Ritual uses of palms in traditional medicine in sub-Saharan Africa: a review

Palms (Arecaceae) are prominent elements in African traditional medicines. It is, however, a challenge to find detailed information on the ritual use of palms, which are an inextricable part of African medicinal and spiritual systems. This work reviews ritual uses of palms within African ethnomedicine. We studied over 200 publications on uses of African palms and found information about ritual uses in 26 of them. At least 12 palm species in sub-Saharan Africa are involved in various ritual practices: Borassus aethiopum, Cocos nucifera, Dypsis canaliculata, D. fibrosa, D. pinnatifrons, Elaeis guineensis, Hyphaene coriacea, H. petersiana, Phoenix reclinata, Raphia farinifera, R. hookeri, and R. vinifera. In some rituals, palms play a central role as sacred objects, for example the seeds accompany oracles and palm leaves are used in offerings. In other cases, palms are added as a support to other powerful ingredients, for example palm oil used as a medium to blend and make coherent the healing mixture. A better understanding of the cultural context of medicinal use of palms is needed in order to obtain a more accurate and complete insight into palm-based traditional medicines.


Background
Traditional medicines in rural sub-Saharan communities recognize that the occurrence of disease can result from the intrusion of negative supernatural forces [1,2]. These forces are often defined as witches, sorcerers, broken taboos, displeased ancestor spirits or deities [3][4][5][6][7][8]. Afflictions which are mostly related to the action of the malevolent forces are either serious and chronic or emerging suddenly and unexpectedly [4][5][6][7]. The patient is often considered a victim, and the therapy must heal not only physical symptoms but also social relationships to liberate the patient from suffering [9]. Thus, traditional healers often apply divination and various rituals in order to understand the overall significance of a healing process and counteract its cause. As a consequence, traditional remedies are not merely used for curing a disease, but are also used to obtain protection or to overcome curses [3,7,10,11].
Traditional remedies are derived from palms throughout the tropics and subtropics to cure many disorders [17][18][19][20][21]. Since palms are part of the everyday life of nearly all rural people in Africa, it may be expected that they are also important in the spiritual framework of rural life in Africa. Even though many studies report ethnomedicinal uses of African palms, from the late nineteenth century [22,23] to very recent times [24]-especially recent studies pay little attention to rituals. In the latest studies on African traditional medicine palms are included among raw lists of plants used for specific ailments [20,[25][26][27][28][29][30][31]. Detailed preparation and application of palm remedies are rarely mentioned [32][33][34][35][36]. While these types of studies may be useful when searching for potential modern drugs, they do not reveal the ideas underlying the use of the cited medicines nor do they explain why certain plants were selected for a ritual, or their exact therapeutic practice. On the other hand, most of the recent ritual palm use records came from anthropological studies, where the emphasis was put on the explanation of the ritual itself, but the botanical species was not defined [37][38][39].
Here we focus on palm-derived African ethnomedicine that includes ritual elements. By ritual (or magical treatment) we understand any medicinal practice involving objects (e.g. palm nuts) or behaviors (e.g. incantations) believed to have some healing powers and/or ability to counteract or influence the actions of malevolent forces.
We argue that we can only have an accurate insight into traditional medicine if we understand the cultural context of medicinal use of palms (and other plants). In this perspective we address the following specific questions: Which palm species take part in rituals or specific ceremonies? Which palm parts are mostly used? And finally, are palms present in the spiritual framework of African traditional medicines today?

Methods
In total 26 scientific papers and books on African traditional medicine provided information on ritual uses of palms in Sub-Saharan Africa. This information was extracted and listed with scientific names, plant parts used and detailed use description (Table 1). Our bibliographic search employed several databases, including PubMed, Embase, and Google Scholar. In addition, we conducted a dedicated search with search engines of the State and University Libraries of Aarhus, National Library of Denmark and Copenhagen University Libraries, Mertz Library, and Harvard University Libraries where most of old, limited access literature was studied.
The extracted information was standardized to generally accepted terminology for palm morphology following Dransfield et al. [40]. When oil was given as a palm part used and the author did not mention the scientific name of the palm it was assumed that palm oil was extracted from the African oil palm Elaeis guineensis, since processing of the fruits for edible oil has been traditionally practiced in Africa for thousands of years [41]. Medicinal uses referring to "coconut" were assigned to Cocos nucifera. Some palms remained unidentified, such as those used for "palm wine", which can be produced from various species including Elaeis guineensis, Hyphaene spp., Raphia spp., as well as Phoenix reclinata [41]. Country names referred to in the older literature which are no longer in use, were updated to the current names, i.e., Northern Rhodesia to Zambia, Dahomey to Benin. Species and author names coincide with the World Checklist of Palms [42] and The International Plant Names Index (IPNI) [43] for other plant species. The authors of scientific names of palms are included in Table 2, and authors of other plant species in the (Table 1).

