Definition: Traditional Medicine¹ is the sum total of the knoledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of physical and mental illnesses. The terms complementary/alternative/non-conventional medicine are used interchageably with traditional medicine in soma countries.

Traditional Medicine is an extremely diverse subject in the context of the multicultural Plurinational State of Bolivia. Because each indigenous group, and remember there are officially 36 in the country, has its own concept of health and illness, we are faced with a wide range of Traditional Medicines.

The Political Constitution of the State establishes that both the cultural heritage and the knowledge of the Indigenous Peoples should be respected and protected (Article 98, 99, and 100 of Section III of the Cultures of CPE). This implies that a particular approach for the point of view of health. In Bolivia, there are 36 official indigenous groups, each with its own culture and specific worldview which means there also are 36 concepts of what is health and illness. While the concept Vivir Bien (to live well) already implicates a rethinking of the western concept of development, it is not exempt from also a rethinking of the concept of medicine. Therefore, Traditonal Medicine takes great importance in the context of Vivir Bien and health.

Health and Illness and its Relation to a Worldview of Medicine²

The categories of observed illness in bolivia indigenous medicine are different than biomedicine: illness is seen among the indgenous as a break in natural or social order. It is the dieties, Pachamama (Mother Earth), Dios de la sociedad (God of the social order), or an individual who cause the evil. A person become sick because he or she has violated an established rule of cociety or the deities of the Andean cosmos (or the forest spirits in the case of the Guaraní).

The role of the 'tradition doctor' is to reestablish this equilibrium both social and religious orders. Healing rituals are closely linked to the Andean and Guaraní religious world and often fuses elements of Christianity.

According to Andean medicine, helath and sickness comes from the earth and all health is derived from plants that the same earth offers to humans. Thorugh the deities and the earth, the worlds of the dead and the living, a traditional doctor cures a sickness. The body and the spirit are part of one comprehensive and harmonious system such that a change in one will cure the sickness. The indigenous populations differentiates between sckness of the body and sick of the 'spiritual'. Each one of the types of sicknesses is distinct; however they also believe that the spiritual realm can  affect the realm of the body and vice versa. For example, the act of 'cursing' or becoming angry can cause a 'spiritual' sickness or worsen an already existing ailment; it will affect, more than others, mothers concerned por their children. The first step therefore to address a sickness is to make a diagnosis within the family nucleus.

Widespread and Growing Use of Traditional Medicinel³

Traditional Medicine (TM) is widely used and of rapidly growing health system and economic importance. In Africa up to 80% of the population uses TM to help meet their health care needs. In Asia and Latin America, populations continue to use TM as a result of historical circumstances and cultural beliefs. In China, TM accounts for around 40% of all health care delivered. TM practitioners are generally understood to be traditional healers, bone setters, herbalists, etc. TM providers include both TM practitioners and allopathic medicine professionals such as doctors, dentists and nurses who provide TM/Complimentary Alternative Medicine (CAM) therapies to their patients — e.g. many medical doctors also use acupuncture to treat their patients. Meanwhile, in many developed countries, CAM is becoming more and more popular. The percentage of the population which has used CAM at least once is 48% in Australia, 70% in Canada, 42% in USA, 38% in Belgium and 75% in France.

In many parts of the world expenditure on TM/CAM is not only significant, but growing rapidly. In Malaysia, an estimated US$ 500 million is spent annually on this type of health care, compared to about US$ 300 million on allopathic medicine. In the USA, total 1997 out-of-pocket CAM expenditure was estimated at US$ 2700 million. In Australia, Canada and the United Kingdom, annual CAM expenditure is estimated at US$ 80 million, US$ 2400 million and US$ 2300 million respectively. In developing countries, broad use of TM is often attributable to its accessibility and affordability. In Uganda, for instance, the ratio of TM practitioners to population is between 1:200 and 1:400. This contrasts starkly with the availability of allopathic practitioners, for which the ratio is typically 1:20 000 or less. Moreover, distribution of such personnel may be uneven, with most being found in cities or other urban areas, and therefore difficult for rural populations to access. TM is sometimes also the only affordable source of health care — especially for the world’s poorest patients. In Ghana, Kenya and Mali, research has shown that a course of pyrimethamine/sulfadoxine antimalarials can cost several dollars. Yet per capita out-of-pocket health expenditure in Ghana and Kenya amounts to only around US$ 6 per year. Conversely, herbal medicines for treating malaria are considerably cheaper and may sometimes even be paid for in kind and/or according to the “wealth” of the client. TM is also highly popular in many developing countries because it is firmly embedded within wider belief systems.

