Local Health Traditions Research Articles

Chromatographic Profiling and Cytotoxic studies of Extracts of Buchanania lanzan Spreng and Albizia lebbeck Benth

The various Indian systems of medicine in addition to numerous local health traditions have been successful in managing cancer across the globe using herbs. Keeping all this in mind, the present study has been taken up, to study the cytotoxic potential of B.lanzan and A.lebbeck barks. The objective of the present study is to explore the scientific basis of both plant bark for its anti-carcinogenic utility. Different extracts of plants were screened using the MTT assay technique, and potent extracts were subjected to HPTLC and HPLC to evaluate total phenolic and flavonoid present in crude extracts of plant bark. In our study, we found that the ethanolic fraction of B. lanzan had higher phenolic content 34.92 µg/mL than other fractions. While in the case of flavonoids ethyl acetate fraction of A.lebbeck contain the highest concentration 17.00 µg/mL. In the MTT assay, B. lanzan ethyl acetate extract (B-EA), ethanolic extract of B. lanzan (BE) and A. lebbeck ethyl acetate extract (L-EA) had shown an IC50 value of 113.9 µg/mL, 247.4µg/mL, 152.7µg/mL, while in A549 cells, B-EA, BE, L-EA had shown 226.9µg/mL, 269.1µg/mL, 123.3µg/mL IC50 values respectively. The effect of samples B-EA, and L-EA was found different in HeLa cell lines from the other two studies. The samples B-EA and L-EA showed the value of 91.9µg/mL and 257.1µg/mL, respectively. A. lebbeck ethanol extract (LA) did not show significant inhibition in HepG2, A549, and HeLa cells, and sample BE did not show substantial inhibition in HeLa cells. B.lanzan and A. lebbeck have a high potency to treat liver, lung and cervical cancers in vitro, although extensive pharmacological and clinical studies are required to explore inherent mechanisms in future.

Comparative Evaluation of Rasa (Taste), Phytochemical Characterisation, HPTLC Fingerprinting and Antioxidant Activity of Taruni peya (Modified Rose Tea) Brewed using Five Methods: A Research Protocol

Introduction: A “rose” is usually a flowering shrub of the genus Rosa that has thorny stems and fragrant blooms. Humans have been using roses and their preparations since ages for health benefits. Rose tea is an infusion prepared from rose buds and petals that is popular for its mild flavour and possible health benefits, including its antioxidant content. It can be drunk as a hot or cold infusion. Need of the Study: No research has been done to date on the effects of brewing procedures on Rasa, phytochemical characterisation, High-performance Thin-layer Chromatography (HPTLC) fingerprinting, and the antioxidant properties of modified rose tea. A new field for standardising the brewing process for beverages like modified rose tea will be made possible by the study of these factors. Aim: To evaluate of Rasa (taste), phytochemical characterisation, HPTLC fingerprinting, and antioxidant activity of Taruni peya {Modified Rose (Rosa centifolia Linn.) tea} prepared by five different brewing methods. Materials and Methods: An experimental study will be conducted in the Department of Dravyaguna Vigyan, Mahatma Gandhi Ayurved College and Hospital and Research Centre (MGACH and RC), Salod, Wardha, Maharashtra, India, from April 2024 to June 2025. Roses (Rosa centifolia Linn.) will be collected from the natural habitat of the plant. The plant material will be authenticated and identified from Foundation for Revitalisation of Local Health Traditions (FRLHT), Bengaluru, Botanical Survey of India (BSI), or the Botany Department or by an authorised person of the Dravyaguna (Pharmacology) Department. Rasa Nirdharana (Taste) of the samples will be analysed using parameters mentioned in Samhitas. Charaka, Sushruta, and other acharyas, have described the method of the perception and determination of taste by putting a substance on the tongue in which the Rasa perceived soon after the substance comes in contact with the tongue is called Rasa. Standard Pharmacognostical character and phytochemical characterisation will be performed on all samples using standard methods like macroscopy-microscopy and HPTLC fingerprinting will be studied as given in Ayurvedic Pharmacopoeia of India. Antioxidant properties will be studied by using 2, 2-diphenyl-1- picrylhydrazyl (DPPH), Ferric ion Reducing Antioxidant Potential (FRAP), and phosphomolybdenum assay. Analysis of Variance (ANOVA) test will be used for statistical analysis with a level of significance at p-value<0.05.