Results
We found references to ritual uses of at least 12 palm species in sub-Saharan Africa, and they were used for 81 different purposes (for a complete list see the (Table 1). Ritual uses of palms were encountered for 13 different countries and 19 different ethnic groups in the region ( Figure 1). The results were organized following the part of palm used.
The palm fruit is made up of three carpels that fuse to form a drupe with one or a few seeds, covered by a thin seed coat. The seed consists mostly of a large oily endosperm which when immature is watery and gelatinous before it turns hard in the mature seed. The seed has a small embryo near one of the germination pores which are thin areas of the bony endocarp. Palm seeds are often called palm kernels or palm nuts [44]. The seed(s) is (are) surrounded by a three layered pericarp consisting of an outer leathery exocarp, a middle fleshy and oily or fibrous mesocarp, and an inner endocarp which may be thick and bony or thin and papery. Palm oil may be extracted from the fleshy mesocarp or from the endosperm of the seed in which case it is called kernel oil. Red palm oil, extracted from Elaeis guineensis fruits, gets its characteristic color from carotenes in the mesocarp, although it can be bleached to produce colorless oil [41,44].
Palm leaves usually are assembled in a rosette at the end of the stem. Each leaf consists of a sheath, a petiole, and a lamina which in turn is made up of a midvein (rachis) and several leaflets (pinnae). In some palms (Cocos, Elaeis, Phoenix, Raphia), the midvein is elongate and has several leaflets that form a pinnate leaf. In other palms (Borassus, Hyphaene), the rachis is reduced and all leaflets radiate from a single point to form a palmate lamina [44]. The uses mentioned below either refer to whole palm leaves or to leaflets, which are dried and used for weaving. In some cases fibers are extracted from the leaflets and used for weaving.
Palms produce a sugary sap for their growth, which is often tapped by humans and used to prepare a fermented beverage called palm wine. Palm sap is extracted from different species, including Cocos nucifera, Borassus aethiopum, and Elaeis guineensis. Tapping is done by cutting the inflorescence and collecting the sap from the injured peduncle or inserting a tube into the palms growing point in the heart of the crown and placing a container at the end of the tube to collect the sap [41].
Roots of palms are adventitious: they originate from the lower part of the stem and are not part of a tap-root system. Therefore, roots can be collected from the palm without the need to dig them out of the ground, and subsequently employed for a variety of purposes [44].

