Al-Razi and Islamic medicine in the 9th century

Although Baghdad was only 50 years old in the 9th century, it was at the peak of its political power; a powerhouse of learning and the leading medical centre of the time. It was there that many important Greek works were translated into Arabic, including Dioscorides’s Materia medica, which formed the basis for Arabic pharmacology. While Islamic physicians revered Greek medicine and seldom questioned it, they began to add comments and to contribute views in the 9th century CE, and observations of their own. Of the physicians who worked in Baghdad during this era, one stands out as quite exceptional. Abu Bakr Muhammad ibn Zakariyya al-Razi (865–925 CE; 251–313 AH)—known to the Latin world as Rhazes—was so called after the place where he was born and died—Rayy, near Tehran. Alone among his contemporaries, al-Razi specifies all his sources, which are divided almost equally between Islamic writers and the ancient Greeks (particularly Galen). He is thus an invaluable source of earlier, often lost, works. Al-Razi was a musician and a money-changer until his 30s, when he began to study medicine in Baghdad. He went on to become one of the greatest physicians of the medieval period, writing over 200 works; half of them on medicine, but others on topics that included philosophy, theology, mathematics, astronomy and alchemy. The largest and most important of al-Razi’s medical works is Kitab al-Hawi fi al-tibb1 (The comprehensive book of medicine), a collection of medical notes that al-Razi made throughout his life in the form of extracts from everything he had read, as well as observations from his own medical experience. Translated into Latin in the 13th century, Kitab al-Hawi was repeatedly printed in Europe during the 15th and 16th centuries under the title Liber Continens. Printed as it was when printing was new, al-Razi’s writings had a major influence on the development of medical practice in Europe. The Kitab al-Hawi is an enormous work: in its published form it consists of 23 volumes, two of which are further divided into two lengthy parts. Each volume deals with specific parts or diseases of the body, although the groupings of ailments are often idiosyncratic. The volume that includes gout, for example, also covers diseases related to large and small worms in the abdomen, piles, hunchback, varicose veins and elephantiasis. Amongst these massive files of working notes are to be found the occasional case history, as well as a glimpse of al-Razi as a practising clinician (a collection of over 900 case histories recorded by some of his students and issued posthumously exists under the title The Book of Experience or Casebook).

Some of al-Razi’s ideas have parallels with ideas today. For example, he suggests that: ‘The physician, even though he has his doubts, must always make the patient believe that he will recover, for the state of the body is linked to the state of the mind.’ He cautioned against unnecessary use of drugs, and
particularly polypharmacy: ‘If the physician is able to treat with nutrients, not medication, then he has succeeded. If, however, he must use medication, then it should be simple remedies and not compound ones’. Unlike the polypharmacy promoted by some other Islamic authors in the 9th century, al-Razi rarely recommends compound remedies, and when he does, these have few ingredients. All the leading physicians of Baghdad used medicines whose beneficial effects had been identified during the classical period. For example, they used opium in a variety of forms, both external and internal, for ailments and conditions in every part of the body, especially where pain was involved.2 Opium was considered particularly effective for diseases of the intestines and of the eyes, but it also featured in a number of remedies to treat gout and painful joints.

The inflammation of joints associated with gout might explain why ancient Greek physicians described the condition under various names, which they appear to have applied to gout and rheumatism alike. Al-Razi gives four recipes for ‘gout and the joints’ in Kitab al-Hawi. All of these are pastes or dressings to be applied to the painful areas with, in one instance, a damp piece of paper or cloth to keep the medication moist. Opium occurs in all of them, henbane in one and hemlock in two—one of which also has mandrake. A paste that al-Razi describes as good contains equal parts of opium and liquid storax (Liquidambar orientalis).

