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Abstract

In this entry, traditional medicine is understood and treated as systems of medicine or healthcare distinct from the global paradigm of scientiﬁc medicine, as they have evolved and exist in the various human cultures of the world. Such systems are closely connected with the adaptation of various human groups to their physical environment or ecological niche and the social organization that makes their day-to-day living possible and meaningful. These healthcare or medical systems might be given various appellations from various points of view or perspectives, but they are basically aimed at and result from the basic need of human beings to maintain health, guess and diagnose the causes of illness, treat illness, and prevent its occurrence. Scientiﬁc medicine, because of its alliance with technology and commerce, its global push, and globalizing effects, stands as a gigantic rival to all such traditional systems with which, willy-nilly, they have to deal.

Introduction

The term “traditional medicine” (TM) is ambiguous in the sense that it has more than one meaning. There is a sense in which every society, country, or culture has its traditional medicine which may be compared and contrasted with its modern medicine as it has evolved with the help of new discoveries or improved techniques and external inﬂuences. Sometimes the term “traditional medicine” is used to refer to any medicine based exclusively on plants and other natural products in the environment. Sometimes “traditional medicine” is used as a contrastive term to denote health practice other than “Western scientiﬁc medicine” (WSM) which variously is also designated in available discourse and writings as “allopathic,” “conventional,” “mainstream,” “dominant,” or “orthodox” medicine. Traditional medicine may thus be understood as medical systems and practices as they had evolved over generations within various cultures or societies before the modern era, characterized by closer contact between the various peoples that populate the earth and the Western-driven phenomenon of globalization. A discussion of traditional medicine in general is therefore inevitably an exercise of comparing alternative systems of medicine or healthcare and practices to the globally dominant system of Western scientiﬁc medicine. Apart from such approach, there is the possibility of studying in their own right the anthropology, history, and development of each medical system or healthcare practice different from the dominant paradigm. Such a vast study cannot be undertaken here and must be left for various experts better qualiﬁed and interested in carrying out such studies. Sometimes the following terms are used to designate traditional medicine: indigenous medicine, folk medicine, alternative medicine, parallel medicine, complementary medicine, and soft medicine. The World Health Organization (WHO) deﬁnes traditional medicine as “.. .the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses” (WHO 2002). This is a good general working deﬁnition that needs only unpacking and elaboration for each valid case of TM.

Healthcare systems like homeopathy, naturopathy, osteopathy, chiropractic, shamanism, and faith healing, (Weil 1998) are mainly counterpositional to allopathic or WSM and are best understood and appreciated within the Western world, particularly the United States of America, where they have ﬂourished as rivals of the dominant healthcare system. Generally believed to have been founded by the German physician Dr. Samuel Hahnemann (1755–1843), homeopathy is a system of medicine that proceeds under the idea that minute doses of a substance are therapeutic against a disease if in large amounts the same substance produces in a healthy person symptoms similar to the disease it cures. Naturopathy or naturopathic medicine is a system based on emphasis on natural therapies such as foods, light, warmth, exercise, massage, fresh air, and avoidance of medications. Osteopathy, also founded by an allopathic physician, Andrew Taylor Still (1828–1917), who was dissatisﬁed with the heavy dependence on drugs of Western scientiﬁc medicine, places emphasis on and directs therapy toward the skeletal form of the body, manipulating the bones to effect cures. Chiropractic was invented by Daniel David Palmer (1845–1913) and is a system based on the conviction that the state of a person’s health in general is determined by the condition of his/her nervous system; hence the mechanical manipulation of the spinal column to achieve cures. Shamanism is a system of medicine which employs both physical and nonphysical means, accessing the spirit realms of gods, daemons, and ancestors to effect cures or afﬂictions. Sometimes the medical systems of indigenous peoples, “primitive peoples,” or non-Westerners in general are wrongly blanketed as Shamanism. Faith healing uses religion and prayer rather than drugs to achieve cures.

