Part i: Aetiology
In the Islamic Middle Ages, medical discourse was shaped by epistemological postures concerning causality.[853] Aetiology of diseases can be divided into three categories according to the type of causes: natural, astral, spiritual.
Natural causes of diseases described the effect of changes in the natural world on the humoral composition and disposition of human beings. Astral aetiology was concerned with the way in which the motions of celestial bodies and their location at the time of birth, astrological consultation, or illness, correlate with and even cause changes in human bodies. And, finally, spiritual causes comprised supernatural entities, such as Jinn, demons, and other spirits, that harm human beings by attacking their health. As this study will show, the lines between these categories are often blurred. However, we can speak of a shift of emphasis within the aetiological discourse in the medieval period. The heterogeneous nature of medieval Islamic thought and philosophy from the ninth to the fourteenth centuries led to a medical pluralism which encompassed astrology and magic.[854]We can say that a theory of astral aetiology was articulated in the ninth century, emerging from astrological texts and making its way into the works of physicians who advocated astrological medicine well into the twelfth century, as we can see in the works of Ibn Ridwan (d. 1068) and al-Ainzarbi (d. 1153).[855] It grew out of an assertion made by Hippocrates that astrology “is not a small part of the science of medicine.”[856] Abu Ma'shar al-Balkhi (787-886), one of the most influential astrologers of the Middle Ages and the early modern period,[857] quotes the aforementioned Hippocratic dictum,[858] and in Kitab al-Madkhal al-kablr ila cilm ahkam al-nujum (The Great Introduction to the Science of the Judgements of the Stars), in which he composes a comprehensive philosophical model for astrology, we find an explanation of the role of the stars in the preservation and perversion of health.[859] According to Abu Ma'shar, medicine and astrology are interrelated sciences.
The first is the study of the terrestrial (ardiyya) causes of disease whereas astrology is the study of their astral and higher (Ulwiyya) causes.[860] [861] [862] [863] Medicine looks into changes in the elements as they manifest in the seasons and humoral balance, but astrology looks into the astral origins of these changes. Therefore, astrology perfects medicine since it extends causal inquiries to the higher origins. This leads Abu Ma'shar to conclude that “astrology is higher and nobler than medicine” and every physician must be an astrologer.11So an astrologer first ascertains if a certain period is characterised by a certain quality, then he would say:
That is a time for the health of bodies, their staying alive, and the balance of their natures, and what indicates this is such and such planet. And if the time is not balanced due to some elements overcoming it, then he [the astrologer] should say: this is a time for the illness of the bodies, their transformation, their corruption, and the weakness of their natures. What indicates this is such and such planet. That this planet to which that thing of advantage or disadvantage is attributed, it is known [... by] advance knowledge, length of experience, and [the observation of] manifest and hidden signs [...]. Then he [the astrologer] considers that planet which indicates an advantageous or disadvantageous time, and if the signification denotes some living individuals [...] he should say that the state of this person is so and so in terms of staying alive, damage, advantage or disadvantaged2
So, the stars indicate the general “quality” of a certain period; due to their influence on the four natures, “the nature of time is formed’43 generating specific external conditions that are referred to in Arabic as hdldt al-zamdn (conditions of the time). If the astrological reading of a certain individual points to this particular period (prognosis) and determines the characteristics and propensities of the individual from a birth chart (diagnosis), then the astrologer has what is needed to predict the state of this individual (hdldt al-shakhs) in this period.[864] So these conditions (hdldt) are determined by the motions and locations of the celestial bodies.
