Hawaiians in ancient times followed a healthy lifestyle that included a well-balanced and nutritious diet, physical fitness achieved through both labor and sport, and a fastidious attitude toward personal hygiene. The first Westerners to visit the Islands remarked on Hawaiians' grace and strength, bright teeth and general cleanliness. Health was understood to be the result of pono, or right, living; illness followed imbalance in some aspect of life, whether spiritual, mental or physical. Healers addressed each of these as the root or cause of illness, integrating psycho-spiritual methods such as prayer, revelation and group discussion with physical treatments.
In treating the physical body, Hawaiians were adept with herbal medicines (la`au lapa`au). Medical kahuna used careful observation and palpation in making a diagnosis and used herbs in conjunction with massage, manipulation, bone setting and heat or hydrotherapy. Healers followed a rigorous course of training, sometimes studying for decades. One method of learning anatomy and symptoms involved using a papa`ili`ili, or pebble diagram, laid out in the form of a body. All healing involved a large spiritual component and prayers and chants accompanied every stage from the gathering of plants to the final pani, or ritual end of the treatment.
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