Indigenous Health Knowledge Systems in the Philippines:
A Literature Survey1
By
Pedrito dela Cruz and Alana Gorospe Ramos
I.
Introduction
A rich cultural heritage abounds in the Philippines where there are
approximately 110 ethnolinguistic groups. They make up a large portion of the
Philippine population, with more than 12 million people. Alongside the three
dominant ethnolinguistic groups - the Tagalogs, Visayans and Ilocanos, Philippine
ethnic groups are a rich resource of indigenous knowledge (IK).
Louise Grenier defines indigenous knowledge as the “unique, traditional and
local knowledge existing within and developed around specific conditions of women
and men indigenous to a particular geographic area (IDRC 2005). The World Bank
(WB) defined IK as the basis for “community-level decision-making in areas
pertaining to food security, human and animal health, education, natural resource
management and other vital economic and social activities” (Gorjestani 2000). The
WB definition is not confined to indigenous peoples alone, but to all communities that
have developed their own body of knowledge.
Indigenous knowledge is also regarded as “traditional knowledge” in the
literature. The Convention on Biological Diversity (CBD) for instance, defines
traditional knowledge as “the knowledge, innovations and practices of indigenous
and local communities around the world. Developed from experience gained over the
centuries and adapted to the local culture and environment, traditional knowledge is
transmitted orally from generation to generation. It tends to be collectively owned and
takes the form of stories, songs, folklore, proverbs, cultural values, beliefs, rituals,
community laws, local language, and agricultural practices, including the
development of plant species and animal breeds. Traditional knowledge is mainly of
a practical nature, particularly in such fields as agriculture, fisheries, health,
horticulture, and forestry” (CBD 1992).
Socio-economic and political changes however, threaten this abundance of
indigenous knowledge, just when there is growing awareness of IK’s potential to
contribute to poverty alleviation and sustainable development. As local habitats are
lost to encroaching industries and populations, local peoples have had to relinquish
precious land, flora and fauna. Studies have also noted that increasingly,
socialization of indigenous peoples has been into the mainstream culture which is
dominated by western science and symbols, rather than into their own indigenous
1
Paper presented at the XIIIth CONSAL Conference, Manila, Philippines (2006).
cultures, wherein they stand to lose an invaluable part of their heritage and
knowledge systems (Castro-Palaganas 2001).
Global initiatives to preserve and integrate IK in development programming,
such as the World Bank’s Indigenous Knowledge for Development Program, have
since sprung into action to counter the diminishing trove of indigenous knowledge,
but limitations exist foremost of which, is that IK has not been systematically
documented:
“It is ironic that an awareness of the value of indigenous knowledge —
particularly its potential contribution to sustainable development and poverty
alleviation — is growing precisely at a time when such knowledge has never
been under greater threat. It is in danger of disappearing not only under
influence of global processes of rapid change, but also because the capacity
and facilities needed to document, evaluate, validate, protect and
disseminate such knowledge are lacking in the South.” (SciDev 2005)
Through documentation, we are able to record and preserve indigenous
knowledge for validation and dissemination, but not all indigenous knowledge may
provide solutions to our development problems, nor can they be transferred and
applied to other communities, because they are locale and culture-specific. The
process of evaluation and validation are important to critically assess what and how
IK solutions are able to contribute to sustainable development, and to identify which
do not.
IK has been the basis for local decision-making in communities in the
following sectors (SciDev 2005):

Agriculture – intercropping techniques, crop diversity, pest control, seed
varieties, animal production and healthcare, ethno botanical research;

Human Healthcare – through the use of traditional medical knowledge
and medicinal plants use;

Biology – botany and fish breeding techniques;

Natural Resource Management – water management
conservation techniques, forestry management;

Education – local languages and oral traditions.
and
soil
IK is also considered a “key element of the social capital of the poor”, since it
is an asset towards ensuring survival through food production and providing for
shelter, as well as for achieving control over people’s lives (IKPages 2005).
II.
Indigenous Health Knowledge Systems in the Philippines: Objectives
and Methodology
The diversity of IK cultural practices and traditions in the Philippines includes
indigenous health knowledge systems consisting of traditional healing practices. At
present, the Philippines has more than 12,000 species of plants, from which 1,500
species are used by traditional herbalists. It is common knowledge that indigenous
peoples have known the healing properties of several herbs for generations.
In a country where people, especially in remote areas where a sizeable rural
population live, have low access to the formal health care system, traditional healing
modalities provide the alternative. Integrating traditional health knowledge systems
into the formal health systems not only helps preserve an invaluable and functional
aspect of our cultural heritage, but also enhances the formal health delivery system.
The WHO has classified the Philippines, along with Hong Kong, Malaysia,
Mongolia, Singapore, Thailand, and Australia, as a country “supportive” of traditional
medicine. This means that Government recognizes the role played by traditional
medicine, supports its proper use, initiates efforts to bring proven traditional medicine
into the formal health service system and takes measures to control its safe practice,
despite its not being part of the formal health service system.
This study hopes to provide an overview of indigenous or traditional medicine
documentation in the Philippines, as part of a global initiative to map, document and
organize IK information resources, in aid of their protection and integration into local,
regional and national programmes. Though preliminary, this study attempts to
identify important indigenous or traditional health systems studies and researches,
with a focus on traditional medicine, existing in pre-selected libraries, research and
information centers, in government and non-government institutions in Metro Manila.
