MEDICAL ISSUES IN RAMAZAAN

1.   Effect of medicines and medical treatments on fasting

2.   Reasons for which one may excused from fasting in Ramadaan

3.   Is it permissible for a woman to deliberately get her period in Ramadan?

4.   Does acupuncture affect the fast?

5.   Ruling on nose drops for one who is fasting

6.   Ruling on eye drops for one who is fasting

7.   Fasting person having an injection

8.   Does having an anaesthetic via injection during Ramadaan break the fast?

9.   Using a puffer for asthma does not invalidate the fast

10.  Using contact lenses after putting them in a cleaning solution does not affect the fast

11. Is acid reflux one of the things that invalidate the fast?

12. Cupping for one who is fasting

13. He swallowed blood whilst he was praying

14. Does taking blood invalidate the fast?

15. Ruling on taking the “Ramadan tablet”, which reduces the effect of hunger, at sahoor during the month of fasting

1.   Effect of medicines and medical treatments on fasting

Praise be to Allaah.

There follows a list of a number of things used in the medical field, explaining what does and does not break the fast. This is a summary of shar’i research presented to the Islamic Fiqh Council during its regular meetings:

I – The following things do not have any effect on the fast:

o    Eye drops, ear drops, ear syringing, nose drops and nasal sprays – so long as one avoids swallowing any material that may reach the throat.

o    Tablets or lozenges that are placed beneath the tongue for the treatment of angina pectoris etc., so long as one avoids swallowing any material that reaches the throat.

o    Vaginal pessaries, douching, use of a speculum, or internal digital examination.

o    Introduction of a scope or coil (IUD), etc., into the uterus.

o    Introduction of a scope or catheter into the urethra (male of female), or injection of dyes for diagnostic imaging, or of medication, or cleaning of the bladder.

o    Drilling of teeth (prior to filling), extraction or polishing of teeth, using a miswaak or toothbrush, so long as one avoids swallowing any material that reaches the throat.

o    Rinsing, gargling or applying topical treatment in the mouth, so long as one avoids swallowing any material that reaches the throat.

o    Injections, whether subcutaneous, intra-muscular or intra-venous – with the exception of those used for purposes of nutrition.

o    Oxygen.

o    Anaesthetics, so long as they do not supply nutrition to the patient.

o    Medicines absorbed through the skin, such as creams, lotions and patches used to administer medication through the skin.

o    Introduction of a catheter into the veins in order to examine or treat the vessels of the heart or other organs.

o    Laparoscopy for the purpose of diagnosis or surgical treatment of the abdominal organs.

o    Biopsies of the liver and other organs, so long as this is not accompanied by the administration of nutrients.

o    Gastroscopy, so long as this is not accompanied by the administration of nutrients.

o    Introduction of medicine or instruments into the brain or spinal cord.

o    Involuntary vomiting (as opposed to self-induced vomiting).

II – The Muslim doctor should advise his patient to postpone the above-described treatments and procedures until after he has broken his fast, if it is safe to do so and will not cause any harm (even if these procedures will not have any effect on his fast).

Majma’ al-Fiqh al-Islami (Islamic Fiqh Council), p. 213.

2.     Reasons for which one may excused from fasting in Ramadaan.

Praise be to Allaah.  

One of the ways in which Allaah has made things easy for His slaves is that He has only enjoined fasting upon those who are able to do it, and He has excused those who are unable to fast for a legitimate shar’i reason. The legitimate reasons for which one may be excused from fasting are as follows: 

1 – Sickness 

Sickness means everything that means that a person is not healthy.  

Ibn Qudaamah said: the scholars are agreed that it is permissible for the sick person not to fast in general. The basis of that is the aayah in which Allaah says (interpretation of the meaning): 

“but if any of you is ill or on a journey, the same number (should be made up) from other days”[al-Baqarah 2:184]

It was narrated that Salamah ibn al-Akwa’ (may Allaah be pleased with him) said: “When this aayah was revealed – ‘And as for those who can fast with difficulty, (e.g. an old man), they have (a choice either to fast or) to feed a Miskeen (poor person) (for every day)’ [al-Baqarah 2:184 – interpretation of the meaning] – those who wanted not to fast could do that, and pay the fidyah (i.e., feed one poor person for each day). That remained the case until the following aayah was revealed, i.e., the verse: 

‘And as for those who can fast with difficulty, (e.g. an old man), they have (a choice either to fast or) to feed a Miskeen (poor person) (for every day)’

[al-Baqarah 2:185 – interpretation of the meaning] – so it abrogated it.”  

The sick person who fears that fasting may make his sickness worse or that it will slow down his recovery or damage a part of his body, has the option of not fasting, and indeed it is Sunnah for him not to fast and it is makrooh for him to complete his fast, because that may lead to his death. So he has to be cautious and protect himself. Moreover, if the sick person is very ill, that makes it permissible for him not to fast. But if a healthy person fears difficulty or tiredness, it is not permissible for him to break his fast, if all that happens to him when he fasts is that he becomes tired. 

2 – Travelling 

In order for traveling to result in a concession excusing one from fasting, the following conditions must be met: 

a-     The journey must be long enough that prayers may be shortened.

b-    The traveler must not intend to settle in the place to which he travels.

c-     His journey must not be for any sinful purpose, rather it should be for a sound purpose, according to the majority of scholars. That is because being allowed not to fast is a concession and relief that the sinner does not deserve on his journey, because the purpose of his journey is to commit sin – such as one who travels in order to commit banditry, for example. 

