Chronic wounds, defined as wounds that fail to progress through the normal stages of healing in an orderly and timely manner, present a significant challenge to healthcare systems worldwide. These wounds, often persisting beyond 4–12 weeks despite appropriate treatment, are associated with considerable morbidity and healthcare costs (Bowers and Franco, 2020; Serra et al., 2015). These wounds, often caused by conditions such as chronic venous insufficiency (CVI), lymphatic insufficiency, chronic limb ischemia (CLI), diabetes, skin tears, or prolonged pressure, can lead to severe complications, including infections and amputations, thereby reducing patients’ quality of life. Specifically, CVI may manifest as significant skin changes, including venous eczema and lipodermatosclerosis, as well as active chronic venous ulcers (CVUs), which represent a serious form of skin tissue damage. CLI can result in localized or extensive arterial ischemic ulcers (IAUs), and in some patients, both arterial and venous wounds may even occur simultaneously in the same patient, referred to as mixed arterial and venous ulcers (MAVLUs). Furthermore, diabetic patients may experience diabetic foot ulcers (DFUs), which contribute to increased overall morbidity in this population (Serra et al., 2017; De Franciscis et al., 2014; Serra et al., 2018; Costa et al., 2022; Serra et al., 2014; Serra et al., 2015; Ammendola et al., 2017).

The increasing prevalence of chronic wounds has prompted a search for effective and accessible treatments, leading to a renewed interest in herbal medicine practices (Monika et al., 2022; Maver et al., 2015; Shedoeva et al., 2019).

Among traditional medicine, encompassing the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, has been utilized for centuries to treat various ailments, including wounds (Elendu, 2024; Reyes-García, 2010; Hill, 2009).

Herbal remedies, in particular, have played a pivotal role in wound management due to their antimicrobial, anti-inflammatory, and healing properties (Polerà et al., 2019; Gasbarro et al., 2013).

Thus, medical humanities are useful to examine the social dimensions of herbal medicine use. The knowledge of medicinal plants is often passed down through generations, and herbal remedies for chronic wounds are embedded in local cultural practices, shaping social relations and community identity (Xu et al., 2023). Moreover, the increasing integration of traditional and modern healthcare systems in many countries has led to the establishment of ethnobotanical research, which bridges scientific knowledge with traditional healing practices (Duke and Ayensu, 1985). The herbal medicine plays a multifaceted role in the treatment of chronic wounds, with its significance shaped by both pharmacological properties and cultural contexts. By employing sociological and anthropological perspectives, it is possible to understand the complex relationships between people, plants, and healing practices, providing insights into how traditional and modern medical systems can collaborate for improved wound care management (Xu et al., 2023).

The management of chronic wounds presents an ongoing challenge across both biomedical and traditional medical systems. Biomedical approaches to wound care are typically guided by standardized protocols involving antiseptics, debridement, antibiotics, and advanced therapies such as compression therapy, skin grafts, or bioengineered dressings (Frykberg and Banks, 2015). These methods are supported by clinical evidence and are widely used in hospital settings; however, they often require specialized care, are resource-intensive, and may be difficult to access in rural or economically underserved areas (Gray et al., 2018).

In contrast, traditional medical systems—particularly those rooted in ethnobotanical knowledge—approach wound healing through culturally embedded practices that incorporate locally available plants with known or perceived antimicrobial, anti-inflammatory, and regenerative properties (Shedoeva et al., 2019; Maver et al., 2015; Monika et al., 2022). Rather than isolating biological mechanisms, these practices often involve holistic understandings of illness, treating the wound not just as a physical ailment but as a disturbance of bodily, environmental, or spiritual balance. Remedies are typically administered through poultices, decoctions, and infusions, often prepared by caregivers within the family or community (Dorai, 2012).

While biomedical and traditional medicine are sometimes presented as opposing paradigms, increasing research suggests they can be complementary rather than contradictory. Several medicinal plants used in traditional systems have demonstrated pharmacological efficacy in laboratory and clinical studies (Polerà et al., 2019), supporting calls for more integrative approaches. However, there also remain tensions—such as differences in epistemologies, regulation, and professional authority—that complicate integration.

