The liver in Greco-Arabic and Islamic medicine
2024; Lippincott Williams & Wilkins; Volume: 23; Issue: 1 Linguagem: Inglês
10.1097/cld.0000000000000137
ISSN2046-2484
Autores Tópico(s)History of Medicine Studies
ResumoLIVER MEDICINE IN ISLAM AND ITS LEGENDARY PROPONENTSMedicine was an integral feature of medieval Muslim culture although millennia before the advent of Islam it had been practiced in Mesopotamia, ancient Egypt, and Persia—known as Iran since 1935—and elsewhere in Asia.1 Islamic physicians, philosophers, and scholars had wide-ranging interests in health and disease, and as the scientific understanding of the basis of illness grew, they searched for causes of disease and probed possible treatments and cures.1 Islamic civilization once occupied territory from India in the East to the Atlantic in the West, and later spilled out of Arabia into Syria, Egypt, and ancient Persia whereas the commercial reach of the civilization encompassed Latin America and China and everywhere in between.1 Islamic thinkers and scholars in Baghdad and Toledo translated, into Arabic, philosophical and scientific works from Greek; the Eastern Christian language Syriac; Pahlavi (from pre-Islamic Persia); and Sanskrit. Translations were started during the Caliphate that began in 632 ce, and included the extant medical literature that was handed down from the giants of Greek and Roman Medicine (especially the highly influential savants Hippocrates and Galen), and other Greek scholars in Alexandria, Egypt. Then followed endorsement and embellishment by the fabled Arab and Persian Islamic thought leaders in science, engineering, philosophy, and medicine. Data were expertly gathered and cataloged, and encyclopedias were published so that others could easily identify, source, and understand medical pearls in what was, even then, a bewildering compendium of texts in a variety of languages. Medicine in Islam became known by the Arabic appellation Unani2,3 (or Unani Tibb, meaning Greek Medicine) which translates as Greek (or strictly Ionian) and indicates its pedigree as having been derived originally from Greek medicine,4 which also explains the English designation Greco-Arab, even though there were other influences too. Nowadays, Unani or Unani Tibb refers to an alternative holistic system of medicine that has been practised in the Indian subcontinent and elsewhere in South Asia, since its introduction there in the 8th century ce.3,4 There is some intriguing evidence that Greek medicine may even have arrived in India with the Asian campaign (327–325 bce) of Alexander the Great.4 Developed from the Greco-Roman Medicine of Buqrat and Jalinoos (Urdu for Hippocrates and Galen, respectively) and influenced by Indian medical teachings, Unani Tibb doctrines2,3 espouse 7 basic physiological principles (The so-called Umoor-e-Tabiya comprised Akhlaat [Humors], Arkan [Elements], Mizaj [Temperaments], Arwaah [Life forces], Aaza [Organs and Systems], Quwa [Faculties or Powers], and Afa'al [Functions]. These can be combined, eg, blood is hot and wet, phlegm is cold and moist, yellow bile is hot and dry, and black bile is cold and dry.), which include among others influences the 4 Hippocratic body humors (written in Urdu): dam (blood), balgham (phlegm, ie, mucus, from the lungs), safra (yellow bile, from the liver), and sauda (black bile, in the gallbladder) responsible for sanguine, phlegmatic, choleretic, and melancholic dispositions—the same corresponding 4 physical elements—air, water, fire, and earth, respectively, and the "temperaments" (or qualities)—cold, hot, wet, and dry (Figure 1).FIGURE 1: (A) Image of woodcut from Physiognomische Fragmente, zur Beförderung der Menschenkenntnis und Menschenliebe (1775–1778) by Johann Caspar Lavater, depicting the 4 humors: phlegmatic (upper left, ie, mucus phlegm, phlegma φλέγμα), choleric (upper right, ie, yellow bile, xanthe chole ξανθη χολή), sanguine (lower left, ie, blood, haima αἷμα), and melancholic (lower right, ie, black bile, melaina chole μέλαινα χολή). (B) The association between the 4 elements—fire, earth, water, and air (depicted on the outside of the figure)—and the 4 Hippocratic humors (yellow bile, black bile, blood, and phlegm), enveloped in the inside by the 4 qualities: dry, moist, hot, and cold. The natural state (physis, φύσις), that is good health (eucrasis/eucrasia, εὐκρᾶσις/ία), is achieved when there is a proper blending and balance of the elements, qualities, and humors in amount and strength. When these are disproportionate, disease, that is, dyscrasia (δυσκρασία) ensues. Reproduced with permission from Rothschuh.5Theories relating to natural science, mathematics, astrology, astronomy, alchemy, religion, philosophy, architecture, textiles, and agriculture were entertained, and even elaborated and extended upon by adding findings from their own astute observations and fresh discoveries, which led to new conclusions. There was seemingly no end to Islamic ingenuity, creativity, and inventiveness in such diverse fields as mathematics, astronomy, architecture, engineering, surgery,6 and even poetry, as so eloquently, colorfully and graphically reported7 by Professor Salim TS A-Hassani (Emeritus Professor of Mechanical Engineering and Honorary Professorial Fellow at the Faculty of Humanities, at the University of Manchester, in the United Kingdom). In addition, Islamic investigators, principally in 1st century ce Alexandria, improved on age-old techniques such as distillation (Figure 2) and crystallization, and the use of alcohol as an antiseptic. Deriving from or, more likely, preceding these innovations, came the improved fabrication of dark eye shadow (al-koh'l or al-kuhul, كحولa)—that was so fashionable in ancient Egypt—by means of the sublimation of stibnite (an antimony ore) into a fine gray-black powder that replaced the customary time-honored lead-containing galenite ore that was ground to a thick dark pigment. In 1530, the Swiss physician Paracelsus applied the term alcohol, that is, the Latinized form of al-koh'l, to another more popular product of distillation, namely alcohol of wine, later spirit of wine (known as ethanol since 1892), and spirits (referring to the vapors that arise during the distillation process), that is, the vernacular for hard liquor.8FIGURE 2: Engraving depicting Mary or Maria the Jewess (Latin: Maria Prophetissa or Prophetissima from Michael Maier's book Symbola Aurea Mensae Duodecim Nationum, 1617), an early alchemist who lived in Alexandria, Egypt, between the 1st and 3rd centuries ce, and whose inventions were crucial to the perfection of the process of distillation, as reported by Adam Rogers, in his 2014 book, Proof: The science of booze. Houghton Mifflin Harcourt, Boston. Mary's name survives in her invention, the bain-marie (Mary's bath), a water bath device that limits the temperature of the distillation process. Inset: An Alembic apparatus, invented by Mary the Jewess, and later used by Rhazes in the preparation of kerosene. Credit: Wellcome Collection https://creativecommons.org/licenses/by/4.0/Islamic physicians devised their own complex interpretations pertaining to medications, clinical practice, nature of disease, diagnoses, treatments, and cures. In fact, Western doctors actually first learned of Greek and Roman medicine, including the works of Hippocrates and Galen, by reading Arabic translations and other treatises by Islamic physicians who were recognized and celebrated in the West.9 Translations from Arabic back to Latin and later other languages, followed. (Arab Islamic civilization slid into a decline following the devastation of Baghdad by the Mongols [1258 ce], the ascendancy of the Turkish Ottoman Empire, and the 14th century conquest by Christian armies of the Al-Andalus [الأَنْدَلُس] Muslim Empire on the Iberian Peninsula. This Reconquista of "Christian" Iberia culminated in the surrender of the Nasrid kingdom of Grenada by Sultan Abu 'Abdallah Muhammad XII, to the forces of the united Spanish Crown of Ferdinand II of Aragon and Queen Isabella I of Castile in 1492,10 under whom the dominions of Spain were fully united. And coincidentally, the Moors [a Christian European, and now somewhat derogatory term {from the ancient, Berber-speaking, Mauri}, for the Muslim inhabitants of the Mahgreb, the Iberian Peninsula {Al-Andadalus}, Sicily and Malta that they controlled between 711 and 1492 ce] and the Jews alike were expelled from Spain in 1492, and eventually from the entire Iberian Peninsula.) Islamic centers of learning had grown out of famous mosques, and hospitals were often established at the