Aztecs Knowledge on Medicine
The Aztecs settled in Mexico’s Central Valley and established the city of Tenochtitlan in 1325. At the time of the Conquest, in 1521, the city held approximately a quarter million inhabitants.
The only surviving records that can provide insight into Aztec medical practices were produced during the first century of Spanish colonization. These manuscripts, informed by Nahua physicians, long lost pictographic codices, and oral histories, reveal common illnesses and symptom, methods of diagnosis, and prescribed treatments. It is important, however, to keep in mind that these invaluable texts emerged from Spanish institutions that desired to put an end to the Aztec practices that the Church deemed idolatrous. Nevertheless, enough evidence has been preserved for scholars to gain an understanding of the Aztec’s medical system and the ailments it sought to remedy.
The Aztec understanding of disease was based on magic, but its practice was based on empiric treatments that had demonstrated their usefulness over the centuries. They believed that each god or group of gods ruled a specific anatomical area, which they could heal or make ill. The connection they made between a divinity and a particular disease or group of diseases was based on avocatory ideas; for instance, the God of rain (Tlaloc) ruled the lungs and the respiratory system because they had noticed that, during the wet season, respiratory diseases were more frequent.
Medical professionals among the Aztec people held no higher class than any other professional, such as carpenter, cook, or stone mason, and are equally male and female practitioners. Physicians of both sexes were skilled in a variety of medical practices, including phlebotomy, bone-setting, and the healing ritual of covering a patient with ashes. They were also knowledgeable about the properties of roots, herbs, trees, and stones and able to administer them as medicines.
Female physicians practiced massage and anointing. Additionally, disorders of the anus, festering of the skin, the surgical removal of eye growths, and making prognoses fell under their purview. Male physicians, on the other hand, were noted for their work as diagnosticians, and ability to give stitches and make incisions. They were also responsible for administering potions, purgatives, and emetics.
Even though Aztecs had a pathophysiological understanding of diseases different than ours, they were able to develop effective medicine—even more effective than that of their European conquerors. The cornerstones of the system of medicine were:
Aztecs had understood the importance to health of hygiene. They took daily baths and also shared weekly steam public baths as a medical and social event.
The streets of the Empire were kept clean through regular sweeping, and this hygienic environment extended to personal practices as well. Childbirth in all cultures can be quite a dangerous time, but this was eased by Mexica midwifes who made sure to keep the room clean and eased the pain with massage and herbs.
Health care of mother and child:
After every young woman got married, she received help from a midwife who advised her on pregnancy, delivery and child rearing. Breastfeeding was obligatory for the first three years of the child’s life. The objective was to ensure adequate nutrition during their first years of life.
As one of the gods of medicine and healing, Ixtlilton was responsible for helping children sleep by bringing them darkness and a peaceful night’s sleep. ‘Bringing a child darkness’ could sound pretty ominous but in reality it was a caring and nurturing act to perform and Ixtlilton was known as a gentle god.
Physicians came from families traditionally dedicated to the science of healing; as a result, they accumulated a great collection of medical information and skills. They divided their practice into several specialties, such as general practice, surgery, pharmacology, etc. One of the observations that impressed Spanish soldiers was how indigenous physicians treated wounds; they cleaned them carefully and then they covered them with vegetable ointments that led to quick healing. On the contrary Spanish physicians treated wounds with boiling oil and hot iron instruments that delayed wounds healing.
Because many of plants used in medical treatment are sacred within pre-Latin American religions, much of the archaeological and ethnographical information of these plants’ rituals and uses have been destroyed by the Spanish Conquest or distorted by Spanish missionaries.
Centuries of empiric and family medical tradition had given Aztecs access to at least 300 plants with healing properties. In Tenochtitlan, capital of their empire, they had extensive fields and green houses to culture these kinds of plants. They prepared pills in which the therapeutic substances were mixed with animal fat or vegetable resins. The medicinal qualities of these plants were used to cure ailments from cuts and burns to excessive flatulence, with some of these plants still regularly used in Mexico today.
The Aztecs also used a type of antispasmodic medication - medicine that could prevent muscle spasms and relax muscles, which may have been helpful during surgery. The Passion flower was used for this purpose, a flower which still grows in Mexico today. The passion flower is still used today as an herbal remedy, believed to help with insomnia, epilepsy, and high blood pressure.
