Usada - Background

Ailments Treated by Traditional Medicines

Excerpts from Fred B. Eiseman, Jr., Usada Bali: Traditional Medicine in the Jimabaran Area, South Bali, 2001. These essays are posted here with permission from I Wayan Suarnaya (Linud), with great appreciation. Please do not reproduce or use without written permission from Linud. Copies of the entire manuscript can be obtained from Ganesha Bookshop and Music Workshop in Bali.

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First of all it should be understood that Balinese people use traditional medicines to cure body problems, not to prevent them. Medicines are use on sick people to cure them, not on well people to prevent sickness. Many large tourist hotels in Bali have spas that offer what they call traditional Balinese massages and treatments. These tend to be expensive and may feature various spices, honey, yogurt, and other exotic ingredients that are implied to be based upon traditional Balinese culture.

This appears to be the usual attempt to capitalize upon the visitors' lack of knowledge of the local scene. Balinese people do seek massage from tukang pijet, massage experts, if they have sore backs or aching muscles. But they never get massages if they are perfectly well. The usual ingredients in a traditional Balinese massage are simple and inexpensive. Sometimes the masseur uses only coconut oil. For sore muscles a popular liniment is arak, rice brandy, in which a couple of Balinese red onions, bawang barak, have been crushed.

Second, it should always be kept in mind that there is no clear distinction in the Balinese mind between sekala and niskala. Traditional medicines are sekala, in the sense that they come mostly from plants. But, after all, plants are living things and so probably contain powers that are niskala. The living element in the body is the spirit, atma, a truly niskala entity. Un-natural disruptions in the functions of the body may indicate conflicts between the sekala and niskala aspects of the body. And so restoring these functions to harmony has certain niskala aspects.

I don't think many Balinese people would be able to explain how they feel about such matters, since it is not normal to think along those lines. But, I can't help feeling that some aspects of the use of traditional medicines transcend simple physiology and biochemistry and have roots in the belief in unseen forces that is an automatic way that Balinese people think about everything that they do. In other words, this is very much an unvoiced assumption that underlies a great deal of the practice of usada and is not likely to be mentioned or even though of by average people.

The nomenclature used by most Balinese people to specify the location of a pain or other abnormality is not very specific. For example, the word basang, which means "stomach", does not necessarily refer to the organ that anatomists call the stomach, but, rather, to almost anywhere in the area of the abdomen. Pengeng is any kind of headache, regardless of where located and whether constant or intermittent, severe or mild. As indicated previously, most people don't have clear notions of the fine points of human anatomy and so cannot be very specific when describing an illness.

There is a general feeling that many medicinal preparations that are applied to the skin are effective in controlling problems that lie below the skin. We in the Western world certainly use plenty of liniments and lotions. Most of these are used to control superficial problems in the areas where they are applied such as dryness of skin, superficial infections, color of hair, or sunburn. Some people take this a step further and buy preparations that they think may help problems below the surface, such as baldness or sore muscles. There is always the great hope that the local application to the skin of some formula or another that will be able tocure a pesky problem that lies beneath and out of sight and reach. Fortunes have been made in providing such formulas to the public.

Western knowledge holds that the use of such elixirs is wishful thinking and that the treatment of internal disorders requires the use of internal medicines. There are no pathways by which substances applied to the skin can penetrate below the skin and into the body. Liniments relieve sore muscles because 111 of the massage that accompanies their use and because of the mild local irritation of the skin that their ingredients produce, resulting in a superficial warming sensation.

In Bali a great many internal disorders are commonly treated by external applications. Sometimes these external applications are applied to the body at a distance from the site of the disorder. A favorite treatment for headache is to apply an external medicine, boreh, to the feet. If one exhibits skepticism toward the effectiveness of this kind of thing, the response is always of the form: "Just try it yourself and see if it doesn't work." I don't get headaches and so have not put it to a personal test.

