SOME SYMBOLIC DIMENSIONS OF ANDEAN MATERIA MEDICA

Kathryn S. OthsDepartment of Anthropology

The University of Alabama

ABSTRACTTherapeutic healing symbols should be recognized as being embedded in and arising from a cultural

context, 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 dimensions of traditional medical systems. Ethnographic data from an Andeanhamlet in Northern Peru provides evidence that the symbolic content of remedies is rooted in the collectiveexperience of the people and can be shared across all types of healing encounters. The three symbolic qualitiesof materia medica 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 mechanical and phar-macological methods 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 Lee 1967), topsychological processes (such as Dow's example ofthe healer presenting the patient with a paradox).Dow also recognizes medicine itself as representingone type of healing symbol derived from thegeneralized symbolic media, that is, the general cul-tural milieu. ("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 symbolic 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 objects encode culturally salient in-formation.

A few studies have looked at the symboliccontent of traditional materia medica, such as thework of Finkler (1985), which dwells on the culturalsalience of ritual cleansing with branches and waterin Spiritualist healer ministrations, and that ofTurner (1975), in his detailed descriptions of Ndem-bu healing. These few examples notwithstanding,the symbolic properties of traditional medicinessuch as herbs, 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 communicate multiple symbolicmeanings (Blumhagen 1979). Katz (1981) has sig-naled the symbolic efficacy of the biomedicalsurgeon's implements. 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 domain 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.

Where does the potency of therapeutic actslie? Certainly in part, in the persona 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 living-the 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-

Oths] Andean Matena Medica 77

lected and manipulated by the healer. Thus, manytherapeutic healing symbols should be recognizedas first, embedded in and arising from a collectivebody 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 embellishedthere. 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. However, in his search toidentify the universals of symbolic healing, Dowshows us that for symbolic healing to be possible, aculture must establish a general model of the mythicworld, that is, a model of 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 emphasisis 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, notesthat "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 symbolic medium ... al-ready contains the culturally established aspect ofvalue" (p.64). I wish to emphasize what Dow alludesto: In addition to creating symbols, a healer is oftenlikely to borrow them wholesale from the repositoryof shared cultural meaning.

The suggestion that materia medica hassymbolic efficacy a priori to its clinical use is not un-reasonable when one considers that the practices ofhealers, both biomedical and traditional, are actual-ly largely constituted of accumulated and refinedfolk knowledge (Gaines & Hahn 1985; Garro 1986).

It is important to recognize that there areelements of meaning symbolically encoded directlyonto the very materia medica used in all cultures.Finkler refers to this when she suggests that in as-sessing a healer's treatment of chronic illness, oneshould look for "emotionally charged symbolsderived from the sufferers' collective experience"(1985:196). Meanings arise from the collective ex-perience, and become collective expressions, of apeople. As cultural artifacts, these healing symbolscan be manipulated, not just by a specific healertype, but across the broad spectrum of indigenouspractitioners within a culture, as well as by lay per-

sons who administer home remedies to themselves,relatives and friends.

In the remainder of this paper, I will ex-amine the symbolic dimensions of materia medicawhich arise from collective experience in the Andes,focusing specifically on three components of mean-ing.

Setting

In 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 Andes of Peru while carry-ing out an in-depth study of medical treatmentchoice and health outcomes 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 1000hectares of starkly beautiful but difficult mountainterrain of ridgetops, vertiginous hillsides, ravinesand valleys.

This area is arguably the most Westernizedareas of the Andes. Spanish is the only languagespoken by these highland people (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 household consumption,as well as the principal cash crop for trade with thecoastal 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 practices. 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 remedies in Chugurpampa. I also indicatehow these qualities, originating in the local culture,are imputed to newly acquired medicines, such as

78 Central Issues in Anthropology 1X1992

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 ascommon but unconscious constructs in their beliefsand practices.

Despite the innumerable remedies used,their desirable properties can be identified whenlooking at them as a group. The three most salientsymbolic characteristics of serrano materia medicaare seen in the preferences for remedies which are1) black in color, 2) noningested, 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 Remedies

The black varieties of animal and plantspecies are preferable as a treatment for a myriad ofillnesses. Upon close examination, 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 hasbeen 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, sickness). 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, orpostmenstrual debility; and blackened white cornfor burns.

