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Economic Botany 54(3) pp. 344–357. 2000q 2000 by The New York Botanical Garden Press, Bronx, NY 10458-5126 U.S.A.

MEDICINAL PLANTS USED BY LATINO HEALERS FOR WOMEN’S

HEALTH CONDITIONS IN NEW YORK CITY1

MICHAEL J. BALICK, FREDI KRONENBERG, ANDREANA L. OSOSKI,MARIAN REIFF, ADRIANE FUGH-BERMAN, BONNIE O’CONNOR,MARIA ROBLE, PATRICIA LOHR, AND DANIEL ATHA

Balick, Michael J. (Institute of Economic Botany, The New York Botanical Garden, Bronx,NY 10458), Fredi Kronenberg (The Center for Complementary and Alternative Medicine(CAM), Research in Women’s Health, and Rosenthal Center for CAM, Columbia College ofPhysicians and Surgeons, Columbia University, New York, NY 10032), Andreana L. Ososki(The City University of New York Graduate School and Institute of Economic Botany, The NewYork Botanical Garden), Marian Reiff (The Center for Complementary and Alternative Med-icine, Columbia College of Physicians and Surgeons, Columbia University, New York, NY10032), Adriane Fugh-Berman (Dept. of Health Care Sciences, George Washington Univer-sity, School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, #2B–417, Washing-ton, DC 20037), Bonnie O’Connor (MCP Hahnemann School of Medicine, Philadelphia, PA10102), Maria Roble (The Center for Complementary and Alternative Medicine, ColumbiaCollege of Physicians and Surgeons, Columbia University, New York, NY 10032), PatriciaLohr (University of Southern California School of Medicine), and Daniel Atha (Institute ofEconomic Botany, The New York Botanical Garden, Bronx, NY 10458). MEDICINAL PLANTS

USED BY LATINO HEALERS FOR WOMEN’S HEALTH CONDITIONS IN NEW YORK CITY. EconomicBotany 54(3):344–357, 2000. This paper examines the use of medicinal plants by Latino healersin New York City to treat various women’s illnesses. Eight Latino healers collaborated on thestudy through consultations with female patients who had one of the following conditions asdiagnosed by biomedically trained physicians: uterine fibroids, hot flashes, menorrhagia, orendometriosis. The study identified a total of 67 plant species prescribed by the healers in theform of mixtures or as individual plants. Voucher specimens were collected from local botanicasand identified by specialists at The New York Botanical Garden. Studies of immigrant tradi-tional healers and the plants they use in an urban setting can provide interesting ethnobotanicaldata and information to assist in diagnosing conditions and contributing to treatment of patientsfrom Latino as well as non-Latino communities.

PLANTAS MEDICINALES USADAS POR CURANDEROS LATINOS EN EL TRATAMIENTO DE ENFERMEDADES

FEMENINAS EN LA CIUDAD DE NUEVA YORK. Este documento examina el uso de plantas medicinalespor curanderos Latinos en la ciudad de Nueva York en el tratamiento de varias enfermedadesen mujeres. Ocho curanderos Latinos colaboraron en el estudio a traves de consultas con pa-cientes mujeres que tenıan una de las siguentes condiciones de salud diagnosticadas por medicos:fibroma del utero, incrementos de temperatura repentinos, menorrea o endometriosis. El estudioidentifico un total de 67 especies de plantas prescritas por los curanderos ya sea en mezclas oindividualmente. Muestras de los especımenes fueron colectadas en botanicas locales e identifi-cadas por especialistas en El Jardın Botanico de Nueva York. Estudios de curanderos tradicion-ales inmigrantes y sus plantas en un area urbana pueden proveer datos etnobotanicos interesantese informacion que asista en el diagnostico del estado de salud y contribuya al tratamiento depacientes tanto de comunidades Latinas, como no Latinas.

Key Words: ethnomedicine; ethnobotany; women’s health; uterine fibroids; menorrhagia; en-dometriosis; hot flashes; Latino.

Traditional medical practices are an importantpart of the primary health-care delivery system

1 Received 20 April 1999; accepted 24 December1999.

in much of the developing world (Akerele 1988;Bodeker 1994; Cunningham 1993; Sheldon, Bal-ick, and Laird 1997:5). According to the WorldHealth Organization, an estimated 3.5 billionpeople in the developing world depend on plants

2000] 345BALICK ET AL.: MEDICINAL PLANTS USED BY LATINO HEALERS

as part of their primary health care (Balick andCox 1996:57–58). Nonbiomedical healing sys-tems vary across cultures but conceptually theyoften focus on balance and harmony, which maybe treated mentally, physically, or spiritually(Bodeker 1994; Hewson 1998; O’Connor 1998).Biomedical treatment systems are often concep-tually different than traditional systems focusingon Cartesian dualism, where body and mind aretreated separately and technological and surgicalprocedures are often used for the treatment ofphysical diseases (Bodeker 1994; Hewson1998). In many countries, the acceptance of tra-ditional medicine by governments as a formalcomponent of health care has been slow, exceptperhaps in Asia and Europe. In China, for ex-ample, for over three decades there has been anintegration of traditional medicine into the na-tional health-care system (Akerele 1988; Bodek-er 1994). In urban settings such as New YorkCity, immigrant communities use traditionalhealth-care practices often exclusively or in ad-dition to conventional biomedical treatment(O’Connor 1998). Interest in receiving such tra-ditional care may be in response to differentconcepts of disease that are not recognized bybiomedically trained physicians (O’Connor1998). Traditional medicinal treatments oftenprovide culturally familiar techniques that treatboth the physical and spiritual condition of anindividual (Bodeker 1994; O’Connor 1998;Pachter 1994).

