Understanding Traditional African Medicine in Nigeria

Understanding Traditional African Medicine in Nigeria

Introduction

In many developing countries especially in Africa, traditional medicine is still the main source of health care delivery in spite of the growth of religious enlightenment and western civilization in the areas of modern technology and orthodox medicine. According to experts, the World Health Organization records noted that an average of 80% of the total populations of Asia, Latin-America and Africa use traditional medicine in meeting their primary health care needs. This is as a result of what Kasilo and Trapsida notes as “its cultural acceptability, affordability, and accessibility”. For many people in Africa, Asia, Latin and America particularly and those living in rural areas, traditional/herbal medicine is the only available, accessible and affordable source of health care. There has been a steady upsurge of interest in the use of traditional medicine both in developed countries and developing countries of Africa, Asia, Europe and Latin America. In these countries herbal medicine is usually referred to as complementary and alternative medicine.

Definition

According to the New International Webster Comprehensive Dictionary of English Language, Deluxe Encyclopedic Edition, the word traditional means “relating or depending on tradition” while tradition itself means “the transmission of knowledge, opinions, doctrines, customs, practices from generation to generation originally by word of mouth and by example. Aso, it defined the word medicine as “a substance possessing or reputed to possess curative or remedial properties, the healing arts; the science of the preservation of health and of treating diseases for the purpose of cure” . Health is a level of functional and/or metabolic efficiency of an organism, often implicitly human (Kasilo 33). In his own view Awofeso defines health as “a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture and personal responsibility,” while Saracchi notes that health is “a condition of well-being free of disease or infirmity, and a basic universal human right”. However, Onunwa faulted the definition of Saracchi when he notes that: Health as understood by Africans, particularly the Igbo of Nigeria, is far more social than biological. It does not entirely mean an absence of physical ailments. There is a clear unity of concept of psychosomatic interrelationships that is  apparent reciprocity between mind and matter. Health therefore, is not an isolated phenomenon but part of the entire magico-religious fabric far more than an absence of disease .

 Concurring to Onunwa’s assertion, Australian Aboriginal people are of the view that “health does not just mean the physical well-being of the individual but refers to the social, emotional, spiritual and cultural wellbeing of the whole community”. This is a holistic view of life and includes the cyclical concept of life and death. Nevertheless, the most common definition of health is the one given by World Health Organization (WHO) which sees it as “a state of complete physical, mental and social well-heing and not merely the absence of disease or infirmity”. The World Health Organization constitution also states that the enjoyment of the highest attainable standard of health is one of the fundamental human rights of every human being. Overall health is therefore achieved as a combination of physical, mental, emotional and social well-being which together is commonly referred to as the health triangle.

  In the article, “Promoting the Role of Traditional Medicine in Health Systems: A strategy for the

African Region”, the World Health Organization summarized the definition of traditional medicine is the “sum total of all knowledge and practices, whether explicable or not, used in diagnosis, prevention and elimination of physical, mental or social imbalance and  relying exclusively on practical experience and observations handed down from generation to generation, whether verbally or in writing”. With these descriptions, various forms of medicines and therapies such as herbal medicine, massage, homeopathy, mud bath, music therapy, wax bath, reflexology, dance therapy, hydrotherapy, mind and spirit therapies, self-exercise therapies radiation and vibration, osteopathy, chiropractice, aromatherapy, preventive medicine, radiant heat therapy, therapeutic fasting and dieting spinal manipulation, psychotherapy, etc. are a few elements of traditional medicine . To Ekeopara, Traditional healing refers to all the methods that are employed for the cure and prevention of diseases and protection and preservation of lives and property of individuals against powerful forces of nature that are believed to pervade the environment. Adesina defines “traditional medicine as a cultural gem of various communities around the world and encompasses all kinds of folk medicine, unconventional medicine and indeed any kind of therapeutically method that had been handed down by the tradition of a community or ethnic group”. This is the understanding of traditional medicine that will undergird this work.

 

Origin of Traditional Medicine

 The origin and history of traditional medicine in Health Care Delivery as far as humanity is concerned is as old as the history of man himself. The Book of Beginnings recorded God as the manufacturer and originator of herbal medicine. And God Said, let the earth bring forth grass, the herb yielding seed, and the fruit tree yielding fruit after his kind, whose seed is in itself, upon the earth and it was so. And the earth brought forth grass, and herb yielding seed after his kind and the tree yield fruit, whose seed was in itself after his kind and God saw that it was good. (Genesis 1:10-11)

Before the creation of man, the Holy Book recorded that the Creator did not permit rain to fall upon the earth because there has not been created the man that will utilize the herbs that the earth will produce. After creating man, God made him the Estate Manager and Caretaker of after planting a botanical Garden in Eden. He told man that some of the fruits and herbs are good for food while others can be poisonous and are capable of causing death (Gen 2:5.7.8.9.15,16,17).

