8.2: Ethnomedicine

Ethnomedicine refers to the medical systems based on the cultural beliefs of varying ethnic groups (e.g. Traditional Chinese Medicine).

1. Ethno-nosology: Refers to the cross-cultural systems of classification of health issues.[1]. In a wide sense, nosology deals not only with diseases, but with any kind of medical condition, like injuries, lesions or disorders. Medical conditions, like diseases, can be defined by cause, pathogenesis (mechanism by which the disease is caused), or by a collection of symptoms, medical signs and biomarkers, particularly when the other two definitions are not available (idiopathic diseases). From a nosological point of view, medical conditions could be divided in disorders, diseases, syndromes, lesions and injuries, each one with some specific meaning
2. Culture-bound syndromes: Also known as culture-specific syndrome, or folk illness, is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease, whether it be psychological or physical, only within a specific society or culture.
3. Disease/Illness Dichotomy: Dichotomy is the division of one thing into two parts or a subdivision into halves or pairs. In medical anthropology, the two aspects of sickness are divided to better care and heal those in need. Disease and Illness are two very different things in the medical field that are responded in different ways. Diseases are the biological and psychological malfunctioning of the body physically. Illnesses deal with the psychology of the human where the psychosocial experiences bring on the sense of illness or disease.
4. Diagnosis/Divination: A diagnosis is the act of identifying or determining the nature and cause of a disease or injury through the evaluation of a patient. Divination is the seeing of future events or somehow gaining unknown knowledge through the supernatural.

Traditional Healing and Western Medicine

Cultures around the world offer various perspectives on the relationships between healing, spirituality, and illness. The coexistence of traditional and biomedical healing systems common in many places, and finding somewhere where only one method is relied upon is difficult. Medically pluralistic societies and cultures provide a variety of treatment options in both traditional and modern practices.

Traditional healing is largely regarded as the oldest form of structured medicine, and from it came the later forms of medicine commonly practiced. Traditional healing was originally an integral part of semi-nomadic and agricultural tribal societies, and involved the use of ceremonies that included plant, animal or mineral- based medicines, energetic therapies, or physical techniques. Common medical practices and persons that lie in the realm of traditional healing include acupuncture, herbalists, shamans, and faith healing.

Western medicine, compared to traditional healing, bases its theories and practice of medicine on the scientific method and on knowledge supported by scientific research. The practice is more based in empiricism rather than culture, but its effects and use can be seen in a wide variety of societies. Many civilizations, both current and early, utilized forms of Western medicine including Ancient Egypt, Greece, and the Medieval Arab Empire. Modern day Western medicine was considered to have been developed around 300 BCE by Hippocrates. Common medical practices and persons employed by Western medicine include surgeons, physical therapists, psychiatrists, and dentists.

The "sick role" is a term used in traditional medicine that is prevalent in western societies. It is culturally defined as an agreement between the patient and family members of the patient to acknowledge that the person is sick. Examples of this can be seen when a person has cancer and is encouraged by his or her family to seek treatment, thus acknowledging the sick role in the process.

Often in Western culture, traditional healing concepts still exist in the form of various superstitions and traditions. The concept of the Aphrodisiac though it has little scientific backing is still common in western culture. An Aphrodisiac is a food or substance that is believed to increase sexual energy or prowess. Examples of aphrodisiacs differ between cultures examples include oysters in English speaking countries, Balut in the Philippines, and Durian throughout Southeast Asia.

Healing Substances

Cultures use a variety of different substances for healing. Some cultures rely on drugs to induce a state of healing, while others put their lives in the hands of healers such as shamans to regain health. In many cases, people rely on both medical pluralism and medical syncretism. Medical pluralism refers to the integration of biomedicine and other forms of healthcare, while medical syncretism is the fusing of more than one medical practice, such as fusing spiritual practices with biomedical practice. It is important to note that in many cases the state of healing that is accomplished in one culture may not be able to be accomplished in another due to differing perspectives on how the substance is meant to affect a person. For example, there is a vast difference between the use of drugs for recreation and their use for healing. In some cultures it is believed that during drug use a person reaches a heightened state in which they are able to begin healing, whereas in other cultures this heightened state is used for pure enjoyment.