same sites. There medical apprentices could observe and learn in a practical fashion, from seasoned physicians. The medieval Islamic world produced some of the greatest medical thinkers in history. They made advances in surgery,7 built hospitals11 (Figure 3), and welcomed women into the medical profession.12FIGURE 3: The Mansuri Hospital in Cairo, Egypt, an important teaching hospital. Credit: Sailko, Wikipedia Commons, https://creativecommons.org/licenses/by-sa/3.0/Most prominent among the Islamic polymaths were 2 Persian clinicians: Abu Bakr Muhammad ibn Zakariya' al-Razi (c864–c925 ce) (أبو بکر محمد بن زکریاء الرازي) often known as (al)-Razi (Latinized to "Rhazes," Figure 4A), and Abu 'Ali al-Husayn bin Abdullah ibn al-Hassan bin Sina al-Balkhi al-Bukhari (أبو علي الحسين بن عبد الله بن الحسن بن علي بن سينا البلخي البخاري) (980–1037 ce, Figure 4B), aka "Avicenna," a Latinized moniker that was probably a misinterpretation of ibn Sina, as heard by Western ears. In his General Prologue to the Canterbury Tales (A collection of 24 stories, written in Middle English by Geoffrey Chaucer between 1387 and 1400, presented as part of a story-telling contest by group of pilgrims as they traveled together from London to Canterbury to visit the shrine of Saint Thomas Beckett at Canterbury Cathedral. Aside from some surviving manuscripts of questionable originality, the first printed version was published by William Caxton in 1476.), Geoffrey Chaucer (c1340s–1400), the renowned 14th century English poet, author, and civil servant, actually mentioned the authorities of these 2 Persian intellects11; such were their international reputations. The third Islamic polymath, known as "Averroes" Abū l-Walīd Muḥammad Ibn ʾAḥmad Ibn Rušd [1126–1198] [أبو الوليد محمد ابن احمد ابن رشد.] hailed from 12th century Andalusia, where he campaigned fervently for the restoration of Aristotelianism into Islamic thinking, and for which he became especially familiar and influential in Western Europe.FIGURE 4: Statues of (A) Rhazes and (B) Avicenna, in the Scholars Pavilion at the United Nations in Vienna, Austria. Credit: Yamaha5, Wikipedia Commons, https://creativecommons.org/licenses/by-sa/3.0/.The cardiocentrist ancient Egyptians attributed intelligence, emotions, and sensation to the heart, which they treated with reverential deference by not removing it from the body during mummification. In parallel with the lungs, intestines, and stomach, the liver was removed, for use by the owner in the afterlife, and stored in a specific canopic jar protected by the god Imsety, a son of Horus (Figure 5). On the other hand, the medieval Greco-Arab physicians followed the tortuous path laid out by their Greco-Roman mentors to identify the liver as one of the body's major organs. Aristotle (384–322 bce), a long-time disciple of Plato and later tutor to Alexander, the 13-year-old son of King Phillip of Macedonia and future conqueror of the known world, saw the liver as the origin, albeit indirectly, of the Vital Heat of the heart (also called innate or natural heat [calidum innatum]). Aristotle considered the heart to be the cardinal organ, located strategically at the center of the body and its vascular system, as befits the noblest of organs.13 For Aristotle, the heart was not only the first active organ that he saw in a fertilized hen's egg but was also the source of blood—the life force—with which the heart was richly endowed. In keeping with prevailing Greek views on physiology, Aristotle considered the heart to be the origin of the vessels through which its vital heat, maintained by the pneuma (spirit or soul), was distributed throughout the body, including the brain. Consequently, and unquestionably for Aristotle, the heart was the seat of the soul for, he observed that "when the heart is made cold, the individual dies." Aristotle's ideas were expressed explicitly in his formidable text on biology, De Partibus Animalium (Περὶ ζῴων μορίων, in Greek),14 which was later translated into Arabic, as Treatises 11-14 of the Kitāb al-Hayawān (كتاب الحيوان), and ultimately into Latin.15FIGURE 5: (A) Four canopic jars containing, from left to right, the liver, lungs, stomach, and intestines, guarded respectively by the gods, the 4 Sons of Horus—namely the human Imsety; Hapy, the baboon; Duamtef, the