Essentials of Complementary and Alternative Medicine (June 1999)

C
LIENT
 B
EHAVIOR
The client's behavior provides important clues for diagnosis and treatment. Wandering sickness entails such symptoms as fever, hives, piles, or sores. Staying 
sickness can be identified by compulsive or erratic actions and by lethargy or self-destructive activities. The former ailments (wandering sickness) can be passed from 
one person to another, in contrast to the latter (staying sickness).
T
REATMENT
The treatment for wandering sickness usually entails herbs; once allopathic medical substances were encountered, they were added to the list of curative agents for 
wandering sickness, as the native shamans observed the positive effects of many of the new medicines. The treatment for staying sickness involves singing, speaking 
in public, blowing the harmful agents away from the client, sucking the harmful agents from the client's body, eating the flesh of the dangerous object whose violation 
caused the problem, or placing the client on a sand painting. In the case of staying sickness, some treatment implements (such as crystals, tobacco smoke, and eagle 
feathers) are used to connect the shaman's power (or  heart) with the client's self-healing capacities, whereas other implements (such as rattles and the shaman's 
voice) are directed toward the spirits. Herbalists can also appeal to spirits when treating wandering sickness by requesting that they bless the various plant remedies.
Treatment Setting
Treatment is attempted in an environmental setting created by the shaman or other healing practitioner. It is usually out-of-doors and often around a fire. For some 
types of wandering sickness, the shaman may refer the client to an allopathic physician's office or a hospital, both of which would then serve as the environment for 
treatment. Thus, the function of the institution is for healing whether it represents the Piman tradition or allopathy. The  practitioners involved in healing can range from 
the allopathic physician or nurse to the Piman shaman or herbalist. Staying sickness is primarily treated by shamans, whereas wandering sickness is treated by 
herbalists or referred to allopathic physicians.
P
ROGNOSIS
Prognosis, or anticipated outcome, is hopeful if the treatment is appropriate, prompt, and powerful. If the treatment does not meet any of these criteria, or if the client's 
condition is of such a nature that it cannot be successfully treated, premature death may result, or the indisposition may continue. Suicide can result from staying 
sickness, whereas fatal heart attacks from  horned toad sickness (i.e., circulatory disorders) are common.
C
LIENT
 R
OLE
In the Piman system, the clients' first priority is that of treatment, and they assume the role of cooperating with the practitioner; for example, when they are told to 
refrain from further violating the dangerous objects that cause staying sickness, they obey. Each person has internal capacities, or  strengths, located in specific parts 

of the body. In staying sickness, the strength of each dangerous object interfaces with the victim's strength. Thus, the victim's strength can serve as the repository of 
the ailment; once the shaman has located it, such treatments as massaging the muscles or sucking out the impurities can be initiated.
F
AMILY
 R
OLE
The major priority of the client's family is to obtain treatment for its indisposed family members. The parents take on the role of avoiding the violation of dangerous 
objects and their dignity; this might not only result in their own affliction but in that of their children. Parental misdemeanors are considered to be a frequent cause of 
infant birth defects. The Piman society places a high priority on the availability of healing practitioners for its members. Society also plays the role of obeying 
traditional spiritual laws so that its people will be protected from plagues and epidemics.
G
OAL OF THE
 M
ODEL
The goal of this healing model is to uphold the  way—that is, the Piman customs that were given to the tribe at the time of creation. The Piman tradition attempts to 
assist the lives of individuals and keep the society proper. This propriety results in health and happiness; failure to follow the traditional commandments is thought to 
result in sickness. The strength of the Piman model is exemplified by their response to the allopathic description of how germs can cause communicable diseases: the 
Pima Indians simply subsumed this new information under their category of wandering sickness because germs were described as invisible microorganisms that 
appeared to wander through the body.
Example 2: The Curanderismo Healing Model
Curanderismo, or Mexican-American folk healing, is a coherent, comprehensive system of healing that primarily derives from the synthesis of Mayan and Aztec 
teachings along with Mexico's heritage of Spanish Catholicism. However, traces of Arabic medicine and European witchcraft can be discerned as well. Its underlying 
concept is the spiritual focus of the healing; the typical  curandera (female practitioner) and  curandero (male practitioner) who subscribe to this world view place the 
religious element at the center of their practice (
16
).
P
RACTITIONERS
The practitioners will vary depending on location; a practitioner who is referred to as a  curandera in San Jose, California, may correspond to a  señora in San Antonio, 
Texas; a medica in New Mexico; and a parchera in parts of Guatemala. Most practitioners of Curanderismo are women, but the proportion varies geographically. 
Curanderas typically are called to their profession by spiritual entities; they apprentice themselves to a friend or relative until they are considered ready to practice. 
Most of them are part-time practitioners who do not charge a specific fee, but are given a small offering or gift.  Curanderos (male practitioners) have similar powers. 
The setting is often the home of the practitioner; the function is diagnosis and treatment.