Describing the remedies 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 remedies because of their blackcolor. Remedies are often burned or blackenedbefore use. Examples include grains (wheat and bar-ley for aches 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 people. The Incans were a high al-titude people, with all of their major settlementslocated above 3000 meters. 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 gazeddirectly 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 imbalance 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 majority of illnesses observed 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 mother 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 firmly holds thatthe baby could have died if exposed to the sun'srays, which were particularly intense that day. Val-dizan and Maldonado, two physicians-cum-folklorists, also discounted 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 Maldonado's compen-

Oths] Andean Materia Mcdica 79

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 Arequipa, butnot La Libertad), is drinking the milk of 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 ofblack: "Use this black grain, it heals everything ex-cept death!" It would be difficult, however, to ex-trapolate from such a comment to a definitiveMediterranean origin for the sierran belief in blackmedicines.

Isolated references to the preference for aremedy which is black have been made from otherparts of the world. Holland (1961:255) reported thatamong Mayans, only black chickens are used forcuring rituals. Yet Logan's finding in Guatemala,also in Central America, that dark colors are clas-sified as hot are contrary to the serranos' under-standing of black as a cooling element.

Noningested Remedies

The vast majority of traditional techniquesand remedies for illness, particularly culture-specific illness, are noningested and usually nonin-vasive as well. That is, they are taken or used inways other than through the oral route. Themajority of noningested remedies are applied to theexterior of the body in the form of baths, rubdowns,or massages. The avoidance of ingested medicines,it seems, is heightened by the cultural fear of beingharmed by swallowing dangerous substances, par-ticularly since the vehicle for a sorcerer's machina-tions is often food.

sobo (rubdown): The rubdown with aguinea pig is a popular and highly trusted method ofdiagnosis and treatment. The practice consists oflightly passing or rubbing a healthy guinea pig overall parts of the body of the patient. The animal ex-tracts or pulls the sickness (jala la enfemxedad) outof the patient into its own body and dies. The proce-dure is emicly likened to an x-ray; the animal isbelieved to be so sensitive that the patient's diseasestate will be absorbed by it, causing the illness to beimprinted on the identical part of the guinea pig(see also Doughty 1968; Chiappe, Lemlij and Mil-lones 1985).

A sobo for a mild case of susto might con-sist of rubbing the sick person with a separate spe-cial white stone on three consecutive days, eachtime putting the stone into the ashes. A picture il-lustrating what ails the person will appear on the

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 areroutine methods 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 word-is a cor-ruption of frotaci6n (frotar = friction rub down;flotar = to float). This subtle change in meaningfrom "rub down" to "float" changes the word todemonstrate the emphasis on the liquid dimensionof the remedies. 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 presses 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 muscles often accompanies 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 outdoors to a hilltop. The seatedpatient covers him or herself with a poncho, placinga hat on top. Meanwhile, the caller buries the pack-

80 Central Issues in Anthropology [X1992

et of beans in a discreet place, then addresses theheavens in the direction where the soul loss tookplace. An article of the patient's clothing is swung ina sweeping motion towards the cardinal directionsto beckon back the detached 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 name), come here,don't stay away, it is here you left your place." Thesequence is then repeated.

enema (enema): Home-prepared enemasare a common remedy 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 member,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 more 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, abdomen, 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 (potatoes versus weeds), al-beit without harming the vessel.

Most of the techniques listed above, then,aim to draw out the illness from the body. The ex-ceptions, however, can be explained by the sameprinciple albeit in reverse, or "drawing in". In thecase of susto, the llamada works to pull the soulback into the body. The compuesta 'closes', or pullsback together, bones which have been untowardlyopened. What, then, is the common symbolism link-ing these noningested remedies?