Phytopharmacological Perspectives of Tinospora cordifolia Chemical Constituents and Medicinal Properties

According to the World Health Organization, 80% of the world’s population relies mostly on traditional remedies including the use of plant extracts or active components. India’s mega-biodiversity and knowledge of rich historic traditional systems of medicine (Ayurveda, Siddha, Unani, Amchi, and local health traditions) give a solid foundation for the use of a wide range of plants in general healthcare and the treatment of common disorders. Tinospora Cordifolia is a Deciduous woody climbing shrub found in India, China, and Africa. It is a member of the Menispermaceae family. This plant’s pharmacological importance stems mostly from its root, stem, and leaf. It contains a variety of photoactive chemicals, including alkaloids, steroids, glycosides, lactones, polysaccharides, and others. Practically every portion of the plant has immunomodulatory effects. It is a significant medicinal plant used in Ayurveda medicine to treat colds, fevers, diabetes, and even rheumatoid arthritis.

Use of Herbal Drugs in Local Health Traditions in Purnagiri Hills, District Champavat, Uttarakhand

The state Uttarakhand is rich with floral and faunal diversity including plants used by local inhabitance to cure health problems. Himalayan region always has been the treasure of herbs from ancient time. Himalayan herbs are highest in quality and potency. There are numbers of side effect are noted using allopathic medicines which leads towards reuse of medicinal plants available locally. Keeping this in view an attempt has been made to enumerate the common medicinal plants used in traditional therapeutic system of Uttarakhand, India. Results reveal that 29 plant species are used for primary healthcare.
 Purnagiri hills located in Champavat district of Uttarakhand is reservoir for a large number of medicinal herbs during the field survey large number of medicinal plants like Adina cordifolia (Roxb.) Hook. (Rubiaceae), Asparagus adscendence Roxb. (Liliaceae), Artemesia nilgirica (Clarke) Pamp. (Asteraceae), Berberis aristata DC. (Berberiridaceae), Colebrookea oppositefolia Sm. (Lamiaceae), Elephantopus scaber L (Asreraceae), Pinus longifolia Roxb. (Pinaceae), Tamarix gallica L. (Tamaraceae), Urtica dioica L. (Urtecaceae) and many more with their use in local health traditions by local habitants were recorded. One of the serious challenges to biodiversity and ecological functioning is climate change. Climate change and global warming are well known issue that has had an impact on the biodiversity. Second thing over exploitation of Himalayan forest leads these valuable herbs in endangered category. Some of the plants recorded are critically endangered and rare. We have to pay attention towards the conservation, cultivation of these herbs.

“Integrative Health System” beyond “Integrative Medicine”

One Nation, One Health System has many dimensions, and an inclusive Integrative Health System is one of the overarching and cross-cutting approaches to attain it. This paper discusses the imperatives for creating an Integrative Health System that incorporates AYUSH and Allopathic knowledge traditions. Since Integrative Health System is a term diversely understood and used, the need to conceptualize it and come to a shared understanding is highlighted. The paper brings insights and tools from a Health Systems perspective to suggest conceptualizing an Integrative Health System framework. It proposes that the IHS has three components— Integrative Medicine, Integrative Public Health, and an Integrative Health Care System. After discussing these components, the paper moves on to the Health Systems Research required for designing an Integrative Health Care System. The Complex Adaptive Systems approach is considered appropriate and explained. An illustration is provided from a study conducted to study the role and status of Ayush services and Local Health Traditions in the Public health system. Inferring conclusions from the study mentioned above and similar studies undertaken by the author, few illustrative inputs regarding Integrative Health Systems are provided, which would adequately support an ecosystem that allows interaction and dialogue between systems. It is postulated that this requires a shift in thinking from the dominant positivist paradigm to a critical holist paradigm.