History And Development

The earliest history and development of TM is hidden behind the veil that separates written records from unwritten history. But if we extrapolate from the present to the past, it can be surmised that, in adapting and surviving in their environment, the various peoples and corresponding cultures of the world learned by induction and experience the uses of available mineral, botanical, and animal materials in sustaining health, preventing infections and curing diseases. The history of WSM is usually traced back to Hippocrates of Cos (460–377 BC), popularly called the “Father of Medicine,” because he introduced the scientiﬁc approach to healing by seeking physical rather than magical/religious/ supernatural causes for disease. His followers, such as Claudius Galen of Pergamum (c. 129–199 AD) “who holds the same place in the history of medicine as Ptolemy does in the history of astronomy and geography” (Farrington 1944) and Maimonides (1135–1204 AD), further developed his system to make it the foundation of WSM as it is today. The ethical quintessence of this system is the idea that the health and wellbeing of the patient is the overriding consideration of medicine. Maimonides perhaps gave it the clearest expression when in his so-called Physician’s Prayer he stated: “May I never see in the patient anything but a fellow creature in pain.. ..” The roots of Western traditional medicine might be traced further back than Hippocrates to the Babylonian Code of Hammurabi (c. 1754 BC) in ancient Mesopotamia which regulated among other things the practice of medicine and surgery.

These early foundations of Western medicine were further developed with inﬂuences from ancient Egyptian, Arabic, and Roman elements. In the European so-called Middle Ages, Avicenna alias Ibn Sina (980–1037 AD) wrote a medical treatise, The Canon of Medicine, in which, for the ﬁrst time, the idea of clinical trials was clearly introduced, earning him the title of “Father of Early Modern Medicine.” The development of Western medicine reached its apogee with the European Industrial Revolution of the eighteenth and nineteenth centuries which drew its impetus from the slogan that “Knowledge is Power” (Francis Bacon, 1561–1626) convertible into commercial value; from the idea that all knowledge is unqualiﬁedly good; from the belief that nature is, in principle, completely knowable and controllable; and from perception of the universe as something which should be explored, subdued, dominated, and exploited (Tangwa 2002).

Distinct countries, cultures, or regions whose traditional medicine had greatly ﬂourished and deserve focal study and appreciation in their own right include but are not limited to China including Taiwan, Korea, Japan, (Hye-Lim et al 2012) India (Borins 1987), and Africa (Chatora 2003; Abdullahi 2011). The history and evolution of any of these systems of medicine and healthcare would be unique and most interesting, but all are likely to be different and distinguishable from WSM in two important respects: relationship to technology and the market, without necessarily ruling out the possibility of another traditional medicine system evolving in imitation of WSM. WSM is so interwoven with technology that it is properly called “techno-medicine.” The use of technologies in medicine and healthcare (“telemedicine’) is progressively overcoming hurdles and challenges previously posed by time and space, and “nanotechnologies” are facilitating medical research and applications at the atomic and molecular levels. On the other hand, the resources needed for these developments are made available by the open capitalist market, thereby further cementing the marriage, so to speak, between medicine and the market within the industrialized Western world. There is no doubt that market forces have driven up enormously healthcare costs, especially of medical technologies. The relationship between medicine and the market has been widely and critically discussed (Callahan and Wasunna 2006) but seems iron-cast and unstoppable. The question continues to be raised as to whether the institutions and traditions of Western medicine and healthcare are morally compatible with market theory, thinking, and practice, and it has been suggested that there is such an intrusive conﬂict of values between the two that they should not be conjoined no matter how attractive the apparent consequences may appear; but the marriage waxes on ever stronger.

Conceptual Clarifications/Definition

Wherever human beings have lived, there has been the need to adapt themselves to the peculiarities of their physical environment or ecological niche. In doing this they develop common ways of facing the same problems, similar ways of doing the same things, similar attitudes and expectations, and eventually similar ideas, beliefs, ways of thinking, and practices – this is their culture. A culture, therefore, is what results from the adaptation of a group of people to a particular environment and is necessarily underpinned or anchored on a shared worldview (Tangwa 2014). The need to maintain health, to prevent disease, to guess the cause of disease, and to treat it develops naturally along with other aspects of the culture. This is their traditional medicine, with strong links to their environment and their culture. It is important and inevitable that this medicine be “indigenous.” Medical ideas coming from abroad remain foreign until they have been accepted, domesticated, and indigenized. Traditional medical knowledge is not limited to knowledge of the medicinal properties of herbs, animal products, or minerals, although these latter types of knowledge are an indispensable part and parcel of it. Traditional medical knowledge covers all that is necessary to maintain health, prevent disease, and treat ailments, be they physical, psychic, or mental. That is why the WHO deﬁnition quoted in the introduction above is a good working deﬁnition. Traditional medicine is necessarily holistic, and to the society/ community in question, it is their “conventional,” “mainstream,” “orthodox” medicine, while incoming new ideas and practices can be described as “unconventional,” “unorthodox,” etc., unless and until they have been domesticated and indigenized. From this point of view, it is regrettable that Western scientiﬁc medicine, globally dominant and expansive though it be, is referred to in the dominant literature and discourse variously as orthodox, mainstream, and conventional medicine as if it were so in all possible domains and contexts.

