Native Hawaiian Healing

Even more than before, Hawaii and its traditional culture of the Hawaiians is internationally popular and admired. And it keeps growing. In 2005, well over 7 million tourists visited Hawaii to experience the beauty and mystique of the Hawaiian Islands. However, authentic knowledge of traditional Hawaiian culture and philosophy often unfortunately take a back seat to commercialized events and brief sight seeing trips. To each his own. Still, many go to Hawaii for relaxation and healing of the body, mind, and spirit. They do not only want to see Hawaii, but also try to feel it and understand it. As a part-native Hawaiian physician (on my personal and professional journey learning about my heritage and ancestors), it seemed difficult to find basic accessible information on Hawaiian healing as practiced by kupuna (elders) and medical kahunas (extensively trained specialist in medicine), and not from a commercial source. Sensing a strong need for this non-commercial or uncensored information, I have written this article.

Note that I am not a kahuna. I have humbly tried to summarize and provide references for basic cultural and historical aspects of Native Hawaiian healing for all on the web to enjoy. Politically speaking, there is a lot currently going on in terms of Hawaiian identity and self-governance as seen in a magnitude of media reports and even US senate documents and activities. This paper is not about politics. It is about sharing and preserving the documented Native Hawaiian culture and healing philosophy for others to appreciate. My paper is presented in 6 parts. The first part involves an overview of Hawaiian healing philosophy, values, and definitions. The second part is a concise outline of medical kahuna history and even methodology. Thirdly, lomilomi (Hawaiian "massage") is briefly discussed, while the fourth part deals with Hawaiian psychology. The fifth part is a look at the tradtional Hawaiian diet and exercise norms from the past. And finally, part 6 profiles Hawaiian spirituality and healing temples, which are also found on some tourist maps as worthy attractions.

PART 1
Introduction To Cultural Hawaiian Values, Philosophy, And Healing Concepts

Hawaiian beliefs and values provide an understanding toward traditional holistic wellness. Kupuna (respected elder) Kaholokai was quoted to say, "We must always ask permission with creator consciousness and gather only what is needed, then replant, protect, and balance the plants natural habitat. Healing is about restoring balance and not necessarily about being cured" ¹. When healing, the secret is to have lokahi (unity) of the body, mind, spirit, and nature collectively ². A healer must incorporate the interconnectedness within ourselves, each other, nature, and spirituality. Their emphasis on group dependence, compared to the more westernized concept of individualized independence, was characteristic of other indigenous people as well. Both patients and healers might benefit from awareness and application of the core Hawaiian concepts of aloha (love, compassion, charitable, sympathy), pono (correct and true nature), lokahi (unity), mana (divine power and authority), ohana (family), and 'aumakua (ancestral spirit)^3-8 , among others.

With the basic Native Hawaiian view that illness is related to a lack of balance with mana (divine power and authority), it is understandably a critical concept. An improper balance in mana may be from wrongful actions, thoughts, words, violating the kapu (taboo), displeasing the Gods, etc. Unhealthy thoughts, words, and actions were thought to contribute to disease ⁹. The following are a list of other important core Hawaiian cultural values and their closest English equivalents¹⁰: pa'ahana (industry), koa (courage), kupono (honesty), kuleana (privilege and responsibility), ha'aha'a (humbleness), ho'omanawanui (patience), among many others. Palua (dualism) suggests the application of these core values to the healer and patient, or to oneself, and everything else (people, nature, God).

Also, the unique na piko 'ekolu (three navels or centers) and na'au (gut emotions, intuition, intellect) concepts in relation to a Hawaiians' life and health is essential. The Hawaiian piko concept is unique and only roughly analogous to the chakra system of India and Asia. The crown piko or po'o or manawa piko represents the past, and one's spirituality, ancestors or 'aumakua. The navel piko or waena piko relates to the (present) earth and family, or current "umbilical" family ties. The genital piko or ma'i piko is related to the (future) offspring. The lower abdominal region also includes the na'au center of emotions, intellect, and intuition .^11-14 The piko and na'au concepts could allow a healer to systematically remember their holistic approach. Note that, all pikos are equally important, related, and communicating and can be included in personal and therapeutic processes.