Cancellation of the concession for traveling: 

This concession of traveling is cancelled by two things: 

(i)                When the traveler returns home and enters his hometown, which is the place where he resides.

(ii)              When the traveler decides to stay indefinitely, or for a lengthy period in one place, and the place is fit for settling in. Thus he becomes a resident (or non-traveller), so he should pray his prayers in full and not break his fast in Ramadaan, because the rulings on travel no longer apply to him. 

3 – Pregnancy and breastfeeding 

The fuqaha’ are agreed that pregnant and breastfeeding women may break their fast in Ramadaan, on the condition that they think there is a risk that they or their children may become ill or more ill, or be harmed or may die. The evidence for this concession in their case is the aayah (interpretation of the meaning: 

“and whoever is ill or on a journey, the same number [of days which one did not observe Sawm (fasts) must be made up] from other days”[al-Baqarah 2:185]

This does not refer to merely being sick, for the sick person who will not be harmed by fasting is not allowed to break the fast; here sickness is mentioned as a metaphor for any situation where fasting when sick may cause harm. This is what is meant by sickness here. That may be the case in pregnancy and when breastfeeding, so these two cases are included in the concession of breaking the fast. The evidence that women in these cases are allowed not to fast is the hadeeth of Anas ibn Maalik al-Ka’bi (may Allaah be pleased with him), who said that the Messenger of Allaah (peace and blessings of Allaah be upon him) said: “Allaah has relieved the traveler of fasting and half of prayer, and He has relieved the pregnant and breastfeeding woman of fasting.”  

4 – Senility and old age 

Senility and old age refers to one who is old and has lost his strength, or who is approaching death, so that every day he becomes weaker, until he dies, or who is suffering from a terminal or incurable illness and has no hope of recovery. The evidence that it is prescribed for such people not to fast is the aayah (interpretation of the meaning): 

“And as for those who can fast with difficulty, (e.g. an old man), they have (a choice either to fast or) to feed a Miskeen (poor person) (for every day)”[al-Baqarah 2:184]

Ibn ‘Abbaas (may Allaah be pleased with him) said that this aayah has not been abrogated, and it applies to old men and old women who cannot fast, so for each day they should feed one poor person. 

5 – Intense hunger and thirst 

If a person is overtaken by intense hunger or unbearable thirst, then he should break his fast and eat just as much as he needs to ward off that hunger, then he should refrain from eating for the rest of the day, and make up that fast later on. 

The scholars added to intense hunger and thirst the fear of weakness when meeting the enemy, or fearing or expecting an attack, such as when one is surrounded. So if a fighter knows for sure or thinks it most likely that there will be fighting because he is facing the enemy, and he fears that fasting may make him weak when fighting, and he is not traveling, then he may break his fast before fighting. 

6 – Compulsion 

Compulsion means one person forcing another to do something or not to do something against his will, by means of threats. 

Al-Mawsoo’ah al-Fiqhiyyah, vol. 28, p. 73.

3.   Is it permissible for a woman to deliberately get her period in Ramadan?

Praise be to Allaah.

Firstly: 

If a woman needs to take medicine in order to get her period, either because she does not get it at all except by means of medication, as mentioned in the question, or because she does not have a regular period, as is common among women, there is nothing wrong with that if the medicine is permissible in and of itself and no harm will result from taking it. 

If she gets a period after taking the medicine, then she should stop praying and fasting for the length of her period, then she should make up the fasts but not make up the prayer, as applies to all other women with regard to their periods. 

Al-Nawawi (may Allah have mercy on him) said:  

If she takes medicine to menstruate and gets her menses, she does not have to make up [the missed prayers]. Similarly, if she takes medicine to abort a foetus and she aborts it and bleeds after that (i.e. nifaas), she does not have to make up the prayers she missed during the nifaas period, according to the correct opinion. End quote from al-Majmoo‘, 3/10. 

Secondly: 

It is haraam for a woman to deliberately take this medicine in Ramadan or close to it for the purpose of not fasting in Ramadan. 

Al-Mardaawi (may Allah have mercy on him) said: 

It is permissible to take medicine in order to get one’s menses. This was stated by Shaykh Taqiy al-Deen [i.e., Ibn Taymiyah] and this is the only view he mentioned in al-Furoo‘, unless that is done close to Ramadan in order not to fast. This was stated by Abu Ya‘la al-Sagheer. 

I [al-Mardaawi] say: and there is no one who disagrees with him. 

End quote from al-Insaaf, 1/273. See also al-Furoo‘, 1/393; al-Fataawa al-Kubra, 5/315 

Shaykh Mansoor al-Bahooti (may Allah have mercy on him) said: 

It is permissible for a female to take permissible medicine in order to get her menses, but not close to Ramadan in order not to fast. (The same ruling applies to) travelling (close to Ramadan) in order not to fast.

End quote from Kashshaaf al-Qinaa‘, 1/218 

And Allah knows best.

4.     Does acupuncture affect the fast?

Praise be to Allaah.

Firstly: 

Using needles is an ancient Chinese way of reducing pain and treating a number of various diseases by inserting needles into various parts of the body. 

The specialist in this field, who is called the acupuncturist, inserts a sharp needle into any one of hundreds of specific points on the body. Insertion of the needle causes a sharp prick, but this quickly dissipates, to be followed by a prickling sensation or feelings of dizziness or drowsiness, or by pain when the needle is left in place. 

