Scientific Philosophy and Principles in Medicine 9789815050806, 9789815050820, 9789815050813, 981505080X

Table of contents :
Cover
Title
Copyright
End User License Agreement
Contents
Preface
Dedication
Introduction
1.1. GENERAL
1.2. LANGUAGE AND EDUCATION SYSTEM
1.3. HISTORICAL UNCERTAINTY DISCUSSIONS
1.4. PHILOSOPHY PRINCIPLES
1.4.1. Philosophy and Medicine
1.5. LOGIC
1.5.1. Bivalent (Two-Value) Logic
1.5.2. Fuzzy Logic
1.5.2.1. Fuzzy Philosophy of Science
1.6. RECOMMENDATIONS
1.7. BOOK CONTENT AND READING RECOMMENDATIONS
CONCLUSION
REFERENCES
Thought Principles and Science “It is not Possible to have Active Mind without Thought or Thought without Mind”
2.1. GENERAL
2.2. Thought Inferences
2.2.1. Mind-Heart
2.2.2. Standardization Trap
2.2.3. Thinking Elements
2.2.4. Thinking in Education
2.3. REASONABLE THINKING TYPES
2.3.1. Rational Thinking Gains
2.3.2. Rational Thinking Models
2.3.2.1. Deduction
2.3.2.2. Induction
2.3.2.3. Analogy
2.3.2.4. Hybridity
2.4. SCIENTIFIC REASONING
2.5. POSITIVISTIC THINKING
2.5.1. Scientific Method and Recommendations
2.6. PHILOSOPHICAL LINGUISTIC THINKING PRINCIPLES
2.7. EXAMPLE FROM THE SCIENCE HISTORY
2.7.1. “How?” and “Why?” Questions
2.8. PHILOSOPHY, RATIONAL THINKING AND LOGIC COMBINATION
REFERENCES
Medicine History “For Countries' Political History, for Humanity, Science History has Importance”
3.1. GENERAL
3.2. MEDICINE SCIENCE HISTORY
3.3. MEDICINE HISTORY
3.3.1. Physicians in Ancient Egypt
3.3.2. Physicians in Ancient Mesopotamia
3.3.2.1. Relationship Between Disease and Witchcrafts in Ancient Mesopotamia
3.3.3. Ancient Greek Medicine
3.3.4. Alexandria Medical School
3.3.5. Effects on Early Islamic Medicine
3.4. ISLAM AND MEDICINE
3.4.1. Zakaria Al-Rhazes
3.4.2. Avicenna
3.5. OTHER PHYSICIANS IN ISLAMIC CIVILIZATION
3.5.1. Curement Methodologies in Islamic Medicine, Physicians and Hospitals
3.6. EARLY RENAISSANCE MEDICINE HISTORY
CONCLUSION
REFERENCES
Medical Terminologies “Word and Sentence Epistemology are the Key Career Expertise”
4.1. GENERAL
4.2. LANGUAGE
4.2.1. Etymology and Epistemology
4.2.1.2. Words
4.2.2. Words' Root (Etymology)
4.2.3. Terms
4.2.4. Concepts
4.2.5. Definitions
4.2.6. Sentences
4.3. MEDICAL TERMINOLOGY
4.4. PHILOSOPHICAL THOUGHT
4.4.1. Imagination
4.4.2. Design
4.4.3. Idea Generation
4.4.4. Knowledge and Elements
4.4.5. Knowledge, Language and Conception
4.4.6. Approximate Reasoning
4.5. SCIENCE AND MEDICINE
4.5.1. Scientific Hypothesis
4.6. MEDICINE AND PHYSICIAN
4.6.1. Diagnosis
4.7. Some Medical Words, Terms and Terminologies
CONCLUSION
REFERENCES
Philosphy Principles and Types “Does philosophy? Metaphysics? Or both? Constitute the Scientific Bases of Development?
5.1. GENERAL
5.2. PHILOSOPHY DEFINITION
5.3. ACADEMIC PHILOSOPHY
5.3.1. Information Philosophy
5.4. HISTORICAL DEVELOPMENT OF EDUCATION SYSTEMS
5.5. Steps in the Philosophic Thinking
5.5.1. Imagination
5.5.2. Design
5.5.3. Productiveness (Idea Generation)
5.6. KNOWLEDGE PHILOSOPHY
CONCLUSION
REFERENCES
Philosophy in Medicine “Verbal Expressions in Medicine can Develop through Innovative Ideas Generation by the Philosophy”
6.1. GENERAL
6.2. PHILOSOPHY AND WISDOM IN MEDICINE
6.3. MEDICINE AND SCIENCE
6.4. MEDICAL EDUCATION
6.5. PHILOSOPHER PHYSICIANS
6.6. HEALTH AND ILLNESS DEFINITIONS
6.7. SCIENCE, PHILOSOPHY AND MEDICINE
6.8. SCIENCE PHILOSOPHY AND EDUCATION
CONCLUSION
REFERENCES
Logic Principles and Rules “In the Philosophy Field Logic Produces Rational Ideas that Lead to Beneficial Consequences”
7.1. GENERAL
7.2. LOGIC DEFINITION
7.2.1. Simple Fundamentals of Logic
7.2.2. Classical and Mathematical Symbolic Logic
7.3. LOGIC ELEMENTS
7.3.1. Logic Conjunctives
7.3.2. Proposition
7.3.3. Inference
7.3.4. Proposition Inferences
7.4. MATHEMATICAL SYMBOLIC LOGIC MATRIX (SLM)
7.5. LOGICAL MODELS
7.6. LOGICAL REASONING
CONCLUSION
REFERENCES
Fuzzy Logic Interferences in Medicine ”Medical Verbal Diagnosis and Treatment Methods are Fuzzy”
8.1. GENERAL
8.2. Human-Computer Logic
8.3. Verbal Uncertainties
8.4. Fuzzy Thoughts
8.4.1. Fuzzy Logic Versus Crisp Logic
8.5. Fuzzy Logic Rules
8.5.1. Vague Words
8.6. Fuzzy Sets
8.6.1. Normal Fuzzy Sets
8.7. Fuzzy System
8.8. Fuzzy Logic Inference
8.8.1. Medical Fuzzy Correlation
8.9. Fuzzy Logic Models in Medicine
8.8.1. Fuzzy Logic Model
8.9. Fuzzy Logic in Medicine
8.10. Fuzziology
CONCLUSION
REFERENCES
Numerical and Graphical Diagnosis “Numbers Help to Construct Graphics for Better Understanding”
9.1. GENERAL
9.2. Uncertain Number of Information
9.3. Medicine and Probability Methods
9.3.1. Subjective Probability
9.3.2. Relative Probability
9.4. Medicine and Statistical Methods
9.4.1. Assumptions and Subjects to Notice
9.4.2. Practical Regression Analysis
9.5. Medicine and Mathematics
CONCLUSION
REFERENCES
Medicine and Engineering “Engineering is Supportive to Medical Instruments and Software”
10.1. GENERAL
10.2. KNOWLEDGE GAIN
10.3. BIRTH, DEATH AND POPULATION MODELS
10.3.1. Population Model Without Restriction
10.3.2. Source Restrictive Population Model
10.3.3. Food Restrictive Population Model
10.4. INJECTION MODEL IN MEDICINE
10.4.1. Successive Injection Model
10.5. DIALYSIS MACHINE MODEL
10.6. DIABETICS TEST MODEL
10.7. SENSITIVITY – HEARING RECEPTION MODEL
10.8. EPIDEMIC DISEASE MODEL
10.9. BLOOD CIRCULATION MODEL
10.9.1. Blood Flow Velocity and Types
10.9.2. Total Preferred Blood Resistance
10.10. HUMAN ENGINEERING
10.10.1. Human Engineering Innovation
10.10.2. Medicine and Human Engineering
10.10.3. Recommendations
CONCLUSION
REFERENCES
Conclusion
Subject Index
Back Cover

Citation preview

Scientific Philosophy and Principles in Medicine Authored by Zekâi Şen

Istanbul Medipol University Kavacık Ekinciler Cd. No:19 34810 Beykoz/Istanbul Turkey

Scientific Philosophy and Principles in Medicine Author: Zekâi Şen ISBN (Online): 978-981-5050-80-6 ISBN (Print): 978-981-5050-81-3 ISBN (Paperback): 978-981-5050-82-0 © 2022, Bentham Books imprint. Published by Bentham Science Publishers Pte. Ltd. Singapore. All Rights Reserved. First published in 2022.

BSP-EB-PRO-9789815050806-TP-313-TC-11-PD-20221201

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CONTENTS PREFACE ................................................................................................................................................ i DEDICATION ......................................................................................................................................... iii CHAPTER 1 INTRODUCTION .......................................................................................................... 1.1. GENERAL ................................................................................................................................ 1.2. LANGUAGE AND EDUCATION SYSTEM ........................................................................ 1.3. HISTORICAL UNCERTAINTY DISCUSSIONS ............................................................... 1.4. PHILOSOPHY PRINCIPLES ............................................................................................... 1.4.1. Philosophy and Medicine .............................................................................................. 1.5. LOGIC ...................................................................................................................................... 1.5.1. Bivalent (Two-Value) Logic ......................................................................................... 1.5.2. Fuzzy Logic .................................................................................................................. 1.5.2.1. Fuzzy Philosophy of Science ............................................................................ 1.6. RECOMMENDATIONS ........................................................................................................ 1.7. BOOK CONTENT AND READING RECOMMENDATIONS ......................................... CONCLUSION .............................................................................................................................. REFERENCES ...............................................................................................................................

1 2 3 6 9 10 12 13 14 15 15 16 18 19

CHAPTER 2 THOUGHT PRINCIPLES AND SCIENCE “IT IS NOT POSSIBLE TO HAVE ACTIVE MIND WITHOUT THOUGHT OR THOUGHT WITHOUT MIND” ............................. 2.1. GENERAL ................................................................................................................................ 2.2. Thought Inferences .......................................................................................................... 2.2.1. Mind-Heart .................................................................................................................... 2.2.2. Standardization Trap ..................................................................................................... 2.2.3. Thinking Elements ........................................................................................................ 2.2.4. Thinking in Education ................................................................................................... 2.3. REASONABLE THINKING TYPES .................................................................................... 2.3.1. Rational Thinking Gains ............................................................................................... 2.3.2. Rational Thinking Models ............................................................................................ 2.3.2.1. Deduction ......................................................................................................... 2.3.2.2. Induction .......................................................................................................... 2.3.2.3. Analogy ............................................................................................................ 2.3.2.4. Hybridity .......................................................................................................... 2.4. SCIENTIFIC REASONING ................................................................................................... 2.5. POSITIVISTIC THINKING .................................................................................................. 2.5.1. Scientific Method and Recommendations .................................................................... 2.6. PHILOSOPHICAL LINGUISTIC THINKING PRINCIPLES ......................................... 2.7. EXAMPLE FROM THE SCIENCE HISTORY .................................................................. 2.7.1. “How?” and “Why?” Questions .................................................................................... 2.8. PHILOSOPHY, RATIONAL THINKING AND LOGIC COMBINATION .................... REFERENCES ...............................................................................................................................

22 22 26 29 33 34 36 39 42 43 45 45 46 47 48 51 56 57 58 63 65 66

CHAPTER 3 MEDICINE HISTORY “FOR COUNTRIES' POLITICAL HISTORY, FOR HUMANITY, SCIENCE HISTORY HAS IMPORTANCE” ............................................................. 3.1. GENERAL ................................................................................................................................ 3.2. MEDICINE SCIENCE HISTORY ........................................................................................ 3.3. MEDICINE HISTORY ........................................................................................................... 3.3.1. Physicians in Ancient Egypt ......................................................................................... 3.3.2. Physicians in Ancient Mesopotamia ............................................................................. 3.3.2.1. Relationship Between Disease and Witchcrafts in Ancient Mesopotamia .......

68 68 70 75 76 77 78

3.3.3. Ancient Greek Medicine ............................................................................................... 3.3.4. Alexandria Medical School ........................................................................................... 3.3.5. Effects on Early Islamic Medicine ................................................................................ 3.4. ISLAM AND MEDICINE ....................................................................................................... 3.4.1. Zakaria Al-Rhazes ........................................................................................................ 3.4.2. Avicenna ....................................................................................................................... 3.5. OTHER PHYSICIANS IN ISLAMIC CIVILIZATION ..................................................... 3.5.1. Curement Methodologies in Islamic Medicine, Physicians and Hospitals ................... 3.6. EARLY RENAISSANCE MEDICINE HISTORY .............................................................. CONCLUSION ............................................................................................................................... REFERENCES ...............................................................................................................................

80 83 84 85 88 90 95 97 99 104 104

CHAPTER 4 MEDICAL TERMINOLOGIES “WORD AND SENTENCE EPISTEMOLOGY ARE THE KEY CAREER EXPERTISE” ............................................................................................ 4.1. GENERAL ................................................................................................................................ 4.2. LANGUAGE ............................................................................................................................ 4.2.1. Etymology and Epistemology ....................................................................................... 4.2.1.2. Words ............................................................................................................... 4.2.2. Words' Root (Etymology) ............................................................................................. 4.2.3. Terms ............................................................................................................................ 4.2.4. Concepts ........................................................................................................................ 4.2.5. Definitions ..................................................................................................................... 4.2.6. Sentences ....................................................................................................................... 4.3. MEDICAL TERMINOLOGY ................................................................................................ 4.4. PHILOSOPHICAL THOUGHT ............................................................................................ 4.4.1. Imagination ................................................................................................................... 4.4.2. Design ........................................................................................................................... 4.4.3. Idea Generation ............................................................................................................. 4.4.4. Knowledge and Elements ............................................................................................. 4.4.5. Knowledge, Language and Conception ........................................................................ 4.4.6. Approximate Reasoning ................................................................................................ 4.5. SCIENCE AND MEDICINE .................................................................................................. 4.5.1. Scientific Hypothesis .................................................................................................... 4.6. MEDICINE AND PHYSICIAN ............................................................................................. 4.6.1. Diagnosis ....................................................................................................................... 4.7. Some Medical Words, Terms and Terminologies ........................................................... CONCLUSION ............................................................................................................................... REFERENCES ...............................................................................................................................

106 106 108 110 111 113 114 115 118 118 119 120 120 121 121 122 124 126 128 129 130 131 133 136 136

CHAPTER 5 PHILOSPHY PRINCIPLES AND TYPES “DOES PHILOSOPHY? METAPHYSICS? OR BOTH? CONSTITUTE THE SCIENTIFIC BASES OF DEVELOPMENT? .................................................................................................................................. 5.1. GENERAL ................................................................................................................................ 5.2. PHILOSOPHY DEFINITION ............................................................................................... 5.3. ACADEMIC PHILOSOPHY ................................................................................................. 5.3.1. Information Philosophy ................................................................................................ 5.4. HISTORICAL DEVELOPMENT OF EDUCATION SYSTEMS ...................................... 5.5. Steps in the Philosophic Thinking ................................................................................... 5.5.1. Imagination ................................................................................................................... 5.5.2. Design ........................................................................................................................... 5.5.3. Productiveness (Idea Generation) ................................................................................. 5.6. KNOWLEDGE PHILOSOPHY .............................................................................................

138 138 140 147 149 152 155 156 156 157 157

CONCLUSION ............................................................................................................................... 159 REFERENCES ............................................................................................................................... 159 CHAPTER 6 PHILOSOPHY IN MEDICINE “VERBAL EXPRESSIONS IN MEDICINE CAN DEVELOP THROUGH INNOVATIVE IDEAS GENERATION BY THE PHILOSOPHY” ........ 6.1. GENERAL ................................................................................................................................ 6.2. PHILOSOPHY AND WISDOM IN MEDICINE ................................................................. 6.3. MEDICINE AND SCIENCE .................................................................................................. 6.4. MEDICAL EDUCATION ....................................................................................................... 6.5. PHILOSOPHER PHYSICIANS ............................................................................................ 6.6. HEALTH AND ILLNESS DEFINITIONS ........................................................................... 6.7. SCIENCE, PHILOSOPHY AND MEDICINE ..................................................................... 6.8. SCIENCE PHILOSOPHY AND EDUCATION ................................................................... CONCLUSION ............................................................................................................................... REFERENCES ...............................................................................................................................

160 160 162 164 165 167 169 172 175 176 176

CHAPTER 7 LOGIC PRINCIPLES AND RULES “IN THE PHILOSOPHY FIELD LOGIC PRODUCES RATIONAL IDEAS THAT LEAD TO BENEFICIAL CONSEQUENCES” ............ 7.1. GENERAL ................................................................................................................................ 7.2. LOGIC DEFINITION ............................................................................................................. 7.2.1. Simple Fundamentals of Logic ..................................................................................... 7.2.2. Classical and Mathematical Symbolic Logic ................................................................ 7.3. LOGIC ELEMENTS ............................................................................................................... 7.3.1. Logic Conjunctives ....................................................................................................... 7.3.2. Proposition .................................................................................................................... 7.3.3. Inference ....................................................................................................................... 7.3.4. Proposition Inferences .................................................................................................. 7.4. MATHEMATICAL SYMBOLIC LOGIC MATRIX (SLM) .............................................. 7.5. LOGICAL MODELS .............................................................................................................. 7.6. LOGICAL REASONING ....................................................................................................... CONCLUSION ............................................................................................................................... REFERENCES ...............................................................................................................................

177 177 179 181 181 183 183 186 190 191 192 195 200 202 202

CHAPTER 8 FUZZY LOGIC INTERFERENCES IN MEDICINE ”MEDICAL VERBAL DIAGNOSIS AND TREATMENT METHODS ARE FUZZY” ......................................................... 8.1. GENERAL ................................................................................................................................ 8.2. Human-Computer Logic .................................................................................................. 8.3. Verbal Uncertainties ........................................................................................................ 8.4. Fuzzy Thoughts ................................................................................................................ 8.4.1. Fuzzy Logic Versus Crisp Logic ......................................................................... 8.5. Fuzzy Logic Rules ........................................................................................................... 8.5.1. Vague Words ....................................................................................................... 8.6. Fuzzy Sets ........................................................................................................................ 8.6.1. Normal Fuzzy Sets ............................................................................................... 8.7. Fuzzy System ................................................................................................................... 8.8. Fuzzy Logic Inference ..................................................................................................... 8.8.1. Medical Fuzzy Correlation ................................................................................. 8.9. Fuzzy Logic Models in Medicine .................................................................................... 8.8.1. Fuzzy Logic Model .............................................................................................. 8.9. Fuzzy Logic in Medicine ................................................................................................. 8.10. Fuzziology ...................................................................................................................... CONCLUSION ...............................................................................................................................

204 204 207 209 211 213 215 218 219 220 221 223 224 226 230 232 233 234

REFERENCES ............................................................................................................................... 234 CHAPTER 9 NUMERICAL AND GRAPHICAL DIAGNOSIS “NUMBERS HELP TO CONSTRUCT GRAPHICS FOR BETTER UNDERSTANDING” ................................................... 9.1. GENERAL ................................................................................................................................ 9.2. Uncertain Number of Information ................................................................................... 9.3. Medicine and Probability Methods .................................................................................. 9.3.1. Subjective Probability ......................................................................................... 9.3.2. Relative Probability ............................................................................................ 9.4. Medicine and Statistical Methods .................................................................................... 9.4.1. Assumptions and Subjects to Notice .................................................................... 9.4.2. Practical Regression Analysis ............................................................................. 9.5. Medicine and Mathematics .............................................................................................. CONCLUSION ............................................................................................................................... REFERENCES ...............................................................................................................................

237 237 239 244 248 249 249 252 255 257 258 259

CHAPTER 10 MEDICINE AND ENGINEERING “ENGINEERING IS SUPPORTIVE TO MEDICAL INSTRUMENTS AND SOFTWARE” .............................................................................. 10.1. GENERAL .............................................................................................................................. 10.2. KNOWLEDGE GAIN ........................................................................................................... 10.3. BIRTH, DEATH AND POPULATION MODELS ............................................................. 10.3.1. Population Model Without Restriction ....................................................................... 10.3.2. Source Restrictive Population Model ......................................................................... 10.3.3. Food Restrictive Population Model ............................................................................ 10.4. INJECTION MODEL IN MEDICINE ................................................................................ 10.4.1. Successive Injection Model ........................................................................................ 10.5. DIALYSIS MACHINE MODEL .......................................................................................... 10.6. DIABETICS TEST MODEL ................................................................................................ 10.7. SENSITIVITY – HEARING RECEPTION MODEL ........................................................ 10.8. EPIDEMIC DISEASE MODEL ........................................................................................... 10.9. BLOOD CIRCULATION MODEL ..................................................................................... 10.9.1. Blood Flow Velocity and Types ................................................................................. 10.9.2. Total Preferred Blood Resistance ............................................................................... 10.10. HUMAN ENGINEERING .................................................................................................. 10.10.1. Human Engineering Innovation ................................................................................ 10.10.2. Medicine and Human Engineering ........................................................................... 10.10.3. Recommendations ..................................................................................................... CONCLUSION ............................................................................................................................... REFERENCES ...............................................................................................................................

260 260 262 263 263 266 268 269 270 272 277 280 281 284 285 287 288 292 293 295 295 295

CHAPTER 11 CONCLUSION ............................................................................................................ 297 SUBJECT INDEX .................................................................................................................................... 

i

PREFACE In any education system, principles of thought, science philosophy, and logical principles exclusion from the basic courses give way to mimic, rote, mechanical and non-productive graduates and career experts. With a thought, concrete and intangible information opens the door for smart inferences. Especially in medicine studies (diagnosis, treatment, healing, clinical works) and research, these topics play a fundamental role in the exploitation of linguistic and verbal information and knowledge data. One wonders if imagination, design and idea generative human thought triggering science, philosophy and logical principles are ignored, then what takes place in the social enlightenment? Throughout history, starting from ancient Greek, Hellenistic and Islamic civilizations, further enlightenment took place in the West with the renaissance dawn up today. At the roots of each civilization, contributions were philosophical and logical principles, and most of the knowledge was verbal and written in books. Among the most fundamental issues in these civilizations, first of all, the medical, philosophical and logical knowledge presented by philosophers, physicians and doctors on human health has reached today's level of development. As in many professions today, especially in medical education and professional works, productive and dynamic thinking, philosophical verbal knowledge productions, and logic rules for rational inferences are almost forgotten; instead, only mathematics, computer software, medical instrument measurements and outputs, classical algorithm, method and knowledge applications take place. The most effective philosophical issues in the philosophy of medicine are ontology and epistemology, which is yet well developed neither in the career nor in the medicine education system. It is, therefore, essential to develop, implement and support medicine educational ventures in the philosophy of medicine with the support of logical principles. Although there are many publications on medical philosophical procedures, education in philosophy medicine lags behind. Unfortunately, there are few textbooks based on the philosophy of medicine with a few anthologies in this field. Most of the training programs concerning medicine mention about ethics, medicine history, and medical humanities. The author of this book has lectured first-year undergraduate students about science philosophical and logical principles and their usage in the medicine profession. The content of the book mostly depends on these lectures at the Istanbul Medipol University. It is the observance of the author that the students carefully listen to these principles after all explanations are verbal and logical with philosophical ingredients. The main theme of this book is to emphasize the significance of science philosophy and logical principles in medicine education, training and professional executions. In the absence of these basic topics, physicians, doctors and medical specialists remain addicted to the classical case studies ready computer software, classical algorithms, methods and procedures. Future improvements and advancements remain obsolete without knowledge of these topics. Innovative ideas and generative intelligence gain importance through science philosophy and subsequent logical principles applications, which help minimize medicine uncertainties in almost every issue and case study. Hopefully, this book provides a forum for a harmonious integration with patients towards effective diagnoses and treatment solutions.

ii

The author thanks the medicine department at Istanbul Medipol university for providing the opportunity to lecture to first-year medicine undergraduate students each year about the philosophy of science and medicine. I could not complete this book without the love, patience, support and assistance of my wife, Fatma Şen.

Zekâi Şen Istanbul Medipol University Kavacık Ekinciler Cd. No:19 34810 Beykoz/Istanbul Turkey

iii

DEDICATION

Prophet Mohammad (pbuh) famously said. “When you hear that a plague is in a land, do not go to it and if it occurs in a land that you are already in, then do not leave it” Ibn-i Sina (Avicenna) said: Prayer is that which enables the soul to realize its divinity. Through prayer human beings worship absolute truth, and seek an eternal reward. Prayer is the foundation-stone of religion; and religion is the means by which the soul is purified of all that pollutes it. Prayer is the worship of the first cause of all things, the supreme ruler of the entire world, the source of all strength. Prayer is the adoration of the one whose being is necessary.

Scientific Philosophy and Principles in Medicine, 2022, 1-21

1

CHAPTER 1

Introduction Abstract: Basic knowledge and information are acquired through the language in the family, society and education, which should be based on philosophy and logical principles. In the field of medicine, a dialog can be established between the doctor and the patient for diagnosis with linguistic (verbal, oral) information exchange rather than mathematical expressions. This chapter presents rational thinking with logical principles, preferably combining the basic principles of philosophy in medicine with the treatment of uncertainty, the results of which are presented according to the usual bivalent (crisp, two-value) logic. The necessary and effective structural steps of rational use of language are presented based on verbal knowledge and uncertainties in information production. It is emphasized that innovative ideas, procedures and methods are possible through research and development activities, if the language, philosophy, and logic principles are observed for the most reasonable cases, even with approximate decisions.

Keywords: Education, Language, Logic, Medicine, Philosophy. Medicine and philosophy are integrated and almost similar, as Aristotle (382-323 BC) mentioned in many of his writings that the work of medical doctors and philosophers is closely similar. On the other hand, Hippocrates (460-375 BC) said: “Medicine cannot be without medical truth, and philosophy cannot be without medical truth.” “All traditional logic habitually assumes that precise symbols are being employed. It is, therefore, not applicable to this terrestrial life but only to an imagined celestial existence.” (Russell, 1923). “So far as the law of mathematics refers to reality, they are not certain. And so far as they are certain, they do not refer to reality. ” (Einstein, 1925).

Zekâi Şen All rights reserved-© 2022 Bentham Science Publishers

2 Scientific Philosophy and Principles in Medicine

Zekâi Şen

As the complexity of a system increases, our ability to make precise and yet significant statements about its behavior diminishes until a threshold is reached beyond which precision and significance (or relevance) become almost mutually exclusive characteristics.” (Lotfi Asker Zadeh, 1965). 1.1. GENERAL Social, medical, cultural, economical and environmental disciplines require linguistic and verbal discussions before a numerical database treatment, through the principles of philosophical thinking and logical inference. Preliminary data between a physician and patient is verbal, in addition to simple temperature and blood pressure measurements. The basic information is sensed and learned orally by the etymologic and epistemological contents of sentences. It is not necessary that each sentence reflect reasonably causative and effective answers for information contents. The ones with unanswered questions give each person a chance to think about the issue deeply to reach a better evolution than before. If the predicate is related to the consequent part in a logical sentence, i.e., proposition, the rational consequences are reachable; otherwise, one must gather more information through discussions, debates and comments for a better assessment of the predicate-consequent relationship. For example, in medical treatments after the diagnostic decisions, there is always uncertainty in terms of vagueness, bluntness, incompleteness and fuzziness, which include skepticism and doubts. These are the components of philosophical thinking for a possible solution alternative (Chapters 5 and 6). In order to transmit and receive information, speaking, listening, writing and reading, and many actions that are linguistically more human, are parts of language, which help to communicate. Language is the essential tool for the philosophy of science and the execution of knowledge and information at times of request. The linguistical entities provide almost instantaneous graphs of the information in the forms of objects, facts and realities. Johansson and Lynøe (2008) explained perceptions based on talking, listening, writing, and reading (linguistic acts) as intentional communication elements. They exist by inter actions among three elements; act, content and object. For example, when one reads a physician's report about his heart problem explaining the specific features, the reading is an action. In general, any reading act about the heart problem and its properties is referred to as the content in terms of assertions based on logical propositions. According to crisp (bivalent) logic, if a proposition is false, there is no logically intentional object. On the contrary, if it is completely

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accurate, then there is a logically acceptable object. On the other hand, partial accuracy refers to the intentional object in the fuzzy logic domain (Chapter 8). The three integral constituents are body (health), mind (the ability to think and make decisions) and spirit (sensitivity and responsiveness, awareness and the ability to stay alert, passionate desire to get out of the 'attractor' of egocentric thoughts and desires, compassion and love, the more subtle and spiritual reality). The simultaneous activation ('ignition') is called a consciousness resonance. The main purpose of this book is to clarify verbal uncertain expressions by the recommendation of science, philosophical and logical principles through various intermingled chapters concerning medical issues. 1.2. LANGUAGE AND EDUCATION SYSTEM The dynamic education system in any society should focus on scientific researches, developments, innovative improvements and productions. Instead of statically planned lessons in every branch of science, it is suggested that scientific philosophical thinking, logical principles, especially fuzzy logic, uncertainty principles, and some geometry (from sketches, shapes, Figs graphs, images) should be included among the basic foundations of education before mathematics courses. Al-Farabi (870-950) believed in the role of language in human’s social life and in conveying information, asking questions and resolving conflicts by describing distinctions and classifications similar to Aristoteles (BC 384-322), but in a more advanced way. The way to understand is through language, in which one can express ideas and discuss with other individuals, thereby distributing basic information about the topic of interest. Language consists of words and sentences, provides expressions and is the umbrella of the climate of thought (Chapter 2). The first foundation of any language is words that reflect materialist or imaginary issues existing or nonexistent, as well as the essence of ideas that guide comprehension and expression. In the materialistic world, every word is the name of a subject depending on its form and geometry because the word helps to imagine the living form of the subject in the human mind. In general, each word has an etymological and epistemological background, which forms the basis of the logical and rational load for meaningful and understandable linguistic expressions that generate shape, geometry, and logical traces in the mind and memory of the individual. Depending on their thinking abilities, anyone can devise ideas in the form of

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diagrams, sketches, pictures, images and Figs to convey the message to others (Chapters 2 and 4). Human thoughts are concentrated in terminological words depending on each discipline, such as every expert translating medicine and thoughts into words and sentences for better understanding. Correction and development of understanding can be increased by knowing the epistemic and etymological contents of each word that is systematically combined into sentences depending on the grammatical feature of the language. An idea can be explained in simpler language terms for better understanding rather than complex expressions. One of the main means of possible enlightenment in a society is the master of a common language that spreads ideas across different classes and disciplines. The development of ideas in a more scientific direction is possible through frequent information exchange and discussions, reading and writing. Knowledge is the result of the ability to think or comprehend, and, thus, to distinguish right from wrong (Chapter 2). Chaos

Observations Philosophy Rational thinking Logic a)Two-value b) Fuzzy Language Fig. (1.1). Structural steps of language.

Among the traditions of a nation, there are meaningful words that support the common understanding that helps to generate pronunciation, spelling and grammar, otherwise, the disruption of this tradition destroys communication. As a result, philosophical thought and logical expositions of rules cannot survive in

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such a society. The term philosophy has a wide meaning, from a cloudy speculative fantasy (fuzzy) to a bit of formal logic (bivalent). (Fig 1.1) shows that the basis of all uncertainty components is language, which needs philosophical and logical principles for its enrichment that lead to rationally reasonable inferences. The flaws in any traditional education system can be stated as follows (Şen, 2014). 1. Teachers’ authoritative responsibilities based on law and traditional rules may not allow for productive rational thinking. In such an education system, any answer is definitive, i.e., based on bivalent Aristotelian (BC 384-322) logic without any reference to Al-Farabi (870-950) logic (probability) or fuzzy logic (Zadeh, 1967). 2. Hardware is considered only indispensable, and software based on the philosophy and logic of science is used unconsciously. Thus, the way is paved for memorization, transportation, copy-teach and mechanical education system. 3. The information is taken from the books without efficiently critical inquiry; with certain concepts, regardless of any element of uncertainty. 4. Scientific concepts are not thought, and therefore, a one-sided thought pattern is followed, and a single answer is given to each problem with 100% scientific accuracy, which everyone should accept without hesitation. 5. Scientific assumptions, hypotheses and idealizations that do not have such validity, especially in medical sciences, are preserved strictly. Scientific results are considered correct under a number of preconditioned assumptions. There is always a certain amount of uncertainty in medical research case studies. On the other hand, the followings are the key points of a modern and innovative educational system. 1. Traditional and classical elements should be minimized and even removed from an innovative education system. Authorizeable teachers should be knowledgeable, empowered and capable of giving dynamic information. 2. Teacher should not be completely dependent on educational tools, and the students should try to push the teacher for more information on the margins of the material presented through questions and discussions. 3. It should not be forgotten that each scientific result is subject to uncertainty and doubt for further refinements leading to innovative idea generations. 4. Logical propositions containing premises are formed between subcategories of causal variables, and then logical and rational consequences of the subject variable are added to each of these premises.

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5. It is useful to give a common assignment to ensure students’ understanding and to ask for a solution to the problem with their individual abilities and linguistic background. 1.3. HISTORICAL UNCERTAINTY DISCUSSIONS Religion, science and technology were, in retrospect, tacitly seen as an integrated whole. Thus, although the ancient agricultural societies of Mesopotamia and Egypt were not centrally interested in acquiring knowledge based on empirical evidence, they nevertheless produced such knowledge (Chapter 3). It was left to the ancient Greek natural philosophers (for example, Thales of Miletus, 624-546 BC) to be the first to adopt a purely philosophical and logical attitude towards knowledge of nature. This knowledge was important for sailors when Ptolemy (100-170) theorized about how the planets and the stars move around the Earth. At night, sailors found their way through the positions of the celestial bodies (Johansson and Lynøe, 2008). Later, great scientists such as Galileo (1562-1642) and Newton (1643-1727) thought and wrote about purely philosophical issues. Conversely, great philosophers such as Descartes (1596-1620) and Leibniz (1646-1716) made lasting contributions to the fields of physics and differential mathematics. In the period when the Islamic culture was the most advanced scientific-philosophical culture in the world, important personalities such as Ibn Sina (Avicenna) (9701037), Ibn Rushd (Averroes) (1126-1198) and Zakaria Al-Rhazes (854-925), contributed to medicine (Chapter 3). Newton (1643-1727) used a less restrictive understanding of scientific knowledge in natural philosophy than philosopher John Locke (1632-1704). In his understanding, science required moral or practical certainty rather than metaphysics or absolute certainty. This is to say that scientific statements are inherently fuzzy in character. They had different understandings of what kind of uncertainty was necessary for scientific knowledge. Locke’s concept of scientific knowledge included absolute certainty that could not be a matter of degree. He succeeded in making a sharp distinction between scientific knowledge on the one hand, and “judgment” on the other with his term for what he called “probable opinion”. Here again, the possible view is valid only in the case of ambiguous knowledge, that is, when scientific statements are fuzzy in their structures. On the other hand, Newton’s (1643-1727) practical certainty is a matter of degree, and to accept degrees of certainty is to accept degrees of probability. For this reason, in Newton’s (1643-1727) philosophy, a sharp distinction could not be maintained between scientific knowledge and a possible view of understanding. Therefore, it is necessary to use fuzzy statements as intermediate expressions. In any case,

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Newton agreed that his knowledge was not absolute certainty until the integrity of his empirical natural philosophy provided true knowledge. To sustain his distinction, he had to supplement logic with rhetoric. Rhetorical statements are vague or imprecise sets of information in the form of fuzzy sets (Chapter 8). The most well-known reasoning is probabilistic reasoning in the sense that it produces results that have this or that degree of certainty, and thus one or another degree of probability and yet still have one or another degree of ambiguity. Later, in the century, with the idea of using evidence, and in particular empirical evidence, to argue for truth or at least believability, the concept of probability become identified with the idea that something is believable or unbelievable in the light of the evidence. All these last expressions are teachable in terms of fuzzy sets (Zadeh, 1968). Not every conclusion from probable reasoning is acceptable, but only some have vague degrees. Therefore, for any probable reasoning, it is necessary to have a measure of when and why such reasoning is acceptable. It is also necessary to find ways to measure the degree of uncertainty that indicates how measurable an outcome is. To this end, Huygens (1629-1695) first published an account in 1675 to show the treatment of quantitative probabilistic reasoning in games of chance. His treatment lacked words for the customary use of illustrating concepts of probability. On the other hand, Leibniz (1646-1716) stated that in order to support scientific achievements, researchers must accept that absolute certainty is an ideal they can reach. The degrees of probability should be accepted and associated with knowledge during scientific studies. Since the objective definition of probabilities requires measurements that are impossible to have at the stage of scientific thinking. The best that can be done is to add subjective probability values to each statement especially based on many years of experience and expert opinions. This last sentence is particularly appropriate in medical research, where empirical and experimental data are extensively available in each clinical case study. However, it is preferable and better to express uncertainties in any statement in terms of ambiguity by fuzzy sets and membership degree MD) attachments to each element in the set (Chapter 8). Therefore, reasoning with probable conclusions may be acceptable rather than dismissed. In fact, probability is a relation between the evidence disclosed by researchers and the conclusions they draw. This is similar to a doctor inferring probability from the information given by a patient. It is also possible to say that there is a legal model originally given by Al-Farabi (872-950) for probable reasoning logic. As Leibniz (1646-1716) said, we need a new logic to know the degrees of probability, because it is necessary for judging the evidence of factual and moral issues. Therefore, a new logic, such as fuzzy

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logic, is developed in the 1960s (Zadeh, 1968). Recently, emerging fuzzy logic principles can fulfill the linguistic background of any formulation, algorithm, and equation (Zadeh, 1972, 1973, 1974, 1975). David Hume (1711-1776) claimed that “all reasoning concerning matter of fact seems to be founded on the reflection of cause and effect and the probable arguments with which Bayes was concerned can indeed be understood as reasoning from effect to cause”. Keynes (1921), on the other hand, thought that probabilities were not merely relative frequencies based on observation. Moreover, for him, probabilities were degrees of belief, and it was necessary not only to attribute probabilities primarily to propositions, but also to recognize that propositions are always probable in relative to other propositions (Chapter 9). He endorsed the “conceptual” or “classical” idea of probability. Russell (1948) said that degrees of rational belief could be determined by reason. A degree of rational belief is a subjective measure of the logical relations between antecedents and the consequences. In medicine, such probabilities circle, but they are not just degrees of belief, because they are based on experience and expert opinion. When the evidence changes, degrees of belief also change due to uncertainty in thought rather than in experience, for they are logical relations of partial entailment between propositions expressing conclusions for which one has degrees of belief. Probabilities as degrees of belief are subjective; they represent psychological states (Ramsey, 1978). It is important to understand the rationality of probability judgments that derive from scientific research. They are dependent on whether they correspond to something external to them or whether they can be derived from a supposedly objective principle of indifference, but rather, on the relation of the beliefs to one another. Russell states that the purpose of inductive arguments is to make their conclusions likely true given the correctness of their premises. In deductive arguments, however, we want the conclusions to be true, given the truth of their premises. Instead of claiming that regularity happens in all cases, sometimes it happens only in a certain percentage. If a percentage is given or otherwise, a quantitative statement about the relation of one event to another, this statement is called a statistical law (Carnap, 1995). The concepts of science and everyday life can be considered in three main groups as classificatory, comparative, and quantitative. A classificatory concept simply means the allocation of an object in a certain class. They vary widely for

Introduction

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information about an object. For example, if someone says that, an object is blue, hot, or cubical; they make relatively poor statements about the object. All these words contain uncertainty and as a result, they can be easily expressed by fuzzy subsets. By placing the object in a narrower class, information increases, although it remains relatively modest. Such narrowness corresponds to the narrowness of fuzzy subsets, which is equivalent to the increase of information content. For example, the statement that an object is a living organism is very vague, but it is an animal, says a little more. As classes continue to shrink, we have an increasing amount of fuzzy sets but still relatively little information. Comparative concepts are more effective in transferring knowledge. For example, this object is hotter than that object; gives more information than classifier concepts. The third type of scientific concept is quantitative because of measurement. The main conclusions are that the scientific knowledge cannot be completely verifiable or falsifiable, but always fuzzy, which provides potential for further research. As a general conclusion, science and any quality associated with it, are never completely verifiable or falsifiable, but can always be fuzzy, and so further developments are always valid for places and societies in the form of intuition, traditional science, and occasional revolutionary science (Kuhn, 1970). Deterministic science and physics were developed with the exclusion of uncertainty through a set of idealistic, restrictive and simplistic assumptions. Today, there are elements of uncertainty in almost every branch of human activity and especially in the field of medicine. Uncertainty principles include Newtonian physics, Euclidian geometry, non-linear mathematical equations, and quantum physics, fractal geometry, chaos theory and fuzzy logic, although they are crisp in Aristotelian (BC 384-322) logic (Peitgen, 2004; Elwan, 2014). On the other hand, some other subjects remained uncertain for centuries, such as the earth and medical sciences, sociology, physiology, human behavior and many more that the reader can think of. The classical education system was in domination by deterministic principles to the extent that science explained reality. Probability, statistics and stochastic time series methodologies have made further advances in numerical analysis (Chapter 9). 1.4. PHILOSOPHY PRINCIPLES The first problem encountered when trying to define what is meant by a “philosophy” of science, is the notorious ambiguity of the term “philosophy (Ernan, 1983). Science itself is objective, but its foundation as philosophy is uncertain, imprecise, fuzzy and rather vague. How can scientific progress be possible if science and its philosophy are uncertain? However, the pictures of reality are becoming more different than ever. In particular, many scientific

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theories believed to be true, have turned out to be false, or there is much debate over their verifications or falsifications. In the field of scientific philosophy, scientists are quite uneasy about testing and setting boundaries to distinguish scientific knowledge from pseudo-scientific. It is not possible to have scientific thought without knowing or at least even unconsciously living the philosophical progress that provides complete freedom in scientific thought. Although many academics today think that they produce scientific articles without considering the philosophical components in their approaches, in fact, their procedures involve scientific philosophical thinking. The complete freedom of philosophical thought provides many scenarios about any relevant phenomenon, but logic removes an enormous amount of them based on results contrary to general philosophy or at least to common sense. Common sense is not always reliable, but it is common for all people to conclude or decide on a case. Philosophers of science seek the study of general scientific properties that are often relevant as a knowledgeproducing activity. According to rational explanations, it is worthy to consider philosophically and logically verification procedures, the correctness of theories and patterns of development combined with the truthfulness of theories. A detailed account of the origin of the distinction between science and philosophy is presented by Frank (1952). 1.4.1. Philosophy and Medicine Philosophy and medicine are twins; each needs the other for improvement in thoughts, diagnosis, treatment, healing and inferences from ambiguous statements. Although logical principles are approximate products of reasoning, they are like teachers who are experts in reaching rational conclusions. Caplan (1992) has asked the question, “Is there a philosophy of medicine?” He also expressed the relationship between philosophical principles and medicine. However, the author of this book supports the fruitful idea that philosophy in medicine is necessary at every stage of medical treatment. The philosophy and logic seek to reach the truth; the purpose of medicine is to cure diseases to maintain the health of the body. Thinking and then applying logical principles are necessary steps to reduce uncertainty in the medical discipline. In particular, the history of medicine is filled with the evaluations made in medicine from the ancient Greek civilization and all civilizations after it to the present day (Chapter 3). Even though medical research has advanced in an unprecedented way, there remains the question “What is the disease?” There are basic questions that have not found definitive answers, such as “What are the chances of cancer curement? Only very objective scientific tools cannot solve health problems, there are other dimensions in the human body, such as mind and spirit, that require compassion, culture, moral advice, ethics and social environment. In order to fulfill all the

Introduction

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aforementioned medical explanations, philosophical epistemology, ethics, logic and metaphysical principles are needed, as explained in the various chapters of this book. The role of philosophy is to verbally discuss rather vague facts, misunderstandings and critical concepts (Chapters 5 and 6), which can then be translated into rational statements in propositions through logical principles (Chapters 7 and 8). Tosam (2014) argued that one of the weaknesses of modern Western medicine is its over-dependence on Cartesian ontology, which sees the human body as machines to be studied with scientific logic, and the physician as a technician whose aim is to repair dysfunctional bodies. This modern metaphysical perspective neglected the patient as a subjective being. This deficiency cannot be remedied without a revision of the Cartesian reductionist worldview. A more detailed explanation of the relationship between philosophy and medicine is available in his paper. The main concern of medicine is to bring dysfunctional operations of the human body and mind and to retreat them into the proper order to satisfy the body and mind for comfort, peace and reliability. Treatment and medical relationships for the art of the human body and mind are listed as diagnosis, treatment and healing. Janicek and Hitchcock (2004) explained this point by stating that medicine is “the art and science of diagnosing, treating, preventing and maintaining health” Is it not possible to develop thoughts without knowing the epistemological background of each understanding and criticizing it philosophically? (Chapter 4). In any discipline, including medicine, collecting information is not enough, but thoughts that require the application of philosophical and logical principles are essential to be achieved through refinements of crucial and critical thinking, imagination, experimentation and expert opinion. Medicine is not concerned with universal physical phenomena that scientific principles can only control; its task is a man in general and each individual in particular. Therefore, medical treatment given to one person cannot generally be administered to another patient in the same way (Chapter 8). Today, although technologically developed tools are at the service of physicians for better diagnosis, since the results of these tools are different for each patient, fuzzy logic rather than bivalent (crisp) logic comes to the fore in medical sciences (Zadeh, 1968). Still, the best diagnoses are based on practical decisions after collecting all valid information. Unfortunately, today’s medical treatments rely only on objective scientific materialist body parts, without considering other dimensions such as mind, and spirit. Although science itself is a product of philosophy, its philosophical foundations have been partly forgotten, and highly decisive methodologies have been used to solve medical problems. Especially, in the

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medical business, there are rather vague principles rather than deterministic ones in each case of health care, and therefore, philosophical thinking combined with logical principles helps understand the basic concepts so that the physician can serve the patient during the recovery process. The physician can even understand some of the patient’s feelings from facial impressions (physiognomy); accordingly, depending on philosophical principles, he can give oral calming advice before medical treatment. Avicenna (970-1037) mentioned facial features and made it one of the second practical branches after medicine, astrology and imaginative interpretation, magic and alchemy (Thomann, 1996). 1.5. LOGIC There are philosophical, rational or irrational expressions regarding every human thought in daily life communications, but the logical ones have a sentence structure in the form of propositions with a rational combination of cause and effect. This means that there is reasonable and acceptable judgment consideration that leads to widely acceptable statements. These statements have explicitly or implicitly “if (reasons) then (consequences)” implications (Chapters 7 and 8). Logic defines rational prescriptions from the ocean of philosophy. Its primary task is to generate systems and criteria for distinguishing rational arguments expressing inferences from uncertain ones; due to these processes, new claims are produced from those that have already been established. It provides a mechanism for expanding knowledge, understanding, good reasoning and explanation. The following points are among a few that are the target of logical principles. 1. The prudent use of authorized knowledge and the solutions are not completely dependent on information devices, the scientist’s attempt to break the marginal limits of common certainty through discussions and questions with logical principles. 2. Any scientific conclusion is subject to uncertainty and doubt, and therefore, further improvement is required through rational considerations that lead to innovative ideas and changes. 3. Keeping logical principles, rules and preliminary philosophical steps on the agenda by scientists to each problem can be solved with expert contributions. 4. Scientific thinking should be directed towards the falsifiability of conclusions or theories rather than readily and easily acceptable conclusions. This can be achieved first by logical principles and then by experimentation. For practical medicine, Stanley and Campos (2013) noted that establishing the diagnosis is a crucial aspect because of relatively little logical and pedagogical

Introduction

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attention. Therefore, it is necessary to consider the logic of medical diagnosis in order to reach conclusions that are more rational. Recently, a very detailed explanation of Al-Farabi’s (870-950) views on principles of logic is offered by Hodges and Therese-Anne (2020). Al-Farabi (870-950) argued against Galen that logic in terms of probability is useful in practical arts as medicine, agriculture, and nautical where actual outcomes have to be predicted (Schacht and Meyerhof, 1937). This seems like the confusion between possibility and probability at first glance. However, more likely AlFarabi (870-950) believed that the laws of modal logic could be fine-tuned to work with “Probably” rather than a modal operator. Al-Farabi (870-950) says that “Necessarily every A is a B” and “Like most As are Bs” is treated as equivalents. Nevertheless, would not make a correlation between “Probably” with “Necessarily” instead of “Possibly”? There is further evidence that Al-Farabi (870-950) experimented with other sentence forms in modal logic. Both Avicenna (Street, 2001, 2015) and Averroes (1126-1198) quote Al-Farabi (870-950), for example, taking into account syllogism propositions that include “insofar as”, “Every A can be a B insofar as it is a B”. Al-Farabi (870-959) wrote some necessary and sufficient conditions for certainty (López-Farjeat, 2018; Black, 2006). He also points to the semantic range of acquisition: “either through a certain proof or persuasion through”. 1.5.1. Bivalent (Two-Value) Logic The term philosophy has a wide meaning, from a cloudy speculative fantasy to a piece of formal logic. Formal logic in philosophy until recently is considered as the Aristotelian (BC 384-322) bivalent logic of completely defined classes as true or false; positive or negative; black or white; beautiful or ugly, etc. All scientific hypotheses, theories and ideas are primarily measured based on this logic, and as a result, classical scientists emerged with dogmatic beliefs. The reason that so many academicians do not qualify as scientists is due to the certain nature of the binary logic. In this logical field, even cloudy, ambiguous, uncertain, and imprecise qualities are classified into strictly distinctive and mutually exclusive sections, and only one alternative is considered scientific (Chapters 2 and 7). None of the scientific knowledge is accountable as completely crisp without doubt; otherwise, scientific development cannot continue. Scientific development is not due to the exactness of the knowledge but rather due to vague characteristics. The terms vague, imprecise, uncertain, blurred, and cloudy are altogether referred to as fuzzy information (Zadeh, 1968). After the beneficial contributions of bivalent logic over the centuries, this book additionally proposes

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the use of fuzzy logic to determine the boundaries of scientific knowledge, especially in medical sciences. 1.5.2. Fuzzy Logic To clarify the distinction between formal bivalent (classical), symbolic (mathematical) and fuzzy logic, it should be noted that if something is true or thought to be true, it is given the number 1 and its alternative as 0, which implies the impossibility of intermediate situations. There is no mixture of the two states. In other words, partially right or wrong, which is the basis of human thought, is not taken into account. Fuzzy logic even assigns degrees of belief (degree of confirmation or falsification) to a scientific work that takes values between 0 and 1, inclusive. The verifiability of scientific knowledge or theories by logical positivism means that the limits of science are equal to 1, without including Farabi's (870-950) probabilistic proposition or Popper's (2012) falsification principle (Chapter 5). The conflict between verifiability and falsifiability of scientific theories involves fuzzy philosophical underpinnings, but many philosophers of science have come to solutions with the bivalent logic of clarity that goes against the nature of scientific development. Unfortunately, “fuzzy philosophy of science” has not been introduced sufficiently so far in the education system, although many philosophers of science have tried to resolve this problem by introducing the argument of probability (Carnap, 1987) and sometimes the possibility of the limits of scientific knowledge and scientific development has entered the literature sufficiently. Therefore, one of this book's purposes, especially in Chapter 8, is to explain fuzzy logic in the demarcation of medical knowledge and scientific progress. Scientists are not entirely objective in justifying scientific boundaries or progress, but the components of fuzzy logic are the impetus for the generation of new theories. The entire verifiability of the scientific rule can be tested by the fuzzy inference engine for better understanding and dissemination of knowledge (Chapter 3). In fact, all cases in many disciplines, especially medicine, have fuzzy features. The foundations of scientific philosophy include embedded fuzzy components. The dogmatic nature of scientific knowledge or belief gives the impression that science, the fruits of formal bivalent logic, is not in doubt, while fuzzy logic keeps the scientific arena alive and fertile for future scientific plantations and generations of knowledge. In a fuzzy proportion, the premises contain the reasons for the evidence and the subsequent parts represent the partial conclusion in agreement with the antecedent part. In this way, each position receives a share of the general representational logic and yields its own subsequent part, which is also partial. Logicians must recognize that not only can a proposition require or contradict other propositions,

Introduction

Scientific Philosophy and Principles in Medicine 15

but that propositions may also partially require or contradict other propositions. Therefore, we say that the results of some measurements are correct when they require acceptable premises; we can say that a conclusion is likely or possibly true when it is “partially” required by the premises we take for granted. In other words, where conclusions are necessary with respect to premises, it is likely that partially necessary conclusions are related to the premises. According to Keyne (1883-1946), probability includes the part of logic that deals with rational but imprecise arguments. The same sentence can be read using probability instead of possibility, which means that the antecedents contain fuzzy subsets. Therefore, it is part of logic, but not mathematics. The principles of fuzzy logic help to solve complex problems verbally through the basic rules of logic; philosophy is necessary for linguistic interpretations, which can lead to even bivalent and symbolic logical forms in mathematical formulations before the definition of logical information. The question here is to ensure that university graduates know the background verbal meaning of each formulation otherwise, they will be trained in a mechanical, traditional and rather static way (Şen, 2020). 1.5.2.1. Fuzzy Philosophy of Science Scientific consequences depend on the logical premises of the phenomena concerned. The proportions are verbal and linguistic expressions, and, therefore, contain vagueness and imprecision in the early stages of philosophical reflections. As more rational or empirical scientific evidence becomes available, the validity of these statements increases, but some uncertainty remains. Scientific statements are considered true based on assumptions, but more often than that, they are accepted with some degree of probability. However, attaching an objective probability to scientific statements is a difficult task, so in practice, subjective but more expert-based probabilistic proportions are added to medical treatments (Chapter 9). After a detailed explanation of the proponents and opponents of scientific absolute truth and probability, a fuzzy idea and hence degree of membership rather than probability is presented in considering fuzzy subsets (Chapter 8). 1.6. RECOMMENDATIONS After what has been mentioned in the previous sections, the following points are worth considering for better rational and innovative directions.

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1. Research and Development (R&D) activities, innovative ideas, procedures, methods and application instructions are possible for the most reasonable activities even with approximate decisions, provided that attention is paid to the principles of language, philosophy and logic. 2. The absence of innovations without basic research and application work may require initial costly investments, if they are not supported to a limited extent by private companies. 3. Systematic and mechanical education institutions can graduate students with certificates, but with such a document, their business and commercial interests may not be effective because innovation requires critical and sometimes offline ideas that can be even against classical systematic thinking. 4. Everything learned must pass through scientific principles, philosophy and logic, which are components of rational and reasonable ideas and aspects of innovation. In particular, logical thinking should lead to a set of rules for the task concerned. 5. Medical orientations should be intertwined with innovative ideas and applied in a superior way to attract public opinion and attention. 6. Medical instrumentation developments are possible with a physician-engineer team collaboration that exchanges knowledge and experience (Chapter 10). In such a team, the philosophical and logical principles of science provide a common platform of understanding among contributors. 1.7. BOOK CONTENT AND READING RECOMMENDATIONS This book is the result of such lecture notes considered in Turkish and English at Istanbul Medipol University, National and International Medical Schools. The book consists of ten chapters, and each of them describes the philosophy of science intertwined with medical science. In many countries, the philosophy of science, principles of logical inference, approximate reasoning, rationality and the history of medicine are not considered collectively in a plausible order. Throughout the book, there are topics that encourage medical professionals to share a common interest with engineers in the aspects of biomedical instrumentation (Chapter 10). This book highlights the importance of an inventory of innovative, productive ideas that should be based on scientific, philosophical and logical principles together with the collaboration of aspects of engineers to invent new ideas, tools, robots or at least their modifications to a certain extent. Human abilities include the educational dimension, experiences gained over time, and expert insights that can inspire a person to add new ideas to existing ones. These days, innovative

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findings provide ratings and economic benefits in nearly every aspect of life, including service industries. In all disciplines, there are different principles of thought that lead to knowledge and rational reasoning inferences. In this book, the following key points are suggested for the application of medical philosophical and logical principles. a. b. c. d. e. f. g. h. i. j. k. l. m. n. o. p.

Definition and fields of philosophy. Logic principles and rules. Philosophy and logic of medicine. Linguistic predicates and interferences in the medicine discipline. Medical words and sentences. Types of uncertainty and implications. Open-mind and validation. Scientific aspects. Cause-effect relationships. Crisp (bivalent), symbolic, probabilistic and fuzzy logics. Prognosis, verbal, meaningful, educational research. Fuzzy logic inferences in medicine. Rational medicine models. Medicine and computers. Medicine and engineering. Human engineering

Chapter 1 provides a brief overview of the scope content of all chapters, along with some of the key points in their discussion, including philosophy, logic, uncertainty principles and historical arguments. Chapter 2 presents different versions of thinking to arrive at plausible diagnoses with possible appropriate treatment decisions, all of which are explained to provide approximate reasoning. Chapter 3 concentrates on contributions from ancient Egyptian, Mesopotamian and Greek thinkers, and later Muslim philosophers and medical and pharmaceutical experts. Chapter 4 focuses on medical terminology in terms of words and sentences based on etymology and epistemology concepts, words, terms, definitions and sentences.

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Chapter 5 covers basic philosophical concepts and their implications for education systems. It is stated that without the philosophy of science, it is not possible to renew or change the existing methodological principles Chapter 6 highlights the wisdom in medical education by presenting the importance of philosophy in diagnostic and therapeutic treatments. Chapter 7 introduces bivalent (crisp) rule sets and inference systems to arrive at rationally applicable conclusions and their further applications. The concept of the symbolic logic matrix (SLM) encourages, above all, the search for logical relationships that can then be translated into a set of logical rules or simple mathematical expressions. Chapter 8 is about fuzzy logic principles, the most widely used linguistical communication tool in medical diagnosis work between physicist and patient, and guides the physicist to the most appropriate medical transcription alternatives. Chapter 9 provides information on numerical and graphical diagnosis methods based on probability, statistics and regression methodology with rational approaches. Chapter 10 exemplifies the diverse generation of instrument and laboratory equipment ideas and the use of various laboratory tools that require the collaboration of medical and engineering expert knowledge. In this chapter, various models are first explained verbally and then suitable mathematical models are obtained for the operation, management and maintenance of the medical devices by working on the engineering mathematical foundations. The following flowchart (Fig. 1.2) is designed to help readers address topics of interest, and those who are fully interested in the book can follow the path for convenience. While there are cross-references between chapters, the book is designed so that each chapter can be read with minimal overlaps. CONCLUSION Scientific and technological research, developments and innovations are the main drivers of today's commercialization for the survival of any company, society and country with a desire for an economic future. This chapter highlights the importance of an inventory of innovative, productive ideas that should be based on scientific, philosophical and logical principles along with engineering aspects found in every human who wants to invent new ideas, tools, gadgets, robots, and modifications at least to some extent. These human capabilities include the educational dimension, experience gained over time and expert insights that can

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inspire a person to add new ideas to existing ones. All these are explained by taking into account language, science, philosophical aspects and especially fuzzy logical principles with comparative explanation against the bivalent logic. SCIENIFIC PHILOSOPHY AND PRINCIPLES IN MEDICINE

MEDICAL TERMINOLOGIES

MEDICAL TERMINOLOGIES

PHILOSOPHY PRINCIPLES

Engineering interest

Philosophical

Logical interest

Numerical inetrest

interest

HISTORY OF MEDICINE

Terminology interest

THOUGHT PRINCIPLES AND TYPES

Historical interest

INTRODUCTION

PHILOSOPHY IN MEDICINE

LOGICAL PRINCIPLES AND RULES

FUZZY LOGIC INFERENCE IN MEDICINE

NUMERICAL AND GRAPHICAL DIAGNOSES

MEDICINE AND 19 ENGINEERING

Fig. (1.2). Book reading flow diagram traces.

REFERENCES Black, D.L. (2006). Knowledge (‘Ilm) and Certitude (yaqin) in al-Farabi’s Epistemology. Arab. Sci. Philos., 16(1), 11-45. [http://dx.doi.org/10.1017/S0957423906000221] Caplan, A.L. (1992). Does the philosophy of medicine exist? Theor. Med., 13(1), 67-77.

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[http://dx.doi.org/10.1007/BF00489220] [PMID: 1604434] Carnap, R. (1987). The Confirmation of Laws and Theories, Scientific Knowledge, edited by Janet A. Kourany, Wadsworth Publishing Company. Carnap, R. (1995). Introduction to the philosophy of science" New York: Dover Publivations, Inc.. Abu Elwan, R. (2015). The effect of teaching “chaos theory and fractal geometry” on geometric reasoning skills of secondary students. International Journal of Research in Education Methodology., 6(2), 804-815. [http://dx.doi.org/10.24297/ijrem.v6i2.3876] Ernan, M. (1987). Alternative Approaches to the Philosophy of Science, Scientific Knowledge, edited by Janet A. Kourany, Wadsworth Publishing Company. Frank, P.F. (1952). The Origin of the Separation between Science and Philosophy. Proceedings of the American Academy of Arts and Sciences,Contributions to the Analysis and Synthesis of Knowledge 2 Published by: American Academy of Arts & Sciences Stable 80(2), 115-139.The Origin of the Separation between Science and Philosophy., https://www.jstor.org/stable/20023644 [http://dx.doi.org/10.2307/20023644] Hodges, W., Therese-Anne, D. (2020). Al-Farabi’s Philosophy of Logic and Language. The Stanford Encyclopedia of Philosophy (Fall 2020 Edition), Edward N. Zalta (ed.) Al-Farabi’s Philosophy of Logic and Language.https://plato.stanford.edu/archives/fall2020/entries/al-farabi-logic/ Janicek, M., Hitchcock, D.L. (2004). Evidence-based practice: Logic and critical thinking in medicine. Chicago, IL: American Medical Association Press. Keynes, J.M. (1921). A treatise on probability. London, MacMillan London: MacMillan. Kuhn, T. (1970). The Structure of Scientific Revolutions Chicago.148. López-Farjeat, and Xavier, L., Al-Farabi’s Psychology and Epistemology. The Stanford Encyclopedia of Philosophy (Summer 2018 Edition), Edward N. Zalta (ed.), https://plato.stanford.edu/archives/ sum2018/entries/al-farabi-psych/ Peitgen, H.O., Jürgens, H., Saupe, D. (2004). Chaos and Fractals New Frontiers of Science, Springer, Second Edition: 853 pages. Popper, K. (2012). 14. Popper, K., (2012). The Logic of Scientific Discovery London, New York: Routledge Publishing Company.479. Ramsey, F.P. (1978). Truth and probability in foundations. Essays in Philosophy, Logic, Mathematics and Economics", edited by D. H. Mellor London: Routledge and Kegal Paul. Russel, B. (1948). Human knowledge: Its scope and limits. London: George Allen and Unwin. Schacht, J., Meyerhof, M. (1937). Maimonides against Galen, on Philosophy and Cosmogony. Bulletin of the Faculty of Arts of the University of Egypt (Majallat Kulliyat alĀdāb bi-al-Jāmi‘a al-Miṣriyya) 5, 53-88. Street, T., Campos, D.G. (2001). “The Eminent Later Scholar” in Avicenna’s Book of the Syllogism. Arab. Sci. Philos., 11(2), 205-218. [http://dx.doi.org/10.1017/S0957423901001096] Street, T. (2015). Arabic and Islamic Philosophy of Language and Logic. The Stanford Encyclopedia of Philosophy (Spring 2015 Edition), Edward N. Zalta (ed.). https://plato.stanford.edu/archives/spr2015/ entries/arabic-islamic-language/ [http://dx.doi.org/10.1353/pbm.2013.0019] Şen, Z. (2014). Philosophical, Logical and Scientific Perspectives in Engineering., Springer.56(2), 300-15. [http://dx.doi.org/10.1353/pbm.2013.0019] Şen, Z. (2020). Human engineering for innovative research and commercialization directions. International Journal of Research. Innovation and Commercialisation, 3(1) [http://dx.doi.org/10.1504/IJRIC.2020.109376]

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Şen, Z., .Human engineering for innovative research and commercialization directions. International Journal of Research, Innovation and Commercialisation 3(1) [http://dx.doi.org/10.1504/IJRIC.2020.109376] Tosam, M.J. (2014). The Role of Philosophy in Modern Medicine. Open J. Philos., 4(1), 75-84. [Published Online in SciRes ]. [http://www.scirp.org/journal/ojpp]. [http://dx.doi.org/10.4236/ojpp.2014.41011] Zadeh, L.A. (1968). Fuzzy algorithms. Inf. Control, 12(2), 94-102. [http://dx.doi.org/10.1016/S0019-9958(68)90211-8] Zadeh, L.A. (1972). A fuzzy-set theoretic interpretation of linguistic hedges. J. Cybern., 2(3), 4-34. [http://dx.doi.org/10.1080/01969727208542910] Zadeh, L.A. (1973). Outline of a new approach to the analysis of complex system and decision processes. IEEE Trans. Syst. Man Cybern., SMC-3(1), 28-44. [http://dx.doi.org/10.1109/TSMC.1973.5408575] Zadeh, L.A. (1974). Outline of a new approach to the analysis of complex system and decision processes,” IEEE Trans. Syst. Man, Cybern., SMC-3, 2844. Zadeh, L.A. (1974). On the analysis of large-scale systems,” Systems Approaches and Environment Problems, H. Gottinger, Ed. Gottingen, Germany: Vandenhoeck and Ruprecht 23-37.

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CHAPTER 2

Thought Principles and Science “It is not Possible to have Active Mind without Thought or Thought without Mind” Abstract: Thoughts are the triggering arrogance of rational thinking to explore possible relationships among different procedures that lead to reasonably acceptable results. To this end, in this chapter, different thinking procedures are clearly explained based on the principles of proportional inference and interpretation that lead to acceptable and ultimately useful generations of knowledge, even though they may contain an element of uncertainty at the current level of scientific knowledge. The basic questions that are valid today and will be valid in the future throughout the history of science are “How?” and “Why?” A series of suggestions are given to find answers to these questions. Especially in medical sciences, the principles of mind (brain)-heart communication are explained for the production of linguistically comfortable and acceptable information. A series of suggestions are made about ways to find answers to these questions from thinkers in different cultural civilizations, which are the basic elements of the history of science. Finally, examples from the history of science are given in detail for the development of verbal knowledge developments.

Keywords: Analogy, Deduction, Induction, Positivism, Rationality, Reasoning, Thinking elements. 2.1. GENERAL Prior to anything in this book, there is a distinction between the words thought (opinion, idea, mind, consideration, imagination, concept and proposal) and thinking (consideration, cerebration-mind activities, cogitation, drift and reasoning). The former implies all available information and knowledge ready for use in the mind and memory, whereas the latter is the dynamism of this knowledge to reach better improvements, modifications, innovations and sustainable idea generations. Everybody is conscious under the light of consciousness. Even though one is left alone away from every physical thing, the thoughts do not leave him/her alone. Human beings perceive, understand and grasp knowledge by thinking, and therefore, can manage and arrange their Zekâi Şen All rights reserved-© 2022 Bentham Science Publishers

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thoughts for further thinking media. With inspiration from the environment and surrounding medium conditions, a human can imagine and generate different thoughts as a mind factory production. Thinking ability and process are given to humanity as gifts from Allah (God), and continue in a sustainable manner through a set of evolutions from birth to death. The triggering effects of thinking are family life, social, cultural, traditional, economic, and educational institutions through which one can arrange daily life in a sustainable manner by means of philosophical thinking and subsequent logical inferences. The term philosophy has a wide meaning, including from a “cloudy speculative” fancy to a piece of “formal logic.” Philosophy and logic are the basic tools of thought sustenance and thinking activity to reach rational conclusions. They provide different perceptions, views and real and imaginary subject shapes through bodily sense organs, which provide virtue formation to minds, and afterwards they collectively help to approach reality as close as possible with additional new ideas generation. Two important concepts concerning thoughts and thinking are information and knowledge. The former refers to the awareness (understanding) about the subject through personal experience and education; the latter is a clear form of knowledge that is helpful for understanding the core meaning. On the other hand, knowledge is the objective information that has relevance and helps reach rational conclusions. After the procession of thoughts with information and its refined form of knowledge in mind, they are transferable to other individuals with a common language, and accordingly, intellectual, almost intellectual and quite intellectual individuals start to appear in society. Verbal and numerical knowledge is converted to logical rules along cause-result (input-output) relationships leading to rational conclusions. In this manner, the knowledge that is not harmonious in the philosophical arena takes systematic and rational forms by means of logical tools. Philosophy and logic together lead to harmonious, sustainable and rational thoughts and thinking procedures in society. Systematic forms of haphazard thought arrangements of philosophical and logical thinking started to appear about 2500 years ago before Christ (BC). Even before these years, there were preliminary pieces of philosophical and logical thinking capabilities among human beings. Starting from Thales (BC 623-545), as the first philosopher, ancient Greek philosophy opened the doors to a particular way of thinking that planted the roots for the intellectual tradition. Here, there is often an explicit preference for the life of reason and rational thought (Wrenn, 1995). The philosopher, who first systemized philosophy and logic was the ancient Greek thinker Aristoteles (BC 384-322), and therefore, philosophy can be classified into two temporal parts as before and after him. Thinking capability and its natural result in the form of logic leading to rational inferences have developed

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during various civilizations at different regions for some periods of time. For this reason, philosophy and logic fundamentals were searchable in the civilizations even before the ancient Greek period. Systematic linguistic, verbal, geometric, arithmetic, and number forms appear as archeological remnants. After the philosophical imaginations and thinking, even prehistoric pictures, animations, patterns on the cave walls and handmade gadgets such as pottery, cups, wheel and lever give the impression of many early technological activities during pre-ancient Greek civilization. Medical practices and knowledge came along different civilizations in an accumulative manner up today. Today, the reason why the thoughts and thinking systematization is from the ancient Greek civilization is due to their rational combination of speculative thoughts by means of philosophy and logic. One can even ask, from where did the systematization of Greek thinkers take their original ideas and further develop and improve them? The answer is primarily from the ancient Egyptian and Mesopotamian civilizations (Chapter 3). Among the ancient civilizations' philosophical and logical thinking principles, there was syllogism (logical comparison), leading to practical inferences rather than irrational consequences. During the ancient Greek civilization, even in the shadows of speculative thinking, the principles took clear forms under the light of logical principles. The existence of such rules became shareable by many individuals, and hence, more intellectual societies started to appear. Initially, logic depended on propositions coupled with critical thinking that led to rational consequences (Chapter 7). During the ancient Greek civilization, importance was not given to experimentation, but the thinking path was on the way of rational and logical inferences only. Another example of critical thinking is to benefit from thought storage for a combination of the necessary parts, similar to jigsaw puzzle games. The following points emerge from thought and critical thinking. 1. The whole is based on the use of the inductive thinking and deduction method by dividing it into small parts as explained in Section 2.5.2. 2. The number of parts is certain, but none of the parts are the same so they have randomness, or uncertainty. 3. Three different tips are used to interlock the parts. These are. a. Searching for the compatibility in the interlocking of the parts. b. Searching for meaningful matching by naked eye looking at the whole picture. c. In addition, investigation of texture (picture) suitability.

