So here we stand in a in the ecological botanical garden in the on Mount Carmel, Haifa. And we would like to meet today one of the leading professors in the traditional medicine. An historian, Professor Efraim Lev, from the Technion, and the University of Haifa, thank you for coming. >> I'm very happy to be here. >> Efraim, I would like to ask you about the role of Islamic and Arabic medicine in the Middle East. What are your insights? How it is connected to the other medical systems in Greek medicine, in Ayurveda, in India, in China, and other places? >> This is a very interesting issue of transfer of knowledge, transfer of medical knowledge. From my perspective, is that the medicine and the pharmacology became science within the classical period, starting with the Hellenistic period, meaning the Greek, they control almost the whole of the ancient word. And they collected all the different doctrines and the medical system and created the Greek medicine. Now this medicine was transferred into the Roman word, and this Greek medicine, you can find elements from the Indian medicine, for example, because Alexander the Great was there, in the fourth century B.C.. And so here we've got Hippocratic Galenic medicine, we can say. So the Roman period, we have very innovative and very good kind of medicine. And this was the medicine that the Arab absorb, okay? The Arabs collected medical books while they were conquering the ancient world. They were translating them. And around the 9th Century, they started to produce new knowledge. So the Arabic medicine, you can say, is a Greco-Roman medicine that was improved by the Arabs with elements of Persian medicine and, mainly, elements from the Indian medicine. >> The Ayurveda. >> The Ayurveda, yeah. So, eventually the Indian medicine affected the Arabic medicine mainly by the medicinal substances. We know about hundred new medicinal substances that were inserted into the Arabic medicine. And they were brought from India, Sri Lanka and even China. >> So when you talk about substances, medicinal substances, I understand that mainly it includes herbs that come from all over the region, from Asian, from Europe. But there are other remedies as well, from the mineral kingdom and from animal origin and so on. Can you, a little bit, open up the discussion and talk about those non-herbal remedies and how they would insert it into the herbal medicine at that time? >> For my research, I know that they were about between 280 to 300 medicinal substances in the Medieval Middle East or Medieval Mediterranean. Now about 80% of them are from vegetal origin, and five- >> Pure herbs. >> Pure herbs, yeah. Some of them were fruits that people were eating. Raisins that people were using for perfume. And some other were spices and so on. But in general, we're talking about 80%. And the rest, 20%, are substances from animal origin or inorganic substances. Between 5 to 10%, each of these groups. And it's understandable because plants cannot move, so it's easier to get them. Plants, you use to eat, so it is safer. Now, when you talk about the animals, you need to hunt them, you need to go and search for them, which is harder, and that's why some of them are more expensive. And regarding the inorganic materials, usually, interestingly enough, they were using them especially for external treatment. Because people do not take inorganic material into their body on a regular basis. >> I see. And how did they pick the herbs that are medicinal? I mean, you were talking a lot about the doctrine of signatures. So what is the rationale there? How do you identify a plant like this one, lower leaves or laos nobilis, has a medicinal property? What is the techniques or technology that you use in order to say, wow, this is medicinal, this is safe, this is not safe. This can act or not? >> Okay, for that we need to go to pre-history. Because people were testing their environment from very early age. And not just they test it, they were watching animals, so their knowledge was accumulated along the years. We're talking about hundred thousands of years and, Maybe a bit later, and interestingly enough, in different places of the world, we can see that people were using some ideas. Some of them were religious and some of them were more rational, and one of them, one of the most interesting one in my opinion, is doctrine of signature, doctrine of correspondence. >> So what's the meaning of that? >> The meaning of that is people believe that God created the animal kingdom and the planktonic kingdom and so on. He also created all the diseases, but since he created man or human, and he wanted to help them, so he colored some plants in color that will help people identify how can they use them. And God gave them names. All shapes, and so on. So the main criteria of the doctrine of signature is to start with the shape. So if you have a plant, for example, orchid. And the bulb is in the shape of a testicle, people used it in order to improve the sexual ability of men. And the other criteria is the color. So people in different places, different