Globally, about 85% of the traditional medi-cines used for primary health care are derivedfrom plants (Farnsworth 1988:91). As peopleleave their native surroundings and migrate tourban centers, they bring their medical traditionswith them (Baca 1978; Gordon 1994; O’Connor1998). In New York City, immigrant peoplescontinue to import, buy, sell, and utilize herbsand other traditional remedies to serve their ownethnic communities. Much of the current workin ethnobotany is concerned with the loss of tra-ditional knowledge and the preservation of bi-ological diversity in remote parts of the worldwhere cultures and their ecosystems are beingdestroyed by development. However, by recog-nizing the widespread use of plants as medicineby ethnic communities in urban centers, inter-esting ethnobotanical studies can be designed forthis environment. The results can be used to helpbiomedically trained physicians improve thesuccess of health-care delivery to these ethnic

groups in culturally appropriate ways (Domini-can, Chinese, Indian, Korean, etc.) (Gordon1994; O’Connor 1998; Pachter 1993, 1994). Inaddition to learning about the uses of medicinalplants in a new setting, often in combinationwith biomedical modalities, their potential fortherapeutic benefit can also be evaluated.

Within Latino communities of New YorkCity, the curandera/o (healer), the espiritista(spiritist healer), and the plants they use are partof everyday life for many people. In these com-munities the botanica (Figs. 1, 2) a shop sellingtraditional remedies, has the role of herbal phar-macy, providing fresh and dried herbs, mixturesand tinctures, as well as religious and ritualitems such as candles and sacred waters (Borelloand Mathias 1977; Delgado and Santiago 1998).Some of these herbs are imported from the Do-minican Republic, Peru, and Brazil, whereasothers are grown locally in the state of NewYork.

This paper focuses on the plants used by agroup of Latino healers as part of an on-goingstudy on herbal therapies for women’s health.The plants were prescribed by healers to treatwomen who had one of the following conditionspreviously diagnosed by a biomedically trainedphysician: uterine fibroids (benign connectivetissue tumors); menorrhagia (excessive uterinebleeding); endometriosis (growth of endometrialtissue outside of the uterus) or hot flashes (sud-den brief sensations of heat often experiencedduring menopause). We will discuss: 1) themethods we developed to collect ethnobotanicaldata in the urban environment, 2) the healers’backgrounds, 3) the plants prescribed for uterinefibroids, menorrhagia, endometriosis, and hotflashes, the frequency of the plants in prescrip-tions, the healers’ methods of collection, thecommonalities between healers and, 4) the ben-efits of such research in relation to the goals ofethnobotany as a discipline and to health carefor women and immigrant communities.

METHODS

The project, Ethnobotany in the Urban Envi-ronment involves work with healers from Latinoand Chinese communities in New York City, al-though this paper focuses specifically on the La-tino healers and their plants. Healers were iden-tified through community networks and inter-viewed extensively about their traditional prac-tices. Those who treated a substantial number of

346 [VOL. 54ECONOMIC BOTANY

Fig. 1. A popular botanica in New York City frequented by several of the healers involved in this project.Fig. 2. Inside the botanica, fresh and dried plants sold beside perfumes and religious goods. Photos by

Christine Douglas.


women patients and used plants as part of theirhealing practices were selected to participate inthe study (Reiff et al. 1996). The InstitutionalReview Board of Columbia University, Collegeof Physicians and Surgeons (IRB) granted per-mission for the study. Each patient and eachhealer in the study signed a formal consent inadherence with IRB rules and regulations.

Patients selected were women from variouscultural backgrounds, who had been diagnosedby a physician (MD) with either menorrhagia,endometriosis, hot flashes, or uterine fibroids.The patients responded to advertisements postedin the New York City area requesting researchsubjects with the specific women’s conditions.During the study each Latino healer was to havea consultation with each patient, although basedon uncontrollable circumstances, not all healersmet with each patient. One healer saw as few astwo patients whereas two other healers saw asmany as ten patients. The other five healers sawbetween two and ten patients each. One fibroidpatient, FB002, was seen twice by two of thehealers—once in 1996 and then again in 1998.She is considered as two patients, because shereceived different prescriptions at each consul-tation.

A traditional healer, a patient, and two re-searchers were present at each consultation.Consultations were conducted at The Center forComplementary and Alternative Medicine atColumbia University or at the healer’s homes oroffices at convenient times for all participants,often on weekends and evenings. Consultationswere conducted in either Spanish or English de-pending on the healer’s preference. Patients’ andhealers’ names were coded to maintain confi-dentiality.

There were two phases of the study. In thefirst phase, we worked with Latino healers fromvarious parts of Latin America and included pa-tients with all four health conditions listedabove. The second phase narrowed the researchto healers from the Dominican Republic and pa-tients with uterine fibroids. This is one of a se-ries of papers being written on methodology, theresults, conclusions, and applicability of this re-search. Another paper will also consider the re-sponse of the patient to different healers andhealing systems, and the comfort level amonghealers and patients of different ethnic back-grounds and healing systems.