D
IAGNOSIS
Diagnosis is based on the history of the malady, the symptoms, and (retrospectively) on the response to treatment. Diagnosis may involve natural, psychological, and 
spiritual procedures. On the natural level, a practitioner can observe the client and ask questions. On the psychological level, a  curandera may claim that she can see 
her client's aura, or energy body; the size, color, and shape of this aura can be an important diagnostic sign. Some  curanderas claim that diagnosis can be carried out 
at a distance through what is often called  mental telepathy. On the spiritual level, the nature of a client's problem is often revealed to the practitioner in dreams by a 
spirit guide. Initial diagnoses often are carried out by the clients themselves or by family members and neighbors.
C
AUSE
Etiology, like diagnosis, can be natural, psychological, or metaphysical. The role of bacteria and viruses is taken for granted as a possible causal factor. Another 
alleged natural cause of a client's difficulty is  empacho—indigestion due to a ball of food being lodged in the intestine, or food sticking to the wall of the stomach. 
Psychological causes are thought to be behind  bilis (caused by anger or fear), envidia (caused by jealousy), mal aire (caused by imbalances in relationships or 
personal qualities), and  caida de mollera— the perception that an infant's fontanel is too low because of the mother's neglect. Metaphysical etiologies abound; 
embrujada, an illness caused by sorcery, involves the participation of demonic spirits, whereas  mal puesto (a mental/behavioral disorder in which the client engages 
in bizarre conduct) results from a hex. Sometimes there is a combined etiology;  empacho can be brought about when a mother forces her child to eat too much or to 
consume food the child dislikes.
C
LIENT
 B
EHAVIOR
The client's behavior is used to make a diagnosis; for example, if diarrhea, crying, vomiting, and sunken eyes accompany a fallen fontanel, the diagnosis of  caida de 
mollera is confirmed. One form of envidia is  mal ojo, which occurs when someone with an evil eye stares at the victim because of envy or desire. Symptoms include 
fever, headaches, vomiting, and drooping eyes. In contrast, gas, constipation, a bitter taste in the mouth, and a  dirty white tongue accompany bilis.
T
REATMENT
Treatment is generally carried out by specialists. Herbal treatments are supervised by the  herbolaria, médica, and herbalista, whereas the señora prescribes home 
remedies. The client's  vibrating energy may need to be modified by incantations or manipulation. Suggestion, confession, and persuasion are employed; the 
practitioner may increase clients' self-esteem by getting them involved in group activities and church functions, or asking them to visit a holy shrine. The  mágica 
combines herbs with spiritual practices, such as praying, chanting, sprinkling holy water, burning incense, and lighting candles. Exorcisms are done by an  espiritista, 
or medium, who is adept at enlisting the help of benevolent spirits and ridding the client of malevolent ones. The etiology must be accurately made to ensure both the 
proper type of treatment and the most appropriate practitioner.
R
EGIONAL
 D
IFFERENCES
Important regional differences exist within the system of Curanderismo. For example, its model of health emphasizes balance in relationships and behavior. But a 
balance of emotional humors and the avoidance of an excess of either hot or cold foods is important as well. An exception is found in Southern Texas, where the 
consideration of hot and cold foods as treatment is virtually absent. The role thought to be played by witchcraft in causing a malady also varies from location to 
location.
P
ROGNOSIS
Prognosis is favorable if the treatment regimen is closely followed up. However, failure to comply may lead to a worsening of the condition or, in the case of such 
problems as caida de mollera and mal puesto, to premature death. Suicide can result from metaphysical sources or from failure to find a spiritual approach to life's 
problems. The function of the  institution, whether it is the curandera's home, the home of the client, a church, or a hospital, is to reflect the divine order and, in so 
doing, to facilitate the client's recovery.
C
LIENT
, F
AMILY
, 
AND
 S
OCIETAL
 R
OLES
The client's priorities and roles are to work closely with the  curandera, following her directions carefully, especially those of a spiritual nature. The family's priorities 
and roles are of great importance because familial allegiance and obligation are overriding cultural values. Family members generally accompany the client to the 
Curanderismo sessions and assist the client's compliance with the regimen. The society's priorities and roles are to support the client's recovery because the entire 
community is concerned and affected when a member becomes ill.
G
OAL OF THE
 M
ODEL
The goal of the Curanderismo model is to assist the recovery of the client, restoring his or her balance within a social framework that preserves the traditions of the 

family and the Mexican-American subculture. Suffering and infirmity are seen as an inevitable part of life and as part of God's plan to instruct human beings and lead 
them to salvation. Sickness is not seen as a punishment from God, but as a challenge.
Example 3: The Kallawaya Healing Model
The Kallawaya practitioners of Bolivia trace their tradition back to the legendary Tiahuanaco cultures of 400 to 1145 AD, continuing through the eras of other pre-Inca 
cultures, the Inca empire, and the Spanish conquest, to present times.
P
RACTITIONERS
Kallawaya practitioners often travel to parts of Argentina, Chile, and Peru, but always in small groups rather than alone (
17
). Most Kallawaya practitioners are males, 
but talented females are admitted to the profession as well.
