Open Journal of Philosophy
2013. Vol.3, No.1A, 117-121
Published Online February 2013 in SciRes (http://www.scirp.org/journal/ojpp) http://dx.doi.org/10.4236/ojpp.2013.31A019
The Epistemology of Symbols in African Medicine
Innocent Ngangah
Department of Philosophy, Anambra State University, Igbariam, Nigeria
Received December 11th, 2012; revise d J a nu a r y 2013; accepted January 27th, 2013
This article will discuss the epistemology of symbols employed by African traditional medical practitio-
ners in treating their patients and the essence of such symbols among traditional communities across the
continent. Relying on diverse studies by other researchers and my own investigation conducted among the
Igbo of south-eastern Nigeria, this paper will explore relevant aspects of African traditional medicine as
they relate to symbols employed by the practitioners in their effort to offer health care and general well-
being to their clients.
Keywords: Symbols; African Medicine
Introduction
Although various studies have been conducted on the subject
of symbols and traditional medical practices in African com-
munities—and I will be referring to such studies in this dis-
course—this article will dwell largely on the semiotic and phe-
nomenological implication of African medical symbols.
The paper will be divided into three sections. The first sec-
tion will dwell on definition and clarification of terms, espe-
cially as they touch on the concept and application of symbols
in African medicine. Second, the article will present the meth-
odology of African traditional medical practices as observed
and recorded by ethnographers, philosophers, and social scien-
tists who have conducted research in this key area. This section
will also underscore the customary nature of traditional medi-
cine—which makes the employment of symbols rather impera-
tive—by drawing attention to some key differences between
traditional and modern medical practices. Third, the article will
enumerate some of the key symbols utilized in African tradi-
tional medical treatment with a view to extrapolating their
symbolic import within the context of a given cognitive system.
Although this paper draws its inferences from researches con-
ducted across the continent and from my own research in south-
eastern Nigeria, I will restrict myself to observed phenomena
and will try to avoid sweeping generalisations because of “the
diversity of the continent and the attendant whimsical changes
in the cultures of the people of Africa” (Isiguzo, 2010).
Symbolism Models Employed in This Study
Essentially, this paper is exploring the epistemology or
knowledge of culture-specific meanings traditional African
medical practitioners invest on the herbs, objects, techniques
and other tools they employ in their treatment of patients. And
when things, including the aforementioned, and as with every
spoken or written word, are invested with meaning they become
signs. According to Daniel Chandler,
We interpret things as signs largely unconsciously by re-
lating them to familiar systems of conventions. It is this
meaningful use of signs which is at the heart of the con-
cerns of semiotics (Chandler, 2012).
Such “meaningful use of signs” is also at the heart of this ar-
ticle.
Because of the nature of this study, we will be concerned
specifically with a special group of signs called symbols. N. K.
Dzobo thinks that “While signs provide simple information,
sym b o ls are used to co mmunicat e complex kno wl edge.” (Dzobo,
1992). But Maduabuchi Dukor has a more elaborate explana-
tion:
Symbols are cultural realities imbued with cultural mean-
ing and any suggestive symbol … is epistemic and the-
matic. It is an overt expression of the reality behind any
direct act of perception and apprehension, which really
possesses scientific connotation outside its normal, obvi-
ous or conventional meaning (Dukor, 2006).
Symbols in general, in Dukor’s view, refer to that which ex-
presses, represents, stands for, reveals, motivates, and makes
known another reality. In other words, symbols are tools em-
ployed by man for the purpose of understanding the world,
himself and his environment, and usually characterized by
communicative and cognitive qualities.
For the philosopher, Charles Sanders Peirce, a symbol is
technically,
a sign which refers to the object that it denotes by virtue
of a law, usually an association of general ideas, which
operates to cause the symbol to be interpreted as referring
to that object (Peirce, 1931).
He goes further to stress that “The symbol is connected with
its object by virtue of the idea of the symbol-using animal,
without which no such connection would exist.” (Saussure,
1983). The symbol-using animal Pierce has in mind here is
none other than the human being. Symbols are natural to man
and had been recognised as such even before the dawn of for-
mal language. Man cannot function in his cultural milieu with-
out symbols. In fact, the evolution of man cannot be separated
from the evolution of symbols. Symbols enable man to under-
stand the world around him. They could be seen as a synthesis

I. NGANGAH
of man’s social and cultural environment.
There are two leading models in the scholarly investigation
of signs, including symbolic signs, a combination of which we
shall be adopting in our exploration of symbols in traditional
African medical practices. They are the two-part model of the
sign as enunciated by the linguist Ferdinand de Saussure and
the philosopher Charles Sanders Peirce’s three-part model. For
Saussure, a sign is composed of a signifiant and a signifié, two
terms we have come to know in English as “signifier” and “sig-
nified” respectively. The signifier points to the form of the sign
while the signified points to the concept it represents for the
user of the sign. These two components, according to Saussure,
constitute the sign; and the relationship between them is what
he termed “signification”.