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4. The use of trial and error (a series of tests) frequently steps in critical thinking studies. Rational thinking targets a phenomenon and tries to answer different questions during a problem solution. The thinker should try to understand verbally the generation mechanism of the phenomenon and while trying to understand the parts separately, it is actually a matter of revealing their physical functioning. It is necessary to reveal the generation mechanism orally, first in the form of philosophical knowledge and then as logic rules deductions. One can list additional points for critical thinking as follows: (1) Determining the critical philosophical (verbal) expressions of the first knowledge. (2) Make logic propositions at every step of the research. (3) Propose hypotheses related to the behavior of the event under consideration leading to an acceptable theory. (4) All possible tests (experiments) of the hypothesis need completion. Here comes the mind experiment first, and then the test with observations and measurements. (5) It is also important to express the results by mathematical symbols, which are correct under the falsification thread. In classical thinking, people place the information they receive in their minds without judgment, assuming that they have been verified before. These people almost believe in the necessity of protecting the information, which they are easily accustomed to giving importance to the issues about where and how to use the information, as if they are static, and they protect it like a taboo instead of criticizing them. Belief is related to the heart, some people, especially those who attach importance to materialistic rational knowledge seal their freedom of thought by unwittingly believing in the information. The classical knowledge, just like opium, that enters the human mind and descends to the heart is no longer discussed, criticized and improved. Hence, human become a prisoner to his own knowledge, and even if one says that knowledge is not naturalistic, s/he becomes stuck in a natural mysticism. In this respect, in the classical education systems’ thought becomes dull with the information that is given almost in the form of pills, which are swallowed without digestion. In societies where classical thoughts exist, the flow of information does not change over the years. Political and historical information also becomes very dull

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and uncritical, and therefore, the prevailing opinion does not allow for rationalism. However, uncritical information cannot benefit knowledge, because the evolution of thought and knowledge is through critical thinking. The more the rational criticisms, the more widespread is the knowledge development, productivity and informatics in a society. Those who enter the early educational institutions with rather authorial thought face a system that does not give importance to the critical thinking, but ready thoughts acceptance and instead of discussion, they remain silent with cloudy irrational explanations. In order to generate information and knowledge useful to society and eventually to humanity, active critical thinking must dominate thoughts. In cases of no productive thought, the rules of logic do not work. In front of the question “What is thought, or thinking?” one can not make distinction easily. Everybody is conscious and, therefore, thinks about the objects and events to some degree, but the thinking activity is not concerned with objectivity, because there are many subjectivities. In fact, thinking is an activity that is very difficult to define objectively. It has also an omnipresence in our consciousness, and hence, one takes for granted that s/he knows what is meant by “thinking”. Thoughts are ready knowledge accumulations as prescriptions in the memory. Thinking is the brain activity and thought is the human memory storage of knowledge. On the thinking issue, philosophers Thomas Hobbes (1588-1679) and Gottfried Wilhelm Leibniz (1646-1716) advise continuous contemplation. In this chapter, the fundamental principles of thinking based on thoughts are discussed and possible relationships are presented among different thinking procedures explicitly. In the first sections, mention has concentrated on different thinking stages and after the propositional inferences, final knowledge generations are specified. The primary purpose from such an approach is to reach at the end to rational information through the critical thinking arguments, propositions, and inferences and also to bring them into widespread acceptable forms. 2.2. Thought Inferences In human thinking, thoughts exist in two ways. The first ones depend on the brain, mind and memory activities; and the second are inspirations, in other words, heart feelings under emotional impacts. As pervasive and vital as they are in human experience, emotions have long remained an enigma to science (McCarty, 2019). Thoughts may lead to inference within inferences, where rational, materialistic directions are concerned with mind, and the spiritual (intangible, incorporeal, inert, religion, metaphysics and moral) directions are related to the heart. During the history of philosophy, debates among thinkers and philosophers made distinction between mind and heart knowledge and some time the heart is

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considered at the peak of thoughts. The author of this book thinks that inferences are obtained through the rational thinking based on partially uncertain thoughts, and the ones that have ripened and reached at the scientific level, are approved by the heart, and hence, become more sustainable and durable in mind. Thoughts that are approved by the heart are hardly variable, but they are subject to improvements through innovative approaches leading to better information and knowledge contents. Human beings, as biologically vivid and rational creatures, are not concerned only with the materialistic aspects of the knowledge development. It is not necessary that every person should bulge to improve and develop materialistic knowledge only, but one is also affected by the surrounding environment and objects, and hence, thoughts may change over time; one may feel spiritually comfortable after the approval of any new knowledge by heart or may not need to such approval. However, much of the information approved by heart does not change easily; most often, they are related to the belief and faith aspects. After their imprints in the heart, the ones that are concerned with, for instance, religious, nationalistic or some intangible thoughts, they do not change by time easily. The subject of this book is not concerned with the knowledge that are approvable by heart, but the ones that are beneficial to human in daily life scientifically based on philosophical and logical principles leading to rationally acceptable consequences. It is not possible to state that the knowledge perception by the mind and heart is completely independent of each other. There were not thinkers or philosophers, who advocated that they are not affected mutually and have distinctive thought tracks completely. Artificially distinctive thoughts occurred throughout the history based on various methodologies. For example, positivistic (rationalism) thinking way has selected ignorance of belief, mysticism and metaphysical thoughts. However, throughout the history of science, many thinkers and philosophers have expressed their views openly, even outside rationalism. In positivism, nonmaterialistic and untestable knowledge is not accepted as scientific information (August Compte, 1798-1857). He even stated that each department of knowledge passes through three stages: theoretic, theological and metaphysical or abstract. According to these stages, some of the thinkers opened the doors for their mystical, metaphysical and belief dimensions in cooperation with scientific principles. In recent years, pure rationalism and positivism are in recession and instead, in scientific research, mysticism, metaphysics and spiritual aspects take place to a certain extent by some scientists, but scientific end products do not include these features, because they are objective. Thought and thinking are two subjective human activities that cannot be defined objectively, but each individual lives with them in a conscious way throughout life. Each one knows omnipresence consciousness by the perception of the objects

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around him/her or in the mind even though they mean visionary something in the thinking activity with input supports from all sense organs either from real or virtual environment. More information on such aspects is available from the works of Thomas Hobbes (1588-1679) and Gottfried Wilhelm Leibniz (1646716). Like the computers, the thinking process is the software for brain hardware. In any scientific and technological work humans must not forget themselves. In our days, variety of ready software is taken as the source of knowledge by letter by letter complication, and hence, solution is obtained almost without criticism. Any software has the collection of linguistic (philosophical), and especially, logic principles’ systematic flow charts to convert input data to output. Thinking might take place either internally or externally by talking to others and it gives one spiritual, mystical or virtual deeds. Thinking products are expressed in language by words, sentences, arguments and propositions. On the other hand, thoughts provide the priory basis that is activateable by thinking principles to reach at better interpretations and decisions. One can say that thought and thinking feed each other like hen or egg problem. Of course, thoughts are not triggered only by individual’s own thinking capabilities, but impacts from others also play significant role. (Fig 2.1) implies similarity between a tree and thoughtthinking chain. The structure in this Fig represents composite and successive interdependence between the elements with ripeness and as end products. Hence, the thoughts and thinking elements renew each other leading to thought improvements and ripeness, where the old-fashioned ones are dropped from the thought background as rottenness and renewal thinking process produces new ones. Sometime the old or first thoughts about the phenomenon of concern are forgettable or deleteable completely by replacement with better alternatives. The thought and thinking activities are flexible, purposive, self-developing and at times automatically grasped under the light of new facts. Although science is pure and unique in terms of its principles, in societies that are knowledgeable, everyone can assume that their subject is scientific and argue differently from others. The reason for this is the lack of philosophy of science and scientific qualifications. The origin of science is unique, just like a seed, but branches from a single stem emerge, and eventually the fruits of science bud and start to mature. More information on this aspect is available in the book by Şen (2014). At this stage it is worthwhile to remind two sayings by Chinese philosopher Confucius (BC 552-479) as follows. “He, who learns but does not think, is lost! He who thinks but does not learn is in great danger.”

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“When you know a thing, to hold that you know it; and when you do not know a thing, to allow that you do not know it – this is knowledge.” Thought is the transmission of external environmental effects perceived by the human sensory organs to the brain through body neural networks and take shape according to different fictional scenarios and models that are quite personal, but deductions are respectable by others. As a result of these inferences, not only material, but also personal characteristics arise, such as intuition, feeling, belief and mysticism. In this respect, material resources are mentionables in the form of the first information source depending on perceptions from the outside world as information sources. The externally perceived effects for the thought formations are mostly material, but not all thoughts have only materialistic origin. It is also possible for a person to make inferences with very personal judgments as own delusional disorder. The source of the thought formed in this way is not materialistic.

Prepositions

Sentences

Argumants

Invalid arguments

Words

Fig. (2.1). Thinking structure.

2.2.1. Mind-Heart Individuals strictly dependent on the pure scientific principles are not able or cannot accept simultaneous and cooperative functioning of mind and heart. In fact, mind (brain) and heart communicate with each other continuously. If someone feels a danger then heart beats start immediately at faster rate than at peace and relaxation cases. This point implies that even in medical treatments mind-heart couple functioning has some share depending on the dialog between the physician and patient (Chua and Bliss-Moreau, 2016). Al et al. (2020)

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mentioned that the brain continuously receives signals from the body and the environment. Although one is mostly unaware of internal bodily processes, such as the heart beats, which can affect the perception. There are two distinct ways in which the heart beat modulates conscious perception. At this stage a point for remembrance is that spirituality does not mean religion only. Along the history, some religions have been in clash with the scientific thoughts, for instance, before the renaissance in Europe due to the church authority. However, not all the religions had the same authoritative impacts against the scientific activities. It is not necessary that one should be atheist for rational scientific inferences, because these thoughts originate from the heart rather and ripen in the mind. It is a fact that the mind feeds back to heart and vice versa. It is enough to invite the two ends to work jointly to reach at the best result. Of course, rational thinking in mind must shed light on the heart as it is the central approval authority. It may not be possible to approve all the information by heart or mind. Especially, scientific information must have an objective character for acceptance by all. It is never under the authority of an individual or authoritative group for subjective benefits. Chao and Bliss-Moreau (2016) stated that “humans experience is a unified self that integrates our mental lives and physical bodies, but many studies focus on isolated domains of self-knowledge. We tested the hypothesis that knowledge of one’s mind and body are related by examining metamemory and interoception. We evaluated two dimensions of metamemory and interoception: subjective beliefs and the accuracy of those beliefs compared to objective criteria. Taken together, these findings suggest a common mechanism subserving knowledge of our cognitive and bodily states.” Those who have classical thinking way take the information and then keep in their minds and hearts without any critical reasoning. They are satisfied to know where to apply this information automatically without any criticism or improvement. They stamp their thinking freedom by grasping the information in the name of rationalism and put them into their heart, which implies that they have full faith and belief in the correctness of the scientific information. In this manner, classical thinking rests in the heart and consolidates in the minds of those who think that they are independent and do not need improvement. The classical thinking starts in this manner, and hence, human become slave to such information even though they may think that the information should not be dogmatic. In this manner, perhaps unconsciously they dive into the mysticism oceans. This renders the thinking activity into a rather dogmatic procedure, and by this way, they swallow up the pills without digestion leading to any curement in thinking. In this manner, artificial thinkers start to appear in the media, because information generation, renewability, evolution and innovative improvement towards new horizons are

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shackled. In such societies, it is rarely possible to see informationally lively individuals, and therefore, this domain is fulfilled by stagnant informational possessing individuals, who do not care about dynamic and generative thinking activities. In these societies not only information dogmatization is valid, but also divinized persons appear by support of some groups. Under such circumstances, instead of information generation, artificial personalities and graduations from education institutions generate an army of individuals without critical thinking. They can establish scenarios in their groups not by quality but by quantity. A society without the classical thinking is bound to accept any information from others as prescriptions without generative thinking. Herein, not only scientific information, but art, music, culture, belief, and traditional aspects are also accepted without assessments and critics. Virtually the society remains as scientifically nonproductive; generatively stagnant and dependent on the information accumulation only. Since there is no dynamism in thinking process, they cannot control the quality of input information, and hence, additional information production is not achieveable. In classical thinking societies, the information flow does not change many years, and in the meantime, since thinking is out of rationalism, information takes place dogmatically. It is well-known that any information without criticism is not scientifically acceptable, because criticism is the necessary deed for information evolution and improvement. Any society without critical views cannot generate innovation and improvement in the present level of knowledge. Furthermore, youngsters attending education institutions for new information gain may lose their childhood freedom in thinking, confronted with classical information, and hence, instead of critical thinking, they respect the authorities in the society. As a result, one may think in terms of personal benefit and self-information gathering instead of information generation dissemination, improvement and dynamism. If there is no critical though and thinking at a place or time neither the philosophical nor the logical principles work for betterment. In the classical thinking systems, authorities try to show that information is excellent and they should remain as they are without any improvement. Unfortunately, in many education systems, the information is imported without any new idea generation, and therefore, the information resources are not renewably active (Section 2.2.4). Consequently, others take place in the society to market practical information under the “know-how” implications. Instead of trying to obtain innovative and improved practical knowledge, the society may fall into information sterilization and humans may become problematic with each other. The only thing that remains for the people to do is to press a button, arrange extravagant opening ceremonies and advertisements, which show as if the best is achieved. If there are not sufficient research institutions or centers, the problems

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are thought to originate from the miss cooperation among the universities, states and industries without an effective triple cooperation, which is advised to be strengthened always. Especially politicians, bureaucrats and academicians are divinized as individuals or research groups, and they are appointed for administrations to control many mechanisms without capability and ambition towards future horizontals of science and technology. Confucius (BC 552-479) stated the following quote. “The more man meditates upon good thoughts; the better will be his world and the world at large.” It is well-known that in science prime importance is given to mind, but ponderances over the following sayings may provide connection between mind and heart affairs (http://www.sachastewart.net/blog/2018/5/3/the-wisdom- of-th-heart. Visited on 22 March, 2021) “Your heart holds your inner knowledge and true authentic self; however we rarely take time to connect in to understand its wisdom.” “Your mind can get caught up in a whole load of judgement, story-telling, negative thinking, and past belief patterns that aren’t actually reality, or true in this time of your life.” “It’s easy to become side-tracked by what you think you “should” do, or what you “can’t” do, going over all the pro’s and con’s trying to Fig out in the mind the right path to take, how you should handle things, or the choices you should make.” “However, it’s the heart that helps you to connect to what is true for you, to that internal instinct and inner calling. I love the yogic philosophy of the head bowing down and surrendering to the heart. The heart has the deep inner wisdom, and then the intelligence of the mind can Fig out how to make it evolve.” “Scientifically the heart and the brain are always talking, and the heart sends a lot more messages to the brain, than the brain sends to the heart. In fact the heart contains 65% neural cells that store memory and knowledge, and it significantly affects how we view the world.” “Bring to mind something, or someone, that you have genuine care for; feeling a sense of appreciation and gratitude. Rather than letting this just be a thought,

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really receiving this as a felt sense in the body. This builds the coherence between the mind and the heart allowing them comes together in harmony.” 2.2.2. Standardization Trap As consequences of above circumstances, there are many meetings, ceremonies, plenty of award and plate distributions, but less work, less scientific prediction, less innovation or modification with imitations, which are defendable more even though they are not very effective. In these societies instead of knowledge generation based on critical thinking, stagnantly thinking personals carry authoritative orders with dogmatic, classical, standard and conventional information bases. Those who are at the corner stones in such societies try to appoint others, who can get orders and do whatever the authority orders, and hence, everything take the standard model form. These personnel are presented as intellectuals and awarded with titles and high positions. In societies, where standard, normal and no extraordinary individuals emerge, there is not real enlightenment due to the absence of generative critical thinking and the social problems is bound to increase without satisfactory solutions. In order to get rid of such conditions, it is necessary to attach significance to rational and critical thinking with attachment to science philosophy and logic principles as explained in the next chapters and sections of this book. In societies, where there is not sufficient information generation, readily available ones are insufficient or missing the discussions among the personnel is regarded like undepleateable knowledge sources. The meaning of modernization is understood as against the local culture and tradition, and hence, the society is regimented by these ideas. Scientifically unproductive thoughts are extended to far horizons by those who advocate the loyalty to standardize institutions. In our days, knowledgeable person is not the one who accumulates information, but generates knowledge even within local cultural and traditional environments. Stagnant knowledge recognition is defective classical standard systems. Real recognition as an expert is possible in societies, where there are competitive, generative non-standard thinking media. In the classically thinking societies individuals who wish to generate, develop or improve knowledge are met with difficulties, where the standard thinking may lead to some worldly views only without rational knowledge dissemination. In some societies such thoughts provide personal interest without any benefit to the society. Unfortunately, there are such groups in societies, where knowledge sources are unconsciously based on incomplete mutual understanding, and hence, there is meagerly fundamental knowledge generation, if any. The scientific journals in these societies may be numerous, but they remain as the media for

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paper publications without open door for criticism. Such journals cannot reach at international respect levels. In the meetings, there may appear scientifically brutal debates instead of critical discussions. In any society, where there is not knowledge generation with critical thinking, there may arise thoughts as the local cultural traditions, customs, beliefs, religion and judgment, which may block scientific development completely or partially. In this respect, they may even choose the way of belittling the culture and native language as not being scientific. In the history of science, there are no civilization enlightenments that prospered rationally and scientifically irrespective of local traditions and language. Among such societies, there are the ones, who think that there are not corresponding words or sentences in the native language, and therefore, they prefer to convert the education language to a foreign one with the expectation that individuals will be more enlightened. If the history of science is reviewed then one can realize that many nations translated foreign philosophical, logical and scientific documents to native language, and hence, enlightenment is spread in the society without any distinction between educated and non-educated (Chapter 3). These societies are bound in long-term to understand their mistake, but it might be too late for back return, because there is no remnant of trust to own culture and language under the foreign impacts. In the extraordinary structure of scientific thoughts, there are directions to get away from taboos, dogmatism and scientism. Any individual may construct in own soul without bothering anybody extraordinary borders of critical thinking domains based on rational scenarios, and hence, knowledge generation ways are kept open continuously. However, sole thinking may not lead to beneficial scientific results. For this purpose, the philosophy of science coupled with logical principles are leaders as explained in the following chapters of this book.

2.2.3. Thinking Elements Thinking in terms of wisdom refers to forms of reasoning and deliberation in which knowledge, reflection, attitude and life experience are combined with emotional, social, and ethical capacities. Human can gather information about the internal and external worlds by thinking, which is a phenomenon that accumulates rationally in the generative manner by time. At the root of all knowledge, there are words, terms, concepts, sentences, propositions and in addition to their philosophical mixture and logical principles for verbal inferences. The dynamo of the information generation factory is the philosophy (critical thinking), and rational control tool of productions is logical principles. Anybody who complies with the philosophy and logic rules ends up with linguistic (verbal) information.

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Even by approximate reasoning, they keep the knowledge in their minds as dynamic thoughts imprints. At the time of need, they provide linguistical solutions by activating their intelligence through dynamic thinking. The common language is a tool to transfer available knowledge to other individuals in the society. The fundamentals of any problem do not end up with solution without critical assessments. However, by usage of the philosophical and subsequent logical rule applications based on the thought storage in the memory, one can reach at better solutions with conviction. If necessary, they convert all linguistical information into symbols, and hence, start to furnish mathematical principles for analysis leading to formulations, equations and algorithmic analytical and numerical solutions by computers. The main purpose of education is to expose distinguishable, clear, transparent and rational knowledge as the thinking sources. To collect knowledge just for “to know” is the way of memorization and to store them in the mind (memory) stagnantly. The essence of real education is to teach students art of thinking processes. The fundamental principle in education is to avoid memorization and dogmatisms, the so called scientism knowledge, but to equip and encourage the learner with critical reasoning principles. It is not necessary that the end product of every reasoning leads to rational information. Questioning helps to expose any incompleteness and by critical reasoning one can approach rationally at least to approximate truth. Common people may communicate daily with their nonproductive thinking way and they can end up with neither solutions nor improvements. As a result of this, there remains an individual that cannot produce, but criticizes others and the system that remains continuously without any improvement or betterment suggestions. In this respect, critical thinking ability is the most essential need in life. Stanovich et al. (2000) stated that much research in the last two decades has demonstrated that human responses deviate from the performance deemed normative according to various models of decision making and rational judgment (e.g., the basic axioms of utility theory). This gap between the normative and the descriptive thinking is interpretable as systematic irrationalities in human cognition. However, four alternative interpretations preserve the assumption that human behavior and cognition are largely rational. 1. 2. 3. 4.

Performance errors. Computational limitations. The wrong norm application by the experimenter. A different construal of the task by the subject.

On the other hand, Oaksford and Chater (2009) considered humans as the rational creatures similar to Aristotle (BC 384-322). The borderline between rationality

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and irrationality is fundamental to many aspects of human life including the law, medicine, mental health, and language interpretation. Thinking principles are explained in various sources (Claxton, 2006; Beghetto and Kaufmann, 2007), and hence, provide objectivity in thinking. Rothstein and Santana (2015) described the question formulation technique as developed by the authors over several years of working with learners across a range of socio-economic backgrounds, including bilingual learners. Thinking ability is specific subjective drive in human, which leads to production of further generative ideas, and takes its final shape after passing through proper processes. For this reason, in order to keep thinking alive, thinking elements must be taken into consideration always. Thinking elements are inborn faculties, but they can be improved by time through societal or formal education stages. In front of a question, “What is the main element to have a good life?” one can answer that happy and comfortable life depends on critical thinking. Especially, such happiness triggered by verbal knowledge (philosophy) and its trimming tool of logic helps to produce better knowledge, and in this way happy man conveys happiness to other individuals, which further increases in the mutual happiness. Any person can gain comfort by thinking about the social life, selection, decisionmaking, responsibility, technology, science, human relations, mutual knowledge share, moral values and behaviors, empathy, and collective living culture. 2.2.4. Thinking in Education By means of thinking ability possession through education, one can further improve rational production quality. In principle, it is necessary to work for critical thinking ability level of any individual to reach at a higher level. For this purpose, it is necessary to tame thinking capability on any topic with concerns of philosophical principles and logical rules. The real thinking is the process of directing this ability by means of correct rational rules. It is, therefore, necessary to activate thinking on the basis of existing thoughts towards better idea generation domains. Any successful education system realizes that the thinking is a gainable ability. The main purpose is to develop and improve students’ thinking abilities in an accelerative manner. It is certain that the thinking capability has a direct relationship with mother tongue. In a study by Özcan (2009) on the secondary school students’ thinking and project development, it is mentioned that these activities augment the thinking capabilities and project development skills. All such studies indicate that the students starting even from the primary school, and preferably secondary school need empowerment with basic philosophical principles, and especially, logical rules so that they can rely on their thinking capabilities and generate new ideas by

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commenting any information or knowledge that they come across, and hence, gain self-confidence. The effective elements on the productive thinking in education provide linguistic rationality, flexibility; and successful tests. According to the conclusions of various researches, supportive effects of productive thinking principles and information technology elements help to develop thinking skills and in the mean-time academic succession rate improvements (Aranda et. al., 2019). In another experimental study, Asma et al. (2011) observed that the science and technology education support the thinking capabilities of primary school students. Finally, based on various researches and by taking into consideration the student understanding problems, critical thinking appears as an essential part in the overall educational system. This is a good start to direct even the primary school students towards thinking and critics. Many thinkers allege that thinking capabilities, especially, during education help to sharpen personal ability for selfreliance confidence. Prior to anything, the teacher must have the capability of critical thinking principles under the light of aforementioned explanations. Fig. (2.2) presents various stages in an educational status, which reflects the basic understanding principles, knowledge gathering and inference skills. The three supportive types of understanding and knowledge are mutually inclusive to certain extends, and hence, in the education rather than crisp (two-value) logic (Chapter 7), the principles of rather uncertain fuzzy logic (Chapter 8) lightens the way to rational conclusions including the crisp logic as extreme cases. The defective points in any traditional education system can be specified and summarized as follows. 1. There is a though authority of teaches, who are directed according to a set of state or traditional rules, which may not give freedom to generative critical thinking. In such a system, logic means any answer to any question as either black or white (two-value logic). This is classical logical attitude towards the problem solving. 2. Teaching media, which is referable to as educational gadgets, may become indispensable units and they are exploited in a crisp and rather hardware flexible manner without change throughout years. In some communities, such devices may easily become show off instruments for attention as technological wonders rather than basic educational concepts. 3. There are ready answers expectation to questions in textbook style, which are only jointly shared by different learners and teachers alike without uncertainty. 4. Scientific concepts are provided in a crisp manner as if there is only one way of thinking and solving the problems with scientific certainty.

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5. Assumptions, hypotheses and idealizations are the common means for mind to grasp the natural phenomena, and therefore, any scientific conclusion or equation is valid under certain simplifications.

EDUCATION STATUS INITIAL DOMAIN Interest, Appreciation, Emotionality, Values, Attitudes PHYSOLOGY Manupilation, Inference, Organized skill

COGNIVITY Knowledge, Abilities, Skills, Intelect, knowledge

Fig. (2.2). Education system basic understanding and knowledge gain compositions.

On the other hand, in a modern and innovative educational system, the following points are considerable, which are contrary to classical or traditional education.

1. Traditional and classical elements minimizations are necessary and even their refusal from an innovative education system. The teacher is the one who is knowledgeable and has knowledge giving ability. 2. The students should try to force the educational gadgets dependent teachers through discussions and questions on the margins of the presently available information for improvement. 3. Each scientific conclusion is subject to uncertainty, and hence, further information refinements should lead to modifications for innovative ideas. 4. In the education agenda, the philosophical bases and logical principles need

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empowerment by teachers so that each student can grasp and approach the problem with own abilities. 5. Falsifiability principle of Popper (1955) enhances scientific conclusions or theories rather than exactness or concrete belief. According to the author’s view as explained above, in many countries the reason why productive education system is not available, is due to the missing of the scientific philosophical and logical principles. If basic education system is based on a foreign language instead of native one, then the productive and innovative information generation abilities are unsharpened, where common people cannot benefit and appreciate basic concepts mutually in their own language. The fundamental bases in any education system are to enrich the ability of thinking by science philosophy and logical approaches with the approximate reasoning principles for new, modified or innovative information generations. Any education system without these approaches is like infertile information and knowledge soil with meager idea harvesting. The author of this book wishes that if he is given permission to establish an education institution then the following items are harmoniously successful according to their significance levels. 1. 2. 3. 4. 5. 6.

Native language. Thinking principles and science philosophy. Logic and especially fuzzy logic. Science history. Geometry (Shape information). Phenomenological and physical event appreciation, i.e., to appreciate the generation mechanism verbally and then experimentally. 7. Mathematics. 2.3. REASONABLE THINKING TYPES There are practical and theoretical human reasonable thinking categories. The practical group includes personal, family, society, national and at the end humanitarian ethics, moral, and behavioral rules with dialog among individuals, where philosophical principles and logical rules are not as effective as in the cases of theoretical thinking, due to the effects of traditional, religious and national feelings. On the other hand, in the theoretical thinking group, as will be explained later in this book, maximum benefit from philosophical and logical principles is in the scene starting from rational imaginations to reach scientific inferences. After theoretical reasoning, the knowledge inferences are objective and valid, and

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therefore, they are collectively referred to as scientific information. Reasoning types can be classified as follows. 1. Critical reasoning: One must not forget that even the scientific information is not absolutely true, but they are probabilistic (Al-Farabi, 872-950) falsifiable (Popper, 1955). For this reason, during the information evolution, end product knowledge is criticizeable at every stage. The validity of confirmation between the knowledge and reality is testable and in this way knowledge improvements take place continuously. Not only the sources of knowledge are questionable, but also their quality, and final inferences. Thomson (1996) states that critical reasoning is centrally concerned with giving reasons for one’s beliefs and actions, analyzing and evaluating own and other individuals’ reasoning. Common to these activities are certain distinct skills, for example, recognizing reasons and conclusions, assumptions, drawing conclusions, appraising evidence and evaluating statements, judging whether conclusions are warranted, and underlying all of these skills is the ability to use language with clarity and discrimination. 2. Productive reasoning: Available knowledge clusters are questionable for their continuity and validity under new conditions and possibility of alternative solutions, flexibility properties remembrance and hence, the care for validity limits. Monk (1980) suggested that there has been a common and influential view of scientific research that it has two aspects as thinking up hypotheses with theories (context of discovery) and evaluating them (context of justification). The first is held to be a psychological process, not amenable to logical analysis, and not within the province of philosophical study. Only the second is held to admit logical or rational reconstruction. On the strength of these doctrines, philosophers in the mainstream have confined their attention to the logical reconstruction of the science results, ignoring their generation. 3. Ontological reasoning: Here not only materialistic life means are reasoned, but additionally metaphysical events are also taken into consideration in order to understand the meaning and value of the real life. For instance, the subjects of birth, death, after death, and especially, religion related affairs are considerable in a convenient systematic domain. It is said that this reasoning type is not scientific, but the author of this book states that in scientific reasoning such types may play role provided that at the end philosophical and logical principles are applied rationally. In other words, such metaphysical feelings may trigger the ambition to make scientific researches. Ontological reasoning means collaborative problem solving in which a communication group is agreed upon by the participating information prior to the communication actually taking place. Hence, ontological reasoning implies collaborative problem solving in which several simplifying assumptions take

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place. da Silva and Agusti-Cullell (2009) defined ontological reasoning as means of collaborative problem solving in which a communication space is agreed upon by the participating agents prior to the communication actually taking place. Hence, ontological reasoning implies collaborative problem solving in which several simplifying assumptions take place. 4. Practical reasoning: Any type of reasoning in daily life of an individual enters into this category. Among this type of reasoning life facilitators are basic knowledge, ability, practical methods and techniques. According to Douven (2008) the idea that knowledge is conceptually related to practical reasoning is becoming increasingly popular. In defining this idea, philosophers have been relying on a conception of practical reasoning that evicted drastically from one, which has been more traditionally advanced in analytical philosophy, and hence, assigns no special role to knowledge. 5. Prohibitive reasoning: Herein, in cases of confrontation of a set of problems’ impacts are destroyed. For instance, protection against a gun fire is such a reasoning type. 6. Systematic reasoning: In order to solve a definite problem, a systematic way composed of various components is planned for reaching at the knowledge target. Human thinking and reasoning activities take place along imagination (subjectivity), description (visualization of the imagination in the form of shapes or geometry) and idea generation (interpretation). In this manner, one can reach to innovative ideas or modification of the existing ones with critical reasoning. In knowledge improvement observations in addition to experience are discussions and critical debates with other experts. One can collect knowledge through various means, but imagination is more important than knowledge accumulation, because it provides dynamism in critical thinking and reasoning. One can have tremendous amount of knowledge for use only without any modification or innovative thinking productions. One of the basic questions is whether scientific models or human experts can make more reliable diagnostic research? The answer on the expert view side depends very much on the disciplines among which are medicine, law, sociology, economy, politics, psychology, earth sciences, astronomy, etc. The reader can decide on own behalf according to the subject of interest. One must not forget that in some instances scientific models and human experts jointly take place for better consequences (Chapter 9).

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2.3.1. Rational Thinking Gains If one should ask what are the benefits of critical and rational thinking and explanations in the previous sections then the following items are given hopefully as satisfactory answers. Prior to anything, there must be realization of a problem in the mind. 1. It must not skip from mind that any problem does not have a single solution, but may have alternatives. For this reason, there is a proverb in Turkish, “mind is superior to mind”. 2. Since, there are alternative solutions, various views exist and the researches try to select the one that is most suitable for own thinking and tries to solve the problem in a convenient way. 3. One must try and benefit from all types of thoughts stored in the memory prior to the problem solution. 4. The ambition about the problem is very important encouragement and triggers proper solution searches. 5. Consideration all the previous steps paves the way to reach at new solutions leading to knowledge improvements. 6. If personal information and thinking capabilities are not sufficient to tackle the problem then other related expert individuals are consulted for generative critical discussions. 7. After reaching at the solution with new information inputs and digesting them, the knowledge becomes treatable temporarily for a while until someone rationally updates it. 8. Understanding the linguistic relationships, reasoning and causative factors with their modification by time. 9. One may reach to better life style by combining all the previously obtained knowledge. 10. In one’s studies, there appears self-reliance on the information gained, and accordingly, one may write a document, papers or book about all what knowledge s/he has on the topic concerned. 11. Taking feedbacks by criticizing first one’s and then others’ ideas, give way to find better inference directions. 12. Especially, by listening and giving value to others’ ideas, one can contribute mutual understanding in critical thinking leading to joint rational conclusions. 13. The ideas’ share provides contact and communication with others, and hence, one may have better respect in the society.

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14. Insufficiency of one’s and others’ ideas for the problem conceptualization may lead to a set of assumptions that may render the problem for a simple initial solution level. 15. After reaching at a solution with rather strongly acceptable suggestions, one can convey these messages to others for common share. 16. By means of criticism one can reach to innovative, modified or new solutions. 17. If philosophical and logical principles are employed in the solution mechanism then one can suggest its practical use in the society. 18. Anyone who is accustomed with critical thinking can gain the ability to ask and to be asked for reaching at better knowledge levels. 19. If problems are not soluble only by personal thinking and ideas, different sources are available for knowledge, and hence, one gets the habit of benefiting from other references and scientific sources. 20. Information and experience are not individual subjective views only, but intermingled with others’ ideas and by this way the vision of thinking is widened and rendered into universally acceptable level. 21. One can deepen thinking capabilities starting from even initial questions and criticisms, and then reaches at improved levels by better ripen regulations, systematic, methodological, consistent and reliable rational ideas. 22. More productive rational information is generatable by combination of life facts and philosophical reasoning ingredients. 23. In problem solutions, critical questioning and benefits from up to date knowledge help individuals to avoid extremes that may end up with unacceptable or dogmatic consequences. 24. One may learn how to reach at more fruitful and productive consequences by activating critical and rational thinking ways during practical life. 2.3.2. Rational Thinking Models During education of different disciplines and even after graduation, how much significance is attached to innovational, modifiable or new knowledge ends? Let us think what the answer to this question is. The most significant dimension is to develop models for the problem solutions and their generation mechanisms’ proof and to make predictions for future cases (Chapter 10). In order to reach success with modeling tools, it is necessary to depend on the critical thinking and rational reasoning principles. Şen (2014) stated that thinking and modeling may be thought as the two faces of a medallion. In the history, great thinkers have provided models for the benefit of others in a systematic manner. Productive accomplishment is possible by employing one or the other model or their mixture to arrive at desirable conclusions by critical thinking and grasp of

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interior model mechanism functions rationally. Unfortunately, in recent years with the accumulation of computer software, many people started not to care for the fundamentals of the problem, but depended on their automatic use through pressing variety of buttons to visualize end products on the computer screen without care about the philosophical and logical principles. Is it possible for one to write a computer program or software without indulging the principles of philosophy and logic? The answer is no. Human beings can develop their thinking capabilities and abilities through visual inspection of subjects in the surrounding environment by considering their relationship with internal physiological principles starting from basic knowledge fragments and their rational collection in a systematic manner at least through a conceptual model. On the other hand, from the holistic vision, one can put them into parts to understand more what take place in their combinations. The most important point that is missing in any education system is the thinking models, but direct analytical, mathematical, empirical or numerical models are introduced with quite insufficient philosophical and logical principles. The success is sought in imitative, repetitive, and partially plagiaristic and alike conceptions that enter into the education system and continue even after the graduation. Among the attributes of science are four seemingly different but intertwined ways of reasoning that have become formal and fuel of scientific stirrings. These are deductive, inductive analogical and hybrid models. The problem solution depends on either of them or their various combinations. The following common points are worth to consider. 1. Logical examination of an event from the rationality points of view. 2. Inputs and outputs (cause-effect) are linked at least primarily by reasoning. 3. The logical principles in the justification of reasoning help to combine the causative (premise, input) part to the effective (result, conclusion, output) part. 4. The principles of classical (two-value) logic are identity (A is A), non-conflict (A and non-A), and middle state exclusion. In medicine rather than two-value, fuzzy logical principles are used more frequently (Chapter 8). The simple structures of these models are represented in Fig (2.3) in causative (input), consequent (output, result) and between connective unit (box) for deduction and induction types. In these models, there is a middle box that relates the input information to output and it needs philosophical, logical, rational conceptual or mathematical principles successful connections.

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Fig. (2.3). Thinking models, (a) Deduction, (b) Induction.

2.3.2.1. Deduction Deductive model system empowers one with holistic level information towards parts. It is possible that anybody with own ability can put the problem into parts, and hence, become successful in rational grasp leading to innovative or modified knowledge generations. Recently, it is equivalently referred to as a “top-down” approach. The large scale problem may be generalized by a theory, which is then rationally narrowed down into more specific hypotheses, which can be tested. For instance, in nature and environment, there are many events with a set of causal factors. The first holistic rational view provides some impressions by means of the rational thinking that the event is composed of several parts, and hence, the deductive thinking manner tries to explore what these parts are. In order to identify the causative factors, the thinker must first have knowledge about the large scale behavior characteristics and then ponder upon the small scale parts of the causative factor contributions with their joint behaviors to give rise to the large scale event. In such an overall approach, after the causative factors’ identification, the whole generation mechanism feature of the holistic event becomes more obvious in detail. It is not necessary to use the same knowledge set for each part. After the analysis of the parts, they are synthesized to generate the original wholeness within a certain error percentage, which is adapted as ±5% or ±10% in practical works. Such rational inferences may not always be reliable. The rational connection of parts may cause some misleads also, and therefore, skepticism is bound to be in deductive as in other inferences, but in order to reduce mistakes empirical and experimental works play as supportive roles. 2.3.2.2. Induction Inductive thinking works the opposite way around the deductive reasoning. This means it goes from small scales (Parts) to broader ones. For this purpose, it is

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necessary to employ processes after taking into consideration all available rational thoughts in the literature. This implies transition from specific to general rational knowledge. The inductive reasoning is also called as “bottom-up” model. Different terminologies and methods are developable by examining parts from different angles. Sometimes, it is very difficult or even impossible to try and solve the problem by inductive reasoning. In order to achieve success, it is necessary to know the different parts joint to each other in harmony. Overwhelmingly, many researchers, philosophers and educationist prefer inductive model usage. In this model, the students are equipped with supportive information through different courses (physics, mathematics, chemistry, biology, etc.) and they are expected to combine them to reach at a problem solution. In order to give ideas to students, not only courses related to the interest, but also supportively related topics must be provided so that they can combine these information under the questions of how?, and why?, for solution, which might not be at the level of an expert. Unfortunately, in many career educational institutions and universities training is confined to curriculum and special topics with weak inter-connections. For example, in any medicine education system, there are rarely courses on philosophical thinking and logical inferences prior to physics, mathematics or any other fundamental subject. The question is then how the students can generate useful and better information without any idea about science philosophy and logic principles? After about four years of undergraduate education, the students equipped with different pieces of courses, are expected to produce useful projects and scientific or technological works. On the other hand, in the inductive education system, if the courses are separated with impermeable barriers without overlap among them, then this model cannot generate new ideas. The graduates have a set of courses completed with success, but ignorant about the principles of thinking including philosophy and logical inferences. 2.3.2.3. Analogy Apart from the above mentioned inferences, there is also analogy model, which has almost synonymous meaning with similarity. Pena (2008) provided detailed information about analogical thinking in medicine. This thinking method is extensively useful in human learning, reasoning and provides arguments for problem solutions. There are thought analogies, whereby one can reach to conclusions with parts, which are already in the familiarity of a physician. The history of work on analogy in modern cognitive science is sketched focusing on contributions from cognitive psychology, artificial intelligence and philosophy of science. Because of the single origin of science, when one looks at the origin of

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scientific knowledge, the similarity (analogy) method appears like daylight. An example in terms of physics is that all known scientific laws until now (Newton, Hooke, Ohm, Fick, Hubble, Darcy, Fourier, etc.) are similar to each other. In all of these laws, the rules of direct proportionality and linearity are valid between two variables. Hence, it is possible to express each one of these laws verbally as: “Two variables are linearly and directly proportional” If the two variables are force and acceleration, Newton's law states that the force is directly proportional with temporal velocity change (acceleration) and the relationship has linear (not curvilinear) form. By analogy, if in this expression stress (voltage difference) is substituted by acceleration and strain (electric current) by force then one understands Hooke's (Ohm’s) law. This similar expression in words and sentences are a result of a philosophical thought, which leads to mathematical equations, but the opposite is not true. Hence, scientific laws are all similar to each other under the light of analogy. The linearity assumption keeps its form since many centuries and even today in many works. The main reason for this is that naturally humans think straightforwardly. For instance, many scientific laws such as Newton (16431727), Ohm (1789-1854), Fourier (1767-1830), Hooke (1635-1703), etc. have linear formulations. The generality and simplicity are satisfied by linearity principle. For instance, Fourier law states that the heat amount is directly and linearly proportional with the temperature time difference. However, in natural phenomena linearity may be valid for short times or space scales, but at large scales it may not be valid. Especially, nonlinear differential expressions, whatever are the fundamentals, exhibit chaotic behaviors by very slight changes in the initial conditions, which imply that non-linear equations in mathematics do not have certain stable solutions (Lorenz, 1963). This implies that if at one instant the position of the solution time or space locations are known, it is not guaranty that the next step estimations will remain in a deterministic orbit or trend. In this manner, even though science is believed by many as the truth, the aforementioned examples indicate that in real time and space, the solutions are not deterministic, but have uncertainty components especially in small scales. 2.3.2.4. Hybridity In scientific research, much knowledge can be produced not only by the aforementioned three thinking methodologies, but by combination of them in a hybrid rational thinking model. In a series of studies conducted in the form of forward-feeding (induction) and feedback (deductive) in a way that analysis and synthesis reasoning in different studies are intertwined, revealing the most useful and contently information by using a combination of thought methods. In general,

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such a hybrid thinking possibility takes place most frequently between the deductive and inductive methods. The best understanding of nature and the environment is achieveable through the skillful use of the above mentioned thinking methods. From time to time, these approaches overcome each other's shortcomings and provide the most possible result. 2.4. SCIENTIFIC REASONING Is the science the way of finding the truth? If so, what is the truth? The science cannot find the truth, but approximates it. In any scientific research, there are assumptions, initial conditions, idealizations and simplification principles. Absolute truth is unique, but science by modeling suggests approximations to this truth. In any scientific work, always approximate reassigning principles are valid, and therefore, scientific ends have uncertainty that can be explained in terms of probability, statistics, fuzziness and falsifiability, [Al-Farabi (870-950); Popper, 1955; Zadeh, 1965]. On the other hand, systematic information networks are considered as the science, but this is not correct. During the history of science knowledge findings had systematization, which more than enough slows down mind functions or provides recession in the mind so that a mechanistic view takes place with repetition of existing knowledge. Any scientific information or knowledge is subject to suspicion for improvement. Today, whatever the scientific topic is, abstract thinking gradients are excluded, but in reality this is not valid point. In a society if scientific thinking are not well established then information transfer from relevant sources are regarded as scientific without any suspicion or criticism These are the main hindrances along the way of scientific enlightenment in a society, because mechanistic, memorable and imitative information sources become available and dependable. This may imply respect to science, but in science, there is no respect to knowledge without suspicion. Especially, in our days, anyone can reach at any type of systematic information through electronic means from anywhere without any dynamism in the information content or perception. Even this implies that all systematic information is not scientific. For instance, in the military, there is a certain hierarchy in a very systematic manner according to internal rules, but the overall system is not scientific at all. In the meantime, one can state that the religious information is not scientific, but the religious principles are not given to humanity by force, they are accepted in complete freedom and address the human soul, and therefore, many individual may admit the religious system without suspicion and such a belief does not close the doors for scientific researches. Perhaps, they ignite internal feelings of an individual and one can start and work

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scientifically without any problem.

There is no standard and universally acceptable definition of science, which is due to its suspicious character. The best definition is the conversion of randomly intake information and knowledge into a systematic and rational form under the light of the philosophical thinking and logical principles such that the end product is objectively understandable by anyone interested in the topic. This definition gives the idea that human intakes basic knowledge from the surrounding environment (subjects, society, individuals, education, literature, books, internet, etc.) and combines them into rationally meaningful forms with progress towards better than the existing alternatives. The following points are among the basic features of science. 1. Science is materialistic: It is concerned with materialistic subjects only. 2. Science is phenomenistic: It is concerned with measurable and countable quantities. 3. Science is objective: Far away from the conception of a single personal idea. 4. Science is philosophical: Deduction of scientific information originates from rational thinking and its linguistical expressions. In science, philosophy is necessary, but not sufficient. 5. Science is logical: Any information based on philosophy cannot be scientific prior to their filtration and refinement through the logic principles. 6. Science is selective: There may be a set of alternative solutions in science, and among them the most revealing one deserves selection under the light of the previous steps. 7. Science is general: Scientifically reached information is valid temporally and spatially at every instant and location. 8. Science is critical: Scientific information can be valid for some time, but under the light of suspicion and criticism, they process with improvement, and hence, become more general. 9. Science has its history: There is not a single location and civilization for the development of scientific information throughout the centuries (Chapter 3). Unfortunately, today in many parts of the world, the history of science is started only from ancient Greek and meagerly from previous civilizations as Egypt and Mesopotamia. However, even in its own countries the contributions from Islamic civilization are ignored, especially, the Andalusia (Spain) civilization from where the enlightenment entered into the European societies starting Renaissance. 10. Science is antidemocratic: It is not possible to crown scientific information by general elections or social questionnaires. Throughout the history of science,

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there are numerous instances, when the original idea of a single thinker became acceptable without any consensus. In scientific works even none materialistic feelings are taken into consideration with constructive benefits. Among these are the following stages. 1. Production of scientific information necessitates imagination without which there cannot be any original initiative and productive thinking (Chapter 4). 2. Independent thinking implies philosophy, which is not sufficient by itself for scientific inferences, but needs the support of logical principles. 3. After imagination, the next stage is the design, which brings to mind whether mathematics or geometry (shapes) plays major role in the crystallization of scientific ideas? (Chapter 4). In many societies, the answer is mathematics, however, any individual generates the ideas starting from abstract or concrete shapes, which imply that geometry is the essential tool for design productions. 4. After the passage of preliminary thinking stages, it is time to test them through logical principles whether they are rational or not. Logic, in the first place seeks whether the relationship between variables is directly or inversely proportional. If logic does not respond to such answers then it is necessary to consult experiments, and hence, there is completely new door for scientific research (Chapter 4). 5. Knowledge generation contemplation and sharing are also effective in scientific works. Anyone after going through the previous stages is ready for critical and rational thinking to generate additional new information that may be beneficial to humanity, in general. The information must also be measureable by scientific criteria. 6. The first step in information testing is the criticism by the thinker own and then others’ ideas along the same line. 7. As a final stage, information enters into laboratory for further testing and check, because experiments are the reliable means in scientific information confirmation (Chapter 10). As Muslim thinker Al-Farabi (870-950) stated about more than 1100 years ago that the scientific subjects are probabilistic, because they include uncertainties. On the other hand, Popper (1955) stated that the scientific knowledge is falsifiable, i.e. it is not absolute truth and in this way, he has confirmed Al-Farabi’s original idea. Science and technology developments need human life sustainability impulse for body and mind healthiness. There exist three development stages in the history of science. 1. Internal: Conception of a certain topic as science.

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2. External: Interaction among different civilizations. 3. Holistic: Environmental expansion. Individuals equipped with active mind should learn how to use it for productive works. Anybody can generate different ideas about a phenomenon, but for their usefulness in a society one should put them into a harmonious systematic framework. Rational constructive elements need for better shapes, regulations and productivity by philosophic and logical principles. For this, university-industr-state cooperation is necessary. Those who identify themselves as scientist must stand away from unscientific circles. In general, human thought can be categorized into three parts. 1. Phenomenological events’ examination with objectivity. 2. Regulation of relationships among the society, institutions and individuals. 3. Assessment of things that are involved with internal feelings. Attachment of significance to phenomenological events without philosophy and logic principles may lead to dogmatic and stagnant information accumulation. Until 19th Century, the most respectable scientific revolution was Newton’s physics, and there were many who believed in its absolute validity, and hence, the scientific principles became as faith. However, later relativistic physics and then onward quantum physic turned down such beliefs (Einstein, 1905; Bohr, 1934). 2.5. POSITIVISTIC THINKING Positivistic thinking view established by August Compte (1798-1857) has been shaken from its foundations. From the creation point of view, human prefer always good, easy, simple and nice. During the scientific development, the most influential view has been positivistic principles and deterministic thoughts. Such societies were blind and deaf for many years, because of their deterministic searches without any room for uncertainty. In some societies, scientific direction is adapted almost without any thinking in a copy-paste manner. One cannot make scientific researches and findings prior to the understanding of the basic science features. It is advised that the following points are worth for consideration in the scientific researches. 1. Scientific discoveries are not divine laws: These are the end products after tedious and long searches and they are the ones that no one has been able to discover before. Similar to the expansion of the universe, and plate tectonics (the continents do not remain statically at the same place but move), likewise one must not forget that natural events are in permanent progress and break

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records without determinism. 2. It must be kept in mind that throughout the science history, the deterministic conclusions are not general, but they are generalization of inferences according to the circumstances. For this reason, researcher must try to find some missing or uncertain points in any scientific document, and hence, the falsification principle of Popper (1955) comes into view similar to the probabilistic feature of any scientific finding as stated by Al-Farabi (879-950). Only in this manner science continues to give birth for new ideas or improvements and developments. 3. One should know the history of science, and accordingly, with inferences from the past, future works can be guided better. It is very unfortunate that in some societies there are individuals at respectable positions, who think that all unknowns are covered by the present scientific researches, and there remained nothing to search for new knowledge. This principle is valid for geographic inventions in the world, but such a principle is completely outside of the scientific circles. For instance, today in medical science although many facts are known about human body, but still there remains at least 15-20% uncertainties. 4. Especially, in medical scientific researches, direction must be given more weight toward uncertainty principles (falsifiability, probability, chaos, fuzzy). The author of this book thinks that there is always some uncertainty in many events including medicine, and therefore, the scientific research will progress continuously. Especially, in recent years, the statement “certainty in uncertainty” is well established among the researchers, but it is not true, because the science develops within the uncertain domain of uncertainty, which is bound to remain permanently in the future. Those who are not aware of what the science is they may fall into a great error by thinking that the science is a panacea for every problem. Those who believe in science dogmatically and deterministically may not take into consideration uncertainty ingredient in scientific researches. 5. Human must not forget himself in scientific and technological developments. Today, scientific and technological progresses give expectations about peace, balance, order, right and justice, but such ambitions should continue also in the future. The connection of these concepts to science makes it rather utopic and dogmatic without giving any domain to other subjects such as medicine, law, social sciences, etc. A close look at the history of science indicates that during the science and technology development periods, people had better health, and especially, education systems. The most important scientific structure as a result of rational thinking prior to anything is conceptual models (verbal relationships, philosophy and logic). In

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scientific studies, exclusion of uncertainty gradients is achieved by simple and basic concepts under the light of the following major assumptions. 1. 2. 3. 4.

Homogeneity (independence from points). Isotropy (independence from directions) Uniformity. Linearity.

In order to enter the science arena, one of the conditions in the thinking world is to criticize and to be criticized. For criticism of the event or phenomenon of study suspicion thoughts are necessary and one must try to reduce their effects to the minimum and to raise benefits to the maximum. As an example, let us consider the Newton law as there are specifically similar laws in almost each career domain (Section 2.3.2.3). Instead of accepting this law as it is (F = ma), why not try and consult to rational and critical thinking and more attractive and productive information by means of the following questions. 1. 2. 3. 4.

Why the relationship has a direct proportionality? Why the mass is accepted as constant? Why linearity is valid and non-linearity is excluded? Is this law valid at every time, location and scales?

During the whole science history up to 19th Century, the Newtonian physics is regarded as the most complete physical law and it became as a faith among some scientists. According to this view, momentum, energy and mass conservation principles were sufficient to explain any physical phenomena. Furthermore, some scientists stated that if the initial positions and velocities are known then not only future, but also back predictions provide real pictures by scientific methodologies. In this manner, reality could be calculated in time and space independently from each other. Along the same view, many thinkers advocated that the same principle can be validly applicable to any other subject without distinction, and hence, they had solidarity among themselves and also encouraged the others to join their views. Underlying this thinking was the idea that God had created the universe and left it as an automatic clock and human can discover this automation and make necessary predictions or any calculations as desired. This thought is based on the regularity, harmony, determinism, simplicity, controllability and uniformity assumptions. They believed in casualty of these assumptions and made others also to believe. In this manner, human thinking entered a positivistic view in any research and the others who did not adapt this view were not respected properly. This indicates that if rational, logical and cultural principles do not take place in scientific thoughts then one day human may worship to his findings.

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Anyway, sooner or later such thoughts are bound to bankrupt. The first objections to Newtonian mechanistic views came at the beginning of 19th Century from heat studies with thermodynamic laws (Carnot, 1824). These laws implied that the Newtonian laws are not valid in every case, and hence, another scientific revolution started to take place. Hence, naturally mechanistic view and Auguste Compte (1798-1857) positivistic thought principles started to recess. The most important thermodynamic view is very simple and stated that if the universe works as a clock similar to a machine; the machine starts to depreciate and after some time loses its function. According to the thermodynamic view anything in the universe experiences aging and such a thought was advocated even by some of the ancient Greek thinkers. For instance, Plato (BC 428-348) stated that the ontology of presence is grasped by human, in fact each presence exists because of its “idea”, which corresponds to absolute existence and they do not deform or change by time, but their appearances change. Hence, one can advocate that whatever exists presently is bound to change by time, and accordingly, any scientific law has tendency to change, and therefore, physical laws that are valid presently may not be valid any more sometime in the future. These changes are a result of a divine superpower, and humanity is always in confrontation with such changes, and therefore, the information renewal is necessary. For today, we know that the world went through an evolution and plate tectonics, which provided today’s continents’ positions, and likewise they are bound to change in the future. Initially, these continents were stuck to each other, but they became separated during geological era periods that we cannot appreciate as human beings, but recognize by scientific researches. For instance, say, before one billion years, the climate was much different than today’s conditions depending on the continental positions. As a result, the meteorological laws that were valid at that time are no more valid today. It is not necessary to become a conjecturer to speculate that during the remaining life time of the universe, there many changes are bound to take place, and therefore, present day physical laws might not remain as they are today. One should regard the scientific facts for the times that they are valid, but they may not have the same validity in the future. On the other hand, in the development of today’s science and technology, human thinking also is in continuous change and reached to the present level with philosophical and logical science productivities. Due to the idea generative nature of human, they grasp information and knowledge always in the optimum, easy, simple, beautiful and homogeneous and isotropy ways. Even though one may realize that the events are complex, nonlinear, chaotic and uncertain, but s/he tries to render them down to the perceptible simplicities under the light of assumptions. In the meantime, the ones that are not simple seem ugly, and therefore, do not take them into consideration at least in the

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first approximate scientific works. At both end, one comes out with the positivistic views as mentioned earlier. However, the certainty rules struck one’s interest. Some societies have remained with the certainty principles and concluded that everything is not only well-defined in science, but they are deterministically intact of uncertainties. Such determinisms have rendered them into scientifically deaf and blind thinkers. They believe to the ones that are at their minds scientifically without any criticism. Along the history, the scientific system development remained stagnant even under the light of free thinking. Of course, sometimes consciously, the scientific and technological developments are stopped in this manner even with good intentions. The most important example for this is the Euclidian (BC 330-275) geometry, which restricted human natural geometrical thinking into points, lines, planes and volumes with dimensions of 0, 1, 2 and 3, respectively. This geometry is not updated during more than two thousand years. It is not possible to make a natural picture with Euclidian geometry principles. This geometry is now over-dominated by fractal geometry, which has come into the existence since 1980s (Mandelbrot, 1982). In the fractal geometry, instead of prime number dimensions, decimal fractal dimensions are valid such as 1.24, 2.87 and 3.43, etc. By means of fractal geometry, it is now possible to make even artificial natural scenes that are not easily distinguishable from the real ones. On the other hand, instead of two-value (0-1, white-black, yes-no, etc.) Aristotelian (BC 384-322) logic, fuzzy logic with inclusion of middle between 0 and 1 become in use in the scientific and technological works from 1980s onward. Aristotelian (BC 384-322) logic provides two alternatives as opposites without any middle alternative, and in this manner, restricts the thinking domain to extremes only. The more is the society away from the Aristotelian (BC 384-322) logic, the more are free thinkers, criticisms, comprisable and mutual understanding modes. This does not mean that Aristotelian (BC 384-322) logic has not been useful. Yes, it is very useful, especially for deterministic mathematical equations and many algorithmic forms, but it does not help in expert systems decision making processes except under restrictive assumptions. The fuzzy logic founder is Lotfi Asker Zadeh (1921-2017), Zadeh (1965). Fuzzy logic principles are explained in Chapter 8. Today fuzzy logic rules are employed almost in all the artificial intelligence studies. Besides, the two-value logic is inclusive within the fuzzy logic as extremes. The two-value logic is dominant in the education systems all over the world, and therefore, logically the minds are handicapped to a certain extent and could not think easily for a set of alternatives. As Francis Bacon (1561-1626) stated Aristotelian logic frozen the logical thoughts throughout the history of humanity. This does not mean that the people did not think according to fuzzy logic, of course they did, but it did not enter scientific domain easily except during the last 50 years (Zadeh, 1975).

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2.5.1. Scientific Method and Recommendations During any wander within the thinking world, one can sort the following cases, and if adapts them as guidance then appreciates the scientific information and knowledge. 1. Scientism: After the grasp of the scientific characteristics one must feel their reflections in the mind and heart. The scientist, conscious of objectivity, criticism, selectivity, and generalization, reaches at what is searched for coupled with scientific falsifiability. 2. Non-scientific views: One does not reflect personal subjective views as science, because science depends on collective rationality and logical principles share. There will always be some non-scientific ideas and loves in the mind and heart of even a scientist, but these may trigger thinking capability toward better research aspirations provided that the end product target is objective. 3. Qualification-ability: A scientist must not have qualification abilities only, but additionally, capable to resist against wrongness. In Turkish culture there is a proverb “Submit the work to one who is competent”, but minority cares about this saying. In any occasion that is not ethical or correct, the scientist must raise voice with objection for warning. 4. Mind-heart solidarity: The scientist depends on rationality and tries to come out with objectively convincing inferences. One can accept rational findings that originate from the mind and then approve it by heart seal. Such an approval may be valid for a certain duration, then by critical review and revision a better development level is reachable after the mind renewable acceptance and again heart approval towards scientific improvements (Section 2.2.1). 5. Anti-democratic: In science there is no democracy, but it is at equal distance to each individual, society, and worldly ideologies. In scientific studies not equality, but inequality principles are valid. There is not absolute tolerance, but continuous criticism, comment and discussion for innovative developments. 6. Variability: Any scientist knows that the scientific information is subject to criticism at any time and location. Scientist wishes that information is criticizeable by others in the class, presentations and through publications. Information without any criticism cannot have a scientific character. 7. Consciousness: Scientist does not need to have titles (Prof.) after all the highest scientific title is Ph. D. A scientist should respect the opinion of those even without titles, but suggest scientifically acceptable valid information and knowledge. There is no rule that the scientific views are the property of educated individuals only. In Qur’an there is a verse, which states “Are those who know and who do not know, equal? Of course, those who know, they are superior.” Unfortunately, in many societies this has been evolved to saying as:

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“Are those with university certificate equal to others without certificate?” In job applications, perhaps this last saying may play significant role, but there is another saying, which states that: “the mirror reflection of an individual appears in deeds and works without caring for sayings” 2.6. PHILOSOPHICAL LINGUISTIC THINKING PRINCIPLES The following Fig provides a representative flow diagram in general about the scientific stages starting from unknown world in terms of uncertainties, difficulties, vaguenesses and complexities, which trigger philosophical thinking stage including previous unripen thoughts. The active philosophical thinking stage brings out new ideas, which may also include some uncertainty, but at reduced rates (Fig. 2.4). The philosophical inferences are not yet in the form of scientific conclusions, because there is a need for logical principles to filter the uncertainties as much as possible. The conceptualization of the logical principles appears in the form of scientific principles, laws, theories all of which may also include uncertainty at the least scale. This final form of uncertainty implies the suggestions of Al-Farabi (870-950), who stated that scientific topics are probabilistic and in recent decades Popper (1902-1994) expressed this idea by a modern terminology as “falsifiability”. In the transition from the philosophical thinking to logical stage, there are always hypothesis and a set of assumptions that bring the complexity of the event to the graspable level, and therefore, the final scientific results are valid under the light of these assumptions. In science, there is no law or theory free of assumptions. Especially, native language helps to grasp reasons and to understand basic and fundamental conceptions in the area of interest. Language and thoughts are related and help to. 1. 2. 3. 4. 5. 6. 7.

teach and convey information. facilitate problem solving. represent ideas and events. convey motives, intentions, feelings and beliefs. issue requests and commands. categorize the things, subjects. verbalize relationships.

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Fig. (2.4). Sequence of scientific stages.

Scientific philosophy is concerned with word, sentences, hedges, terms and terminological key words among which are the following aspects. 1. Linguistic words (variables), (movement, temperature, pressure, age, etc.). 2. Sub-words – adjectives - (fuzzy sets, words), (high, low, beautiful, old, new, positive, etc.). 3. Hedges (fuzzy coverage), (very, rather, almost, more or less, approximately, etc.). 4. Machine: very rather, almost very approximate, very small, very almost medium, etc.). Some of the logical implementations are given as examples from the contents of medicine. 1. Sentences (implications), (I went at noon time with few of my friends to hospital and we waited for a while and after the treatment we left the hospital) (Chapters 4, 7and 8). 2. Sub-sentences (Predicate, conditions, causes), (Temperature is high, blood pressure is moderate, he is old, etc.) (Chapter 8). 3. Logical connections (ANDing, ORing, NOTing), (Temperature is high AND blood pressure is normal OR rather variable) (Chapter 7). 4. Relations (Consequence, effects), (High temperature leads to health problems) (Chapter 8). 2.7. EXAMPLE FROM THE SCIENCE HISTORY The literature reflects in detail about the life history of any ancient Greek and Western thinkers or scientists, in addition to their thoughts and what were the significance of their thinking abilities. However, other civilization thinkers and

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scientists are not mentioned in such detail, for instance, Abo’l-Iz Al-Jazari’s (1136-1206) pioneer of innovative robotic and other mechanical device designs. He lived at the border town of Turkey in the southeastern province next to Iraq. The reason for his selection is not only due to his ingenious devices, but additionally his way of thinking and views about the science. More detailed information about his thoughts can be found in two significant works by Nasr (1976) and Hill (1974). Let the readers decide how valid his suggestions are for today’s scientific researches. 1. This innovative thinker started in his book with praise to Allah (God) and then he thought about the owner of earth and universe and pondered about them by philosophical thinking and he concluded that the absolute knowledge is with Creator. However, during his era in the west, thinkers were under the pressure of church authority (scholastic thinking) and they could not express their views freely. 2. He requested as much as possible from Allah (God) so that he could dive into the philosophical deepness, but in a general term Hikmah (mystery, profoundness, profundity, divine wisdom), which does not concentrate only on materialistic and positivistic views, but also mixture of cultural, religious and philosophical thoughts. His desire overlaps completely with Einstein’s (18861955) thoughts about more than how God created the universe, but prior to creation how God imagined and designed the universal creation. 3. Abo’l-Iz Al-Jazari (1136-1206) has reviewed all the previously available works (literature review) concerning his thoughts, and accordingly, he has also criticized some of them. One can see in his works, the first time in the history, similar to today’s reference system that he cited previous thinkers, and hence, citation system has started during the medieval ages. Such a behavior is among today’ ethical principles. In Islam not the right of Muslim, but the right of any human is the most observance duty to Allah (God). 4. Abo’l-Iz Al-Jazari (1136-1206) as wrote in the introduction section of his book, started to think about some subjects causing to movement by others, and hence, the original ideas about the robotics have started to take place in his mind and thoughts. Of course, this is a result of what he has read about the previous books or articles especially by Archimedes (BC 287-212) from ancient Greek and Heron (10-170) Hellenistic civilization thinkers. This indicated that he has also worked with physical principles within the natural sciences domain. Ancient Greek civilization has brought many original ideas and science principles, but all of them were based almost on quite speculative thoughts leading to rational idea productions only. However, more advanced logic based rational thinking, criticism, and especially, experimental works have emerged during the medieval Islamic civilization.

