The Role of Traditional Healers and Traditional Medicine in Bali

The Role of Traditional Healers and Traditional Medicine in Bali

“Science without religion is blind, religion without science is paralysis.”

                                                                                                     Albert Einstein      

A lecture in the village on the Traditional Medicine

Collecting some plants for medicine

Abstract: In this paper, I will explore the various types of traditional healers (balian) of contemporary Bali, and the roles that they play, as well as how traditional medicines are used as one of the alternative forms of supporting the healing process.

In Bali, we believe in two different worlds: the visible world (sekala) and the invisible world (niskala). We, the sekala beings, share our living space with the niskala beings, which can be either malignant or benevolent in character. We believe that the invisible beings can cause many kinds of misfortunes including accidents, crop failure, death of a family member, or loss of a job. To neutralize the negative powers of the invisible beings to us, we should create harmonious relationships with them in order that they can provide us with protection, rather than plaguing us with difficulties.

If someone gets slightly sick in Bali, the first thing they will do is to make traditional medicine with ingredients that are available in the surrounding area. This knowledge about traditional medicines is transmitted from generation to generation, both orally and by means of written documents, which were originally influenced by the Ayur Vedic literature from India. If these traditional medicines fail to cure someone, then usually they seek help from local allopathic practitioners like nurses or medical doctors. On the other hand, if the allopathic practitioners fail to cure their ailment, or if they cannot afford the relatively higher cost of allopathic treatment, many people will go to a traditional healer in order to seek a cure through spiritual and mystical ways of healing, perhaps accompanied by more specialized forms of herbal medicine.

There are many types of balian in Bali, so people can go to a specialist depending on the kind of sickness involved. Some balian are not strictly speaking healers, but rather provide advice and guidance on how to deal with troubles caused by unseen spirits, either divine or demonic. However, even in this case the larger question of maintaining a healthy relationship between the “seen” and “unseen” worlds is at stake, so that balian of this type can be understood as making important contributions to both personal and community health.

A female healer known as dasaran or spiritual medium

How happy we will be if God blesses us with good health,  prosperity, as well as long life. According to the World Hearlh Orgainization, good health is the state of being of people who are  physically, mentally and socially healthy and there is no defect in their physical body (Meitriya, personal communication 2007). According to Made Setiawan (2009), Balinese only consider themselves sick if they can’t eat and walk or work in the rice-fields. If someone feels sick, the first thing s/he will do is to try to heal herself/himself by making traditional medicines based on ingredients that can be found in the surrounding area of the places where they live. Then, if they can’t cure themselves, then they will first turn to a traditional healer who lives nearby nearby, rather than to an allopathic doctor trained in modern medical methods. They will visit the house of the healer, bringing with then offerings (banten) that typically contain fruit, uncooked rice, coffee, sugar, acoconut, an egg and a nominal amount of cash.

Since ancient times, our human ancestors have tried to maintain their health through proper diet and the use of herbal remedies aimed at maintaining the balance of “hot” and “cold” states of the body. At the same time they also tried to look for effective ways to cure sickness, to find and use the right medicines to treat those who were suffering from diseases. While some of the great medical traditions of the past have been lost, there are others that preserve effective ways to cure sickness even today. For instance, we still find that traditional medicine is still strong in the Chinese, Indian and Arab traditions and in the Malay-Indonesian archipelago in islands like Sulawesi, Kalimantan, Java and Bali. In Bali, there are many ancient palm-leaf manuscripts called Longar Usada that deal with the traditional medicines. These are, specialized manuscripts that provide guidance for those who want to be professional traditional healers or balian. The Balinese word usada is originally from the Sanskrit word oṣadha, or auṣadha, thus highlighting our belief that the knowledge oof traditional medicines and herbal cures in Bali was influenced by the Ayur Vedic form of traditional medicine from India (Nala, 1991: 18).