Specifically, the study aims to:
1. Determine current levels of interest and awareness of indigenous health
knowledge systems among cultural and information scholars and
medical practitioners through an inventory of documentation;
2. Determine the focus or main content of these studies so as to be able to
identify research gaps that can be addressed by future studies;
3. Encourage the integration of traditional health knowledge systems into
the formal health system to preserve a rich and functional aspect of our
cultural heritage and at the same time, enhance the framework of formal
health services delivery in the country.
The literature survey attempts to cover the following specific themes:

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Indigenous and traditional medical practices in the provinces;
Various approaches to community-based traditional medicine programs in
support of primary health care;
Surveys of resources: inventory of medicinal plants; inventory and
mapping of traditional healers;
Development of new drugs or products to combat diseases that worsen
the conditions of the poor (e.g., anti-malarial products from herbs); and
Integration of western and traditional medicine, where appropriate, and
the implications of such an integration.
Research methodology for the study consisted of the following:
1. Key Informant Interviews – a total of seven (7) key informants were
interviewed namely:
Dr. Jaime Galvez Tan
Former Secretary
Department of Health (DOH), Philippines
Former Director, National Institutes of Health
University of the Philippines, Manila
Dr. Michael L. Tan
Chair, Department of Anthropology
University of the Philippines, Diliman
Dr. Eufracio Abaya
Professor, Department of Anthropology
University of the Philippines, Diliman
Dr. Isidro Sia
Former NIRPROMP Director, Department of Health
Head, Pharmacology Department
University of the Philippines, Manila
Mr. Edgardo Quiros
Former Associate Professor, Institute of Library and Information
Science, University of the Philippines, Diliman
Current Project Manager, BuddyWorks, Telehealth Project
Because information resources on the history of traditional medicine in the
Philippines were scarce, questions for key informants focused mostly on the
development of traditional medicine in the Philippines. Key informants were also
asked as to what were the more important theoretical and practical studies on
traditional medicine systems in the country that should be reviewed or revisited. They
were also asked as to what challenges remained, with regards to the development of
traditional medicine in the Philippines.
Due to the huge volume of information resources, it was decided that only
literature identified by the experts would be reviewed for this study, however an
extended bibliography would be attached, for those who would wish to review other
traditional medicine resources in the Philippines.
2. Site Visits to Libraries and Information Centers
Library research was undertaken to review information resources and
research documents identified by the experts as well as to locate more materials that
might have been missed, using the book or journal’s reference list. Citation analysis
of certain materials was also used to enhance identification of the most cited works
in Philippine traditional medicine literature.
The libraries and information centers that were visited were:
F.B. Herrera, Jr. Medical Library
University of the Philippines, Manila
Dissemination Center
Department of Pharmacology
University of the Philippines, Manila
Medical Library
University of the East Medical Center
Filipiniana Section
University of the Philippines, Diliman
Library
Institute of Philippine Culture (IPC)
Ateneo De Manila University
Department of Health (DOH) Central Library
Department of Health Essential National Health Research (ENHR) Office
Health Action Information Network (HAIN)
Reading Room
Philippine Institute of Traditional and Alternative Health Care
Reading Room
Community Medicine (COMMED)
Search terms used were narrowed down to “traditional medicine”, ”folk
medicine”, “herbal medicine”, “alternative medicine”, and “medical anthropology” –
terms which yielded bibliographic records both in library catalogs using LCC and
indexes using MeSH systems, such as HERDIN. The search term “traditional
medicine” yielded the most number of relevant bibliographic records.
The combined bibliographic resources from the above institutions and
databases hopefully provide an adequate sampling of the documentation on
traditional medicine systems in the Philippines.
III.
Overview of the Development of Indigenous/Traditional Medicine in the
Philippines
While we can assume that knowledge of the curative virtues of herbs was
handed down from generation to generation, documentary accounts of the curative
virtues of herbs started only during the Spanish period (1521-1898) mainly by
Spanish missionaries. The earliest document is a treatise on indigenous medicinal
plants written by a Franciscan, Father Blas dela Madre de Dios, around 1611, which
was never published. Another unpublished document is that of a manuscript
completed by Father Jose de Valencia in 1669 entitled Flora Filipina, which was also
never published. The strong interest of Spanish missionaries in indigenous medicine
was captured in accounts like that from Fr. Murillo-Velarde’s Historia de la Provincia
de Philipinas de la Compana de Jesus. Published in Manila in 1749, it referred to a
Jesuit Father Tomas de Montoya, who died in Manila in July 1627, and who was
considered by the natives as their doctor, surgeon and spiritual healer on account of
the knowledge he had gained of some herbs and domestic medicines. Of the
documents produced during the Spanish period, the best known were those of
Father Blanco’s Flora de Filipinas (published in 1737, 1845, and 1877), which
discussed the use of the medicinal plants, and Dr. Pardo de Tavera’s, Plantas
Medicinales de Filipinas, published in 1892. (Quisumbing 1951)
The American Period (1898-1935) was characterized by scientific vigor,
during which scientific research papers dealing with medicinal plants were published.
With the establishment of the Government Laboratories, later called the Bureau of
Science, studies were conducted. This was followed by intensive research on the
chemical constituents, pharmacology, and therapeutics of medicinal plants by the
University of the Philippines. Quisumbing (1951) categorized the activities during
this period into: 1) survey; 2) chemical; 3) pharmacognostical; 4) pharmacological; 5)
pharmaceutical; and 6) therapeutical. Surveys on medicinal plants and their uses
were conducted in many parts of the archipelago, resulting to a total of 590 species
surveyed by 1931. Chemical studies dealing with the composition and values of
Philippine foods, and active principles of many Philippine medicinal plants were
undertaken. Pharmaceutical studies included those that were undertaken by the UP
College of Pharmacy, drugstores and private laboratories. (Ibid)
During the Commonwealth period (1935-1941), surveys were extended to
regions not previously explored. Some clinical and chemical investigations were also
made.
