Greco-Arab and Islamic Herbal Medicine

Traditional System, Ethics, Safety, Efficacy, and Regulatory Issues

Bashar Saad, Omar Said

• Publisher: Wiley
• Year: 2011
• Print ISBN: 9780470474211
• eBook ISBN: 9781118002261
• Edition: 1
• Topic: Physical Sciences
• Subtopic: Organic Chemistry

This book presents a systematic review on traditional Arab herbal medicine including historical background, medical innovations introduced by Arab physicians, common roots of Arab medicine and western medicine, methodology of drug discovery and therapy in Arabic and Islamic medicine, a state-of-the-art description of traditional Arab herbal medicine, and evidence-based safety and efficacy of Arab and Islamic medicines. The usage of modern cell biological, biochemical, in vitro and in vivo techniques for the evaluation of medicinal plant safety and efficacy is also discussed. The toxicity of herbal formulations safety, quality assurances, and chemical analytical techniques are introduced in this book.

Chapter 1

An Overview of Greco-Arab and Islamic Herbal Medicine

1.1 Introduction

Natural products, such as plant, fungal, and bee products, as well as minerals, shells, and certain animal products, represent the oldest form of medical treatment. Currently, many of the commonly used drugs are of herbal origin and about 25% of the prescription drugs contain at least one herbal-derived active ingredient or synthetic compound, which mimics a plant-derived compound. There are over 80,000 plants that have medicinal uses throughout the world and usually a specific part of the plant is used for medical preparations such as tablets, infusions, extracts, tinctures, ointments, or creams. The pharmacological action of these medicines is often described in very general terms, such as carminative (an agent that prevents formation of gas in the gastrointestinal tract or facilitates the expulsion of said gas), laxative (an agent that induces bowel movements or loosens the stools), demulcent (an agent that forms a soothing film over a mucous membrane, relieving minor pain and inflammation of the membrane), antitussive (cough suppressants), or antiseptic (antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection). Unlike synthetic drugs, which usually consist of a single and often synthetic chemical, herbal-based medicines contain multiple constituents.

In the history of science, Arabic medicine, Islamic medicine, Arab–Islamic medicine, Greco-Arab medicine, or Greco-Arab and Islamic medicine are terms that refer to medicine developed during the Golden Age of Arab–Islamic civilization (seventh to fifteenth century), which extended from Spain to Central Asia and India (Figure 1.1). This civilization became the center of brilliant medical developments and innovations, as well as great achievements in astronomy, mathematics, chemistry, philosophy, and artistic culture. Arab and Muslim scholars translated and integrated scientific knowledge of other civilizations into their own. As will be seen in the following chapters, however, Arab–Islamic medicine was not simply a continuation of Greek ideas but a venue for innovation and change. These included the discovery of the immune system, the introduction of microbiological science, and the separation of pharmacological science from medicine. Medicine in general is considered to be one of the most illustrious and best known achievements of Arab–Islamic civilization, which influenced Western medical circles to such an extent that it was included in the curriculum of medical schools up to sixteenth century.

Figure 1.1 The medieval Arab–Islamic Empire at its largest extension.

Despite great progress in allopathic medicine, Arab–Islamic medicine has continued to be practiced within the Mediterranean as well as most Arab and Islamic countries (Table 10.2), where cultural beliefs and religion often lead to self-care or home remedies in rural areas and consultation with traditional healers. In addition, Arab–Islamic therapies are most often utilized by people who have faith in spiritual healers and herbalists. These people are the first to be consulted for problems such as infertility, impotence, diabetes, obesity, epilepsy, psychosomatic troubles, and many other diseases (see Chapter 10). The popularity of herbal preparations based on Greco-Arab and Islamic medicines has increased worldwide in the past four decades, probably because of the sustainability of this medicine over the years. Other factors include the notion that herbal-based drugs are safe (see Chapter 13), that they are relatively inexpensive, the restricted access to physicians imposed by managed care, and the adverse effects of synthetic drugs.

Chapter 10 provides an overview of Greco-Arab and Islamic medicine practiced in countries other than those in the Middle East, such as Iran, India, Turkey, Maghreb region, and Pakistan [1–10]. India is the only country where Greco-Arab medicine has an official status. It was introduced by Arabs and soon took firm roots in the subcontinent. Greco-Arab and Islamic medicine as practiced in Muslim communities of the Indo-Pakistan subcontinent is known as Unani-Tibb. “Tibb” is an Arabic word meaning “medicine,” while “Unani” is thought to be derived from “Ionan” (meaning Greek), acknowledging the influence of early Greek medicine on Greco-Arab and Islamic medicine. A Unani physician is known as a hakim. However, the Unani medicine currently practiced in the Indo-Pakistan subcontinent is vastly different from its Greco-Arab roots. It benefited from the native medical system or folk medicine in practice at the time in various parts of central and southern Asia, mainly Ayurvedic medicine and Chinese medicine.