jackal; and Qebehsenuef, the falcon. Canopic jars are containers that were used by the ancient Egyptians during the mummification process, to store and preserve the viscera of their owner for the afterlife. They were commonly either carved from limestone or were made of pottery. Inset: micrograph of mummy liver histology, courtesy of the series editor, Dr A. Reuben, who received it as a generous gift from the late Professor Peter Scheuer (1928–2006), one of the leading histopathologists of his generation. (B) Hieroglyphs for the 4 sons of Horus used on Egyptian canopic jars.And yet the ancient world was decidedly Hepatocentric, at least until 1628, when William Harvey showed that pumping by the heart circulated the blood around both the major systemic and the minor pulmonary circuits. Hippocrates (or more accurately his disciples of the so-called the Hippocratic school, who are often referred to as "The Hippocratics"), who predated Aristotle, reasoned that, "If we are able to live a good life, it is because of the health of our liver." The liver is a source of the natural force with which digestion, maturation, attraction, and repulsion are accomplished. And with these forces, the organs digest the food and transform it, after its attraction and retention. If the liver's transformative force is weakened, diseases occur in the body, such as dropsy (a contraction of the archaic term for edema, namely hydrops, ýdropos ύδρωπος in Greek from húdōr ὕδωρ, ie, water) when control of fluid balance is undermined. The cure must therefore be accomplished by returning the liver to its normal equilibrium. Following in the footsteps of his hero, Hippocrates, Galen (131–200 ce), opined that the liver is the "master organ" of the human body, that emerges before all other organs are formed in the fetus. In his book, "On the usefulness of the parts of the body" (Περί χρείας μορίων in Greek, De usu partium in Latin),16 Galen described the liver as a warm and moist organ (a favorite description also found later in Arabic parlance, promoted by The Prophet) wherein a fire (one of the 4 ultimate elements—along with air, water, and earth—of which all matter in the world is composed, according to the theory of 5th century BCE philosopher Empedocles17) burned perpetually, supposedly in the hot dry yellow bile. The heat of the liver was the source of the human spirit, which traveled to the brain via the heart. To resolve any confusion in understanding by medieval and later Renaissance readers, Galen clarified—admittedly, not entirely successfully—that "… the heart is, as it were, the hearthstone and source of the innate heat by which the animal is governed." Aristotle almost had it right, and though Galen attributed to the liver the origin of the vital heat, he also reasoned erroneously that the liver was involved in blood formation, as the principal instrument of sanguification (sanguifactionis officina) and the source of the blood vessels (fons venarum) that facilitate the circulation around the body of the blood manufactured by the liver. (As we know, in the case of hematopoiesis, here Galen was also wrong.) To the Ancient Greeks, the liver housed the human soul, with its complex emotions. Hepa, the root of terms used scientifically to describe liver-related topics (as in hepatology), is thought to be derived from the Ancient Greek word hèpar (η′παρ), which may stem from the word hedoné (ηδονη), meaning pleasure.18 Many centuries later innate heat was mundanely attributed to friction caused by the motion of blood through the arteries, as expounded in the first edition of Chambers's 1728 Cyclopædia (Figure 6), as follows: "For 'tis hence we know, that this innate Heat is no more than the Attrition of the Parts of the Blood; occasion'd by its circulatory Motion especially in the Arteries."FIGURE 6: (A) First edition of Chambers's Cyclopaedia or An Universal Dictionary of Arts and Sciences. London: James and John Kimpton; 1728. Two-volume thick folio edition in 19th-century paneled calf, ruled in black, spines in 7 compartments with raised bands, lettered in gilt, with armorial crest and letter in gilt, titles printed red and black, engraved folding frontispiece to volume I, 19 engraved plates (plate XIV in 2 parts), some folding, the anatomy plate browned as usual, printed