In recent times, there has been tendency in many countries to desire to go back to nature in terms of diet and medicine, so that traditional medicines made from natural ingredients have become more and more popular. One important consideration for using traditional medicine is that with their use there are minimum side effects in the long run, especially if we compare their use to the usage of synthetic, allopathic medicines produced by large pharmacuetical companies. In Bali, where the higher cost of allopathic medicines is also a factor, there has been a growing movement to use organic foods and to maximize the functions of the traditional medicines. Some farmers have started going back to their traditional ways of cultivating rice by incorporating the waste products of their domestic animals into the soil and thus improving the quality and quantity of nutrients needed by plants that grow in the rice-field and gardens (Ngurah Karyadi, pc 2010). One government institution in Bali known as UNHI (Universitas Hindu Indonesia) has supported the importance of traditional healers and traditional medicines by establishing a department to accommodate those who are interested in gaining more knowledge in traditional study in that institution will be rewarded a certificate entitling them to treat patients in traditional ways.

The Ayur Veda is the ancient medicinal book for the Hindu population of India. It has been used from ancient times up to the present day, and has influenced the development of modern medicinal treatments as well. The contents of this book are often found attractiveand useful by modern medical doctors, health experts and pharmacologists throughout India, and this has led to the establishing of institutes for the study of the theories and practices of Ayur Vedic medicine that are officially recognized by the Indian govenment. Most of the knowledge about medicine in Bali which is described in the palm-leaf manuscripts called Usada originated from the Ayur Veda,, but there has been considerable local develpment too, since traditional medicines have long been a part of the life of the societies of the Malay-Indonesian archipelago, and in fact the materia medica of the archipelago were traded throughout the ancient world, especially from sources in the highland and jungle areas of Sumatra. Many of the ingredients that were once traded as far as India, Greece and Rome to the west, and China to the east, are similar to those that are found in Bali and have been preserved in recipes for medicines recorded in the Usada manuscripts. The rich variety of medicines and treatments recorded in these manuscripts is reflected in the fact that there are specialized lontar usada that describe the symptoms of particular illnesses and the ways that have been found most effective in treating them.[1]

If we read translations of the Ayur Veda or the Lontar Usada we may find it almost hard to believe that the medical science was so highly developed and codified in ancient India and Inodnesia that we   information about medicines that are still effective to the present day. The effectiveness of these ancient practices is beginning to receive positive attention from modern medical practitioners and scholars throughout the world, attesting to the power of the steadfast meditation and practical experience of the medical experts of the past.

According to the Ayur Veda  we humans are made up of three components; they are the physical body (sthula-sharira), metaphysical body (suksma-sharira) and the “soul” or Self (atma, or antahkarana sharira). According to the Ayur Veda, life itself is a combination of elements including the body (raga), senses (indriya), mind (manah), and soul or Self (atma). Someone will be considered to be truly healthy if they are healthy in each of these components. Thus the path to recovery from illness, according to both the Ayur Veda and Lontar Usadha, is a the holistic one.  According to the Balinese belief called Tri-Hita-Karana (“The Three Sources of Human Wll-Being”) humans are social beings who live in a close relationship with other human beings, with their environment and with their unseen Creator. Thus community health depends on maintaining a balanced set of interrelationships between the human community, the environment and the unseen world of divine forces and the Creator.  Since offerings [See Figures 1] are an important way that humans interact symbolically with the unseen world and with their environment, they thus play an enormously important role in Balinese religious life, as well as in all traditional healing practices, both those aimed at healing the body, and those aimed at healing the “soul” (atma).  

Offerings on the ground to placate demonic spirits

According to Balinese believe the human body can be understood as composed of five basic elements called the Panca Maha Bhuta. These are earth (pertivi), water (apah), wind (bayu), light (teja) and ether (akasa). These elements make up the Buana Alit or microcosm of the human body, which is intimately connected through the deities of the directions and parts of the human body to the unseen forces of the macrososm, or Buana Agung. The “higher knowledge” of Balinese spiritual and medical practices is based on a thorough knowledge of how the unseen forces of the five directions “take their place” in the organs and major elements of the physical body. Therefore, the occurrence of any kind of disease in the human body is considered to have a very strong connection with the environment and the outside universe (Buana Agung), and a holistic cure for an illness must take account of this intimate relationship between the physiology of the human body and the metaphysical components of the environment and universe. The “flow of energy” in the human body is often descibed by members of the agricultural communities of Bali as comparable to the flow of the irrigation waters of the rice paddies: . The human body in the agricultural community is compared to the flow of the irrigation system of the rice fields: if the flow of the water is clogged, then people will get sick (Dr. Made Setiawan, p.c. 2010). In this case, too, we see that in the Balinese view there is always a strong connection between the inner and outer worlds of the human body and the environment.

