History of medicine in the Philippines

The history of medicine in the Philippines discusses the folk medicinal practices and the medical
applications used in Philippine society from the prehistoric times before the Spaniards were able to set a
firm foothold on the islands of the Philippines for over 300 years, to the transition from Spanish rule to
fifty-year American colonial embrace of the Philippines, and up to the establishment of the Philippine
Republic of the present. Although according to Dr. José Policarpio[1] Bantug in his book A Short History
of Medicine in the Philippines During The Spanish Regime, 1565-1898 there were "no authentic
monuments have come down to us that indicate with some certainty early medical practices" regarding
the "beginnings of medicine in the Philippines" a historian from the United States named Edward
Gaylord Borne described that the Philippines became "ahead of all the other European colonies" in
providing healthcare to ill and invalid people during the start of the 17th century,[2] a time period when
the Philippines was a colony of Spain. From the 17th and 18th centuries, there had been a "state-of-the-
art medical and pharmaceutical science" developed by Spanish friars based on Filipino curanderos
(curandero being a Spanish term for a Filipino "folk therapist") that was "unique to the [Philippine]
islands."[3]

The babaylans were the first healers within the tribal communities of ancient Philippines. Later emerged
folk doctors and the training and deployment of true medical practitioners as can be seen in the
progression of Philippine history. At present, medical personnel trained based on Western medicine -
such as Filipino nurses, physicians, physical therapists, pharmacists, surgeons among others - coexists
with the still thriving group of traditional healers that do not have formal education in scientific
medicine who often cater to people living in impoverished areas of the Philippines.[4

Folk medicine

There are ten categories of non-medical traditional healers or folk doctors in the Philippines: the
babaylan ("religious leader"), albularyo, the manghihilot or hilot (the traditional "massage therapists"),
the magpapaanak (the traditional "midwife", also sometimes called a hilot), the mangluluop, the
manghihila, the mangtatawas, the mediko, the faith healer, the local shaman healers (such as those that
are from the Cordilleras).[4] Most folk healers in Philippines believe that their "medicinal" and healing
skills come from a supernatural being or given to them by God. Their practice and methods of curing
ailments involves superstitions,[3] recitation of prayers and religious rituals accompanied by the
mediation of the Holy Spirit,[4] herbology, hydrotherapy, massage therapy, and divination.[3] Although
often found active in rural communities, traditional Filipino healers can also be found in small urban and
suburban neighborhoods. During Spanish times in the Philippines, the Spaniards refer to folk doctors or
traditional as mediquillos ("herbal scientists"), herbolarios, and sometimes as "superstitious quacks".
They were even called by the Spaniards simply as matanda (the "elder").[3]

Babaylan
According to sociologist and anthropologist Marianita "Girlie" C. Villariba a babaylan is a woman mystic
who is "a specialist in the fields of culture, religion, medicine and all kinds of theoretical knowledge
about the phenomenon of nature." In ancient Filipino society, the babaylans are believed to be a woman
who had been possessed by a spirit, or a woman who had dreams or had encountered life-altering
experiences, or a woman who has inherited the role to become a "mystical woman" from an elder
babaylan. Their functions include the role of community leaders, warriors, community defenders,
priestesses, healers, sages and seers.[5] Although babaylans were mostly women, there were also male
babaylans, which were men dressing up as women to be able to act the role of the female babaylan.

