Oths (1992) Symbolic Dimensions of Andean Materia Medica

8/2/2019 Oths (1992) Symbolic Dimensions of Andean Materia Medica

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SOM E SYM BOLIC DIM ENSIO NS OF ANDEAN MATERIA MEDICA

Kathryn S. OthsDepartment of AnthropologyTh e University of AlabamaABSTRACTTherapeutic healing symbols should be recognized as being em bedded in and arising from a culturalcontext, which both specialists and nonspecialists then draw upon in treating the sick. The symbolic aspects ofmaterial features of medical systems have been discussed in reference to biomedicine, but little discussion hasbeen devoted to these symbolic dim ensions of traditional m edical systems. Ethnographic data from an Andeanhamlet in Northern Peru provides evidence that the symbolic content of remedies is rooted in the collectiveexperience of the p eople and can be shared across all types of healing encounters. The three symbolic qualitiesof m ateria m edica identified are blackness, topicality and liquidity, [index words: symbolic healing,ethnomedicine, medical anthropology, Peru, Andes)

Much anthropological attention has beenaccorded the symbolic aspects of healing (Frank1961; Moerman 1979; Dow 1986). The symbolic con-tent of healing therapies is seen as contributing,often substantially, to the efficacy of clinical inter-ventions alongside other m echanical and phar-macological m ethods utilized. Types of healingsymbols, as Dow (1986) has recently discussed,range from narrated (see Levi-Strauss 1967) anddramatized myths (casting out demons, findingsouls, etc.; see Murphy 1964; Rubel 1964;Glass-Cof-fin 1991), to trance states (see L ee 1967), topsychological processes (such as Dow's example ofthe healer p resenting the patient with a paradox).Dow also recognizes m edicine itself as representingone type of healing symbol derived from thegeneralized symbolic m edia, that is, the general cul-tural m ilieu. ("Based on the myth that medicines areeffective, a doctor might give a patient a placebo",1986:64). In general, though, less attention has beengranted the symb olic aspects of the material fea-tures of medical traditions. My interest here is inthe realization of symbols in objects (not words orevents) of culturally agreed upon medicinal value,and in how these o bjects en code culturally salient in-formation.A few studies have looked at the symboliccontent of traditional m ateria m edica, such as thework of Finkler (1985), which dwells on the culturalsalience of ritual cleansing w ith branches and waterin Spiritualist healer ministrations, and that of

Turner (1975), in his detailed descriptions of Ndem-bu healing. These few examp les notwithstanding,the symbolic properties of traditional med icinessuch as h erbs, baths and lotions have largely es-caped the attention of social scientists.

Paradoxically, relative to traditionaltherapies the materia medica of biomedicine hasbeen more widely treated in terms of its symbolicdimensions. The white coat of the physician hasbeen shown to comm unicate multiple symbolicmeanings (Blumhagen 1979). Katz (1981) has sig-naled the symbolic efficacy of the biomedicalsurgeon's im plements. Hahn and Kleinman (1983)discuss the effect of the placebo, a representation ofbiomedicine's power to alter disease and healthstates. Elsewhere, I have referred to the symbolismof the chiropractor's medical implements (Oths inpress). The symbolic potency of biomedical inter-ventions exported to the third world has long beennoted, viz. the notorious preference for injectionsover oral medicine. In all the above cited studies,both traditional and biomedical, the symbols of heal-ing are viewed as a part of the dom ain of the healer.These therapeutic symbols are imbued with power,it would seem , in so much as they are the insignia ofthe healer's office.Wh ere do es the p otency of therapeutic actslie? Certainly in part, in the person a of the healer.Yet, part of the symbolic efficacy of the materiamedica of any healing tradition exists independentof and apart from the particular healer employing it.The materia medica of a healing tradition ismaterial culture that symbolically unites disparatedomains of everyday lived experience, with thepower inherent in snared cultural meaning broughtto bear on one of the most vital arenas of actualeveryday livin g-th e experience and alleviation ofpain and suffering.While perhaps achieving their greatestpotency in the hands of a healer because of the addi-tional symbolic import the social role of healerprovides, the symbols of healing do not necessarilyoriginate in the healer. They are often merely col-


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lected and manipulated by the healer. Thus, manytherapeutic healing symbols should be recognizedas first, em bedd ed in and arising from a co llectivebody of believers, i.e. the cultural context, and, ul-timately, put to use by culturally sanctioned healersto achieve their greatest efficacy. Thus, the power oftherapeutic symbols may not arise in the healingcontext, but rather be brought to it and em bellishedthere. As Dow*s (1986) analysis seems to indicate,the repeated successful experience of the healerand healed with a particular remedy augments itssymbolic status all the more. In this article, I dealwith the first aspect of symbolic efficacy.Dow*s (1986) recent work on symbolic heal-ing centers discussion around the structure of thehealer-patient interaction. H owever, in his search toidentify the universals of symbolic healing, D owshows us that for symbolic healing to be possible, aculture must establish a general model of the mythicworld, that is, a m odel o f experiential reality,believed in by healers and potential patients(1986:60). Symbols from the generalized symbolicmedia, he holds, are particularized (i.e. ex-propriated, refashioned) by the healer for manipula-tion in the therapeutic encounter, thus becomingwhat he calls 'transactional symbols'. His em phasisis on the fact that the healer or curer "form(s)" or"creates" (p.60) transactional symbols "to which thepatient attaches emotion". He at one point, notes