The notion that the course of the celestial bodies affects natural conditions and controls the changes in the four natures/humors is adopted in medical texts. In his Firdaws al-hikma (The Paradise of Wisdom), written in 850, the Abbasid physician Abu Hasan ‘Ali ibn Sahl Rabban al-Tabari—teacher of Muhammad ibn Zakariyya al-Razi (854-925)—explains that air and water are the determiners of health, but the motions of the stars transform the state of the elements and qualities (istihdldt) in the sub-lunar world and, as a result, cause changes in the air and water. For example, if the sun gets closer, the qualities air and fire become stronger producing a state conducive to health, but, if it is far, then they weaken and become cold and this is conducive to corruption?[865] [866] This is followed by the familiar confirmation: “the wise man Hippocrates said that astrology is not a small part of the science of medicine.’46 Deeply influenced by Abu Ma‘shar, Yuhanna ibn al-Salt (fl. 910), physician and colleague of the prominent translator and physician Ishaq ibn Hunain (c. 830-c. 9io),i[867] [868] composed a text explicitly dedicated to astrological medicine in which he aimed “to provide the physician with what he needs from astrology to be aided in the knowledge of the causes of diseases.’48 He refers to medicine as “a higher science’ because of its interconnection with astrology that looks into the higher causes of illness.1[869] Like Abu Ma‘shar and al-Tabari, he considers celestial motions as being responsible for changes in the quality of air. He writes, “The Creator, glorified and sublime, created the planets moving and luminous, crushing the air with their light. [They] warm and rarefy it with their motions so that it would accept the nature of generation and corruption,” denoting the preservation of health and its deterioration respectively.[870] Later in the text, Ibn al-Salt provides a list of celestial conditions and locations that rule over diseases. ‘Ali ibn ‘Abbas al-Majusi (d. 982 or 994) is another physician who believed in the astral origin of diseases. In Kdmil al-sind 'a al-tibbiya (The Complete Art of Medicine), he confirms that transformations in elements, qualities, and humours are caused by the motions of the spheres which result in the cooling and heating of air breathed into the body.[871] [872] [873] [874] [875] [876] [877] That the stars exert an influence on human bodies through the mechanics of motion and temperature is one aspect of medieval Islamic aetiology; it is not merely physical, however, but also incorporates the psychical. Abu Ma'shar explains that they act “through their rational soul, by virtue of being alive, and through their natural movement [...] by God's permission.’^ These celestial rational souls are reminiscent of the Neoplatonic notion of daemones. Plotinus explains that they are “sequent upon the Gods of the Intellectual Realm, consonant with them, held about them, as the radiance of the stars.” Plotinus speaks of a host of divine entities that are closely related to the stars who “administer particular things to the purpose of the entire Universe.’^3 This ‘psychic' element of Abu Ma'shar's astrological theory combined the Neoplatonic anima with the stoic view that the cosmos is a network of causal channels through which the vivifying power of the pneuma flows?4 His mode of causality is thus non-mechanistic but volitional?5 Physicians such as al-Tabari subscribed to this notion. He writes that all moving things, including the celestial bodies, have souls and affect the terrestrial world through actions from a distance like a magnet.26 He also asserts that “the heavens bring life” as a result of astral volition and causation?7 However, the rational souls of the planets and stars should not be understood as a host of beings resembling tribes of demons and supernatural entities. One ought to imagine the universe a single, articulated animal, since it is a body with no void in it. In the largest [part] of it—I mean the higher, nobler body—is the psychic, noble power. In what is below it, in accordance with the power of a superior command, these psychic powers are in each of the things that possess souls, for example a single man.2[879] [880] We find this asserted by Ikhwan al-Safa’ (The Brethren of Purity), who were a tenth-century coterie of underground philosophers. They produced an encyclopaedic corpus on natural and occult philosophy and sciences called Rasa’il Ikhwan al-Safa1 (Epistles of the Brethren of Purity)?0 In it they explain that “the first power that flows from the Universal Soul towards the world is in the honourable luminous entities that are the fixed planets and then after them [into] the moving planets.”[881] [882] [883] They use the term ruhaniyyat to describe the multiplication of this power in the planets and the agency whereby planets influence the world below.32 Regarding them they write: “the concealment of their essence and the apparentness of their actions are indications that in the world there are spirits that are concealed to sensation. Their actions are apparent, whereas their essences are concealed; they are called the spiritual beings (ruhaniym).”33 They are linked and behave in this terrestrial world according to two categories of behaviour: “by way of the natures of the bodies [to which they are linked], as is reported in the books of astrology” and by way of their souls and volition[884] The Brethren mention the ruhdniyydt of the planets and their counterparts in the human body. For example, the ruhdniyydt of the Sun control the wholeness and completeness of the universe and they correspond with the innate heat in the body.