Albularyo

The albularyo (the "herbalist", herbolario in Spanish[3]) is the "general practitioner" and the "primary
dispenser of healthcare" in the hierarchy of traditional folk doctors in the Philippines. Because of the
mass amount of different dialects spoken in the country, they have a diverse set of names depending on
the region (suranho, sirkano, baylan, hapsalan, tambala, mananambal, etc).[6] He or she is
knowledgeable in the use of medicinal herbs. The skill of the albularyo is commonly handed down from
one generation to another in a family-line, involving apprenticeship. Abularyos are mostly the elders of
the Barangays.[6] The common folk diagnosis is that patients become sick due to supernatural "illness-
causers" such as a duwende (dwarf), a nuno, a lamang-lupa (a "creature from the earth or underground
or under the soil"), a tikbalang, or a kapre. He or she usually includes forms of prayers, such as bulong
("whispering" prayers) or orasyon (oration or "prayer recitation"), while treating patients. Albularyos
may also practice rituals to drive away evil spirits, such as the performance of the kanyaw (cutting and
bleeding chickens, then draining their blood on particular perimeters of the house), or the slaughter of
pigs to search for the right type of liver that would reveal the cause of an illness. Sacrificial offerings are
also sometimes used during treatments. Some albularyos choose to treat patients only on certain days
of the week, such as Tuesdays and Fridays, or on the feast days of the Sto. Niño and the Black Nazarene,
with the belief that healing powers are greater during those days.[2] The methods and practices used by
albularyos vary per region.

Cebuano Mananambal

In Cebu, located in the Visayas region of the Philippines, a traditional albularyo is called a mananambal
and their work of healing is called panambal.[7] Like the general albularyo, mananambals obtain their
status through ancestry, apprenticeship/observational practice, or through an epiphany and are
generally performed by the elders of the community, regardless of gender. Their practice, or panambal,
has a combination of elements from Christianity and sorcery which appear to be opposites since one
involves faith healing healing while the other requires Black magic, Witchcraft, etc.[8] The combinations
are a reflection of the legacies left from the conversion to Catholicism of the islands from Spanish
colonization, since the Indigenous of Cebu had direct contact with the Portuguese explorer Ferdinand
Magellan, and on-going Indigenous practices before colonization. The panambals cover natural and
supernatural illnesses using a wide range of methods. Two common methods used are herbal medicine
and orasyon, healing prayers deriving from a bible equivalency called the librito.[8]

Mananambals treat major and minor ailments. These ailments include but are not limited to: headache,
fever, cold, toothache, dengue fever, wounds, Infection, cancer, intellectual impairment, and other
illnesses thought to be caused by supernatural creatures.[8] Aside from biological treatments, patients
may also come to mananambals to form or break any form of relationships from marriage to
friendships.[7] Treatments are dependent on the type of sickness and on the mananambal themselves.

The use of herbal remedies

Biophytum sensitivum, also known as sensitive plant, is used by some mananambal to treat fatigue.[7]

Herbal remedies are conducted in a variety of ways including decoction (tea making), expression
(pounding of the plant then applying the extract on affected area), and infusion (infusing plants in water
for a certain period of time then applying the result to affected areas). These particular botanical
remedies involve extracting the essential parts out of the plant material, and can be transformed into
oil, ointment, and other forms of medicine. The Rubbing of Lana is the use of botanic oil from coconut
and rubbing it onto affected areas.[7] Plant materials consist of leaves, tree bark, and roots. Herbal
extracts can either be consumed or applied to affected area(s).[8]

Plants for herbal medicine are obtained through a panagalap or the search for plants in mountains and
forests which then undergo fumigation or palina. Aside from plants, this yearly concoction search also
scavengers for potions, candles, oil, and amulets.[7]

A plethora of medicinal plants are used in the Cebuano region and as mentioned above, depend on the
mananambal and their diagnosis of the illness. Common plants used by mananambals are Mangagaw
(Euphoria hirta) for dengue fever, Dapdap (Erythrina variegata) for hemorrhoids, Tuba-Tuba(Jatropha
curcas) for arthritis, Noog-noog (Solanum) for hyperacidity, Wachichao (Orthosiphon aristatus) for
kidney problems, Sabana/Labana (Soursop) for cancer, and Kipi-kipi for fatigue (Biophytum sensitivum).
Kipi-kipi is a plant known around Southeast Asia for its instant sensitivity to touch.[7]

Orasyon
Oraysons encompass the Catholic aspect of the panambal. As mentioned above, oraysons are given by
the librito which has an unknown origin. There are theories that connect the librito with the Spanish
missionaries either before or during colonization because of its Latin texts.[7] This form of treatment can
be done through the blessing of a medicinal object given to the patient by prayer or blessing the
patients directly. Oraysons can be combined with other treatments.[7]

