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Food as Medicine in Muslim Civilization
1 | 2 | Next By Nil Sari Table of contents 1. Introduction
2. Elements (unsur) and their Qualities
3. Humours (khilt) and Their Qualities
4. Temperaments
5. How Humours Influence Nutrition
6. Classification of Foods According to the Theory of Elements
7. How Foods and Medicaments Exert an Effect on the Health
8. Classification of Foods According to Digestion
9. Foods with Curative Properties (Gidâ-yi devâî)
10. Examples of Treatment with Foods: Birds and Fish Used in Treatment
11. A Balanced Diet for Preserving Health
12. Food Combinations to Avoid Harm
13. Dietary Rules according to Temperament
14. Adjusting Diet According to the Season
15. Meal Times and Amounts
16. Importance Attached to Food Preparation and to the Cook
17. Prescriptions for Foods and Beverages Written by Physicians for Ailing Members of the Palace Household
18. From Today's Perspective
19. Sources * * * 1. Introduction  | Large image | Figure 1: A banquet given by the commander-in-chief Lala Mustafa Pahsa to the janissaries in Izmit, 5 April 1578. Topkapi Palace Museum Library, MS H1365, fol. 34b. |
The main reason why food and beverages were of such importance in medicine is that they not only provide nutrition but also preserve health and possess curative properties. Consequently healthy dietary practice emerged as a distinct field of medical knowledge. The subjects of nutrition, diet and digestion with respect to leading a healthy life and the treatment of disease are discussed at length in Ottoman period medical manuscripts. Vegetables, fruits, animal foods and minerals such as salt are dealt with not only in medical and pharmaceutical works, but even in works on chemistry. Although carbohydrates, proteins and vitamins were as yet unknown, the importance of good food and a balanced diet for healthy living was recognised. The principles of healthy and balanced nutrition in Ottoman medicine are based on the theories of "elements" and "humours". Even today we can observe relics of this theory, which remained current until the beginning of the twentieth century. To clearly explain the importance of nutrition in Ottoman medicine, it is necessary to take a brief look at the theory of elements and humours; in other words, the philosophy of medicine at that period. I will endeavour to explain this theory as simply as possible, although it consists of definitions and interpretations that cover a wide field, are very complex, and sometimes difficult to comprehend. Despite some variations in opinion regarding the details of this theory among Ottoman physicians, the basic framework of the philosophy of medicine corresponded to the outline I will give below. All of the information in this text is based on manuscripts and printed Ottoman sources, without any interpretation of my own. It should not be forgotten that evaluating the medical concepts of the Ottoman period in the light of today's medical knowledge would lead to distortion of Ottoman medical philosophy as a whole, and so should only be done with the greatest caution and based on firm evidence. Since explanation of the information in the text in accordance with today's knowledge of the metabolism and endocrinology is a separate subject of research, these will not be taken into account here. 2. Elements (unsur) and their Qualities  | Large image | Figure 2: An Ottoman Bazar scene. Topkapi Palace Museum Library, MS H1365, fol. 93a. |
3. Humours (khilt) and Their Qualities The human body contains four fluids or humours; that is, blood, plegm, yellow bile and black bile. We cannot define the four humours in the literal sense of the words used to express them. Humours are the fluids first generated by the process of digestion. Blood has a hot and moist nature (sanguine); phlegm is cold and moist (phlegmatic); yellow bile is hot and dry (choleric); black bile is cold and dry (melancholic). A good and healthy humour or combination of humours can be digested and assimilated into the tissues. These are restorative, beneficial humours. Humours with the appropriate qualities taken in moderate amounts nourish the body. Each of the four humours also has sub-categories. Balance between the humours indicates health. When the quality or amount of the humours deviate from the normal, however, the humoral balance is disturbed and this causes disease. The humours that have caused the disease need to be expelled from the body by means of medicaments. The humoral balance may be distorted by external factors, especially diet, resulting in disease. Abnormal humours that cannot be digested or transformed into a proper form are expelled from the body. When necessary one should help the expulsion process by means of diet or medicaments. 