Pierce, working independently, came up with a three-part, or
triadic, model of the sign which interestingly equates Saus-
sure’s dyadic model while introducing a third element, the “ob-
ject” of a sign, thereby amplifying the scope of the sign.
Pierce’s three-part model of the sign is made up of the follow-
ing: the “representamen” or the form of the sign (the equivalent
of Saussure’s “signifier”), an “interpretant” or the sense it
makes to the sign-user (the equivalent of Saussure’s “signified”,
except that Pierce’s “interpretant” is itself another sign in the
interpreter’s mind) and an “object” or what the sign refers to.
Pierce’s triadic model of the sign is often represented as the
semiotic triangle, and there are many variants of it. For the
purpose of this study in medical symbolism, and utilizing
Nöth’s 1990 “sign vehicle”, “sense” and “referent” terms, but
including the original Piercean terms and the Saussurean
equivalents, I have come up with a customized symbol-specific
semiotic triangle as follows (Figure 1).
Pierce refers to the “interaction” between the representamen,
the object and the interpretant as “semiosis”, a term which is of
more practical relevance to us in this study than Saussure’s
two-way “signification” concept of the sign—or, specifically
for our purpose, the symbol. Pierce’s model gives room for the
creation or evocation of another symbol in the mind of the
interpreter (say, the traditional doctor, the patient, or a given
society). According to Pierce,
a sign ... addresses somebody, that is, creates in the mind
of that person an equivalent sign, or perhaps a more de-
veloped sign. The sign which it creates I call the interpre-
tant of the first sign.
This perspective will enhance the analytical aspect of this
study because in the traditional medical environment a symbol
is often invested with various meanings even within the same
semiotic code, and without necessarily contradicting Lévi-
Strauss’s observation that once “the sign has come into histori-
cal existence it cannot be arbitrarily changed”.
Methodology of African Traditional Medicine
Let me begin by asserting that African traditional medical
practice is generally more all-encompassing than its orthodox
Western equivalent. Whereas the average orthodox medical
doctor treats the body of his patient, the average traditional
healer treats the person of his patient. The latter goes beyond
clinical issues to delve into the social, cultural and spiritual
world of his patient all of which are believed to impact upon his
health within the traditional milieu. That is why the traditional
doctor is often part physician and part priest—someone who
administers both physical and spiritual remedies and whose
office resembles a shrine more than the secular workplace of
the orthodox doctor. As such, African traditional medicine is
more mystical than empirical—more oriented towards the ma-
nipulation of symbols but not necessarily less efficacious than
orthodox medicine. (Bourdillon, 1989). L. B. Grotte, a Western
medical doctor who understudied the practices of a typical Af-
rican traditional doctor, the Ifa physician-priest of western Ni-
geria, observes as follows:
Disease can be considered in Ifa medicine as a disorder or
misalignment of the internal or external milieu of the pa-
tient. Part of the role of the physician is to align the pa-
tient with the matrix of influences that will rebalance their
particular disorder. Sometimes also, a disorder develops
as a result of losing or ignoring a relationship with a ma-
trix of influence.
Against this background, the methodology of African tradi-
tional medicine is understandably different from that of Western
Sense
(interpretant or signified)
Referent
(Pierce’s “object” of the symbol
what th e symbol stan ds for)
Sign vehicle
(representamen or signifier)
MEDI CAL SYMBOL
C A
B
Figure 1.
Symbol-specific semiotic triangle.
118

I. NGANGAH
medicine. Most of what I noted while enquiring into the tradi-
tional medical practices of the typical dibia (native doctor) in
various communities of eastern Nigeria coincide with Grotte’s
description of the methodology employed by his Ifa counterpart.
Grotte’s observation:
Utilizing non-familiar forms of diagnosis, such as divina-
tion and dream interpretation, in addition to the traditional
format of questioning, observation and touching, the Ifa
physician may use familiar techniques of dietary therapy,
psychotherapy, surgery, and herbal medicine, but may
also perform exorcisms, rituals, sacrifices and other pro-
cedures which seem more the province of priests than
physicians.
In other parts of Africa, the priestly or spiritual function is an
integral part of the methodology used by traditional healers.
The sociologist, M. F. C. Bourdillon, reporting on a similar
study among the Shona, observes that,
Most traditional healers in Shona society claim to be
guided in their art by a helping spirit who takes posses-
sion of the healer from time to time, when, according to
Shona belief, it is the spirit who speaks through the body
of the host ... traditional healers attribute their knowledge
of indigenous medicines to the influence of their spirits,
who reveal cures in dreams, or guide the healers in the
veld to appropriate plants.