Other remedies

Botany and prayers can be combined with other remedies. Tayhop is a ritual procedure performed
through the combination of the blowing the patient's head gently with prayer. Another ritual procedure
that is accompanied with orayson is tutho, the application of saliva on the patient's head.[8]

Supernatural procedures consists of panubay, using supernatural manifestations to diagnose the

patient, and pagtamabalsa nasuldan which is the performance of exorcism.[7]

Due to the Philippines' position as a geopolitical gateway to Southeast Asia, medicinal influences from
visitors and immigrants to the islands influenced and formed remedies. Certain mananambal methods
aligned with their neighboring countries, such as China. One of these shared methods is Cupping
therapy, an ancient therapy method using special suction cups on affected areas of the skin.[8]

Cebuano Mananambal in the present

Mananambal practice is on-going into the present. In 1997, the Philippine Government enacted
theTraditional and Alternative Medicine Act (TAMA) legalizing Indigenous medicine.[9] Patients that
seek help from mananambals are more commonly found in the low-income class and are in isolated
communities because of the payment options. Paying the shaman is either not necessary or cheap. It
can also be in the form of trade for life-stock and food.[10]

Hilot

The hilot may refer to either the manghihilot or the magpapaanak:[2]

Manghihilot

Main article: Hilot

The manghihilot ("massager", "folk massage therapist", "folk chiropractor") uses massaging techniques
to treat sprains, fractures, and other similar conditions that affect the skeletal system and the
musculatory system, including ligaments. The practice treats illnesses a variety of ways based on its own
universal law and natural Law (physical manipulation, herbal remedies, and dietary/life style advice).[11]
Manghihilots are either chosen by maestros or master albularyos, or through apprenticeship.[11]
Gender is not a limiting factor since they can be any gender. When chosen, their trainings include a
pilgrimage to a sacred mountain to perform the oracions, or words enabling the communication with
the spirit world or the panawagan.[11] Similar to the albularyo practice, the hilot is a fusion of spiritual
and medicinal practices with physical manipulation and the focus of healing the whole body being the
main distinctions between the two practices. Illnesses were referred to as pilay and were defined by
imbalances in the body which are explained by their enkanto, or unseen entities, elements, and
manifestations in the body.[11] This practice shares similarities with India's Ayurveda and Traditional
Chinese Medicine.

Traditional Chinese Medicine similarities

The geopolitical position of the Philippines as either being the gateway to either enter or exit Southeast
Asia has allowed the exchanging of medical knowledge between immigrants, whether they are colonial
predecessors or neighboring countries. The Chinese diaspora (see also: Chinese mestizos) showed one
exchange. The trade between China and the Philippines was recorded as early as the eighth century and
enhanced in the sixteenth century.[12] The activity of trade during the sixteenth century was especially
active because of the Manila-Acapulco Galleons. The methods used by manghihilots is similar to the
Chinese acupuncture study of the Yellow Emperor's Body, the idea that the body through fluids of
energy known as a yin and yang, in Traditional Chinese Medicine (TCM).[13] Native Filipino medicine
uses the four elements (earth, water, fire, and air) to diagnose conditions while TCM views the
conditions of the body through the Five Element Theory: fire, earth, wind, metal, water, and wood.[13]
Another similarity is the diagnosis of imbalance caused by engkantos, or the unseen entities within the
body. For instance, the manghihilot may describe a person who is having trouble breathing air by calling
that trouble engkanto sa hangin meaning air entity. This person's actual condition may be asthma
according to Western medicine. In TCM, this imbalance may be explained by the imbalance set between
yin and yang (the force of yin may be dominating the body and vice versa).[13] Other similar
approaches to diagnosing include herbs (not necessarily accompanied by the blessing of it shown in the
Albularyo practice), taking patient history, facial diagnosis, and tongue diagnosis.[12] Current research
on the Hilot shows that it is not clear as to whether or not the Chinese medicine had a direct influence
on the Hilot or the Hilot had an influence on TCM because it is not clear whether these Hilot methods
were a coincidence of similarities or borrowed from Traditional Chinese Medicine since the people
coming from Southern China were primarily involved in commerce. It is also not clear which Indigenous
practices originated from Ayurveda. It is not known whether these merchants had medical knowledge.
Framework: spiritual and material

Mt. Banahaw, located in Luzon, is considered a sacred mountain by manghihilots

Research shows two components in Hilot healing: the spiritual component and the material component.

