Kambo, also known as vacina-do-sapo, or sapo (from Portuguese "sapo", lit. meaning "toad"), is the dried skin secretions of the kambô, a species of frog, used as a transdermal medicine. Kambo is usually used in a group setting, called a Kambo circle or Kambo ceremony. The effects on humans usually include tachycardia, nausea, vomiting, and diarrhea, however, a meta-review of 50 studies in which 11 cases of acute intoxication were examined found that extreme cases may include psychosis (occasionally severe), SIADH, kidney damage (including acute renal failure), pancreas damage, liver damage including toxic hepatitis, dermatomyositis, esophageal rupture, seizures, and death, although evidence for these is limited. Kambo, which originated as a folk medicine practice among the Amazon indigenous peoples, is also administered as an

alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and alt ...

treatment in the West, often as a

pseudoscientific Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method. Pseudoscience is often characterized by contradictory, exaggerated or unfalsifiable claim ...

cleanse or detox. The ceremony involves burning an arm or leg and applying the kambo secretion directly to the burn. Promoters claim that kambo helps with several illnesses or injuries. There is no

scientific evidence Scientific evidence is evidence that serves to either support or counter a scientific theory or hypothesis, although scientists also use evidence in other ways, such as when applying theories to practical problems. "Discussions about empirical ev ...

that it is an effective treatment. It seems to be particularly dangerous to take a kambo with large quantities of water. Doing that is associated with SIADH and severe electrolyte imbalances: changes in plasma and urine osmolarity, hypokalemia, hypomagnesemia and hypophosphatemia. Naloxone is under study as a possible antidote; hospital treatment also includes medicines to protect organs from damage and restore electrolyte function.

Common terms

* Kampo pae, name used by the Noke Kuin (formerly Katukina) * Dow kiet, a word used by the Matses * Sapo, kampô, kampu, vacina de sapo or vacina da floresta, in Brazilian Portuguese "Kambô" is a common name of '' Phyllomedusa bicolor'', an Amazonian tree frog, also known as the blue-and-yellow frog, bicolored tree-frog, giant monkey frog, giant leaf frog, or waxy-monkey tree frog. "Sapo" means "toad" in Spanish and Portuguese. The frog is an anuran amphibian that inhabits the Amazon and

Orinoco The Orinoco () is one of the longest rivers in South America at . Its drainage basin, sometimes known as the Orinoquia, covers , with 76.3 percent of it in Venezuela and the remainder in Colombia. It is the fourth largest river in the wor ...

basins in South America.

History

Natives who practice kambo are

Panoan Panoan (also Pánoan, Panoano, Panoana, Páno) is a family of languages spoken in Peru, western Brazil, and Bolivia. It is possibly a branch of a larger Pano–Tacanan family. Genetic relations The Panoan family is generally believed to be relat ...

-speaking indigenous groups in the southeast

Amazon rainforest The Amazon rainforest, Amazon jungle or ; es, Selva amazónica, , or usually ; french: Forêt amazonienne; nl, Amazoneregenwoud. In English, the names are sometimes capitalized further, as Amazon Rainforest, Amazon Forest, or Amazon Jungle. ...

, such as the Mayoruna, Matses, Marubo,

Amahuaca The Amahuaca or Amhuaca are indigenous peoples of the Americas, indigenous peoples of the southeastern Amazon Basin in Peru and Brazil. Isolated until the 18th century, they are currently under threat from ecological devastation, disease and viole ...

Kashinawa The Huni Kuin (also known as: ''Kaxinawá'', ''Cashinahua'', ''Kaschinawa'', ''Kashinawa'', ''Caxinauás'') are an indigenous people of Brazil and Indigenous peoples in Peru, Peru. Their villages are located along the Purus River, Purus and Cur ...

, Katukina, Yawanawá, and the

Kaxinawá The Huni Kuin (also known as: ''Kaxinawá'', ''Cashinahua'', ''Kaschinawa'', ''Kashinawa'', ''Caxinauás'') are an indigenous people of Brazil and Peru. Their villages are located along the Purus and Curanja Rivers in Peru and the Tarauacá, ...

. There are ethnographic studies on the use of kambo in traditional Noke Kuin medicine in the region of the state of

Acre The acre is a unit of land area used in the imperial Imperial is that which relates to an empire, emperor, or imperialism. Imperial or The Imperial may also refer to: Places United States * Imperial, California * Imperial, Missouri * Imp ...

, in the

Brazilian Amazon Brazilian commonly refers to: * Something of, from or relating to Brazil * Brazilian Portuguese, the dialect of the Portuguese language used mostly in Brazil * Brazilians, the people (citizens) of Brazil, or of Brazilian descent Brazilian may also ...

