Indigenous traditional knowledge in health care and biodiversity stewardship in the Brazilian Amazon: a scoping review with a focus on the Tenetehara Tembé (Alto Rio Guamá Indigenous Territory, Pará, Brazil)

Indigenous traditional knowledge in health care and biodiversity stewardship in the Brazilian Amazon: a scoping review with a focus on the Tenetehara Tembé (Alto Rio Guamá Indigenous Territory, Pará, Brazil) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Indigenous traditional knowledge in health care and biodiversity stewardship in the Brazilian Amazon: a scoping review with a focus on the Tenetehara Tembé (Alto Rio Guamá Indigenous Territory, Pará, Brazil) Juliane Larissa Barbosa Santos¹, José Augusto Carvalho Araújo² This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8399552/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Indigenous knowledge systems are deeply entangled with territorial stewardship and everyday health practices in the Amazon, yet this evidence is scattered across disciplines and often poorly indexed. Methods: We conducted a scoping review. A primary database search (SciELO, LILACS, BDTD, CAPES Portal, PubMed, Scopus and the ISA repository; August–September 2025) combined controlled and free‑text terms for Indigenous peoples, traditional knowledge, health/care, medicinal plants and biodiversity/territory. To address sensitivity and known indexing gaps, we added supplementary targeted searches for the Tenetehara Tembé / Alto Rio Guamá Indigenous Territory and performed backward citation tracking (December 2025). Results: The primary search retrieved 80 records; 5 evidence sources met the inclusion criteria. Supplementary searches added 5 additional eligible sources, totaling 10 included sources. Evidence converges on (i) intermedicality and medicinal‑plant use as part of biocultural identity, (ii) territory and forest integrity as determinants of Indigenous health, and (iii) legal‑ethical imperatives for equitable benefit‑sharing and Indigenous authorship in knowledge-based interventions. Evidence specific to the Alto Rio Guamá territory exists but remains limited and concentrated in the social sciences and nursing, signaling a disciplinary and indexing gap rather than an absolute absence of research. Conclusions: Integrating Indigenous knowledge into public health and biodiversity policies requires intercultural governance, protection of land rights, and research designs led with Indigenous participation. For the Tenetehara Tembé, priority research needs include community‑defined health outcomes, participatory ethnobotany, and environmental‑health monitoring aligned with local territorial projects. Indigenous peoples traditional knowledge medicinal plants intermedicality territory biodiversity Brazilian Amazon Tenetehara Tembé INTROCTION The Brazilian Amazon concentrates exceptional biocultural diversity: high species richness and hundreds of Indigenous peoples with distinct languages, territorial histories and therapeutic systems [ 1 – 4 ]. In many Amazonian contexts, health is not reducible to biomedical care; it is produced through relations among body, spirit, community and territory, including the everyday management of forests, rivers, gardens and pharmacopoeias [ 3 , 4 ]. These knowledge systems are increasingly pressured by land conflicts, deforestation, extractivism and climate‑related stressors—processes that simultaneously erode biodiversity and disrupt the social reproduction of knowledge [ 10 ]. The Alto Rio Guamá Indigenous Territory (TIARG), in northeastern Pará, is home to Tenetehara Tembé communities [ 5 ]. TIARG is embedded in the ‘Belém Endemism Center’, a region with intense historical deforestation and high conservation urgency [ 10 ]. In this setting, medicinal‑plant knowledge and territorial practices are not merely ‘cultural’—they are practical infrastructures for wellbeing and resilience [ 13 – 17 ]. Despite a growing body of work on Indigenous health in Brazil, previous editorial feedback highlighted two recurring problems in manuscripts about TIARG: (1) overly restrictive search strategies that miss interdisciplinary and locally published evidence, and (2) misalignment between titles that promise a TIARG‑specific synthesis and results drawn from other territories. This review responds by explicitly mapping (a) the broader Amazon evidence on traditional knowledge, health and biodiversity, and (b) what is directly documented for the Tenetehara Tembé and TIARG. Objective: To map and synthesize evidence on Indigenous traditional knowledge and practices related to health care and biodiversity/territorial stewardship in the Brazilian Amazon, with a specific focus on the Tenetehara Tembé of the Alto Rio Guamá Indigenous Territory (Pará, Brazil). METHODS Design We conducted a scoping review following the Joanna Briggs Institute (JBI) guidance for scoping reviews and reported the review according to PRISMA‑ScR [ 6 , 7 ]. This design was chosen because the evidence spans heterogeneous approaches (ethnobotany, anthropology, nursing, ecology and legal‑ethical analysis) and because part of the relevant TIARG literature is not consistently indexed in health databases. Eligibility criteria We included empirical studies (qualitative, quantitative or mixed), theses/dissertations, and peer‑reviewed theoretical or legal‑ethical analyses that addressed at least two of the following domains: (i) Indigenous traditional knowledge/practices, (ii) health/care/illness, and (iii) biodiversity, environment, forest or territory. We prioritized sources situated in the Brazilian Amazon; however, we also included Brazilian Indigenous studies from other biomes when explicitly used to inform methods or concepts relevant to Amazon contexts (e.g., participatory ethnobotany) [ 9 ]. We included publications in Portuguese, English or Spanish and excluded items without accessible full text or without Indigenous‑related content. Information sources and search strategy Primary search: SciELO, LILACS, BDTD, CAPES Portal, PubMed, Scopus and the ISA repository were searched in August–September 2025. To reduce false negatives produced by overly conjunctive queries, we