Wednesday, June 14, 2017

Traditional Arabic Medicine

Women shopping at an herb and spice store,
Aleppo,Syria, 2007. Click on photos to enlarge.
Traditional Arabic Medicine (TAM) is far less well-known in the U.S. compared to other “traditional,” i.e., non-Western medical practices such as traditional Chinese medicine or traditional Indian (Ayurvedic or Unani) medicine. Per the World Health Organization, “Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant-, animal- and mineral-based medicines, spiritual therapies, manual techniques, and exercises applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.”

Much of the roots of Traditional Arabic Medicine stem from the Alexandrian conquests and the subsequent hundreds of years of rule by Greek colonists in the Hellenistic States, stretching from what is now Egypt to the western edges of what is now India. The medical works of Hippocrates and Galen laid the foundations for medical practice in the Middle East. Greek-derived medicine survived the Roman conquests and was later formalized by the translations of Greek texts into Arabic in the 8th century A.D. Major Ayurvedic texts were also being translated into Arabic at the same time, and Ayurvedic practices were melded into Arabic medicine

Advances in medicine during the Abbasid Caliphate (8th to 13th centuries) included the establishment of hospitals, surgical methods, medical encyclopedias, medical schools and the standardization of botanical preparations. The western reaches of the Islamic empire reached into what is now Spain, with centers of learning in Cordoba and Granada. Toward the end of the 12th century, translations from Arabic to Latin of such works as the Canon of Medicine and the Comprehensive Book on Medicine laid the foundation for the development of “Western” medicine in Europe.

Current use of TAM varies widely across the Middle East, and within countries by socio-economic status and education. Ethnobotanists have identified 200 to 300 plant-derived products in common use. The list includes: anise, black seed, cardamom, chamomile, cherry, cinnamon, clove, coriander, cress, cumin, fennel, fenugreek, flax, frankincense, galingale, ginger, Greek sage, henna, laurel, licorice, mastic, mint, mustard, nutmeg, olive, parsley, pepper, pimento, rosemary, saffron, senna, sumac, Syrian rue, turmeric and wormwood.

As an example of how one of these might show up as a modern dietary supplement ingredient, frankincense (Boswellia serrata) contains various boswellic acids, which can be concentrated into a Boswellia extract. Boswellic acids have been shown to inhibit the inflammation pathway. In clinical trials, Boswellia extracts have demonstrated promising effects in osteoarthritis, colitis and asthma.

In many cultures, traditional medicines include animal
parts in addition to plants. This shop has starfish and
turtle shells in addition to herbs, spices and food.
The 21st century future for TAM is not as strong as it is for traditional Indian or Chinese medicine. A 2006 visit to Damascus and Aleppo found herb-selling traditional Arab pharmacies in the souks, but in the suburbs there were cars double-parked in front of modern pharmacies where consumers raced in to buy glucosamine, ginkgo and other non-indigenous complementary and alternative medicines.

A survey of Arab practitioners in the Middle Eastern region provides evidence that TAM does not have this forward-looking momentum. Practitioners considered to be knowledgeable in their trade inherited the practice from their fathers or male relatives, or learned it as an apprentice. The survey's authors mentioned that the number of practitioners they were able to locate was fewer than reported in earlier surveys. There was limited exchange of information among healers, and no systematic instruction of the next generation of healers. The healers either sourced their herbs from the wild - limiting them to what grew locally - or purchased products from traditional Arab pharmacies. On average, each healer used only 22 botanical products in their practice - far fewer than the 200-300 that ethnobiologists had identified as still in common use. On the bright side, there are attempts to establish re­search/teaching centers, including gardens for medicinal plants.

To remain vibrant, any traditional medicine requires schools to continue to graduate practitioners, agreed upon definitions for botanical materials, stable sources of those plants and a population of consumers seeking traditional treatments. Given the current world dominance of “Western” medicine, advocates of traditional medicine may also try to apply evidence-based research methods to traditional practices. This typically involves identification of the active compounds in plant extracts, followed by evaluation through human studies. This approach can be conducted at regional universities. Or students from the region who have moved to other countries to complete their advanced education could conduct research there on treatments they were familiar with from childhood.

Black Seed (Nigella sativa) is one of the most commonly used botanical products throughout the Middle East. It is also an example of “Prophetic Medicine” - referring to health and disease statements found in the Holy Koran and in the Hadith - writings, sayings and traditions from Mohammad, the Prophet of Islam. An English translation of one statement: “There is healing in black seed for all ailments, except death.” Usage is oral consumption of the crushed seeds, sometimes mixed with foods (especially honey), or else oil extracted from the seeds. Traditional uses include treating  asthma, allergies, bronchitis, gastro-intestinal problems, to increase milk production in nursing mothers, and others. Placebo-controlled human studies suggest that Nigella extracts might lower blood pressure, cholesterol and fasting glucose.   

And because what's old is new again, local pharmacies carry dietary supplements containing ingredients such as chamomile, cinnamon, fenugreek, frankincense, garlic, ginger, turmeric...


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