Early Hawaiians led active lives, ate fresh foods, and consulted with kāhuna lapa‘au whenever they suffered from illness or injury. Every Hawaiian family had a healer: a person trained to diagnose, gather and prepare plant medicine, and administer cures. Children who showed aptitude in botany or caregiving began learning alongside their elders.
In addition to herbal medicine, Hawaiian healers incorporated lomilomi to relieve pain, correct malformations, stimulate blood flow, and set bones. They prescribed steam treatments and immersion in fresh or salt water. Many ailments were viewed as having emotional or spiritual causes, so kahuna often guided patients through ho‘oponopono, conflict-resolution techniques to restore balance within an individual and his or her community. Hawaiian healers acted as doctor, pharmacist, and psychologist, treating the whole person rather than isolated symptoms. Prayers and protocols guided each step of the healing process.
For centuries, Hawai‘i’s geographic isolation spared its residents from the epidemics that swept across the continents. But when Western ships arrived in 1778, they brought foreign contagions for which Pacific Islanders had no immunity. Smallpox, tuberculosis, and venereal disease decimated the native population. The intense colonization that followed had a similar effect on Hawaiian cultural practices, including the healing arts.
Dr. Nils Larsen lamented this double tragedy. The Cornell-trained physician served as the chief of medical staff at Queens Hospital in Honolulu from 1924 to 1942 and is credited with modernizing medical care in the Islands. Despite his credentials, he championed lā‘au lapa‘au and adopted several indigenous prescriptions into his own practice—such as kalo (taro) supplements to promote dental health.
“The Hawaiian doctor reached a point of skill in analysis, thinking, and practice that was quite amazing for his time,” Larsen wrote in his treatise, Medical Art in Ancient Hawai‘i. He praised kāhuna lapa‘au for their knowledge of the physiological effects of over 300 plant species, their comparatively modern approach to childbirth, and their use of autopsy in post-mortem diagnosis. He bitterly complained that “this system of medicine that was built on observation, deduction, experimentation and clinical trial . . . was lost as their whole culture succumbed to the pompous tide of European conquest.” Thankfully, on that last point Larsen was mistaken; traditional Hawaiian medicine was not entirely lost.
For two centuries, Western medicine increasingly supplanted traditional practice. Kāhuna lapa‘au died, taking their expertise with them. But threads remained, passed down through families and preserved by a few akamai (smart) historians.
Dr. Isabella Abbott documented the use of medicinal plants in her authoritative book, Lā‘au Hawai‘i. Born in Hāna in 1919, Abbott became Stanford University’s first female biology professor and the world authority on Pacific seaweeds. After retiring, she returned to the Islands to lead the University of Hawai‘i’s ethnobotany program. In numerous publications, she described how Hawaiians treated asthma with tea made from ko‘oko‘olau leaves, and head concussions with mashed noni fruit. She noted that noni has since been determined to contain xeronine, an alkaloid used to address arthritis, menstrual cramps, and high blood pressure.
Another renowned Hawaiian historian, Mary Kawena Pukui, shared in detail how pregnant women’s diets were regulated: They used less salt and ate cooked fish rather than raw. They chewed on hau (tree hibiscus) sticks to encourage lubrication during delivery—similar to the hibiscus buds Kaho‘ohanohano prescribed. According to Pukui, a kahuna might massage a mother’s stomach to position the baby, or later bind the mother’s abdomen in kapa (barkcloth) to help her expel the afterbirth. Infants were carefully cleaned and their umbilical cords tended to. Larsen, who was familiar with these practices, approved: “This is an extremely sane, sensible, and modern concept of how to handle a pregnant woman and newborn baby.”
Hawaiian healing methods—past and present—don’t merely meet modern medical standards. In some ways, they surpass them. Kainoa Horcajo, a Hawaiian cultural advisor who studies both lā‘au lapa‘au and lua, Hawaiian martial arts, explains a fundamental difference between Hawaiian and Western medicine: “Traditional practice focuses on bringing one back into equilibrium; it’s a constant process of reflection, adjustment, and reflection,” he says. “Western medicine often attempts to address an acute symptom without a holistic overview of the body. In other words, you can take a pill to fix your upset stomach—but the list of side effects is three pages long. That’s not about returning your body to a state of balance and pono [integrity], but about trying to rectify one particular imbalance without acknowledging the others it may cause.”
When Kaho‘ohanohano supervises a pregnancy, “it’s all-encompassing,” she says. She offers guidance to couples trying to conceive, then supports them through the prenatal process, labor, postpartum, and nursing. “We lomi them. We pray with them. We feed them. We do everything for them! We work through the obstacles or trauma that they might have; that’s ho‘oponopono. If they’ve had trauma around miscarriages or abortions, or if they were sexually or physically abused—this is the perfect time to bring those things up. To be able to give birth in a clear, positive way, you sometimes have some work to do.”
After two decades of practicing lā‘au lapa‘au, Kaho‘ohanohano felt called to share what she’d gathered from her many teachers. She wanted to disseminate the traditional ‘ike (knowledge) before it disappeared. A single Facebook announcement to that effect brought her a dozen students. Similar to a hālau hula (hula school), the class is an intimate cohort that follows the Hawaiian principle of learning by doing: Ma ka hana ka ‘ike. For the past two years, they’ve met weekly to talk story and make medicine. Just as her ancestors did, Kaho‘ohanohano teaches by donation. “If students can pay, great. If not, just show up,” she says. “Commitment is the payment.”
Several of Kaho‘ohanohano’s students have their feet in both worlds—traditional and modern healing. “Western medicine doesn’t recognize the interconnectedness of different disciplines,” says Kyra Glover Ka‘alekahi, a certified occupational therapist and one of those students. “When you start to look only through a lens that diminishes or tries to boil down and capture essences, then you miss so much of the interplay of who we are.”
Who we are—our identity—figures into health outcomes. The Native Hawaiian Health Care Act in 1988 acknowledged that when cultural practices such as lomilomi are incorporated into Hawaiian patients’ healing regimens, they are more likely to seek treatment and thrive. That expectant mother who chewed the hibiscus buds chose Kaho‘ohanohano as her midwife for a reason: she wanted a birth plan that honored her identity as a kanaka wahine, Hawaiian woman. She had used Western-trained midwives for her first two pregnancies, but for her third baby she hoped to find a piece of herself that was missing.
Her delivery at home went smoothly—surrounded by family and uplifted by pule (prayer). Afterward, Kaho‘ohanohano mashed some shiny black fruits into a pulp and applied the juice to the infant’s crown. The baby’s grandmother remarked, “Oh wow. I never seen that used since I was a little girl. My elders used that in our births back then.” The mother was jubilant. Following the ancient practices of her ancestors throughout her pregnancy had restored that missing piece—not only for her, but for her relatives and her child. “That is in essence what we’re doing here,” says Kaho‘ohanohano. “Returning what was stolen long ago, healing across generations.”