The older we become, the more we are likely to succumb to sicknesses caused by microbes, imbalances in our diet or lack of proper exercise and the habits that support good health. Does this mean that any time we get sick we have to take synthetic medicines, whose side effects can damage vital organs like the liver or kidneys, disturb or cause allergy effects? Many modern Balinese do turn to this kind of medicine, but many more do not, first because of a fear of the powerful side effects of modern medicines, but perhaps more important due to the high cost of imported medicines, or medicines produced by the big pharmaceutical industries of modern Indonesia. With this in mind many people now feel that it would be better if we learned more about traditional medicines, and went back to using methods of proven effectiveness that are known in numerous parts of the archipelago.

In treating diseases, Balinese society has long recognized not just a tradition of medicines made from sources available in the environment, but also a number of traditional “specialists” whose methods of healing partly derive form the Lontar Usada, partly from knowledge or “healing power” that has been handed down from one generation to the next, or (as we believe) granted to certain people through a divine inspiration. These traditional ”specialists” are known up to the present day in Bali. All of them are called balian, whjch means “traditional healer”. These include:

• balian usada, who learn how to cure through reading and study lontar usada, often with a spiritual teacher, or guru
• balian ketakson, also called dasaran or tapakan, who gain their knowledge through divine blessing and heal people through trance possession, sometimes combined with massage techniques and herbal cures
• balian paica, who also are said to gain their knowledge through divine blessing, but in this case usually identified with a special found object that is the sign of their state of blessing; they typically heal through massage and herbal techniques, combined with meditation and concentration on the afflicted aspect of a patient’s body or “soul” (atma)
• balian uut, who are expert at setting broken bones, healing muscle sprains and similar techniques, often handed down in a family
• Balian campuran, whose healing power is a mixture of the above types
• balian manak, traditional midwives (these have been largely absorbed into the state-certified system of midwives (bidan) in modern Bali)

 

Balian Kulit or traditional dermatologist 

In the lontar usada, we find instructions on how to diagnose diseases, information on the various types of diseases, how to safeguard the health of pregnant mothers and babies, the ingredients and recipes for various kinds of medicines, the auspicious and inauspicious days to treat the diseases that inflict human beings, amd how to treat diseases caused by both sekala (visible) and niskala (invisible) beings, as well as the signs of incurable illnesses. In practice, however, most balian relay on knowledge that has been handed down to them, or learned from observing other balian in their practice. It appears that the lontar usada were composd at a time when balian were the only medical practitioners of Bali, and that they composed these works as reference books based on their vast experience in treating diseases. This is what has made them interesting to modern scholars and students of medicine, who would like to revive some of the more complicated forms of treatment found in these priceless manuscripts.  

The influence of the belief in invisible beings (niskala) is very strong in Bali. We believe that many illnesses are caused either by deities who have been neglected, or by demonic spirits. However, only a trained and experienced healer can detect the difference between the sicknesses caused by deities and by demonic spirits and more everyday forms of diesase. Therefore, in many case we will consult a traditional spiritual healers (dasaran, or balian ketakson) to find out what kind of sickness we suffer from, and what may have caused it. This type of traditional healer doesn’t give the patient medication to treat their sickness, but rather goes into a trance to communicate with the unseen world and in that way provide guidance on what to do to heal the patient. Usually, the balian doesn’t recall what s/he has said during the trance session, because s/he will be in a state of trance, or as we understand it, in invivisble world of the ancestors and divine spirits, and “from there” able to speak to someone in this world who may have neglected an important ritual duty, constructed some element of their houseyard or household shrine improperly, or failed to give due respect to the ancestors or some other being of the invisible worl.d Sometimes during the trance session, he spiritual medium gives the patients the ingredients to be used to treat their illness. If that is the case the family members of the patient will look for the ingredients either in the garden or in the forest nearby their houses, or perhaps purchase the the ingredients if they are available in the local market.