Fruit (palm oil)
In Zambia, palm fruits were used in prayers before administrating a drug to ensure the effectiveness of medicine and successful recovery of a patient. The Ba-Ila healer used a rattle made of round palm fruits on a handle during ritual therapies [45]. To the Lunda in Zambia, the red color of the mesocarp oil from Elaeis guineensis symbolized power, but it also was interpreted a sign of murder and witchcraft [9].             * scientific name not mentioned/specified by the authorassumption made based on the palm part used; as follows: •coco-nut a ➜ Cocos nucifera.
On Mfangano Island in Kenya, the Suba and Luo still use the fruits of Cocos nucifera to alleviate skin rash associated with HIV/AIDS. The diseaselocally known as 'chira' , and its etiology is related to the transgression of principles governing sexuality or seniority. These include adultery committed during a wife's pregnancy, having sexual intercourse during the harvest, or failure to observe the proper separation of sexuality between generations [46].
Disorders of the reproductive system that fail to respond to rational therapy are often explained by witchcraft or broken taboos [7,47]. In Nigeria, to prevent miscarriage Yoruba people used to roast a tortoise with coconut water and half a bottle of palm oil from Elaeis guineensis, after which the mixture was ground to powder [47]. The powder was consumed in a corn flour pudding, taken every morning and evening during one menstrual period, followed by sexual intercourse five days after finishing menstruating. The Yoruba saw the tortoise as a symbol for a prostitute, which might signify that when a woman suffered miscarriage it could be due to committed adultery or a broken taboo [47]. Sex taboos in particular were often used as an explanation for the occurrence of a disease [45,48]. For the treatment of malaria, the Yoruba used start the ritual with two rings painted on the neck, one with shea butter (Vitellaria paradoxa), and another with Elaies guineensis oil [47].
In Liberia, the Mano used red palm oil in treatments of mysterious diseases. To awake a patient in coma, red palm oil was mixed with a burned knot of the parasite Loranthus micranthus and rubbed on the patient's cheeks toward the mouth in order to make him talk (all information in this paragraph derived from [48]). Another magical medicine was prepared from any branch broken off by wind but lodged before it reached the ground, mixed with some burned plants and Elaeis guineensis oil. The paste was put into a little horn tied to a cut off cow's tail. The traditional healer asked the sick man a question while brushing his face with the tail. If there was no answer, it meant that the patient would die. If he answered, the healer took some medicine with his left third finger, and rubbed it over the patient's heart while saying specific prayers. The broken but not fallen branch perhaps symbolized hope for the patient to wake up. The palm oil was used to blend the various added ingredients. Similar symbols appeared when healing fractures in Liberia. A few branches from various shrubs and trees were gathered, together with any broken twig which was healed but growing in a twisted position. The charred wood was mixed with red palm oil, and the ointment was then applied to the fracture. The twisted branch probably symbolized the twisted limb. Another example of sympathetic magic among the Mano was a cure for acute hepatitis, in which shelf fungi shaped like a liver were mixed with Elaeis guineensis oil and rubbed over the liver. In a cure for palpitation, the Mano mixed red palm oil with an inflorescence of Costus sp. and a handful of buds from Harungana madagascariensis. Part of the mixture was put in an iron spoon with four pebbles that had been heated in the fire. There would be three pebbles used if the patient was a female. Notably, the stone represented longevity and strength, and the red color of palm oil as well as the red sap from H. madagascariensis probably symbolized the color of the treated heart. Gender specific symbolic medicines were also used in Liberia for rheumatism due to yaws. Enchanted elements were the leaves and bark of living plants and red palm oil, which represented the active male elements. The charred plants and "burned" oil represented the soothed, magical, more preventive female elements. Male and female medicines were mixed in order to form even more powerful Mano medicine, and possibly to achieve an ideal balance between active and controlled features of persons and situations. Women in Liberia used to protect themselves from getting sick during the meetings of the Ba Kona snake society using a medicine horn made of charred twig of Protomegabaria stapfiana and red palm oil. The medicine was tied to the woman's waist and licked from the finger whenever she felt dizzy or afraid. Although in many ritual medicines palm oils served merely as a rubbing agent, the use of the oil could also be a taboo. In Liberian Sukba Society it was forbidden to put red E. guineensis oil into a horn of medicine, which was a fetish prepared to protect from witchcraft. If the taboo was broken, the fetish could turn against its owner; catch him and kill him instead of the witch [48]. In Gabon, the Masango used the leaves of Hyptis lanceolata mixed with palm oil to apply on the body as medico-magic [49]. Palm oil is still offered to a variety of vodun spirits in Benin [37]. For the annual yam celebration, the guardian spirit Legba receives yams, palm oil, chicken blood, and other offerings. Throughout coastal Benin, palm oil is also used in vo, which are sacrifices or offerings used in daily problem solving. An example of vo is a calabash containing kola nuts, palm oil, and other items indicated by the diviner. It is placed in the center of a paved road, and by end of the day it is run over by cars, so the problems are destroyed [37]. In Benin near almost every door there used to stand the Legba-pot, filled every morning and evening with cooked maize and palm oil [50]. For another vodun called the "Vulture's Dish", passers-by used to deposit a little food or palm oil, to bring luck or ward off danger [50].