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5. Abo’l-Iz Al-Jazari (1136-1206) said that reading some books or documents without critical suspicious view means just transfer of knowledge without modification or innovation, but he has rescued himself from just knowledge transfer through critical thinking and assessment and after all, he could look at the problems with his own eyes and mind. In this manner, he continued to write his thoughts in complete freedom, independence and self-reliance. He directed his researches first of all by critical reading of Aristotelian (BC 384-322) and ancient Greek works. 6. Although he expressed that during the studies, he has come across with difficulties and borings from time to time, but he did not give up and continued for research patiently. He stated that by perseverance and awakening his sleepy thoughts wakened up and hence, continuous thinking and by whipping he got rid of numbness. For this purpose, he did whatever was available at his hands and mind. In this manner, he started to become well-known in his society, because of his mechanical and physical works leading to indigenous devices. 7. Apart from others, in the book of Abo’l-Iz Al-Jazari (1136-1206), there are sentences, which shed light on even today’s science, industry and technology. For instance, he said that: “Information without any application remains between falseness and truthiness.” In this way, he advised that any work must not remain in the theoretical form, but must be converted to application or to useful services. The knowledge must be turned to applications and technology so that apart from the truthiness or falseness, they become serviceable and helpful to humanity. All his advices are valid even today, because he has said many things that went over centuries and did not lose their validity. 1. In the introduction of his book, Abo’l-Iz Al-Jazari (1136-1206) states that after messy information scraps and previous thinker parlances classification, better and simpler scientific inferences are achieveable. The scientific affairs may confront with difficulties, but they are handbill by means of systematic categorizations. In many publications, the best definition of science is given by Einstein (1886-1955) as the knowledge that are in taken by sense organs randomly from external environments, but they are combined rationally through mind functions so as to reach systematic scientific information. Abo’lIz Al-Jazari (1136-1206) has explained almost the similar view about 800 years before him. 2. Abo’l-Iz Al-Jazari (1136-1206) did not work for his own wonder, but for conveying information to other individuals. For this reason, he said:

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“According to things that I wanted to learn, I wished to leave written document for others to learn.” In this manner, he thought to have communication with others, who are centuries away from him. Later, he gave up this idea, because he was hesitant that others could find his mistakes. His feelings are even valid today, because some academicians do not provide questioning opportunity for listeners. In Islamic tradition, there is a saying. “Whoever teaches me a word, I become his servant” is repeated always, but without grasping and applying its meaning. 1. In order to discover different directions of Abo’l-Iz Al-Jazary’s (1136-1206) thoughts, some people around started to open their mind to him. He had many support from the contemporary rulers and philosophers, and reached to collect the productive fruits to see the moonlight of the nights that he worked. The rulers of his time requested him to write a book after all what he has worked for useful information production. He wrote the book on “The Book of Knowledge of Ingenious Mechanical Devices” with the encouragement and support of the state and today we have in our hands his original writings and drawings in Arabic, which has been translated into English (Hill, 1974). There was not such a work until his time and even many centuries after: 1. In the introduction of his book, another advise is that one should behave fairly by thinking that each individual is created with certain abilities and gifts that are different from others. 2. Another information concerning engineering (geometry, shapes, imagination, design) understandings, which are ornamented in his book by pictorial drawings, letters and number notations. Even though engineering is wellunderstood as applied science in recent centuries, but his productive works are full with refined engineering drawings. Information and knowledge are productions that depend on self-civilization and cultural bases and they are presented for the service of humanity. Those thinkers are no more the property of their own culture and civilization, but belong jointly to humanity. During the history of science, knowledge and science migrated to cultures and civilizations that welcome them (Chapter 3). In the history, there is no culture or civilization that had scientific achievements without self-culture,

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language and belief system. It is not quite possible to adapt some other culture and civilization with exclusion of self-ones to achieve scientific and technological activities. It is advised to achieve the scientific and technological achievements internationally, but their derivations could be based on self-culture (especially, native language, civilization and cultural principles. Any civilization that has been productive in science and technology did not leave aside self-civilization and cultural principles. Taking the examples from the history of science, one can state that in the future, almost the same pattern will continue. In general, human thinking can be grouped into three categories (Section 2.4). 1. External physical objects that are phenomenological and provide possibility to simultaneous examinations. 2. The relationship regulation of each individual with the societal institutions, associations and foundations. 3. Assessments of internal circumstances. These three groups are quite independent from each other, but they are interactive in the thoughts of each individual simultaneously or each one passes through the mind for useful information generation. Science and technological advancements are reached only by means of phenomenological subjects, but the others are not emancipateable from critical thinking. The best indicator for this is to observe from time to time within the development process of science that researchers and thinkers might keep their thoughts outside the phenomenological facts and make generalizations, which are then taken by others without any criticism and suspicion, but with advocation. In the historical development process of the science, such generalizations cause to stagnations in the dynamic scientific thinking, and hence, lead to the recession in information content. In the past, as for the phenomological thinking, two types were against each other, and hence, revolutionary scientific thinking productivity slowed down. These tendencies are imbedded in the nature of human creatures. Anyone or any society with the four thinking types as explained in Section 2.2. may reach at the scientific and technological levels of today. In some countries, these thinking types are competing with each other, and therefore, the scientific and technological developments advance with turtle paces. Briefly, in order to equip any free thinking type in the internal feelings of any individual, not only scientific and technological developments, but also it is necessary to consider circumstantial conditions. Science and technology history is full of such subjects (Chapter 3).

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2.7.1. “How?” and “Why?” Questions For science all what have been explained above are necessary, but they are not sufficient. All the scientific answers are given as responses to questions “how?” and “Why?” Under the light of these answers, human beings can describe only what one sees, hears or works on as a research. As for the answer to the question what the sickness is? Almost everybody can provide linguistical answers about its description, symptoms, appearance, color, taste, etc. Even one can write of information and knowledge many pages about their verbal descriptions. In this manner, the sickness can be explained to others. The first answer to a question “what is the problem?” provides the basic description about it. For instance, one can order the words about how a fire takes place when two dry woods are rubbed against each other by force. In fact, anyone who sees this operation observes the emergence of the fire, and hence, if the same question is asked depending on the experience one can repeat almost the same definition, and hence, one is now capable to answer to the question how? For this reason it is not sufficient that someone should know the knowledge about the event, but after the answers to the question the subsequent question is why? Hence, answers direct one towards the scientific inferences and conclusions. The answers to question “How?” provide information share among the society members without scientific detail. It is not necessary that all the answers to question “How?” must be kept in mind. In fact, for this purpose in modern times, there are other means, which are electronic media, and especially, internet facilities. Whenever one mentions about the knowledgeable society, one implies the existence of media devices. It is also certain that each century had more knowledgeable societies compared to the previous centuries or decades. A continuous interrogation of an event by means of previous questions may start from the whole and these may help to put it into parts with experience (Section 2.5.23.2). Information and knowledge progress with innovative ideas, and furthermore, the end results need experimental checks and in case of consensus, the science is approved for the time being under a set of assumptions. Science concentrates on a certain part of universe or human body as a subject, and tries to find general laws depending on the experimental results, and hence, leads to a commonly acceptable information group. On the other hand, various trials, based on different feelings logically under the sequence of thinking stages, are collectively scientific affairs. In these definitions, the focus of science is differentialable from the plain knowledge according to the following points. 1. Science is concerned as subject of a part of the universe or human body as physical existences. This implies that science does not concentrate holistically

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2. 3. 4.

5. 6.

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on the universe. By means of piecewise scientific information collection science can reach at the whole picture (see Section 2.3.2). In the scientific investigations, not only observations and experimentations, but a group of methodologies must also have a share for information. However, general knowledge is taken by sense organs without any methodology. As mentioned earlier, science is selective, but knowledge does not have such a property and may come even without selection. Science tries to find some universal laws that are expressible verbally about the validity of the target subject, and may later be expressed mathematically. The science searches for such laws in various natural phenomena, but does not care who has put these laws into effect. Science necessitates regularity, in other words, systematic knowledge, whereas plain knowledge as one keeps in mind does not need systematic ordering. This implies that science is not attached with unsystematic knowledge. As mentioned above, in the second part of science definition, sense feelings are wrought into regular shape with logical principles (Chapters 7 and 8). In knowledge collection, there are uncertainties, but they are filterable through the logical principles for rendering into rational and scientific conclusions Otherwise, the collection of knowledge remains without systematic formation and cannot reach at science level.

After all these points, one can understand that knowledge is inside the science and the science tries to give productivity and rationality to the irregular knowledge. Another question is why some people are engaged with science and what are the purposes? The purpose of science can be summarized along the following points. 1. Some of the old philosophers and thinkers, and especially Socrates (BC 470399) have attached the knowledge with virtue, dignity, respect and at the end with power. This means that whoever holds the knowledge in mind has the power. In our days, any society tries to keep the best power at hands by any means. At early centuries, superstitious thoughts were among such means, and the thinking channels were directed by these means (Chapter 3). Later, medical treatment means are regarded as the source of power by people. After the 18th Century, and especially, posterior to the industrial revolution, the science is respected as the most deterministic power source, and in later years technology coupled with it. 2. It is consciously known that the natural sources in the universe have limits, and after some time, they may not be sufficient for sustainability of humanity, and therefore, instead of natural sources some artificial replacements have started to appear as a result of scientific and technological studies through artificial

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intelligence. The more is the human mind quality improvement, the more comfortable the humanity will sustain the necessary sources in the future. 2.8. PHILOSOPHY, COMBINATION

RATIONAL

THINKING

AND

LOGIC

Even though Ph.D. means Philosophy of Doctorate implying that the holders should know the basic philosophical structure about their research topics prior to any methodological applications, unfortunately in many research institutions all over the world, the students are trained in a rather dogmatic and mechanical manner. Hence, the end goal becomes in a dire “publish or perish” ideology, perhaps with slight improvement or modification of the existing methodologies, in addition to their mechanical uses in many applications through computers. For instance, artificial neural networks are means of matching the given input data set to output data even without knowing logically what is taking place between successions of layers within software. Unfortunately, classical education systems are based on very systematic, crisp and organized framework in some centuries still based on the Aristotelian (BC 384-322) logic, which has only two alternatives like truth and false. Real life and its reflections as science have almost in every corner gray information source at fore- and back-grounds. It is a big dilemma how to deal with gray information sources in order to arrive at scientific conclusions with crisp and deterministic logical principles. However, fuzzy logic principles with linguistically valid propositions and rational categorization provide a sound solution methodology for the phenomenon concerned (Zadeh, 1973, 1975). The preliminary steps are genuine logical and uncertain conceptualization of the phenomenon with its causal and resultant variables that are combined through the fuzzy logical inference machine propositions (Chapter 8). Such an approach helps not only to visualize the relationships between different variables logically, but furnishes a philosophical background about the mechanism of the phenomenon that is presentable to anybody linguistically without mathematical treatment. In an innovative education system, the basic philosophy and fuzzy logic justifications are advisable in problem solutions linguistically prior to any crisp bases such as mathematics or systematically deterministic algorithms. In this way, the students can develop their mind productions and analytical thinking capabilities with the support of teachers, who are also trained or at least worked along similar directions (Şen, 2014). Since, the modern philosophy of science insists on the falsification of current scientific results (Popper, 1955), there are always room for uncertainty, ambiguity, vagueness, imprecision and fuzziness in any scientific research activity. Innovative education systems should lean more towards the basic scientific

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philosophy for the problem solving with fuzzy logical principles (Ross, 1995). However, many publications in recent years are software applications without grasps of basic principles based on linguistic and logical foundations. Any innovative research should have either a new amendment, modification or at least a soft logical basis for the advancement of science and technology. On the other hand, in human engineering, the applications of the scientific methodologies to various socio-economic and civilization activities are verifiable, but again with linguistic and logical ingredients (Chapter 10). Otherwise even the applications remain mechanical. It is stated herein that rather than mechanical studies and ready software usages directly, the inside exploration of the methods, models, and algorithmic procedures is advised at least on gray level to a certain extent and if possible in full extend. Of course, it is preferable to explore the prime ingredients on philosophical, linguistic, logical and scientific bases. Especially, in medical studies fuzzy logic has prime importance. REFERENCES Al, E., Iliopoulos, F., Forschack, N., Nierhaus, T., Grund, M., Moty, P. (2020). Heart–brain interactions shape somatosensory perception and evoked potentials. Proceedings of National Academy of Sciences of the United States of America. Edited by Peter L. Strick Pittsburgh, PA: University of Pittsburgh. Aranda, M.L., Lie, L., Guzey, S.S. (2019). Productive thinking in middle school science students’ design conversations in a design-based engineering challenge. Int. J. Technol. Des. Educ. [http://dx.doi.org/10.1007/s10798-019-09498-5] Asma, L., van der Molen, J.W. (2011). van aalderen, S.,Primary Teachers’ Attitudes Towards Science and Technology. In book: Professional Development for Primary Teachers in Science and Technology 89-105. [http://dx.doi.org/10.1007/978-94-6091-713-4_8] Beghetto, R.A., Kaufman, J.C. (2007). Toward a broader conception of creativity: A case for “mini-c” creativity. Psychol. Aesthet. Creat. Arts, 1(2), 73-79. [http://dx.doi.org/10.1037/1931-3896.1.2.73] Carnot, S. (1824). Reflexions sur la Poissance Motrice du Feur sur la machines proper a developer cette Puissance. (Reflections on the Motive Power at Fire) Paris: Bachelier. Claxton, G. (2006). Thinking at the edge: developing soft creativity. Camb. J. Educ., 36(3), 351-362. [http://dx.doi.org/10.1080/03057640600865876] Chua, E.F., Bliss-Moreau, E. (2016). Knowing your heart and your mind: The relationships between metamemory and interoception. Conscious. Cogn., 45, 146-158. [http://dx.doi.org/10.1016/j.concog.2016.08.015] [PMID: 27597541] da Silva, F.S.C., Agustí-Cullell, J. Chapter 6 Ontological reasoning. Capturing Intelligence, Elsevier, 2, 175187.ISSN 1574-9576. (2008). [http://dx.doi.org/10.1016/S1574-9576(08)80014-7] Douven, I. (2008). Knowledge and Practical Reasoning. Dialectica, 62(1), 101-118. [http://dx.doi.org/10.1111/j.1746-8361.2008.01132.x] Einstein, A. (1905). Zur Electrodynamik bewegter Körper, Annalen der Physik,17 (“On the Electrodynamics of Moving Bodies.”). 891-921. Bohr, N. (1934). Atomic Theory and the Description of Nature. Ox Bow Press.

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Lorenz, E.N. (1963). Deterministic no periodic flow. J. Atmos. Sci., 20(2), 130-141. [http://dx.doi.org/10.1175/1520-0469(1963)0202.0.CO;2] Lorenz, E.N. (1963). Deterministic no periodic flow, Journal of the Atmospheric Sciences 20, 130-141. Mandelbrot, B.B. (1982). The fractal geometry of nature. San Francisco: W. H. Freeman 57 McCraty, R. (2019). Heart-Brain Neurodynamics: The Making of Emotions. In book: Media Models to Foster Collective Human Coherence in the PSYCHecology (pp.191-219). DOI: 191-219. [http://dx.doi.org/10.4018/978-1-5225-9065-1.ch010] Nasr, S.H. (1976). Three Muslim Sages.New York: Caravan Books. Pena, G.P., de Souza Andrade-Filho, J. (2010). Analogies in medicine: valuable for learning, reasoning, remembering and naming. Adv. Health Sci. Educ. Theory Pract., 15(4), 609-619. [http://dx.doi.org/10.1007/s10459-008-9126-2] [PMID: 18528776] Popper, K. (1955). The logic of Scientific Discovery., New York: Routledge.479. Ross, T.J. Fuzzy Logic with Engineering Application., John Wiley & Sons, Ltd.607.ISBN: 978-0-470-7476-8. (1995). Rothstein, D., Santana, L. (2015). Make just one change: Teach students to ask their own questions.Cambridge, MA: Harvard Education Press. Oaksford, M., Chater, N. (2009). Précis of bayesian rationality: The probabilistic approach to human reasoning. Behav. Brain Sci., 32(1), 69-84. [http://dx.doi.org/10.1017/S0140525X09000284] [PMID: 19210833] Özcan, S. (2009). =Yaratıcı düşünce etkilerinin öğrencilerin yaratıcı düşüncelerine ve proje geliştirmelerine etkisi. The effect of generative thought on students in project development) Gazi University, Ankara, Turkey. Stanovich, K.E., West, R.F. (2000). Individual differences in reasoning: Implications for the rationality debate? Behav. Brain Sci., 23(5), 645-665. [http://dx.doi.org/10.1017/S0140525X00003435] [PMID: 11301544] Şen, Z. (2014). Philosophical, Logical and Scientific Perspectives in Engineering. Intelligent Systems Reference Library 143 Springer.260. Thomson, A. (1996). Critical Reasoning A practical introduction Routledge 11 New Fetter Lane, London EC4P 4EE Wrenn, C.B. (1995). Naturalistic Epistemology.https://www.iep.utm.edu/ Zadeh, L.A. (1973). Outline of a New Approach to the Analysis of Complex Systems and Decision Processes. IEEE Trans. Syst. Man Cybern., SMC-3(1), 28-44. [http://dx.doi.org/10.1109/TSMC.1973.5408575] Zadeh, L.A. (1965). Fuzzy sets. Inf. Control, 8(3), 338-353. [http://dx.doi.org/10.1016/S0019-9958(65)90241-X] Zadeh, L.A. (1975). The concept of a linguistic variable and its application to approximate reasoning, parts 1,2 and 3, Inf. Sciences, 8: 199–249, 8: 301–357, 9: 43–80

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CHAPTER 3

Medicine History “For Countries' Political History, for Humanity, Science History has Importance” Abstract: The history of medicine shows that medical sciences are historically intertwined with different civilizations according to advice on linguistical forms and written books. The first medical treatments were based on superstitions that had been overturned by principles of rationality for the past 2500 years. For example, several medical treatments were based on amulets, totem symbols and tattoos, originally thought to drive away evil spirits from the sick body. The history of medicine offers visions of the evolution of medical treatments. In this chapter, all civilizations and their leading medical philosophers and recommendations are coherently explained in a harmonious manner so that the reader can understand centuries of valid and invalid disease treatment procedures and better alternatives.

Keywords: Ancient Egypt, Avicenna, Civilizations, Islam, Medicine History, Mesopotamia, Old Greek. 3.1. GENERAL Medical treatment methods, such as amulets, totem symbols and tattoos, have emerged against evil spirits that cause diseases in the body. With the discovery of the writing, medical information records were accumulated and taken under protection in the temples, which were the center of social life. Since recording (tablets) outside the temple was forbidden, medicine became a profession of the clergy, and few people knew the script except the priests (Bayat, 2016). A brief summary was given by Jackson (2014), who stated that medicine touched all of us at some point in our lives. Medical care has always-utmost importance, whether we live in a high-technology society that uses the diagnostic and therapeutic tools of modern bioscience or in an isolated rural community, where health care is less formal, intrusive and less commercial. Indeed, as modern societies increasingly struggle to cope with chronic conditions such as cancer, heart disease, arthritis, obesity and depression, we have come to rely heavily on medicine’s ability to help us live our lives happily, healthily and productively. One of the first few questions asked by anybody who goes to the doctor today is about past conditions of the disease, whether they have close relatives with a past Zekâi Şen All rights reserved-© 2022 Bentham Science Publishers

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or present disease, so the doctor tries by all means to collect preliminary information. Physicians gain more experience and expert opinion through expertise inquiry style, because of trial and error methodological approximate reasoning. In general, gained knowledge depends on bivalent logic rules. Émile Littré (1801-1881), a French medicine historian, stated the following saying. “If physicians do not want to fall into a simple art degree, they must be aware of their own history with great care and importance to the inheritance of the past references.” There is not a concrete agreement even among all physicians throughout the history of medicine, because knowledge information has been in constant development over the centuries under critical debates and appreciation. On the other hand, the physician and philosopher Pascal (1623-1662) suggested that “It is necessary to respect each physician training throughout hundreds of years in his/her century as the same physician learning continuously.” Although some of the treatment methods in the past have been abandoned, some of them are still applied today. For example, acupuncture (needle cure), phytotherapy (herbal cure) and hydrotherapy (water cure) are some of them. Those who think old medical treatments are nonsense should remember that some of the daily treatments are treated in the same way. The history of medicine is important for physicians, who want to think philosophically and logically about medical advances over the centuries. Knowledge of past stages of medical development and awareness of today’s modern medical methodologies and their possible future improvements may encourage some physicians to consider and work on improving existing medical knowledge (methods, drugs) and treatment methodologies. Over the centuries, the philosophy of medicine and its results show that medical knowledge is not static, fixed or unchanging, but is in constant improvement towards a better direction that is expected to continue in the future. Especially physicians and scientists who ponder on the future of medicine have left marks on the history of medicine, and for this reason, the author advises young physicians to read about the history of medicine and at least the biographies of a few physicians. The vision for the history of medicine as a tool provides classical insights into past examples and their impacts on society, and this topic is essential in medical education curricula, but unfortunately, there is rarely a case in today’s programs. A physician can evaluate the pros and cons of past medical developments, which provide a comprehensive view of past medical events, their effects and stages

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through which types of medical treatments have passed in the light of his thinking ability, and thus strive to move towards better innovative developments in the future. On the other hand, Chinese civilization provided the first examples of technology; Indian civilization developed the counting system; ancient Egyptian civilization provided the first techniques of measurement and geometry; Mesopotamian civilizations provided the first examples of celestial and astrological observations and related ideas. These civilizations used philosophical and logical tools and aspirations for their thought products. Starting with the Sumerian civilization about 3000 years ago, many preliminary human tools, instruments and gadgets were produced from stone, clay, bone, wood, cupper, bronze and iron materials. In ancient Greek and Hellenistic civilizations, all previous civilizations have reflections at different scales. Macedonian King Alexander the Great (BC 356323) tried to benefit from the known world during the reign of ancient Greek civilization, Egypt, Mesopotamia and Persia, reaching almost the borders of China and India. After all, it cannot be said that the principles of philosophical and logical thinking before the ancient Greek civilization were completely arbitrary and speculative, but were not found in written documents. They were practically applicable knowledge and technologies for everyday life. The reader can find a detailed history of medicine in books by Major (1954) and Sigirist (1955). The following sections explain the contributions of different civilizations related to medical science and its treatments according to historical chronology. 3.2. MEDICINE SCIENCE HISTORY A first glance at the map in Fig (3.1) is enough to appreciate the origin of science history, including medicine. The history of medicine goes back centuries before the history of science, because before dealing with other materialistic beings, human beings first cared about their own health. From this Fig, it is obvious that early civilizations along rivers readily took advantage of the availability of fresh water. The most influential places in the history of early medicine were the Nile, Tigris-Euphrates, Indus, and Yellow River regions. In the past, due to transportation difficulties, any development in one of these regions could not reach the other regions. Interactions remained with river beds or nearby fields. From this point of view, unfortunately, apart from papyrus and clay tablets, there is no real evidence of the history of medicine in these regions. Later, the ancient Greek and Hellenistic civilizations, based on the information and experience from these regions, transformed them into a systematic framework in written document forms. After these two civilizations, the Islamic civilization has

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brought all these resources to light tremendously with more clinical and hospital structures in different parts of the world, including Central Asia, Middle East, North Africa and Andalusia (Spain). With the emergence of Islam, all the scientific and medical knowledge of previous civilizations was collected by Muslim philosophers, logicians and physicians and more important innovative developments were produced with various methodological approaches, and then Western civilization took all these informative and enlightenment thoughts into Europe prior to the Renaissance.

Fig. (3.1). First human settlement regions.

(Fig 3.2) presents a diagram of the phases of the history of science. It arose initially based on medical thoughts, knowledge and inferences, superstitious and forms of witchcraft. In general, discomfort in the human body has been attributed to super-spiritual attributes, and various ritual celebrations were held to get rid of Satan in the body. Some of these ritual acts have succeeded without any rational and logical basis.

SCIENTIFIC DEVELOPMENTS

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1) Witchcraft 2) Common sense 3) Speculations 4) Rationality 5) Experiments

Fig. (3.2). Thought advancements in science history.

For thousands of years, remedies have remained in the hands of chieftains and enthusiasts. It is understood from (Fig 3.2 ) that the first methodological treatments in the scientific and medical fields began with witchcraft. As the level of knowledge and information increased, they began to search for root causes of diseases, but without knowing the invisible causes, they considered the causes such as moon eclipse, sun, planet and star locations and lighting as natural and astronomical effects. On the other hand, evil spirits that can enter the human body and cause disease are expelled from the body depending on the concealment of certain substances such as water, soil and plant. The witchcraft belief gradually began to lose importance; hence, common sense thoughts began to emerge with cause-and-effect logical thinking about health and other natural sciences. In the fourth and fifth centuries BC, ancient Greek thinkers combined philosophical thought with logical guidance, yet speculative traces remained in the distinction between useful and dangerous descriptions of cause. Although philosophical and logical principles have begun to play an important role in human thought, the lack of experimental studies has led to erroneous results. In this period, many philosophers emerged, such as Aristotle (BC 384322), Socrates (BC 470-399), Platon (BC 428-347), Democritus (BC 460-369), Empedocles (BC 490-330), Thales (BC 625-550), Aneximandros (BC 610-546), and Apollonius (BC 3-AC97). The most important physicians in these centuries

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were Hippocrates (BC 460-370) and Galen (129-200), who made important and rational contributions to the field of medicine. Hellenistic civilization king Alexander the Great (BC 326-355) expanded his state to the Aegean coasts of Anatolia, Egypt (Nile River), Mesopotamia (TigrisEuphrates rivers), Persia, and India, and hence, transferred all scientific and medical information to Athens. After his death, these lands were divided among the three commanders, and a mixture of ancient Egypt-Greek civilizations began to exist in the city of Alexandria under the name of the late Hellenistic civilization during the reign of Ptolemy (100-170). This civilization left a trace in the history of science by means of its Alexandrian library, museum and lighthouse. The Hellenistic period (BC 323- AC 30) started after ancient Greek civilization, where rational knowledge production continued in the light of philosophy and logic principles, and therefore, it is clearer and more reliable than previous speculative inferences. Roman Empire paid little attention to early scientific and philosophical developments, and so the enlightenment of ancient Greek and Hellenistic civilizations declined without regard for libraries or museums. After the emergence of the Islamic civilization, the Muslims’ research for useful information and the old civilizations’ lands conquests; they came across different scientific and medical information sources in written books on subjects such as nature, medicine, philosophy, logic, geometry, arithmetic, music and art, which were mostly in Greek and to a lesser extent in Sanskrit and Syrian languages. In the science center established in Baghdad during the Abbasid period, they are translated into Arabic at “Bayt-ul-Hikmah”, that is, “House of Wisdom”. These translations later laid the foundation of Western civilization, which transmitted scientific thought and knowledge from the regions Andalusia, North Africa and the Middle East regions extending to Central Asia and India. Today, although the West has jumped from the ancient Greek civilization to the Western civilization, the real trigger of the Renaissance is the Islamic civilization, which consolidated the knowledge and information resources of all previous civilizations with comprehensive, innovative scientific contents. In the first 100-200 years of Islam, free thought based on ancient Greek philosophy and logical foundations began to take better forms of enlightenment in part through critical debate and some innovative changes to the ancient systems of thought. This movement increased the interest in ancient Greek and Hellenistic sources. In about 830 AD, during the Abbasid Reign, the ruler Caliph Al-Ma’mun (786-833) ordered the establishment of a scientific, philosophical and logical institute to translate all the useful books from different languages into Arabic, in “Bayt Al-Hikmah” (House of Wisdom) in Baghdad. Thus, after the reign of Roman Empire, completely new philosophical, logical and rhetorical subjects

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entered the educational systems in the Islamic world. By the way, due to the possibility of fast and continuous writing in Arabic letters, manuscript book reproductions increased in the shortest possible time Experimental reasoning started with Muslim thinkers, philosophers and physicians by considering factual data. The historical evolution of knowledge and philosophical, logical and scientific information and throughout history is illustrated in Fig (3.3) as a flowchart starting from four completely independent civilizations (Egypt, Mesopotamia, India and China) and how the transitional stages took place during the past centuries to reach today’s scientific level EUROPE (Renaissance)

ISLAM (BAGHDAT, Dimashkh, Buhara, Semerkant, ANDULISIA

Sabaeans (Harran, in Turkey) HELLENISTIC (Alexandre the great (Greek+Egypt) PERSIANS

OLD GREEK (Eastern Anatolie, Thrace, Athens Atina)

CHINA INDIA (Indus River) (Yellow River)

EGYPT MESOPOTAMIA (Nile River) Tigris-Euohrates Rivers (Symarian, Akkadian, Babylon, Chaldean, Harran)

Fig. (3.3). Inter-civilization relationships based on scientific development stages.

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These philosophical, logical and freedom principles in thought have reached Western and Southern Europe from Andalusia (Spain) and North Africa. Crusaders also transferred important knowledge and experience from the Middle East. Thus, enlightenment and freedom movements began to take place in Europe independently under the domination of the church. This is the real Renaissance (New Birth) for Europe, which began in the 16 century, not after the ancient Greek era, when Westerners adhered to it as complete disinformation, but after the Islamic civilization, which is also well known and appreciated by independent western scholars. For example, in Sarton (1884-1956) book, numerous contributions are mentioned from Islamic civilization to the pre-Renaissance history of science. Of course, the inventor of the printing press accelerated the publication, and distribution in Europe, and the first translations into the Latin language began in the Andalusia city of Cordoba. The translation movement sparked scientific thought in Europe, and in the early stages of the Renaissance Galileo (15641642), Leonardo da Vinci (1452-1519) and Rene Descartes (1596-1650) emerged as the leading thinkers of Western Europe. 3.3. MEDICINE HISTORY There is no definitiveness as to the origin date of medicine, but it is assumed that it goes back to the origin of humanity. This leads us to the conclusion that almost the oldest profession is the profession of medicine. The Renaissance advanced practical and theoretical knowledge, which were combined with medical experimental approaches that led to important innovative developments. Western educational institutions benefited from Latin translations of Zakaria Al-Rhazes (841-926) and Avicenna (980-1037), and this trend continued almost into the eighteenth century. The first hospitals in the West failed to offer similar solutions to the Islamic world. Scientific advances were made possible by a few free thinkers, who were not initially interested in the anatomy and pathology of Galen (129-216) but based their treatment on the principles of Hippocrates (BC 460370). The most important ability of any human being is to use the mind. Although other organs, such as the hand assist in the production of assistive devices, their mental activity functions lag far behind. In the history of medicine, people have tried various herbs for their beneficial effects and have come to conclusions by doing experiments. On the other hand, additional knowledge and experimental information are obtained by observing sick animals according to their plant-eating patterns. All this information is then used for treatments. For example, wounds are

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treated with plant fibers and leaves, broken bones are fixed with tree branches and mud, and pains are treated with stones heated in the sun. About three thousand years ago, medical knowledge was written on clay tablets (Mesopotamian civilization) or on papyrus, layers (ancient Egyptian civilization) and the transfer of written information began between successive generations and civilizations. In Europe, the ability to write was in the hands of religious leaders, so knowledge of medical treatment remained under their jurisdiction. According to (Fig 3.2), in later centuries, the accumulation of knowledge started before Christ and continued to develop and reach today’s level. Medicine in Islamic civilization is very much developed. For example, the medical teachings of Avicenna (970-1037) have been used in Europe for centuries. The first institutional establishments emerged through madrasahs (universities) in the ninth century, and later became higher education institutions in the eleventh century. Colleges in the West had a quite different system of appearance. Higher education institutions in the Islamic world, the Qur’an and the Prophet Mohammad’s sayings, are centered in religious establishments with philosophy, logic and natural sciences. However, after the 16th century, before the Renaissance in Europe, religious authorities viewed philosophy and logic as questionable subjects. Despite this, philosophy and logic books are reproduced and kept in school and mosque libraries. Those who are eager to learn these subjects and natural sciences have benefited from house education systems. In the absence of corporate schools, students eager to learn different subjects lived in different cities. For example, who wants to learn medical knowledge should go to the city of the specialist(s)? For this reason, unfortunately, institutional structuring could not be realized in the Islamic world. This was an obstacle to the expansion of scientific education, research and development dissemination. 3.3.1. Physicians in Ancient Egypt Whether or not Egyptian medicine and papyrus content paved the way for future knowledge, the clinical scenarios in the Ebers papyrus represent one of the earliest observations of heart failure syndrome (Bryan, 1930; Nunn, 1996; Saba et al., 2006). The practical works and visions of ancient Egyptian physicians are presented in the following items. 1. Golden fillings were used in teeth, at least among those who could afford it, and such operations began in the 4th dynasty. 2. One of the papyri describes the definition of a large wound on the head. The details of this definition are that the doctor carefully observes the membrane

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surrounding the brain, the folds of the brain and the surrounding fluid. 3. Those that use papyrus are not only experienced but also knowledgeable. 4. It is possible to understand from the papyrus writings that the physicians of that period thought of the brain as the center of the human body. 5. The social status of the physicians was not clearly known. The first physician we know about was the architect of the step pyramid named Imhotep (BC 2667 - MÖ 2648), the next man of King Coser (Djoser). 6. Physicians in ancient Egypt had a noble dynastic heritage. 7. Two papyri are noteworthy, containing almost rational visions void of common sense, alternatives and false beliefs. 3.3.2. Physicians in Ancient Mesopotamia Regardless of Egyptian civilization, all civilizations between the Tigris and Euphrates rivers are considered Mesopotamian. Sumerians (BC 4500-1900), Assyrian (BC 2500-609), Acadians (BC 2334–2154), Byblos (BC 2500-100), Phoenician (BC 3200-2750) and Hittite (BC 1350-1300) civilizations reigned in successive centuries. Although the Mesopotamian civilization is as old as Egypt, we know much less about Mesopotamian medicine as the cuneiform source material has been much less researched (Retief and Cilliers, 2007). Some medical information about these civilizations is presented in the following points. 1. They used witchcraft and pseudo-scientific methodologies for treatment. Physicians used speculative approaches when using drugs,, 2. As in all ancient civilizations, Mesopotamians used plant elements such as roots, branches, fruits and leaves as medicine. 3. It was almost too difficult to recommend a specific medical treatment for the known disease. 4. They knew to have water retention in the body, fever, hernia, scabies, leprosy and some of the skin diseases were known and likewise they also knew hair, throat, lung, liver and stomach diseases and they are well diagnosed. 5. They were also therapeutic drugs for the treatment of all these diseases. 6. The treatment is not only based on herbal medicines, but also ground stones and salt minerals and some animal parts are used in the production of medicine. 7. A magic number effect was believed to be a cure. The most preferred among these numbers are 3, 7 and their folds. For example, medicaments with suitable compositions have been produced from 3, 7 or 21 sesame seeds. 8. The dose was given 7 times in the same way, branding was applied 3 times. 9. Numbers are used because they are believed to have secret magical powers that affect medicine.

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10. As in many ancient civilizations, herbal elements were used during lucky times such as the full moon and the collected material was believed to provide better healing 7 days before or after the full moon. 11. Preparation of syrups as medicine usually requires a special person, a child or a virgin. There was a belief that their generosity and purity provided additional effects in the drug mixture. 12. Compared to the Egyptian civilization, only small and medium-sized surgical treatments were applied in the Mesopotamian civilizations. 13. Physicians are less dependent on empirical expertise despite many medical problems and written documents. 14. The position given to the physician is attractive, because physicians, priests, innkeepers and bakers are at the same level. 15. This classification was not as strange as it might seem, and physicians were not official employers in the palace, but they earned their living from land registry records outside the palace. 16. During the reign of Hammurabi (BC 1790-1750), there were prescriptions for unsuccessful physicians, like the prescriptions of successful physicians. 17. According to the reign of Hammurabi (BC 1790-1750), if a physician treated a noble person’s broken bone, he paid five silvers, and no nobles paid three silvers. 18. If he is a slave of a noble, he should give two silvers for his treatment. 19. Payments for surgical processes were higher, and failure penalties were prescription dependent. If the slave’s treatment results in death, the nobles appointed a new slave; one of the physician’s hands must be amputated. 20. Surgical treatment was constantly dangerous for the patient and therefore, physicians in the Babylon land had to be more careful if the patient was from a noble class. 21. Veterinarian was another direction in Mesopotamian civilizations, 22. Sorcerer promises and evil prayers were used to assist physicians in the treatment of humans or animals, because it was believed that diseases, like other things, were created by the gods. 23. The effects of medical treatments are temporary. 3.3.2.1. Relationship Between Disease and Witchcrafts in Ancient Mesopotamia In some civilizations, it was thought that disease was related to prophecy and practices were made accordingly. Such situations never existed in Islamic civilization but prevailed in Europe under the hegemony of church authority. Compared to ancient Greek rational medicine, Mesopotamian medicine was predominantly religious (Kinnier-Wilson and Reynolds, 1990; Geller, 2004; Stol, 2004; Thomas, 2004). Some points can be mentioned as follows:

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1. The idea that disease is subject to the gods gave the impression that it was the main means of communication with the prophecy of the gods. 2. Through divination, the physician can discover the desires of the gods, thereby obtaining useful information about the cause of the disease that the gods already knew, and leads to future inferences. Such considerations were respected as the only method of treatment. 3. Different methods of divination were used, which led to the study of such subjects as bird flight, the strangeness of creation or the birth of animal and stars. 4. Dreams had a very special place in prophecy, vivid dreams gave the impression of reality and meanwhile, they were revered as news from the gods because of their inconsistency. 5. Understanding the language of dreams was the responsibility of physicians and priests. 6. Pharaoh’s dream of “seven fat cows and seven thin cows” as mentioned in the Bible and Qur’an and refers to Prophet Joseph. 7. There are similarities between Hebrew, ancient Egyptian and Babylonian beliefs that prevail even in primitive civilizations. 8. As for the divination, the Babylonians and their neighbors relied on hepatoscopy (a method used by Babylonians for divination). 9. Hepatoscopy (haruspex) is a type of divination that deals with the examination of animal liver (especially goat and lamb). 10. As it is understood from many texts that the lungs provide prophetic information for modeling on clay tablets, the oracles examine the five round pieces and give their prophecies by looking at the positions of these pieces. 11. Such clay models are only found in the land of Babylon. 12. There were many models with inscriptions in various languages, implying that the Babylonian divination technique was carried to distant lands. 13. Models were evidence of how these ideas and cultures were transferred from one center to another. 14. The idea of using animal liver in Babylonian civilization stems from the similarities between the functioning of human and animal bodies. 15. They also discovered the importance of blood as it meant life. 16. When one loses blood, he becomes weak and may die from excessive blood loss. 17. The reason why so much importance is given to the liver is that it is the richest blood reservoir and carrier among all organs. 18. From time to time, the liver is considered the center of life and is the center of other organs. But then they accepted the heart as the center of the mind. 19. The Babylonians almost realized that disease was transmitted from person to person.

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3.3.3. Ancient Greek Medicine In the Hellenistic period, the first Greek medical school was opened in Knidos in the 6th and 7th centuries BC, and Alcmaeon of Croton wrote the first anatomical text in this school before Hippocrates (BC 470-360). The four elements (water, air, fire and soil) balance was the main cause of human health, called isonomy. The ancient Greeks relied on ancient Egyptian ideas and remedies for their treatment. They also believed in evil spirits or angry gods as causes of diseases. Apollo’s Asclepius could easily cure diseases. Also, prayer and sacrifice were common healing methods in Asclepius’ tomb. Asclepius was thought to have the art of healing and the source of divine knowledge of medicine. Around 500 years BC, however, Greek doctors became more interested in using philosophy, observation and logic to discover the causes of disease (Pearce, 2016). The essence of this civilization goes back to various predecessors, including Egyptian, Mesopotamian, Indian, and others, as a result of Alexander the Great’s conquests of the then well-known world from Macedonia to India. During all these centuries, knowledge and experience in medicine and all other subjects were carried to the Aegean coast and from there to Athens, giving birth to the ancient Greek civilization and pre-Islam medical studies can be summarized as follows: 1. According to tradition, the founder of Greek medicine is Asklepios (one of the Greek gods of health and medicine), mentioned in the work of Homers (BC 800-701). Asklepios, the excellent physician of his time, is later known as the idealized son of Apollo. Asklepios learned the art of healing from the humanheaded horse mythological creature, Chiron, and as a result of killing all people with this art, he was killed by lightning struck by Zeus, 2. Usually, Asklepios is depicted with a baton surrounded by a snake. But still, the two snakes as symbols of modern medicine must have something to do with this first version. In fact, the stick in Asklepios’ hand had no medical significance, but only Hermes and Mercury represented the magic wand as the messengers of the gods and protectors of commerce, respectively. 3. Although, it is not well-known whether Asklepios lived, his cult, which was given in the form of a ceremony as a religious treatment method, as in private temples, spread. 4. Accordingly, bathing is a kind of listening period followed by “incubation period”. The dreams seen during this period are interpreted by the priests of Asklepios, and various gifts are presented to the temple. The use of medicine in the temple was limited. The drugs were recommended by doctors elsewhere.

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5. No surgical procedure was applied to the temples, and the treatment was basically psychological. Such stencil treatments were not Greek inventions and were practiced in Egyptian civilization. It should not be thought that Greek medical treatment does not give weight to psychological treatment. 6. Greek physicians have used plant roots or leaves as medicine for centuries. They gathered roots and herbs to use in witchcraft. After a while, they become enriched with information about their treatments. 7. They also believed that the gathering times should coincide with certain phases of the moon and nighttime hours. On the other hand, this process was practiced during magic songs and was regarded as quite dangerous. As one thinker put it, hair-like collections of roots and herbs plucked from tiger skin. 8. Considering the necessary precautions, this operation was safe. The physician’s task was to determine the appropriate dose. 9. Greek medicine did not only consider practices; some theories were also developed. Different Greek schools had the disposition to think about the world, and it is not surprising that the same was true for medicine. 10. From the earliest times of history, there were four schools as follows: a. Pythagoras (BC 597-467) medical school: Health depends on the balance of internal forces in the body, and the mind is considered the center of the senses. b. Sicily medical school: Its founder was Empedocles (BC 494-434), who introduced the idea of the four elements (water, soil, air and fire). Here, indoor and outdoor body air has become important. c. Ionia medical school: Some anatomical cadaver surgeons were searched. d. Abdera medicine school: Physical education, training and diet were the most important in medicine. Among the members of this school are Democritus (BC 460-370), who first introduced the concept of the atom and Hippocrates (BC 460-370). These four early schools of medical thought gave way to two centers, one in Knidos and the other in Kos. Kos thought of medicine during the Hippocrates (BC 460-370). The Kos school took a more general approach and went to die with various medical problems. It would be fair to say that the Kos school was the first center of classical medicine. The Hippocrates (BC 460-370) collection of some sixty important texts include the reflections of his colleagues and students’ thoughts in Kos. Hippocrates (BC 460-370) talks about the effects of environment and climate on health, especially, the spread of epidemics, the nature of local water and food, and even people in his work “Weather, Waters and Towns”. The study opened a whole new field of research. However, the most common among Hippocrates (BC 460-370) books contain aphorisms. Even today, many people have heard his words.

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“Life is short, art is long. Opportunity runs away quickly, experience is unreliable, judgment is difficult”. Despite this, the second sentence below is less well known. The physician should be prepared not only to perform his duties, but also to ensure the cooperation of the patient, his attendants, and those around him.” This sentence reminds us the “Hippocratic Oath” that physicians have adopted as a behavioral guide for centuries, emphasizing that the physician’s duty is to work for the benefit of the patient and the sanctity of trust between them. Although critics of Hippocrates (BC 460-370) sometimes accuse him of producing general knowledge rather than treating the individual, his school aims high. The first signs of scientific medicine in the Islamic world were based on his studies. He adopted a scientific perspective and used scientific methods in an area dominated by magic and purity. His decisions were careful and based on measurements. The superstitions prevailing at that time rejected all relevant philosophical ideas and words. He also kept records of the cases he treated, describing his successes and failures in a manner befitting a true scientist. Unfortunately, this tradition could not be continued in the West after that. It was revived in Islamic civilization in the 9th century but was not practiced in Europe before the sixteenth century. His oath is as follows (Jackson, 2014). “I swear by Apollo the physician, Asclepius, Hygeia, and Panacea and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement: To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; to look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher’s sons and to disciples bound by an indenture and oath according to the rules of the profession, and no others. I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and similarly, I will not give a woman a pessary to cause an abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, whom ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all

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humanity and in all times; but if I swerve from it or violate it, may the reverse be my life. The following quotes are about various cases in medical studies by Hippocrates (470-360) (https://www.goodreads.com/author/quotes/248774.Hippocrates on March 22, 2021) “People think that epilepsy is divine simply because they don't have any idea what causes epilepsy. But I believe that someday we will understand what causes epilepsy, and at that moment, we will cease to believe that it's divine. And so, it is with everything in the universe.” “The physician must be able to tell the antecedents, know the present, and foretell the future — must mediate these things, and have two special objects in view with regard to disease, namely, to do well or to do no harm.” “It’s more important to know what sort of person has a disease than to know what sort of disease a person has.” 3.3.4. Alexandria Medical School As a physician, Galen (129-200) tried to study the anatomy of the human body and presented Figs on his observations. This primary knowledge was based in part on the dissections of the human corpus, conducted out of scientific curiosity. It is possible to say with certainty that the slavery group conducted by the researches during the ancient Greek period and before the Renaissance in Europe provided relevant free people. For example, multiplication with Roman numbers was not possible, so, slaves were loaded for such a job that took all these years. However, in the same period, Muslims in Central Asia, the Middle East, North Africa and Andalusia (Spain) were able to perform arithmetic operations (multiplication and division) with Arabic numerals, which are used all over the world today. This indicates that the philosophical and scientific thoughts passed from the Islamic civilization to Western Europe, not from the ancient Greek civilization. Ancient Greek civilization emerged from the Aegean coastal region of Anatolia and later moved to Thrace in the north and then to Athens in the West. However, it started to disappear from the second century onward BC. Later, its mixing with the Egyptian civilization gave birth to the Hellenistic civilization (Serageldin, 2013). This civilization medical school began in Alexandria. The characteristics of this school are given below:

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1. The Alexandrian Museum is famous for its medical school founded by Herophilos (BC 335-280) in the third century BC. Although his exact date of birth is unknown, he visited Chalcedon (today Kadıköy on the Asian side of Istanbul) next to Bosphorus during the Byzantium period. 2. He studied medicine on island of Kos on the Aegean coast and was invited to Alexandria by Ptolemaios Soter (BC 367-282) and practiced medicine during the Ptolemaios Philadelphia period (Herophilos, BC 335-280). It has gained a great reputation and is preferred by students, who want to benefit from his knowledge. 3. Studies on human cadavers attracted more attention to Alexandria than any Greek city. 4. Such freedom provided him with great opportunities and Herofilos (BC 335280) benefited immensely from such a situation. He studied the mind, nervous system, arteries, and veins with the distinction between these two veins, the genitals and the eye. Although he based medical theory and practice on a mixture of four parts, he focused more on anatomy research. 5. He claimed that the center of the nervous system was the mind, not the heart, and drew the nerves from the mind to the spinal cord. 6. He wrote about the rete mirabile (a mixture of vasculature, great neural network) that exists in animals but not in humans. Some parts of the human anatomy are mentioned in his words. Parts of the human anatomy are still named after him today. On the other hand, Galen (129-200) wrote a book on medicine and mentioned the following points. “The best physician is also a philosopher.” “The chief merit of language is clearness, and we know that nothing detracts so much from this as do unfamiliar terms.” “The combination of pictures and words together can be really effective, and I began to realize in my career that unless I wrote my own words, then my message was diluted.” “I think that cognitive scientists would support the view that our visual system does not directly represent what is out there in the world and that our brain constructs a lot of the imagery that we believe we are seeing.” 3.3.5. Effects on Early Islamic Medicine The scientific foundations of today’s medicine are laid down by Muslim physicians, thinkers and philosophers. The transfer of this knowledge from

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Central Asia, Mesopotamia and Egypt to Andalusia (Islamic Spain) led to its spread to Western Europe, and thus modern medicine reached today’s high levels. The following points are some of the reflections of Islamic medicine history. 1. Although there are no direct and clear concepts in the Qur’an, signs regarding social hygiene are given. 2. After the spread of Islam in Persia and Byzantine, the ancient Greek medicine, which had been idle for centuries, entered a period of revival. 3. Revived in the works of ancient Greek physicians, philosophers or thinkers [Aristotales (BC 384-322), Hippocrates (BC 460-370), Galen (129-299), Ptolemy (100-170), Archimedes (BC 287-212) and others] Muslim physicians, philosophers and thinkers made almost the first inferences for today’s foundations. 4. The work of Aristotle (384-322) was often at the forefront in medical circles. Some Muslim physicians had ideas from Empedocles (BC 494-434), Anaxagoras (BC 500-428), Socrates (BC 469-399) and Plato (BC 428-348). 5. Herbal medicine had a special place in Islamic medicine. First-century scholar Dioscorides (40-90) book on “Materia Medica” was translated into Arabic with the title “Kitab el-Hashish”, meaning “Plants Book”, but updated with a lot of additional information. 6. Muslims first benefitted from the ancient Greek philosophers Pythagoras (BC 570-495), and Platon (BC 428-348). The main reason for this was that they identified philosophy with medicine. 7. The establishment of a new foundation based on the teachings of Galen (BC 129-200) through the educational system. 8. Scholars from Alexandrian produced outstanding works based on the works attributed to Hippocrates (BC 460-370), and these works are used by Muslim physicians 3.4. ISLAM AND MEDICINE After the developments in the previously described sections during the various civilizations period, Islamic medicine began to develop its own concepts, methodology, diagnosis, medicine and treatment subjects. Edriss et al. (2017) provided a brief history of Islamic medicine and its transition to Europe. They wrote that Islamic culture flourished between the 9th and 13th centuries. Scientists during this period made significant contributions to the fields of mathematics, science and medicine. Caliphs and physicians-built hospitals provided universal care and formed the basis of medical education. Physicianscientists have made significant advances in medical care, surgery, and pharmacology. Notable authorities include Al-Rhazes (865–925), who wrote

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“Kitab al-Hawi fi’t Tibb” (Comprehensive Book on Medicine), a 23-volume textbook that provided the main medical curriculum for European schools in the 14th century. Ibn Sina (Avicenna) (980–1037), an outstanding Muslim scholar, wrote “Al Qanun fi’t Tibb” (The Law of Medicine) and produced an encyclopedic work of medical treatment combining his own observations with medical knowledge from Galen (129-200) and philosophy from Aristotle BC 384-322). Mansur (1380–1422) wrote the first color picture book on anatomy. Other notable physicians compiled information on physiology studies, including the use of medicinal herbs, advanced surgical techniques, cataract extraction, and pulmonary circulation. These books and ideas provided the foundations for medical care during Europe’s recovery from the Dark Ages. The following points are some reflections from Islamic medicine. 1. Adaptation of the ideas of ease and balance of Hippocrates (BC 460-370-Galen (BC 129-200) to Islamic medical schools. 2. The basic organs of the body are understood as the characters, mixtures, qualities and elements of air and earth depending on the seasons. Attributes are human senses such as cold, heat, dryness and wetness that occur during the various seasons of a year. 3. Anatomy and physiology are inseparable in Islamic medicine and entered different branches of medicine. 4. The Islamic view sees creatures as signs of Allah (God), and hence, Muslims’ emphasis on the study of the human body is a very sacred identity. 5. Allah’s concept of wisdom emerges at the highest level and is related to human anatomy, which encourages intense tests. 6. Islamic law was against dismembering the body, since God’s most honorable creature could be treated with reverence. 7. Ibni Nefis (1210-1288) was among the most famous physicians and invented blood circulation nearly 400 years before the Western physician William Harvey (1578-1657). Muslim physicians had greatly different ideas from Galen’s (BC 129-200) anatomy and physiology. 8. Huneyn bin Ishak (810-873) was the founder of pharmokognosy, which is one of the main branches of pharmacology and examines natural remedies. He also classified plants and wrote corresponding translations in various languages. 9. Avicenna (970-1037) completed the most important branch of physiology, which examines the functions of the mechanical, physical and biochemical systems of living organisms with the definition of blood circulation. 10. Ibn Habib (1313-1374) from Granada in Andalusia (Spain) understood that plague was contagious and laid the foundation for the quarantine system. 11. Muslims attached great importance to experimental studies and thus further developed medical science. For example, Ali Ibni Rab-Ibn el-Taberî (780-

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12. 13. 14.

15. 16.

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850) wrote “Firdevs el-Hikmah” (Paradise wisdom) book, whereas Zakaria El-Rhazes (865-925) books were “Kitab El-Hawi fi't-Tibb” and “Kitab el-Tıbb el-Mansur”, who made important contributions to medical science. Especially, his book “El-Hawi” has been the basic reference book of Westerners for centuries. Avicenna (970-1037) book “Kitab el-Kanun fi't-Tibb” (The Medicine Law) has been the most famous and main reference source in the West for centuries. In Abu'l-Kasim el-Zehravi’s (930-1013) book called “Kitab el-Tasrif”, “The book of Clarification” some fine points in surgery are mentioned and information is given about the skin cells. Although, Averroes (Ibn Rushd) (1126-1198) was a philosopher; he also worked on therapeutic issues and his book is known in the West as “Colliget” “Kitab el-Kulliyat fi’t-Tibb”, “The book of corpus in Medicine” Ibni Baytar (1197-1248) wrote the book on botanic and pharmacy, “Kitab elCami fi'l-Edviyet el-Mufrede”, (The book of Medicine), which was translated into Latin under the name of “Simplica”. Muslim influence in the West reached its peak in the thirteenth and fourteenth centuries, just before the Renaissance, and its influence was seen in the universities of Salerno, Montpellier, Padua, Bologna and Paris.

There were many famous physicians in the Islamic civilization, among them are the following: 1. Among the physicians, philosophers and thinkers, who helped Islamic medicine reach its peak, there is Ibn Ebu Usaybia (1198-1270) with his “Uyun el-Enba fî-Tabakat el-Etibba” (Important information about the biography of medical scholars). Ibn el-Kifti (1172-1248) and his book “Tarih el-Hukema” (History of Physicians and Philosophers); Ibn Hallikan (1211-1282) who wrote “Defeat elAyan” (Death of Scholars). Ali Ibn Abbas el-Mecusi (Haly Abbas) (d. 994) had “Kamil es-Sinaat” (Peak of Art) drug content grades. 2. The medical center in Gundeshapur City was moved to Baghdad in the second half of the 8th century, when ophthalmologist Yuhanna Ibn Masewaiyh (777857) was well-known. He is known as “Janus Damascenu” in the Latin-West and as a prolific author he was the first Christian scholar to write a medical work in Arabic. 3. Thabit Ibn Qurra (836-901) defined smallpox in his book “Tezkire”, (Discourse on Medicine) years before Zakaria El-Rhazes (865-925) and this work was accepted as a standard medicine for many years. 4. After Ibn Masewayh, his student Hunayn Ibn Ishaq (809-873) became a pioneer physician and translator. 5. Hunayn (809-873) wrote the book “Kitab el-Ash Makalu fill-in” (Ten subjects

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6.

7. 8. 9.

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about ophthalmology), in which he presented anatomical eye Figs with a systematic ophthalmologist explanations. His other work is Kitab el~Mesail fi’1-Ayn” (Ophthalmology Problem Book). Thabit Ibn Qurra (836-901) mentioned in his work “Tezkire” before Zakaria El-Rhazes that he had also defined smallpox and measles diseases and put the problems into a standard form. El-Kindi (Alkindus) (803-873) established physio-physolology, and thus, became a pioneer in this subject, which deals with the relationship of mind and spiritual processes with physical processes such as physiology. El-Kindi (Alkindus) (803-873) is one of the first to write the relationship between astronomy, astrology and medicine in his work “Et-tibb en-nucumi” (The star of medicine). The first Muslim physician in the first half of the 9th century was Ali Ibn Rabban el-Taberi (780-850). The name of his first book on systematic medicine is “Firdevs el-Hikmah” (Paradise of Hikmah). He translated medical information from Syrian, Greek and Indian (Sanskrit) languages. His work was not only limited to general cosmological principles and subjects of medicine, but also included Indian medicine. He gave extensive knowledge and information especially in the field of anatomy.

3.4.1. Zakaria Al-Rhazes His contributions to the discipline of medicine were taught in European universities until the 18th century. Muslim physician, philosopher and chemist Zakaria Al-Rhazes (865-925) was born in the city of Rey, Iran. After studying philosophy, mathematics, natural sciences and astronomy in the city of birth, he completed his education mainly in Baghdad and other Islamic cities. He was the head of the Baghdad hospital. Many of his works have been translated into Latin and are still in the environment (university, institution and schools) even in the 18th century. Benefiting from Hunayn Ibn Ishaq (809-873), he had an education in Baghdad and thus learned Greek, Persian and Indian medicines (Edriss et al., 2017). He became interested in alchemy, but later gave up and concentrated only on medical studies. 1. His most famous medical work is “Kitab el-Hawi fi't-Tıbb”, “Book of Content in Medicine”, which is a comprehensive encyclopedia known as “Continens” in the West. This work conveyed the medical knowledge of Galen and Hyppocrates, and it is also rich in observation and experimentation rather than theory. The book “Al-Hawi” was translated into Latin in 1279 after much painstaking work by the Sicilian Jewish physician Ferech Ibn Salim (Farragut).

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2.

3.

4. 5.

6.

7.

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The book “Liber Continens” is one of the nine books in the library of Paris University. The same book was published 40 times between 1498-1866. Another valuable work is “Kitab el-Tibb el-Mansur (Medicine Book for Mansour), which is known as “Liber Medicinalis and Almansorem” in the West. Other medical books by Zakaria Al-Rhazes (865-925) are: “Kitab Taksim el-Ilel” (Division of Disease Reasons), known in the West as “Liber Division Morborum”; “Kitab el-Fahri” “Liber Pretiosus”; in the West; “Kitab el-Cederî ve'l-Hasbe” (Book on Measles and Smallpox Subjects) and “Liber de Pestilentia” in Latin. This last book has been translated into English as “On Small-Pox and Measles” and into French, “De la Variole et de la Rougeole”. This book provides basic and useful information about the measles and smallpox. The influence of Zakaria Al-Rhazes (865-925) was practically at the peak of medicine in almost all branches of medicine in the West. His other influential books are “Kitab el-Medhal el-Talim” (Introduction to Medicine Teaching) in Latin “Introduction in Medicinam” and “Terkib Al-Adviyye” (Mixture medicines) “Akrabadin”, and in Latin “Antidotarium”. Al-Rhazes (865-925) explored new ways of using mercury in medicine and suggested the use of stitches made from the animal gut for wounds. Some of his articles are “On the most famous physicians treatment failure of all diseases”, “Why illiterate physicians are more successful than expert specialists”, “Treatment in an hour”, and “The book of everybody, who cannot find a nearby physician”, which has been very popular, because it was in the form of an encyclopedia about human health and every disease was described in detail with useful information for every house and kitchen. He examined the effects of air temperature, wind and humidity on the human body for houses to live a healthy life and suggested that every house should have a laundry room. His recommendations include avoiding bad odors, ventilating the patient’s room, keeping the room temperature appropriate, finding clean drinking water and washing the body frequently. He also stated that physicians should behave ethically. He hated charlatan physicians and respected medical deontology. He stated that the physician should behave well to his colleagues, patients, patient relatives and people and obey the rules during his service. He paid great attention to these points.

The following value statements are quoted by Al-Rhazes (865-925) in the medicine domain “If the people of this religion are asked about the proof for the soundness of their religion, they flare up, get angry and spill the blood of whoever confronts them

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with this question. They forbid rational speculation and strive to kill their adversaries. This is why truth became thoroughly silenced and concealed.” “You claim that the evidentiary miracle is present and available, namely, the Koran. You say: 'Whoever denies it, let him produce a similar one.' Indeed, we shall produce a thousand similar, from the works of rhetoricians, eloquent speakers and valiant poets, which are more appropriately phrased and state the issues more succinctly. They convey the meaning better and their rhymed prose is in better meter. … By God, what you say astonishes us! You are talking about a work which recounts ancient myths, and which at the same time is full of contradictions and does not contain any useful information or explanation. Then you say: 'Produce something like it'” 3.4.2. Avicenna He was born in Central Asia in 970, and his ideas on the philosophy of medicine, physics, human senses (physiology) and religion have been very influential all over the world. He is a Muslim thinker, who had philosophical thoughts about the creation of humans. His major book “Qanun et-Tipp” which means “Law of Medicine” contains important philosophical phrases about medicine. He laid the cornerstones of scientific information first on observations and then on experiments, followed by philosophy and logic, but he stated that although they infer information, they are still not complete. His statement: “I apply on the patients the information that I learn” implies working on previously unused observations and experimentation. Ülken (1988) has pointed to the importance of experiments in philosophy by saying that “Experimentation and rationalism constitute a non-divisible unity in his works” Çubukçu (1986) informed that he learned philosophy at a young age and memorized the entire Qur’an at the age of ten and received his medical knowledge from Isa Ibn Yahya, and continued as follows: “He deepened in short time duration in philosophy, logic, astronomy, physics, mathematics, and in natural sciences. He cured Sultanı Nuh Ibn Mansur in Bukhara and the sultan appointed him as the head of Sıvan ul-Hikme library in his palace. Although he continued his works for some time in Bukhara, after the Sultan’s death he moved to Rey City in Iran. At the age of 17 he proved that he is superior to all physicians in this city, and he also cured Rey Governor Mecdu'dDevle. After some time, he went to Hemedan City, where the governor Shemsu'd-

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Devle respected him and he also cured this governor, and consequently he is appointed as a minister”. During this period, he wrote the most well-known book on the Law of Medicine, which has been used in the West for centuries, and it had undeniable effect on today’s modern medical rules. Feyyaz and Tan (2009) and Kahya (1995) wrote the following about him: “Ebu Ali Huseyin Ibn Abdullah Ibn Ali Ibn Sina in Latin Avicenna (970-1037) is the first physician, who made injection the first time underneath the skin. He is pioneer in stomach and intestine scientific diseases investigation. He also studied the effect of spiritual causes on digestion system. Some said that there is no medicine, but Hippocrates (BC 460-370) made it exist, Galen (129-200) revived, Rhazes (865-925) corrected and Avicenna (970-1037) completed the missing. In his book “Ash-Shifa” (Healing) in the physics chapter; he stated the first principle of dynamic state about almost five hundred years ago from Isaac Newton (1643-1726). According to him, any subject is either in the steady state or moves along a line in rhythmic manner. It continues to the same state, if there is no interference from outside. Additionally, in the same book Avicenna (970-1037) has stated many preliminary principles about the music and also voice types” It is obvious from all these explanations that he considers the remnants of knowledge left over from ancient Greek and Muslim thinkers; and commented on them by making a new updated explanation. Avicenna (970-1037) gave the definition of medical science as follows and none of his predecessors gave such a complete definition. “Medicine science focuses on the subjects of health and disease cases of human body and when the health is lost how it can be regained” Avicenna (970-1037) has thought and frequently used the philosophy as objective key information to reach reality through a systematic methodology. He understood the hunger of philosophy, which is possible by the love of knowledge. Science tries to infer how the human organ functions for generation of information objectively, but the philosophy tries to support why and how the organ exists in terms of ontology quite subjectively. In his book, the “Law of Medicine” he touches on hand and fingers by saying that: “As for the fingers, thumb has a distinctive position among others. If it was located in some other location, its existing functions should not function. For instance, if it took place within the palm, it could not function as necessary. If the bone of thumb did not have a specific connection with the bones of other fingers its distance from the fingers should increase and on one side the thumb and on the

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other four fingers should not have the possession of raising the subjects. In its present configuration the thumb with the collective functioning of other scan hold the subjects”. This statement shows us how his extreme and abnormal thoughts could lead him to reality and its functions as parts of the human body. His ontological thoughts centered on the materialistic and spiritual existences of human. From these principles Avicenna (970-1037) reached through observations, experience, experiments, and philosophical thinking that Allah (God) has created humans in the perfect manner. His thoughts about the nerve system indicate that: “If all nerve system originated from the brain, it should be big. For instances, nerves in the hands and legs should cover longer routs, and hence, there should be more frequent injury problems, and in the meantime, the nerves at upper leg and heap should be subjected to difficulty for contraction and relaxation. Due to these, the Glorious Allah (God) started the spinal cord from the mind, and hence, provided a grace. Spinal cord is a canal that originates from the brain in such a way that the nerves originate from two sides and extending towards below, providing the communication of organs directly with the brain. For this reason, Allah (God) protected the nerves by means of harsh bone canal”. After all what have been said, one can understand, to thank Allah (God), and hence, in the medicine works; he did not depend on the materialistic existences only, but also on the spiritual dimensions. In addition to the points, he also stated the following subjects: 1. Avicenna (970-1037) got interested in all the branches of science, and this interest continued under very difficult conditions until his death. Any topic that he dealt in the field of science has developed in the literature in small or larger scales. As part of his life story, he stated that: “I grew up, remained without country, but my value increased, but without costume”, 1. World history did not recognize productive writings at his scale. The number of his books is about 200, but he passed away at the age of 57. His books were based on philosophy, physics, metaphysics, physiology, mathematics, logic and medicine. 2. His influence on the Christian scholastics has been great. Dante (1265-1321) counted him between Galen (129-200) and Hippocrates (BC 470-360) as in Fig (3.4).

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Scaliger (1540-1609) considered him as equal to Galen (129-200), but much more advanced in philosophy. He is known as the “King of Medicine”. He had sincere friends and some enemies. Poets cursed him and religious scholars tried to rebut his teachings. Caliph Mustencid burned his books in Baghdad in 1150. Under all these conditions, in addition to his administrative public duties, his fruitful works are admirable even today. He recognized the universal human type in the Middle-Century. His “Kitab esh-Shifa” (Healing Book) is about 18-volume encyclopedic book that includes topics about medicine, physics, metaphysics, logic, mathematics, religion, economy, politics, minerals and music. This book is translated into Latin under the name “De Mineralibus”. Avicenna (970-1037) shortened this book under the name of another one as “En-Necat” (Liberation). Avicenna organized his book “Ulum el-Hikmah” (Philosophy of Nature) into eight chapters and they are related to Aristotle (BC 388-322) as follows: a. Kitab el-Kiyan (Libri Physica Auscultationis): Matter, format, space and movement concepts are discussed. b. Kitab el-Esma ve’l-Alem (Libri de Coelo et Mundo): Four elements are discussed as the foundation of the universe. c. Kitab el-Kevn ve’l-Fesad (De Generatione): Considers the universe in general. d. Meteorology. e. Kitab el-Maadin (De Mineralibus): It is about metals. f. Kitab el-Nebat (De Plantis): Its subject is plants. g. Kitab el-abayi el-Hayavan (De Animalis Nature), which is based on the animal features. h. Kitab el-Nefis ve’l-His and Mashes is about human self and perception, i.e. psychology. Avicenna (970-1037), who has left behind many valuable works, has a respectable position as well-known as other known Muslim thinkers such as Biruni (973-1048) in the history of science in the West. Avicenna (970-1037) thoughts were not free as Biruni’s (973-1048), but he provided methodological approaches based on the event inspection and inference. His philosophy is like Aristotelian (BC 384-322), new Plutonic (BC 478-348) philosophy and mixed with religious ingredients. His book “Law of Medicine” is also studied in some of the Islamic countries. Avicenna (970-1037) based his initial thoughts about medicine by consideration of Galen’s (129-200) book but added his specific and original ideas along the same direction with observations, experience and experiments. For example, the separation of middle eye membrane inflammation from lung membrane, the role of water and soil in infectious diseases, qualification of skin diseases and their descriptions are included in the same book. It is well-

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known in the West as “Canon Medicinae”. 7. Among the Avicenna’s (970-1037) book chapters are different topics such as general principles of medicine, simple medicines, diseases of internal and external organs, diseases that cover the whole body rather than a single organ, medicine mixtures and treatment methods. 8. After the translation to Latin in the 12 century by Cremona Gerard (11141187), with the invention of printing machine, his book is printed frequently next to Bible. 9. During the last 30 years (1470-1500) of the 15th century, it is published 15 times in Latin language, and once in Hebrew. There are numerous interpretations and citations about the book. 10. This book had an encyclopedic style, and therefore, had a strong systematic format and provided any symptom that may be felt as the indication of disease. In order to understand its greatness, it is necessary to provide some examples. For instance, brain vein occlusion, meningitis, diabetics, jaundice disease causes are explained in the book in detail. Also, psychiatry, melancholia, psychotic depression, insomnia (sleeplessness), forgetfulness and spiritual disorder topics are presented. 11. Some parts of this book keep its validity even today and some of them can be summarized as follows: a. Psychiatry (spiritual physicist) and psychotherapy advice are used, and they are valid in our days in the same meaning. He also mentioned about the effect of music on spiritual health. b. His advice about health include body movements, washing and massage. c. He signifies the importance of preventive physicians. d. Especially, elderlies must not leave walking practices, they must not eat much in the evenings or nights with less use of salt. e. He also advised the classification in disease diagnosis according to pulse types and defined them in such a way that they are still used in our days. 12. Avicenna (970-1037) discovered the causes of meningitis as body temperature, extreme headache, vomit, neck hardening and delirium. Infectious diseases spread types and the infectious nature of tuberculosis is among the new observations and inventions by him. He described the feeding benefits of mother milk for children. If mother is sick, then someone must take care of the children and the specifications of foster-mother. 13. According to Avicenna (970-1037), urine check can be trustable under certain conditions. Urine must be taken in the morning and must not be delayed for examination a long time. Prior to the urine delivery, the patient must not eat or drink anything. The patient must not make any unusual activities such lying down, to get up late in the morning, not be fatigue, all of which affect the urine as hunger and rage. Sexual relations cause blurriness in urine also

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nausea and vomiting may change the urine composition and its color. The urine indications appear as its color, density, blurriness and limpidness, smell, precipitate and foaming. 14. Although, during his period, there was no permission for surgery, there are some indications that surgery is tried on monkeys.
Perhaps another most popular book of Avicenna’s (970-1037) is “El-Urcuze fi't-Tıbb” (Poems on Medicine Subject), which facilitated the memorization of the students in an easy way. 15. Avicenna (970-1037) examined the medicine information from ancient ages, including Indian, Uygur, Dioscorides, Galen (129-200), Hippocrates (BC 470360), and Asklepios and Roman period. The following quotes are stated by Avicenna (970-1037), which has implementations even today (https://www.brainyquote.com/quotes/avicenna_ 230542 March 22, 2021). “The knowledge of anything, since all things have causes, is not acquired or complete unless it is known by its causes.” “Now it is established in the sciences that no knowledge is acquired save through the study of its causes and beginnings, if it has had causes and beginnings; nor completed except by knowledge of its accidents and accompanying essentials.” “Therefore, in medicine we ought to know the causes of sickness and health.”

Fig. (3.4). Avicenna, Galen and Hippocrates.

3.5. OTHER PHYSICIANS IN ISLAMIC CIVILIZATION Apart from Al-Rhazes (865-925) and Avicenna (970-1037), who cared for medical researches, there were other contributions by different Muslim thinkers.