Many people today use the term “traditional medicine” simply as a contrastive term to Western scientiﬁc medicine, otherwise known as allopathic medicine, by comparison and contrast with homeopathic medicine. However, it must be recognized that allopathic medicine is the most inﬂuential medical system in the world today. The global inﬂuence and various appellations and designations of allopathic medicine create a conceptual problem that needs clarifying in any discussion of traditional medicine. In little more than a century, Western traditional medicine had rapidly evolved, thanks to science, technology, and the Industrial Revolution, resulting in “Western scientiﬁc or allopathic medicine.” WSM or allopathic medicine is essentially dualistic, having accepted the sharp distinction between body/mind introduced by Rene Descartes (the “father” of modern Western philosophy) and opted to concentrate on the former, under the conviction that all diseases have traceable physical causes. For this reason, medical systems that do not accept the body/mind dichotomy, let alone prioritize the physical over the nonphysical, can be termed “holistic” in contrast to WSM. The close alliance between WSM, commerce, and the open market has also had the effect of enormously empowering its health research and development. Concomitantly, the Western world had overrun the rest of the globe, using conquest, enslavement, colonization, proselytization, commerce, and education. Consequently, WSM is also present to varying degrees in nearly all other parts of the world. The fact can be nuanced but not disputed that Western culture, Western systems and practices, and Western science and technology have spread and become dominant in most parts of the modern world. However, Western scientiﬁc medicine should accurately be described as such and not as “conventional,” “orthodox” or “mainstream” in non-Western cultures/contexts where it is not yet the ﬁrst or only port of call for health-seeking behavior. Countries/cultures whose TM has evolved satisfactorily and is still strong and dominant within their context today are mainly those which had escaped Western colonization, proselytization, education, or domination – China, Korea, Japan, and Vietnam might be plausible examples.

Ethical Dimensions

The fundamental ethical values, principles, precepts, and injunctions that guide, have guided, and should guide TM are no different from those that have been identiﬁed in WSM and given such very catchy titles as autonomy, beneﬁcence, nonmaleﬁcence, and justice (Beauchamp and Childress 2001). These four principles are evidently basic and many procedural rules, precepts, and injunctions can be derived from each of them. They have been widely discussed in biomedical ethics literature and given the descriptive name “principlism.” In TM these basic moral principles may not be stated or discussed in these terms, but they are recognized and captured in various idioms, metaphors, and other ﬁgures of speech. To easily realize this, it is important to understand that autonomy, to begin with, connotes and implies respect for the otherness, individuality, distinctiveness, and dignity of other human beings and, by extension, even that of nonhuman beings (plants, animals, and inanimates). Justice or fairness is equity in dealing with and treating others, as conceived under autonomy above. Beneﬁcence or doing good, at least in the intentional/motivational orders, is ensuring that acts/actions are motivated by the intention of achieving noble ends/aims/objectives. Nonmaleﬁcence, which sets the rock bottom, minimalist condition for ethical correctness, is the avoidance of doing harm knowingly, deliberately, or willingly. Overarching these four principles is the very idea of morality as a human value and of moral equality and equity as the cord that binds together and renders operational the four fundamental principles. Where this is not recognized or seriously taken into consideration, neither the four principles nor moral sensibility in general can get off the ground, let alone have applicability.