[885] The Brethren point out that the ruhdniyydt are known by the occultists, astrologers, magicians, and physicians.3[886] According to them, magic cannot be practiced without astrological knowledge to determine when the planets and their ruhdniyydt are in advantageous states. Moreover, they assert that medicine is a type of magic whereby natural and astral powers are harnessed to create cures to “maintain the health of bodies and remove the causes of illnesses.”3[887] As a result, they refer to medicine as “licit magic” (sihr haldl) because it is concerned with restoring humoral composition, in contrast with forbidden magic or sihrhardm that causes the corruption of the humours[888] And so, in astro-medical theory, each planet has a specific set of qualities and, depending on which sign they fall in and their aspects, some may have beneficent or malignant effects indicating health and disease. Saturn, for example, can cause melancholic illnesses. Furthermore, these effects are transmitted into our world through the ruhdniyydt, the spiritual volitional forces of the planets. An astrologer is able to identify such causes and correlate them with changes in the elements or humours. The harmful capacities of these ruhdniyydt can be harnessed by a magician to hurt and curse victims with illness. Ghdyat al-haklm, known in the West as the Picatrix, is a treatise on magic written in the tenth century that has been falsely attributed to the Spanish mathematician and astronomer Maslama al-Majriti. Maribel Fierro convincingly identifies the author as the tradition- ist and occultist Maslama al-Qurtubi (d. 964)[889] He explains that knowledge of the correspondences among things and the stars is essential in order to invite the ruhaniyyat to bestow their powers into a talisman or ritual.[890] [891] [892] [893] [894] [895] But he adds that we must prepare our spirits by theurgic rituals in order to communicate our will to the stars and their ruhaniyyat^ It is notable that in magic these ruhaniyyat tend to be endowed with more personality and a level of tangibility, in contrast with the ruhaniyyat we encounter in the context of natural philosophy and astrology. In the Ghaya we read: The ruhaniyya may appear in the spiritual world [of the magus] as a person that would converse and teach him what he desires, it may endear him to kings and sultans, tie and unravel any matter he wills [...] and answer the caller with what he wants [...] talismans are the most powerful choice for attracting a ruhaniyya [...] and that is because the natural properties through the ruhaniyya can perform wondrous acts singlehandedly.42 Elsewhere, the author claims that the “wise man” receives his power from the ruhaniyya that “strengthens and inspires him and opens the gates of wisdom being connected to him by his high star [...] Wise men and kings entered into covenants with this ruhaniyya by prayer and names.” He follows this with a series of invocations using the names of such spirits or ruhaniyyat.43 The powers of the celestial ruhaniyyat are infused into terrestrial things; consequently, incenses and other magical concoctions contain within them spiritual or ruhaniyya powers.44 The Brethren’s exposition in ruhaniyyat and that in the Ghaya are directly derived from the pseudo-Aristotelian hermetic corpus. This is a number of treatises in which Aristotle is presented as the teacher of Alexander the Great, advising him on state administration but largely providing magical and theurgic means for attaining victory and glory. Several of these treatises are found in a seventeenth-century manuscript in the British Library, Delhi Arabic 1946: In the one called al-Istimatis, the planetary ruhaniyyat are given names and these also appear in the Ghaya.45 TABLE 17.1 Despite the names and prescribed invocations found in the texts mentioned so far, ruhaniyyat must be perceived as tools that impel volitional forces to facilitate natural processes which benefit the operator. The ruhaniyyat are vital agents constituting the celestial level of the emanating and emanated hypostases as multiplications of the World Soul. But these entities are not always employed for good purposes. For example, in the Ghaya we find grim spells that cause horrible pains and diseases. The following is an example: this is a concoction that kills through the gradual corruption of organs. Little sharp rods of iron are inserted into the mouth of a spotted toad to pierce their way out of the legs. The toad is to be positioned so as to appear balancing on its head with a plate of lead underneath to collect the fluid that pours out. This fluid is to be burnt as incense for causing the corruption of organs.[896] We can invoke the ruhaniyyat that will strengthen this malice. Elsewhere the author indicates that the ruhaniyyat of Mars in its fall can cause corruption of health^[897] and so they must be invoked on a Thursday with elaborate rituals. Despite all this, the author largely remains faithful to the Neoplatonic ontology of these ruhaniyyat and insists that they are astral volitional forces that work by means of astral emanations. They constitute the first level of the cosmic individuation of the Universal Soul[898] These must remain distinct from supernatural beings, referred to in Islam as Jinn and devils, who belong “to a mysterious world that cannot be seen, [and who] breed and die,” adding that Islamic law sanctions the belief in these “fiery” creatures.[899] Surprisingly, the Ghaya lacks any instructions for receiving aid from subjugating Jinn and devils. The Brethren too explicitly differentiate between them and celestial souls. They explain that there are two kinds of spirits: first, those not attached to bodies; if they are good they are angels, if they are bad they are devils and Jinn; second, those “attached to the bodies of the planets [...] having an influence on the world in two types of influence, one of which is through the elements of their bodies as delineated in the books on astrology, and the other through their souls.”[900] It seems then that in the medical discourse of the early medieval period spiritual aetiology is ascribed mostly to the physical and psychical influence of the stars. Diagnosis and prognosis were established on two levels (the terrestrial and the celestial) and, therefore, astrology played a great part in these processes; natal charts had to be drawn up and astrological elections were done to determine inclinations toward disease or humoral imbalances, to protect against them, and to treat them. The body and soul are connected to the motions and volitions of the stars, making the purpose of medicine an alignment: physical, natural and spiritual.