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Among these, the following points are enough for an explanation. 1. In the 11 Century, there were extensive medicine activities in Egypt, Syria and Mesopotamia. Ali Ibn Rıdvan (987-l068) from Cairo, who was known by Latin as Haly Rodoam, provided the topography of medicine. He interpreted “Arsh Parva” of Ibn Butlan (ll. century) as “Takvim es-Sihha” (Health curement), and later translated into Latin. 2. Ophthalmology is another branch of medicine that reached its peak in years about 1000. His works on this subject are rich in content and translated into Latin. Until the rapid advances in ophthalmology in France in the first half of the 18th century, these works remained the best handbooks on eye diseases. The work “Tezkiret el-Kehhalin” (Selected Writings for Ophthalmologists) by Ali Ibn Isa (1389 – 1459) was used in Europe until the 18th century. Ishak Ibn Suleyman (855-955) was an early ophthalmologist. 3. Abu Marwan Abd al-Malik Ibn Zuhr (1094–1162) wrote a book “Taysir filMudawat wal-Tadbir” (Book of Simplification Concerning Therapeutics and Diet) and attributed it to his student and friend Ibn Rushd in Latin Averreos (1126-1198). He responded to his teacher with his book “Kitab el-Kulliyat fi'tTibb” (General Principles of Medicine). Averroes (1126-1198) of Andalusia was the strongest follower of Aristotle (BC 384-322) philosophies. His collective book “Kulliyat” was translated into Latin in 1255 under the name “Colliget”. In the second part of this book, information about physiology and psychology is given. In this book, he defended Zakaria Al-Rhazes (865-925) and Ibn Zuhr (1094-1162) against the thoughts of Hippocrates (BC 470-360) and Galen (129-200). 4. An increasing number of physicians, even those who were non-Muslim, were feeling free and independent in Baghdad, Cairo, and Andalusia palaces in the Islamic world. For example, Musa Ibn Meymun (Moses Maimonides) (11351204) was a selective physician, philosopher and pioneer of religious education. He was the student of Averroes (1126-1198) and Ibn Tufeyl (11101185). He was born in Andalusia (Spain), and he spent the most effective duration of his life in Cairo during the Salahaddin Ayyubi dynasty and his son’s reigns. 5. In the Middle Age of Europe, he became aware of Ibn Nefis's (1210-1288) revolutionary finding of the small blood circulation system and in the 12. Century, Eastern Europe began to enter a development stage, and the Islamic world started to fall back. 6. Ibn Nefis (1210-1288) has benefited from the blood circulation work of Avicenna (970-1037), in the 13th century although he has provided the blood circulation almost as today’s information. This definition was meaningless in the West due to its stand against the content of the Bible. Such that after

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Miguel Servatius (1511-1553) wrote in his book the blood circulation in this manner, but he was found guilty by the engisization court, which caused his escape, but as a physician lived in Vienna for about 10 years then, he returned and during his prayer in a church, he has been burned over his books. Ibn Nefis (1210-1288) is known as the second Avicenna (970-1037) as a philosopher, interpreter and physician. In 1924, an Egyptian physician brought out the reality that he has discovered small blood circulation before several centuries than Miguel Servetius (1511-1553) and Realdo Colombo (15161559). This gave the idea that William Harvey (1578-1657), Servetius (15091553) and other western physicians have learned Ibn Nefis (1210-1288) views through Andrea Alpago’s (1450-1522) translation. Ibn Nefîs’s (1210-1288) wrote a great work with title “Kitab esh-Shamil fî Sinaat et-Tibbiyye” (Extensive Book in the Subject of Medicine Art). On the other hand, he wrote as the summary of Avicenna’s work “Law of Medicine”, “Kitab Muciz el-Kanun” (Summary of Law of Medicine). After Ibn Nefis (1210-1288) his student Ibn al-Quff (1232-1286) was known as a famous surgeon and wrote a book of 20 papers titled as “Kitab el-Umdeh fi Sinaat el-Cirahah” (Basic Book on Surgery). He is the one who mentioned about the capillary veins, which could be observed only under the microscope after many centuries. During the same period, another specific book is written on the first aid “Kitab Gunyet el-Lebib and Gaybet et-Tabib” (Shelter of Clever Person in the absence of a Physician). In the 14th century “Black Death”, the big punishment of God to humanity as plague disease epidemic is considered by Andalusia physicians as infectious and epidemic disease. The famous state man, historian and physician Ibn Hatib (1313-1374) in Granada wrote his famous book “El-Makale Menfaat esSail an el-Maraz el-Hail” (On Plague Disease). The infectiousness reality has been proved by experiments, research, autopsies, common sense and trustable diagnoses. When someone catches a plague in a house or in the city, those who first deal with the sick, then the neighbors and others who enter that house get sick, and so the plague spreads. Those who get off a ship from an epidemic country also bring the disease together and transmit it to all the people of the port, except those who do not encounter anyone It is the most important achievements of Muslims to understand that outbreaks are the most infectious diseases.

3.5.1. Curement Methodologies in Islamic Medicine, Physicians and Hospitals In Islamic civilization, physicians had a separate place in the society, and they

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were among the priorities in demand for health. Their methodologies, diagnoses, subjects and thoughts can be stated briefly as follows: 1. Islamic medicine gave priority to protect the body from diseases rather than curement of the illnesses. For this reason, body protection physician experts had a significant position in the official and social circles. 2. Daily worships necessitate continuous cleanness among the Muslims, and hence, taking a bath from time to time. The use of miswaak (is a teeth cleaning twig made from the Salvadora persica tree) for dental cleaning goes back to Prophet Mohammad time. Similarly, fasting and not filling the stomach, to eat slowly and to take into consideration other daily diet applications. It is not a coincidence that in the 12th century, Andalusia physicist Abo Marwan Ibn Zuhur (1091-1161) wrote a book on feeding subject titled “Book about feeding regime”. 3. In order to regulate the digestion system and for its better performance, Muslim physicians applied laxatives frequently. On the other hand, to get rid of poison from the body and to adapt the body to new seasonal climatic situations, they have suggested blood donation. This procedure is named as “Hajamat” in Arabic Cupping” in English. 4. The physicians in Hyppocratian medicine did not help sick persons, who did not provide any curement. However, Zakaria Al-Rhazes (865-925) insisted on assistance to those with impossible curement cases and he stated that real physician attaches significance to such an assistance as a great duty and he said: “Any physician must make the patient to believe that they will recover even though he/she did not believe in such a case. Body obeys the order of spirit, but the physician must encourage the patient even at the bed of death”. On the other hand, Avicenna (970-1037) along the same direction said the following sentence. “The physician must never give his hopeless impression to the patient as for the impossible savage” In this manner, Zakaria Al-Rhazes (865-925) and other Muslim physicians have handed over to the Western physicians hope even in cases of impossible recovery: 1. A complete hospital has been constructed the first time in the history by Harun Al-Rasheed in Baghdat in the 8th century. Later as the head of the hospital Yuhanna Ibn Masewaiyh (777-857) has been appointed and this hospital became as a pilot for other hospitals. Among these is the famous 10th century

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Adudi hospital established by Iranian ruler Adudddevle. Zakaria Al-Razes (865-925), who was brought as the chairman of the hospital at Rey City wrote the book titled “Kitab fi Sifat el-Bimaristan” (Subject Book on Hospital Quality). The first hospital was constructed in Cairo during Tulunogullari reign in 872, and there were 5 hospitals in the 10th century. In each one, physicians, health employees, pharmacists, orthopedists and barbers completed the whole administration. Apart from the treatment services, there were basic medicine and expertise education and the research workers in action. In Andalusia (Spain) hospitals had botanical gardens nearby the hospitals, where physicians grew local and imported plants from which various medicine were produced. The most famous hospital in Egypt was constructed in the 13th century by Mansour Kalaun after demolition of Fatimid Palace under the name of Mansouri Hospital. In this hospital, there were different wards and hundreds of beds. Additionally, there were class rooms, library, mosque and independent administration offices. Those who failed in examinations and who did not have a certificate could not serve as physician. Pharmacists and those who worked on fractures and dislocations were under the control of state. Anyone, who did not pass the examination and did not have the diploma given by the state could not practice medicine. In 931, there were physician’s union, who travelled from one city to others. Islamic hospitals spread widely during the Anatolian Seljuk State and their architecture has affected the Europe and the clinical medicine education. On the other hand, army wilderness hospitals are learned by Crusaders and transferred to the Western Europe. .

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3.6. EARLY RENAISSANCE MEDICINE HISTORY Ancient Greece ideas dominated the Islamic world and with the advancement of philosophical and scientific renewal and then started to dominate, especially West and South, during the Medieval Ages. Although Greece was close to Europe, they did not take philosophical and scientific thought from them, but after the collection of the ancient Greek knowledge and improvement in an unprecedented manner, the Europeans transferred this knowledge from the Islamic civilization, which is overlooked by the Westerners. In medicine, the origin goes back to Hippocrates (460-377BC) and later to physician Galen (131-200). It seems that Aristotle (384-322 BC) considered pre-Galenian (129-216) explanations as if organs have a specific purpose in themselves. In the medieval period Avicenna (930-1050), Rhazes (854-925) and other Muslim thinkers, philosophers, logicians (Al-Farabi, 872-950) and many others brought their findings into more understandable, scientific and logical formations in the history of medicine.

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The initiation and early bases of Western medicine are based on the transition and translation to Arabic from ancient Greek sources, which are further developed by Muslim physicians, philosophers, logicians, thinkers and writers. Muslims’ undeniable savages of many ancient Greek philosophers and physician works and early Hellenistic books, as explained in the previous sections, provided a transition of medical ideas to the West. Especially, since the 9th century, during the Abbasid period in Baghdad, numerous translators were engaged to translate ancient Greek and Hellenistic works into Arabic. The translations from Greek to Arabic led Muslims to original publications in the history of medicine, and hence, knowledge synthesis gained unprecedented speed and regional distribution all over the Islamic world, including Andalusia (Spain). After all these developments in the Islamic world, the medieval period started to mark the beginning of the Renaissance. Nutton (2012) states that: “If the roots of the Western tradition of medical ideas go back to Classical Antiquity, those of its institutions indubitably have their origin in the Middle Ages.” In this sentence, there is an implicit mention of Islamic medicine's contribution to Western Europe. Universities were established all over Europe, and gradually society began to care for medicine and medical treatment, which extensively existed in the Islamic world for at least 5 to 6 centuries prior to Renaissance. Paracelsus (1493-1541) countered the old teachings of Aristotle (BC 384-322) and Galen (129-299) with innovative and progressive theories concerning medicine, chemistry, alchemy, and psychology; he did not mention the most famous Al-Rhazes (865-925) and Avicenna (970-1037) even though they have provided numerous theoretical, practical and clinical knowledge about human medicine even after almost 8 centuries from Galen (129-200). Paracelsus (14931541) considered many superstitious ideas, but Al-Rhazes (865-925) and Avicenna (970-1037) excluded superstitious ideas and based all medicine knowledge on rational bases. Even though Galen’s ideas were respected in the Islamic world, the spread of Paracelsus ideas led to the further decline of Galenism. In Europe, academic medical development has started first by Vesalius (1514-1564) works that dealt with meticulous anatomical studies during the early Renaissance period relying more on his thinking than on Galenic orthodoxy, but benefited from the Islamic medicine translations. Another early Renaissance physician Harvey (1576-1657) is considered the first discoverer of blood circulation at the Padua School in southern Italy, but Ibn Nafis (1213-1288) wrote about blood circulation in Arabic, whose book was translated into Latin in which heart was identified as blood-pumping center of the body.

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Unfortunately, many scientists have very superficial knowledge about the history of science and physicians about the history of medicine. That is the view expressed by Garrison (1929), who wrote one of the early books on the topic titled “History of Medicine” and suggested that medical history must be rewritten from time to time. Porter (1996) explains well that new knowledge was gained, and the foundation laid for scientific medicine in its modern sense. According to him, the 18th century was a health disaster. Conrad (2003) mentioned about Muslim popular medicine as follows: “As some of the popular medical lore was of no use at all in preventing or treating medical ills, it is worth asking how such customs could survive in the face of what must have been repeated proof of their worthlessness.” He gives the answer as follows: “If an amulet failed to protect a villager in an epidemic, his death would be explained in specific terms – a poorly made amulet or an extremely powerful demon; far less common was the conclusion that amulets and talismans, in general, were useless.” In other words, patients were said to die despite the treatment but were reckoned to be cured because of the treatment. The following text is a brief reflection of passages from the book written by Karagözoğlu (2016). It would be simplistic to look upon the Muslim world merely as the conduit for ancient Greek knowledge transferred to Europe. The classical works of Aristotle (BC 384-322), Hippocrates (BC 470-360), and Galen (129200) were eventually transferred to Europe through Islamic Spain. However, Muslim contributions are more significant than these transfers, particularly in the areas of chemistry and medicine. The medical knowledge available in the Muslim world was so far advanced as compared to the Medieval West. Muslim innovation and work in chemistry and medicine flourished from about 900-1200. After the translation efforts of Andalusia (Spain), Toledo and other places, books from Arabic sources became standard medical texts in Europe. Why the Muslim world was so far advanced in medicine as compared to Europe? Much of the answer to this question relates to the different world views of the two societies. As we noted previously, throughout the Qur’an, there is a strong emphasis on the value of knowledge. Since the pursuit of knowledge is viewed in a most positive light, experimentation and discovery are encouraged and indeed supported by the government. This world view is in direct contrast to that of Europe during the Medieval Age.

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After the end of the Western Roman Empire, the Catholic Church stepped into the void formed by its end. It was regarded that all knowledge is revealable through the church. Therefore, the pursuit of knowledge for its own sake was viewed with suspicion. Also, the Church placed its emphasis on the soul, so medical treatment of the body was not valued. In fact, the hospitals of the Medieval Age, usually run by monks, were places to take seriously ill people to either live or die, based upon God's will. During the Medieval Age, instead of care for the body, lack of care was evidence of godliness. Mortification, the abuse of the body for spiritual reasons, was widespread during the Medieval Age. The medical works of Galen (129-200) and Hippocrates (BC 470-360) returned to the West by way of Andalusia, the Middle East and North Africa, recovered through Latin translations of what had become the Muslim medical classics in the Arabic language. Through the intellectual ferment of the Islamic present, Europe recovered some of its past. Medicine in medieval Islam was an area of science that advanced particularly during the Abbasids' reign. During the 9th century, Baghdad contained over 800 doctors, and great discoveries were made in the understanding of anatomy and diseases. The clinical distinction between measles and smallpox was described during this time. Famous scientist Avicenna (970-1037) produced treatises and works that summarized the vast amount of knowledge that scientists had accumulated, and was very influential through his encyclopedias as aforementioned, “The Qanon of Medicine” and “The Book of Medicine”. The work of him and many others directly influenced the research of European scientists even prior to the Renaissance. It was those Muslim physicians, who made accurate diagnoses of plague, diphtheria, leprosy, rabies, diabetes, gout, cancer and epilepsy. Avicenna (9701037) theory of infection by “traces” led to the introduction of quarantine as a means of limiting the spread of infectious diseases. Muslim doctors laid down the principles of clinical investigation and drug trials, and they uncovered the secret of sight. They mastered operations for hernia and cataracts, filled teeth with gold leaf and prescribed spectacles for defective eyesight. They passed on rules of health, diet and hygiene that are still largely valid today. In addition, Muslim doctors learned how to use sedatives, they pioneered the use of antiseptics to clean wounds, and they also used sutures made from gut and silk to bind wounds. In all areas of both practical and theoretical medicine, they were ahead of their colleagues in Europe, where people often considered sickness to be a sign of immorality, punishment from Allah (God) or

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“As a condition caused by supernatural forces, which might take the form of diabolical possession.” The Islamic world not only provided a slender but ultimately successful line of transmission for the medical knowledge of ancient Greece and the Hellenic world; it also corrected and enormously expanded that knowledge before passing it on to a Europe that had abandoned observation, experimentation and the very concept of earthly progress centuries before. Physicians of different languages and religions cooperated in building a sturdy structure whose outlines are still visible in the medical practices of our own time. The two main translators of classical material from Arabic into Latin were Constantinus (also known as Leo), Africanus (1020-1087), who worked at Salerno and in the cloister of Monte Cassino, and Gerard of Cremona (11401187), who worked in Toledo in Spain. It was no accident that both translators lived in the Muslim-Christian transition zone, where the two cultures fructified each other. It was no coincidence that Salerno, Europe's first great medical faculty of the middle Ages, was not close to Muslim Sicily, nor that the second, Montpellier, was founded in 1221 in southern France, near the Andalusia border. Among the other translations, two significant Arabic medical books were translated into Latin. The first, “Introduction to Medicine” written by Hunayn Ibn Ishaq (809-873), remained a popular medical text in Europe for 700 years. The second book was written by Avicenna (970-1037). He is arguably the most famous and influential of all the Islamic philosopher-scientists. His famous book, “Al-Qanun fi’t-Tibb” (“The Canon of Medicine”), made its first appearance in Europe by the end of the 12th century, and its impact was dramatic. Copied and recopied, it quickly became the standard European medical reference work. It was used both throughout Europe and the Islamic world from the 11th to the 18th centuries for over 700 years and was reprinted at least 35 times in Europe. Its medical material was the pharmacopoeia of Europe and was a required textbook at the University of Vienna. In his writings, he spelled out the procedures for testing the effectiveness of a new drug. Translations of Al-Rhazes's (865-925) Al-Kitab al-Hawi and other works followed rapidly. Printed while printing was still in its infancy, all his works gained widespread acceptance. The ninth book of Al-Kitab al-Mansuri (Concerning Diseases from the Head to the Foot) remained part of the medical curriculum at the University of Tübingen for many decades. Contemporary Europeans regarded Avicenna (970-1037) and Al-Rhazes (865-925) as the greatest authorities on medical matters, and portraits of both men still adorn the great hall of the School of Medicine at the University of Paris. Roger Bacon

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(1219-1294) consulted Avicenna (970-1037) to further his own inquiries into vision. Despite their belief in now superseded theories such as humors and miasmas, the medicine of Al-Rhazes (865-925), Avicenna (970-1037), and their contemporaries is the basis of much of what we take for granted today. It was not only Al-Rhazes (865-925) and Avicenna (970-1037), who influenced Europe. Translations of more than 400 Islamic authors, writing on such varied topics as ophthalmology, surgery, pharmaceuticals, child care and public health, deeply influenced the rebirth of European science. Muslim alchemists influenced medieval European alchemists, particularly the writings attributed to Jabir Ibn Hayyan (Geber) (721-815). Several chemical processes, such as distillation techniques, were developed in the Muslim world and then spread to Europe. CONCLUSION There is a saying that the current and future developments are not appreciable in the absence of historical knowledge evolution stages, which is also valid for medical sciences. This chapter gives detailed information and knowledge about the history of medicine, considering the civilizations before Christ up to today. It is seen that all medical contributions until the 18th century were coupled with philosophical thoughts, but then science and philosophy were separated from each other in the West. The most influential historical medical contributions originate from ancient Greek and later by Islamic civilizations, all intertwined with philosophy. REFERENCES Bayat, A.H. (2016). Tıp Tarihi. (Medicine History).İstanbul, Turkey: Zeytinburnu Belediyesi Basımı. Bryan, C.P. (1930). Ancient Egyptian Medicine the Papyrus Ebers. Conrad, P. (1992). Medicalization and Social Control. Annu. Rev. Sociol., 18(1), 209-232. [http://dx.doi.org/10.1146/annurev.so.18.080192.001233] Çubukçu, A. (1986). Türk düşünce tarihinde felsefe hareketleri. Ankara, 102 sayfa. Philosophical movements in Turkish thinking history. Ankara. Edriss, H., Rosales, B.N., Nugent, C., Conrad, C., Nugent, K. (2017). Islamic Medicine in the Middle Ages. Am. J. Med. Sci., 354(3), 223-229. [http://dx.doi.org/10.1016/j.amjms.2017.03.021] [PMID: 28918826] Feyyaz, S., Tan, M. (2009). Tıp ilminin babası İbni Sina., 54. http://www.fordham.edu/halsall/source/ 1020Avicenna-Medicine.html Jackson, M. (2014). The History of Medicine. A Beginner’s Guide. One world Publications.(p. 221). 10 Bloomsbury Street London WC1B 3SR England: Kahya, E. (1995). El-Kanun Fi’t tıp çevirisi. Ankara, Atatürk Kültür, Dil Tarih Yüksek Kurumu Yayınları, 32 sayfa. (Translation of Law of Medicine. Ankara, Atatürk Culture, Higher Institution of Language and History Publication, 32 pages).

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Karagözoğlu, B. (2017). Science and Technology from Global and Historical Perspectives.. Springer-Nature. [http://dx.doi.org/10.1007/978-3-319-52890-8] Wilson, J.V.K., Reynolds, E.H. (1990). Translation and analysis of a cuneiform text forming part of a Babylonian treatise on epilepsy. Med. Hist., 34(2), 185-198. [http://dx.doi.org/10.1017/S0025727300050651] [PMID: 2187129] Major, R.H. (1954). A History of Medicine. (pp. 20-26). Springfield, Ill.: Charles Thomas Publ.. Nunn, J.F. (1996). Ancient Egyptian Medicine. Norman: University of Oklahoma Press. Nutton, V. (2012). Ancient Medicine.. London: Routledge. [http://dx.doi.org/10.4324/9780203081297] Pearce, J.M.S. (2016). Greek medicine: a new look. Brain, 139(8), 2322-2325. [http://dx.doi.org/10.1093/brain/aww114] Porter, R. (1996). The Cambridge illustrated history of medicine. Cambridge University Press. Saba, M.M., Ventura, H.O., Saleh, M., Mehra, M.R. (2006). Ancient Egyptian medicine and the concept of heart failure. J. Card. Fail., 12(6), 416-421. [http://dx.doi.org/10.1016/j.cardfail.2006.03.001] [PMID: 16911907] Sarton, G. (2013). Introduction to the History of Science (3 v. in 5), Carnegie Institution of Washington Publication no. 376. Introduction to the History of Science (3 v. in 5), Carnegie Institution of Washington Publication no. 376. Serageldin, I. (2013). Ancient Alexandria and the dawn of medical science. Glob. Cardiol. Sci. Pract., 2013(4), 47. [http://dx.doi.org/10.5339/gcsp.2013.47] [PMID: 24749113] Sigirist, H.E. (1955). A History of Medicine. (Vol. Vol. I, pp. 381-391). New York: Oxford University Press. Stol, M. (2004). An Assyriologist reads Hippocrates. In: Horstmanshoff, H.F.J., Stol, M., (Eds.), Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine. (pp. 63-77). Leiden: Brill. Thomas, R. (2004). Greek Medicine and Babylonian Wisdom. In: Horstmanshoff, H.F.J., Stol, M., (Eds.), Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine. (pp. 175-186). Leiden: Brill. Ülken, H.Z. (1988). İslam felsefesi kaynaklarıve etkileri. Istanbul, Ülken Yayınları, 85 sayfa (Islamic philosophy sources and impacts. Istanbul, Ülken Publications, 85 pages).

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CHAPTER 4

Medical Terminologies “Word and Sentence Epistemology are the Key Career Expertise” Abstract: Terminological concepts are the most important aspects of scientific research and development activities, as this book briefly provides epistemological content about the fundamentals of medicine. In scientific literature, the terminology is a combination of single or complex terms in the form of keywords that provide the first impression about an event. Medical terminology and phrases help professionals understand each other without much discussion. Information and knowledge are generally hidden in the etymological and epistemological concepts, such as words, sentences, definitions, terms, terminology and their current scientific structures. Advances in knowledge exchange and improvement processes are the results of conceptualization and terminological applications, especially as a paradigm shift in medicine. Linguistic data, which is a widely used communication tool in medical sciences, contain imprecision and ambiguity. These uncertainties can be minimized by making terminological agreements among experts.

Keywords: Approximate reasoning, Etymology, Epistemology, Diagnosis, Design, Hypothesis Terminology. 4.1. GENERAL Information and knowledge are hidden in the etymological and epistemological concepts through words, sentences, definitions, terms, terminology and current scientific structures. The information is in the hands and minds of experts and helps establish mutual linguistic agreements between doctors and patients in concise, short, easy and meaningful ways. Any professional knowledge develops over time as more refined scientific terminology becomes available about the problems. All terms specific to nature, medicine, art or technical branches, are called scientific terminology, and their specific collections are keywords. They provide instant information about the content of the topic. The language-specific syntax provides a meaningful grammar structure for sentences. These contain basic and formal knowledge with approximate rational and meaningful validity. Rational communication helps to perceive and understand others and leads to the sharing of a common idea. Reasonable classification of relevant topics in words Zekâi Şen All rights reserved-© 2022 Bentham Science Publishers

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leads to a more intelligible medium of communication so that treatment that is more meaningful can be defined. Terminological elements are a unique vocabulary for the foundations of scientific bases. Conceptualization and terminological practice evolve through knowledge exchange and improvement processes and a paradigm shift in disciplines. As a result, knowledge changes fundamental processes with improvements to necessary requirements and relationships between disciplines. In this section, the framework of knowledge exchange, language development and the philosophy of science are used to examine medical terminology as knowledge growth, which is lexically-semantically through a series of transformations, such as insertion, deletion, redefinition and reorganization (Lanna and Antia, 2016). Therefore, depending on consciousness combined with basic knowledge, the scientific path found to specialization in medical research. Thus, a mutual agreement on the subject begins to form in a harmonious information community in the human mind, and thus, rational inferences and final decisions are reached. In the medical field, for example, physicians can associate specific words with objective facts through language, enabling them to reach intelligent objectivity from their lexical origins (etymology) and semantic loads (epistemology). Knowing the origin of a language helps determine the historical background of that language. Languages are in constant evolution, scientifically and technologically adapting from local dialects on the one hand, and foreign languages on the other. Almost all the medical terminology has Latin and Greek origins with distortions in original pronunciations. For example, the most common and confusing plural forms have been defined from Greek-originated English words and some improvement methods (Kavaklı, 2016). Grammarly structured knowledge leads to mutual agreement by providing a common logical basis for better understanding. Research is the name given to all the rational mind studies based on the curiosity and persistent desire in human nature to clarify the unknown aspects of an event in nature, medicine, etc. In such mind studies, imagination, philosophy, logic, scenario fiction, design (shapes), and trial and error procedures play an important role. Many functions come together from time to time in simple or complex forms to produce rational means to solve the problem. As in many education and research centers, training researches should not receive boring, mechanical, transferrable, rote and inefficient knowledge. Rather than such dogmas, research must grow constantly and sometimes in a leap over time, but in the process of continuous accumulation.

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In general, there are three types of verbal data in the form of fuzzy information, as in Fig. (4.1) (Chapter 8). Verbal data are derived from common sense, experiences or expert views.

Data Features

Vague

Imprecise

ambiguous

Fig. (4.1). Linguistic data types.

Meanings of words and sentences are mentioned in the following sections about the field of medical science. Furthermore, some information is presented about the topics that can be deduced from this mutual communication, especially from the conversations between the doctor and patient on medical issues. 4.2. LANGUAGE There is a distinction between verbal and numerical knowledge, and when looking at historical knowledge development processes, verbal knowledge always takes place in the field of thought before numerical data (Chapter 9). Oral information is possible not only with mother tongue or foreign languages, but also with rhythmic movements of the hand, arms and body. Even today, texts filled with verbal expressions rather than numerical information play the most important role in books, scientific papers, projects and research studies. In this respect, each profession has a wealth of verbal expressions rather than numerical knowledge and information. Medical terminology words and phrases help professionals understand each other without much discussion. Among different fields of science, verbal knowledge is the most effective medicine, because medical specialists pre-communicate with patients for oral information retrieval. No matter how strong his expertise is, the physician tries to understand the patient's complaint by asking questions. Whoever complains about health first tells his relatives what kind of ailment he has, and even in these complaints, there is not enough explanation and information to understand the ailment, and the doctor who listens to the same complaints decides to prescribe accordingly. Thus, the physician who collects verbal information for diagnosis determines the appropriate medicine for the patient and provides the treatment.

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Thought, perception and language are interdependent tools as elements of one's communication with other individuals. While physical issues are labeled by common sense and rationality, emotions are psychological types with very little content that can be expressed in words. However, languages are also tied to emotional experiences and perceptions. Conceptual knowledge, along with emotions, helps to establish communication between individuals, preferably through their mother tongue. Language and emotions are mutually inclusive, and therefore one can generate emotions, feelings and thoughts based on conceptual knowledge, meaningful words for labeling topics and sentences for his expression on philosophical, logical and rational grounds. Lindquist et al. (2015) provided extensive, reviewable evidence from developmental and cognitive science to reveal that language helps humans acquire conceptual knowledge, such as abstract concepts and emotion categories throughout their lives. Critically, language also helps concepts make meaning sense of ongoing sensory perceptions. They also explained predictions from a psychological constructivist model of emotion in which language serves as the “glue” for emotional knowledge, connecting concepts to embody experiences and then shaping the ongoing processing of sensory information from the body to generate emotional experiences and perceptions. When language intends to convey the ideas envisioned by the mind, it either puts them or writes them down as primitive people did. A system of signs is necessary for a person’s thoughts to be accepted or criticized by others through discussions. These signs manifest themselves in pictures, Figs, graphs, texts and verbally in words and sentences. On the other hand, dumb people communicate with hand and arm signals. The mother tongue is the epitome of oral speech art. Languages change and evolve over time with the addition of new concepts and terms. This change can occur not only with the diversification of concrete subjects, but also with some abstract concepts such as human imagination. By bringing these concepts together in terms of order and accuracy, meaningful results are reached grammatically and logically. Therefore, it can be appreciated that thoughts are verbally structured within the framework of logical principles for rational knowledge production. Language not only causes the manifestation of various events that conceptualize and tried to perceive, but also causes these ideas to mature further. There is no tool for communication and thought development other than language. Language is what we call a system of verbal or written signs used to elicit thoughts with specific intentions and convey them from one person to another. Language is expressed in signs for dumb people. Animals get along with few signs and sounds. Human language is actually the activity to speak with words, and each language has its own grammatical rules. According to these rules,

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thoughts can be conveyed in harmony by knowing the grammatical syntax rules, so that the transfer of thoughts to others can occur correctly, regularly and in harmony. Along with grammar, philosophy and logic, language serves to generate and define systematic ideas from the world of thoughts. The scientific development of a society is related to the vocabulary that produces new connotations with the development of a language. Consistent developments in different disciplines lead to new lexical units in the light of the adequate response in the language. Such reactions attribute new notions and concepts to the pavement of progress. This process becomes evident with reflections from different languages at different times. As scientific, technological and social affairs develop in a society, new words, concepts and terminological vocabulary expand to new horizons. Therefore, the terminologies are not location-dependent, but are used universally all over the world. Language development takes place with enrichment, systematization and terminology supported by new words and terms. Even in the background of any scientific, mathematical basis, logical propositions are always based on words, terms and terminologies that lead to approximate reasoning and rational conclusions. It is recommended that the researcher depends on symbolic (mathematics) and numerical (arithmetic) analysis after making rational verbal inferences through intuition, vision and mental activities. Language serves to understand the internal and external dynamics of a person's thoughts by structuring them between events or questioning their formation mechanism. Among the most important language functions are the following points. 1. Language is a verbal and sensory information communication tool. 2. Verbal relationships are valid between cause and effect variables. 3. It is not possible to switch to symbolic software (mathematics) without verbal understanding. 4. Provides effective use of philosophy of language (including imagination), and principles of logic that allow rational inferences. 4.2.1. Etymology and Epistemology Etymology is the study of the roots of words from which language they originate and what their meaning is. It deals with the origin, historical development and meaning of a word. Etymology, in the sense of science, investigates the root of every word that contains information only about itself. Clear word meanings help to bring different words together by perceiving the theory of knowledge (philosophy) (Chapters 5 and 6). Apart from this, it is possible to express a

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broader line through logical principles. The meaning of the word may be through the subject’s perceptions of experience or rationally naming it by hearing from others. Mentally placing the words in the minds in a meaningful way to fall within the field of “epistemology”. When the mind encounters the same word many times, it instantly recognizes its etymologic and epistemological meanings quite automatically with instant perception. Revealing information, equations, formulas, plans and projects in the thought system is always possible with linguistic expressions. For example, when one says “measles”, it means a feverish and contagious disease that occurs in children causing small red spots, and incubation lasts at least one to two weeks. One can write detailed information about measles, especially a doctor who knows all kinds of measles and decides the appropriate treatment. 4.2.1.2. Words Words in any language become common perception tools of society by giving meaning to our minds with hearing and speaking experiences over the years. A person uses the language every day and immediately grasps the meanings of common words and phrases. Due to understanding, the mind requires a habit of understanding meaningful words and passing them to others when necessary. Each word is a symbol of different internal and external properties of objects, real or imaginary. The ensemble of subjects means nothing without the consciousness of the human mind. Just as a newborn child is named, a subject is named so that the object is known. As there are different languages, the topics should have different names in the languages. People recognize that object with words in their mother tongue and take an attitude accordingly. For example, if the meaning of the word “disease” is well known, it is easier for a person to decide when to see a doctor. Since every word in the language evokes meaningful symbols, a tool establishes the link between people and the environment. For example, what the word “hospital” means to an English speaker is the same as “krankenhaus” in German, and the word “mustashfah, ‫ ”ﻣﺴﺘﺸﻔﺔ‬in Arabic. Therefore, etymologically similar words in every language express the same epistemological understanding, and their physical existence is known by the speaker; in this way, different language communities can perceive almost exactly the same meaning. Words have different functions in a language. Most refer to symbols, some are the necessary grammatical elements (noun, verb, predicate), and the rest represent activities. In this respect, words or terms are the smallest units that carry meaning

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in a language. The word implies the general understanding among the people, and the terms express the special and singular meaning according to the specific subject under consideration (Şen, 2014). Ambiguous impressions and concepts are produced by human thought, which divides visual reality into parts and categories, leading to useful inferences by words such as names, nouns or adjectives. Since each word has sub-categories, there is insufficient content about the integrity of the truth. For example, measles, cancer, etc., are disease words. There are common words that form the basis of similar or same topics in our memory. Words are the basis of sensations, thoughts and perceptions. They collectively serve to provide partial and, thus, distorted conceptual models of reality that represent the world produced or perceived by the human mind. It is not a world where we are bound by an umbilical cord of vital and inseparable links whose natural evolution brought into being (Dimitrov and Korotkich, 2002). In a way, thinking is speaking quietly to express thoughts in language, which is most commonly a system of words and sentences. There are some perceptions, judgments, symbols and signs in all scientific matters, including medicine. The properties of subjects or objects represent thoughts because of their ordering according to certain rules. Unbiased evaluations of the histories of science, medicine, art, technology, literature, engineering, etc., show the impact of cultural activities. Their attraction to the public can be achieved with language, which is the necessity for philosophy and logic (Chapter 7). In this regard, many of the rational ideas of the ancient Greek philosophers were successfully revived, especially in the 8th century and later, by translating the primary sources into Arabic and then conceptually digesting them. In the chain of historical knowledge developments, starting from the 12th century, Arabic sources were translated into Latin. Although Latin is the common religion language for European countries, each country translated what they learned from Latin into their mother tongue (English, French, German, Danish, Spanish, etc.), which led to scientific and technological developments. This point illustrates the importance of the mother tongue along with the culture in education and research circles. There is the European Union for economy, science, law and defense, but not for a common language. Words and terms represent concrete topics, while some represent abstract topics. In this respect, words are divided into two abstract and concrete. For example, “hospital” refers to a concrete concept. But, “culture”, “homeland”, “spirit”, “white”, “black”, “less”, “more”, “beautiful”, “wealthy” are abstract conceptual words. It should not be overlooked that thoughts are not only concrete, but also

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mostly composed of abstract words. For example, when the “angel” is mentioned, a weightless abstract concept is understood. Stuart Mill (1874–1879) said that concrete words represent something quite certain, and abstract words represent a quality. According to the types of words, the rules of logic can be divided into bivalent (crisp) (Chapter 7) and fuzzy (Chapter 8) types. To make the distinction more concrete, the word “fever” is a concrete type, and the word “feverish” is an abstract type. When we say “human”, a physical entity appears in our minds, but “humanity” is an unconcerned word. Similarly, “health” is a word expressing concreteness, while “healthy” refers to an abstract case. The abstract nature of words is the main source of arguments among people. As mutual understanding increases, so does the efficiency of thinking because abstract words add richness to thoughts. Their logical discussions are the subject of many agendas and continue with endless sessions. Centuries ago, different philosophers and physicians emphasized the importance of language. For example, the ancient medical philosopher Galen (129-200) made the following quotes. “The chief merit of language is clearness, and we know that nothing detracts so much from this as do unfamiliar terms.” “The combination of pictures and words together can be really effective, and I began to realize in my career that unless I wrote my own words, then my message was diluted.” “The reason that I keep writing is that all my most powerful messages about the fates of wild places that I care about need to have words as well as images.” 4.2.2. Words' Root (Etymology) Verbal knowledge plays an unprecedented role because people understand each other by speaking. In learning and communication, the words as labeling of subjects play a major role, and anyone with the ambition to gain professional expertise should enrich his vocabulary on the relevant topic. Not only the words, but also their roles in rational sentences are very important to reach intelligent goals and professional qualifications of high standards. Meiers (2007) referred to some key research findings that are more precise to understand what constitutes effective professional development and the links between professional development, knowledge improvement, and practical and sustainable learning. He also noted that this helps evaluating professional development programs, which have implications for the timing of assessment problems and the nature of information gathered in assessment. For this to be successful, it must be clearly known what each word means and what it implies. Otherwise, confusion of

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meaning, misunderstanding and subjective personal interpretation occurs, which lead to difficulties in communication and collective thinking. Native words are learning tools based on years of hearing and speaking experiences. People recognize this issue with words in their native tongue and take an attitude accordingly. For example, when the meaning of the word “abyss” is well known, the place of time (cliff) can be very dangerous. Thus, even a single word can express meaning in a person's feelings and spread to his whole self. 4.2.3. Terms Each conceptual word is equivalent to a term. For instance, “nerve” is a single term, but “nervous” is a complex term. In scientific literature, the terminology is a composition of single or complex terms in the form of keywords that provide the first impression about the event. There are also verbal terms related to signifiers about the event under examination. Such collective words help the mind achieve productive results intelligently. In addition, terms lead to concepts that are components of thought and thinking activities. The terms also allow the categorization of different subjects that are like each other. Such a categorization was presented by Aristotle (BC 384-322) in ten types as follows: 1. Substance – something which is relatively independent; the kind of thing that a being is. 2. Quantity – the way in which something can be counted (divided into continuous and discrete). 3. Quality is divided into the following forms. a. Habits and dispositions (relatively stable but changeable modes of being). b. Natural capabilities and incapability (stable and unchanging modes of being). c. Affective qualities and affections (highly unstable and changeable modes of being). d. Shape 4. Relatives – the ordination contained within one thing towards another. 5. Place – the way, in which a thing is identifiably located. 6. Time – the pastiness, present, or futurity of a thing. 7. Posture – the relative orientation of a thing’s parts to one another. 8. Destitution – the way in which a thing possesses another as a modification (e.g., glasses). 9. Action – the way, in which a thing dynamically alters itself or another. 10. Being-acted-upon – the way in which a thing is dynamically altered by itself.

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Medical terms are in form of one-word term, which can be simply derived from compounds or a combination of words. Drozd and Seibicke (1973) considered derivation and compounding for the basic word-forming ways. 4.2.4. Concepts Concepts are expressed in terms, but terms are not concepts. Concepts can be expressed with the epistemic word, and therefore, a close relationship can be established in any language, because propositional information contents are highly objective based on the principles of arguments, consensus, unification and alliance about an idea. Concepts are also parts of logical propositions (Chapter 7). One of the main problems in the philosophy of medicine is how to use language accurately to express concepts and propositions (Chapters 5 and 6). A sufficiently careful treatment of terms and concepts is a prerequisite for efficiency and best use in the medical language. There are situations that should be considered in terms of content in the use of syntax (grammar) and semantic medicine. For example, the physician may ask, “Do you have a headache?” If yes, is this really your headache physiologically? Alternatively, do you have a headache in a crowd of words in an environment? If the answer is “yes”, the physician may also ask if he or she has jaundice. Is the yellowing seen by a non-specialist on that person's skin? or yellow eyes? or is it a known disease? Yes, but only a medically qualified person can make a decision. Examining the events that are the subject of human thought leads to the emergence of concepts that express some of the events in question. Concepts are soft information that comes from the study of some concrete events that are memorable and originate from thought. The abstractness of knowledge as a concept takes its place in the mind as concrete or abstract thought. Concepts are defined as abstract designs produced by thoughts and differ from concrete ones, because of their restrictive, precise, and clearly perceivable contents. For example, abstract concepts are highly vague due to the prevalence of the embodied approach to cognition, and concepts, therefore, drive meaning from several perceptions and emotional systems as a result of interaction with the environment. Borghi et al. (2017) offered a critical review of the latest theories on abstract concepts. They advocated the distinction between abstract and concrete concepts, in which abstract concepts are grounded in metaphors, situations, introspection and emotion. They also introduced multiple representation theories, in which abstract concepts evoke linguistic information. The most promising approach is given by multiple representation views, which combine an embodied perspective with recognition of the importance of linguistic and social experience.

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On the other hand, in order to study concepts, they need to be defined cognitively. There are assumptions for general-purpose non-linguistic concepts that are laid out in concrete words. Barbara et al. (2014) argued that languages differ significantly in how they carve up the world by name. Either these concepts are heavily language dependent, or the words of a language cannot be a direct route to them. They illustrated the point with a study of words for human locomotion and showed that the conceptual content shared in several languages differs from the answers suggested by any single language. Concrete words are general-purpose concepts commonly used by individuals. Through conceptual understanding, one can better define the underlying components of knowledge towards new and better representations and generalizations Each of the abstract concepts contains information about the subject or object under study. Concepts can be thought of as mind-taking pictures of words that sense organs have conversations about subjects. Just as formal or verbal expressions are called from the computer’s memory when requested, our concepts come out of our memory with the information messages that are used by reflection on our mind screens. Concepts and information are hidden in everyone's minds as though designed in silence, because concepts are in the form of imaginations or dreams. For example, when the concept of “wound”, is considered, a body of information that includes all concepts together with their properties should be considered. The imagination of the concept of wound covers all kinds of wounds. Imaginations are general unapproved concepts. All events perceived by sense organs or metaphysics occupy the human mind, but the idea that they have different categorical appearances in mind is the first inference. So the person looking at the surrounding natural environment can see green areas or vertical green patches, blue background, brown areas, small parts and creatures, etc., and therefore can make a mental classification about them. Each of these classifications expresses a concept (a part of the whole event). Each of the shapes drawn on the walls of ancient caves reminds a concept. They are also called unsung heroes, because when people see the same thing, they perceive blurry, but in some way different categorical respects. When a shape is drawn on the floor or wall, others perceive what is meant, even if they do not have a commonly spoken language. In order to represent especially the qualitative aspect of scientific thought, sentences are used to show the situation of different terms relative to each other. These functions as the emergence of basic units in thought, and with their subsequent interpretations, help to determine complex events first verbally, then formally, and finally logically (Chapter 7 and 8). For example, the amount of vaccine injected per unit time is defined as a “dose”. Similarly, the force applied

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per unit area “strain” is equals to the amount of blood pumped by the heart per minute and the amount of blood flowing per unit area per unit time is called blood “flow rate” or “discharge”. It is measured as the amount of blood (ml/min) passing through a certain area in the blood circulation system in a certain time, that is, the “blood flow rate”. The entire circulation of blood flow in an adult human is about 5–6 liters per minute (Chapter 9). Concepts need to be disseminated so that they can be perceived, learned and criticized by others. The first condition for knowledge production is people’s ability to understand and explain the concepts, especially in mother tongue. Verbal expression of the concepts has meanings, even if the concept is abstract, in the forms of speaking and writing. It can be appreciated how important the concepts and the terms are in thinking system. Especially when establishing a model for an event, thoughtful concepts related to that event are introduced in a meaningful way on philosophical (verbal) grounds. The terminology of a subject is what the terms put together, and can be very well understood by concepts through thoughts and language. For example, a meaningful word about a subject can be perceived as a term. However, “blood”, “bone”, “temperature”, water, “ come”, “ask”, “read”, and so on are terms, but “and”, “or”, “not”, “even”, “is”, “more.”, are not terms. Information is obtainable about the quality or quantity of objects by combining concepts, terms and terminology. There are many definitions made in scientific disciplines. The definition of velocity in physics is distance per unit time. In the definition of velocity, “path” and “time” are terms. The volume of water passing through a section in unit time is another definition as “flow rate” in water sciences and as “blood flow” in medicine. In the human mind, concepts that include generalizations of different characteristics specific to the person or the subject are also found in dreams. For example, when the concept of “body” is considered, it is a collection of all organs. The mental understanding of the body concept is not a single standard body. Therefore, scientific knowledge is generalization. Dreams and imaginations are common in the emergence of concepts. Concepts are ideas or mental images, categories are a class or division of things, which are words in the form of certain nouns, verbs, and vowels or written expressions, in the more specific case of terms and definitions related to science terminology. The more original these terms are in mother tongue, the faster and more efficient is instant understanding. For example, the words “homogeneous”, “isotropic” and “matrix”, are explainable as “point-independent”, “direction independent” and “conjugate”, respectively in English, so they can be easily

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perceived and understood. Otherwise, the time spent to understand the meanings of foreign words in mother tongue delays conceptual understanding for a while, which causes inefficiency in thought production and communication. 4.2.5. Definitions After the concepts and terms are, understood definitions emerge as one of the basic elements of human thoughts. Each definition helps to perceive the studied event in terms of time and/or space. Definitions are sentences that can be constructed simply, whose information content is practical and used immediately. There are many definitions made in different branches of science and medicine. Definitions in nature, medicine, science and engineering often represent systematic and conceptual information relative to time or space. Scientific conceptual definitions can be developable based on measurements, predictions, replicates and explanations, especially by experts. There is a distinction between definition and classification. Philosophy of science proposes a standard alternative that provides scientific definitions with better matching natural variation in a given phenomenon. This means that it is not an alternative to the standard explanation, but an approach that captures the early-mid stages of research towards true scientific descriptions. Attention is then turned to the psychology’s concept of the operational definition, how it relates to the scientific definition. Operational definitions are not scientific, but psychology gives consideration. The standard explanation of the scientific definition is why a supposed alternative to the standard account is not an alternative, and why operational definitions are not scientific definitions, as suggested by Hibberd (2019). 4.2.6. Sentences Not every sentence represents a statement. Everybody automatically uses many phrases in everyday speech and does not pay attention to their type, because there is no reason to pay attention. However, in very special cases, the content of sentences that is important for others need to be considered in detail. Below are sentences for different situations. 1. 2. 3. 4. 5.

Question: Is your stomach throbbing with pain? Demand: Could you explain more information about the headache? Compulsory: One has to drink, sleep, etc. Meaningful: How well you explained it. Reporter: “Ali” has a stomachache.

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The most striking among these sentence contents is the last one, because it expresses the situation. However, we can group such sentences into two classes. 1. Ambitious: Just as “Ali” has a stomachache, “Mehmet Yiğit” has headache. 2. Builder: I promise I will diagnose your disease tomorrow. In the light of the foregoing, the physician should pay attention to what kind of sentences are necessary for treatment under which conditions. 4.3. MEDICAL TERMINOLOGY Linguistic medical terminology describes the human body for health and disease processes. Betts et al. (2016) have explained that the root of a term often refers to an organ, tissue or condition. They gave the cases of hypertension disorder, as an example, the prefix “hyper” means “high” or “over”, and the root word “tension” refers to pressure, hence the word “hypertension” means abnormally high blood pressure. In medicine majority of root words, prefixes and suffixes are frequently derived either from Latin or Greek languages. Most medical languages contain anatomical terminology related to the names of various parts of the body. The intelligibility of knowledge can be gained through language elements, for example, through mutual terminological understanding between physician and patient. Of course, behind each term and terminology, such as disease names, there are measles, tuberculosis, cancer and alike, which explain the origins (etymology) and semantics (epistemology) of the language. A physician should have critical and solid knowledge of medical terminology. As Latin and Greek terms predominant in medical terminology, it is also the duty of a physician to explain each term in the mother tongue in times of need for better mutual understanding with the patient. The richer is the vocabulary terminologically, the more competent and respected the physician is in the medical community, and therefore, the better the delivery of patient. To understand terminology, one can break down the words as root words to get the basic working knowledge. Vakulenko (2014, 2015) came out with some important term features that have a dual role as they operate in a specific domain, where they are customary and widely used, and in the common area where they have a highly specialized nature. It is conjectured by him that to carry out demarcation of the terms from the nonterms, it is expedient to consider the fact that all terms are generally divided into two major groups as proper terms and terminological words. A terminological neologism is based mainly on the native lexical reserve.

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There are two quite different phenomena in medical terminology as strictly processed, internationally standardized and rapidly evolving non-standardized terminologies of individual clinical branches. In the past, most of the medical terms and terminologies were derived from Latin and Greek words, but recently it is the current syntactic method for forming terminological compounds. Besides the most common ways of forming terms, there are also some marginal ways, the results of which are acronyms, eponyms, metonyms, etc. To understand the meaning of these rather rare medical terms, it is necessary to become familiar with their etymology and epistemology. 4.4. PHILOSOPHICAL THOUGHT Thoughts may be transcendental (extraordinary, metaphysical), but are grasped by critical thinking. Philosophical thought is important, because human beings can gain a greater ability to interpret, explain and infer knowledge. There are three very important successive stages in the thought process. In Chapter 6, their philosophical explanations are given in detail. 4.4.1. Imagination This word reminds us that there is a dreamer in thought. We can say, “I imagine, therefore I am” for being, because imagination is the first stage of thoughts. Another, important parlance for perceiving “I perceive, then I am” statement evokes another aspect of a thinking being. One may suspect the subject, but not the perceptions, because they exist from the very first moment. The purpose of the imagination is the spontaneous existence of an appearance or some reflections from the world that can be kept in mind. It should be noted that the imaginary subjects meet certain criteria in order to be intelligible. Some targets, such as physicians and patients are physical, but some are similar to imagination and appear physically in the minds but are unknown in reality. As Bosnak (2007) pointed out, their realm is embodied imagination; these aspects present themselves as “others” with a subjective existence different from reality. If one says that there is no such thing as imagination in medicine, he is wrong. Extraordinary works are always a product of imaginations. For example, a doctor works in the light of all specialist background information, also listens to type of disease from the patient and makes a diagnosis based on the imagination of the specialist’s knowledge as to which medicine is more useful and attractive for treatment. A physician who does not envisage such thoughts in his mind is doomed to stay with classical book information sources. Imagination ensures the constant vitality of the mind and the maturation of critical thinking. Bosnak

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(2007) suggested a radical change of perspective in medical sciences, stating that the most absolute and unmediated form of embodied imagination is a dream, which presents a holistic world view so that one is convinced. 4.4.2. Design Imaginations are in virtual environments, but they need to take shape. Their reviews and criticisms in the form of shape designs add more information to the thinking profile, and, therefore, lead to opinions that are more expert. The necessity of the physician also emerges at this design stage of thought. For this reason, it is defined as a profession that transforms designs into art with their thoughts and imaginations, not just as people fulfill the function of medicine with their dull geometry shapes. Just like a work of art, the physician can generate work by conceiving it based on skill and intuition. Süt (2014) suggested that scientists could define a plan and systematic form based on evidence for the solution of any health problems using data with a high degree of accuracy. The main purposes are to measure disease prevalence and compare interventions, predictions, associations or etiology (the cause, set of causes, or manner of causation of a disease or condition) assessments. A medical study requires good planning, including research protocol, ethical approval, data collection, data analysis, interpretation and publication of data analysis results, which are all concerned with physicians’ designs in medicine. Making designs in different ways, not in the form of dull and perceived memorization or repetition, but with options of the previous perceptions in different ways, by introducing an innovation that can give excitement to the physician. This excitement is in the form of a spark or the appreciation of this innovation by others turns into a flame and internal confidence can be improved. Criticism of a simple innovation by others adds an additional dimension of thought leading to productivity. 4.4.3. Idea Generation A physician’s productivity is not only in concrete works, but also in the productivity of ideas through generative imaginative thinking. Ideas in mind should be communicated with other individuals. In this respect, it is beneficial to make wise verbal inferences to make intelligent verbal inferences within the framework of philosophy and contemplation, and thus to generate collectively beneficial ideas.

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First of all, the physician should provide productivity primarily not only in terms of material but also in terms of thinking with simple, fast and optimum treatments. In the production of practical application, it is highly beneficial to share new medicine knowledge with others so that it can be disseminated through publications and communication as a common sharing. Shah et al. (2000) wrote about the conceptual design generation that a wide variety of formal methods are devised and used for idea generation. Model outputs are supported by experimental data for the effectiveness of the results and applications that may require engineering design (Chapter 10). They presented experimental methods, data collection and analysis techniques for a set of effectiveness metrics based on the statistical design experimental principles (Chapter 9). Measure of effectiveness is outcome consisting quantity, quality, innovation and diversity of opinion generations. There are two experimental methods direct and indirect, in the first, the effect of the design problem type and various parameters lead to an idea generation method. The second provides decomposition into principal components, and its overall effectiveness is predicted by experimental studies and their interactions. 4.4.4. Knowledge and Elements The word “science” is closely related to other terms such as known, knowledge, consciousness, scholar and scientist (Chapter 2). Knowing is a collection of activities that people are always together in life and can never give up. First, human communication with inner and outer worlds begins with perception and comprehension. It is a series of mental activities that emerge as a result of summarizing visual, verbal and imaginative information with personal perception and questioning about what is going on around. One can know something by listening to others or by experience and experimentation. Knowing instead of listening achieves the goal after some successive works. Today, extensive technological and communication facilities provide access to research evidence. Scientific epistemology is on the rise in the area of medical knowledge, which has been the subject of fierce debate among the medical professionals with many antagonisms and an increasing emphasis on research. Many physicians depend on the presumption and availability of medical knowledge to arrive at their final treatment. Marshall (1997) stated that scientific epistemology defines knowledge with a research process. Experts claim that esoteric knowledge access has no validity in this process, and therefore, the rise of medical scientific epistemology partially undermined the authority of the medical profession. Access to scientific research evidence can be used to undermine the individual authority of professional experts.

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In addition, “to know” is to have knowledge of something or to learn how to do a job. To know something also means to recognize. Among these different definitions, perhaps the most comprehensive and most sought-after and derived word is “science”. In order to understand what science is, it is useful to understand the other derivatives that existed before it and the differences between these derivations separately. The main source in the production of the word “science” is civilizations and languages. Despite minor differences in semantics, it is possible to come across articles that show some fundamental differences between science and scientism. While the word science refers to all kinds of knowledge activities obtained through repeated observations and experiments, scientism has started to be used mostly in concepts related to metaphysics, human belief and spirit. There are scientifically productive works of people who have not received higher education. Morr and Subercaze (2010) stated that while knowledge management has become an established discipline with many applications and techniques, it is difficult to adopt in health services. Although, the health sector is largely knowledge and evidence-based, medicine is expected to be applicable in daily health care activities; furthermore, the provision of care responds to the cooperation of several partners who must exchange information to ensure the quality of care. In public health, the decision is mainly based on data and a shift towards evidence diagnosis. All living things have innate knowledge. For example, some animals can walk as soon as they are born, and can distinguish between beneficial and harmful substances. Man, on the other hand, can access information as he gets older (even months, not years), although this information is available in his creation. The crying of a hungry baby is the best example of this. However, as a result of external events encountered in the course time, people store information in memory and use it when they need. Memory helps to store information just like computer memory. Types of information other than what is available in memory are color, sound, shape, size, etc. Knowledge is produced by verbal expressions or sensations. Every person naturally perceives the effects of processes with their sense organs. Man knows some qualities. Human acquires information from other living and non-living beings with quality perceptions through sense organs. If someone is asked to write down opinions and all kinds of information about “disease”, they can write pages and talk for hours. People who have more knowledge are called wise. However, these people cannot be qualified as scientists because they do not have the conditions required by science.

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4.4.5. Knowledge, Language and Conception As explained in Section 4.2, language is one of the most important factors for the knowledge production. Therefore, language is needed in order to convey the qualities that a person perceives and can transfer to others. Without language, man would not have the capacity to store information. For this reason, the first philosophers, thinkers and scientists described human beings as creatures that can comprehend. Every perception of information can be verbalized and the information becomes clear and transferable to others. The transformation of knowledge into a benefit for others is possible only with the principles of common language and logic. According to Sadegh-Zadeh (2015), a lot of medical knowledge is obtained using theories of experimental and clinical medicine, but not all-medical knowledge is accessed in this way. An important part arises from simply describing phenomena without using any background theory. First of all, experimental and clinical knowledge is generated by theories in medicine. They proposed eight sections of analysis, shallow and deep medical, classificatory, causal, experimental, theoretical, practical, clinical knowledge and medical meta-knowledge types. No matter where society information is found, its first name is made with an appropriate word in the language of that society. In the selection of these words, in order to determine the information clusters, after the main verb is determined in the emergence of that information, subsets are formed and therefore, information groups emerge. For example, the verb to read in English implies many activities. According to these activities, school is the place where reading is done collectively and systematically; the instructor is responsible for teaching students to read. By knowing the verb, all the nouns related to it can be derived immediately. The richness of the language helps a lot in this regard; otherwise, words from foreign languages are taken. For example, cotton was first taught to Europe by Muslims; its origin is the Arabic word “gotn”. In other words, where information about something first appears, its name is given in the language of that community. From all this, it becomes clear how much language is necessary for information storage and communication. Here, the richness of the language is, in a way, directly proportional to the richness of the knowledge production. From what has been explained above, it is understood that man is a creature who can store information from events. Knowledge can be acquired through birth, worldly life, experience and education. The more people live with others, the more information they gain and the more they increase their vocabulary. The two types of information mentioned above are the information that is necessary for a person to adapt to the social environment in addition to the purpose of learning

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something. A third source is an experience and sometimes-accidental knowledge to understand events. Learning some of this information is dangerous. For example, one may die if he jumps from too high a place. They realized that fire could be achieved after a long time of rubbing two pieces of dry wood together. All these activities are sources of information. In acquired knowledge, there are certainly human efforts to make their life more comfortable. If a person can grasp the meaning of information content and keep it in his memory that information will be consciously remembered and can be used when necessary. The ability to grasp a person’s perceptions intelligently through the sense organs is known as consciousness. To be conscious, knowledge needs complete digestion, along with understanding. There are concepts that can be expressed in concise language as a single word. If a person can gather information about one or more activities in society, he is a scholar. What are things he knows from others? and how? When one manages questions that begin with a series of comments, he can get useful information. If a society behaves like this, that society will become a knowledgeable society after a certain period of time. If a person is knowledgeable in many subjects and can generously pass on existing knowledge to others, he is popularly referred to as a generous and wise person. These people were respected like the scientists of today, whereas in ancient times, there was no science but philosophy. These untitled persons are Aristo (BC 384-322), Socrates (BC 470-399), Avicenna (9701037), Biruni (973-1048), Newton (1647-1727, and Einstein (1886-1955), (Chapter 3). The information can be seen in three parts. The first is the information obtained from the creation as Allah’s, (God's) gift, the information obtained through experience as well as the information gained based on family and school. The third type has now become knowledge learned through friction between people. Briefly, information is the emotional qualities that are perceived and stored in our brain and one can say that acquired from the facts around us through learning or observation. It is also possible to reveal information with mental activities. The need for information is to make decisions with judgments. There is also a metaphysical version of information transmitted from the metaphysical world to people through thought. Religious beliefs with absolute truth cannot be considered as scientific knowledge. Perhaps one point that comes to mind is whether metaphysical and physical knowledge is completely independent of each other. As explained later in this book, science is not tied to metaphysical considerations, but scientists may have such thoughts. As explained in Chapters 2 and 3, philosophical activities led to the production of knowledge from physical and metaphysical words. Although the two thought systems seem to have separated on

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paper in recent centuries, metaphysical thoughts and realms still seem necessary for the development of science. Another word about knowledge is a pedant. The reason why it is said among the people that there is no benefit from his knowledge is that such people do not have concrete knowledge, but have the desire and ambition to show themselves as knowledgeable. These people do their best to pretend as knowledgeable, even on subjects that they are not well aware. Word information processing is used to execute by the computer rather than the way humans process information. Computers process numerical data information according to logical and mathematical rules. Not all kinds of knowledge are scientific, except those obtained by filtering from logical principles to reach rational conclusions. It is not possible to accept emotional knowledge as scientific. In order to avoid confusion, it is useful to divide the information into two as scientific and non-scientific. The following principles should be followed in scientific knowledge. a. b. c. d. e.

The information is critical and questionable in all aspects. The information is not personal, but interpersonal objective. The information is verifiable through experimentation. The information is obtained as a result of systematic studies. The information changes over time and shows improvements in a correct direction.

There is a lot of information that people acquire from various sources throughout their lives. It is unscientific in many disciplines, as many do not adhere to these principles. 4.4.6. Approximate Reasoning Among the most effective human mind activities is rational and approximate reasoning for generations of ideas, which through continuous research and development (R&D) works, lead to methodologies, algorithms and scientific principles. The reasoning stage is reached provided it is stimulating for the initial drive of mental forces, due to some involvements such as science, engineering, construction, trade, company or firm business. The firing of reflection on a phenomenon comes with physical or mental effects that control the event of concern. These effects depend on conceptions about the event, the first geometric sketches of the conceptions with simple shapes or parts and the connections between them (Şen, 2014). In this way, ideas are crystallized and transmitted

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linguistically to other individuals to receive their criticisms, comments, suggestions or support for the improvement and final decision on mental thought. Decision-making is an important process for reasoning in problem solutions for inference about observable aspects based on a set of information that may include different sources of uncertainty. The reasoning is based on graduated concepts, where everything is a matter of the degree that is everything has softness (elasticity). The theory of fuzzy logic took its general form with the first publications of Zadeh (1965). Instead of a uniform degree of belonging (equal to 1 or 0) he wanted to generalize the traditional concept of sets through degrees of belonging between 0 and 1, inclusive. These efforts are attributed to the following complications during the modeling of the problem. a. Real situations are not crisp and stable; therefore, they cannot be precisely described. b. A full description of a real system often requires far more detailed data than a human can recognize process, and comprehend at the same time. Zadeh calls the last statement the “principle of incompatibility”; this implies that the closer one looks at real-world problems, the fuzzier becomes his decision. All decisions can be expressed by a language and then translated into universally used symbolic logic based on the principles of mathematics, statistics or probability. Unfortunately, in many educational systems, language and then symbolism sequence translated to mathematics and then to linguistic understanding, which is contrary to human reasoning abilities. This is one of the main reasons why creative thinking and reasoning lack in many institutions around the world. Avoiding such a problem is approximate reasoning, where facts are explained in natural languages. Subjectivity dependence on personal thoughts is greatest in the perception stage and subjectivities decrease as the person enters the visualization domain, and at the final stage the objectivity becomes at least logical, but still, some uncertainty (vagueness, incompleteness, missing information, etc.) may remain. Accordingly, the final decision remains not crisp but fuzzy. Uncertainty always exists in social, medical, cultural, economic, commercial, engineering, etc. and so on, but uncertainties can be minimized by a set of restrictive assumptions without much harm to the final decision.

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4.5. SCIENCE AND MEDICINE For science to be recognized, man must first know himself and realize his relationship with other creatures in this universe. Man has qualities such as selectivity among a series of alternatives that are not possible by other living things in making decisions and putting them into practice according to the events he encounters. By means of the ability to perceive, a person immerses himself in the realm of thought and contemplation, which are affective not only mathematically, but also spiritually from what is happening around him. By separating the events with their good and bad aspects, this is kept in mind, and the event is studied to the extent that reason and thought to allow, as far as scenarios and fictions allow. Comparative interpretations of the investigation event are made with some principles, and previously unknown results are reached. With intelligence, a person can examine and interpret in detail. Scientists want to interpret and understand nature and the environment with curiosity, desire and definition as a systematic knowledge structure that distinguishes scientific information from others. This information is rational (logical), orderly (systematic), complete, and verifiable, but has an error-prone aspect. Science, like products of other human thought activities, began with mythology and primitive conceptions of the world (Chapter 3). Unlike science in mythology, there is boundless imagination, and a clear line can never be drawn between facts and fiction. To understand the world scientifically, it is necessary to reconstruct it with concepts and assumptions based on experience. Science is first and far most a product of human curiosity and interest. In its simplest form, science is the activity of producing rational information from the knowledge structure and research methods. For some, science is nothing more than technological innovation. Such a view is too narrow and artificial. On the other hand, the idea that science is only for physics, chemistry and biology, is quite common. This is where science is put in limited containers. Such thinking is but the tendency in science to exclude social and medical humanitarian issues. Science counts as mathematics, but this is not very realistic. Mathematics and logic alone have nothing to do with the facts of observation. Both may not rely on observation and serve to summarize with a predefined set of symbols and definitions to draw conclusions. In other words, they act as tools in scientific activities. The sentences that make up the essence of science are rational, logical and general. Science, as a human activity, cannot be aimless and must control forces in nature or the human body and understand their workings from the very beginning. To achieve this goal, it is necessary to clarify, explain and predict the facts. As

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science becomes institutional, it makes knowledge possible through observations and experiments that can be expressed in logical sentences (propositions). Where foresight is important, science can be explained theoretically. Explanation means understanding based on knowledge in the context of science. Foresight, means taking control of the environment as the practical goal of science. Science is more concerned with explanation than pure prediction. Applied science, called technology, tries to control events with predictions. Among the fundamental questions, is medicine a science? It may not be pure and basic science, but scientific principles are involved to arrive at rationally acceptable medical conclusions, even with some uncertainty. Medicine is among the applied sciences, as the diagnosis and treatment solution depends on the applications in the human body. Here, applied science implies that the principles of pure science are applicable. As a result of complex procedures and clinical instrumental reports, the uncertainty component remains in medical information and knowledge. 4.5.1. Scientific Hypothesis Hypotheses are fundamental elements in all scientific disciplines, including medicine, and are the key assumptions for scientific development and progress. In order to achieve scientific purposes, it is useful to make some summary presentations to explain the common and joint behavior of knowledge or subsets by understanding the rules of logic. As with many attempts of man throughout his life, some basic beliefs are among the foundations of science. Because of these beliefs, the scattering of information is brought together, and the event is understood and explained. Some sentences are given special or written forms in the most concise and short way. The following points are among the primitive and basic assumptions in the conduct of scientific activities. a. Assuming that a group of phenomena without full control is not well explainable and there is no determinism in scientific activities. Many phenomena exist in the universe to enable people to reason and engage them, and make then understand the harmonious environment in the universe by drawing conclusions after examination. b. Do not leave events in the environment unclear; assume that they are comprehensible and understandable. c. Science is for people’s convenience, and therefore, they are happier in their search for knowledge.