Three of al-Razi’s four remedies for gout and the joints include colchicum, which had been used for treating gout since at least the second millennium BCE. Indeed, its active ingredient, colchicine, is still used to treat acute attacks of the condition today. ‘Where gout is accompanied by high fever, the recipe contains seeds that cause diuresis without giving out much heat, such as those of white colchicum, water melon and cucumber. These, in equal parts, are mixed with one third of a part of opium, and an oral dose of four dirhams (12 g) of the mixture with the same amount of sugar is analgesic and effective within the hour.’

‘Where there is no high fever, the ingredients, in an oral remedy, are: colchicum, opium, borax, colocynth, ammi, aristolochia, and mountain thyme.’ One of the two recipes illustrates a common feature of al-Razi’s writings: he makes clear that he was not prepared simply to accept what he read, but wished to reserve judgement about the effects of medicines until he had investigated them personally. ‘I have heard amazing accounts, amongst which is the following: the physician of . . . prescribed for gout a potion prepared with two mithqals (4.5 g) of colchicum, half a dirham (1.5 g) of opium and three dirhams (9 g) of sugar. The drug is said to be effective within the hour, but I need to verify this.’ Al-Razi’s willingness to test the validity of therapeutic claims and theories in practice is illustrated in another passage in Kitab al-Hawi. He identified the symptom complex that heralded the onset of meningitis—dullness and pain in the head and neck, the avoidance of bright light (photophobia), insomnia and exhaustion—and wondered how best to treat these patients: ‘When the dullness (thiqal) and the pain in the head and neck continue for three and four and five days or more, and the vision shuns light, and watering of the eyes is abundant, yawning and stretching are great, insomnia is severe, and extreme exhaustion occurs, then the patient after that will progress to meningitis (sirsaˆm) . . . If the dullness in the head is greater than the pain, and there is no insomnia, but rather sleep, then the fever will abate, but the throbbing will be immense but not frequent and he will progress into a stupor (lıˆthuˆrghas). So when you see these symptoms, then proceed with bloodletting. For I once saved one group [of patients] by it, while I intentionally neglected [to bleed] another group. By doing that, I wished to reach a conclusion (ra’y). And so all of these [latter] contracted meningitis.’ Although we would be unlikely to recommend bloodletting for patients with the prodromal symptoms of meningitis today on the basis of this evidence, al-Razi’s approach to refining his treatment reflects a way of thinking about one of the principles to be observed in drawing inferences about the effects of treatments, namely, the need for comparison. Acknowledgments I am grateful to Emilie Savage-Smith for identifying passages in Al-Razi’s work which are relevant to the objectives of the James Lind Library, and for her input in to an earlier draft of this commentary.
 
Ulasan...

Walau bagaimanapun, al-Razi tetap diletakkan dalam senarai ahli falsafah muslim yang terkemuka sehingga ke hari ini. Sumbangannya yang besar dalam bidang perubatan dan kimia sangat berharga kepada generasi selepasnya. Manakala dalam bidang falsafah, al-Razi memberi sumbangan besar dalam menghuraikan falsafah logik, metafizik, moral, dan kenabian dengan cara rasional dan harmoni. Oleh sebab itulah al-Razi terkenal sebagai seorang ahli falsafah yang rasional dan murni.

Al-Razi atau nama sebenarnya Abu Bakar Muhammad bin Zakaria al-Razi, lahir pada tahun 236H bersamaan 850M. Sesetengah pendapat mengatakan yang beliau lahir pada 1 Sya'ban 251H bersamaan 865M. Beliau anak kelahiran bum! Iran iaitu di Ray dekat Tehran merupakan seorang tokoh falsafah yang masyhur pada kurun ke-3 Hijrah.

Beliau pada zaman mudanya menjadi pemain gambus (rebab, rebana) sambil menyanyi, kemudian dia meninggalkan pekerjaan itu dan mempelajari bidang perubatan dan falsafah. Beliau belajar ilmu kedoktoran dengan Ali ibn Rabban al-Thabari (192 - 240H bersamaan 808-855M) dan belajar ilmu falsafah dengan al-Balkhi. Dalam masa yang sama beliau juga belajar matematik, astronomi, sastera, dan kimia.

