Diagnosing the disease is the foundation of treatment

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Diagnosing the Disease is the Foundation of Treatment

 

Al-Ḥāfiẓ al-Suyūṭī said in his commentary on his book Itmām al-Dirāyah li-Qurrāʾ al-Nuqāyah:

“Diagnosing it—meaning the disease—is the foundation of treatment; otherwise, whoever treats without diagnosis, his error is closer than his correctness.” End quote.

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I say: The meaning of al-Suyūṭī’s words is that whoever gives medicine without diagnosing the disease—whether it is hot or cold, wet or dry—his error is closer than his correctness. This is because he may sometimes happen to be correct without knowing it, since he did not diagnose the disease. Rather, it may coincidentally be that the medicine is hot while the disease is cold, or the medicine is cold while the disease is hot. He errs much more often because he does not know: is the disease hot or cold? Nor does he know: is the medicine hot or cold? He merely prescribes it because he read in books that these medicines benefit such-and-such conditions, so he compounds them and starts prescribing them to people.

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Thus, diagnosing the disease is the foundation of treatment, because without it, the one who prescribes medicine is lost and wandering, prescribing while blind to the nature of the disease.

This is among the afflictions that have befallen the Ummah in this era. That is only because the contemporary medical school does not concern itself with the issue of the four temperaments in diagnosing disease. Rather, they proceed by naming the type of disease and then giving something that merely suppresses the symptom.

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People were influenced by these theories, which led them to use herbs without following the rules of humoral medicine, but instead according to the contemporary theory that claims one medicine is given to everyone.

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An example of this: someone who has a headache—its treatment, according to modern practitioners, is a painkiller for everyone, despite the differences in their temperaments, without paying attention to the cause of the disease: is it hot, cold, wet, or dry? And without paying attention to the nature of the medicine: is it hot, cold, wet, or dry—so that it may be used by opposites.

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It is well known that painkillers do not remove the cause of the disease; they merely numb the nerves, so the pain subsides temporarily, then returns after a while, and so on. Some people remain suffering their entire lives and are not cured, because the cause is still present.

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Some people, seeking financial profit or claiming to be physicians, spread on social media mixtures in which they combine honey with turmeric, pepper, cinnamon, and ginger, for example, then say: “This benefits heart diseases, liver diseases, blood diseases, stomach ailments, joint pains, cough, and strengthens sexual power”—for everyone. They list many diseases, until the reader thinks this medicine is the hidden secret and buried treasure. Some people then believe that this medicine benefits absolutely, since they do not know the principles of humoral medicine, so they buy it for themselves and their loved ones, then they are harmed and fall ill. They then think that humoral medicine is false, incorrect, old, and ineffective for diseases—when in fact this is only because their disease is hot and the medicine is hot, so neither they nor the one who prescribed the medicine knows. In reality, this mixture’s benefit is conditional: it helps cold, wet, phlegmatic diseases and harms hot, dry, yellow bile diseases. For diseases of the heart, liver, blood, stomach, joint pains, cough, and others include both hot and cold types, each with its signs and its treatment. Even humoral headache has its causes, signs, and treatment.

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So that the matter becomes clear, I will mention some causes, signs, and treatments of one disease out of hundreds of hot, cold, wet, and dry diseases—namely, headache. It includes: sanguine: hot-wet, yellow bile-dominant: hot-dry, phlegmatic: cold-wet, and black bile-dominant: cold-dry types—so that the precision of this medicine becomes clear, and the ignorance of those who give medicine without diagnosing the disease.

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A headache caused by predominance of blood—that is, hotness and wetness—has the following signs: redness of the face and eyes due to the redness of the blood; swelling of the face and eyelids due to wetness; great heaviness in the head due to increased weight from fullness of blood; throbbing, meaning strong movement of the arteries, due to intense need to draw in cold air; and a large pulse, meaning long, wide, and elevated.

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If the signs indicate blood, then treatment is by opposites: reducing the blood through bloodletting of the cephalic vein, to draw the material specifically from the head; using cold, dry medicines such as tamarind with a little sugar, or peeled lentils with sour pomegranate water or unripe grapes; and applying ointments to the head made from barley flour, for example. Then the temperament is changed with cold, dry foods such as lentils, dried fava beans, barley bread, vinegar, and the like.