used complementary strings (health‑focused and biodiversity/territory‑focused), combining and deduplicating results before screening. Supplementary search: Because TIARG/Tembé evidence is frequently published in regional journals or books not captured by biomedical indexing, we performed targeted searches using ‘Tenetehara’, ‘Tembé’ and ‘Alto Rio Guamá’ and screened reference lists of included sources (December 2025) [ 13 – 17 ]. Selection process and data charting Titles/abstracts and full texts were screened against eligibility criteria. For each included source, we charted: publication year, location/Indigenous group, design, domains addressed (knowledge–health–biodiversity/territory), and the most relevant findings for intercultural policy and research. Synthesis We conducted a narrative thematic synthesis organized around three analytic axes: (1) intermedicality and medicinal‑plant knowledge, (2) territory/biodiversity as determinants of health, and (3) legal‑ethical conditions for knowledge use (benefit‑sharing, rights and authorship) [ 11 ]. Table 1 Primary and supplementary search strategy (summary). Source Languages Example search string (adapted) SciELO / LILACS Portuguese, Spanish (Indigenous peoples OR Indigenous populations) AND (traditional knowledge OR ethnobotany OR medicinal plants OR intermedicality) AND (health OR care OR disease) PubMed / Scopus English (Indigenous OR Amerindian) AND (traditional knowledge OR ethnobotany OR medicinal plants OR intermedical*) AND (health OR healthcare OR illness) AND (Amazon OR Brazil) BDTD / CAPES Portal Portuguese (povos indígenas OR populações indígenas) AND (plantas medicinais OR etnobotânica OR saberes tradicionais) ISA repository Portuguese "Terra Indígena Alto Rio Guamá" OR "Tembé" Supplementary targeted search Portuguese, English (Tembé OR Tenetehara OR "Alto Rio Guamá") AND (saúde OR health OR plantas medicinais OR ethnobotany OR território OR biodiversity) Source: Authors (2025) RESULTS Study selection The primary database search retrieved 80 records. After deduplication and screening, five evidence sources met eligibility criteria [ 8 – 12 ]. Given the known disciplinary fragmentation and indexing limitations for TIARG/Tembé publications, supplementary targeted searches and citation tracking identified five additional eligible sources [ 13 – 17 ]. In total, ten sources were included in the synthesis. Characteristics of included evidence Included sources comprised ethnobotanical field studies [ 8 , 12 ], participatory‑methods research [ 9 ], public health/anthropological analyses of Indigenous health policy [ 13 , 17 ], nursing reflections [ 16 ], ecological syntheses on land protection [ 10 ], and legal‑ethical discussions about traditional knowledge and drug development [ 11 ]. Table 2 Included evidence sources (n = 10) and key contributions. ID Evidence source Setting / Indigenous group Design Key findings (abridged) E1 Oliveira KF (2020) [ 12 ] Brazil (Indigenous community; not Amazon-specific). Qualitative/ethnobotany (education). Documents medicinal plant repertoire; highlights intergenerational transmission risks under socioenvironmental change. E2 Strachulski J, Silva AA, Floriani N (2021) [ 8 ] Brazil (Parintintin). Qualitative ethnobotany. Reports medicinal species use; frames forest as therapeutic and spiritual territory; intermedicality in everyday care. E3 Ponte VS, Aquino MJS (2014) [ 13 ] Pará, Brazil (Tenetehara Tembé; TIARG and Gurupi). Anthropology/public health policy analysis. Shows how differentiated Indigenous health policy interacts with territorial struggles, leadership mobilization and identity recognition. E4 Ponte VS, Ribeiro BESS (2019) [ 14 ] Pará, Brazil (Tenetehara Tembé; TIARG). Historical-geographical analysis. Describes territorial dynamics, conflict and environmental governance in a high-deforestation region; links territoriality to wellbeing. E5 Ponte VS et al. (2021) [ 15 ] Pará, Brazil (Tenetehara Tembé; TIARG). Ethnographic/reflective chapter. Connects health, medicinal plants and territoriality; discusses forest dependence and knowledge as resistance. E6 Souza Tembé BR et al. (2023) [ 16 ] Pará, Brazil (Tembé). Reflective study (nursing). Discusses culturally grounded child growth/development care; emphasizes intercultural communication and service adaptation. E7 Pataxó Hãhãhãi H, Rodrigues L (2025) [ 9 ] Brazil (Pataxó Hãhãhãi). Participatory ethnobotany. Proposes Indigenous-led methods; catalogues medicinal plants and reinforces ethical co-production and consent. E8 Santos CAG et al. (2024) [ 10 ] Amazon Basin (multiple territories). Ecological synthesis / modeling. Links land protection to reduced deforestation and climate stress; argues Indigenous governance is central to biodiversity and health. E9 Lal R et al. (2023) [ 11 ] Global (incl. Brazil examples). Legal-ethical analysis. Highlights benefit-sharing, FPIC (free, prior and informed consent) and the need for Indigenous authorship/governance over knowledge. E10 Ribeiro BESS, Ponte VS (2020) [ 17 ] Pará, Brazil (Tenetehara Tembé). Anthropology/ethnography. Shows how land conflict and environmental degradation reshape medicinal plant access and knowledge transmission; ties resistance to health. Source: Authors (2025) THEMATIC SYNTHESIS 1) Intermedicality, medicinal plants and biocultural identity Across ethnobotanical and qualitative sources, care is consistently described as intermedical: people navigate biomedical services (consultations, prescriptions, referrals) while mobilizing Indigenous therapeutic systems as a parallel and interacting layer of care. Rather than a simple “either/or” choice, the literature depicts a pragmatic ecology of care in which clinical encounters, household practices, and community-based healing are combined according to availability, perceived efficacy, and cultural meaning. [2, 3, 15–17] Medicinal plants emerge in these accounts not as isolated “remedies,” but as part of a relational pharmacopoeia tied to territory, kinship, ritual practices, and collective memory. Evidence from the Parintintin and from the Tenetehara Tembé highlights the forest as both a pharmacy and a moral-spiritual landscape, where