. Since the mid-20th-century, kambo has also been practiced in urban regions of Brazil. In 2004, Brazil banned the sale and marketing of kambo. Import is illegal in Chile. Outside of South America, it first became known as an alternative therapy in the late 2010s. In 2021 the Therapeutic Goods Administration of Australia (TGA) banned the use of Kambo in Australia and classified it as a schedule 10

poison Poison is a chemical substance that has a detrimental effect to life. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figuratively, with a broa ...

. It is listed in the category for “substances of such danger to health as to warrant prohibition of sale, supply and use”.

Indigenous use

Kambo_ritual_-_inoculating_skin_with_poisonous_secretions_of_Phyllomedusa_bicolor_tree_frog

To collect the secretions from the frog's body, first, the frog has to be caught. A practitioner will tie the frog to four sticks placed in the ground with its limbs completely stretched. The pulling causes the frog to become stressed enough to activate its defense mechanism and secrete a substance containing peptides from its skin. After obtaining secretions, the frog goes back into the wild. The secretions are then left to dry. Small burns are created on the skin, and a small dose of the frog secretions applied to the open wounds. In native practice, the secretions are removed from the wounds after 15 to 20 minutes, ending the acute symptoms. Traditional practitioners claim that it aids fertility, cleanses the body and soul, increases strength, and brings good luck to hunts. It is used by natives to expel "panema" (bad spirit) and to induce abortions. The secretions are also commonly used in people who suffer from tikish or laziness, a condition perceived as unfavorable by the Noke Kuin as the person stops participating socially. Joaquim Luz, a Yamanawa leader, criticized commercial sales and kambo's use without the preparation or permission of indigenous peoples, saying that the toxin users are at risk of death. Other native groups have also expressed concerns.

Non-indigenous use

Outside South America, a kambo ceremony can involve just two people, the practitioner, the participant, or many participants at once, which is known as a kambo circle. Participants are encouraged to bring plenty of water, a towel, and a bucket. There are usually yoga mats on the floor and the ceremony room, which is often the practitioner's living room, is heavily incensed. During the ceremony, the participant's skin is deliberately burnt multiple times, usually on the upper arm or leg, by the practitioner using a

smoldering Smouldering (British English) or smoldering (American English; see spelling differences) is the slow, flameless form of combustion, sustained by the heat evolved when oxygen directly attacks the surface of a condensed-phase fuel. Many solid mate ...

stick or vine. The practitioner uses saliva or water to reconstitute the frog secretions and place it on top of the burnt skin. Participants may be encouraged to shout ''"Viva"'' whenever one of them vomits into their bucket. Short-term effects include violent nausea, vomiting, diarrhea,

edema Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's Tissue (biology), tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels t ...

(swelling) of the face, headaches, and tachycardia. The secretions seem to be

vasoactive A vasoactive substance is an endogenous agent or pharmaceutical drug that has the effect of either increasing or decreasing blood pressure and/or heart rate through its vasoactivity, that is, vascular activity (effect on blood vessels). By adju ...

(affecting the circulation), explaining why they are absorbed rapidly. Intoxication may occur immediately or within hours.

Medical claims

Non-indigenous users and practitioners of kambo claim that the alternative medicine helps with a wide variety of issues and conditions. These claims include treating addiction, depression, and chronic pain, reducing fevers, increasing fertility, boosting energy and physical strength, and improving mental clarity. It is also claimed that kambo removes negative energy and cleanses the soul and body.There is a report of a single patient with acute myeloid leukemia who normalized his blood cell count and reached a complete remission which lasted more than 4 years after kambo application (and without any chemotherapy), but the causal role of kambo in this positive outcome is not proven so far. There is currently no

to these claims. There is no solid medical evidence on how the frog toxins work, whether they are useful for treating anything, and whether they can be used safely: no clinical trials have tested them on humans, . Reports of adverse effects are numerous, including for use with experienced guidance. The possible use of some of the peptides, such as caerulein, for therapeutic purposes has been evaluated due to their intrinsic analgesic properties, however, the overall in vivo effects, i.e., the concomitant administration of all of these peptides to humans, still appear uncertain. Kym Jenkins of the Royal Australian and New Zealand College of Psychiatrists, in a ''

Sydney Morning Herald ''The Sydney Morning Herald'' (''SMH'') is a daily compact newspaper published in Sydney, New South Wales, Australia, and owned by Nine. Founded in 1831 as the ''Sydney Herald'', the ''Herald'' is the oldest continuously published newspaper i ...

'' article, said "people with mental illness are a more vulnerable group anyway for a variety of reasons. If you're feeling very anxious or very depressed ... you're automatically more vulnerable and you could be more susceptible to people advertising or marketing a quick fix. I do have concerns that people can be preyed upon when they are more vulnerable." The

Australian Medical Association The Australian Medical Association (AMA) is an Australian public company by guarantee formed as a professional association for Australian doctors and medical students. The association is not run by the Australian Government and does not regul ...

supports the Australian Therapeutic Goods Administrations ban on the sale, supply, and use of kambo, saying it considers kambo to be a “significant health risk”.