in double columns throughout. (B) Frontispiece from the first edition. Ephraim Chambers (1680–1111), inspired by John Harris's Lexicon Technicum set out to compile a more comprehensive work which he dedicated to King George, the Second and Four which Chambers was elected to the Royal Society in 1729. His Cyclopedia was the model for all future encyclopedias, including Encyclopaedia Britannica.Greco-Arab physicians considered that the heart, the brain, and the liver are the 3 principal organs of the body, which, incidentally, historically have vied with each other for dominance.19 In keeping with 4 humor theory proposed by the Hippocratics and supported by Galen, disease in the Greco-Arab system of medicine results from imbalance or dyscrasia (from the Greek duskrasía δυσκρασία, a "bad mixture," in contrast with harmony of the humors or eucrasia, from the Greek eukrâsis εὐκρᾶσις) of the 4 bodily humors (3 of which originate and are made/stored in the liver, spleen, and gallbladder), as described above in the 7 physiological principles of Unani and portrayed in Figure 1. The character or moods of persons, conveyed by the words sanguine, phlegmatic, choleric, and melancholic, depend on the relative abundance of these 4 humors, which have their own distinctive attributes; blood is hot and moist, phlegm is cold and moist, yellow bile is hot and dry, and black bile is cold and dry. Incidentally, Galen's ideas about physiology prevailed for 14 centuries, until the Renaissance. According to Greco-Arab practice, herbs may correct humor imbalance and cure diseases.20 Avicenna, born in the late 9th century in Afshana near Bukhara in Maverounnahr, Central Asia, in the Persian Empire, was arguably the most renowned of the Islamic polymaths—known as Al-Shaykh al-Ra'is (The Main Sheykh) and Al-Mu ́ xallim al-Thani (The Second Teacher, after Aristotle). He had many skills and professional roles, including authorship of approximately 450 books and articles, 240 of which still exist today, and 40 of which focus on medicine. Among his two most significant contributions to medieval medicine were "The Book of Healing" (کتاب الشفاء, Kitab al-shifa'), a philosophical expansive scientific encyclopedia based on the Aristotelian tradition as modified by Neo-platonic influences and Muslim theology, and "The Canon of Medicine" (Al-Qanun fi-l-tibb, القانون في الطب), which was also entitled "The Law of Medicine." Avicenna completed his Canon (Figure 7) around 1020 ce, as a 5-volume textbook in Arabic (Avicenna, Canon of Medicine 5 Volume Set. University Professor of Islamic studies Seyyed Hossein Nasr PhD [Editor], Laleh Bakhtiar [Translator]. Kazi Publications Inc., Chicago 2015.). The Arabic text of The Canon was published in Rome in 1593, having been translated into Latin by Gerard of Cremona in the 12th century. The Canon displaced the works of Galen, Al-Razi, and others, and became essential reading at several medical schools around the world. At the universities of Leuven in Belgium, Montpellier in France, Salermo in Italy, and many in Germany, its texts were studied well into the middle of the 17th century, and in Padua, Italy even until 1715. Later, scholars translated The Canon into several more languages, including English, French, and German, and it became one of the most famous and influential books in the history of medicine. Within its pages, Avicenna laid out many recommendations for medical practice. The first Hebrew edition of Avicenna's Canon, translated from the Arabic, was published in Naples 1491/2, whereas the English edition Book 1, translated from Medieval Latin by C. Gruner, did not appear until 1930. The Canon of Medicine set standards for practice in the Middle East and Europe, and it provided the basis of Unani Tibb, in India. In the United States at the University of California, Los Angeles, and Yale University, New Haven, Connecticut, some principles of The Canon are included in History of Medicine courses. According to William Osler (1921),21The Canon is "… the most famous medical textbook ever written" and it has remained as "… a medical bible for a longer period than any other work."FIGURE 7: (A) A page from Avicenna's Canon of Medicine. Credit: Ali Esfandiari, 2007. (B) 1484 CE Latin translation of Avicenna's Canon of Medicine located