Expert Understandings of the Causes of Illness
The herbal doctors and dedicated amateurs say that most community members have a substantial knowledge of "balance" and the effects on it of various foods. As the evidence shows (see below), they are wrong in this, but, for the experts, physical well-being is understood as depending on diet, with all other determinants distinctly secondary.
Chief among these secondary sources are trauma and supernatural agencies, but even these involve the bodily imbalance based on diet. Injury and spirit attack can cause illness, but they can also lead to imbalance, which may bring on further, often more serious, consequences.
For illnesses resulting from either of these nondietary causes, becoming well again requires, as one step, that the effects of the external causes be terminated by overpowering the spiritual agency or overcoming the traumatic injury. This is done, for example, by exorcising the dangerous spirit, pepo , if it is a spirit-caused illness; by manipulating the broken bones if there be such; or by stopping the bleeding if that is present. This termination by itself, however, may not end the patient's distress. What seems to be shock, following broken bones, or various continuing symptoms, following attacks by supernatural beings, are taken as a sure indication that, in addition to the directly observable results, the body's fundamental balance has been upset by the trauma or spirits.
Infection is understood to operate in a manner quite different from that posited by Western medicine. In balance medicine, although it is diet that is the original cause, the person who has been "infected" is ill not because of his diet but because of that of someone else who has become ill in the ordinary
way. This latter person's diet-based disease is transmitted to the one infected by it. The transmission occurs through small particles that leave the original patient's body and enter the second's through the openings in the skin where hair grows.
Diagnosis and Treatment
Regardless of complaint, the Galenic doctor's first step is to take the patient's pulse. This is done by putting the thumb, normally the right thumb but the left can be used, on the patient's left wrist. It is essential that it be the left wrist because it is understood that the major blood vessels that pass through the entire body are found near the surface only on the left side. By feeling the vessel in the left wrist, three vital diagnostic facts can be established: whether the force of the blood is strong or weak; whether blood flow is normal, fast, or slow; and whether the blood vessel itself is normal, thick, or thin.
A fast pulse and a thick-feeling vein are taken to indicate excess hot, since this condition is understood to involve there being too much blood. A slow pulse and a thin vessel result from insufficient blood and indicate an excess of cold, while too much dry is shown by a weak pulse and a thick vessel. Excessive wet, which is present when there is too much additional fluid (i.e., "maji") in the blood, produces a fast pulse and a thin vessel.
Patients are not asked to remove any clothing, nor is there any physical examination other than the taking of the pulse, but general appearance is noted with attention to paleness, flushes, obvious physical signs such as drooping eye lids, and signs of fatigue. After the patient reports his symptoms and is questioned about the location and nature of any reported pain, he or she is asked about appetite and diet, sleep, bowel and bladder performance, and changes in energy. The data collected in this way are used to establish the type of excess that is the basis of the patient's illness.
Once the type of excess is identified, the next step is to establish where in the body the excess is located so that treatment can be directed to that location. In all cases, therapy consists in overcoming the excess through contributing to the opposite element. Thus, excess hot is treated by increasing cold, excess wet by increasing dry, and so on. The medicines used vary according to the location of the excess, but the basic steps in the treatment of all diseases are similar and follow from understandings concerning the importance of the balance of the four elements.
When excess is located in the head, it is never necessary to cleanse the system since treatment does not involve digestion. The treatment of all other sorts of illnesses, however, often begins with the cleansing of the patient's system in order to ready the body for the changes that are to be made by the medications and dietary regimen that will be prescribed.
One of the herbal doctor informants said that the treatment of all illnesses not based in the head begins with a thorough cleansing in the way to be described in a moment. The other two agreed that cleansing is carried out in the way described, but they understand it to be necessary only sometimes and to be positively harmful when the patient is weak and/or old.
This cleansing is done by a single administration of a laxative in the summertime, when laxatives are understood to affect the body more fully, and of an emetic in the winter, when laxatives are understood to be only partially effective. The two methods of cleansing are seen as alternatives, and patients receive one or the other, rather than both, at the beginning of treatment.
There is only a single emetic in common use. A drink is prepared of one and a half "bottles" (roughly, liters) of water that has been boiled but whose volume has not been reduced and the juice of three limes. The water and lime mixture is allowed to cool and the patient is made to eat something (for obvious reasons it matters little what it is), and the mixture is drunk. The patient then waits for fifteen minutes when a twig 18 or 20 centimeters long and 1 to 2 centimeters in diameter with one end split and frayed into a brush, an mswaki (pl. miswaki ), more commonly used as a toothbrush, is put down his or her throat. This causes vomiting of a sort that is understood to include the entire content of the system, not just recently eaten food.