Seed
In Liberia, palm kernel oil was applied with owl's feathers on wounds resulting from scarification performed during the Poro initiation rites [48]. In Cameroon, fresh seeds of Elaeis guineensis were mashed and mixed with other plants to treat mental fatigue. The residues of medicine were put under the pillow, and only if the patient dreamed of a young girl with erected breasts, there was hope for cure [51]. Elaeis guineensis seeds were also used as sacred objects in rituals involved in oracles, which helped to discover the cause of disease or other calamities for example the Afan oracle of the Ewe in Togo, or the Ifa oracle of the Yorubas and Fa oracle of the Fon in Benin [51]. In the Afa divination in Benin, 16 palm nuts were cleared, marked with certain Afa motif, and thrown from right hand to the left to reveal the destined combination [50]. In 1990s palm nuts were still used in Benin in secret Fa divination in order to decrypt and read the signature of Faa god of oracles [38].
Craw-craw, is the local term for onchocerciasis or river blindness, which causes itchy rashes and nodular swellings on the skin. In Liberia crawcraw was threated with mashed leaves of the brimstone tree Morinda lucida made into a leaf packet with two palm seeds. The packet was roasted in the fire and the pulp rubbed on the skin. According to Harley [48], p. 92 "The nuts obviously are magical". Among the Mano in Liberia, impotence, which was widely believed to be caused by witchcraft, used to be treated with palm seeds chewed with young leaves of Microdesmis puberula, and the mass was then rubbed on the genitals [48]. The presence of M. puberula in the treatment for impotence might be linked to its wood which is very hard [52].
In Ghana, hollowed out Borassus aethiopum seeds are still used by Haussa's as containers for a charred medicinal mixture called 'katala' in Haussa. This mixture is rubbed into skin incisions during scarification practices [11].
The seeds of Raphia hookeri were sold in 2010 and 2011 on markets in Ghana and Benin to treat a baby's fontanel when it "beats", which is seen as an unhealthy symptom [11,53]. The seeds are roasted over the fire until they are black as coal, ground to powder, mixed with oil and the mixture is smeared on the fontanel. The seeds are also boiled as tea or added to herbal baths to treat babies with beating fontanels [54].

Inflorescence/infructescence
In Ghana, empty infructescences of Elaeis guineensis alone or mixed with ginger (Zingiber officinale) are burned and applied as magical medicine in the form of an enema to small children to encourage them to walk at an early age [ van Andel, unpublished]. Also in Ghana, the Akan burn inflorescences from Elaeis guineensis so the smoke drives away bad spirits [7,11].

Leaves
In Zambia splints made of palm mats used to be tied around broken limbs with bark strips, and medicine was applied on the skin under the mats [9]. Simultaneously, the legs of a chicken were broken and treated with the same medication. The Lundas believed that when the chicken starts to walk again, so will the patient. Palm leaves were used as protective barriers by the Ba-Ila. A string made of fibers extracted from the palm leaf was suspended on poles in front of the hut to warn pregnant women. If a pregnant woman entered a hut where there was a baby, its skull would part into pieces [45,55].
During secret meetings of the Mano in Liberia, a curtain of young Raphia vinifera leaves protected from any outsider who could perform witchcraft, bring poison, or any person who recently had sexual intercourse [48].
In Cameroon, fresh bud leaves of Raphia vinifera are still suspended as a curtain in the villages' entrances to ward off the evil [ van Andel, unpublished].
In Benin a vodun Vo-sisa used to be placed opposite to the house gates to defend the inhabitants from harm. It usually consisted of a pole, with an empty old calabash for a head, and a body composed of grass thatch, palm leaves, fowl's feathers, and snails' shells [50].
Palms were also used as protective amulets. In Benin and Togo, ill people carried twigs of Elaeis guineensis around the neck or arm to achieve invulnerability [51].
In South Africa, during the hondlola purification ceremony, performed after a cure was accomplished, the Thonga protected themselves from perspiration of those who had sexual relations. A convalescent was provided with fowa, which was a kind of round rattle made of palm leaf tied around the ankle. Madness, which the Thonga associated with spirit possession, was treated by waving a large palm leaf from the milala palm (most probably Hyphaene coriacea) in front of the patient, which would "scatter the spirits". Also "when it bites inside" a medicine was prepared from various equally cut roots that were tied together with a band of palm leaf, and boiled to bring out the active principles of the drug [10].
Palm fronds are still used in Benin in kudio, which are sacrifices used to heal a dying person by exchanging the life of an animal for that of the person [37]. Also, offerings are made to various vodun spirits over a fresh bed of azanritual palm fronds which mark the sacred spot [37]. The azan was also worn around the throat, to protect from witchcraft or from being killed during war [50]. In Benin, palm fronds are also carried by people involved in punishing social deviants, and those suspected of witchcraft [38]. During the recent 'witch parades' organized to punish and march the accused Beninese women to prison, the witches were bedecked in wreaths of palm fronds [39]. Perhaps palms bring justice because they are associated with understanding, peace, and harmony, or with indwelling tree spirits themselves [56]. In South Africa a thief was punished by confrontation with palm leaves, which, by a kind of supernatural judgment, turned into snakes [10].
Palm leaves also served in various ceremonies, rituals and religious festivities. In Kenya, the Camus tied the leaves of Hyphaene coriacea to boys' legs and heads of women during the circumcision ceremony [57]. Skirts made from palm leaves were used by the masked Poro dancers, and by the Mwila women on festive occasions [45,48]. Leaves of Hyphaene petersiana were used in Namibia to prepare bridal hats among the Ovambo [58]. Nowadays, in Uganda, leaves of Phoenix reclinata are used for ceremonial and religious purposes [59]. Betsimisaraka people of Madagascar use leaves of Dypsis pinnatifrons in decoration of churches. Leaves of Raphia farinifera are used for making crosses, and they are burned as incense at the church [12]. Entire leaves of Dypsis fibrosa are used by the Betsimisaraka to decorate houses at clerical festivities [14]. Carrying the palm fronds on Palm Sunday is an important Christian tradition practiced now in many parts of Africa [60,61].