Figure \(\PageIndex{1}\): A flowering peyote, in cultivation.

Examples of healing substances include Peyote, a rare cactus found in Mexico containing the chemical mescaline which induces hallucinogenic experiences if ingested properly. This cactus has historically been used ritualistically in many indigenous cultures. It causes an enhanced feeling of introspection and visual or audio hallucinations. Another example is the magic mushrooms of Oaxaca, similar to the Peyote in which the consumer enters a psychedelic state and is able to allow the mushrooms to heal themselves spiritually and physically. Ayahuasca is an Amazonian plant mixture that is capable of inducing altered states of consciousness, usually lasting between 4 and 8 hours after ingestion. Shamans or medicine men take ayahuasca to communicate with nature or to see what is causing a patient’s illness on a spiritual level. The drink is taken in the form of tea, typically in a ceremonial session under the guidance of an experienced drinker. The main ingredient of this jungle tea is a vine, Banisteriopsis caapi, which like the tea itself is also called ayahuasca (which means ‘vine of the soul’ or ‘vine with a soul’). This vine is combined with a variety of plants that contain the psychedelic drug DMT. The Banisteriopsis caapi contains an MAOI, which allows the DMT to be active orally. Coca, tobacco and alcohol can also be considered healing substances and are more prevalent across cultures than the aforementioned drugs.

Ethnobotany

Ethnobotany The study of native plants that is used by a particular culture. The study of these plants is used to garner accurate understanding of their medical potential and cultural usage. An ethnobotanist's job is to travel to different locations in the world for the purpose of studying the relationships between plants and culture. Their knowledge is gleaned from the perspective and information provided by the culture with which the plant is used. Ethnobotanists look for plants which effectively treat disease or relieve symptoms. These plants can then be synthesized into medication to provide treatment for other populations.

Figure \(\PageIndex{2}\): Mayan priest performing healing

The roots of ethnobotany can be traced back to an ancient Greek surgeon named Dioscorides. He was the first person to organize plants into specific classifications. Around AD 77, Dioscorides produced the publication, “De Materia Medica”, which consisted of information on all the plants he researched. This botanical reference book compartmentalized approximately 600 plants. It also included facts about the plants such as; what season it was in bloom, how to use it medicinally, its toxicity level and whether or not it was edible. In 1542 Leonhart Fuchs achieved a similar feat when he published, “De Historia Stirpium”, another botanical reference book that catalogued plants indigenous Germany and Austria (the book contained information on about 400 plants). Another important figure in the development of ethnobotany was John Ray. He was the first person to understand and explain the concept of species; he also produced important publications such as, Catalogue of Cambridge Plants, Synopsis Methodica Avium et Piscium and Methodus Plantarum (works were published between 1660–1713). The methods for categorizing plants continued to develop and it reached its apex with a Swedish medical student named Carl Linnaeus. Linnaeus invented the classification system known as taxonomy. This system of classifying organisms is still utilized in contemporary times. His book, Species Plantarum, had listings for approximately 5,900 plants. The term ethnobotany was developed by John Harshberger around 1895. Harshberger was the professor of botany at the University of Pennsylvania. He spent many years traveling the globe researching and cataloguing different regions native plant life.