Semasa Mansur ibn Ishaq ibn Ahmad ibn Asad menjadi Gabenor Ray, al-Razi diberi kepercayaan memimpin rumah sakit (hospital) selama enam tahun (290-296H bersamaan 902 - 908M). Pada masa ini juga al-Razi menulis buku al-Thibb al-Mansuri yang dipersembahkan kepada Mansur ibn Ishaq ibn Ahmad. Kemudian al-Razi berpindah ke Baghdad atas permintaan Khalifah al-Muktafi (289 - 295H bersamaan 901 - 908M), yang berkuasa pada waktu itu.

Dalam menjalankan kerjaya kedoktoran, beliau dikenal sebagai seorang yang pemurah, sayang kepada pesakit-pesakitnya, dermawan kepada orang-orang miskin dan memberi rawatan kepada mereka secara percuma. Hitti menyifatkan al-Razi sebagai seorang doktor yang paling agung dalam kalangan doktor Muslim dan juga seorang penulis yang produktif.

Kemasyhuran al-Razi sebagai doktor bukan sahaja di dunia timur, tetapi juga di barat; sehinggakan beliau telah digelar The Arabic Galen. Setelah Khalifah al-Muktafi wafat, al-Razi kembali ke Ray, dan meninggal dunia pada 5 Syaaban 313H (Oktober 925M).

Para sarjana berpendapat bahawa al-Razi mengalami sakit mata dan kemudiannya buta pada penghujung hayat-nya. Al-Razi menderita akibat ketekunannya menulis dan membaca yang terlalu banyak.

Dalam dunia keilmuan, tradisi pro dan kontra tidak pernah luput sejak zaman dahulu bahkan sehinggalah ke hari ini. Demikianlah pada zaman al-Razi, beliau tidak terlepas daripada ditentang oleh para ilmuwan sezamannya.

Penentang al-Razi yang dapat dikenal pasti oleh para sarjana dan ilmuwan Islam ialah Abu Qasim al-Balkhi. Beliau banyak menulis penolakan terhadap buku-buku al-Razi, terutama buku 'Ilm al'Ilahi. Begitu juga dengan Syuhaid ibn al-Husain al-Balkhi, beliau mempunyai banyak perbezaan dengannya al-Razi terutama tentang teori kesenangan. Teorinya tentang kesenangan itu

dijelaskan dalam kitabnya Tafdhil Ladzdzat al-Na^s, yang ditulis kembali oleh Abu Sulaiman al-Mantiqi al-Sajistani dalam Siwan al-Hikmah.

Karya-karya dan sumbangan

Al-Razi merupakan antara tokoh yang produktif dalam lapangan penulisan. Hal ini terbukti dengan banyak hasil karya beliau ditemui termasuk yang telah hilang. Tidak kurang daripada 200 buah karangan termasuk buku, makalah, dan surat-surat telah dihasilkan oleh al-Razi dicatatkan para pengkaji. Karya-karya beliau banyak membincangkan persoalan falsafah, perubatan, sains, ketuhanan, al-Quran, ilmu kalam, bahasa Arab, fiqh dan usul fiqh, geometri, dan sejarah.

Kemasyhuran al-Razi bukan sahaja menjadi kebanggaan kepada dunia Islam malah ketokohan dan kepakaran beliau turut diakui oleh dunia barat. Hal ini terbukti dengan banyak karya-karya beliau telah menjadi rujukan dan panduan dunia barat terutamanya dalam bidang perubatan. Sehingga kini karya-karya al-Razi masih diguna.

Kitab al-Hawi (Liber Contines) merupakan sebuah ensiklopedia amalan perubatan terapeutik yang dihasilkan olehnya menjadi rujukan dunia Eropah. Minat yang mendalam dunia Eropah kepada karya agung yang seberat 10kg ini terbukti dengan penerbitannya beberapa kali sejak abad ke-12M lagi sehingga abad ke-17M.

