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Arabian Drugs in Early Medieval Mediterranean Medicine$

Zohar Amar and Efraim Lev

Print publication date: 2017

Print ISBN-13: 9780748697816

Published to Edinburgh Scholarship Online: September 2017

DOI: 10.3366/edinburgh/9780748697816.001.0001

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Discussion and Conclusions

Discussion and Conclusions

(p.228) 4 Discussion and Conclusions
Arabian Drugs in Early Medieval Mediterranean Medicine

Zohar Amar

Efraim Lev

Edinburgh University Press

Abstract and Keywords

This chapter draws some conclusions from the researches laid out in the previous chapter. It considers the extent of the Indian contribution to the inventory of medicinal substances in the early Islamic period, as well as how evidence of such contributions seems so scarce in comparison. The chapter also discusses the distribution of these drugs and how they were spurred on by ‘strong market forces’ — namely, the new trading routes and economic conditions created by the Arab conquests and their governmental policies. Literature and translations were just one way to transmit medical knowledge from the Classical to the Arab world and from there to the West; others were trade, diplomacy, pilgrimage, and waves of conquests. The chapter thus shows how the Arabs rendered a transformation of the entire medieval world, including the comprehensive dominance of Greek pharmacology along with Persian and Ayurvedic drugs.

Keywords:   Arab medicine, Greek medicine, Persian medicine, Indian medicine, Arab conquests, Arab governmental policies, strong market forces, medieval trade, drug distribution, medical knowledge

Dols rightly remarks in his article that despite the great contribution of the Indians to the inventory of medicinal substances in the early Islamic period, their documentation is very vague: ‘Consequently, although Indian medicine made a substantial contribution to early Islamic medicine, these men remain shadowy figures.’1 Indeed, even though remnants of the Indian medical legacy can be found in the medical books of al-Ṭabarī, al-Rāzī and others, it is the Greek medical tradition that predominates in their writings. The two authors named represent physicians hailing, geographically, from the margins of influence of the Indian legacy. The Indian healing tradition was deferred to the Greek tradition at an early stage during the rule of the Abbasids in Baghdad. One of the reasons for this, as mentioned previously, was the influence of many of the translators of the Bayt al-Ḥikma, who were typical representatives and propagators of the Classical school. After all, this was an ancient heritage in the Middle Eastern sphere and was well-known for its culture, languages, customs and patterns of thought.

The Christians had already ‘rendered’ Galenic medicine, in which, in their opinion, pagan traces remained. They translated it selectively and in such a way that Judaism and Islam could adopt it without demur. True, the Arabs appreciated the Indian legacy, but it was too foreign in its spiritual, physical and philosophical culture. Al-Bīrūnī, a physician whose writings embody a great deal of Indian knowledge and who was well acquainted with Indian medicinal substances unknown to the Greeks, describes the case quite well. Notwithstanding the contribution of the Indian medical legacy, in the end it seems as if al-Bīrūnī believed that precedence should be given to the Greeks, not only because they were more advanced and superior in their (p.229) medical knowledge and practice, but also because their legacy better suited the people of the Near East and their mentality:

Every nation has specialised in one art or technology. The Greeks, before the Christians, surpassed the latter in the discussion of this art and took it to the pinnacle of perfection. Were Dioscorides living amongst us, he would have searched our mountains and forests for herbs. All our wild plants would have become drugs and used as cures. The people of the West have surpassed us in such arts and, through scholarly and experimental work, have benefited us. Amongst the people of the East no one but the people of Hindustan has advanced in this field. Their principles, however, are different from those of the West. Moreover, they and we are at different poles with regard to language, religion, customs, ceremonies and habits. As they overemphasise cleanliness to the point of exaggeration and avoid uncleanliness as much as possible, there is no possibility of a dialogue between us.2

