, sativa plant due to the widely recorded purchased in Oman and the United Arab Gulf folk medical practices certainly merit hadith of Muhammed that black seed is Emirates indicate that lead compounds further study in the framework of modern the cure for all diseases, except death. There such as the mineral Galena are being evidence-based medicine and randomised is abundant evidence from clinical trials substituted for antimony19. Although lead controlled clinical trials. Prejudices of that Nigella sativa exhibits antioxidant, has an antibiotic effect, it is also highly scientists and physicians against traditional anti-inflammatory, immunomodulatory,toxic and numerous cases of lead poisoning practices, however, are hampering efforts to antibacterial, antiviral, antitumor and in children have been reported in the Gulf, test traditional medicines for efficacy and antiparasitic effects18. A mixture of Aloe vera since kohls are used on children (who absorb safety. But large numbers of Gulf residents and Nigella sativa is a common traditional more lead than adults) along with another are using traditional medicine (67% of glucose regulator for diabetics. popular lead-based medicine called Bint al respondents in a United Arab Emirates Another common and ancient folk Dhahab (Zahab), or ‘daughter of .’ Woolf study in 2008 reported using a herbal remedy is the use of kohl, the dark eyepaint reported 25 infants admitted to the Royal medicine) and many of them attest to the commonly seen on Arabic women, which Hospital in Oman from 1987 to 1989 with healing properties of these substances and is not just for beautification. Kohls contain acute lead poisoning (encephalopathy), practices21.

References 1. World Health Organization (WHO). texts/muslim/hadith/bukhari/ Accessed Lucknow: Sidrah Publisher 1998. General Guidelines for Methodologies on 2011. 18. Saad B, Said O. Greco-Arab and Islamic Research and Evaluation of Traditional 10. Hana NS. Al-Tibb Al Shabi fi al-khaleej. Herbal Medicine: Traditional System, Medicine. Geneva: WHO 2000. Doha, Qatar: GCC Folklore Center 1998. p. Ethics, Safety, Efficacy, and Regulatory 2. Scudder LR III. The Arabian Mission’s 158-191. Issues. Hoboken: John Wiley and Sons Story: In Search of Abraham’s Other Son. 11. Hssanien MMR, Fawaz S, Ahmed AF, 2011. p. 159-169. Grand Rapids, MI: Wm. B. Eerdmans Al Emadi S, Hammoudeh M. Effect of 19. Hardy AD, Vaishnav R, Al-Kharusi Publishing Co. 1998. p. 168-69. in treating chronic SSZ, Sutherland HH, Worthing MA. 3. Weber AS. Folk Medicine in Oman. Int J headache and chronic back pain at “Al Composition of Eye Cosmetics (Kohls) Used Art and Sci 2011; 4:237-274. heijamah” clinic HMC. World Family in Oman. Journal of Ethnopharmacology 4. Gotting F. Healing Hands of Qatar. Doha, Medicine Journal 2010; 8. 1998; 60:223-234; Hardy, AD, Walton RI, Qatar: Doha Modern Printing Press 2006. 12. Zainel A. The Mystery of Curing Diseases: Myers KA, Vaishnav R. Availability and p. 109. Hijama. In Weber AS et al, eds. Qira’at: Chemical Composition of Traditional Readings from the Students of Weill Cosmetics (“Kohls”) Used in the United 5. Labat R. Traité akkadien de diagnostics et Arab Emirates of Dubai, Sharjah, Ajman, pronostics médicaux. 2 v. Paris: Académie Cornell Medical College in Qatar 2001- 2011. Doha, Qatar: Dar al Sharq 2011. Umm Al-Quwain, Ras Al-Khaimah, and internationale d’histoire des sciences 1951. Fujairah. Journal of Cosmetic Science 6. Majno GM. The Healing Hand: Man and 13. Nzeako BC, Al-Namaani F. The 2006; 57:107-125. Antibacterial Activity of Honey on Wound in the Ancient World. Cambridge, 20. Woolf DA. Aetiology of Acute Lead Massachusetts: Harvard University Press Helicobacter Pylori. Sultan Qaboos University Medical Journal 2006; 6:71-76. Encephalopathy in Omani Infants. 1975. p. 211-215. Journal of Tropical Paediatrics 1990; 7. Teles e Cunha, J. The Portuguese Presence 14. Jull AB, Rodgers A, Walker N. Honey as a 36:328-330. in the Persian Gulf. In: Potter LG, ed. Topical Treatment for Wounds (Review). The Cochrane Library 2009; 4:1-47. 21. AlBraik FA, Rutter PM, Brown DA. Cross- The Persian Gulf in History. New York: Sectional Survey of Herbal Remedy Taking Palgrave Macmillan 2009. p. 208. 15. Watts HG. Cutaneous Cautery (Al-Kowie): by United Arab Emirate (UAE) Citizens in 8. Ibn Qayyim al-Jawziyyah. Medicine of A Study in a Pediatric Outpatient Clinic Abu Dhabi. Pharmacoepidemiology and the Prophet. Trans. Penelope Johnstone. in Central Saudi Arabia. Annals of Saudi Drug Safety 2008; 17:725-732. Cambridge: Islamic Texts Society 1998. p. Medicine 1989; 9:475-478. 3. 16. Abou-Elhamd K-EA. Kaiy as Traditional Therapy for Pain: Is it Helpful or a Myth? 9. Al Bukhari, Sahih. Hadith. Trans. M. Alan Weber, Ph.D. Muhsin Khan. University of California The Journal of Laryngology & Otology Weill Cornell Medical College Qatar Center for Muslim-Jewish Engagement. 2009; 123:566-568. From http://www.usc.edu/schools/ 17. Farooqi MIH. in the Doha, Qatar college/crcc/engagement/resources/ Traditions of Prophet Muhammad. Contact: [email protected]

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