Etkin - Enthopharmacology

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ETHNOPHARMACOLOGY: Biobehavioral Approaches in the Anthropological Study of Indigenous MedicinesNina L. EtkinDepartment 55455 of Anthropology, University of Minnesota, Minneapolis, Minnesota

INTRODUCTION Ethnopharmacology, broadly, constitutes the study of plant, mineral, and animal substances used to affect health, the prefix "ethno-" designating preventive and therapeutic modalities other than Western biomedicine. To the extent that most medicinal substances are of plant origin, ethnopharmacology is closely allied with medical ethnobotany, but it is more appropriately viewed as a multidisciplinary study that encompasses Western/botanical and ethnotaxonomic classifications, assessments of how plants are perceived and used in varied sociocultural contexts, constituent analyses and investigations of pharmacologic activities, and examinations of the physiologic or clinical impact of plant use on human health. A proper study of ethnopharmacology should embrace a broad ecological perspective that is both biobehavioral and multidisciplinary. In this regard, it is consistent with some of the central debates in anthropology that seek to comprehend the dynamics of human environment relationships and to assess their impact on health and disease.General Literature OverviewCOMPENDIA, COMPILATIONS, AND LISTS Many studies in ethno pharmacology are based in rather general works that document the use and constituents of (principally) plant substances used medicinally. Although 23

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some have been recently reprinted, herbals (of varying rigor in botanical and phytochemical detail) as well as official national pharmacopoeias, formu laries, and pharmaceutical codices tend to represent the older literature on medicinal plants. Among the most recently published and inclusive com pilations of ethnopharmacologic data are: (a) many that treat broadly or narrowly defined geographic regions or ethnic groups--e.g. China (19, 32), North America (29), Central America (30, 80), South America (136), the Caribbean (160), Ethiopia (95), West Africa (56, 116, 147), India (138), Tibet (156), Indonesia.(36), Fiji (141), and the entire world (28); and special ized works that concentrate on (b) specific p1ants--e.g. Gossypium spp. (cotton) (59, 70), Tabernaemontana (148), Aloe vera (60), and Chamaeme tum nobile and Matricaria recutita (chamomiles) (99); (c) individual or classes of constituents--e.g. psychoactive khatamines (57), antibacterials (23), and ginsenosides (47, 112); or (d) particular applications--e.g. in the treatment of cancers (31, 67), malaria (1, 89), "infections" (54, 110), or hepatic disorders (69). While some of these offer little more than "mind numbing" lists generated through "alkaloid mongering" (14), others are useful repositories of data that serve in the main to illustrate the predictive value of cross-cultural comparisons of plant utilization (155). Several of the more comprehensive presentations (e.g. 11, 33) are at least implicitly ecological in orientation, as they divide attention among the climatologic and human histories of the region and the use not only of medicinal plants, but also of flora and fauna in diet, manufacture, shelter, and other applications. But for the greatest part, these ethnobotanical inventories present botanical and pharmacologic data disembodied from their social contexts; they cannot accommodate theoretical or conceptual issues, and in fact contain little by way of analysis, or even interpretation. They lack careful attention to the specific circumstances and contexts in which plant utilization occurs-i.e. data regarding mode of preparation, dose, type and duration of application, and the like. An exciting and unique addition to the recent literature that bears special attention is Moerman's (107) reference on the medicinal flora of Native America [which significantly expands his earlier work (105)]. Where even the most inclusive compendia on indigenous medi cines still provide us fundamentally only with documentation, Moerman's work is genuinely a research tool: It is the most comprehensive and taxonomi cally reliable reference of its type and is exhaustively indexed; moreover, the rich computerized data bank on which the two volumes are based is electroni cally accessible on-line, its utility seemingly limited only by the energies and imaginations of researchers.BIOBEHA VIORAL STUDIES In contrast to general inventories are studies that attempt more broadly to contextualize features of perceptions about plants and


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of plant use, pharmacology, and physiologic import. The best of these investigations tend to be based in prolonged fieldwork or other means of acquiring more intimate knowledge of a population. They explore both biological and behavioral parameters to formulate questions within the broad outlines of a human ecology that seeks to understand human-plant interactions in the most comprehensive sense and to assess the impact of such behaviors 'on health. To the extent that such inquiries are more consistent with various theoretical and conceptual formulations within anthropology, they are high lighted in the discussion that follows. The review of these multidimensional studies is selective and representative, not exhaustive, and is organized to address the origins and refinements of plant utilization; multicontextual uses of plants; and application.EFFICACY AND THE INTERPRETATION OF PLANT UTILIZATION


