Dr. Mahdi Muhaqqiq
The author is a well-known Iranian scholar who has edited, either alone or jointly with other scholars, numerous classics of Islamic philosophy, mysticism, jurisprudence, etc. Among these are: Sabzawari's Sharh Ghurar al-fara'id (1348 H.Sh) (which he, together with T. Izutsu has also translated into English), Nasir Khusro's Diwan (1357 H.Sh), `Abd al-Razzaq Lahiji's Shawariq al-‘ilham fi sharh Tajrid al-kalam, Shaykh Hasan ibn Zayn al-Din's Ma`alim al-din wa maladh al-mujtahidin (Ma`alim al-usul), Abu `Abd Allah Muhammad ibn Abi Bakr Tabrizi's Sharh-e bist-o panj muqaddameh-ye Ibn Maymun.
In the history of Greek
medicine three main schools were notable, namely the empiricists (Ashab al‑Tajarib), the dogmatists
(Ashab al‑Qiyas), and the
methodists (Ashab al‑Hiyal). Different
opinions and arguments of these sects can best be seen in two works of Galen:
"On Medical Sects for Students" (Fi
firaq al‑tibb li al‑muta'allimin) and "On Medical
Experience" (Fi al‑tajribah al‑tibbiyyah).
In his work, Pinax, which is in
fact a list of his own works, Galen advises the students to start their studies
by reading "On Medical Sects." Hunayn ibn Ishaq, who translated this
book into Arabic, says that the purpose of Galen was to bring side by side the
arguments of these three sects, which differ from each other by genus. Hunayn
also adds that each of these sects includes smaller divisions which differ from
each other by the species. This book, known as De sectis in Latin, was one of the sixteen works by Galen which
were compulsory for the medical students of Alexandria. Galen's "On Medical
Experience" was translated by Hunayn from Greek into Syriac and by Hubaysh
from Syriac into Arabic. In this work, Galen creates an imaginary court in
which the representatives of each school demonstrate their positions and refute
the positions of the other schools. He starts his work by saying:
The art of healing was
originally invented and discovered by analogy (qiyas) in conjunction
with experience (tajribah) and today
also it can only be practised excellently and done well by one who employs both
of these methods.
Although his position is made clear in
the above passage, yet he disassociates himself from either of the two sects,
namely the dogmatists and the empiricists, in the following statement:
You must not allow yourself to
think that what I am about to say first against empiricism in this book is my
own personal opinion, or that the second argument I use in support of
empiricism is my own view. Rather I shall let one of the dogmatists bring
forward the first argument, which is similar to Asclepiades' view, and the
second argument shall be laid down by a representative of the empiricists,
Menodots if you like, or Serapion, or Theodosius."
At the same time as the
Greek medical heritage was being transmitted into Arabic, arguments concerning
the nature of these sects were taking place among Islamic physicians.
Al‑Mas'udi states that
at the time of al‑Wathiq, the `Abbasid caliph, a group of philosophers
and physicians, among which were Bukhtishu`, Ibn Masuyah, Hunayn and Salmuyah,
were asked by the caliph about the origin of medicine and whether it was sense
experience, reason or tradition. One of those present spoke about the arguments
of each sect on these matters. When al‑Wathiq asked about the opinion of
the majority of the physicians, they unanimously declared that they are in
favour of the dogmatists.
Ishaq ibn Hunayn in "The
History of Physicians and Philosophers" quotes John Philoponos as saying
that Asclepius, who was the first physician, invented medicine with the help of
experience. And after mentioning the physicians who appeared after Asclepios,
Ishiq continues as follows:
They considered experience and
analogy as the most –correct methods of medicine. Medicine thus continued to be
transmitted from those pupils to those members of their families whom they
taught and left behind.
When Plato appeared and
studied the treatises, he realized that experience alone was bad and dangerous
and that analogy alone was not correct. Therefore, he considered the two views
together as correct. He burned the books which they had composed and left the
old books which contained the two views together.
Ishaq mentions that after
Plato, Hippocrates the son of Heracleides remained as the unique man of his
time, the man of perfect virtue, the one who had become proverbial, the
philosopher‑physician. He strengthened the art of analogy and experience
in a marvellous manner, so that no blame would be able to dissolve it and tear
it apart. Then he continues:
When Hippocrates died, he left
behind children and pupils from the clan of Asclepios and other clans. Medicine
continued to be transmitted from those physicians to those whom they taught,
until the time of the appearance of Galen. The noteworthy physicians in the
interval between Hippocrates and Galen are quite a few.