In several cultural contexts, these two systems often coexist in a hybrid form. Patients move fluidly between formal healthcare providers and informal, culturally rooted care practices. This coexistence is not merely pragmatic but shaped by structural constraints (e.g., healthcare access), cultural identity, and trust in ancestral knowledge. In fact, the Global Centre for Traditional Medicine in Jamnagar Gujarat – India – showcases a defined move to integrating the two systems (Singh et al., 2012).

Understanding how these systems interact in everyday healing practices is crucial for designing more inclusive and effective healthcare strategies in regions where biomedical care may be perceived as distant or insufficient (Jama et al., 2024).

For clarity and consistency, key terms and concepts employed throughout this article—particularly those related to traditional and ethnomedical practices—are defined in the Table 1.

This ethnographic study aims to bridge the existing knowledge gap by systematically documenting whether patients with chronic ulcers use herbal medicines and other forms of traditional medicine in the management and treatment of chronic ulcers, the possible method of preparation of the medicines and the cultural meanings that patients attribute to this type of treatment.

In the context of Italy, the region of Calabria offers a rich tapestry of traditional healing practices deeply rooted in its history and culture. Ethnobotanical studies have documented the use of various medicinal plants in this region. These plants have been employed to treat a range of ailments, including wounds, reflecting a profound understanding of the local flora’s medicinal properties. Moreover, recent scientific investigations have begun to validate the efficacy of herbal Calabrian remedies (Passalacqua et al., 2007; Patti et al., 2025). For example, traditional foods, such as honey have been suggested as potential therapeutic applications for chronic wounds (Governa et al., 2019), thus underscoring the importance of integrating traditional knowledge with modern scientific research to develop effective wound care strategies. Despite the rich heritage and potential benefits of herbal medicine in Calabria, there remains a scarcity of comprehensive ethnographic studies exploring their application in chronic wound management. Understanding the traditional practices, cultural beliefs, and local perceptions surrounding wound care in this region is crucial for several reasons. Firstly, it can lead to the identification of novel therapeutic agents derived from local plants. Secondly, it can inform culturally sensitive healthcare interventions that resonate with the local population’s beliefs and practices, thereby enhancing patient compliance and outcomes. Lastly, it contributes to the preservation of intangible cultural heritage, ensuring that valuable traditional knowledge is not lost to future generations (Krippner et al., 2011; Xu et al., 2023).

Southern Italy—particularly the Calabria region—has experienced a slow but persistent transformation in the relationship between healthcare systems, local communities, and traditional healing practices. This period has seen a resurgence in ethnomedical knowledge, particularly concerning chronic wound management, due to the fact the region facing systemic underfunding, rural depopulation, and healthcare disparities (Gallante et al., 2011). Calabria remains one of Italy’s most underserved regions, marked by limited access to specialized medical services such as vascular care, especially in mountainous and peripheral rural areas (Costa et al., 2025). Against this backdrop, herbal medicine has emerged not merely as an alternative therapeutic option but as a coexisting and culturally legitimized system of care (Passalacqua et al., 2007; Patti et al., 2025). Parallel to this informal medical sphere is the formal biomedical system, represented by vascular clinics, general practitioners, and hospital services. In Calabria, this system is often perceived by participants as distant, overburdened, and inaccessible, particularly in rural zones with high elderly populations (Brienza et al., 2002). The perception of medical over-specialization and bureaucratic delays drives many patients to seek more immediate and culturally resonant care through traditional means. In this ethnomedical landscape, one can also identify the presence of intermediary figures: pharmacists, nurses, and even local herbalists who—while situated within or adjacent to the biomedical model—facilitate informal exchanges of plant knowledge and reinforce traditional practices through tacit approval or discreet collaboration. This convex arrangement—where traditional knowledge-holders, patients, informal intermediaries, and the biomedical system all intersect—produces a hybrid model of healthcare (Byrne et al., 2022). The ethnographic data demonstrate that this hybridity is not simply a result of resistance to biomedicine, but rather a negotiated response to structural deficiencies, cultural identity, and therapeutic pragmatism (Maizes et al., 2009). Just as political parties and social movements interact dynamically in the field of climate activism, in Calabria, vernacular healing practices and institutional medicine continually redefine their boundaries through everyday interactions and community narratives. Additionally, socioeconomic and political marginalization plays a key role in shaping the persistence of herbal medicine (Costa-Font and Sato, 2025). Rural Calabrian communities are often excluded from national public health discourse, echoing a broader trend of healthcare inequity across southern Italy. This marginalization fosters a localized form of therapeutic autonomy, where the use of native plants, knowledge sharing within families, and gendered caregiving roles become forms of resistance and resilience in the face of systemic neglect (Taroni, 1861). The Calabrian ethnomedical system operates within a complex social ecology—one where traditional healing, gender, local epistemologies, and biomedical infrastructures continuously overlap and influence each other. This analysis helps reposition herbal medicine not as a relic of the past, but as a living cultural system responding dynamically to contemporary healthcare challenges (Patti et al., 2025; Krippner et al., 2011).

