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African medicine: tradition and beliefs

Reports of killings to obtain body parts for “muti” (the Zulu word for medicine) brought African beliefs into the spotlight, including practices to do
with healing. Indeed, many African healers use herbs that have been used to obtain drugs for Western medicine. In this article, the second in a
series on traditional systems of medicine, David Okpako gives his interpretation of traditional African medicine

he major traditional healing meanour for ritual treatment is a

T systems that have survived the

impact of modern biomedicine
(driven by germ theory) are the
necessary part of managing the ill-
ness.The rituals that are undertaken
to appease the angered ancestor are
Indian systems (Ayurveda and not initiated until confessions of
Unani), traditional Chinese medi- the misdemeanour have been
cine and traditional African medi- extracted from the ill patient.
cine (TAM).The Asian systems have Confessions are believed to be
written philosophies and pharma- therapeutic. This is one reason for
copoeias, whereas TAM is an oral suggesting that the allusion to
tradition and there are no written ancestor spirit anger is a shorthand
records of the thoughts behind its reference, a metaphor for sustained
methods and materials. emotional distress.
Traditional medicine is practised The rituals accompanying the
in different ways in different parts of use of herbal medicines are referred
Africa, but one characteristic feature to as “incantation”. Incantation is
of traditional medicine — wherever medical poetry. It is a collection of
in Africa it is practised — is the carefully chosen words used to

This object is part of a display in the Wellcome Gallery at the British Museum, London
belief that serious illness can be bring out the healing effect of the
caused by a supernatural agency, for medicine. These procedures have
example, ancestor spirit anger (see the combined effects of resolving
below). I suggest that this allusion to emotional contradictions in the
the supernatural is a metaphor for mind of the patient, and his or her
what ancient Africans knew, from relatives, and assuring them that
experience, to be a major predispos- everything possible is being done in
ing factor for the occurrence of the cultural context to heal the sick
serious illness, namely, sustained person. Targeting the emotion as
emotional distress arising from a therapy is legitimate. In modern
breakdown in the social and spiri- medicine we know now that sus-
tual environment of the patient.This tained emotional upheaval can
interpretation comes from a close cause different illnesses.
study of how TAM practitioners and The discipline of psychoneuro-
their clients manage illness. immunology is a study of the
The other common feature of networks used by the brain to
traditional medicine in Africa is the control host immunity and the
widespread use of plant and animal brain may control the body’s
parts for the preparation of medi- Wooden vessel designed to hold sacred palm nuts used defences against disease — there are
cines. It is for these fundamental for divination by Ifa priests: divination plays a role in receptors on lymphocytes and
similarities in traditional medicine traditional African medicine macrophages that respond to cen-
practices throughout Africa that I tral nervous system neurotrans-
use the term TAM in this article. I have dis- the ancestors protect their living descendants. mitters. Ancient Africans recognised the
cussed these two features of TAM in relation In return, the ancestors demand from their profound influence of the mind on human
to, first, the scientific search for modern drugs descendants veneration and strict adherence well being. They recognised that sustained
in the plants used in TAM and, second, the to the moral laws that the ancestors have laid negative emotions, such as guilt, fear and hate,
possible impact of attitudes acquired from down.1–3 Similar beliefs exist in other parts of can lead to illness. They knew this through
TAM on the use of modern drugs by indige- the world.4 experience and they passed this knowledge
nous populations. The term “traditional” In some African ethnic groups (eg, the on through myths and beliefs that society
refers to the fact that the system evolved end- Urhobo of southern Nigeria), ancestor spirit could use in the upbringing of the young.
ogenously in African societies and has been veneration is the core of the traditional reli- This interpretation of TAM leads to two
handed down from generation to generation. gion. Serious illness or other misfortune can major questions that are of interest to the
result if a descendant should fail in his or her pharmacist. First, what sort of drugs should
Ancestor spirit anger obligations to the ancestors. An immoral act we expect to discover in African medicinal
Ancestor spirit anger has been used as an (eg, incest), it is believed, can trigger ancestor plants? And, second, what is the impact of
explanation for the occurrence of serious spirit anger and result in serious illness. TAM on the use of modern medicines by
illness. In most of Africa south of the Sahara, Divination and incantation play a role in Africans or in Africa?
a commonly held belief is that the spirits of TAM. Divination (the consultation of an
oracle) is the diagnostic mechanism used in Plants used in TAM
David Okpako, PhD, FRPharmS, is TAM to discover a hidden sin (ancestor spirit Some modern medicines have been
professor of pharmacology at the University anger). If divination reveals ancestor spirit developed from African medicinal plants.
of Ibadan, Ibadan, Nigeria anger, exposition of the hidden misde- However, if as I have argued, the major ther- 25 February 2006 The Pharmaceutical Journal (Vol 276) 239