Traditional and Conventional Western Medicine

The common factor among Traditional Medicines is viewing illness of the body in connection to mental illness and environmental issues.

'There is a richness of knowledge among local doctors in both the Andes and Amazon. The challenge is to recognize and value these distinct forms of understanding and knowledge in the field of health, and incoporate them gradually into the 'official' health systems. There exists a unique conception of health in the indegenous propulations and their understanding of sickness is no only based in pathologies and biological attributes, rather they consider that other factors such as social, environmental, spiritual order demote sickness and an imbalance.'⁴

Desde el punto de vista occidental se comprendería esta dialéctica entre cuerpo y mente de la siguiente manera. El cuerpo humano es un sistema perfecto y, salvo la vejez como factor natural de la muerte, las enfermedades provienen de agentes externos. Estos agentes externos en la Medicina Natural se comprenden como desbalances de la dinámica natural del cuerpo. Hasta este punto la cuestión no varía significativamente de la Medicina Occidental pero es cuando se toma en cuenta la importancia de la mente dentro de la enfermedad que la Medicina Tradicional toma otro giro.

La Medicina Occidental trata los síntomas de las enfermedades con medicamentos eficaces haciendo énfasis en la enfermedad física ya que es inminente y la amenaza de muerte, inmediata. La Medicina Tradicional, aunque tiene repertorios de medicamentos de origen herbal y animal, se centra también en los hábitos del enfermo. Los hábitos del paciente son algo que desde la Medicina Occidental se busca corregir desde la Promoción de Salud, mostrando los correctos hábitos de vida para prevenir la enfermedad. Promocionar la salud puede sugerir la corrección de los hábitos, o crear buenos hábitos en las generaciones emergentes, pero en individuos donde los malos hábitos se han cristalizado debido a que los han tenido por mucho tiempo, se vuelve difícil combatir estas costumbres con mensajes.

Los malos hábitos de toda índole tales como los alimenticios o las adicciones, están profundamente arraigados en la estructura psicológica del individuo. Cualquier acción que se lleve a cabo prolongadamente deja de requerir voluntad consciente y se convierte en un proceso automático el cual puede ser un buen hábito o un mal hábito. Estos automatismos son creaciones naturales de la mente (y no solo la humana) para promover la adaptación a una situación recurrente5. Lastimosamente esta adaptación no tiene siempre una connotación positiva y cuando el acto repetitivo es dañino, en muchos casos puede asimilarse hacia los procesos involuntarios de la mente, generando de esta manera un automatismo de un mal hábito.

Cualquier persona que haya sufrido enfermedades a causa de un mal hábito sabe lo difícil que es acabar con estos hábitos automáticos de la mente, los cuales con el tiempo se vuelven adicciones dentro del balance químico del cuerpo. En la Medicina Occidental hay un amplio repertorio de medicamentos para atacar los productos de estos automatismos dañinos (los síntomas) pero difícilmente se trata el origen del problema que es la mala costumbre arraigada en el inconsciente del individuo. El médico le sugiere, y en casos es imperante con el paciente en cuanto a los malos hábitos que debe dejar, pero se requiere más que una amonestación para acabar con los automatismos del cerebro humano.

Es aquí donde entra en juego el factor característico y único de la Medicina Tradicional que es el proceso ritual. Los procesos rituales de muchas Medicinas Tradicionales y Alternativas, si son llevados a cabo correctamente- son los únicos que pueden, mediante la sugestión, afectar directamente los procesos inconscientes del cerebro en donde se encuentran arraigados los automatismos. Toda acción que se hace por segunda naturaleza deja de ser hecha por la consciencia y se transforma en un proceso inconsciente de manera que el inconsciente es el blanco de los procesos rituales, los cuales con música y otros procesos de sugestión afectan directamente estas zonas. Claro está que es supremamente complicado saber qué tipo de sugestión ritual estimula cuál parte del cerebro en donde se encuentra tal o cual automatismo responsable de un mal hábito que a su vez causa una enfermedad, pero precisamente ha sido este conocimiento el que los Pueblos Indígenas han perfeccionado a través de los siglos.