Other studies, notably those of G. L. Chavunduka, (1988)
and V. W Turner’s (1967) among the Ndembu, indicate that the
methodology of traditional medicine is similar across Africa.
Traditional treatment techniques include, among others, the
following: physical and/or spiritual enquiry, observation,
touching, dietary prescription, psychotherapy, surgery, herbal
medicine, bone-setting (doesn’t necessarily involve surgery),
exhuming charms and spiritual objects, extracting confessions
from the patient, priestly sacrifices and procedures, traditional
vocalizations (mantra), and use of protective charms and amu-
lets. Of comparative interest here is a similar study in tradi-
tional medical methodology conducted by Alexander K. Smith
among the Bon community of India.
Symbolism of African Traditional Medicine
It is difficult to isolate African traditional medicine from the
gamut of other customary practices and beliefs such as ances-
tral worship, belief in the cyclical nature of life and the unbro-
ken communion between the dead, the living and the unborn—a
related feature of which is reincarnation—divination and belief
in cosmic laws which govern man’s interaction with both spirits
and nature. All of this spurns a series of symbols associated
with the gods, with various elements of the observable and
invisible world and, interlinked with them, with the wellness of
the individual. How the African traditional medical practitioner
and his patient evoke and utilize these symbols to redress
physical, mental and spiritual maladies will engage our interest
in this third section of the study.
Although the traditional herbalist is strictly speaking differ-
ent from the traditional or ancestral priest, their functions, in
practice, so easily overlap that I have combined both roles in
this study into what I term the physician-priest. In the tradi-
tional setting, the medical symbols employed by the herbalist
are drawn from the same traditional belief system superin-
tended over by the high priest who serves, like the herbalist, as
a healer of first resort and, unlike the ordinary herbalist, as a
consultant oracle in personal and communal matters. Both,
however, can conduct divinations, hence my decision to merge
these two primary actors in traditional healing in the term, phy-
sician-priest.
The high priest or physician-priest’s role, as Grotte points
out below, is that of an interpreter of the visible and invisible
causes of the patient’s ma lady.
The high priests interpret the factors surrounding a pa-
tient’s misalignment by means of their connection to the
various oracles of the religion. These reveal themselves
through divinatory activity of the priests and an elaborate
corpus of oral tradition that interprets the divinatory
symbols.
The scope of this study will not permit us to investigate this
“elaborate corpus of oral tradition” (Mbiti, 1991) alluded to
above but we can briefly look at some of the divinatory and
other medical symbols employed by the physician-priest.
In “Language and Thought in Aquinas: From the Semantics
of Being to the Epistemology of Being”, Rosa E. Vargas quotes
Aquinas as remarking that “the mode of signification in the
terms we impose on things follows on our mode of understand-
ing.” She then takes off from there to make a case for the ne-
cessity of establishing the “modes of relationship” or “modes of
signification” between symbolic vehicles and the sense they
make to us. Her observation:
Our terms not only signify things in the world, they also
signify those things in a certain mode. This mode of sig-
nification is grounded in our modes of understanding the
things signified by our terms. Thus, for Aquinas the rela-
tion between language and world is always mediated by
thought. If our modes of signification follow on our
modes of understanding, then an analysis of the mode of
signification of a term provides an insight into our mode
of understanding what is signified by that term.
In the light of the above, and utilizing the three “modes of
relationship” used by linguists for broad-based categorization
of symbols, I have tabulated below some African traditional
medical symbols I have identified in the course of this enquiry.
The list is by no means exhaustive and the items listed are in-
tended to serve as examples. In the notes beneath the Table 1, I
have explained how one mode differs from another.
What are the implications of these “modes of understanding”
for the African traditional medical practitioner (the physi-
cian-priest), his patient and the traditional society at large? This
will be examined in the rest of this paper. But there is one thing
we can immediately deduce from the above table which, I re-
peat, is by no means exhaustive: no mode of signification
seems to be overwhelmingly dominant within the traditional
medical environment. I think this goes to indicate that treating
the total man (spirit, soul and body) is of more importance in
traditional medicine than paying lopsided attention to the body,
like orthodox medicine, at the expense of the spirit and the soul.
The symbolic mode of the items listed in the first column of
the table points to their conventionality and the regime of spiri-
tual and social laws which govern their applicability, meaning
and usefulness as instruments for spiritual and medical recon-
struction. According to Pierce, symbolic signs such as the ones

I. NGANGAH
Table 1.
African traditional medical mode.
Symbol (sy mbol ic mode ) Icon (iconic mode) Index (indexical mode)
Cowrie
Nzu (calabash chalk)
Cloth
Amulet (or ta li s man)
Libation
Divination
Numbers (in a numerological sense)
Earth (land)
Kola nut
Prophetic utterance
Totem/figuring
Gong (sound)
Colour (red, black, white)
Mystical so u nd
Herbs (trees/plants)
Invocation
Animal skin
Idol (image)
Shrine
Cardinal points
Animals (owl , cat, dog, etc.)