Acupuncture is used to reduce pain and to treat various cases which include arthritis, asthma, migraine, abscesses and eye diseases, in addition to some forms of mental illness. The Chinese still use this method and since the end of the 1950s this traditional method has been used to reduce pain in major surgery, where the patient remains awake but feels a little discomfort or does not feel any pain at all. 

See: al-Mawsoo‘ah al-‘Arabiyyah al-‘Ilmiyyah (al-Wakhz bi’l-Ibar). 

Secondly: 

Abu’l-Waleed ibn Rushd said: 

They are unanimously agreed that at the time of fasting, the fasting person must abstain from food and drink, and intercourse, because Allah says (interpretation of the meaning):

“So now have sexual relations with them and seek that which Allaah has ordained for you (offspring), and eat and drink until the white thread (light) of dawn appears to you distinct from the black thread (darkness of night)”

[al-Baqarah 2:187]

And they differed concerning some issues. Some they kept quiet about and some they spoke about. As for those that they kept quiet about, one of them has to do with what reaches the inside of the body (al-jawf) but is not nourishment and what reaches the inside of the body by a route other than that by which food and drink reach it, such as injections. 

The reason for their differences is based on the way they looked at that which nourishes and that which does not nourish, because the texts speak of that which nourishes. So those who thought of fasting as a rational concept did not regard that which nourishes as being the same as that which does not nourish. Those who thought of fasting as an act of worship and something that is not subject to any rational discussion said that what is meant by fasting is simply refraining from whatever may reach the inside of the body, whether it is nourishing or not nourishing. 

Thirdly: 

Injections which are meant as medical treatment and not as food or nourishment do not break the fast of the fasting person, whether they are intravenous or intramuscular. Injections which are meant to provide nourishment do break the fast, as is the view of the majority of modern scholars. 

This has been discussed previously in the answer to question no. 65632. See alsoMuftiraat al-Siyaam al-Mu‘aasirah by Dr. Ahmad al-Khaleel, 65-68 

Fourthly: 

The needles used in acupuncture do not come under the same heading as injections meant to provide nourishment and they do not come under the heading of food or drink; rather no kind of solution or liquid can be introduced to the body through them, as is the case with regular medicinal injections. Rather they are a kind of pricking that is administered to specific places on the body with no intention of using them to introduce any kind of liquid into the body, as mentioned above. 

Based on that, they do not affect the fast and there is nothing wrong with using them for medicinal treatments, if it is proven that they are of benefit to the patient. 

And Allah knows best.

5.     Ruling on nose drops for one who is fasting

Praise be to Allaah.

It is proven that the Messenger of Allaah (peace and blessings of Allaah be upon him) said: “Snuff water up into the nose deeply, unless you are fasting.” Narrated by al-Tirmidhi (788) and classed as saheeh by al-Albaani in Irwa’al-Ghaleel (935). 

This hadeeth indicates that it is not permissible for the fasting person to let water reach his throat via the nose. 

Based on that, if the nose drops are small in amount such that they will not reach the throat, then there is nothing wrong with that, but if they do reach the throat and can be tasted, then the fast is invalidated and has to be made up. 

Shaykh Ibn Baaz said:  The same applies to eye drops and ear drops. They do not break the fast according to the more correct of the two scholarly opinions, but if he finds the taste of the drops in his throat, he should make up the fast in order to be on the safe side, but it is not obligatory, because these are not openings through which food and drink enter the body. But nose drops are not permissible, because the nose is an opening through which food and drink may enter the body. Hence the Prophet (peace and blessings of Allaah be upon him) said: “Snuff water up into the nose deeply, unless you are fasting.” The one who does that has to make up the fast because of this hadeeth and similar reports, if he finds the taste of that in his throat. End quote. 

Shaykh Ibn ‘Uthaymeen said in Fataawa Ramadaan (p. 511): If nose drops reach the stomach or the throat, then they break the fast, because the Prophet (peace and blessings of Allaah be upon him) said, according to the hadeeth of Laqeet ibn Sabrah: “Snuff water up into the nose deeply, unless you are fasting.” So it is not permissible for the fasting person to put drops in his nose that can reach his stomach or his throat, but as for nose drops that will not reach them, they do not break the fast. 

With regard to eye drops – and also using kohl – and ear drops, they do not break the fast of the fasting person. End quote. 

Based on this, the fasting person should not use nose drops unless it is too difficult for him to go without them, in which case he should use them but he should be careful not to let any of that reach his throat. If he swallows any of that he should make up that day. 

If he knows that he cannot help swallowing some of them, then it is not permissible for him to use them unless his sickness is so bad that it is permissible for him not to fast, which is if fasting will cause him harm or unbearable hardship. See also questions no. 50555 and 38532. 

And Allaah knows best.

6.     Ruling on eye drops for one who is fasting

Praise be to Allaah.  

The scholars differed concerning eye drops and whether or not they break the fast. 

The view favoured by Shaykh al-Islam Ibn Taymiyah and by Shaykh Ibn ‘Uthaymeen, is that they do not break the fast. 

Shaykh Ibn ‘Uthaymeen said: 

Shaykh al-Islam Ibn Taymiyah was of the view that kohl does not break the fast, not even if the taste of the kohl reaches the throat. He said, this is not called food or drink, and it is not like food or drink, and it does not have the same effect as food or drink. There is no saheeh hadeeth from the Prophet (peace and blessings of Allaah be upon him) which expressly indicates that kohl breaks the fast, and the basic principle is that it does not break the fast. An act of worship remains valid unless it is proven that it is invalidated. What he said is correct, even if a person can taste it in his throat. Based on the view favoured by Shaykh al-Islam, if a person puts drops in his eyes whilst fasting and tastes it in his throat, that does not break his fast. 

