Oh Ramadan come forth, for the hearts are ill. The word “Ramadan” comes from the Arabic root word for “parched thirst” and “sunbaked ground.” Through fasting, a Muslim experiences hunger and thirst and sympathizes with those in the world who  have little to eat and drink every day. It teaches us to be charitable. Through increased charity, Muslims develop feelings of generosity and good will toward others.
O ye who believe! Fasting is prescribed to you as it was prescribed to those before you, that ye may (learn) self-restraint (Taqwa). (Quran 2:183)
Ramadanis the month of fasting, one of five pillars of Islam, and is ordained for Muslims in the Quran. In the Arabic language the word for fasting ‘sawm’ means abstinence and this applies to eating, drinking, sexual relations and all immoral vices from dawn to sunset. Islam exempts the duty of fasting for pregnant or nursing women where there is reason to fear harm to the mother or child, prepubescent children, older people, those with a mental illness, the sick and those with chronic illness if there is medical concern that harm may occur. Despite all of this, many patients still choose to fast and that is an appreciable thing.


Benefits of fasting in Ramadan
It is clear from Holy Quran the essence of fasting is learning Taqwa, which is more than self-restraint. It is Allah’s consciousness which endows the person to be aware of the presence of Allah in every moment of his life.
Fasting increases devotion and brings a Muslim closer to the Creator. It creates the recognition that everything we have in this life is a blessing from Allah. It teaches self-control or self-restraint and thereby good  manners, courtesy, good speech and good habits.
Fasting during Ramadan is one of the major pillars of Islam and this is also noted in the sayings of the Holy Prophet (peace be upon Him) who said:” Islam is based on five principles which are:
       To testify that none has the right to be worshipped but Allah.
       To establish the prayers
       To pay Zakat
       To perform Hajj
       To observe fast during the month of Ramadan.


Spiritual benefits of Ramadan
Fasting has many spiritual benefits. It allows deep introspection and an awareness of one’s relationship with Allah and others around them, a great appreciation of blessings. It encourages compassion, care and charity. There are several physical benefits too. Fasting reduces low-density lipoprotein and cholesterol levels. It also improves weight and glycemic control. It could also regenerate the entire immune system by ‘flipping a regenerative switch’ according to a new research study. Smoking is prohibited, so Ramadan is an opportunity to promote smoking prohibition.

Importance of Ramadan
Ramadan is the most precious month in the Islamic calendar and it is necessary for the Muslims to fast in the month of Ramadan. Holy Quran was first revealed in the month of Ramadan. Fasting in the month of Ramadan is the fourth Pillar of Islam among the five. It helps to attain Taqwa. Taqwa basically is performing of actions which please Allah and abstaining from those actions that displease Allah. Laylat al-Qadr which is also known as the night of Decree or the night of Power is in this month, so that it is better than thousand months.


In this Holy month, the gates of Paradise are opened, gates of Hell are closed and the devils are chained up. Umrah in Ramadan is equivalent to Hajj. Muslims observe I’tikaaf (residing in the mosque for worship) in the month of Ramadan especially in the last 10 days of this Holy month. It is very rewarding act in Ramadan to offer Iftar (sunset meal to breakfast) to those who are fasting. It is also highly recommended to give Zakat and Sadaqah (voluntary charity) in the Ramadan. It is said in an authentic Hadith of Prophet Muhammad (peace be upon Him) that fasting in the Ramadan sincerely out of faith and in the hope of reward, we will be forgiven all our previous sins, provided the major sins are not committed.
Both physical and spiritual rewards can be drawn from fasting. As noted by Dr. Shahid Athar, M.D.,”The physiological effect of fasting includes lowering of the systolic blood pressure, blood sugar level and lowering of cholesterol. In fact, Ramadan fasting would be an ideal recommendation for the treatment of mild to moderate, stable, non-insulin diabetes, obesity and essential hypertension.”

As stated in the Quran, Allah promises forgiveness and vast reward for a fasting person:
“Lo! Muslim men and women (who submit to Allah), men who believe and women who believe, men who obey and women who obey, men who speak the truth and women who speak the truth, men who persevere (righteousness) and women who persevere, and men who are humble and women who are humble, and men who give alms and women who give alms, men who fast and women who fast, men who guard their modesty and women who guard their modesty, men who remember Allah much and women who remember. Allah hath prepared for them forgiveness and a vast reward.” (Quran 33:35)
Three stages (Ashras) of Ramadan
There are three Ashras of Ramadan, each of which has a benefits and dua. The first stage of Ramadan begins from the 1st and ends on the 10th of Ramadan. The second stage from 11th to 20th of Ramadan and the third stage from 21st to 30th of Ramadan.
  1. First Ashra of Ramadan:

First ten days of Ramadan are the days of Mercy. Every Muslim should seek the grace of Almighty Allah these days. There is special verse that Muslims  usually read in the first ten days. The purpose of first Ashra is to practice mercy towards other brethren, bringing mercy, the act that Allah loves the most. Control your anger and treat your fellow Muslims well.