PART 2
Kahuna Lapa'au Are Holistic Traditional Healers

A kanaka maoli (indigenous Hawaiian) sought help from their kupuna (elder) when ill or with unbalanced mana (divine power and authority). If that was unsuccessful or not appropriate, then the Kahuna lapa'au or healing specialist was sought out. Simple word of mouth and reputation provided a healing Kahuna with patients¹. The now deceased and still respected Native Hawaiian healer Papa Henry Auwae was quoted as saying, "Healing is 80% spiritual, and 20% medicine" ². A Kahuna lapa'au received decades of training, had education and preparations in a heiau ho'ola (healing temple), made "hale (house) calls", and could be generalists or highly specialized. The general term kahuna refers to a native who was a trained professional specialist (eg. canoe building, hula, healer, chanter, genealogist, and many others). The specialized healing trade was often passed on in the family, but sometimes a youth was identified as an individual with characteristics and potential great enough to recruit into the profession of medicine. Like a family member, the chosen youth would live with the kahuna and have about two decades of training. During their schooling, medical students used 480 red, black, and white pebbles in the shape of a body, which was on 365 meshes of makaloa mats, to identify anatomical and pathological locations. Possibly of esoteric significance, Hawaiians training in astronomy used the same mats with 365 meshes and the same 480 pebbles^1,3,4,5.

Types of medical kahunas included the kahuna haha (diagnostician by palpation), kahuna kahea (healer who called out to gods), kahuna lomilomi (holistic traditional massage), kahuna 'ana 'ana ("black magic sorcerer"), kahuna la'au lapa'au (herbal healer), kahuna koholua (performed minor surgeries), kahuna ho'ohanau (obstetrician), and many others^1,6.

The following are commonly documented Kahuna lapa'au methodologies for healing practices (in no strict order)^1,7-12

1) Asking for guidance from Akua (Godly higher power) and 'Aumakua (ancestral spirits) are required for all steps of healing. The healer needs to be have sufficient mana (divine power) and be without personal negative thoughts^7,8. Prayer identifying situation and needs, as well as a personal cleansing or ho'oponopono (traditional healing practice and counseling for conflict resolution) for healer and patient were done. The healer needs to have their own balanced mana in order to heal ^1,9 and is a facilitator of healing. Sometimes, a cleansing or treatment would include a sacred dip in the ocean or ingestion of diluted ocean water or herbs^1,9. Again, spirituality was an essential component, as seen in the help, approval, guidance, and appreciation expressed to the Akua and 'aumakua for everything they accomplished.

2) Acceptance of case or referral.

3) Discussion and identification of illness ("internal and external") and treatment with patient ^1,8. This may include dream work¹³, which utilizes the conscious, subconscious (preconscious and unconscious), and symbolism.

4) Incorporation of family and community in ceremony or ritual and ho'oponopono^1,12.

5) Specific recommendations for specific diet are given to patient¹.

6) History and physical exam. This may also include diagnostic work with intuitive or spiritual healing techniques. The Kahuna haha were known to pass their hand over an individual and localize the site of abnormality¹.

7) Lomilomi (type of massage) and/or la'au (herbs), still under spiritual guidance, could promote better mana, pono, and lokahi ^1,9.

8) Respectful communication occurred "on all levels" with patient until healing occurs¹.

9) Closing prayer.

There is only limited information on modern practicing traditional Hawaiian healers. In a 2002 survey of 25 traditional Hawaiian healers on O'ahu, 68% reported that they are skilled in more than one healing modality. The modalities were ho'olomilomi (type of massage), la'au lapa'au (herbal healing), and ho'oponopono (traditional counseling with conflict resolution). 56% of healers said they were training haumana or students ^14,15. In another study, some adolescent Native Hawaiians were reported to practice traditional healing, specifically ho'oponopono (traditional counseling for conflict resolution) and lomilomi (traditional holistic massage) ¹⁶ . A Kahuna lapa`au was and is a culturally appropriate healer and accounts for body, mind, spirit, culture, and nature when healing. Their holistic healing approach might be reasonably viewed by some as universal and timeless.