One con

cept useful in dealing with these themes is "efficacy." (I do not deal here with such other overarching concepts as the intrinsic merits of preserving ethnomedical knowledge or the cross-cultural consistency of the ways specific plants are perceived and used.) Insofar as all peoples define efficacy as an indicator of some combination of symptom diminution, resolution of dis comfort, or restoration of health, medicinal and other uses of plants can be considered effective if they meet culturally defined expectations (of patient, curer, and social group). But efficacy is culturally constructed

(44); that is,

the specific criteria that determine how or when some prevention or treatment works may differ considerably among popUlations; and semiotic, physiolog ical, social, and other measures may be variably salient. It is helpful to understand distinctions between indigenous (local, inside) criteria and those imposed from the outside, typically to conform with the paradigms of Western biomedicine. Thus, as an extreme example, the Hausa I understand effective treatment for smallpox to include the discomfiture of spirits, and Aztec headache cures should produce nosebleed

(118), the crite

rion in both cases being that disease agents are forced out of the body. By contrast, biomedical evaluation of efficacy for these treatments would include the measure of viral titers for the former, and for the latter, less dramatic signs such as simple analgesia. While such examples help to discern sometimes fundamental differences among medical ideologies, an exaggeration of such indigenous/biomedical ("emic/etic") differences obscures at least as many cases in which definitions of efficacy and the expectations of treatment overlap, sometimes remarkably. Even the germ theory of etiology, which is often heralded as a uniquely biomedical concept, finds parallels in many otherlUnless otherwise indicated, ohservations on the Hausa of northern Nigeria are based in the author's unpublished field observations.

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medical systems: in Hausa, for example, dauda (dirt, in the general sense of contamination) connotes something akin to microorganism infection-that is, etiologic agents that are invisible, yet a normal part of the physical environ ment, water/filthlfood-borne, communicable, preventable, etc. However, many researchers, usually those outside of the ethnographic traditions, are loath to lend credibility of any sort to non-Western modes of treatment. To wit, they often describe their field experiences with herbalists in adversarial terms, presenting indigenous healers as "secretive," "uncooperative," and in the last analysis, "wrong" about illness etiology or about how a particular medicine works (e.g. 1 7). Some anthropologists, too, are guilty of reifying the "emic/etic" distinction to imply (at least) that while all those "other" (indigenous, folk) explanations are interesting in their "ernie" ways, and their symbols worthy of extensive debate, biomedicine still has the advantage in being more "right," closer to the "truth." Thus, one important contribution of a biobehavioral perspective in ethnopharmacology is to point the way to evaluating the efficacy of plant utilization in view of specific sociocultural contexts within which such behaviors occur (34, 38, 40, 42-46). ORIGINS AND REFINEMENTS OF PLANT UTILIZATION Two related questions in ethnopharmacology are concerned with how specific therapeutic and preventive modalities developed and how they are modified over time and cross-culturally. Most of us are beyond invoking the "intuitive wisdom" of populations who somehow understand when and how best to avail themselves of the substances and energies around them. And we understand that, although local ecologies are important in affecting how people interact with their biological surroundings, the selection of medicines is neither merely a reflection of epidemiologic patterns (24, 162) nor simply a function of the diversity and availability of ambient flora and fauna (106). But we are still curious to know the relative importance of situations in which, for example, efficacy was (by some criterion or another) empirically verified, or plants first acquired significance for other reasons best interpreted through the analysis of different (intangible) symbols.Symbols, Signs, and the Meaning of Medicines

Although ethnotaxonomies are considered to be reflections of how people organize their knowledge of the physical universe, the interpretation of those classifications varies, as one observes, for example, in differences among structuralist, ethnoscientific/pragmatic, and utilitarian views (35, 72, 1 08). Among the various means that anthropologists have entertained to compare medical systems, several classificatory or descriptive schema stand out.