Attesting to the above assertion, Ekeopara in his book, African Traditional Religion, An Introduction, averred: It is quite probable that man as soon as he has reached the stage of reasoning found out through trial and error that plants can be used as food, that some might be poisonous and may even lead to death when eaten while some had medicinal value and power. The entire essence of traditional medicine revolves around the use of natural herbs in the bodily, spiritual, emotional and psychological healing of the total man. God is the source of nature and the manufacturer of the herbs. Therefore, God is the source of traditional or herbal medicine. King David in Psalm 104:14 stated thus: “He causes the grass to grow for the cattle and herbs for the service of man.

 Onunwa, observed that healing is a part of the whole complex religious attempt by man to bring the physical and spiritual aspects of the universe as well as man who lives in it into the desired consistent harmony. The idea of “wholeness” is therefore not alien to the African mind. Healing becomes a cardinal religious practice because African cosmology demands that life in the world must be kept free from problem especially ill-health and obstacles that may hinder the fulfilment of desired goals.  In the traditional African world view, health and healing are connected just in the same way they are with the fundamental theme of life. Herbs were the first medicines used by pre historic man. They are, therefore, part of every cultural tradition and have helped the development and growth of herbal medicine in Nigeria.

Still on the history of traditional medicine, Ekeopara noted that: Before the advent of western medicine our forebearers depended largely on traditional medicine and healing methods for the treatment of ailments and the cure of various types of diseases.

Mhame states that: Since the early 1970, the World Health Organization (WHO) has reportedly advocated for the recognition of Traditional Health Practitioners (THPs) as Primary Health Care Provider and for the integration of traditional medicine into the National Health System. Several calls have been made on Federal Government of Nigeria to take responsibility for the health of their people and to formulate national policies, regulations and standard, as part of comprehensive national health programs to ensure appropriate, safe and effective use of traditional medicine.

 Traditional medicine and its practitioners were officially recognized by the Alma Ata declaration in 1978 as an important resource for achieving the targeted goal of rendering good health care services for all by the year 2000. Since then, member States and the World Health Organization governing bodies have adopted a number of resolutions and declaration on traditional medicine. Notable among the resolutions are on “Promoting the Role of Traditional Medicine in Health Systems: A Strategy for the African Region”. This resolution v as adopted by WHO Regional Committee for Africa in Ouagadougou, Burkina Faso, on August 31. 2000 and the declaration of the Decade of African Traditional Medicine (2000-20 10) by the Heads of State and Government in Lusaka, Zambia in July 2001. It was also resolved that a day be observed annually as African Traditional Medicine Day all over Africa and other parts of the world including Nigeria. That day is 31st day of August. The year 2010 marked a Decade since the institution of African Traditional Medicine Day. African Traditional

Medicine Day was commemorated in 2003 in South Africa in conjunction with the 53 session of WHO Regional Committee for “African Traditional Medicine, our Culture, and Our Future” which Nigeria also attended. This singular act has created enabling environment for training and collaboration between practitioners of traditional medicine and conventional medicine for networking and information exchange.

Types of Traditional healers

The traditional healer, as defined by the WHO (1976), is a person who is recognized by the community in which he lives as competent to provide health care by using vegetable, animal and mineral substances and certain other methods based on the social, cultural and religious background, as well as on the knowledge, attributes and beliefs that are prevalent in the community, regarding physical, mental and social well-being and the causation of disease and disability the following are the different types of healers in traditional African society:

Traditional Herbalists: Herbalists use mainly herbs, that is, medicinal plants or parts of such plants-whole root, stem, leaves, stem bark or root bark, flowers, fruits, seeds, but sometimes animal parts, small whole animal — snails, snakes, chameleons, tortoises, lizards, etc: inorganic residues -alum, camphor, salt, etc and insects, bees, black ants etc. is such herbal preparations may be offered in the form of (i) powder, which could be swallowed or taken with pap (cold or hot) or any drink, (ii) powder, rubbed into cuts or incisions made on an part of the body with a sharp knife, (iii) preparation, soaked for some time in water or local gin, decanted as required before drinking; the materials could also be boiled- in water, cooled and strained (iv) preparation pounded with native soap and used for bathing; such ‘medicated soaps’ are commonly used for skin diseases, (v) pastes, pomades or ointments, in a medium of palm oil or shea butter, or (vi) soup which is consumed by the patient. The herbalist cures mainly with plants which he gathers fresh. When seasonal plants have to be used, these plants are collected when available and are preserved usually by drying to eliminate moisture.