After mentioning Hippocrates
and Galen, who supported experience together with analogy, Ishaq refers to
methodism as follows:
Among them there was one who held a
different opinion and composed books on the procedures of methodism in the craft
of medicine. He wanted to corrupt the people and to lead them away from the
belief in analogy and experience. Some physicians continued to accept
methodism, and others did not, until Galen appeared. He disapproved of
methodism, destroyed it, burned the books that existed on it, and invalidated
that technique.
As mentioned above, in the
3rd/9th century, scholars and physicians paid special attention to these three
sects and their arguments. What was agreed upon was that experience and analogy
should be used together to solve medical issues and that each one alone was not
valid. This point has been made clear by Ibn Abi Sadiq Nishaburi (fl. 5th/ 11th
century) in his "Commentary on Hippocrates's Aphorisms". In
connection with the first aphorism, that is "Life is short, and art is
long, the occasion fleeting, and experience is dangerous and analogy is
difficult" (al‑`umr qasir wa
al‑sina`ah tawilah wa al‑waqt dayyiq wa al-tajribah khatar wa al‑qada
‘asir), Ibn Abi Sadiq comments that if experience is not based on analogy
and not founded on a principle and rule it can be very dangerous. On the other
hand, analogy, which is difficult in itself, cannot be used as a source for
other arts, without the help of experience.
The most
comprehensive account on the medical sects is given by the Iranian physician
Ibn Hindu of Qumm (d. 420/1029) in his book entitled "The Key to the
Science of Medicine" (Miftah al‑tibb).
The sixth chapter
of Miftah al‑tibb is devoted to
the medical sects, a summary of which is as follows:
Each of the various
medical `sects' has its own particular view and method in recognizing illness
and treating it. The physicians agree that the goal of medicine is to confer
the benefit of health; that is, to give health to sick persons. On the method
of obtaining the things which are beneficial to health, however, they differ.
Some say that such thins are obtained through experience (tajribah ). These are called `empiricists'. Others believe that
experience alone is not enough, but that is must rather be combined with
analogy (qiyas); these are called the `dogmatists'. There is also a third
group, called the `methodists' (ashab al‑hiyal),
because they imagine that they have, through clever tactics, cut short the
science of medicine, purifying it of the superficialities and accretions with
which the empiricists and dogmatists preoccupy themselves.
Ibn Hindu, after introducing
the three sects, goes on to describe and characterize each of these sects as
follows.
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The empiricists say that
medicine is derived from experience, experience being the knowledge which is
obtained through the senses. They also say that the principles and rules of
medicine result from four things: incident (ittifaq),
intention (iradah), comparison (tashbih), and the use of something in
one case that was used in another similar case (naql min shay' iki shabihihi).
`Incident' is in turn divided
into two parts: natural incident, such as a nosebleed, a sweat, vomiting, or
something similar which occurs naturally and which brings either benefit or
harm; and `accidental' incident, which occurs in a human being neither
naturally nor through his intention, and which similarly results in either some
benefit or some harm. An example of an accidental incident is when a sick
person falls and blood flows out of him.
`Intention' means when
something is experienced by choice; the motive for such an `experience' may be
something seen in a dream or other similar thins.
`Comparison' is when the
physician employs one of the three instances mentioned above (that is
intention, natural incident, or accidental incident) when a new case presents
itself. For example, when he sees that his patient, who has a bloody fever,
obtains relief through a flow of blood from his nose, whether that occurs
naturally, accidentally, or through his personal will, then he will try
drawing blood in similar illnesses.
Finally, naql is the method employed when the physician encounters an
illness which he has not seen before, or which he has seen but for which there
is no proven treatment. In this case he will resort to naql, that is he will use a medicine which has been proven in the
case of one illness in a similar illness, or will use a medicine proven in the
case of one organ of the body for another similar organ; or if he does not have
access to the proper medicine, he will use a similar one.
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The dogmatists hold that there
is no doubt that sense and experience are the root and principle of all
sciences and arts, but these must be subject to the instruments of thought.
They say that the rules of medicine and of other arts must be derived through
thought and analogy; that is, the determination of unknown things through
things which are known. It is through the use of thought and analogy that the
various natures and constitutions may be known, and through which the faculties
which are the cause of changes in the body may also be known.
Causes of changes in the body
are of two types. One is that which necessarily results in alteration: such as
climate, movement and rest, food and drink, sleep and wakefulness, and
constipation and looseness, as well as mental occurrences such as sorrow or
happiness, anger or joy. The second type of .cause is that which results in a
change in the body without that change being necessary: such as the change
which appears as the result of the blow of a sword, the attack of a wild
animal, or burns inflicted on the body.