Documentation and validation of local health traditions of Hassan district, Karnataka

Documentation and validation of local health traditions of Hassan district, Karnataka

In vitro Propagation of Curcuma caesia Roxb. via Bud Culture Technique and ISSR Profiling of the Plantlets for Genetic Homogeneity

An in vitro propagation protocol has been developed for Curcuma caesia Roxb., an endangered medicinal plant by Foundation for Revitalisation of Local Health Traditions and Central Forest Department of India. The plant bears poorly germinated seeds and produces two-storage organs: rhizomes and multiple root tubers. Only rhizomes have medicinal-economic values. They serve as propagules too, which results in a shortage of planting material. Therefore, a complete one-year production cycle of C. caesia has been standardized through in vitro propagation including explants establishment (one month), subculture cycles (seven months), rooting (one month) followed by primary hardening (one month) and secondary hardening (two months). Dormant shoot buds on rhizome served as explants for culture initiation on Murashige and Skoog (MS) medium supplemented with different concentrations of 6-benzyladenine (BA) and kinetin (KIN) in combination with citric acid (CA), adenine sulfate (AdS) and indole- 3-acetic acid (IAA). Maximum bud break (70%) was obtained on MS with 8 mg L-1 BA, 8 mg L-1 KIN, 100 mg L-1 CA, 200 mg L-1 AdS and 2 mg L-1 IAA (standard medium). Shoot production potential continued on this medium during the subsequent seven-month-long subculture cycle. The in vitro raised shoots rooted best on ½-strength MS containing 1 mg L-1 indole-3-butyric acid. Plantlet survival rate was >95% after acclimatization. The genetic homogeneity of plantlets with the mother plant was analyzed using Inter Simple Sequence Repeats which generated a monomorphic banding pattern to confirm the uniformity of in vitro raised plantlets of C. caesia.

Efficacy of the topical application of C1 herbal oil on superficial external wounds and split thickness skin graft donor sites for wound healing

BACKGROUND: C1 herbal oil is developed by Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Government of India and is based on Local Health traditions (LHTs) for wound healing. This study is planned to assess the efficacy of C1 herbal oil on Superficial External Wounds and Split Thickness Skin Graft (STSG) donor sites for wound healing. MATERIALS AND METHODS: The study is a prospective, open-label, randomized, controlled, two-phased clinical trial for a duration of 28 days. Outpatients of age group 18–60 years, of either sex requiring STSG coverage of at least two strips will be recruited in Phase 1 of the study. The donor site will receive the topical application of C1 herbal oil prior to the standard dressing, whereas the normal saline will be applied on the control site. The dressings will not be changed, except when it is fully soaked with exudates or will easily fall off or show any signs of infection. Subjects with superficial external wounds will be recruited in Phase 2 of the study. The test site will receive C1 herbal oil-impregnated dressings, whereas the other group will receive saline gauze dressing, to be changed every 24 h or earlier in case of soakage or accidental removal. The duration of wound healing was the primary outcome measure. The pain during dressing change will be evaluated with a visual analog scale and wound assessment by Bates Jensen Wound Assessment Tool. DISCUSSION: Ayurveda herbal wound dressing may significantly reduce the time for epithelialization of wounds. It may be beneficial in decreasing healthcare costs besides including Ayurveda medicines in mainstream clinical medicine for wound care. TRIAL REGISTRATION: Clinical trials registry- India: CTRI/2017/10/010150

Local Health Traditions, Cultural Reflections and Ethno-taxonomical Information on Wild Edible Fruit Yielding Medicinal Plants in Melur Region of Madurai District, TamilNadu, India

Revitalization of local health traditions (RLHT) has become an inevitable aspect of human wellbeing in the post COVID era. An ethnobotanical survey was carried out to collect information on local health traditions and cultural reflections associate with the age old use of wild edible fruits (WEFs) from common plants in Melur Region of Madurai district, TamilNadu, India as the habit of consuming WEFs is quite common among people in this region and has not been completely abandoned in particular among the age old people. Information presented in this paper has been gathered from local people using an integrated approach of botanical collections, group discussions and interviews with questionnaires during the period from Apr 2021 to Mar 2022. As much as 29 informants were interviewed, among the informants 6 were local health-care practitioners (Vidiyars). Studies on the use of WEFs from common plants in Melur resulted in collection and documentation of information on a total of 34 ethnomedicinal plant species distributed across 20 families. Medicinal plants used by local people are listed with scientific name, family, local name, plant part(s) used, mode of consumption and preparation and medicinal uses. Data collected during the study clearly indicates that fresh parts of the plant (Fruit (Ripe/ Unripe)) were more preferred in general for the preparation of medicinal formulations by the local health practitioners. Documented ethnomedicinal plants were mostly used to cure long term complications associated with diabetics, gastrointestinal disorders, skin diseases, poison bites and nervous disorders. Howsoever, results of this study is clear record to the claim that the local people still depend on medicinal plants to overcome situations like COVID pandemic as fruits from most of the plants documented serve as natural source of immune boosters. Further, in-depth studies (both In-silico and Pre Clinical trials) are expected to bring to limelight the hidden quantum of bioactive compounds in the fruits these medicinal plants and their therapeutic potential.
 Keywords: RLHT; Medicinal Plants; Folklore Medicine; Wild Edible Fruits (WEFs); Ethnobotany