Herbal medicines are classified in many European countries as drugs; in the United States, they are sold as dietary supplements. Unfortunately, in the Arab–Islamic world as well as in China and India, they are mostly sold over the counter without regulation. As discussed in Chapter 11, safety assessment of herbal products has often been neglected since prolonged and apparently safe use is usually considered as evident. Nevertheless, evidence of the toxicity of such products has accumulated. This is not surprising, since herbal products are complex mixtures of secondary metabolites, many of which are potentially toxic (e.g., hepatotoxic and nephrotoxic). Therefore, the widespread use and popularity of herbal-based medicines raises concerns and fears over the professionalism of practitioners and safety, quality, and efficacy of these products. In regard to safety, biomedical journals have reported serious side effects, particularly hepatotoxicity. These matters are covered extensively in Chapters 11 and 12.

The popularity of natural product-based therapies is rapidly increasing and global sales of herbal products top $100 billion a year. In 2008, $4.8 billion were spent in the United States and a large center of complementary and alternative medicine has been established recently at the NIH (National Institute of Health). And more recently, the NIH has sponsored large clinical trials of botanicals such as St. John's Wort and Ginkgo.

In the course of the following chapters, we intend to reveal the complexities, encourage comparisons, and offer answers to questions such as the following: How did Arab–Islamic medicine reach such high levels of knowledge and practice? How did Arab–Islamic scholars lay the foundations of modern Western medicine and pharmacology? How did Arab and Muslim physicians discover and successfully treat diseases? How did Arab and Muslim scholars lay the foundation for clinical trials and animal testing? And finally we give an overview of currently used medicinal plants in the Arab world and their efficacy and safety. This book is organized around 19 major topics, reflected by the titles of these chapters: (1) An overview of Greco-Arab and Islamic herbal medicine, (2) History of Greco-Arab and Islamic medicine, (3) Herbal medicine, (4) The Arab–Islamic roots of Western medicine, (5) Contributions of Arab and Islamic scholars to modern pharmacology, (6) Natural drugs in Greco-Arab and Islamic medicine, (7) Method of therapy in Greco-Arab and Islamic medicine, (8) Commonly used herbal medicines in the Mediterranean, (9) The current state of knowledge of Arab herbal medicine, (10) Greco-Arab and Islamic medicine practiced outside the Middle East, (11) Biosafety of herbal medicine, (12) Arab medicinal plants: from traditional uses to scientific knowledge, (13) Modern in vitro test systems, (14) Modern in vivo evaluations and clinical trials, (15) Medical ethics in Arab and Islamic medicine, (16) Medicinal herbs and extracting their active ingredients, (17) Food therapy, (18) Drug development from herbal sources, and (19) Herbal remedies: use and demographic and regulatory issues. In this introductory chapter, we will give a brief overview of the main topics of this book.

1.2 The Golden Age of Arab–Islamic Civilization

The development of Arab–Islamic civilization started in the Arabian Peninsula, the homeland of the Arabs. The Peninsula is predominantly deserted and the tribes who inhabited this area were nomadic, that is, they traveled from one grazing land to another. The great unifying power of these nomadic Arabs was clearly the Prophet Mohammad (peace be upon him) (570–632) from the Quraysh tribe that ruled Mecca. Though Mecca was a prosperous caravan city, it was still tied to traditional social customs and was governed by the tribal societies of the desert. Each tribe worshipped its own gods in the form of objects from nature but all Arabs worshipped one object in common, the Kaaba, a large black stone at Mecca, which made Mecca significant as a place of worship and pilgrimage. The Prophet was able to unite the nomadic tribes and to create a strong nation, able to defeat the two powerful empires at that time, the Persian and Byzantine Empires.

The Byzantines and Persians were the first to feel the power of unified Arabs. At Yarmuk in 636, the Arabs defeated the Byzantine army (Table 1.1). Syria fell in 640. A decade later, the Arabs had conquered the entire Persian Empire. Egypt, the Maghreb (North Africa), and Spain were all conquered and under Arab rule by the 720s. Arab expansion in Europe ended after the loss of the Battle of Tours in 732. The Arabs not only conquered new lands, but also became scientific innovators through originality and productivity. They preserved the cultures and knowledge of the conquered lands, tolerated religious minorities within land they had conquered, and were careful to protect the purity of their religion, language, and law from any foreign influence.