Sap (palm wine)
In Nigeria, to recover from smallpox, palm wine was drunk and rubbed on the body of the patient. Relatives were advised not to sleep near an infected person, nor visit anyone outside. Roasted groundnuts (Arachis hypogaea) were not to be eaten during an epidemic, and no drumming could be performed. These activities would offend the Shopanna god who, according to Yoruba beliefs, was responsible for bringing smallpox epidemics upon mankind. For successful recovery it was also necessary to make an offering to the Shopanna god by sprinkling palm wine all over the house to appease the god [47]. Ancestor spirits appreciate drinks, and palm wine was often used in offerings and fetishes to obtain their favor and help or to reduce their anger and, therefore, the risk of disease or other calamity [10,48]. To engage a powerful being in a relationship of beneficial exchange and prosperity, palm wine was a valued consumable and lubricant of good relations and hospitality. In Kenya, Mijikenda people used to place the coconut shells filled with palm wine on ancestors' graves as an offering [62]. In Benin, sodabi which is a locally distilled palm wine is still used in offerings made to vodun spirit called Tchambaan old spirit based on domestic African enslavement [63].
The Mano of Liberia carried amulets for protection against witchcraft, made from small horns with enclosed palm wine and charred and powdered twig of Ixora sp. and Vernonia conferta. By licking the medicine from the finger, a person was ensured that if anyone wanted to bewitch him, he would foolishly turn himself out, and would subsequently be called to account [48]. Although most medicines were directed toward the cure and prevention of disease, some could also embrace poisons [5,9,10,64]. In Liberia, a poisonous mixture was prepared while calling the name of the victim, put under the thumbnail and then placed in a gourd of palm wine. The victim was offered the lethal drink, always using the left hand [48].

Root
Ritual uses of roots are few. Roots of Elaeis guineensis in mixture with the resin from Daniellia oliveri and Commiphora africana were reported to keep away bad spirits in West Africa [51].
In Ghana, a decoction from Borassus aethiopum roots is still used by Kokomba traditional healers in the treatment of any disease caused by a curse [Gruca, unpublished]. In Togo, macerated roots from B. aethiopium are used in herbal baths, and powdered or decocted roots from E. guineensis are used orally to treat epilepsy [65]. It is believed that epilepsy occurs mostly during the full moon. Mysterious and spontaneous diseases such as epileptic seizures are often associated with supernatural forces [66].

Entire palm tree
Palm trees played a protective role in Zambia. According to Ba-Ila beliefs, a person could be guarded from harm during the entire life by hiding one's life in a palm tree. This protective ritual ensured that only if the palm tree would fall the person would die, and since this event was considered unlikely, a palm tree was a safe place to hide one's life [45]. That might be because the palm tree, due to its unchanging beauty of the evergreen foliage, is considered a symbol of everlasting life, permanence and strength [67]. In Zambia, solitary growing palm trees also provided sacred places where rites and customs traditionally associated with half-gods were performed [55].
The French botanist Chevalier [68] published a varietal name of the African oil palm (Elaeis guineensis var. idolatrica) referring to its divine characters. Current taxonomy treats this name as a synonym of E. guineensis [42] but it is still mentioned as the "idolatrica" palm in some literature even if it cannot be recognized taxonomically. In Benin, the "idolatrica" palm has been recently reported as sacred and protected where ever it grows because it is seen as the realization on earth of the god Fa. Nobody is allowed to cut it down or to use its fruits for making oil. The ritual use of these palms is reserved for soothsayers called bokonon [69].
In Madagascar Cocos nucifera and Dypsis canaliculata are still planted at sacred places by the Betsimisaraka people [13]. The Wanaka of East Africa believed that the coconut palm has a spirit, and destruction of this tree is equivalent to matricide because the coconut tree gives people nourishment, as a mother nourishes her child [56].