PART 3
BODY (KINO): THE PHYSICAL ASPECTS OF HAWAIIAN HEALING
LOMILOMI

Lomilomi was and is a "sacred healing art" ¹ and type of traditional holistic massage. Like other specialties of traditional Hawaiian healing knowledge, lomilomi was strictly passed on by oral tradition and experience. The skills were only passed from kumu (teacher) to haumana (student). Any deviation from what was exactly taught was a sign of disrespect. The physical techniques were very diverse (depending on individual teachers, personal styles, and regions). Many techniques included both the use of hands and forearms. Tingling or "chicken skin" sensations helped the healer identify areas of the body that were pathological ^1,2. This area would be emphasized during the session. Utilization of ho'oponopono and spirituality by the kahuna lomilomi was similar to the other holistic traditional healers or kahuna lapa'au. This sacred holistic massage also incorporated body (kino), mind (ho'oponopono), spirit ('aumakua,ancestors), and nature (plants,salt, and water).¹

PART 4
MIND: HAWAIIAN PSYCHOLOGY
Ho'oponopono

Groups or societies need some degree of peace and functional ability to accomplish their goals. The Native Hawaiians had such a system called ho'oponopono that was used for resolving conflicts in their relationships. The well documented traditional Hawaiian (group, individual, or family) conflict mediation method,called ho'oponopono, has spirituality, intent, communication, mutual forgiveness, restitution, repentance, emotional maturity, and respectfulness as the foundation of its effectiveness toward healing. This practice essentially addresses, heals, resolves, and "lets go" of past and present conflicts between the patient themselves, other people or family, God, and nature. ^1,2,3 Ho'oponopono is a specialized skill that requires training. An outline summary ^4,5 of the ho'oponopono process is as follows:

1) Family/group agrees to participte in ho'oponopono in the spirit of truth. The haku (mediator or leader) is respected by all parties.
2) Opening prayer asking for guidance fron Akua (Godly higher power) and 'Aumakua (ancestral spirits)
3) Problem(s) is identified and discussed.
4) Each involved party gets chance to be heard with "as needed time outs" done to cool off. This step may take more than one day.
5) Mutual confession and acceptance of responsibility is attained.
6) Forgiveness, and release/closure are achieved. All layers of conflict (body, mind, spirit, nature) would be addressed before closure.
7) Closing prayer with declaration of confidentiality and official end of problem.
8) Closing ritual and or meal.
9) Return to normal activities..

It is known that 'olelo ( words) was and is very important and influential to Hawaiians ¹. In fact, the power of suggestion with healing was utilized by traditional healers, including being used to manipulate pain.⁶ If a Kahuna asked a patient if a particular herbal preparation could help them, and they said "no", they might be refused treatment. If they said "yes", then they were given the treatment¹. Trust and optimism were essential. Also, practitioners were known to sometimes identify relationships or psychological stressors as possible causes of patient's complaints. They would then start with counseling or ho'oponopono before other treatments were started ². If symptoms resolved after ho'oponopono, then nothing further was necessary.

PART 5
BODY (KINO): PHYSICAL ASPECTS OF HAWAIIAN HEALTH AND HEALING
NATIVE HAWAIIAN NUTRITION AND EXERCISE

Plants were associated with different Gods, therefore, foods from nature were possibly a source of mana (divine power and authority) for the Hawaiians. Remember that it was impossible to truly separate the Hawaiian unified concepts of man, nature, and spirit as they were always thought to be interacting and influencing each other.

The traditional Native Hawaiian diet was low in fat (7-12%), high in complex carbohydrates (75-80%), moderate in protein (12-15%), and high in fiber ^1,2. Common foods included taro, sweet potato, breadfruit, seaweed, bananas, mountain apple, and fish. Traditionally, animal meat was rarely eaten by the Hawaiian commoner. For further details about this, see section on Hawaiian foods. The traditional natural Hawaiian diet and active lifestyle possibly fulfills the recent American Cancer Society (ACS) health promotion guidelines. Recent ACS guidelines³ recommend eating greater than 5 servings of fruits and vegetables a day, ingestion of whole grain over simple sugars, high fiber, and minimal red meat.

It is well established that proper nutrition and exercise are important modifiable risk factors for cancer, as well as cardiovascular disease. In the Behavioral Risk Factor Surveillance System (BRFSS) study in 2001, only 50.9% of Native Hawaiians exercised regularly, and only 17.2% ate more than 5 servings of fruits and vegetables per day.⁴ A small study of 25 Native Hawaiians, and other reports, showed decreased weight, improved blood pressure, and lowered cholesterol while on the traditional Hawaiian diet ^1,2 . A program called Uli'eo Koa is a pilot program that uses culturally appropriate methods to improve diet, as well as physical and spiritual wellness ^5,6.