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A headache caused by predominance of yellow bile—that is, hotness and dryness—has the following signs: intense hotness of the head; thirst, because yellow bile is hotter than all other humors; relief from cold things; dryness of the nostrils; bitterness of the mouth, because what descends from the blood to the palate of wastes is mixed with yellow bile, which is bitter; insomnia due to dryness and hotness of the blood; rapid pulse, caused here by the intense hotness of yellow bile necessitating much movement and strong need to draw in cold air, and by its intense dryness necessitating rigidity of the instrument and resistance to full expansion, so the pulse becomes rapid to compensate by speed for what it lacks in size; clarity of the urine, because the material ascends to the brain due to its subtlety and intense hotness; and the color of the face tending toward yellowness, because bile, due to its subtlety, penetrates to the surface of the skin and makes it yellow.

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If the signs indicate yellow bile, then treatment is by opposites: purging yellow bile with things such as tamarind, jujube, and manna; using cold, wet medicines such as violet and water lily; and here the emphasis on cooling should be greater than in the sanguine type. Then the temperament is changed with cold, wet foods such as fish, milk, sweet cheeses, watermelon, and the like.

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A headache caused by predominance of phlegm—that is, coldness and wetness—has the following signs: heaviness in the head due to increased weight from fullness and immersion of hotness because of abundance of material; weakness of strength due to its quality opposing the ruh and innate hotness; weakness of the nerves due to their wetness and coldness, since their strength lies in hotnesst and dryness, which are absent; inability to bear the head; deep, prolonged sleep due to relaxation of the nerves from wetness and coldness; wetness of the nostrils and mouth because the wastes of the brain are pushed toward them; slowness of the pulse, due here to little need for ventilation because of coldness and weakness of strength, since its foundation is hotness; and whiteness of the urine due to the whiteness of the predominant humor and absence of coloring hotness, for yellow bile colors urine yellow.

If the signs indicate phlegm, then treatment is by opposites: purging phlegm with things such as colocynth fat, since it is hot and dry and facilitates phlegm, after adjusting the consistency of the material with hot, dry medicines such as anise and chamomile; hot, dry gargles made from mustard and thyme with honey; then changing the temperament with hot, dry foods such as honey, thyme, small birds’ meat, onions, and the like.

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A headache caused by predominance of black bile—that is, coldness and dryness—has the following signs: heaviness in the head due to abundance of thick material and its coldness, but less than the phlegmatic type due to its dryness and lesser quantity in the body; dryness of the nostrils and eyes due to coldness and dryness; insomnia; inclination of color toward blackness, as the skin takes on the color of the predominant humor; dryness of the head; narrow pulse, caused here by rigidity of the instrument due to intense dryness, which prevents expansion, since expansion requires softness and softness requires moisture; slowness of the pulse due to little need for ventilation; and whiteness and thinness of the urine due to solidification of black bile and none of it being expelled into the urine—this is when maturation has not occurred. After full maturation, it becomes black and thick due to much of it mixing in.

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If the signs indicate black bile, then treatment is by opposites: after full maturation, with decoctions of hot, wet medicines such as raisin decoction and borage; expelling black bile with dodder along with manna; then changing the temperament with hot, wet foods such as chicken meat, egg yolk, bulgur, carrots, and the like.

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How to distinguish the physician from the herbalist

The physician is the one who knows the principles of humoral medicine: the four temperaments, temperaments and humors, and other matters such as pulse, urine, stool, anatomy, functions of organs, and specific diseases with their causes, signs, and treatments. He knows medicines by their properties and temperaments—hot, cold, wet, and dry. He examines symptoms and signs, pulse, urine, stool, and so on, to know the cause, then prescribes the medicine. And the Healer is Allah.

As for the herbalist—who merely gathers herbs and sells them—he is the opposite of all this. He does not know medicine, does not distinguish the temperaments of diseases and medicines, does not ask about causes and signs, pulse, urine, stool, and so on. Rather, he strikes blindly, erring much and being correct little. In reality, his harm to people is great, and to the reputation of humoral medicine as well, because people think he represents humoral medicine, while humoral medicine is innocent of him.