Fire (smoke)
Natural events (thunder)
Dreams (& interpretation)
Sacrifice (animal sacrifice)
Ancestral-worship
Exorcism
Ritual (mode s of )
Medical sym ptoms
Note: Explanatory notes to the table: Symbolic mode—in this mode the relationship between the signifier and the signi-
fied is essentially arbitrary and conventional in a way which makes it necessary for it to be learnt. The typical examples
here are words, numbers, and flags; Iconic mode—in this mode the relationship between the signifier and the signified is
based on real or perceived resemblance or imitation. Here the signifier looks, sounds, t astes , etc, like th e signified . Based
on “direct percept ion”, typical examples are pictures , signature tunes, metapho r and onomatopoeia; Indexical mode—in
this mode the relations hip bet ween the signi fier and the signifi ed is no t arbit rary b ut i s d efined by direct connectio n o cca-
sioned by association or a cause-and-effect affiliation . Based on “an act of judgment or inference”, typical examples are
medical symptoms, measuring tools, pointers, signals, natural signs, such as thunder, etc.
tabulated in this column “direct the attention to their objects by
blind compulsion” within the context of this study, Pierce’s
“blind compulsion” points to cultural attributes or belief sys-
tems imbibed by members of a given community over time. It
is this cultural and spiritual sensitivity or faith that the physi-
cian-priest rests upon to deliver spiritual and bodily remedy to
any afflicted member of the community. This, perhaps, explains
why most of the items which fall under this column pertain to
the sacred functions (such as using cowries, nzu, numbers, kola
nut for divination, and making prophetic pronouncements) tra-
ditionally reserved for the priest.
Under the iconic mode (Column 2 of the table), we encounter
medical symbols governed by “relationship of resemblance”.
Three health processes could be evinced here: 1) the physi-
cian-priest’s use of all the listed items, except herbs, to appease
the ancestors—whom the patient resembles by blood—and to
petition the gods, by whom the patient’s spiritual essence is
connected to the big invisible God; 2) the use of the herbs’
curative powers to restore the patient’s health—to make him
reclaim his health and resemble his wholesome self; 3) the use
of relevant colours and mystical sound to attract or repel revi-
talizing or destructive forces represented by those colours. Red,
for instance, in many African societies, symbolises life and is
utilized as such.
It is important to note that aside from their physical proper-
ties, the symbolic properties of herbs are also taking into ac-
count in the physician-priest’s choice of herbs for treating a
given ailment. V. W. Turner reports an interesting case: among
Zambia’s Ndembu people, a healer told him that he uses the
Kapwipu tree (S. madagascariensis) to treat stomach upset in
children because the Kapwipu is a hard tree and hardness, for
the Ndembu, symbolises strength and health. A similar consid-
eration is given to the symbolic properties of cowries. Cowries
are viewed as symbols of “womanhood, fertility, birth, and
wealth” (Boone, 1986). This explains why they feature promi-
nently in divination and fortune-telling routines.
Finally, we will take a look at the symbols which fall within
the indexical mode (Column 3 of the table). These are medical
symbols which are not arbitrarily used because their usage is
occasioned by the physician-priest’s effort to manage, induce or
perceive a cause-and-effect situation in the life or circum-
stances of the patient. Every act here is predictable or, at least,
precise in interpretative terms. When the priest, for instance,
sees a smoke emerging from his invocative pot, he knows im-
mediately that “there is fire on the mountain”—he knows some
evil has been devised against the patient. A cloudy wind from
the west—where the sun sets—according to Mazi Okeke, a
traditional healer from Abatete in south-eastern Nigeria, could
be an indication that death is blowing over the head of his pa-
tient. Similarly, the cry of an owl spells witchcraft as accurately
as the spots on his neighbour’s child tells this healer the child is
suffering from chicken pox. Dreams are also amenable to accu-
rate interpretation as long as the dreamer can accurately recall
all the actors which featured in the dream. Mode of ritual and
worship are indexical symbols, as well, because they are not
arbitrarily done but are constrained to follow long-standing
traditional order.
Conclusion
In closing, it is important to state that even orthodox medical
practitioners often assert that much of what ails their patients
are psychosomatic rather than mere afflictions of the body.
Since African traditional medical practice is dually oriented
towards disorders of the soul and of the body, maybe there are
some things both traditions can learn from each other for the
overall benefit of the patient. And maybe the easiest way of
achieving this much-needed synergy is through a renewed em-
phasis on the conscious and subconscious roles traditional
medical symbols could play—as they are currently playing in
Asia—in Africa’s public health-care system. I modestly hope
this paper has, in some way, contributed to the exegetic value
of medical symbolism in Africa.
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