The healers examined the patients using the

diagnostic techniques from their own medicalsystems (e.g., urine analysis, energy) and pre-scribed their own treatments. The patients wereasked not to take the treatments prescribed bythe healer in order to increase the likelihood thattheir symptoms remained consistent for evalua-tion by the other healers and because permissionfor this action was not obtained from the IRB.The recommended treatments usually consistedof medicinal herbs, but also included massageand/or other therapies. After the healer had seena patient, a follow-up interview was conductedcovering the plants prescribed by the healer.

The plant interviews were conducted at thehealer’s home, at his/her workplace or, occasion-ally, at Columbia University. Only the healerand researchers were present during the plant in-terviews. Specific questions were asked abouteach plant prescribed, such as the part of theplant used, preparation, the effect of the plant onthe patient, any other uses of the plant, and anyconditions or times when the plant should notbe used medicinally. Questions were also askedabout the nature of the plant material, such as,where is the plant collected, what is its naturalhabitat and its stage of development at the timeof collection. The healers were also queried onthe time of the day specific plants are collected,the effect of the moon on collection, if any, andwhether rituals are performed at the time of col-lection. Lastly, questions were asked about thesource of the plant in the urban setting as wellas its cost. The plants were either purchased ata botanica or at local markets with the healer, orwere purchased alone by the researcher andbrought to the plant interview to verify the iden-tity of each collected plant with the healer. Be-cause the botanicas primarily sell the plants bytheir common name, it is important to have thehealers confirm the identification of the plants.

After the plant interviews were completed, thebotanica where the healer typically buys his/herplants was visited to learn more about the originof the specific plants prescribed. These visitsconsisted of informal conversations, typically inSpanish, with the staff persons at the botanica,aimed at understanding more about the origin ofthe plants, their collection methods, and howthey were shipped to New York City.

The plants prescribed by the healers were pur-chased by the researchers, identified by the heal-ers, and prepared as voucher specimens, withscientific names determined by specialists at The


Fig. 3. An altar commonly seen in a healer’s workplace, which is an important part of healing rituals.

New York Botanical Garden. Some uncertaintyof identification remained if only plant frag-ments were collected: for example, only the rootor a bag of crushed leaves, as opposed to awhole plant. All fresh plant specimens collectedfrom the botanicas and local markets werepressed, dried, and catalogued into a database atthe Institute of Economic Botany and depositedat The New York Botanical Garden Herbarium(NY).

RESULTS AND DISCUSSION

In this paper we present: profiles of the heal-ers; an analysis of the healer-patient distributionof consultations; a table of the medicinal plantsprescribed by the healers for all four women’shealth conditions; the frequency of plants pre-scribed by the healers; and the methods of col-lection used by the healers and two botanicas.

HEALER PROFILES

The study included eight healers, six womenfrom the Dominican Republic and two men (onefrom Puerto Rico and the other from Colombia).A summary of their diverse backgrounds and di-agnostic methods follows. Some healers, such asHS009, HS010, and HS014, have lived in the

United States for over 30 years, whereas othershave lived here less than 10 years. The languageability varies from speaking only Spanish to flu-ency in both English and Spanish. These factorsmay influence the types of plants prescribed bythe healer.

HS009. This healer is originally from PuertoRico and has been living in the United States for51 years. He is fluent in both English and Span-ish. He calls himself an espiritista and works ina botanica in New York City. His knowledge ofplants was learned from his mother, a healer inPuerto Rico, as well as through books. His treat-ments consist of prayer, herbal teas and baths,diet, and exercise.

HS010. This healer is from the province ofRestauracion, located in the Northwest region ofthe Dominican Republic near Haiti. She hasbeen living in the United States for about 30years and is fluent in English and Spanish. Shecalls herself a ‘‘facilitator of good health’’ andworks from her home. At the age of 14 her aunt,who is a curandera and espiritista, passed on thespiritual part of becoming a healer through aspecial ritual. In her practice, she employs herbsas well as meditation, exercise, diet, aromather-apy, candles, and prayers (Fig. 3).


HS013. This healer travels extensively inSouth America and between New York and Flor-ida. He was born in Colombia and has beenhealing since he was five years old. He callshimself a curandero. He speaks Spanish and hismethod of diagnosing patients involves lookingat the patient’s body through a glass of water to‘‘see’’ the illness. His prescriptions consist ofherbal teas, baths, and vaginal douches.

HS014. This healer is from Santo Domingo,Dominican Republic. She has been living in theUnited States for about 30 years and speaks En-glish and Spanish. She does not call herself aprofessional healer, although she has been treat-ing people since she was seven years old. Shebecame a healer because of a dream she had inwhich her grandmother told her she had the abil-ity to heal. Her grandmother died that night. Sheuses prayer, herbs, and massage to treat her pa-tients and says that her belief in Jesus is hersource of healing ability.

HS015. This healer is from the DominicanRepublic. She has been living in the UnitedStates for eight years and works in a botanica inNew York City. She speaks Spanish and herknowledge of plants came from her mother. Sheconsiders herself a ‘‘naturalist’’ who is knowl-edgeable about plants and enjoys helping others.Her treatments consist of herbal teas, baths, andvaginal douches.