The World War II period (1941-1945) did not impede the interest and studies
on medicinal plants. Impetus was given to the cultivation of drug plants, like castor oil
plants, coca plant and a few others. Less than two months after the establishment of
the Occupation Republic, Executive Order No. 14 was promulgated creating a
committee on medicinal plants to study those actually growing in the Philippines and
to propose methods and processes suitable for the local production and manufacture
of medicinal drugs and other preparations (Quisumbing 1951; Maramba-DOH 1993).
The post-war period saw the publication of Eduardo Quisumbing’s Medicinal
Plants of the Philippines. Published in 1951 by the then Department of Agriculture
and Natural Resources, the book contains information on 858 species of medicinal
plants, of which 63 species are recognized in various pharmacopoeias. All available
information on each specie was incorporated in the book, including records wherever
the plants occur throughout the world. In the introductory part of the book, Dr.
Quisumbing extensively referred to the vast collection of literature about medical
herbs in the country in the private library of Dr. Leon Ma. Guerrero (who was a
principal researcher and consultant to major medicinal plants studies). He also
mentioned the Scientific Library of the Bureau of Science, the National Library, the
Library of the University of the Philippines, and the library of the St. Augustine
Church.
Promotion and utilization of indigenous and alternative medicine in the
communities gained headway when Community-Based Health Programs (CBHPs)
were founded in the early 70s. The CBHPs, which seek to make health care
accessible particularly to the poor, advocated the utilization of indigenous health
resources as one of the program pillars. The experience of CBHPs further provided
impetus, especially in the rural areas, where the use of medicinal plants for relief of
common ailments has never been abandoned since most households and schools
maintain herbal gardens. To CBHP implementers, there was a realization that the
traditional medicine initiatives under the CBHPs were, in a sense, a review of what
the people already knew with the added value of helping expand this stock
knowledge (Tan as cited in Maramba-DOH, 1993). A number of researches aimed at
determining the acceptability and utilization of medicinal plants has been undertaken
during this period. The more significant of these is the 1976 community survey done
by Comprehensive Community Health Care (CCHP) of the University of the
Philippines to determine when and for what illness of conditions the people use
herbal medicine.
The first official mandate in that recognized the usefulness of plants for
medicinal purposes was issued as a Letter of Instruction from the Department of
Education in 1973, which encouraged public schools to have herbal gardens, and for
health educators to include medicinal plants and their preparations in the list of
available modalities for first aid management. By 1977, the National Science
Development Board funded multi-disciplinary research and development activities
with the participation of the community (Maramba-DOH, 1993). In 1977, the National
Integrated Research Program on Medicinal Plants (NIRPROMP) was organized, with
the aim of systematizing the study of medicinal plants in the Philippines with an end
goal of providing safe, effective, and affordable pharmaceutical products derived
from commonly available plants. The creation of the NIRPROMP signified the
renewed interest of government in creating a momentum for medicinal plants or
herbal medicinal products in the Philippines. To date, the program has transferred
the technology to pharmaceutical manufacturers for the production of 7 herbs in
commercial form: Lagundi; Sambong; Tsaan Gubat; Hierba Buena; Acapulco; Atis.
Under the NIRPROMP, more than 2,000 abstracts and bibliographies on medicinal
plants, which date back to the 19th century, had been published, while the ethno
medical use of more than 1,600 plants had been compiled. It has also conducted
training programs on the proper use of medicinal plants in various regions of the
country.
In 1992, under the leadership of Dr. Juan M. Flavier, the Traditional Medicine
Unit was formally established at the Department of Health. In 1995, Fidel Ramos
appreciating the potentials of traditional medicine in health, tourism and economic
progress, included this as one of his administration’s pole-vaulting strategies.
In order to ensure adequate government support for key areas such as research,
technology transfer, regulation and promotion as well as harness the increasing
participation of the private sector and civil society groups in traditional and
indigenous health, RA 8423 creating the Philippine Institute of Traditional and
Alternative Health Care (PITAHC) was signed into a law in 1997. A cursory review of
PITAHC’s accomplishments since it formally operated, shows that it has ably put on
track vital activities relative to its promotion, public awareness, technology transfer
and networking functions. However, other strategic areas like R&D, HRD, and policy
development have not proceeded as envisioned due to lack of resources, and a
redirection of priorities.
In 1998, recognizing the value and increasing appreciation for alternative
medicine, the National Demographic and Health Survey (NDHS) included questions
on knowledge, attitude and practices on the ten DOH-endorsed herbal medicinal
plants and their uses. A section on traditional medicine was again included in the
recently published 2003 NDHS, providing important statistical data from the field to
shed light on actual knowledge and use of these medicinal plants in primary health
care.
In March 2003, DOH, DOST, PITAHC and the National Institute for Health,
started developing a “National Unified Health Research Agenda” with inputs from the
various consultations that have been and are still being conducted. The research
agenda is expected to include not just bio-medical or pharmacological research on
medicinal herbs, but also on the social and anthropological underpinnings of
traditional health practices.
IV.
Survey of Literature
The academe has been the primary knowledge producer of most of traditional
medicine literature with respect to its cultural and social relevance and historical
development. A good number of documentation has been produced by
anthropologists through ethnographies, a comprehensive record of the culture or
society under study, and primarily an output of anthropological field work wherein the
researcher lives “as one” with the members of the group he or she is studying.