The practitioners involved among the Kallawaya represent various skills and functions.  Herbalarios collect plants; yerbateros prepare medicines from the plants; 
curanderos apply the herbs and other medicines;  yatiris (also known as amautas) are spiritual healers; and  partidas are midwives. Over time, Kallawaya practitioners 
began to perform more than one function; hence, many of these traditional divisions have become less rigid. Nevertheless, all practitioners mediate between the 
environment and the client (and, in some cases, the community at large). If a Kallawaya healer cannot help a client, there may be a referral to an allopathic physician, 
especially if surgery is needed; it is a common practice for referrals to go in both directions because some allopathic physicians send clients to Kallawaya healers.
D
IAGNOSIS
Among the Kallawaya, diagnosis is as important as treatment. A client's body is seen as the microcosm of the natural environment. The healer's task is to make an 
accurate diagnosis, and an initial decision must be made as to whether the client should be referred to an allopathic physician, who serves as a resource for infectious 
diseases, broken bones, internal injuries, and other problems in which Kallawaya healers feel they tend to be less effective. Another decision involves whether the 
sickness can be treated by the person doing the diagnosis, or if another Kallawaya healer should be consulted. After making the first decision, and before making the 
second decision, the practitioner must determine the problem.
A common diagnostic tool is the casting of coca leaves, in which the healer holds several leaves high above his or her head and drops them onto the ground or onto a 
ceremonial mesa (a cloth that purportedly has spiritual powers and on which various objects are displayed). Each aspect of the leaf is instructive—the side of the leaf 
exposed, the orientation of the leaf, its resemblance to the Christian cross, and its relative location to other leaves. The practitioner also takes the client's pulse (at the 
heart, left arm, and right arm) and blood pressure and makes direct observations of the tongue, eyes, breath, urine, and feces. An irregular pulse is an immediate sign 
of disharmony. The color of the tongue and iris are observed carefully as is the dilation of the client's pupil.
It is important that the practitioner and client come to an agreement. Family members often are present when the diagnosis is announced, and they may be given 
tasks to perform. The clients and their families are fully informed and are advised to share the diagnosis with the entire community—except in the case of  kharisiri (i.e., 
sorcery), which the practitioner might treat privately to keep others from being alarmed. In general, liver, stomach, and respiratory problems are the most commonly 
diagnosed sicknesses, but Kallawaya healers also diagnose and treat most other conditions, both physical and psychological, that are familiar to allopathic 
biomedicine. In addition, they work with spiritual problems such as  susto, the loss of one's haio (i.e., soul), which is often conceptualized as a vital fluid that animates 
each human being. Each person has a major and a minor haio, and maintaining harmony between them is a crucial life task.
C
AUSE
Etiology is seen as a disintegration of harmony between the clients and their community and/or natural environment, except when there is a direct metaphysical 
intervention (as in kharisiri). Thunder is perceived as capable of bringing affliction to both humans and animals.  Susto has several possible etiologies—sorcery, 
traumas, shocks, or an inclement wind that captures a baby's soul (which is why the birth process occurs indoors). Sometimes it is the major  haio that is lost, and 
sometime the minor haio; in either instance, the individual loses balance.
C
LIENT
 B
EHAVIOR
This factor provides important clues for diagnosis and treatment. In general, a calm client is healthy; crying and screaming may be signs of soul loss. The symptoms of 
susto vary, but include depression, anxiety, laziness, loss of appetite, shaking, fever, nausea, hearing noises in the ears, and passing gas. Folk tradition in Bolivia 
defines being sick operationally as someone who is unable to work.
T
REATMENT
Treatment is highly individualized, but the importance of a balanced diet is emphasized by many practitioners who tell clients to “eat food from the area and during its 
season.” The Kallawaya healers employ more than 1,000 medicinal plants, approximately one-third of which have demonstrated their effectiveness by Western 
biomedical standards, and another third of which have been judged to be probably effective (
18
). These plants redivided according to the three distinct  weathers that 
the gods Pachamama (the great Earth Mother) and Tataente (Father Sun, the Creator) have given to their district—namely, hot, mild, and cold.
Coca leaves play a major role in many of the healing procedures because the plant is said to grow between the world of human beings and the world of the spirits. A 
coca and quinine mixture has been used to treat malaria—most notably, as the Kallawaya tell the story, during the digging of the Panama Canal, which is a triumph 
that brought these native people worldwide attention. The fungus of corn or bananas produces a type of penicillin used to treat local infections. More serious 
infections are treated by a tetramycin preparation yielded from fermented soil, which is also used to treat various chronic ailments.
Kallawaya medicine generally is accompanied by rituals involving prayers, amulets, and  mesas. Llama fetuses are commonly used in the preparation of  mesas 
because the llama is a sacred animal to these people. Amulets are placed on the  mesa or worn around the client's neck, giving him or her confidence and spiritual 
power. Different amulets represent health, love, wealth, or equilibrium with the deities Pachamama and Tataente.  Mesas also are used to prevent sickness or 
imbalance, often for the entire community.
Herbal preparations usually are ingested, but occasionally they are used in conjunction with a  steam box; the nude client enters the receptacle that is filled with steam 
created from the medicinal mixture. The active ingredients of the herbs enter the pores of the client, and the sweat eliminates the toxins. Also, there is an 
armamentarium of procedures that do not involve herbs, including healing songs (especially for treating insomnia) and dances (particularly to renew the client's supply 
of energy).