Marketing

In non-indigenous use, the frog secretion is described and marketed as a " detox" treatment, cleanse, purge, and as a "vaccine", which is "good for everything". Kambo has been marketed both as a "scientific" remedy, emphasizing the biochemistry, and as a "spiritual" remedy, emphasizing its indigenous origins. Purging (deliberate vomiting) has been a popular treatment since the 1800s. "Detox" has been described by Edzard Ernst, emeritus professor of complementary medicine, as a term for conventional medical treatments for addiction, which has been "hijacked by entrepreneurs, quacks, and charlatans to sell a bogus treatment." In Brazil, given the growth in the consumption of kambo in urban centers, there has been criticism by indigenous people, academics and communicators regarding the

cultural appropriation Cultural appropriation is the inappropriate or unacknowledged adoption of an element or elements of one culture or identity by members of another culture or identity. This can be controversial when members of a dominant culture appropriate from ...

of indigenous knowledge, the process of extracting the secretion of the ''Phyllomedusa bicolor'' frog, the form of transmission of wisdom, and the price charged by the ritual and the mystification of the origin of the frog. There is also concern about pharmacological patents on the peptides identified in kambo (see

biopiracy Biopiracy (also known as scientific colonialism) is defined as the unauthorized appropriation of knowledge and genetic resources of farming and indigenous communities by individuals or institutions seeking exclusive monopoly control through patent ...

), the commercialization of the kambo outside its place of origin, and the unknown impact on frog populations, since many more are now removed from their natural habitats. In light of the chemical complexity of the frog toxins, and their complex and potentially fatal effects, the authors of a 2022 review on the diagnosis and treatment of kambo cases said they urged "strict surveillance of the websites that encourage the use of this substance and eurge greater control of e-commerce or illicit trafficking of animals and secretions, including through the dark web".

Environmental impact

The effect of the increased use of kambô rituals, and trafficking of the frogs and their secretions, may have an effect on the population of '' Phyllomedusa bicolor'' in its natural habitats: the forests of

Bolivia , image_flag = Bandera de Bolivia (Estado).svg , flag_alt = Horizontal tricolor (red, yellow, and green from top to bottom) with the coat of arms of Bolivia in the center , flag_alt2 = 7 × 7 square p ...

, Peru, Brazil, the Guianas,

Colombia Colombia (, ; ), officially the Republic of Colombia, is a country in South America with insular regions in North America—near Nicaragua's Caribbean coast—as well as in the Pacific Ocean. The Colombian mainland is bordered by the Car ...

, and Venezuela. ''Phyllomedusa bicolor'' is not considered an

endangered species An endangered species is a species that is very likely to become extinct in the near future, either worldwide or in a particular political jurisdiction. Endangered species may be at risk due to factors such as habitat loss, poaching and inv ...

by the

IUCN The International Union for Conservation of Nature (IUCN; officially International Union for Conservation of Nature and Natural Resources) is an international organization working in the field of nature conservation and sustainable use of natu ...

. Besides ''Phyllomedusa'' (species?), other threatened endemic frog species of South America's neotropical regions have been poached and smuggled on the

black market A black market, underground economy, or shadow economy is a clandestine market or series of transactions that has some aspect of illegality or is characterized by noncompliance with an institutional set of rules. If the rule defines the se ...

. File:Waxy Monkey Tree Frog Phyllomedusa sauvagii.jpg, ''Phyllomedusa bicolor'' File:Rã arborícola face.jpg, Tree frog, Caetité, Bahia, Brazil File:Phyllomedusa hypochondrialis.jpg, ''Phyllomedusa hypochondrialis'' File:Phyllomedusa burmeisteri01b.jpg, ''Phyllomedusa burmeisteri'' File:Phyllomedusa iheringii01.jpg, ''Phyllomedusa theringii'' File:Phyllomedusa trinitatis.jpg, ''Phyllomedusa trinitatis'' File:Phyllomedusa distincta01.jpg, ''Phyllomedusa distincta'' File:Phyllomedusa boliviana - Bolivianischer Makifrosch.jpg, Bolivian Phyllomedusa File:Phyllomedusa azurea.jpg, ''Phyllomedusa azurea''

Parasitology

Smuggling amphibians such as ''Phyllomedusa bicolor'' can spread parasites. Zoos keep frogs for conservation purposes, and there are many parasites present in these animals that naturally occur only in the native habitats. It is recommended for imported

amphibians Amphibians are four-limbed and ectothermic vertebrates of the class Amphibia. All living amphibians belong to the group Lissamphibia. They inhabit a wide variety of habitats, with most species living within terrestrial, fossorial, arbore ...