health is co-produced through relationships among humans, non-humans, and ancestral narratives. In this framing, “treatment” is inseparable from belonging and responsibility to place. [5, 10, 12–16] At the same time, multiple sources describe pressures that destabilize this biocultural system. Knowledge transmission is reported as vulnerable to schooling regimes disconnected from territory, generational discontinuities, market substitution of native species, and reduced access to forest areas under land pressure. These processes do not simply reduce the availability of medicinal plants; they weaken the social pathways through which knowledge is learned, validated, and responsibly applied in daily life. [8, 12, 15–17] Taken together, the included studies suggest that intermedicality is not merely a “cultural preference,” but a structural response to changing territorial conditions and unequal access to services. Intercultural care, in this sense, requires more than incorporating “traditional practices” into biomedical settings; it requires recognizing that Indigenous therapeutics operate within a living territorial system. When territory is constrained or degraded, the health system loses not only biological resources, but also the biocultural infrastructures that sustain safe, meaningful, and locally effective care. [ 4 , 9 ] 2) Territory and biodiversity as determinants of Indigenous health Included sources converge on a blunt causal chain: weakened territorial control increases environmental degradation, which reduces food and medicinal diversity, disrupts livelihoods, and amplifies psychosocial stress. This relationship is not presented as symbolic; it is treated as a material pathway through which health risks accumulate over time, affecting nutrition, exposure to hazards, and the capacity to maintain culturally differentiated care practices. [ 12 , 9 , 17 ] Macro-ecological syntheses reinforce this pathway by documenting that Indigenous land protection is among the most effective strategies to curb deforestation and related climate stressors. In these accounts, territorial integrity functions as a population-level protective factor: safeguarding biodiversity, buffering climate extremes, and sustaining the ecological conditions that underpin both subsistence and medicinal systems. Health, therefore, is indirectly shaped by governance of land and the ecological stability it enables. [ 10 ] Within TIARG, geographical and anthropological analyses show how territorial fragmentation and conflict shape mobility, subsistence strategies, and everyday security. These dynamics influence where and how communities can hunt, gather, cultivate, and access forest resources, while also producing chronic uncertainty and stress. The literature links these territorial constraints to the feasibility of maintaining culturally grounded health practices and of negotiating health care pathways with external services. [ 13 , 16 ] Across these sources, “territory” appears less as a background variable and more as a primary determinant that organizes exposure, resilience, and cultural continuity. The synthesis suggests that Indigenous health policy cannot be reduced to service coverage alone: it must engage the territorial conditions that sustain biodiversity, food systems, and medicinal knowledge. In TIARG, the conditions for culturally differentiated care are inseparable from the political-ecological realities of land security and environmental protection. [ 10 , 14 , 17 ] 3) Rights, benefit-sharing and epistemic justice Legal-ethical analyses stress that translating traditional knowledge into “products” (e.g., medicines) without robust governance reproduces extractivism in a new form. Knowledge is not treated as a neutral resource; it is a collective asset embedded in rights, responsibilities, and historically unequal relations. In this framing, research and innovation can either strengthen Indigenous sovereignty or become another mechanism of appropriation. [ 16 , 11 ] Across sources, recurring requirements include free, prior and informed consent, fair and transparent benefit-sharing, protection of collective rights, and accountability mechanisms that remain meaningful beyond a one-time signature. These elements are presented as safeguards against symbolic participation and against the conversion of community knowledge into external value without reciprocal commitments. [ 13 , 10 ] A consistent thread is the demand for Indigenous participation not only as “informants,” but as co-authors and decision-makers, shaping study design, interpretation, dissemination, and the distribution of benefits. Epistemic justice, here, is not rhetorical: it concerns who has authority to define outcomes, classify practices, and decide what can be shared, with whom, and under what conditions. [ 9 , 4 ] These conditions are not add-ons; they shape whether intercultural health policies and research agendas become protective of Indigenous autonomy or merely another layer of administrative control. The thematic synthesis suggests that governance, rights, and authorship are themselves determinants of research quality and policy legitimacy. Without them, “innovation” risks repeating the same asymmetries that have historically harmed Indigenous communities—now under a scientific or public-health label. [ 12 , 8 ] DISCUSSION Principal findings This review shows that evidence on Indigenous traditional knowledge, health and biodiversity in the Brazilian Amazon is real but fragmented [ 8 – 17 ]. The Tenetehara Tembé / TIARG literature exists and directly addresses health policy, territoriality and medicinal knowledge [ 13 – 17 ]; however, much of it is located in regional journals and books, which explains why a strictly biomedical, highly conjunctive search strategy can wrongly ‘manufacture’ an apparent gap. Policy and practice implications For health systems: culturally differentiated care requires more than translation—it requires service organization that respects Indigenous governance, territorial mobility and the local therapeutic repertoire [ 13 , 16 , 17 ]. For environmental governance: protecting Indigenous lands is