Specific culturally related physical activities of Native Hawaiians includes the hula (traditional dance), lua (Hawaiian martial arts), working in the taro lo'i (taro or kalo field), surfing, paddling, hiking, and swimming in the ocean, among others. Relaxation was also an important part of treatments by traditional Hawaiian healers. According to Hawaiian culture authority John H. Wise (a half-Hawaiian), a common combination treatment called 'apu involved rest, relaxation, prayer, and herbs ⁷. In other words, Hawaiians could "enhance their mana" by reinstating the culturally relevant idealistic ways of eating natural foods, maintaining daily physical activity, meditating or having relaxation in their daily life, and not abusing substances or committing offenses (to themselves, others, nature, and their spirituality).

PART 6
SPIRIT: HAWAIIAN HEALING GODS AND TEMPLES

All facets of healing by traditional Hawaiian healers involved spirituality and prayer. Although resources vary a bit, the main Hawaiian healing Gods were Lono, Ku, Hina, Kane and Kanaloa. However, 'Io was the highest of all other Gods. Ku and Hina represented the duality of male and female aspects of healing. Lesser Gods of healing included Ma'iola (brought health and life out of sickness), Mauliola (God of health, "breath of life"), Nu'akea (Goddess of milk-giving), many others and personal 'Aumakua. These Gods, Goddesses, and ancestral spirits were called upon to help with all stages of healing. Healing temples called heiau ho'ola were dedicated to a specific God. For example, the heiau ho'ola of Lono.

The equivalent of a medical school are heiau found in 'Aiea in O'ahu, called Keaiwa and another in Kau, Hawai'i called Honokane heiau. The mana of the healing kahuna was passed on via teaching, but ultimately to the haumana or student by breathing ha , or the breath of life, on the crown of the head or mouth. The breath of ha was also used on medicinal herbs¹. See part 2 on the kahuna la'au lapa'au for other details. Preparations and treatments were always done in conjunction with prayers. Symbolic healing numbers were five and less often four. For example, an herbal preparation was given with instructions to take it five times a day for five days. Reasons for these specific numbers is not known¹. Kaona, or a hidden meaning, was a concept implemented frequently in the Hawaiian language and their communications².

For example, lima in Hawaiian means five or arm/hand/finger, which are of course used by the palpating diagnostician called kahuna haha. Ha, the number four in Hawaiian, also means the breath of life. These are all intimately related. Interestingly, manamana lima also means finger in Hawaiian, and coincidentally there are four main Gods that were honored above all others, except the greatest One God named 'Io. According to one source, there were five Gods considered the highest of all others. However, most sources say there are only four.

An example of a translated healing Hawaiian prayer to 'Io (from Mrs. Emma Ahuena Taylor, a descendant of kahuna named Kahaku'ikawaiea) is as follows:

"Gnawing bird lazily poised
'Tis the owl crying nearby
From his sacrificial pit
Here is the boy-child (stricken)
Suddenly agitated are the relatives,
Let it come to pass, let (the sorcerer) be done to death
Finished, oh Lono (God of healing) he lives"³

Conclusion

I hope this provides a basic introduction to Hawaiian healing and philosophy. We are all connected to our past, but live in the present. And both of these help us to form the future. If you simply remember the piko concept of this article, then one could say that this paper incorporates body, mind, spirit, and nature (or in other words a healthy holistic approach) of the past, present, and future. Aloha.