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HUMORAL CLASSIFICATIONS Many studies have described the selection of specific plants and other items of medicine as consistent with basic cognitive principles based in binary oppositions: hot-cold, sweet-sourlsalty/bitter, wet dry, yin-yang, right-left, etc-various humoral models through which health is understood as some balance of these symbolic/nontangible qualities. Thus, a medicinal is chosen because it has the quality opposite to that of the disorder it is used to treat or prevent. Tedlock (151) has recently challenged the significance of these symbolic contrasts. Especially for the hot-cold categorization in Latin America, she argues that it has become reified, an artifact of "scientism" and field methodologies that center about contrasting pairs of terms that, in effect, force respondents to select one or another. Less restrictive methodologies have elicited understandings broader than simple binary oppositions, in some cases describing continua that range considerably between two given categories (52, 55, 10 1, 102, 151).

In other cases, patterns of plant utilization are informed by the understanding that some tangible (organoleptic) attributes of the plant indicate its utility. Thus, the milky latexes of Euphorbia spp. are used in Hausa and other societies as galactogogues (e.g. 143), nettles (Urtica spp.) are used in New Guinea and Belize to treat headache (5, 76), and Hausa and Israeli healers (120) treat circulatory ailments and jaundice with red (Cassia absus, Lawsonia inermis) and yellow (Cochlospermum tinctorium) plants, respectively. The importance of these cultural categories notwithstanding, one must observe that somewhat less attention has been paid by anthropologists to biological bases of plant selection and therapeutic outcome. The mne motechnical identification of "signatures," for example, may to greater or lesser degrees be related as well as to empirical observations; one notes, for example, the presence of antimicrobial and hemostatic red quinones in some red plants (ostensibly chosen for their color), and healing (phagocytotrophic) properties of other, resinous plants (ostensibly chosen for their adhesive property), all of which are used in the treatment of epidermal disorders (25, 26). And in Colombia, amenorrhea is treated with plants selected not only for appropriate hot-cold valence and irritating action, but also for emmenagogic, oxytocic, anti-implantation, and/or abortifacient effects.g. Persea amer icana, Cinnamomum zeylanicum, Ruta chalepensis, and Petroselinum cris pum (15). Colombian women obfuscate thc differences between abortifacient and menses-stimulating effects,ereflecting an indigenous understanding of a physiologic state intermediate between pregnant and not. This cements the control that women have over their reproductive health in a society in which contraception/abortion might otherwise be strongly sanctioned. Indeed, evi dence of similar obfuscation is common throughout the Native American literature (107).DOCTRINE OF SIGNATURES

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ETKINPlant utilization may be guided as well by the

PHYSIOLOGIC INDICATORS

expectation of certain outcomes that make up a healing process that journeys from proximate to ultimate effects. For example, for many people early signs of healing include evidence that disease leaves the body. Thus, for Hausa therapy, especially of gastrointestinal disorders, plant medicines taken early in treatment

(Solanum, Sterculia, Momordica spp.) are expected to eventuate Tamarindus, Lagenaria, Moringa spp.) (45).

in diuresis, emesis, etc, while ultimately one expects emollient, antispasmod ic, and costive action (from


Similarly, as noted above, the proximate outcome of Aztec headache medi cines timately one anticipates that the pain will subside

(Aregemone mexicana, Helianthus annus) is nosebleed, while ul (118). These examples

illustrate differences among various indigenous and Western interpretations of efficacy, but they also indicate similarities that are poorly understood, if considered at all. To illustrate, is the biomedical concept of side effects-e.g. the emetic quality of most neoplastic agents-in any way concordant with what have been interpreted as early/proximate effects in other medical treat ments? In other cases non-Western and Western ascriptions of efficacy are more obviously aligned, although the specifics of perceived etiology and mode of action still vary. Thus, throughout the literature one finds examples of plants examined for efficacy in the treatment specifically of disorders for which they are indicated in some non-Western medical system. For example, Ishida et al activities of Paeoniae

(73) and Kawashiri et al (85) note the anodyne, sedative, and anticoagulant lactiflora and P. moutan, which have long been used in

Chinese medicine for the treatment of intravascular hemostasis ("stagnant blood"), which is perceived (by both biomedicine and Chinese medicine) to require anti-inflammatory, sedative, and analgesic treatment. Such studies are more meaningful if not only the plants tested match those indicated in indigenous therapy, but also the mode of preparation and administration duplicate or at least approximate indigenous therapy. For example, O'Neill et al extracts of the trans-Asian antimalarial