Al-Sharh al-Mumti’, 6/382.

7.    Fasting person having an injection

Praise be to Allaah.  

It is permissible for a fasting person to take medicine by injection, whether intramuscular or intravenous, during the day in Ramadaan, but it is not permissible for the fasting person to be given an injection for nourishment purposes during the day in Ramadaan, because that comes under the ruling on eating and drinking; having this injection is regarded as a trick aimed at breaking one's fast in Ramadaan. If the intramuscular or intravenous injection can be given at night, that is better. 

And Allaah is the Source of strength. May Allaah send blessings and peace upon our Prophet Muhammad and his family and companions. 

Standing Committee for Academic Research and Issuing Fatwas, 10/252

8.     Does having an anaesthetic via injection during Ramadaan break the fast?

Praise be to Allaah.

Being given medicine via injection does not break the fast, whether it is intramuscular or intravenous, so long as the injected substance does not provide nutrition, because in that case it is like food and drink which are forbidden to the one who is fasting. 

It says in Fataawa al-Lajnah al-Daa’imah (10/252): 

It is permissible to be given medicine via injection into the muscles or veins when fasting during the day in Ramadaan. But it is not permissible for the fasting person to be given nutrients during the day in Ramadaan, because that comes under the same rulings as consuming food and drink, and this injection is regarded as a means of breaking the fast in Ramadaan. If it is possible to give the injection into a muscle or vein during the night, that is preferable. End quote. 

Shaykh Ibn ‘Uthaymeen (may Allaah have mercy on him) was asked about the spread of anaesthesia through the body – does that break the fast? And what about the flow of blood when a tooth is extracted? 

He replied: 

Neither of these breaks the fast, but the blood that flows after removal of a tooth should not be swallowed. End quote. 

Fataawa Ramadaan, p. 525 

It makes no difference whether it is a local or general anaesthetic. Many of the fuqaha’ have stated that if a person who is unconscious is awake for even a moment of the day, his fast is valid, so long as he formed the intention to fast from the night before.  

Imaam al-Shaafa’i said in al-Umm (8/153): 

If a man loses consciousness for a day or two days during the month of Ramadaan, and he did not eat or drink anything, then he has to make up those days. But if he was awake for part of the day, then he is regarded as having fasted on that day. End quote. 

Ibn Qudaamah said in al-Mughni (4/343): 

If he was unconscious for the whole day and did not wake up at all, then his fast is not valid, according to the view of our imam (i.e., Imam Ahmad) and al-Shaafa’i… 

If the person who was unconscious woke up for a part of the day, his fast is valid, whether that was at the beginning or the end of the day. End quote. 

And Allaah knows best.

9.     Using a puffer for asthma does not invalidate the fast

Praise be to Allaah.  

Using a puffer for asthma during the day in Ramadaan does not invalidate the fast. 

The puffer used for asthma does not invalidate the fast because it is a pressurized gas that goes to the lungs, and is not food, and it is something that is always needed, in Ramadaan and at other times. 

Fataawa al-Da’wah, Ibn Baaz, no. 979. 

See the booklet Sab’oon Mas’alah fi’l-Siyaam (Seventy issues related to fasting). 

Shaykh Ibn ‘Uthaymeen said: 

This puffer evaporates and does not reach the stomach, so in this case we say that there is nothing wrong with using this puffer when you are fasting, and you do not break your fast by doing that. 

Fataawa Arkaan al-Islam, p. 475 

The scholars of the Standing Committee said: 

The asthma medication that the patient uses by inhaling it reaches the lungs via the trachea and does not reach the stomach, so it is not food or drink or anything of the sort… So it seems that the fast is not broken by using this medicine. 

Fataawa Islamiyyah, 1/130 

And Allaah knows best.

10.        Using contact lenses after putting them in a cleaning solution does not affect the fast.

Praise be to Allaah.

It is permissible to use contact lenses when fasting, and the fact that they are first placed in a cleansing solution does not matter, because the worst that can happen is that some of this solution leaks into the eye. Thus it is like eye drops, and eye drops do not invalidate the fast, according to the correct scholarly opinion. 

Shaykh Ibn ‘Uthaymeen (may Allaah have mercy on him) said: There is nothing wrong with a fasting person using kohl, or putting drops in his eyes, or putting drops in his ears; even if he notices the taste of that in his throat, that does not invalidate his fast, because it is not food or drink, and is not like food or drink. The evidence forbids eating and drinking, and that does not include things that are not like food or drink. What we have mentioned is the view favoured by Shaykh al-Islam Ibn Taymiyah (may Allaah have mercy on him) and it is the correct view. End quote. 

Fiqh al-‘Ibaadaat, p. 191 

11.        Is acid reflux one of the things that invalidate the fast?

Praise be to Allaah.  

Acid reflux is something that happens involuntarily. A person may feel some acidity or bitter taste in his oesophagus but it does not reach the mouth. In this case it is not regarded as one of the things that invalidate the fast, because it does not come out to the mouth. 

But if it comes out to the mouth, then in that case it comes under the ruling on reflux or vomiting. 

The word qalas (translated above as reflux) was interpreted as meaning vomiting, or as referring to a small amount of vomit that reaches the throat but does not fill the mouth. And it was said that it was that which is regurgitated by the stomach when it is full. 