To better understand the context of the empirical case study, a map has been created (Figure 1) highlighting all the main characteristics of the Calabria region, with the cities most involved in the research circled in red.

This article is grounded in an ethnographic research approach, which is particularly suited for exploring the cultural, symbolic, and practical dimensions of traditional medicine in specific social settings. Ethnography provides tools for in-depth engagement with communities, enabling the documentation of local knowledge systems and therapeutic practices as they are lived and experienced (Shah, 2017). Participant observation and semi-structured interviews, key methods of ethnographic inquiry, allow researchers to immerse themselves in the field and follow social dynamics, meaning-making processes, and interactions surrounding healthcare choices (Morgan-Trimmer and Wood, 2016).

The present study is based on long-term, multi-sited ethnographic fieldwork conducted in Calabria, Southern Italy, between January 2019 and November 2024. The research focused on patients with chronic wounds attending the vascular surgery clinic of the Dulbecco University Hospital in Catanzaro.

Eligibility required the presence of one or more chronic wound conditions and the use of herbal medicine for wound management, along with the patient’s willingness and ability to participate in ethnographic data collection, which included semi-structured interviews and participant observation. All participants were required to be 18 years of age or older. Patients were excluded if they did not use herbal remedies, declined to participate, were unable to provide informed consent, or had cognitive or communication impairments that could interfere with the qualitative research process.

Regarding the sex of the patients 54 were males (45%) and 66 were females (55%), aged between 61–92 years with a mean age of 71.38 years. The participants were divided in four groups. The first group consisted of 89 individuals (74.17%) with skin changes of venous origin (venous eczema and lipodermatosclerosis) and/or chronic venous leg ulcers (CVLUs), 35 were males (39.33%) and 54 were females (60.67%). The second group consisted of 10 individuals (8.33%) with arterial leg ulcers (ALUs). Seven were males (70%) 3 females (30%). The third group consisted of 12 individuals (10%) with mixed arterial and venous ulcers (MAVUs). Seven were males (58.33%) and 5 were females (41.67%). The fourth group consisted of 9 individuals (7.5%) with diabetic foot ulcers (DFUs). Five were males (55.56%) and 4 were females (44.44%).

The ethnographic engagement included semi-structured interviews, participant observation in clinical and community settings, and the production of detailed field notes, enabling a comprehensive understanding of herbal medicine usage in the management of chronic ulcers. The study particularly sought to explore the cultural logic of wound classification, plant selection, and preparation methods, as well as the gendered transmission of ethnobotanical knowledge.

The first author, an experienced in qualitative and ethnographic research, led the fieldwork, with prior research experience in Southern Italy. His familiarity with local dialects and cultural norms facilitated rapport-building with elderly informants and access to gender-specific domains of knowledge. Although not a practitioner of herbal medicine, the researcher shared an interest in local health traditions and was transparent about the study’s aims. Informed consent was obtained from all participants. Interviews were conducted in Italian, recorded, and professionally transcribed. Participants were assigned pseudonyms to ensure confidentiality. The methodology was reviewed and approved by the Institutional Review Board of the Interuniversity Center of Phlebolymphology (CIFL) (Reference: ER. ALL.2018.73A). The multi-sited nature of the fieldwork allowed for comparative insights across various sub-regions of Calabria, capturing regional and gendered variations in healing practices. Participant observation included household visits where remedies were prepared, informal conversations with patients and caregivers, and observation of the therapeutic use of plants in everyday contexts. While men were often observed preparing poultices for work-related injuries, women—especially grandmothers and mothers—emerged as the primary transmitters and custodians of plant-based healing knowledge.

