Contribution of al-Zahrawi ( Albucasis ) in the field of Pharmacy and Pharmacology with respect to his treatise

276 Review Article: Contribution of alZahrawi (Albucasis) in the field of Pharmacy and Pharmacology with respect to his treatise Kitab al-Tasreef Mohd Akhtar Ali1, Mohd Danish2, Hamiduddin3 Abstract Abūl-Qāsim Khalaf ibn ʿAbbās al-Zahrāwī Latinised as Abulcasis or Zahravius, lived between 936–1013 AD. He was born and raised in Al-Zahra a suburb of Córdoba (Arabic: Cortoba) in Spain. He was a famous surgeon, a talented pharmacist and a capable pharmacologist. Zahrawi is very famous for his surgical contribution, but this work explores his pharmaceutical and pharmacological contribution with respect to his treatise Kitab al-Tasreef. He served as the court physician to Caliph ʿAbd ar-Raḥmān III an-Nāṣir (912–961 AD). He wrote his famous book “Kitab al-Tasreef li-man ‘ajaza ‘an al-ta’lif” (The Arrangement of Medical Knowledge for one who is not able to compile it) around the year 1000 AD after fifty years of clinical experience. This book is also a chief source for indicating pharmaceutical contribution of al-Zahrāwī apart from the field of surgery. Twenty seven volumes, from Volume 3 to 29, of thirty volumes of the book Kitab alTasreef are related to Unani pharmacy and pharmacology. Ibn Abī Uṣaybiʿa (1203-1270 AD) remarked him only as an expert of pharmacy and pharmacology. Al-Zahrāwī devoted his entire life and genius to the advancement of pharmacy, medicine and surgery. He sketched a few drawings of pharmaceutical instruments and mentioned their use in his book. Significant pharmaceutical contributions of al-Zahrāwī are reflected by him through Kitab al-Tasreef which has not been highlighted, there is need to evaluate and emphasize the pharmaceutical contributions of al-Zahrāwī. This review is an attempt in this direction.


Introduction
Abū al-Qāsim Khalaf ibn ʿAbbās al-Zahrāwī, is well-known in the West as Albucasis or Abulcasis or Zahravius. He was born in 936 AD in al-Zahra', which is six miles northwest of Córdoba, Spain (al-Andalus). 1 His ancestors were from the al-Ansar tribes of Madina, who came with Muslim armies which conquered and after that stayed in Spain. Al-Zahrawi travelled rarely and resided mostly in Córdoba. He was a practicing physician, pharmacist as well as great surgeon. He also served as court physician to caliph ʿAbd ar-Raḥmān III an-Nāṣir (912-961 AD) 2 who ruled Andalusia (al-Andalus) for the 50 years which formed all sciences reached their peak so this period was known as 'Golden age'. 3 Zahrawi also served as the personal physician to Al-Hakam II (915-976 son of ʿAbd ar-Raḥmān III). The first recognized biography of al-Zahrawi was revealed in Al-Humaydi's Jadhwat al-Muqtabis fi Dhikri Volat al-Andalus (On Andalusian Savants) compiled six decades after Al-Zahrawi's death 4 . After a long and memorable medical profession, he died in 1013 AD at the age of 77. He authored his famous book "Kitab al-Tasreef

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li-man 'ajaza 'an al-ta'lif" (The arrangement of medical knowledge for one who is not able to compile it) around 1000 AD. It is collection of about fifty years of his medical practice and experience knowledge. The book consists of thirty volumes and it covers different aspects of medical knowledge. The book has sections on medicine, surgery, midwifery, pharmacology, therapeutics, dietetics, psychotherapy, weights and measures, and medical chemistry. 5 In European languages his name is written in more than a dozen ways like Abulcases, Albucasis, Bulcasis, Bulcasim, Bulcari, Alzahawi, Ezzahrawi, Zahravius, Alcarani, Alsarani, Alcaravi, Alcaravius, Alsahrawi. 3

Brief introduction of Kitab al-Tasreef li-man 'ajaza 'an al-ta'lif
The Kitab al-Tasreef is a compilation of Al-Zahrawi's over 50 years of medical and surgical experience. Many people are of opinion that al-Zahrawi has contributed only in the field of surgery, which is not the case. This misunderstanding among the medical fraternity is may be due to the fact that he has been highlighted mostly for his surgical contribution. Till date most of the information available regarding Zahrawi's medical contribution is related to only his surgical contribution. Surgery is mentioned and described only in 30 th volume of at Tasreef. Twenty-seven volumes, from Volume 3 to 29 of the book are related to Unani pharmacy and pharmacology. According to Ibn Abī Uṣaybiʿa (1203-1270) Zahrawi was the person having great knowledge of Mufrad (single drugs) and Murakkab (compound formulations). He was also an expert physician. The largest among all his writings is al-Tasreef which is complete in every aspect of its meaning and description. 6 The book Kitab al-Tasreef is considered as a medico-pharmaceutical encyclopedia, and one of the greatest of its time. 3 Dr. Sami Khalaf Hamarneh (b. 1925), in recent years has investigated the life and work of al-Zahrawi, and gave a major emphasis to the pharmaceutical information and contribution, which is found not only in the twenty-fifth and twenty-eighth treatises of Kitab al-Tasreef but in most of the volumes (3 rd to 29 th volume). 1 Al -Zahrawi's name was forgotten for so many centuries for two reasons: firstly, his name was altered and distorted in so many ways; and secondly, those who copied his works did not refer to him as being the source of their knowledge. 3 Al-Tasreef was a manual text for medical syllabus in several of the European universities for many centuries, but displaced Avicenna's "The Canon of Medicine" as the flanked by 12-17 th centuries AD. 4

