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world’s population uses herbal remedies to treat illness and optimize health. Technically, an herbal medicine contains only leafy plants that do not have a woody stem.20_{A more}

comprehensive term is botanical, including all therapeutic parts of all plants, from the root (e.g., ginseng), the bark (e.g., willow), the sap (e.g., from aloe), the gum (e.g., frankincense) or oil (e.g., from nutmeg), the flowers (e.g., echinacea), the seeds (e.g., gingko biloba), to the fruit (e.g., bil- berries). Botanical remedies often use the whole plant, which practitioners claim is superior to using a single active extract because other components in the plant may work together synergistically in the preparation to enhance the therapeutic value and to buffer any side effects. For this same reason, plants are often combined in formulary mixtures, particularly in Traditional Chinese Medicine.

Most consumers select botanical reme- dies instead of biomedicine because they believe they are safer and more effective than prescription drugs or they are treating chronic conditions for which biomedicine has little to offer in the way of relief. Some

proponents note that botanicals have been used for centuries and that reported deaths each year number in only the hundreds, compared to over 100,000 deaths due to prescription drug–induced conditions.39, 44

The key word is reported. The Dietary Supplement Health and Education Act (DSHEA) passed by Congress in 1994 defines dietary supplements as separate from food and drugs and thus outside the scope of federal monitoring. Manufacturers are exempt from regulations requiring that complaints, injuries, or deaths due to con- sumption of their product be reported to the Food and Drug Administration (FDA). Though the FDA retains the right to protect the public from harmful products, the burden of proof is on the government to prove that a particular botanical remedy is unsafe. Many manufacturers have volun- tarily adopted good manufacturing processes, and the American Herbal Products Association has created a botani- cal safety rating system that classifies herbs as (1) safe when consumed appropri- ately; (2) restricted for certain uses; (3) use only under the supervision of an expert; and (4) insufficient data to make a safety classification.

Unfortunately, the explosive, unregu- lated growth of the industry has resulted in numerous problems. Of particular con- cern is the interaction of botanicals when used with biomedical therapies. For example, gingko biloba reduces the effec- tiveness of some prescription drugs, such as certain antacids and antianxiety med- ications, while potentiating others, including anticoagulants, antidepres- sants, and antipsychotics.10_{In addition,}

some botanicals can interact adversely with anesthesia, and others can increase side effects of radiation therapy.32

Consumers may also experience allergic reactions or poisoning due to interaction between two or more products, and some researchers suggest autoimmunity dis- eases may be triggered by use of immune-boosting herbs in persons pre- disposed to such disorders.7, 11, 45_Further,

natural products can be adulterated with pesticides, heavy metals (such as mer- cury), or prescription drugs (such as war- farin or alprazolam).15_{(Tables of selected}

botanical remedies for each ethnic group are available through the Food and Culture book companion website.)

examples. In addition to folk healing, both Traditional Chinese Medicine and Ayurvedic medicine make extensive use of botanical medi- cine (see the chapters on each American ethnic group for more details).

Homeopathy also prescribes therapeutic sub- stances, such as botanical medicine, diluted venom, or bacterial solutions, and biomedical drugs. Originating in Germany, homeopathy is based on the concept that symptoms in illness are evidence that the body is curing itself, and accel- eration or exaggeration of the symptoms speeds healing. One primary tenant is that “like cures like.” Naturopathic medicine also focuses on help- ing the body to heal itself, usually through non- invasive natural treatments (including some physical manipulations, as the following section describes), although biomedical drugs and sur- gery are used in certain cases. Nutritional ther- apy, based on whole foods and dietary supplements, is the foundation of naturopathic health maintenance and healing.

Application of Physical Forces or Devices.

Manipulations of the body operate on the shared premise that internal functioning improves with minor adjustments of physical structure. Chiropractic theory states that misalignments of the spine interfere with the nervous system, interrupting the “innate intelligence” that regu- lates the body, resulting in disease and disorder. Osteopathic medicine proposes that blood and lymph flow, as well as nerve function, improves

through manipulation of the musculoskeletal system, particularly the correction of posture problems, mobilization of bone joints, and spine alignment. Health problems are treated through restoration of mobility and suppleness.

Several Asian healing therapies can be classi- fied as the application of physical forces or devices and are practiced by family members in the home, by folk healers, by specialists in the therapies, or by traditional Chinese medical physicians. Massage therapy, acupressure, and pinching or scratching techniques are used to release the vital energy flow through the twelve meridians of the body identified in Traditional Chinese Medicine, primarily by relieving muscle tension so that oxygen and nutrients can be deliv- ered to organs and wastes removed. Coining is a related practice in which a coin or spoon is rubbed across the skin instead of pressing or pinching specific points. Acupuncture is similar to acupressure in that it attempts to restore the balance of vital energy in the body along the meridians, but it differs in that it stimulates spe- cific junctures through the insertion of nine types of very fine needles. The needles do not cause bleeding or pain. Acupuncture is considered useful in correcting conditions where too much heat (yang) is present in the body. In conditions of too much cold (yin), another technique is pre- ferred, called moxibustion, in which a small burning bundle of herbs (e.g., wormwood) or a smoldering cigarette is touched to specific loca- tions on the meridians to restore the balance of energy. A similar method is cupping, the place- ment of a heated cup or a cup with a scrap of burning paper in it, over the meridian points.39

Application of electricity is used in various elec- trotherapies, primarily to stimulate muscle or bone healing, especially in sports medicine. Biofeedback also uses small electric pulses to teach a person how to consciously monitor and control normally involuntary body functions, such as skin tempera- ture and blood pressure, to alleviate health prob- lems, which include insomnia, gastrointestinal conditions, and chronic pain. Hydrotherapy involves the application of baths, showers, whirlpools, saunas, steam rooms, and poultices to relieve the discomforts of back pain, muscle ten- sion, arthritis, hypertension, cirrhosis of the liver, asthma, bronchitis, and head colds. In addition to the hydrotherapeutic qualities, the mineral con- tent of the water is considered stimulating. 50 TRADITIONAL HEALTH BELIEFS AND PRACTICES

Ginseng, a root found in both North America and Asia, is one of the most common herbal remedies used in the nation. It reputedly pro- motes health through increased strength and vital- ity, and may be taken specifi- cally to treat digestive upset, anxiety, or sexual impotence.