Indeed, the influence of Indian physicians can barely be found in the medieval Arabic glossary of drugs.3 Some of these physicians and translators were retained in historical memory and were perpetuated in a minor way in late Arab medical historiography, namely by Ibn Abī Uṣaybiʿa and al-Qifṭī. However, the others have faded from the pages of history. Still, according to Ibn al-Nadīm, the Sasanians (during the rule of Ardeshir and his son Shahpur, and later rulers) copied and translated various books from India into Persian.4 Also, as we have seen, some were re-translated later into Arabic while others were translated directly from Hindi into Arabic.5 The picture differs with regard to the medicinal substances themselves. The dominance of the Galenic approach failed to erase the contribution of the competing doctrines, specifically the Indian, Persian and Babylonian. As we have mentioned, a multiplicity of ‘new’ medicinal substances from India and Persia penetrated Galenic–Arab pharmacology. Some even came to hold a central position in the practical medicine of the medieval period, such as various kinds of myrobalan and sugar. This undoubtedly happened – first due to their effectiveness and, then, because they filled a gap or were better alternatives to ancient ‘Greek’ drugs. Furthermore, there was an inverse movement of Greco-Arab drugs permeating into Indian medicine due to the influence of Arab pharmacology on Indian physicians.6

(p.230) The influence of the Indian–Mesopotamian region on the inventory of Arab drugs or, even more, on the Greek drugs can be learnt from the names of drugs in common use among physicians at that time, as found in medical books. Having multiple synonyms for each medical substance is a well-known phenomenon that has even created a literary genre.7 Nevertheless, each substance had one or two more common names that in most cases ‘gave away’ its origin. With all of the challenges posed by this issue, an analysis of plant names can still provide a primary indication of their origin. Several scholars have already dealt with this issue. Levey demonstrates this from al-Kindī’s book: 31 per cent of the substances’ names are of Mesopotamian origin (Aramaic, Syriac and Hebrew), 23 per cent Greek, 18 per cent Persian, 13 per cent Indian, 5 per cent Arabic and 3 per cent Egyptian; the rest are unknown. He states that the Persian and Indian names should be taken together, totalling 31 per cent, equal in fact to the Mesopotamian percentage. In that case, the Greek names take third place.8 Similar data, for example, the connection between the Greek, Persian and Sanskrit terms, are derived from the analysis made mainly by Oliver Kahl of the prescriptions found in the books of Sābūr Ibn Sahl,9 Ibn Tilmīdh,10 al-Ṭabarī11 and al-Rāzī.12 In addition, Ben Mrād made a statistical linguistic analysis regarding the origin of the names of drugs mentioned in medieval Arabic literature.13

This trend is even more evident in the pharmacological book of al-Samarqandī (died in Herāt, Persia, in 1222). Although this book appears considerably later, it points to a strong Indian–Persian influence, accounting for 54 per cent of all medicinal substances, followed by Mesopotamian 20 per cent and Greek 17 per cent, with the rest being ancient Arab, Egyptian and Chinese.14 Table 4.1 displays this information:

Table 4.1 Greek vs Persian/Sanskrit names of drugs in various medical books




Sābūr ibn Sahl

12.5 %


Ibn al-Tilmīdh

12.7 %

34.9 %

Al- Ṭabarī


38.3 %







(p.231) It appears that in the beginning, the main attraction to the Asian medicinal substances was caused by Arab contact with India and its treasures. This process also generated a new literary genre named ‘News of India’ or ‘Wonders of India’.15 This genre dealt mainly with gifts, objects and precious articles that were brought from the newly occupied territories (that is India) to the Umayyad and Abbasid rulers.16 Nevertheless, the dramatic change occurred when these prestigious articles, which were originally designated for the upper socio-economic strata, became available, over time, to a wider public. This was due to the market forces (supply and demand) that facilitated their distribution in large quantities, thus lowering the prices. Typical examples of this phenomenon are commercial documents from the Cairo Genizah, especially those dealing with India trade17 and trading posts along these routes, such as Aden.18

These drugs were distributed due to the ‘strong market forces’, namely the new trading routes and economic conditions created by the Arab conquests and their governmental policies. The vast majority of these substances were fully accepted, first, as spices, perfumes, incense and ingredients for dyeing and tanning and, later, as medicines. Literature and translations were just one way to transmit medical knowledge from the Classical to the Arab world and from there to the West; others were trade, diplomacy, pilgrimage and waves of conquests. These exposed the population to a new medical tradition, new physicians from various schools of thought and new medicinal substances.19 As noted above, the Arabs rendered a transformation of the entire medieval world, including the comprehensive dominance of Greek pharmacology along with Persian and Ayurvedic drugs. This was the case until the eighteenth century. At that time, a disengagement from Galeno-Arab medicine began first in Europe and later in the Middle East. Its ‘relics’ can still be seen in traditional societies in different parts of the world: North Africa, the Middle East and Arabia.20 However, in the culinary world of the West, Indian spices such as coconut, turmeric and nutmeg dominate to this day. The ‘triumph’ of the Galenic legacy during the Abbasid period stands out, therefore, mainly on the theoretical level. At the same time, the Indian medical legacy ‘conquered’ its own vast domain in a practical way by introducing a notable representation of medicinal substances that became assimilated into Galenic medicine.