Ibogaine

Figure \(\PageIndex{3}\): Iboga, a principal component of ibogaine

As stated previously, ethnobotany is the study of how a culture uses its indigenous plants for medicinal purposes. An example of an idiosyncratic way of healing (pertinent to ethnobotany) can be seen in the religious rituals of the Bwiti. Bwiti is a religion that is practiced by the people of Gabon (a country in west central Africa). This particular creed relies heavily on the use of ibogaine (a powerful psychoactive which is derived from the root of the Tabernanthe ibona shrub). Tabernanthe iboga is indigenous to Gabon and is easily accessible to people of the Bwiti religion. Iboga is most commonly ingested through chewing on the root of the shrub or brewing the plant into a tea. The plant is revered by the Bwiti because of its hallucinogenic properties which cause practitioners to receive revealing visions and deep introspective self-contemplation. Iboga is consumed for religious ceremonies, initiations, coming of age rituals and healing processes. When a person within the Bwiti community becomes ill he or she is fed iboga to get in touch with their imbwiri. The imbwiri is a spirit represented in a human configuration which will either cure the individual or provide valuable information on the antidote. Iboga was brought to Europe by French and Belgian researchers in the late 1800’s. By the 1960’s ibogaine (although still rare) had been introduced to many different parts of the world. (mainly as a psychoactive drug). The medical potential of this drug was discovered by a man named Howard Lotsof in 1963. He realized that this substance could combat heroin and opiate addiction. It also could alleviate the painful and mentally exhausting withdrawal symptoms. Howard cured his own heroin addiction through this method and introduced ibogaine to his friends who were also habitual heroin users with positive results. As time progressed ibogaine was found to be useful in treating many addictions including unhealthy reliance on cocaine, crack, alcohol, methamphetamine, and nicotine. Even though this drug showed potential towards battling addiction it was outlawed in many countries (including the U.S.) because of its hallucinogenic properties. Although ibogaine has been marked illegal there are still underground clinics that provide full treatments serving the drugs medical ideology. Research on ibogaine is still being conducted today and it could eventually become a fully marketable, synthesized anti-addiction medication.

Ayahuasca 

For thousands of years Amazonian shamans have been concocting and administering one of the most powerful psychoactive substances on earth. The main psychoactive ingredient in Ayahuasca is DMT, and users report life-changing trips, often involving out of body experiences and extraterrestrial contact. Ayahuasca remains a schedule 1 drug in the U.S. and many other countries. The brew is made by mixing Banisteriopsis caapi, which contains the DMT, with Psychotria Viridis, which contains MAO inhibiting alkaloids and allows for oral ingestion. Ayahuasca is gaining popularity in the western world as people attempt to create centers in the U.S. where one can safely consume the drug.

The Candlenut Tree 

The Kukui or Candlenut tree, is an example of an indigenous plant used by a culture for food, medicine, and other purposes. Native Hawaiians used the nut, sap, and leaves for various everyday uses. The nut, which produces copious amounts of oil, was strung onto palm fronds and used a torch or candle (thus the name Candlenut). The nut was also roasted and sprinkled on food for added flavor, but it was also known to have laxative properties. The sap of the green nut was spread on cuts and cold sores to speed up healing. The leaves and flowers were used for making lei. As a child growing up in Hawaii, my friends and I made spinning tops out of the shell of the nut. Many visitors to Hawaii would recognize the Kukui nut as the black, shiny nut strung on ribbon to make a lei that lasts indefinitely. The unique part about this tree is that all of the components of the tree are toxic, but the seed, leaves, flowers and bark can be all be used in medicine systems if used in the correct way. The candlenut tree provides a multitude of uses including health benefits, decoration, jewelry making, and more.

The Cure-All Herb

The "Cure All Herb" is a herb called Combretum micranthum, but is most commonly known as Kinkiliba. It is found in West Africa, specifically Senegal. This drinking herb has a positive impact on the population drinking it. Kinkiliba is the most common herbal tea found throughout West Africa. Many West-Africans begin their morning with a cup of this powerful tea that is great for maintaining general health and well-being. Kinkiliba is known to aid in the treatment of fevers, colds, aches, pains, and the flu; but is also used to aid weight loss, sleep loss, and even cancer. This herb is a natural diuretic and helps to speed up the healing process when one is ill. One may also apply solutions of the leaves or the roots to speed up the healing of old wounds. This miracle tea is also known to prevent malaria and lower blood pressure. The herb serves as an antibacterial and antispasmodic as well.

The Detoxifying Herb

Kelle (khaya senegalensis) is a common herb used throughout West Africa for a body cleanser and energy booster. West Africans soak the bark in water and drink the mixture for a general detoxification and intestinal cleanser. Kelle is also used to bring down fevers and to combat general fatigue. Khaya senegalensis is very effective when it is used as a body cleanser or an energy booster, but it also has other uses. For example, the seeds and leaves can be used to treat fevers and headaches, and the roots can help with the treatment of mental illness or as an aphrodisiac.