that "if a transactional symbol used in healing is aparticular version of a generalized symbolicmedium, then it will more likely evoke emotions"(p.60) since a "generalized sym bolic medium ... al-ready contains the culturally established aspect ofvalue" (p.64). I wish to emphasize what D ow alludesto: In addition to creating symbols, a healer is oftenlikely to borrow them wholesale from the repositoryf shared cultural meaning.The sugg estion that materia m edica hasymbolic efficacy a priori to its clinical use is not un-easonable when one considers that the practices ofealers, both biomedical and traditional, are actual-y largely constituted of accumulated and refinedolk know ledge (G aines & H ahn 1985; Garro 1986).It is important to recognize that there areeaning symbolically encod ed directly

er refers to this when sh e suggests that in as-

m the collective ex-e collective expressions, of amanipulated, not just by a specific healerof indigenousithin a culture, as well as by lay per-

sons who administer home rem edies to themselves,relatives and friends.In the remainder of this pap er, I will ex-amine the symbolic dimensions of materia medicawhich arise from collective exp erience in the A ndes,focusing specifically on three com ponents of mean-ing.

SettingIn exploring the issue of the symbolic ef-ficacy of materia medica, I draw on ethnographicmaterial I gathered among a group of highlandpeasants in the Northern An des of P eru while carry-ing out an in-depth study of medical treatmentchoice and health o utcomes from 1987 to 1989.The community in which I lived andworked, Chugurpampa, is a hamlet (caserio) nestledin the western Cordillera of the Northern PeruvianAndes covering an altitude range of 9,450 to 12,300feet (2875 to 3750 meters). The hamlet can be foundin the district of Julcan in the Otuzco province ofthe department of La Libertad. The desert-like en-vironment supports a principal but sparse vegeta-tion of cacti and eucalyptus, lush green during therainy season, brown and dusty during the drymonths. Houses are scattered over more than 1000

hectares of starkly beautiful but difficult mountainterrain of ridgetops, vertiginous hillsides, ravinesand valleys.This area is arguably the most Westernizedareas of the An des. Spanish is the only languagespoken by these highland p eople (serranos) anddress is Western except for the ubiquitous sombreroand poncho. The principal occupation of the ser-rano is agriculture. Potatoes are produced as themain subsistence crop for hou sehold consumption,as well as the principal cash crop for trade with the

coastal market. Market participation is extensive.Nine hundred and two (902) permanent residentspopulate the 166 Chugurpampino households (442female; 460 male). My sample consisted of 166 mem-bers of 32 households, which I visited at two weekintervals for 24 weeks to collect illness case historiesand discuss serrano beliefs and p ractices. A total of591 separate illness cases were obtained for analysis.Dominant Symbolic Themes in Andean MateriaMedica

I illuminate three principal symbolic com-ponents I have encountered across all types of in-digenous rem edies in Chugurpampa. I also indicatehow these qualities, originating in the local culture,are imputed to newly acquired med icines, such as


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Pharmaceuticals and over-the-counter commercialpreparations. The categories used are theanthropologist's own . For the most part they are un-articulated by the sierrans themselves, existing ascomm on but un conscious constructs in their beliefsand practices.Despite the innumerable remedies used,their desirable p roperties can be identified whenlooking at them as a group. The three most salientsymbolic characteristics of serrano materia medicaare seen in the p references for rem edies which are1) black in color, 2) n oningested, and 3) liquid inform. In many cases, two or more of the qualitiesare situated in the same remedy, ostensibly increas-ing the symbolic efficacy of that particular remedy

Black Quality of RemediesThe black varieties of animal and plantspecies are preferable as a treatment for a myriad ofillnesses. Upo n close exam ination, the illnesses thatthe quality black alleviates appear to be those thatare caused by or produce excess heat. As black isdirectly absorptive of the sun's hot, especiallyultraviolet, rays (which leads to the common prac-tice of wearing light colored clothes when in the sun[Ward 1989:50]), black objects are useful for theirpower to absorb or draw out harmful heat that has

been trapped in a body through direct contact withthe sun's rays or other sources of heat.The heat-absorbing, that is, cooling, powerof black organic matter extends beyond its effectover naturally produced heat to include other typesoimal (evil, bad, sickne ss). Thus, one finds blackremedies preferred for "hot" illnesses of diverseetiologies such as: wild barley {sebadilla, charac-terized as "like barley but it's black") for some typesof mal aires, or evil airs; barley 'coffee' for kidneypain; dark beer and vitamin tonics for debilidad, or

postmenstrual debility; and blackened white cornfor burns.Describing the remed ies themselves, blackcorn is ground and added to topically applied lo-tions for toothache, backache, or headachereported to be caused from overexposure to the sunor hearth. Black guinea pigs are highly sought afterfor giving the most effective diagnostic andtherapeutic rubdowns (sobos de cuyes). Black herbs,such as wild barley and black nettle (ortiga negra)are distinguished as remed ies becau se of their blackcolor. Remedies are often burned or blackenedbefore use. Exam ples include grains (wheat and bar-ley for ac hes and bruises, white corn for burns),sugar for diarrhea, and even avocado pits, dog hair,

goat beard and lamp carbide for various other hotconditions.The use of black as a counter to heat is notan explicit tenet of highland medical beliefs. Onlyone informant, an extremely articulate curiosa