apeutic target in serious illness is the tations as antipyretic remedies do, in fact, be said to be two extremes in a continuum in
emotion, then the plant remedies used in the show anti-inflammatory properties in con- the mode of action of medicines. If, in TAM,
management of such illness would not neces- ventional laboratory experimental models.6 serious illness is seen as having its origins in
sarily be expected to yield “drugs” (chemicals These kinds of plants need to be more emotional distress, and the emotion is a ther-
that are selectively toxic to disease-causing carefully investigated; they contain cyclo- apeutic target, in this system the mode of
agents). In TAM, medicinal plants are merely oxygenase inhibitors, flavonoids, diterpenes, action of plant medicines in life-threatening
part of a total management regimen with the immunomodulators, anti-tumour necrosis illnesses may veer more to the placebo side of
overall object of assuring the client that the factor-α, antioxidants and many others. In the continuum than selective toxicity.8
problem is being taken care of. malaria (probably the commonest cause of
Another important point to note is that fever, aches and pains in Africa), inflammation Impact on modern medicine
TAM tends to exclude poisonous plants.The mechanisms are known to contribute signifi- A second consequence of the interpretation
plants used in illness management are known, cantly to the pathology of the disease.7 of TAM given in this article is that it provides
from experience, not to be poisonous to an explanation for some of the extraordinary
humans. In modern medicine, the use of poi- Poisonous plants As discussed, poisonous behaviour of Africans towards modern drugs.
sons as drugs is possible because weights, plants are excluded from the pharmacopoeia Some of the misuse of modern drugs
volumes and dosage regimens can be deter- of therapeutic agents in TAM. Many African (eg, non-compliance) is believed to derive
mined accurately, in absolute units. This was communities have experience of such plants, from ingrained attitudes acquired from a
not the case in traditional African cultures either as a result of accidental poisoning or culture in which TAM is used, where adher-
and an important criterion for using a plant as because they know these plants from cen- ence to dosage and unwanted side effects of
medicine (or food) was that it was not overtly turies of use as poisons. Numerous examples medicines are not issues as they are with
harmful. Any plants that produced dramatic of fish poisons, arrow poisons, ordeal poisons modern medicines.9 In the African cultural
toxicities when used in the treatment of ill- (used to detect witchcraft), or poisonous environment the pharmacist’s role in carefully
ness would, therefore, have been rejected and, mushrooms are known in African communi- explaining the prescription to the patient in
over time, excluded from the oral pharma- ties and traditional healers do not use them as order to ensure compliance is, therefore,
copoeia of traditional remedies. In general, medicines.A familiar example from Nigeria is crucial.
the same process of trial and error that the calabar or esere bean (Physostigma veneno-
resulted in the selection of plants for food sum) from which the powerful anti- Conclusion
would have applied to the selection of cholinesterase physostigmine was eventually Traditional African medicine is a fundamen-
medicinal plants. However, this should not be isolated. Investigators interested in developing tally different form of healing from biomedi-
taken to mean that commonly used plant medicines through exploiting indigenous cine. In the former, resolution of emotional
remedies in TAM would be free of side effects knowledge can miss out a lot if they do not distress is a major therapeutic goal. This idea
if used as we use drugs in modern medicine. enquire about what plants the people know is embedded in the African belief that serious
Traditional healers avoided known to be poisonous and which they, therefore, life-threatening illness may be underpinned
poisonous plants as therapeutic agents, avoid as therapeutic agents. by the anger of supernatural agencies such as
whereas such plants, as we know, are the ancestor spirits acting to enforce community
major sources of drugs now used in modern Plants used for serious illness Some moral laws. In trying to exploit traditional
medicine. Examples are Atropa belladonna and plants are used in the management of serious knowledge in the development of medicines
Physostigma venenosum.This is consistent with life-threatening illness where supernatural from African medicinal plants, the basic
the central theory in modern pharmacology, agencies are believed to be the cause. Some assumptions underlying the traditional use of
which is that the drug be selectively toxic to plants commonly used to treat minor such plants must not be ignored. Such under-
the cause of the disease. This point should ailments may also be used to treat serious standing will help to steer medicinal plant
serve to emphasise that plant remedies used in illnesses. The essential feature of plant use in research in Africa in a rational direction.
TAM are in general not directed at the spe- the management of serious illness is that the
cific cause of the illness. Notwithstanding, it application of the remedy is accompanied by
does not mean that scientific analysis of tradi- esoteric evocations addressed to the spirits References
tional plant remedies may not yield drugs. For and the plant itself. Here the objective is 1. Twumasi PA. Medical systems in Ghana: a study in medical
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herbal remedy is used as a respiratory medi- important therapeutic target. 2. Jansen JM. The quest for therapy: medical pluralism in the
cine in Germany (see PJ, 24/31 December Lower Zaire. Berkley: University of California Press;1978.
2005, pp790–2). One must keep an open Placebo effect The problem for the inves- 3. Price-Williams DR. A case study of ideas concerning disease
mind. tigator is that in using plant remedies in this among the Tiv. In: Ademowagun ZA, Ayoade JA, Harrison IE,
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these are used without divination or incanta- tendency to promote what we now call the
tion. It is from among this category of plants placebo effect. From the way traditional heal- 8. Okpako DT. Traditional African medicine: theory and
that medicinal plant research may yield mod- ers use plant preparations in the management pharmacology explored. Trends in Pharmacological Sciences
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240 The Pharmaceutical Journal (Vol 276) 25 February 2006