It is also necessary to know
the type of illness which the physician intends to treat, for if it is not
known it will not be possible to take it away from the body. Finally, one must
know the extent of the illness in order that the type of treatment be
determined. The extent will vary in accordance with the following factors: the
bodily strength of the patient, age, temperament, the season in which the
illness appears, the weather on the day it appears, the type of city the
patient lives in, and his habits and profession.
The difference between these
two sects is that when a patient comes to an empiricist he refers to his
previous experience of persons who have had the same type of illness to the
same degree, and who are of similar age and temperament. Then he prescribes the
same medicine which proved effective in the past. The analogist will, however,
on the basis of the same evidence ‑ that is age, temperament, habits, and
residence ‑ envisage a general rule with regard to each type of sickness,
and when he is presented with a new case will refer to that rule.
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As for the
methodists, they examine neither the causes of illnesses, nor the habits and
age of the patient, nor the times of the year, temperament and residence,
bodily strength or the members of the body. They do not pay attention to each
separate and particular case in itself, and they say that such cases are
unlimited. Their attention is directed instead to a knowledge of the most
general aspects which consist, according to them, either of `constipation' and
`looseness', or a combination of the two. By `constipation' they mean the
trapping of waste which should normally be eliminated from the body, such as
the retention of urine and other such things. By `looseness' they mean an
excess in the elimination of these same wastes, such as constant urination and
the like. By a combination of the two, finally, they mean a sickness which
combines both the conditions, such as an eye which is swollen but which is at
the same time constantly tearing.
The methodists
state that the treatment of these three general illnesses is accomplished
either through the management of food and drink, through rest and movement, or
through sleep and wakefulness.
Ibn Hindu finally declares
that the dogmatists are correct, and goes on to demonstrate the invalidity of
both the empiricist and methodist schools. He concludes that it is the
dogmatists who hold out the possibility of progress in methods of diagnosis and
treatment. The empiricists, because they do not believe in analogy, are
extremely limited in this area As for the methodists, who do not deal at all
with particularities but pay attention only to certain general aspects, are
subject to many errors.
In this paper an attempt was
made to show that the arguments of the three Greek medical schools were
continued among the physicians of the Islamic world. In spite of the fact that
among the Greeks attention was paid to experience and analogy together, it
appears that Islamic physicians were more in favour of analogy. It can be
suggested that this is due to the influence of logic in the centres of
scholarship. The influence of logic is evident not only in medicine but also
in Arabic grammar and Islamic jurisprudence. It is hoped that more research
would be carried out on this point.
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1. Edited by Muhammad Salim
Salim (Cairo 1978).
2. Edited by Richard Walzer
(Oxford 1944 ).
3. Introduction of MS of
Galen's "On Medical Sects," p.4.
4. Hunayn ibn Ishaq, Risalah ila `Ali ibn Yahya, fi dhikr ma
turjima min kutub Jalinus, edited by Bergstrasser (Liepzig 1925) p. 4.
5. Ibn Jumay', Treatise to
Salah ad Din on the Reviual of the
Art of Medicine, edited and translated by H. Fahndrich (Wiesbaden 1983) p.
19.
6. Galen, "On Medical
Experience," p.85.
7. Ibid., p.87.
8. Al Mas`udi, Muruj al‑dhahab, edited by Charles
Pellat (Beirut 1973) vol.4, p.373.
9. Ishiq ibn Hunayn's Tariq al‑'atibba' by Franz Rosenthal,
Oriens, No 7 (1954), pp. 75 and 77.
10.
Ibid., p.77.
11.
Ibid., p.78.
12. Ibn Abi ' Usaybi'ah, 'Uyun
al‑'anba' fi tabaqat al‑ atibba; edited by Nidar Rich (Beirut 1963‑65) p.461.
13. Hippocrates,
"Aphorisms", in The Genuine Works
of Hippocrates, translated by
Francis Adams (Baltimore 1936) p.292 and The
Medical Works of Hippocrates, translated
by John Chadwick (Illinois 1950) p.148.
14. Buqrat, Kitab al‑fusul (MS No. 5205, Astan‑e
Quds Library, Mashhad, Iran).
15. Sharh Kitab al‑fusul, MS Osler Library, Montreal, No.
7785/66, p.3.
16. Edited by M. Mohaghegh and
M. T. Danishpajuh (McGill Institute of Islamic Studies, Tehran Branch 1989).
17. M. Mohaghegh, Miftah al‑tibb
wa minhaj al‑tullab(A
summary translation) Medical Journal of the Islamic Republic of Iran, vol. 2,
No. 1. (Tehran 1408/1988) pp. 61‑63.
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