(traditional healer), clearly verbalized a plausiblereason for the use of black as a remedy, saying itwas 'the contrast to the sun's rays'.The sun is one of the most powerful sym-bols for Andean peop le. The Incans were a high al-titude people, with all of their major settlementslocated above 3000 m eters. They worshipped thesun as their god , Inti. Their regular feasts and bloodsacrifices to Inti to insure its continued cycling arewell-known. The sun was believed so powerful anddeserving of respect that the person who gazed

directly at it would die (Garcilaso de la Vega 1973[1617]). Down to the present day, the sun is seen bythe ever element-conscious sierrans as the ultimatelife-giving and life-taking force, seconded only byrain (i.e., water). Both the sun and the rain are vitalfor producing the subsistence crops upon whichtheir survival rests. However , an im balance in ex-posure to either, that is, too much sun or too littlesun (producing an excess of its opposite, cold) ortoo much or too little rain, will destroy the crops.Likewise, sunshine and water are essential in-gredients to human health, but in excess or absenceimmediately cause one to suffer. Thus, it followsthat the vast m ajority of illnesses ob served in thisstudy are attributed to the sun, cold , wet or any com-bination of the three. (The elemental force of windis much less frequently cited as an illness etiology.)

A common criticism of doctors from thecoastal cities is that they do not understand the ill-nesses caused by the sun. One m other would notreturn to the Julcan health post because the doctorbelittled her for her beliefs. She had gone for a diag-nosis and prescription without taking the baby, asthe sun was hot and would have burned the child.The doctor laughed at her but she firmlyholds thatthe baby could have died if exposed to the sun'srays, which w ere particularly intense that day. Val-dizan and Maldonado, two physicians-cum-folklorists, also d iscounted as fanciful the Peruvianhighlanders* belief that heat (calor) from the sun orhearth might be pathological (1922:102).

The strength and importance of the sun athigh altitude must not be taken lightly. The sym-bolism it has for sierrans derives originally from,then embellishes, natural ecological circumstances,a point which will be treated below in more detail.

The origin of the belief in the healingproperties of black substances is unclear. One ex-ample from Valdizan and Maldonad o's compen -


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dium of indigenous Peruvian medical traditionsmerely hints at the importance of black for "hot" ill-nesses. A remedy for irijua, an illness of excessiveangry emotion in a child (found in Areq uipa, butnot La Libertad), is drinking the milk o f a blackburro (1922:105). Burgel (1976:57-58, quoting al-Bukhari 1376), in trying to prove the unscientific,rudimentary and 'dubious' nature of IslamicProphetic medicine, cites a phrase attributed toMuhammad which proclaims the healing power ofept death!" It would be difficult, however, to ex-trapolate from such a comment to a definitivesierran belief inblackmedicines.

Isolated references to the preference for aemedy which is black have been made from othery black chickens are used foring rituals. Yet Logan's finding in Guatem ala,n Central Am erica, that dark colors are clas-ied as hot are contrary to the serranos' under-

RemediesThe vast majority of traditional techniquesremedies for illness, particularly culture-

ive as well. That is, they are taken or used inother than through the oral route. Therior of the body in the form of baths, rubdowns,ages. The avoidance of ingested medicines,

cularly since the vehicle for a sorcerer's machina-s often food.sobo (rubdown): The rubdown with a

ghtly passing or rubbing a healthy guinea pig overs or pulls the sick ness (jala la enfemxedad) outent into its own body and d ies. The pro ce-y likened to an x-ray; the animal is

ghty 1968; Chiappe, Lemlij and Mil-

A sobo for a mild case of susto might con-white stone on three consecutive days, eachme putting the ston e into the ashes. A picture il-

stones. For a case of mal ojo, a sobo can be per-formed with an egg.bano (bath): Foot baths and sit-downbaths of organic matter steeped in hot water are

routine m ethods of treating cold illnesses. For ex-ample, for a headcold a hot foot-soaking in eucalyp-tus leaves and salt will 'pull the illness out throughthe feet', clearing congested sinuses within minutes.Herbal baths are a standard remedy for the varioussupernaturally caused mal aires.flotacidn (float): The flotaci6n is a rubdown or rinsing with a liquid or unguent. Apparent-ly flotaci6n-not a standard Spanish wo rd -is a cor-ruption of frotaci6n (frotar = friction rub down;flotar = to float). This subtle change in meaning