The literature reviewed in this section, specifically those of Jocano (1973) and
Tan (1987), have been widely cited in traditional medicine resources, as well as by
our key informants. Planta (1999) gives an informative historical account of the
development of traditional medicine during Spanish colonial times. A DOH
bibliographic database on traditional medicine is also reviewed, alongside more
recent health IK documentation such as those by Sia and Galvez-Tan. The following
readings provide an adequate background on the socio-cultural perspectives on
traditional medicine in the Philippines.
A. Socio-Cultural Aspects of Indigenous/Traditional Medicine
A master’s thesis in history by Planta, traces the development of traditional
medicine and pharmacopoeia in the 16th to the 19th centuries. According to the writer, it
is the first of its kind, attempting to establish the continuity of traditional medicine and
pharmacopoeia and to show that “traditional medicine and its underlying cures have
shown remarkable effectiveness and stability through time” (1999). It attempts to
portray Filipino culture and society through its traditional medical and healing
practices. The study includes a bibliographic review of some of the earliest works on
traditional medicine, citing Pardo de Tavera’s work, Plantas Medicinales de Filipinas
(1892) as perhaps the most comprehensive during its time. The thesis ends with a
chapter on the American colonial period, focusing on the introduction of the American
public health system in the Philippines, and how this has affected the traditional
medicine system.
Jocano’s Folk Medicine in a Philippine Municipality (1973), is credited by
fellow anthropologist, Michael L. Tan, as one of the first studies to probe into the
“broader medical culture”, e.g. local concepts of health and illness, embedded in
people’s religious and philosophical views. In his preface to the book’s second printing,
Tan attributes his consequent interest in traditional medicine to the insightful
ethnography of Jocano’s work in Bay, Laguna, Philippines.
According to Jocano, the book was written to present an ethnographic
account of folk medicine among Filipino peasants in Bay, a municipality of Laguna. It
was also written to provide health innovators, a case study on how the local residents
are able to meet their medical needs. The study notes that there was a wide
acceptance of folk medicine among the local people; this despite the fact that western
medicine had been in existence in Bay since the early 1950s, according to Jocano.
The study covers local concepts of health and illness, classification of diseases, a
system of diagnosis, a chapter on traditional medical practitioners, e.g. albularyos
(herbalists), manghihilots (masseurs or bone-setters) and, magpapaanak (midwives),
to name a few. Aspects of medical care are also discussed in separate chapters based
on specializations in Bay folk medicine, such as: mother and child care, treatment of
common illnesses and faith and healing.
Studies on local concepts of health and illness have since been subjects of
interest in ethnographic literature. Usug, Kulam, Pasma by Tan (1987) perhaps stands
as one of the most authoritative discussions of traditional concepts of health and
illness in the Philippines. It noted the gap between the “professional” and the “lay”
perceptions of health and illness, and therefore attempted to bridge this gap through
the understanding of indigenous philosophy and knowledge, specifically those relating
to health and illness. Basically it draws from a wide spectrum of literature in the social
sciences to identify a Filipino traditional medical system from within culture as a whole.
Linguistic analysis was used extensively, Tan said, because “language is the concrete
expression of what we think, as well as the way we think”. This analysis also included
the connotative aspects of words and ideas, not just the direct and obvious meanings.
This approach was inspired, Tan said, by Frake’s work published in 1961, wherein he
approached the study of illness through ethno linguistic analysis, a study which was
able to draw from the Subanuns, their own disease criteria.
The Tan study reviewed a good number of ethnographies, extracting various
concepts and issues of health and illness, reflected in local terminology. Tan
formulated three theoretical typologies of illness causation based on the literature,
namely: mystical theories of illness causation, personalistic theories of illness
causation and the naturalistic theories of illness of causation. Tan said that health and
illness “provide focal points for cognitive frameworks”, and as such are useful “social
metaphors”.
“…The human body itself becomes a source of symbols…for the description
of emotional states, as well as social structures. Thus in other languages, the
head (ulo) denotes leadership, as the right hand (kanang-kamay) refer’s to a
leader’s closest adviser” (1987).
Tan also recognized the use of traditional medicine as a tool of dominant
classes, to propagate the “backwardness” or “primitiveness” of a group. He said that a
deeper analysis is required to look at aspects of traditional medicine that tend to hide
reality, specially if it is used to maintain a certain status quo in a community (1987).
With the pronouncement by the WHO that traditional medicine should be
developed as a viable alternative to western biomedicine especially in developing
countries, the DOH spearheaded the mapping of information resources on traditional
medicine in the Philippines with the implementation of the Filipino Traditional Medicine
Comprehensive Database Project (FTMCDP) undertaken by the Community Medicine
Development Foundation, Inc. (COMMED) in 1995, for the Department of Health
(DOH). The FTMCDP is a two-volume compilation of traditional medicine resources in
the Philippines which aimed to provide a “functional data resource on Filipino
traditional medicine”, and facilitate its integration into the Philippine health care
delivery system (1995). It was a 12-month project composed of 3 major activities:
database development, publications and primary research. Its primary research
component focused on mapping 191 traditional medical practitioners (TMPs)-their
demographics, their healing practices and philosophy, as well as their distribution and
networking, within the Philippines. It includes a good number of ethnographies that
describe traditional healing practices (both spiritual and herbal-based therapies),
historical literature and pharmacological studies on medicinal plants. Food and
nutrition traditional practices are also included in this database.