See al-Majmoo’ by al-Nawawi, 4/4 

The ruling on this is that if it is returned to the stomach when it could have been expelled, this breaks the fast, and if a person swallows it because he is unable to expel it, then it does not affect the fast. See question no. 12659. 

It says in al-Sharh al-Sagheer (1/700) concerning qalas: 

If he is not able to expel it – such as when it does not pass the throat – then he does not have to do anything. 

Ibn Hazm said in al-Muhalla (4/225): 

Reflux that comes out of the throat does not invalidate the fast, so long as the person does not deliberately swallow it back after it reaches the mouth when he is able to expel it. 

Then he said (4/348): 

We do not know of any difference of opinion concerning the fact that reflux and blood, which come out from a person and do not go back to the throat, do not invalidate the fast. Even if there were a differing opinion, we would not pay any attention to it, because there is no text that says that this invalidates the fast. 

It says in al-Muntaqa Sharh al-Muwatta’ (2/65): 

It was narrated from Maalik that he said: Whoever burps and reflux reaches his mouth but he swallows it back down, he does not have to make up that day of the Ramadaan fast. Ibn al-Qaasim said: Maalik said: If it comes out to a place where if he wanted to he could expel it, but then he swallows it back down, then he has to make up that fast. If he suppresses it before that, then he does not have to do anything. 

It says in al-Insaaf: 

If some vomit or reflux reaches his mouth and he swallows it, then he has broken his fast. This was stated by Imam Ahmad. This ruling applies even if it is a little because it is possible to avoid doing that. 

It says in Haashiyat al-‘Adawi (1/448), after mentioning the ruling on reflux: 

Reflux is like vomit, which is what is regurgitated by the stomach when it is full.

12.  Cupping for one who is fasting

Praise be to Allaah.  

The cupper and the one to whom cupping is done both break their fast; they have to refrain from eating etc for the rest of that day, and they have to make up that day later on, because the Prophet SAWS (peace and blessings of Allaah be upon him) said: “The cupper and the one to whom cupping is done both break their fast.” 

Narrated by Abu Dawood, 2367; Ibn Maajah, 1676. Classed as saheeh by al-Albaani in Saheeh Abi Dawood, 2074. 

And Allaah is the source of strength. May Allaah send blessings and peace upon our Prophet Muhammad and upon his family and companions. 

Al-Lajnah al-Daa’imah li’l-Buhooth al-‘Ilmiyyah wa’l-Ifta, 10/262

13.  He swallowed blood whilst he was praying

Praise be to Allaah.  

You should not have swallowed this blood; you should have taken out a tissue whilst praying and spat the blood into it. 

Because you swallowed it without meaning to, your fast is still valid, but if you swallowed it deliberately then you have to make up this day. 

Ibn Qudaamah (may Allaah have mercy on him) said: If blood flows in his mouth or he burps up something (reflux) from the stomach, and he swallows it, then he has broken his fast even if it was a small amount, because the basic principle is that anything that goes from the mouth to the stomach breaks the fast. 

The basic principle is that the fast is broken by everything that reaches the stomach from the mouth, with exception of saliva because it is not possible to avoid it. But this principle applies to everything else. 

Al-Mughni, 4/356 

And Allaah knows best.

14.  Does taking blood invalidate the fast?

Praise be to Allaah.  

If the blood that is taken from him is regarded as being a small amount, then he does not have to make up that day. But if it is considered to be a large amount, then he should make up that day so as to avoid an area of scholarly dispute and so as to be on the safe side and be sure that he has fulfilled his duty. 

Fataawa al-Lajnah al-Daa’imah, 10/263 

Shaykh ‘Abd al-‘Azeez ibn Baaz (may Allaah have mercy on him) was asked about taking blood in Ramadaan for the purpose of testing. He replied: 

Such tests do not invalidate the fast, rather they are forgiven because they are something that is necessary and they are not like the things that are known in sharee’ah to invalidate the fast. 

Fataawa Islamiyyah, 2/133 

Shaykh Ibn Jibreen said: 

If a person donates blood and a large amount is taken, that invalidates his fast, by analogy with cupping, which refers to the act of letting blood flow from the veins in order to relieve sickness or so that this blood may be stored for emergencies. But if it is a small amount then that does not invalidate the fast, such as taking a small amount with a needle for the purpose of testing. 

Fataawa Islamiyyah, 2/133.

15.  Ruling on taking the “Ramadan tablet”, which reduces the effect of hunger, at sahoor during the month of fasting

Praise be to Allaah.

The scholars have defined fasting as worshipping Allah by refraining from things that break the fast such as food, drink and intercourse, from the break of dawn until the sun sets. As Allah says (interpretation of the meaning): “and eat and drink until the white thread (light) of dawn appears to you distinct from the black thread (darkness of night), then complete your Sawm (fast) till the nightfall” [al-Baqarah 2:187]. And according to the hadeeth of Abu Hurayrah (may Allah be pleased with him) the Messenger of Allah (blessings and peace of Allah be upon him) said: “Fasting is a shield, so there should be no obscene or ignorant talk, and if someone tries to fight him or insult him, let him say, I am fasting, twice. By the One in Whose hand is my soul, the smell of the mouth of the fasting person is better with Allah, may He be exalted, then the fragrance of musk. ‘He gives up his food and drink and desire for My sake. Fasting is for Me and I shall reward for it, a tenfold reward for each good deed.’” Narrated by al-Bukhaari, 1795. 

