Essentials of Complementary and Alternative Medicine (June 1999)

DIAGNOSIS AND DIVINATION: THE REALM OF SPIRIT
Diagnosis
There are numerous methods of diagnosing disease. Diagnostic ability depends more on the intuition, sensitivity, and spiritual power of the healer than on the 
precision of a particular diagnostic technique. Therefore, diagnostic methods may vary not only from tribe to tribe, but also from healer to healer. Healers may create 
new diagnostic methods or find creative adaptations of practiced techniques in any particular healing session.
As in Western medicine, the Native healer observes presenting symptoms and frequently asks the patient to describe them. The healer pays attention to the age and 
gender of the patient, the history and duration of the problem, and nonverbal cues, such as posture, breathing, tone of voice, and general deportment. The Lakota 
holy man, Fools Crow, would talk to the patient about his philosophy of healing (
54
). He would also discuss the possible causes of the disease, the patient's lifestyle 
and relationships, and how the patient's disease was affecting his family. The purpose of this lengthy discussion was not merely diagnostic, but also “to draw the 
people completely into the curing process, to engage their total persons, to get them communing fully with  Wakan-Tanka [the Great Spirit] and the Helpers, and to 
enhance their own curing abilities and those of the ‘hollow bones' [clear-minded healers] who treated them” (
89
). Fools Crow would enter the sweat lodge or practice 
other rituals of purification and communion to ask his helping spirits, the Great Spirit, or both for further information about diagnosis and treatment.
Among the Navajo, if the medicine man is unsure about diagnosis, diagnostic specialists may be consulted: “They are able to place themselves in a state of trance at 
will, and diagnose illness by divination—hand trembling, star gazing, crystal gazing, or ‘listening”' (
90
). These Navajo diagnosticians practice techniques in common 
with healers of many other Native traditions. Wintu shaman Flora Jones enters an altered state of consciousness by smoking wild tobacco, drinking clear acorn 
water—an offering to her helping spirits— and singing sacred songs, accompanied by an assistant (or “interpreter”), the patient, and various friends and family 
members. According to author P.N. Knudtson's observations, “With the diagnostic powers of the spirit-helpers acting through her hands, she begins to move her 
fingers carefully across the patient's body sensing unseen, internal injuries or abnormalities” (
91
). Flora Jones feels the patient's disease or pain in her own body: “I 
become a part of their body.”
Divination
Medical divination is the attempt to elicit medical information from divine or spiritual forces. It is commonly practiced by interpreting dreams, waking visions, or omens 
seen in such apparently random events as a toss of coins, a pattern in flowing water, or the crackling of a fire. Medical divination has a world-wide distribution. It was 
practiced by the Chinese more than three thousand years ago. African Zulu shamans cast “the bones,” seeing the diagnosis and prognosis of disease in a prayerful 
toss of ivory and other personally meaningful objects. Native Americans employ water, fire, smoke, stones, crystals, or other objects as projective fields in which they 
can “see” the reason and course of a disease. Sometimes, the patient is asked to read the markings on a stone in a type of free association to help both the patient 
and the healer discover relevant information from the  realm of Spirit—what we might call the unconscious, both personal and collective. This realm of Spirit may also 
be accessed in the pan-Indian Sweat Lodge Ceremony (
92
), during the Lakota Yuwipi (
31
) or Cree Kosãpahcikéwin, “Shaking Tent” (
93
), during which helping and 
diagnostic spirits speak to the holy person in the darkness. Spirits also supply diagnoses during the darkness of dream-time. Before sleep, the healer cleanses herself 
with the smoke of a sacred plant, such as sage or cedar, and prays that the dream spirits inform her of diagnosis, treatment, and prognosis.