from "rub down" to "float" chan ges the word todemonstrate the emphasis on the liquid d imensionof the remed ies. Flotaciones are used to treat mus-culoskeletal problems or pains in the internal or-gans, especially the stomach, kidney, liver, or gallbladder.cataplasma (compress): Poultices of leavesare occasionally applied to the skin for bruises, cuts,sores, stomach aches, and respiratory complaints.compuestas (musculoskeletal manipula-tion): Each lay chiropractor (componedor) orbonesetter (huesero) has a unique style of spinal ad-justment. A patient may be lying face down orprone, sitting, standing, or on all fours while thehealer kneads and p resses the body to correct itsalignment. Some shake and roll a patient in ablanket with the assistance of another person. Thebody is rubbed down with a special selvatic oint-ment (chuncho), then wrapped tightly with a longflat cloth belt to keep the bones from shifting backout of place. The patient is instructed to remain in-active, preferably in bed, until the following morn-ing. Massage of the m uscles often accom panies theadjustment.sahwno (smoke): A sahumo is the practiceof inhaling the smoke of a fire-toasted substance.llamada (calling): The llamada is a ritualact of therapeutic intervention performed by allamador, or soul caller, to call back a soul detachedfrom the body due to a fright, or susto.

Promptly at sunrise, the healer preparesthe patient for the llamada with a rub down ofblessed beans or grains and agiia florida, a specialmedicinal water often used in traditional rituals,while he chants prayers. The ceremony of thellamador moves outdoo rs to a hilltop. The seatedpatient covers him or herself with a poncho, placinga hat on top . Meanwhile, the caller buries the pack-


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et of beans in a discreet place, then ad dresses theheavens in the direction w here the soul loss tookplace. A n article of the p atient's clothing is swung ina sweeping motion towards the cardinal directionsto beckon back the detach ed soul. During this, thecaller recites the Lord's Prayer, ending with "Ibelieve in the little souls (las almitas) of (patient'sfull name)". Then , the caller places the clothingunder the client's hat and sings with bursts of whis-tling interspersed: "(Patient's nam e), come here,don't stay away, it is here you left your place." Thesequence is then repeated.

enema (enema): Home-prepared enemasare a comm on rem edy used for gastrointestinal com -plaints. They often include laundry soap, floripon -dia (Datura arborea) or other toxic substances.Though prepared by a healer or family m ember,enemas are generally administered in private by thesick person him- or herself, except in the case ofchildren. Though certainly an invasive method, thisnonimbibed remedial application fits the nonin-vasive category loosely, as what is applied is not ex-pected to remain in the body for m ore than a shorttime until it is expelled along with other illness-generating substances.

Many of these noninvasive, externally ap-plied techniques are used to chupar (suck out), jalar(pull or drag out), and sacar (draw out, pull out orextract) the illness from the sick body. Life-enhanc-ing or life-threatening entities are pulled from thesurface of the body (babies in birth versus the mal insickness) through the feet, skin, abdom en, pelvis, orcrown-in the face of obstacles such as limitedresources or enemy sorcery without causing thebody harm. The action imputed to these remedies,the noninvasive extraction of illness from the body,symbolically represents the struggle of the serrano,against so many obstacles (sun, rain, wind, frost), topull life-giving or life-threatening by-products fromthe surface of the earth (p otato es versus wee ds), al-beit without harming the vessel.

Most of the techniques listed above, then,aim to draw out the illness from the body. The ex-ception s, however, can be explained by the sameprinciple albeit in reverse, or "drawing in". In thecase of susto, the llamada w orks to pull the soulback into the body. The com puesta 'closes', or pullsback together, bon es which have been untowardlyopened. What, then, is the common symbolism link-ing these noningested remedies?Topical rem edies symb olize the Serrano'sresistance to intrusion. Non ingested, noninvasiveremedies remain on the outside, thus respecting theinviolate, imp enetrable, closed character of serranofamily, person and body. A s m entioned often in theliterature, one finds in the A nd es a cultural em-

phasis on privacy, a resistance to intrusionmanifested in the m inimal physical contact betweenpeople (Stein 1961), an aversion to deep involve-ment with non-family. In e ssence, the "nonpenetra-tion" of their lives by others, esp ecially by foreignelements, is an ideal. This is not to say that sierransdo not ingest pharmaceutical m edicines, but therisks in doing so are believed to b e great and there-fore avoided if possible, with some exceptions whichwill be shown. The one seeming exception, theenema, is a substance introduced and expelledagain in short order. In the case of soul-calling andskeletal adjustment, one's own body is reintegrated-no foreign element is introduced.