Shaykh Ibn ‘Uthaymeen (may Allah have mercy on him) said: 

The things that spoil the fast are called by the scholars al-muftiraat (things that break the fast). The basic principles concerning that are three, which were mentioned by Allah, may He be glorified and exalted, in the verse (interpretation of the meaning):

“So now have sexual relations with them and seek that which Allaah has ordained for you (offspring), and eat and drink until the white thread (light) of dawn appears to you distinct from the black thread (darkness of night), then complete your Sawm (fast) till the nightfall”

[al-Baqarah 2:187].

The scholars are unanimously agreed that these three things spoil the fast. 

Al-Sharh al-Mumti’, 6/235 

With regard to the medicine referred to in the question, according to the website mentioned, it is a tablet that contains herbs and substances that it is permissible to use and consume, and it is called the “Ramadan tablet.” it contains different types of vitamins (B1, B2, B6, B12) and other substances that are beneficial to the body and which provide energy to the body during the day and reduce feelings of hunger, because these substances are able to help the brain to issue orders to the body to seek nutrition from excess fat in the body instead of from the empty stomach. 

There is no doubt that taking these tablets and medicine during the day in Ramadan breaks the fast and no one would dispute that, because it is the kind of food which reaches the stomach directly. 

It seems that the question is about the ruling on taking this tablet at night, before dawn, because this medicine has the ability to give the body ongoing energy and it has the ability to prevent feelings of hunger. So some may think that it is not permissible to take it at night, because it has a lasting effect during the day. But this is mistaken thinking. Rather it is permissible to use it, so long as it is taken at a time when it is permissible to consume food and drink. 

With regard to its ongoing effect during the day, that does not mean that it cannot be taken. There is no difference between it and the food eaten at sahoor. One of the important reasons for delaying eating sahoor is that it gives the body more strength to be able to fast during the day. 

It was narrated that Anas ibn Maalik (may Allah be pleased with him) said: The Prophet (blessings and peace of Allah be upon him) said: “Eat sahoor, for in sahoor there is blessing.” Narrated by al-Bukhaari (1823) and Muslim (1095). 

Al-Haafiz Ibn Hajar said: 

In the hadeeth of Anas, “Eat sahoor, for in sahoor there is blessing”, what is meant by blessing is reward, or it is blessed because it gives one strength and energy to fast, and makes it less difficult. 

And it was said that the blessing coming from waking up and offering du’aa’ at the end of the night, before dawn. 

It is most likely that the blessing of sahoor comes from a number of things: it is following the Sunnah, differing from the People of the Book, it gives one strength for worship, increases energy, wards off the bad attitude that may result from being hungry, makes one give charity to the one who asks at that time or joins him to eat, it reminds one to remember Allah and call upon Him at times when a response is most likely, and reminds one to form the intention of fasting for the one who forgot to do so before he went to bed. 

Fath al-Baari, 4/140 

Shaykh Muhammad ibn Saalih al-‘Uthaymeen (may Allah have mercy on him) said, discussing the blessings of sahoor: 

One of its blessings is that it supplies nourishment to the body throughout the day and helps one to be patient in refraining from food and drink, even during the long, hot days of summer, whereas when a person is not fasting you will find him drinking five or six times a day, and eating twice. But Allah has instilled blessing in sahoor, so it makes the body able to cope with fasting. End quote. 

Liqa’ al-Baab al-Maftooh (Introduction to no. 223). 

To sum up: there is nothing wrong with taking these tablets. 

For more information on the permissibility of taking hormones for sports at sahoor, please see the answer to question number 49686. 

And Allah knows best.

Fatwaislam

1.      Blood Test for the Fasting Person

2.      Nasal Drops, Eye Drops and Ear Drops for the Fasting Person

3.      The ruling on using Toothpaste for the fasting Person

1.      Blood Test for the Fasting Person

2.      Nasal Drops, Eye Drops and Ear Drops for the Fasting Person

3.      The ruling on using Toothpaste for the fasting Person

Alifta

1.     Using menstruation-prevention pills during Sawm and Hajj

2.    Asthmatics using spray inhalers

3.     Do injections invalidate Sawm?

4.     Do nutritive injections break Sawm?

5.     Do insulin injections break Sawm?

6.     The blood coming out of the body that invalidates Sawm

7.     Drawing a blood specimen from a fasting person for blood analysis

8.     Using toothpaste and mouthwash while observing Sawm

9.     Anesthetic injection for a fasting dental patient

10.   Does a semen specimen collected by masturbation break Sawm?

11.   Using a breath-freshening spray to remove unpleasant odors from the mouth while fasting

12.   Using a new Siwak or swallowing parts of it while fasting

1.     Using menstruation-prevention pills during Sawm and Hajj

Q: Is it permissible for women to use menstruation-prevention pills in order to completely perform Sawm (Fast) or Hajj? If so, is better to take them or refrain from using them in Sawm, Hajj or `Umrah?

A: The basic ruling is that such an act is permissible, and we know no evidence that opposes this ruling. A woman performing Salah (Prayer) while the menstrual blood is prevented by the effect of pills has nothing to do with the validity of the act of worship (i.e. Salah). The rulings relating to menstruation are inapplicable unless the menstrual blood has already flown out of the body, as usually happens. But as long as it is not necessary for a woman to take these pills, it is better for her to refrain, to be on the safe side. This is applies only when taking such pills does not prevent pregnancy due to the cessation of menstruation. If it may result in this, the wife must have a prior permission from her husband. As-salamu `alaykum (May Allah's Peace be upon you).

