Pasma is a malady unique to Philippine folk medicine, bound to elements in its physical world,
and like bales, is one of the favorite go-to diagnosis by the albularyos, hilots and medico.
It is accepted as a disease entity in many provinces and tribal cultures,
differing in the regional variations and contributions of myth and superstition,
but sharing in the belief that it is most commonly brought about by
exposure to "cold" and water in its varied presentations.
Water is believed to be the vehicle by which this unhealthy coldness
enters the body – through skin pores, through the vagina, cervix
and uterus, or through other avenues of entry imagined by folklore or
rural science, and if the exposure is repetitive enough, it eventually manifests as "pasma"
in the variety of ways it can present.
Rural
physics
Rural physics and the quirky provincial ways are often looked upon with
urban derision and burgis incredulity, but as often, with tolerant amusement.
It is a world inhabited by elves, good and bad, black and white (duwendeng
itim o puti), tikbalangs and kapres, and countless other
creatures of regional mythologies. The rural folk whistle to summon the wind to
grace the heavy stillness of a warm day with a breeze. They slaughter
a chicken, its neck spurting blood, praying as they circle the house
to drive the evil spirits away. They predict tomorrow's weather by the
night skies. They believe earth-dwellers inhabit the termite mounds
(nuno-sa-punso) who will inflict illness on
those who disrespect or disturb their earth mounds. They go to their
village healers who diagnose their illnesses from imagined signs in
a slaughtered pig's liver or configurations made by raw eggs or melted
candles in water. In this setting of folklore, pasma finds a welcome and believable position in the health care beliefs of rural folk.
HOT-COLD DISEQUILIBRIUM
In pasma, they draw upon their abundant collection of lore and version
of rural science to distill a hot-cold belief system. They believe in
the contributions of the physical elements in the causation of disease,
in the imbalances of hot-and-cold, and how water facilitates the entry
of negative or "cold" energy through traditional pathways
or mysterious and imagined conduits. Cold water is believed to be harmful
to health if one is exposed to it after physical exertion. Washing the
hands or feet when tired is ill-advised. Showering or even a sponge
bath after a hard day' s work is avoided, as this can cause the cold
to enter the body through the skin pores. Showering or washing after
sexual intercourse is not advisable, as cold may enter the body through
the vagina, cervix and uterus. Baths are generally avoided after childbirth,
as long 14 to 21 days, strongly advised in the old world hilot's manual
of postnatal care (Suob).
Washing clothes after ironing is a big rural no-no; but to the rural
housewife's possible dismay, it is acceptable to iron after washing
clothes. Any kind of prolonged and repetitive activity that causes undue
tiredness and trembling of the extremities is avoided for fear it might
eventually lead to a more permanent tremulous condition.
VENGEFUL EARTHFOLKS
Although chronic and recurrent disruptions of the "hot-cold"
equilibrium is the cause most often blamed for pasma, in some regions
mythologies and superstitions enter into the mechanisms of causation.
Local healers, through diagnostic "tawas,"
may attribute "pasma" to vengeful earth folks – duwende
or nuno-sa-punso, whose dwelling places might have
been wittingly or unwittingly disrupted or disrespected by rural pedestrians.
Manifestations
Pasma is a cumulative condition that covers
a wide spectrum of complaints – from a simple tremor of the hands (the most common complaint attributed to pasma), numbness
or swelling of the extremities, to a constellation of symptoms and signs – usually
attributed to a chronic repetitive habit or behavior, especially one
that causes recurrent "unhealthy cold exposure" or imbalances
of the hot-cold elements.
Inevitably, in its motley
ways of presentation and cause, pasma has its own diagnostic
nomenclatura. In the classic
all-inclusive diagnosis, pasma includes the common tremors of the hands, excessive
sweating and swelling of the hands and feet, numbness, pain in the distal
extremities and knees, prominent veins in the hands and feet.
Some are more system- or cause-specific diagnoses: pasmang
bituka, pasmang matanda, pasmang sapatos, pasmang
mata.
• Tremors or shakiness (pangangatal),
especially of the hand, in traditional rural notion of health and disease,
is almost always initially attributed to pasma.
• Numbness (pagmamanhid)
and swelling (pamamaga)
and pain (kirot)
of the hands and feet, and sometimes of the knees, commonly blamed on
too frequent washing, invariably pass through the "pasma"
diagnosis.
• Abdominal pains for those who take baths during
their menstrual periods or wash after sexual intercourse.
• Unsightly veins in the hands and legs, are
attributed to the too frequent exposure of the body to cold water after
hot or washing when tired or physically exhausted.
• Pasmang-bituka, abdominal pains and
flatulence attributed to drinking cold water when tired and coming from
the heat.
• Pasmang-sapatos, sweating of the feet
from tired and shod feet getting wet in the rain.
• Pasmang-matanda, a common arthritic
affliction of the hands, feet and knees in older patients, is often
attributed to frequent practice of the tired-cold bathing.
• Pasmang-mata, the frequent blinking
and visual blurring in someone who spends the good part of the day inside
a hot and sweaty environment, and washing the face at day's end with
cold water.
Coping
ways
From the still prevalent belief in pasma as
a common rural malady caused by certain lifestyle habits and behavior,
a hand-me-down list of DO's-and-DON'Ts endures in folkloric therapeutics.
Many cases of "pasma" never make it to the local healers;
many resolve with tincture of time or with adherence to a preventive
rural regimen of behavior modification.
• Tiresome repetitive movements of the upper extremities should
be avoided.