Treatment Setting
The setting depends on the client's mobility; if the client cannot go to the healer, the healer will go to the client. However, female Kallawaya practitioners typically do 
not leave their homes; thus, their clients must come to them. In La Paz and other large cities, there are clinics where clients can visit a Kallawaya practitioner. The 
function of the institution is for diagnosis and treatment regardless of its location, but the client's preference usually is home visitation, which is far from the influence 
of hostile spirits and unfamiliar surroundings and near to familiar animals, plants, and land. Hospitals are dreaded, in part because the color white, in folk traditions, is 
associated with the death and burial of infants.
P
ROGNOSIS
Prognosis, or anticipated outcome, depends on many factors—the sickness itself, its severity, and the cooperation of clients and their families. The confidence and 
the faith of the client are key factors because herbal treatment is a slow process that requires a great deal of patience. Belief is thought to activate the self-healing 
mechanisms that are fundamental to recovery.
If the treatment does not work, or if the client's problem occurs where no practitioner is available (e.g., a serious industrial or traffic accident), premature death may 

result. There are few suicides among the Kallawaya; such an act would bring dishonor to the family. Death, however, is a natural process that can be prepared for and 
confronted with valor; after death, one or both of one's souls rejoins Pachamama, the great Earth Mother. Premature death, however, is often attributed to 
metaphysical intervention.
C
LIENT AND
 F
AMILY
 R
OLE
In the Kallawaya system, the client's first priority is that of treatment, and he or she assumes the role of cooperating with the practitioner. The major priority of the 
client's family is to obtain diagnosis and treatment for its indisposed family members. The parents take on the role of providing emotional support for the client, 
maintaining his or her faith, and providing practical assistance, for example, helping administer medicinal herbs. The family receives an accurate and honest 
diagnosis (with the exception of instances of sorcery) and is informed of the client's progress or deterioration, as would be the case if the condition is incurable; for 
example, acquired immunodeficiency syndrome–related conditions or terminal cancer.
S
OCIETAL
 R
OLE
It is the priority of the Kallawaya society to maintain a balanced environment that exists in harmony with nature. The community, at times, plays the role of expelling 
members who endanger this balance. Another role is to support clients by bringing them food, money, music, and anything else that will maintain their faith and 
motivation to recover; this community process is referred to as  ayni. A festive ceremony for offering group assistance is referred to as  apreste and is frequently used 
to treat susto. Society places a high priority on the availability of healing practitioners for its members. There is a vigorous attempt to train students to become 
effective practitioners. It is the duty of the eldest son of a healer to become a healer himself, and the boy will spend some 14 years in preparation before he will be 
allowed to assist his mentor (
17
).
G
OAL OF THE
 M
ODEL
The goal of the Kallawaya model is to maintain and restore the harmonious relationship of community members, the community as a whole, and the natural 
environment. The Kallawaya practitioner needs to guarantee the availability of medicinal plants and proficient healers who are conversant with health, sickness, the 
natural realm, and the world of spirits. Prevention involves the practice of moderation in daily life and of the maintenance of trust among members of the community.
Example 4: The Chinese Healing Model
P
RINCIPAL
 C
ONCEPTS
/D
IAGNOSIS
The model of traditional Chinese medicine is based on the belief that health problems reflect disharmony between the individual and the environment, or within 
individuals themselves. A practitioner will conduct the diagnosis in a way that examines an imbalance in the  yin and yang (i.e., “dark” and “light”) forces that impinge 
upon the client's inner forces. Pulse diagnosis is a common diagnostic method, supplemented by keen observation, including the practitioner's use of smell and taste. 
Etiology focuses on the interruption or blockage of  qi, the driving force of both the cosmos and human life; this is the  energy that has two manifestations—yin and 
yang. Qi flows along its own bodily channels, or  meridians. It can be blocked by environmental stress, faulty eating habits, or careless behavior patterns. Indeed, 
learning about the client's behavior is an important part of the diagnosis; key symptoms of  qi blockage or imbalance are irritability, anxiety, depression, and insomnia 
(
19
).
P
RACTITIONERS
Medical practitioners include physicians and their apprentices. In some areas, a shaman is the sole practitioner available; in other areas, a client might prefer a 
shaman to a physician. A few shamanic practitioners still implement their own version of traditional Chinese medicine, intermingling the notion of  qi with their own 
traditional rituals. There are also practitioners who specialize in herbal treatment or massage; the latter often use their fingernails, knuckles, and elbows to unblock 
the flow of qi.
T
REATMENT
/P
ROGNOSIS
Treatment can involve acupuncture, herbal medicine, moxibustion (applying cones of herbal substances to the skin and igniting them), diet, and massage. The 
prognosis is usually positive if the instructions are followed diligently, especially when changing one's lifestyle is involved. Considerable emphasis is placed upon 
follow-up after the treatment and on prevention of further problems. Death is seen as part of the life cycle and is accepted gracefully. However, a premature death or 
suicide can be the result of continued or extreme imbalance.