The interviews were conducted in Italian and were recorded end consequently professionally transcribed, and the duration was among 45 min. The research materials were undertaken by the first author and supplementary analysis was undertaken at the conclusion of the field research. Pseudonyms are used in this paper for all participants to maintain confidentiality.

The medicinal plants identified in our study are summarized in Table 2, in which botanical taxon and family, local name, English common name, used parts, type of preparation and treated wound or skin changes have been provided for each plant.

Fieldnotes were systematically analyzed following the approach of Emerson et al. (1995), involving two key phases: (i) an initial open coding stage, where recurring themes such as gender roles, healthcare access, and symbolic plant use were identified; and (ii) a second stage of memo-writing, enabling the interpretation of underlying meanings and tensions in the data. This dual-stage coding process facilitated the recognition of both shared patterns and local divergences in ethnomedical practices. The methodology also drew from Falzon’s (2009) concept of multi-sited ethnography, enabling the tracing of herbal knowledge across different sociomedical contexts—from clinics to kitchens, from family storytelling to lived patient care. Through this lens, the study investigated not only what plants were used, but how, why, and by whom they were prepared and applied—paying close attention to narratives of empowerment, resourcefulness, and cultural continuity in the face of systemic healthcare limitations. The ethnographic methodology employed in this study offers a rich, context-sensitive account of how herbal medicine persists and evolves in Calabria. It foregrounds the voices of patients and caregivers, particularly women, and sheds light on how cultural knowledge systems interact with healthcare structures, socioeconomic conditions, and therapeutic efficacy.

The data analysis revealed four main themes and different subthemes. Figure 2 illustrates the thematic hierarchy, detailing each theme along with its corresponding subthemes.