(117) determined antiplasmodic activity in the chloroform and butanol Brucea javanica only to learn that

those same extracts are toxic. Aqueous extracts, however, which much more closely resemble the form in which this plant is used in indigenous medicines, are also antiplasmodic and are nontoxic. Similarly, Hagos et aI's tions of Acacia

(62) prepara tortilis according to local specifications influenced respiratory

conditions such as asthma, against which it is used in Somali medicine. Other recent examples in which indigenous medical indications have been "con firmed" in aqueous extracts by biomedicine include studies of hepatotrophic activity in Butea monosperma (157), antimicrobial activity in Forsythia suspensa (91), and antineoplastic activity in Zedoariae, Cicadea, Wisteriae, and Hostae (167). The same (aqueous) preparation must be used, and atten tion must be paid to combinations of plants, which may affect activity through

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additivity, potentiation, neutralization, etc. For example, monoamine oxidase inhibitors in some plants prevent deactivation of the hallucinogenic trypta mines derived from other plants in the same preparation (149). Some Western interpreters persist in failing to appreciate the signficance of plant combinations or other forms of preparation, viewing these as "some sort of magic" or, in the case of Cave (17), as an active ingredient combined with others that are "mostly ballast." One finds, as well, studies of plants selected because of inclusion in non-Western pharmacopoeias but tested for activities either not explicitly related to or altogether different from the original intent. For example, Tanaka et aI's (149) search for new monoamine oxidase in hibitors that might be useful for the treatment of psychoses led them to test plant medicines used in the treatment of "various diseases." Similarly, Hao & Qicheng's (64) investigation of cardiotonic activity included Cordyalis bul leyana because many species of this genus are "used in Chinese medicines." And Lee et aI's (94) search for new neoplastic agents included Salvia miltior rhiza because of its "good reputation in Chinese medicine," albeit for astrin gent and antiarthritic indications, while Hikino et al (69) demonstrated anti hepatotoxic activity in Allium spp. but noted its use in various medicines as an antihelminthic, disinfectant, and "tonic." Many similar examples are found throughout the literature (61, 75, 109, 140). Still other investigators report studies of plants from a non-Western medical system but provide no information regarding the symptoms for which it was originally recommended (6, 7, 9, 20, 93, 104, 121, 142, 145, 165). What such studies imply is that there is a greater likelihood of finding pharmacolog ically active plants when one samples an existent pharmacopoeia, but chemi cal descriptions tell us little unless we understand the contexts in which these plants are used. These interpretive problems are compounded by in vestigations that report the activities of plant extracts prepared in ways that hardly approximate preparation in situ-i.e. as nonaqueous extracts. For example, Nogami et al (113) observe ulcer protective effects for Atractylodes iancea, a plant commonly used in indigenous Chinese medicine for the treatment of stomachache and indigestion, but they report on methanol ex tractions. And the import of Yamahara et aI's (166) report that the Japanese stomachic Saussurea lappa indeed demonstrates cholagogic and antiulcer activity is certainly diminished by their note that only acetone, not aqueous, extracts are active in this way. Parallels to all these examples are found throughout the literature, as are cases in which the referent symbols or physiologic signs are less immediate, more elaborate reflections of indigenous cosmologies (68, 78).PSYCHOACTIVE PLANTS


Psychotropic plants are botanically diverse but they produce similar effects on the human central nervous system. By over emphasizing such effects, researchers have implied that psychoactivity has

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motivated use of these plants. In contrast, Rodriguez et al (134) have sug gested that other pharmacodynamic features of these plants account at least for their initial selection: First antimicrobial and antiparasitic effects signaltheir utility in the therapy of various infections. Second, emesis and purga tion, which may account for at least some of the (mechanical) antiparasitic

effects, and which typically have been interpreted as side effects to psy choactivity, may have been selected initially as dosage indicators for the safe and effective use of these plants. Touw (153) also offers an interestingAnnu. Rev. Anthropol. 1988.17:23-42. Downloaded from www.annualreviews.org by Instituto Venezolano de Investigaciones Cientificas on 08/06/11. For personal use only.