  1. Second Ashra of Ramadan

The second Ashra of Ramadan consists of the following ten days, this is a time of forgiveness. These are the days of forgiveness and a Muslim should ask for forgiveness from Almighty Allah. This is the time when forgiveness of Allah is at its peak. This is the best time for asking for forgiveness for all sins. Always ask forgiveness from Almighty Allah all these days. Be sure not to repeat sins after you ask for forgiveness.
  1. Third Ashra of Ramadan:

The third Ashra of Ramadan is known as the protection from hell, which means Nijat. At the end of Ramadan we are seeking Allah’s protection from hell fire. Every Muslim must pray for the protection of hell fire. The last Ashra is very important and superior. In this Ashra, Laylah ul qadr also falls which is better than the nights of thousands of months. Many Muslims also practice Aitkaf and try to pray as much as possible.

Ramadan Implications for general practice
As clinicians, we need to establish whether the patient’s health may be significantly affected by fasting. Advising patients on diet, medications, physical activity and early warning signs that require one to annual their fast is important. Empowering patients provides them with the confidence to optimize their fasting and shared decision making is vital when disagreement may rise. Practices may consider training a staff member as a ‘fasting advisor’, who can receive guidance from local religious leaders and experienced clinicians to confidently manage the fasting patient.


Fasting in practice makes a Muslim true Muttaqi. As to the characteristics of a Muttaqi, Quran says:
“It is not righteousness that ye turn your faces towards east or west; but it is righteousness to believe in Allah and the last day and the angels, and the books, and the messengers; to spend of your substance, out of love for Him, for your kin, for orphans, for the needy, for wayfarer, for those who ask, and for the ransom of slaves; to be steadfast in prayer, and practice regular charity; to fulfill the contracts which ye have made; and to be firm and patient, in pain and adversity, and throughout all periods of panic. Such are the people of truth, the Muttaqoon.” (Quran 2:177)
In Ramadan Fasting and Diet 
Before the fajar time, take the meal which allows to store energy. A healthy food and balanced diet should be encouraged. In Ramadan, dehydration is experienced but fasting prevents common problems such as headache, constipation, and lethargy.


Fasting and diabetes (Ramadan)
Patients who are suffering from diabetes should consult their doctors before taking decision that they can fast or not. Patients with non-insulin dependent diabetes on medication may have their dosages and timings reviewed. Insulin dependent diabetic patients are discouraged from fasting. If they still wish to fast, they must reduce their background insulin by 20 percent and altering the midday insulin which can reduce complications. It is recommended that the blood glucose level should be monitored, it does not cause in breaking one’s fast. Before Ramadan, diabetic patients should take some assessments to measure their capacity of fasting.

Fasting and the workforce of Ramadan
It is important for all the team to be aware of this and ensure the working environment allows for maintained productivity, standard of patient care and interaction. A significant proportion of working staff and training in general practice observe Ramadan. The advice on diet, hydration and the safety of fasting is as much applicable to staff as to patients and the fasting clinician should take precautions so their practice is never compromised.

Ramadan is a month held important by the Muslim population and acknowledging this, valuing diversity, understanding patient’s concerns. The striving is to provide support regardless of an individual’s decision. It will further improve care in general practice. We should embrace this unique challenge.
Medication during fasting in Ramadan
Some persons are ill and need their medication throughout the day to cure. Oral medications invalidate one’s fast and when possibly they can taken around the fasting time, with longer acting forms considered. Injections, intravenous treatment, eye drops, ear drops and blood tests do not invalidate the fast. Patients with poorly controlled lung disease should be made aware that medication compliance is of paramount importance and should be compromised by their decision to fast. Advice patients to seek reliable religious counsel alongside medical opinion. Medication inhaled or spray forms invalidate the fast.


Ramadan in Quran
There are many references of fasting and about the month of Ramadan. In Quran there are many verses which indicate the importance of fasting and this precious month. Allah appreciate the Muslims who sacrifice their eating, praying five times a day and thank to Allah all the time for His blessing.
“The month of Ramadan is that month in which Quran was revealed, a guidance for the people and clear proofs of guidance criterion. So whoever sights (the new moon of) the month, let him fast it; and whoever is ill or on a journey, then an equal number of other days. Allah intends for you ease and does not intend for you hardship and (wants) for you to complete the period and to glorify Allah for that to which He has guided you; and perhaps you will be grateful.” (Quran 2:185)
“Indeed, We sent the Quran down during the Night of Decree. And what can make you know what is the Night of Decree? The Night of Decree is better than a thousand months. The angels and the spirit descend there in by permission of their lord for every matter. Peace it is until the emergence of dawn.” (Quran 97:1-5)