HS019. This healer is from the DominicanRepublic and speaks Spanish. She has been inthe United States for three years and practicesas a healer at her home, seeing around 20 clientsa week. She learned about the use of plantsthrough her mother and grandmother who wereboth curanderas. Her treatments consist of herb-al teas and modifications of her patient’s diet.

HS020. This healer has been in the UnitedStates for 10 years and speaks English and Span-ish. She is originally from the Dominican Re-public where she learned about the use of plantsfrom her grandmother and great grandmother.She consults with patients in her home. Her di-agnosis involves the examination of urine andthe majority of her treatments are herbal teas.

HS021. This healer left the Dominican Re-public at the age of 23. She lived in Venezuelaand Puerto Rico before moving to the UnitedStates. Her use of plants was learned primarilyfrom her grandmother. She also receives spiri-tual guidance, as did her grandmother, that helpsher in healing her patients. She speaks Spanish

and consults with patients at her home. Hertreatments usually consist of herbal teas and sheuses the examination of urine to determine thenecessary treatment for her patient.

HEALER-PATIENT DISTRIBUTION

There were 13 patients involved in the study.Of those, eight had previously been diagnosedby biomedical practitioners with uterine fibroids;two with hot flashes; two with menorrhagia; andone with endometriosis. Among the eight heal-ers, healers HS010 and HS014 each saw ten pa-tients; healer HS009 saw six patients; healersHS020 and HS021 each saw five patients; healerHS015 saw four patients; healer HS013 sawthree patients; and healer HS019 saw two pa-tients. There were a total of 45 consultations; 34with uterine fibroid patients, four with hot flash-es patients, six with menorrhagia patients, andone with an endometriosis patient. There weremore uterine fibroid patients seen by the healersthan those with the other conditions, which mayimpose bias on the distribution of plant speciesby condition.

MEDICINAL PLANTS PRESCRIBED

BY HEALERS

Table 1 lists the plants prescribed by the La-tino healers for uterine fibroids, hot flashes, andmenorrhagia including the vernacular name usedby each healer. Some of the healers referred tothe plants in Spanish whereas others used En-glish. Although endometriosis was included inthe study, no healer ever prescribed plants forthis condition. Voucher numbers for all collec-tions, made by Andreana Ososki (AO), are listedin parentheses following the plant family anddeposited at NY.

As many as 74 and not less than 67 specieswere prescribed by the Latino healers (five areundetermined and two are determined to family,see Table 1). Some plants are listed with thefamily name only as the voucher consists ofsmall fragments (e.g., roots) making a positiveidentity extremely difficult. Four other taxa arelisted with only vernacular names, buzunuco, ca-jollo de yuca, espigelia, and yarumo because itwas not possible to collect voucher specimens.

One species Doyerea emetocathartica (Cu-curbitaceae) is known by three names, batata deburro, batata zandumbia, and batata zambomba.According to one of the Dominican healers, ba-tata zandumbia and batata de burro are ‘‘almost’’


TABLE 1. PLANT SPECIES PRESCRIBED BY LATINO HEALERS FOR THE TREATMENT OF UTERINE FIBROIDS,HOT FLASHES, AND MENORRHAGIA.

Species [family] {voucher number} Vernacular name Condition1

Achillea millefolium L. [Asteraceae] {AO 7} mil en rama m, ufAgave sp. [Agavaceae] {AO 12, 14, 47, 48, 49, 57, 62} maguey de bestia ufAloe vera (L.) Burm. f. [Asphodelaceae] {AO 77} sabila ufAmbrosia peruviana Willd. [Asteraceae] {AO 24} artemisa, altamisa ufAnanas comosus (L.) Merr. [Bromeliaceae] {AO 102} guarpo, pineapple hf, ufAnisum vulgare Gaertn. [Apiaceae] {AO 63} anıs m, ufApium graveolens L. [Apiaceae] {AO 93} celery ufArgemone sp. [Papaveraceae] {AO 26, 52, 59, 111} cardo santo ufBeta vulgaris L. [Chenopodiaceae] {AO 95} beet, remolacha m, ufBixa orellana L. [Bixaceae] {AO 39, 43} bija ufCaesalpinia coriaria (Jacq.)Willd. [Fabaceae] {AO 60} guatapanal ufCassia fistula L. [Fabaceae] {AO 50} canafıstula ufChamaemelum nobile (L.) All. [Asteraceae] {AO 5, 30, 32, 65, 68} manzanilla, chamomile m, ufChenopodium ambrosioides L. [Chenopodiaceae] {AO 3, 23, 27} apasote, epazote ufChiococca alba (L.) Hitchc. [Rubiaceae] {AO 105} timacle ufCitrus sp. [Rutaceae] {AO 79, 99, 116} orange, limon hf, ufCoccothrinax argentea (Lodd. ex Shult. & Schult. f.) Sarg. ex Becc.