Traditional Birth Attendants (TBAs): The World Health Organization defines a traditional birth attendant (TBA) as a person who assists the mother at childbirth and who initially acquired her skills delivering babies by herself or by working with other birth attendants. In the northern parts of the country, TBAs are of the female sex only, whereas in some other parts both males and females are involved. TBAs occupy a prominent position in Nigeria today as between 60-8 5 per cent of births delivered in the country and especially in the rural communities are by the TBAs.

They know how to diagnose pregnancy, confirm it and determine the position of the growing foetus. They have been seen to provide pre-natal and postnatal care and so combine successfully the duties of the modern-day mid-wife. Highly experienced TBAs have been recognized to assist in obstetric and Paediatrics care, as they manage simple maternal and hah hood illnesses. As a result of their exposure and experience, and more particularly the TBA’s concept of human reproduction, as exemplified by pregnancy and childbirth being normal biological functions of human life linked holistically to cultural/social practices, TBAs have been trained to assist in orthodox’ medicine practices at the primary health care level.

With their extra hands, a greater coverage of primary health care leading to improved maternal or child health and the lowering of maternal and child mortality and morbidity, have been achieved. TBAs are usually old and experienced women who see their assignments primarily as contributing their skill for the good of the community. With experienced TBAs, child delivery by Caesarean section is not common since it is hardly necessary to seek surgical help during child birth.

Traditional Surgeons: The various forms of surgery recognised in traditional medical care include: (i) the cutting of tribal marks: traditional surgeons usually cut tribal marks into the cheeks, bellies, etc. and charred herbal products are usually rubbed into these bleeding marks to effect healing,(ii) male and female circumcision (Clitoridectomy): traditional surgeons carry out these simple surgical operations with special knives and scissors: blood-letting operations and wounds that result from these operations are usually treated with snail body fluid or pastes prepared from plants.

 These practices are, however, fast dying out in urban areas; (iii) removal of whitlow: diseased toes or fingers are usually cut open and treated. Piercing of ear lobes: particularly in the youth to allow the fixing of ear rings. Extraction of tooth: infected teeth or teeth with holes, that bring pain to the mouth are removed and treated with herbal medicines prepared in local gin.

Traditional Medicinal Ingredient Dealers: These dealers, more often women, are involved in buying and selling of plants, animals and insects, and minerals used in making herbal preparations. Some of them, who indulge in preparing herbal concoctions or decoctions for the management or cure of febrile conditions in children or some other diseases of women and children, may qualify to be referred to as traditional healers.

Traditional Psychiatrists: The traditional psychiatrist specializes mainly in the treatment of lunatics and those with mental disorders. Lunatics are usually restrained from going violent by chaining them with iron or by clamping them down with wooden shackles. People w ith mental disorders who are violent, particularly those that are demon possessed, are usually called or beaten to submission and then given herbal hypnotics or highly sedative herbal potions to calm them, in order to bring them to a state of mental, emotional and psychological calmness as well as tranquility. Treatment and rehabilitation of people with mental disorders usually take long periods.

 Unlike the bone setter, the traditional psychiatrist and the traditional birth attendant whose duties are well defined and specialized, the herbalist is the general practitioner in traditional medicine. He is expected to be knowledgeable in all the various aspects of healing and in the functioning of the various organs of the body. Much is expected of him, as by his wealth of experience and knowledge he is expected to determine the nature of the patient’s illness, treat him and also predict the course of his treatment. In a typical traditional setting, he corn bines the role of the present day doctor with that of the pharmacist and the nurse

Practitioners of Therapeutic Spiritism: These practitioners include diviners or fortune tellers, who may be seers, alfas and priests, and use supernatural or mysterious forces, incantations, may prescribe rituals associated with the community’s religious worship and adopt all sorts of inexplicable things to treat various diseases. The practitioners are usually consulted for diagnosis of diseases, their causes and treatment. With their ability to deal with the unseen, and the supernatural, they are usually held in high esteem in the community. They are believed to have extra-sensory perception and can see beyond the ordinary man. They can receive telepathic messages, can consult oracles, spirit guides etc. and perform well where other traditional healers and orthodox doctors fail. Their activities include, making prayers, citing and singing of incantations, making invocations and preparing sacrificial materials to appease unknown gods. It is believed that diseases which are caused by supernatural forces will be readily diagnosed and treated by these practitioners. This, in itself stems from the belief that certain medical ingredients — unusually large trees that are believed to house spirits, astronomic herbs, grave-yard plants like the physic nut, protective plants such as the wild colocynth or Sodom apple or even some reproductive herbs like the sausage tree or the tree of life itself— have spiritual powers and can be effectively utilized by these practitioners for the good of all.