Brief volume wise introduction of Kitab al-Tasreef
Vol.
Brief Contents of Volume

Manuscripts of Kitab al-Tasreef
There is no complete collection of the 30 volumes of al-Tasreef in any one library in the world. 3 Some partial or about to complete manuscripts of al-Tasreef are present in around 12 1-27). Bankipore MS. no 17 (the register general library no. is 2146) is also housed at the same above library, but it consists of only the 30 th volume which is mainly concerned to surgery) it was written in the Naskhi script in 1188 CE. This manuscript has nearly 200 illustrations and drawings of clinical and surgical instruments. This is considered as one of the earliest and one of the finest manuscripts of al-Tasreef.

Contribution of Zahrawi in Pharmacy and Pharmacology
Al-Zahrawi (Abulcasis 936-1013) devoted his whole life and brilliance for the betterment practice and advancement of surgery, medicine and pharmacy. He was one of the greatest surgeon of early Islam, and also a great educator and psychiatrist. 21 His principal writing is the Kitab al-Tasreef, a thirty-volume medical encyclopedia. 22 He pioneered the preparation of drugs by distillation and sublimation. His Liber Servitoris contains a large number of recipes and elucidated how to prepare simple as well as complex drugs. There are excellent explanations and comprehensive descriptions of medicopharmaceutical technology. In syrup section there was description of every pharmaceutical step in preparation as well as methods for making syrup transparent and clear. He discussed the three natural sources of medicines: vegetable, animal and mineral orign and their compound products. Further the procedures including preparing, washing, burning, roasting, and storing of medicinal products are also discussed. In 28 th treatise, he mentioned Galena, litharge, cadmia and the special procedures for their isolation, cleaning and the physical and chemical treatment. He also mentioned Verdigris, vitriols, method of changing of trioxide arsenic (white arsenic) into red arsenic, method of calcination of mercury, method of making Cinnabar or vermillion by sulphur and mercury, method of salt ammoniac extraction. These method remained as it is up to late European Renaissance. Al-Zahrawi recommended a caustic distillate which is known in Persian as "deg bardeg" which means earthenware or an urn on top of another (boiler over boiler) in processing of medicines. He also recommended the use of minerals, elements and precious stones either in individual form or compounded with other simple medicines. He also mentioned processes for the extraction of juices such as Aloe, Absinthium, Fumitory, Lycium, Galbanum, Sarcocol and Liquorice. Further some more procedures e.g., method of washing Acacia (gum arabic), distilling of camphor, whitening of vinegar, ameliorating colocynth with additional gums, burning Scammony, drying Squill, opium extraction from the poppy, cardamom and lily cooked with honey for medicament. He also described processes for distillation of sandal and other woods, refining of olive oil. A modified and sophisticated method of aromated water of Roses is also discussed by him. The author also discussed the burning (Ihraq) of horns and shells, eggshells, various bones, lobsters and crab, snakes, and scorpions hounds. He described the processes for preparing, cleaning, perfuming and preservation of fats and other greases; purification of honey, and its incorporation with syrups and other compound of medicine and the whitening procedure of wax. He described in detail various dosage forms like confection, laxatives, pills, enemas, pessaries and suppositories, ordinary syrups with or without vinegar, and robs; strong and purgative aromatic juices, decoctions and infusions; inhalers, gargles and medicinal dusting powders for the treatment of wounds and their pharmacological virtues; and recipes of cordial remedies. Al-Zahrawi described cosmetics luxuriously spiced perfumery, toiletries, delicacy, hair dressing and charmer adornments, eye salves (pulverized as in kohl, and in liquid form for drops), collyria and eye compresses, balms, liniments and dentifrices. He is credited for inventing under-arm deodorants, hair removal sticks, hand lotions, hair dyes for changing human hair color, hair care for normalizing kinky or curly hair. Some other cosmetics were also invented by him including solid lipsticks which were perfumed stocks rolled and pressed in special moulds and some mineral oils which were used for medication purposes as well as aesthetic and beautification purposes. He made copious advances in perfumery and discovered perfumed stocks, rolled and pressed in special moulds which are comparable to modern roll-on deodorants. Zahrawi also made-up nasal sprays and developed efficient mouth washes. 13,23 He mentioned properties of diets and drugs, and their preparation, restoration, amelioration, and cooking procedures, identifying of cereals, breads, wines, waters, soft drinks, legumes, meats, fishes. He also mentioned aging of drugs; medico pharmaceutical nomenclature, and technology; and weights and measures. 14 He mentioned methods of fumigation to kill mice, lice and undesired insects in pharmaceutical vicinity. 21 Al-Zahrawi was the first physician to use a sponge steeped in aromatics to patient's nostrils and lips. This Arabic innovation consisted in immersing the anesthetic sponge in a boiled solution made of water with resin of the cannabis plant (hashish), opium and wheat infusion. The dried sponge used as a carrier for the active ingredients after the evaporation of solution. 24 He also explained advantages and disadvantages of powder and tablet. 1 Three drawing are exhibited in the manuscript versions of the 28 th treatise which are related to pharmaceutics. Their importance lies in the fact that they were projected more as illustrations of pharmaceutical processes rather than as adornment of the manuscript. The first two drawings are of molds prepared of ebony wood, or some other kinds of wood, or grinding stone-for making tablets. Zahrawi's al-Tasreef refers for the first time how tablet molds are perfectly described and marvelously illustrated. The chosen board or plate was made of smooth, hard wood piece two fingers in thickness (about 2 inches thick, 9 inches long and 1 1/2 inches wide). It was cut vertically in two halves. Circles equal to the size of the desired tablets are pinched upon both halves and each circled area is imprinted to half the height of the tablet. For printing name of tablet, a mirror image of the name of the manufactured tablets can be inscribed on one side of the mold. These engravings are painted with suitable oil (duhn) similar or complementary to the manufactured medication, which also acts as a lubricant or to prevent sticking of material in the molds. For making the tablets of an exact weight, Zahrawi recommended the following process: Press a small part of the kneaded material into the mold while soft, and then weigh it. If it is lighter than the required weight, widen the engravings in the wood until the pressed tablet achieves the desired weight. 21 The third pharmaceutical drawing is mentioned under the title: "How to Strain Decoctions and the Illustration of the Strainers 'al-Marawiq'". It comprises three strainers. The first one is smallest in size and is prepared with thin, porous cloth. The second is larger than the first and is prepared with less porous cloth; while the third which is also the largest, is prepared with thick cohesive cloth. The drawing of the strainers is very practical and scrupulous, and is executed very clearly. The medication to be prepared was first boiled into decoction and macerated, then strained through a sieve made of hair. Meanwhile the strainer was set so that one would be shelved over the other, with the coarsest on the top and the finest at the bottom. Then, into the strainer, a fluffy (carded) piece of horsehair or washed palm fibers was placed. Thereafter, the decoction was decanted in and strained from the first to second to the third. The filtrate was collected from the strainer to a receiver underneath. The useless was then removed while the clear and useful filtrate was taken for use either alone or mixed with other syrup. 21