The spiritual component treats the relationship between the body's attitude and universal energy. In
other words, the goal is to bring the body back to harmony. This focuses on inner change. One way this
can be achieved is through the Banahaw Devotional Technique. Tracing its origins to the fifteenth
century, this technique requires the performance of orasions and sacrificial rituals to influence the
body's spirit.[14] The goal of this is to ask for forgiveness from God. Depending where the manghihilot
and their patient are located, the popular location to perform this technique is in the active volcano of
Mt. Banahaw, located in Luzon. Following the Banahaw Devotional Technique is the Pagpapahalaga, or
the Valuing Process in which the goal is to direct inner change to outer change with the use of inner
understandings. These inner understandings is presented within the following three modules: mabuti
(self-honesty), makabubuti (sincerity), makapagpapabuti (consequential goodness).[14] The Banahaw
Devotonal Technique and Valuing Process are treatments for inner conflicts within the body such as
stress which causes the imbalance of the four elements.[14]

The physical material component is addressed through four modalities and this time focuses on external
forces in order to restore balance between the four elements. The bio-chemical modality promotes
chemical component changes through the process of breaking down foods, herbs, vitamins, and
minerals.[14] The neuro-electrical modality is the use of electricity, in the form of positive and negative
ions, to break down material goods in the body. The goal of the third process, electro-magnetic field
(EMF), is to cause a change in the neuro-electric field to restore the normal function of the body's
cells.[14] The final modality is the bio-mechanical process which is the modality that has chiropractic
similarities. This process focuses and manipulates the interaction of bones, tendons, and muscles to
restore their normal functions[14]. The direction of treatment among all four modalities is from material
components (outer) to the inner components of the body.

Manghihilot in the present

The sophistication of the practice has evolved overtime and is still being practiced primarily in rural
areas of the Philippines. The challenges of incorporating traditional/alternative medicine into the
Philippine national health care system shows the competition against Western medicine because of the
stigma of superstition and the lack of scholarly evidence to prove alternative medicine effective.[15]
There are organizations advocating for the fusion of both western medicine and alternative medicine
out of the Traditional and Alternative Medicine Act (TAMA) passed in 1997 to make healthcare
accessible in rural areas.[15] The Philippine Institute of Traditional and Alternative Health Care (PITAHC)
is one of the advocacy groups formed from TAMA and one of their objectives is to: "Encourage scientific
research on and develop traditional and alternative health care systems that have direct impact on
public health care".[12] With this objective, the organization advocates for the continuation and
legitimization of hilot. The ancient practice of the hilot has become a debate in public health policy in
the Philippines.

Magpapaanak

The magpapaanak, the other "hilot", is the folk "midwife" who does prenatal visits and check-ups to
pregnant mothers. Normally a woman, she delivers babies during childbirth and often performs the
ritual called the suob (a form of "aroma therapy" performed while placed under a cloak).[2]

Mangluluop

The mangluluop is a folk specialist who makes a diagnosis based on the resulting appearance of a
burned concoction composed of freshwater shell or saltwater shell (kalanghuga), salt, a piece of palm
leaves that were blessed by Catholic priests during Palm Sunday, and charcoal resulting from coconut
shells, coconut midribs. The burning of these materials is done while placed inside a tin plate
accompanied by prayers and invocations and the making of the sign of the cross three times over the
body of the patient. Depending on the appearance and shape of the burned materials, mangluluop
refers and sends the ill person to either the albularyo, the mediko, or the manghihilot for further
treatment. After the ritual and after telling the patient to which folk doctor to go next, the freshwater or
saltwater shell is powdered by the mangluluop and prayerfully applies the powder following the steps of
how to make sign of the cross on the patient's forehead, palms, and plantar arches of the feet. The
remainder of the concoction is then thrown under the stairs at the entrance of the home to prevent evil
spirits from re-invading the house.[2]