 The instructions which these practitioners use include magic stones which are usually thrown to the ground. Sounds so produced are read and interpreted. Some take replies of messages in a pool or glass of water. Others depend on the throwing of cowries, coins, kola-nut seeds, divining rods, keys or sticks, etc. Divination has come of age, its various functions linked with religion, creation myths, cosmology et cetera. 

Concept of illness and disease

In African traditional setting, there was always an explanation as to why someone was suffering from a certain disease at a particular time. According to Ayodele , diseases mostly revolve around witchcraft/sorcery, gods or ancestors, natural, as well as inherited. Illness in the African society is different from the allopathic Western medicine point of view. Illness is believed to be of natural, cultural, or social origin . Cultural or social illness is thought to be related to supernatural causes such as angered spirits, witchcraft, or alien/evil spirits, even for conditions now known to be well understood in modern medicine such as hypertension, sickle-cell anemia, cardiomyopathies, and diabetes. African traditional beliefs consider the human being as being made up of physical, spiritual, moral, and social aspects. The functioning of these three aspects in harmony signified good health, while if any aspect should be out of balance, it signified sickness. Thus, the treatment of an ill person involves not only aiding his/her physical being but may also involve the spiritual, moral, and social components of being as well. Many traditional medical practitioners are good psychotherapists, proficient in faith healing (spiritual healing), therapeutic occultism, circumcision of the male and female, tribal marks, treatment of snake bites, treatment of whitlow, removal of tuberculosis lymphadenitis in the neck, cutting the umbilical cord, piercing ear lobes, removal of the uvula, extracting a carious tooth, abdominal surgery, infections, midwifery, and so on. According to Kofi-Tsekpo, the term “African traditional medicine” is not synonymous with “alternative and complementary medicine.” African traditional medicine is the African indigenous system of health care and therefore cannot be seen as an alternative.

Herbal medicine

Herbal medicine is a part and parcel of and sometimes synonymous with African traditional medicine. It is the oldest and still the most widely used system of medicine in the world today. It is used in all societies and is common to all cultures. Herbal medicines, also called botanical medicines, vegetable medicines, or phytomedicines, as defined by World Health Organization (WHO) refers to herbs, herbal materials, herbal preparations, and finished herbal products that contain whole plants, parts of plants, or other plant materials, including leaves, bark, berries, flowers, and roots, and/or their extracts as active ingredients intended for human therapeutic use or for other benefits in humans and sometimes animals.

Herbal medicine is a special and prominent form of traditional medicine, in which the traditional healer, in this case known as the herbalist, specializes in the use of herbs to treat various ailments. Their role is so remarkable since it arises from a thorough knowledge of the medicinal properties of indigenous plants and the pharmaceutical steps necessary in turning such plants into drugs such as the selection, compounding, dosage, efficacy, and toxicity. The use of herbal medicines appears to be universal in different cultures. However, the plants used for the same ailments and the modes of treatment may vary from place to place. The plants used for medicinal purposes are generally referred to as medicinal plants, i.e., any plant in which one or more of its organs/parts contain substances that can be used for therapeutic purposes, or in a more modern concept, the constituents can be used as precursors for the synthesis of drugs. For example, a number of plants have been used in traditional medicine for many years without scientific data to back up their efficacy. In this case, these plants, whole or parts, which have medicinal properties, are referred to as crude drugs of natural or biological origin. They may further be classified as “organized drugs,” if such drugs are from plant parts with cellular structures such as leaf, bark, roots, etc., and “unorganized drugs,” if they are obtained from acellular portions of plants such as gums, balsams, gels, oils, and exudates. Compared with modern allopathic medicine, herbal medicine is freely available and can easily be accessed by all. As a result, there is limited consultation with traditional healers because there is a fairly good knowledge of common curative herbs especially in the rural areas except in the case of treatment of chronic diseases. Even where consultation is done, there is lack of coherence among traditional healers on the preparation procedures and correct dosage of herbal medicines. However, according to WHO, at least 80% of people in Africa still rely on medicinal plants for their health care. In Nigeria, and indeed the entire West Africa, herbal medicine has continued to gain momentum, some of the advantages being low cost, affordability, availability, acceptability, and apparently low toxicity.

A detail of plant parts used in herbal medicines is as follows:

1.    Roots—i.e., the fleshy or woody roots of many African plant species are medicinal. Most of the active ingredients are usually sequestered in the root bark rather than the woody inner part.

2.    Bulbs—A bulb is an underground structure made up of numerous leaves of fleshy scales,

e.g., Allium sativa (garlic) and Allium cepa (onions).