4. Temperaments The ways in which the opposing qualities of the four elements combine and interact are called "temperaments". If the opposing characteristics are present in equal amounts there will be a balance. But if one or more of the hot, cold, moist or dry qualities are dominant the balance is disturbed. When this occurs the person's temperament is distorted, and their equilibrium (itidâl) is upset. We can talk about the proper ratio of characteristics for each individual person rather than an ideal combination identical for all. It is rare for a person to have a temperament in perfect equilibrium. For example, if fire is the dominant element in a particular person, his temperament is hot; but if water is dominant, the temperament of that person is cold. There are four such simple temperaments. There are also four composite temperaments. For example, if hot and moist qualities are both dominant in a person, that person has a sanguine temperament. If hot and dry qualities are dominant they produce a choleric temperament; if cold and dry qualities dominate they produce a melancholic temperament; and if cold and moist qualities dominate they produce a phlegmatic temperament. These temperaments may be present in a stronger or weaker form, and this causes differences amongst individuals. In addition, temperament varies according to the geographic location, season, age and gender. Temperament should always be taken into consideration both in medical treatment and diet. Each person should eat in accordance with their own temperament. Although some people may have a strong constitution and be able to eat and digest unwholesome food, this should not be depended upon, because the bad humours, which cannot be digested, accumulate gradually, damaging the person's health. Humans learn in time which foods are harmful for them. Sometimes a harmless food that a person has eaten previously might cause harm the next time, and such foods should be avoided. 5. How Humours Influence Nutrition
 | Large image | Figure 3: A plant figure. Source: Abdullah b. Ahmad al-Andalusi Ibn Baytar, Câmiu mufredat al-adviya wa'l-agdiya. Süleymaniye Library, Ayasofya Collection, MS 3748. |
It is because humours are formed by digested nutrients that the characteristics and amount of what a person eats and drinks affects the health of a person either favourably or adversely. Preserving the humoral balance and thus a person's health is possible by means of proper nutrition. If possible, the first step in treating an illness is to correct the distorted humoral balance by means of foods consistent with the patient's temperament; that is, by means of an appropriate diet. Only if this does not work is resort made to medication. The following words by the Islamic physician Razi's are famous: "If you can cure a person by diet, do not suggest medication". 6. Classification of Foods According to the Theory of Elements  | Large image | Figure 4: A plant figure. Source: Ibn Baytar, Câmiu mufredat al-adviya wa'l-agdiya. Süleymaniye Library, Ayasofya Coll., MH 3748. |
Cold foods: Foods that are cold create phlegm. Cucumber, squash, purslane and lettuce are cold vegetables. They cause weakness (süst). Hot foods: Foods that are hot by nature create yellow bile. Such foods mainly consist of spices and similar condiments added to food. For example, ginger, pepper, dry coriander, cumin, cinnamon, onion, garlic and mastic are hot foods. Dry foods: Dry foods create black bile, a cause of melancholy. They lead to loss of appetite and constipation. Foods such as millet, lentils and dried meat are examples of dry foods. Moist foods: Moist foods are those without strong salty, sweet, sour or bitter flavours. They have a softening effect. Noodles and spinach cooked with rice and meat are examples of moist foods. 7. How Foods and Medicaments Exert an Effect on the Health  | Large image | Figure 5: A plant figure. Source: Ibn Baytar, Câmiu mufredat al-adviya wa'l-agdiya. Süleymaniye Library, Ayasofya Coll., MS 3748. |