[Arecaceae] {AO 106}cana uf

Daucus carota L. [Apiaceae] {AO 97} carrot ufDoyerea emetocathartica Grosourdy [Cucurbitaceae] {AO 82, 109} batata zandumbia, batata

de burrouf

Equisetum giganteum L. [Equisetaceae] {114} cola de caballo ufEucalyptus sp. [Myrtaceae] {AO 4, 18, 20} eucalipto ufFevillea cordifolia L. [Cucurbitaceae] {AO 72, 75} ayamo, jayamo, jallamo ufFicus religiosa L. [Moraceae] {AO 78} alamo ufGenipa americana L. [Rubiaceae] {AO 36} jagua hfGouania lupuloides (L.) Urb. [Rhamnaceae] {AO 84} bejuco indio ufGuazuma ulmifolia Lam. [Sterculiaceae] {AO 73} guacima ufHelichrysum italicum (Roth) G. Don f. [Asteraceae] {AO 85} siemprefresca ufIllicium verum Hook. f. [Illiciaceae] {AO 64} anıs de estrella ufKalanchoe gastonis-bonnieri Raym.-Hamet & H. Perrier [Crassula-

ceae] {AO 45}mala madre uf

Lavandula angustifolia Mill. [Lamiaceae] {AO 41, 66} algucema ufMalus pumila Mill. [Rosaceae] {AO 98} apple hfMentha sp. [Lamiaceae] {AO 22} yerba buena ufMomordica charantia L. [Cucurbitaceae] {AO 54} cundeamor ufMusa x paradisiaca L. [Musaceae] {AO 101} platano ufMyrsine sp. [Myrsinaceae] {AO 104} palo santo ufOpuntia ficus-indica (L.) Mill. [Cactaceae] {AO 40, 46} tuna, alquitira m, ufPanax pseudoginseng Wall. [Araliaceae] {AO 112} ginseng ufPetiveria alliacea L. [Phytolaccaceae]{AO 1, 10, 11, 15, 53, 89, 90} anamu m, ufPetroselinum crispum L. [Apiaceae] {AO 92} parsley ufPhoenix dactylifera L. [Arecaceae] {113} palma ufPimpinella anisum L. [Apiaceae] {AO 88} anıs m, ufPinus caribaea Morelet [Pinaceae] {AO 71, 76} cuaba ufPiper marginatum Jacq. [Piperaceae] {AO 2, 33, 91} anıs ufPlantago major L. [Plantaginaceae] {AO 8, 25} llanten, yanten m, ufPluchea carolinensis (Jacq.) G. Don [Asteraceae] {AO 80} salvia ufPsidium guajava L. [Myrtaceae] {AO 107} hoja guayaba ufRosa sp. [Rosaceae] {AO 83} rose petals ufRosmarinus officinalis L. [Lamiaceae] {AO 19, 86} romero ufRuellia tuberosa L. [Acanthaceae] {AO 51, 69} periquito, guaucı ufRuta chalapensis L. [Rutaceae] {AO 17, 21, 37} ruda m, uf


TABLE 1. CONTINUED.

Species [family] {voucher number} Vernacular name Condition1

Saccharum officinarum L. [Poaceae] {AO 42} molasses, miel de pulga m, ufSecuridaca virgata Sw. [Polygalaceae] {AO 38, 70} maraveli ufSenna alexandrina Mill. [Fabaceae] {AO 74} hoja madre ufSenna ligustrina (L.) H.S. Irwin & Barneby [Fabaceae] {AO 44} sen ufSolanum melongena L. [Solanaceae] {AO 96} baby eggplant ufSolanum tuberosum L. [Solanaceae] {AO 118} papa ufSpermacoce verticillata L. [Rubiaceae] {AO 16, 55, 67, 110} juana la blanca ufSpinacia oleracea L. [Chenopodiaceae] {AO 115} spinach ufTabebuia impetiginosa (DC.) Standl. [Bignoniaceae] {AO 35} palo de arco ufcf. Taraxacum officinale Weber [Asteraceae] {AO 61} diente de leon ufTilia mandshurica Rupr. & Maxim. [Tiliaceae] {AO 6, 29, 34} tilo hf, m, ufTournefortia gnaphalodes (L.) Roem. & Schult. [Boraginaceae]

{AO 9}planta marina uf

Uncaria tomentosa (Willd. ex Roem. & Schult.) DC. [Rubiaceae]{AO 81}

una de gato uf

Vaccinium macrocarpon Aiton [Ericaceae] {AO 100} cranberry ufZea mays L. [Poaceae] {AO 94, 108} barba de maız ufZingiber officinale Roscoe [Zingiberaceae] {AO 58} ginger, jengibre hf, ufZingiber zerumbet (L.) Sm. [Zingiberaceae] {AO 56} jengibre amargo uf[Asteraceae] {AO 31} artemisa, altamisa uf[Lamiaceae] {AO 28} yerba buena ufundetermined {AO 103} palo brasil ufno voucher buzunuco ufno voucher cajollo de yuca ufno voucher espigelia ufno voucher yarumo uf

1 Data in the Condition column is abbreviated: hf 5 hot flashes; m 5 menorrhagia; uf 5 uterine fibroids.

the same plant whereas in the botanica, batatazandumbia is known as batata zambomba or asbatata de burro. In Liogier (1974:141–142;1986:304), batata zandumbia, batata de burro,and batata zambomba refer to the species Doy-erea emetocathartica. In this study both batatade burro and batata zandumbia were prescribedand were considered to be the same species.

Agave sp., one of the plants most frequentlyprescribed by the healers, is notoriously difficultto identify from dried material, combined withthe fact that several species are native to the Do-minican Republic. It is likely that several Agavespecies are harvested and sold for the medicinalplant trade. The material purchased in New YorkCity may also be from cultivated plants in theDominican Republic or perhaps elsewhere.Therefore we were unable to offer a positiveidentification of the voucher specimens collectedof Agave.