The preceding interpretation illuminatesthe curious practice serranos have of insisting thatone not go outside to work, play or travel afterhaving applied "hot" ointments or lotions to the skin(also the rule for sobos or antibiotic injections). Therationale is that on e must not risk getting cold ordamp (from dew, rain or sweat) with such a remedyin use, as this would cause a condition to worsen. Itmight be reasoned that this injunction would serveto force ill people to take a needed rest, but in factpeople often forego the topical treatment instead ofmissing work. A simple humoral explanation wouldostensibly be sufficient, i.e., that going from hot tocold/wet would cause bodily disequilibrium andthus illness. It would not explain, however, why thesame prohibition does not exist for ingested hotmedicines. An explanation more consistent with ser-rano secrecy and fears of witchcraft is that medica-ments applied to the exterior could be detected byothers (neighbors, en em ies) as a sign on e is sick orweakly, information which is preferably kept con-fidential for one's own protection.

The remedies that tend to be applied exter-nally are the traditional on es, with modernmedicines b eing m uch m ore likely to be ingested.This appears to indicate practices that are old anddeeply em bedded in local beliefs. Likewise forTzintzuntzan, Foster (1988) notes the existence ofmany of the same noningested remedies found inChugurpampa (without identifying them as such).H e offers his op inion that their origin is probably in-dependent of humoral m edicine, and by this I takehim to mean pre-Conquest,

Ironically, many modern medicines, onceintroduced, are u tilized in novel ways; almost in-variably, these consist of the topical application ofsubstances designed to be used orally. A few ex-amples of nonorthodox use include: toothpaste ap-plied to cheek for toothache; pen icillin pills crushedand mixed into a flotation; and, Milk of Magnesiamthpisco (sugar cane brandy) applied topically forbruises, muscle ach es and skin eruptions. One ofthe novel uses reversing this pattern is the practice


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of ingesting Mentholatum or Vick's Vaporub forrespiratory ailments. The preparations containherbs that are normally ingested, such as mentholand camphor, thus placing them in the ed iblecategory.The second symbolic current runningthrough the assortment of different external treat-ents, also applicable to the first point about blackremedies, is that of "pulling out" or "extracting" thellnessfromthe body. The imagery takes its shaperom the serrano etiological notions of contagionnd equilibrium. M ost illness agents are seen tonter the body as if by osmosis, as in the cases ofsun, cold, viento (wind), and mal dafw (sor-ery). Less often, illness enters through the stomachh the consumption of improper or tainted food(or lack of it) to cause problems of the liver, gallmal dafw, or debilidad. Illness, however, isever believed to enter through the mouth in theorm of germ s. Sickness and evil forces are pulledin, not destroyedhin it as are germs accord ing to biomedical

In pulling out the mal from the body, therevague sense that the sickness is yet a vi-re must be d isposed of lest it (be used to) harmher victim. One of the most graphic indicationsat illness is not destroyed but merely relocated inernal world, either into the air or onto an ob-it can harm again) is seen in the treat-f the guinea pig after a sob o. The healeranimal pointing it away from the self toid contact with the mal. After dissecting theit in a hidden location

Therefore, the mal is a contagious entity or

milar to the Japanese conceptual framework of aand evil existing in sickness and thed in general [see Ohnuki-Tierney 1984]).Symbolic imagery also draws from and isirmed by concrete physical reality in the casethe preference for n oningested remed ies. Ser-

y biomedical on es, which wereillness but doing more

Liquid RemediesThe third pattern I detected in the sierrawas a marked preference for remedies in a fluidform. The vast majority of rem edies recorded fell

into this category. Again, traditional m ateria m edicawas largely liquid, while patent and pharmaceuticalremedies could be either liquid or solid in form.However, it did appear that the favored m odernmedicines were liquids, and that where there was achoice (e.g., aspirin tablets versus drops) the liquidform usually prevailed.Traditional medicines and practices in liq-uid form include the aforementioned noningestedbanos, flotaciones, and enemas, in addition to the in-numerable varieties of ingested herbal and food in-

fusions, fruit juices, and medicinal waters. Apatented black tea, Te Toro, is another populardrink believed to have medicinal qualities. Al-coholic beverages such as beer, pisco, cognac, andpure alcohol are popular remedies of internal andexternal use. Manufactured liquid med icines in-clude eye drops, vitamin tonics, cough and an-tibiotic syrups (jarabes), and antacids (bicarbonate)to which water must be added. Bottled isopropyl al-cohol and topical antiseptics are also popular.Serranos will use teas and brews made of

locally available herbs and foods to treat practicallyall ailments. The common process is to steep thecrude items in boiling water for 5-10 m inutes, thendrink the liquid (not the leaves or pulp) with sugar,sometimes adding drops of lemon, alcohol, ormedicinal waters. The teas may be taken alone orcombined with patent or pharmaceutical drugs. It isof note that literally the only traditional med icinestaken internally are food products, most of whichSerranos find or grow themselves. That is, they in-troduce into their bodies only elements which arenot 'foreign', but a part of them already, producedby their blood and sweat in the field s, or found intheir pastures and surroundings. It might seem mostnatural to extract the m edicinal properties of herbsby infusion, but leaves could conceivably be stewedas greens and eaten. Also , instead of being eatenfruits are made into juices when used as a curative.