to go through a quarantine process to verify they are not spreading parasites that could damage other ecosystems. Parasite infection rates in frogs is 51%, while in salamanders it is 13%. Individuals who want to have them as pets are obligated and encouraged to get them examined to detect gastrointestinal parasites that could potentially be harmful. ''Neocosmocercella fisherae'' is the first

nematode The nematodes ( or grc-gre, Νηματώδη; la, Nematoda) or roundworms constitute the phylum Nematoda (also called Nemathelminthes), with plant-Parasitism, parasitic nematodes also known as eelworms. They are a diverse animal phylum inhab ...

species found parasitising ''Phyllomedusa bicolor'' from the Brazilian Amazon Region.

Notable deaths

A 40-year-old businessman was charged in Brazil in 2008 with the illegal exercise of medicine and

felony murder The rule of felony murder is a legal doctrine in some common law jurisdictions that broadens the crime of murder: when someone is killed (regardless of intent to kill) in the commission of a dangerous or enumerated crime (called a felony in s ...

after administering kambo toxins to a business colleague, who died; the deceased's son, who said his father had pressured him into participating, suffered more minor effects. In Chile in 2009, Daniel Lara Aguilar, who suffered from chronic

lumbar disc disease Lumbar disc disease is the drying out of the spongy interior matrix of an intervertebral disc in the spine. Many physicians and patients use the term lumbar disc disease to encompass several different causes of back pain or sciatica. In this artic ...

, died immediately after taking kambo administered by a local shaman in a mass healing ceremony; the autopsy was inconclusive due to preexisting conditions. The medical literature reported the 2018 case in Italy of a person with no known preexisting conditions besides obesity, who, according to autopsy reports, died of cardiac arrhythmia while under the effects of kambo use. In March 2019, kambo practitioner Natasha Lechner suffered a cardiac arrest and died while receiving kambo. In April 2019, a homicide investigation was opened into the death by "severe cerebral edema" of a young person who had taken kambo toxins in Chile; the import of the frog and its secretions is illegal in Chile.

Pharmacology

The frog secretes a range of small chemical compounds of a type called peptides, which have several different effects. Peptides found in the frog secretions include dermorphin and deltorphin. The peptides then bind to opioid receptors, sauvagine, a

vasodilator Vasodilation is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The process is the opposite of vasoconstriction, ...

, and dermaseptin, which exhibits antimicrobial properties '' in vitro''. Various other substances such as phyllomedusin, phyllokinin, caerulein, and adrenoregulin are also present. There is active medical research into the peptides found in the skin secretions of ''Phyllomedusa bicolor'', focusing on discovering their biological effects. There have been some preclinical trials in mice and rats, but no phase-1 tests or

clinical trials Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...

of safety in humans, .

Notes

References

{{reflist, refs= {{cite web , last1=Scherer , first1=Jennifer , title=Australians Are Using This Amazonian Frog Poison Aa A Controversial Alternative Medicine , url=https://www.sbs.com.au/news/the-feed/australians-are-using-this-amazonian-frog-poison-as-a-controversial-alternative-medicine , website=SBS , access-date=15 December 2019 , archive-url=https://web.archive.org/web/20191107012338/https://www.sbs.com.au/news/the-feed/australians-are-using-this-amazonian-frog-poison-as-a-controversial-alternative-medicine , archive-date=7 November 2019 , date=7 November 2019 {{cite web , last1=Van Zeller , first1=Mariana , last2=Brown , first2=Jasmine , last3=Effron , first3=Lauren , date=29 March 2017 , title=This Amazonian tree frog's poison has become part of the latest supercleanse trend , url=https://abcnews.go.com/International/amazonian-tree-frogs-poison-part-latest-super-cleanse/story?id=46431345 , website=ABC News , access-date=15 December 2019 , archive-url=https://web.archive.org/web/20170329211353/https://abcnews.go.com/International/amazonian-tree-frogs-poison-part-latest-super-cleanse/story?id=46431345 , archive-date=29 March 2017 , url-status=live {{cite web , last1=Lavoipierre , first1=Angela , title=Tree frog poison being used as an alternative medicine , url=https://www.abc.net.au/news/2018-09-07/kambo-tree-frog-poison-used-as-alternative-medicine/10060126 , website=ABC News , access-date=15 December 2019 , url-status=live , archive-url=https://web.archive.org/web/20180907171022/https://www.abc.net.au/news/2018-09-07/kambo-tree-frog-poison-used-as-alternative-medicine/10060126 , archive-date=7 September 2018 , date=7 September 2018 {{cite web , last1=Schwarcz , first1=Joe , authorlink=Joseph A. 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