communities around the world used to use plants that their flower or fruits are yellow, they used them to treat, for example, hepatitis, okay? And red flowers or red coral or red hematite were used to treat diseases with blood or other things that are about red, and so on and so forth. So this is a doctrine of signature. And by the way, you can still find it, you can still find it in the markets of our present day, our world. >> So if you go to these markets and you look for these gestures of, herbal gestures or non-herbal gestures, like what you are talking about in the doctrine of signatures. Can you identify a continuity from the Middle Ages to current markets in the Middle East, in the Mediterranean, can you still see those medical inputs in today's markets? >> Of course. From market surveys that I conducted with colleagues in Israel and then in Jordan and from my visits to markets in Egypt and Morocco, Turkey and other places, it is very clear that the medicine, the Arabic medicine of the medieval period, exist in the market of today. So you go there and you find all the material from animal origin, inorganic origin or plants, they still exist. They still sell them in the markets. >> For medical purposes, you mean. >> For [FOREIGN] for medical purposes, yeah of course. Some of them, of course, are spices and condiments and so on. But people are coming to buy to improve their health, it's very interesting. And when you interview the sellers and you ask them, what do you do with this? Or even a customer come to the seller and ask for his advice, they would take a book from the 13th century and consult it. Some of the books were written by Muslim physician at the time, Ibn al Bayan, for example. And some of the books that are still used until present day, one of them was written by the 13th century physician and pharmacist [FOREIGN]. And it called [FOREIGN] and this is very interesting. >> And I know that you have special interest in prescriptions that were written by Jewish physicians like Maimonides. I mean, you have this understanding that their activity was part of the Islamic or Arab world as well. Can you elaborate a bit about Maimonides and other Jewish physicians working as part of the Arab medical system at that time? >> Yeah, of course. The last 15 years I'm working on the amazing collection named Cairo Geniza. The Cairo Geniza is like a 3 hundred thousand fragments that were found in an Israel synagogue in Cairo about 120 years ago. And they were brought to Cambridge, the vast majority is in the Cambridge library. And the rest are spread in more than 60 collections around the world. And many scholars work on various issues that you can learn from this huge collection, and are working on medical fragments. Now I was lucky enough to find 1,800 fragments that deal with medicine in the Cairo Geniza, in the main collection in Cambridge. Out of which, 140 are prescriptions, real prescription, practical prescription. Prescription that was written by a physician after he checked and talked with a patient and he wrote it in order that the pharmacist will make it. Now this prescription tell us exactly what happened there in the precious moment, the intimate moment, between the physician and the patient. And tell us about the material that were really used. Because when I studied the material that I found in the prescription, with my research group, and the material that were mentioned in 70 list of materia medica, that were also found, and I compared it with the material that I found in medical books that were found in the Geniza, there was a gape of 30%. Meaning that in the book or in the books, you can write a recipes that are very long and include like 15, 20 materials. In reality, the recipes were shorter, like five, seven materials. And it is more practical and these are the materials that were on the shelf of pharmacies. And these are the materials that were used and they were used by Jewish patients, pharmacist, and physician. Christian patient, pharmacist and physician and of course Muslim, that were the majority. So answering your previous question as well, we're talking about Arabic medicine. That's why I called it Arabic, because in the Arabic medical system, the vast majority of the practitioner were, of course, Muslim. But there were many Christians and many Jews as well and Maimonides was one of them. >> So he was referred as a Jewish Arab practitioner? >> No, I think he was a Jewish person but he was an Arab physician. >> Okay so you can actually identify his handwriting on specific prescription? >> Yeah, Maimonides had a unique handwriting, their special list that working on the Geniza, and I can find what he wrote. And I was lucky enough to work with a colleague, Dr. Ramir Rashir, he found lately in two new prescriptions that were written by Maimonides. We spent time to transcribe them, translate them, and we even tried to- >> Yeah, to prepare them together. >> To prepare one of them together with some other colleagues. Here in Israel and it was a very interesting experience, of course. >> What striked