Modern science confirmed that over 85 percent of the herbs Aztecs used are truly effective. The herbs the Aztecs used contain compounds found in drugs used today. Thus, it wasn’t just like a placebo effect, not just superstition; it actually worked.
The Mexica massively outstripped their European contemporaries in their use of herbs. Moctezuma I, ruler of the biggest alliance in the Empire from 1440-1469, established a botanical garden with approximately two thousand different species of plants.
Francisco Guerra’s 1966 article, “Aztec Medicine,” states,
Medical art ticiotl was believed by the Aztecs to have been developed among the Toltecs by four wise men, Oxomoco, Cipactonal, Tlatetecui and Xochicaoaca. Sahaguin also recorded that these scholars knew the nature and qualities of herbs, which were good, bad, harmful, deadly or medicinal.
Teonanácatl or liberty cap mushrooms (Psilocybe mexicana) is a subtropical member of the gilled Hymenogastraceae family. Teonanácatl is native to southern Mexico, growing in rich soils and along deciduous forests. Teonanácatl grow in Summer and early Autumn. Teonanácatl has red to brown flesh that bruises blue with pressure. Mature teonanácatl are between 4 and 12.5 centimetres tall with convex caps up to 3 centimetres wide.
Teonanácatl was used throughout southern Mexico by the Aztecs for treatment of fever and rheumatism.
Peyotl or Peyote (Lophophora williamsii) is a monocotonous, perennial succulent of the Cactaceae family. Peyotl is native to northern Mexico. Throughout spring and summer, peyotl can be identified by its pink, white, and red polymerous flowers. Peyotl can also be identified by its vasculature’s resemblance to a Fibonacci spiral. It grows in ‘buttons’ from the ground, rarely growing more than a few inches tall.
The Aztecs used peyotl to treat arthritis, skin wounds, bites, and fever. Because of the limited area that peyotl grows within, the Aztec had to develop a reliable infrastructure to transport these plants from the Rio Grande region throughout their empire and to societies to the South and East of themselves where their use has been reliably recorded.
Aztecs had a great knowledge of anatomy, for instance they had 4000 words–to name the different anatomic structures – more than we have in modern medicine. This knowledge helped them in their surgical interventions.
Obsidian was abundant in the region, providing the Mexica with reliable access to it. Following the invasion of Spanish conquistadors, the Spanish replaced European made objects like shaving blades with obsidian.
Obsidian is sometimes still used in surgery today, as the small and precise incisions lead to faster healing for patients. Though as obsidian is more brittle and significantly more expensive than stainless steel, its use is not widespread.
Besides being educated practitioners of surgery, the Aztecs were also educated in phlebotomy, dentistry, and midwifery.
The nahuatl, the language spoken by the Aztecs, gives us some clues about the way they conceived medicine. For instance, the nahualtl word pahtli means drug but also poison; they understood that the same substance could heal and also kill, depending on how it was used. We learn that they divided illnesses into two main categories: bleeding (ixtli) and infectious (temalli). For instance, the word extla-ixtli means hematuria because it is composed by extla (kidney) and ixtli (bleeding) or the word extla-temalli that means pyelonefritis since it is composed of extla (kidney) and temalli (inflamation). This is not far from the one we currently use in the Western world.
In Mexica tradition, health was perceived as “balance,” whereas illness and disease were “imbalance.” Balance, however, was influenced by season and varied by age, gender, personality and exposure to environmental temperature extremes. A central medical-related theme held that balance was effected favorably or adversely by diet.
Aztec physicians held that there were, in fact, many varieties of fever, each with its own etiology: totonqui and motlehuia, general terms for fever, referred to hot fevers located in the head often accompanied by swelling in the stomach and suppuration of the skin; the hot fever tletl, possibly synonymous with totonqui, required cooling herbal treatments; iztac totonqui, known as “white fever” or a “high fever,” was a hot fever with swelling and suppuration of the flesh; and the hot fever matlaltotonqui, or “green fever,” presented with dark bruising.