DISCUSSION AND CONCLUSION
Abul Qasim Zahrawi (936-1013 AD) was not only a great surgeon, but also a great physician, pharmacist and pharmacologist. His expertness in various aspects of medicinal science can be observed and understood by an overview at one of his most famous book al-Tasreef. He compiled this book after around 50 years of medical, surgical and pharmaceutical practice and experience. His surgical expertise is mostly known and highlighted by many people. It is true that the basics and foundations of many surgical procedures and instruments are applied today and many things have been adopted from his book. The contribution of al-Zahrawi in pharmacy and pharmacology was mostly neglected and not highlighted. In the present paper we have discussed about al-Tasreef and their topics in each volume of the book. The detail about surgery has been discussed only in volume 30; in most of the volumes from 3 to 29 the description is mainly about different aspects of pharmacy and pharmacology i.e., preparation of different type of compound formulations, their efficacy, preservation and many more. Preparation of sharbat (syrup), sikanjabeen (a liquid dosage form), itrifal (a semisolid dosage form), majoon (Confection), jawarish (a semisolid dosage form), eye drops, safoof (powder), oils, perfumes etc, all are discussed in detail. Some chapters are devoted to dietary regimen, schedule according to age and disease. We have mentioned about some of manuscripts which are present in libraries of different countries. The translations of al-Tasreef in different era and different languages have also been mentioned in the paper. A section regarding pharmaceutical and pharmacological contribution is also discussed in the paper. Thus, it can be concluded that al-Zahrawi's pharmaceutical and pharmacological contribution needs more popularity and publication. It will help people of present era to gain knowledge and apply it in present time which was discussed thousand years ago but applicable even today. Only surgical contribution has made al-Zahrawi so great that he is referred as Father of Surgery, his pharmaceutical and pharmacological contribution's publicity will benefit more people and elevate his greatness. Acknowledgement: The authors would like to express their thanks to Dr. Zahid Husain, Principal of ZH Unani Medical College & Hospital, Siwan and Khuda Bakhsh Oriental Library In-charge and their team for cooperation and support for this work.

Conflicts of interest:
There are no conflicts of interest.