Healers and researchers are faced with unusu-al challenges while collecting medicinal plantsin an urban environment. Botanicas may not al-

ways sell the plant or part of the plant neededby the healer or different common names maybe used for the same plant species. Commonnames can and do differ between or even withincountries, and can also differ on individual cityblocks or even in individual shops. Their dis-tinction is of concern for patients buying medic-inal plants by common names. In addition, withonly plant fragments or parts of the plants avail-able, it is a challenge for researchers to deter-mine the species of the plant. Some samplesconsist of ground leaves or flowers, wood orroots. These samples are difficult to identify be-cause there is little reliable comparative materi-al. Herbaria are full of pressed leaves, fruits andflowers, but few contain wood or root samples.Differences in common names, and the fact thatthe plant can appear in so many forms (e.g.,fresh, dried, fragments) can impede fieldwork inurban markets.

The plants prescribed by the healers for uter-ine fibroids (Table 1) comprise the highest num-ber of species (65 species not including the five


undetermined specimens and the two specimensdetermined to family). Eleven plant species wereprescribed for menorrhagia and six species forhot flashes. The distribution of plant species isdue to the larger number of consultations foruterine fibroids versus the other two conditions,menorrhagia and hot flashes, which each haveunder 10 consultations. There also may be alarger number of plant species for uterine fi-broids due to the number of healers prescribingplants for uterine fibroids versus the other twoconditions. All eight healers saw at least oneuterine fibroid patient whereas four of the heal-ers saw at least one menorrhagia patient andthree of the healers saw at least one patient withhot flashes.

The plants prescribed most commonly amongthe healers for uterine fibroids were Agave sp.,Kalanchoe gastonis-bonnieri, and Petiveria al-liacea. Each of these plants was prescribed byfour of the eight healers. The following specieswere used by three of the eight healers to treatuterine fibroids: Aloe vera, Argemone sp., Betavulgaris, Chamaemelum nobile, Saccharum of-ficinarum, Spermacoce verticillata, and Uncariatomentosa. Healers HS010 and HS014 both pre-scribed Chamaemelum nobile and Tilia mand-shurica to treat menorrhagia.

The distribution of plant species may also bedue to the individual condition. Uterine fibroidsmay need to be treated with mixtures that con-tain a larger number of plants than menorrhagiaor hot flashes. This will be considered in greaterdetail in future papers.

FREQUENCY OF PLANTS PRESCRIBED

BY THE HEALERS

Figure 4 illustrates the frequency with whicha plant was prescribed by the healers during thestudy. Only those plants that were prescribedmore than four times appear in the graph. Themost frequently prescribed plant among thehealers was Agave sp. Out of 45 consultationsthis plant was prescribed a total of 21 times. Itwas a plant employed by four of the eight heal-ers. The second and third most frequently pre-scribed plants were Saccharum officinarum andBeta vulgaris. These two plants were alwaysused together in a mixture. Three of the eighthealers prescribed this mixture for uterine fi-broids and healer HS014 also prescribed thismixture for menorrhagia.

Agave spp. are used to make tequila and mes-

cal, as well as being an important source of fiber,and are also used medicinally (Simpson andOgorzaly 1995:501). In Morton (1981:87–89)there are many cited medicinal uses of Agavespp. in Central America and the Caribbean: onespecies, Agave cocui Trel. has been used as apoultice to drain and shrink tumors whereas an-other species, A. vivipara L. has been reportedto have been used as an emmenagogue, and A.cocui contains steroidal sapogenins; tigogenin,and hecogenin. Hecogenin from A. sisalana isused commercially as a source of cortisone (De-wick 1997:246; Morton 1981:87–88).

Beta vulgaris and Saccharum officinarum ap-pears to be a popular mixture among the Do-minican healers to treat uterine fibroids. Two ofthe healers reported this mixture as being im-portant to shrink fibroids. Another healer pre-scribed Agave sp. to reduce the fibroid and thenprescribed the B. vulgaris and S. officinarummixture to strengthen and fortify the uterus afterthe fibroid had been drained from the body. Thefact that some plants are frequently prescribedmay suggest potential leads for investigating al-ternative treatments for uterine fibroids, menor-rhagia, and hot flashes. In a future paper, we willreport on the chemical and biomedical literatureto determine known constituents and chemicalactivity of the plants identified in this study.

METHODS OF COLLECTION

The collection methods for one of the plantsprescribed, Chamaemelum nobile is comparedamong four healers and two botanicas in Table2. Information was gathered about harvest rela-tive to the time of day, the phases of the moon,and the collector to understand if these factorsare considered to contribute to the healing abil-ity of the plant.

The plant parts collected are the same for thehealers and botanicas, except for healer HS010,who reported that she would also collect theroots of Chamaemelum nobile for severe casesof menorrhagia if she were living in the Domin-ican Republic, although in New York City shecannot typically buy the roots at a botanica.Healers HS010, HS014, and HS021 all agree oncollecting the plant in the morning. HealersHS010 and HS021 also collect the plant in thelate afternoon. Healer HS015 suggests that theplant can be collected anytime. Only healerHS010 said the moon phase had an effect on theplant collected. Although healer HS014 said the


Fig. 4. The most frequently prescribed plant species for the three conditions studied (uterine fibroids, hotflashes, menorrhagia).

