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Table 3 Gastrointestinal and Genitourinary Disease Conditions Treated by Shamans of Kwamalasamutu and Përëre Tëpu.

From: Disease concepts and treatment by tribal healers of an Amazonian forest culture

Trio Disease Concept

Diagnostic symptom(s) and descriptive field notes



Ere nakuikan

Liver pain; associated with yellowing of eyes (kanamë enu), nausea (ninujaman), emesis (yiwenatae), weakness (arerenna), and dark-tinged urine. Trio healers describe pain distribution ranging from epigastrium extending to the right upper quadrant. Hepatomegaly (ererimpë toje) is noted on examination. Clinical correlation is suggestive with hepatitis, a common endemic disease of lowland Amazonia.

Eta nakuikan

Spleen pain; a disease concept characterized by left upper quadrant abdominal pain and an enlarged spleen on examination. Splenomegaly is associated by Trio healers with chronic malaria (kananaman).

Iwaku nakuikan

Abdominal pain, non-specific. Niwapahhan refers to tenesmus, electric sensations in the abdomen compared by Trio healers to the shock of an electric eel (arimina), often preceding profuse episodes of watery diarrhea.

Iwaku toje

Swollen abdomen, recognized by Trio shamans as pathologic, yet of uncertain etiology, attributed by one shaman as a result of "too much air in abdomen".


Pinworm (Enterobius vermicularis), common among children and associated with perianal pruritus.


Ascaris lumbricoides. According to Trio, Ascaris worms "eat when you eat" and heavy infestations are believed to lead to failure to gain weight and abdominal pain secondary to obstruction. Amepa refers to infection from the dog tapeworm Dipylidium caninum, in which segments of the nematode are noted in stools.


Watery diarrhea.

Niputan munune

Dysentery. Watery diarrhea with blood (munu) and/or mucus (asinokato)

Urutupë nakuikan

Dyspepsia is referred to as stomach pain (urutupë nakuikan), described by Trio as burning inside the stomach (urutupë atuma awe), which may be exacerbated by dietary intake of certain foods, for example hot peppers (pëmëi).


General term for diarrhea. Alternative term for loose stool is tiputae. Iweti is the Trio term for normal feces; constipation is koekaewa.



Ejamori nakuikan

Kidney pain. Flank pain; associated with dark urine (suku), commented by Trio shamans to sometimes occur with severe malaria (marareja).

Imone kureta

Literally translated "evil uterus", the disease concept was applied to vaginal bleeding in elder women (nosi).

Imone nakuikan

Dysmenorrhea, literally translated "uterine pain".

Imone toje

Swollen uterus with persistent bleeding not in association with pregnancy (minome). Trio healers stated if untreated may progress to death.

Isuku nakuikan

Dysuria. Isuku kureta, literally translated 'bad bladder', this term is applied when gross hematuria is present. The Trio attribute the condition to sexual intercourse with other non-marital partners or from trauma. Gonorrhea is referred to as ëriime and is stated to be a non-endemic disease condition.


Menses. Heavy and prolonged menses with associated passage of large clots (munu tëpu, literally "blood stones") is referred to as iyeta nimutan. In Trio cosmology, menstruation has associations with the origins of the Moon (Nunnë). Although menstrual fluid is considered extremely polluting to the spirit, menstruation is believed a natural process necessary for fertility. Abnormal uterine bleeding is considered as a disease state (esenë).