Indian Plural Health System and Resilience: Lessons from COVID-19

Beginning with a brief recent history of plural health systems in the Indian context, this is a commentary on the idea of resilience from the perspectives of AYUSH and local health traditions (LHTs) as witnessed historically and during the COVID pandemic. By narrating the AYUSH systems’ experiences during COVID-19, in providing health care and in attempts at building rigorous research and evidence, it examines their potential future engagement in the public health scenario in the country. The article contextualizes the potential core functions of plural and integrative health systems for the resilience of the Indian health system.

Global Knowledge Gaps in Equitable Delivery of Chronic Edema Care: A Political Economy Case Study Analysis.

Background: Most existing research in chronic edema (CO) care takes place in high-income countries and is both clinically and medically focused, although often accorded low prestige and status. A myriad of challenges define the problems and important gaps in understanding and translating what we know into sustainable practice. Less considered, however, are the consequences and socioeconomic significance of this "knowledge gap" in an increasingly globalized world. This article seeks to address this lacuna by suggesting a political economy approach across three different income settings, the United Kingdom (high), Kerala in India (middle), and Uganda (low), to learn from international practice and understand the contribution of local (community-specific) health traditions. Methods and Result: We used a comparative case study approach. In the three case studies we demonstrate how particular thinking, sets of power relationships, and resource distributions influence and structure the provision of CO management more generally. We demonstrate how these intertwined and often invisible processes reflect a market-led biomedical hierarchization that focuses on high-interventionist, high-cost approaches that are then imposed on lower income settings. At the same time, low-cost but evidence-based local knowledge innovation in wound and CO care from low- or middle-income countries is neither recognized nor valued. Conclusion: We conclude that unpacking these dynamics is a necessary route to providing a more equitable health delivery accessible for the many rather than the few.

AN EXPLORATORY REVIEW OF PHARMCOLOGICAL ACTIVITIES OF NOTCHI KUDINEER- A SIDDHA HERBAL DECOCTION USED IN COVID-19

COVID-19 Caused by the novel corona virus (SARS-CoV-2), which has already pushed the entire global community to change their priorities towards finding a suitable anti-viral medicine and a vaccine. While most of the countries have started to prescribe vaccines, which show varied levels of efficacy, finding an effective anti-viral medicine against the virus is still in the early stages despite full-fledged research activities at global level. Many countries particularly those having a rich traditional health science background like India and China started to recommend medicines belonging to local health traditions. The public utilization of those medicines also yielded good results in terms of prevention of the viral infection, reducing the severity of disease or/and reducing the number of days required to recover from the disease as perceived and reported by the patients and doctors.
 In Tamil Nadu, there are more than 80 million populations. Siddha medicine is the most widely used system of traditional medicine. ‘Suram’ is the Tamil word equivalent to the term ‘fever’. Kabasuram (Also known as Aiya suram) is one among the 64 types of fevers mentioned in Siddha symptoms of which are identical to those of COVID-19. “Notchi kudineer”– a Siddha herbal formulation is being used since many centuries for fever and respiratory disorders with remarkable success. This review article attempts to explore the pharmacological evidence in support of the therapeutic usage of “Notchi kudineer” hence justifying its usage in respiratory related illnesses having fever as a main symptom like the current pandemic of COVID-19.

Local health traditions (LHTs) of Kailashahar subdivision, Unakoti district, Tripura

