Definition of Disease
Relativity in Disease Definition
Disease in the Qur’an
Superstition and Disease
CLASSIFICATION OF DISEASE
Acute & chronic
Amradh al qalb & amradh al badan
NATURE OF HUMAN DISEASE
Reaction and Adjustment
Attitude to Disease
Excuse from Obligations
CAUSES OF DISEASE
Endogenous & Exogenous
Intrinsic & Extrinsic
DISEASES AND QADAR
Disease as Qadar
Treatment of Disease as Qadar
Definition of disease: Health is a condition in which all of the body
functions are integrated and are being maintained within the limits of optimal design (Bowman p. 4.2). Disease is divergence
from the normal (Gaussian mean) but not all deviation is disease because of the reserve capacity and ability of the body to
adjust. In most cases, a deviation must also be related to other adverse changes to be able to constitute disease. The demarcation
between pathology and normal physiological variation can be fine. Hunger and thirst for example are psychological warning
signs and are not pathological conditions. A hungry person is not in immediate danger to any part of the body. When the situation
of food deprivation persists over a long time then pathological changes appear.
Relativity in Disease Definition: The definition of disease is very relative.
A high blood pressure in an elderly person does not have the same implication as the same level in a younger person. Temperature
levels have different interpretations in neonatal and adult infections. Adolescent behavior that may be normal would be considered
illness in adults. There are changes in the body that should be accepted as normal processes of aging and not as diseases.
There is a space-time variation in definition and perception of disease depending on the culture, beliefs, attitudes, and
prevalence of diseases. In localities where the burden of major diseases is high, some minor ailments may be ignored whereas
in other places they are taken as serious diseases. There are diseases that may be associated with social status. Some diseases
become reclassified with changing public opinion for example homosexuality was considered a mental disorder half a century
ago but is now accepted as normal sexual expression. New diseases continue to be defined
due to changes in the causative agents, host factors, or new scientific knowledge. Some old diseases like small-pox
Multi-dimensional definition of disease: Definition of disease considers
several dimensions that may operate singly or in combination: moral/spiritual, biological/pathological (khuruuj al badan ‘an al i’itidaal), psycho-social, or normative/statistical.
Loss of spiritual equilibrium is a disease in itself and soon leads to physical disease. Most diseases involve disturbances
in the equilibrium of the normal body physiology. These biological disturbances may be within the range of normal physiological
variation or may be clearly pathological. The psycho-social dimension of disease is associated with loss of equilibrium and
may precede or follow physical disturbances. The normative or statistical dimension is the most confusing. Sometimes people
are branded ill because they fall at the extreme end of the health-illness spectrum. In the final analysis it is the perception
of disease by the victim, the family or the health care givers that defines disease. The underlying pathology need not correspond
with the victim’s disease complaint; perception operates in between.
Disease in the Qur’an: The Qur’an has used several terms
to refer to disease. In the subject form the word maradh has been employed. In
the adjective form the words maridh and saqim
have been used (27:89, 37:145). The Qur’an being primarily a book of moral guidance, spends more time discussing the
causes and treatments of moral diseases and gives relatively little space to physical diseases. Humans are argued to undertake
the necessary research to understand the physical diseases
Superstitions and disease: The growth of scientific knowledge about the
pathology of disease has contributed to a marked decrease in superstitious beliefs that have plagued mankind for centuries.
Superstition is an attempt to understand and come to terms with frightening and dangerous disease phenomena that afflict humans.
In the absence of true knowledge there is resort to superstitious beliefs and explanations. Despite much progress in scientific
medicine, the majority of humans still suffer from the consequences of superstitious beliefs.
Pathology: Pathology is concerned with abnormalities of structure and
function which result from disease or are produced by disease (Bowman p. 4.3). It seeks to explain the why of a disease which
includes: etiology, pathogenesis, morphological changes, and the functional impairment. Most of pathology is about the reactions
of the body and its adjustment to insults.
Manifestations of disease: Disease manifests as symptoms or signs. Symptoms
are subjective patient complaints or description of disease. Signs are objectively verifiable disorders. A syndrome is a combination
of symptoms and signs associated with a disease condition. Symptomatology is perhaps a better indication of disease severity
because it includes the personality of the patient and reactions. Thus the same pathology does not produce the same symptomatology
in all patients. Those with strong iman may complain less about pain than others.
Fear of death also affects worry and complaint about disease.
