Module VII

Folk Medicine in Hispanics in the Southwestern United States

Contributed by Nancy Neff, M.D., Assistant Professor, Department of Community Medicine, Baylor College of Medicine

The objectives of this module are to:

Understand the origins and applications of Hispanic folk medicine;
Identify common Hispanic folk illnesses and their remedies;
Incorporate the knowledge of Hispanic folk medicine beliefs into the development of effective patient management and counseling plans.

While stereotypical folk medicine is often thought to be used by only poor and/or unacculturated people, the truth is that all of us have used (or have had used on us) some form of folk medicine in the guise of home remedies. People use folk remedies (or home remedies) for several reasons: treatment of minor illnesses (for which they would not consider consulting a doctor), the retention of a locus of self control and if accessibility to medical care is limited. Treatment may be given in one's own home, one of a relative, or in certain cases, it could be at a curandero's (or lay healer's) home.

Personal belief systems are integral to the type of folk medicine used. During the process of growing up, individuals learn the concepts of sickness and health along with religious faith from their families.

Folk medicine (or lay medicine) is "the ordinary person's concept of health, illness, and healing; it is the treatment of disease practiced traditionally among the common people stressing the use of herbs and other natural substances" (Webster). It is felt that intrinsic goodness and comfort come from these--they are accessible, economical, and validated by one's family and faith. While the medical profession has tended to attribute any beneficial effects from folk remedies to the power of the placebo, many of these remedies have been in existence for thousands of years and, as such, may well have physical benefits.

Assignment: List at least three personal health beliefs that derive from your family upbringing and the interventions practiced by your mother or other care giver when you were ill.

Concept of Disease

Intrinsic to an understanding of why people choose folk medicine is an understanding of how the ordinary person defines disease. The term "disease" generally signifies any organic illness. All cultures have systems for classifying diseases on the basis of etiology, signs/symptoms and treatments. Many cultures-modern and ancient, have felt that when one's system is out of balance, one will become ill. Physicians have often seen patients who, when they feel well, believe they are well, leading to a denial of or delay in diagnosis and treatment of early stages of diseases such as diabetes mellitus, hypertension, and tuberculosis. The concept of disease prevention is completely alien in this belief context.

Origins of Hispanic Folk Medicine

People tend to look for reasons why they become ill. From the ancient Greeks came the concept that disease occurs when there is an imbalance of the four humors, or, what has survived into Hispanic folk medicine today, that disease is caused by an imbalance between hot and cold principles. For health maintenance, avoidance of exposure to extreme temperatures is important. Vasoconstriction and a low metabolic rate signify one has a "cold" disease while "hot" conditions are characterized by vasodilation and a high metabolic rate. Examples of "hot" diseases or states are pregnancy, hypertension, diabetes, acid indigestion, susto, ojo and bìlis. Some "cold" disease examples are menstrual cramps, frio de la matriz, coryza, pneumonia, empacho, and colic. Most people do not think about hot and cold principles unless they have been stressed by illness or are in another vulnerable state. The goal of treatment is to restore harmony and balance. Thus, "hot" diseases are treated with "cold" remedies, and "cold" diseases are treated with "hot" remedies.

The Meso-American Indians had a very sophisticated system of health, disease, and treatment. They established the first medical schools in Mexico fifty years before Jamestown was settled, and used a pharmacopeia of over 5,000 well studied and efficacious Indian herbal medications that have been categorized in the Badiano Codix (1552). In that native system of medicine, a strong connection between religion and health existed.

Utilization of Lay Healers Among Hispanics

Studies have shown that 90% of folk medicine adherents do not use the services of a curandero, or lay healer, but obtain their remedies from a hierarchy of lay healers

Neighbors and relatives are valuable sources of information. Those whose conditions cannot be treated by a senora/abuela are usually referred to a yerbero (herbalist), sobador (massage therapist), or partera (mid-wife, who also treats problems with young children). If these (specialists) cannot handle the problem then the patient is referred to a curandero total (the lay healer who may use multiple modalities). These people are highly respected in the local community and they may come from either a family with a tradition of curanderisimo or receive the gift of healing (el dón) later in life. Two of the most highly revered lay healers in South Texas and Mexico, Niño Fidencio and Don Pedro Jaramillo, lived in the late 1800's and early 1900's; they both have active followers who venerate them at shrines today. There is no direct remuneration for services rendered by the curanderos, but most of them do accept gifts. While the curandero has clear expertise in folk illnesses, 80% of the folk remedies are for medical problems. Most curanderos know what they cannot handle and will refer severe health problems to the medical profession, including their own.

TREATMENT FOR COMMON MEDICAL ILLNESSES

The names, indications, efficacy, and safety of common folk remedies used by lay healers are listed in table Folk Remedies Everyone Should Know shown below.