Because of the diversity of studies, 19 typologies were initially used to
categorize resources. This was later reduced to 6 major themes, which the project
team believed, characterized the important aspects of traditional medicine in the
Philippines. These are:
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Religious Practices and Social Well-Being
Local Understandings of Illness Causation and Prevention
Healing Process
Traditional Health Practitioners
Food and Nutrition
Interaction Between Traditional Medicine and Biomedicine
The terminal report is divided into 3 major parts: Part 1 covers the objectives
and methodology, Part 2 consists of an extensive annotated bibliography introduced
by informative review essays, and Part 3 presents the results of the TMP survey. No
major updating of the bibliographic report, however, has been undertaken since 1995.
More recent work on traditional medicine research was undertaken under the
auspices of NIRPROMP, one of which was undertaken by Dr. Isidro Sia and a team of
medical doctors of the University of the Philippines, Manila. The project was a
documentation of 15 ethnolinguistic groups in the Philippines, a project that has been
and continues to be the basis for collecting and documenting traditional medicine
practices, specifically plant resources. This study documented health IK of 15
ethnolinguistic groups mostly living in the Cordilleras, Palawan, other parts of
Luzon,and Mindanao.
The International Institute of Rural Reconstruction (IIRR) has long been an
advocate of the promotion and integration of indigenous knowledge in development
planning, all over the world. In aspects of health, the IIRR produced Indigenous
knowledge and Practices on Mother and Child Care: Experiences from Southeast Asia
and China, a resource book on indigenous maternal and child health care (2000). The
book was a result of a workshop attended by 57 IK practitioners from 7 countries. As
an introductory resource, it provides a cross-cultural overview of indigenous mother
and child practices in Southeast Asia and China. It provides much needed focus on
maternal and child health, two of the most marginalized groups in national health care
programmes. In addition to the introduction written by Dr. Jaime Galvez-Tan, there are
extensive discussions of the Philippine experience, e.g. on the chapter on maternal
and newborn care in different cultural settings, accounts from the B’laan in South
Cotabato, the Ifugaos, Kalagan Muslims, Tausugs, and Kalingas, are presented. There
are also Philippine accounts with regards to the care of the sick from two rural
communities in Camarines Sur, and Occidental Mindoro; an account of marriage and
sex rituals among Tausugs and Kalagans in southern Philippines, and an account of a
sibling care practice among the B’laan.
A chapter of the resource book focused on retrieval, documentation and use
of indigenous knowledge, with most of the cases based on community level initiatives
in the Philippines. The cases document some of the success stories in promoting
indigenous practices in maternal and child health using such strategies as community
mobilization, exploration of innovative communication approaches, formal and informal
education strategies and intergenerational attempts to promote indigenous health
practices for mother and child.
B. Medicinal Plants Inventory
An interdisciplinary effort currently characterizes the development and
promotion of traditional medicine in the Philippines. The medical sciences have
focused their efforts on the material culture, or the materia medica utilized in traditional
healing, primarily medicinal plants. Critics however have said that this practice of
“stripping” the herbal medication from its other social functions relegates herbal
medicine simply as a modality (Segismundo 1995). From the point of view of
systematic documentation of herbal medicine however, these efforts have produced
significant and substantial inventories of medicinal plants and their pharmacological
properties.
Quisumbing’s work on medicinal plants (1951) is regarded as one of the
earliest and most authoritative texts on medicinal plants. Conditions after World War II
during which time imported drugs were scarce, inspired research for this book on
Philippine medicinal plants, for their possible therapeutic uses. Entries were
accompanied by descriptions of the plant, their pharmacological properties and uses
as well as names in the vernacular. There is also a well-discussed section on the early
writings of Spanish missionaries on herbal medicine, which had already been cited
earlier.
Few systematic studies came after Quisumbing’s post-war book (Co 1977)
which was the rationale behind the University of the Philippines’ Botanical Society’s
attempt to promote traditional medicine through documentation of medicinal plants and
their therapeutic uses. The book entitled, A Manual on Some Philippine Medicinal
Plants (1977), sought to enlighten people of the potential healing properties of local
medicinal plants. Sections of the book were divided into the following: anti-infectives,
antipyretics, anti-rheumatics, food invigorators and hemostatics, antitussives and antiasthmatics, analgesics, tranquilizers and hypnotics, tonics, counter-irritants and
antihelmintics, liver-cleansing and vision-aiding, diuretics, expectorants, and even
snake bites.
Michael L. Tan undertook a feasibility study in 1977, on the integration of a
medicinal plants component into CBHPs for the Mindanao-Sulu Secretariat of Social
Action (MISSSA). The study entitled Philippine Medicinal Plants in Common Use: Their
Phytochemistry and Pharmacology noted a growing interest in medicinal plants and
traditional medicine in general among CBHP personnel (1978). CBHPs as mentioned
earlier, were tasked to make health care more accessible to the poor, and the use of
indigenous medicine was adopted as one of its pillars. But information resources on
traditional medicine were still scarce which was the primary reason that this handbook
was developed.
The handbook discusses more than 200 plants, but Tan cautions in his
Introduction that a lot of material had to be excluded, e.g. listings of local names for
plants, botanical descriptions, methods of collection, processing and propagation, and
even the cultural context of traditional medicine, information often overlooked,
according to Tan.
Each plant entry in the handbook is accompanied by its scientific and local
name, a brief description of the plant and suggested preparations and uses. Some
plants noted more for their nutritional value rather than curative value, were also
included such as the gabi (colocasia esculenta), a common root crop in the
Philippines. Tan followed up this handbook with a revised edition in 1981. It included
additional plants and preparations based on the Philippine National Formulary and the
Chinese Pharmacopoeia. The revised edition also noted that local programs had
begun to develop their own herbal preparations and to document these, showing more
heightened community involvement.