 

Advice

Therefore, my advice to everyone who wishes to be treated with herbs and the like is not to accept being prescribed herbs before diagnosis. Whoever prescribes herbs merely based on the patient saying, “I am ill with such-and-such,” has exposed him to harm and destruction, like one who gives poison to another. This is because he has violated the rules of humoral medicine, since he does not know them. He does not distinguish the causes and signs of diseases, let alone prescribe treatment. He is not a physician but merely proceeds without any clear method or knowledge deceived by the books of simple drugs he reads. These books usually do not state, for each disease, that this medicine benefits the hot or cold type; rather, they only mention the temperament of the drug itself, then speak of what diseases it benefits, without usually mentioning the temperaments of diseases. Thus, these people were tempted by what they found in books and began applying what they read to people without knowledge of rules and principles, causing much harm.

If a patient has a headache, epilepsy, joint pain, stomach pain, cough, or other diseases, how can medicine be prescribed without knowing the temperament of the disease? These diseases may be hot, cold, wet, or dry, each with its signs. Most diseases have hot, cold, wet, and dry forms—so how can medicine be prescribed without diagnosis?

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Conclusion

This widespread affliction throughout the Islamic Ummah requires greater effort in spreading humoral medicine with its known principles. No land is free of herbalists who claim knowledge of herbs and understanding of what they benefit among diseases, prescribing medicines to people and destroying them, becoming a cause for weakening people’s belief in humoral medicine and turning them away from it—because herbalists are the overwhelming majority who claim knowledge of ancient medicine, and people believe them, while in reality they are ignorant pretenders. It is not true, as commonly claimed, that herbs do not harm if they do not benefit, and that it is therefore fine to take them from the internet or from any herbalist. Rather, most medicines benefit in one aspect and harm in another. The physician knows what harms and what benefits, because he knows the temperament and properties of the medicine and the temperament of the disease. So do not throw yourselves into destruction at the hands of these herbalists who do not diagnose your diseases and do not know the temperaments of medicines and diseases.

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(1) In physicians’ terminology: a long pulse is one that extends beyond four finger-breadths of a normally proportioned hand; a wide pulse is wider than a fingertip; and a high (elevated) pulse is one that rises upward.

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(2) In physicians’ terminology: phlebotomy (faṣd) is a deliberate severing of continuity in the veins using a lancet.

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(3) In physicians’ terminology: the cephalic vein is a vein that appears at the bend of the elbow on the lateral (outer) side.

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(4) In physicians’ terminology: thirst is the nature’s need for the cold and wet—that is, in excess—because among physicians the term is used only for excessive desire for water. Thus, when it is said “so-and-so has thirst,” what is meant is that it is excessive in him.

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(5) In physicians’ terminology: bile (mirra) is one of the four temperaments. Linguistically, mirra means strength and intensity; it was applied to yellow bile because it is the strongest of the humors, and also to black bile because it is the most intense, due to its thickness, stability, and solidity.

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(6) In physicians’ terminology: a rapid pulse is one that completes the expansive movement in a short period; that is, the duration of its movement is very short compared to the normal pulse.

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(7) In physicians’ terminology: a great pulse is one that exceeds in length, width, and elevation.

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(8) That is, the urine flask.

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(9) In physicians’ terminology: purgation (istifrāgh) is the elimination of wastes from the body, whether naturally or through treatment, such as nosebleed, diarrhea, vomiting, sweating, and the like.

Purgation is the mobilization and expulsion of bodily materials. General purgation may refer to that which occurs from the entire body, or to that which is brought about through treatment; partial purgation refers to that which is expelled from a specific organ, such as snuffs and induced sneezes that purge the head alone. It may also refer to the evacuation of all humors; in that case, partial purgation denotes the expulsion of a specific humor, as occurs through diarrhea or vomiting.

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(10) In physicians’ terminology: the rūḥ is a subtle, vaporous substance generated from the blood entering the heart, specifically in its left ventricle, since the right ventricle is occupied with drawing blood from the liver. They used this term to distinguish it from wind (gas) in the abdomen. As for the human spirit, none knows its true reality except Allah. In al-Qāmūs al-Muḥīṭ: rīḥ (wind) has plurals arwāḥ, aryāḥ, riyāḥ, and rīḥ. End quote.

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(11) In physicians’ terminology: innate hotness is a hot, pleasant, airy substance that has no sharpness, stinging, burning, putrefaction, or corruption.

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(12) In physicians’ terminology: a slow pulse is one that completes the expansive movement over a long period; that is, the duration of its movement is very long compared to the normal pulse.

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(13) In physicians’ terminology: a narrow pulse, deficient in width relative to the breadth of the fingertips.

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(14) That is, ventilation (aeration).

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