REFERENCES
PART 1

1. Roots of wisdom: indigenous healing provides the cornerstone for todays herbal medicine, Clute M, Bokur D, Gregory C, Evans L. (Healthwell; 2001). Retrieved on 11/20/03 from www.healthwell.com/delicious-online/d_backs/may_01/wisdom.cfm
2. Mai Iluna Mai (It Comes From Above), Naone KL. (Honolulu, Hawaii, Kumu A'o and The Hawaii Community Foundation, 2002).
3. The Kahuna Religion Of Hawaii, Bray D, Low D. (Garberville, California Borderland Sciences, 1990).
4. Core Hawaiian Cultural Values. Retrieved on 4/19/03 from http://www.hoolokahi.net/value.html
5. Man, Gods, And Nature: A Hawaiian Nation I. , Dudley M. (Honolulu, Hawai'i Na Kane O Ka Malo Press, 1990).
6. Reflections of a Native Hawaiian physician: Hawaiian cultural values in western medical practice, Ka'ano'i M E (Pacific Health Dialog, 8(2):375-379,2001)
7. The Need For Hawai'i: A Guide To Hawaiian Cultural And Kahuna Values. Ka'ano'i P. (Jefferson City, MO, Ka'ano'i Productions, 1992).
8. Hawaiian Values. Kanahele G, (Honolulu, Hawai'i; Project Waiaha, 1982).
9. Nana I Ke Kumu. (Look To The Source): Volume 1 & 2, Pukui M, Haertig E, Lee C. (Honolulu, Hawai'i; Hui Hanai, 1972).
10. Hawaiian Dictionary. Pukui M, Elbert S, (Honolulu, Hawai'iUniversity of Hawai'i Press. 2003). Retrieved on 6/04 from www.wehewehe.org
11. Ka Lama Kukui: Hawaiian Psychology, Rezentes WC. (Honolulu, Hawaii'A'ali'i Books., 1996).
12. Hawaiian Lomilomi Big Island Massage, Kahalewai N. (Mt. View, Hawai'i Island Massage Publishing, 2000).
13. Historical and cultural aspects of Native Hawaiian health, Blaisdell R. (Social Process in Hawaii, Special Issue, 32:1-21,1989)
14. Historical and philosophical aspects of lapa'au traditional kanaka maoli healing practices, Blaisdell R. (Honolulu, Hawaii.1991). Retrieved on 9/12/03 from www.inmotionmagazine.com/kekuninf.html

REFERENCES
PART 2

1. Hawaiian Herbal Medicine. Kahuna La'au Lapa'au, Gutmanis J. (Honolulu, Hawai'i:Island Heritage, 1976).
2. Roots of wisdom: indigenous healing provides the cornerstone for todays herbal medicine, Clute M, Bokur D, Gregory C, Evans L. (Healthwell: 2001). Retrieved on 11/20/03 from www.healthwell.com/delicious-online/d_backs/may_01/wisdom.cfm
3. Native Hawaiian Medicine. Chun, MN. (Honolulu, Hawaii: First Peoples Productions, 1994).
4. Ruling Chiefs Of Hawaii, Kamakau, SM. (Honolulu, Hawaii:Kamehameha School Press, 1961).
5. Outline Of Physical Therapeutics. Handy, ES, et al. (Honolulu, Hawaii:Bernice P. Bishop Museum Bulletin. 1934).
6. The Kahuna Versatile Masters Of Old Hawai'I, McBride, L. (Hilo, Hawai'i: Petroglyph Press, 2000).
7. The Kahuna Religion Of Hawaii, Bray D, Low D. (Garberville, California: Borderland Sciences, 1990).
8. Mai Iluna Mai (It Comes From Above), Naone KL. (Honolulu, Hawaii: Kumu A'o and The Hawaii Community Foundation, 2002).
9. Hawaiian Lomilomi Big Island Massage, Kahalewai N. (Mt. View, Hawai'i: Island Massage Publishing, 2000).
10. Historical and cultural aspects of Native Hawaiian health, Blaisdell R. (Social Process in Hawaii: Special Issue, 32:1-21.1989)
11. The Gifts of Civilization: Germs And Genocide In Hawai'i, Bushnell O. (Honolulu, Hawaii: University of Hawaii Press, 1993).
12. Polynesian Herbal Medicine, Whistler W. .Lawai, Hawai'i: National Tropical Botanical Garden, 1992).
13. Nana I Ke Kumu. (Look To The Source): Volume 1 & 2, Pukui M, Haertig E, Lee C.(Honolulu, Hawai'i: Hui Hanai, 1972).
14. Hawaiian health practitioners in contemporary society, Chang HK. (Pacific Health Dialog:8(2):260-273, 2001).
15. Holistic Practices Of Hawaiian Health Practitioners, Chang H. (American Public Health Association Conference Presentation, Abstract#43346, 2002).
16. Sociocultural and community factors influencing the use of Native Hawaiian healers and healing practices among adolescents in Hawaii, Bell CK, Goebert DA, Miyamoto RH, Hishinuma ES, Andrade NN, Johnson RC, McDermott JF Jr. (Pacific Health Dialog:8 (2): 249-259,2001).