Este conocimiento debe ser protegido y estimulado para que los rituales que desde siglos atrás han sido capaces de corregir los automatismos de malos hábitos (los cuales en occidente son responsables de muchas enfermedades) no pasen a ser solamente rituales de índole cultural y de identidad. Es necesario salvar la esencia de este aspecto de la Medicina Tradicional así como las plantas y animales que usan para apoyar estos procesos.

Basic Concepts of Traditional Medicine⁵

These difinitions my differ according to standards of other countries where traditional medicine is used and therefore, should be used only as a reference.

Herbs

Herbs include crude plant material such as leaves, flowers, fruit, seed, stems, wood, bark, roots, rhizomes or other plant parts, which may be entire, fragmented or powdered

Herbal materials

Herbal materials include, in addition to herbs, fresh juices, gums, fixed oils, essential oils, resins and dry powders of herbs. In some countries, these materials may be processed by various local procedures, such as steaming, roasting, or stir-baking with honey, alcoholic bverages or other materials.

Herbal preparations

Herbal preparations are the basis for finished herbal products and may include comminuted or powdered herbal materials, or extracts, tinctures and fatty oils of herbal materials. They are produced by extraction, fractionation, purification, concentration, or other physical or biological precesses. The also include preparations made by steeping or heating herbal materials in alcoholic beverages and/or honey, or in other materials.

Finishe herbal products

Finishe herbal products consist of herbal preparations made from one or more herbs. if more than one herb is used, the term mixture herbal product can also be used. Finished herbal products and mixture herbal products may contain excipients in addition to the active ingredients. However, finished productos or mixture productos to which chemically defined active substances have been added, cluding synthetic compunds and/or isolated constituents from herbal materials, are not considered to be herbal.

Traditional use of herbal medicines

Herbal medicines include herbs, herbal materials, herbal preparions and finished herbal products, that contain is active ingredientes parts of plants, or other plant materials, or combinations. Traditional use of herbal medicines refers to the long historical use of these medicines. Their use is well established and widely acknowledged to be safe and effective, and may be accepted by national authorities.

Therapeutic activity

Therapeutic activity refers to the successful prevention, diagnosis and treatment of physical and mental illnesses; improvement of symptoms of illnesses; as well as beneficial alteration or regulation of the physical and mental status of the body.

Active ingredients

Active ingredientes refer to ingredients of herbal medicines with therapeutic activity. In herbal medicines where the active ingredientes have been identified, the preparation of these medicines should be standardized to contain a defined amount of the active ingredients, if adequate anlytical methods are available. In cases where it is not possible to identify the active ingredients, the whole herbal medicine may be considered as one active ingredient.

REFERENCIAS BIBLIOGRÁFICAS

¹ Organización Panamericana de la Salud/Organización Mundial de la Salud. Pautas generales para las metodologías de investigación y evaluación de la medicina tradicional. Ginebra, OPS/OMS, 2002. Disponible en: http://www.ops.org.bo/textocompleto/pi31763.pdf

² Escobar Alcón, Lucio. Coordinador Nacional de la Dirección General de Medicina Tradicional e Interculturalidad del Ministerio de Salud de Bolivia. Investigador de la Cultura Andina. Salud e Interculturalidad en Bolivia.

³Organización Panamericana de la Salud/Organización Mundial de la Salud. Estrategia de la OMS sobre Medicina Tradicional 2002-2005. Ginebra:OPS/OMS; 2002. Disponible en: http://www.ops.org.bo/textocompleto/pi31676.pdf

⁴ Organización Panamericana de la Salud/Organización Mundial de la Salud: Una visión de salud intercultural para los pueblos indígenas de las Américas. Washington D.C: OPS/OMS; p. 35

⁵ Organización Panamericana de la Salud: Oficina Regional de la Organización Mundial. Pautas generales para las metodologías de investigación y evaluación de la medicina tradicional. Ginebra:OPS/OMS; 2002. Disponible en: http://www.ops.org.bo/textocompleto/pi31763.pdf