Allah’s servant for whom He says in the Quran:
“When My servants ask thee (Muhammad) concerning Me, I am indeed close (to them); I listen to the prayer of every suppliant when he calleth on Me; Let them also, with a will, Listen to My call, and believe in Me; That they may walk in the right way” (Quran 2:186)
Alas, today’s Muslims are a far cry from those who follow the dictates of the Quran. They may like to listen to the advice of Ibrahim ibn Adam (A.S), a great saint of Islam, when he was asked, “Allahu ta’ala declares:’ O My human creatures! Ask Me! I will accept, I will give!’ Nonetheless, we ask but He does not give?”
Ibrahim (A.S) said: “You entreat Allahu ta’ala, but you do not obey Him. You know His Prophet (peace be upon Him), but you do not follow Him. You read the Quran al karim, but you do not follow the way it prescribes. You utilize Allah ta’ala’s blessings, but you do not thank Him. You know that paradise is for those who worship, but you do not make preparations for it. You know that He has created hell for the disobedient, but you do not fear it. You see what happened to your fathers and grandfathers, but you do not take a warning. You do not see your own defects, you search for defects in others. Such people must be thankful, since they do not sink into the earth, and since it does not rain fire from the sky! What else could they want? Would not this suffice as a recompense for their prayers?” (Ithbat an-Nubuwwat)
Hadiths about the Ramadan
There are many hadiths which determine the importance, benefits and rewards of fasting. Our Holy Prophet (peace be upon Him) is an practical example for all the Muslims in every aspect of the life. He can seek knowledge by follow His practice regarding every aspect of life. Allah has given the message through Quran and to perform in practical, we can see the life of Holy Prophet (peace be upon Him) or by follow His Sunnah and teachings.


Hadiths about the Ramadan
It was narrated that Abu Hurairah (May Allah be pleased with him) said:
The Messenger of Allah (Peace be upon Him)  said: “Whoever fasts Ramadan out of faith and in the hope of reward, he will be forgiven his previous sins.”
[Sunan an-Nasa`I Book-22 Hadith-116]

Narrated Abu Huraira (May Allah be pleased with him):
Allah’s Messenger(Peace be upon Him)  said, “When the month of Ramadan starts, the gates of the heaven are opened and the gates of hell are closed and the devils are chained.”
[Sahih al-Bukhari Book-30 Hadith-9]

Narrated Abu Huraira (May Allah be pleased with him):
I heard Allah’s Messenger (Peace be upon Him)  saying regarding, “Whoever prayed at night in it(the month of Ramadan) out of sincere Faith and hoping for a reward from Allah, then all his previous sins will be forgiven.”
[Sahih al-Bukhari Book-31 Hadith-1]

Abu Hurairah (May Allah be pleased with him) reported:
Messenger of Allah (Peace be upon Him)  said, “The five (daily) Salat (prayers), and from Jumu`ah prayer to the (next) Jumu`ah prayer, and from Ramadan to Ramadan are expiations for the (sins) committed in between (their intervals); provided the major sins are not committed.”
[Sahih Muslim Book-1 Hadith-130]

Narrated `Aisha (May Allah be pleased with her):
Allah’s Messenger (Peace be upon Him)  used to practice I`tikaf in the last ten nights of Ramadan and used to say, “Look for the Night of Qadr in the last ten nights of the month of Ramadan.”
[Sahih al-Bukhari Book-32 Hadith-7]

Umm Ma`qil (May Allah be pleased with him) narrated that:
The Prophet said: “Umrah during Ramadan is equal to Hajj.”
[Jami` at-Tirmidhi Book-9 Hadith-132]

It was narrated that Ibn `Umar (May Allah be pleased with him) said:
“The Messenger of Allah (Peace be upon Him)  enjoined the Zakah of Ramadan on everyone, young and old, free and slave, male female, a Sa of dates or a Sa of barley.”
[Sunan an-Nasa`i Book-23, Hadith-0]

Narrated `Aisha (May Allah be pleased with her):
Allah’s Messenger (Peace be upon Him)  said, “Whoever died and he ought to have fasted (the missed days of Ramadan) then his guardians must fast on his behalf.”
[Sahih  al-Bukhari Book-30, Hadith-59]

Abu Ayub (May Allah be pleased with him) narrated that:
The messenger of Allah (Peace be upon Him) said: “Whoever fasts Ramadan, then follows it with six from Shawwal, then that is (equal in reward) to fasting every day.”
[Jami` at-Tirmidhi Book-8 Hadith-78]

In a well-known hadith, Muhammad  (Peace be upon Him) said, ”Allah, the Almighty and Master of Honor, says: `All actions of a person are for himself, except the case of his fasting which is exclusively for Me and I shall pay (recompense) for him for the same. `The fast is a shield (against vice and the fire of hell). Therefore when anyone of you is fasting he should abstain from loose talk and avoid verbosity and noisy exchange of words.”
[Bukhari and Muslim: Abu Hurayrah]

For a True Muslim, end of Ramadan is not “The End” but start of a new journey leading towards the Jannah. Ramadan is time to empty your stomach to feed your soul.May this Ramadan lay the foundation stone to the path of Taqwa!.After Ramzan we celebrate Eid ul Fiter.

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