This ethnographic study sheds light on the enduring vitality of herbal medicine in the management of chronic wounds among patients in Calabria, southern Italy. Far from being an outdated or marginal practice, the use of medicinal plants emerges here as a living tradition, deeply rooted in familial memory, shaped by gendered knowledge transmission, and adapted to meet the evolving healthcare needs of aging, rural populations. One of the most salient findings of this research is the pivotal role of women as custodians of herbal healing knowledge. In the Calabrian context, the use and transmission of medicinal plant practices are predominantly matrilineal: grandmothers, mothers, and daughters form a chain of intergenerational knowledge that binds ethnomedical wisdom to caregiving roles within the family. This gendered structure not only reinforces women’s agency in domestic healthcare but also positions them as cultural stewards who mediate between tradition and necessity. The dataset, which shows significantly more female citations of herbal use compared to males, reinforces this dynamic. While men do participate — particularly in the application of poultices for work-related injuries or self-treatment — it is women who sustain the broader ethnobotanical framework for chronic wound care, particularly for complex and long-term conditions like venous ulcers or diabetic foot complications. In parallel, the findings reveal that herbal medicine persists not in isolation from, but in response to, structural deficiencies in the biomedical system. Many participants turn to plant-based therapies not out of ideological opposition to conventional medicine, but due to pragmatic barriers: lack of access to specialists, long waiting times, the high cost of treatments, and the limited presence of vascular clinics in rural Calabria. Herbal medicine thus fulfills a dual role: it is both a therapeutic alternative and a culturally resonant form of health self-management. This is particularly evident in the treatment of chronic ulcers — conditions known for their slow healing trajectory, recurrence, and resistance to standard protocols. In this landscape of therapeutic frustration, herbal treatments are perceived as empowering, offering patients a degree of control, familiarity, and low-cost accessibility. Another crucial finding is the selective and context-specific use of plants for different types of chronic wounds. The participants demonstrated not only deep familiarity with local flora but also a form of cultural logic in plant selection, tied to the perceived etiologies of wounds. For venous leg ulcers and related conditions like lipodermatosclerosis and venous eczema, plants such as Achillea millefolium, Cichorium intybus, Marrubium vulgare, and Equisetum arvense were frequently cited — species known for their anti-inflammatory, antimicrobial, and circulatory-enhancing properties. This suggests that local knowledge aligns, at least partially, with pharmacological profiles recognized in scientific literature. In contrast, for arterial ulcers and diabetic foot ulcers — conditions associated with ischemia and systemic metabolic dysfunction — informants frequently cited the use of Calendula arvensis, Citrus bergamia, Plantago major, and Vitis vinifera. These species were valued for their regenerative and antiseptic properties, as well as for their ability to stimulate tissue repair in wounds with poor perfusion. Remarkably, while diabetic and ischemic ulcers are more prevalent among elderly men in the study, it was predominantly women who reported the preparation and administration of the remedies — a finding that again underscores their caregiving centrality in chronic illness contexts. The methods of preparation reveal further insights into the symbolic and practical dimensions of healing. Decoctions and infusions are not merely biochemical processes for extracting active compounds — they are ritualized acts that connect the healer with the plant and the patient. Decoctions, involving prolonged boiling, are associated with the extraction of a plant’s essence and are perceived as stronger, systemic treatments, often used for entrenched or internal conditions. Infusions, by contrast, are gentler and associated with nurturing, ongoing care — often made by older women for their spouses or children. Poultices and squashed pulps, on the other hand, suggest a more immediate, hands-on mode of healing. These methods are often employed in acute or visible wounds, especially by male informants. This division not only indicates gendered modes of practice but also points to a vernacular taxonomy of treatment intensity, urgency, and appropriateness. The use of raw plant materials in squashed pulp or direct application is especially revealing of a Calabrian ethos of proximity to nature — the belief that healing can emerge from minimal intervention and maximum intimacy with the natural world. Finally, the resilience and cultural persistence of these practices should not be underestimated. In an age of medical globalization and pharmaceutical dominance, the Calabrian model illustrates how traditional medicine continues to coexist with modern healthcare. The persistence is driven by both structural necessity (healthcare gaps, economic constraints) and cultural identity. For many of the informants, especially the elderly, herbal medicine is not merely a therapeutic choice but a form of continuity — a connection to the ancestors, to the land, and to ways of life that resist erasure. The symbolic dimensions of healing, the stories associated with each plant, and the ritualized modes of preparation form an intangible heritage that is as crucial as any pharmacological effect. This study contributes to the understanding of how ethnomedical knowledge remains deeply embedded in local ecologies, gender dynamics, and healthcare behaviors. Herbal medicine in Calabria is more than a survival strategy; it is a social institution — one that fills therapeutic gaps, affirms cultural belonging, and reconfigures care in the absence or inadequacy of biomedical solutions. For policymakers and health professionals, these findings underscore the importance of engaging with local knowledge systems not as competitors to modern medicine but as potential allies. The future of chronic wound care, particularly in underserved areas, may lie not in the displacement of traditional practices but in their integration — ethically, respectfully, and with a deep understanding of their cultural roots.

Building on the ethnographic insights of this study, we propose that meaningful integration of traditional knowledge and biomedical practice in Calabria could take the form of community-based initiatives that include local knowledge holders—particularly experienced elder women and local herbalists—in patient education and self-care support programs. For example, community health worker (CHW) models could be adapted to rural Calabrian contexts by training culturally embedded mediators who are familiar with both local ethnobotanical practices and basic biomedical wound care. These mediators could serve as trusted liaisons between patients and healthcare providers, helping to translate medical advice into culturally resonant practices while also ensuring that traditional remedies are used safely and complementarily. Such initiatives would not only improve patient adherence and therapeutic outcomes but also affirm the cultural legitimacy of local healing traditions. Importantly, any integration must be grounded in mutual respect, participatory dialogue, and ethical safeguards to avoid the extraction or devaluation of community-based knowledge systems. Future policy and health interventions should prioritize these pluralistic and collaborative approaches as part of a broader strategy to address healthcare disparities in underserved regions like Calabria.