AIM: Tripura is a state that covers wide valleys and plains that make up the vivid landscape. More than half of Tripura remains covered by green and moist deciduous forests. Many rural and tribal communities of the Kailashahar, Unakoti district of Tripura depend on traditional systems for the treatment of ailments. The present work has been conducted to document local health traditions (LHTs) from traditional healers and the utility of medicinal plants for treatment. MATERIALS AND METHODS: As per the intramural project allocated by the Central Council for Research in Ayurvedic Sciences, New Delhi to the Regional Ayurveda Research Institute, Itanagar has conducted a seasonal Medico Ethno Botanical Survey in the forest of Kailashahar subdivision of Unakoti district, Tripura during the year 2018–19. LHTs were documented according to the standard format provided by the Ministry of Ayush, Government of India by interviewing local traditional healers; thereafter, a collection of medicinal plant specimens, as well as digital photography of plants were used for treatment in various health conditions and for healing purposes. The properties of all herbal formulations were compared and correlated with the Ayurvedic literature and presented systematically and scientifically following the standard protocol. RESULTS AND DISCUSSION: The Medico Ethno Botanical Survey team conducted a survey and documented 33 LHTs with 15 polyherbal and 18 single herbal formulations of 50 plants from traditional healers of the study area. Documented formulations have been used for the treatment of seven human body systems, namely locomotor, gastrointestinal, respiratory, urinary, integumentary, endocrine, and urogenital. CONCLUSION: LHTs documentation throws light on the traditional practices for the treatment of human ailments of different body systems by using locally available plants and plant products. Procedures are economic, effective in treatment, and feasible for the rural and tribal populace in the management of health. Herbal formulations are validated with Ayurvedic fundamental principles to understand their high potential medicinal value.

Local health traditions (LHTs), oral health traditions (OHTs), and ethno-medicinal practices (EMPs)

Local health traditions (LHTs), oral health traditions (OHTs), and ethno-medicinal practices (EMPs)

Ethnomedical Importance of Traditional Medicinal Plants among the Indigenous People of Kanchanpur Subdivision of North Tripura District

Aim: Documentation of local health traditions (LHT) during the Medico-ethno Botanical Survey (MEBS) by the Regional Ayurveda Research Institute (RARI), Itanagar, was conducted in the remote forests and rural areas of Kanchanpur subdivision of North Tripura. Rural and tribal populace residing in the nearby forest locality is dependent largely on the traditional system of medicine for the treatment and management of health disorders. Materials and methods: The MEBS team documented LHT claims from the tribal and rural populace living in natural forest by discussion and interview with traditional healers as per the provided LHT format, followed by recording of the global positioning system (GPS) location, digital photography of the healer and raw drugs used in formulations. The team also collected the raw drugs sample for identification. Results and discussion: The MEBS team documented a total of 21 folk claims with 4 polyherbal and 17 single herb formulations collected from the Kanchanpur subdivision, North Tripura, along with digital photography of traditional healers and plants used in formulation. The properties of all 17 single herbal formulations were compared and correlated with the Ayurvedic literature. Conclusion: The documented LHT of Kanchanpur subdivision, North Tripura, will benefit in treatment of health-related issues. Properties of plants enlisted in the documented LHT from the local healers are compared and correlated with claimed health conditions to derive significant clinical relevance. The enlisted traditional claims of single herb formulations are pertaining to diseases like udarashula, amlapitta, sutikasrava, mushkavriddhi, kasa, jwara, pratishaya, katishula, twak vikara, uccha raktachapa, vrana, and sarpa damstra can be proposed for clinical trials to achieve the conventional line of treatment. Further it is necessary to study the herbs used in LHT to understand and validate the novel biomolecule for its high potential in treatment and further utilization in Ayurvedic formulation for the benefit of mankind.

Traditional Healing Practices among the Indigenous People of Kumarghat, Unakoti District, Tripura

Aim: Tripura is a state with a rich biodiversity. Many rural and tribal communities of the Unakoti district of Tripura are depending on traditional systems for the treatment of ailments. The present work has been carried out to document the local health traditions (LHTs) with the help of traditional healers and uses of locally available medicinal plants. Materials and methods: Per- the Intramural Research (IMR) project (2018–19) allotted by the Central Council for Research in Ayurvedic Sciences (CCRAS), New Delhi, to Regional Ayurveda Research Institute (RARI), Itanagar, to conduct seasonal medico-ethno botanical survey (MEBS) in the forest subdivision of Kumarghat of Unakoti district, Tripura. The LHTs were documented by interviewing tribal healers of the rural area and collecting medicinal plant specimens and digital photograph of plants and healers have been carried out systematically and scientifically. Results and discussion: The MEBS team documented 50 folk claims with 13 compound and 37 single formulations of 53 plants from 13 tribal traditional healers in the study area. Single herbal formulations were validated for clinical importance with the classical Ayurvedic literature. Conclusion: The tribal and rural populace are benefiting from the home remedies in the management of ailments by using the plants available in the nearby forest area of their locality. Of the documented 50 traditional practices, few unique claims required further scientific validation for the benefit of humankind. Clinical significance: Of the documented 37 single herbal formulations, 7 claims vary in part use of the plant as generally mentioned in the classical text. It is noted that the use of different parts of the plant also having same indications as mentioned by the traditional healers, such as kokilaksha [Hygrophila auriculata (Schumach.) Heine], apamarga (Achyranthes aspera L.), rama seethalika (Amaranthus tricolor L.), mathysakshi [Alternanthera sessilis (L.) R. Br. ex DC.], ulatkambal [Abroma augusta (L.) L.f.], and bimbee [Coccinia grandis (L.) Voigt].