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It should not be forgotten that the cases are regular under these assumptions. Although the perception of phenomena may seem independent and disordered, it is necessary to try to understand the existing regularity of the perceived parts by relating them to mental and logical procedures. After all these assumptions, why can scientific activities are carried out? And how? Should the chain of questions constantly occupy the human mind? All phenomena have a cause-effect relationship that must be described logically and rationally in the next chapters. 4.6. MEDICINE AND PHYSICIAN It is understood that the English words medicine, physician, and doctor are derived according to the functions and activities of the human body. These words, which make sense among the activities, express the person who is a master and competent, and, therefore, adopts scientific principles. A physician is a person, who knows his job well and gives priority to scientific methods in practice. This specialist performs the treatment after thoroughly questioning the patient and diagnosing client’s complaints well. The word physician has the same meaning as the word doctor, which includes knowledge, master and expertise in the field of medicine. On the other hand, the word medicine, with its deep meaning, also means kindness and gentleness. Medicine also means the discipline that treats the human body (material) and soul (spiritual) within the scope of basic, practical and applicable knowledge. It also contains a very good and detailed analysis of the work done. Physician, in the context of the word doctor used by younger generations, means a person with gentle and kind nature, who knows his job well as a specialist. The root of the word medicine comes from the Latin word Medicus, which comes from mede which means physician and medeor to heal. In order, the medical subjects to become fully functional, inferences come to mind in the light of medical philosophy and logical rules. As such, they have allowed the use of almost everyone, who deals with philosophy for centuries, especially in ancient Greek and Islamic civilizations, by being interested in medical science and having access to basic information. Western concerns have defined the “soul” as the stretch between the worlds of various states of being (between our opposite sides), and furthermore, the extension is between morality, eternity and the soul (Bosnak, 2007). The word “hikmah” in Arabic and Turkish means “wisdom” in English, as in all Islamic countries, constantly implying that it is possible to consider not only materialistic but also spiritual elements in order to achieve therapies in the field of medicine. Despite the fact that philosophy is based entirely on material principles, the word wisdom with its materialistic and spiritualistic implications is better understood in the light of the previous explanations, and it is more suitable for the

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field of medicine. Specialists who try to improve human health with treatment methods after diagnosis are called folk medicine specialists. In particular, for the first time in the history of medicine, real folk medicine specialists emerged when they lived in public without any institution. Thus, it was ensured that the basic medical information of physicians was easily transferred to the public. Primitive methods of treatment of society include the practical applications of medicine among the people. In folk medicine practices, treatment methods have been applied from time to time with such irrational and unscientific experiences. This medical knowledge among people lost its validity over time and had to leave its place to the knowledge obtained according to the methods of philosophy and logic, which led to the science of medicine. In the history of medicine, more scientific knowledge has taken the place of medical knowledge among the people. Efforts are necessary to develop the ones suitable for scientific criteria by using the folk knowledge in public. In the last 70-80 years, people's orientation to scientific medicine, medical sociology and anthropology (the study of human origins) has begun to apply modern medical methods and devices. Folk medicine is examined with its material, spiritual aspects and anthropology are emphasized, and the diagnosis and treatment of the people are guided by modern medical methods. Diseases are not only related to the disorder and discomfort in the material organs of the man, but also to one's worldview, thoughts, and connection with the fuzzy environment (Chapter 8). It has also been found to be associated with spiritual states. Focusing on the sociology of medicine, besides the medical therapy treatments, oral recommendations help the diagnosis to some extent. Another aspect of diseases is directly related to the deterioration of the human biological structure. Physicians try to treat the patient with shorter and more effective fuzzy ways with modern methods, after adding the social aspects related to lifestyle, traditions, culture and religion. Although these issues are also included in the area of social scientists, physicians and general practitioners benefit from these aspects. 4.6.1. Diagnosis As a semantic load, this word is also considered as a preliminary research, the initiation of the information process and communication between individuals (doctor-patient) about the subject of mutual interest. Diagnosis is reachable after the patient’s complaints are recognized, based on current methodologies, experiences, expert views, and relationship determinations. In the medical language information, knowledge, beliefs and assumptions play important roles in the oral diagnosis stages. These words actually took effect even in conversations between medical professionals. There are also relationships between these words

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and the medical language. Language in the medical field has implications for medical concepts, reliability and consequences. Among the general topics of the language are the following points. 1. Health, sickness, disease and infection situations. 2. Diseases such as tuberculosis, cancer, malaria, measles, smallpox, dysentery, venereal, and so on. 3. Heart, intestine, liver, skin, cell, genetics, heredity, etc. related to the human body. 4. Patient can be referred to the neurology, dermatology, urology, internal medicine, external medicine, eye, etc. as branches. 5. Practical diagnosis, intervention, treatment, cause, medication, prescription, emergency, etc., are among the words used in doctor-patient conversations. The words in the articles mentioned here and the sentences containing them help facilitate communication between doctors and patients. Suggesting similar or quite different medicine by physicians for the same disease reveals an ambiguous treatment. It is understandable how valid the fuzzy logic principles explained in Chapter 8 are in medicine. Medical professionals may not even have a consensus, because the language includes verbal ambiguities. Although they may think that they are discussing the same topic, they may not realize that there are slightly different situations. When the information content of a word is examined, it can have two possibilities as almost understood or clearly understood. The former refers to the understanding of meaning by another person, within the available information contents. For example, there is also information that is perceived without asking anything from a person's facial expression or body movements. A rote acquaintance is based on non-verbal inferences from facial expressions, devotions, contemplations or actions. Such non-verbal studies are particularly in the fields of psychology (through all the forms of thought, love, and behavior that determine and direct an individual, a community) and psychiatry (the branch of medicine dealing with mental and nervous diseases, diagnosis of diseases), which are concerned with the individual self. The following points are also important for clear information. 1. Trying to develop knowledge that people are familiar with. 2. While doing a job, the doctor who sees the bleeding in the patient’s vein during the operation will intervene to stop the blood flow immediately and apply perceptual information.

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3. While dealing with the patient, it is recommended to pay attention to a matter related to spiritual state and to apply knowledge according to morality. 4. Solutions are produced with expert knowledge, sometimes called practical knowledge. 5. Know-how is a type of knowledge other than practical and specialized knowledge. Even if each of the above types of information has a logical structure, people who use this information may not know the rules of logic, because this is how definition, perception, auditory, and non-verbal information is received. It is preferable to gain knowledge by knowing what the essence of logic is. It is propositional knowledge, because this knowledge takes place according to the rule of logic, that is, the cause-effect relationship. The most common type of information found in scientific articles, books, and reports is propositional information. However, the better ones become identifiable by criticizing their proposition knowledge. In order to understand the differences between the types of information, it is useful to examine sentences such as the following. 1. 2. 3. 4. 5. 6.

I know my brother has chest pain. I think he has chest pain. I suspect my grandson “Mehmet Yiğit” has chest pain. “Ali Zekai” is afraid of chest pain. I think “Fatma” has chest pain. I hope you do not have chest pain.

The most important points in these sentences are “to know”, “to think” or “to doubt ” in verbal forms. Each of these verbs expresses uncertainties in the medical field. Some of these verbs are quite precise, while others express uncertainty. The degrees of the uncertainty of the predicates are again different from each other in terms of verbal ambiguity. For example, the heaviest thing for a person is “fearing”, ” thinking” and” wanting”. 4.7. Some Medical Words, Terms and Terminologies There are many basic words used in the medical field and among physicians and some people. Some of them are given below with their semantic loads (These are compiled from different sources on different websites). 1. Abdomen area (Abdomen). 2. Abortion. 3. Short-term loss of consciousness (Absence).

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4. The formation is filled with purulence (adrenaline) limited by tissue in the style of a bag from the surrounding tissues. 5. It is a hormone secreted by the inner parts of the adrenal glands. The function of this hormone in nature is to prepare the organism for emergency movement, and its effect appears as the pulse of blood transferred from the internal organs and the skin to the muscles, the glycogen in the liver changes to glucose and, thus, providing an emergency energy source (abscess). 6. A state characterized by the person's aggression towards the environment, excessive activity (agitation). 7. Disturbingly irritating flooding (agitated). 8. Long, thread-like parts extend from the body of the nerve cell. The axon acts as a signal transducer. Nerve impulses at the end of the axon are transmitted to other neurons or related organs (axon). 9. Auditory nerve (acoustic nerve). 10. To show a short and relatively severe course (acute). 11. Pain relief (analgenic). 12. Substances are also called anesthetics (anesthesia). 13. It is one of the basic conditions of healthy life to destroy microbes, that is, single-celled parasites, such as bacteria, viruses, and fungi, that cause diseases by settling in the tissues of human animals and plants. Many substances such as antiseptic antibiotics and disinfectants have been developed for this purpose. However, generally, some properties and uses of all these substances called “microbe” killers are different. History of antiseptics that people used without knowing why and how they acted for centuries before the “microbe theory” was invented. For example, keeping the raw meat in the form of sausage by kneading it with plenty of salt and spices, making pickles by keeping the vegetables in a concentrated salt and lemon or vinegar solution prevented the spoilage of these nutrients by destroying the bacteria to a great extent. Today's antiseptics are the products of Louis Pasteur's valuable work. How antiseptics work is not fully explained, and how chemical antiseptics act on microbes. These substances can enter directly into the microbe cell, preventing their vital functions as well as they may have destructive effects by melting the outer membrane of the microbe cell. However, many antiseptics have the same effect on normal cells, therefore, these items should be used with care; when some antiseptics are taken orally or injected into the body, it can cause severe consequences or even death (antiseptic). 14. There are single-cell microorganisms. These are smaller than mushrooms, but bigger than viruses. Some are disease-causing, some are harmless; some bacteria are also useful, for example, soil's nitrogen-producing bacteria, which can be classified according to their shape coccus round bacillus rods vibrios comma shaped spirillums wavy (bacteria).

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15. It is a piece of fabric (bandage) that helps to bandage the wound or to keep the gases and to fix boards in place. 16. Rod-shaped microorganisms, for example, the causative agent of tuberculosis is bacill called Koch acil; it is the part of the trunk between the chest and pelvis regions. There is continuity with the pelvis cavity in the lower part of the west separated by the diaphragm forming a muscle split from the chest (abdomen). 17. Inflammatory products such as red cells, bacteria and destroyed tissue remains are the body's resistance to a specific microorganism. There are two types of immunity, active and passive. Active immunity occurs when the disease is very mild. Disease-causing organisms induce antibody reactions in the body, which continue for a lifetime in some cases. If passive immunity is the antibody reaction that is qualified to awaken, it occurs by the inoculation of the microbes with reduced or changed strength into the body (immunity). 18. It is a piece of fabric (bandage) that helps to bandage the wound or to keep the gases and to fix boards in place. 19. Red cells are tissue fluid (pus) that contain inflammatory products, such as bacteria and destroyed tissue remnants. 20. It is the covering tissue liquid (cereha). 21. It is one of the oldest branches of medicine. It is based on the repair of diseases, injuries, structural defects in the body that cannot be cured by medication or other treatment methods, or the recovery by cutting the diseased organ (surgery). 22. Incomplete defect (defect); degeneration of the normal structures of tissues and failure to perform their normal functions. 23. Moral values stipulated to be followed in the relationships of people with the same profession group (deontology). 24. Mental and physical depression reluctance (depression). 25. Department of science investigating skin diseases to the skin (dermatology). 26. Death and expulsion of the womb before the 28th week of pregnancy (miscarriage). 27. Fluid accumulation in body cavities or tissue “pleural effusion” is the accumulation of fluid between two pleural leaves (effusion); graphic representation of heart muscle activities (electrocardiography). 28. Doctors give the patient an injection or a gas through the respiratory tract before the operation to avoid pain during the operation. 29. Auditory nerve (acoustic nerve). 30. To show a short and relatively severe course (acute). 31. Pain relief (analgenic).

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CONCLUSION The principles of medical terminology are explained in more detail, starting from the contents of words on a smaller scale through the etymological (root meanings) and epistemological (meaning load) expressions of each definition that leads to terminological sentences on a large scale. In addition to the importance of mother tongue, in order to get along with people in a society, the importance of communication between doctor and patient is exemplified. The ways to reach preliminary conclusions are mentioned about the diagnosis and treatment procedures. Finally, some common medical words, terms and terminologies are reflected in different books and internet sources. REFERENCES Barbara, C. (2014). Malt, B.C., Silvia P Gennari, S.P., Mutsumi Imai, M., And Ameel, E.,.Where are the Concepts? What Words Can and Can't Reveal. In book: Concepts: New Directions, Publisher: MIT Press Betts, J.A., Chowdhury, E.A., Gonzalez, J.T., Richardson, J.D., Tsintzas, K., Thompson, D. (2016). Is breakfast the most important meal of the day? Proc. Nutr. Soc., 75(4), 464-474. [http://dx.doi.org/10.1017/S0029665116000318] [PMID: 27292940] Borghi, A.M., Binkofski, F., Castelfranchi, C., Cimatti, F., Scorolli, C., Tummolini, L. (2017). The challenge of abstract concepts. Psychol. Bull., 143(3), 263-292. [http://dx.doi.org/10.1037/bul0000089] [PMID: 28095000] Bosnak, R. (2007). Embodiment: Creative Imagination in Medicine, Art and Travel. London, New York: Routledge, Taylor and Francis.139. Dimitrov, V., Korotkich, V. (2002). Fuzzy Logic: A Framework for the New Millennium, Springer.397. Drozd, L., Seibicke, W. (1973). Deutsche Fach und Wissensschaftsprache: Bestanaufname, Theorie, Geschicgte. Wşsebbaded, Oscar Btandsetter Verlag. Hibberd, F.J. (2019). What is Scientific Definition? The Journal of Mind and Behavior (2019), 40(1), 29-52. J. Mind Behav., 40(1), 29. Kavaklı, N. (2016). Difficulties in Learning Common Greek-Originated English Words: The Case of Pluralization. Journal of Language and Linguistic Studies, 12(1), 110-123. Antia, B., Ianna, B. (2016). Theorising terminology development: Frames from language acquisition and the philosophy of science. Lang. Matters (Pretoria), 47(1), 61-83. [http://dx.doi.org/10.1080/10228195.2015.1120768] Lindquist, K.A., MacCormack, J.K., Shablack, H. (2015). The role of language in emotion: predictions from psychological constructionism. Front. Psychol., 6, 444. [http://dx.doi.org/10.3389/fpsyg.2015.00444] [PMID: 25926809] Marshall, T. (1997). Scientific knowledge in medicine: a new clinical epistemology? J. Eval. Clin. Pract., 3(2), 133-138. [http://dx.doi.org/10.1046/j.1365-2753.1997.00075.x] [PMID: 9276588] Meiers, M. (2007). Teacher Professional Learning, Teaching Practice and Student Learning Outcomes: Important Issues. In book: Handbook of Teacher Education 409-414. [http://dx.doi.org/10.1007/1-4020-4773-8_27] Morr, C.E., Subercaze, J. (2010). Knowledge Management in Healthcare. In book: Handbook of Research on Developments in e-Health and Telemedicine: Technological and Social Perspectives Knowledge Management in Healthcare., 490-510.

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Sadegh-Zadeh, K. (2015). Handbook of Analytic Philosophy of Medicine, Philosophy and Medicine. 119. [http://dx.doi.org/10.1007/978-94-017-9579-1_11] Shah, J.J., Kulkarni, S.V., Vargas-Hernandez, N. (2000). Evaluation of Idea Generation Methods for Conceptual Design: Effectiveness Metrics and Design of Experiments. J. Mech. Des., 122(4), 377-384. [http://dx.doi.org/10.1115/1.1315592] Süt, N. (2015). Study designs in medicine. Balkan Med. J., 31(4), 273-277. [http://dx.doi.org/10.5152/balkanmedj.2014.1408] [PMID: 25667779] Şen, Z. (2014). Philosophical, Logical and Scientific Perspectives in Engineering. Springer Springer.260. [http://dx.doi.org/10.1007/978-3-319-01742-6] Vakulenko, M. (2014). Term properties and modern terminological systems development. Terminology Science and Research, 24, 29-38. Vakulenko, D.V. (2015). The use of information technology time method analysis of artery oscillograms for the study of adaptive mechanisms of the organism. J. Educ. Health Sport, 5(9), 621-632. Zadeh, L.A. (1965). Fuzzy sets. Inf. Control, 8(3), 338-353. [http://dx.doi.org/10.1016/S0019-9958(65)90241-X]

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CHAPTER 5

Philosphy Principles and Types “Does philosophy? Metaphysics? Or both? Constitute the Scientific Bases of Development? Abstract: In this chapter, cases of free and unlimited thinking on philosophical grounds are explained more, and there is a close connection between philosophy and medicine. In addition, the philosophy of medicine and the ways of understanding the concepts of philosophy are explained with an emphasis on its possible relationship with medicine, especially bioethics. There are always unknowns about the disease and health, and it has been explained that no matter how much the philosophical principles try to come up with approximate rational solutions, they always remain in uncertainty, albeit marginally. It is stated that the philosophy of medicine is a branch of philosophy that explores issues in theory, research and practice in the field of health sciences. Before any explanation, from the very beginning, the etymological and epistemological features of “philosophy” and “science” help the reader to grasp the contents of this book. A set of recommendations are given in the form of systematic information to a thinker to provide dynamism towards more productive and generative directions.

Keywords: Academic, Productiveness.

Design,

Imagination,

Knowledge,

Philosophy,

5.1. GENERAL Apart from the detailed thinking and its principles, herein, much more coverage of free and unlimited thinking cases is explained on philosophical foundations. In philosophical thinking, one tries to infer meaningful information and possible relationships among social, natural and medical event etymological and epistemological features. Philosophy provides a completely free-thinking system about information concerning positivistic (materialistic) existences (Günay, 2004; Kemple, 2019). Especially, individuals can dive into unlimited and uncertain worlds even in a speculative manner, whoever is eager to search and relate the subjects of interest to reach quite rational results. The initial systematic informative human works have begun in the fifth century BC (Chapter 3). Prior to this data, the only information source was speculative, partially with primitive Zekâi Şen All rights reserved-© 2022 Bentham Science Publishers

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logical reasoning, due to the non-existence of well-established, examination and experimentation facilities. Major information concerns were medicine, social, meteorological, and astrology subjects. Philosophy kept its domination for many centuries until almost two hundred years ago. Later, the scientific way became separate from philosophy and entered into an independent disciplinary form. Unfortunately, after this separation today in the universities, philosophical subjects are not given significance. Logical principles are almost forgotten; instead, mathematics and its principles became overwhelmingly effective. Early human beings understood their role for survival in nature. Even though the life period starts with birth and continues until death, during this period, humans could not perceive that they are a part of nature. Even today, each individual has different perceptions during life period, and nobody can appreciate philosophy’s role from the first day of birth. As time passes, humans understand alive and nonalive subjects in the surrounding environment and evaluate their own situation among the subjects, and hence, life starts to get in touch with thinking abilities (Chapter 2). However, some others add spiritual dimension to life for preparation and the hereafter life. Herein, the “addition” implication is very meaningful because each individual, whether wants or not, must embrace the natural facts and compulsorily try to live with nature in peace with mutual correspondence and abidance to the physical laws. Schramme (2017) discussed information about the philosophy of medicine and explained the ways to understand the notion of philosophy by concentrating on its possible relation with medicine and especially bioethics. Normative account of medicine does not show that the philosophy of medicine needs to aim at normative guidance like bioethics. Philosophy of medicine is a discipline, which benefits from the philosophical and medical principles through logical rules to arrive at rationally useful decisions for the benefit of patients. There is no sharp distinction between the philosophy and medicine, especiallyin verbal discussions to identify a common terminology among the medicine experts. In medical research, the conceptual models start to play a role, which can later be quantified through software for common use. Medical experts work for the goodness of the patients with verbal philosophical communication by means of diagnostic-focused questions and their assessments on the basis of philosophical and logical principles. In general, medical science is empirical, and therefore, there are always remnant uncertainties in each diagnosis. On the other hand, Mbih and Tosam (2014) provided a different view. They argue that contrary to what some philosophers think, there is a very close link between philosophy and medicine. This is evident from ancient Greece with the works of Hippocrates (BC 470-360) until the present day, but unfortunately, the

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significance of philosophical principles is rather overlooked in the present medical education systems. As already explained in Chapter 3, during the Islamic civilization's golden ages, the philosophical contents played intensive roles in the works of Al-Rhazes (865-925) and Avicenne (970-1037). During the time, the most advanced and prominent scientific-philosophical contributions appeared both in philosophy and medicine issues. The objective of the philosophy is to search for truth, whereas medicine strives for health and well-being by fighting against bacteria and viruses. The more the unknowns about the disease and health, the more the philosophical principles try to come out with approximate rational solutions, which always remain in uncertainty even though marginally. In medicine, there are no standard solutions that can be applied with firm knowledge because each patient body reaction is different from others. During consultations with patients, physicians, may come across philosophical aspects such as metaphysics, etymology, epistemology, ethics, and logic for rational decisions. Mbih and Tosam (2014) also argued that one of the weaknesses of modern Western medicine is its over-dependence on the Cartesian ontology, which considers human bodies as machines that need study using scientific logic, and the physician as a technician whose job is to repair dysfunctional bodies. This modern metaphysical outlook resulted in the neglect of the patient as a subjective being. Such a deficiency is not overcomeable without reviewing the Cartesian reductionist worldview. The philosophy of medicine is a branch of philosophy that explores issues in theory, research, and practice within the field of health sciences (Wulff et al., 1986). In the late twentieth century, debates among philosophers and physicians ensued about whether or not the philosophy of medicine is considered as a field of its own, either philosophy or medicine (Arthur, 1992; Lee, 2013; Bhattacharjee, 2014). The most important principles for systematic rational conductions turn around four ingredients, namely, critical thinking, physical existence, philosophy and logical rules. These are the steps for those who are interested in generation of nexus thoughts under the guidance of critical thinking about the virtual and actual worlds. In this chapter, detailed information is presented about the definition and content of philosophy in the science domains including medicine prior to logical principles applications. 5.2. PHILOSOPHY DEFINITION In general and in simple words, philosophy is defined in English as the love of knowledge and wisdom in the framework of materialism, but in Arabic, it is

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referred to as Hikmah, which also includes religious information (Chapter 3). Philosophy of science excludes all the spiritual, religious and metaphysical concepts and concentrates only on the materialistic existences to reach rational and logical scientific inferences. Such a philosophy is known as the positivistic philosophy of science. Positivist logicians replace philosophy with science, which is not agreed upon completely by the author of this book. Philosophical thinking is not the property of highly educated people only, but since it is the combination of knowledge and wisdom, common people may also share such a way of understanding, discussing, and pondering in the search for ultimate truth, which may still stay as vague, blunt and uncertain to some extent. Such uncertain ingredients fall within the domain of philosophy in the form of suspicion for better and quite clear understanding. About wisdom, the Chinese philosopher Confucius (BC 552-479) said the following quotations. “By three methods we may learn wisdom: First, by reflection, which is noblest; second, by imitation, which is easiest; and third by experience, which is the bitterest.” “Wisdom, compassion and courage are the three universally recognized moral qualities of men.” In general, truths are relative and may change by the accumulation of new knowledge and their systematic scientific information forms. If absolute truth does not exist, then the knowledge is quite subjective and interpretable by different thinkers, philosophers, and scientists. For instance, up to now, there is not a single truth for light, because, depending on the convenience, sometimes it is considered as waves and in others as photons. Hence, scientific truth, if any, may depend on personal thought, which others may not accept. As for the human feeling, “fatigue”, “illness”, “frustration”, and “stress” are dependent on human sense perceptions. All these sensory feelings are not objective and have to remain subjective. As explained in Chapter 10, human beings have invented some auxiliary instruments to augment sensory feelings in a more objective manner, but even then, there are still uncertainties in many of these aspects. Each one of these instruments is based on a set of hypotheses and then reached into theory form with testing through the empirical data limits. Empirical data records help improve the instruments sensitivity, and hence, they become more reliable, but still with uncertainties. Although most of the medicine specialists rely upon the theoretical or empirical findings of previous experts, minority suspects from each piecesminority suspects from each piece of information, and tries to reach a better level of achievement, which is accomplishable through philosophical and logical

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rational thoughts and thinking activities. Authoritative information and knowledge are well established in many institutions and universities, but their authority is affectable by philosophical and logical principles. Rationalism is reachable provided that even though approximate reasoning is founded on the philosophical and logical aspects. Power of knowledge depends on rationalistically and empirically valid judgments. However, raw philosophical knowledge needs ripening by human mind activities to reach the level of reliable knowledge, and additionally scientific information. For rationalistic knowledge and information, formal logic principles are applicable in the forms of two-valued and/or fuzzy logic rules (Chapters 7 and 8). The internal consistency of philosophical thoughts is securable by systematic logical approximations with less uncertain remnants. Uncertainty may remain a source of subjectivity, which needs more confirmation by objective, rational principles. Finally, one may say that various initial knowledge sources are combinable through science philosophical principles and logical rules for more reliable calculations and interpretations. Among all knowledge sources, empirical ones are the most reliable in medicine or by confirmation of convenient theories. Prior to any explanation, right from the beginning, the etymological and epistemological features of “philosophy” and “science” help the reader to grasp the contents in the subsequent chapters. Unfortunately, these words are used frequently, even in academic circles, but without crisp, brief and satisfactory insights. Especially, philosophy of science plays a major role in any topic for productive and fruitful idea generations. The philosophy has five principal principal divisions: ontology, ethics, metaphysics, and epistemology and aesthetics, which are mutually inclusive to some extent. The major topic is ontology in the search for existence. (Fig 5.1) represents each subject, where ontology embraces all of the other branches of philosophy. The (Fig 5.1) shows interferences among different philosophical disciplines for philosophical experts, who may not care for science or medicine philosophy. Ontology is the most extensive pondering and thinking space, where there are materialistic and non-materialistic (spiritual) Figs, existences, features, concepts and alike. The non-materialistic part is confined to the metaphysic. Ethics is a common area for each individual in any deed, but it also has relative aspects for each civilization, society, culture and religion in which the moral identities play the most significant role. Aesthetics is a very special form of philosophy, which may not affect other philosophical activities strongly.

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PHILOSOPHY ONTOLOGY METAPHYSICS

EPISTEMOLOGY

AESTHETICS

ETHICS Moral

Fig (5.1). General topics in overall philosophy.

One of the branches of philosophy is epistemology, which covers the scope, meaning, understanding and logical content of knowledge. Therefore, it is referred to as the theory of knowledge, prior to the ripeness in the form of scientific information (Chapter 4). It is also related to the study of the nature, source, and validity of knowledge. To explore the epistemological world, two significant questions are often asked: “how does one know and understand?” and “what is true or false?” As mentioned earlier, the activity of thought content also enters under the umbrella of epistemology. The final goal is to establish reliable, dependable and valid information. Epistemology seeks answers to a number of fundamental questions, such as “whether reality can be known?” Skepticism, in its narrow sense, is the position claiming that people cannot acquire reliable knowledge and any search for truth is in vain. This thought was well expressed by Gorgias (BC 483-376), the Greek Sophist, who asserted that nothing exists and that if it did, we could not know it [Jean-Paul Frederich Richter (1763-1825) in the Eclectic Magazine of Foreign Literature, Science and Art. 12: 317. hdl: 2027/iau.31858055206621].

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Philosophy as the origin of the word emerged from the combination of the Greek words 'philo' and 'sophia'. In a sense, it can mean literally and plainly “love of knowledge”, but it has even deeper meanings in terms of information theory (epistemology). Philosophy also deals with abstract concepts and entities that contain the most free thoughts, which are classical and virtually extraordinary. Hence, it provides some inferences about them primarily through rational approaches. In the past, it is accepted that all kinds of thought productions were under philosophical subjects until the 18th century. In this respect, philosophy is used as a concept that includes the sciences. Today, philosophy is perceived in isolation from science. This is a potential mistake, because at the root of every thought is language, philosophy and logic that encompass all rational reasoning and implications. If one of them is not perceived fully, it is not possible for scientific knowledge to reach efficient productivity. It is thought that scientific subjects are no more within the scope of philosophy as before, and with the emergence of many different branches in science, they remain outside the scope of philosophy. However, philosophy is at the root of all sciences and arts as thought processes that are somewhat irrational at the beginning, but gain rationality through logical rules, and hence, approaches even approximately to acceptable results. It is rather unthinkable to satisfy people or the validity of science or art without philosophy. The title obtained as a result of doctoral studies in different subjects of science is “Ph. D.”, which is “Philosophy of Doctorate “. These words reveal the necessity for doctoral studies in every discipline to have philosophical bases (Section 5.3). It is essential that a person with Ph. D. degree in a particular discipline should know the content of the subject not mechanically, rote fully and stereotyped, but on the philosophical bases. Philosophy implies briefly systematic thinking, reasoning with the logical rules, where reasoning means improvement in the available knowledge blocks. Philosophy also interrogates the information by questions such as “what is information and what are the types of knowledge?” Philosophical approaches asked questions and sought answers even before the rules of logic were established by Aristotle (BC 384-322) about 2500 years ago. In general, philosophy and science try jointly to determine the degree of knowledge accuracy in respective subjects. In philosophy, knowledge is the product that emerges from relations between subject and object. The subject of this book is not about general philosophy, but the philosophy of science, in general, and its role in medicine. The following points are worth noticing.

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1. As for philosophy, and especially the philosophy of science, is concerned, not all philosophers are scientists, but their views shed light on scientists. Since there are no formulas, mathematical symbols, complex equations and only vocabulary in philosophy, it attracts everyone, who likes general discussion even though not scientific 2. In order to reveal the correct inferences from the philosophy of science, first philosophical information pave the way for the context of how logical proposition and inference rules work 3. When the researcher has information about the philosophy of science and the functioning of the rules of logic, it is useful to include a general physics course in order to appreciate the generation mechanism of the event concerned again with the principles of philosophy and logic. The most effective philosophical issues in the philosophy of medicine are ontology and epistemology, which are not yet well developed either in the career or in the medical education system. It is, therefore, essential to develop, implement and support medicine educational ventures in the philosophy of medicine. Yet education in philosophy of medicine is lagging behind even though there are published papers in different medical-oriented international journals. Unfortunately, there are few textbooks on the philosophy of medicine (Wulff et al., 1991) with few anthologies in this field (Nelsen and Nelson, 1999). Even in contemporary innovative programs dedicated to the medical humanities, ontology and epistemology of medicine are less often allocated as course of their own than are medical ethics, history of medicine, literature and medicine, and other areas in medical humanities (Grant, 2002; Grant et al., 2002. Basic knowledge and skills in the philosophy of medicine are conduciveable to a reasonable, critical, and reflexive approach in medicine, which may improve medical practice. One of the significant branches of general philosophical topics is metaphysics (beyond the physical world), which searches for the roots of reality and existence in a non-materialistic world. The basic questions are “What exists?” and “What is real?” in order to search for the ultimate natural existences. The answers to these questions are not simple and straightforward. For this reason, in positivistic logic and science, the metaphysical world is exterminated completely. Hence, it is assumed that in science works, there are no metaphysical ingredients, but scientist can have their own metaphysical thoughts and thinking activities. According to the writer of this book, there is no clear-cut boundary between science and metaphysics, but intermingling exists to a certain extent. The more the ideas are transferrable from the metaphysical world to the scientific arena, the more the science can flourish in this manner. In the ancient Greek period, astrology was a sort of metaphysical knowledge, but during the Islamic period, it became astronomy with objective criteria and observations. On the other hand,

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metaphysical thoughts exist in theology as parts of religious theories that deal with God conceptions, which are not testable at all and hence, non-scientific. Another aspect of general philosophy is ontology as the study of the universal and natural existences. Ontology is concerned with the basic reality about the matter or spirit, orderliness and lawfulness of the natural subjects. According to the philosophy of science, there is no truth, but quite false empirical theories. This statement is according to the two-valued logic (Chapter 7), but almost all of the theories fall within the domain of fuzzy logic (Chapter 8). Even in the history of science, most theories have some or even a low degree of truthlikeness. Although the evolution of science brought better theories, they are still probable with a high degree of truthlikeness. For instance, in the medical sciences, modern and standardized therapies are based on scientific theories that have extreme effectivenesses, but they are based on theories with acceptable degrees of truthlikeness. Popper (1972, p. 335) summarizes the truth in the following quotation. “I have in these last sections merely sketched a programme […] so as to obtain a concept of verisimilitude which allows us to speak, without fear of talking nonsense, of theories which are better or worse approximations to truth. I do not, of course, suggest that there can be a criterion for the applicability of this notion; any more than there is one for the notion of truth. But some of us (for example Einstein himself) sometimes wish to say such things as that we have reason to conjecture that Einstein’s theory of gravity is not true, but that it is a better approximation to truth than Newton’s. To be able to say such things with a good conscience seems to me a major desideratum of the methodology of the natural sciences (Popper, 1959; Popper 1972, p. 335).” Popper’s epistemological fallibility realism is far more reasonable than all forms of positivism. Social constructivism does not imply that it is in no need of improvements. Johansson and Lynøe (2008) stressed a semantic observation that underpins epistemological realism, and present it by means of a detour. Taking lessons from the history of science, the notion of truthlikeness leads one to future developments through scientific thinking and achievements similar to technological developments. Like engineers try to improve the malfunctioning machine or replace it with new discoveries, medical scientists also try to improve or invent new, better and more valid theories for health cases. It is possible that one assertion may have more truth than another, which also means by definition that it is less false. Some theoretical arguments and inferences show a certain view is true or probably true, whereas others may be practical in the sense that they are meant to show that one ought to act.

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Many disciplines in their research, design and structure construction tasks try to solve the problems with the applications of scientific, mathematical, economic, social, and practical knowledge. Almost all education system is based on crisp scientific rules, formulations, algorithms and software, which are obtainable swiftly through the internet. However, in the presence of computers, the internet and books, many seek solutions on two-value logic, which leads to memorization and almost blind application of the scientific outputs without critical review and even complete ignorance of basic philosophical and logical principles, which are very helpful not only for understanding the generation and creative production mechanism behind each solution, but additionally to train and educate students for a better expertise. The classical education system, students, expect solutions based on available techniques and numerical data rather than essential science philosophical and logical principles. Attachment to these principles should precede database, because through a set of principles, one can formulize the problem solution linguistically (Chapters 7 and 8). 5.3. ACADEMIC PHILOSOPHY Although the philosophy of medicine is a field that seeks to explore fundamental issues in theory, research, and practice within the health sciences, ignorance of the philosophical topics in medicine education implies that neither the students nor the graduates can tackle such issues except the ones, who have trained themselves towards ontological, epistemological metaphysical and ethical issues. As already explained in Chapter 3, although medicine history developed along with philosophy, but in modern times, it is missing from the education systems. Caplan (1992) debated whether there was a distinctive field as “philosophy of medicine?” It is defensible that this topic was among the old physicians’ interests, and it started to reappear recently in some academic circles. The philosophy of medicine helps to reduce uncertainties together with logical principles in the medical research domain sufficiently through the academic departments of medical college concepts such as explanation, causation, experimentation and debates over applications of scientific knowledge. Using only the word doctorate can give dull information about the internal structure of the research study. However, the “Philosophy of Doctorate” is briefly equal to Ph. D. academic degree. The most important phase, prior to doctoral studies beyond the principles learned in master's degree, is the basic factors that play role in problem solution and their interactions in terms of the science philosophy. Although even today Ph.D implies philosophical ingredients in the research activities, “how many of Ph. D. holders in the world are aware of philosophical

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concepts of their research?” There are Ph. D. theses full of mathematical expressions without their philosophical and subsequent logical concepts. How can such a title owner produce innovative additions to existing literature and information? There are numerous Ph. D. holders worldwide, but their scientific innovative contributions are quite low. This point indicates that in many institutions and universities, rather than philosophical and logical principles, unfortunately, mechanical applications or minor modification researches are plenty. Among the differences between doctoral studies and previous studies are the following important points. 1. Determination of the finest detail about the mechanism of the verbal-weighted philosophy from different angles (physics, geometry, location, time, application) 2. Determination of the effect (cause, input) and response (result, output) variables that give rise to the problem for scientific methodological applications 3. Identification of simple or compound propositions between effect and response variables in the form of logical principles 4. Suggestion of all verbal philosophy and logic deductions for numerical analysis by mathematical equations, if necessary 5. Consultation of analytical or if not possible, numerical solutions of the mathematical equations with an appropriate methodology 6. Examination of the preliminary criticism of the results from the philosophical and logical principles points of views 7. Comparison of the results with the measurements, if any, graphically and numerically. In these comparisons, the practical acceptance of the solutions must lie within ±1%, ±5% or ±10% error limits according to the sensitivity of the problem 8. Criticism and discussion of the conclusions from different aspects and determination of the missing points, if any 9. Position of the doctoral study among the existing literature in terms of science and application Today, the boundaries of science are not sufficiently developable with formalism, imitation, repetition, rote learning, mechanization, and especially with standard thoughts. In communities behind these boundaries, the non-adoption of formal critical, constructive, expansive, rational, logical and philosophical activities continue for years in the form of a tree that does not yield fruit (Chapter 2). Although the root of rational thought lies in curiosity to make fruitful inventions, it is similar to focusing on hard-to-reach and unlikely goals in science, medicine, art, literature, and other branches, where thoughts are not primarily philosophized.

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Even though philosophy can only be thought of as shaping and organizing the world of thoughts, combining it with the facts of culture, civilization and paying attention to the native language at every stage are indispensable elements. Science philosophy is one of the most excluded subjects in many societies even though the philosophical thinking principles are the most important in the world of thoughts. Unfortunately, the meaning of philosophy emerges as “empty word”, “unwise thoughts”, and “unnecessary for society”. The abstraction of philosophy from the public has not been as effective as its abstraction among the intelligentsia. A person who does not care for the philosophy in the subject is unqualifiable as an academician, let alone as a scientist. Like the word philosophy, the academy is also a Greek word, and it was started and continued for centuries by philosophical thinking principles. Especially, science philosophy is an essential first subject for every education system that desires to benefit from scientific productions. Although the philosophy of thought is mentioned here in general, it should focus on the “philosophy of science and medicine” in terms of enlightenment. However, according to the classes of thought to be given later, even those who know neither the origin nor the meaning of philosophy are caught up in philosophical thoughts, especially those related to matter. Its definition is given above, and it implies wisdom and knowledge. This is such a love that new information is producible by continuous thinking after the dissemination to other individuals in the society. One can also perceive and judge the information, and new ones are producible by different philosophical thinking. Philosophical thoughts serve to more useful information production through chain reactions as if an atomic nucleus was shattered. In a sense, philosophy is the engine of knowledge generation. Philosophy is a silent, imageless and weightless activity in one's inner world, but gives peace to mind and soul. Today, all scientific subjects (social, medical, engineering, business, astronomy, physics, chemistry, mathematics, etc.) have emerged from the principles of philosophy. Since all this information, whose origins are the same seed, branched out and forgot the originals in some societies, and therefore, professional fanaticism started to emerge. For example, in many scientific disciplines today, methods of thinking always emerge in deductive, inductive, analogy (simulation) or hybrid styles (Chapter 2). Thus, people with philosophical orientation can benefit from one or more of these thought methods to reach scientific productions. 5.3.1. Information Philosophy Even if knowing or acquiring knowledge occurs only through perceptions, the words’ meanings are understood clearly and explainable to others with communication. There is a great difference between knowing and knowledge. The

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necessary and sufficient condition to know is to perceive the subject. Although the perception is a necessary prerequisite for information, it is not sufficient. Competence for knowledge is possible by thinking about the perceived subject and understanding and explaining its information content. Accordingly, a knowing person does not mean a knowledgeable person. If one cannot go beyond perception, which is necessary and sufficient for knowing without reasoning, only some meanings are stored statically in the memory. For knowledge, some thought operations need to be done after perception and for this purpose, questioning and critical thinking must intervene based on philosophical principles. Information without criticism and doubt ensures that the people are not knowledgeable as information knowing people. In the field of philosophy, critical discussion of knowledge from different aspects of reality leads to rational inferences. Perception alone is not enough for philosophical thinking without interpretation and explanation. Philosophy provides approximate reasoning in completely free, open and hidden extraordinary thinking domains about subjective topics, which are not yet respected as scientific works. In the past, until the eighteenth century, any type of thinking procedure was impregnated with philosophical thinking grounds, and therefore, philosophy included scientific works. Today, philosophy is regarded as it is almost separate from sciences. This is a mistake because philosophical content is at the root of any thought. The word philosophy has entered almost into all languages in a brokenly pronounced manner. For philosophy, one has to have ambition, wonder and search for knowledge with inert desires. Today, even though philosophy is understood as a search for materialistic existences, it also includes other spaces as spiritual dimensions. For instance, along with such spiritual feelings, their philosophical contents are cared for by ancient Greek philosophers such as Socrates (BC 469-399) and Plato (BC 428-348). Today it is thought that science does not overlap with philosophical thinking, and even though there are many scientific disciplines, they may be regarded as away from philosophy. As in its definition, philosophy is at the roots of systematic, rational thinking in scientific and artistic activities. Without philosophical thinking, one can hardly convince others scientifically. In short, philosophy implies systematic thinking and reasoning with logic principles support even in an approximate manner. It leads to the deduction of knowledge ensembles with generative thoughts. Even the informative knowledge generations are critically questionable through philosophical reasoning. The questions as to “What are the informative knowledge and what the types of knowledge are” were also asked prior to Aristotle (BC 384-322) in different civilizations, but the first imprints started to appear during ancient Greek

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civilization. Although scientific information and knowledge are based on rationality and experimentation, philosophy is also concerned with metaphysical world affairs and religion, which may help improve. Philosophy of science aims to reach the correct degree of informative conclusions. Philosophy is a product of interactive relation actions between the subject and object, and especially it is a product of trying to know the subject by the object. If the question “What is the philosophy?” is directed to many people, they may respond by saying that it is the way of real discovery. In fact, philosophy opens the way to examine all information types in finer detail, whether they are visible or invisible. The relationship among these existences can be explored first by philosophical thinking principles subjectively and then, to a certain extent, objectively by the application of logical principles. The word “ontology” implies today as the combination of different basic ingredients concerned with all subjects in the universe. These can have small or big scales less than a human can grasp, see or appreciate. In this respect, it is not important to the creator of the subjects, but the relationships among them are the main concern. Not only thinking but more importantly, perceptions are the main drives to grasp ontological existences, which do not need to have a position at some location in the space. Today, even the most advanced scientific principles prove that human existence started after inanimate existence. Ontology is everything that is perceptible or not, visible or not, that can be expressible and comes to one’s mind. If the existences are visible or imaginative, but perceptible, then they are ontologies. The emergence of information, its types, innovations, and rescue from stagnancy are the points that indicate the significance of philosophical thinking, and hence, stagnant knowledge can gain rational dynamism by critical philosophical interrogations. In countries with effective education, instead of stagnant knowledge and their transfer, the weight is directed towards their criticism, assessment and development to improve results from the previous alternatives. Hence, the emergence of thought experiments and physical structures become healthy, productive and sustainable at least among the philosophical thinking capability possessing individuals. On the other hand, some philosophers advanced the theory of evolution and suggested that human beings came into existence randomly from a single cell and, by time, became human beings. This also implies that the animate existences existed even before millions of years ago. Today there are two different views about existence; one is the creation and the other evolution theories. The former is based on the existence of a creator, God, with spiritual, mental and body material

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existences and the latter is based only on materialistic views without experimental studies. The core of the most effective existence is mental activities, which are the sole principles of philosophical thinking. Philosophy, in a way, is an unlimited thinking capacity for rational deductions. Its purpose is to provide rational answers to any question about any phenomenon considered. In Islamic literature, apart from philosophy, there is wider coverage of all materialistic and spiritual thinking domains, which is referred to as “Hikmah” (wisdom) in Arabic, and is commonly accepted in any Islamic country (Chapter 3). Hikmah is the way of knowledge and information deduction either in the spiritual world or as an addition to the materialistic space of existences. The Islamic way of through philosophy and especially Hikmah are achievable through combined mixtures of imagination, design and deep thinking principles (Chapter 4). From a philosophical viewpoint, information sources are not confined to the materialistic world only; by criticism one can reach at higher levels of enlightenment spiritually and materialistically. In philosophy, one must first criticize inferences and then the way is open for others’ critical assessments. Philosophy tries to infer any type of information and knowledge about a phenomenon by intermingling art, science and other knowledge patterns. The main and final purpose of philosophy and especially Hikmah is to reach true knowledge, but unfortunately, such a mission has not been completed even today. As already mentioned in the previous chapters, rather than a deductive look at the phenomenal generations, inductive perception provides more detailed information in various disciplines such as medicine, engineering, physics, and alike, (Chapter 2). In any topic, perception and understanding are the philosophical thinking principles. Philosophy provides critical assessment leading to knowing ability by means of unlimited content and deep thinking. Conceptions of any information and knowledge without philosophical bases remain in mind as stagnant, memorized, mechanical and unproductive scriptures. Philosophy furnishes all the ways to generate scientifically and any hidden information extracted in the body of ontological existences. It continues its dominance in mental functions, as already explained in Chapter 2. 5.4. HISTORICAL DEVELOPMENT OF EDUCATION SYSTEMS Philosophical or non-philosophical information and knowledge were written initially in books during the ancient Greek civilization, which provided the transfer of information by reading the written scripts. Consequently, the first education system became twin (double education), including writing and reading

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functionalities (Fig 5.2). In the Islamic world, the reading of the Qur’an is regarded as the most significant function of humans.

DUAL EDUCATION READING

WRITING Fig. (5.2). Dual stage schools.

If the question is “where is the philosophy in this double education system”; it is certain that philosophy is an unavoidable ingredient in any education system, which always exists in a sustainable manner among intellectuals. Even though it is not shown explicitly in Fig (5.2), it is there hidden as in the present-day education systems. As a result of human thought evolution, instead of double education, a triple education system came into existence with grammar, logic and rhetoric (Fig 5.3). Again although philosophy is not expressed explicitly, it is still there in a hidden manner. How could logic come into power without philosophical principles?

TRIPLE EDUCATION

GRAMMER Who?, What?, Where? Ne zaman? Fig. (5.3). Triple-stage schools.

LOGIC Why?

RHETORIC How?

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By the time the questionable features started to take place in the triple education system, and writing, reading and rhetorical expressions started to be imprinted among the intellectuals in society, and questions as “what?”, “who?” and “where?” took significant roles in the grammatical expressions in addition to “why?” and in the logical domain “how?” rhetorically. Each one of these questions triggers the mental thinking and ability to have more systematic information and by the time the society is saturated with such questions and answers, leading to systematic information accumulation. In the triple education school, there is no explicit role of philosophy, but as mentioned before, it is always there. Rhetoric is significant even in today’s education systems, because the teacher may have storage of well-known information, but if not able to communicate and transfer this knowledge to the students, then the teaching remains crippled. After developments over time, the quadrantal education system started to occur, as in Fig (5.4). This has similarities to today’s education system, and, therefore, has more meaningful content for present education. Instead of double and triple systems, it includes new topics as a result of societies’ requirements, such as arithmetic, geometry, music and astronomy.

QUADRANTEL EDUCATION

ARITHMETIC

GEOMETRY

MUSIC

ASTRONOMY

General numbers İndependent of time and space

Numbers dependent on space

Numbers dependent on time

Numbers dependent on time and space

Fig. (5.4). Quadrangle stage school.

In this system, the logical element in the triple system is replaced by mathematics and even today, without back support of logical principles in the education system, it is dominant among the basic courses, as preferable and expansive in various types, including calculus, derivation, integration, probability and statistics. How can pure mathematics be productive without the background of logical principles? This is the basic drawback in sole mathematical teaching without its relationship to logic. Frequently, one can hear that mathematics is logic, but as is clear from the previous education systems prior to mathematical elements in the education systems, logic was thought. A similar situation also dominates in other scientific topics without philosophical background support.

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Finally, in Fig (5.5), within the multiple education systems different topics are given for production along the scientific and technological developments, but philosophical and logical ingredients are also indicated. Is it possible to come across rationality without philosophical and logical foundations? In such cases, affection feelings become favorable in a society, which is quite important, but philosophical and logical principles have priority weights for scientific and technological developments.

LOGIC ?

Where is affection ?

SCIENCE

LOGIC ?

TECHNOLOGY

EDUCATION

PHILOSOPHY

Fig (5.5). Education-Science-Technology-Philosophy-Logics.

5.5. Steps in the Philosophic Thinking Philosophy is a preliminary ability for one to live in an integrated manner with the surrounding environments, because there is no human without mind and thinking. One can grasp even metaphysical or abnormal features of a subject as a result of thinking. Grasp with criticism principles leads to the benefit of a society in any deed. The physical existence of an individual is necessary, but not sufficient for information perceptions leading to understanding, explanation and interpretation

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abilities. It is possible to mention three subsequent stages in a thought experiment, which were explained briefly in Chapter 4. 5.5.1. Imagination Human prior to anything is an ontological identity, who imagines things prior to the thinking process. Rene Descartes (1596-1650) stated that “I am thinking, therefore I exist” However, about 600 years before him, Avicenna (970-1037) made a thought experiment and imagined himself far away from the physical world, stars, planets and any existence in the universe. Hence, he would not see anything; since he was thinking, then he concluded that he existed. Humans may be suspicious of the knowledge perceptions, but not from the perception itself, because it is an inert ability with him since creation. This brings one to the conclusion that there is no thinking without imagination, which is the existence of something in the human thinking by itself or by the conception of some perceptible phenomenological visions. Imaginative things may not be real, but some measures are taken into consideration for their scientific examinations. If one states that in medical studies or even engineering, there is nothing imaginative, then this is a big mistake. Every abnormal works are imaginative and they appear in suitable medium and conditions. For instance, the engineering imagination for better structures from esthetical, more economical, attractive and stronger are all within the imaginative thoughts for improvements of the consequent ends. If a medical doctor does not care for imaginative thoughts, then s/he remains in the stagnant and noninnovative information circles without new development. Imagination continuously feeds mind thought trainings, and such thoughts lead to critical thinking activity. Without imaginative thoughts, one remains within the borders of memorization. As already mentioned in the previous chapters, medicine and science have started with imaginative and speculative ideas (Chapter 3). 5.5.2. Design Design is the subsequent element of rational thinking after the imaginative thoughts and their impulses. Imaginative things, even though they are in the virtual medium, can be converted into a shape, i.e., geometry forms. Anyone who can visualize the shape of the phenomenon of concern can make better explanations, and after critical view can reach the best solution for the time being. Today many career owners want to be designers in their activities. Hence, the

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more imaginative thinking, the more innovative designs. One can gain ambitious desires provided that the thinking capability after imagination can lead to new shapes with generative ideas. Such ambition may originate from the inside flame or design appreciation by other individual's incentive and encouragement provisions. On the contrary, criticism by individuals on the proposed methodological design may open ways for far more improvements in the design. Ancient Greek philosopher Plato (BC 428-348) wrote at the forehead of his academy that: “who do not know geometry cannot enter inside”. 5.5.3. Productiveness (Idea Generation) The production of a career is not obvious only by designs, but in the meantime, the application of the imaginative designs, and therefore, to derive further ideas towards better directions. Ideas and opinions emerge in mind and their transfer to other individuals requires verbal information, inferences, interpretations and recommendations. Hence, it is significant to infer rationally verbal deductions by philosophical principles linguistically. According to an old criterion, this stage is contemplation, and at the end of such a stage, beneficial, informative idea generations become possible. Career owners and thinkers must take into consideration their productions simplicity, speediness, and economic principles not only in stagnant thoughts, but more importantly in active thinking processes. Share the practical productions with others encourages joint decisions; hence, a common stage is reachable for a more expansive common interest. 14th century, Islamic thinker and social philosopher Ibn-Khaldun (1322-1406) stated that: “if one can visualize thoughts in shape forms then one cannot make mistakes easily” 5.6. KNOWLEDGE PHILOSOPHY Even though “to know” and knowledge gain start with perceptions, their verbal expression imprints in mind about various subjects are conveyable to other individuals, at least linguistically. The necessary condition for knowledge is the perception of the subject. However, information perception is also necessary, but not sufficient. For sufficiency, one must ponder the subject and try to understand what it implies meaningfully, and after understanding, share its clear explanation with others. According to this principle, the one who knows is not a knowledgeable person.

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Perception is a necessary and sufficient prerequisite for knowing, but if further measures are not taken into consideration, then rational knowledge is not reachable due to the remnants of some stagnant meanings. For knowledge grasp, after perception, some rational functions must be executed in mind. For such a task definitely, interrogation and critical thinking assessments are necessary. In any education system, if the knowledge is given without criticism and suspicion, in such a case, those who perceive the knowledge remain as knowledgeable individuals without intellectual capability. Such a person graduates as a knowledge load porter and can define only the knowledge without rational application possibilities. As already explained in Chapter 4, epistemology is a branch of philosophy for knowledge meaning, existence, and validity degree. Systematic knowledge structure provides dynamism to a thinker towards more productive and generative directions. The following items provide points for the researcher and scientist. 1. Each philosopher cannot be a scientist, but their views provide light for scientists. Philosophy is not to know mathematical formulations, symbols and complex equations, but it attracts human interest due to its verbal content, and even this principle may attract mathematics lovers 2. It is necessary to provide a transition from linguistic knowledge to scientific philosophy interferences. 3. Any researcher, under the light of the scientific philosophy, must consider the generation mechanism of the concerned event first on the philosophical bases. 4. It is also very important to include the visualization of the event in scientific research. For this purpose, it is recommended here to glance at the history of science such that in each investigation, the shape (geometry) of the event is taken into consideration even at the first stages of simplification and assumptions. For instance, the revolution of electrons around the kern of an atom is visualized even though it is not correct, but simplifies imagination, and visualization and triggers the thought process for better solution suggestions. As mentioned above, quotations by Plato (BC 428-348) and Ibn-Khaldun (1322-1406) indicate to give more weight to shape (geometry) training prior to the mathematical loading of minds without shape conceptions, philosophy and logic principles. 5. After the execution of the previous steps, one needs mathematical rules in order to transfer logical concepts to symbolic representations. 6. In the curriculum, more weight should be given to the history of science and technology philosophically for the present science and technological advancements.

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CONCLUSION The main theme of this chapter is the philosophical principles and their various types as science, medicine, academic, information and knowledge philosophies. Various definitions of philosophy are presented with relationship to medicine and the steps for arriving at the philosophical issues are gives including imagination, design and idea generation procedures in detail. The main contents of the philosophy as are also explained in detail including ontology, epistemology, metaphysics, aesthetics and ethics. REFERENCES Arthur, C.L. (1992). "Does the philosophy of medicine exist?". Theoretical Medicine. Does the philosophy of medicine exist., 13(1), 67-77. [http://dx.doi.org/10.1007/BF00489220] [PMID: 1604434] Bhattacharjee, P.K. (2014). “Working Philosophy of All Medicines” (PDF). International Journal of Advanced Engineering and Global Technology., 2(7), 823-827. Caplan, A. (1992). When medicine went mad. Bioethics and the Holocaust. Totowa, NJ: Humana Press. [http://dx.doi.org/10.1007/978-1-4612-0413-8] Günay, M. (2004). Metinlerle felsefeye giriş. (Introduction to philosophy by text). 302. Grant, V.J. (2002). Making room for medical humanities. J. Med. Humanit., 28(1), 45-48. [http://dx.doi.org/10.1136/mh.28.1.45] [PMID: 23671051] Grant, V.J., Jackson, A., Suk, T. (2002). Courses, content, and a student essay in medical humanities. J. Med. Humanit., 28(1), 49-52. [http://dx.doi.org/10.1136/mh.28.1.49] [PMID: 23671052] Johansson, I., Lynøe, N. (2008). Medicine and Philosophy: A Twenty-First Century Introduction. [http://dx.doi.org/10.1515/9783110321364] Kemple, B. (2019). Introduction to the Philosophical Principles. Logic, physics and Human Person. Continuum. Physical Insight 184. Lee, K. (2013). Lee, K., (2013). "The Philosophical Foundations of Modern Medicine". Theoretical Medicine and Bioethics. 34(5), 437-440. [http://dx.doi.org/10.1007/s11017-013-9253-5] Tosam, M.J., Tosam, M.J. (2014). The Role of Philosophy in Modern Medicine. Open J. Philos., 4(1), 7584. [http://dx.doi.org/10.4236/ojpp.2014.41011] Nelson, L.J., Nelson, L.H. (1999). Meaning in medicine: a reader in the philosophy of health care. London: Routledge. [http://dx.doi.org/10.4324/9780203823415] Popper, K.R. (1959). The Logic of Scientific Discovery, Harper Torch Book edition, New York Popper, K.R. (1972). Objective Knowledge. Oxford. Schramme, T. (2017). Philosophy of medicine and bioethics. Handbook of the Philosophy of Medicine, 3-15. [http://dx.doi.org/10.1007/978-94-017-8688-1_58] Wulff, H.R., Pedersen, S.A., Rosenberg, R. (1991). Philosophy of Medicine — An Introduction. 2.London: Blackwell Scientific Publications.

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CHAPTER 6

Philosophy in Medicine “Verbal Expressions in Medicine can Develop through Innovative Ideas Generation by the Philosophy” Abstract: This chapter aims to provide a physician with the foundation and principles of philosophy in medicine for freer and independent thinking. In previous chapters, a sub-branch of the philosophy of medicine related to epistemological concepts and metaphysical implications was highlighted, including ethical and even moral principles. The philosophy of medicine is a blend of medical education and training with philosophical aspects to achieve improvements and innovative findings for public health services. The philosophy of medicine includes the contra-active interactions of diseases, health and the search for effective reciprocity. By asking questions about how medical and health professionals know what to do, and detailed information is given in terms of practical medical wisdom. How should they make the right and wise decisions in morally complex and uncertain situations? And what is the patient’s role in this decision-making process? In medical practice and research, it is recommended to start problem-solving with philosophical thinking and then logical evaluations in order to reveal a better diagnosis, treatment and healing qualities for patient care.

Keywords: Education, Health, Illness, Medicine, Physician, Science, Wisdom. 6.1. GENERAL Health has been the most important feature for human beings since time immemorial, and all worldly activities depend on a healthy body with care for shelter, dressing, feeding, physical training and disease avoidance. A productive mind exists in a healthy body. Accumulation of the preliminary knowledge and information beginning from ancient civilizations before Christ has led to classification according to diseases, and hence, philosophy and logical imprints helped the organizers, administrators, health experts and physicians in modern times. The philosophy of medicine is a branch of the general philosophy that searches for health care through various practical applications, laboratory as well as clinical experiments and theoretical generalizations. Among the philosophy of medicine, sub-branches are related to epistemological concepts, ethics and even metaphysical implications, including moral principles. The philosophy of medicine is a mixture of medical training and education with philosophical Zekâi Şen All rights reserved-© 2022 Bentham Science Publishers

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fundamentals to reach improvements and innovative findings for social health care. The philosophy and medicine remained jointly until the 18th century and then became quite separate. The meaningful separation and content coverage of each medical word need philosophical and logical explanations for the distinction of each one from the others, such as disease, diagnosis, patient, physicist, disorder, etc. (Chapter 4). In general, metaphysics is a branch of philosophy that deals with the analysis of topics, events and phenomena not only from scientific but also from spiritual, religious, imaginary and speculative perspectives. It is a transmissive transaction between reality and anti-reality, where most often, the transition is from antireality to reality (bivalent logic principles). Metaphysics is under the umbrella of ontology that tries to explain the existence of subjects in natural and physical events in their uncertain evolvement channels. One of the most important issues in the philosophy of medicine is the contraactive interactions between disease and health for a mutually effective production mechanism. The search for their causes and reasons is among the subjects of philosophy of medicine. Disease and health are quite uncertain holistic concepts, but the question “what are the components of these words” leads one to philosophical thinking, where there are numerous ideas among physicists and specialists. Uncertain concepts are one of the main causes of philosophical wonders (Chapter 8). In other words, trying to put into pieces a concept with its causes is achievable through information from classical books. However, criticizing the basic definitions based on philosophical and logical rules helps to reach detailed levels of informative and productive understanding. In the past, deductive (holistic) philosophical inferences were the main impetus for thinking, but modern times rely on more inductive (piece-wise) searches for topics and case studies (Chapter 2). For inductive approaches, there are methodologies to obtain the finest points of integrity and develop relationships between various pieces for in-depth understanding and solution possibilities. The hierarchical order of each piece provides information between the functions of the next piece, and therefore, integrity is achievable from the systematic organization of the pieces. For example, in medical research, one can start with the study of an organ that provides deductive information holistically. However, more refined information can be obtainable by continuing to the next sections for the tissues, cells, macromolecules, and then micromolecules at atomic and sub-atomic scales. Such a detailed, informative structure reveals its importance not only for physicians, but also for those working as laborants in clinics. This informative array of knowledge provides an opportunity to medicate each piece.

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6.2. PHILOSOPHY AND WISDOM IN MEDICINE Dekkers and Gordijn (2007) have asked questions about medical wisdom and health from a practical point of view as “How should they make the right or a wise decision in morally complex and uncertain situations?” and “What is the patient’s role in this decision-making process?” Aristotle (BC 384-322) defines practical wisdom (prognosis) as follows: “knowing the right thing to do in a particular circumstance through understanding the circumstance rightly, knowing what matters, and effective means-end reasoning to bring about what matters.” The word “prudence” means self-evaluation and self-interest; every object that provides a better way of life and independence is the moral value of prudence. On the other hand, Al-Farabi (870-950) added something completely new to philosophy about wisdom, and he explained that this is the problem of the real existence and essence of existence (Mahdi, 1990). According to him. “wisdom is knowledge and understanding of the truth” For any given problem, there are quite different understandings among individuals, but with marginal uncertainties, they can have great inclusiveness. Patient and physician morality is one of the most effective tools for mutual rational communications. For example, patients who are aware of their illness and are calm take the given advice wisely, otherwise, a direct recommendation helps. Egonsson (2016) rationally discussed the main alternatives taking into account the consent. On the other hand, Edmondson and Pearce (2007) wrote that reasoning and judgment in healthcare require complex responses to problems, whose demands typically arise from several areas of expertise simultaneously. They further argue that current evidence or value-based models of healthcare reasoning, despite their merits, are insufficient to comprehensively explain responses to such problems. The physician must be attentive to wisdom-based reasoning to incorporate knowledge, thought and life experience with social, emotional and ethical capacities. However, uncertainty and fuzziness are everywhere, which rational knowledge and expertise help keep to a minimum. Edmondson and Pearce (2007) exemplified the application of wisdom using cases in psychiatry, where the nontechnical aspects of problems often come to the fore and require more systematic analysis than traditional approaches offer, but they also argued that this thesis is valid in the health care field.