3.    Rhizomes—Woody or fleshy underground stem that grows horizontally and brings out their leaves above the ground, e.g., Zingiber officinale (ginger), which is used for respiratory problems; Imperata cylindrica (spear grass) for potency in men and Curcuma longa (turmeric), an antioxidant, anti-inflammatory, and anticancer drug.

4.    Tubers—Swollen fleshy underground structures which form from stems/roots, e.g., potatoes and yams such as Dioscorea dumetorum (ona-(igbo)) for diabetes and Gloriosa superba for cancer.

5.    Bark—The outer protective layer of the tree stem or trunk. It contains highly concentrated phytochemicals with profound medicinal properties. A host of plants have barks of high medicinal value.

6.    Leaves, stems, and flowers of many plants are also medicinal.

7.    Fruits and seeds also contain highly active phytochemicals and essential oils.

8.    Gums, exudates, and nectars, which are secreted by plants to deter insects and grazing animals and to seal off wounds, are very useful in the pharmaceutical industries.

Sale of herbs in form of dried or fresh plant parts is as lucrative as the prepared medicines. They are usually displayed in markets and sold with instructions on how to prepare them for maximum efficacy.

In many areas of Africa, the knowledge of plant species used and the methods of preparing and administering the medication, especially for serious ailments, still reside with traditional healers. Secrecy and competition still surround the use of these medications, with the healers often being reluctant to hand down their knowledge to anyone but trusted relatives and initiates .

Methods of preparation and dosage forms

Methods of preparation of herbal medicines may vary according to place and culture. The plant materials may be used fresh or dry. With experience, a particular method is chosen to increase efficiency and decrease toxicity. Generally, different methods of preparation include:

1.    Extraction—This is prepared with solvent on a weight by volume basis. Sometimes, the solvent is evaporated to a soft mass.

2.    Infusions are prepared by macerating the crude drug for a short period of time in cold or hot water. A preservative such as honey may be added to prevent spoilage.

3.    Decoctions are made by boiling woody pieces for a specified period of time and filtered.

Potash may be added to aid extraction and as preservative.

4.    Tinctures are alcoholic infusions which if concentrated may be diluted before administration.

5.    Ashing—The dried parts are incinerated to ash, then sieved and added as such to water or food.

6.    Miscellaneous—Other types include liniments for external applications in liquid, semiliquid, or oily forms containing the active substances; lotions which are liquid preparations intended for skin application. Poultices are prepared from macerated fresh part of plant containing the juice from the plant and applied to skin. Snuffs are powdered dried plant inhaled through the nostrils. Dried plants may be burnt, and their charcoal is used as such. Gruels are cereals/porridges made from grains, to which dried powdered plant or its ash is added to be taken orally. Mixtures are sometimes prepared with more than one plant to give synergistic or potentiating effects of the composite plants.

There are also different methods of administration. Apart from the common routes such as oral, rectal, topical, and nasal, other methods include smoking a crudely prepared cigar containing dried plant materials or by passive inhalation. Others are steaming and inhaling the volatile oils exuding from the boiling plant material. These can be used to relieve congestion, headaches, or pulmonary problems. Sitz baths are used for piles

Ethnobotanical surveys

Information on plants is obtained through ethnobotanical surveys, which involves the study of plants in relation to the culture of the people. Many plants are used in African traditional medicine, but little information is available on their active ingredients/constituents. Ethnobotanical surveys involve the interaction with the people and their environment and are therefore participatory approaches, in which local people are able to contribute their knowledge on the uses of plants within their environment. This may involve the identification, documentation, conservation, and utilization of medicinal plants. Much of the ethnomedicinal information is largely not validated. In Nigeria, a number of authors have published a lot of data on plants with their curative values. These provide a vast array of information for scientific research and validation. Preliminary scientific knowledge is drawn from studies on in vitro and in vivo bioassays on crude extracts of various plants.

Using plants as medicine provides significant advantages for treating many chronic conditions. For example, information from folklore medicine in Nigeria has it that Rauvolfia vomitoria is used for treating hypertension and other nervous conditions while Ocimum gratissimum is used for treating diarrheal diseases. Others include Citrus paradise seeds for resistant urinary tract infections, pure honey for chronic wound treatment, Carica papaya seeds for intestinal parasites, Garcinia kola seeds for pain and inflammation, and Aloe vera for skin diseases. The same is also true for plants from other African countries. Knowledge of most of these curative properties was accumulated over time from evidence-based observations. A few examples of some Nigerian plants and their uses are shown in table below