Of the numerous ailments recorded in this medical literature, fever is ubiquitous. An explanation for the pervasiveness of fevers in the historical record can be found in scholarship on the endemic and epidemic diseases that impacted the Aztecs. Respiratory and gastrointestinal infections were common in the pre and post-Hispanic eras, while the arrival of Spaniards resulted in waves of epidemics that lasted for a century.
To respond to this everpresent symptom, the Aztecs relied on their vast botanical pharmacopeia and their highly skilled physicians.
The word “totonqui,” is a combination of “tona” and “motlehuia.” Tona translates as “"to be hot or sunny” and motlehuia means “to have fire within.” This form of hot fever was often located in the head, in general, including the eyes, face, mouth. In some instances, the fever was located in the abdomen or chest. These fevers were often accompanied by swelling of the stomach, inflamed eyes, and skin disorders- festering sores, blisters, abscesses, and pustules. Ailments of the heart such as an “anguished heart,” pain in the heart, or being “faint” or “sick” of heart were also associated with this form of hot fever. Treatments for this fever involved purging phlegm and pus from the body, bring the fever to the surface of the skin, and a therapeutic bath.
The term tletl is also used for fever throughout the the Florentine Codex. Tletl may be synonymous with totonqui; however, there are some indications that it may have been a particularly high form of fever. “Tletl,” meaning “fire,” is a synonym for tonalli. Additionally, many of the herbs used to treat it, are noted as “cooling,” “cooling the body,” or lowering “the temperature.” These herbs are not, however, the only fever remedies noted to be cooling. The herb tetzmitic or quauholli, used to treat motlevia, and tlalmizqitl, used to treat totonja, are also described as having a cooling effect.
There are two other recognized forms of hot fever, iztac totonqui and matlaltontonqui. Iztac tontonqui, translates to “white fever.” This fever is characterized by festering, abscesses, and swelling underneath the skin. Remedies for iztac totonqui are taken internally and applied topically to draw fever and pus to the surface of the skin.
Matlaltotonqui is known as “green fever.” Matlaltotonqui is noted to be a “high fever” that manifests as bruises and dark spots on the skin. Once the green fever is brought to the skin’s surface it is lanced with a sharp obsidian tool. For matlaltotonqui brought on by phlegm destroying the heart, the phlegm is purged in order to lower the fever.
Three entries in Book Eleven of the Florentine Codex describes:
It is required by one who purges blood, when much flows from his rectum…And one who purges from his rectum and vomits, when it cannot be stopped, they quickly give it to drink. Thus it is stopped at both ends. And one who has a pain in the side which begins in his side and reaches into his heart, as if he would suddenly faint; or who has an ailment settled in the chest, as if he would sleep, [as if] he were about to die of it – [this one] is to drink it; it will quiet him. And one who is sluggish, [who] starts in. vain, whose arms become paralyzed, whose mouth becomes twisted, whose arms become paralyzed, [whose] legs wobble– he drinks it. Some bathe themselves in it. The medicine is warm, tepid…And also one who is already suffering from a swelling stomach drinks it in order to recover. Also whatever the ailment, it thereby leaves; and it cleanses the insides. And one who encounters fever and chills, so that there is pain in the sides, in the chest, in the nerves, as if the heart were seized, beginning in the sides– [this one] is to drink it. It will cast [the sickness] out; thus it will be ended.
He who has a fever, a fever located internally while there are chills on the surface of the body, or settled in the nerves, drinks [an infusion of] its roots. Thereafter the fever, which is within, comes up to the surface; thereby the nerves are quieted.
When some one has much phlegm settle in him, when it seems that it will make him dizzy, he drinks it thickened. And one who has a relapse drinks it; it throws off the fever which is within one. And it cleanses the urine. And one whose head is fevered or whose head blisters is relieved therewith. And when someone is anguished in his heart, or a humor is oppressive, iztauhyatl and quauhyayaual are ground up…One who coughs also drinks it.
Iztauhyatl, as one of the herbs associated with Tlaloc, is used when treating “cold, aquatic” ailments.
On the entry of yoalxochitl. Its entry states:
It is required by one who contracts a high fever, such as the white fever, when the body swells. It is placed there where the body swells, in order to gather [the swelling], which later breaks or dissolves. And all the abscesses or sores are bathed with it, so that the flesh heals over where the sores were.