Diagnosis: Diagnosis are measures including history, physical examination,
and logical deduction or induction that lead to definition of a disease. There is a role for istikharat in the diagnostic process. Allah can guide a believing and diligent physician to the correct conclusion
from available more often than the non-believing one. A definitive diagnosis need not be made before treatment starts. Treatment
is started using a tentative diagnosis. The true diagnosis may be deduced from the response to treatment. One of the strengths
of empirical science is that a disease can be treated successfully without fully understanding its pathogenesis or even how
the treatment works at the molecular level. This occurs for example in cases when a new unknown chemical compound is tried
on animals and then on humans with good results. It is then adopted as a treatment. The mechanism of action is established
only later or may never be established definitely. However this strength has a back-side to it. Using treatments whose mechanisms
of action are not well understood can lead to side effects and adverse effects later.
Prognosis: Prognosis is an empirical estimate of the future course of
the disease. From the Islamic view-point, prognosis is part of the knowledge of the unseen (‘ilm al ghaib). The physician does not have the privilege to say anything definitive about the future prognosis.
He or she can only extrapolate based on available data and must always have the humility to say ‘Allah Knows Best’
Relation between diseases of the heart (amradh al qalb) and diseases of the body (amradh al badan): There is
a 2-way interaction between physical and spiritual maladies. Disbelief (kufr) leads
to a lot of human cruelty like psychological or physical torture because of lack of moral restraint. Diseases of the heart
such as jealousy lead to violence and even death. Lack of spiritual equilibrium leads to inability to handle the normal stresses
of life such that the victims become addicted to alcohol and psycho-active substances with consequent physical illness. Addiction
to power and sex leads to violence. Physical diseases may cause so much depression and loss of hope that they develop into
diseases of the heart.
CLASSIFICATION OF DISEASE
Duration: Diseases may be classified by their duration as acute or chronic.
Acute disease is a temporary disturbance of homeostasis. Chronic disease may establish a new level of homeostasis.
Moral Criteria: Diseases may also be classified by cause as diseases
of the heart (amradh al qalb) and diseases of the body (amradh al badan). These two categories have been mentioned by the Qur’an. Diseases of the heart include:
doubt(shakk), passion (shahwat), and …. (ghil)
(2:10, 5:52, 8:49, 9:125, 22:53, 24:50, 33:12, 33:32, 33:60, 47:20, 47:29, 74:31, 2:16). Diseases of the body mentioned
in the Qur’an include: blindness (ama)
(p 851 2:2:17-18 … 80:2, 3:49 … 12:96), akma (congenital blindness
4:49), deafness(sum) (2:18, 2:171, 6:39, 8:22, 10:42, 21:45, 27:80, 30:52, 43:40),
lameness (araj) (p 807 24:11 … 48:17), leprosy (baras) (p 189 3:49, 5:110), dumbness (bukm) (p 204 2:18 …17:97).
Physical cause: Disease can also be classified by physical cause: infectious
(viral, bacterial, fungal, protozoal), neoplastic, allergic, genetic, congenital, nutritional, environmental, mental, degenerative,
metabolic, circulatory, or hormonal. The Prophet (PBUH) talked about the contagiousness of leprosy (Ibn al Qayim p. 154).
The inflammatory process is a reaction to the original disease pathology in both its acute and chronic forms and is essentially
a defensive measure. It is sometimes also harmful to the body on its own. Most disease processes are actually attempts by
the body to repair damage.
Site: Disease can also be classified as local or systemic. Fever is a
systemic condition whereas a local wound is a local condition. However local conditions become systemic with time and systemic
conditions may have particular effects on some local tissues. The Prophet (PBUH) described the human body as one physiological
entity such that if any part is afflicted the whole body suffers. Thus the local-systemic dichotomy is not important.
Mental cause: Disease can be classified as physical or mental. This classification
is not valid all the time because in many instances mental conditions have a physical basis. Mental disorders are either neuroses
(anxiety, phobia, hysteria, obsessive-compulsive disorders, or depression) or psychoses. Psychoses are more serious than neuroses.
Psychoses normally require drug treatment whereas the preferred management for neuroses is psychotherapy. Psychoses can be
organic or functional. Some types of epilepsy have an organic basis. The functional psychoses are either affective disorders
or schizophrenia. Examples of affective disorders are: (manic-depressive disorders, endogenous depression, reactive depression.
Schizophrenia involves disorders of thought, emotions, will, body movements, delusions, and hallucinations. The Qur’an
uses the term madness (junuun) to refer to the major disorders like psychoses.
Neuroses are described as sadness (huzn), worry and anxiety (hamm and ghamm). The Qur’an also explains how
the label of madness is used to refer to righteous people like prophets who are abused because they differ from the general
public that is bent on evil.