Penemuan al-Razi berkenaan sakit campak cacar tulen (smallpox) dan campak biasa (measal) turut menjadi bahan rujukan perubatan di dunia Barat malah turut diulangi penerbitannya beberapa kali sehingga abad ke-18M. Kedua-dua karya ini juga merupakan sumber kurikulum tradisional di kalangan para pengamal perubatan Islam.

Kitab al-Mansur (Liber medicinalis ad al Mansorem) juga karya agung al-Razi dalam dunia perubatan. Al-Razi telah menghasilkan buku ini ketika beliau di Khurasan di bawah pemerintahan Gabenor al-Mansur Ibnu Ishaq. Dalam buku ini terkandung 10 penemuan berkaitan tentang amalan sent dan sains perubatan. Buku ini dianggap satu karya beliau yang tulen dan mencerminkan kematangan dan kepakaran beliau dalam amalan perubatan moden.

Dalam buku ini juga beliau menekankan betapa pentingnya cara pemeriksaan yang teliti sebelum membuat sesuatu kesimpulan tentang sesuatu penyakit. Satu falsafah yang terpenting dalam karya al-Razi ini ialah kebenaran dalam ilmu perubatan merupakan suatu yang amat sukar diperoleh dan walaupun banyak tersedia rujukan namun kurang juga nilainya sekiranya dibandingkan dengan amalan seorang doktor yang sentiasa menggunakan kuasa pemikiran dan logiknya.

Al-Razi menentang sekeras-kerasnya amalan penipuan dan penyelewengan dalam amalan perubatan. Padanya penyakit jasmani tidak boleh dipisahkan dengan penyakit rohani. Oleh sebab itu, dalam merawatnya kedua-dua pendekatan iaitu rohani dan jasmani terus digemblengkan.

Al-Razi turut memberi sumbangan yang besar dalam bidang kimia dengan terhasilnya Kitab al-Asrar (The Book of Secrets). Buku ini telah diterjemahkan ke dalam bahasa Latin dan merupakan sumber utama maklumat bahan kimia sehingga abad ke-14M. Antara lain kejayaan al-Razi dalam dunia perubatan ialah penemuan rawatan kepada penyakit cacar dan pengasingan alkohol dalam penghasilan antiseptik.

Sumbangan al-Razi dalam bidang falsafah tidak kurang hebatnya, dengan terhasilnya banyak karya tentang falsafah sudah cukup untuk membuktikan minat yang mendalam al-Razi dalam bidang falsafah. Karya beliau dalam bidang falsafah yang berjudul Al'Thib al-Ruhani merupakan karya teragung beliau dalam bidang falsafah. Karya ini berkisar tentang cara pengubatan penyakit jiwa dan pengubatan fizik yang menyembuhkan tubuh badan.

Antara karya utama yang membincangkan persoalan falsafah ialah al-Sirah al'Falsafiyyah, Amarah al-lqbal aI'Dawlah, Kitab al-Ladzdzah, Kitab al-llmi al-Ilahi, Maqalah fi ma baid al'Thabiiyah, dan al-Syukuk 'ala Proclus.

Alt Sami al-Nasysyar telah mengesan sebanyak 97 buah buku yang telah dihasilkan oleh al-Razi yang merangkumi bidang-bidang al-Quran (tafsir) lima buah, Ilmu kalam 40 buah, Falsafah 26 buah, Bahasa Arab tujuh buah, Fiqh dan Usul Fiqh lima buah, Perubatan tujuh buah, Geometri lima buah, dan Sejarah dua buah.

Brockelman seorang pengkaji biografi orientalis pula membahagikan penulisan tokoh ini kepada 13 bidang dengan hanya menemui 38 buah karya sahaja, antaranya History dua buah, Fiqh tiga buah, Quran tiga buah, Dogmatics 13 buah, Philosophy lapan buah, Astrology satu buah, Cheiromancy satu buah, Rhetoric satu buah, Encyclopedia satu buah, Medicine satu buah, Physionomy dua buah, Alchemy satu buah, dan Mineralogy satu buah.