me when we prepared my prescription is that it is not purely about herbs, that he started with lifestyle changes and nutritional changes, and only then talk about herbal remedies. >> Yeah. >> Like drugs. >> Yeah. >> So he doesn't start right from the herbs or the drugs, but works with nutrition, with context, with lifestyle, with mind-body connections. >> Yeah. >> That's typical to that time? That it's not just remedy-oriented, but something more holistic? >> Yeah, yeah, the Arabic medicine, from what I learned, is very holistic on one hand, and very personal on the other hand. Meaning that the physician would talk with the patient and collect information and then when he prescribed, he prescribed specifically for the person. Meaning he wrote a new prescription for each meeting. So the main idea was to take the knowledge from the book, and from his experience, and make it the right thing for this person. >> So in a- >> Regarding his age, regarding his weight, regarding the climate and many other factor, so the prescription was personal, okay? >> So in today's language, we call it patient centered care. >> Okay. >> Or patient tailored treatment. >> Absolutely, this is it. >> This is it. >> Yeah, and I have many proofs for this. Now on the other hand, each prescription or in many prescriptions we found the diet at the end of the prescription. Or other, Things that the patient should do, or should not do, okay? This is very important. And from there, and from Arabic books, medical books, we learned that diet was a very important thing in the general idea of health at that time. Mother would choose which kind of bread or what kind of meat she would prepare according to the health of the family member. >> So it basically goes to the kitchen realm. >> Yeah. >> It's not just something you buy with a specific physician, but you take it into the kitchen, you prepare something like herbal remedies, homemade remedies as well. >> Yeah, yeah. >> You intergrate it into your common life. >> Yeah, it was part of your life and it was important. And they tried to spread this idea with books and even with books that deal with food. >> So I would like to ask you several questions about the topic of cancer and traditional medicine, traditional Arab medicine. We had an experience, few years ago, collaborating with you and colleagues from Egypt and from Turkey, and later on, I think, from Jordan as well. >> Mm-hm. >> Identifying herbs that are specifically used for cancer treatment. And we published it together and we understood that those herbs were not just something that belonged to the past, but people still use them for cancer treatment >> And we even traced herbs that have some in vitro studies that suggest that they have anti-cancer activity. I would like to ask you to your opinion, what is the role of historian or someone like you that stands between history and ethnobotany, and traditional medicine, really you stand there in between. What's the role of persons like you in modern oncology research, or integrative oncology research? How do you see the prospects of research in these area? >> First of all, I think it's good that a historian, a ethnobotanist, a ethnopharmacologist and a physician will communicate as we do. And it is very important to create research groups because I can go to the sources. And I can get the knowledge from those sources. And people like you, and people in the lab, should check these materials and see if their historical use is still possible today. Is it still make scientific sense to use them and I'm sure that in some cases it is, because otherwise if we work separately all the knowledge that we produce will stay in the academia. And will not be transferred into the science, especially the medical science and treatment. So plants that were used in the past should be studied and researched in labs in order to find the active materials. And I'm sure and I know that some of them are good to treat cancer and some of them are good just to help cancer patient when he got the chemotherapy and so on. >> I remember that in our research you identified herbal remedy comes from the oriental mistletoe. >> Yeah. >> [FOREIGN] I think it was a prescription from Baghdad from the Middle Ages that you traced. And at that time there was another study published in Jordan about the effectiveness of this oriental mistletoe in laboratory with hematoncology cells. And then we decided to look based on what you suggested previously, and that Jodanian results, we have decided to observe that, to explore that in ovarian cancer cells. And we found that it really has activity so it's not something that belongs to an old prescription or recipe from Baghdad in the 12 or so century, but something very relevant to today. >> Yeah, you're absolutely right and I think its only early bird. I mean, this issue should be taken more seriously. And more money should be invested of taking the historical medical and pharmaceutical knowledge and try to find its activity and use it today. >> Thank you very much, [FOREIGN] >> A pleasure. [LAUGH] >> [LAUGH]
