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HACAMAT Skip to content Sağlığı koruma veya tedavi amacıyla kan alma.
1/2 Müellif: ABDULLAH KÖŞE Bölüme Git
Kelimenin aslı Arapça hicâme(t) olup “emmek” anlamındaki hacm kökünden gelir; hacamat yaptırmaya ihticâm, bu işi meslek edinen kişiye haccâm, kullandı…
2/2 Müellif: MAHMUT RIDVANOĞLU Bölüme Git
FIKIH. Hacamatın Hz. Peygamber zamanında da sağlığı koruma ve bir tedavi metodu olarak uygulandığı, bizzat kendisinin hacamat yaptırdığı, hatta hacama…
Kelimenin aslı Arapça hicâme (t ) olup “emmek” anlamındaki hacm kökünden gelir; hacamat yaptırmaya ihticâm , bu işi meslek edinen kişiye haccâm , kullandığı fanus ve bardak gibi aletlere de mihcem (mihceme ) denir. Bu yöntemle kan almak yahut vücudun istenen yerine kan toplamak için, küçük bir fanus ters tutularak içine süratle sokulup çıkarılan bir alev vasıtasıyla havası boşaltıldıktan sonra vücuda kapatılmakta, böylece kanın, üzerindeki hava basıncının azaldığı o kesime hücum etmesi sağlanmaktadır. Eğer amaç sadece kan toplamak değil kılcal damarlardan kan almaksa fanus, o kesim bir bıçakla çizildikten sonra kapatılır ve bu durumda kan iç basıncın etkisiyle kolaylıkla dışarı çıkar, yani fanus tarafından emilmiş olur. Bu işlemlerden birincisine “kuru hacamat”, ikincisine “kanlı hacamat” denir. Ancak Türkçe’de hacamat denilince akla daha çok ikincisi veya atar ve toplar damarlardan fazla miktarda kan alınması gelmektedir ki bunun adı Arapça’da fasd dır; bu işi yapana da fassâd adı verilir. Türk halkı arasında kuru hacamat için “şişe çekme” tabiri kullanılır.
Genellikle kuru hacamatın amacı kılcal damarlardaki kanın o bölgeye akışını sağlamak, böylece yakın bir bölgedeki kanamayı durdurmak veya vücudun o kısmını ısıtmak, yahut özellikle bazı cilt hastalıklarında derideki kan deveranını arttırarak tedaviye katkıda bulunmaktır. Bu yöntemden modern tıpta da iç organlara olan kan hücumunu azaltmak için faydalanılmış, fakat sonraları bundan vazgeçilmiştir. Yerini uzun süre önce sülük koymaya bırakan kanlı hacamat ise bugün halk arasında da genellikle terkedilmiş durumdadır.
Tıp tarihinde kan alma yöntemiyle tedavinin ilk defa nerede ve ne zaman başladığı konusunda kesin bilgi yoktur. Ancak bugün de bazı ilkel toplumlarda görüldüğü gibi eski Mezopotamya, Mısır ve diğer Ön Asya uygarlıklarında birçok hastalığın bedene giren cinler ve kötü ruhlar tarafından meydana getirildiğine inanıldığı ve hastalığın geçmesi için bunların sihir-büyünün yanı sıra kan alma yoluyla vücuttan çıkarılmasına çalışıldığı bilinmektedir. Zamanla bu tür düşüncelerin yerini tecrübeye ve bilimselliğe bırakmasıyla hastalardan kan alma gerçek anlamda bir tedavi metodu haline gelmiştir (İbn Ebû Usaybia, I, 6). Grek filozof-hekimi Empedokles’ten (ö. m.ö. 435) itibaren XIX. yüzyılın ortalarına kadar tabâbette hâkim olan hümoral patoloji teorisine göre, dış dünyanın yapı taşları sayılan dört unsura (toprak, su, hava, ateş) karşılık insan vücudunda da dört sıvı (kan, balgam, sarı safra, kara safra) bulunmakta ve bunların denge halinde olması sağlığı, dengenin bozulması ise hastalığı meydana getirmektedir (bk. AHLÂT-ı ERBAA ). Hipokrat ve Galen (Câlînûs) gibi Eskiçağ’in ünlü hekimleri bu teoriyi benimsediklerinden onları izleyen İslâm hekimleri de dahil bütün dünya asırlarca hastadan kan almayı en güvenilir tedavi yöntemi diye kabul etmiştir. Klasik tabâbette hemen her hastalığın kandan kaynaklandığı kanaati hâkim olduğu için tedavi sırasında akla derhal kan almak geliyor ve ilk önce bu yola başvuruluyordu. Bu yöntemin özellikle XVII. yüzyılda çok yaygın uygulandığı, bu yüzden yetkililerce her hekimin kan alma usulünü bilmesinin şart koşulduğu görülmektedir.