When the season calls for a laxative, there is a choice among a variety, with selection depending on the patient's condition. The components of the various laxatives interact and produce qualities in the compounds not present in the components by themselves. Although all laxatives are by their nature hot, there is substantial variation in the particular properties of specific compounds and choice among them is important to therapeutic effect. Like emetics, the basic purpose of the laxatives is to ready the system for medication and a new dietary regimen, but different laxatives have different effects and care must be taken to choose one that will not exacerbate the patient's illness. In some disorders due to excess cold, a properly chosen laxative can have therapeutic as well as preparatory functions.
It might be useful to consider a common illness and its treatment. The illustrative illness is one of a whole class particularly to be found in women and the elderly. It is understood to result from excess cold centered in the lungs. This type of disease results in weakness, loss of appetite, and coughing. Runny nose and difficulty in breathing are associated with some of the specific diseases of this type. Some of these diseases, including the one we will consider, can be fatal, especially in the elderly whose aged systems are understood to respond less well to attempts to reestablish balance.
A useful laxative for beginning treatment for this type of disease is compounded of cinnamon (sanamaki ), tamarind (ukwajuu ), and asafetida (halilaji ). To compound this laxative, the cinnamon, tamarind, and asafetida (using only the small white kernels) are soaked for twelve hours in water and then
boiled for five or ten minutes. The solids, after being taken out of the water, which is thrown away, are squeezed in a cloth producing a liquid that the patient drinks. A few spoonfuls to a quarter of a teacup is sufficient to attain this compound's desired effects.
The cinnamon contributes dryness, the asafetida hotness, and the tamarind wetness and coldness, with the result being a hot and wet laxative. This particular combination is both more effective and safer than others in cleansing the systems of all sufferers from excess cold. At the same time, it has some therapeutic effect in lung disorders, through its influence on balance in the lung area.
After the patient has had his system cleansed with the laxative, the full treatment regimen begins. Medications are given and dietary restrictions (miko ) are imposed. Every disease has its own dietary restrictions, which are viewed as being as important in treatment as the medications are. The restrictions and medications are intended to work together in restoring the body's balance through what might be thought of as "an oppositional strategy." At least part of the treatment of a cold disease, for example, involves giving the patient hot medicines, keeping him or her from eating cold foods, and, perhaps, encouraging the eating of hot foods. Treatment is not as simple as this sketch suggests, since the patient's age and unique personal balance, the season of the year, and the effects of wet and dry also have to be considered, as does whether the foods and medicines are heavy or light in the stomach.
The common lung disorder to be considered is called balghamu and is understood as resulting from an excess of wet abetted by an excess of cold. A patient suffering from balgamu has a fast and weak pulse in a blood vessel that feels thin. He or she will complain of a headache on the right side of the head only and will have a cough that produces phlegm (makohozi , sing. kohozi ). When the patient awakens in the morning, there will be white matter in the corners of the eyes which is wet rather than hard. If the condition indicated by these symptoms is left untreated, it can result in paralysis.
It is generally characteristic of patients with balgamu to talk about the past and to tell stories of things that happened years ago. This behavioral pattern, like the illness it is associated with, is caused by excess wet. The wetproduced behavior varies across a wide range, from being so mild and similar to the patient's usual behavior that it is not noticed by relatives to being so extreme that it must be treated before or concurrently with the treatment of the physical manifestations of the disease.
The three herbal doctors agree that for these symptoms an emetic is given if the illness occurs in the winter and a laxative is given if it occurs in the summer, but two of them say that the cleansing must be delayed until recovery has begun if the patient has been weakened by the disease's progress before treatment. All agree that following the emetic or laxative, the patient is put on a restricted diet that excludes beef, apples, grapes, and all spices save
vinegar (siki ). In the early stages of the disease, the laxative and the regimen alone sometimes lead to a rapid cure without further treatment, but in more advanced cases, medication is needed.
The medication for balgamu is compounded of three components: three pennies' weight of fennel seed (shimari ), an equal weight of ginger (sanamaki ), and six pennies' weight of rock sugar all ground to a powder. The three ingredients are mixed together, and the patient is given one soup spoonful three times a day. This treatment is viewed by informants as usually effective save in very advanced or difficult cases that have progressed to paralysis. For these last, different treatments focusing on dry herbs that also have cold properties are called for, with their exact formulations differing from case to case and established on a trial-and-error basis.
The intrinsic relationships among the understandings concerning balgamu and its treatment are now easily seen. The fundamental understandings involved concern the supreme role of the balance among the four elements in body functioning. These understandings are connected to understandings about what to do when the body is malfunctioning by simple extensions or implications: basically, the nature of imbalance must be discovered and the balance reestablished by adding elements opposite to the excessive one.