Divination plays a prominent role in Cherokee diagnostics (
94
). The healer holds a pebble in each fist and recites a prayer formula. When the healer opens his or her 
hands, if the pebble in the right hand moves, the answer to the diagnostic question is favorable; if the pebble in the left hand moves, the answer is unfavorable. In a 
similar way, a silver coin may be immersed in water and its movements interpreted. In another Cherokee divination, a freshly cut stick is partially immersed in a stream 
at daybreak. The healer recites his or her own name and the name of the patient, and while circling the stick in a prescribed manner recites the formula, “Now! Long 
Person...,” quoted at the opening of this chapter. The healer must then interpret the clarity of the water, the presence of floating debris, or the omens presented by 
passing fish or birds flying overhead.
It must be emphasized, again, that the essence of Native American diagnostics is not the technique, but the ability of the healer to see the patient with the inner eye of 
spirit, to sense disturbances of energy with the hands and heart, and to commune with higher sources of knowledge. For this reason, the diagnostic procedures are 
ineffective if merely imitated and cannot be easily taught to those who do not participate in Native tradition.
SACRED TECHNOLOGY: HOW MEDICINE PEOPLE PRACTICE HEALING
Methods of treatment are as varied as methods of diagnosis. The most common methods include prayer, chanting, music, smudging—purification with the smoke of 
sacred herbs—herbalism, laying on of hands, counseling, and ceremony (
Table 13.2
).

Table 13.2. Common Therapeutic Method*
Prayer and Chanting
Healing always begins with prayer. The healer prays each day to prepare himself or herself for the work ahead. The healer may also pray with and for the patient. In 
addition to the invocation of transcendent powers and presence, prayers serve a very practical purpose for the patient. They focus his or her mind on the problem at 
hand. Among northern plains nations, the patient wraps pinches of tobacco in small pouches of cloth (“tobacco ties”) while praying for health and divine help. The 
patient's prayerful preparation for healing is, of itself, healing.
Prayers are directed towards the highest good and generally closed with the traditional expression, “All My Relations.” This expression is far more than a Native 
American version of Christianity's “Amen.” “All My Relations” is a statement of the basic Native American philosophy that we should always dedicate prayers to the 
health, harmony, and balance of all natural and spiritual relations: the Stones, Plants, Animals, Two-leggeds, Earth, Sky, Sun, Moon, Ancestors, Spirit Helpers, and, 
most importantly, the Great Spirit.
Chants, like prayers, may be spontaneous or culture-specific formulas, such as the complex Night Chant of the Navajo or the “remaking” chants of the Cherokee. 
Some chants, such as those used in Si.si.wiss (“Sacred Breath”), an intertribal healing tradition from the Puget Sound region of Washington State, use specific 
breathing techniques along with sacred words to drive noxious forces out of the body or to attract healing power.
5
Music
Many prayers are sung. There are songs to express gratitude, to celebrate, or to invoke the power and blessings of every aspect of nature; there are songs to willow 
trees, thunder spirits, snow flakes, salmon, bear, the winds of the Four Directions, water, fire, and to healing and guardian spirits. Songs may attend the gathering and 
preparation of herbal medicines. In  Si.si.wiss tradition, songs empower the healer and provide a continuous background during the laying on of hands. Some songs 
are healing power: they enter the patient to seek out and remove pathogenic forces or invading spirits. Songs are received in dreams or visions, or are learned from 
elders and medicine people.
Most songs are accompanied by a regular drum-beat. Sometimes, the drum itself is an agent of healing; its rhythm entrains the minds of both healer and patient and 
leads them to an expanded awareness of self and spirit. Many healers substitute or add the rattle to their healing sessions, using the sound and movement of the 
rattle to shake away disease. In the Indian Shaker Church, bells, a new “medicine” borrowed from Christianity, accompany the healing songs and evoke God's healing 
power. The Indian flute, although rarely used in healing others, can be an important instrument of self-healing. Patients play the flute to empty the mind of worries and 
preoccupations while meditating with Nature and attuning to Her healing power.