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Today, each hospital has a chief physician with many years of experience and expertise in managing critical patient cases. Such high-level specialists are aware of the theoretical and practical aspects of specialization, based on the philosophical, logical experimental, empirical and theoretical foundations of medicine. The origin of the medical field understanding is possible by looking at the meaning of the words philosophy and wisdom (Chapter 5). These words, which also include the word medicine, have different derivations. Among them are the judiciary, the court and the like. The word wisdom is also used very often in daily language, but when asked about its meaning, even many intellectuals cannot give a satisfactory answer. In fact, the word wisdom also has the Greek meaning of two words philosophy (philo and Sophia) (Chapter 5). However, the word wisdom expresses not only the material but also the spiritual dimensions. In both cases, it is possible to reveal neither philosophy nor wisdom and knowledge without the foundations and elements of thought as explained in Chapter 2. There are well-known philosophical quotes from eastern and western philosophers. For example, Imam Ghazali says (1058-1111) said. “I percept, then I exist” It is equivalent to the following phrase “I think, and then I exist” As the Western thinker Rene Descartes (1596-1650) quotes about 400 years after him. Philosophical thinkers understand that they are swimming in an environment of wisdom. In this case, every individual has a philosophy, and philosophy is the basis of even today's science subjects. In many countries, intellectuals are expected to produce ideas such as philosophy or wisdom in education systems. In such an education system, rote learners and uncritical mechanical transfers of knowledge also have naïve listeners (Chapter 5). In the encyclopedic or internet information world, soulless (in the sense of knowledge) or mechanical answer keys can act upon finding ready-made solutions. Since each person’s complaints from the same type of disease are slightly different from each other, they search for treatment in the light of expert advice instead of misleading and dull information. In this way, their knowledge evolves dynamically over time. In order to eliminate this dullness, it is necessary to make rational inferences, at least by adhering to the world of philosophy (wisdom). Just as a plant needs sunlight, water and minerals in the soil in order to survive and produce various fruits, the trio of skeptical thinking, philosophy and logic bears the fruits of knowledge in the fields of medical science and technology. One of the questions is whether there is a curriculum of philosophy, logic and skepticism in the medical education system. Unfortunately, there is no clear

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answer, but today, in some societies, young people are prone to education in an environment far from their mother tongue. Can a person have philosophy, logic, and skeptical thoughts in a foreign language? Or is it possible to get clear information in a foreign language with the exact origin and meaning of the words? Is it possible to produce useful scientific knowledge in a society dominated by rote, transmitting and mechanical education systems? Is high-level science and technology enlightenment education possible completely in a foreign language? Is it necessary to revive thought and philosophy in a society with mother tongue perceptions? After all that has been said, if we go back to the origin of a word, “wisdom” perception, understanding and reasoning play a role in making better decisions and judgment by logical rules from the knowledge community. In case of an event related to physical law, the decision is reachable according to the rules of that law, and when related to medicine, the decision is according to the basic rules of medicine. Apart from the medical jurisprudence, both parties have responsibilities as medical professionals and patients to observe their obedience and rights to abide by laws. This decision is valid based on the current level of knowledge, but with possible prospects for improvement. 6.3. MEDICINE AND SCIENCE All the rules of science are based on logical principles after philosophy, as these principles help irrational thoughts and support science, technology and methodologies in various professions, such as medicine (Chapter 10). In medical practice and research, it is recommended first to solve the problem with philosophy and then with logical evaluations in order to reveal a better diagnosis, treatment and healing qualities in terms of health and patient care. For example, despite recent advances in science and technology, there are still some inaccuracies in diagnosis and treatment methods (medicine improvement) in healthcare. Some of these are due to the lack of physical structure, and some of them are due to a lack of medicine or misdiagnosis, treatment and practices. To minimize such errors, it is necessary to increase the functionality of philosophy, which is the main engine of principles of thought and logic, as tools of the reason that lead to rational inferences for better medical service developments. For this purpose, it is a necessity to reach innovative diagnosis methods and findings by sprouting the basic knowledge of philosophy in medical education. Philosophy with logic is necessary to reduce misdiagnosis practices and unfortunate doctorinduced explanations. Unfortunately, philosophy and logic-based medical education training is rarely available in institutions in many countries. The elimination of these errors and how they can be improved requires deep

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philosophical thought combined with the logical principles that constitute the theoretical infrastructure of the sciences that have been doubtful throughout history. However, thanks to these, it is possible to reach productive, useful and meaningful information with new horizons by getting on ships in the endless ocean of information. Coastlines may become hazy when there is not enough information. In these cases, if the principles of philosophy and logic are always adhered to, the environment will be illuminated with new horizons. Dealing with the history of science from ancient Greece reveals the importance of philosophy by bringing together the thought products of previous civilizations (Chapter 2). Philosophy originated as a core subject in ancient Greece, but “rational” inferences from the world of imagination and speculative considerations prevailed with useful knowledge generation without experimentation and testing. While the production of knowledge was very dependent on philosophical thoughts at that time, today, even with laboratory, experiment and computer facilities, philosophy and logic inferences are needed as usual in order to produce new science and technological knowledge. It is understood that philosophy, logic and moral rules were given importance in the works of people, who emerged in the field of medicine, such as Galen (129200) in Hellenistic civilization. Later, among many prominent thinkers in Islamic civilization, medicines were Zakaria Al-Rhazes (854-925) and Avicenna (9701037). They used the rules of ancient Greece medicine, which were quite speculative, but developed logically on a rational basis by philosophy and logic. Although, these Muslim thinkers could not give up philosophy and logic, they gave a new direction to medical science by adding clinical, hospital, pharmacy and experimental system possibilities (Chapter 3). Let us repeatedly underline that philosophy and logic are necessary for scientific studies, especially in medicine. A non-philosophical and illogical education system only serves to make money. 6.4. MEDICAL EDUCATION Although there is a lot of knowledge in basic biology, chemistry, anatomy, psychology, pathology and many clinical disciplines, diseases, healing (therapy) and disease-based methods, diagnosis and treatment principles are common. In education, which is almost devoid of philosophy, it is not possible to train physicians with an investigative spirit by paving the way for acceptance, mechanical knowledge and insufficient studies instead of critical reasoning. There are not many scientific research methods for clinical balance. Another productive aspect of philosophical thinking in medicine is to increase the ability to think verbally by incorporating logic, the semantic loads of words and sentences, mathematical methods (Chapters 4 and 10), ethical values and even metaphysical

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considerations (Chapter 5). The most important goals in this book are to develop the linguistic, visual and rational intelligence abilities of the medical students with the principles of philosophy and to try and ensure the emergence of questionable, investigative, innovative and productive medical individuals in society. Zhang et al. (2013) explained that since medical education goes through an important process of internationalization, it is important for the medical community to understand how different countries provide medical education. Especially, in recent years, changes in medical education require continuous improvements with future strategies in the light of recent developments. Although international guidance is important, without the history, language and culture of medicine, it does not have full meaning and understanding, especially among physicians, patients, and the public in general. Since it constitutes a very important part of social institutions such as medicine, education, law, state and culture, it deserves to be interpreted and formed primarily with verbal (philosophy + logic) rules. Philosophical knowledge, methods, tools, practices and views need to be re-evaluated to transform from static (stagnant) situations into dynamic levels. For this reason, it is imperative to strengthen the concept, method, word and sentence meanings (epistemologies), moral-ethics, and logic foundations and to support philosophical thinking methods in order to improve the situations encountered in doctor-patient relations. The most important feature of a physician is that the diagnosis-healing twin is successful with medicine allocation based on philosophical and logical principles. With the development of science and technology, the reason why much clinical information was quite inaccurate becomes understandable due to the absence of philosophy. According to Zadeh (1997) and Sadegh-Zadeh (1981), misdiagnoses were up to 30-38%. The fact that medical sciences are generally normative (verbal) reveals the importance of philosophy in the fields of medicine. Adapting and using the principles of philosophy makes medical language, concepts, knowledge, information and decisions more reliable. In addition to knowledge, and beliefs, assumptions also play an important role in medical research and practice. The next chapters of this book provide information on what these concepts mean in terms of philosophy and logic. For all these concepts, it is necessary to develop first the medical language. It is useful to remind a subject that is very useful to be mentioned here. For example, is the most important subject in education systems mathematics or morphology (geometry)? Many people can answer mathematically because it dominates many education systems, but we can come to the consensus that geometry (a form of things) is more important for linguistic and visual

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interpretations (Chapter 5). Learning mathematics means no better thought can arise than what classically existed without logical foundations. Inspirations are obtainable by interpreting the shapes in the forms of the figure, graph, map, and picture (Chapters 4, 9 and 10). If one asks what triggers their thoughts most, shaping knowledge plays a large part, especially in medicine. Likewise, it can trigger mathematical thoughts and other basic sciences to reach better and more rational results through logic. A person first perceives information or learns from the teacher through audiovisual presentations, which may contain some errors, but should keep them in mind after filtering through logic leading at least to approximate reasoning and decision with maximum avoidance of mistakes. 6.5. PHILOSOPHER PHYSICIANS Local cultural beliefs, religion, personal skills, knowledge and ideas have played an important role in the philosophy of medicine among physicians for over a thousand years in many civilizations (Chapter 3). Originally, people used herbs used for treatment, supplemented by prayers for healing in addition to the words of respected wise men (Chapter 3). Philosophy enables the physician to distinguish between reality and illusion or reality and superficial appearances, which are very important in diagnosis (Pellegrino and Bulger (2001). The physician can decide on treatment after the collective judgment of all evidences based on philosophical thought, logical rules and information gathered from the patient, observations and clinical test results. The role of philosophy is to generate ideas for problem solving and logic helps define rational prescription from the philosophy of medicine Hamper (2003) stated that philosophy has a reputation for being complex, esoteric and divorced from reality. However, just as basic sciences, biochemistry, physiology and anatomy are at the core of our understanding of medicine, philosophy can answer fundamental questions about our daily issues of life, death, knowledge, reason and religion, just to name a few. Except for clerics, doctors are in a unique position to grapple with such problems. All it takes to reap the fruits of so much intellectual effort is to be aware of some basic philosophical arguments. Almost all the first medical thinkers (physicians) were experts in philosophy and logic. Among these, it is possible to mention the ancient Greek period Hippocrates (BC 470-369) and Galen (129-200 of the Hellenistic period. In the Muslim world, world-famous thinkers are Zakaria Al-Rhazes (854-925) and Avicenna (970-1037), who took their philosophical ideas to the next level from

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the ancient Greek civilization by making use of experiments, actual observations, experiments and body testing. Actually, the philosophies of medical science, namely, verbal knowledge sources with their close relationship with the rules of logic, help transform verbal knowledge into useful propositions as rational conclusions. For example, Al-Farabi (872-950), one of the Muslim thinkers and philosophers, said that apart from these verbal ambiguities in medicine, physics, mathematics and even science, it is based on a moderate and obvious stereotyped bivalent logic. Beginning with Aristotle (BC 384-322), it is incapable of representing real-life problems. Al-Farabi (872-950) implied that the results of science that day and even today are falsifiable. Unfortunately, the thoughts of AlFarabi (872-950) were overlooked even in his own country. Karl Popper's (19212017) supported this with the following saying. “Science is falsifiability” This fits the ideas of Al-Farabi’s intellectuals a clicé. After the explanations above, it can be said that the philosophers who grew up in the medical world and the thinkers who gave importance to logic later had a close relationship with medicine. Physicians had the support of philosophy in their systems of thought, as they were associated with the idea of wisdom to arrive at useful knowledge levels (Chapter 5). For example, Zakaria Al-Rhazes (865-925) was both a physician and a philosopher. Similarly, Avicenna (980-1037) was a physician, philosopher, and logician. El-Kindi (801-873 went down in history as the first founder of psychophysiology. Especially, Andalusian Averroes (11261198) wrote a philosophy-based book on internal medicine and practiced it (Chapter 3). During the first philosophical currents of ancient Greek and Islamic civilizations, there was much need for philosophy and logic in medicine; as ideas developed based on observations and experiments by asking “why?” and how?” questions, medicine began to inevitably enter the field of philosophy for verbal answers. Philosophy and logic principles are very effective in medicine to reveal the philosophy of science and objective knowledge instead of practicing a profession with dull knowledge. While a philosopher thinks about the universe and its physical functions by questioning on large scales, the physician evaluates the events occurring in the human body on a small scale. In these respects, it cannot be denied that there is a close relationship between philosophers and physicians. In the past, when the relationship between medicine and logic was the most intense, philosophers and physicians explained medical events with philosophical

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theories and tended to obtain medical knowledge from theory with generalizations. The most reliable measure of the cause and effect of human thought is logic. Although, the origin of mathematics is logic today, mathematics courses are without principles of logic in schools and universities. In the history of medicine, well-known philosophers are Hippocrates (BC 470360), Galen (129-200), Ibn-u Rushd (Averroes) (1126-1198), Al-Farabi (872950), and Al-Rhazes (865-925) Avicenna (970-1037) (Chapter 3). Throughout history, many civilizations have added knowledge improvements considering the remnants of knowledge from the previous civilization. However, philosophical and logical ideas provided useful transmissions to later civilizations even after some wars. Contrary to the claims in Western society, many Islamic philosophers’ sources of information, especially Zakaria Al-Rhazes (864-925), gave clinical lectures for the first time stating that: “the information obtained and produced by the sense organs”. in the light of logic, and he claimed that there is uncovered information. 6.6. HEALTH AND ILLNESS DEFINITIONS A topic discussed in the philosophy of medicine for many years is what are health and disease. Generally, people think that these concepts are understandable. Patients seek treatment from healthcare professionals. First interventions in clinics are about getting the patient’s health under protection from diseases as much as possible. For example, childbirth and the occurrence of high blood pressure are not diseases. Therefore, it is not possible to draw a clear line between health and disease, and they do not have precise definitions because they occur in different forms and conditions among a large number of populations. In society, there are different opinions on what health is. Individuals know the meaningful distinction between health and disease and thus can decide when and where to seek medical treatment. Since, there is no certainty in terms of philosophy and logic in the definitions of health, disease and related concepts, some ethical problems may complicate the solution. Especially, if there is a situation between life and death, ethics and moral rules play a role as well as philosophy and logic. In the recent past, disease treatments were based on the knowledge and experience of the physician, nursery, simple clinical tests and first aid box. Today, there are almost all modern amenities available, such as images (X-ray, MR), diet, healthy foods, vitamin pills, running shoes, therapy, therapy, sensible drinking, health

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checks, and more. Health and disease receive a great deal of attention from the media, which dedicate significant time and space to health issues. Everyone has at least some experience and knowledge (Nettleton 2021). Niebroj (2006) stated that medicine has become more technologically powerful, implying that philosophical and logical rules are not as effective as they were in the past. Unfortunately, technology tools are misused from time to time. To avoid such situations, doctors, patients and society need the reinforcement of reliable basic information. It seems that the only way to avoid it is to stick to philosophical thought and reflection guided by logical rules and expertise gained through experiences and case studies. The degree of uncertainty in definitions and identifications of health and disease (illness, sickness) can pose critical problems for highly valid treatment prescriptions. Each definition has its pros and cons. The World Health Organization's definition of health should be critically evaluated, considering the definition appropriate to the current disease case. Disease and ailment are used interchangeably even by the public and medical professionals. The disease points out that there are not many conveniences in human health and the lack of a normally functioning system. Among these is the inability of body organs to perform their functions. In addition, there are situations that are contagious from outside the body or come from the environment and weaken by disrupting the normality in health. Discomfort includes situations that cannot be known objectively. It is possible that these conditions can be regulated and corrected with medication. Philosophy helps to discover ways to reach the principles of recognizing, knowing and doing, and as in all sciences, tries to get an overview of cause-effect relationships. Throughout the history of philosophy, the most affected area is science, it aims to recognize and introduce the human body and the universe. Philosophy and logic are always needed for science to reach accurate information. According to René Descartes (1596-1650) “Philosophy is like a tree; its roots are metaphysics, its trunk is physics. The branches that come out of the trunk are all sciences. These can be grouped into three branches: medicine, technique, and morality.” On the other hand, the educator Friedrich Paulsen's (1846-1908) said that “The main root of every science is philosophy; the one who leaves this root cannot live.” Beginning with ancient Greek, science remained guided by philosophy until the 18th century. Today, the philosophy of every profession has emerged under the name of philosophy of science. These include philosophy of medical, philosophy

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of engineering, philosophy of economy, etc. In general, those who are interested in the philosophy of medicine consider morality, ethics, and virtue before materiality to reach the secrets of the universe by pursuing maturity (perfection). In the history of science, many philosopher-physicians have shaped medicine with their ideas and studies (see Chapter 3). Hippocrates (BC 470-360) emphasized the role of philosophy in medicine with the following quotes. “philosophy should be put into medicine and medicine into philosophy”, “if a doctor is also a philosopher, he will rise to the level of gods”. Galen (129-200) quotes the following in his work “A Virtuous Physician Must Be Philosopher”, that. “Since most of the physicians place wealth above virtue, the art of medicine is not for the benefit of the human being, but for gaining goods. In this case, no one can be a skilled physician, because it is not possible for a person to be rich and to gain a high rank and honor in medicine”. Hippocrates (BC 470-360) abhors wealth, seeks peace of mind and body, and advices abstinence from gluttony, erotic tendencies, deprivation, and contentment. To study medicine, it is necessary to gain experience and skills first in philosophy and logic and then in medicine. Doctors who can apply this principle in their lives are highly respected in their profession, and their knowledge continues to increase day by day. German physician Samuel Hahnemann (1755-1843) suggested that: “Philosophy is the main element of all sciences. Without philosophy, science cannot survive; it remains as an auxiliary knowledge in the nature of handicrafts. Especially, medicine can never be done without philosophy.” On the other hand, the philosopher-physician Rudolf Virchow (1821-1902) said: “We did not find our methods without philosophy. We did not try to discover a new logic for every event. We have accepted the old, well-established, wellthought-out logic.” Pointing out how important philosophy and logic are in the field of medicine, he said: “you think you are a small entity, whereas the whole universe is in you” Philosophy needs consideration when asking questions about patients and diseases in search of answers. The physician should try to make verbal thought (philosophy) with rational (logical) inferences by using the knowledge he has

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acquired about a disease he encountered for the first time. After detailed inquiries, specific information about the disease is obtainable from the patient. A good physician should try to provide treatment and healing solutions by trying to get information not only about the body, but also about the thoughts, mind, relationships, environment, and past and current situations of those concerned. The physician tries to share these issues through inquiries with the patient by means of inquiries, almost all of which are in the form of linguistic legislation. In a sense, philosophy includes relationships between people, their environment, neighbors and relatives. All these relationships also relate to medical conditions in a community that can affect the local or general spread and transmission of a microbe that causes disease infections. For example, “stress”, which is frequently mentioned today, can occur under the influence of social, environmental, economic, political and physical conditions. The physician can benefit from the interviews he has with different patients every day by capturing generally valid information through philosophy. If medicine strays from philosophical thought, it falls prey to false and speculative views. For medical faculties, the subjects of history of medical (Chapter 3), philosophy (Chapter 5), mathematics (Chapter 10), science and natural philosophy are recommended. Disease treatments made with the methods of dull science in medicine are far from meaningful philosophy and logic conversation. Not only scientific methods, but also philosophy, ethical and moral rules are applicable functionally to medicine. Recently, medical ethics has begun to emerge as an industry in the world. 6.7. SCIENCE, PHILOSOPHY AND MEDICINE In the history of humanity, philosophy, logic, art, morality, law, religion, language and science coexisted in ancient times, but science became independent of them much later. The scientific experimental method requires discipline and sustained effort in many ways, contributing to the long-term observation and experience. Because pre-scientific facts are unmeasured, unchecked and not criticized, science was intermingled with philosophy. Scientific thinking systematizes the results of observations and experiments within the framework of certain rules. Human beings have been able to evaluate their prehistoric knowledge and experience only by passing them through non-objective tests with rational thinking methods (Chapter 2). Philosophy, which dominates the entire world of thought, includes the principles of recognizing, knowing and applying what the human mind can grasp. Boyd (2000) gave information about concepts such as disease and health that are difficult to define precisely. One reason is that they contain value judgments and have metaphoric roots. The precise meaning of terms such as health, healing and

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wholeness will remain elusive since the startling clarity of perspective derived from experience alone resists the reduction of first-person judgments (including religious ones) to third-person descriptions (including science). Philosophy tries to derive a general world view from the results of different thought products. Throughout history, science was at the heart of philosophy, but by the 18th century, it began to gain an independent state. Philosophy focuses on universal recognitions that lead to human and scientific results. The relationship between science and philosophy before Christ began in ancient Greece and continued until the middle of the 18th century. Although many subjects outside of medicine seem to continue their way independently of philosophy, they cannot develop without philosophical considerations filtered through logical principles. The philosophy of medicine should have its own system of thought, like the philosophy of science. For example, in the field of medicine, there is a deep-rooted relationship between the dominant philosophy and the physician (doctor). The success of a physician primarily depends on verbal knowledge (philosophy). Philosophers did this by thinking (contemplation), and physicians by looking at the magnificent order of the human body (Bayat, 2016). Although science in the ancient Greek civilization remained entirely within philosophy, medicine began to separate from the philosophy of science, albeit partially, thanks to the first experiments and observations made in the Islamic civilization. For example, Hippocrates (BC 470-360) expressed how important philosophy was in medicine at that time by saying. “he should bring philosophy to medicine and medicine into philosophy” and “if a physician is also a philosopher, he will rise to the level of gods”. Among physicians, those who make treatment recommendations based only on book knowledge, unconsciously exclude philosophy. In addition, those who treat patients by interpreting verbal information quite independently of the book knowledge engage philosophical thought. One of the philosophers of the Hellenistic period, a well-known physician in the field of medicine, wrote an article under the title of: “The virtuous physician must be a philosopher.” and said that. “Since most of the physicians keep wealth above virtue, the art of medicine is for the benefit of the human being, not for the benefit of the person.”

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Innovative information should not be expected from physicians, who pursue money, prestige, respect and wealth with traditional knowledge. It is not possible for them to reach the level of knowledge and prestige with their own abilities. As with many professions today, there is no need to pay homage to philosophy to achieve the highest levels of academic promotion. The major philosophical title is the Ph. D., so a person who has completed his doctorate should know the philosophical explanation of the subject he has studied (Chapter 5). Can those who come to the doctorate level with mechanical, imitative, rote and boring use the principles of philosophy rationally understand and explain? In general, it is not possible to become rich by adhering to the philosophy of medicine because philosophy does not make a person much money. Neither Hippocrates (BC 470-360) nor the physicians of later civilizations were rich, but they were able to access the wealth of knowledge with their philosophical thoughts supported by logical principles, skills, and science. In any case, those who pursued knowledge despised material wealth with their philosophy and did not run after it. Physicians who devote themselves to philosophical thoughts seek peace of mind, body, and bodily balance (Bayat, 2016). Today, although there are not enough philosophy courses in medical faculties, it is necessary to have knowledge in the fields of philosophy and logic in order to produce innovative ideas in medicine. Thus, new knowledge can be generated by gaining dynamism, and previous knowledge sets can be enhanced to some extent for better improvements. The German physician Hahnemann (1755-1843) expressed how important philosophy was and said: “Philosophy is the main element of all sciences. Science without philosophy cannot survive; it remains as an auxiliary knowledge in the nature of handicrafts. Especially, medicine can never be done without philosophy.” On the other hand, the philosopher-physician Rudolf Virchow (1821-1902) quoted the following: “We did not find our methods without philosophy. We did not try to discover a new logic for every event. We have adopted the old, well-established, wellthought-out logic.” Philosophical knowledge and research need to explain the functioning of all materialistic and spiritual beings in the universe to some extent.

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6.8. SCIENCE PHILOSOPHY AND EDUCATION In almost all the universities in the world, a close review of curricula shows that, especially in medicine, engineering and science departments, philosophy of science and basic logic seem to lack and instead, mathematical content is overwhelmingly superior to other subjects. Mathematics depends on logical principles, but there are not enough philosophy and logic of science courses to pave the path to enlightenment before mathematical education. At this point, the question is whether education provides enlightenment without the philosophy and logic of science. Without these two essential components, educated people base their knowledge on mechanistic, memorized and highly dogmatic levels. If education goes through the philosophy of science supported by logic, it is the process of producing knowledge. Since philosophy is based on language, as stated in Chapter 3, education must provide lively and rational information with words, sentences, arguments and propositions that can then be mathematically translated to symbolic logic (Chapter 4). Philosophical and logically supportive education provides motivation, encouragement, and ambitious desires for knowledge acquisition, not only for students but also for educators. Another question is, is it possible to develop a theory without philosophy and rational thought? And does the same apply to the invention of a device, tool or methodology? The answer to this question is not entirely positive. John Dewey (1859-1952) put the importance of philosophical and logical thinking in the following words, sentences, propositions and arguments. “Education is a laboratory in which philosophic distinctions become concrete and are tested.” Philosophy is wisdom; education transmits this wisdom from one generation to the other. Philosophy represents a system of thought; education adopts this idea in the context of teaching. Philosophy embodies a way of life; education is preparation for life. Philosophy is knowledge acquired through natural reason; education is the development of this reason and other powers of the mind. All problems of education are the problems of philosophy. “Education without philosophy would mean a failure to understand the precise nature of education.” No education system can provide dynamism without philosophy, and especially, philosophy of science combined with logical rules leads to rational and reasonable thinking, and the sustainability of thought. Is there anyone who can understand life without philosophy and who can propose innovative findings without the

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philosophy of science? The education system takes its practical direction with the scientific principles of philosophy and logical rules. CONCLUSION The most emphasized point in this chapter is the lack of philosophical and logical principles in today’s medical university education system; therefore, the basic medical terminologies depend on a crisp, memorable, mechanical and automatic way without understanding the core of the concepts and terminologies. The importance of philosophical aspects is exemplified by some daily work cases. The role and sharpening of wisdom are possible with the philosophical considerations in medicine. It is mentioned that there are also terms whose definitions are not fully known, such as disease and health. REFERENCES Bayat, A.H. (2016). Tıp Tarihi (Medicine History). Zeytinburnu Belediyesi Basımı.306. Boyd, K.M. (2000). Disease, illness, sickness, health, healing and wholeness: exploring some elusive concepts. J. Med. Humanit., 26, 9-17. [http://dx.doi.org/10.1136/mh.26.1.9] [PMID: 12484312] Dekkers, W., Gordijn, B. (2007). Practical wisdom in medicine and health care. [http://dx.doi.org/10.1007/s11019-006-9033-3] [http://dx.doi.org/10.1007/s11019-007-9072-4] Edmondson, R., Pearce, J. (2007). The practice of health care: Wisdom as a model. Med. Health Care Philos., 10(3), 233-244. [http://dx.doi.org/10.1007/s11019-006-9033-3] [PMID: 17120113] Egonsson, D. Preference and Information. Routledge, Taylor and Francis.176.ISBN 9781138278226. (2016). Harper, C.M. (2003). Philosophy for Physicians. J. R. Soc. Med., 96(1), 40-45. [http://dx.doi.org/10.1177/014107680309600113] [PMID: 12519806] Mahdi, M. (1990). Philosophical Literature. In: Lee Young, M.J., (Ed.), Religion, Learning and Science in the 'Abbasid Period., Cambridge: Cambridge University.78-79. [http://dx.doi.org/10.1017/CHO9781139424912.008] Nettleton, S. (2021). The Sociology of Health and Illness. UK: Polity Press. Niebroj, L. (2006). Defining health/illness: Societal and/or clinical medicine? Journal of physiology and pharmacology: an official journal of the Polish Physiological Society 57(4), 251-62. Pellegrino, E., Bulger, R.J. (2001). Physician and Philosopher: The Philosophical Foundation of Medicine. Carden Jennings Publishing. Sadegh-Zadeh, K. (1981). Handbook of analytic philosophy of medicine. Springer. Zadeh, L.A. (1997). Toward a theory of fuzzy information granulation and its centrality in human reasoning and fuzzy logic. Fuzzy Sets Syst., 90(2), 111-127. [http://dx.doi.org/10.1016/S0165-0114(97)00077-8] Zhang, Q., Lee, L., Gruppen, L.D., Ba, D. (2013). Medical education: Changes and perspectives. Med. Teach., 35(8), 621-627. [http://dx.doi.org/10.3109/0142159X.2013.789495] [PMID: 23631405]

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CHAPTER 7

Logic Principles and Rules “In the Philosophy Field Logic Produces Rational Ideas that Lead to Beneficial Consequences” Abstract: The main information in this chapter is about logic, which helps to reach more rational and productive thoughts and ideas about an event involving medical sciences. In general, after the philosophical thinking principles, the logical rules lead to inferences that are more rational, and therefore, knowledge becomes more applicable. Logical words and propositions are explained on bivalent (crisp) and fuzzy logical rule-based expressions. Logic plays a very crucial role in the medical sciences, based on sound reasoning. Mathematics based on binary logical principles is useful in science, but fuzzy logic principles and rules play a central role with extreme predominance in medical science because communication between doctor and patient takes place linguistically before laboratory analysis for some numerical data.

Keywords: Conjunctive, Inference, Logic, Mathematics, Models, Proposition, Reasoning, Rules. 7.1. GENERAL Logic is a Greek word coming from “logos” and can mean a number of meanings, including proposition, reason, rule, rationality, comparison and inference. It is also a correct way of reasoning to determine the most rational product from a set of alternatives. All disciplines need logical interpretations, inferences and consequences. In this way, thinking is achievable with logical principles that do not require mathematical principles for inference. Aristotle (BC 384-322) established its main place in philosophy with bivalent logic based on the exclusion of the middle cases, which guide to distinguish between true and false only. Since there are two categories, the inferences from this logical system cannot suit natural and medical events exactly. The exclusion of the middle positions leads to the acceptance of certainty right from the beginning. In binary logic, truth (false) is represented by 1 (0) as the number with belonging degree characteristic values.

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Logic serves to reach more rational and productive thoughts and ideas. It is not the art of eloquence, but the art of intelligent deduction about validity, scientific objectivity, generalization, selectivity and testability. Logic is like a tool that is necessary not only in science, but also in human access to all kinds of rational interests. Scientific inferences are logical, rational and testable with facts. One tries to falsify valid scientific inferences by tests to arrive at results closer to reality. Scientific testability is possible with strict logic rule applications. Science cannot gain functionality and innovation without logical rules and principles. In the previous chapters, rational deductions were explained as possible after philosophical thoughts with the application of logic principles. The first formal bivalent (two-value) logic played a very active role in the history of science (Aristotle, BC 384-322). In the history of science and medicine, the first multiplelogic alternative was suggested by Al-Farabi (872-950) based on the probability concepts. One interpretation of logic's probability means that there are intermediate values of the events between two opposite situations, namely, true and false. He was inspired by the Prophet Mohammad’s saying. “the best of deeds is the ones between the two extremes.” This statement implies the inclusion of the middle cases. On the other hand, Nasiruddin Hodja (1208-1284) quoted the following proposition. “the one who complains and who is complained is right.” Inferences made by bivalent rules of logic are very useful, but insufficient, especially in medical, because a mutual agreement between doctor and patient is rarely absolute certainty. Until the 20th century, almost all studies were overwhelmingly achieved according to bivariate logic only. According to bivalent logic, in any dilemma, the mind has to choose one thing and reject the opposite (duality). Therefore, logical crispness plays an effective role in such a choice, even if it is approximate. The mind cannot transcend it; therefore, it is best to reconcile the opposite. In classical bivalent logic, vagueness, ambiguity, and incompleteness, i.e., uncertainty is not a possibility due to two alternatives as absolutely true or false. Such a mindset can trap the human mind in routines, stereotypes, prejudices, and habits and render the thinking ability incapable of authentic experience gains. Recently fuzzy logic methodologically includes all alternatives between twovalue logic extremes in a systematic manner (Zadeh, 1973). This means that in many disciplines, including medicine, there is no deterministic truth or false. In

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Chapter 8, fuzzy logic developed by Lotfi Asker Zadeh (1921-2017) is explained in detail for better rational agreements and common decisions. 7.2. LOGIC DEFINITION Since the word “logic” comes from the Greek language, it means rational reasoning, intellect, dialect, argument, and critical thinking towards valid comparative relations. More broadly, logic is the analysis and evaluation of arguments (Gensler, 2017). Sound reasoning is the basis of logic and plays a crucial role in many fields of sciences. A wide variety of different principles are needed for sound reasoning in different fields, and “a logic” means a set of principles for some kind of sound reasoning and rational conclusions. There is no widely acceptable formal definition of logic (Mossakowski, et al., 2005). Formal or informal language is within the principles of logic as semantics to arrive at meaningful inferences that help capture, encode or simply record arguments that apply to the given language. The foundations of bivalent logic can be learned from the books Bradley and Swartz (1979) and Wogu (2010), which provide detailed logical prepositions and systems of inference. In today’s present perceptions, logic appears even in the form of ratios in sentences, discourses, rules, reasons, justifications and propositions, if they tend to make the right decisions. Rational philosophy is required before logical reasoning, followed by mathematics, probability, statistics, and engineering and computer software as supportive subjects. Rather than plain logic, critical logic plays a role in improving the current level of knowledge leading to innovative findings. The final products of logical reasoning are in grammatical form without numerical measurements. Bivalent principles of logic are systematized by ancient Greek thinker Aristotle (BC 384-322), and later on, the same logic is redefined by Muslim thinker Averroes (1126-1198) as: “the tool for distinguishing between the true and the false” Logic is the basis of all scientific disciplines that deal with the principles and criteria of inference validity. In short, it is the science of reasoning and is considered as the science of formal reasoning principles that investigates valid or erroneous relations. Logic is a method for developing the reasoning ability to understand facts in a formal (systematic) and rational way to reveal the basic valid relationships

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between the meaningful cause and effect variables. Thus, it can be said that logic guides correct thinking, and the information that goes through the philosophical process after logical thinking provides consistent inferences. Since, it is an ideal, easily understandable and directly applicable proof tool, it serves to determine the provisions that do not cause irrationality. The results are consistent with facts, and inferences are consistent with reality, objectivity and consciousness. Processes of acceptance, idealization and simplification are basic assumptions for understanding the operability of an event in the light of approximation inferences valid in science and medicine. Only the rules of logic allow one to come in touch with valid knowledge, rational understanding and communication. Logic provides to reach harmonious objective facts because of the action of the mind by enacting subjective cases. Logic leads to friendly synchronization of discrete mental processes with common valid intentional propositions. It determines the activation of real phenomena in the environment during human life. Failure to follow the rules of logic leads to skewness and bias in scientific results. Unreasonable situations are divided into two different classes, formal and informal. The official ones determine the exact logic after deductible rationalizations. In daily life, there are many examples where vague questions and criticisms such as “you do not speak logically”, “What you say are illogical”, and so on. In each one of these phrases, the word logic carries a negative connotation, while logical principles are the basis of indispensable rational inferences. The abundance of such questions in a society indicates that adherence to logical principles is rather unimportant. The expected answer behind each one of these types of questions is “I do not agree with you.” or “I expect that you agree with me.” However, if the same criticisms are among the rational people or specialists, every question can be refutable with answers, and finally, an approximate rational consensus is shared. In this way, logic means the right way of thinking and rethinking for the best consensus inference. Logic separates rational prescriptions from the general ocean of philosophy, filters and defines, and transforms ideas into more rational forms. Its primary task is to establish systems and criteria for distinguishing rational arguments from irrational ones.

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7.2.1. Simple Fundamentals of Logic It is evident from the history of science that contemporary logicians have discussed the ideas of earlier logicians in a laudable style. In any educational system, after the ability to think philosophically, logic plays the role of the next step in rational inferences among many variables. Unfortunately, education systems have infrequent and insufficient formal training in logical principles and their extraordinary mind sharpening and brain experiments to arrive at innovative ideas. This is particularly the case in medical institutions, where students are fed various classical concepts, definitions, rules, logical statements and mathematical formulations. How mathematical educations are innovative, productive and generative without logical principles? It is essential to mention the logical principles in order for the younger generations to be interested in the sciences of logic and to reach rational evolutions endlessly. Logic, because ofits importance in scientific inferences, has its own status and importance in reasoning for final decision-making. Logic is the search for a priori rational and formal truth that helps in the intelligent management of conceptual, abstract or mathematical models. Practical and pure logical principles play an emphatic role in the very bases of mathematical modeling and computer software for fast, reliable and valid problem solutions (Chapters 9 and 10). Software supporting these intellectual activities is more effective when they depend on solid logical foundations. Scientific revolutions are achievable after the effective application of logical principles and rules. In order to be among such innovative studies, the rules of logic can be deductible for effective information manipulation. Reasoning tasks are achievable by formal languages (Şen, 2014). Francis Bacon (1561-1626) said, “knowledge is power” philosophically and showed the way of industrialization. Knowledge and power are inseparable, and therefore, they discover the origin of truth, and there is no knowledge in the traditional sense without logical rules, power is needed for knowledgeability. None of these interpretations can dominate the medical sciences, otherwise, they will remain in the hands of some authoritative statutes. Intellectual content of medicine is developed after philosophical reflection through the principles of logic. 7.2.2. Classical and Mathematical Symbolic Logic On classical logic, D’Agostino and Modgil (2018) explained that it is a wellstudied example of abstract argumentation theory that gives argumentation-based characterizations of non-monotonic inference over possibly inconsistent sets of classical formulas. This enables single-agent reasoning in terms of argument and

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counter-argument, and non-monotonic reasoning in the form of dialogues between computational and/or human agents. Logic can also be defined as ” correct and regular way of thinking” (Şen, 2014). There are three concepts in this concept, “logic”, ”regular” and “true”. For logic to exist, a language is needed that helps to reflect at least initial ideas about a topic, event or phenomenon. Because logic requires discussion, the first regularity in the language is sentence structures that are useful in conjunction with logic to express ideas grammatically (Chapter 4). Otherwise, teaching or learning in isolation can lead to stereotypes and boredom. In everyday conversations, people automatically say what they think and mean. This automation does not apply to scientific knowledge generation or modeling due to the exclusion of the systematic logical principle. It is necessary to go over the information with the available thoughts logically to draw rational conclusions. It is also necessary logically review information with current considerations in order to arrive at rational conclusions. One needs to build sentences that fit common sense and logic. Logical sentences (propositions) must have pre-information content as an antecedent (premise, cause) and follow-up (consequent, reaction) part as inference. After giving preliminary information, sentences are expected to contain scientific comments about rational approximate decisions. These are logical propositions, which are sentences with pre- and post-part properties. Let us consider an example to understand better: “Those who read this book and keep some information in their minds by interpretation and understanding they can convey the informative knowledge to others.” Here, “read”, “interpret” and “hold” are preliminary information positions called the premises of the proposition. Based on these premises, it is necessary to decide in order to arrive at a conclusion with a judgment of succession. The successor part here is “to convey information”. Thus, a decision is reached by visualizing and questioning the antecedent parts. According to two-value logic, a proposition is either true or false. Propositions, hypotheses and assumptions are suggestible logically in order to progress in scientific directions. For this purpose, researchers try to confirm them with some propositions about the subject. For example, a well-known proposition is that “extreme cold causes to flu” This proposition was put forward after a few observations, and, therefore, still

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holds general validity. Some propositions can be derived by rational means, others empirically. For example, if one cannot prove experimentally, but can determine by observations, the premise is: “physicians gain expertise by experience.” From all past observations so far, this appears to be true. However, according to bivalent logic, there is the opposite statement. “physicians cannot gain expertise by experience.” which is not valid? There is symbolic logic, in terms of symbols that are the basis of mathematical equations. Like the translation of a proposition into other languages, it can be presented by symbols in mathematics. In order to be independent of language, all conjunctions such as “AND”, “OR”, “NOT” are indicated by letters and some symbols (Sloutsky and Goldvarg, 2004). For example, in mathematics, all arithmetical operations are logical reflection of “AND”. Thus, logical language emerges just like the language of symbols. This logic is not different from bivalent logic in that it assumes two alternatives as true and false. In any career, modeling methods have taken a mathematical view in terms of symbols based on bivalent logic, and the models give approximate results (Chapters 9 and 10). 7.3. LOGIC ELEMENTS The rules of logic help to study facts or events that may have different elements. We can explain these in the following subsections. 7.3.1. Logic Conjunctives While many words contain information, others do make sense on their own. They play an important role when they come between two words or sentences. Unfortunately, these are used automatically regardless of their logical meanings. In order to give a meaning to these words, which cannot logically produce much perception, the situations in Fig (7.1) are explained with two circles as an event or subject, each expressing a word or a sentence.

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A A

A B

B

B a

A B b A

A B NOT“A”

B NOT“B”

Fig (7.1). a) “ANDing” b) “ORing” c) “NOTing”.

There are three types of logic connectors, “AND” (intersection), “OR” (union) and “NOT” (exclusion). They produce a single result, but it is not possible to make a judgment (decision) for them individually. 1) “ANDing”: Unfortunately, in textbooks, it has a geometric shape similar to (Fig 7.1a), and hence, students give an answer as “intersection” without its logical implication. The conjunctive, “AND”, connects two things, concepts, words or sentences. It requires duality in order to coexist in the same place and time. One of the simplest examples is: “blood AND urine tests are necessary.” does it mean that both must exist at the same time and place? The answer is yes. 2) “ORing”: This is another logical conjunction also based on two subjects as in

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the following expression. “blood OR urine test is necessary.” This conjunction leads to three independent conclusions. In classical textbooks on modern mathematics, they are represented by a geometric shape, as in Fig (7.1b), meaning “union”. The conjunction “ORing” gives results individually or jointly. The logical conjuncture “'OR” means that at least one of the two parts must exist. 3) NOTing: This logic operation depends on a single event with two alternatives existing one and its opposite. For example, the following statement expresses this situation. “urine test is NOT” necessary.” There are two alternatives, as in Fig (7.1c). These three conjunctive operations form the basis of logic proposals, whether bivalent, fuzzy or symbolic logic (Chapter 8). In summary, the three logical conjunctions are ubiquitous in everyday communications. In order to acquire verbal knowledge, it is necessary to understand the semantics (epistemology) of these three conjunctions very well. In this way, philosophical thought, expertise and the ability to extract information leading to rational conclusions can be written with predecessor and successor sentences as follows in the preparation of medical treatment. “IF water AND yogurt AND onion AND lemon are mixed, THEN it becomes a useful drink for health.” This is a logical sentence (proposition), the antecedent parts related by “ANDing” junctions. Propositions are sentences for logical expression reflections that verbally express the premise and consequent parts relationship. The proposition is true or inconsistent and according to Aristotle (BC 384-322), bivalent logic propositions are either true or false without any middle case. In Chapter 8, proportional logic is explained as fuzzy logic fundamentals, which have been used recently everywhere and is very convenient for medical studies. Propositions are viewable in two groups, namely, categorical and conditional. The former relates the premise part in a proposition to the consequent by consideration of categories; the latter has consequently conditioned on the premise. It would not be an exaggeration to claim that propositions are central to logical studies for thinking, since such studies proceed through the compositions and segments that are expressible by propositions.

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7.3.2. Proposition Propositions are the sentences that bring the concepts together through grammatical rules and logical conjunctives. The most important characteristics of the propositions are conceptual knowledge through rational reason according to the principles of logic. For example, bivalent logic propositions can either be verified or falsified, let us say. “The use of medicine cures the disease.” is a proposition, in which the implication of IF…THEN is implicitly disguised. There is an idea in this proposition that medicine eventually improves with drug use. Likewise, the sentence “IF patient takes medicine THEN he will be healthier” This is an obvious proposition. The question here is whether the patient has recovered. In a simple proposition, there is a premise concept that takes the place of the subject, and another, called the predicate for the successors. If there are more than two premises, they are called compound statements. Many antecedent concepts are loaded as subject by the predicate. For example, the sentence “IF the temperature decreases AND blood pressure falls THEN human body sustainable life is in danger” This is a combined proposition. Here, the two premise concepts are interrelated. Another feature of propositions is that there are qualitative or quantitative relationships between concepts. These relationships aid decision making by understanding what the verdict is. While conducting a study, various previous works on the subject are reviewed, and thus, necessary basic knowledge is obtained. Sentences read or spoken have a meaning, but there are those that show comparative situations in terms of complete logical rule in the following general format as aforementioned. “IF ........ THEN .....”. In such a propositional structure, any suggestion between IF and THEN is “premise”, “reason”, “predecessor” “antecedence”, “precedence” or “input”, and the part after THEN is “predicate”, “effect”, “successor”, “consequent”, “result”, or “output”. In everyday language, alternatives are “causes” and “effects”, respectively. Thus, in practice, it can be grasped that a proposition is interpretable as determining the effect in the light of the causes. Propositions can have bivalent crisp or multi-value fuzzy logical types (Chapter 8). The first type directly accepts

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one of the two incompatible, mutually exclusive and complementary “true” or “false” oppositions, in line with the exclusion of the middle between the two extremes. Here, the logic is precise with true-false options (not fuzzy). Today, based on the working principle of mathematical equations, algorithms and computer software lies bivalent logic with two numerical degrees of belonging 1 (true) or 0 (false). The relation between two concepts through the conjunctions in a proposition serves to decide whether the inferences are true or false. Propositions can first be divided into two in terms of positive and negative implications. In positive propositions, it is confirmed that the features of the predicate are also present in the subject. For example, statements like “fever is high” and “he is fat” are phrases like “A is A”. The negative proposition is false based on the principle of opposition. The positive statement is not necessarily based on another proposition. It is seen that the features in the predicate do not pass to the subject. For example, the proposition “pain is not mild” is of this type. Their general premise is “A is not B” in bivalent logic. A negative statement is based on a proposition that precedes it. Detailed information on this subject is given by Salmon (2013). In the simplest form, one can say that a proposition consists of a subject, a predicate and conjunctions that connect them. Such propositions combine the two concepts and classify the commonalities between them as an inference or conclusion. In addition, there are also categorical propositions that are divided into two positive (affirmation) or negative (rejection) according to the accuracy of the burden the predicate gives to longing. This distinction of simple propositions is related to the transition of the predicate feature to the subject, that is, the feature classification. However, simple propositions can quantitatively be divided into universal (containing all options) and partial (containing some options). When it comes to combining these classifications in terms of quality and quantity, a common classification of simple propositions comes into view. These are: 1. Universal positive propositions: In these propositions, all the features of the predicate pass to the subject. For example, in the proposition “all people live” The feature of vitality is completely found in humans. These are universal positive propositions. 2. Universal negative propositions: No feature of the predicate pass to the subject, and therefore, the proposition is good. This means that everything in the verb is excluded by the subject. For example, the statement “No one is a robot” is universally negative.

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3. Partial (certain) positive propositions: Propositions that can confirm the passing of some features of the predicate to the subject are of this type. Some features of the predicate are found by the subject. For example, in proposing “some people are sick” disease in the predicate passes to the subject in the sense that some people are sick. 4. Partial (specific) negative propositions: It is the negation of the previous one. In these propositions, it is desired to give a feature to the subject by ignoring the feature of the predicate. For example, the following statement is an example of this “some people are not sick” While single propositions have been mentioned so far, propositions are also the subject of logic as a group of two or more simple propositions. Simple propositions are joined by the logical conjunctive “AND”, “OR” and “NOT”. For example. “bone is hard AND light” It is a unified proposition by taking its subjects in common and combining them with logical principles. Propositions can also be classified in that they describe the entities to which they correspond. In this classification, the concepts that make up the proposition can be explained as follows in terms of representing the reality, necessity or possibility. 1. Real proposition: Consists of concepts that directly involve real objects in the world. They are simple propositions that represent entities, that is, objects, as they are, without any conditional acceptance, necessity or possibility. For example, the following statement is a real proposition “all students have success” 2. Mandatory statements: They may not represent real world objects, but necessarily represent objects whose existences cannot be proven. They are correct propositions in form and content. These propositions are mostly based on abstract concepts. For example, it is known that the proposition. “Imagination and dream are vague” neither imagination nor dream are real, they are virtual concepts. There is always “vagueness”. 3. Proposition of possibility: Concepts contain neither the truth nor the necessity. The propositions and the concepts based on them are subject to probability, statistics, and randomness, i.e., uncertainty. In order to deal with them logically, theories are under the name of probability calculations (Feller, 1957).

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These are propositions that contain information about possible objects that cannot be defined with complete certainty. For example, the proposition “you can get well tomorrow” This characterizes a probability event. Especially in medicine, such propositions are frequently used. With the logical inferences made over time, one can see the propositions with high probability content at the beginning that approaches certainty. It is also possible to classify the propositions according to the relations that may exist among themselves. These relations depend on how much the predicate imposes on the subject. The first class of propositions to consider correlation in the previous explanations is categorical ones. It can be said that these issues are divided into two according as “yes” or “no”. For example, in the proposition “the doctor is diligent” diligence is an abstract concept, but performance is presented by referring to the subject of the doctor. The statement: “Victory is not healthy” is again a categorical statement and it is auspicious. If there is a conditional relationship between two propositions, they are called conditional statements. For example, the premise “people are emotional” This brings one to the conditions of human being emotional. Concluding propositions are derived from the premises according to the principles of reason, identity, contradiction, and the impossibility of the third state (Şen, 2003). As mentioned earlier, there is also a hypothetical proposition of IF…(Antecedent) ..THEN….(Consequent). In case of a positive rational structure in the antecedent part, the conditions implied by the consequent also follow positively. In general, the event that occurs in the consequent part implies that it occurred hypothetically in the antecedent part as well. “IF …. ONLY IF…..” is another statement for hypothetical proposition. This implies the occurrence of the consequent requires that the priority arise due to the causal factor. For example: “IF and ONLY IF I have a lot of money, I can buy anything I need.”

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The causal relationship indicates the discrete proposition through mutual exclusivity. In the case of multiple connections between the antecedent and consequent parts, the causal relationship has not clear establishment. For example, the proposition “IF moral virtues are obeyed in a society THEN there is almost equality” may mean different connotations in various societal lives. A person, who has not been given moral principles since childhood may play several roles in different interpretations that those who fully experienced the moral rules fully. Categorical propositions aim primarily at the identity of their terms, i.e., what things are either in their substance or at their accident, and may therefore, tend to use categorical propositions in search of definition; separating propositions one thing from another; and hypothetical propositions when questioning “why” and “how” (Şen, 2014). 7.3.3. Inference When ones introductory thoughts are quite complex, metaphysical, imaginative, blurry, etc., a general scientific inference engine is presented as in Fig (7.2). Here, the most important role is within the “science inference engine”, which is strengthened by appropriate logical principles. Logical principles and rules transform the unknown from the world of thought into scientific knowledge with the qualities of systematization, generalization, predictions and criticism. We can list them as follows. 1. In cases where the thoughts are very complex and blurry, it is necessary to make general and verbal logic inferences, which are assumptions that can explain the event by observation, on the one hand, and to comment on bivalent logical reasons on the other. Here, the scientist verbally identifies with his intellectual thinking, logic, expertise and prior knowledge and observations or events in thought and virtual environments. Logical rules can be mathematized with symbols. Very systematic collection of information leads to a theory. The validity of theories relative to the current level knowledge becomes partially or fully valid after positive passage of appropriate experiments. Experiments should be conducted, albeit gradually, to determine the validity of untested theories,. For example, it was almost believed by Einstein (1886-2055) after various thought experiments that light beams are attracted by large masses. Evidence for this view, however, appeared many years later, observationally and quantitatively by Eddington (1882-1919) during a solar eclipse.

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2. The first element of intervention is reason and logical principles related to the scientific inference engine of the complex and fuzzy world of thought. 3. Without observations, the principles of reason and logic cannot serve to draw purely scientific conclusions. Therefore, many speculative, but pseudo-rational thoughts arose during the period of ancient Greek civilization, some of which became obsolete due to the lack of experimentation.

NATURE C o m p l e x i t y

Experiment

Observation Rationality

Scientific inference engine

Systemization

Theories

Logic

Scientific knowledge

Mind

Thought world Fig (7.2). Science inference.

Philosophy of science takes many events to scientific results by considering them on logical inferences and observations. If they are not testable, they remain suspicious (possible, probabilistic, falsifiable) about their scientific contents. In order to eliminate these doubts, it is necessary to test the systematic information set predictions or inferences with the mind-logic-observation triad. If a theory passes at least one or more tests, it is scientific. If the theory passes with logical rules, scientific criteria, and successful tests, it is judged scientific. Accordingly, not falsifiable theories inevitably direct man to a non-scientific level. Accordingly, theories that cannot be falsified can inevitably direct one to an unscientific level. Assuming that every confirmed theory is scientific without a doubt can lead to the conclusion that the theory is false. In this respect, falsifiable theories by Popper (1955) are recommendable. 7.3.4. Proposition Inferences The most important aspect of logical propositions is verifiability or falsifiability, which is absent in concepts and terms. The judgment derived from the conceptual

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knowledge in proposition and attribution imposes the successor as either verifiable or falsifiable. Coming to a decision in this way is called inference from propositions. Inferences are consequents of logical reasoning. Development and induction from the reasoning processes are explained in Chapter 2. In order to make inferences from propositions with deductive reasoning, the first premise must contain universal knowledge. This means that there is more comprehensive information in the antecedent part of the proposition than in the successor that should convey this information. To make reasonable cuts, two pieces are required, one on a large scale and the other on a smaller scale. There is a final proposition in terms of judgment. Between the two-premise proposition and the last proposition, there is connection through the word “therefore”. The following example presents these features. “Every human body is exposed to disease” (Big proposition) “Ali is a human” (Little premise) therefore. “Ali is prone to disease” (Inference proposition)” The reasoning here is deductive, since the first proposition includes the second. If the big premise is true, the inference is certainly true. In inductive reasoning, more comprehensive propositional information is obtained, in which the inductive thinking process is widely used in scientific modeling studies. This is because there is extensive knowledge in science and modeling similar to computer programming software. Consequently, deductions are possible by inductive reasoning. After the model is established, the details can be explored and interpreted. On the other hand, while examining the events, it is desired to draw some conclusions from the examples of the general event. Someone in the laboratory may want to draw general conclusions from reviews of limited availabilities under special circumstances. In this respect, it is clear that the inductive reasoning method is more dependable in scientific inferences (Chapter 2). 7.4. MATHEMATICAL SYMBOLIC LOGIC MATRIX (SLM) The concepts, terms, definitions, propositions and inference methods presented above have logical foundations. It is also possible to symbolize and use these propositions with mathematical symbolic logic rules. All propositions have logic conjunctions that determine the relationships between different concepts and

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terms (Section 7.3). They play a logical role in determining the inference of relationships. In symbolic logic, concepts are usually denoted by lowercase letters. For example, the term 'tree' can be represented by the letter, 't'. Likewise, the words “water”, “fire”, “human” and “metal” can be symbolized with the letters, 'w', 'f', 'h' and 'm', respectively. In general, the conjunction words “AND”, “OR”, “NOT are represented by “U”, “∩“, ““Ù“, “Ú”, “~”, “®” and accordingly, different symbols can be written ( HYPERLINK "https://www.researchgate.net/profile/Vladimir-Sloutsky" Sloutsky and HYPERLINK "https://www.researchgate.net/scientific-contributions/Yevgen iya-Goldvarg-2011127980" Goldvarg, 2004). For example, the proposition a (aÙb) explains that “a” is a concept or variable and, “b” another concept that are combined with the conjunction “AND” to form a bivalent logic or fuzzy logic proposition . Symbolic and other types of logic are described in books written by different authors (Blackburn et al., 2007; Mossakowski et al., 2005; Şen, 2003; Kakas, 2019). Brief notation and reasoning are explained with the concept of “symbolic logic matrix” (SLM) to determine modeling principles using reason and logic. For this, let us assume that all the variables related to the event are represented by lowercase letters such as u, t, v, x, y, z. The first question in the model setup is whether there is a correlation between the variables affecting the relevant event. To answer in a systematic way, first, consider a square matrix consisting of rows and columns equal to the number of variables. For example, if there are 4 variables (such as v, x, y and z), their positions are shown in the SLM (Fig 7.3). Each row and column is labeled with the same variables, combined in a common square location between the columns and rows. It can be understood that the concept of SLM is to combine variables two by two as in the figure. v

x

y

x

D

?

y

?

D

v

z

Fig. (7.3). Symbolic logic matrixes.

z

D

D

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To better understand the procedure, the following points reflect the characteristics of SLM coupling. 1. It has as many rows and columns as the number of variables, so a square matrix is valid. 2. Variables are shown in the first row and column, respectively. 3. Variables are doubled at each of the common square positions outside the first row and column. For example, the common property of x and z variables appears, where row x and z column intersect. 4. The letters D along the main diagonal imply that the same variable is completely dependent on itself. 5. SLM is symmetrical with respect to the main diagonal. Therefore, it is sufficient to consider only the upper or lower triangular matrix. 6. At each position of the matrix, there are icons of,, D and ? The first (second) arrow implies a direct (inverse) proportional relationship between the two variables. The most important sign is ?, that is, there is no logical judgment between the variables that requires experimentation. After determining the SLM by cause, what kind of direct or inverse relationships exist between the variables, and hence, off-diagonal positions are filled with arrows or question marks. 1. “?” locations in SLM cannot be logically decided on what kinds of relationships exist. Therefore, it is necessary to resort to observations or experiments to decide the type of relationship. For example, in Fig (7.4), it is not possible to make a decision about the relationship between x and y variables, and therefore, the relationship can be determined by observation, experiments and/or measurements, and accordingly, the SLM relationships are completed by adding a direct or invers arrow. Finally, the matrix gets rid of the question mark and takes its final form (see Fig 7.4). 2. An important point is that principles of logic can determine whether relations are directly or inversely linear, but logic cannot decide easily whether the relations are non-linear. 3. Different interpretations are possible after SLM completion. For example, what are the relationships between v and other variables? As in Fig 7.4, x, y and z variables affect the v variable . It results that v is inversely related to x, but directly proportional with y and z, 4. SLM helps to derive even mathematical relationships. Common relations in mathematics are represented by the implicit function v = f (x, y, z), which makes no sense in practical studies and applications. Therefore, an explicit mathematical expression needs to be determined. In the light of the valid

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relationships, the mathematical expressions can alternatively be written as follows. v x y z

v

x

y

z

T

T

T

T

Fig. (7.4). Complete logic matrixes.

v = c(yz)/x or v = c(y+z)/x where c represents proportionality constant and should be calculated from the data, if any (see Chapter 9). In order to decide which of these equations is valid, it is necessary to use basic and simple information logically. The important point to note is about the units of the two sides. The common unit of the mathematical combination of independent variables on the right-hand side must have the same unit of a dependent variable, v, on the left-hand side. 7.5. LOGICAL MODELS In general, classical science problem-solving approaches operate with bivalent logic. Nearly every corner of nature, medical or the social sciences, has a gray foreground and background based on verbal knowledge. It is not possible to deal with exact gray information results decisively with bivalent logic and mathematical symbolic principles.

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Artificial representations and models often appear in the form of precise and bivalent logic. Unfortunately, most are based on a vague set of restrictive assumptions when trying to discover and explain phenomena. The social and medical sciences are self-explanatory, and there are always partially overlapping results among different experts on the same phenomenon, depending on their experience and expertise. Conflicts of opinion lead to potential questions in educational and research activities, which are initially descriptive, highly vague with unclear grammar, mostly based on clinical, laboratory and field studies. Along with field or laboratory measurements that lead to numerical data, experience is the most valuable and important part of grammar. The natural, medical and social sciences advance through accumulative and transitional experiences for those who wish to experiment with the relevant event. It is not possible to represent experience by mathematical models, equations or algorithms based on deterministic and bivalent logic only. So the question is, is it translation to bivalent logical principles or change logical propositions and inferences to explain the uncertainty in the next chapter? To soften the effects of uncertainties, a set of assumptions is required before real problem solving by bivalent logic. Assumptions of homogeneity, isotropy, uniformity, and linearity for bivalent logic and mathematics are among the constraints of any conceptual or analytical modeling. It is almost impossible to derive mathematical equations without assumptions. Many disciplines seek to educate their members in bivalent logic principles, physical principles, mathematics, and statistical methodologies for randomness in numerical data. It is time to change this view with the uncertain data being treated in the light of fuzzy logic principles (Chapter 8). Fig (7.5) shows a model with a connector or mechanism that provides logical rule relationships between the inputs and output elements. IF Reasons Inputs

LOGIC RULES 19

THEN Results Output

Fig. (7.5). Logic process model.

In this Fig, the structure of logical modeling is illustrated with all the elements that link cleverly to the results as a set of logical rules (propositions). In general, three types of logic can be used for rational inferences after philosophical reasoning.

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1. Classical logic [bivalent, fragile, solid, black and white, Aristotelian (BC 384322)] is dominant in almost every field since the 3rd century before Christ and its influence will continue in the future. 2. Mathematical symbolic logic [symbols, mathematics, algebra, Al-Khawarizm (780-850)]. It has begun with the Islamic civilization. 3. Fuzzy logic [words, sets, no equations, no coefficients, gray, Lotfi Asker Zadeh (1921-2017)]. Bivalent logic is so deeply entrenched, especially in western culture that the fuzzy logic reflecting natural human logic has long been ignored. The principles of fuzzy logic are discussed in Chapter 8. In order to work with bivalent logic, it is necessary to consider the variables holistically as causal (causes, inputs) and effective (results, outputs). There are two basic principles to perform the logic simply. However, one cannot compare more than two variables at once. The two fundamental principles of rationality take the form of questions such as:

1. “What is the relationship between two variables?” The answer is either in “directly or “inversely” proportional. 2. “What is the “linear” or “non-linear” form of relationship? Since non-linearity identification is quite difficult, it can often be revealed by linear visualization.

Directly proportional

Indirectly proportional

1

Linear

Non-linear

Fig. (7.6). Basic logical combinations.

The answers to these two questions logically highlight four alternatives, directly proportional and linear or indirectly proportional and linear or directly proportional and non-linear or inversely proportional and non-linear, as in Fig (7.6).

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The first step is the philosophical (linguistical) visualization of the relevant phenomenon. The second step is logical inferences, as explained above. The third step is for non-linearity in search for the mathematical alternative functions, some of which are shown in Fig (7.7). y

y

x

x 1

y

y

2

x

x 3

Fig. (7.7). Logical inference functions.

4

Accident possibility

As an example, Fig (7.8) shows four possible relationships between alcohol level and accident risk for logical inference. It is well understood by approximate reasoning that there is a direct relationship between these two variables. The answer to the next question is “linear or non-linear?” It needs logical thinking, that does not allow unlimited alcohol intake, and there is a limit, and therefore the relationship is non-linear.

A B C D

0 0

Alchol level

Fig. (7.8). Alcohol level and accident possibility relationship.

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Logical thinking guides to determine which of these alternatives is most suitable for the answer to the question. “Is it possible for non-drinkers not to have accidents?” The answer is no, which gives the impression that the representative solution cannot pass through the origin and thus, alternatives C and D are out of order. Alternative, A is the only solution as a directly proportional and non-linear case . Finally, in this section, the following questions are asked to the reader with a deductive approach based on bivalent logic. “What kind of relationship logically applies between population and time”. Consider the assumptions that there are no natural disasters, n wear, epidemic, earthquake, migration, etc., in a society, then how will population growth be over time? The possible relationship between the two variables can appear in one of the forms in Fig (7.9). One wonders which one? The answer is left to the reader. Finally, after the aforementioned explanations, one can draw a flow chart for the modeling procedure as in Fig (7.10). The first step is the linguistic visualization of the phenomenon through philosophical reflection. The second step is logical inferences, as explained above. The third step represents the shape extraction as in Fig (7.10), and finally, the mathematical stage is based on symbolic logic.

Fig. (7.9). Population change by time.

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Philosophy (linguistic)

Logical inferences

Shape of relationship

Mathematics Fig. (7.10). Sequential arrivals to mathematics.

7.6. LOGICAL REASONING The design process is considered as a logical process in which both theory, (that is, axioms) and the purpose are revised gradually using induction, deduction, and other methodological alternative possibilities for thinking. Induction is the expansion of the designers’ thinking, beginning with pieces of information and synthesizing them in a systematic way; the deduction is useful if the physician intends to derive all the available facts from the available information; and finally, any inconsistencies in the deductive thought process can be applied with limiting reasoning. The two ways of logical reasoning are analysis (inductive reasoning) and synthesis (deductive reasoning) by considering a case in the medical sciences. Deductive reasoning initiates the process of reaching pieces from a whole, while inductive reasoning begins to reach the whole from the pieces. The first helps to draw general conclusions from specific examples given as a whole. Logical sentences are generally called propositions that explicitly or implicitly contain the IF-THEN structure (Section 7.3). (Fig 7.11) shows the structure of logical expressions similar to (Fig 7.5) as black or gray box models.

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IF Reasons (Precedent)

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Generation mechanism

THEN Results (Consequent)

Fig. (7.11). Preposition model.

This Fig shows that the propositions describe the types of cause-effect relationships without entering the internal production mechanism of the work phenomenon. Therefore, the philosophy of the internal production mechanism is not considered in detail. However, naturally, such logical expressions give some information about the production mechanism of the model. Here, a deductive modeling system is followed depending on the inferences obtained from the integrity of the case. Therefore, rational reasoning is used in writing logical rules. Any logical statement (proposition) must contain in the antecedent, all the input variables with the logical conjunctive and the consequent part, in logical agreement with the antecedent part. In a logical rule, there is always some kind of connection between the premises and the consequents (conclusions). Sometimes arguments can take the form of long chains of logical rules. Among these rule bases, some arguments are strong, and some are weak. Although, one can attach a “degree of belief” to each fuzzy logic statement, this is not possible in bivalent logic, because without uncertainty there, the final crisp decision is either completely true or false. All empirical sciences, including medicine, are falsifiable by epistemic uncertainty in bivalent logic and mathematical evaluations. The basic form of empirical argumentation depends on the perceptions arising from the preliminary arguments. It can be noted that the perception-claim transition in the medical sciences takes place in the debates that lead to final decisions. Physicists’ arguments have long relied on X-ray images, and recently computed tomography; magnetic resonance imaging (MRI) and functional neuroimaging have begun to play a role in medical diagnostic work. It is hoped that in the future, more advanced technologies can help physicians to reason better through computer simulation work.

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Most of the world’s education systems are based on bivalent logic when it comes to the final decision, the notions of true or false are valid with the exclusion of the middle case possibilities. Pure scientific education excludes logical principles that lead to such extremes. Any reader and scientist familiar at least with the history of science can understand that many people often think either absolutely right or wrong way. CONCLUSION The roles of bivalent and mathematical symbolic logic principles are presented with current examples. The reader is advised to go into the logical background regardless of the case study involved and the mathematical expressions without a logical background are inactive knowledge. After the bivalent logic features, propositional structures are explained by various examples to better understand what the types of logic mean in school and university education systems. In this way, the reader is given the impression that logical principles are everywhere, especially behind mathematical expressions. The use of verbal logical propositions is essential parts of diagnosis in medical sciences and practice. REFERENCES Blackburn, P., Van Benthem, J., Wolter, F. (2007). Handbook of Modal Logic. Bradley, R., Swartz, N. (1979). An Introduction to Logic and Its Philosophy. Hackett Publishing Company. D’Agostino, M. (2018). A study of argumentative characterizations of preferred sub theories. [http://dx.doi.org/10.24963/ijcai.2018/247] Feller, W. (1957). An Introduction to Probability Theory and applications. John Wiley and Sons. Gensler, H.J. (2017). Introduction”. Introduction to logic. (3rd ed.). New York: Routledge. [http://dx.doi.org/10.4324/9781315693361] Kakas, A. (2019). Informalizing Formal Logic. Informal Log., 39(2), 169-204. [http://dx.doi.org/10.22329/il.v39i2.5169] Mossakowski, T., Goguen, J., Răzvan Diaconescu, R., Tarlecki, A. (2005). What is a Logic? In book: Logica Universalis. Birkhauser. [http://dx.doi.org/10.1007/3-7643-7304-0_7] Salmon, M.H. (2013). Introduction to logic and critical thinking. Wadsworth, Cengage Learning. Sloutsky, V.M., Goldvarg, Y. (2004). Mental representation of logical connectives. Q. J. Exp. Psychol. A, 57(4), 636-665. [http://dx.doi.org/10.1080/02724980343000413] [PMID: 15204127] Şen, Z. (2003). Modern Mantık (Modern Logic). Bilge Kültür Yayınları., 168. Şen, Z. (2014). Philosophical, Logical and Scientific Perspectives in Engineering.. Springer-Nature. [http://dx.doi.org/10.1007/978-3-319-01742-6] Wogu, I.A.P. (2010). An Introduction to Logic, Critical Thinking and Arguments in Philosophy. In book: A Preface to Logic, Philosophy and Human Existence. Pumack Education Publishers.

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Zadeh, L.A. (1973). Outline of a New Approach to the Analysis of Complex Systems and Decision Processes. IEEE Trans. Syst. Man Cybern., SMC-3(1), 28-44. [http://dx.doi.org/10.1109/TSMC.1973.5408575]

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CHAPTER 8

Fuzzy Logic Interferences in Medicine ”Medical Verbal Diagnosis and Treatment Methods are Fuzzy” Abstract: This chapter presents the principles of uncertainty, imprecision, vagueness, incomplete and random data types, treatments and diagnostics principles in medicine. For example, a disease can manifest quite differently from a patient, doctor and social perspective. It is stated that knowledge-based medical treatment decision support systems will develop further with fuzzy logic evaluation due to uncertainty involvement. This chapter offers a series of recommendations on aspects of uncertainty in the medical sciences. The comparison of fuzzy and bivalent (crisp) logic and the fuzzy logic preference in medicine are explained with evidence. Fuzzy logic inference modeling with medical vague words is presented on a sample with four inputs (temperature, blood pressure, urine quality and heart rate), for diagnosing disease as an output estimate. Finally, the use of fuzzy logic in medicine is explained by a set of diseases classifications.

Keywords: Computer, Fuzzy, Human, Linguistic, Medicine, Set, Vague, Verbal. 8.1. GENERAL Inheritance of uncertainty in medicine includes, imprecision, vagueness, incompleteness, missing and random items that are effective in the stages of disease diagnosis, treatment and recovery. A disease can manifest itself quite differently from a patient, doctor and social perspective. In addition, chronic disease can affect patient in a variety of ways, and therefore, the definition of the disease requires greater uncertainty and imprecision in the forms of fuzziness. The most descriptive definition of a disease has varying degrees of uncertainty even among experts. Although the terms health and disease have opposite meanings, they are mutually inclusive. According to the definition made by the World Health Organization (WHO), health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. On the other hand, there is confusion between words disease, illness, and sickness in medicine.

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We have fuzzy logic principles at our disposal to deal with uncertainty and imprecision. Fuzzy logic offers partial truth values between true and false (Torres-Iglesias and Nieto, 2006). Sadegh-Zadeh (2015) stated that the concepts of health, illness, and disease can be analyzed in fuzzy theory. They are non-Aristotelian concepts that violate the basic principles of classical bivalent logic. An iterative scheme to define the controversial concept of disease supports the fuzzy concept of disease. An outline is given of prototype similarity theory of disease. Fuzzy logic necessary interpretation depends on set theory, which is the most appropriate way to express any variable in terms of finer categories at the diagnosis stage and in development of knowledge-based systems for medical tasks, including syndrome differentiations. It is stated that trials with the following systems developed by their group in Vietnam by Phuong and Kreinovich (2001) are beneficial. Fuzzy expert systems are for various medical applications such as syndromes differentiation in traditional eastern medicine, lung diseases, case based reasoning for medical diagnosis. They are also useful for the classification of western and eastern medications, and also for the diagnosis and treatment of integrated western and eastern medicine. All these systems have been developed and tested in hospitals. Knowledge-based medical treatment decision support systems have to evolve further with fuzzy logic assessments, due to the involvement of uncertainty. Concepts and identification of interrelationships between medical domains can be achieved with fuzzy sets, association inferences, and decision-making algorithms to preserve the inherent fuzziness of medical concepts. Chapter 7 provides detailed information about the bivalent logic rules that are crisp and exclude the middle. The first opposition to this logic came from the Muslim philosopher Al-Farabi (850-930), who criticized Aristotle (BC 384-322) in the subjects of philosophy and logic and said that the certainty principle on which the bivalent logic is based is not valid exactly especially in natural, social and medical sciences. Considering the uncertainties in the subjects of physics, geometry, mathematics and logic, which are among the natural sciences, he gathered these science branches under the umbrella of “probability”. This view has remained buried as lost history for about more than 1100 years in the history of science. His contemporaries, Muslims and Westerners considered Aristotelian (BC 384-322) bivalent logic principles, and hence, uncertainties in the science remained unnoticed. In the West, until the 18th century and the early 19th century, scientific precision became almost as believable like a religion on the basis of bivalent logic. Immediately after Einstein's (1879-1955) general and special relativity theories, which overturned Newton's (1643-1727) physics, Niels

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Bohr (1886-1962) imported uncertainty in quantum physics (particle physics), which brought into consideration of Al-Farabi(850-930) suggestion as a probabilistic description of nature and science. It is now objectively understood that the innovative states of geometry are fractal geometry, non-linear mathematical differential equations are chaotic and therefore convenient for fuzzy logic assessments because of uncertainty. Nearly 1100 years after Al-Farabi (850-930), an Azerbaijani scientist from Central Asia, who lived in the USA, Lotfi Asker Zadeh (1921-2017) was unable to reach definitive conclusions even when he solved the monstrous crisp (bivalent) logic mathematical equations. He finally thought of this very complex structure logically in terms of fuzziness, excluding the bivalent logic. His fuzzy set paper was rejected from many scientific journals, but in 1965, he managed to publish his first article in an international journal, where he was an associate editor. For several years, this fuzzy paper is not cited in the Western world. About, 10 years after its publication, its applications began to appear in Asian (Eastern) countries such as Japan, India, Malaysia and Indonesia. Fuzzy logic is based on a multiple logic schemes with intermediate values between the two extremes, (true, 1 and false, 0). If everyone thinks with fuzzy logic, he can feel how compatible this logical order is to understand the events that exist in human natural thinking. It is in accordance with the words of Prophet Mohammad: “The best work done lies in between the extremes” For mathematical equation derivations according to bivalent logic rules, simplifying assumptions, idealizations, and hypotheses are introduced to remove uncertainties Chapter 7). The reason for including these assumptions is due to the exclusion of the uncertain middle part. As such, it is accepted from the outset that equations in physics and other branches give approximate results, but they are falsifiable (Popper, 1959). There is always an uncertainty, especially in medicine and social studies such as law and economy. In the bivalent logic, statements with words, idioms and sentences are treated as absolute true or false without any intermediate content. Patients explain their complaints to the physician with verbal ambiguities in words and sentences. In this respect, one of the first things that medical graduates should do is to interview patients to gain expertise by consideration of fuzzy logic rules instead of bivalent(crisp) logic.

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8.2. Human-Computer Logic Extensive information is provided by Dix et al. (2004) on the basics of human and computer interaction from different perspectives. Everyone is faced with uncertainties, which are sometimes thought to be certain in daily life. These cases are formally (systematically) planned to make predictions based on some assumptions with bivalent and mathematical symbolic logic rules (Chapter 7). Various studies are carried out to gain certainty over these assumptions and simplification concepts in research and modeling studies. However, going from large to small scales, it turns out that there is less certainty, but more uncertainty. For example, perceiving a very distant object as a point gives the impression that it is dimensionless and amorphous. As this object gets closer, it transforms into as a three-dimensional shape like a ball. After getting closer, it looks like a twodimensional tray. It is, therefore, reasonable to conclude that there are gradual fuzzy size changes rather than sharp transitions between successive positions. Bivalent and mathematical symbolic logic assumes these transitions as integer dimensions equal to 0, 1, 2, and 3. In fractal geometry, dimensions are decimal numbers in addition to integers. Fractal geometry is outside the scope of this book, which is the geometry of nature that serves to examine irregular, complex, sophisticated and random shapes (Mandelbrot, 1982). In order to better explain the fuzzy concept of logic, let's interpret the geometric shapes of the disk, cylinder and stick in Fig (8.1) and their reflections on the Cartesian coordinate system with axes labelled “length” and “diameter”. Length Stick Cylinder

Disc

Disc Cylinder

Stick

Diameter

Fig (8.1). Disc, cylinder, rod.

What are the differences between these shapes? Comparing their lengths and diameters provides straightforward verbal information. The disc has a “large” diameter, and a “small length”. The cylinder height is “medium”, but the stick has a cylindrical shape with a “longer” height compared with the others. Likewise, looking at the Cartesian coordinate system, it is clear that there are overlaps in

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diameter and length that are not allowed in bivalent logic. Overlaps mean the exclusion of bivalent logic from both axes with the inclusion of fuzzy logic principles.

