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The bomoh's original role was that of a healer and their expertise was first and foremost an in-depth knowledge of medicinal herbs and tajul muluk or Malay geomancy. This was supplemented by Sanskrit mantera (mantras) owing to the ancient Hindu-Buddhist influence in the region.
Malay metaphysical theory holds that the body, and in fact the universe itself, is made up of the four classical elements of fire, water, earth, and wind. Illnesses are often said to be caused by an imbalance of these elements. To restore this balance, patients are advised to bathe in cool water to which lime juice is added. The bomoh also works with rituals and incantations, called jampi.
Some bomoh use cemeteries to summon spirits to fulfill requests by supplicants, while others only deal with a single spirit. It is said that sometimes the bomoh selects the spirit, while other times, it is the spirit who selects the bomoh. Spirits are said to be able to heal the sick, seek missing persons or even investigate reasons for bad luck. Spirits can also be used to attack people, cause sickness and misery and many other bad things. Bomoh who have a particular religion may incorporate their religious practices into their craft.
Traditionally, healing rituals of some bomoh involved music and dance, such as the main puteri or main peteri (a trance-dance from Kelantan and Trengganu often connected to mak yong), the main lukah (a fisherman's dance from Pahang), and the main saba (which re-enacts the heavenly princesses [puteri kayangan] dancing around a saba tree). The music is played by an assistant called the tuk minduk.
The bomoh's craft remained largely unchanged even after Islam became dominant until the Islamic revival in the 1970s and 80s. Bomoh were then seen as deviant from the Muslim faith because of their invocation of spirits and the potentially harmful black magic they were accused of practicing. This period saw a drastic decline in authentic bomoh and many fraudulent shamans filled the void. As a result, bomoh are today looked at with suspicion even though they are still commonly consulted for personal reasons.