simultaneously a biodiversity strategy and a public health intervention [ 10 , 14 ]. Research gaps Evidence remains limited on TIARG regarding community-defined outcomes (child health, chronic conditions, mental health), longitudinal environmental‑health monitoring, and participatory ethnobotany co‑designed with Tembé leadership [ 9 , 16 ]. Future studies should align with TIARG territorial management projects, include Indigenous data sovereignty agreements, and anticipate benefit‑sharing and authorship from the outset [ 11 ]. Strengths and limitations Our main strength is an explicit two-step approach: a primary database search plus targeted searches to reduce indexing bias. Limitations include reliance on accessible full texts and the heterogeneity of evidence types, which precludes quantitative meta-analysis. CONCLUSIONS Indigenous knowledge in the Amazon is a living health technology and a biodiversity stewardship system. For the Tenetehara Tembé of the Alto Rio Guamá Indigenous Territory, existing studies already connect health, medicinal plants and territorial struggle, but the evidence base is still thin relative to the urgency of socioenvironmental pressures. Submitting future work as intercultural, co-produced research—grounded in land rights, ethical governance and Indigenous authorship—offers the most credible pathway for both scientific quality and political responsibility. Declarations Ethical approval and consent to participate: Not applicable (review of published/archived sources). Consent for publication: Not applicable. Data and materials availability The data table is available in the manuscript (Table 2). Conflicts of interest: The authors declare no conflicts of interest. Funding: National Council for Scientific and Technological Development - CNPq. Author Contribution JLBS and JACA participated in the conception and design of the study, carrying out data collection and manuscript writing, as well as critically reviewing the text. Acknowledgments: The authors thank CNPq and the Doctoral Program in Environmental Sciences at the State University of Pará (UEPA). References Instituto Brasileiro de Geografia e Estatística (IBGE). Censo 2022: população indígena. IBGE; 2022. Diegues AC. Etnoconservação: novos rumos para a proteção da natureza nos trópicos. Hucitec/NUPAUB–USP; 2000. Toledo VM, Barrera–Bassols N. La memoria biocultural: la importancia ecológica de las sabidurías tradicionales. Icaria; 2008. Alves RRN, Rosa IM. Biodiversity, traditional medicine and public health: where do they meet? J Ethnobiol Ethnomed. 2007;3:14. 10.1186/1746-4269-3-14 . Instituto Socioambiental (ISA). Terra Indígena Alto Rio Guamá (TIARG) – ficha territorial. ISA; 2023. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA–ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. 10.7326/M18-0850 . Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141–6. 10.1097/XEB.0000000000000050 . Strachulski J, Silva AA, Floriani N. Força da floresta, saúde e doença: o uso da flora medicinal pelos Parintintin do Amazonas. Rev Cerrados. 2021;19(1):329–60. 10.46551/rc24482692202114 . Pataxó Hãhãhãi H, Rodrigues L. Participatory ethnobotany in Indigenous health: study conducted among the Pataxó Hãhãhãi and discussion about ethnomedicine among his people, Brazil. J Ethnobiol Ethnomed. 2025;21:34. 10.1186/s13002-025-00706-0 . Santos CAG, Cunha HFA, Cunha AC, Hellenkamp S, et al. Protecting Amazon’s Indigenous lands: a multidisciplinary approach. Front Ecol Environ. 2024;22(7):e2796. 10.1002/fee.2796 . Lal R, Baeraiya B, Thakur R, Gautam RK, Narayan S, et al. Traditional knowledge in drug development and the rights of Indigenous peoples: a legal and ethical perspective. J Drug Alcohol Res. 2023;1(1):99–106. 10.4303/JDAR/236889 . Oliveira KF. Sustentabilidade e usos de plantas medicinais em uma visão decolonial: saberes tradicionais indígenas e práticas de saúde na Aldeia Indígena. Dissertação (Mestrado em Educação). Universidade Federal Rural do Rio de Janeiro; 2020. Ponte VS, Aquino MJS. Ação local, território e serviço público de saúde: os Tenetehar–Tembé entre a diferenciação e a universalização. Rev Pós Ci Soc. 2014;11(21):185–200. Ponte VS, Ribeiro BESS. Terra Indígena Alto Rio Guamá: da unificação à ruptura. Rev GeoAmazônia. 2019;7(14):75–102. Ponte VS, Ribeiro BESS, Bentes LV, Santos JS. Tudo a gente depende da floresta: (des)construções de saberes tradicionais e territorialidade (Terra Indígena Alto Rio Guamá, Pará, Brasil). Investigação Científica Fibra Farmácia. 2021;1:05–115. Souza Tembé BR, Putira Sacuena ER, Lima NCS, Mesquita DS, Parente AT, Castro NJCC. Child care among the Tembé in growth and development follow–up: a reflection study. Esc Anna Nery. 2023;27:e20220422. 10.1590/2177-9465-EAN-2022-0422en . Ribeiro BESS, Ponte VS. A nossa briga mesmo é a terra, prioritária: saberes tradicionais em saúde e territorialidade Tenetehar–Tembé. Anthropológicas. 2020;31(1):105–40. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 29 Dec, 2025 Editor assigned by journal 23 Dec, 2025 Submission checks completed at journal 23 Dec, 2025 First submitted to journal 18 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In many Amazonian contexts, health is not reducible to biomedical care; it is produced through relations among body, spirit, community and territory, including the everyday management of forests, rivers, gardens and pharmacopoeias [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These knowledge systems are increasingly pressured by land conflicts, deforestation, extractivism and climate‑related stressors\u0026mdash;processes that simultaneously erode biodiversity and disrupt the social reproduction of knowledge [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Alto Rio Guam\u0026aacute; Indigenous Territory (TIARG), in northeastern Par\u0026aacute;, is home to Tenetehara Temb\u0026eacute; communities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. TIARG is embedded in the \u0026lsquo;Bel\u0026eacute;m Endemism Center\u0026rsquo;, a region with intense historical deforestation and high conservation urgency [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this setting, medicinal‑plant knowledge and territorial practices are not merely \u0026lsquo;cultural\u0026rsquo;\u0026mdash;they are practical infrastructures for wellbeing and resilience [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite a growing body of work on Indigenous health in Brazil, previous editorial feedback highlighted two recurring problems in manuscripts about TIARG: (1) overly restrictive search strategies that miss interdisciplinary and locally published evidence, and (2) misalignment between titles that promise a TIARG‑specific synthesis and results drawn from other territories. This review responds by explicitly mapping (a) the broader Amazon evidence on traditional knowledge, health and biodiversity, and (b) what is directly documented for the Tenetehara Temb\u0026eacute; and TIARG.