treatment of psychoactive substances in a discussion of Cannabis that stresses its early uses as fiber (thread and rope) and food (seeds). It is plausible, then,

to suggest that the psychotropic effects were discovered secondarily (or in any case later) when, for example, stores of hemp fiber, food, or refuse were ignited (by accident, to reduce surplus, or as acts of aggression) in quantities sufficient and often enough to make clear the psychotropic effects to those within range of the smoke. Similarly, Plowman (126) suggests a more prosaic origin for coca (Erythroxylum spp.). While most considerations of this plant(over)emphasize the psychoactivity not even of coca proper but of the cocaine refined from it (159), Plowman suggests its origin as a famine food that was

exploited from wild stands in the eastern Andes. As associated medicinal properties were noted, the plant was collected and traded on a regular basisand variably domesticated to select for different qualities. Its activity was further modified by development of such cultural practices as sun drying, chewing in quids, addition of alkaline substances, and the like. Studies of coca stand in interesting juxtaposition to those of ginseng (Panax and Eleutherococcus spp.), the pharmacologic activity of both having been the subject in Western biomedicine of considerable hyperbole Whereas the confusion of coca with cocaine has led to attributions of exaggerated potency.

for the former, the reputation of ginseng as a panacea-which is not borne outin laboratory and clinical investigations (96)--errs in the other direction. In sum, studies of the various indicators for the selection of medicinal

plants should avoid a pervasive biomedical bias that tends to dismiss all symbolic ascriptions as "intellectual-nonpragmatic;" blurs distinctions be tween proximate and ultimate physiologic indicators; offers fragile generalizations that extend to a whole medical system and even across medical systems; and ignores the fact that the empiricism that biomedicine calls upon

to judge efficacy might find close parallels in other medical systems, thereby denying that non-Western peoples are keen observers of their physical en vironments, capable of a high degree of mastery and control.

Plant Domestication and Adaptation for Medicinal UsesEVOLUTION OF PLANT USE

Research on nonhuman primate feeding ecolo gy has shed light on the development of human dietary patterns, and more

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recently has been refined to accommodate nondietary uses of plants. For example, chimpanzees select and eat Aspilia spp. in patterns different from those used in the acquisition of plant foods. The antimicrobial activity of this species and its inclusion in some human pharmacopoeias are consistent with suggestions of medicinal (therapeutic or preventive) plant utilization (71, 135, 154, 158, 164). Such studies have interesting implications for the origin and development of human patterns of medicinal plant selection. Researchers have recently discussed the significance of different preparatory modes, especially in view of the enhanced digestibility and diminished toxicity that is achieved through various types of manipulation (65, 83, 146). Of further interest is that chimpanzees feed on naturally burned plant parts that they do not ordinarily consume and that are toxic in the unmodified state (e.g. A/zelia seeds). While it is not known to what extent this represents normal feeding for chimpanzees, or what specific implications this has for the development of human food preparations (58, 90, 111, 124), surely the control that early human populations established over fire, and the use of heat and other modes of plant preparation, profoundly affected the evolution of human diets. An thropologists with interests in ethnopharmacology would do well to follow these leads and extend such observations to other plant uses-,e.g. to medicin al applications.PLANT DOMESTIC ATlON Researchers have sought to understand human attitudes toward their biotic universe, including health related values, by studying the anthropogenic origin of domesticated plants. However, it is hard to distinguish the consequences of manipulating (whether deliberately or accidentally) putatively "wild" plants from the elaborate processes of growing "crops." Both are perhaps best understood as lying on a continuum of means of extraction (51, 127). But the problem remains of knowing why a plant was domesticated. The literature is concerned largely with food plants, in part because of the misperception that plants are either and always foods or medicines. This dichotomization has blinded us to the full ramifications of plant use (43, 45, 46). Another question that has received little attention is the extent to which plants first cultivated as medicines later were used also or exclusively as foods, and vice versa. Soybeans (Glycine max), for example, were first cultivated in China as medicine (83) and only later, and then emphatically, became part of diet; whereas, as noted above, Andean coca (Erythroxylum spp.), which may have been first a (famine) food, now is categorized as a medicine and, intermediately, as a "tonic." For the large number of species that serve both as medicines and as foods we might never unravel questions of precedence. Thus, the origin of particular human-plant interactions is likely as multivalent as contemporary plant use suggests. The more conventional explanations of plant domestication that relate