Traditional Chinese physicians treat clients in an office setting but will sometimes visit clients in their homes. The function of the institution is to provide a quiet, 
comfortable place for diagnosis and treatment. Often, the site will be selected on the basis of the surrounding  qi, especially that believed to exist in the natural 
environment.
C
LIENT
/F
AMILY
/S
OCIETAL
 R
OLE
The client is expected to cooperate with the practitioner. His or her priority is to relax and not resist; by  flowing with the treatment, tension is avoided that would 
hamper the movement of qi. Clients are also assigned the role of obeying their physician; for example, a diet may be prescribed that will help to balance a client's  yin 
and yang qualities.
The family of the client has the priority to seek help. Family members are told about the client's condition and are asked to cooperate with the physician. At its best, 
the family will reflect the laws of nature. For example, the  law of the mother and child enacts itself in the family as well as in the environment, where earth is seen as 
the mother of metal; metals melt into water, and water condenses on metal—its mother. Water nurtures wood which, in turn, is the  mother of fire. These five elements 
interact harmoniously, serving as an example for the family. The family enacts the  role given them not only by the physician but by nature itself.
Society is also a part of nature, and one of its priorities must be to encourage the teaching and practice of the healing arts. Society plays the role of mirroring both the 
macrosystem of the universe and the microsystem of the body. Each bodily organ has its counterpart in society; for example, the heart (a  fire organ) is the supreme 
master, whereas the gallbladder (a wood organ) corresponds to the official who makes decisions and judgments. The time of day and time of year are important for 
treating the client's ailments, just as they are important for decision making by the society's rulers.
G
OAL OF THE
 M
ODEL
The goal of the traditional Chinese medical model is to relieve the pain and tension of the client's disorders and prevent their recurrence. On a broader level, however, 
the goal is to promote harmony within the body—and among the client, family, community, and environment.
Example 5: The Allopathic Biomedical Model
The allopathic biomedical model exhibits both similarities and differences when compared with the traditional models of the Piman shamans, the  curanderos, the 
Kallawaya practitioners, and the traditional Chinese physicians. As practiced in Western and Western-influenced societies, allopathic biomedicine typically deals with 
urgent matters at a rapid pace; Siegler and Osmond call the emergency ward “a microcosm of the hospital as a whole” (
11
). A client usually comes to the hospital, 
clinic, or physician's office voluntarily (or is brought by others, but rarely against his or her consent), agrees to be called a  patient, and is referred to as a case. The 
patient is frequently handled by  physicians who use physically invasive procedures to determine what the patient  has rather than what the patient  is. On the basis of 
this procedure, treatment begins, and it is often “unpleasant, disgusting, painful, expensive, life-threatening, or sometimes all of these” (
10
), but not always so. 
Nevertheless, the procedure usually works well enough for people to repeat it when they again believe that their health, or their very lives, are threatened, and for 
them to advocate it to family and friends.

D
IAGNOSIS
A diagnosis is usually made by the physician and follows logical procedures that may be carried out with or without input from the client; in the allopathic diagnostic 
process, extensive input from the family is rarely requested, and input from the client's community is almost never involved. Etiology is always considered natural 
rather than metaphysical. However, treatment sometimes proceeds in the absence of a diagnosis, a clear etiology, or even a favorable prognosis (
11
).
C
LIENT
 B
EHAVIOR
The client's behavior is connected to the diagnosis through symptoms (the client's reported experiences) and signs (the results of examinations of the client's body). 
The treatment of symptoms and signs sometimes proceeds in the absence of a known etiology. For example, a physician will often prescribe medication to lower a 
client's fever before identifying the cause of the fever.
T
REATMENT
Treatment is usually medicinal or surgical and specific for each condition, but when a diagnosis is unclear, it may proceed by trial and error. Treatment is oriented 
toward specific objectives and is adjusted to the response of the client. Prognosis, which is the physician's perspective on the course of the client's problem, is based 
on diagnosis. The physician will discuss such matters as the chances of recovery, the probable length of time needed for recovery, and the chances of a relapse. The 
physician offers hope, but often cannot promise a cure. Premature death is seen as a failure of the diagnostic and treatment system or as a result of a serious ailment 
that is unresponsive to the best treatment currently available. Suicide typically is seen as an extreme outcome of a psychiatric disturbance or reaction to the illness.
F
UNCTION OF THE
 I
NSTITUTION
The function of the institution, whether the setting is the physician's office or a hospital, is to provide care for clients. Some physicians are based at a hospital, 
whereas others may work at an office. Practitioners in the allopathic medical system include physicians (who treat the clients), nurses (who assist physicians in caring 
for the clients), and various rehabilitationists (who teach clients how to regain lost or damaged bodily functions). These personnel are subject to formal regulative and 
licensure procedures to maintain standards of quality.
G
OAL OF THE
 M
ODEL
The allopathic biomedical model holds that its clients can assume the  sick role. While assuming this role, they can receive care and are not expected to assume their 
ordinary responsibilities. Clients are expected to obey their physician, nurse, and/or rehabilitationist. The client's family is expected to seek help. Family members are 
permitted to receive information about the client's condition and progress. Their role is to cooperate with medical personnel in carrying out the treatment. The client's 
society is expected to protect its other members from ill people who are a danger to them. Society/government is also expected to protect clients against incompetent 
practitioners.