Eski tabâbette hacamat yapmak için insan vücudunda on dört bölge, fasd yöntemiyle kan almak için de otuz ile kırk üç arasında damar tesbit edilmiştir. Klasik tıp kitaplarında hangi bölgeden veya damardan kan almanın ne gibi hastalıklara iyi geleceğine dair ayrıntılı bilgiler, hatta bu iş için uygun olan mevsimlerle gün ve saatler verilmekte, meselâ eğer âcil bir durum söz konusu değilse mevsimlerden ilkbaharla sonbahar tavsiye edilmektedir. İbn Sînâ’ya göre kan almak için en uygun vakit ayın ortasındaki gündüzün ikinci ve üçüncü saatleridir (el-Ḳānûn fi’ṭ-ṭıb , I, 212); Zehrâvî ise bu konuda vakit tayinine gerek olmadığını söyler (et-Taṣrîf , II, 541).
En eski dönemlerden günümüze kadar, sebebi bilinsin veya bilinmesin, birçok rahatsızlığın tedavisinde fasd ve hacamat yöntemleriyle ya da sülük kullanmak suretiyle hastalardan kan alınmıştır. Ancak tecrübelerin artması, hastalıkların sebebi ve tedavi şekliyle ilgili bilgi ve imkânların değişmesiyle bunun yanlışlığı ortaya çıkmış ve sonuçta kan almanın sadece bazı hallerde uygun olacağı anlaşılmıştır. Bugün modern tıpta da gerekli durumlarda kan alma (phlebotomy) yoluna gidilmekte, gerek koruyucu hekimlikte gerekse bazı hastalıkların tedavisinde bu usul geçerliliğini belli ölçüde de olsa sürdürmekte, ancak bu iş için daha kolay ve daha sağlıklı olan şırınga ile doğrudan damara girme metodu tercih edilmektedir.
Genel tıp kitaplarında fasd ve hacamata ayrılan özel bölümler yanında konuyla ilgili müstakil eserler de kaleme alınmıştır. Bunlar arasında Hipokrat, Galen, İbn Mâseveyh, Ali b. Rabben et-Taberî, Buhtîşû‘ b. Cibrâîl, Huneyn b. İshak, İbn Mâsse, İshak b. İmrân, Kustâ b. Lûkā, Ebû Bekir Muhammed b. Zekeriyyâ er-Râzî, Fârâbî ve Ali b. Abbas el-Mecûsî’nin Kitâb (Risâle) fi’l-faṣd , Kitâb (Risâle) fi’l-ḥicâme , Kitâbü’l-Faṣd , Kitâbü’l-Ḥicâme gibi adlarla kaleme aldıkları eser ve risâleler sayılabilir (bk. Sezgin, III, 444, 448). Hisbe ile ilgili eserlerde de hacamatçıların bulundurmaları gereken aletler ve tıbbî ölçüler çerçevesinde uymaları gereken esaslar ayrı bir bölümde ele alınmıştır (bk. İbnü’l-Uhuvve, s. 247-253; Şeyzerî, s. 89-97).
BİBLİYOGRAFYA
Lisânü’l-ʿArab , “ḥcm”, “fṣd” md.leri.