TABLE 2. COLLECTION METHODS FOR CHAMAEMELUM NOBILE.

Healer/botanica Parts collected Collecting times Effect of moon Who collects plants?

HS010 leaves, flowers, roots morning and late af-ternoon

on full moon plantshave more energy

oldest in house, wom-en, men healers

HS014 leaves, flowers morning none anyoneHS015 leaves, flowers anytime none anyoneHS021 leaves, flowers morning and late af-

ternoonnone anyone

botanica 1 leaves, flowers anytime none anyonebotanica 2 leaves, flowers anytime none anyone, usually farm-

ers

moon does not have an effect when C. nobile iscollected, she does believe the moon affects peo-ple and, therefore, those who are taking thisplant. She remembers her grandmother telling

her that medicinal plants should not be collectedduring the new moon. The idea that plantsshould not be collected during the new moon isalso reported in Hernandez Colon’s work (1976/


77) in the Dominican Republic province of Ped-ernales.

Healer HS010 was the only one to specifywho collects the plant. She also believes somepeople are known to have ‘‘bad hands’’ and theyshould not collect plants because they can causeharm to them. She believes this is true for allmedicinal plants.

From Table 2 it appears that methods of col-lection are healer-specific rather than being spe-cific to individual plants or to the botanicas.Shopkeepers at both botanicas agreed that any-one can collect Chamaemelum nobile—usuallyfarmers collect it without regard to the time ofday and moon phase. According to a staff personat one of the botanicas, the methods of collec-tion are oriented purely toward business—any-one can collect any of the plants, at any time ofthe day. The only exception he noted was Rutachalapensis, which he indicated should not becollected during the new moon, an idea also re-ported by healer HS014 and in Hernandez Co-lon’s work (1976–1977).

Through interviews with the healers and theshopkeepers at the botanicas, additional infor-mation not presented in Table 2 was also gath-ered about the methods of collection. HealerHS010 noted that all plants should be collectedduring the ‘‘calm time,’’ early in the morning orlater in the afternoon between 4 P.M. and 5 P.M.,out of respect for the plant. The heat of the day(between noon and 3 P.M.) is said to be the worsttime to collect, because plants are sensitive tothe heat, which lessens their healing power. Forhealer HS010, midnight is the time when plantsare collected for special treatments. Accordingto healer HS014, plants should not be collectedat night because that is when they are resting.Healer HS014 also reported that anyone can col-lect medicinal plants except for Ruta chalapen-sis, which cannot be collected by women duringmenstruation.

Before collecting medicinal plants, both heal-ers HS010 and HS014 perform a ritual. HealerHS010 usually sings to bless the plant and na-ture. She learned songs as a child from hergrandmother. She said there is a different songfor each type of plant. One of the songs is aboutwomen orange collectors who become so im-mersed in their singing that they forget to collectthe oranges. Other collectors arrive and take allthe oranges while these women are singing, sothey are left with only branches. The use of

prayers and other orations during plant collec-tion is not uncommon in Latin America (Arvigoand Balick 1998:10).

Healer HS014 asks the plant for forgivenessbefore picking it and then asks it to help her healthe patient. She then thanks the plant. She re-ports that it is better if the plants are organic.Healer HS014 buys fresh plants from the botan-icas, because she does not trust the dried plants,as they could be mixed with other plants or havebeen touched by evil spirits or by someone prac-ticing Santerıa, a syncretic Afro-Caribbean re-ligion.

Because the Dominican Republic has a sub-tropical climate, the healers collect the plantsthroughout the year as needed for healing. Ac-cording to most of the healers, out of respect forthe plant, the plants should be collected at a ma-ture stage.

According to Hernandez Colon (1976/77), inthe province of Pedernales, all plants tradition-ally have a specific time and method for collec-tion that is as important as the actual preparationof the plants. As people have become more de-tached from the natural environment, thisknowledge has been lost. In this study, however,it was observed that some of the traditionalmethods of collection are still remembered byhealers. As most of the plants are bought at bo-tanicas, the methods of collection are not inpractice in New York City.

CONCLUSION

This study offers a model for studying the re-lationships between plants and people, withinthe context of traditional medical systems in anurban setting. The results illustrate the plantsprescribed by Latino healers for the four con-ditions, the various diagnostic techniques em-ployed by the healers, and the different methodsof collection used by the healers and the botan-icas. This study generated a broad spectrum ofinformation concerning medicinal plants used byLatino healers considering the small sample size.The results from this study show the potentialof this model employing a larger sample size.

We observed that the patients were comfort-able during the consultations with the healers,even when those patients were outside the heal-er’s culture. Two of the patients returned to thehealer for treatment following this study; futureresearch will report on their results. In addition,information collected from the transcripts of the


healer/patient interviews offers perspective fromthe patients’ experience. One patient, an anato-my and physiology research scientist in NewYork City, often asked many questions, partic-ularly about the functioning of the herbs andshowed great interest in how the healers learnedabout the use of the plants. Future papers willexamine more closely the patients’ experiencewith the various healers and their treatments.