The ingredients of traditional medicines that are taken from nature are mostly in the form of the roots, tubers, stems or leaves of plants These plant materials are often the same as those that are used for condiments or spices in cooking food. Therefore, the use of traditional herbal medicines has almost no side effects on those who use them, even if we use them every day In the Ayur Vedic method of healing, the ingredients of medicines are also taken mainly from the roots tubers, bark, leaves, flowers and fruits of plants. But they also use some ingredients taken from certain parts of the bodies of animals or from mineral sources. In contemporary Indonesia cosmetic and medicines similar to those of the Ayur Vedic form of medicine have been developed from the ancient Javanese art of making herbal concoctions known as jamu. These herbal cures and cosmetics based on traditional ingredients are now produced in factories and sold in local markets or in the traditional stands which are opened in the market area or along the side of busy streets or roads during the evening. These “over the counter” forms of traditional medicine are also quite popular in Bali. Drinks made from jamu that are effective in stengthening the immune system or dealing with minor illnesses like the common cold are also carried around in the mornings by Javanese women who act as itinerant jamu sellers, always ready to mix up a hearty drink of jamu for a nominal cost equivalent to about half a dollar in US currency.

A number of anthropologists who have worked on matters of community health in Bali have drawn the conclusion that Balinese myths and rituals have a deep interconnection with the maintenance of individual and community health (cf. Lovric 1987, Connor 1986). Lovric’s work (1987) points out that the relationship between myths concerned with the origin of evil and the personification of the fear of evil in beliefs around black magic (pangiwa) can bring trouble to the community in the form of ‘strange illnesses’ such as lumpuh (paralysis), bebai (mental depression said to be cause by a disembodied spirit sent by an enemy or desperate would-be-lover) or kasmaran (romantic obsession). This is a subject that is notoriously difficult to access for researchers, for the simple reason that the “scientific study” of magical phenomena is not easily distinguished in the popular imagination from the idea that the real aim of such study is mastery of the black arts. As Lovric and others have noted, the most important concept here seems to be the idea that by knowing the source of a community or personal illness we can understand how to treat it. If a disease—especially an epidemic—results from a massive disorder in the spiritual realm, it may have been caused by an angry deity who has been neglected or treated without due respect by the community. In this case the “cure” for the illness will be ritual action, sometimes on a massive scale that will “send back” the source of the problem to its origin, or convert the negative forces (bhuta kala) who are causing the problem to their divine equivalents (as dewata). This concept of community health, disease and cure is reflected in myths that have found their way into literary works that explain the origin of troubles that in the Middle World (madhyaloka), the world of humans, plants and animals (cf/ Ariati, 2009). 

The main types of ttraditional Balinese medicines can be categorized as follows:

•       Boreh, paste made from ground leaves and roots of local herbs, rubbed on the body to provide healing effectss

•       Loloh or Jamu, herbal beverages used to treat a variety of ailments

•       Simbuh, herbs that are chewed up and sprayed onto a sore area of the body

•       Usug, herbal rubs made of ingredients like dadap leaves (Erythera indica), coconut oil and crushed shallots

 

Making boreh or herbal paste 

Those are the most basic types of herbal cure that can be made by many Balinese/ However, there are alsom more complicated remedies and medicines that are only understood in detail by balian, the traditional healers who specialize in using traditional medicines to help people recover from particular types of illness.. The more complicated types of traditional medicines can be studied from the lontar usada from spiritual teachers (guru) who are entitled to transmit their knowledge on to new students. Due to the fact that traditional healers must deal with the complex, metaphysical world of the unseen forces, learning the traditional healing arts is considered both sacred and dangerous; therefore, those who want to master the knowledge of becoming a balian usada must be purified and protected by their teachers in order that the practitioners of black-magic can’t attack them. This in turn is so because of the close connections that are said to exist between magical power to do good (penengen) and magical power to do evil (pangiwa). In stories like the famous stories about the witch Calonarang or a powerful black magician called I Gede Basur, the sacred formulae (mantra) that are used to do evil are said to be the same as those used to heal and bring benefit—but pronounced backwards.