Family	Specie	Local name	Part used Medicinal uses
Acanthaceae	Acanthus montanus		Stem, twig Syphilis, cough, emetic, vaginal discharge
Amaranthaceae	Amaranthus spinosus		Whole plant Abdominal pain, ulcers, gonorrhea
Apocynaceae	Alstonia boonei		Root, bark,      Breast development, filarial worms leaves
Bombacaceae	Adansonia digitata		leaves, fruit, Fever, antimicrobial, kidney, and pulp, bark            bladder disease
Combretaceae	Combretum grandiflorum	Ikedike	Leaves	Jaundice
Euphorbiaceae	Bridelia ferruginea	iri, kirni	leaves, stem, bark, root	insomnia, mouth wash, gonorrhea
Hypericaceae	Harungana madagascariensis	Otoro, alilibarrafi	Stem, bark, root bark	piles, trypanosomiasis
Fabaceae	Afzelia africana	Apa-igbo, akpalata	leaves, roots, bark, seeds	gonorrhea, hernia
Liliaceae	Gloriosa superba	mora, ewe aje, baurere	tubers, leaves	gonorrhea, headlice, antipyretic

The curative properties of herbal medicine are validated through scientific investigations, which seek to understand the active chemistry of the plants. The therapeutic activity of a plant is due to its complex chemical nature with different parts of the plant providing certain therapeutic effects. Chemical components or phytochemicals found in plants that are responsible for the various therapeutic effects include alkaloids, glycosides, tannins, acids, coumarins, sterols, phenols, etc. Many modern pharmaceuticals have been modeled on or were originally derived from these chemicals, for example, aspirin is synthesized from salicylic acid derived from the bark of Salix alba and the meadowsweet plant, Filipendula ulmaria. Quinine from Cinchona pubescens bark and artemisinin from Artemisia annua plant are antimalarial drugs. Vincristine and vinblastine are anticancer drugs derived from Madagascar periwinkle (Catharanthus roseus), used for treating leukemia. Morphine and codeine, derived from the opium poppy (Papaver somniferum), are used in the treatment of diarrhea and pain relief, while digitoxin is a cardiac glycoside derived from foxglove plant (Digitalis purpurea). Medicinal plants are also important materials for the cosmetic industries.

The use of herbal drugs dwindled toward the end of the 19th century due to the advent of synthetic chemistry. However, there was a resurgence of interest in plant medicines in more recent years, as synthetic drugs became less effective due to high levels of resistance and also due to higher toxicity and cost. It is estimated that more than half of all synthetic drugs in use are derived from plants

Clinical practice of African traditional/herbal medicine

In African traditional medicine, the curative, training, promotive, and rehabilitative services are referred to as clinical practices Clinical practice can also be viewed as the process of

evaluating conditions of ill-health of an individual and its management. These traditional health care services are provided through tradition and culture prescribed under a particular philosophy, in which the norms and taboos therein are strictly adhered to and form the basis for the acceptability of traditional health practitioners in the community they serve.

According to the World Health Organization (WHO), health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”  and views health as one of the fundamental rights of every human being. The combination of physical, mental/emotional, and social well-being is commonly referred to as the health triangle.

The recognition of disease and illnesses in traditional Africa meant that every society needed to devise means of containing its problem. Worldwide, different societies have different herbal traditions that have evolved over a long period of time. Similar to modern day Western treatment patterns, African traditional societies also involved herbalism, surgery, dietary therapy, and psychotherapy, in addition to traditional exorcism, rituals, and sacrifice. These medical technologies had evolved even before the coming of the “white man” (Arabs and Europeans). Successful treatments became formalized, sometimes with prescriptions of correct methods of preparation and dosage. In addition, the ingredients and the manner of preparation varied with the ailment but were also dependent on various factors such as geographical, sociological, and economic, but the significant point was that in many cases, patients were cured of their physical or psychological ailments. In African traditional medicine, traditional health practitioners (THP) assess patients in order to diagnose, treat, and prevent disease using their expertise by the following methods:

Divination

Divination means consulting the spirit world. It is a method by which information concerning an individual or circumstance of illness is obtained through the use of randomly arranged symbols in order to gain healing knowledge. It is also viewed as a way to access information that is normally beyond the reach of the rational mind. It is a transpersonal technique in which diviners base their knowledge on communication with the spiritual forces, such as the ancestors, spirits, and deities . It is, therefore, an integral part of an African traditional way of diagnosing diseases. The “spirit world” is consulted to identify the cause of the disease or to discover whether there was a violation of an established order from the side of the sick person. This is established through the use of cowry shells, throwing of bones, shells, money, seeds, dice, domino-like objects, or even dominos themselves, and other objects that have been appointed by the diviner and the spirit to represent certain polarities on strips of leather or flat pieces of wood. The divining bones that form the large majority of the objects include bones from various animals such as lions, hyenas, ant-eaters, baboons, crocodiles, wild pigs, goats, antelopes, etc. The bones represent all the forces that affect any human being anywhere, whatever their culture. Because of the revealing powers of divination, it is usually the first step in African traditional treatment and medicine