There is growing interest in traditional prac-tices of health care as a complement to biomed-ical health care (Astin 1998; Eisenberg et al.1993, 1998). With this changing behavior it isimportant for biomedically trained practitionersto understand the use of herbs and the possiblesynergistic effects or other herb-drug interac-tions with pharmaceutical prescriptions (Miller1998). The potential interactions of plants asherbal medicines with pharmaceutical medica-tions is poorly understood, and there are fewstudies on this subject (Eisenberg et al. 1998;Miller 1998). Contraindications and occasionalcases of toxicity based on misuse are importantissues of traditional medicine to be consideredwhen using herbs.

There are significant, but somewhat parallelsystems of health care providing needed servicesto people in New York City. These systems, al-though specific to given ethnic groups, havesimilar foundations based on long standing tra-ditions (O’Connor 1998). Immigrants bring withthem their own health systems and treatmentsthat are familiar and have proven effective basedon generations of use (Baca 1978; Bodeker1994; Gordon 1994; O’Connor 1998). The useof familiar health care is conditioned by familymember’s views on health and by other culturalfactors that may not transfer from one culture toanother (Akerele 1988; Pachter 1994). Cultur-ally specific disease concepts of immigrant com-munities may not be understood by biomedicallytrained doctors and, therefore, many in thosecommunities are drawn to their own health-carepractitioners (Kraut 1990; O’Connor 1998;Pachter 1994). Health care provided by tradi-tional healers such as the espiritista and curan-dera/o is often more affordable than servicesprovided at local clinics and hospitals (Bodeker1994). The consensus of the healers in the studywas that their traditional treatments were effec-tive and that many people return to see themwhen they had other problems.

There is increased interest in the United States

population in using a low technology approachto healing; this is especially the case with wom-en’s health, because biomedical treatment forwomen’s health problems is perceived as involv-ing invasive treatments such as surgeries andhormones, which many patients find undesirable(Gordon 1994; O’Connor 1998; Pachter 1993,1994). To understand the therapeutic potential ofother medical systems, there is a need for morestudies of traditional health-care practices, aswell as clinical research. The results from thisstudy can offer a potential model for future stud-ies of traditional health-care practices in com-munities around the country.

Although many ethnobotanical studies areconducted in remote regions of the world, thereis a wealth of information that can be learnedfrom working with immigrant communities inlarge cities (Gordon 1994; Kendall 1987; Kraut1990; O’Connor 1998; Pachter 1993, 1994; Ra-makrishna and Weiss 1992). Studies in urbansettings require an awareness and understandingof the limits of a city environment. For example,due to strict government regulations in the Unit-ed States, healers often feel hesitant to identifythemselves openly. Challenges for the investi-gator include understanding the mechanisms ofhow the plants are brought to the cities, becausenot all the plants arrive by legal means. A dif-ferent set of skills is needed to work in a cityversus a rural area, such as the ability to workwith plant fragments far removed from their nat-ural environment, and skills to carry out this re-search in diverse ethnic communities. We con-sider this category of research to be urban eth-nobotany as it is somewhat different from eth-nobotanical research conducted in remoteregions.

Urban ethnobotany is often supported by thehealers and the community because it maintainsand gives value to cultural ties. There is a dy-namic exchange of plants and knowledge amongcultures that provides urban fieldwork with com-plexity and richness. In an urban setting there isa spectrum of specialists ranging from the part-time generalist to the full-time healer specialists;some work from botanicas and others work fromtheir homes. Many healers have other jobs inaddition to their healing practices. This is alsothe case elsewhere with traditional healers (Ar-vigo and Balick 1998:5–7).

This study has provided an important oppor-tunity to learn about the rich and varied health-


care practices used within immigrant communi-ties in New York City. Working with a large,multidisciplinary team makes possible an ex-change of ideas and enhances the conclusions ofthe results. Future studies will incorporate ad-ditional ethnic communities as well as other ur-ban centers in the United States and elsewhere.The dynamic environment and complex culturalinteractions in an urban setting offer a challeng-ing opportunity for expanding the frontiers ofresearch on the relationship between plants andpeople.

ACKNOWLEDGMENTS

We would like to thank the healers for their invaluable knowledge andcollaboration on the study; the patients for their interest and enthusiasm;the research assistants (Dara Amchin, Liliana Cortes, Gilda Perez, LauraRollins, Diana Santana) for their efforts; the staff at the botanicas foranswering many questions; the staff at The New York Botanical Garden,especially Rubert Barneby, Hans Beck, Piero Delprete, Tom Zanoni, andgraduate students, Alberto Areces and Nora Barboza, for their help inidentifying specimens, Christine Douglas for the photographs, DouglasDaly and Jan Stevenson for their help with the manuscript, and AıdaAlvarez and Juan Carlos Saborıo for their help with the Spanish trans-lation. This project was supported in part by grants from Arum Ltd.,Edward P. Bass, The Philecology Trust, the Center for Complementaryand Alternative Medicine Research in Women’s Health (NIH #U24-HD33199-02) at Columbia University College Physicians and Surgeons,The Center for Environmental Research and Conservation at ColumbiaUniversity, The Fetzer Institute, The Institute of Economic Botany at TheNew York Botanical Garden, Metropolitan Life Foundation, The NationalGeographic Society, Nu Skin International, and in kind contributionsfrom Sony Entertainment and Maxell Corporation.

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m j. b ,f kronenberg,andreana l. ososki m r f … · city, the curandera/o (healer), the...

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