The real world is fuzzy, complex and full of uncertainties. Due to the immaturity of human thought, understanding and comprehension, there are always uncertainties in many social, medical, economic and technical issues. To treat available data as probabilistic, statistically, stochastic, chaotic and mathematical, the operation of computers today relies entirely on binary (two-value, crisp) and mathematical, symbolic logics. Since it is not possible to fully grasp a real phenomenon due to the inadequacy of human knowledge, people interpret such events in their thought system by simplifying them with some restrictive assumptions. Unlike computers, humans can approximate and process data and information that is highly inadequate, incomplete, and uncertain. In general, vague, incomplete and imprecise sources of information such as complexity and uncertainty are fuzzy features. It is expressed by Zadeh (1968) that: “the more closely the real world problems are examined, the more blurred (fuzzy) the solution becomes” Humans cannot grasp the details of natural information simultaneously and interactively, and, therefore, cannot draw definite conclusions. It is important to note that information sources contain verbal information mixed with ambiguities in addition to basic and precise information. People can think in imprecise terms and communicate with others what they know verbally (linguistically). The more one learns about a system, the better the understanding, and thus the fewer complexities, but the uncertainty does not disappear completely. In addition to the complexity of systems or lack of data, it causes numerical randomness as another type of uncertainty (Chapter 9). All the rules of logic and reasoning in the previous chapters had some implicit assumptions. First, bivalent and mathematical symbolic logic are based entirely on the principles of certainty. Although the probability is said to be similar to fuzziness, the latter includes verbal and numerical data and statements to arrive at final interventions. Until the pioneering works of Zadeh (1965, 1968), a clear methodology was not proposed for dealing with fuzziness. There is no methodology for handling ambiguity through bivalent or mathematical, symbolic logic norms. Especially, in the last two centuries, verbal uncertainties are ignored. For example, assumptions are made that the materials or events are uniform (homogeneous), and that the variables change continuously and deterministically

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with time and space without any element of uncertainty. Such simplifying assumptions and hypotheses are suggested for research to arrive at analytical solutions. Even in logic and approximate reasoning, it could be argued that concept, terms and propositions are definite according to bivalent logic, and that all symbolizations and inferences are related to these ideal combinations. However, in the study of natural and medical phenomena, it is not known how their behavior will be in the near future, and therefore, there are uncertainties. It was foreseen that the bivalent logic was insufficient, and therefore, symbolic logic (mathematics) was developed and used as a common language in all branches of science; although there are developments in the propositions of different languages in this direction. Researchers preferred classical logical inferences that could be handled by the uncertainty principles of fuzzy logic. Especially, in the 18th century, according to the three-state law put forward by August Compte (1798-1857), uncertainties were not found in science. To him, ambiguous phenomena were theological, speculative or metaphysical. Although, probability, statistical and stochastic methods are established according to the principles of classical and symbolic logic (mathematics), they are used to model and calculate numerical uncertainties, especially to draw meaningful results by processing the inevitable uncertainty components in medicine and earth sciences. The concept of probabilistic risk is introduced to measure marginal uncertainty from various mathematical and statistical models for future uncertain implications, (Chapter 9). 8.3. Verbal Uncertainties Although traditional methods provide numerical information about any medical issue, verbal information play important role for the final decision. Verbal statements are more susceptible to various manipulations of psychological uncertainty and can provide better estimates of individual preference over a range of possible options. Windschiltl and Wells (1996) suggested that numeric measures tend to elicit deliberate and rule-based reasoning from participants, while verbal measures allow for more associative and intuitive thinking. Given that there are many situations where human decisions and behaviors are not based on deliberate and rule-based thinking, numerical measures may misrepresent how individuals think about uncertainty in those situations. In situations of uncertainties, risky and likelihood associated with any disease, it is possible to use subjective or objective percent verbal uncertainties to represent the role of vague terms (Chapter 9). Ambiguous communications may have probabilistic (risky) outcomes, likelihoods or verbal chances. For example, Juanchich et al. (2019) provided an overview of research on verbal probabilities.

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A questionnaire method is used to consider the meaning of verbal probabilities and their revealences. An overview of the key findings in the field is provided, including how people interpret the degree of certainty conveyed by verbal probabilities, factors influencing that interpretation, how verbal probabilities are versatile and useable to frame uncertainty and how speakers use verbal probabilities to make predictions. General information on medical words and phrases is presented in Chapter 5, and explanations on ambiguities are partially presented in Chapter 6. For 6-7 decades, probabilistic, statistical and stochastic methodologies have been applied in the field of uncertainty based on numerical data. For example, the number of female patients, who come to the hospital to give birth within a period of time, is obtained, and therefore, the percentage of births among all patients is determinable as a number between 0 percent and 100 percent (Chapter 9). This percentage is valid for a certain period but does not remain constant even in the same periods in the future. In this case, a series of numbers emerges for consecutive durations, and thus a general rule can be reached with one of the applications of probability, statistical and stochastic methods. Especially in the medical field, uncertainties are frequently verbal rather than numerical. Therefore, early assumptions of patient disease provide diagnosis with verbal ambiguities through mutual communications. For example, when a person complains of body temperature and goes to the doctor, he is asked a few questions such as the following, so that the flow of information from the patient to the doctor is in the form of verbal uncertainty. The type and number of these questions may increase depending on the severity of disease. Doctor: “What have you got?” or “why are you complaining?” Patient: “My fever is high” Doctor: “When did it start?” Patient: Towards the evening” Doctor: “What did you eat and drink?” Careful interpretations of these questions and answers will lead one to understand that there is a world of verbal ambiguity in each of them, and accordingly, a world of verbal ambiguity in diagnosis and therapeutic methods and medicine prescription. For this reason, at the end of health research, the doctor may recommend a certain medicine and ask to see it again, let’s say, a week later. After one week, the effectiveness of the medicine is understood as positive or negative, and therefore, rationally and logically, the doctor perceives the

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relationship between the medicine and the effect on the patient, and increases his expertise by trial and error method. Such a relationship remains with him verbally, and now the doctor expands his expertise through similar advice, treatments and medications to other patients with similar complaints. On the other hand, the ambiguous word in the sentence “patient has a high fever” includes the word “high” as ambiguous verbal information and it can be understood around 38oC-40oC. The next question is, “When did it start?” It also implies uncertainty about time, and the patient may say it was “late afternoon” with a verbal uncertainty in hours. As a result of uncertain verbal words compilation, the physician can suggest the most appropriate medicine recommendation in the light of questions, answers, expert opinions and treatment for possible healing in verbal ambiguity sentences. However, depending on the basic knowledge, experience and expertise of physician, the verbal ambiguities are reduced in communications. Regarding uncertainty, the following points are recommended for further consideration. 1. It is considerable that uncertainty exists in all natural, social, medical and physical phenomena. 2. The fact that the home account does not match the market in daily life is a proof that people live in fuzzy environments. 3. Quantum physics emerged in the field of uncertainty (probability and statistics) against the physics of Einstein and Newton (1643-1727). 4. In 1927, physicist Heisenberg (1901-1976) stated that humanity cannot not accurately measure the positions and velocities of matters at the same time. 5. About 2300 years old Euclidean (BC 330-275) geometry is replaced with natural fractal geometry as explained above (Mandelbrot, 1977, 1982). 6. In the last 50 years, it is understood that second-order differential equations, whose solutions are thought to be deterministic, are never exact and contain chaoticism depending on the initial conditions, (Lorenz, 1972). 7. Aristotle (BC 384-322) logic cannot deal with linguistic uncertainty, but fuzzy logic principles are competent to handle them through a set of logical rules that reflect the internal generation mechanism of relevant event. The best way for a medical student or university graduate is to pay attention to fuzzy content in communication with patients and clients. 8.4. Fuzzy Thoughts Medical professionals are aware of highly uncertain decisions. When a patient applies to the doctor, he gives information about his health complains and the physician verbally lists the necessary medicines according to his knowledge and experience. An expert arrives at conclusions after gathering information through

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bivalent (crisp) or fuzzy logic rule guidance. Just like crisp logic concepts, fuzzy inferences also require terms and propositions, and it is necessary to classify each word that corresponds to the variables of cause and effect. Whatever the subject is, it is always necessary to begin with critically questionable opinions, otherwise, rote, mechanical and blind knowledge will lead to highly invalid judgments. Throughout history, experts in any discipline have understood that generating ideas begins with philosophical thinking and then logical rules. Just as everyone has their own style, desire and curiosity to learn, rational inferences can be made in the form of verbal ambiguity within the free thought disorder of philosophy. If one listens to some thinkers after the probabilistic explanations of Al-Farabi’s (872-950), one can understand the ambiguity in communication and thoughts. David Hume (1711-1776), the 17th century English thinker and philosopher on human perception, said. “We expect similar results for similar reasons. This is in all the empirical implications we make”. Another western thinker, Nils Nilsson (1933-2019), made the following sentence about learning machines. “The activities of any device that is a learning machine is a function of past experiments” Below are quotes from Ashley Montagu (1905-1999) that point to verbal ambiguities about cultures and the evolution of human thought. “Man is a creature that discovers its own answers. It is because of this ability to discover that cultures are born.” As for logical inferences, it is useful to pay attention to the following points about what fuzzy thinking inferences are. 1. There are uncertain truths in every person's daily thought system. 2. Assumptions and simplifications are made to exclude uncertainties. 3. There is certainty according to the scale of the event. For instance, point, circle, disk, sphere, molecule, atom, etc., are all matter of scales. 4. The real world is complex and partially uncertain depending on the level of thought. 5. Mathematics, analytic solutions and computers demand certainty and precision. 6. Unlike computers, human beings can think approximately and can process very insufficient, incomplete, vague and uncertain data.

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7. Expressions do not need to be precise, as a person thinks and verbally conveys information to others. 8. The more one learns about a system, the better can understand it, but the uncertainty does not go away completely. 9. The greater is the complexity and the more scant the data, the more effective the fuzziness. 10. Lotfi Asker Zadeh’s (1921-2017) fuzzy logic suggestion found resistance as the word fuzzy means insecurity and uncertainty. 11. Fuzziness does not comply to strict scientific principles and is against deterministic science. 12. Researchers working on probability theory and statistics opposed fuzzy logic systems. They thought that fuzzy logic method calculations might be dealt with probability and statistical methods. 13. Fuzzy concepts and systems have attracted attention in various research centers around the world with a real control application by Mamdani and Assilian (1975). 14. In order to control a system well, the number of equations gradually increases and becomes complex, even chaotic. Fuzzy logic rule solutions are simpler. 15. When Holmblad and Östergaard (1978) dealt with fuzzy concepts and control, fuzzy modeling principles gradually began to attract attention from many disciplines, including medicine. 16. The use of fuzzy logic is slowing down in the west, but has grown up strongly in the east, and particularly, in Japan, Singapore, Korea and Malaysia. Today, the Tokyo subway is operational on fuzzy logic principles. 17. The interpretation of many problems is understood by verbal expressions, value judgments and thoughts rather than numerical data. 18. Language contains ambiguous words and sentences, but it is the most effective tool for information flow and communication. 19. The Turkish phrase, “People understand by talking, animals get along by coking” expresses vagueness, ambiguity and imprecision. 20. The validity of bivalent (two-value) logic causes conflicts among people as there is no room for consensus due to the exclusion of the middle. 21. The physician should first collect verbal information, then make simple measurements and afterwards perform clinical tests. 22. In order for a mother to tell her child to turn off the oven if the cakes are baked, she can tell numerically at what temperature the child should turn off the oven or more simply turn it off if the top of the cake starts to turn to light brown. 8.4.1. Fuzzy Logic Versus Crisp Logic Gürsel (2016) stated that fuzzy nature of decision-making process in healthcare

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forces technology manufacturers and researchers to use productive and seamless solutions. The conversion from fuzzy concepts and ideas to crisp values, i.e., defuzzification, causes loss of certainty and can weaken the final decisions. Soft computing as a promising set of techniques is a fast-developing and popular field that helps meet the need for productive and seamless healthcare. He also explained the fuzzy logic applications in healthcare decision-making. The number of publications on fuzzy logic in healthcare is increasing every year. Fuzzy logic can be used as a classifier or as a selection process of a particular disease type or diseased patients or determining the risk ratio of a disease or in a data mining algorithm or in the construction of a decision support system. The general behavior of the phenomenon under consideration can be explained from different perspectives, rather on a philosophical level, showing the importance of language (fuzzy, verbal, and linguistic) in the planning and handling the problem. During the presentation and definition stages of the problem, verbal contributions are encourageable through a variety of relevant questions and comments. Causal effects on the problem can be described with all possible details and verbal suffixes of the variables. Among the causal effects, a single variable is shown as the subject of the problem, and thus, there are causal and subject variables. Each variable should be divided into at least two or preferably no more than seven subcategories (fuzzy sets). Between the subcategories of causal variables fuzzy logical propositions containing the antecedents are formed, and then the logical and rational consequence parts of the subject variable are added to each of these antecedents. To achieve understanding, it is useful to try and solve a common problem and ask for solutions depending individual abilities and linguistic background (fuzzy). The following points are against the classical bivalent education system. 1. Authorized knowledge is available through questions, discussions, and solutions and dependent entirely on knowledge tools, and scientists try to overcome the marginal limits of crisp information. 2. Any scientific conclusion is subject to uncertainty and doubt, and therefore, further refinements are necessary leading to innovative ideas and changes. 3. It is essential that logical principles, rules and preliminary philosophical foundations are on the agenda so that each problem can be solved with expert knowledge. 4. Scientific thinking is extended towards the falsifiability of conclusions or theories rather than readily acceptable definitive conclusions. In a fuzzy education system, in addition to some points in the classical education, the following points should be considered. Individuals who do not have the

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appropriate education are fuzzy, because they do not have the appropriate terminology or concrete scientific laws for the definition and modeling of the phenomenon. The main importance in fuzzy logic is not just the subcategorization, that is, fuzzification, but the relationship between them. Fuzzy thinking includes the following steps. 1. Identification of variables for the description of the event at hand, such as “temperature”, “blood pressure”, “urine” and “heart pulse”. 2. ‘low’, ‘medium’, ‘high’, ‘warm’, ‘more’, etc., are for fuzzification of variables that are adjectives (fuzzy set separation) 3. State suggestions between fuzzy sets of input (causal) and output (consequent) variables, which should include the logical connectors in the propositions. There are two sources of information for defining the fuzzy set valid for the problem solving. 1. Logical deductions that can be partially useful even for a non-expert. 2. Problem specific knowledge and expert conclusions from previous similar studies. 8.5. Fuzzy Logic Rules Fuzzy set theory and fuzzy logic are very appropriate and applicable foundations for the development of knowledge-based systems in medicine related tasks such as interpretation of medical findings, single or differential diagnosis of diseases from various fields of medicine, optimal selection of medical treatments and also treatment for real-time monitoring of patient data. As explained in the previous sections after the problems of verbal ambiguity (fuzziness), it is now possible to edit and include some logical propositions, and problems can be solved with fuzzy logic rules. For this, first of all, it is necessary to understand what the differences are between the bivalent and the fuzzy sets. The concept of the classical approach is based on bivalent logical habits. In the bivalent logic, the membership (belonging) degree (MD) of each elements in a set is assumed as 1 or 0. Lotfi Asker Zadeh (1921-2017) developed the fuzzy logic approach with wide applications in set theory by arguing that the MDs are in decimals for set elements and vary between 0 and 1, inclusively. In this way, the MDs definition provides three basic properties for each fuzzy set (Fig 8.2).

216 Scientific Philosophy and Principles in Medicine Characteristic degree

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Membership degree

1.0

1.0

0.0 2

3

4

a

“Few ”

0.0

“Few”

2

3

4

b

Fig (8.2). Sets a) classical, b) fuzzy.

1. The fuzzy set is normal, i.e., at least one of the elements equals 1 to the highest MD. 2. The fuzzy set is monotonous, that is, the MDs on the right and left are constantly increasing or decreasing between 0 and 1. 3. The fuzzy set is symmetric, if the MDs equidistant from the element with MD = 1 are equal on the right and the left sides. In Fig (8.2a) the word “few” is shown as a classical logic word in a rectanglar shape. According to the same logic rule, the belonging degrees of all numbers less than 2 and greater than 4 are equal to 0. Thus, 0-1 logic emerges, and there is no distinction between the belonging of the cluster elements. According to classical logic people have to think of two extreme values as heaven-hell. However, this is not real, and hence, the fuzzy logic is more suitable for human nature and philosophical thinking, because there are middle elements with different MDs. In classical logic sets, such human-like notions as “quite reasonable”, “almost natural”, “mild illness”, “severely ill”, “quite chronic” and alike are executed. On the other hand, looking at the MDs in Fig (8.2b), they are not rectangular. The word in question (here “few”) contains an ambiguity and the MD is expressed with values between 0 and 1. In this fuzzy logic set, there is no longer equality but inequality. According to this Fig, there are a number of elements most significantly between the two extremes and at least one of them equals 1 to the highest MD. The further away from this most representative value, the lesser are the MD values. In fuzzy logic patients with similar “illness” complains can be classified by adjectives such as “light”, “little”, “medium”, “heavy” and “extreme” disease. In Fig (8.3), classical and fuzzy sets are shown without numbers, which do you think is more natural and human friendly?

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Characteristic degree “light” “little”

1.0

“medium” “heavy” “extreme”

0.0

Disease

a Membership degree

1.0

“light”

“little”

“medium” “heavy”

0.0

“extreme”

Disease

b Fig (8.3). Diseases logical classifications a) two-value logic, b) fuzzy logic.

Now, if a person or physician reviews classifications of bivalent logic with rational thought, at least the following conclusions can be reached. 1. According to classical logic (Fig 8.3a) the transition between disease classes occur indefinitely and suddenly, that is, there is no difference in priority of importance between disease classifications. 2. If a large number of people in the “middle” class is considered as sick, it will be undertood that the disease level of each person is not different from others. 3. Concluding that the same medicine is equally beneficiel for patients in the same disease class. On the other hand, according to the fuzzy logic classification in Fig (8.3b), it is quite possible to make the following comments. 1. None of what is said for classical logic in the first three items above fits into the fuzzy disease classifications.

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2. In each disease class, there are differences between the patients who have less or more than the normal in that class. 3. If the physician directs his basic knowledge and expertise according to fuzzy logic classification, more detailed and concious specializations can be gained. 8.5.1. Vague Words There are many vague words in medical topics that can only be understood by specialists after years of experience and clinical event involvements. Some of them are predicates, quantifiers, temporal and spatial concepts. Predicates include singular vague words like “ill”, “sick”, “cancer”, “adolescent”, “baby”, “child”, “teenager”, “young”, “old”, “headache”, “pain”, and “stress”. As for the quantifiers the words are such as “some”, “several”, “few”, “all”, “almost”, “quite”, “adolescent” and “baby” “suddenly”, “instantaneously”, “slowly”, “rapidly”, “acute”, “chronic”. Among some of the timely frequent vagueness implication words are “frequently”, “rarely”, “almost”, “seldom”, “often”, “usually”, “generally”, “always” and alike. Spatial vaguenesses words are “extensively”, “areal”, “regional”, “spread”, and some others. Among the predicate vagueness words, the age of individuals are given in Fig (8.4). Membership degree

1

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Fig (8.4). Vague word: B, Baby; C, Child; T, Teenager; Y, Young; M, Middle age; O, Old; V, Very old presentation.

Fuzzy taxonomy implies the division of a universal discourse, say, human age into several fuzzy sets, such as B, C, T, Y, M, O and V (Fig 8.4). All successive sets are mutually inclusive. In addition to the series of fuzzy sets in the Fig, there are fuzzy clustering procedures called fuzzy classification, which divide a collection of subjects into more than two classes through fuzzy logic principles (Bezdek, 1973; 1981; Höppner et al., 1999; Xu et al., 2013; Ferreiraa and Carvalho, 2014). Everyone agrees that it is not possible to divide people sharply by “age”, “health”, “illness”, etc., into different classes. This example shows that fuzzy logical principles and inferences are indispensable in various disciplines such as medicine, law, politics, etc. It is possible to deal with fuzzy logic, which

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supports each other both qualitatively and quantitatively. If a heart attack is considered, there is no definitive cure, but vagueness represented by fuzzy sets and logic. Each vague word can be represented by a triangle, trapezium or bell shape fuzzy sets as in Figs (83b and 8.4) or by valid alternatives. The “age” on the horizontal axis for each set needs a subjective but common-sense definition by experts and in this way words are converted into numbers with MDs. An expert may recommend teenagers between the ages of 10 and 16. Others may argue these numbers, but suggest another couple close to these ones, and therefore, there may be some disagreement about the limit ages, but this will not affect the final decision at the relative error limit of more than 5%, which is practically acceptable. At this stage three different vagueness classifications can be defined as linguistic, epistemic, and semantic common to everyone. The one who deals with the difference of knowledge is called epistemic vagueness. It can also mean terminological jargon among specialists. Epistemic stems from epistemology, which deals with the semantic load of each word. Semantic vagueness is about meaning in language or logic. It is often used in linguistics, philosophy, and computer science. In particular, marginal differences arise in understanding a relationship within the type of semantic vagueness. Finally, ontological vagueness is about understanding of reality of existence. 8.6. Fuzzy Sets There are several assumptions for the validity of mathematical equations and formulations present in scientific studies. Therefore, as stated in the previous section, there are no strict and crisp boundaries in each sub-classification and daily life communication. As mentioned above, Heisenberg (1901-1976) stated about 100 years ago that man can never reach the exact truth with science, because uncertainty always exists, so we live in an uncertain, i.e., ambiguous, hazy and fuzzy world. In cases of fuzziness, personal preferences come into play. For example, “loving the colors”, “tasting the food”, “tipping the food” and “helping a charity” are all about individual preferences that are all fuzzy. For example, when the word “good” is said, there is a relativity that varies from person to person. For some, complete and ideal “goodness” may be opposed to a less important good for others. In this respect, the word “goodness” has a certain range of change in the human mind and thought. This means that there is no such thing as absolute “goodness” in this world. In general, the word “health” means disease-free and everyone has the same level of health. However, in real life the MD for “health” varies from person to person. There is a condition between 0 and 1 MD

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1.0

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representing most or many contiguous conditions that are relatively less healthy than the full health. The word “health” has a choice of crisp and distinct fuzzy sets as shown in (Fig 8.5). By thinking about each of these, the reader can somehow infer the first differences in his thinking between bivalent and fuzzy sets.

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Fig (8.5). Types of sets a) Definite; b, c, d, e, f) Fuzzy sets.

By replacing the word “health” given here with another word, the reader can constantly try to make comments or reinforce their knowledge about sets and especially fuzzy sets. For example, there may be words “good”, “young”, “beautiful”, “rain”, “profit”, “loss”, etc. 8.6.1. Normal Fuzzy Sets As in classical logic, there are propositions and stability principles in fuzzy logic. It has fuzzy logic propositions and inferences, fields of variability and elastic sets. It is known that when working with fuzzy logic, set elements take any MD between from 0 to 1, but antecedent sets in the propositions must have certain properties. Among them, the most important points are as follows:

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1) The fuzzy set must be normal. Here, at least one of the elements in the set must have an MD equal to 1. Abnormal and normal fuzzy sets are shown in Fig. (8.6).

1.0

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Fig (8.6). Fuzzy sets a and b) abnormal, c) normal.

The conclusion that can be drawn from this is that the maximum MD should not be less or greater than 1. 1. Fuzzy sets in propositions should have convex shapes as in Fig (8.7c). Within the variation space of each fuzzy set, no local reductions are allowed in the MDs (Fig 8.7a and b). 1.0

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Fig (8.7). Fuzzy sets a and b) concave, b) concave, c) convex.

8.7. Fuzzy System At the end of every scientific search, it is necessary to establish a system, that is, the sequence of steps of logical reasoning. Researchers often use fuzzy systems for a variety of reasons and the following points are recommended for consideration. 1. Because real world events are very complex, it is not always possible to control them with mathematical equations. As a natural consequence of this, the researcher prefers to resort to approximate but solvable methods. 2. All equations in different professions are analytically derived based on a set of

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crisp assumptions that only approximate the real world. 3. Uncertainty residues are quantified by a factor of safety or risk (probability) which is a confirmation of the uncertainty components in the results of bivalent logic system. 4. In addition to the numerical data, linguistic information and verbal data are given importance for better solutions. The importance of verbal data is increasing day by day. 5. Risk calculations in infectious disease transmission studies require numerical values of some variables. However, verbal risk percentages are most frequently used the medicine. They have either expert subjectivity or data based probabilities (relative frequencies) (Chapter 9) In general, Fig 8.8 shows the classical and fuzzy system model structures in three parts, inputs, conversion box to output. Numerical input data

MATHEMATICAL METHODS

Numerical output data

a FUZZY RULE BASE

Fuzzy input set

FUZZY INFERENCE ENGINE

Fuzzy output set

b Fig (8.8). Modeling systems a) classical, b) fuzzy.

When comparing such systems, it is noteworthy that bivalent logic state is based on mathematical equations and formulas through certain scientific conservation principles, (mass, energy and momentum), that apply in the light of restrictive assumptions (Fig 8.8a). Such a system is deterministic and needs numerical data for model execution. The fuzzy system in Fig (8.8b) shows that the mathematical models are first replaced with the base of logical rules and then the outputs are obtained by executing these rules. Some of the salient points in the comparison of the two systems are given below.

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1. The input and output variables of the classical system are based on bivalent logic rules in the form of mathematical formulations with their crisp interrelationships. 2. Classical systems, without understanding the internal mechanism of the work, produce solutions even mechanically with mathematical formulas instead of logic rules. 3. The fuzzy system ensures the establishment of the valid logic rules of the event internal mechanism. Hence, this system steers in reliable, more dependable and scientifically innovative directions. The better understand the differences between the two logic systems, the following points are worth considering. Each of the units here has different tasks, but they are partially related to each other. 1. Knowledge Base Unit: Contains input and output variables in the form of either numeric database (bivalent logic, i.e., mathematics) or verbal database (fuzzy logic and sets) types. 2. Rule Base Unit: Contains all rules in logical IF-THEN type statements that bind inputs to output variables. Each rule logically links a portion of the input space to the output space. 3. Inference Engine Unit: It is shown as a box in the Fig above. It is a mechanism that includes all the collection of operations that make the system act according to logical rule bases or mathematical equations that lead to an output based on valid relationships between input and output. 4. Output Unit: It is the collection of output values obtained as a result of information interaction through fuzzy logical rule bases or mathematical equations, by means of inference engine. 8.8. Fuzzy Logic Inference A general fuzzy logic extraction and expansion scheme with input fuzzification and output defuzzification operators is given in Fig (8.9). This figure shows that they need fuzzification (verbal uncertainty) provided that input and output information is numerical data rather than fuzzy. After reaching the result according to the fuzzy inference engine, defuzzification is required to return to the number space for applications. The fuzzification and defuzzification procedures are well described by Ross (1995).

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FUZZY RULE BASE

Input data

DEFUZZIFIER

FUZZIFIER

Output data

FUZZY INFERENCE ENGINE

Fig (8.9). Fuzzy logic model general inference systems.

The main question in Fig (8.10) is, are expert verbal (fuzzy) opinions or mathematical models or software more effective and reliable for better results in different professions. Medicine?

Physics? Sociology?

Physiology? Earth sciences?

Engineering?

Astronomy?

Law?

Fig (8.10). Mathematical model, software and expertise.

In this way, it should be taken into account that each expert tries to find a solution for rational inferences by thinking according to the rules of bivalent and fuzzy logic. The discussion of the question “mathematics or off-the-shelf software helps solve medicine problems?” is left to the reader to encourage for more detailed and effective analysis. This way, the reader can understand why the principles of logic are more important. If some of the readers can write computer software, this indicates that they have at least intentionally applying the bivalent logic, because a computer program cannot be easily written without knowing the bivalent logical fundamentals of the problem involved. 8.8.1. Medical Fuzzy Correlation Observations, experiments, patient medical examinations and human rationality are among the triggers of scientific development in medical sciences. Philosophy of science focuses on the ontological and epistemological aspects of experts for rational inferences taking into account two theories, namely, black box (Chapter 7, Fig 7.6) and representational theories that describe static structures and dynamic systems with causative functions

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Engineers have detailed information of all mechanical devices and machines, but to other experts only input and output variables are functionally visible, which is in the form of black box models. They provide information about statistical correlations and equations between input and output variables (Chapter 9). The numerical value of the association is provided by the correlation coefficient ranging from -1 to 1 inclusive, where + 1 (-1) is for positive (negative) relationship and zero means full independence. In different disciplines, the correlation coefficient can be defined according to the scope of the career. In medical sciences, such a classification within biomedicine is given by Austin Bradford Hill (1897-1991), a pioneer in randomized clinical trials and studies of lung cancer and smoking. The following criteria are described by Hill and Johansson and Lynøe (2008). 1. Power. Strong statistical associations are more likely to be causal than weak ones. Weak associations are more likely to be explained by undetected biases or confounding variables, but a slight association does not exclude the possibility of a causal association. 2. Consistency. If different studies conducted at different times and places and on different populations, show approximately the same relationship, then a causal relationship is more likely than just one study. The lack of consistency does not rule out a causal link, because most causes only work under certain conditions and in the presence of certain common factors. 3. Specificity. This criterion requires that one type of cause produces only one kind of specific effect in a particular group of people, such as lung cancer among a particular group of workers exposed to a particular substance. As a general rule, it is clearly invalid. Since diseases may have more than one cause, lack of specificity does not exclude the presence of a cause. 4. Temporality. A cause must precede an effect in time. According to Hill, medical researchers should ask: ‘What is a chariot and a horse?’ For instance, “Does the particular diet because of a particular disease or does the early stage of this disease lead to these particular eating habits?” However, it is hard to completely exclude the possibility of simultaneous cause and effect. 5. Biological gradient. It should be a unidirectional dose-response curve; more doses should lead to a greater response. The more cigarettes a person smokes per day, the more likely he is to die from lung cancer or chronic obstructive lung disease; the death rate is higher among smokers than non-smokers. However, the absence of such a dose-response relationship does exclude a causal association. 6. Plausibility. The imposed causal relation must conform to the contemporary biomedical paradigm and the general mechanisms it proposes, that is, it must be

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biologically plausible. Lack of credibility does not exclude causality and the association found may be important for developing new causal hypotheses. 7. Coherence. The idea of imposed causality should not contradict the association with existing knowledge about the disease. For example, the association between smoking and lung cancer is consistent with our knowledge that smoking damages bronchial epithelium. The absence of consistency does not mean that there is no causality. 8. Experimental evidence. The strongest support for causality comes from experiments (e.g., preventive intervention studies) where the presumed causative agent can be introduced (whereupon the effect should be increased or strengthened) and removed (whereupon the effect should be eliminated or weakened). 9. Analogy. If a causal relationship is found in previous similar research, this makes it more likely that even the current association reflects a causal relationship. Hill says that since we know that the sedative and hypnotic drug thalidomide can cause congenital anomalies, strong associations between other drugs and such abnormalities may also be signs of causal relationships. 8.9. Fuzzy Logic Models in Medicine Most concepts in medicine are fuzzy, vague and ambiguous. Due to the imprecise nature and relationships of medical concepts, the fuzzy logic method becomes suitable for applications involving diagnosis and therapeutic procedures. Ambiguous medical conditions can be described by fuzzy sets. Fuzzy logic proposes efficient solution generation methods capable of yielding approximate reasoning results. Traditional quantitative analysis approaches are not appropriate in medicine studies due to the complexity and uncertainty. The inadequacy and uncertainty of information and the contradiction of knowledge are general facts in medicine. Some of the sources of uncertainty in medicine are as follows: 1. The information obtained from the patient is vague. 2. The patient's medical history is usually provided by the patient himself and/or his family members or relatives. Since this information is mostly subjective and verbal, it is fuzzy and ambiguous. 3. The physician tries to obtain objective data during the examination, but in some cases the border between normal and pathological conditions is not sharp. 4. Possibility of error in the laboratory, diagnostic test results and even incorrect or incomplete information about the disease before the examination. 5. The patient may have false, exaggerated or understated symptoms, and therefore, neglect to mention some of them.

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Fuzzy logic plays an important role in medicine and has been explored in many medical applications (Phuong and Kreinovich, 2001; Mahfouf, 2001; Barro and Marin, 2002; Greeda et al., 2018). Some of the applications of fuzzy logic in medicine are given below. 1. To detect breast, lung or prostate cancer. 2. To assist in the diagnosis of central nervous system tumors. 3. To distinguish benign lesions (disorder in the structure of organs, tissue disorder) from malignant ones. 4. To show quantitative estimates of drug use. 5. To characterize stroke subtypes and accompanying ischemia (lack of adequate blood flow to maintain cell functions) paralysis. 6. To improve decision making in radiation therapy (verbal speech therapy). 7. To control hypertension during anesthesia (eliminating the feeling of pain by giving anesthetic drugs and anesthetizing). 8. To determine the flexor-tendon (bending, bending-ligaments connecting the muscles to the bones) repair techniques. 9. To determine the appropriate lithium dosage. 10. To calculate the volume and size of brain tissues in MR (Magnetic resonance) images and to analyze functional MR images. When modeling with bivalent logic all variables are considered holistically without any subclassing. For example, the variables “Alcohol level” and “Percentage of accidents” are holistic as shown in Chapter 7 Fig (7.5). This means that bivalent logic serves to model in integral and holistic forms: In order to model with fuzzy logic, it is necessary to consider each variable in parts, taking into account the sets of “low”, “medium” and “high” alcohol levels, not as holistic alcohol level a a single variable. In this type of modeling from parts to the whole, the inductive reasoning model can be applied (Chapter 2). In Fig (8.11a), such a granular approach consists of 4 parts “Low”, “Medium”, “High” and “Very high” and “Very small”, “Small”, “Medium” and ” Big” sets on X and Y variables, respectively, and thus, each variable is represented by four fuzzy sets. Thus, 4x4 = 16 boxes (pixels) are automatically revealed to determine in detail whether there is a relationship between each fuzzy sets of the X and Y variables.

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Fig (8.11). shows that some fuzzy rules are valid or invalid with the words Yes or No. Fig 8.11b graph is left for the reader to write down the valid fuzzy logic rules base using the same fuzzy logic pad (16 boxes).

Let us assume that there is a holistic linear proportional relationship between X and Y according to the bivalent logic. Such a relationship is also shown in the same Fig by a straight line. Now, considering which boxes represent such a relationship according to the fuzzy logic infrastructure, it is enough to look at the validity of the fuzzy logic rule for each box separately. For example, the following fuzzy logic rule does not apply. IF X is “V. High” THEN Y is “Medium” On the other hand, the following fuzzy logic rule is valid, because it represents part of the straight-line on the same graph IF X is “V. High” THEN Y is “Big” On the other hand, representations of people aging according to the bivalent and

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fuzzy logic clusters are presented in Fig (8.12). From this Fig, it can be seen that the age sets of “Young”, “Middle ” and “Old” are mutually exclusive in the bivalent logic, the characteristic degrees are equal to 1 and the ages in each set are equally important. Thus, it is concluded that those in the lower age group have equal views in terms of age, and for example, those in the “Young” age group suddenly become middle-aged.

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Fig (8.12). Classical-Fuzzy logic comparisons.

Contrary to the bivalent logic, the following points look more realistic if each of the age sets on the right side of Fig 8.12 is represented by nested trapeziums and triangles. 1. There is no degree of equality between people in all age sets, and they feel unequal in terms of age. 2. There are gradual transitions between sets instead of sudden transitions. 3. There is overlap between the two neighboring age sets. For instance, for a

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while, a person may feel both “Young” and “Middle” aged. 4. A person who enters a set, for example, the “Young” age set, feels very young at first, but gradually enters the “Middle” age group, feeling that the youthness is gradually disappearing. 5. One person in each age set is included at most in the year where MD is equal to 1, which is an instant from bivalent logic. 8.8.1. Fuzzy Logic Model Some propositions may be based on imprecise logic. Logical “direct” or “inverse” proportionality relationships between variables can be defined holistically (Chapter 7). On the other hand, human knowledge is full of uncertainty in terms of doubtful, ambiguous, vague, incomplete, and approximate situations, which are the elements of uncertainty, and thus, fuzzy logic. There is no room for middle exclusion, and all-cause and effect inferences in a proposition are quite fuzzy. For example, when one says “somewhat is true” and “quite wrong,” he automatically understands partial certainty. Unlike bivalent logic, these two options are no longer mutually exclusive, but inclusive (overlapping, partly common). The emergence of the investigated event is highly subjective, which makes it reasonable to have differences in opinions among people and a flexible way is opened to reach common concessive solutions in the medical, social, economic, and engineering fields by taking the opinion of several experts instead of one. Fuzzy principles are explained in detail in various sources (Zadeh, 1968, Ross, 1995; Şen, 2003). First of all, fuzzy logical inferences for problem solutions based on uncertain thoughts, concepts, terms (words), propositions (sentences) and inferences have become widespread in recent years. Its differences from other logic types are summarized in the following points. 1. In fuzzy logic, uncertainties have important roles that are not covered by classical probability calculations, because of verbal ambiguities rather than numerical uncertainties. When it is called “health” in classical logic, its opposite is “disease” in bivalent logic. Classifications in fuzzy logic are partial descriptions of the same concept, such as “almost healthy”, “healthier “, “quite healthy “, “extremely healthy “; “little sick”, “very sick”, “extremely sick”, etc. It is possible to process such uncertainties by means of fuzzy logic rules. 2. Fuzziness is a convenient multiple logic for verbal information executions. Mathematical expressions are used in all models so far, but fuzzy logic has neither equations, coefficients, nor parameters. All models are bundles of propositions (rule base).

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In order to model with fuzzy logic, first the variables affecting the event are determined. For example, a medical model with four fuzzy input variables such as “temperature”, “blood pressure”, “urine”, and “heart pulse” play a role on the output variable “disease”. The second issue is which of these words will be antecedents (inputs, causes) and which is consequent (output, effets) be successor. This is similar to the separation of dependent and independent variables in mathematics. For example, the word “disease” forms the proposition successor, and therefore, four words are antecedents. Let (Fig 8.13) represent four- input and single-output (FISO) model structure as in Fig (8.8). “temperature” “blood “urine” “heart pulse”

Fuzzy logic rules

“Disease”

Fig (8.13). A medicine model.

In classical logic, the antecedent and consequent variables depend on bivalent logic, as explained in Chapter 7, Section 7.5. For fuzzy modeling, these words are first fuzzified by consideration of convenient fuzzy sets. Herein, five fuzzy sets are adapted for the “disease” consequent variable such as “less”, “medium”, “sufficient”, “much” and “excessive”. Similarly, all antecedents and consequent variables are fuzzified as follows: 1. Temperature, (“less”, “medium”, “a lot”) as a symptom is the most important part of the antecedent part. 2. Blood pressure, (“less”, “medium”, “much”, “too much”) is another antecedent variable, which reflects the next important symptom. 3. Urine, (“less”, “medium”, “a lot”) is also another antecedent variable and may depend on laboratory tests. 4. Heart pulse, (“classical”, “medium”, “modern”) is also in the antecedent part of the logical proposetion and serves as a serious health indicator. 5. “disease” (“less”, “medium”, “sufficient”, “a lot”, “excessive”) is the consequent part of the proposition, that is, the variable for prediction. As a second step, the number of logical propositions can be decided automatically without thinking about the mechanism of event occurrence. The mechanical number of propositions is equal to the combination of all fuzzy sets in the predecessor variables as 3x4x3x3 = 108, because the ancedent part has 4 variables consisting of 3, 4, 3, and 3 fuzzy sets, respectively.

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In fuzzy logic propositions, the antecedents are connected by the logical conjunctive “AND” and the propositions (fuzzy rules) are by the “'OR” logic conjunction. As an example some propositions are written explicitly as follows. Rule 1: IF temperature is “medium” AND blood pressure is “very” AND urine is “little” AND heart pulse is “classic” THEN disease ??? OR Rule 2: IF temperature is “less” AND blood pressure is “medium” AND urine is “less” AND the heart pulse is “classic” THEN disease ??? OR Rule 3: IF temperature is “a lot” AND blood pressure is “a lot” AND urine is “less” AND the modernity is “classic” THEN disease ??? OR IF “" “" “" “" THEN disease ??? OR IF “" “" “" “" “" ” THEN disease ??? OR Rule 108: IF temperature is “a lot” AND blood pressure is “too much” AND urine is “a lot” AND heart pulse is “modern” THEN disease??? The review of the fuzzy rule base is requested from an expert or expert group. In the automatically written fuzzy rule base, some rules are illogical depending on the expert views, and, therefore, should be eliminated. Expert opinions eliminate the illogical ones, and thus, the rule base is finalized with logically valid propositions. 8.9. Fuzzy Logic in Medicine Medical research in the diagnosis and therapeutic phases and in between has complexes that lead to inappropriate qualitative and quantitative analyzes and related decisions. There is always a lack of knowledge in medicine, and even what is available may have imprecision, vagueness, bluntness, grayness, incompleteness and possibilities. The sources of uncertainty can be classified as follows (Abbod et al., 2001).

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1. Detailed information about the patient. 2. The patient’s medical history, is usually provided by the patient and/or his family. This is often highly subjective and imprecise. 3. The physician usually obtains objective data physically, but in some cases, the boundary between normal and pathological conditions is not sharp. 4. The results of clinical laboratory and other diagnostic tests may include some errors or even inappropriate behavior of the patient before the examination. 5. The patient may have simulated, exaggerated, understated symptoms or may not mention some of them. 6. To highlight the growing paradoxes of mental disorders against the absence of a natural classification (Marchais, 2002). Classification in critical (i.e., borderline) cases is difficult, especially when considering a categorical diagnosis system. Fuzzy logic plays an important role in medicine (Barro and Marin, 2002; Boegl et al., 2004; Mahfouf et al., 2001; Steimann, 2001). Some examples show that fuzzy logic covers many disease groups, such as the following. a. Predicting response to treatment with citalopram in alcohol. b. Analyzing diabetic neuropathy and detecting diabetic retinopathy at the early stage (Lascio et al., 2002). c. Determining the appropriate lithium dosage dependence (Sproule et al. 1997). d. Calculating brain tissue volumes from magnetic resonance imaging (MRI) and analyzing functional MRI data. e. Improving decision-making in radiation therapy. f. Controlling hypertension during anesthesia (Oshita et al., 1994). g. Determining flexor-tendon repair techniques. h. Detecting breast, lung, or prostate cancer cases. i. Representing quantitative estimates of medicine use. j. Among many other areas of application to mention a few are. i. Examining fuzzy epidemics. ii. Making decisions in nursing, beat electro-acupuncture accommodation (Im and Chee, 2003). 8.10. Fuzziology In everyday human life, almost all information is not facts, but there are vaguenesses, ambiguities, imprecisions, and uncertainties, in short, fuzziness. Human perceives information with sense organs and organizes it linguistically. The comprehensive fuzziness study of human knowledge is referred to as fuzziology. Also, fuzziness is an eternal companion of any process of knowing. In

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a way, it is the science of fuzziness with certain principles that are the source of fuzziness in thoughts. It expands the field of human research in transcendental ways towards a man-made world. The field of fuzziology includes connotations, labels, classifications, analyses, sensations, perceptions, fragments, thoughts, distorted models of partial reality, the label of self-centered minds, and meaningful thoughts. A person accustomed to bivalent logic cannot easily perceive beyond duality. In the fuzzy world, knowledge has no definite boundaries. Fig (8.14) shows the stages of achievements at human desires that may not be rational. Human grasp and understanding

Desire agitates the mind

Complicated desires (human)

Fig (8.14). Stages in fuzzy world.

Most often, human desires are in the form of fuzziness, in which approximate reasoning occurs according to natural logical expressions. As explained in Chapter 7, “IF…(P)….THEN…(C)….”, is one such statement that has a logical interrelationship between P (Premise) and C (Consequent) categories. Herein, there are two parts, one between the IF …THEN part, prior knowledge (premise) P, and THEN… conclusion (the consequent), C, or final decision based on the logical proposition. Fuzzy logical statements are hypothetical, but in the form of a primitive ordinary and common logical framework, because they are reflections of human desires, ambitions and will. The qualitative leap of consciousness to a higher level results in transcending the fuzziness. CONCLUSION The importance of fuzzy logic principles in the text is explained with examples, and therefore, verbal knowledge and information usage and uncertainties are taken into consideration. With fuzzy set theory, different types of medical fuzzy words are revealed by their inferences. The superiority of fuzzy logic principles over bivalent (crisp) logic is presented based on logic rule base generation procedures. The fuzzification and, if necessary, the defuzzification processes are given with simple examples in order to make a final decision. In addition, fuzzy logic systems, modeling procedures, and inference types are presented in relation to medical studies. REFERENCES Abbod, M.F., von Keyserlingk, D.G., Linkens, D.A., Mahfouf, M. (2001). Survey of utilisation of fuzzy technology in Medicine and Healthcare. Fuzzy Sets Syst., 120(2), 331-349. [http://dx.doi.org/10.1016/S0165-0114(99)00148-7] Dix, A., Finlay, J., Abowd, G., Bea, R. (2004). Human-Computer Interaction. Publisher. Prentice Hall.

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regulation of nicardipine infusion. IEEE Eng. Med. Biol. Mag., 13(5), 667-670. [http://dx.doi.org/10.1109/51.334626] Phuong, N.H., Kreinovich, V. (2001). Fuzzy Logic and its Applications in Medicine. Published in Proc. of Asian Pacific Medical Informatics Conference APAMI-MIC'2000,;, Hong Kong, September 27-30, 2000, pp. 1-11; full version published in International Journal of Medical Informatics, 62(2-3), 165-173. Popper, K.R. (1959). The Logic of Scientific Discovery, Harper Torch book edition, New York Ross, T.J. (1995). Fuzzy Logic with Engineering Applications. A John Wiley and Sons, Ltd.London: Publication. Sadegh-Zadeh, K. (2015). Handbook of Analytic Philosophy of Medicine.Springer. Sadegh-Zadeh, K. (2000). A Forum for Bioethics and Philosophy of Medicine. J. Med. Philos., 25(5), 605638. [http://dx.doi.org/10.1076/0360-5310(200010)25:5;1-W;FT605] [PMID: 11035544] Sproule, B.A., Bazoon, M., Shulman, K.I., Turksen, I.B., Naranjo, C.A. (1997). Fuzzy logic pharmacokinetic modeling: Application to lithium concentration prediction. Clin. Pharmacol. Ther., 62(1), 29-40. [http://dx.doi.org/10.1016/S0009-9236(97)90149-1] [PMID: 9246017] Steimann, F. (2001). On the use and usefulness of fuzzy sets in medical AI. Artif. Intell. Med., 21(1-3), 131137. [http://dx.doi.org/10.1016/S0933-3657(00)00077-4] [PMID: 11154877] Şen, Z. (2003). Modern Mantık. (Modern Logic). Bilge Kültür Sanat Yayınları. Torres, A., Nieto, J.J. (2006). Fuzzy logic in medicine and bioinformatics. J. Biomed. Biotechnol., 2006(2), 1-7. [http://dx.doi.org/10.1155/JBB/2006/91908] [PMID: 16883057] Windschitl, P.D., Wells, G.L. (1996). Measuring psychological uncertainty: Verbal versus numeric methods. J. Exp. Psychol. Appl., 2(4), 343-364. [http://dx.doi.org/10.1037/1076-898X.2.4.343] Xu, C., Zhang, P., Li, B., Wu, D., Fan, H. (2013). Vague C-means clustering algorithm. Pattern Recognit. Lett., 34(5), 505-510. [http://dx.doi.org/10.1016/j.patrec.2012.12.001] Zadeh, L.A. (1965). Fuzzy sets. Inf. Control, 8(3), 338-353. [http://dx.doi.org/10.1016/S0019-9958(65)90241-X] Zadeh, L.A. (1968). Fuzzy algorithms. Inf. Control, 12(2), 94-102. [http://dx.doi.org/10.1016/S0019-9958(68)90211-8]

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CHAPTER 9

Numerical and Graphical Diagnosis “Numbers Help to Construct Graphics for Better Understanding” Abstract: The main concern of this chapter is to explain the use of probabilistic and statistical numerical dataset analysis in medical sciences, leading to computer graphics, tabular classifications and representations. These treatment procedures support medical professionals to advance their linguistic knowledge of a disease with numerical and visual results. Fuzzy and bivalent logic comparisons are presented for pulse rate, heart rate, and blood pressure based on age-related tables, which are used to elicit graphical and mathematical equivalents. Probabilistic and statistical assessment methods are explained in detail with some numerical data. In such quantitative assessments and methodological applications, the importance of assumptions is recommended as a significant warning and necessary guidance. The most frequently used regression methodology to determine relationships between two or more medical variables is explained with mathematical and graphical representations. Finally, the relationship between medicine and mathematics is explained.

Keywords: Assumptions, Graphs, Mathematics, Medicine, Numbers, Probability, Regression, Statistics, Tables, Uncertainty. 9.1. GENERAL Mathematical programming in computers, as in many fields of application, supports swift processing of numerical datasets, especially with probabilistic and statistical procedures leading to computer assessment algorithms, which help medical experts to make reliable inferences. Therefore, graphical results can be seen quickly if numerical data is available. Beck et al. (1996) noted that two paradigm shifts are currently taking place in medicine, first, diagnosis and therapy are increasingly based on the understanding of biochemical processes that cause the diseases, and second, diagnosis and therapy are becoming quantitative. The use of visualization techniques in medicine is related to the second phase of these developments as the emergence of quantitative medicine. It allows a physician to tailor treatments individually, generally using a computer-based planning system. Zekâi Şen All rights reserved-© 2022 Bentham Science Publishers

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The basic mathematical modeling of magnetic resonance (MR) is dependent on Fourier analysis. Multiplexed imaging schemes such as Fourier encoding are used in clinical magnetic resonance imaging for sensitivity enhancement (Nichol et al., 2013). Similarly, the simulation of some uncertain medical events is obtainable by means of suitable algorithms, such as stochastic modeling processing coupled with probability and statistical contributions. In medical applications, when the empirical input datasets are insufficient, incomplete and error-prone, the physicians find difficulties in valuation, formulization and decision-making. Even with the advancement of technological medical instruments and their output information, there are always some uncertainties, which are not avoidable completely. Medical data, apart from the simple tests, have high complexities, and therefore, even outputs from automated instruments need a review by an expert in the area. In order to command the input-output relationship, it is necessary to know the internal structure of any software as for the assumptions and hypotheses. Automatic employment of ready software may yield biased information about the concerned case. Among the activities of philosophy, those related to medicine began with the passion for knowing nature and human health to a certain extent by interpreting some primitive observations by means of interaction with the environment. In the past, the realization of such a passion without any measuring device, was achievable only by approximate logical reasoning through useful propositions. They are taken as the basis of theories, and finally, by reaching some general provisions, valid laws were obtained for treatment procedures. Over the centuries, these developments later laid the first numerical foundations for further rational developments and inferences, but meaningful common science language with the intervention of numerical, arithmetical, and especially statistical tools. Sometimes, it was not immediately apparent that the interpretations were made only because of reason, logic, common sense and experience accumulation. Developments based on them with quite defective diagnoses slowed down information accumulation. Especially, in the last two hundred years, developments in medical procedures, devices and instruments have made the data digital, and the development of methods has led to the evaluation and assessment of these numbers. In this way, the branch of “statistics”, that is, measurement and data evaluation, became more important than mathematics. Demiray (1988) defined the statistics as “the branch of applied mathematics, whose principles take into account methodical grouping as much as it aims to examine the phenomena derived from the theory of probabilities or the series of numerical data.”

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In this definition, there are ideas such as the uncertainty of events, the division of the number sequences obtained by processing to reflect the characteristics of the event and making useful interpretations to reach a conclusion. With the development of technology, novice and professional researchers, and technicians have observed that the events are not entirely clear, but have uncertain content at different scales. Such uncertainties in the field of medicine have existed since the early periods of history, and despite all kinds of science and technology developments, there is still a certain amount of verbal or numerical uncertainty. “Probability”, “statistics” and more generally “stochastic” computational methods are very useful in the study of such events for uncertainty assessments, which involve the concepts of bivalent logic with precise procedures and interpretations and fuzzy logic rather than mathematics (Chapter 8). As a result, due to the increasing number of measurements from experiments in clinical laboratories, the uncertainty components in medical studies are bound to reduce, but still, there are residuals. The principles of the successful evaluation of numerical studies are based solely on the evaluation of measurements with the probabilistic and statistical concepts that lead to rational and physical interpretations. For this reason, before the medical application of statistical formulas and methods, the internal formation structures of the examined events should be known, as mentioned in the previous chapters, verbally in order to interpret the numerical conclusions results with reason and logic (Şen, 2002). In the field of medicine, while most of the diagnoses were based on verbal information in the past, much deeper and more precise diagnoses can be reached with supporting numerical information today. The main reasons for this are the updating of technology, engineering software and devices that enable digital data assessment. In addition to the most frequently used Magnetic Resonance (MR) devices today, there are many different devices such as X-rays offered to medical professionals for visual examinations that enable verbal and numerical data as a result of layer-by-layer human body scanning. If there are measurements, it is possible to make a diagnosis with more meaningful interpretations by converting this set of numbers into graphical forms, which provide visual inspections and enable the physician to make diagnoses that are more meaningful. 9.2. Uncertain Number of Information As for uncertain numbers, statistical and probabilistic methodologies are at the service of medical studies as there is no absolute certainty in medical works. Although all prognostic projections are available after quantitative evaluations, it is always difficult to recommend the most appropriate treatment for any patient.

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All prognoses of physicians and patients involve uncertainty, which is reflected in the treatment strategy for a particular disease type. The physician cannot be certain of the final product of diagnosis and treatment with complete confidence. Sources of uncertainty arise from the physician’s knowledge and the patient’s information. For example, if the physician certainty (uncertainty) is 95% (0.05) and the patient’s 80% (0.20), the common precision is 0.95x0.80 = 0.76 (%76), which means that the common uncertainty is 0.24 (%24). Dhawale et al. (2017) noted that today patients often present large amounts of information to a physician to optimize their management or even “request” a treatment strategy, in addition to information from literature searches, web-based data banks, and other sources. However, while the increase in data available to physicians is explosive, the information a patient obtains might not necessarily be accurate, relevant to the patient’s condition or easy to interpret. While the physician accumulates appropriate information, he also recognizes that only some similar age patients and diseases will respond to a particular treatment based on currently accepted criteria. A different treatment strategy for the patient may have a higher success probability than the patient is primarily concerned. However, the scientific literature cannot provide answers regarding the most appropriate strategy for every patient. There are classical data treatment methodologies, as shown in Fig (9.1). Quantitative data are obtainable through office consultations, observations or clinical trial measurements. Classical Methodologies

Probability

Statistics

Stochastics

Fig (9.1). Numerical data classical treatment methodologies.

There are also recent modern methodologies for processing numerical datasets to achieve productive results that are completely different from normal approaches (Fig 9.2) Preliminary numerical information is quite simple and usually based on preliminary measurements, such as temperature, blood pressure, pulse rate, etc. According to many years of experiences, the number of pulses should be between 70 and 80. Situations outside the lower (upper) limit of 70 (80) are in danger.

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(Fig 10.3) shows two different cases for the graphical representation of pulse rates, one in the bivalent (crisp) and the other in the fuzzy (multivalued) logic cases (Chapter 8). Modern methodologies

Chaos

Fractal

Fuzzy

Fig (9.2). Modern numerical data treatment alternatives.

Although there are lower and upper limits in Fig (9.3a), smooth transitions appear in Fig (9.3b). Normal pulse rates are dependent on human age. Young people have lower levels of pulse rate than the elderly do. The same person’s heart rate also changes slightly during the day depending on activities, and there is no fixed number of heart rates other than the average value according to the activity. Disease degree

Disease degree

1.0

0.0

1.0

70

a

80

Pulse rate

0.0

70

b

80

Pulse rate

Fig (9.3). Pulse rate, a) crisp, b) fuzzy logic.

If the pulse rate becomes too high, it causes blood pressure to rise, and serious problems may occur with the heart vessels. A verbal relationship is valid between the pulse rates and blood pressure measurements. Because of the measurements made in healthy people, the high value of normal blood pressure is expected to remain between 11-14 and 7-9 (Frese et al., 2011). In Table 9.1, normal pulse rate values are presented according to age. Table 9.1. Normal pulse rate. Age interval

Pulse rate

0–1

120 – 140

1–3

90 – 120

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(Table 9.1) cont.....

Age interval

Pulse rate

3–7

90 – 100

7 – 20

80 – 90

>20

60 - 80

In the last line of this table, it is stated that if the age is more than 20 years, the pulse rate is between 60 and 80 (Davidovic et al., 2013). Here, classification is based on the bivalent logic. However, a qualified physician is aware of a certain amount of interventions between classes. For example, 81 or 82 instead of 80, which is the upper limit for those over 20, does not mean that person is over 20. Similarly, the heart rates of people are shown in the Table 9.2 during one minute according to their ages. Table 9.2. Pulse rate speed (pulse/min) Age group

Blood pressure (mmHg)

Age interval

Pulse/minute

β in other words γ > 0. According to positive γ values, Eq. (10.5) gives increasing population trend over time (Fig 10.2a). c) Conversely, if the death rate is greater than the birth rate, population growth has a decreasing trend corresponding to the mathematical elements in Eq. (10.5) as α < β i.e. γ < 0. Graphs related to this situation are given in Fig 10.2b. 10.3.2. Source Restrictive Population Model In the previous section, human beings had unlimited resources for sustainability items like water and food. However, in places where there are famine, epidemic diseases, wars and, earthquakes, volcanoes, people die because of lack of resources. The population model for these societies cannot be presented by Eq. (10.5). There are restrictions on food, water, energy and environmental resources in natural living standards, and accordingly, sustainable adequacy restrictions come to the fore. Therefore, family planning and population restrictions are considered as practical solutions. If the upper population limit for these conditions is Pu its determination must be taken into account by the restrictive natural resources conditions. It is possible to express the amount of natural resources possession by this population symbolically as [1 - P(t)/Pu], implying that at the population level, P(t) = Pu everything is depleted. It should be noticed that this P(t)/Pu term is always less than one. Therefore, the restrictive population model by taking into account the budgetary discussions in the previous section, can be written as follows: (10.6) According to the mathematical principle of variable separation rule, it takes the following form. [1/P(t) + 1/Pu]/[1-Pu/P(t)]dP(t) = γdt

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Completion of integration process leads to: Ln{P(t)/[1 - P(t)/Pu]} = γt + c Using the initial condition (t0, P0) the integration coefficient, c, is. c = Ln[P0/(1 - P0/Pu)] Replacing it with previous mathematical expressions and arrangements after algebraic manipulations yields. (10.7) The unrestrictive population model for Nu → ∞ can be obtained as in Eq. (10.5). In very large times (t → ∞), Eq. (10.7) yields P(t) = Pu. The upper population level depends on the initial population number, P0, and γ. If P0(t) < Pu, then there is the population by exponential growth at the beginning. As P(t) increases, population growth decreases. From Eq. (10.6) as P(t) → Pu then dP(t)/dt → 0. Restrictive population growth curve is presented in Fig (10.3).

Fig. (10.3). Limited population curve (N0=50000; Nu=75000; y= 0.09).

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Comparison of this with Fig (10.2) shows the role of the restrictive commodity because the population has an upper level. 10.3.3. Food Restrictive Population Model Taking into account Eq. (10.6), the individual growth rate can be written as follows. [1/P(t)]dP(t)/dt = γ [1 - P(t)/Pu] The differential term on the left-hand side shows the individual share from the growth rate, which is called the personal growth rate, and it can be logically deduced from its direct correlation with P(t). The expression [1 - P(t)/Pu] is called the degree of saturation. Smith (1963) stated that the restrictive population growth model of food, F(t), where this term is expressed as [1 - F(t)/T], and T is the saturation ratio with F(t) indicating the food level at time, t. Thus, the food restrictive population growth model takes the following form. (10.8) Another suggestion is that the level of food depends not only on population, but also on population growth. (10.9) where β and α are constants. In the case of saturation, F(t) = T and P(t) = Ps, where Ps represents the saturation population and therefore, there is no population variation. Hence, from Eq. (10.9), one can obtain that T = βNs. The use of this information renders the Eq. (10.8) into the form below. (10.10) After the definition of ν = γα/β, this expression can be rewritten as: (10.11) Integration of this expression through mathematical separation of the variables leads to the following equation after necessary arrangements. (10.12)

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It is not possible to solve this expression analytically, so its numerical solution is shown in Fig (10.4) as a sigmoid function. 1000 900 800 700

P(t) N(t)

600 500 400 300 200 100 0 -150

-100

-50

0 t

50

100

150

Fig. (10.4). Food restrictive population model result.

10.4. INJECTION MODEL IN MEDICINE The injection introduces a substance into the bloodstream through a hollow hypodermic needle and a syringe pierced through the skin into the body. In this process, the substance concentration changes not only in time, but also in the three-dimensional space within the bloodstream. It is necessary to think of infinitesimal distances in space as dx, dy and dz, hence, infinitesimal areas are dAxy = dxdy, dAxz = dxdz and dAyz = dydz, and finally, the volume element, dV = dxdydz. Substance dose, S(t) at time instant t, and amount of change in substance amount is dS(t), and hence, medicine change per unit volume with respect to time is dS(t)/dV(t). Logically, the greater is the volume of matter at a given time, the greater the variation. Such rational thinking leads to the conclusion that the substance varies in a linear and directly proportional manner with its quantity, and therefore, the following simple differential expression can be written.

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(10.13)

Here, c is proportionality constant. The integration of this expression leads to the following expression with the boundary condition when V = V0 then S = S0. (10.14) Herein, k is a coefficient consisting of proportionality and integration constants. The graphical representation for three alternatives as increase (k > 0), decrease (k< 0) and constant (k = 0) are given in Fig (10.5). Real benefit is possible with graphical visual perception and subsequent interpretations (Chapter 9).

Fig. (10.5). Substance change alternatives.

Basic pharmacology, which is the branch of medical science, deals with the effects of medicine and tries to study the change of substance concentration in human blood. The variation of the substance dose concentration with time after intravenous injection is an important issue. In addition, the concentration change after a series of subsequent time-interval injections, the prediction of substance interactions is an important topic in medical research. 10.4.1. Successive Injection Model Let us try to construct a model for the change in substance uptake concentration in the patient’s vein under the light of Eq. (10.14). One of the key assumptions is that at time zero, t = 0, a specific dose, D0, is injected into the patient’s bloodstream and then over time the substance dose, D(t) begins to decrease. Under these conditions, it is possible to write the following expression as an Eq. (10.14). D(t) = D0e-kt

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After a certain time, T, if a second injection of the same dose is given, the concentration just before the injection confirms to the expression below. D(T) = D0e-kT At the time of dose injection, T, will be the reminder from the previous injection according to: D(T) = D0 + D0e-kT or succinctly. D(T) = D0(1 + e-kT) This new concentration starts to decrease with time and after a certain time, t, from the second injection instance, the validity of concentration expression for t > T is as follows. D(t) = D0(1 + e-kT)e-k(t - T) Again, after another T time interval just before the third injection case, i.e., at 2T time interval from the first injection, the concentration is expressible as. D(2T) = D0(1 + e-kT)e-kT Thus, similar to the previous mathematical expressions the amount concentration after injection, takes the following form. D(2T) = D0(1 + e-kT + e-2T)e-kT In this manner, the dose reduction rate after the third injection would be. D(t) = D0(1 + e-kT + e-2T)e-k(t - 2T) Considering such an injection sequence after the n-th injection leads to the following expression. (10.15) The terms in parentheses indicate the mathematical geometric series, whose sum leads to. (10.16) Theoretically, after multiple injections (n → ∞), the final expression approaches

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the D(nT) → D0/(1 - e-kT), which is independent of n, substance saturation can be reached and if the saturation level is indicated by Ds, then the final version can be written as: (10.17) This expression is useful for the following case studies and applications in medical literature. a) The injection time interval, T, is provided for initial dose concentration, D0 and saturation level are known. b) If injection interval, T, to reach the saturation dose level is known, what is the initial dose amount, D0 ? The main disadvantage in this procedure is the slow process to reach saturation level. Another approach is to inject the first initial dose and consecutive injections according to the saturation dose, Ds and hence T can then be calculated as: D(T) = Dse-kT If after the second injection the amount is D2, the expression for the saturation dose becomes: Ds = D(T) = Dse-kT + D2 and D2 = Ds(1 - e-kT) = D0 In Fig (10.6), dose changes with time intervals are shown according to both approaches. From this Fig, it is obvious that the saturation state can be quickly reached by the second method. This situation is useful for some medicine side effects understanding. For an effective treatment, Burghes and Borrie (1981) recommended continuation of subsequent D0 injections after the first double dose, 2D0,. 10.5. DIALYSIS MACHINE MODEL The kidney, which is a vital part of the body, removes waste and excess fluid from the blood and ensures wastes extraction during the urethra. In the case of partial kidney failure, wastes accumulate in the blood and after some amount; it becomes toxic and can cause health problems and even death. In order to prevent such

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dangerous cases, a solution is possible with a kidney (dialysis) machine. The aim is to direct the dirty blood to this machine, pass it through the filters and return the clean blood back to the human body.

Fig. (10.6). Medicine injection method results.

There are two opposite flow directions in a dialysis machine in the same tank; one for unclean blood, the other for pure blood; and there is a filter between the two (see Fig 10.7).

Fig. (10.7). Kidney machine elements.

The filter helps to replace the waste mass due to the concentration difference between the two opposite flows. The filter is made of porous material with size regulation to allow blood cell passages. The wastes are separated from the blood due to concentration difference. The rate of contaminants passage into the clean liquid depends on the following factors. a. Blood and cleansing fluid flow rates. b. Permeability coefficient of the filter. c. The length of the filter.

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d. Difference in concentrations (contaminated blood and clean fluid). From the starting point of dialysis, there is a horizontal flow to the right along the x-axis. In Fig (10.8) the infinitesimal distance, dx, is shown as the dialysis part.

Fig. (10.8). infinitesimally small dialysis intervals.

The main variables are concentrations in blood and fluid, and they vary across the filter. Let x be the concentrations of blood and fluid at any distance, as Cb(x) and as Cf(x), respectively. Principles of rational thinking and logic state that the amount of waste passing through the filter depends on the concentrations difference and the greater is the difference, the greater the amount passage. In addition, the material throughput increases as the filter length increases. According to the symbolic logic matrix (SLM) in Chapter 8, the amount of waste pass is directly proportional to both the concentration difference and the filter length. Therefore, the amount of waste passage, dm, per unit time, dt over an infinitesimal distance can be written as: dm= k[Cb(x) – Cf(x)]dx Here, k is a proportionality coefficient corresponding to the filter permeability (hydraulic conductivity). On the other hand, there are flows of blood and fluid that carry these concentrations in both infinitesimal areas, A-C and D-F. There is equilibrium in the system in terms of flow rates. The amount of waste in blood flow is equal to, Qb input QbCb(x) from section A-C. On the other hand, according to the continuity (mass balance) principle, the amount of waste passing through the filter is QbCf (x + dx) in the fluid flow passing through D-F section. Hence, the equilibrium expression takes the following form. QbCb(x) = k[Cb(x) - Cf(x)]dx + QbCf(x + dx) Simple algebraic operations lead to the following expression. Qb[Cf(x + dx) - Cf(x)]/dx = - k [Cb(x) - Cf(x)]

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Infinitesimally small dx efficiency becomes: (10.18) This is the differential equation for the small part of the dialysis machine. Similarly, considering the principle of continuity in dialysis for fluid flow rate, Qf gives rise to the following expression. (10.19) The last two equations show how the overall kidney machine works, so, the final equilibrium is as follows. dCf(x)/dx - dCb(x)/dx = - (k/Qb) [Cb(x) - Cf(x)] + (k/Qf) [Cb(x) - Cf(x)] After further simplification of this expression, the concentration difference and constant terms take the following forms: C(x) = Cb(x) - Cf(x) and α = (k/Qb) - (k/Qf) respectively. Hence, in short, the following simple equation is reachable. (10.20) The general solution of this differential equation is simply. (10.21) Here, c is integration constant. Replacing the same notations in this last statement similar to Eq. (10.18) yields. (10.22) Its integration becomes. (10.23) where c1 is a new integral coefficient. From Eq. (10.21), Cb(x) can be obtained as.

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(10.24)

Boundary conditions are needed to determine the solution constants. For this we assume that the initial concentration in the blood is Cb0 at the inlet and the dialysis concentration at the inlet is zero, hence, the initial conditions become as follows. Cb(x) = Cb0 for x = 0 and Cf(x) = 0 for x = L where, L denotes the length of the filter. Under these conditions, the general model equations for the artificial kidney machine by calculating the coefficients c and c1 from the joint solution of the equations (10.23) and (10.24) are as in the following box. (10.25) The most important problem in the interpretation of these equations is to seek the best separation of waste from the blood. Total waste, W, separation from filtered blood can be expressed by the following finite integration from x = 0 to x = L. L W = k[Cb(x) – Cf(x)]dx 0 Considering of Eq. (10.18) the integration process results as. W = - Qb[Cb0 – Cb(L)] The important point from the dialyses machine is that the total amount of waste cleaning is, TW, and its definition is given by the following expression. TW = (Qb/Cb0) [Cb0 – Cb(L)] Usage of Eq. (11.25) leads to. TM = Qb [(1 - e-αL)/(1 - (Qb/Qs)e-αL] In light of all explanations finally one can obtain.