(p.232) The pace of the distribution of the substances was undoubtedly inconsistent chronologically and regionally.21 The waves of distribution of the ‘Indian’ plants were known to the Arabs and in the Middle East from early times.22 For example, cinnamon and nard were known there during the Biblical period. Pepper, cardamom, aloe and the Indian agarwood were known from Classical times.23 So, some of the Indian substances mentioned in the Arab sources were probably known to a limited extent in earlier periods and spread again, later, in a second and more substantial wave during the Middle Ages.24 Nevertheless, even in that period there were some substances whose medicinal uses were introduced relatively later, such as those used to preserve the Egyptian mummies. In passing, we should note that medicinal substances were distributed in the opposite direction, too, from the West (Middle East and Europe) to the East, as exemplified by poppy and saffron,25 two plants with a long and rich history.

As previously mentioned, Arab sources assumed that some of the above-mentioned substances were Chinese.26 To these we should add such plants as Chinese species of rhubarb, rose, castor oil plant and celadine. Some substances are mentioned as Yemenite though their primary origin is Indian: warras (wars; Flemingia grahamiana = Flemingia rhodocarpa), mungo bean (māsh; Phaseolus mungo) and screw pine (duhn al-kādhī; Pandanus odoratissimus). Since Yemen and Eastern Africa (Ethiopia) were on one of the main trading and distribution routes of these substances, it is likely that they were culturally very deeply integrated there, perhaps even before the Islamic conquests. In this group we should include some Indian precious stones such as diamond, agate, cornaline, pearl and corundum.27

While most of these substances are tropical plants and only their dry products were distributed, certain plants were introduced into the Middle East as agricultural crops in places where the tropical and subtropical climate allowed for their cultivation, including oranges, lemons, bananas, mangos, eggplants and cucumbers. A close investigation of the ‘Indian’ substances and crops reveals that not all of them were ‘new’ to the territory of the Muslim empire. Some had been in use in Persia and Mesopotamia even before the rise of Islam.28 In sixth-century Persia, spinach (ʾisfānākh; Spinacia oleracea), apple cucumber (dastabuya; Cucumis melo var. dudaim) and sugar cane appear to have been known. The last-mentioned is an example of a product (p.233) already appearing in the Classical sources. However, as an agricultural crop, it was introduced to the Middle East much later.29 By the same token, we may mention substances probably known in Mesopotamia before the Islamic conquests, including jasmine (yāsamīn; Jasminum sp.), musk (misk; Moschus moschiferus), coconut palm (al-jawz al-hindī; Cocos nucifera) and lacca (lakk; Laccifer lacca). All of these appear in the Babylonian Talmud, dated to the fourth and fifth centuries AD, in which valuable practical data can be found.30 This means that the Arab erasure of the border between the Sasanian and Byzantine domains furthered the spread of these products and crops which had begun beforehand. The use of other crops known on a limited scale in the Middle East before the Islamic conquests expanded after it, as is the case of cotton (quṭn; Gossypium herbaceum), sebesten (sabistān; Cordia myxa), hemp (qunnab; Cannabis sativus var. indica), and indigo (nīl; Indigofera tinctoria). Persian substances (in some cases identified by their names), the use of which expanded due to the Arab conquests, include berberry (ʾamīrbārīs; Berberis sp.), perfumed cherry (maḥlab; Prunus mahaleb), neem (ʾazādadrakht; Melia azedarach), manna (taranjubīn; Alhagi maurorum) and bezoar-stone (ḥajar al-bādazuhr) (Map, p. xiv).