at the University of Texas Health of San Antonio. (C) Avicenna, Canon of Medicine 5-volume set. University Professor of Islamic Studies Seyyed Hossein Nasr, PhD (editor), Laleh Bakhtiar (translator). Kazi Publications Inc., Chicago; 2015.Avicenna considered the liver to be "… the seat of nutritive or vegetative faculties," "…the seat of manufacture of the dense part of the humors…," and also the origin of the body's vessels. Further, Avicenna also agreed with Galen's notion that the heart "is the hearthstone etc." (as mentioned above), and he stated in The Canon that the heart produced breath, that is, "the vital power or innate heat." Avicenna indicated that liver malfunction may lead to a variety of diseases, which fortunately could be corrected by appropriate herbal intervention.20,22,23 In this context, he described the medicinal properties of the herb Hypericum perforatum, which recently found use in traditional medicine for jaundice, other liver diseases, gallstones, rheumatoid arthritis, and other inflammatory conditions (it should be noted that this is not an endorsement of such therapy), and he also mentioned Tamarix nilotica (Ehrenb.) Bunge for the treatment of liver, stomach, and inflammatory problems.23 Avicenna's assertion that the liver separates moisture from the blood anticipated Starling's discovery a millennium later,24 that the liver is the major source of lymph production (it was the Danish physician,Thomas Bartholin [1616–1680], of course, and not Starling, who discovered the lymphatic system). Consequently, the distortion of the architecture of the liver in cirrhosis and other chronic liver diseases leads to ascites, a condition of lymph overflow from the liver.25 Avicenna, without any facilities for investigation, introduced criteria for diagnosing liver disease in an era when the emphasis could only be on history and physical examination.26 The Persian physician Rhazes (Latinized from Al-Razi) was a chemist, alchemist, pharmacist, philosopher, and scholar (Figure 4A), who lived from 865 to 925 ce. He was the first to distinguish measles from smallpox, and records indicate that al-Razi traveled throughout Persia, teaching Medicine and treating rich and poor alike. He invented many devices, including spatulas, flasks, mortars, and phials, and described 2 methods for the production of kerosene, termed naft abyad (نفط ابيض "white naphtha"), using an apparatus called an alembic that was allegedly also invented by the same Maria/Mary the Jewess (Figure 2 and inset), who excelled in distillation. Rhazes was prolific, penning more than 200 scientific books and articles, extensive discussions on pharmacy (Rhazes was also a Pharmacist) including the introduction of mercurial ointments. Known as the "Father of Pediatrics," he wrote the likely first text to distinguish Pediatrics as a separate field of medicine and was the first doctor to write about immunology and allergy. He may even have discovered allergic asthma, and to recognize that fever is a defense mechanism against disease and infection. In a book relating 33 clinical cases, Rhazes told the histories of each of the patients that he visited, describing the clinical features and the diagnosis and treatment of every one of them, which included a case of septic arthritis after an abscess in the liver. Indeed, he also wrote separately a dedicated hepatology textbook entitled, "About the Liver" Dar Hey'ateh Kabed (Persian ﻛﺒﺪ ﻫﻴﺄﺕ ﺩﺭ). And, as it happens, Abū Marwān 'Abd al-Malik ibn Zuhr ( أبو مروان عبد الملك بن زهر, Latinized Avenzoar), an Andalusian physician in 12th century Seville, also described the anatomy of the liver, spleen, and abdomen, and their diseases and treatment, in Kitab Al-Taysir the last book that he wrote before he died. As for Avenzoar's contemporary, close friend and collaborator, Abū l-Walīd Muḥammad Ibn ʾAḥmad Ibn Rušd (أبو الوليد محمد ابن احمد ابن رشد, Latinized as Averroes), he was a jurist and philosopher, a passionate and strong proponent of Aristotelianism, which earned him both admiring supporters and hostile detractors, but he was not particularly celebrated in medicine. Nonetheless, his name was recently used, illogically but expediently it seems, as the acronym for a recent randomized clinical trial of anticoagulants in patients with atrial