A little over one third of the medicinal herbs and treatments are indicated for the treatment of fever. These treatments were intended to restore equilibrium in the body. Every individual, therefore, had to practice moderation in all things to preserve health, and in the instance of ill health, restore equilibrium.
The Codex also contains multiple entries for herbs used to treat fever and symptoms of gastrointestinal distress, such as diarrhea and poor digestion.
Chocolate Used for Medical Treatment
The word cacao likely originated with the Olmec peoples who occupied the lowland regions of the eastern Mexican gulf coast. Cacao-related terms were subsequently adopted and expanded by adjacent Mayan people, who even in the early 21st century exhibit a diversified, extensive cacao-related vocabulary. In addition, actual remains of cacao residues have been preserved at archaeological sites, where chocolate beverages were offered to the deceased The Mexica, or Aztecs, who were relatively late arrivals in the central valley of Mexico, adopted/assimilated cacao as a food/medicine.
Several documents, among them the Badianus Manuscript, Florentine Codex and Princeton Codex (Ritual of the Bacabs) provide a baseline for inquiries on the medical uses of cacao.
Written in 1552, the Badianus Manuscript lists a host of ailments cacao-based remedies could treat, including angina, fatigue, dysentery, gout, hemorrhoids and even dental problems.
The Aztecs used cacao to mask the unsavory flavors of other medicinal ingredients, including roots used to treat fever.
Diseases could be “hot” or “cold”, “wet” or “dry”, and physicians treated them with oppositely classified pharmaceuticals. Though cold by nature, cacao could supposedly be prepared in hot or cold forms, depending on necessity.
Some saw chocolate as a treatment for specific illnesses. In the late 1500s and 1600s, Western doctors experimented with chocolate as a treatment for many of the same conditions it had been used for in the Americas, including chest pain, fevers, stomach problems, kidney issues and fatigue.
As for the nutritional content of cacao itself, several studies have suggested that the flavanoid compounds common in unprocessed dark chocolate may reduce risks from clogged arteries and increase circulation to the hands and feet. Unfortunately, since the mid-1800s, dutching has removed dark chocolate’s acidity—and its flavanoids. Around the same time, people were starting to add cocoa butter back into processed chocolate to make bars, along with the dairy and sugar that are now common in modern chocolate candy. These manufacturing methods probably make chocolate more of a medical hindrance than help.
Chocolate prepared by the Aztecs would not have undergone dutching, so it might have benefitted heart health, possibly eased chest pain. The high calorie count of even early forms of chocolate also means it could have benefited patients fighting draining diseases like smallpox.
Agustin Farfan published his Tractado Breve de Medicina in 1592 in which he identified and recommended local Mexica herbs and their properties and medical uses. Farfan observed that chili peppers, rhubarb and vanilla were commonly used by the Mexica as purgatives and that chocolate brewed as a thermally hot beverage was used, traditionally, as a laxative. He described a suitable method used by the Mexica to counter colic: maize tortillas were heated and then applied directly onto the patients’ abdomen to reduce pain.
Chocolate was drunk by the Mexica to treat stomach and intestinal complaints, and when the cacao was combined with liquid from the bark of the silk cotton tree (Castilla elastica), it was said to cure infections. Childhood diarrhea was treated with a prescription that used five cacao beans. These were ground and blended with the root of tlayapoloni xiuitl (unknown plant) and then drunk. To relieve fever and faintness the prescription called for 8–10 cacao beans to be ground with dried maize kernels and blended with tlacoxochitl then, the mixture was drunk. It was also noted that patients stricken with cough who expressed phlegm should drink an infusion prepared from opossum tail, followed by a medicinal chocolate beverage into which had been mixed three herbs: mecaxochitl (Piper sanctum), uey nacaztli (Chiranthodendron pentadactylon) and tlilixochitl (Vanilla planifolia). Preparations of tlatlapaltic root (unknown plant) to control fever, for example, were made more palatable when mixed with cacao.