Spiritual perspective

Spiritual-based cases are handled in the following manner:

i.          Spiritual protection: If the cause of the disease is perceived to be an attack from evil spirits, the person would be protected by the use of a talisman, charm, amulets, specially designed body marks, and a spiritual bath to drive the evil spirits away. These are rites aimed at driving off evil and dangerous powers, spirits, or elements to eliminate the evils or dangers that may have befallen a family or community.

ii.        Sacrifices: Sacrifices are sometimes offered at the request of the spirits, gods, and ancestors. Sometimes, animals such as dogs and cats are slaughtered or buried alive at midnight to save the soul of the one at the point of death, with the belief that their spirits are strong enough to replace life. There is also the view that because they are domestic animals and are very close to people, sometimes when they see that someone very close to them is about to die, they offer their lives for that person to live. This is true especially where the animal dies mysteriously; thus, it is believed that it had offered its life in place of the life of its owner. Rituals are sometimes performed in order to consecrate some herbs without which the medicine is meaningless. Divine and ancestral sanctions are considered necessary before and during the preparation and application of medicine.

iii.     Spiritual cleansing: Spiritual cleansing may be required of the sick person to bathe at specific times for a prescribed number of days either with water or animal blood poured from head to toe. This practice is common among some communities in Ghana.

iv.      Appeasing the gods: If a disease is perceived to be caused by an invocation of a curse or violation of taboos, the diviner appeases the ancestors, spirits, or the gods according to the severity of the case. The individual is often required to provide certain items for sacrifice and/or libation, such as spotless animals (dove, cat, dog, goat, and fowl), local gin, cola nut, eggs, and plain white, red, or black cloth. These items are usually specified by the gods. The used items may be thrown into the river, left to rot, or placed at strategic places, usually at cross roads at the outskirts of the community, depending on the nature and severity of the case.

v.         Exorcism: This is a practice of expelling demons or evil spirits from people or places that are possessed or are in danger of being possessed by them. Many of the traditional communities believe that illness, especially mental illness, is mostly caused by evil spirits. Exorcism can only be performed by a religious leader or a priest who has the authorities and powers to do so. Sometimes, an effigy made of clay or wax would be used to represent the demon and would ultimately be destroyed. Exorcism may be accompanied by dancing to the beating of drums, singing, and sometimes flogging the individual or touching him/her with strange objects such as animal tails and other objects to chase out the spirit. The possessed individual would be somewhat agitated but would only calm down as soon as the spirit is removed from the body. Exorcism is practiced, not only in Africa but also in ancient Babylonian, Greek, and other ancient cultures of the Middle East. This practice is also performed for those who are mentally challenged. In their view, until the possessed person is delivered from the power of that evil spirit, the person will not have his or her freedom. Hence, the practice of exorcism is considered necessary.

vi.      Libation: Libation involves pouring of some liquid, mostly local gin on the ground or sometimes on objects followed by the chanting or reciting of words. It is usually regarded as a form of prayer. The liquid could also be water or in modern times, wine, whisky, schnapps, or gin. Some cultures also use palm wine, palm oil, and coconut water, while some others use corn flour mixed with water [38]. Libation pouring as is practiced in some communities has three main parts, namely invocation, supplication, and conclusion.

•    Invocation: They first invoke the presence of the almighty God, mother earth, and the ancestors. According to the practitioners of libation pouring, offering the ancestors and spirits drink is a way of welcoming them

•    Supplication: After invocation, requests are made to the invoked spirits, gods, or ancestors to intercede on their behalf for mercy and forgiveness of offenses such as taboo violations and to seek for spiritual consecration (cleansing) of either the community or individual(s). The content of the prayer is usually case specific.

•    Conclusion: At the end of the libation pouring, they thank the invoked ancestors and spirits. They finally invoke curses on those who wish them evil or failure, meaning that in the process of prayer, it would be unwise to seek the welfare of one’s enemy. Therefore, those who wish evil (i.e., enemies, witches, and people with evil powers) on them should fall and die. In this process, the person pouring the libation would be pouring the drink or liquid on the ground as he is reciting the prayers, followed by responses to each prayer point by observers.