[Issued by His Eminence Shaykh Muhammad ibn Ibrahim Al Al-Shaykh, may Allah be merciful to him]

2.    Asthmatics using spray inhalers

Q: I am seventy-three years old and I suffer from asthma, for which I use an inhaler. When I experience an asthma attack I feel completely suffocated, so I use it as a treatment. I have to use it often because these attacks occur frequently, especially in Ramadan, in which I may use it several times. What is the ruling on my Sawm (Fast)? Do I have to make up for these days or offer Kaffarah (expiation)? I should mention that when I spray it in my mouth I feel it in my abdomen and throat.

A: After considering the Fatwa request, the Committee gave the following answer:

We have issued Fatwa no. 1240 concerning the ruling on using asthma spray during the daytime in Ramadan. It is as follows:

Asthma medication which a sick person inhales reaches the lungs through the windpipe and does not reach the stomach. It does not constitute food or drink, nor is it regarded as similar to them. Rather, it is similar to urethra drops, deep head and body wound medication, kohl, enemas and medicines which reach the brain or the body but not through the mouth

or the nose.

Scholars have differed regarding the invalidation of Sawm through using them.

Some scholars view that if a fasting person uses any of them, their Sawm is not invalidated.

The other group views that some of these medicines break Sawm while others do not. However, all scholars are of the opinion that taking these medicines is not the same as eating or drinking.

However, if anyone breaks their fast by using them, it is considered the same as eating and drinking in view of that all of them reach the stomach voluntarily. It was authentically reported that the Prophet (peace be upon him) stated: Sniff water up into the nose deeply, unless you are fasting. The Prophet (peace be upon him) excluded the fasting person from this for fear of water reaching the throat or stomach if one sniffs water strongly which can spoil fasting. This indicates that everything which reaches the abdomen voluntarily breaks fast.

Among the scholars who did not consider Sawm invalid by this were Shaykh of Islam, Ibn Taymiyyah (may Allah be merciful to him), and other scholars who had the same opinion. They did not validate the analogy between these medicines and food and drink because the evidence does not indicate that nullifiers of Sawm are all that reach the brain, the body, or the stomach, or enter the body through an opening. Thus, as long as there is no Shar`y (Islamic legal) evidence to the effect that nullification of Sawm is conditional on one of these descriptions, it is right to suspend the ruling of invalidation of Sawm in this case. Moreover, deeming these medicines the same as water which reaches the throat or the stomach because of deep sniffing is not correct because they are different. Water is a type of nourishment, and thus if it reaches the throat or the stomach, it spoils Sawm whether it enters through the mouth or the nose which are merely passages. For this reason, Sawm is not invalidated by Madmadah (rinsing the mouth) or careful inhaling of water, as neither of the actions are prohibited. Hence, the mouth being the regular passage has no effect on the ruling. That is to say, if water and the like enter (the throat or the stomach)

through the nose, it will take the same ruling as entering through the mouth. Furthermore, in some cases it is used as a nourishing passage, and consequently it is the same as the mouth. In conclusion, the opinion that seems correct is that inhaling the medicine in question does not break Sawm because, as is mentioned above, it does not fall under the same ruling as food or drink in any aspect.

May Allah grant us success. May peace and blessings be upon our Prophet Muhammad, his family, and Companions.

Permanent Committee for Scholarly Research and Ifta'

3.     Do injections invalidate Sawm?

Q: What is the ruling on injections during Sawm (Fast)?

A: It is better to avoid injection except when necessary, since it is legitimate for a fasting person to break their Sawm when ill. However, it is most likely that it invalidates Sawm as it reaches every part of the body, including the stomach. In addition, it has a greater effect than other medicines that reach the stomach, because the latter is distributed among the organs of the body, whereas the injected medicine reaches every part of the body. Moreover, there are now injections used for nourishing those who are badly stricken with diseases and are unable to take food by the mouth. Hence, it is included under the same ruling as food. However, the famous opinion maintained by many scholars in other countries is that it does not break Sawm, but we cannot rely upon their opinions because they vacillate. Sometimes they deem something impermissible, and after a while they deem it permissible. They first judge it according to the rules of Shari`ah (Islamic law), but a while later some ignorant people may permit it and they follow them.

4.     Do nutritive injections break Sawm?

[Issued by His Eminence Shaykh Muhammad Ibn Ibrahim Al Al-Shaykh, may Allah be merciful to him]

5.     Do insulin injections break Sawm?

Q: I am a diabetic man and I have to have a hypodermic injection on a daily basis. When I do not have this injection my blood sugar level rises. To get straight to the point, is it permissible for me to have such an injection during Ramadan? It may be worth mentioning that my health condition deteriorates every Ramadan because I stop taking the injection. I thus remain at the hospital and break my Sawm (Fast) for about ten days which I make up later on. Please advise. What should I do bearing in mind that such an injection is not effective when it is taken during the night?

A: It is permissible for you to have the injection referred to in the question in the daytime without being required to make up for the Sawm of any days. However, if you can take the injection during the nighttime without facing any hardship, this will be more proper.

May Allah grant us success. May peace and blessings be upon our Prophet Muhammad, his family, and Companions.

Permanent Committee for Scholarly Research and Ifta'

6.     The blood coming out of the body that invalidates Sawm

Q: What is the standard that determines the kind of bleeding that invalidates Sawm (Fast)? How does it invalidate Sawm?