NATURE OF HUMAN DISEASE
Reaction and adjustment: a patho-physiological disturbance is normally
a response to a biological, physical, or chemical insult or injury to the body. Thus most disease manifestations including
their symptoms and signs are a reaction to injury and an attempt to re-adjust. From this point of view the disease process
is a benefit and not a harm. Most disease processes operate at the cellular level. The causes of cell injury are: hypoxia,
physical agents, chemical agents, infectious agents, immunological anomalies, genetic, and nutritional disorders. Cells respond
to injury in two ways: (a) adaptation: atrophy, hypertrophy, and hyperplasia.
(b) Acute injury which could terminate in death or could be reversed.
Attitude to Disease: In an Islamic context, disease does not always connote
a negative or bad event. There are indeed many situations when what is a disease situation is actually beneficial. Falling
ill may be Allah’s way of forcing the person to take a desired rest or care for the body before it can deteriorate further.
Death from some diseases was said by the Prophet to be martyrdom (shahadat). Patience
in the face of severe illness is a reason for entering paradise (jannat). The pain
due to disease is a reminder of the punishment and suffering that the evil-doers will suffer from. Disease can be an opportunity
for personal redemption by expiation/atonement for previous sins. The trials that one goes through and the eventual patience
can be rewarded by Allah’s forgiveness. Disease may enable a person return to the due equilibrium in life. Falling sick
may at times be Allah’s blessing in disguise that a person is incapacitated and thus is prevented from pursuits that
could prove more dangerous for him. While a person is sick and is not busy with the routines of life he may have time to reflect
and remember Allah.
Punishment: Some diseases are due to disobedience. Acts of disobedience
may be followed by epidemic disease or by disease in an individual. The disease may be directly related to the sin such as
liver cirrhosis due to chronic alcohol consumption or there may be no direct relationship.
Disease as an excuse from obligations: Allah in recognition of the burden
of disease and the need to give the body a chance to recuperate excused the sick from some physical religious obligations
(2:10, 48:17, 2:184, 2:185, 2:196, 4:43, 4:102, 5:6, 9:9, 73:20).
CAUSES OF DISEASE
Sufficient Cause of Disease: When all the factors that produce a certain
pathological condition are existing, we say that there is a sufficient cause of disease. However humans can never know for
sure that there is a sufficient cause because Allah’s divine will (qadar)
is involved. There are many cases when all the humanly-known factors of a disease exist but the disease does not occur. This
is because of the unknown factor attributable to Allah alone.
Necessary cause: There are empirical factors that must operate for a
certain pathological condition to occur. These are referred to as necessary causes. For example the tubercle bacillus is a
necessary cause for the disease of tuberculosis. Humans must know the necessary causes of diseases. Denying their existence
is denying the cardinal principle of sunan Allah fi al kawn and is akin to superstitious
Multi-factorial Causation of Disease: Human diseases, like the human
organism, are complicated and usually several factors are involved in their causation. Humans may know some of the factors
and ignore others. It is not necessary to know all the factors in order to treat a disease. Since the factors usually act
in sequence, knowledge of only one may be sufficient to interrupt the causal pathway.
Endogenous and exogenous causes of disease: Endogenous diseases are caused
by factors from within the human body or the internal environment. Exogenous diseases are caused by factors in the external
Intrinsic and extrinsic diseases: Intrinsic diseases are genetic or in-born.
Extrinsic diseases are those acquired after birth. Some diseases are in infancy and may be an extension of intra-uterine problems
or are acquired early in life. These include: intra-uterine growth retardation, prematurity, congenital birth injuries, and
inborn errors of metabolism.
Environmental causes of disease: heat, cold, radiation, water, smoke,
and high altitude can lead to patho-physiological disturbances and disease. Extreme heat can cause heat-stroke and dehydration.
Water kills drowning people. Humans on the average inhale many liters of air a day that bring in smoke and other air-pollutants.
Inhalation of smoke and other atmospheric pollutants causes respiratory diseases including lung cancer. The low levels of
oxygen at high altitudes can cause hypoxia. Extreme cold causes frotbite or death from endothermia. Irradiation causes neoplasia
and chromosomal damage. Humans on their own free will ingest chemicals as drugs that have many adverse reactions. Natural
and man-made toxins are ingested with food. The Qur’an anticipated space travel (
). Prolonged life under zero gravity may have long-term effects on the human organism that are not yet known.
Genetic: Genetic diseases could be a single gene disorder or they may
be multi-factorial involving more than one gene even other non-genetic environmental factors. Single-gene disorders could
be autosomal or X-linked. As part of the parity principle of human creation, each gene is in pairs one from each parent with
the possibility of a dominant or recessive combination. Mutations and chromosomal damage can alter the body’s growth
metabolic processes resulting in disease. These operate through disturbances of protein and enzyme synthesis or function.