fibrillation.27 Enter, Abū ʿImran Mūsā ibn Maymūn ibn ʿUbayd Allāh, otherwise "Moses 'son of Amram' son of Maimon of the Obadians, the Cordoban" (أَبُو عَمْرَان مُوسَى بْن مَيْمُون بْن عُبَيْد ٱللّٰه) in Arabic, and Rambam, (רמב״ם), which is the Hebrew acronym for Rabbi Moses (Moshe) ben Maimon or Maimonides (Figure 8). He was a medieval Sephardic Jewish philosopher who became one of the most prolific and influential Torah scholars of the Middle Ages. In his time, he was also a preeminent astronomer and he served as the personal physician of Saladin28 (Saladin was the epithet for the ethnic Kurd Yusuf ibn Ayyub ibn Shadi [c. 1137–1193], first Sultan of Egypt and Syria, who founded the Ayyubid dynasty, and defeated the Crusaders at the Battle of Hattin in 1187, thereby re-establishing Muslim military dominance in the Levant). Maimonides (1138–1204) was born in Córdoba, Al-Andalus, in the Almoravid Empire, with an illustrious ancestry tracing back to the Royal House of King David of Israel. He worked as a rabbi, physician, and philosopher in Morocco and Egypt. After he died in Egypt, his body reburied in Tiberias, on the banks of the Sea of Galilee (Lake Kinneret). Maimonides was highly prominent in the Islamic and Arab sciences. He was influenced by Avicenna, his contemporary Averroes, and also by the renowned early Islamic philosopher and jurist Abu Nasr Muhammad Al-Farabi (Persian: ابونصر محمد فارابی, Arabic: أبو نصر محمد الفارابي, Latinized to Alpharabius, c. 872–c. 951), who excelled in metaphysics, ethics and logic, political philosophy, the sciences, cosmology, mathematics and music theory.FIGURE 8: (A) This "traditional portrait" is an imaginative representation of Maimonides—since no true likeness exists—possibly by the 19th-century American illustrator Arthur Burdett Frost. The depicted Maimonides signature in this picture is unequivocally authentic as it resembles his numerous verified signatures found in the Cairo Geniza. (B) Manuscript page by Maimonides. Judeo-Arabic language in Hebrew letters. Originally published in the Jewish Encyclopedia (1901–1906), Funk and Wagnalis, New York. (C) This bronze statue of Maimonides, by sculptor Amadeo Olmos Ruiz, was erected in 1964 in the Plaza de Tiberiades in the Jewish old quarter of Cordoba (Maimonide's birthplace), quite near the old synagogue. The sculptured face of Maimonides is remarkably similar to that of the statues of Avicenna, which were allegedly authentic28. The feet are shiny due to frequent touching, for good luck, by visitors. Courtesy: Ajay Suresh, https://creativecommons.org/licenses/by/2.0/deed.enMaimonides was an illustrious philosopher and polymath in both the Jewish and Islamic worlds, knowledgeable about Greek and Arabic medicine and a disciple of Galen and Greek humorism. In his medical writings that were influential for generations,29 Maimonides detailed a wide spectrum of conditions from his own observations, experience, and interpretation of authoritative works of others.30 He emphasized moderation and a healthy lifestyle. His description of hepatitis was uncannily accurate,31 "The signs of liver inflammation are eight in number as follows: high fever, thirst, complete anorexia, a tongue which is initially red and then turns black, biliary vomitus, initially yellow egg-yolk in color which later turns dark green, pain of the right side which ascends up to the claviclew. Occasionally a mild cough may occur and a sensation of heaviness, which is first felt on the right side and then spreads widely…." MEDICATIONS IN ISLAMIC MEDICINE Plant-derived compounds are generally easily accessible and mostly affordable, and there is a deep belief that herbal remedies are natural and harmless alternatives to synthetic drugs. Thus, complementary and alternative herbal medications, health supplements, and the consumption of weight loss nostrums has risen sharply recently in Europe, and the United States,31 whereas traditional remedies have long been popular among indigenous and ethnic groups, especially in the Far East. Up to 65% of patients with liver disease are taking herbal preparations and the like, often with bad outcomes from hepatotoxicity, because pre-existent liver damage can reduce reparative responses to additional injur
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