In addition to seeing highly nutritive foodsas a means to fortify the body when suffering fromillnesses characterized by symptoms of weakness,weight loss or poor appetite (gynecologicalproblems of women always fall in this category),there is a tremendous faith among serranos invitamins. Even though expensive, patented vitamintonics are very popular and especially recom-mended for women, children and the elderly. Theseare generally only available at the regional marketin Julcan on Sundays or on the coast. Dark beer (cer-


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veza negra) is also highly touted as a restorativetonic.The foregoing examples demonstrating thepreference for liquid (and black colored) remediessuch as ton ics and dark beer is also evident in the

following illustration: The health post doctorprescribed vitamins in pill form quite frequently,especially during his annual school visit in Chugur-pampa to con duct student health examinations. Yetnot one of the handful of families who were con-vinced to try them was observed to buy them asecond time, even though vitamin pills were one ofthe few items the post was well stocked with, and atsubsidized p rices much cheaper than tonics on themarket. Vitamin pills (solid) are not seen as havingany noticeable effect, whereas vitamin tonics (liq-uid) are popularly comm ented upon as having animmediate, highly salubrious effect.

Liquid remedies prevail in several otherforms. The many medicinal waters, of which agiiaflorida, agiia de susto, and agiia cananga are ex-amples, are available in sierran stores in the districtand provincial tow ns. They are prepared byspecialists to use for culturally defined illnessessuch aspena (grief) and susto. Drop s of these maybe taken internally, but most application is external.The numerous types of banos and liquid flotacionesare usually prepared from herbs or leaves, the mostcomm on being the locally abundant eucalyptus orcamphor. Hum an or animal urine is added to banosfor som e diseases, and used as a flotaci6n in others.One unusual local remedy calls for a sick infant toingest som e drop s of the bathwater of an infantcousin. Pisco and cane alcohol are common liquidsused for rubdowns to coo l the body. They also stopa bloody nose and tooth aches. Kerosene is rubbedover the body for muscular pains.

Baths and rubdowns are procedures whichsymbolically reenact the nourishment and revitaliza-tion of the earth and all life forms by the rains. Asnoted, the aguacero, or rain, is a constant inpeop le's lives, bothersom e at times but a necessityfor survival. While at the same time overexposure torain is potentially dan gerous to one's crops orhealth, in measured doses it renews, restores, andnourishes. I do not view the use of liquids, in par-ticular baths and rub-downs, as principally a sym-bolic cleansing act, as has been reported for similartreatments in other areas of Latin America (seeFinkler 1985). First, notion s of clean liness andpurity do not have the same connotations as in theWest or Japan, obsessively sanitary-hygienic cul-tures on a relative worldwide scale. That is, thedaily bath is not practiced nor is it the symbol forpurity. Purity of air and food are seen as much m oreconducive to health than bathing. Also , the rub-down is seen as mechan ical, not ritual, in the sense

it draws put the m al in a real, not metaphysicalsense. Highly ritualized procedures accompany onlya professional llamada or sobo.An emphasis on liquids also has aphysiological basis. In the Northern Peruvian

Andes, the high altitude, desert climate (often dry),wind, heating and chilling from the marked diurnaltemperature changes, higher metabolic rate, physi-cal exertion, and consumption of alcohol (adiuretic) all combine to produce rapid systemicwater loss (Ward 1989; Heath & Williams 1989).Ample liquids are required in the diet (soups andteas are served at every meal) because of the ten-dency for the bod y to dehydrate in the sierran en-vironment.Dehydration might account for the im-

mense popularity of bicarbonate antacids, such asAlka Seltzer, Sal de Fruta Eno, Sal de Andrews,and Yasta, which act as a rehydration fluid byproviding water and restoring electrolyte balance.Although their express purpose is relief from com-mon ailments (gas, colic) of the digestive tract at-tributed to greasy and heavy foods, I am convincedthat often the primary cau se of gastric disturbanceis a systemic water im balance or another problemaggravated by such loss. Ironically, overuse of an-tacids can create stomach irritation, setting in mo-tion a vicious cycle of antacid use.One traditional substance taken orallypresents an ostensible anomaly according to myanalysis: Pulgantes, or purgatives, are a class of in-gested liquid substances which are non-food items.{Pulgante a corruption oipurgante, for purgative;pul- meaning neat, polished, clean as in pulcro or .pidir). However, rather than being seen as a remedyper se, the pulgante is generally viewed as a pre-treatment procedure. The intended effect of thiscommon practice is to flush out a full stomach (es-tomago llend) before taking a remedy. The pulgante

cleanses or "pulls out" the food in the stomach sothat the action of the m edicine is not impeded.Thus, similarly to enemas, the pulgante remains inthe body only long enough to purge it.It may be apparent by now that the threesalient properties of sierran medicine outlinedabove, blackness, topicality and liquidity, are notmutually exclusive but rather overlappingcategories. Many remedies have, or combine withintheir various ingred ients, two or three of the sym-bolic characteristics: For instance, dark beer is both

black and liquid; a flotaci6n of any sort may be bothexternally applied and liquid; a mix of black corn(black) and alcohol (liquid) rubbed over the backand face (topical use) is a comm on treatment todraw out the pain of a toothache brought on by sunoverexposure.