The precondition for morality and the four fundamental principles of ethics are, in a loose and general sense, equally relevant to and important across all cultures, in all ﬁelds of human endeavor and activity, and within all possible human contexts and perspectives. In practice, they function as a team or single value set, completing and balancing each other, in such a manner that one cannot be singled out as being more or less important than any other, and none can claim to be absolute, since any of them can be violated, given a sufﬁcient ethical justiﬁcation. For these reasons, synthetic minds might tend to view them as all hanging from one single stem, whereas analytic minds may regard them as analyzable into various branches. In any case, one ethical principle, in a particular context and existential situation, can take precedence over another, or one ethical norm or rule can countermand another, as when, for example, one were to violate conﬁdentiality or break a promise to save a human life. By contrast, a nonethical reason can never justify the violation of an ethical principle, norm, or rule.

From these fundamental principles, many other derivative principles can and have been formulated to help morality along. Some such procedural principles are metaphorical, others mythical, and still others simply practical. Examples of some of such derivative principles and metaphors may include: human rights, human dignity, human solidarity, sacredness of human life, “created in God’s image and likeness,” etc. But beyond myths and metaphors, which harmlessly and quite usefully (from the moral perspective) can be taken literally, critical reﬂection may suggest that (staying on the metaphoric plane) the chameleon is not without chameleonic dignity, nor the aloe vera plant without aloe veric dignity. Every creature and every existing thing have their own intrinsic value and inner reasons, even if unknown to human beings, for being there. The focus and emphasis on human beings can therefore only be justiﬁed from the point of view of moral agency, not from that of morality as such.

Human beings are the only moral agents on earth. Some moral “patients,” being nonhuman, nonrational, or human but incompetent, have no conceivable moral obligations at all, whereas moral agents bear the whole weight of responsibility for whatsoever they choose or refrain from choosing to do or act upon.

The four principles, in the terms, language, and idioms as they have been stated are, of course, very much a paradigm of the industrialized Western world, where their relevance and urgent applicability have been made abundantly manifest by various activities that have violated or run the risk of violating them, such as human enslavement, colonization, and medical experimentation on humans without their knowledge and well-informed, voluntary consent. They, nevertheless, remain equally important even where they seem to be lying dormant for want of any perception of urgent risk or hazard, the discussion of which would surely have brought them to the fore. The industrialized Western world deserves credit for the coinage of the very convenient terms and idioms in which these principles are discussed today. But the fundamental principles themselves are not absent in any human culture, even if they are not thought of or understood in the same terms. The salient point about these principles is not that they are four in number – the “big four” – as some people refer to them, but rather that they are clearly overarching as well as necessarily plastic in their applicability, leaving ample room for cultural perspective, situational context, and existential pressure to impinge on them.

In some cultures, such as Nso’ culture of the grassy highlands of Bamenda in Cameroon, these principles are captured in and derivable from two guiding adages: one that states that “a human being is a human being simply by being a human being” and the other that states that “the essence of a human being is having a good heart (will).” The ﬁrst of these adages implies that a human being, irrespective of his/her descriptive and particularistic attributes, is autonomous and of inestimable worth and must therefore be treated with due consideration and equity by other human beings (respect for intrinsic value, autonomy, and justice). The second adage implies that a human being is less than a human being if she/he does not shun evil, including avoidance of harm, or if she/he is not imbued with at least good purposes and intentions (beneﬁcence and nonmaleﬁcence).

These principles are what make living in communities or societies as human beings possible and harmonious. They may not be “discovered” for some time or theoretically nailed onto an analytic frame, but they are there alright, implicitly wrapped up in social norms, traditions, and practices.

In most of the so-called developing world, particularly in sub-Saharan Africa, it is estimated that about 80 % of the populations depend on TM as opposed to WSM as a means of healthcare (WHO 2002). But owing to rapid and intensive urbanization, slowdown or breakdown in traditional systems, TM in most countries has been invaded by quacks, charlatans, con-wo(men), and all manner of livelihood seekers. In most of these countries, TM exists side by side with WSM. In some of these countries practitioners of WSM have contempt for, a superiority complex against and an exploitative/colonizing attitude toward TM, often referring to its practitioners as “witchdoctors,” “necromancers,” “sorcerers,” etc. This attitude, derived from the impressions and reports of the early colonial adventurers and scholars (Kingsley 1964; Conrad 1950) and from Western education in general is highly resistant to correction; but, while witchdoctors, necromancers and sorcerers there certainly may be in these settings, they are not equivalent to healers even though they could have a tangential connection with the healthcare system.