Smudging
Native healing sessions frequently begin with smudging, which is a ritual cleansing of place, healer, helpers, patient, and ritual objects with the smoke of a sacred 
plant, typically sage (salvia apiana, other salvia subspecies; or referring to the wormwoods:  artemisia vulgaris, a. tridentata, a. frigida, etc.), cedar (libocedrus 
descurrens or juniperus spp.), or sweetgrass (hierochloe odarata). Some healing ceremonies consist of nothing more than smudging the patient while praying. 
Smudging induces an altered state of consciousness, heightened emotions
6
, and increased sensitivity. Because the tools of the Native healers are hands, heart, and 
spirit, sensitivity to energetic or spiritual imbalance is a necessity for diagnosis and therapy.
Herbalism
Native Americans generally believe that, in ancient times, there was a local plant cure for every disease. Today, because of drastic changes in the environment and 
population and the scourge of new diseases, these remedies are not as effective. Most of my Native relations do not hesitate to see a conventional medical doctor for 
any condition that generally requires antibiotics or surgery. Native Americans use herbs  and Western medications, realizing that each has its strengths and 
weaknesses.
Native American herbal medicine, like the gifts of Native agricultural technology, saved the lives of early colonists and continues to save lives today. According to 
Virgil J. Vogel's classic  American Indian Medicine, “about 170 drugs which have been or still are official in the  Pharmacopeia of the United States of America or the 
National Formulary were used by North American Indians north of Mexico, and about 50 more were used by Indians of the West Indies, Mexico, and Central and 
South America” (
95
). Jacques Cartier (1491–1557) was cured of scurvy by a Huron decoction of pine needles, which are high in vitamin C. Native Americans taught 
Europeans to cure malaria with quinine, to expel toxins with ipecac, and to treat constipation with the most commonly used laxative in the world today, cascara 
sagrada (rhamnus purshiana).
Herbal remedies can reduce fevers, inflammation, and pain and, when applied topically, prevent infection. Weatherford (
96
) has an unsurpassed narrative account of 
the gifts of Native American medicine to Western pharmacology. Some herbs, such as “Grandfather Peyote,” are considered medicines for the body and soul and are 
ingested in a spiritually charged atmosphere of drumming, singing, prayer, and cedar smoke. Peyote has been attributed with cures of leukemia, tuberculosis, 
pneumonia, stroke, and other disorders (
97
).
Native herbalists may have a repertoire of 300 or more herbs (
98
, 
99
), used singly or in various combinations. Some herbalists use only the plants that appear to them 
in dreams, which is often a result of praying for a particular patient. In the 1920s, a Lakota healer told Frances Densmore, “A medicine man would not try to dream of 
all herbs and treat all diseases, for then he could not expect to succeed in all nor to fulfill properly the dream of any one herb or animal” (
100
). It may be futile to look 
for distinct chemical agents in Native American medicine as explanations for efficacy, because much of an herb's effect may be due to ritual methods of gathering and 
usage. At St. Regis, Mohawk Nation, there are approximately 200 ways of gathering plant medicines (
101
). In the Navajo Night Chant, some plants are gathered only 
when the lightning flashes or used only during specific chants (
32
).
Laying on of Hands
Massage, healing touch, and non-contact healing are practiced by Native healers throughout North and South America. Native Americans find it amusing that 
therapeutic touch, a similar modality, is being tested in modern medical and nursing research. Yet few nurses have sought pointers from America's senior 
practitioners! In Native practice, the intent of massage is not merely physical. Often the hands are used to sweep away or remove spiritual intrusions or to brush in 
healing powers.
Cherokees warm their hands over coals and circle their palms either on or above an affected area (
102
; and personal communication, Cherokee medicine man 
Keetoowah
7
, 1978). Some healers hold their hands to the front and back of an affected area, creating what they now call “electrodes within the body” (
103
). The 

healer imagines that electricity is moving from one hand to the other. Sometimes the muscles are rubbed in a manner similar to Western massage. The Cherokee use 
massage to relieve tension, sprains, and pain. Massage oils made of buffalo fat, bear grease, or sea algae may also be applied. To increase the healing effect, the 
medicine person massages specific therapeutic points (
104
) or practices an ancient indigenous form of acupuncture and moxibustion (the application of heat or 
burning herbs to the body) (
105
). For example, Eagle Plume, a renowned Blackfoot medicine man, treated his son's knee injury by inserting rose thorns into the skin 
and burning them down to the bottom (
106
).