Table 1.1 Timeline of Arab Islamic Civilization.

Year	Historical Event
570	The Prophet Mohammad is born in Mecca
622	The Prophet and followers emigrate to Medina. The first year of Islamic calendar
632	Death of the Prophet
632	Muslim armies consolidate their power over Arabia
634–644	Muslim forces advance through the Persian and Byzantine empires
636	Battle of Yarmuk. Byzantine emperor Heraclius is defeated by Muslim army in Syria
642	Arabs conquer Byzantine Egypt and expand into North Africa
656	Mohammad's son-in-law, Ali, succeeds to the leadership of Islam
661–750	Umayyads rule in Damascus
711	Tariq with a mixed force of Arabs and Berbers invades Spain
712	Muslims advance into Sind (modern-day Pakistan) and Central Asia
725	Muslims occupy Nimes in France
750–945	Abbasids rule in Baghdad
756–929	Umayyad emirs rule in Spain
762	Al-Mansur founds Baghdad
786	Haroun al-Rashid becomes caliph in Baghdad
792	The first papermaking factory in the Muslim Empire is built in Baghdad
813–823	Al-Mamun reigns in Baghdad. He founds the House of Wisdom
823	Beginning of Muslim conquest of Sicily
909–1171	Fatimids expand in North Africa
929–1031	Umayyad caliphate reigns in Spain
969	Fatimid conquer Egypt and transfer their capital to Cairo in 973
976	Al-Azhar university is founded in Cairo
1058	Seljuks take Baghdad
1090	Cordoba is sacked by Almoravids
1096	First Crusade. Christians rule in Jerusalem in 1099
1145–1232	Almohads rule in Spain
1171	Saladin overthrows the Fatimids in Egypt
1171–1250	Ayyubid Dynasty rules in Egypt and Syria
1187	Saladin returns Jerusalem to Arab–Islamic rule
1206–1406	Mongol Empire
1492	Christian Reconquest of Spain
1453–1922	Ottoman Empire
1494–1566	Suleiman I guides the Ottoman Empire to its fullest extent, ranging from Morocco to the Caspian Sea and the Persian Gulf and into Europe through the Balkans to Hungary
1922	End of the Ottoman Empire
All dates given in the table are those of the Christian calendar. Bold entries denote dynastic rule.

The first problem after the death of the Prophet was who should be caliph, the spiritual and secular successor to the Prophet (PBUH). The first four caliphs were elected by a tribal council of elders and are referred to as the Orthodox Caliphs, ruling from 632 to 661. However, as the empire grew, this form of government became increasingly inadequate. In addition, tribal and clan rivalries continued. Finally, the Umayyad clan took over and established the Umayyad Dynasty (661–750). From now on, the dynastic p...

Table of contents

• Cover
• Title Page
• Copyright
• Foreword
• Reference
• Preface
• Acknowledgments
• Chapter 1: An Overview of Greco-Arab and Islamic Herbal Medicine
• Chapter 2: History of Greco-Arab and Islamic Medicine
• Chapter 3: Herbal Medicine
• Chapter 4: The Arab–Islamic Roots of Western Medicine
• Chapter 5: Contributions of Arab and Islamic Scholars to Modern Pharmacology
• Chapter 6: Natural Drugs in Greco-Arabic and Islamic Medicine
• Chapter 7: Method of Therapy in Greco-Arab and Islamic Medicine
• Chapter 8: Commonly Used Herbal Medicines in the Mediterranean
• Chapter 9: The Current State of Knowledge of Arab Herbal Medicine
• Chapter 10: Greco-Arab and Islamic Medicine Practiced Outside the Middle East
• Chapter 11: Biosafety of Herbal Medicine
• Chapter 12: Arab Medicinal Plants: From Traditional Uses to Scientific Knowledge
• Chapter 13: Modern In Vitro Test Systems
• Chapter 14: Modern In Vivo Evaluations and Clinical Trials
• Chapter 15: Medical Ethics in Arab and Islamic Medicine
• Chapter 16: Medicinal Herbs and Extracting Their Active Ingredients
• Chapter 17: Food Therapy
• Chapter 18: Drug Development from Herbal Sources
• Chapter 19: Herbal Remedies: Use and Demographic and Regulatory Issues
• Appendix A: Plant Naming
• Color Plates
• Index