Essential qualities: A food's essential qualities (coldness, hotness, moistness, dryness) can affect the person who eats it, and its effect will be proportional to the degree of these qualities. Examples of these have been given above. Substance: Foods like meat and bread are called absolute nutrients (mutlak gidâ), because they affect the health solely by their substances. Various organs of animals whose meat is eaten, and animal products such as eggs, milk, honey and cheese are also used in treatment as well as being consumed as food. The nutritional strength of these foods varies. For example, the nutritional strength of undercooked eggs or meat stock is high, whereas that of most vegetables and rosewater is low; that of apples is moderate. Power (kuvvet, hâsse, hâsîyet): This is the power of a foodstuff or medicinal substance to produce a particular effect. If a substance taken alone functions as an analgesic, emetic, laxative, diuretic or sedative, it is described as a "medicament with a power unique to itself"; that is, it has medicinal power. If the effect of such a substance (such as the Mediterranean fan palm (Chamaerops humilis) is in harmony with the nature of human beings it is non-poisonous. However, if the effect of a substance is against human nature, as in the case of sevkerân [1], for example, it is described as having the "power of poison". Notwithstanding that substances are effective through their qualities; it is their "powers" that prevail. For example, there is laxative power in the dried juice obtained from scammony (Convolvulus scammonia) root and turpeth (Ipomoea turpethum) root. To give another example, the poison of the viper snake is hot and scorpion poison is cold, but it is not these characteristics that do the killing; what is fatal is the "power of poison". Amount: The effect of a substance varies according to the amount that is taken. Some that do not have any effect the first time they are taken become effective when they are taken a second or third time, or when the amount is increased. Saffron (Crocus sativus), which is used as a stimulant and appetizer, is an example of this. There also are foods that become harmful as the amount is increased. For example, eating too much onion causes freckles on the face and vertigo. 8. Classification of Foods According to Digestion Foods are also classified according to their being easily digested or not. Gentle (lâtif) Foods: Most of the "gentle" foods are digested with very little residual humour or other residual substances. The gentle foods also assist in expelling food residues. The consumption of gentle foods results in boiling and burning of the blood, and the production of additional yellow bile. Most vegetables (especially radish and mustard), meat stock, egg yolk, liver, mutton and chickpea soup [2], young dove, sparrow, pickles (capers, onion, garlic, radish pickle with vinegar, beetroot pickle with mustard etc) are gentle nutrients (although eating too much pickle causes aging and weakens the nerves). Because the "digestive power" of people who get little exercise and the elderly is diminished, such people should eat in moderation and choose mainly "gentle" foods. For example, instead of meat, they should eat soup made with meat stock. Coarse (galîz [3]) Foods: Coarse foods increase moistness and phlegm, so that the quantity of phlegm becomes excessive. Coarse foods also increase bodily strength and cause plumpness. These foods and beverages should be consumed when very hungry and in moderate amounts so that they are well digested, because they cause indigestion. If a person suffers from congestion (sudde), such as constipation, as a result of eating coarse food, they should eat gentle nutrients, which will unblock the congestion. Accordingly, if congestion occurs after eating coarse foods such as herîse [4], sheep's trotters, unleavened bread or starch halva [5], one should eat gentle nutrients such as capers [6], onion pickle, garlic pickle, radish with vinegar and beetroot pickle with mustard [7], followed by a drink of sirkengebin [8], taking care to eat in moderation. Foods such as pure wheat bread, ripe fruits that have been hung on strings for a few days and fully ripe figs give strength and plumpen the body. When excessive fullness is felt it is necessary to "cleanse" the body, that is, to empty the digestion system. Vomiting is a simple way of cleansing the body. Alternatively the patient may eat less then usual for a few days, or drink a light laxative in moderate amounts. The following short receipt is for a medication used for the purpose of cleansing: "11 dirhems [9] of mastic [10]; one small peeled turpeth root; 1 dirhem of ginger pounded, sieved and warmed with almond oil; and 1 dank [11] of sugar are taken and pounded together, sieved and eaten before going to bed at night. Drink warm water, either plain or mixed with rosewater, and go to bed. A good result will be easily obtained by the morning. For some people 2 dirhems of mastic with 2 dirhems of sugar is sufficient." 9. Foods with Curative Properties (Gidâ-yi devâî)  | Large image | Figure 6: A painting of two sea creatures: stingray and cuttlefish. Source: Ibn Baytar, Câmiu mufredat al-adviya wa'l-agdiya. Süleymaniye Library, Ayasofya Coll., MS 3748. |