\u003c/p\u003e \u003cp\u003eObjective: To map and synthesize evidence on Indigenous traditional knowledge and practices related to health care and biodiversity/territorial stewardship in the Brazilian Amazon, with a specific focus on the Tenetehara Temb\u0026eacute; of the Alto Rio Guam\u0026aacute; Indigenous Territory (Par\u0026aacute;, Brazil).\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eWe conducted a scoping review following the Joanna Briggs Institute (JBI) guidance for scoping reviews and reported the review according to PRISMA‑ScR [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This design was chosen because the evidence spans heterogeneous approaches (ethnobotany, anthropology, nursing, ecology and legal‑ethical analysis) and because part of the relevant TIARG literature is not consistently indexed in health databases.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003eWe included empirical studies (qualitative, quantitative or mixed), theses/dissertations, and peer‑reviewed theoretical or legal‑ethical analyses that addressed at least two of the following domains: (i) Indigenous traditional knowledge/practices, (ii) health/care/illness, and (iii) biodiversity, environment, forest or territory. We prioritized sources situated in the Brazilian Amazon; however, we also included Brazilian Indigenous studies from other biomes when explicitly used to inform methods or concepts relevant to Amazon contexts (e.g., participatory ethnobotany) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. We included publications in Portuguese, English or Spanish and excluded items without accessible full text or without Indigenous‑related content.\u003c/p\u003e\n\u003ch3\u003eInformation sources and search strategy\u003c/h3\u003e\n\u003cp\u003ePrimary search: SciELO, LILACS, BDTD, CAPES Portal, PubMed, Scopus and the ISA repository were searched in August\u0026ndash;September 2025. To reduce false negatives produced by overly conjunctive queries, we used complementary strings (health‑focused and biodiversity/territory‑focused), combining and deduplicating results before screening.\u003c/p\u003e \u003cp\u003eSupplementary search: Because TIARG/Temb\u0026eacute; evidence is frequently published in regional journals or books not captured by biomedical indexing, we performed targeted searches using \u0026lsquo;Tenetehara\u0026rsquo;, \u0026lsquo;Temb\u0026eacute;\u0026rsquo; and \u0026lsquo;Alto Rio Guam\u0026aacute;\u0026rsquo; and screened reference lists of included sources (December 2025) [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSelection process and data charting\u003c/h3\u003e\n\u003cp\u003eTitles/abstracts and full texts were screened against eligibility criteria. For each included source, we charted: publication year, location/Indigenous group, design, domains addressed (knowledge\u0026ndash;health\u0026ndash;biodiversity/territory), and the most relevant findings for intercultural policy and research.\u003c/p\u003e\n\u003ch3\u003eSynthesis\u003c/h3\u003e\n\u003cp\u003eWe conducted a narrative thematic synthesis organized around three analytic axes: (1) intermedicality and medicinal‑plant knowledge, (2) territory/biodiversity as determinants of health, and (3) legal‑ethical conditions for knowledge use (benefit‑sharing, rights and authorship) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary and supplementary search strategy (summary).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLanguages\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExample search string (adapted)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSciELO / LILACS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePortuguese, Spanish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Indigenous peoples OR Indigenous populations) AND (traditional knowledge OR ethnobotany OR medicinal plants OR intermedicality) AND (health OR care OR disease)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePubMed / Scopus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnglish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Indigenous OR Amerindian) AND (traditional knowledge OR ethnobotany OR medicinal plants OR intermedical*) AND (health OR healthcare OR illness) AND (Amazon OR Brazil)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBDTD / CAPES Portal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePortuguese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(povos ind\u0026iacute;genas OR popula\u0026ccedil;\u0026otilde;es ind\u0026iacute;genas) AND (plantas medicinais OR etnobot\u0026acirc;nica OR saberes tradicionais)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eISA repository\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePortuguese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\"Terra Ind\u0026iacute;gena Alto Rio Guam\u0026aacute;\" OR \"Temb\u0026eacute;\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupplementary targeted search\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePortuguese, English\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Temb\u0026eacute; OR Tenetehara OR \"Alto Rio Guam\u0026aacute;\") AND (sa\u0026uacute;de OR health OR plantas medicinais OR ethnobotany OR territ\u0026oacute;rio OR biodiversity)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSource: Authors (2025)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy selection\u003c/h2\u003e\n \u003cp\u003eThe primary database search retrieved 80 records. After deduplication and screening, five evidence sources met eligibility criteria [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Given the known disciplinary fragmentation and indexing limitations for TIARG/Temb\u0026eacute; publications, supplementary targeted searches and citation tracking identified five additional eligible sources [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. In total, ten sources were included in the synthesis.