Kāmus Tercümesi , “ḥacm”, “faṣd” md.leri.
Şerefeddin Mağmûmî, Kāmûs-ı Tıbbî , “saignée”, “scarification” md.leri (II, 941, 952).
Ebü’l-Kāsım ez-Zehrâvî, et-Taṣrîf li-men ʿaceze ʿani’t-teʾlîf (nşr. Fuat Sezgin), Frankfurt 1406/1986, II, 536-544.
İbnü’n-Nedîm, el-Fihrist , s. 104, 411, 412.
İbn Sînâ, el-Ḳānûn fi’ṭ-ṭıb , Bulak 1294, I, 204-213.
Abdüllatîf el-Bağdâdî, eṭ-Ṭıb mine’l-Kitâb ve’s-Sünne (nşr. Abdülmu‘tî Emîn Kal‘acî), Beyrut 1406/1986, s. 41-48.
İbn Ebû Usaybia, ʿUyûnü’l-enbâʾ , s. 1, 6, 33.
İbnü’l-Uhuvve, Meʿâlimü’l-ḳurbe fî aḥkâmi’l-ḥisbe (nşr. M. Mahmûd Şa‘bân – Sıddîk Ahmed Îsâ), Kahire 1976, s. 247-253.
İbn Kayyim el-Cevziyye, eṭ-Ṭıbbü’n-nebevî (nşr. Âdil el-Ezherî – Mahmûd Ferec el-Ukde), Kahire 1410/1990, s. 38-49.
Şeyzerî, Nihâyetü’r-rütbe fî ṭalebi’l-ḥisbe (nşr. es-Seyyid Bâz el-Arînî), Kahire 1365/1946, s. 89-97.
Taşköprizâde, Mevzûâtü’l-ulûm , I, 376.
Hüseyin Remzi, Târîh-i Tıb , İstanbul 1304, I, 39.
a.mlf., Tıbb-ı Nebevî , İstanbul 1324, s. 10-11, 69-70.
Mehmed Hâfız, Kavânînü’l-cerrâhîn , İstanbul 1289, s. 2-4, 36-39.
Gālib Atâ, Tıp Tarihi , İstanbul 1341/1925, I, 16, 23, 32, 50, 77-79, 108, 194.
Osman Şevki [Uludağ], Beşbuçuk Asırlık Türk Tabâbet Tarihi , İstanbul 1341/1925, s. 32-33.
Feridun Nafiz Uzluk, Genel Tıp Tarihi , Ankara 1958, s. 71.
Sezgin, GAS , III, 444, 448.
Bedi N. Şehsuvaroğlu, Eczacılık Tarihi Dersleri , İstanbul 1970, s. 59, 75, 95, 126-127.
Cihat Abaoğlu, Teşhisten Tedâviye , İstanbul 1975, s. 208, 409-410, 460, 861.
Muzaffer Aksoy, Hematoloji , İstanbul 1975, I, 723, 747.
Ayşegül Demirhan, Kısa Tıp Tarihi , Bursa 1982, s. 27, 43.
Bülent Berkarda – N. Orhan Ulutin, Kan Hastalıkları , İstanbul 1983, s. 110-112.
Abdullah Köşe, Hadîslerde Flebotomi (yüksek lisans tezi, 1984), MÜ Sosyal Bilimler Enstitüsü, s. 42, 43-46, 47-48, 49-50.
Mahmûd Nâzım en-Nesîmî, eṭ-Ṭıbbü’n-nebevî ve’l-ʿilmü’l-ḥadîs̱ , Beyrut 1407/1987, III, 91-103.
Muhtâr Sâlim, eṭ-Ṭıbbü’l-İslâmî beyne’l-ʿaḳīde ve’l-ibdâʿ , Beyrut 1408/1988, s. 361-365.
M. A. J. Beg, “Faṣṣâd, Had̲j̲d̲j̲ām”, EI2 Suppl. (İng.) , s. 303-304.
W. Floor, “Bloodletting”, EIr. , IV, 315-316.
Maddenin bu bölümü TDV İslâm Ansiklopedisi’nin 1996 yılında İstanbul’da basılan 14. cildinde, 422 numaralı sayfada yer almıştır.