Physical perspectives

If the illness is of a physical nature, the following approaches are exploited:

a.      Prescription of herbs: Herbs are prescribed to the sick person according to the nature of the illness. Each prescription has its own specific instructions on how to prepare the herb, the dose, dosing regimen, and timeframe

b.     Clay and herbs application: Application of a mixture of white clay with herbs may be relevant in some of the healing processes. The mixture is applied to the entire body for a number of days, especially in the case of skin diseases. The view is that the human body is

made out of the dust or ground; therefore, if the body has any problem, you would have to go to where it came from to fix it. The use of clay with some special herbs is also sometimes used for preventive rituals to ward off the evil spirits responsible for illness.

c.      Counseling: The sick person is sometimes counseled on the dos and don’ts of treatment, the foods to eat or avoid, to be generally of good behavior as established by society and culture, failure of which the good spirits would withdraw their blessings and protection and therefore, open doors for illness, death, drought, and other misfortunes. This is mostly done when it is an issue of a violation of a taboo.

The THPs use experience, added to the accumulated knowledge handed down by their ancestors in order to provide effective and affordable remedies for treating the main ailments (such as malaria, stomach infections, respiratory problems, rheumatism, mental problems, bone fracture, infertility, complications of childbirth, etc.) that afflict populations of the African region and in addition offer counseling/advice and solutions to prevent future reoccurrence.

The various ethnic groups in Nigeria have different health care practitioners aside their western counterparts, whose mode of practice is not unlike in other tribes. The Yorubas call them “babalawos,” the Igbos call them “dibia,” while the Northerners or Hausas call them “boka”. Traditional/herbal medicines have impacted the lives of people, especially in the rural areas where access to orthodox medicare is limited. Apart from the lack of adequate access and the fear of expired or fake drugs, the prohibitive cost of western medicine makes traditional medicine attractive. Various training schools exist for both herbal medicine and homeopathy, and as such, most modern traditional health practitioners have great knowledge of pharmaceutical properties of herbs and the shared cultural views of diseases in the society and they combine their knowledge with modern skills and techniques in processing and preserving herbal medicines, as well as in the management of diseases. In oral interviews with two modern traditional medicine practitioners, Dr. Anselm Okonkwo of Saint Rita’s Ethnomedical Research Center, Enugu, Nigeria, a Veterinary doctor, and Mr. Uche Omengoli of CGP Herba-Medical

Consultancy and Research, Enugu, Nigeria, a medical laboratory technologist, both revealed that their knowledge and ‘gift’ of medical practice were handed down by aged relatives who were also in the practice by both tutelage and supernatural means. Knowledge was however improved by further training, interaction, and discussion with colleagues, consultation of books on herbal medicine, and the Internet. They claimed that the practice was very lucrative, especially since some ailments that defied orthodox medicine such as epilepsy and madness could be completely treated by traditional medicine. The two men divulged that the old concept of secrecy and divination is gradually fading away and being taken over by improved skills, understanding, and use of modern equipment where necessary. Both however agreed to the “mystic” or esoteric power of plants, which they sometimes employ in their diagnosis and treatment. An Enugu, Nigeria-based nonprofit organization, the Association for Scientific, Identification, Conservation and Utilization of Medicinal Plants of Nigeria (ASICUMPON), of which the writer is a member, is committed to “highlighting the usefulness of medicinal plant resources and scientific assessment, preparation and application of these for the betterment of humanity and as Africa’s contribution to modern medical knowledge,” under the chairmanship of Reverend Father Raymond Arazu. Another prominent member of the association, Professor J.C. Okafor, who is a renowned silviculturist and plant taxonomist, is helping members to identify and classify plants. The group also shares and documents evidence-based therapeutic knowledge. Such groups and training schools exist all over Nigeria. ASICUMPON has published a checklist of medicinal plants of Nigeria and their curative values. Other books have likewise produced useful information. The greatest problem still facing herbal medicine in Nigeria is lack of adequate standardization and safety regulations. However, the interest and involvement of educated and scientific-minded people in herbal medicine practice have to a great extent demystified and increased the acceptability of these medicines by a greater percentage of would-be skeptical populace.

 

Conclusion

Long before the advent of Western medicine, Africans had developed their own effective way of dealing with diseases, whether they had spiritual or physical causes, with little or no side effect [. African traditional medicine, of which herbal medicine is the most prevalent form, continues to be a relevant form of primary health care despite the existence of conventional Western medicine. Improved plant identification, methods of preparation, and scientific investigations have increased the credibility and acceptability of herbal drugs. On the other hand, increased awareness and understanding have equally decreased the mysticism and “gimmicks” associated with the curative properties of herbs. As such, a host of herbal medicines have become generally regarded as safe and effective. This, however, has also created room for quackery, massive production, and sales of all sorts of substandard herbal medicines, as the business has been found to be lucrative.

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