A second primary source for information on Mexica medicinal use of cacao is the Badianus Manuscript (dated to 1552), which contains striking paintings of medicinal plants and an expansive text that provided a critical understanding of Mexica disease, nutritional problems and healing techniques. A beautiful colored painting of the cacao tree, perhaps the first to be published, is found on plate 70 of the manuscript.
Excerpts from the manuscript reveal that food was an important component to healing and that cacao was occasionally used as a medicine in treatment. Among the treatments prescribed was the use of cacao flowers as an ingredient in a perfumed bath, prepared to cure fatigue, especially in men who administered the government and held public office. Approximately 10% of the medical conditions identified in the manuscript are nutrition related and include reference to angina, constipation, dental problems (tartar removal), dysentery, dyspepsia/indigestion, fatigue, gout, the heart (overheated), hemorrhoids and lactation difficulties.
Henry Stubbe most telling observation was his citation from Dr. Franciscae Ferdinandez, the Principal Physician in Colonial Mexico during the reign of Philip II, who wrote the following:
“[Chocolate] is one of the most wholesome and pretious [sic] drinks, that have been discovered to this day: because in the whole drink there is not one ingredient put in, which is either hurtful in it self, or by commixtion; but all are cordial, and very beneficial to our bodies, whether we be old, or young, great with child, or others acustomed to a sedentary life.”
Elsewhere, Stubbe cited several prominent Spanish physicians. The first, Dr. Juanes de Barrios, argued that chocolate was all that was necessary for breakfast because after eating chocolate, one needed no further meat, bread or drink. The second, Dr. Juanes de Cardenas, concluded that chocolate lengthened life for the reason that the beverage “yields good nourishment to the body, it helps to digest ill humors, voiding the excrements by sweat, and urine.”
William Hughes published his monograph on the ethnobotany of plants growing in English plantations in America in 1672. Appended to his general text was a specific account entitled Discourse of the Cacao-Nut-Tree, and the Use of Its Fruit: With All the Ways of Making of Chocolate: The Like Never Extant Before. Hughes described the preparation of chocolate paste and complicated recipes and suggested that it was only after the arrival of the Spanish that various ingredients were added to chocolate. He wrote. “the Native Indians seldom or never use any compounds, desiring rather to preserve their healths, then to gratifie and please their palates, until the Spaniards coming among them, made several mixtures and compounds, which instead of making the former better… have made it much worse.”
The field of Aztec Medicine by Francisco Guerra was expanded by the translator of The Human Body and Ideology, Bernard R. Ortiz de Montellano in his monograph, Aztec Medicine, Health and Nutrition.
In eight chapters, Montellano examines Aztec medicine with consideration to the nutritional value of their diets, the spiritual beliefs that shaped their idea of the body, and the political context both pre and post-Conquest. Montellano focuses on four primary sources dating from the 16th and 17th centuries, the Florentine Codex, the Badianus Codex, Ruiz de Alarcón’s Treatise on Superstition, and Francisco Hernández’s Historia Natural de la Nueva España.
Methodologically, Montellano approach is emic, meaning he measures the efficacy of Aztec medicines in relation how the indigenous expected them to perform per their etiology, and etic, as he assesses a remedy’s efficacy independent of Aztec etiology and physiology. To accomplish this task, he consults existing studies and chemical data on herbs and animal-based treatments and evaluates using a four-point scale. Montellano expands his interdisciplinary scope to include nutritional analysis and ethnography to provide insights on the quality of the Aztec’s pre-Hispanic diet and the syncretism still present in modern Mexican folk healing.
Through this research, he concludes that the Aztecs had a diet nutritionally superior to most of their European contemporaries and possessed an exceptionally sophisticated and holistic medical system informed by empiricism.
Francisco Guerra noted that the “repeated observation of disease among the Aztecs led to a pathology made up of a collection of symptoms and regional syndromes.”
Guerra’s discussion of practitioners’ familiarity with skin-grafting, prosthetics, and embriotomy confirms the sophistication of pre-Hispanic medical practices in Mexico.
A more recent assessment by Michael E. Smith concludes, “In the realm of naturally caused ailments and injuries, Aztec medicine was highly empirical and practical."