Molecular diagnosis and gene therapy are growing fields and will give rise to a different understanding of pathology. Islamically
speaking we can not say that there was a genetic or chromosomal mistake. It is all part of Allah’s grand design.
Immunological: Disease arises from disorders of cells of the immune system:
T and B cells, macrophages, dendritic cells, Langhan’s cells, and natural killer cells. Disease could arise in all three
conditions of immunological disturbance: a hypo-active immune system cannot protect the body against invading organisms, a
hyperactive immune system may destroy parts of the body such as occurs in auto-immune diseases, and some immune reactions are abnormal or paradoxical causing tissue damage.
Malnutrition: Under-nutrition causes disease by depriving the body of
essential nutrients. Protein energy malnutrition of children in poor countries is due to lack of protein and calories. Vitamin
and mineral deficiencies disturb normal metabolism. Over-nutrition results in obesity, diseases such as heart disease and
various types of cancer. Excessive intake of necessary nutrients like vitamins causes various hyper-vitaminosis syndromes.
Infection (al ad’wah):
Infection of the human body by other organisms is part of Allah’s plan especially in fulfilling the food chain. It is
part of the balance of the eco-system. This does not however mean that such diseases should be left alone. There has been
some confusion about hadiths of the Prophet (PBUH) dealing with infection and contagiousness of disease. There is actually
no contradiction between hadiths that indicate that disease is contagious and those that indicate the opposite. The Prophet
was speaking about different diseases on different occasions. Even with one disease like leprosy there are contagious and
non-contagious forms (Ibn al Qayim p. 154).
Neoplasms: loss of control over cell multiplication results in cancer.
This is violation of a basic law in biology that equilibrium and homeostasis will be maintained. The molecular basis of cancer
has been elucidated in detail recently. Oncogenes are thought to be the basis for neoplastic growth. Carcinogens as initiators
or promoters interact with the oncogenes to lead to neoplastic proliferation. Age and heredity play a role in cancer etiology.
Malignant neoplasm differs from the benign one in being less differentiated, being anaplastic, high growth rate, invasion
of local tissues, and distant metastases. Normally the immune system is able to detect the neoplastic cells and eliminate
them. In situation of relative immune deficiency it is not possible to eliminate the neoplastic cells.
Degeneration: in old age phenomena of growth and decay are more that
repair and growth and degenerative diseases could result. These are strictly speaking part of Allah’s design and not
DISEASE AND QADAR
Occurrence of disease as qadar:
It is Allah’s pre-destination that a person falls sick. Treatment/prevention of disease not against qadar. Medical treatment is subsumed under the principle that qadar
can reverse another qadar (radd al qadar bi al qadar). In the end all cure is from
Allah and not the human (26:80).
1. Illness is expiarion of sin: ‘ No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls
a Muslim, even if it were a prick he receives from a thorn, but Allah expiates some of his sins for that’ MB hadith
# 1949. ‘The example of a believer is that of a fresh tender plant; from whatever direction the wind comes, it bends
it, but when the wind becomes quiet, it becomes straight again. Similarly a believer is afflicted with calamities (but he
remains patient till Allah removes his difficulties. The fajir is like a pine tree
which keeps hard and straight till Allah cuts it down when He wishes’ MB# 1950. ‘If Allah wants to do good to
somebody He afflicts him with trials’ MB#1951
Blessings of fever: Muslim reported on the authority of Jabir that a
man abused fever in the presence of the Prophet (PBUH). The Prophet responded: ‘Do not abuse it. It wipes away sins
as fire wipes away the khubth of iron’.
2. Blessings of plague: Bukhari and Muslim reported on the authority of Anas Bin Malik that the Prophet (PBUH)
said: ‘plague is martyrdom for any Muslim’.
3. Heat of fever: Bukhari and Muslim reported on the authority of Nafi bin Ibn Omar that the Prophet (PBUH)
said: Fever is an air-current (faih) from hell cool it down with water (ibn al Qayyim).
4. Fever is systemic: Abu Hurairah said: The best-loved among diseases that afflict me is fever because it
enters every organ of mine and Allah the almighty gives each organ its due share of reward (Ibn al Qayim)
5. Suicide: ‘… Whoever commits suicide with a piece of iron will be punished with the same piece
of iron in the hell-fire’ MB hadith # 683
6. Infectious disease: ‘ There is no contagiousness (adwa) ……..and one should run away from the leper as one runs away from a lion’ MB hadith # 1969 Loss of sight: ‘Allah said: If I deprive my servant
of his two beloved eyes and he remains patient, I will let him enter paradise in compensation for them’ MB hadith #