• Washing clothes after ironing is pasma-inducing.
• Showers and bathing should be done in the mornings. Most men
go to bed without bathing, the dirt and grime of the day's work usually
brushed or rubbed off with a dry towel.
• And many of the rural womenfolk, equally observant, avoid bathing
or washing after sexual intercourse, during menses, and for 14 to 21
days postpartum. (see Suob) If they bathe or
wash, they do so with great care, using warmed moist towels.
Folkloric
treatments
Massage
• Ginger, coconut oil and alcohol:
A concoction of ground or mashed ginger (luya) is mixed with a little
alcohol and coconut oil, for massage to the tremulous, painful or swollen
extremities.
• Ginger,
garlic, camphor, onions, etc: Another preparation
used for massage therapy is a concoction of ginger, coconut oil, onions,
garlic, camphor, wintergreen and a small amount of scrapings from naphthalene
balls.
• Ginger,
litlit or ikmo, and coconut oil: Another herbal preparation
used for massage therapy is a concoction of juice from pounded ginger and litlit or ikmo to which is added coconut oil.
• Hugas-Bigas: More
easily accessible is the use of hugas-bigas (water from the washing
of uncooked rice) for use in massage treatments.
Wash and
soaks
• Salt
soaks: For sweating of the hands or feet, soaking into
lukewarm decoctions of salted water for one-half to one hour.
•
Salt and Bayabas Leaves The salt residue from home ice-cream
makers is mixed with water and bayabas leaves, boiled and used as a
healing wash to the extremities.
• Buri:
In Pangasinan, bathing with decoction of leaves used as pasma treatment. (read: Buri)
• Salt and Gas:
The ice-cream maker salt residue is mixed with "gas" (used
for rural lighting) and used for washing the extremities.
• Hugas Bigas (rice-water)
is saved and used for washing or sponge-baths.
• Tawas: Bath water
is prepared with tawas boiled and dissolved in it.
• Urine: In some
provinces, the warm first morning urine, is used as a soak-and-wash
for tremors, numbness and excessive sweating.
Others
• Sand-and-Sweat
Therapy: Seaside treatment – digging and lying
covered with sand for 3-5 hours.
• Herbal-Steam Therapy: Steam from boiling decoction of lagundi leaves (with or without kalamansi leaves) is funneled toward the body, like a modified steam bath, for a half hour, daily as needed.
• Pasmang-bituka:
Daily salted decoctions of solasi
(Holy basil).
• Tawas: In regions
where pasma is sometimes attributed to vengeful earth folks, tawas
is the folkhealer's favorite modality, not uncommonly supplemented with
a bulong or orasyon.
Misdiagnosis
• Many of the tremulous maladies and sundry of complaints attributed
to pasma never make it to the albularyos. Many are self-limited complaints resolving with tincture of time or with some hand-me-down self treatment. Many of
those who consult the albularyos will often have their complaints attributed
as complications of some past malady or as consequence of one of many pasma-inducing behavior. Many of these complaints, ministered to by the albularyos
and hilots, likewise resolve with tincture-of-time, placebo or one of many
folkloric treatments, concoctions, or massage.
• Of course, modern medicine views pasma's pathophysiology
as folksy hogwash. The persistent and worsening cases that eventually
make it to the physician, stripped off its
layers of myth, reveal them to belong to a wide spectrum of medical
conditions – extremity edema from renal or cardiac diseases or
venous insufficiency, numbness of the hands from carpal tunnel tunnel
syndrome or ulnar entrapment neuropathy, extremity numbness from diabetes
or lumbosacral disease, distal tremors which could be benign essential
tremor or parkinson's disease, and a whole slew of underlying conditions–hypertension,
diabetes and inflammatory diseases.
• One case was a 47-year old woman who has been suffering eight
years with progressive tremors, diagnosed as "pasma" and treated
with this-and-that rural herb and a variety of concoctions for massage.
Four years later, it was diagnosed as Parkinson's disease. Alas, the
diagnosis, finally made, did not matter; the treatment, at 40 to 60
pesos a day, was unaffordable.
• Recently, I looked into a 70-year old woman with acute onset left sided weakness. On exam, she manifested with significant systolic hypertension, neurologic findings of left hemiparesis and a right carotid bruit that strongly suggested a stroke syndrome. A week later, on follow up, I learned the family has stopped my prescriptions and, in lieu, has started on a albularyo hilot's regimen who diagnosed it as pasmang-ugat.
Pasma
is a Filipino folk diagnosis shared by most indigenous cultures, handed
down from generation to generation, high on lore and zilch on science,
borne on ignorance and so embedded in their notions of health and disease,
perpetuated by the faith and reliance on their albularyos and hilots
who minister to their maladies with doses of bulongs and orasyons and
a motley of concoctions, occasionally finding relief through tincture
of time, placebo or some mysterious benefits of alternative rural modalities.
And
it will not be surprising to find in this group of patients—self-diagnosed
or diagnosed by albularyos, medicos and hilots to have pasma—many who will turn out to have various other medical conditions
(cardiovascular, circulatory, neurologic, rheumatic, osteoarthritic, inflammatory
and degenerative)–amenable to some form of treatment,
but unfortunately delayed by folklore from the benefits of medical therapies. Fortunately, most of the conditions are chronic and treatment merely delayed. However, sometimes, acute and serious conditions are erroneously labeled as pasma, and appropriate treatments are sadly delayed with unfortunate consequences to health and outcome. |