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αL = (kL/Qb) (1 – Qb/Qf) The most important ratios in the dialysis model are Qb/Qf and KL/Qb. Typical operating ranges are between 100 < Qb < 300 milliliters/min, 200 < Qf < 600 milliliters/min, and 1 < kL/Qb < 3. Calibration with standard measurements is required prior to kidney machine testing on a patient. For example, if Qb changes, if k, L and Qf are constant, the resulting curves resemble (Fig 10.9) (Burghes and Borrie, 1981).

Fig. (10.9). Kidney machine cleanness quantities.

Considering the variation of filter permeability with distance may provide opportunities for further improvement. In addition, the pressure differences between the blood and fluid depths and the upper and lower parts of the filter also play role in possible improvements. 10.6. DIABETICS TEST MODEL The disease that occurs with excess sugar in the blood and urine is called 'diabetes mellitus'. In such a situation, the human body cannot burn sugar, starch and glucose (the body’s main source of energy from carbohydrate foods), because there is not enough substance released by the pancreatic gland insulin (a hormone that keeps blood sugar levels under control). Diabetes detection is usually achieved with a glucose tolerance test. Patients come to the hospital without eating in the morning since the previous night (Avicenna 970-1037, Chapter 3), and they are given a large amount of glucose and the amount of sugar in the blood is measured at regular time intervals. The following verbal assumptions are noteworthy in modeling development based on the blood-glucose regular system.

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a. Glucose is a source of energy for all muscles and organs. There is an optimum level of glucose concentration for everyone. Health problems occur above this level. b. Many hormones affect Blood glucose level. There are other effective metabolisms (the entire chemical changes made in living organisms or living cells to provide movement, energy). These are. I. Insulin is found in the pancreas as β particles: After carbohydrate meal, more insulin is produced in the pancreas. Insulin facilitates blood glucose uptake in the human body. II. Glucagon (the hormone produced by the pancreas that raises blood sugar) is found in pancreas as β particles. Excess glucose is stored in the liver as glucagon and returned as glucose when needed. The model presented here requires a limited number of samples during a glucose tolerance test. Two concentrations are assumed in the model, blood glucose, G(t), and net hormone concentration, H(t). The second assumption represents the cumulative effect of all-important hormones. Insulin increases but decreases cortisone (a hormone secreted by the adrenal glands). The following equations are valid for an infinitesimal time interval relative to the basic model. (10.26) and (10.27) Here F1(.) and F2(.) implicitly represent the arguments of the mathematical functions G(t) and H(t). J(t) is the increase in exogenous blood glucose concentration. Assuming that G(t) and H(t) reach equilibrium positions, G0 and H0, respectively, then. F1[G0, H0] = F2[G0, H0] = 0 Minor fluctuations that may occur from the G(t) and H(t) positions are given as. G (t) = G0 + g (t) and H (t) = H0 + h (t)

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respectively. Here, g(t) and h(t) represent the deviations from the equilibrium state fluctuations. With these, the basic equation becomes. dg(t)/dt = F1[G0 + g (t), H0 + h (t)] + J(t) = f1[g(t), h(t)] + J(t) or similarly as. dh(t)/dt = f2[g(t), h(t)] In these equations f1(.) and f2(.) is another pair of mathematical forms. Considering these functions as straight-lines, they can be written simply as. (10.28) and (10.29) In case of glucose uptake by muscles, the conditions dg(t)/dt < 0 and a > 0 are valid for h(0) = 0. The glucose level in the blood decreases as b > 0 and h > 0. If c > 0, the hormone concentration of in the blood (the common name of the substances secreted by the glands that regulate the functioning of some organs) decreases, and if g (t) > 0, then e > 0 state causes h(t) to increase. Thus, Eq. (10.28) leads to. h(t) = [-ag (t) + J(t) - dg/dt)]/b After making the necessary simplifications, one can obtain. (10.30) The right hand side of this equation is equal to zero except for short time intervals. If glucose is given at t = 0, then for t > 0. (10.31) After solving this equation with mathematical methods, it is possible to return to the first variables for glucose exchange. (10.32) Here there are exactly five unknown constants G0, a, A, w0, and B. Of these, G0 is

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determined by analysis before the first glucose administration. If four glucose measurements are taken at different times G(t1), G(t2), G(t3) and G(t4), four equations can be solved numerically by successive substitution method. Better still, if multiple glucose measurements are taken the use of least square errors calculation methodology through the regression analysis approach (Chapter 9). 10.7. SENSITIVITY – HEARING RECEPTION MODEL Sound is reproduced very precisely each cm is subjected to a pressure range between 0.002 to 2000, so sounds of different frequencies can be separated from each other. The ear has a simple separation capacity to hear the sound of a single drop of water and the noise of a jet from far distances. Although the ears can sense even very small sounds during the night, hearing ability is lower due to high environmental noises during the day. If sensibility is denoted by S and reception perception by P, the first mathematical model is establishable as described by Gustav Fencher (1801-1887). At equal sensitivity intervals, dS, the perception level, dP, decreases continuously. For example, a very weak sound can be heard at night, because there are no strong background noises. On the contrary, in the case of strong background noise, the perception may not be heard properly. The logical and rational considerations of all that has been said above lead to the following simple relational expression. (10.33) After separation of variables implementation, its integration leads to the following expression, where c is the integration constant. P = klnS + c If the minimum level of perception is P0, then S(P0) = 0, corresponds to zero sensitivity. This initial condition gives the coefficient of integration as c = -klnP0, and finally, results after its substitution into the previous equation as. (10.34) A typical solution of this expression is presented in Fig (10.10). The use of this model in practical studies depends on the determination of the constant k. For practical applications, it is necessary to record simultaneous measurements of S and P variables with appropriate instruments. In the case of the measurements, for example, S1 and P1, k = P1/ln(S1/S0). In the presence of many measurements, k can be obtained as the slope of the best straight-line across a scatter of data points on a semi-logarithmic paper.

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Fig. (10.10). Sensitivity perception.

10.8. EPIDEMIC DISEASE MODEL It is possible to develop a mathematical model to express how a contagious disease spreads in a quarantined population. Such a model could provide the answer as to how many people may contact infectious diseases over time. For the development of the model, it is necessary to assume that an infected person will not become sick again after recovery and the duration of transmission is very small. Accordingly, population C(t) is disease carrier at any time, t, S(t) those that can become contagious at any time and D(t) survivors or victims who recover or die. In this case, the equilibrium population, P(t), at any time can simply be written as: (10.35) Let us write the model differential equations based on rational considerations in infinitely minor duration as in the following box. dS(t)/dt = - rS(t)C(t) dC(t)/dt = r(t)C(t) - γC(t) dD(t)/dt = γC(t)

(10.36) (10.37) (10.38)

Here, the constants r and γ take positive values as symptom and recovery rates, respectively. Note that the first two of these equations do not dependent on the variable, D(t). Therefore, it is sufficient to consider the first two equations in the

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box for the variables C(t) and S(t). Either the third equation in the box or Eq. (10.35) can be used to find the component, D(t). Since, there is no change in the population due to quarantine one can write from Eq. (10.35) the following general expression.

Combination and integration of the first two basic equations in the box first yield. (10.39) Considering the initial conditions for the integration operation as C(0) = C0 and S(0) = S0 at t = 0 gives the following solution. (10.40) From Eq. (10.40), dC(t)/dS(t) is a plus (minus) sign since (γ/r)/S(t) > 0, [(γ/r)/S(t) < 0], it means that S(t) < (γ/r), [S(t) > (γ/r)], S(t) is an increasing (decreasing) function. On the other hand, for C(t) → ∞, S(t) → 0, C(t) = C0, and therefore, S(t) = S0. Thus, there is at least one value of S∞ where C(t) reaches zero. From the first two basic equations in the box, C(t) = 0 equilibrium point is obtained for S(t) = S∞. Typical carry-capture plot is given in Fig (10.11).

Fig. (10.11). Disease transport versus capture graph.

From this figure, it is understood that S(t) and C(t) decrease when S0 < (γ/r) if the point (S, C) exists along the trajectory (curve). On the other hand, in the case S0 > (γ/r), S(t) initially increases and reaches a peak if S(t) = (γ/r). Thus, it can be concluded that (γ/r) is an important ratio for the spread of the disease, called the

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“threshold value”. If S0 > (γ/r), an inference is the “disease spread threshold” rule. Accordingly, if the S0 - (γ/r) value is less than (γ/r), the number of people, who will get the disease is approximately 2[S0 - (γ/r)]. To prove this, let us write S0 = (γ/r) + ν and consider a value of ν much smaller than (γ/r). C0 is still smaller at the beginning of the Eq. (10.40) in case of t → ∞.

Furthermore, as a result, approximately the necessary operations for the proof condition are P(t) ≈ S0, and S0-S∞≈ 2ν. Human health statistics determine the number of daily or weekly survivors. Therefore, it is necessary obtain the change in dI(t)/dt evolution over time to compare the model's prediction with the actual values. In the light of what has been said before, it is possible to write: (10.41) After the necessary operations one can obtain.

From here, if S (t) is obtained and then its substitution into the previous equation yields. (10.42) It is not possible to solve this equation analytically. However, when the ratio I(t)/(γ/r) is very small, the expansion of the exponential term to series yields.

Replacing the first two terms of this with the previous equation results in. (10.43) Here.

and

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On the other hand, since it is known that d(tanhx)/dx = sech2x, one can write from mathematics. (10.44) This looks like a bell shape infectious disease curve as in Fig (10.12) and its peak point is t = 2ϕ/αν.

Fig. (10.12). Disease spread curve.

10.9. BLOOD CIRCULATION MODEL The physician Hagen-Poiseuille (1797-1869) based on rational reasoning revealed the first correlation between factors affecting fluid flow in a pipe or vein, thus, providing the blood circulation system that can be thought of as a vessel. It is a channel-like system. Poiseuille blood flow is the amount of blood passing through a vessel cross-section per unit time, called flow rate, Q, or discharge. Poiseuille mathematically expressed this flow rate in terms of the pressure difference, ∆P, at two different points of the vessel, the distance, L, between them, the viscosity of the blood, η, and the vessel radius, r, with the following equation. Q = (πr4ΔP)/8ηL

(10.45)

where the ratio, friction resistance, R, the force on vessel walls against blood flow is given as follows. R = 8ηL/(πr4) Therefore, Eq. (10.45) takes the following form.

(10.46)

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Q = ΔP/R

(10.47)

The literal meaning of this is that the flow rate is directly and linearly proportional to the pressure difference and inversely proportional to the resistance. Resistance against blood flow is directly proportional to the length, L, of the vessel and viscosity, η, but inversely proportional to the 4th power of vessel radius. In the medical field, blood flows due to the pressure difference between the beginning of the system (the aorta - the great artery that comes out of the left ventricle of the heart and distributes clean, red blood all over the body) and the point where the vena cava (main vein) joins the right atrium (heart valve) (Kuroda, et al., 2011). The mean arterial pressure in the systemic circulation is about 100 mmHg and 0 mmHg in the right atrium; the pressure causes blood flow, which is 100 – 0 = 100 mmHg. In simple terms, if the vessel length increases by two times, the resistance will increase two-fold. If the radius of one vessel is half of the other if other factors are constant, the small vessel has 24 = 16-fold greater resistance than the large one. In this case, the blood flow rate is reduced 1/16 times. It can be understood that the most effective factor on resistance and blood flow is the radius of the circulating vessel. As a standard, the viscosity of pure water is taken as 1 and the viscosity of other liquids is based on this benchmark value. For example, the viscosity of plasma (fluid containing white blood cells and red blood cells) is 1.8 and normal blood viscosity is 3-4 (Ho, 2004). Another factor of secondary importance in blood circulation is the viscosity of the blood, which is defined as the internal boundary resistance of fluid to flow (internal friction). Viscosity generates additional resistance to blood flow. There is a logically inverse relationship between viscosity and blood flow. This means that the higher the viscosity, the lower the blood flow, because viscosity is inversely proportional to the fluidity of the blood. In the medical field, erythrocytes (important cells that move through the blood) determine the viscosity in the blood circulation. As in polycythemia (a stem cell disease), an increase in the hematocrit value (the ratio of the volume of red blood cells to the total blood volume) causes excessive red blood cell production in the bone marrow followed by significant viscosity increases in the great vessels. 10.9.1. Blood Flow Velocity and Types In fluid mechanics engineering, the fluid flow rate (discharge) is equal to the product of the flow cross-section area, A, and the average flow velocity, v. On the other hand, the amount of discharge rate, Q, is equal to the volume, V, of fluid per time, t.

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Since, volume equals to area, A, times length, L, so V=AL its substitution into the previous equation leads to. Q = Av

where v = L/t. Comparison this last expression with Hagen-Poiseuille in Eq. (10.45) provides more comments. Since the vessels (aorta, capillaries, etc.) in the human body are very similar from person to person, numerical information about blood flow velocities is given approximately as 36 cm/sec in the aorta, and 0.036 cm/sec in capillaries. Like velocity (cm/sec), which means displacement per unit time and flow (discharge) that means volume per unit time (cm3/sec) are different definitions. As explain above, flow velocity is directly proportional to flow discharge and inversely proportional to cross-sectional area. The larger the crosssectional area, the lower is the velocity. The cross-sectional surfaces in various parts of the circulation system are given in Table 10.1. As can be seen, the total cross-sectional area in the capillaries is 1000 times larger than the aorta. The largest cross-sectional area is in the capillaries and the lowest in the aorta. Table 10.1. Total cross-sectional surfaces in the circulation system. Vein type

Cross-section area (cm2)

Aorta

2.5

Vena caves

8.0

Small arteries

20

Arterioles

40

Small veins

80

Venules

250

Capillaries

2500

There are two different types of blood flow in veins as uniform stratified flow (laminar flow) and complex flow (turbulent flow). While the blood layers continue to flow at the same distance from the wall, there is a very thin inert blood boundary layer in contact with the vessel wall. This layer reduces the resistance of blood flow due to the vascular walls. Starting from this immobile layer, the blood flow velocity continues to increase towards the center of vessel section and the greatest blood flow velocity occurs in the center.

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Steadily increasing flow velocity causes the smooth-stratified flow to become turbulent after a critical level. The uniform-stratified current is quiet, but the other makes noise. The transition to turbulent flow is dependent on vessel diameter and the blood viscosity. Whether the flow is smooth or turbulent can be decided based on the numbers put forward by the medical researcher, Reynolds (1842-1912). He proposed the Reynolds number to decide on the distinction between smooth and turbulent flow and this number is defined in the following mathematical form depending on blood density, ρ, velocity, v, vessel diameter, D and viscosity, η, as: (10.48) If Re < 2000, the flow is laminar, but Re > 3000 corresponds to turbulent flow. 10.9.2. Total Preferred Blood Resistance Although peripheral artery disease is known as the disease of the lateral and end branches of the aorta, it refers to the arterial occlusions, especially in the legs. The sum of all vascular resistances in the blood circulation system is called “total peripheral resistance” and its unit is dyn.sn/cm (Guyton, 1981; Magosso and Ursino, 2002). In practice, it is not possible to measure directly vascular resistance, and therefore, blood resistance, R, is calculated as blood pressure, P, (mmHg) divided by blood flow discharge, Q (m/sec). (10.49) Thus, resistance is defined as the amount of blood pressure per unit blood flow. Logically, resistance is directly proportional to blood pressure, but inversely proportional to the discharge of blood flow. If the pressure difference is 1 mmHg and the flow is 1 mL/sec, the resistance is calculated as 1 mmHg/1mL/sec. In medical science, if the mean aortic pressure is 100 mmHg, the right atrium (atrium) pressure is 0 mmHg, and the left ventricular flow rate is 100 mL/sec, the total peripheral resistance is 100-0 mmHg/100 mL/sec = 1 (Mackram, et al., 2019). When all blood vessels in the body are strongly contracted, the total peripheral resistance may rise up to 4R units, and conversely, when the vessels are too dilated, it may drop to 0.2R units. Since the mean arterial pressure in the pulmonary system sis 16 mmHg and the mean left atrial pressure is 2 mmHg, total pulmonary resistance is about 16/100 = 0.16 (Bourge et al., 1991; Kwan et al., 2019; Widrich and Shetty, 2021). In some diseases, the resistance value can go up to 1, but, in some physiological conditions (the branch of life science that studies

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the functions of the eyes, tissues and organs of living things and how these functions are performed), it can decrease to 0.04. 10.10. HUMAN ENGINEERING Human and engineering activities should not be thought as completely different and non-overlapping. The real question is does human engineering influence human activities. In general, the idea that engineering aspects affect human, and therefore, the impact on human activities comes to mind first through engineering methodological donations and solutions. The view is rather fuzzy because human and engineering activities are intertwined implying human influence on engineering and vice versa. All conceptual models deal with parts of something perceived by human mind as environment that is to be used for what our ego-cantered minds consider meaningful. For example, among these meaningful fragments, there are clear and hidden interrelationships for the exploration of human intellectual mind. Unsupervised or supervised (trained) minds in anything like science, medical engineering, economics, politics and philosophy are concerned with adapting many distorted conceptual models to exert power and predict the emerging dynamics of reality that are beyond our ability and control without uncertainty. In order to understand the meaning of “Human Engineering” let us concentrate on the meaning of “Human” and “Engineering”. The former is a creature, who has mind, and hence, capable to distinguish among many objects in the surrounding. Human beings can grasp, whatever is available in the adjacent environment alive or material. In this manner, one can attach specification to each existence about its appearance, materialistic content, visual features (color, shape, dimensions, taste, smell, etc.). In this manner, human beings became eligible, knowledgeable, informative, cognitive and at the end idea generative. These thought abilities and conceptual grasps provide for anyone unprecedented position among all the ontological existences in the world. One is capable to dominate on anything materialistic by own reach to render natural surroundings in the environment to rather artificial scene for comfort, health, easiness, social relationships, and socioeconomic activities. It is not possible to render human life without their impact on the natural resources in the environment. Such human impacts are everywhere, and they are evidences from deep human history throughout many centuries (Chapter 3). In short, one can state that without human impact on environment human beings cannot have health, socio-economic, cultural and harmonic life on the earth. As for the “engineering”, there are different terminologies in different languages. For instance, in Islamic countries, this career is termed as “Mohandas”, which

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means, who “Geometrize” the thoughts. Is there any engineering task that has been achieved without imagination and design (Chapter 2), which are also dependent on the shapes and geometry in the forms of not only Euclidian geometry that is thought in any education system, but also shapes in the form of functions, flow charts, algorithms, plans, and alike. Hence, an engineering career has an impact on the environment not as common human impacts, but through systematic, artistic, cultural and structural designs. Engineering impact on the society and environment is rather different from the human impact as explained in the previous chapters. Especially, after the nineteenth century, many engineering careers emerged according to the need of the human society. Among these careers at the service of man are mechanical, electrical, mining, and chemical, food, software, computer, industrial, and other engineering branches. One can state that today almost there is no socio-economic, medical, cultural or any other human activity where there is not engineering services. Recently, in the literature, a new terminology has emerged as the “Human Engineering” in order to combine the above-explained human and engineering services. It is not necessary that one should have an engineering degree to serve in the human engineering activities. In this title, the two words “human” and “engineer” need a detailed explanation so that the person recognizes his personality and then especially engineering career is the main topic of this paper. Different engineering careers must be aware of human intellect strength, productivity and the possibility of innovative idea generation aspects through suspicious thoughts, imagination and design in the light of existing information critical review with aspirations of new findings or improvements. Basic knowledge and methodological approaches depend on human-born abilities, ideas and factors. Human beings have psychological, biological, spiritual and physical characteristics, all of which help them to focus on a problem and try to find solutions, and if not possible, to reach the final approximate solutions at least to achieve the final goal temporarily. In general, human engineering strives for error reduction, productivity increment, and safety and comfort enhancements, including health. It is, therefore, human and engineering thought achievements are like each other, hence, to enlarge the vision of engineering “human engineering” concept is coined for a better explanation of the relationships between these two closely related words. As stated by Booher (1990) and Wickends et al. (1997), the human factors achieve their goals through the flow chart in Fig (10.13).

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Fig. (10.13). Human factor cycle.

Humans are bound to change the physical equipment that they work for better end purposes. Task design is concerned with procedures rather than physical features. Environmental design is related to improvements in the environmental impacts of concerned designs. For good system performance, selection part of (Fig 10.13) indicates the best alternative decision in the system under assessment. Human engineering is concerned with the research of the mental and physical abilities of human beings, which are necessary for their healthy works, and the relations with the activity and devices they use at work. Human engineers use scientific knowledge and research methods in the areas of human interest. In Fig (10.13) various units are shown, including system, hardware (building, machine, device, computer, etc.), software (science methods, algorithms, computer software, etc.) and personnel (engineer, doctor, operator, industrialist, etc.). In the absence of one of these three infrastructures, human engineering services are not achievable.

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Fig. (10.14). Elements of human engineering.

Human engineering is the design of buildings or mechanical devices for the comfort of people by considering their physiological or psychological desires. In short, human engineering is the name given to the art of management made to ensure the best harmony between humans and the environment. It is useful to consider the main parts that play a role in the human engineering process within the framework shown in Fig (10.14) (Şen, 2020). The purpose of all the work done is to serve people in order to provide health, peace and comfort full environments. In many institutions and organizations, units called human resources management also fall under the subject of human engineering. In fact, one can consider human engineering succinctly as the art of managing people. Accordingly, human engineering should be based on human thinking and body structures. In addition to these, the social, psychological, political and economic structures and health of human should be considered within human engineering subjects One can consider the infrastructures necessary for human engineering to fulfill its basic functions in four general parts material, economy (budget), personnel and

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institution. As employer and employee, the “human” factor in the organization realizes production based on logical and rational knowledge, which are acceptable as one of the most fundamental sources of production by both economy and management science experts in recent years. 10.10.1. Human Engineering Innovation In order to alleviate various human activity impacts in various aspects such as energy, medicine, economy, industry, transportation, agriculture and waste management tasks, the following five points summarize the necessary requirements (Şen, 2020). 1. 2. 3. 4. 5.

Observation (qualitative, linguistic knowledge). Measurements (quantitative, numerical, information). Generalization (logical rules, mathematical models). Simulation (stochastic replication). Prediction (numerical modeling)

Throughout the history of science, human intellectual triggering toward beneficial inferences began with observation certain events in different topics. Observations motivate humans to ponder the external and then internal working mechanisms on rational and logical bases. The inferences from each observation appear first in the form of verbal information, which provides discussion possibility among concerned individuals. In this way, some original ideas emerge and some of them may remain as fundamental terminological, etymological and epistemological facts. However, whatever the conclusions are, they are debatable and by the time there are improvements. Observations inferences must gain concrete bases through the measurements, if possible, otherwise they are valid until possible direct or indirect measurements achievements. After all the previous explanations, now the role of human engineering needs further explanation. The driving force towards better development is the innovative ideas and their applications in the form of services, instruments and education. Today, development and innovation are the two terms that go hand by hand for better achievements. Engineering, education, innovation, and some other essential ingredients are schematically shown in Fig (10.15). The fundamentals of any successful and fruitful activation in daily life should be based on the science philosophical approximate reasoning and rational, logical inferences, which are expressible linguistically. In this Fig, the impregnation of

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each circular activity in the ocean of science, philosophy and logic is pregnant with new ideas if ambition, innovation, critical reasoning and endurance are run after. Systematic education by itself seldom may lead to innovative ideas. However, education through different stages of experience, expert views and corporation with other individuals, institutions, departments, universities or companies is the main path towards the innovative results. On the other hand, anyone without higher systematic education may also generate innovative ideas through experience, expert views and corporation in a team.

Fig. (10.15). Essential ingredients for innovations.

The question at this stage, “is it necessary to go through a systematic education system for innovative idea generations?” The answer is not necessarily affirmative, because although education seems necessary, but not enough for innovative idea generations. 10.10.2. Medicine and Human Engineering Especially after the Second World War, technological works have developed in a speedy manner and even reached deep space researches. As a side production of these developments, innovative inventions took place in the medical

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instrumentations, and hence, the physicians began to benefit from these instruments at an unprecedented rate. One can count the following points among them (Bronzino and Peterson, 2015). 1. Solid-state electronic developments made possible mapping of the central nervous system as fine as possible. In the same time, different physiological parameter measurements become possible by means of electrocardiogram, and hence, better medical services can be rendered to extensive care patients. 2. New instrument invention desires become the objective of engineers for life facilitation of crippled persons. 3. Nuclear physical researches provided effective diagnosis of abnormal physiological cases speedily. 4. Based on the sonar technology, the ultrasonic diagnosis works became an undeniable diagnosis method in medical research. 5. Spare parts of medical devices are among the usual technology studies. The technology has also helped the heart-related devices, for example, the heart to work with batteries. On the other hand, artificial heart valves and artificial blood vessels are also manufactured. 6. Progress in material sciences has led to the proliferation of disposable materials (needle, thermometer, etc.) after being used once in the medical field. 7. Advances in molecular engineering have led to the discovery and implantation of numerous pharmacological elements. 8. Computer software became effective in the storage, comparison and processing of medical records. Hence, it is possible quickly to associate different disease symptoms with potential diseases in statistical terms. 9. Development of the first computer-based medical instruments, examination of rapid tomography scans with computers, development of clinical approaches in innovative ways, rapid processing of MR images. 10. Introduction of a wide range of new cardiovascular technologies and chemical stents. 11. Preservation of epilepsy and nerve propagation system improvements. 12. Production of artificial organs and tissues. 13. With a better understanding of the cell, many activities such as bimolecular cells, processes and stem cells to repair organ tissues on site. 14. With the development of nanotechnology in tissue engineering, the use of nanomaterials is on the agenda. By means of these, it is possible to heal more diseases and injuries.

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10.10.3. Recommendations In the light of topics mentioned in the previous sections, the following points are worthy of consideration for better innovative orientations. 1. Innovative ideas, procedures, methods and applicative directions are possible through research and development (R&D) activities, and especially as for the better social development is concerned, such activities must be accomplished by state and private sectors with support of universities and research centers. 2. Innovations do not come into existence without basic research and application works, which are not supportive by some institutions, because they may need initial costly investments. Such innovations can be achieved frequently by a combined team from the interested companies and university research departments. 3. Systematic and mechanical education institutions may graduate students with certificates, but their business and commercial interests may not be obtained by such documents, because innovation requires even approximate thinking, but critical and at times, offline ideas. 4. Whatever is learned must pass through the scientific principles and philosophy of science, which is then trimmed for rational, plausible and innovation idea generation directions, and the logical thinking must lead to a set of logical rules for the task concerned. Engineering innovative research doors are open for systematically educated or nonprofessional inventors at equal level, if they walk along a similar research and development path for better improvements. CONCLUSION The content of this chapter presents the application foundations of philosophical and logical principles for medical instruments or scientific developments over time. The mathematical expressions are the most effective means for a medical student or specialist to apply to predict possible consequences. Various medical instrumentation and case study modeling procedures and investigations of possible future collaboration between physicians and engineers are illustrated with examples. This chapter provides a set of recommendations based on all of the previous chapters. Consideration of the mathematical methodologies allows a medical student or practitioner to look forward and generate effective new solutions. REFERENCES Bourge, R.C., Kirklin, J.K., Naftel, D.C., White, C., Mason, D.A., Epstein, A.E. (1991). Analysis and

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predictors of pulmonary vascular resistance after cardiac transplantation. J. Thorac. Cardiovasc. Surg., 101(3), 432-445. [http://dx.doi.org/10.1016/S0022-5223(19)36725-X] [PMID: 1999936] Booher, H.R. (1990). MANPRINT: An approach to systems integration.New York: Van Nostrand Reinhold. [http://dx.doi.org/10.1007/978-94-009-0437-8] Bronzino, D., Peterson, D.R. (2019). The Biomedical Engineering Handbook.Boca Raton: Taylor and Francis, CRC Press. Burghes, D., Borrie, M.S. (1981). Modeling with differential equations. Publisher: Chichester: E.Horwood, New York: Halsted. Guyton, A.C. (1981). The Relationship of Cardiac Output and Arterial Pressure Control. Circulation, An Official Journal of the American Heart Association. Inc., 64(6), 1079-1088. Ho, C-H. (2004). White blood cell and platelet counts could affect whole blood viscosity. J. Chin. Med. Assoc., 67(8), 394-397. [PMID: 15553798] Kuroda, M., Tokue, A., Miyoshi, S., Kadoi, Y., Saito, S. (2011). Echo rounds: anomalous insertion of the inferior vena cava into the right atrium. Anesth. Analg., 112(6), 1296-1299. [http://dx.doi.org/10.1213/ANE.0b013e31821970ce] [PMID: 21467566] Kwan, W.C., Shavelle, D.M., Laughrun, D.R. (2019). Pulmonary vascular resistance index: Getting the units right and why it matters. Clin. Cardiol., 42(3), 334-338. [http://dx.doi.org/10.1002/clc.23151] [PMID: 30614019] Eleid, M.F., Padang, R., Pislaru, S.V., Greason, K.L., Crestanello, J., Nkomo, V.T., Pellikka, P.A., Jentzer, J.C., Gulati, R., Sandhu, G.S., Holmes, D.R., Jr, Nishimura, R.A., Rihal, C.S., Borlaug, B.A. (2019). Effect of Transcatheter Aortic Valve Replacement on Right Ventricular–Pulmonary Artery Coupling. JACC Cardiovasc. Interv., 12(21), 2145-2154. [http://dx.doi.org/10.1016/j.jcin.2019.07.025] [PMID: 31699376] Magosso, E., Ursino, M. (2002). Cardiovascular response to dynamic aerobic exercise: A methematical model. Med. Biol. Eng. Comput., 40(6), 660-674. [http://dx.doi.org/10.1007/BF02345305] [PMID: 12507317] Smith, F.E. (1963). Population dynamics in daphnia magna and a new model for population growth. Ecology, 44(4), 651-663. [http://dx.doi.org/10.2307/1933011] Şen, Z. (2002). Bilimsel Düşünce ve Matematik Modelleme İlkeleri (Scientific Thoughts and Mathematical Modeling Principles).Istanbul: Su Vakfı Yayınları. Şen, Z. (2020). Human engineering for innovative research and commercialisation directions. International Journal of Research, Innovation and Commercialisation, 3(1), 22. [http://dx.doi.org/10.1504/IJRIC.2020.109376] Wickends, C.D., Gordon, S.E., Liu, Y. (1997). An Introduction to Human Factors Engineering.Addison, Wesley, Longman. Widrich, J., Shetty, M. (2021). Physiology, Pulmonary Vascular Resistance.Treasure Island, FL: StatPearls Publishing.

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CHAPTER 11

Conclusion Philosophy and medicine have been twin sisters since the dawn of human history, in order to generate logically rational treatment alternatives that support human health after careful diagnostic studies. Although medicine originally started with suggestions to deal with superstitious ideas, medical content took the principles of philosophical, logical and rational thoughts during the ancient Greek period, reflecting the accumulated rational information and knowledge including ancient civilizations, written in books. Galen was the most famous thinker during this period, combining medical aspects with philosophical and logical components. Philosophically, the fraternity with medicine continued almost until the 18th century. In this period, philosophers and thinkers of the Islamic period also focused on medicine with philosophical and logical rules supported by experiments. The most respected medical expert to emerge in this period is Ibn-i Sina (Avicenna), whose “Canon of Medicine”, book in English “Law of Medicine” provided pre-modern fundamentals of medical science. The first two chapters of this book are concerned with philosophical, logical and rational thoughts concerning past and modern times. Chapter 2 discusses the basic principles of reflective thinking and presents possible relationships between different thinking procedures. In the first sections, different stages of thinking are emphasized and after the propositional inferences, the final knowledge generations are determined. The main purpose of such an approach is to finally arrive at rational knowledge through critical thinking arguments, propositions, and inferences and also bring them into widely acceptable forms. Chapter three details the history of medical science related to early civilizations, including those along the Nile, Tigris and Euphrates rivers before the study of ancient Greece, Islamic, and modern Western medicine. The sections in this chapter include the contributions of different civilizations to medical science and its treatments, in historical chronology. Although linguistic communication between physicians and patients is important, it is emphasized that medical terminological contents provide expert communication between medical professionals. Detailed information is provided in Chapter 4 about these aspects. Etymologic and epistemological concepts of informative knowledge are hidden in concepts, words, sentences, definitions, terms, terminologies and existing scientific structures. The available knowledge is in the hands and minds of experts and is useful for establishing mutual linguistic agreements between patients and physicians in concise, short, easy and

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meaningful ways. Any professional knowledge evolves over time, including more refined scientific terminologies that are significantly related to the subject. Before the applications of logical principles, a separate chapter is devoted to the definition of knowledge in the light of philosophy in the field of medicine. It deals with general philosophy, ontology, epistemology, metaphysics, ethics and aesthetics. However, the philosophy of science, which includes medical research, takes more into account epistemology, ethics and aesthetics. Chapter 5 presents the distinguishing features of medicine from other science subjects. The close relationship between philosophy and medicine is revealed in Chapter 6 with more refined information, continuing with discussion on tissues, cells, macro-molecules, and micro-molecules at atomic and sub-atomic scales. Such a detailed informative structure reveals its relevance not only to specialist physicians, but also to those working as laboratory workers in clinics. The informative array of knowledge provides an opportunity to mediate each piece. Some preliminary explanations of the uncertainties are presented in this chapter as a preparation for the detailed explanations in Chapter 8. In Chapter 7, it is mentioned that logical rules and principles are necessary to define rational prescriptions from the general ocean of philosophy and transform ideas into more scientifically acceptable forms. The main information in this chapter is about logic, which helps to reach more rational and productive thoughts and ideas about an event involving medical sciences. In general, after the philosophical thinking principles explained in the previous few chapters, the logical rule filtering of the rational reductions of the philosophically obtained information is refined and becomes more applicable after the logical rules are loaded. Logical words and sentence propositions are explained based on both crisp (two-value) and fuzzy logical rule-based expressions. Logic plays a very important role in medical sciences, based on sound reasoning. It is recommended that fuzzy logic principles and rules play a central role in medical sciences, as mathematics is based on exact crisp logical principles, and communication between a doctor and a patient takes place linguistically before laboratory analysis of some numerical data. There is always uncertainty especially in social studies such as medicine, law, and economics. Words are treated as absolute true or false without any middle content in idioms and sentences and in two-value logic expressions. Patients explain their complaints to the physician with verbal ambiguities in words and sentences. In this respect, one of the first things that medical graduates should do is to have interviews with patients in order to gain expertise by considering fuzzy logic rules instead of two-value logic (crisp logic). All the rules of logic and reasoning in the

Conclusion

Scientific Philosophy and Principles in Medicine 299

previous chapters had some implicit assumptions. First, two-value and mathematical symbolic logics are based entirely on the principles of certainty. Although the probability is said to be similar to fuzziness, the latter includes verbal and numerical data and statements to arrive at a final inference. In the field of medicine, while majority of diagnoses were based on verbal information in the past, much more in-depth and precise diagnoses can be reached with supporting numerical information today. The main reasons for this are technological updates, engineering software and devices that enable digital data processing. In addition to the most commonly used Magnetic Resonance (MR) devices today, there are many different devices besides X-rays offered to medical professionals for visual examinations, such as layer by layer scanning of the human body. If measurements are available, it is possible to diagnose with more meaningful interpretations by converting this set of numbers into graphical forms that provide visual inspections and enable the physician to make more meaningful diagnoses. The final chapter presents some of the methodologies commonly achieved byengineering studies and physicians, and the possibilities for further collaboration. Especially, in the field of medicine, some basic mathematical foundations are explained with appropriate mathematical formulation derivatives.

300

Scientific Philosophy and Principles in Medicine, 2022, 300-313

SUBJECT INDEX A Ability 2, 3, 4, 36, 38, 39, 40, 41, 43, 44, 45, 82, 125, 154, 156, 166, 280, 289 hearing 280 human-born 289 inert 156 innovative information generation 39 rational intelligence 166 Activities 22, 135, 288 cerebration-mind 22 heart muscle 135 socioeconomic 288 Adolescent 218 Alexandrian 73, 84 library 73 museum 84 Algorithms 8, 126, 147, 187, 196, 205, 214, 237, 238, 250, 251, 289, 290 appropriate statistical method selection 250 computer assessment 237 data mining 214 decision-making 205 Analysis 9, 148, 162 numerical 9, 148 systematic 162 Ancient 24, 73, 77, 78, 160, 297 civilizations 24, 77, 78, 160, 297 Egypt-Greek civilizations 73 Ancient Greek 10, 24, 59, 70, 73, 75, 80, 83, 85, 100, 112, 150, 152, 168, 173, 191 civilization 10, 24, 59, 70, 73, 80, 83, 152, 168, 173, 191 era 75 medicine 80, 85 philosophers 100, 112, 150 Anesthesia 134, 227, 233 Antibody reactions 135 Antiseptics 102, 134 antibiotics 134 chemical 134 Apollo’s Asclepius 80

Applications 17, 18, 60, 65, 66, 122, 123, 147, 148, 205, 226, 227, 238, 239, 251, 252, 257, 258 blind 147 mechanical 148 medical 205, 227, 238, 239 Approval, ethical 121 Arabic 83, 98, 101, 102, 112 cupping 98 language 102 numerals 83 sources 101, 112 Archeological remnants 24 Arguments 8, 14, 17, 28, 46, 113, 115, 146, 167, 175, 179, 181, 201, 278 basic philosophical 167 deductive 8 historical 17 inductive 8 theoretical 146 Aristoteles, ancient Greek thinker 23 Aristotelian logic 55 Aristotle, ancient Greek thinker 179 Arithmetic 24, 73, 83, 110, 154, 250, 252, 253, 255, 256, 262, 266 averages 250, 255, 256, 266 operations 83 Art 11, 80, 82, 87, 106, 109, 112, 121, 143, 144, 148, 152, 172, 178, 291 intermingling 152 oral speech 109 Artificial 55, 294 heart valves 294 natural scenes 55 Asklepios and Roman period 95 Aspirations 70, 289 Avicenna’s work 97

B Babylonian 79 civilization 79

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Subject Index

Scientific Philosophy and Principles in Medicine 301

divination technique 79 Bacteria 134, 135, 140 nitrogen-producing 134 Benefit 17, 39, 42, 43, 50, 82, 84, 94, 124, 126, 139, 149, 171, 172, 173, 262, 263 constructive 50 economic 17 feeding 94 Biomedical 16, 225 instrumentation 16 paradigm 225 Bivalent logic 13, 69, 168, 183, 187, 195, 196, 197, 201, 205, 206, 208, 209, 222, 227, 229, 230, 242 rules 69, 205, 206 stereotyped 168 system 222 Blood 273, 274 and cleansing fluid flow rates 273 contaminated 274 dirty 273 Blood circulation 86, 96, 97, 100, 117, 260, 284, 285, 287 system 117, 284, 287 Boundaries 10, 14, 145, 148, 233, 234 definite 234 Boundary conditions 270, 276

logical 217 mental 116 natural 233 Cloudy 5, 13, 23, 26 speculative fancy 23 Coefficients 264, 265 birth-death ratio 265 birth growth 264 mortality ratio 264 Commerce 80, 82 daily 82 Commodity, restrictive 268 Communication 12, 18, 40, 41, 42, 107, 109, 113, 114, 122, 124, 131, 132, 139, 162, 177, 211, 212, 213, 219, 297 daily life 12, 219 linguistic 297 mutual rational 162 tool, linguistical 18 verbal philosophical 139 Communities 37, 68, 107, 124, 132, 148, 172 harmonious information 107 isolated rural 68 Companies 16, 18, 126, 249, 293, 295 insurance 249 private 16 Completion of integration process 267 Computer 44, 201, 224 program 44, 224 simulation work 201 Concentrations 251, 271, 274, 278 liquid 251 Concepts 106, 118, 127, 132, 141, 160, 188, 205, 226, 239, 297, epistemological 106, 160, 297 medical 132, 205, 226 metaphysical 141 psychology’s 118 statistical 239 traditional 127 virtual 188 Conditions 53, 54, 58, 92, 93, 94, 119, 121, 123, 169, 170, 189, 266 restrictive natural resources 266 Conjunctions 182, 183, 184, 185, 187, 193

C Carbohydrate foods 277 Cartesian coordinate system 207, 251, 252 Chaos theory 9 Chest pain 133 Child 78, 111, 213, 218 newborn 111 Church authority 30, 59, 78 Circulation 86, 117, 286 pulmonary 86 system 286 Civilizations 24, 49, 51, 61, 62, 68, 70, 76, 77, 78, 85, 149, 150, 151, 169, 262 period 85 Classifications 116, 217, 233

302 Scientific Philosophy and Principles in Medicine

logical 184, 185 Connection 32, 44, 52, 91, 126, 131, 190, 192, 201 multiple 190 Consciousness 3, 22, 26, 27, 56, 107, 111, 122, 125, 133, 180, 234, 257 omnipresence 27 resonance 3 Consequences 24, 43 irrational 24 productive 43 Conservation principle 261 Content 2, 96, 106, 109, 115, 118, 136, 138, 140, 142, 144 epistemological 2, 106 Correlation 13, 189, 193, 225, 250, 255 coefficient 225, 250, 255 methods 255 Cultures 6, 10, 31, 34, 61, 62, 103, 112, 142, 149, 166, 212 advanced scientific-philosophical 6

D Data 121, 251 analysis 121 treatment procedures 251 Database 147, 223 numeric 223 verbal 223 Datasets, numerical 237, 240, 245 Decisions 2, 55 diagnostic 2 expert systems 55 Deduction 22, 24, 29, 44, 45, 150, 152, 157, 178, 192, 200, 262 intelligent 178 method 24 rational 152, 178 verbal 157 Deductive thought process 200 Defuzzification processes 234 Deontology 135

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Derivations 62, 115, 123, 154, 163, 206, 258, 260, 261, 263 convenient mathematical formulation 261 mathematical equation 206 mathematical expression 260, 263 Design, mechanical device 59 Detecting diabetic retinopathy 233 Deterministic 9, 12, 47, 52, 55, 65, 196, 211, 222 algorithms 65 mathematical equations 55 principles 9 Developments, electronic 294 Devices 18, 37, 59, 60, 75, 131, 175, 212, 225, 238, 239, 290, 291, 294, 299 assistive 75 heart-related 294 indigenous 60 ingenious 59 measuring 238 mechanical 225, 291 medical 18, 294 Diabetes mellitus 277 Diabetic neuropathy 233 Diagnosis 10, 11, 12, 13, 17, 119, 120, 131, 164, 165, 166, 205, 210, 226, 237, 238, 239, 250, 251, 260, 299 defective 238 healing twin 166 medical 13, 205, 260 plausible 17 Dialysis 260, 273, 274, 275, 276 concentration 276 Dialysis machine 251, 272, 273, 275 model 272 Discrete mental processes 180 Disease(s) 77, 78, 79, 83, 88, 93, 94, 96, 97, 102, 111, 131, 132, 135, 160, 161, 169, 170, 172, 204, 205, 225, 226, 231, 232, 245, 247, 249, 266, 281, 282, 285 and Witchcrafts in Ancient Mesopotamia 78 chronic obstructive lung 225 contagious 111, 281 diagnosing 204 epidemic 97, 266

Subject Index

Scientific Philosophy and Principles in Medicine 303

eye 96 infections 172 infectious 93, 94, 97, 102, 281 jaundice 94 lung 205 measles 88 nervous 132 skin 77, 93, 135 stem cell 285 stomach 77 transport 282 Disorder 29, 131, 161, 227 delusional 29 Distance 91, 117, 244, 269, 274, 277, 280, 284, 286 infinitesimal 269, 274 Distillation techniques 104 Dizziness 244 Drugs 69, 77, 80, 226, 227 anesthetic 227 therapeutic 77 Dysfunctional bodies 11, 140

Electrocardiography 135 Elements 78, 216 cluster 216 herbal 78 Empirical evidence 6 Encyclopedias 89, 102 Encyclopedic work 86 Engineering 18, 156, 239, 288, 289, 299 activities 288 imagination 156 mathematical foundations 18 methodological donations 288 services 289 software 239, 299 Environment 10, 28, 33, 45, 48, 115, 121, 124, 128, 129, 163, 164, 165, 170, 172, 190, 288, 289, 291 harmonious 129 social 10, 124 traditional 33 virtual 28, 121, 190 Epidemics 81, 97, 101, 199, 260, 263 plague disease 97 Epilepsy 83, 102, 294 Epistemological 146, 292 facts 292 realism 146 Equations 47, 195, 196, 197, 254, 255, 257, 275, 276, 278, 279, 280, 281, 282, 283, 284 linear 255 non-linear 47 Equilibrium 279, 281 population 281 state fluctuations 279 Erythrocytes 285 Ethics 10, 11, 39, 140, 142, 145, 159, 160, 169, 171, 172, 298 humanitarian 39 medical 145, 172 European 49, 112 countries 112 societies 49 Evolution 23, 26, 30, 54, 68, 112, 146, 151, 212

E Education 1, 3, 18, 35, 36, 37, 85, 88, 123, 124, 160, 164, 165, 166, 175, 292, 293 medical 18, 85, 160, 164, 165, 166 Education systems 3, 5, 36, 37, 38, 39, 44, 46, 52, 140, 145, 147, 149, 152, 153, 154, 163, 164, 175, 176 dynamic 3 inductive 46 mechanical 5, 164 medical 140, 145, 163 productive 39 traditional 5, 37 Effects 72, 126, 245 astronomical 72 fatigue 245 mental 126 Egyptian civilization 70, 76, 77, 78, 81, 83 Einstein’s theory 146 Electrocardiogram 294

304 Scientific Philosophy and Principles in Medicine

natural 112 theories 151 Expression 3, 15, 47, 111, 132, 154, 177, 256, 263, 264, 265, 268, 269, 270, 271, 272, 274, 275, 276, 280, 298 equilibrium 274 facial 132 linguistic 3, 15, 111 logical rule-based 177, 298 rhetorical 154 stress 47

F False empirical theories 146 Falsifiability principle 39 Falsifiable theories 191 Falsification principle 14, 52 Fatigue 94, 141 Fever 77, 113 Filter permeability 274, 277 Filtering 126, 167, 298 logical rule 298 Flexor-tendon repair techniques 233 Flow 25, 210, 251, 285, 286, 287 laminar 286 smooth-stratified 287 Fluid 135, 274, 285 accumulation 135 mechanics 285 Folk medicine practices 131 Forces technology manufacturers 214 Formal 13, 179 logic in philosophy 13 reasoning principles 179 Fourier 47, 238, 261 analysis 238 encoding 238 law 47 Fractal geometry, natural 211 Friction, internal 285 Functional neuroimaging 201 Functions 44, 91, 152, 251, 269 exponential 251

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human organ 91 interior model mechanism 44 mental 152 sigmoid 269 theoretical probability distribution 245 Fuzzy 6, 13, 14, 58, 108, 131, 205, 211, 213, 214, 217, 218, 221, 222, 223, 230 content 211 coverage 58 disease classifications 217 education system 214 environments 131, 211 expert systems 205 information 13, 108 modeling principles 213 principles 230 proportion 14 statements 6 system 221, 222, 223 taxonomy 218 theory 205 Fuzzy logic 14, 15, 18, 55, 178, 179, 193, 196, 197, 201, 204, 205, 206, 208, 212, 213, 214, 215, 217, 218, 220, 226, 227, 228, 229, 230, 232, 233, 234, 260, 263 applications 214 approach 215 assessments 205, 206 classification 217 clusters 229 inference principles 263 infrastructure 228 method 226 principles 15, 18, 196, 197, 205, 208, 213, 218, 234, 260, 263 propositions 193, 220, 232 rule guidance 212 statement 201 systems 234 Fuzzy set(s) 7, 9, 214, 215, 216, 218, 219, 220, 221, 226, 227, 231, 234 convenient 231 in propositions 221 separation 215 theory 234

Subject Index

Scientific Philosophy and Principles in Medicine 305

G

Human engineering 288, 289, 291, 292, 293 activities 289 influence 288 innovation 292 process 291 strives 289 Human thought 128, 153, 258 activities 128 evolution 153 system 258 Hydraulic conductivity 274 Hydrotherapy 69 Hygiene 85, 102 social 85 Hypertension 119, 233 disorder 119 Hypnotic drug thalidomide 226 Hypothesis terminology 106 Hyppocrates 88 Hyppocratian medicine 98

Gadgets 18, 37, 38, 70 educational 37, 38 Galenic orthodoxy 100 Glucose concentration 278 exogenous blood 278 Glucose exchange 279 Greek 80, 81, 107, 119, 179 languages 119, 179 medicine 80, 81 origins 107

H Habits, drinking 245 Headache 115, 118, 119, 218, 244 Health 10, 58, 99, 101, 121, 278 disaster 101 employees 99 problems 10, 58, 121, 278 Healthcare professionals 169 Heart 22, 30, 68, 76, 219, 244, 285 attack 219 beats 30 communication 22 disease 68 failure syndrome 76 rate and blood pressure relationships 244 valve 285 Hellenic world 103 Hellenistic 70, 73, 80, 83, 165, 167, 173 civilizations 70, 73, 83, 165 period 73, 80, 167, 173 Hepatoscopy 79 Herbal medicine 77, 85 Herbs, medicinal 86 Hormone 134, 277, 278 Human(s) 35, 50, 84, 86, 126, 128 anatomy 84, 86 cognition 35 curiosity 128 life sustainability impulse 50 process information 126

I Images 3, 4, 113, 117, 169, 227 mental 117 Immunity 135 passive 135 Implications 12, 17, 18, 58, 113, 130, 132, 144, 186, 212 empirical 212 spiritualistic 130 Impression 12, 14, 24, 45, 79, 199, 202, 207 facial 12 Indian 70, 88 civilization 70 medicines 88 Industrial revolution 64 Inference(s) 18, 22, 26, 27, 29, 45, 46, 52, 177, 178, 179, 180, 181, 187, 190, 191, 192, 237, 244, 292, 297 non-monotonic 181 probabilistic 244 proportional 22 propositional 26, 297

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306 Scientific Philosophy and Principles in Medicine

reliable 237 systems 18 Infertile information 39 Information 1, 30, 31, 54, 73, 152, 213 deduction 152 flow 31, 213 generation 30, 31 production 1, 31 renewal 54 resources 31, 73 Information accumulation 31, 51, 154, 238 stagnant 51 systematic 154 Information sources 29, 48, 73, 138, 152, 208 imitative 48 medical 73 Innovations 16, 18, 22, 33, 60, 121, 122, 128, 151, 292, 293, 295 technological 128 Innovative 5, 38, 56, 65, 145, 174 developments 56 education systems 5, 38, 65 information 174 programs, contemporary 145 Instruments 18, 37, 70, 141, 238, 260, 292, 294 automated 238 auxiliary 141 sensitivity 141 Insulin 277, 278 pancreatic gland 277 Inter-civilization relationships 74 Inventions 52, 94, 148, 175, 262 geographic 52 technological 262 Inverse proportionality relationships 230 Isaac Newton 91 Islamic 70, 73, 75, 76, 78, 82, 83, 87, 95, 97, 99, 100, 165, 168 civilization 70, 73, 75, 76, 78, 82, 83, 87, 95, 97, 99, 165, 168 medicine translations 100 Issues 3, 7, 87, 108, 147, 208, 260 ethical 147 fundamental 147

imaginary 3 medical 3, 108, 260 moral 7 technical 208 therapeutic 87

K Kidney machine 273, 275, 276, 277 artificial 276 elements 273 works 275 Knowledge 6, 22, 23, 26, 27, 35, 41, 42, 48, 60, 61, 64, 76, 123, 125, 129, 133, 150, 152, 158, 163, 165, 237, 292 linguistic 158, 237, 292 materialistic 27 mechanical 165

L Laboratory 18, 231 tests 231 tools 18 Language 1, 2, 3, 4, 34, 39, 57, 62, 79, 107, 108, 109, 110, 111, 112, 115, 116, 119, 124, 127, 132, 149, 164, 166, 179, 181, 182, 183 communities 111 foreign 39, 107, 108, 124, 164 formal 181 informal 179 logical 183 medical 115, 119, 132, 166 native 34, 39, 57, 62, 149 natural 127 spoken 116 Laws 54 meteorological 54 thermodynamic 54 Learning 113, 124, 125, 167, 182, 212 machines 212 mathematics 167 sustainable 113

Subject Index

Scientific Philosophy and Principles in Medicine 307

Life 1, 89, 134 healthy 89, 134 terrestrial 1 Linguistical information 35 Linguistic 17, 42, 106, 119 data 106 medical terminology 119 predicates 17 relationships 42 Listening, stethoscope 260 Logic 185, 192, 206, 230, 232 conjunctions 192, 232 convenient multiple 230 mathematical equations 206 operation 185 Logic principles 8, 142, 202, 260, 263 bivalent and fuzzy 260, 263 emerging fuzzy 8 formal 142 symbolic 202 Logic rules 25, 223 deductions 25 valid 223 Logical 2, 16, 18, 24, 36, 40, 46, 139, 140, 144, 161, 170, 175, 176, 177, 178, 179, 186, 189, 190, 191, 192, 198, 199, 200, 201, 211, 212, 215, 221, 230, 253, 260, 263, 292, 298 comparison 24 conjunctives 186 deductions 215 explanations 161, 260, 263 inference functions 198 inferences 2, 16, 24, 46, 189, 191, 198, 199, 212, 230, 292 reasoning 139, 179, 192, 200, 221 reconstruction 40 relationships 18, 253 rules 36, 139, 140, 144, 170, 175, 176, 177, 178, 190, 191, 201, 211, 212, 298 Logical principles 1, 3, 11, 12, 16, 34, 39, 44, 57, 64, 139, 147, 148, 177, 180, 181, 190, 202, 298 binary 177 and rules transform 190

Logical propositions 2, 5, 110, 115, 182, 191, 196, 202, 214, 215, 231, 234 verbal 202 Logicians 14, 71, 99, 100, 168, 181 contemporary 181 Louis Pasteur 134 Lung 93, 225, 226 cancer 225, 226 membrane 93

M Machines 11, 54, 58, 94, 140, 146, 225, 273, 276, 290 dialyses 276 malfunctioning 146 printing 94 Magnetic resonance (MR) 169, 201, 227, 233, 238, 239, 299 imaging (MRI) 201, 233 Mathematical 1, 15, 18, 44, 65, 126, 148, 154, 158, 177, 181, 192, 195, 196, 197, 198, 202, 207, 208, 209, 222, 223, 224, 230, 237, 244, 245, 251, 252, 253, 255, 256, 258, 262, 263, 266, 268, 278, 281, 292, 295 combination 195 expressions 1, 148, 195, 202, 230, 251, 253, 256, 295 formulations 15, 158, 181, 223, 263 function 252, 253, 278 loading 158 models 18, 181, 196, 222, 224, 263, 281, 292 principles 44, 177, 258, 266 probabilities 245 programming in computers 237 rules 126, 158, 258 separation 268 teaching 154 athematical treatment 65 Mathematical equations 9, 47, 148, 183, 187, 196, 219, 221, 222, 223, 258, 261 non-linear 9

308 Scientific Philosophy and Principles in Medicine

Mathematical symbolic logic 181, 192 matrix 192 Measles 89, 102, 111, 112, 119, 132 Measure 121, 169, 209 disease prevalence 121 numeric 209 numerical 209 reliable 169 verbal 209 Measurements 7, 9, 15, 179, 196, 238, 239, 241, 243, 249, 252, 280, 292, 299 laboratory 196 numerical 179 Media 30, 33, 63, 170 electronic 63 devices 63 Medical 16, 18, 68, 73, 77, 84, 122, 129, 131, 132, 139, 145, 160, 162, 164, 170, 237, 239, 243, 261, 263, 297, 299 diagnosis work 18 humanities 145 information 73, 77, 129 language information 131 principles 139 professionals 16, 122, 131, 132, 164, 170, 237, 239, 243, 297, 299 services 263 software 261 theory 84 training 160 treatment methods 68 wisdom 162 Medical contributions 104 influential historical 104 Medical instruments 238, 295 technological 238 Medicine 4, 46, 88, 89, 90, 91, 92, 93, 97, 102, 115, 165, 204, 227, 232, 249, 260, 261, 293, 297 ancient Greece 165 and human engineering 293 and statistical methods 249 commercialization 261 education systems 46, 260 expert translating 4

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fuzzy logic in 204, 227, 232 law of 90, 91, 93, 97, 297 semantic 115 systematic 88 teaching 89 theoretical 102 works 92 Medieval, influenced 104 Memory 3, 22, 26, 32, 35, 42, 112, 116, 123, 125, 150 activities 26 computer 123 Meningitis 94 Mental 75, 126, 233 activity functions lag 75 disorders 233 forces 126 Mesopotamian 17, 24, 70, 76, 77, 78, 80 civilizations 24, 70, 76, 77, 78 medicine 77, 78 Messy information scraps 60 Metabolisms 278 Metaphysical 11, 27, 120, 125, 145, 155, 165, 190, 209 ingredients 145 principles 11 Methodologies 9, 18, 27, 64, 65, 77, 85, 91, 98, 126, 131, 146, 161, 164, 175, 210, 237, 255 pseudo-scientific 77 regression 18, 237, 255 stochastic 210 stochastic time series 9 systematic 91 Methods 120, 131, 164, 165, 209, 210, 239, 260, 273, disease-based 165 innovative diagnosis 164 medicine injection 273 modern medical 131 stochastic computational 239 syntactic 120 therapeutic 210 traditional 209 traditional memorization 260

Subject Index

Scientific Philosophy and Principles in Medicine 309

Microbes 134, 135, 172 Micromolecules 161 Middle eye membrane inflammation 93 Mind-heart solidarity 56 Miscarriage 135 Misdiagnoses 164, 166 Modeling 183, 204, 222, 292 fuzzy logic inference 204 methods 183 numerical 292 systems 222 Models 43, 44, 46, 47, 79, 109, 196, 227, 230, 231, 234, 245, 250, 258, 260, 263, 268, 277, 278, 280, 281 binary correlation 245 clay 79 dialysis 277 distorted 234 hybrid 44 hybrid rational thinking 47 inductive reasoning 227 logic process 196 medical 231 numerical 44 population growth forecasting 263 psychological constructivist 109 restrictive population growth 268 Mother milk 94 Mother tongue 36, 108, 109, 111, 112, 117, 119, 136, 164 MR images 227, 294 functional 227 Multivariate development programs 251 Muslim 17, 71, 84, 85, 86, 88, 98, 100, 101, 102, 104 alchemists 104 contributions 101 doctors 102 innovation 101 philosophers 17, 71 physicians 84, 85, 86, 88, 98, 100, 102 scholar 86 Muslim thinker 50, 179 Al-Farabi 50 Averroes 179

Mysticism 25, 27, 29 natural 25

N Natural 208, 263 hazards 263 information 208 Natural philosophy 6, 7, 172 empirical 7 Nausea 95, 244 Neck hardening 94 Nerves 84, 92, 114, 134, 135 acoustic 134, 135 auditory 134, 135 Neural networks 29, 65 artificial 65 Newton’s 47, 51 law 47 physics 51 Numerical data 126, 250, 251 information 126 measurements 251 processing 250 Numerical database treatment 2

O Ontological reasoning 40, 41 Ontology 54, 91, 142, 145, 146, 151, 159, 161, 298 Operation 11, 18, 63, 76, 81, 82, 132, 135, 183, 208, 223, 256, 261, 265, 274 arithmetical 183 dysfunctional 11 simple algebraic 265, 274 Organs 29, 60, 64, 75, 79, 91, 92, 116, 117, 119, 123, 125, 135, 278, 279, 294 artificial 294 diseased 135 human sensory 29 Orthopedists 99 Output defuzzification operators 223

310 Scientific Philosophy and Principles in Medicine

P Pain relief 134, 135 Painstaking work 88 Pharmokognosy 86 Philosophical 3, 4, 5, 6, 10, 11, 12, 16, 17, 18, 24, 25, 34, 36, 39, 40, 43, 44, 57, 73, 120, 138, 139, 140, 142, 148, 149, 150, 153, 155, 157, 159, 163, 165, 167, 170, 172, 173, 174, 178, 180, 185, 297 and logical principles 3, 5, 11, 16, 18, 39, 40, 43, 44, 139, 142, 148, 155 critical 25 developments 73 foundations 11, 138 imaginations 24 issues 6, 159 linguistic thinking principles 57 principles 10, 12, 36, 39, 138, 140, 150, 153, 157, 159, 297 process 180 medical 17 thinkers 163 thoughts 4, 10, 120, 142, 149, 165, 167, 170, 172, 173, 174, 178, 185 translated foreign 34 Philosophical thinking 2, 3, 10, 46, 49, 57, 59, 138, 141, 149, 150, 151, 152, 160, 161, 177, 298 principles 149, 151, 152, 177, 298 scientific 3, 10 stage 57 Philosophy 41, 130, 138, 139, 140, 142, 145, 147, 160, 161, 167, 169, 171, 173, 174 analytical 41 medical 130 of medicine 138, 139, 140, 142, 145, 147, 160, 161, 167, 169, 171, 173, 174 Philosophy and logic 5, 17, 44, 51, 73, 145, 158, 165, 168, 175 of medicine 17 of science 5, 175 principles 44, 51, 73, 145, 158, 165, 168

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Physical 53, 54, 59, 88, 139, 164, 196, 211, 261 laws 54, 139, 164, 261 phenomena 53, 211 principles 59, 196 processes 88 Physiognomy 12 Phytotherapy 69 Pills, vitamin 169 Plague disease 97 Plant fibers 76 Polycythemia 285 Possession 92, 103, 266 diabolical 103 natural resources 266 Pre-ancient Greek civilization 24 Predicate-consequent relationship 2 Pressure 58, 59, 119, 285, 287 aortic 287 arterial 285, 287 Probabilistic 7, 249, 250 methodologies, systematic 249 methods 250 reasoning 7 Probability 213, 244, 245, 250, 253, 258 distribution function (PDF) 245, 250, 253 methods 244 principles 258 theory 213 Problem(s) 5, 6, 11, 33, 40, 41, 42, 43, 44, 45, 81, 127, 148, 162, 168, 175, 214, 215, 260, 263 medical 11, 81 real-life 168 real-world 127 social 33 solving, collaborative 40, 41 Procedures 66, 81, 218, 226, 237, 238 algorithmic 66 fuzzy clustering 218 medical 238 statistical 237 surgical 81 therapeutic 226 Processing 126, 299

Subject Index

Scientific Philosophy and Principles in Medicine 311

digital data 299 word information 126 Proportionality 264, 270, 274 coefficient 264, 274 Proportional 194, 269 manner 269 relationship 194 Propositions 8, 14, 15, 65, 175, 177, 182, 183, 185, 186, 187, 188, 189, 190, 192, 201, 209, 220, 230, 231, 232 hypothetical 189, 190 inference 192 logical inference machine 65 probabilistic 14 Psychological 40, 81 process 40 treatment 81 Psychology 41, 46, 93, 96, 100, 118, 132, 165 cognitive 46 Psychophysiology 168 Psychotherapy advice 94

Recovery process 12 Regression analysis 251, 256 Resistance 284, 285 friction 284 internal boundary 285 Resources 71, 266, 288 environmental 266 natural 288 Respiratory tract 135 Restrictions 263, 266 sustainable adequacy 266 Reynolds number 287 Rhetorical statements 7 Rhythmic movements 108 Ripeness 28, 143 Risk 209, 222, 245, 248 probabilistic 209 Roman Empire 73

Q Question formulation technique 36

R Randomness, numerical 208 Rational 36, 43, 106, 142, 179 communication 106 philosophy 179 principles 142 production quality 36 reasoning principles 43 Reasoning 7, 8, 22, 34, 35, 39, 40, 41, 42, 44, 47, 127, 144, 150, 162, 177, 192, 193, 209 healthcare 162 rule-based 209 synthesis 47 theoretical 39 wisdom-based 162 Reciprocity, effective 160

S Science 9, 14, 15, 52, 62, 109, 142, 195, 196, 219, 248 and technology history 62 atmospheric 248 cognitive 109 computer 219 fuzzy philosophy of 14, 15 philosophical principles 142 revolutionary 9 social 52, 195, 196 traditional 9 Scientific 11, 16, 27, 51, 57, 62, 122, 126, 129, 130, 176, 261, 295 epistemology 122 hypothesis 129 principles 11, 16, 27, 51, 57, 126, 129, 130, 176, 261, 295 thinking productivity 62 Scientific thinking 7, 12, 48, 62, 146, 214 dynamic 62 Scientists, cognitive 84 Sensory information 109 Simplification principles 48, 253

Zekâi Şen

312 Scientific Philosophy and Principles in Medicine

Single 134 celled parasites 134 cell microorganisms 134 Skin 81, 87, 91, 132, 134, 135, 244, 269 cells 87 pale 244 tiger 81 Sleeplessness 94 SLM 194 completion 194 coupling 194 relationships 194 Smallpox 89, 102, 132 Smoking 226, 245 damages bronchial epithelium 226 habits 245 Social 98, 110, 146 affairs 110 circles 98 constructivism 146 Societies 6, 23, 26, 31, 33, 34, 48, 51, 55, 56, 110, 125, 149, 154, 155, 164, 266 agricultural 6 Sociology, medical 131 Software 66, 192 applications 66 computer programming 192 Solutions 12, 14, 33, 35, 42, 43, 46, 47, 147, 148, 213, 214, 223, 224, 269, 276, 288, 289 fuzzy logic rule 213 joint 276 linguistical 35 numerical 35, 148, 269 Sources 64, 134, 292 emergency energy 134 fundamental 292 natural 64 Spiritual processes 88 Statistical 213, 225, 249, 250, 251, 253, 255, 258 analysis 255 correlations 225 methods 213, 249, 250, 251, 253, 258 Stochastic replication 292

Stomachache 118, 119 Storage, human memory 26 Stress 141, 172, 218 Structure 291, 131 economic 291 human biological 131 Style, encyclopedic 94 Supernatural forces 103 Surgical processes 78 Symbolic 18, 192, 193, 194, 195, 274 logic matrix (SLM) 18, 192, 193, 194, 274 principles 195 Symptoms 63, 94, 231, 244, 281 of low blood pressure 244 Syrian languages 73 Systems 35, 37, 73, 84, 86, 109, 112, 179, 180, 205, 208, 213, 221, 222, 223, 224, 237, 284, 285, 290, 294 ancient 73 computer-based planning 237 dynamic 224 nervous 84, 294 quarantine 86 visual 84

T Tendencies, erotic 171 Terminological 106, 107, 119 agreements 106 applications 106 concepts 106 elements 107 neologism 119 Terminologies 17, 46, 106, 107, 110, 114, 117, 119, 120, 133, 136, 288, 297 anatomical 119 medical 17, 107, 119, 120, 136 Tests 25, 37, 50, 178, 191, 245, 250, 277, 278 glucose tolerance 277, 278 Therapy, verbal speech 227 Thinking 22, 23, 24, 26, 28, 30, 31, 34, 35, 36, 37, 39, 43, 46, 48, 59, 62, 127, 152, 155, 156, 200, 206, 220, 262, 264

Subject Index

Scientific Philosophy and Principles in Medicine 313

analogical 46 creative 127 dynamic 35 elements 22, 34, 36 freedom 30 human natural 206 inductive 24, 264 methods 46, 48 phenomological 62 principles 28, 36, 39, 152 scholastic 59 theoretical 39 Thinking capabilities 23, 28, 36, 37, 42, 44, 56, 65, 157 analytical 65 Thoughts 3, 27, 92, 126, 127, 145, 146 egocentric 3 mental 127 metaphysical 27, 126, 145, 146 ontological 92 Tissue(s) 119, 134, 135, 161, 227, 288, 294, 298 destroyed 135 fluid 135 liquid 135 repair organ 294 Tomography, computed 201 Tools 2, 5, 11, 16, 18, 34, 68, 109, 111, 164, 166, 175, 178, 179, 260 educational 5 rational control 34 technology-based 260 therapeutic 68 Transfer 35, 60, 76, 84, 101, 110, 151, 152, 154, 157, 158, 163 uncritical mechanical 163 Tuberculosis 94, 119, 132, 135

V

U Urine 95, 184, 185, 204 composition 95 quality 204 tests 184, 185

Variables, cholesterol 245 Verbal 34, 52, 108, 110, 132, 133, 157, 168, 206, 207, 208, 209, 210, 211, 212, 213, 215, 230, 239, 241, 292, 298, 299 ambiguities 132, 133, 168, 206, 210, 211, 212, 215, 230, 298 inferences 34 information 108, 157, 207, 208, 209, 213, 239, 292, 299 relationships 52, 110, 241 Verbalize relationships 57 Visual inspections 44, 239, 299 Visualization 41, 158, 197, 198, 199, 237 linear 197 linguistic 199 techniques 237

W Wastes extraction 272 Water 70, 72, 80, 81, 89, 93, 117, 163, 185, 193, 248, 266, 280 clean drinking 89 fresh 70 Western 71, 73, 100, 102 civilization 71, 73 medicine 100 Roman Empire 102 World Health Organization (WHO) 204