FIKIH. Hacamatın Hz. Peygamber zamanında da sağlığı koruma ve bir tedavi metodu olarak uygulandığı, bizzat kendisinin hacamat yaptırdığı, hatta hacamatı teşvik ettiği bilinmektedir. Hacamatı o dönemde uygulanan en iyi tedavi metotları arasında sayan (Buhârî, “Ṭıb”, 13; Müslim, “Müsâḳāt”, 62, 63) Resûl-i Ekrem’in ve ashabının genel olarak ağrıya ve baş ağrısına karşı (Buhârî, “Ṭıb”, 15; Ebû Dâvûd, “Ṭıb”, 3) baş, omuz, boyun damarları, kalça ve ayağın üstünden hacamat yaptırdığı (Buhârî, “Ṭıb”, 14, 15; Ebû Dâvûd, “Menâsik”, 35, “Ṭıb”, 4, 5; Tirmizî, “Ṭıb”, 12; İbn Mâce, “Ṭıb”, 21), hacamatın akla ve hâfızaya kuvvet verdiğini söylediği (İbn Mâce, “Ṭıb”, 22) rivayet edilmektedir.
Bazı hadislerde pazartesi, salı veya perşembe günleri, ay içinde de on yedi, on dokuz ve yirmi birinci günler hacamat yapılması tavsiye edilmiş (Ebû Dâvûd, “Ṭıb”, 5; Tirmizî, “Ṭıb”, 12; İbn Mâce, “Ṭıb”, 22), ayrıca vücudun hangi bölge ve damarlarından kan alınmasının uygun olacağına ilişkin bazı bilgilere ve uygulama örneklerine yer verilmiştir (Ebû Dâvûd, “Ṭıb”, 5; İbn Mâce, “Ṭıb”, 21). İbn Kayyim el-Cevziyye, hadislerde mevcut tavsiye ve bilgilerin, dönemindeki tıp âlimlerinin tesbitleriyle uyum içinde bulunduğunu, meselâ bu âlimlerin kanaatine göre ayın hareketine bağlı olarak kan basıncının arttığını, ay ortası ile onu takip eden haftanın hacamat için en uygun zaman olduğunu, âcil durumlar hariç bu zaman dilimi içinde hacamat yapmanın daha faydalı olacağını söyler (eṭ-Ṭıbbü’n-nebevî , s. 42, 45). Buhârî’nin yukarıdaki hadisleri zayıf bulduğu için eserine almadığını kaydeden İbn Hacer ve Aynî gibi âlimler ise hacamat için belli bir zaman tayininin söz konusu olmadığını belirtirler (Fetḥu’l-bârî , XXI, 266-267; ʿUmdetü’l-ḳārî , XVII, 374-375).
Ayın kendi yörüngesi üzerindeki çeşitli konumlarına göre denizlerde, hatta karalarda ve atmosferde med ve cezir olaylarının meydana geldiği, bunun da yeni ay ve dolunay dönemlerinde en yüksek seviyeye ulaştığı bilinmektedir. Günümüzde yapılan bazı araştırmalar ayın insan vücudu üzerinde de benzer etkiler meydana getirdiğini, dolunay günlerinde vücuttaki hormon ve sıvı dengesinde değişmeler görüldüğünü, kadınlardaki doğum ve âdet görme kanamalarının daha şiddetli olduğunu ortaya koymuştur. Bu sebeple hacamat için belli zaman dilimleri tavsiye eden hadislerin hadis tekniği açısından incelenmesi yanında yeni ilmî araştırmalar ışığında değerlendirilmesinden de ilgi çekici sonuçların çıkacağı anlaşılmaktadır.