TM is basically an art rather than a science. It is usually coextensive with personal/family primary healthcare. It is necessarily holistic, aimed at the well-being of the whole composite human person – body, mind, and soul. The non-holistic nature of allopathic medicine is perhaps its greatest weakness and the justiﬁcation for the existence of other systems of medicine, in spite of the global push and dominance of the former. The relationship between body, mind and spirit is one that human epistemological limitations are never likely to permit full understanding; but that the mind or spirit does sometimes have a causal effect on the body cannot be denied. Allopathic medicine shies away from taking this causal relationship between the physical and nonphysical, between mind and body, matter and spirit, seriously, let alone investigating it.

Heretofore TM has had no particular or direct connection with commerce or even the idea of earning a living; its beneﬁts for the practitioner were mostly indirect and voluntary on the part of treated patients. TM is easily accessible and affordable to the populations that it serves and, like any other cultural practice, is modernizable. Some practitioners of TM undergo several years of apprenticeship under a master. Others simply exhibit mastery of the art (divine endowment?) without any prior training (like in the case of some poets, painters, carvers, drummers, dancers, sculptors, etc.). In TM there has been no formal “research” in the sense of well-designed controlled experiments but, in its modernization, scientiﬁc experiments could be introduced. It is, nevertheless, evidence based in the sense that a bonesetter, for example, who sets no bones will not have any patients seeking him/her for bone setting. TM depends on, respects, and preserves biodiversity, a not inconsiderable attribute in our climate changing modern world.

The Moral Impulse In Traditional Medicine

The moral impulse is central in traditional education and in the practice of any profession or trade, including medicine, in the traditional setting that always involved ritual restrictions and taboos, calculated to prevent abuse of specialized knowledge (Tangwa 2011). As a professional group, practitioners of TM, especially in the countries of sub-Saharan Africa, for example, were controlled and restricted by many ritual taboos – such as never administering or making available a poison to anybody, never ever helping to end a human life, be it that of a fetus or a terminally ill patient, etc. Violation of such taboos was sanctioned by mystical loss of professional knowledge and special endowments or by personal misfortune or by a bad death.

But in an age where belief in God and other living spirits, let alone fear of divine anger and retribution, are on the decline; where belief in physical causes for physical effects is on the rise, however, taboos become an increasingly ineffective method of behavior control. Hence the abuses and scandals that today, unlike yesterday, can be observed and catalogued in TM.

There are three main arms or dimensions of healthcare delivery systems in most developing countries, especially in sub-Saharan Africa: authentic and uncorrupted traditional medicine which functions mainly in the rural areas; modern Western-style medicine which operates through hospitals and pharmacies mainly in urban areas; and medicinal hawkers who combine both traditional and modern medicines and operate in both urban and rural areas. While ethics has a ﬁrm foothold in the ﬁrst two categories, it is almost completely absent in the third which, incidentally, is the most rapidly expanding, on account of generalized poverty and ignorance. The sale of fake or expired drugs and the promotion of dangerous self-medication are some of the consequences of this situation. On the other hand, Western-style medicine is notorious for such ethics problems as corruption, iatrogenic harm, bribe-taking, and inefﬁciency.

Conclusion

As an important and inevitable aspect of every identiﬁable culture, traditional medicine exists in all parts of the world. The history, development, and current situation of traditional medicine within each country or culture is varied depending on its relationship with allopathic or scientiﬁc Western medicine and the internal factors that have inﬂuenced its growth. Allopathic Western medicine, based on science and technology, is the most powerful healthcare system in the world today, and its spread and inﬂuence has been greatly assisted by phenomena such as colonization, proselytization, and globalization. In the face of this fact, other healthcare systems, be they traditional or otherwise, have mainly two existential options: merging and integrating with allopathic medicine or cohabiting peacefully side by side with it. Whatever the case, Western or rather global allopathic or scientiﬁc medicine is likely to be profoundly affected and modiﬁed by traditional and other systems of healthcare in the various countries of non-Western culture where it has taken root.

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