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eCharacteristics of included evidence\u003c/h3\u003e\n\u003cp\u003eIncluded sources comprised ethnobotanical field studies [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e], participatory‑methods research [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e], public health/anthropological analyses of Indigenous health policy [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e], nursing reflections [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e], ecological syntheses on land protection [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e], and legal‑ethical discussions about traditional knowledge and drug development [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2 Included evidence sources (n\u0026thinsp;=\u0026thinsp;10) and key contributions.\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eID\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvidence source\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSetting / Indigenous group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eDesign\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKey findings (abridged)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOliveira KF (2020) [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrazil (Indigenous community; not Amazon-specific).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eQualitative/ethnobotany (education).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDocuments medicinal plant repertoire; highlights intergenerational transmission risks under socioenvironmental change.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrachulski J, Silva AA, Floriani N (2021) [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrazil (Parintintin).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eQualitative ethnobotany.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReports medicinal species use; frames forest as therapeutic and spiritual territory; intermedicality in everyday care.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePonte VS, Aquino MJS (2014) [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePar\u0026aacute;, Brazil (Tenetehara Temb\u0026eacute;; TIARG and Gurupi).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eAnthropology/public health policy analysis.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShows how differentiated Indigenous health policy interacts with territorial struggles, leadership mobilization and identity recognition.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePonte VS, Ribeiro BESS (2019) [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePar\u0026aacute;, Brazil (Tenetehara Temb\u0026eacute;; TIARG).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eHistorical-geographical analysis.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDescribes territorial dynamics, conflict and environmental governance in a high-deforestation region; links territoriality to wellbeing.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePonte VS et al. (2021) [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePar\u0026aacute;, Brazil (Tenetehara Temb\u0026eacute;; TIARG).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eEthnographic/reflective chapter.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConnects health, medicinal plants and territoriality; discusses forest dependence and knowledge as resistance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSouza Temb\u0026eacute; BR et al. (2023) [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePar\u0026aacute;, Brazil (Temb\u0026eacute;).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eReflective study (nursing).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiscusses culturally grounded child growth/development care; emphasizes intercultural communication and service adaptation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatax\u0026oacute; H\u0026atilde;h\u0026atilde;h\u0026atilde;i H, Rodrigues L (2025) [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrazil (Patax\u0026oacute; H\u0026atilde;h\u0026atilde;h\u0026atilde;i).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eParticipatory ethnobotany.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProposes Indigenous-led methods; catalogues medicinal plants and reinforces ethical co-production and consent.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSantos CAG et al. (2024) [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmazon Basin (multiple territories).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eEcological synthesis / modeling.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLinks land protection to reduced deforestation and climate stress; argues Indigenous governance is central to biodiversity and health.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLal R et al. (2023) [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGlobal (incl. Brazil examples).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eLegal-ethical analysis.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHighlights benefit-sharing, FPIC (free, prior and informed consent) and the need for Indigenous authorship/governance over knowledge.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 4.3165%;\"\u003e\n \u003cp\u003eE10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRibeiro BESS, Ponte VS (2020) [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePar\u0026aacute;, Brazil (Tenetehara Temb\u0026eacute;).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 28.777%;\"\u003e\n \u003cp\u003eAnthropology/ethnography.