Discussion
At least 12 palm species were found to be involved in various ritual practices ( Table 2). Assuming that palm oil or red palm oil always come from Elaeis guineensis, this was the most commonly documented palm species for ritual purposes in Africa (see Table 1). Because several ritual uses of palms listed in the literature could not be unequivocally referred to a particular species, the picture we draw remains somewhat incomplete with regards to the taxonomic basis for ritual palm uses.
All parts of the palms were used in rituals, but the most commonly used part was the leaf, followed by the fruit and oil extracted from the fruit mesocarp, seed (and extracted palm kernel oil), entire palm tree, sap in the form of palm wine, root, inflorescence and infructescence. The ritual uses of all the mentioned parts were found in both older and recent literature, although most of the recent ritual use records were associated with the palm leaf.
In general, the ritual uses of palms play a double role. In some treatments, the palm is the actual sacred object or the central element of ritual practices, for example entire palm trees determine sacred places, palm seeds accompany oracles and palm leaves serve in offerings. In other cases, palms are used in mixtures with other plants or products. Hence, palms are not the primary ingredient, but support the ritual treatments in some way, like in the case of palm oil, used as a medium to blend and make coherent the various ingredients. It is noteworthy that palm wine and palm oil, which are commonly consumed in Africa, often assist the treatment and the contact with the supernatural world.
Our review shows that palms have been, and probably still are pervasive in African medicinal systems. Their use in medicines reflects the spiritual framework of traditional medical practices, and palms themselves are important and often crucial in disease treatment and prevention. Palm-derived medicines work not only upon diseases of the body, but also directly upon people's psyche and emotions. Palm medicines can act from a distance if so directed by the power of the spoken word. Sometimes taboos must be respected to secure efficacy. Ritual practices merge in all sorts of combinations with palm remedies. There is no assurance that any particular palm used for the treatment of a particular disease has any biologically active component; it may only be its symbolic or spiritual meaning that serves as a powerful ingredient. Some medicinal plants, just like placebo, can be efficacious without biologically active components [70].
The few studies we reviewed that explained the ritual uses of palms in detail were classic anthropological works that embraced studies of the entire native African tribes and cultures e.g. [5,9,10,45,47,48,55]. The best accounts of traditional medical practices came from those who spent years among the local people, not only observing but also sharing their everyday life. Many of the palm uses mentioned in our review came from these sources, but in many cases we do not know whether the cited rituals are still practiced today, as recent studies on African ritual plants are scarce.
One of the obstacles of ethnomedicinal studies is that little attempt is made to show a more comprehensive meaning of illness, which follows the use of alternative diagnoses and therapies in traditional medical practices. Disease episodes are usually presented only briefly and unambiguously disregarding socially important outcomes that may underlie it. Therefore, it is difficult to get an idea of what, from an emic medical point of view, is going on [71].
It is necessary to remember that the belief systems, which have developed over many generations, form the background to African medical treatments. Continuous interactions with the spiritual world are axiomatically absorbed in childhood, and subsequently reinforced in every phase of life. In fact, it is fascinating that ritual uses of palms are not only present in medicinal practices but in many other events practiced since time immemorial until today.
Knowledge of medicinal plants combined with spirituality continues to thrive in Africa today [31]. Some recent ethnobotanical field studies confirm that divination still plays a major role in the traditional knowledge systems, and palms are still used for this purpose just as they were many years ago [38,51,72]. The belief in witchcraft, divination and spiritual healing has come to coexist with Christianity, independence and development [65,[73][74][75][76]. While in Cameroon palm fronds are carried by Christians on Palm Sunday [60], they are also used to ward off the evil in village entrances [ van Andel, unpublished]. Palms are still considered sacred objects, assuring protection from malevolent forces [37,38,63,69].

Conclusions
Palms are used in various prescriptions which include a ritual ingredient or procedure. It is impossible to understand the meaning and use of palms in African healing without seeing these uses as part of overall cultural systems, in which techniques of healing cannot be limited to bio-physical ailments or ideas of intervention. In local terms, food and medicine is not strictly separated, and palm products operate in many ways that cannot be isolated from the larger ensembles of elements and practices of which they are part. Effort must be made to provide meticulous reports on traditional remedies, as the enduring value of African medicines lies not only in the materials used, but also in the methods and the concepts underlying them.