The goal of this model is to treat clients for health problems. Allopaths attempt to restore clients to the greatest degree of functioning possible, or to at least prevent 
the problem from getting worse. A secondary goal is to accumulate medical knowledge so that more ailments can be cured and treatment can become increasingly 
effective (
11
).
TREATMENT MODELS IN CROSS-CULTURAL PERSPECTIVE
The allopathic biomedical model, the Piman model, the Kallawaya model, the Curanderismo model, and the traditional Chinese medical model are all comprehensive, 
yet each presents its adherents with very different world views. The Piman, Curanderismo, Kallawaya, and Chinese models are, in part, spiritual because they 
demonstrate an awareness of a broader life meaning that transcends the immediacy of everyday physical expediency, as well as an  other-worldly transcendent reality 
that interfaces with ordinary reality. An individual allopathic practitioner might work spiritual aspects into his or her world view and practice, but this effort is not 
intrinsic to the medical model as it is widely taught and promulgated.  Spirituality, however, is part and parcel of the other healing systems; their treatment modalities 
would change radically if they were to lose their spiritual components.
The diversities of these models are important when a differentiation is made between  disease and illness. One can conceptualize disease as a mechanical difficulty of 
the body resulting from injury or infection, or from an organism's imbalance with its environment. Illness, however, is a broader term implying dysfunctional behavior, 
mood disorders, or inappropriate thoughts and feelings. These behaviors, moods, thoughts, and feelings can accompany an injury, infection, or imbalance—or can 
exist without them. Thus, English-speaking people refer to a  diseased brain rather than an ill brain, but to mental illness rather than mental disease. Cassell (
20
) goes 
so far as to claim that allopathic biomedicine treats disease but not illness: “physicians are trained to practice a technologic medicine in which disease is their sole 
concern and in which technology is their only weapon.” Shamans often have been described as “technicians of the sacred” (
21
), but their technology involves the 
entry into other worlds so that the spiritual aspects of their clients' problems can be addressed. Dimensions similar to these may start to be reintroduced into Western 
medicine.
The fourth edition of the American Psychiatric Association's  Diagnostic and Statistical Manual of Mental Disorders (
22
) is the first allopathic biomedicinal reference to 
mention “religious or spiritual problems” (
23
). The manual also includes material concerning cultural factors related to mental illness and treatment. First, there is a 
statement about culture and ethnicity in the manual's introduction. Second, the text of the manual mentions cultural variations in idioms of distress, symptom patterns, 
social-cultural correlates of mental illnesses, and courses of disorders.
Third, new cultural annotations point out the following:
Possible cultural factors should be listed for the client being assessed.
Cultural factors are especially important in assessment because normative ideas about personality development and behavior are culture-based to a significant 
extent.
Medical conditions are differentially distributed across various cultural and ethnic groups.
Minority and non-Western cultural groups often suffer under extreme social, economic, and political conditions in comparison to middle-class American groups.
Fourth, there is a “Cultural Formulation Guideline” in the manual's appendix that attempts to instruct clinicians how to make an assessment of an illness within the 
cultural context of the client's experience and judge the implications that assessment has for clinical treatment. Fifth, the appendix also contains a glossary of 
culture-bound syndromes and idioms of distress. This is a collection of non-Western, folk, or popular psychiatric syndromes that are standard forms of mental illness 
in indigenous cultures, but are also found with increasing frequency in the American multicultural society.  Susto is one of the syndromes included, but it should be 
pointed out that anorexia nervosa is found only in Western cultures (
24
).
The inclusion of culturally sensitive material in the fourth edition of the  Diagnostic and Statistical Manual of Mental Disorders is an important step toward recognizing 
alternative models of psychotherapy and medicine. Implicitly, this move necessitates education and training for practitioners whose focus has been biomedicine and 
Western psychotherapy, a world view that is clearly inappropriate for many clients and several disorders.
POSTMODERN PERSPECTIVES
Many traditional people, especially those in the developing world, recognize the advantages of allopathic biomedicine. Its effectiveness in surgery and in treating 
infections, fractures, and trauma is apparent, as is its success in preventing epidemics. Yet these indigenous groups are often wary of how biomedicine can be used 
as a political instrument to discriminate against ethnic groups and socioeconomic classes, and create dependency relations with the industrialized countries who 
supply (and profit from) allopathic biomedicines and implements (
18
). In this way, the contrast of traditional healing models with that of allopathic biomedicine enters 
what has been called the postmodern discourse (
25
), in which the role played by power in mediating paradigms and world views becomes more apparent. (
25
). 
Official medicine (i.e., biomedicine) has more sources of political and financial power than does  traditional medicine (i.e., ethnomedicine), and the latter has had to 
struggle for legitimacy against influential forces. In general, it is a constant struggle for traditional practitioners to preserve their ways of living, feeling, and thinking, 

which all emphasize balance, harmony, and community support (
3
).