Foods consumed for the protection of health or treatment of disease are called devâ-yi gidâ or gidâ-yi devâî (foods with curative properties). Some substances used both as medicament (devâ) and as a food or beverage (gidâ) may be called devâ-i gidâ-i zî hassa or gidâ-yi devâ-i zî hassa (foods with particular curative power). This category consists of foods with a curative effect or substances that are employed primarily for curative purposes but also used as food. For a substance to be classified as a gidâ-yi devâî it must be effective both in its quality and in its substance. Such substances are non-poisonous (nâ-zehr). Foods such as kesk-i cû, a type of blancmange made with barley flour and ewe's milk; and scariole [12] that possess both medicinal and nutritive characteristics, provide relief by their cold quality (bürûdet) on one hand and serve as foods on the other. Physicians prescribe such foods and beverages to their patients. Vegetables and fruits are curative foods. For example, figs, fully ripe grapes and dates are more curative in their nature and so should be eaten sparingly. Those who wish to protect their health should avoid a diet consisting solely of fruit and vegetables because these are foods with curative properties. 10. Examples of Treatment with Foods: Birds and Fish Used in Treatment  | Large image | Figure 7: Makers of the sweet (halva) "ma'muniyya" for the adynamia (Surnâme-i Hümayun, year 1582). Topkapi Palace Museum Library, MS H1344.). Source: Turkish Medical History through Miniature Pictures Exhibition, published by Nil Sari-Ülker Erke, Istanbul: ISHIM, 2002. |
Birds were used as invalid food and for the treatment of diseases. The meat or fat was applied externally to cure wounds and taken internally for the treatment of diseases of the muscles and nervous system and for enhancing virility. Each species of bird was thought to have an effect of its own. For example, duck meat was said to cure hoarseness of the voice, eliminate flatulence, increase virility, and fatten and strengthen the body; while benefits such as relieving deep pain are ascribed to the fat. It is also stated that duck fat cleanses and beautifies the skin. Birds were sometimes cooked with spices and medicinal herbs. For example, goose was cooked with vinegar and spices; biryân [13] was cooked with olive oil and then stuffed with onions and a couple of garlic cloves added; or alternatively cooked like isfidbâc [14], with the addition of chickpeas, white whorehound [15] and cinnamon. The addition of carrots and rue [16] was considered very beneficial. Stock made from young chicken, hen or rooster is both nutritious in its substance and a medicament, while the brain, testicles and excrement are medicaments. It is said that the best roosters are those that have not yet started crowing and the best hens those that have not yet laid eggs. We find diverse recipes for cooking chicken to obtain the required effects. For example, if a chicken is stuffed with misk apples [17] or quince and then roasted, it is very nutritious. Drinking stock prepared by cooking a rooster with ample water and adding polyploidy [18] is a laxative. Recipes are given for dishes to treat certain diseases. For example, for the treatment of lumbago the following dish is prescribed: "Take a rooster and add 20 dirhems of pounded safflower [19] seed, 15 dirhems of polypody, a pinch each of dill [20], fennel seed [21], cumin and carnation, and some chickpeas. Make the dish slightly more salty than usual. When well cooked strain and drink the juice as soup. Cooked garlic is a cure for flatulence." Various fish species, including the goby, turbot, eel, carp, sea bass, pike, red mullet, plaice, bluefish, bream, picarel, grey mullet, sole, two-banded bream, bonito, mackerel and trout, and also the dolphin, are described as curative by medical authors. The benefit of feeding patients with red mullet, goby and scorpion fish is particularly emphasised. There is extensive information in medical books about which fish are best, where they are caught, how to cook them, and with which foods they should and should not be eaten. Since fish are cold by nature they calm the hot humours and thereby have a beneficial effect in cases of diseases of a hot nature. For example, they are good for a dry cough, jaundice, debility, dysentery and fissurations. Fish eggs improve virility and are good for coughs and dysentery. Medications prepared with fish are used in the treatment of various diseases such as chronic furuncles, warts, poisonous stings such as scorpion