Hz. Peygamber’in, kendisine hacamat uygulayan ve aynı zamanda bir köle olan Ebû Taybe’ye bir ödemede bulunduğu bilinmektedir (Buhârî, “Büyûʿ”, 39, “Ṭıb”, 13). Enes b. Mâlik, hacamat ücretinin helâl olup olmadığına dair bir soruya bu olayı naklederek cevap vermiştir (Müslim, “Müsâḳāt”, 62). Onun rivayetinde yapılan ödemenin ücret olup olmadığı açıkça belirtilmezken İbn Abbas bu olayda Resûl-i Ekrem’in ücret ödediğini kaydederek, “Eğer haram olsaydı Peygamber vermezdi” der (Buhârî, “Büyûʿ”, 39, “İcâre”, 18; Müslim, “Müsâḳāt”, 66). Öte yandan Resûl-i Ekrem’in kan bedelini yasakladığı (Buhârî, “Büyûʿ”, 25, 113) ve hacamatçının kazancının pis olduğunu söylediği (Ebû Dâvûd, “Büyûʿ”, 38; Tirmizî, “Büyûʿ”, 46) rivayet edilmektedir. Bazı âlimler, ilk hadisteki kan bedelini doğrudan kan satışı karşılığında alınan ücret olarak, bazıları da hacamat ücreti olarak yorumlamışlardır. Hadisi rivayet eden Ebû Cühayfe’nin hacamat yapan bir köle satın aldığı ve onun hacamat aletlerini kırdığı, bu davranışının sebebi sorulunca da bu hadisi rivayet ettiği (Aynî, ʿUmdetü’l-ḳārî , IX, 287-288; İbn Hacer, IX, 165, 300-301) dikkate alınırsa en azından ravinin yorumunun bu istikamette olduğu düşünülebilir.
Bu farklı rivayetler karşısında ashaptan itibaren değişik ictihadlar ortaya çıkmıştır. Bazı âlimler Hz. Peygamber’in yasaklamasını, hacamatın daha ziyade köleler tarafından icra edilen ve sosyal statü açısından düşük sayılan bir meslek oluşuna bağlayarak hür kişilerin hacamattan ücret almasının câiz olmadığını söylerken bazıları da yasağın sebebini, hacamatın müslümanlar arasında ücretsiz yapılması gereken bir hizmet ve görev oluşuna bağlar. Bir görüşe göre ücret alınması önceleri yasakken sonradan serbest bırakılmıştır; bir başka görüşe göre ise hadisteki yasak onun haram olduğunu değil tenzîhen mekruh olduğunu göstermektedir.
Hadis kaynaklarında, Resûl-i Ekrem’in hacamat yapanın da yaptıranın da orucunun bozulacağını söylediği (Buhârî, “Ṣavm”, 32; Ebû Dâvûd, “Ṣavm”, 29; Tirmizî, “Ṣavm”, 60), kendisinin oruçlu iken hacamat yaptırdığı (Buhârî, “Ṣavm”, 32, “Ṭıb”, 11; Ebû Dâvûd, “Ṣavm”, 30), hacamatın orucu bozmayacağını ifade ettiği (Ebû Dâvûd, “Ṣavm”, 31; Tirmizî, “Ṣavm”, 24) şeklinde farklı rivayetler yer almaktadır. Enes b. Mâlik, oruçlu iken hacamat yaptırmadıklarını ifade ederken bunu hacamatın oruçluya sıkıntı vereceği hususuna bağlamaktadır (Ebû Dâvûd, “Ṣavm”, 30). Birinci hadisi esas alan Hanbelîler’e göre hacamat orucu bozar. Fakat çoğunluk bu hadisin neshedildiğini ileri sürerek hacamatın orucu bozmayacağını belirtir. Buna rağmen bu âlimler de oruçluya sıkıntı verebileceğinden hareketle hacamatın iftardan sonraya bırakılmasını tavsiye ederler.
Hz. Peygamber’in ihramlı iken hacamat yaptırdığı bilinmektedir (Buhârî, “Ṣavm”, 32, “Ṭıb”, 12, 14, 15; Ebû Dâvûd, “Menâsik”, 35); bundan dolayı ihramlının hacamat yaptırması câiz görülmüştür. Hacamattan önce vücudun ilgili kısmının tıraş edilmesi halinde bazı âlimlere göre tıraşla ilgili genel hükümler geçerli iken bazılarına göre bu konuda özel ruhsat söz konusu olup fidye gerekmez veya miktar tesbitinde bu durum hafifletici sebep olarak değerlendirilir.