Leonardo L. Co followed up his 1977 study by publishing Common Medicinal
Plants of the Cordillera Region in 1984. Co observed that during this time, the use of
medicinal plants was already being promoted both by government and nongovernment agencies (1984). Published by CHESTCORE (Community Health
Education, Services and Training in the Cordillera Region), the publication served to
further enlighten readers in the therapeutic properties of certain plants found in the
Cordillera region. In the Foreword by the book’s co-editor Dr. Yvonne B. Taguba,
critiques the pharmaceutical industry, pointing out the high cost of essential drugs,
brought on by the importation of roughly 80% of raw materials to manufacture the
drugs. According to Taguba, the pharmaceutical industry in the country lacked the
support of basic research into local resources (1984) that could have made drugs
cheaper and therefore more accessible by the poor.
The book covers 122 species of common medicinal plants found in the
Cordillera region, home to a number of indigenous peoples (IPs). Each plant has an
entry name, usually the common name of the plant as it is known throughout the
country, the scientific name, the family name and their synonyms (scientific names by
which a plant was formerly designated). Other descriptors were plant description,
habitat and distribution; parts utilized and indications and directions for use.
Illustrations were also provided.
By the mid-1980s, the University of the Philippines at Los Baños had scaledup efforts to document information resources pertaining to medicinal plants use in the
Philippines. By this time, a number of studies on plant pharmacology had already been
undertaken and published, but so far had been unmapped and unorganized. Quintana,
in 1989 compiled a bibliography of Philippine medicinal plants entitled, Philippine
Medicinal Plants: Abstract and Bibliography mainly to collate and organize references
on medicinal plants resources both published and unpublished from the UPLB
campus’ libraries, as well as from other private libraries (1989). Sources for the
bibliography were journals from the UPLB Main Library, the International Rice
Research Institute (IRRI), the College of Forestry, the DOST and other libraries.
Books, journal articles, technical papers, research reports, graduate theses and other
information resources were included in this compilation.
Medicinal Plants by Ludivina S. de Padua (1996) is one of the more recent
publications on medicinal plants’ therapeutic uses. According to the Foreword, this
book is first of a series under the general name, Philippine Plants, conceived to be a
series of several booklets (instead of one volume), that “approaches plant science
from the ecological perspective rather than the purely taxonomic” (1996). Philippine
Plants updates Plants of the Philippines published in 1971 for the University of the
Philippines Science Education Center by the U.P. Press.
Unlike other plant inventories already published, de Padua includes a portion
on ”General Information” of Philippine herbal medicine development, briefly mentioning
new strategies in plant research and institutional changes at the DOH to promote
traditional medicine in the country. Part 1 also includes a discussion on plant products
and categories, which are essential knowledge for the non-medically trained
practitioner. She also discusses collection, preservation and storage techniques of
medicinal plants, emphasizing that different plant parts need different modes of
collection and storage (1996).
De Padua also discusses the 11 major health problems in the Philippines and
provides a quick index of the scientific name of the plant and plant part that have
therapeutic value for such health problem. Part II covers information on 22 medicinal
plants, listing their scientific name, common name in English and a local dialect, a brief
description and localities in which they may be found, suggested preparations and
their therapeutic value.
C. Pharmacological Studies of Philippine Medicinal Plants
A paper by Dr. Jaime C. Zaguirre written in 1944 during World War II entitled
Some Emergency Bedside Preparations of Most Common Local Medicinal Plants,
gives us a rare glimpse of the early exploration of medicinal plants use during that
period. As Zaguirre explained, this was due to the lack of imported drugs as a result of
the war:
“In the Philippines, there are no less than eight hundred plants reputed to
possess certain medicinal virtues. Comparatively, very few of them have been
chemically and pharmacologically studied. However, as a result of the present
scarcity or lack of standard medicaments due to war conditions, revival in the
search for local resources has greatly stimulated wide interest particularly
among the medical circle” (1944).
Zaguirre’s paper, which we found at the University of the East Medical Library,
documents attempts to test pharmacological efficacies of certain medicinal plants,
under emergency conditions. Zaguirre gives suggestions as to where these plants may
be found and how best they are administered. Efficacy was essentially measured by
“trial and error” and the “TED (Therapeutic Effective Dose) gathered from the bedside”
(1944). According to Zaguirre, the normal process of screening was not followed due
to the urgent need to test for alternative local herbal resources to replace scarce
imported drugs at the time. This paper was again circulated in 1949 primarily among
the Medical Field Service School of the Armed Forces of the Philippines, targeting
medical officers. It saw its final publication in 1955.
Dr. Jocelyn Cruz, in her paper entitled Herbal Medicine-A Viable Alternative
for the Filipino People (1985), documents early pharmacologic tests undertaken by Dr.
Alfredo C. Santos way back in 1927, in which he was able to isolate the alkaloids of
Phaeantus ebracteolatus (kalimatas), but that no attempts to put it to therapeutic use
were ever done. Other scientific pharmacological tests followed but efforts of
researchers were not directed nor managed in a systematic way, perhaps through a
lack of a national programme.
Cruz credits the National Integrated Research Program on Medicinal Plants
(NIRPROMP) for fast-tracking the development of the herbal medicine industry in the
Philippines. It was established to identify priority needs and coordinate efforts to
systematize the study of medicinal plants (Cruz 1989). The program identified two
immediate drug needs: the need to distribute medicines within the reach of most
Filipinos, and the need to discover new or better drugs for common diseases in the
Philippines. To address the urgency of the situation, a rapid screening process to
study the efficacy and safety (toxicity) of medicinal plants was developed. Only plants
that have passed this initial screening were tested further in agricultural,
pharmaceutical and clinical trials (1989).