Balian are usually ordinary Balinese people who have gained the power to cure both physical and mental illnesses. The power to cure people can be gained in various ways, sometimes by study with a spiritual master, sometimes by learning the craft from someone older in one’s own family, or sometimes simply from an event, dream or chance finding of a “power object” that gives one the gift of healing. In this way balian are quite different from modern modern medical doctors who go to university to study about how to diagnose and treatment sicknesses based on observation of symptoms and prescription of pharmaceutical drugs or courses of treatment. Being a balian is sometimes not by choice, but rather results from being chosenfor the task by an invisible power. I think it is only possible to understand this completely if you grow up in a country where the belief in the unseen world is very strong and there has been a long tradition of the practice of traditional medicine. Perhaps this is one reason why many of our students are so interested in learning more about the fascinating but complex world of traditional healing in Bali.

In conclusion I should note that people who are called balian in Bali get that name from other people, The balian believe that they had no choice about becoming healers, and that they were chosen to serve as a  channel for the divine, healing force that helps human beings to maintain their health and conquer the ever-present dangers of personal and social illness. The balian don’t call themselves that; they are given the name by other people, out of respect for the sacrifice they make in order to help other people.

Appendix I:

Some examples of the medicinal plants and their usage as medicine include:

1.     For coughing brought on by asthma:

Ingredients: kencur (a kind of ginger used in Balinese and Thai cooking) as big as an adult thumb, one teaspoon of honey, yellow yoke of an egg from a village (free range) chicken

Method of preparation: Wash the kencur cleanly and peel it, then grate it. The grated kencur shojuld then be mixed with water and filtered through cheesecloth into a glass. Honey and the yolk of an egg are added to the golden, yellow liquid and the mixture should be stirred until well mixed.

Method of use: Drink one glass of the liquid every evening.

2.     For ordinary cough:

Ingredients: one piece of kencur root the size of an adult thumb, one-half teaspoon of salt, ¾ cup of boiling water.

Method of preparation: Wash, peel and grate the kencur. Then add ¾ cup of boiling water to the grated kencur. When cooled enough to touch knead the grated kencur in the water, then filter it. Add salt and stir well.

Method of use: Drink one glass each morning after having breakfast.

3.     For hemorrhoids:

Ingredients: 2 pieces of water-chestnut (bangkuang).

Method of preparation: Wash the water and grate the water-chestnuts, then add enough water to make a thickish paste.

Method of use: Apply to the affected area twice a day, morning and evening.

4.     For diarrhea:

Ingredients: ½ glass of coconut water, ½ teaspoon of salt, ½ glass of boiling water.

Method of preparation: How to make it: mix everything in a glass

Method of use: Drink the mixture once a day until cured.

5.     For gastritis or indigetsion (sakit maag):

Ingredients: a piece of turmeric root as big as an adult thumb and one teaspoon of palm sugar (gula Bali), one cup of hot water

Method of preparation: Grill the turmeric and then wash it. Grate the grilled and washed turmeric, then add the water and filter the mixture through cheesecloth. Add the palm sugar, and stir till all the ingredients are well  mixed.

Method of use: Drink one cup twice a day; in the morning and evening.

Works Cited:

Ariati, Wayan P.

2009    Theodicy in Paradise” (South and Southeast Asia Culture and religion, the SSEASR Journal, Vol. III, (June 2009) pp. 47-63.

Connor, Linda

1986    “Balinese Healing.” In Linda Connor, Patsy Asch and Timothy Asch, Jero Tapakan: Balinese Healer—An Ethnographic Film Monograph. Cambridge: Cambridge University Press.

Lovric, Barbara

1987.   “Rhetoric and Reality: The Hidden Nightmare.” Ph.D. thesis, Department of Indonesian and Malaysian Studies, University of Sydney.

Nala, Ngurah

1991    Usada Bali. Denpasar: Penerbit PT. Upada Sastra.

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[1] A transliteration and translation team team from the Faculty of Letters of Universitas Udayana in Denpasar under the direction or Drs. I Nyoman Suarka has scanned and translated 13 of these manuscripts into Indonesian language. For the translations of these improtant documents see: http://www.babadbali.com/pustaka/usada.htm.