Hacamatın abdesti bozup bozmadığı konusunda mezheplerin kanamayla ilgili görüşleri geçerlidir. Kanamanın abdesti bozduğunu söyleyen Hanefî, Hanbelî ve Zeydî âlimlerine göre kanlı hacamat abdesti bozar, Şâfiî ve Mâlikî mezheplerine göre ise bozmaz.
BİBLİYOGRAFYA
el-Muvaṭṭaʾ , “İstiʾẕân”, 10.
Buhârî, “Ṣavm”, 32, “Ṭıb”, 11-15, “Büyûʿ”, 25, 39, 113, “İcâre”, 18.
Müslim, “Müsâḳāt”, 62, 63, 66, “Selâm”, 71.
İbn Mâce, “Ṭıb”, 20, 21, 22, “Ticârât”, 10.
Ebû Dâvûd, “Ṣavm”, 29, 30, 31, “Menâsik”, 35, “Ṭıb”, 3, 4, 5, 11, 12, 14, 15, “Büyûʿ”, 38.
Tirmizî, “Ṣavm”, 24, 60, “Ṭıb”, 12, 21, “Büyûʿ”, 46.
Nesâî, “Menâsik”, 92, 93, 94, 95.
Şâfiî, el-Üm , II, 83, 174.
Hâkim, el-Müstedrek , IV, 209.
İbn Hazm, el-Muḥallâ , I, 255; V, 203; VII, 255-258.
Serahsî, el-Mebsûṭ , I, 83; III, 57.
Mergīnânî, el-Hidâye , İstanbul 1986, I, 122, 162; III, 239.
İbn Kudâme, el-Muġnî , I, 175; III, 36-37; VI, 121-123.
İbn Kayyim el-Cevziyye, eṭ-Ṭıbbü’n-nebevî (nşr. Âdil el-Ezherî – Mahmûd Ferec el-Ukde), Kahire 1410/1990, s. 38-49.
Ahmed b. Yahyâ Mehdî-Lidînillâh, el-Baḥrü’z-zeḫḫâr , San‘a 1409/1988, I, 86-87; II, 253.
İbn Hacer, Fetḥu’l-bârî (Sa‘d) , IX, 165, 300-301; X, 25-26; XXI, 266-267.
Aynî, Şerḥu’l-Kenz , Kahire 1304, I, 83.
a.mlf., ʿUmdetü’l-ḳārî , Kahire 1392/1972, IX, 287-289; XVII, 374-375.
İbnü’l-Hümâm, Fetḥu’l-ḳadîr (Bulak) , II, 64, 232.
Tecrid Tercemesi , VI, 216, 278, 381; XII, 81.
Remlî, Nihâyetü’l-muḥtâc , Kahire 1389/1969 → Beyrut 1404/1984, III, 182.
Derdîr, eş-Şerḥu’l-kebîr , I, 123, 518; II, 58.
Muhtâr Sâlim, eṭ-Ṭıbbü’l-İslâmî beyne’l-ʿaḳīde ve’l-ibdâʿ , Beyrut 1408/1988, s. 361-365.
Abdülhay el-Kettânî, et-Terâtîbü’l-idâriyye (Özel) , II, 326-328.
“Hacâme”, Mv.F , XVII, 14-18.
Mustafa Reyhanlı, “Ayın Esrarlı Gücü”, Sur , XIII/142, İstanbul 1988, s. 46-47.
Mehmed Refiî Kileci, “Dolunay ve Oruç”, Zafer , XVIII/207, Adapazarı 1994, s. 6-8.
Maddenin bu bölümü TDV İslâm Ansiklopedisi’nin 1996 yılında İstanbul’da basılan 14. cildinde, 423 numaralı sayfada yer almıştır.