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DiscussionThe symbolic dimensions identified in

external application, liquid form-encode cul-ally salient information in various ways.f rem edies may occur as an innate char-c of a remedy (e.g., black guinea pig) oray be produced artifactitiously through the char-or burning of a substance (e.g., toasted avocadoBlackness represents a counteractive force tosruptive physiological states produced by the

d its inherent powers have long been a prominentsierrans. With theon of some beverages m ade from plants and

n be topically applied. T he noninvasiveness of

s (thus, obligations, potential con-rong preference for liquid remed ies in the sier-This type of remedy, frequently used in bathsbdowns, symbolically reenacts the nourish-

y remedies are, of course, polysemic in thatey unite in themselves more than one of the threeified symbolic m eanings.With the preceding discussion, a case cann to be built against an adherence to humoraland for the outlines of an indigenous beliefructure still very much in p lace; one which nam esand informs theer treatment. Since Spanish contact, humoral

not wholesale. T he primary organizing con ceptor Andian m edical thought is not a humoral systemhot and cold that classifies all remedies and

d w et) an d their contraries (black being a salientand, insularity, and contagion.The humoral paradigm in many places fitsly onto the first aspect of the belief structure

inrwet, night aincold ) and no doubt has profound-influenced and been influenced by it since its in-not, however, fit the patterns of

of excess heat and cold-the cornerstone of Andeanhealth beliefs-absolutely and unquestionablypredates the Spanish conquest. It would be naive toimagine that early highland natives did not incor-porate the recognized power of the natural ele-ments into their explanations for sickn ess andhealth. Then as now, the weather exerts thedominant influence over the state of one's health,and is nearly always invoked as an explanation of ill-ness etiology.

By looking at their historical and culturalfoundations, the symbolic aspects of healing in theAndes help to rectify a long cherished but simplisticadherence in anthropology to a humoral doctrine ofdisease etiology and treatment to explain sicknessbehavior in Latin America (Foster 1987). This thenmakes understandable the inattention to and fre-quent deviation from the prototypical hot/coldparadigm of treatment one sees in Chugurpampa.

With its intent focus upon the culturallyderived symbolic qualities of efficacious materiamedica, my contribution expands upon Dew's(1986) theoretical framework for the universalaspects of symbolic healing. I examine symbolicmeaning which is first generated in the wider socio -cultural context and then utilized in all types of heal-ing by all types of healers. This m oves the discussionof symbolic healing beyond the confines of itshealer-patient structure into the generalized realmof symbolic media, that is, to the cultural contextfrom which symbolic elements of healing are born.

The approach I follow here helps us to un-derstand another of the means by which convention-al traditional therapies achieve their desired effect.In taking this approach I am not trying to "desocial-ize" or "de-enculture" healing by removing it fromthe social-relational context, but am merely pointingout that there are other dim ensions of healing ef-ficacy to consider as well. In fact, this account ar-ticulates the individual (healer or patient) and thelarger social and cultural milieu by representing theindividual's use of collectively derived decisions asto the meaning of certain medical symbols.

It is sometimes instructive to examine heal-ing and curing objects outside of their clinical con-text. For instance, pharmaceuticals and herbs alikeare studied in isolation to ascertain the biochemicaleffects of such drugs on disease states, that is, todetermine their curing properties. By the sametoken, materia medica may be view ed apart fromthe practitioner-patient interaction to more closelyinspect some of its healing properties. However, indoing so, the materia medica must remain groundedin a wider context if one is to adequatelydemonstrate its meaning for a particular people in aparticular place and time.


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84 Central Issues in A nthropology [X1992

Acktiowledgments:This p aper is ba sed on research condu cted in the Peruvian highlands from 1987 to 1989. Many thanksto Bill Dressier, W oody Ga ines, Allan Young, Linda Belgrave, Debra Schumann and several anonymous

reviewers for helpful com ments on earlier drafts of this work. The research was supported by an Inter-Am erican Foun dation Fellow ship Grant, a National Science Foundation Doctoral D issertation ImprovementGrant, and a Graduate Research Award from the Case Western Reserve University Department of Anthropol-ogy.References Cited