stings, bites by rabid dogs, swellings in the anus, high fever, malaria, deafness, hard lumps on the uvula, psoriasis and jaundice. Medical writers explain which cooking and preparation methods are to be used for the treatment of which diseases. In other words, fish recipes are used for healthy nutrition and for protection from and treatment of disease. Here are some examples of medications containing fish and fish dishes taken from medical manuscripts: Fish poultice: This medicament is made with scorched fish and applied to swellings in the anus. It is also applied to bites from rabid dogs or stings by poisonous animals such as scorpions. Scorched fish head: The head of a salted fish is scorched and the ashes sprinkled on furuncles and warts. Burnt fishbone: The ashes of burnt fishbone are beneficial for psoriasis. Fish heart: The heart of the fish cut in half and cooked with vinegar is especially good for those suffering from malaria or jaundice and those with a hot temperament.Fish cooked in vinegar: Fish cooked with vinegar is good for those with malaria and a hot temperament. Fried fish: Fish fried in a little oil is good for those who are recuperating from a disease because it gives strength. Fish laxative: The stomach of the fish is slit, filled with silk and sewn up with string. Then it is placed into 1800 dirhems of water and cooked until only 300 dirhems of water remain, then strained. Drinking this water causes extreme diarrhea. Dolphin fat: Colocynth [22] is cooked in dolphin fat, which is of a hot temperament. This oil is then dropped into the ear to cure deafness. Please click here to read the rest of the article. Footnotes [1] 1. Hemlock Conium maculatum. 2. Helleborus. A poisonous substance called heleborin is extracted from some species of this genus. [2] Nohud-âb: chickpeas are boiled in water, drained and cooked with chicken or meat stock. [3] Although the word galîz means coarse or thick, in a medical context it refers to foods that are difficult to digest and high in calories, containing large proportions of fat, carbohydrates or sugar. The word lüzûcet, which means viscous, is similarly used. For example, galîz foods with excess lüzûcet cause phlegm. [4] Herîse: a dish made with mutton and whole wheat grains cooked together until tender and then beaten to a porridge. [5] A pudding made by cooking starch in butter and then adding water and honey or sugar. [6] Gemmae capparidis. Buds of the Capparis spinos plant used to make pickles. They are congestive and strengthening. [7] Mustard enhances the appetite. Table mustard is made of seeds of the black (Brassica nigra) and white (Sinapis alba) mustard plants. [8] Oxymel. A drink made of honey and vinegar. [9] Dirhem: approximately 3.32 grams. [10] Resin of the mastic tree, Pistacia lentiscus var. latifolius. [11] Dank: a measurement that varies over place and time, being equivalent to one sixth or sometimes one quarter of a dirhem. [12] Prickly lettuce, Lactuca scariola, or possibly chicory Cichorum intybus. [13] Biryan: meat that is first braised with no or little water and then roasted. In regional Turkish cuisine this dish is called pîren (biryân) and cooked in a pit oven. [14] Isfidbac: an ancient Arab dish for which meat is first cooked with tail fat, chickpeas, onion, coriander, dill and almond milk, and then egg yolks, cumin and cinnamon are added. This dish is recorded in in Ottoman Turkish cuisine in the sixteenth century. [15] Marrubium vulgare. [16] Ruta graveolens. [17] Misk or misket apple: a fragrant variety of apple. [18] Polypodium vulgare. [19] Carthamus tinctorius. Medicaments are prepared from the seeds, which have a laxative effect. The flowers are sometimes added to food. [20] Anethum graveolens. An infusion of the fruits of this plant is used for flatulence and to aid digestion. The aromatic leaves are used as a culinary herb. [21] Fennel is used to relieve gastric complaints and flatulence. [22] Citrullus colocynthis. * Professor Nil Sari, Ph. D., from Istanbul University Cerrahpasa Medicine Faculty, Department of Deontology and History of Medicine, is a world expert scholar in the history of medicine, Islamic medicine and culture and Ottoman science and medicine. Professor Sari is also a key FSTC associate. This article was first published in "Turk Mutfagi (Turkish Cuisine)", edited by Arif Bilgin-Ozge Samanci, Ankara: Kultur ve Turizm Bakanligi Yayinlari, 2008. We are grateful to Professor Nil Sari, author of the article and, for allowing publication. The article was translated from Turkish by Mary Isin. 1 | 2 | Next
by: FSTC Limited, Thu 08 January, 2009
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