Should the AYUSH doctors be underutilized at subhealth centers under Ayushman Bharat while they prove effective at higher facilities under National Health Mission?

AYUSH systems of medicine are the six different indigenous systems of medicine prevalent and practiced in India. Postindependence, these individualized and healer-based systems got government patronization and legal support and converted into medical systems and evolved with time to the present form. From being the department of Indian Systems of Medicine in March 1995 to the Department of AYUSH in 2003 and most recently the ministry of AYUSH in 2014, these systems of medicine have evolved continuously with the growing need of time. With the initiation of National Rural Health Mission in 2005 under the scheme of mainstreaming of AYUSH and revitalization of local health traditions, these systems were promoted at each level and the practitioners came out of their silo and became part of the mainstream health-care delivery system serving both rural and semi-urban communities in the country. However, with the recent AYUSHMAN BHARAT program, these practitioners, especially the Bachelor of Ayurvedic Medicine and Surgery graduates, were offered to serve at the subcenter level as the Mid-Level Health Provider which in a way demotes the cadre. This opinion discusses about this dichotomy situation with AYUSH workforce and government's “easy and soft target” attitude in utilizing AYUSH workforce.

Compendium of Traded Indian Medicinal Plants

Compendium of Traded Indian Medicinal Plants
 ISBN: 978-81-908965-4-2
 Published by Foundation for Revitalization of Local Health Traditions (FRLHT), Bengaluru, Karnataka 560064, India
 @ FRLHT 2018 <http://www.frlht.org>

Medicinal plant diversity in Aravallis

Aravallis ranges are one of the very important features of western part of India which runs from Gujarat to Delhi. It traverses in four states viz., Gujarat, Rajasthan, Haryana and Delhi. Maximum part of Aravallis is confined to Rajasthan. As many as 13 wildlife sanctuaries are confined to Aravallis; 10 in Rajasthan, 2 in Gujarat and 1 in Delhi. As many as 3 protected areas are confined to confluence of Aravallis and Vindhyas, all are in Rajasthan. Forest Department, Rajasthan and Foundation for Revitalization of Local Health Traditions, Bangalore jointly has listed 39 species in the "red list of medicinal plants" from Rajasthan state. Most of these listed medicinal plants are present in 16 protected areas. Out of these 16 protected areas, 6 are rich in medicinal plants. Phulwari, Sitamata, Kumbhalgarh, Mt. Abu. Balaram Ambaji and Jassore sanctuaries having 22, 18, 14, 12, 11 and 10 species respectively. The study revels, that southern part of Aravallis is more rich than northern and central Aravallis. The "nals" of southern part of Aravallis are especially rich in medicinal plant diversity

‘A light inside a pot’: Sites and sources of power emerging from an ethnography of traditional healing in South India

ABSTRACTMedicine and healing have been critical elements of nation-building and governance in India. There is a clear hierarchy: biomedicine, followed by systems like Ayurveda which are to be ‘mainstreamed,’ and local health traditions, which are to be ‘revitalised’. Mindful that power nonetheless resides in positions of marginality, this analysis drew from a health system ethnography on revitalisation of local health traditions in three southern Indian states. Data from multiple interviews with 51 healers, observations of meetings, healing sessions and events convened by healers, as well as a multi-stakeholder dialogue on local health traditions convened by authors were analysed using a grounded analytical process. The state was a source of power, but in an enmeshed, individualised form. Other sources of power included accomplished others who viewed healers and their practices with respect, healers’ collectives that produced and reinforced power through the exercise of certain rituals, and the sacred calling to heal, which assumed stringent criteria for practice and training, while also creating a moral imperative for service orientation. Our study shows how power rests in or is derived from multiple sites and sources that inhere and interact in critical ways with the state and other systems of medicine.