Blumhagen, D aniel1979 Th e Docto r's W hite Coat: The Image of thePhysician in Modern America. Anna ls of InternalMedicine 91:111-116.Biirgel, J. Christoph1976 Secular and Religious Features ofMedieval Arabic Medicine. In Asian MedicalSystems: A Com parative Study. Charles Leslie, ed.pp . 44-62. Berkeley: University of California Press.Chiappe, M ario, Lem lij, M oises, and Luis Millones1985 Alucinogenos y Shamanismo en el PeruContemporaneo. Lima: El Virrey.Currier, Richard1966 The Hot-Co ld Syndrome and SymbolicBalance in Mexican and Spanish-Am erican FolkMedicine. Ethnology 5:251-263.Doughty, Paul L.1968 Huaylas: An Andean District in Search ofProgress. Ithaca: Cornell University Press.Douglas, Mary1975 Th e Healing Rite. In Implicit Mean ings:Essays in Anthropology. London: Routledge andKegan Paul.Dow, James1986 Universal As pec ts of Symbolic Healing: ATheoretical S ynthesis. American Anthropologist88:56-69.Finkler, Kaja1985 Spiritualist Healers in Mexico: Successesan d Failures of Alternative Tlxerapeutics. SouthHadley, M assachusetts: Bergin and Garvey.Foster, George M .1987. On the Origin of Hum oral M edicine inLatin Am erica. Medical Anthropology Quarterlyl(4):355-393.1988 The Validating Ro le of Hum oral Theoryin Traditional S panish-Am erican Th erapeutics.American Ethnologist 15:120-135.

Frank, Jerome1961 Persuasion and Healing. New York:Schocken Books.Gaines, Atwood D., and Robert Hahn1985 Am ong the Physicians: Encoun ter,Exchange, and Transformation. In Physicians ofWestern Medicine. Robert A. Hahn and Atwood D.Gaines, ed s. pp. 3-22. Dordrecht, Holland: Reidel.Garcilaso de la Vega, Inca1973 [1617] Comentarios Reales de los Incas.Lima, Peru: Peisa.Garro, Linda C.1986 Intracultural Variation in Folk MedicalKnowledge: A Comparison Between Curers andNoncurers. American Anthropologist 88(2):351-363.Glass-Coffin, Bonnie1991 Discourse, Dan o, and Healing in NorthCoastal Peru. Medical Anthropology 13:33-56.Go od, Byron J.1977 The Heart of What's the Matter: TheSemantics of Illness in Iran. Culture, Medicine andPsychiatry 1:25-28.Hahn, Robert A., and Arthur Kleinman1983 Belief as Pathogen, Belief as Medicine:"Voodoo Death" and the "Placebo Phenomenon" inAnthropological P erspective. Medical AnthropologyQuarterly 14:3,16-19.Heath, Do nald, and David W illiams1989 High-Altitude Medicine an d Pathology.London: Butterworth and Company.Holland, W illiam R.1961 Highland Maya Folk Med icine: A Studyof Cultural Change. Ph .D. D issertation.Anthropology Department,University of Arizona.


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Oths] Andean Materia Medica 85

Janzen, John1978 The Quest for Therapy: Medical Pluralismin Lower Zaire. Berkeley: University of CaliforniaPress.Katz, Pearl1981 Ritual in the Operating Room . Ethnology20:335-350.Klelnman, Arthur, Eisenberg, L eon, and ByronGood1978 Culture, Dlness, and Care: ClinicalLessons from Anthropologic and Cross-CulturalResearch. Annals of Internal Medicine 88:251-258.Lee, Richard1967 Trance Cure of the !Kung Bushm en.Natural History 76:31- 37.Levf-Strauss, Claude1967 Structural Anthropology. Garden City,New York: Doubleday.Low, Setha1981 The Meaning of Nervios: A Socioculturalnalysis of Symptom Presentation in San Jose,Costa Rica. Culture, Medicine and Psychiatry 5:25-48.Moerman, D aniel1979 Anthropology of Symbolic Healing.

urrent Anthropology 20:59-66.urphy, Jane1964 Psychotherapeutic Asp ects of ShamanismIn Magic, Faith, andAri Kiev, ed. pp. 53-83. New York: Free

Ohnuki-Tierney, Em iko1984 Illness and Culture in Contemporary lapan.Cambridge: Cambridge University Press.Oths, KathrynIn press Unintend ed Therapy: PsychotherapeuticAsp ects of Chiropractic. In Ethnopsychiatry: T)\eCultural Construction of Professional and FolkPsychiatries. Atwood D . Gaines, ed. Albany, NewYork: SUNY .Rubel, Arthur1964 The Epidem iology of a Folk Illness: Sustoin H ispanic America. Ethnology 3:268-283.Rubel, Arthur, O'Nell, Carl, and Rolan doCollado-Ardon1984 Susto: A Folk Illness. Berkeley:University of California Press.Stein, William W .1961 Hualcdn: Life in the Highlands of Peru.Ithaca: Cornell U niversity P ress.Turner, Victor1975 Revelation and Divination in NdembuRitual. Ithaca, New York: Cornell University Press.Valdizan, Hermilio, and Angel Ma ldonado1922 La Medicina Popular Peruana, Vol.1.Lima: Imprenta Torres A guilar.Ward, Michael P.1989 High-Altitude Medicine and Physiology.Philadelphia: University of Pennsylvania Press.Weidman, Hazel Hitson1979 Falling-Out: A Diagnostic and TreatmentProblem Viewed from a Transcultural Perspective.Social Science & Medicine 13B: 95-112.

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Oths (1992) Symbolic Dimensions of Andean Materia Medica