Topical remedies symbolize the Serrano'sresistance to intrusion. Noningested, noninvasiveremedies remain on the outside, thus respecting theinviolate, impenetrable, closed character of serranofamily, person and body. As mentioned often in theliterature, one finds in the Andes a cultural em-

phasis on privacy, a resistance to intrusionmanifested in the minimal physical contact betweenpeople (Stein 1961), an aversion to deep involve-ment with non-family. In essence, the "nonpenetra-tion" of their lives by others, especially by foreignelements, is an ideal. This is not to say that sierransdo not ingest pharmaceutical medicines, but therisks in doing so are believed to be 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 one 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, enemies) as a sign one 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 ones, with modernmedicines being much more likely to be ingested.This appears to indicate practices that are old anddeeply embedded in local beliefs. Likewise forTzintzuntzan, Foster (1988) notes the existence ofmany of the same noningested remedies found inChugurpampa (without identifying them as such).He offers his opinion that their origin is probably in-dependent of humoral medicine, and by this I takehim to mean pre-Conquest,

Ironically, many modern medicines, onceintroduced, are utilized 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; penicillin pills crushedand mixed into a flotation; and, Milk of Magnesiamthpisco (sugar cane brandy) applied topically forbruises, muscle aches and skin eruptions. One ofthe novel uses reversing this pattern is the practice

Oths] Andean Materia Medica 81

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 ediblecategory.

The second symbolic current runningthrough the assortment of different external treat-ments, also applicable to the first point about blackremedies, is that of "pulling out" or "extracting" theillness from the body. The imagery takes its shapefrom the serrano etiological notions of contagionand equilibrium. Most illness agents are seen toenter the body as if by osmosis, as in the cases ofmal aire, sun, cold, viento (wind), and mal dafw (sor-cery). Less often, illness enters through the stomachwith the consumption of improper or tainted food(or lack of it) to cause problems of the liver, gallbladder, mal dafw, or debilidad. Illness, however, isnever believed to enter through the mouth in theform of germs. Sickness and evil forces are pulledout of the body the way they came in, not destroyedwithin it as are germs according to biomedicaltheory.

In pulling out the mal from the body, thereremains a vague sense that the sickness is yet a vi-able entity. Once drawn out, it lingers, and there-fore must be disposed of lest it (be used to) harmanother victim. One of the most graphic indicationsthat illness is not destroyed but merely relocated inthe external world, either into the air or onto an ob-ject (where it can harm again) is seen in the treat-ment of the guinea pig after a sobo. The healeropens the animal pointing it away from the self toavoid contact with the mal. After dissecting theguinea pig, the healer buries it in a hidden locationso that no one can get to it, preferably in an anthillwhere ants devour the mal then die. Healers them-selves can get ill from the sobo procedure.

Therefore, the mal is a contagious entity orsubstance with transmigrant capabilities. It isneither created nor destroyed. (This concept issimilar to the Japanese conceptual framework of abalance of good and evil existing in sickness and theworld in general [see Ohnuki-Tierney 1984]).

Symbolic imagery also draws from and isreconfirmed by concrete physical reality in the caseof the preference for noningested remedies. Ser-ranos have a deep-rooted fear of ingesting potent,potentially iatrogenic drugs. Accounts abound ofremedies, especially biomedical ones, which weretoo hot or strong, helping the illness but doing moredamage than good to the body. Grave illnesses andeven deaths are attributed to the remedies taken foran initially less serious health problem. Therefore,much caution is often exercised regarding medica-tions requiring internal use.

Liquid Remedies

The third pattern I detected in the sierrawas a marked preference for remedies in a fluidform. The vast majority of remedies recorded fellinto this category. Again, traditional materia medicawas largely liquid, while patent and pharmaceuticalremedies could be either liquid or solid in form.However, it did appear that the favored modernmedicines 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 medicines 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 oflocally available herbs and foods to treat practicallyall ailments. The common process is to steep thecrude items in boiling water for 5-10 minutes, 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 medicinestaken 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 fields, or found intheir pastures and surroundings. It might seem mostnatural to extract the medicinal 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-

82 Central Issues in Anthropology 1X1992

veza negra) is also highly touted as a restorativetonic.