Not all medicinal substances defined as ‘new’ are identified with certainty. From writings as far back as Ibn Juljul and Ibn Rushd one learns that some of the substances were unknown in the tenth century or their identification was open to debate among contemporary scholars.31 Some of these substances were featured on Ibn Juljul’s list under the category of those ‘not used but will not be forgotten.’32 This seems to reflect the fact that in early times, the influence of the Ayurveda and the Mesopotamian legacy, especially in the first half of the ninth century, was strong. So the omission of some of them from the inventory of practical drugs in later periods may testify to their rejection, possibly as part of the competition with Galenic pharmacology. Nevertheless, in the test of time and actual circumstances, the vast majority of the new substances from southern and eastern Asia became the most common and sought-after drugs in medieval practical pharmacology.

A study based on documents from the Cairo Genizah, which are a reflection of Mediterranean society as a whole, shows that different categories of information emanating from the fragments may be distinguished as theoretical (p.234) medical writings, contained primarily in medical books (translated Classical books as well as original Arabic), and practical medical knowledge, customarily found in prescriptions, lists of drugs and letters. The differences between the practical and theoretical inventories may be learned and even quantified. Sure enough, this study shows that, in the eleventh to thirteenth centuries, only two-thirds of the substances (278) out of a fuller list based on theoretical sources as well (414) were actually used in practical medicine.33 It stands to reason that some medicines and medicinal substances were used more often than others, depending on price, availability, practitioners’ choices and even local medical trends. Analysis of the inventory of practical medicinal substances shows that it contains the vast majority of the ‘Indian’ substances, which were described as ‘new.’

The most striking example of this are the various species of myrobalan, which appear among the most prevalent practical medicinal substances in prescriptions in the Cairo Genizah34 and symbolically appear as leading substances on the lists of Ibn Juljul, al-ʾIdrīsī and Ibn Rushd.35 Furthermore, the foodstuffs and medicinal substances were fully adopted by and assimilated into the Galenic theories. Arab physicians categorised and classified them according to the Greek theories and doctrines, for instance by determining their nature and degree according to the doctrine of temperament. The major achievement of Arab medicine is, therefore, the incorporation of the practical aspects of both Indian and Persian medicine into the Galenic frame. The theories of the Indian medical tradition, however, did not significantly influence medieval Arab medical thinking and, in fact, left no long-range impact.


(2.) Said, al-Bīrūnī’s, I, p. 7 (in the Arabic source, pp. 10–11); the translation of this important paragraph was already published by Meyerhof, ‘On the transmission’, p. 27.

(4.) Dodge, The Fihrist, II, pp. 575–8, 581.

(5.) Ibid., II, pp. 589–90.

(p.235) (7.) See: Ben Maimon, Un Glossaire, mainly the introduction, pp. 62–7; Maimonides, in his book on the names of the drugs named twenty substances of Indian origin and, in one case, even cites the Indian name; see Ben Maimon, Glossary of Drug Names, no. 112.

(21.) Waves of the continuous dissemination of substances and plants from southern Asia in biblical times and in the Hellenistic and Roman periods are beyond the scope of this article; see, for example, Zohary, ‘The diffusion’.

(24.) Before the Islamic conquests, from biblical times to the seventh century, Arab tribes (the Nabataeans) had a ‘history’ of trade and of being middlemen for spices on the incense routes from India through Arabia to Egypt, Syria and Byzantium; see Meyerhof, ‘The background’, p. 1,852; Watson, Agricultural Innovation, pp. 77–83; Amar, ‘The ancient trade’; Dan, The City, pp. 187–8; De Lacy, How Greek Science, pp. 68–9.

(26.) On the transport of Arabic drugs to China (such as jasmine, saffron, fenugreek and henna) see: Aziz, ‘Arabs’ knowledge’; Ambergris is another example of a substance that the Arabs introduced into India (probably from Yemen and Oman), see: Gode, ‘History of ambergris’.

(p.236) (27.) See entries in Chapter 3.

(28.) On the connection between Iran and Tibet see: Melikian-Chirvani, ‘Iran to Tibet’.

(30.) Lacca in Bavli Ḥullin 28a; Pesaḥim 42b; Jasmine in Shabbat 50b; Musk in Berachot 43a; Coconut palm in ʿEruvin 58a.