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subsistence change to climatic stress or population pressure have made way for more comprehensive feedback models that view change as based in selection among options. These include various coevolutionary models and efforts to explain the anthropogenic origin of plants through analysis of the role of human cognition, foraging strategies, trade networks, and com binations of these concerns (49, 66, 77, 86, 103, 114, 132, 163). Some of these interpretations are particularly reductionistic in positing an especially close fit between the nutritive value of plants and their adoption. Whereas most of these formulations have focused on the increasingly concentrated exploitation of staples, other researchers (48) argue that "cultural factors" that reflect the "sensory appeal" of plants associated with medicine, material culture, diet, cosmetics, and presumably other aspects might have been at least as significant. This view is supported in part by archaeological data from Asia and North America showing that the first domesticated plants were not staples, but instead included species of Canarium, Areca, Capsicum, Persea, Piper, and other plants used therapeutically (as well as in diet, decoration, and manufacture) by contemporary populations in those regions (97, 107). Similarly, Posey (127) describes medicinals among plants that the nomadic Amazonian Kayap6 transplant to their "forest fields" in order to assure access to a range of useful species. Then, if staples were not (always) the first domesticates, as has been conventionally assumed, which attributes were selected? Knowledge of plant constituents is central to such questions. Throughout its history, Western sci ence has focused study upon natural products. Advances in biochemistry have taught us that some classes of natural products can best be understood through their functions in all organisms. Metabolites such as nucleic acids, L-amino acids, and fatty acids are termed "primary" (or intermediary) and are recog nized to be similarly or identically synthesized and utilized throughout the biological world. But a continued concern in ethnopharmacology has been the so-called "secondary metabolites, " a much larger and more diverse collectiv ity that includes such constituents as terpenes, alkaloids, phenols, mycotox ins, and the like. These phytochemicals have traditionally been thought to have no explicit function in the lifeways of the organisms in which they are found; and while they have been perceived to be useful in individual cases for taxonomic differentiation, this only emphasizes their specialty (21, 152). Not only is the distinction between these two features of metabolism blurred, but also it has become increasingly apparent that the so-called secondary metabo lites play roles equally critical for the well-being of organisms, and they mediate the coevolutionary relationships that link plants and animals. For example, many pharmacologically active compounds are produced in defense against intra- and extraspecific competition (allelopaths, for example," " SECONDARY PLANT METABOLITES

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inhibit germination and growth of other plants), microbial and insect infec tion, and other forms of predation (22, 87). Among the better known pharmacodynamic secondary metabolites are various oxidants: quinones e.g. the hypericins in St. -John's-wort (Hypericum hirsutum) and buckwheat (Fagopyrum esculentum); furanocoumarins (psoralens), found throughout the Rutaceae and Apiaceae---e.g. Apium graveolens (celery) and A. sativum (parsley)--and in other families---e.g. Brassica rapa (parsnip); polyacety lenes and their thiophene derivatives, occurring primarily in the Com positae---e . g. Bidens pi/osa. Other defensive compounds include triterpe noids, such as those found in Boswellia carterii, Acanthopanax chiisanensis, and Commiphora spp.; alkaloids; and a large variety of tannins. Other con stituents act as attractants (for pollination and seed dispersal), in some cases through elaborate patterns of chemical mimetism (12). On the other hand, coevolution may be too simple an explanation for the presence of secondary metabolites. Some may more truly be "secondary" in the sense of maintaining basic metabolism under conditions of nutrient restric tion or other environmental constraints (8, 92, 133, 139). There are significant implications here for plant domestication and the development of agriculture and the expansion of "natural" (wild) pharmaco poeias. The domestication of plants and the resulting human perturbations of plant habitat (through irrigation, inter- or monocropping, etc) profoundly affect the type, distribution, and amount of product produced (10). These relationships have not escaped the attention of indigenous peoples who avail themselves of a great variety of plants. For example, throughout the Arabian Peninsula khat (Catha edulis) is sold at different prices at different times of day, the cost diminishing with time postharvest because psychotropic activity gradually decreases (57, 88). Similarly, different potencies of Andean coca (Erythroxylon spp.) (125, 126) and Nigerian kola nuts (Cola spp. ) are re flected in variable cost and other valuations; and the Hausa distinguish generally among medicinal plants by site of collection, plant part, diurnal and seasonal periodicities, and the like. In the same way that food plants are biologically (through selective breeding) or behaviorally manipulated to de toxify them (e.g. by subverting defensive chemicals) or otherwise render them more palatable and culturally acceptable (by cooking, drying, scraping, mixing, etc), people modify medicinal plants for their own, culturally con structed needs. Nowhere is this better or more elegantly illustrated than in the work of Johns (78, 79), who elucidates the complex relationships between the selection and manipulation of domesticated Andean tuber crops-Tropaeolum tuberosum, Lepidium sativum, and Solanum ajanhuiri-to conform with taste desirability and selection for medicinal use in fertility regulation. Thus, there are various sequences through which use, and specifically medicinal use, of a particular plant might become established. Rejection is as