The foregoing examples demonstrating thepreference for liquid (and black colored) remediessuch as tonics and dark beer is also evident in thefollowing illustration: The health post doctorprescribed vitamins in pill form quite frequently,especially during his annual school visit in Chugur-pampa to conduct 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 prices much cheaper than tonics on themarket. Vitamin pills (solid) are not seen as havingany noticeable effect, whereas vitamin tonics (liq-uid) are popularly commented 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 towns. They are prepared byspecialists to use for culturally defined illnessessuch aspena (grief) and susto. Drops 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 mostcommon being the locally abundant eucalyptus orcamphor. Human or animal urine is added to banosfor some diseases, and used as a flotaci6n in others.One unusual local remedy calls for a sick infant toingest some drops of the bathwater of an infantcousin. Pisco and cane alcohol are common liquidsused for rubdowns to cool 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 inpeople's lives, bothersome at times but a necessityfor survival. While at the same time overexposure torain is potentially dangerous 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, notions of cleanliness 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 moreconducive to health than bathing. Also, the rub-down is seen as mechanical, not ritual, in the sense

it draws put the mal 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 PeruvianAndes, 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 body 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 cause of gastric disturbanceis a systemic water imbalance 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 pulgantecleanses or "pulls out" the food in the stomach sothat the action of the medicine 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 ingredients, two or three of the sym-bolic characteristics: For instance, dark beer is bothblack 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 common treatment todraw out the pain of a toothache brought on by sunoverexposure.

Oths] Andean Materia Medica 83

Discussion

The symbolic dimensions identified inNorthern Peruvian highland materia medica-black-ness, external application, liquid form-encode cul-turally salient information in various ways.Blackness of remedies may occur as an innate char-acteristic of a remedy (e.g., black guinea pig) ormay be produced artifactitiously through the char-ring or burning of a substance (e.g., toasted avocadopit). Blackness represents a counteractive force tothe disruptive physiological states produced by thesun or hearth (e.g., fever, sunstroke) through its per-ceived capacity to absorb or nullify heat. The sunand its inherent powers have long been a prominenttheme in the mythical worlds of sierrans. With theexception of some beverages made from plants andfoodstuffs, remedies are preferred in a form whichcan be topically applied. The noninvasiveness ofmost remedies symbolizes the privacy, insularity andlack of trust typifying Andean social relations. It sig-nifies the desire (although unrealizable) to limitone's contacts (thus, obligations, potential con-tamination) with non-family and outsiders. There isa strong preference for liquid remedies in the sier-ra. This type of remedy, frequently used in bathsand rubdowns, symbolically reenacts the nourish-ment and revitalization of life which takes placewhen water pours over the earth in the form of rain.Many remedies are, of course, polysemic in thatthey unite in themselves more than one of the threeidentified symbolic meanings.

With the preceding discussion, a case canbegin to be built against an adherence to humoraltheory and for the outlines of an indigenous beliefstructure still very much in place; one which namesdiseases, indicates their causes and informs theproper treatment. Since Spanish contact, humoralclassification has been adopted where appropriate,but not wholesale. The primary organizing conceptfor Andian medical thought is not a humoral systemof hot and cold that classifies all remedies andprescribes their use for all illnesses, but rather, aconceptual system constructed predominantly onthe elements of sun and rain (subsuming heat, cold,and wet) and their contraries (black being a salientexample) and, insularity, and contagion.

The humoral paradigm in many places fitsneatly onto the first aspect of the belief structureregarding the causal elements of illness (sun:heat,rainrwet, night aincold) and no doubt has profound-ly influenced and been influenced by it since its in-troduction. It does not, however, fit the patterns ofsickness treatment observed. Furthermore, giventhe natural climatic conditions of the Andes and therecorded beliefs and practices of the Incas, the idea

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 sickness 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 moves 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 dimensions 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 viewed 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.

84 Central Issues in Anthropology [X1992

Acktiowledgments:

This paper is based on research conducted in the Peruvian highlands from 1987 to 1989. Many thanksto Bill Dressier, Woody Gaines, Allan Young, Linda Belgrave, Debra Schumann and several anonymousreviewers for helpful comments on earlier drafts of this work. The research was supported by an Inter-American Foundation Fellowship Grant, a National Science Foundation Doctoral Dissertation ImprovementGrant, and a Graduate Research Award from the Case Western Reserve University Department of Anthropol-ogy.

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