Acacia Senegal

Uses - Gum arabic’s main effect is to form a soothing, protective coating over the respiratory, alimentary, and urinary tracts. In conjunction with various astringents, it is helpful for coughs, sore throat, and catarrh (excessive discharge or buildup of mucus in the nose or throat, associated with inflammation of the mucous membrane.), as well as in cases of diarrhoea and dysentery. The mucilage makes a good vehicle for other medicines, in addition to having nutritional value in its own right. However, most of the gum arabic imported to USA goes to the food industry to give body and texture to products for bakers and a hard sheen coating on candies.

Marijuana

Figure \(\PageIndex{4}\): Some cannabis bud, which is well-cured (i.e. dried slowly following a specific procedure). The strain is Sweet Tooth #3

Marijuana has an extensive medical and shamanic history throughout a multitude of cultures. Researchers often site the Chinese to be one of the first cultures to recognize it's medical potential. Author Robert Deitch states, "The Chinese Emperor Fu Hsi (ca. 2900 BC), whom the Chinese credit with bringing civilization to China, seems to have made reference to Ma, the Chinese word for Cannabis, noting that Cannabis was very popular medicine that possessed both yin and yang." Marijuana has long been used in Chinese medical practices. Other cultures such as the Egyptians, going as far back as 1213 BC, have made use of cannabis. It was found in the tomb of Ramesses II. Ancient Egypt would often use marijuana for a myriad of issues such as inflammation, psychological problems, treat glaucoma, cataracts, hemorrhoids, vaginal bleeding, in addition to many other issues. In modern America, the homeopathic potential of cannabis only just began to be recognized in 1973 when Oregon decriminalized the use of marijuana. It wasn't until 1996 that California became the first state in the United States to legalize medical marijuana. Recently the use of medical marijuana has become much more widespread across the country. The most common use for medicinal cannabis is pain management, specifically for patients with long term illnesses, such as cancer. Muscle spams can be much improved with the use of medicinal marijuana, especially in the case of treating multiple sclerosis. Cannabidiol, also known as CBD in marijuana is the non-psychoactive, medicinal part of the cannabis plant. CBD unlike THC, the active ingredient in the plant that creates the euphoric “high”, is almost exclusively used for medicinal purposes. If one where to intake only the CBD parts of the herb, one would only feel pain relief, in addition to relief of any specific ailments they may have – such as an epileptic’s reduction in seizures. In conclusion, marijuana has numerous medicinal properties that have been respected and cultivated by cultures throughout our long human history.

Echinacea

Native to North America and has long been used by the Plains Indians for its medicinal properties. It is believed to shorten the duration of a cold and treat many of the symptoms such as coughing, sore throats, and headaches. Recent studies have suggested that Echinacea has little or no effect on the duration or severity of a cold, and it is merely taken to provide some sort of comfort to the sick person, in many ways a placebo. The effectiveness of Echinacea is still a subject of debate, but it remains a culturally important remedy in North American ethnobotany.

Goldenseal

Also known as Orange-root, Orangeroot, or Hydrastis Canadensis, is a perennial herb in the buttercup family Ranunculaceae, native to southeastern Canada and the northeastern United States and is another prominent herb used in North America. Goldenseal was in extensive use among certain Native American tribes of North America, both as a medicine and as a coloring material. Goldenseal was extensively used for cancers and swellings of the breasts by the Eclectics, although it was not considered sufficient for cancer alone [1]

Pacific Yew

Also known as taxus brevifoila or the Western Yew, is a small fir like a tree that can be identified by its flaky bark, as well as its flat needles that protrude horizontally from either side of the twig. It is usually found in shaded environments alongside trees such as Douglas firs and hemlock. The bark is a traditional medicine used for “internal problems like ulcers and liver ailments”(Turner & Hebda). In recent years Yew bark has become famous for containing a cancer-fighting compound called Taxol that slows or stops cell replication in cancer cells. It is most commonly used in the treatment of breast, lung, and ovarian cancer.

"Pacific Yew, Taxus Brevifolia." Native Plants PNW. N.p., n.d. Web. 01 Dec. 2016. "Paclitaxel (Taxol®, Abraxane®): Cancer Drug Information | CTCA." CancerCenter.com. N.p., 01 Jan. 0001. Web. 01 Dec. 2016.