This literature review looked at pharmacological studies that had been done
at the Departments of Pharmacology of the University of the East Medical Center and
U.P. Manila. Both schools have ongoing programmes to test the efficacy and toxicity of
certain plants, results of which comprise a sizeable databank of medicinal plant
pharmacology. This database is supplemented by studies undertaken by the Philippine
Council for Health Research and Development (PCHRD), which are available through
HERDIN, an online bibliographic database of health literature in the Philippines. There
are approximately 2,000 records on traditional medicine in HERDIN, comprised mostly
of journal articles, research reports, papers and conference proceedings.
D. Mainstreaming Traditional Medicine
With the passing into law of the Traditional and Alternative Medicine Act
(TAMA) in 1997, there have been attempts to promote traditional medicine within the
larger, Western dominated biomedicine culture established in the Philippines. There
have been efforts to sustain this initiative at conceptual and practical levels, primarily
for three reasons: 1) majority of the poor in developing countries such as the
Philippines have little or no access to primary health care, 2) a medical culture based
on Western biomedicine is expensive, and 3) Western medical philosophy has limited
room for acknowledging the psychosocial, cultural and religious basis of traditional or
indigenous health knowledge systems.
Segismundo (1994), in a paper entitled Filipino Traditional Medicine and the
Development of a Relevant Health Care System, presented during the 2nd Asia-Pacific
Social Science and Medicine Conference in Manila, critiqued the inadequacies of the
Philippine health care system: the same problems continued to plague the country –
80% of the population suffered from communicable but preventable diseases,
diseases of the heart and malignant neoplasms were on the rise, and infant and
maternal mortality rates were high at 50.3 and one per 1000 live births respectively
(Tan 1991, in Segismundo 1994). She urged the examination of other health care
delivery models more appropriate to our cultural setting, since health cannot be
isolated from its socio-economic, political and cultural context (1994).
She cites Philippine efforts in the 1970s mainly through NGOS and the
CBHPs, which attempted to integrate traditional medicine in their activities, and the
Department of Health’s (DOH) institutionalization of traditional medicine into the
Philippine Health Care Delivery System, in 1992. Five other government agencies
were also promoting traditional medicine in collaboration with the DOH. Segismundo
however believed that more work needed to be done if traditional medicine was to
break out of its “inferior” label (compared to western biomedicine). In this respect, the
Community Medicine Development Foundation, Inc. (COMMED) took up the challenge
to retool its doctors to make them more effective as community doctors (1994). They
were taught how to document, appreciate and integrate traditional medicine into their
local health strategies. Segismundo urged the exploration of frameworks more
appropriate for the Filipino consciousness (1994), She enumerated examples from
Abaya, Osteria and Bennagen’s community health work.
Castro-Palaganas, et. al. (2001) presents a discussion of the problems in
primary health care delivery in the Philippines where Government has failed in
ensuring access to this basic service in the Cordillera region, home to more than 12
million indigenous peoples (IPs). Because of this, IPs have increasingly turned to
indigenous health knowledge and practices for their health care needs (2001). The
study entitled, Mainstreaming Indigenous Health Knowledge and Practices is one of
the more recent documentation of indigenous health knowledge in the Cordillera
region meant to record and validate certain traditional health practices. It was
undertaken mainly to address the threat facing traditional health knowledge, that they
“face the threat of oblivion as younger generations are secularized and modernized
rather than socialized into their indigenous culture” (2001). The study focuses on the
Kankana-ey women in Badeo, Kibungan, Benguet Province, in northern Philippines.
A specific focus the book is on indigenous notions of health or kasalun-alan and
the women’s life cycle. Women’s health is given emphasis in the study, as recognition
of their role as culture and knowledge bearers with regards to health in general (2001).
An analysis of the health situation in Badeo was also presented, supported with
statistical tables on selected health indicators. A discussion of the programmatic
aspects of primary health care support by donor agencies such as the WHO and the
World Bank, and the effects of policy on community health services is also discussed.
To counter the threat of a decline in oral traditions, traditions that have in the
past ensured the intergenerational transfer of indigenous health knowledge, CastroPalaganas, et. al. encouraged the improvement of school curricula to integrate
traditional medicine practices, as well as to encourage the academe to initiate
dialogues and trainings to preserve herbal cures (2001). Mainstreaming indigenous
health knowledge can also be attained if Local Government Units (LGUs) integrate
traditional medicine practices in their local primary health delivery programmes.
Devolution of health services has given LGUs the options to develop more culturespecific programmes.
As attempts to integrate traditional medicine within the formal health delivery
system were taking off, scientific surveys were undertaken to get “big picture” data on
different aspects of traditional medicine systems. First of these surveys was a study on
Traditional Medical Practitioners (TMPs) by Michael L. Tan (1992). The study
revealed that the Philippines has a significant number of TMPs (1992). The study also
showed that there were different types of traditional medical practitioners, and they
may be grouped into two categories: the empirical (users of medicinal plants) and the
magico-religious (act as medium for spirits; use prayers and sacrificial offerings like
atang). Fifteen provinces and 108 barangays were surveyed. Findings showed that
there was an average of 5.65 TMPs per Barangay or a ratio of 1 TMP for every 320
people. Individual, in-depth interviews were conducted among 224 TMPs. Data on
socio-geographic characteristics, skills acquisition, methods of diagnosis and healing,
and validation were gathered for the survey (1992).