Biomedical technology often determines what is considered authoritative knowledge and, in turn, establishes a particular domain of power. Biomedicine typically 
extends this privileged position to economics, politics, and class relationships; its power is jealously guarded by legislation, medical schools, licensing regulations, 
and medical terminology. Biomedical practitioners generally act out of good faith and noble motives in using their power, but traditional people frequently view 
biomedicine with suspicion (
18
). Rather than supporting the extremist view, which sees any use of biomedicine by indigenous people as a form of colonization, 
postmodernity simply requests that traditional ethnomedicine be allowed to join the medical dialogue—what Anderson (
25
) refers to as the “belief basket of the 
world”—and be assured of a fair hearing. Testing, experimentation, replication, scientific methods, and disciplined inquiry are major contributions of biomedicine and 
are just as important in the postmodern world as they ever were. Possible explanations for health and affliction need to compete, but these explanations must be 
tempered with a revitalized awareness of the role that vested interests and entrenched authority typically play in the outcome of the dialogue (
25
).
Cross-cultural studies have described the ways in which social and cultural forces shape human behavior (
26
) and how natural settings produce classification 
systems that are often remarkably adaptive for indigenous people (
27
). Kleinman (
5
) has drawn upon these findings in describing the way treatment by traditional 
practitioners moves through: 1) the labeling of the problem with an appropriate and culturally sanctioned category; 2) the treatment of the client on the basis of that 
label (including the label's ritual manipulation); and 3) the application of a new label (e.g.,  healed, cured) that is sanctioned as a meaningful symbolic form.
Postmodernists use the term privileged to describe a standard or style that is preeminent in a given time, place, or world view. Biomedicine privileges scientific 
methodology, even though it sometimes applies this methodology in a biased manner. Nevertheless, it is necessary to use outcome measures to determine the extent 
to which ethnomedicine is effective, even on its own terms. Kleinman (
5
) observed that Taiwanese shamans were most successful when dealing with what Westerners 
would term acute, self-limited sicknesses, secondary somatic manifestations of psychological disorders, and chronic ailments that were not life threatening; and 
Finkler (
28
) observed that diarrhea, simple gynecological disorders, somatic manifestations, and psychological disorders were most amenable to treatment by 
Mexican spiritists. In her description of Malay shamanism, Laderman (
29
) described how practitioners use ritual, dialogue, and music to provide intense personal 
experiences that mobilize the immune system. Also, various aspects of Chinese medicine (e.g., pain control, asthma) have been evaluated using Western scientific 
methodology, often yielding positive results (
30
). It is to the credit of biomedicine that the accumulation of such medical knowledge is an important goal. Granted that 
empirical scientific methods are  privileged styles; but at their best, they can produce standards by which other models of healing can be evaluated, thus enhancing the 
effectiveness of procedures by which ailments can be treated. As the practitioner learns about the systems of healing described in the chapters that follow, keep in 
mind the cultural context of all healing systems. These systems may shed light on understanding of biology and provide approaches to benefit our patients, just as 
science may help these systems become more evidence-based and generally applicable.
WHO has launched initiatives to support traditional healers whose expertise is needed if worldwide health care is to become a reality. The value of a plethora of 
medical plants used in ethnomedicine has now been confirmed by pharmacological research, and their cost effectiveness also argues in their favor. The value of 
ethnomedical practitioners and their incorporation into biomedical systems has also become widely heralded since their advocacy by WHO. However, the high cost of 
training folk healers, the reluctance of the medical bureaucracy to accept them, and the decline of ethnomedicine in many parts of the world have frustrated such 
incorporation. The objective of available medical care for all people of the earth by early in the twenty-first century depends upon granting traditional practitioners 
some professional autonomy and educating them in abandoning worthless (and sometimes harmful) practices (
31
). It also involves teaching them and their 
communities about effective public health measures. But this educational process needs to be mutual. Many traditional practitioners use adaptive strategies that 
involve dynamic systems subject to change in response to the community and the environment. Biomedicine can learn a great deal by observing how quickly these 
adaptations are often made, especially during times of emergency. In a world on the brink of ecological disaster, these resourceful tactics may be important skills for 
thoughtful people concerned with both local and global survival.
C
HAPTER
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1.
Frank JD, Frank JB. Persuasion and healing. 3rd ed. Baltimore: Johns Hopkins University Press, 1991:139, 140.
2.
Mahler W. The staff of Aesculapius. World Health [Organization], Geneva, Switzerland, Nov 1977:3.
3.
Kleinman A. Writing at the margin: discourse between anthropology and medicine. Berkeley: University of California Press, 1995:195–196.
4.
Torrey EF. Witchdoctors and psychiatrists. New York: Harper & Row, 1986.
5.
Kleinman A. Patients and healers in the context of culture. Berkeley: University of California Press, 1980:33, 372.
6.
Levi-Strauss C. Structural anthropology. New York: Basic Books, 1963.
7.
Rogers CR. The necessary and sufficient conditions of therapeutic personality change. J Consult Psychol 1957;21:95–103.
8.
Levy RI. Tahitian folk psychotherapy. Int Public Health Res Newslett 1967;9(4):12–15.
9.