Counseling
Because Native healers recognize that  all health problems affect the mind and spirit, counseling is frequently a major part of the intervention. Clan mothers, respected 
female elders, are especially known for their ability to offer kind, wise, yet strong advice during times of emotional difficulty. Native counseling emphasizes health 
rather than pathology. The counselor generally seeks to augment a person's strengths rather than analyze or focus on weaknesses. Humor is frequently used to help 
break obsessive and overly serious thinking or behavior. The goal is not to return a person to an average or “normal” state; instead, the goal is to help the patient 
actualize his or her fullest potential by discovering the gifts of Spirit—“the original instructions.”
Counseling may take the form of talking things out or listening to the insight of an elder or medicine person. The counselor may help the patient create or discover an 
image of improved health, perhaps by interpreting patterns seen in projective fields (e.g., fire, smoke, stones). Or, the healer may help the patient access healing 
guidance by interpreting his or her dreams or visions. The counselor may also use his or her own visualization of healing powers to affect a proximal or distant patient. 
The healer's “office” is often the sacred sweat lodge, hogan, or other ceremonial lodge, where both healer and patient can more easily discard avoidance, denial, or 
hindrance to the truth.
Ceremony
Ceremonial healing includes both healer and patient. The most basic form of ceremony is communicating with the spirit of a disease through prayer and ritual. 
Although the goal of the ceremony is to gather information, leading to the release of pathogenic forces, sometimes the patient must first make an offering to these 
forces—a symbolic gift of words or gesture—to demonstrate acknowledgment and respect.
In Duran's (
77
) effective adaptation of tradition in the treatment of Native American alcoholism, the patient speaks to the spirit in the bottle. When a patient was 
offered an alcoholic drink at a social event, this approach “allowed for the psyche of the client to become aware as to the risk involved as well as to activate the 
unconscious process of the group...” (
107
). According to Duran, the patient has “taken the offensive ‘warrior' stance as opposed to the victim stance.”
Healing power is present in the ubiquitous Sweat Lodge (also called the Purification Lodge or Stone People Lodge). The Sweat Lodge is a dome of willow branches 
covered by blankets in which the patient, healer, and helpers pray and counsel together while ladling water onto red-hot stones. The lodge, pitch black but for the 
glow of the rocks, is a symbolic womb, a return to primal wisdom. Traditionally, separate ceremonies are conducted by and for women and men. In some ceremonies, 
the sacred pipe is smoked to further open the mind to healing guidance (
108
, 
109
).
Healing ceremonies received during dreams and visions belong only to an individual healer. Other ceremonies are culture specific and are powerful affirmations of 
cultural identity and values. There are an extraordinary number of these unique healing ceremonies. The following are just a few:
Navajo “sings” and sand-painting
The Green Corn and Midwinter rites of the Seneca “faces”:  gagosa, which are masks that personify spiritual beings and powers and are often made to fulfill a 
dream
The Lakota Yuwipi
Native American Church ceremonies
Healing rites of the Ojibway Midewewin and other medicine societies
Shamanic exorcisms of the Inuit
Winter “spirit dances” of the Salish
Other Healing Sources
All Native Americans recognize the source of healing in Nature and Spirit. For example, natural elements, such as earth, water, mountain, and sun, are considered 
elder healers; by harmonizing with them, patients may experience spontaneous healing or find intuitive solutions to their problems. Native Americans also recognize 
the healing power of fasting and inner silence as ways to become more receptive to any healing influence. Family and community are also important facets of many 
healing sessions. “Helpers” are often essential to add healing power and to reintegrate the person into the community. As all human beings can attest, illness creates 
a feeling of alienation both from one's own normal self and from normal relations with one's community.