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShows how land conflict and environmental degradation reshape medicinal plant access and knowledge transmission; ties resistance to health.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eSource: Authors (2025)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTHEMATIC SYNTHESIS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e1) Intermedicality, medicinal plants and biocultural identity\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross ethnobotanical and qualitative sources, care is consistently described as intermedical: people navigate biomedical services (consultations, prescriptions, referrals) while mobilizing Indigenous therapeutic systems as a parallel and interacting layer of care. Rather than a simple \u0026ldquo;either/or\u0026rdquo; choice, the literature depicts a pragmatic ecology of care in which clinical encounters, household practices, and community-based healing are combined according to availability, perceived efficacy, and cultural meaning. [2, 3, 15\u0026ndash;17]\u003c/p\u003e\n\u003cp\u003eMedicinal plants emerge in these accounts not as isolated \u0026ldquo;remedies,\u0026rdquo; but as part of a relational pharmacopoeia tied to territory, kinship, ritual practices, and collective memory. Evidence from the Parintintin and from the Tenetehara Temb\u0026eacute; highlights the forest as both a pharmacy and a moral-spiritual landscape, where health is co-produced through relationships among humans, non-humans, and ancestral narratives. In this framing, \u0026ldquo;treatment\u0026rdquo; is inseparable from belonging and responsibility to place. [5, 10, 12\u0026ndash;16]\u003c/p\u003e\n\u003cp\u003eAt the same time, multiple sources describe pressures that destabilize this biocultural system. Knowledge transmission is reported as vulnerable to schooling regimes disconnected from territory, generational discontinuities, market substitution of native species, and reduced access to forest areas under land pressure. These processes do not simply reduce the availability of medicinal plants; they weaken the social pathways through which knowledge is learned, validated, and responsibly applied in daily life. [8, 12, 15\u0026ndash;17]\u003c/p\u003e\n\u003cp\u003eTaken together, the included studies suggest that intermedicality is not merely a \u0026ldquo;cultural preference,\u0026rdquo; but a structural response to changing territorial conditions and unequal access to services. Intercultural care, in this sense, requires more than incorporating \u0026ldquo;traditional practices\u0026rdquo; into biomedical settings; it requires recognizing that Indigenous therapeutics operate within a living territorial system. When territory is constrained or degraded, the health system loses not only biological resources, but also the biocultural infrastructures that sustain safe, meaningful, and locally effective care. [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2) Territory and biodiversity as determinants of Indigenous health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncluded sources converge on a blunt causal chain: weakened territorial control increases environmental degradation, which reduces food and medicinal diversity, disrupts livelihoods, and amplifies psychosocial stress. This relationship is not presented as symbolic; it is treated as a material pathway through which health risks accumulate over time, affecting nutrition, exposure to hazards, and the capacity to maintain culturally differentiated care practices. [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eMacro-ecological syntheses reinforce this pathway by documenting that Indigenous land protection is among the most effective strategies to curb deforestation and related climate stressors. In these accounts, territorial integrity functions as a population-level protective factor: safeguarding biodiversity, buffering climate extremes, and sustaining the ecological conditions that underpin both subsistence and medicinal systems. Health, therefore, is indirectly shaped by governance of land and the ecological stability it enables. [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eWithin TIARG, geographical and anthropological analyses show how territorial fragmentation and conflict shape mobility, subsistence strategies, and everyday security. These dynamics influence where and how communities can hunt, gather, cultivate, and access forest resources, while also producing chronic uncertainty and stress. The literature links these territorial constraints to the feasibility of maintaining culturally grounded health practices and of negotiating health care pathways with external services. [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eAcross these sources, \u0026ldquo;territory\u0026rdquo; appears less as a background variable and more as a primary determinant that organizes exposure, resilience, and cultural continuity. The synthesis suggests that Indigenous health policy cannot be reduced to service coverage alone: it must engage the territorial conditions that sustain biodiversity, food systems, and medicinal knowledge. In TIARG, the conditions for culturally differentiated care are inseparable from the political-ecological realities of land security and environmental protection. [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3) Rights, benefit-sharing and epistemic justice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLegal-ethical analyses stress that translating traditional knowledge into \u0026ldquo;products\u0026rdquo; (e.g., medicines) without robust governance reproduces extractivism in a new form. Knowledge is not treated as a neutral resource; it is a collective asset embedded in rights, responsibilities, and historically unequal relations. In this framing, research and innovation can either strengthen Indigenous sovereignty or become another mechanism of appropriation. [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eAcross sources, recurring requirements include free, prior and informed consent, fair and transparent benefit-sharing, protection of collective rights, and accountability