REFERENCES
PART 3

1. Hawaiian Lomilomi Big Island Massage, Kahalewai N. (Mt. View, Hawai'I: Island Massage Publishing, 2000)
2. Mai Iluna Mai (It Comes From Above), Naone KL. (Honolulu, Hawaii: Kumu A'o and The Hawaii Community Foundation, 2002).

REFERENCES
PART 4

1. Nana I Ke Kumu. (Look To The Source): Volume 1 & 2, Pukui M, Haertig E, Lee C., (Honolulu, Hawai'i:Hui Hanai, 1972).
2. Hawaiian Herbal Medicine. Kâhuna La'au Lapa'au, Gutmanis J. (Honolulu, Hawai'i: Island Heritage, 1976).
3. Shamanic Wisdomkeepers: Shamanism In A Modern World, Freke T. (New York, N.Y:Godsfield Press, 1999: 52-63).
4. Ho'oponopono, "To make right": Hawaiian conflict resolution and metaphor in the construction of a family therapy, Ito K. (Cultural Medical Psychiatry:9: 201-217, 1985 ).
5. . Ho'oponopono: Contemporary Uses Of A Hawaiian Problem-Solving Process, Shook E (Honolulu, Hawai'i:The East-West Center, 1985).
6. Medicine I. Ancient Hawaiian Remedies Known Today, Chapter 24, Ancient Hawaiian Civilization, Wise, J.H.(Honolulu, Hawaii: Mutual Publishing, 1999).

REFERENCES
PART 5

1. The Wai'anae Book Of Hawaiian Health: The Wai'anae Diet Program Manual, Shintani T, Hughes C.(Wai'anae, Hawaii:Wai'anae Coast: Comprehensive Health Center,1993).
2. Obesity and cardiovascular risk intervention through the ad libitum feeding of traditional Hawaiian diet. Shintani T, Hughes C, Beckham S. (American Journal Clinical Nutrition: 53: 1647S-1651S,1991).
3. Hawaii Pacific Inc. Hawaii Cancer Facts And Figures 2003-2004. American Cancer Society. (Honolulu, Hawaii:1-60 2003). Retrieved on 6/04 from www.hawaii.gov/health/statistics/other-reports/cancer2003-04.pdf
4. Hawaii State Department of Health. Community Health Division, Behavior Risk Factor Surveillance System, United States Center for Disease Control and Prevention, (Honolulu, Hawaii: Tables 13,15,17, 2001). Retrieved on 6/04 from www.hawaii.gov/health/statistics/other-reports/cancer2003-04.pdf and 9/04 from www.state.hi.us/doh/stats/surveys/2002/state02
5. Uli'eo Koa- Warrior preparedness, Hughes CK. ( Pacific Health Dialog: 8 (2): 393-400,2001)
6. Uli'eo Koa Program: incorporating a traditional Hawaiian dietary component. Leslie JH (Pacific Health Dialog:8 (2): 401-406, 2001)
7. Medicine I. Ancient Hawaiian Remedies Known Today. Chapter 24, Ancient Hawaiian Civilization, Wise, J.H. (Honolulu, Hawaii: Mutual Publishing, 1999).

REFERENCES

PART 6

1. I Ke Kumu. (Look To The Source): Volume 1 & 2, Pukui M, Haertig E, Lee C., (Honolulu, Hawai'i:Hui Hanai, 1972).
2. Hawaiian Dictionary. Pukui M, Elbert S, (Honolulu, Hawai'iUniversity of Hawai'i Press. 2003). Retrieved on 6/04 from www.wehewehe.org
3. The Cult Of Iolani , Taylor, A (Paradise of the Pacific: December 1931) as quoted in Na Pule Kahiko, Ancient Hawaiian Prayers, Gutmanis J. (Honolulu, Hawai'i: Editions Limited, 1983).

Addendum: Diacritical marks were not possible due to technical limitations with fonts.

Written by Brad Hope MD. February 2006.