In 1992, the DOH endorsed ten medicinal plants (after scientific testing for
efficacy and safety), through its Traditional Medicine Program. In 1998, the National
Statistics Office (NSO), undertook the National Demographic and Health Survey
(NDHS). The survey aimed to collect statistical data on levels and trends in
demographic and family planning indicators (1998, 2003). Specifically, data on fertility,
family planning, childhood and adult mortality, maternal and child health and
knowledge and attitudes related to HIV/AIDS and other sexually transmitted diseases
(2003) were gathered. A section on Traditional Medicine was included in both the 1998
and 2003 surveys. Respondents were asked regarding their familiarity with the ten
endorsed medicinal plants as well as their perceptions on their intended use (NDHS
1998). Results showed that respondents were most familiar with the medicinal uses of
guavas and garlic (1998).
The 2003 NDHS showed a relative improvement in medicinal plants use, as
compared to the 1998 NDHS. For example, awareness levels for ampalaya as a cure
for diabetes mellitus increased from 5 percent in 1998 to 44 percent in 2003. Quality of
data for traditional medicine also improved with the 2003 NDHS wherein data on
familiarity, as well as use, are presented. Northern Mindanao and the Autonomous
Region of Muslim Mindanao (ARMM) posted the heaviest usage of herbal medicine.
Guavas were used in at least 80 percent of households in ARMM, while garlic was
used in 57 percent of households in Northern Mindanao (2003).
The production of various medicinal plants handbooks by government,
NGOs and academic institutions also helped bridge the information and knowledge
gap among health and community workers. Most of these handbooks contained
information on medicinal plants and their therapeutic uses, aimed at reeducating
health workers, trainors and community members in the importance of traditional
medicine resources. As handbooks, they are written in a simple, easy to understand
format, and translated in the local dialect and illustrated. Examples of these handbooks
are Lampuyan: Ideas for Community Projects on Medicinal Plants (1980) by AKAP, a
community health NGO; Mga Halamang Panggamot (1985) by LIKAS of the Center for
Community Services, Ateneo de Manila University; and Medicinal Plants (A
Compilation, Part 1) by Molino-Barrios for the Capiz Provincial Hospital (1983). Fully
illustrated, these handbooks are important information resources to aid in the
education of people on the value of our indigenous plant resources, and thereby slowly
integrating this important resource into the bigger Philippine medical culture.
V.
Conclusion and Recommendations
Ethnographies provide a wealth of information regarding indigenous or
traditional health knowledge systems. They are invaluable records of the holistic,
cultural and environmental context in which these health systems work. The academe,
in collaboration with the Department of Health and other government agencies are
sources of these information materials.
Publications on plant inventories, as handbooks or academic reference books
have been produced by health NGOs as well as the academe. LGUs also produce
their own materials in their own local dialects. Pharmacologic studies had been
undertaken either by commissioned scientists, academic laboratories or as term
papers of students in pharmacology.
Generation of field data on traditional medicine use is improving, with data
from two surveys of the NDHS (1998 and 2003) documenting knowledge of and actual
use of, herbal medicines.
However, experts in the field of social and medical anthropology observe that
there is no synchronized research agenda on traditional medicine and that research
undertakings are highly disparate. According to them, while there are a good number
of literatures or studies that are focused on documenting medicinal herbs and their
pharmacological values, or those cataloguing local beliefs and practices, there is a
dearth of literature in the country that seek to arrive at a cognitive framework that
establishes the socio-anthropological context of these beliefs and practices, including
the use of materia medica. They stress the need for more theoretical and interdisciplinary studies that link traditional medicine to discourses in culture theory or
social theory. Such admonition is being made in the absence of a strong medical
anthropology program, in any major university, that is vital in processing and managing
traditional health knowledge, and at a time when the elders who are knowledgeable in
indigenous healing are considered an “endangered specie”.
Other palpable gaps in knowledge generation and management that need to be
addressed include the following:
-
the need for studies that will enable government – as guardian of
health and safety – to act towards the folkloric-commercial sector
especially with this sector’s use of the media in promoting commercial
products like dietary supplements, or in propagating beliefs that have
no sound foundation;
-
the need to give back to the communities the learning on traditional
health knowledge systems by way of: a culture-sensitive packaging
and dissemination of: a) health education message for the
communities, including indigenous communities; and b) how
traditional health knowledge can be use in primary health care in rural
villages, including lowlands; and
-
the need to establish and disseminate the processes by which
communities themselves can document their knowledge;
It is hoped that the “National Unified Health Research Agenda” which is now
being developed will address these issues.
Bibliography
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Co,
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Terminal Report.
De Padua, Ludivina S. Medicinal Plants.Sta. Mesa, Manila: Island Publishing House,
1996.
Guidebook on the Proper Use of Medicinal Plants. Tagig, MM: Philippine Council for
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Mainstreaming Indigenous Health Knowledge and Practice. Quezon City: University of
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Mga Halamang Panggamot. [Manila]: NMPC, 1979.
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Conference Held in Manila 23-27 May 1994.
Unpublished Materials
Planta, Ma. Mercedes G. “Traditional Medicine and Pharmacopoeia in the Colonial
Philippines, 16th to the 19th Centuries.” Master’s thesis, University of the
Philippines-Diliman, 1999.
Sia, Isidro, et. al. “Documentation of 15 Ethnolinguistic Groups in the Philippines.”
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Websites
SciDev.net
IKPages
Biodiv.org