Duration of Therapy
Disease can have a slow or sudden onset. Similarly, healing can occur quickly or over a long period of time. However, even in serious or chronic disease, long-term 
therapy may not be required. The intensity of therapy is generally considered more important than the duration (
110
). Research in dissociative identity disorder (
111
, 
112
 and 
113
) suggests that sudden changes in consciousness may result in sudden changes in physiology. One alter (i.e., a disassociated identity) may suffer from 
diabetes or allergies, whereas another alter may be asymptomatic and apparently healthy.
In Native American healing, the change of consciousness is not from one pathological adaptive state to another, but rather from an unhealthy condition of mind and 
body to a healthier state. The healing ritual shocks the patient into a new awareness of self and Creation. Healing may not be a gradual process but rather a quantum 
leap. However, Native healers recognize that patients must make lifestyle and behavioral changes that reinforce and maintain the improved condition. Although 
healing may occur quickly, way of life makes healing last.
ORGANIZATION
Lifelong Training
Healing power can be inherited from ancestors, transmitted from another healer, or developed through training and initiation (Johnny Moses, personal communication, 
1988). However, the best way to develop, strengthen, and maintain healing power is through rigorous personal training. Among the Snohomish, “individuals 
sometimes inherit a power from a grandmother, grandfather, aunt, or uncle.... If they want that power to be strong, they have to fast and go through a lot of sacrifice” 
(
114
). The only prerequisite is patience.
Native healers generally train under one principal mentor, often a family or clan member. As anthropologist William S. Lyon notes, “It is really the function of the 
teacher to train the novice how to be trained directly by the spirits” (
115
). However, today, with the greater ease of travel and intertribal communication, many healers 
have several mentors. Wallace Black Elk (
47
) had 11 “grandfathers.” Medicine Grizzlybear Lake (
52
) had 16. Whis.stem.men.knee (Johnny Moses) was asked to 
carry on his family's medicine at age 13, after being shamanically cured of cancer. He studied northern Nootka and Saanich traditions with his grandparents and later 
with several other medicine people (
116
). Among the Yakima, a boy or girl might prepare for spiritual training at age 6, when he or she was brought by an elder to 
secluded places in nature (
26
). Following the practice of many Native nations, the child leaves for his or her first vision quest at puberty. After years of continued 
training and power seeking, sometimes lasting into middle age, the Yakima novice would participate in the “Shaman's Inaugural Dance.”
The English word medicine man implies a uniform role and gender, which is incorrect. As we have already seen, some medicine people are ritual experts; others 
specialize in curing snake bites, setting bones, countering sorcery, divining, prescribing herbs, and so on. The Lakota distinguish the  pejuta wicasa, herbalist, from the 
wicasa wakan, the “holy person” who communicates directly with the healing powers.
O
JIBWAY
 M
EDICINE
 T
RAINING

Medicine training is sometimes the domain of specific medicine societies. Among the Ojibway, this “university” is called the  Midewewin (
117
), a word meaning “the 
sounding [of sacred instruments: drum or rattle]” or perhaps a contraction of  Mino (good) and daewaewin (hearted). A member-sponsor recommends a male or female 
candidate, who is invited to join only after a long period of character assessment. A new member must generally pass through four Orders, or Degrees, before being 
fully accredited as a medicine person. In each Order, a new tutor is assigned.
In the first Order, the candidate is instructed once or twice weekly for one year in the sacred knowledge of plants, songs, and prayers. After initiation rites and testing, 
he proceeds to the second Order; in this Order, the novice learns the history of his people and how to keep the spiritual senses open. In the third Order, the member 
learns to commune with and summon spiritual powers and generate healing energy in the ill. In the fourth Order, the initiate is further purified, tested, and initiated to 
assure that he or she can resist malevolent forces. On completion of the fourth Order, the member can test candidates and confer and confirm power in others. 
Although now fully accredited, his education is not finished. The member continues to learn and train and to abide by the moral code of the Midewewin.