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much a part of the process as is adoption. Cause operates at several different levels, so that all variations of such developments likely have been irnpprtant throughout human history, albeit to varying degrees and changing temporally, spatially, and by plant, disease, and substance category. One cannot prove the suitability of one model or another; several similarly plausible developments can be engaged; and one should in any case be suspect of explanations that invoke only one or even a few such mechanisms, for there is often' as much variation within as there is between p,opulations, an observation that of(en is obscured by the implicit notion in some research of intrapopulation homogeneity-shared views, native taxonomies, and "emic" perspectives. This assumption of homogeneity belies, for example, differences between the fundamental medical understandings of healers and other members of a society, as well as differences between .the understandings among various types of curers and among different categories (class, age, gender, etc) of people at different times, during different phases of a disease, and so on. MULTICONTEXTUAL ,PLANT UTILIZATION Because foods tend to be consumed in larger quantities, the pharmacological ly active constituents in plants used as food would likely have an overall greater impact than those in plants used as medicine and taken only in small doses. Conversely,although individual consumptions of "teas'? 'and "tonics" might entail smalf 'quantities of plant material, the fact that such items are consumed frequently might contribute signficantly to their overall effect. The. point in any case is to determine the health impact of a person's total exposure:: to active plant constituents. Thus, investigations cir-eumscribed by the con ventional disciplinary boundaries-i.e. studies in "medicine," in "nutrition/ diet," etc-may miss the overall impact of plant substances on human biology and culture. Cultures may variously ascribe dietary or medicinal value to different plants, and plants consumed during meals or snacks'may be dis tinguished from plants consumed as medicines, but there is a high potential for overlap;' a plant may be a food, a medicine, a medicinal/healthy food, or a nutritious medicine. The distinctions among sllch:'categories are best blurred and the topic more fruitfully approached from the perspective of "ingested. botanicals. " This is illustrated by medicines used in the Hausa treatment of gastrointes tinal (GI) disorders and malaria, where one observes considerable overlap of "dietary" and "medicinal" plants. Examination of the efficacy of the plants used shows that for GI disorders the Hausa ingest. plants with costive, emollient, and other such' actions, and that oxidative phenomena produced by" certain plants and tl1e patterning of diet likely have antimalarial effects (39, 41, 45, 46). Similarly, Hammerschmidt (63) suggests that a relatively low in-

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cidenceof:cardiovascular disease in parts of China cali be explained in, part by , the antiatherogenic effects of medicinal, dietary, and "tonic" plants spp. (onion, garlic, scallion),

Allium Zingiber officinale (ginger), and Anisodus-

cause diminished platelet aggregation and relieve al!gina pectoris

tanguticus. This suggestion is supported by reports'that some of the plants (115). From New Guinea one can note the significance ,of plants with antimicrobial [Impatiens, Eugenia (clove)], febrifuge (Aneilima, Zingiber), antidiarrhetic (Cinnamomum), and stomachic (Coleus, Zingiber) activities, since theseplants are consumed as part of "medicinal meals" shared by a social collectiv ity, all members of which likely benefit


,cinal applications are illustrated as well by Johns

(76). Interrelated dietary and medi(78, 79), cited above.