Naturopathic doctors trained in the United States attend a four-year program including many biomedical disciplines. Doctors of Chiropractic (DC) are the third largest cate- gory of health care practi- tioners in the United States, following physicians and dentists. Osteopaths are licensed to prescribe medica- tions and perform surgery as Doctors of Osteopathy (DO) in all 50 states.

Kur (spa) therapy is popular throughout Europe, particu- larly in Germany.

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Eighty percent of respon- dents in a study on faith and healing in the southeastern United States said they believe God acts through physicians to cure illness.52

Powwowing is not an American Indian practice; the faith healer asks for direct assistance from God in curing the sick person through the use of charmed objects, such as knotted strings or nails, and prayer or incantation. Magicoreligious Interventions. Spiritual heal-

ing practices are associated with nearly all reli- gions and cosmologies. They typically fall into two divisions: those actions taken by the individ- ual, and those taken on behalf of the individual by a sacred healer.

In Western religious traditions, God has power over life and death. Sickness represents a breach between humans and God. Healing is integrally related to salvation because both mend broken ties.85_{Living according to God’s will is}

necessary to prevent illness, and prayer is the most common method of seeking God’s help in healing. Roman Catholics, for example, make appeals to the saints identified with certain afflic- tions—St. Teresa of Avila for headaches, St. Peregrine for cancer, St. John of God for heart disease, St. Joseph for the terminally ill, and St. Bruno for those who are possessed are just a few examples. Pilgrimages to the shrines of these saints are made for special petitions. In Eastern religions, health is determined mostly by correct conduct in this and past lives, as well as in the virtuous behavior of ancestors. Religious offer- ings are made regularly; for instance, Hindus choose a personal deity to worship daily at a home shrine. Improper actions leading to dishar- mony within a person, family, community, or the supernatural realm can cause sickness. Healing occurs through restoration of balance, often including offerings to the deities or spirits of the living and dead who have been offended.

Individual healing practices developed out of religious ritual include meditation, a contempla- tive process of focused relaxation; yoga, the con- trol of breathing and use of systematic body poses to restrain the functions of the mind and promote mind–body unity; and visualization or guided imagery, induced relaxation and targeted willing away of health problems. Each concen- trates the power of mind on reducing health risks, such as stress, high blood pressure, and decreased immune response, or on alleviating specific medical conditions. Hypnotherapy works in a similar manner; although it is generally done with the aid of a hypnotherapist, self-hypnosis can be learned for personal use.

In many cases the spiritual skills of the indi- vidual are inadequate for the problem, and the help of a sacred healer is sought. These health practitioners generally work through interven- tions with the supernatural world, which may

include prayers, blessings, chanting or singing, charms, and conjury, as well as the use of thera- peutic substances (i.e., herbal remedies) and application of physical cures (i.e., the laying on of hands). Faith healers, most of whom get their healing gifts from God, are common among many Christian groups. Some are affiliated with certain denominations and rites, such as the Cajun traiteurs of Louisiana, who specialize in treating one or two ailments through prayers and charms associated with Catholicism.9, 49_Others,

such as the sympathy healers of the Pennsylvania Dutch who practice powwowing (also known by the German name Brauche or Braucherei), are considered the direct instruments of God.58, 85

Persons with a spiritual calling are often employed to treat illness. Neng among the Hmong, Mexican curanderos (or curanderas), practitioners of voodoo in the American South, and espiritos or santeros (or santeras) in the Caribbean may com- municate with the spirits or saints to heal their patients. Ceremonial invocation is the primary therapy, although charms and spells to counteract witchcraft and botanical preparations to ease physical complaints are used as well.

Shamans, called medicine men among many Native American groups, are sacred healers with exceptional powers. They originated in Russia an estimated 20,000 years ago and spread through- out the world to the indigenous cultures of the Americas, Southeast Asia, Indonesia, Polynesia, and Australia. Remote tribal groups found in Africa, India, and Korea have similar healers. A shaman is a composite priest, magician, and

Chapter 2: Traditional Health Beliefs and Practices 51

Acupuncture attempts to restore the balance of vital energy in the body through the use of special needles.

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A study of physician beliefs about health and religion found that although 91 per- cent of respondents said knowledge of a client’s faith practices is important in care, only 32 percent ask about religious affiliation.13

When Navajos dream fre- quently of death, it is usu- ally considered a sign of serious illness.

Consultation with a Native American medicine man may take hours to com- plete; some healing cere- monies take a week to perform and may cost thou- sands of dollars.27

doctor; the position is passed on from generation to generation, or through a calling that could include fainting spells or convulsive fits due to attacks by spirits. Shamans typically complete lengthy apprenticeships and are initiated through a series of trials simulating death and rebirth. In shamanic systems, sickness is due to spiritual crisis, and healing emphasizes strengthening of the soul through redirection of the life forces or, in cases of serious illness, retrieval of the soul, which may have been stolen by evil spirits. Shamanic practices include visualization tech- niques to create harmony between the patient and the universe, singing, chanting, prognostica- tion, dream analysis, and séances. Shamans are often expert herbalists.3, 72

Pluralistic Health