Various commercial preparations for relieving headaches are commonly used, usually in the form of some kind of adhesive patch that is applied to the temples and left for several hours or days to do its work. Remedies for the pains of pregnancy are applied to the "stomach". Several kinds of medicine used to treat internal disorders are actually sprayed onto the body from the mouth. And to underline the niskala aspects of such treatment, it is believed that the one who does the spraying may not wash his mouth out, lest the medicine not have the desired effect.

All of these techniques, and more, will be described and discussed at some length in later chapters. The reason for mentioning them briefly here is to point up some of the differences in attitude between Balinese medical practice and the ways of thinking that are likely to be encountered in developed countries.

There is a general feeling that mixtures of several medicines are more effective than the use of a single medicine. The word singrong refers to any of several specific formulations using several or many ingredients. Some of these mixtures, with only a few ingredients, may be purchased ready made in little plastic bags in the Jimbaran market. The more complex types of singrong must be purchased in Denpasar. One of the most complex, singrong jangkep, contains 80 different ingredients. Nobody can explain why "more is better". And nobody can explain the specific function of each of the ingredients or why or how they interact with each other to produce a cure. Even Balinese doctors with M_D. degrees tend to give their patients four or five prescriptions for relatively simple medical problems. This seems to satisfy an urge to have as many medicines as possible. I don't know if the underlying feeling is that there is some sort of synergistic action between the components or whether it is just a shotgun approach with the thought that at least one of those things had got to work, sort of a "safety in numbers" type of thinking People don't voice their feelings about such matters. Probably they don't have any. Mula keto.

This sort of "more is better" feeling carries over into other aspects of Balinese life. It is better to have lots of offerings than just a few. It is better to have many ceremonies than just one, and more elaborate ones than plain ones. The feeling even seems to carry over into Balinese art forms where baroque decoration is the norm.

People don't ever experiment with usada by trying out new types of plants or mixtures of ingredients. They are not adventuresome by nature and fear that the unknown might make matters worse. Their conservatism is based upon the feeling that what was good enough for their parents is good enough for them. It works, don't try to change it.

Balinese people use several rather all-inclusive words to refer to common non-specific ailments. Panes, hot, or panes-dingin, hot-cold describe a fever. Panes is the usual sort of hot feeling that accompanies a fever. Panes-dingin is usually described as the alternating hot and cold feeling that accompanies malaria. However, since malaria is not common in the part of Bali in which I live, I wonder if the term refers to the usual feelings that accompany influenza and similar diseases.'

Dingin, without being accompanied by panes, is the cold feeling that is experienced especially by older people, most commonly in the feet, but sometimes also by young babies. In fact, there is a general belief that the feet are the "center of nerves", and that medicines, massages, and manipulations applied to the feet are effective in treating disorders that occur elsewhere in the body.

Nyem is a condition of what we call "blah" in American slang — a loss of energy, weakness, lack of desire to do anything. Ngilut basing, twisting stomach, is a general word for upset stomach resulting in gas pains and often diarrhea. Sakit basang, sick stomach, means almost any sort of pain in the abdomen. Dekah is aly sort of cough. Sebuh is a bruise, lih a sprain.

The term masuk angin, wind enters, is a very common Bahasa Indonesia expression describing what happens when one catches a cold. Jamu is seldom used by people in the area in which I live. It is a Javanese tradition, and the Javanese in the Jimbaran area are the principal users. In fact, the strong Javanese tradition of jamu is not particularly popular amongst Balinese people. Jamu are various kinds of preparations that Javanese people use to promote health and strength and cure common illnesses. Most of the on sold in Bali are ground mixtures of plant materials mixed up with water. Sellers on foot, bicycle, or motorbike peddle their jamu from door to door in many villages. Usually the stuff is dispensed into a glass from the plastic bottles in which it is stored. Packages of commercial powdered jamu ingredients are sold in many little stores. These only have to be dumped into a glass of water, stirred, and consumed.