Manghihila

The manghihila (the "puller") uses the technique known as panghihila (the "pulling"), wherein the
patient is rubbed with coconut oil accompanied by the use of a mirror, strips of cellophane paper that
were used as wrappers of cigarette boxes, strips of banana frond, or wrappings of medicinal leaves. The
type of "pull" felt during the massage therapy becomes the basis of what causes the ailment (i.e. the
"smoothness" of the pull of the material used or the lingering or hovering or the strength of resistance
of the applied material on a specific spot of the patient's body).[2]
Mangtatawas

The mangtatawas (literally "user of tawas") determines the cause and nature of illnesses through the
use of potassium alum, locally known in the Philippines as tawas as one of the primary ingredients. The
other materials used in the diagnostic procedure are candles, eggs, mirrors, plain paper, and paper used
for rolling cigarettes.[2]

Mediko

The mediko is a folk doctor and a specialist that combines folk medicine and some techniques used in
western medicine. He or she prescribes medications and at times uses acupuncture to treat ailments.[2]

Faith healer

Filipino faith healers come from either spiritist groups, diviners (a group that practice divination) or from
persons who were previously saved from illnesses or death and had encountered epiphanies or mystical
experiences who became convinced that they were destined to help sick people after receiving healing
powers bestowed upon them by the Holy Spirit or other supernatural beings. Some of them started as
an albularyo, a mediko, or a hilot. Some faith healers are psychic healers (faith healers who heal patients
remotely), whisperers of prayers (whispers prayers over the affected part of the body of the patient),
prayer blowers (blows prayers on affected areas of the patient's body), anointers that rub saliva over the
affected area of the patient, healers who hovers crucifixes and icons on the body of the patient, and
psychic surgeons (folk surgeons who performs "surgery" on a patient without the use of surgical
tools).[2]

Cordilleras shaman

The shamans from the Philippine Cordilleras are folk healers that heal ailments based on the beliefs of
people collectively known as the Igorots (includes tribes of the Bontok, Gaddang, Ibaloy, Ifugao, Ilongot,
Isneg, Kalinga, Kankana-ey, Ikalahan, I'wak and Tinguian). Their culture believe in rituals that involve
offering of prayers and sacrifial animals, belief in supreme deities or supreme beings, lesser ranked
deities, intermediation by seers or human mediums, and pleasing and appeasing the anito (spirits of the
dead, ancestral spirits, or spirits from nature) to prevent them from inducing diseases and misfortunes.
They also cling to animism, ceremonies that are believed to cure physical and mental imbalances, those
that counter witchcraft, and those that leads to bountiful harvests. Sacrifices, feasts and dances were
performed as a form of thanksgiving and as entertainment for gods and goddesses. Other tribal healers
dispenses magical amulets to use against illnesses and the pouring animal blood on the human body to
avoid and escape death.[2]
Medicinal plants

Years before the arrival of the Spaniards in the Philippines, the use of medicinal plants was the common
way of treating ailments. Early Catholic missionaries such as Fr. Francisco Ignacio Alcina, SJ and Fray José
de Valencia, and Fr. Pablo Clain, SJ were able to compile and publish books regarding these medicinal
plants in the Philippines. Alcina and de Valencia published theirs in 1669, while Clain published his
collection in 1712.[2] The first qualities of plant medicines in the Philippines was first recorded by Fr.
Blas de la Madre de Dios, OFM through his books Flora de Filipinas (Plants of the Philippines) and
Tratado de Medicina Domestica (Treatise on Domestic Medicine).[3]

Early medicinal practices