Folk Remedies Everyone Should Know
Spanish Name	English Name	Use	Efficacy	Safety
*Ajo*	Garlic	Hypertension, antibiotic, cough syrup, tripa ida	+	+ + +
*Azarcón/Greta*	Lead/mercury oxides	Empacho, teething	- -	- - -
*Damiana*	Damiana	Aphrodisiac, frio en la matriz, chickenpox	0	+
*Estafiate*	Wormwood	Worms, colic, diarrhea, cramps, bilis, empacho	+ purgative	- -
Eucalipto	Eucalyptus (Vicks VapoRub)	Coryza, asthma, bronchitis, tuberculosis	+ for respiratory symptoms; doubtful for tuberculosis	+
*Gobernadora*	Chaparral	Arthritis (poultice); tea for cancer, verneral disease, tuberculosis, cramps, pasmo, analgesic	+ as a poultice 0 as a tea	- - - (internal)
*Gordolobo*	Mullein	Cough suppressant, asthma, coryza, tuberculosis	+ +	+ + (if right species)
*Manzanilla*	Chamomile	Nausea, flatus, colic, anxiety; eyewash	+ +	+ + (if no allergy)
*Orégano*	Oregano	Coryza, expectorant, menstrual difficulties, worms	? +	+
*Pasionara*	Passion Flower	Anxiety, hypertension	+ + + sedative	+ + (if right species)
*Rodigiosa*	Bricklebush	Adult onset diabetes, gallbladder disease	? ? ?	? ? ?
*Ruda*	Rue	Antispasmodic, abortifacient, empacho, insect repellent	? ?	- - - (internal & external)
*Saliva*	Sage	Prevent hair loss, coryza, diabetes	+	- - (chronic use)
*Tilia*	Linden Flowers	Sedative, hypertension, diaphoretic	+ sedative	- - (chronic use)
*Tronadora*	Trumpet Flowers	Adult onset diabetes, gastric symptoms, chickenpox	? ? ?	? ? ?
*Yerba buena*	Peppermint	Dyspepsia, flatus colic, susto	+ + +	+
*Zábila*	Aloe Vera	External - cuts, burns Internal - purgative, immune stimulant	External + + + Internal +	External + + Internal - - -
*Zapote blanco*	Sapodilla	Insomnia, hypertension, malaria	? ? ?	? ? ?

HYPERTENSION

Hypertension is defined as a hot illness. In 60% of the cases the etiology is thought to be due to corajes (anger) or susto (fear); the remaining 40% are felt to be due to "thick blood". Cool remedies such as bananas and lemon juice are popular as well as teas of passion flowers (pasionara), linden (tilia), or zapote blanco.

DIABETES MELLITUS

Diabetes mellitus is also a hot illness. While the curanderos will no doubt encourage consultation with a physician, various remedies may also be used. Nopal (or cactus), aloe vera juice, or bitter gourd can be taken. In some areas in Texas and Mexico treatment is started with maturique root infusion for approximately one week if the person is extremely hyperglycemic. Subsequently for maintenance therapy, trumpet flower-herb or root infusion (tronadora), brickle bush (prodigiosa) tea, or sage tea (salvia) are used. The proven safety and efficacy of maturique, trumpet flower, or bricklebush preparations are not known. Aloe vera juice is reasonably safe but aloe vera latex is a powerful purgative. Sage tea taken chronically can lower the seizure threshold and has been reported to cause mental and physical deterioration because it contains thujones and tannins.

Other medical illnesses for which folk treatment by herbalists or curanderos is prescribed include:

Upper respiratory infection

Asthma

Osteoarthritis/rheumatism

TREATMENT OF FOLK ILLNESSES

Curanderos are the clearly acknowledged experts in diagnosing and treating folk illness in the barrio. Folk illness is "a syndrome in which members of a particular group claim to suffer and for which their culture provides a etiology, diagnosis, preventive measure and regimen of healing" (Rubel). Folk illnesses have a high degree of psychological and/or religious overtones. Family involvement is an intrinsic part of the healing process, and people improve because of their religion, personal faith in the remedies, and familial commitment.

Assignment: Review the descriptions of folk illnesses recognized by Hispanics of Mexican origin. For each one, a) identify potentially dangerous outcomes of standard folk treatment and b) consider how you would counsel a patient who attributed his/her symptoms to the folk illness.

CONCLUSION

Since folk beliefs are wide-spread to varying degrees, the effective health care provider would do well to heed the following recommendations:

Understand (and be sensitive) to the role folk medicine may play in patients one encounters;
Practice delivering messages of tolerance and respect - "the art of medicine";
During the interview, ask "What do you think caused your illness?", and "We all have favorite remedies that we use when we are sick. What have you done to treat this condition?";
When appropriate, and not contraindicated, incorporate some benign folk medicine remedies into one's advice to the patient to improve the compliance and trust;
As an example, when encouraging liquid intake for colds and flu, considering suggesting te de manzanilla (chamomile tea) with other electrolyte replacement as part of the therapeutic regimen.