Boyer LB, Klopfer B, Brawer FB, Kawai H. Comparisons of the shamans and pseudoshamans of the Apaches of the Mescalero Indian reservation: a Rorschach study. J Projective Techniques 
1964;28:172–180.
10.
Krippner S, Welch P. Spiritual dimensions of healing. New York: Irvington Publishers, 1992.
11.
Siegler M, Osmond H. Models of madness, models of medicine. New York: Macmillan, 1974:23–27.
12.
Greenfield SM. A model explaining Brazilian spiritist surgeries and other unusual, religious-based healings. Subtle Energies 1994;5(2):109–141.
13.
Russek LG, Schwartz GE. Interpersonal heart-brain registration and the perception of parental love: a 42-year follow-up of the Harvard Mastery of Stress study. Subtle Energies 
1994;5(3):195–208.
14.
Krippner S. A cross-cultural comparison of four healing models. Altern Therap Health Med 1995;1:21–29.
15.
Bahr DM, Gregorio J, Lopez DI, Alvarez A. Piman shamanism and staying sickness. Tucson: University of Arizona Press, 1974.
16.
Trotter RT III, Chavira JA. Curanderismo. Athens, GA: University of Georgia Press, 1981.
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Bastien JW. Healers of the Andes. Salt Lake City, UT: University of Utah Press, 1987.
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Bastien JW. Drum and stethoscope. Salt Lake City, UT: University of Utah Press, 1992:17, 47.
19.
Beinfield H, Korngold E. Between heaven and earth. New York: Ballantine, 1991.
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Cassell EJ. The healer's art. Middlesex, England: Penguin, 1979:18.
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Elinde, M. Shamanism: archaic techniques of ecstasy. New York: Pantheon, 1964:7.
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American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.
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Lukoff D, Lu F, Turner R. Toward a more culturally sensitive DSM-IV: psychoreligious and psychospiritual problems. J Nerv Ment Dis 1992;180:673–682.
24.
Bletzer KV. Biobehavioral characteristics of a culture-bound syndrome perceived as life-threatening illness. Qualitative Health Res 1991;1:200–233.
25.
Anderson WT. Reality isn't what it used to be. San Francisco: Harper, 1990:77, 188.
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Parker I. Discourse and power. In: Shotter J, Gergen K, eds. Texts of identity. Newbury Park, CA: Sage, 1989.
27.
Kim U, Berry JW. Introduction. In: Kim U, Berry JW, eds. Indigenous psychologies. Newbury Park, CA: Sage, 1993.
28.
Finkler K. Spiritualist healers in Mexico: successes and failures of alternative therapeutics. New York: Praeger, 1985.
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Laderman C. Taming the winds of desire: Psychology, medicine, and aesthetics in Malay shamanistic performance. Berkeley: University of California Press, 1991:297–298.
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Kleijnen J, Rietter G, Knipschild P. Acupuncture and asthma: a review of controlled trials. Thorax 1991;46:799–802.
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Edgerton RB. Sick societies. New York: Free Press, 1992.

P
REFACE
The publication of a medical textbook for a new or emerging field always signals a turning point—a shift toward greater awareness of theories, basic science research, 
and modes of clinical practice at the cutting edge of medicine.  Essentials of Complementary and Alternative Medicine represents just such a coming of age for an 
important new clinical and scientific field. With this book and the forthcoming and comprehensive  Textbook of Complementary and Alternative Medicine, information is 
available in one place on the social and scientific foundations of complementary and alternative medicine (CAM) and the safety of CAM products and practices, and 
providing detailed overviews of most CAM systems and modalities.
The primary purpose of these books is to provide medical and health care professionals with useful and balanced information about CAM in general and about 
particular CAM systems and practices. This is an ambitious and difficult task for several reasons. For one, the CAM systems detailed here offer benefits to patients not 
entirely available from mainstream medicine and not easily described in conventional terms. Further, the unifying themes or concepts across these systems are still 
undifferentiated from the dominant perception that unmet patient needs can be addressed outside of conventional medicine. In addition, CAM is characterized by a 
long-term history of vigorous antagonism; differing standards of education, training, and practice; and lack of consensus as to what constitutes sufficient evidence of 
safety and efficacy. Faced with these challenges, we have sought the leading experts in these diverse areas to contribute to this textbook, and have worked with them 
to provide balanced information for the conventional practitioner.
This book is designed to be a companion volume to the forthcoming  Textbook of Complementary and Alternative Medicine and to serve as a clinical resource for 
practicing physicians and health care professionals and for medical and health professions students and postgraduates enrolled in courses on CAM. Although 
originally envisioned as a condensed version of the  Textbook, it quickly became apparent that this objective would be served better by including profiles of only the 
most popular complementary therapies and by focusing the first two parts of the book on safety, patient management issues, and social and scientific foundations of 
CAM. With the clinical reader clearly in mind, this book provides an entire section detailing the safety information needed in addressing CAM products and practices. 
The book also includes an Indications and Precautions Chart (IPC), which provides information-at-a-glance along with chapter references on CAM systems or 
modalities most highly supported by empirical evidence and most likely to be efficacious in the treatment of the most common conditions presented to primary care 
providers.