In a sense, the Aztecs used the scientific method, or experimentation through trial and error, to determine the medical value of the herbs, anthropologists have stated. This method would be considered a bit risky by modern standards, but thanks to the Aztecs, their knowledge is still in practice in many parts of rural Mexico.
Many of the practices involving Aztec medicine have been preserved orally, but manuscripts that have been studied by professionals are about five centuries old.
While many Aztecs did fall due to the diseases Europeans brought with them Scholarship by Alfred Crosby, nevertheless, acknowledges that the abuses and torture the indigenous populations suffered under European rule made them more susceptible to illness.
Europeans Awe at Aztec Medicine and Knowledge
The best compliment to ancient Mexican medicine was made by the leader of the Spanish campaign, Hernán Cortés, who asked king Charles the 5th not to send any more European physicians because the Aztec ones excelled on their own.
When the Spanish conquistadors arrived in Tenochtitlan, they marvelled at the Mexica medical proficiency and were quick to appropriate their knowledge. The Spanish immediately sent correspondence about the Mexica’s use of herbs back home. Soon King Charles V of Spain dispatched agents to learn (and steal knowledge) about these native plants.
Franciscan Friar Toribio de Benavente, known by his native name, Motolinía, meaning "poor one,” wrote the History of the Indians of New Spain after he arrived in Mexico in 1523 at the request of Hernán Cortés. Motolinía’s account of the Aztec medical system is effusive in its praise. He states:
They have their own doctors, experienced natives who know how to apply many herbs and medicines, and this suffices for them. Some of these doctors are so experienced that they have cured many serious and long-standing illnesses which Spaniards had suffered for many days without finding a remedy.
Francisco López de Gómara, Cortés’s secretary and biographer, was similarly impressed by the botanical gardens that housed the Aztec’s herbal pharmacopeia, noting that “Moctezuma had many houses with lovely gardens, some of medicinal and aromatic herbs, others of flowers, roses, and sweet-smelling trees in infinite numbers."
Aztec physicians and the medicinal herbs in their vast pharmacopeia were so well renowned for their efficacy that the King of Spanish sent physicians, including the Protomedicato, and scientists to study medicine in New Spain.
Despite this, the Spanish did not adopt many of the Mexica’s medical procedures. Mexica medical practitioners were centuries ahead of European doctors in their use of anaesthetic drugs in surgery.
It wasn’t until 1846 that William Morton publicly demonstrated ether, the original general anaesthetic in the West, whereas the Mexica had been using herbs to dull pain for centuries. While Europeans had a grasp of how to use herbs to reduce suffering, it nowhere near rivalled the Mexica’s use of plants.
Europeans Edit, Censor, and Destroy Aztec Medical Knowledge
The Spaniards attempted to impose a system of academic, professionalized medicine in their colonies through establishing Protomedicato tribunals to regulate which practitioners held legitimacy and which did not. Under this institution, only academically trained affluent criollos, Spaniards who could prove their lineage, could practice legally. However, the Protomedicato had limited reach outside of urban centers, and New Spain had few physicians. As a result, the majority of the population, including many Spaniards, relied upon curanderos, indigenous healers.
Franciscan friar Bernardino de Sahagún arrived in New Spain in 1528 and wrote and chronicled the beliefs and practices of the indigenous, informed by elders with access to pre-Columbian codices in Tenochitlán, Tepeuico, and Tlatelolco, Sahagún believed that members of the clergy would be able to more clearly spot instances of idolatry, even when hidden under the guise of Catholicism. This fear of heresy, however, impacted the interview questions and what information, conveyed in Nahuatl, was translated into Spanish. This led to an edition of the work known as the Madrid Codex, more favorable to a Spanish audience. The original version of the document was edited and released as the Historia universal de las cosas de Nueva España in 1585.
Codex de la Cruz-Badiano, sometimes referred to as the Aztec Herbal, 1552, or the Badianus Codex was also edited. For example, Martín de la Cruz credits his work to god, and states that he hopes the work will “commend the Indians, though so unworthy, to his royal Sacred Caesarean Catholic majesty,” adding, “we poor and unfortunate Indians are inferior to all mortals, and thus our insignificance and poverty implanted in us by nature, merit forbearance.”
Sometimes people forget that Western medicine is based on herbal medicine and herbal knowledge.
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