A: Bleeding that invalidates Sawm is that which is caused by cupping. The Prophet (peace be upon him) said in this regard: The cupper and the cupped have broken their Sawm.

The same ruling is extended from cupping to other similar practices including any intentional bleeding which might cause a continuous discharge of blood as may weaken one's body. The Shari`ah (Islamic law) makes no distinction in rulings between similar cases nor combines between dissimilar cases. Unintentional bleeding such as nosebleed or wounds caused by a knife on cutting meat, or treading on broken glass and the like, do not invalidate Sawm even if a lot of blood is discharged. The same applies to a small discharge of blood that does not have an effect like that of cupping, such as a specimen extracted for blood analysis, which does not invalidate Sawm.

[Issued by His Eminence Shaykh `Abdul-`Aziz ibn `Abdullah ibn Baz, may Allah be merciful to him]

7.     Drawing a blood specimen from a fasting person for blood analysis

Q: What is the ruling on drawing blood from the right hand of a person observing Sawm (Fast) during the daytime in Ramadan for blood analysis, estimated to be the amount required to fill a medium syringe or ampoule?

A: Blood analysis does not invalidate Sawm and is pardonable, as it is often needed. Moreover, it is not one of the well-known invalidations of Sawm laid down by the Purified Shari`ah (Islamic law).

8.     Using toothpaste and mouthwash while observing Sawm

Q 1: Toothpaste contains some sugar ingredients which a person tastes while using it, keeping in mind that the normal taste of food takes place by the dissolution of the food within the saliva, and then its penetration to the taste receptors. Accordingly, if the tasted matter dissolves within the saliva, then, most probably, no one can avoid swallowing it.

1- Is it permissible for a fasting person to use toothpaste, keeping into mind that

they can use the toothbrush only?

2- What is the ruling on using mouthwash?

It was reported through a good chain of transmission from Ibn `Abbas (Al-Irwaa', 937) that he (may Allah be pleased with him) did not see any harm in tasting honey, butter, and similar foods and then spitting it out while one is observing Sawm (Fast). This view was also reported from some Salaf (righteous predecessors). Thus, after knowing the way in which food is tasted, what is the ruling on tasting food by a fasting person?

A: All praise be to Allah Alone, and peace and blessings be upon the Messenger of Allah, his family and Companions.

There is no harm in using toothpaste during Sawm; however, one should spit out what has been dissolved of the toothpaste in the mouth, and if something from it goes unintentionally into the throat, it will not affect Sawm. By the same token, there is no harm in using mouthwash which contains medication provided that one spits it out and nothing from it goes intentionally into the throat. The same ruling applies to tasting food, there is no harm in doing it as long as one spits it out without swallowing anything of it.

9.     Anesthetic injection for a fasting dental patient

Q 3: The dentist has to give the patient a shot in the mouth for local anesthetization, which does not contain any nutritional elements. Does this affect Sawm (Fast), taking into consideration that the patient can delay the treatment until nighttime or even until after Ramadan?

A: There is no harm in giving a fasting person a shot in the mouth or in another organ of the body for local anesthetization in order to receive treatment, because this shot does not contain any nutritional elements.

10.   Does a semen specimen collected by masturbation break Sawm?

Q: I would like to inform you that, in Ramadan 1410 A.H., I had a second check up in a hospital. At that time I did not have any job opportunity. When I went to the doctor, he asked me to have a semen test and observed that this was necessary. Accordingly, I had to comply and I provided the semen specimen by masturbation. This was during one of Ramadan days.

It was the only day I could go to the hospital, and the appointment was fixed by the hospital to conduct a test for my wife and myself.

Your Eminence, I wish that you give me a Fatwa on this issue. Should I make a Kaffarah (expiation), besides making up for that day by fasting another day? I hope you enlighten me on this matter. May Allah grant you success.

A: If the case is as you mentioned, you have to make up for the day on which you masturbated by fasting a day in its place and there is no Kaffarah required on your part.

May Allah grant us success. May peace and blessings be upon our Prophet Muhammad, his family, and Companions.

11.   Using a breath-freshening spray to remove unpleasant odors from the mouth while fasting

Q : There is a breath-freshening spray in the markets; when sprayed in the mouth, it may be condensed into liquid. Is it permissible for a fasting person to use it to remove bad breath?

A: It is permissible for a fasting person to use a breath-freshening spray if it is only air, but if it contains any kind of liquid or melted materials, one must expel such things from the mouth.

12.   Using a new Siwak or swallowing parts of it while fasting

Q : Dentists recommend cutting the used part of a Siwak (tooth-cleansing stick) every twenty-four hours. This is meant to maintain the effective substance of Siwak while cleansing one's teeth. Does the use of a new Siwak or new part of it affect one's Sawm (Fasting), particularly when some crusts and shreds may fall into the mouth, which may lead to

them being swallowed?

A: There is nothing wrong with using a new Siwak or a new part of it while fasting. The broken pieces and crusts of the Siwak must be spit out of the mouth.

See also: issues on Ramazaan; Zakath; Hajj and Umrah;

References

http://islamqa.info/en/search?key=medical+issues+in+fasting

http://www.fatwaislam.com/fis/index.cfm?scn=sc&sc=10&c=2

http://www.alifta.net/Fatawa/FatawaChapters.aspx?languagename=en&View=Tree&NodeID=79&PageNo=1&BookID=17