Most pharmacologic studies posit human-plant interactions (at least tacitly) assuming that populations (of plants and people) are' fundamentally biologi cally homogeneous. There is reason to suggest, however, that the pharmacologic action and dose-response relationships of some substances are significantly affected by "ethnicity," thereby invoking both genetic and en vironmental differences. For example, the use of coumarin-containing plants by. peoples with variants of "normal" serum albumin A illustrates how fea tures of human biology can significantly affect the physiologic import of medicinal and dietary plants. Albumin variants that occur in high frequency among some Native Americans

(128) bind significantly less coumarin than

albumin A does, and thus the pharmacologic activity of coumarins and related phytochemicals will affect such individuals more profoundly. Similarly, in dividuals' who are protected against severe malaria infection' by an inherited enzyme

(G6PD Med) deficiency are prone to hemolytic reaction to oxidativeViciafaba, the fava bean) (84). Other features that predispose

constituents of a variety of plants, including a number of common medicines and foods (e.g. to differential reactions to pharmacologically active substances include differ ences in metabolism, variability in tolerance due to differences in body weight and fat .. distribution, receptor physiology, and genetic and environmental differences in pharmacokinetics. ' Other salient environmental variables in clude diet, especially protein/carbohydrate ratios and fat content, and con sumption of "drugs" and other pharmacologically active substances. Cultural variables include differences in attitudes about treatment and expectations of outcome

(27, 81, 98, 144).

APPLICATIONFew works discuss specifically the application of ethnopharmacologic data to the resolution of health problems worldwide. Whereas some envision the improvement of primary health care only in terms oLmore efficient man ufacture, distribution, and administration of biomedicine (e.g. 150), others

36

ETKIN


advocate a central role not only for indigenous healers (herbalists, curers, shamans, etc) but also for non-Western medicines (2, 4, 119, 123). Nonethe less, as Brown (4) cautions, "it is not enough to retail the usual pieties about the potential value of plant medicines. " Practical approaches for the im plementation of indigenous medicines must follow rigorous appraisal of their pharmacology and the complex social fabric of which they are a part. Studies that incorporate a clinical component go some distance toward making that a reality. Overcoming significant difficulties in assuring ethical standards in human experimentation, clinical tests have been included in the protocol of investigations of Nigerian (Igbo) antiarthritic medicines (74), plants used in the treatment of dental infections (37), indigenous anti hypertensive medicines (82), and antimalarial activity in Artemisia (161). Among other clinically significant applications of this sort of work are efforts to develop new medicines for infectious agents that have, as adaptations to the (over)use of immunization and therapy, evolved various types of drug resis tance. Perhaps in no case is this more dramatic than in the increasing number of drug-resistant malaria strains and the growing number of studies that address that problem through investigation of natural plant products for antiplasmodial activity (3, 13, 18, 117, 122, 161). Ethnopharmacology has implications as well for (agricultural) development projects for which success depends largely on the extent to which new strategies of resource exploitation inform themselves of indigenous ecological knowledge that has developed in situ ("folk ecology") (16, 53, 127, 129131). Especially to the extent that "development" is wont to focus on staple crops, perturbations of the local ecology, including habitat destruction or simplification, are especially likely to affect "secondary" plants, many of which figure importantly in both medicinal and dietary contexts (42, 45, 46, 50). SUMMARY This discussion is a critical review of studies in ethnopharmacology, particu larly as they contribute to some of the kcy debates in anthropology. A central thesis is to illustrate through exposition and comparison the utility of a biobehavioral and multidisciplinary perspective. Thus, it is important to understand the cultural construction of efficacy and to appreciate the multi plicity of contexts in which plant use occurs. These considerations are applied in the exposition of several themes. (a) Understanding the origins and later refinements of plant utilization requires attention to what medicines mean and to the structural codes that guide their selection, preparation, and administra tion. Consideration of more strictly semiotic/mentalist interpretations, as well as of physiologic indicators, is appropriate. Investigations of plant domestica-

ETHNOPHARMACOLOGY

37

tion, including genetic and cultural manipulations of "secondary" metabo lites, help to shed further light on these questions. (b) Understanding the different contexts in which plant use occurs-diet, medicine, manufacture, etc-helps us to assess the impact of botanicals on human health. (c) Ethnopharmacologic data have a still unexplored potential to help solve real health problems.ACKNOWLEDGMENTS


I thank Daniel Moerman and Paul Ross for discussions and constructive comments during the preparation of this chapter and Marline Spring for verification of bibliographic citations and manuscript revisions.Literature CitedI. Abatan, M. 0., Makinde, M. J. 1986. Screening Azadirachta indica and Pisum2. 3.New York Botanical Garden

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