"Taxus Baccata (common Yew)." Taxus Baccata (common Yew) | Plants & Fungi At Kew. N.p., n.d. Web. 01 Dec. 2016. Turner, Nancy J., and Richard J. Hebda. Saanich Ethnobotany: Culturally Important Plants of the WSANEC People. Victoria, BC: Royal BC Museum, 2012. Print.

Essential Oils

Another form of ethnobotany that has been on the rise in popularity in the United States is the use of 'essential oils'. Essential oils are potent oils that are “extracted from flowers, barks, stem, leaves, roots, fruits and other parts of the plant by various methods” (Ali, et al., 2015). Those who use them believe that they are nature's medicine, and if used properly can treat many infections and ailments, replacing or assisting modern medicine. Through laboratory studies, scientists have found that these oils contain antiseptic and skin permeability properties. Certain essential oils can be even more effective than pharmaceutical antibiotics due to their complex chemical makeup.

One popular way that essential oils are used is through aromatherapy. “Inhalation, local application, and baths are the major methods used in aromatherapy that utilize these oils to penetrate the human skin surface with marked aura” (Ali, et al., 2015). Through use of single oils, as well as combinations or mixtures of oils, people have used essential oil aromatherapy to get relief from “numerous ailments like depression, indigestion, headache, insomnia, muscular pain, respiratory problems, skin ailments, swollen joints, urine associated complications, etc.” (Ali, et al., 2015).

Many are still skeptical of its use, the FDA has not approved of the oils act as medicine. However, use of plants has been the way that many cultures have historically gone about creating medicine, and the effectiveness of essential oils has been proven to many who choose to fight their ailments a more natural way. Some examples of essential oils are Lemongrass, peppermint, orange, and countless others all of which can be used in different ways. Essential oils are starting to become more well known and potentially used on an everyday basis for some, and they are easy to find at pretty much any local grocery store or market.

Critics of Ethnomedicine

Although most individual ethnomedical practices have been criticized for various traits they possess (e.g. claims of spiritual healing being a hoax, psychiatry not being able to cure alcoholism), one argument stands out as criticizing almost all forms of ethnomedicine. This argument criticized the mental orientation of most forms of ethnomedicine. Biologist Horacio Fabrega Jr. Writes:

The implicit assumption adopted by the researcher is that he is dealing with a disorder that is either typically psychiatric or at least psychiatric-like. Excessive preoccupation with this dimension on the part of culturally oriented anthropologists has tended to obscure the influences that biological components have on [culturally defines] illnesses. Consequently, the potential of examining the reciprocal influences that psych culture and biological factors have on instances of illness occurrence [as defined and categorized by subjects] has been missed.

Doctors and anthropologist who practice ethnomedicine experience criticism for making the assumption that an ailment can be cured using ethnomedicine without weighing the possibility of biological medicine.

Biopiracy

Biopiracy is the exploitation of plant and animal species by foreign entities to restrict their general use. There are two parts to biopiracy, being bioprospecting that exploits plant and animal species by claiming patents to restrict their general use. The second piece is the 'piracy', this takes place when individuals or corporations patent these plants and the methods of processing plant based substances, aromas or the genetic information for their exclusive use and sale. The patent often prohibits the communities that identified or actively use the bio active properties, developed processing and extractive technologies and bred the plants, for personal use or sale.

A related concept is bioprospecting. This term is sometimes used to refer to biopiracy with a less negative connotation, where the assumption is the patented item had a known use already. Alternately, the bioprospecting company is searching for novel compounds or genes in items that were not used traditionally. Companies can harvest plants or organisms with little to no opposition in some parts of the world, and then patent any part of them that ends up being useful.[2]

An example of biopiracy was the basmati rice patenting! Basmati is a variety of long, slender-grained aromatic rice which is traditionally from the Indian subcontinent. In 1997 the US Patent and Trademark Office (USPTO) granted a patent (No. 5663484) to a company called 'Rice Tec Inc' based in Texas. There have been many efforts by the Indian government to reclaim the use to their traditional rice grain and to some avail. In one attempt the Indian government filed fifty-thousand pages of evidence to prove that high quality basmati rice varieties already contain the qualities that Rice Tec Inc had patented. Due to a large movement against rice Tec in March 2001 the USPTO rejected seventeen of the twenty claims the patent was based on![3]