mechanisms that remain meaningful beyond a one-time signature. These elements are presented as safeguards against symbolic participation and against the conversion of community knowledge into external value without reciprocal commitments. [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eA consistent thread is the demand for Indigenous participation not only as \u0026ldquo;informants,\u0026rdquo; but as co-authors and decision-makers, shaping study design, interpretation, dissemination, and the distribution of benefits. Epistemic justice, here, is not rhetorical: it concerns who has authority to define outcomes, classify practices, and decide what can be shared, with whom, and under what conditions. [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eThese conditions are not add-ons; they shape whether intercultural health policies and research agendas become protective of Indigenous autonomy or merely another layer of administrative control. The thematic synthesis suggests that governance, rights, and authorship are themselves determinants of research quality and policy legitimacy. Without them, \u0026ldquo;innovation\u0026rdquo; risks repeating the same asymmetries that have historically harmed Indigenous communities\u0026mdash;now under a scientific or public-health label. [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePrincipal findings\u003c/h2\u003e \u003cp\u003eThis review shows that evidence on Indigenous traditional knowledge, health and biodiversity in the Brazilian Amazon is real but fragmented [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The Tenetehara Temb\u0026eacute; / TIARG literature exists and directly addresses health policy, territoriality and medicinal knowledge [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]; however, much of it is located in regional journals and books, which explains why a strictly biomedical, highly conjunctive search strategy can wrongly \u0026lsquo;manufacture\u0026rsquo; an apparent gap.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePolicy and practice implications\u003c/h2\u003e \u003cp\u003eFor health systems: culturally differentiated care requires more than translation\u0026mdash;it requires service organization that respects Indigenous governance, territorial mobility and the local therapeutic repertoire [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. For environmental governance: protecting Indigenous lands is simultaneously a biodiversity strategy and a public health intervention [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eResearch gaps\u003c/h2\u003e \u003cp\u003eEvidence remains limited on TIARG regarding community-defined outcomes (child health, chronic conditions, mental health), longitudinal environmental‑health monitoring, and participatory ethnobotany co‑designed with Temb\u0026eacute; leadership [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Future studies should align with TIARG territorial management projects, include Indigenous data sovereignty agreements, and anticipate benefit‑sharing and authorship from the outset [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eOur main strength is an explicit two-step approach: a primary database search plus targeted searches to reduce indexing bias. Limitations include reliance on accessible full texts and the heterogeneity of evidence types, which precludes quantitative meta-analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIndigenous knowledge in the Amazon is a living health technology and a biodiversity stewardship system. For the Tenetehara Temb\u0026eacute; of the Alto Rio Guam\u0026aacute; Indigenous Territory, existing studies already connect health, medicinal plants and territorial struggle, but the evidence base is still thin relative to the urgency of socioenvironmental pressures. Submitting future work as intercultural, co-produced research\u0026mdash;grounded in land rights, ethical governance and Indigenous authorship\u0026mdash;offers the most credible pathway for both scientific quality and political responsibility.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate:\u003c/strong\u003e \u003cp\u003eNot applicable (review of published/archived sources).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData and materials availability\u003c/strong\u003e \u003cp\u003eThe data table is available in the manuscript (Table\u0026nbsp;2).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflicts of interest:\u003c/strong\u003e \u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNational Council for Scientific and Technological Development - CNPq.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJLBS and JACA participated in the conception and design of the study, carrying out data collection and manuscript writing, as well as critically reviewing the text.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eThe authors thank CNPq and the Doctoral Program in Environmental Sciences at the State University of Par\u0026aacute; (UEPA).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInstituto Brasileiro de Geografia e Estat\u0026iacute;stica (IBGE). Censo 2022: popula\u0026ccedil;\u0026atilde;o ind\u0026iacute;gena. IBGE; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiegues AC. Etnoconserva\u0026ccedil;\u0026atilde;o: novos rumos para a prote\u0026ccedil;\u0026atilde;o da natureza nos tr\u0026oacute;picos. Hucitec/NUPAUB\u0026ndash;USP; 2000.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToledo VM, Barrera\u0026ndash;Bassols N. La memoria biocultural: la importancia ecol\u0026oacute;gica de las sabidur\u0026iacute;as tradicionales. Icaria; 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlves RRN, Rosa IM. Biodiversity, traditional medicine and public health: where do they meet? J Ethnobiol Ethnomed. 2007;3:14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1746-4269-3-14\u003c/span\u003e\u003cspan address=\"10.1186/1746-4269-3-14\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstituto Socioambiental (ISA). Terra Ind\u0026iacute;gena Alto Rio Guam\u0026aacute; (TIARG) \u0026ndash; ficha territorial. ISA; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA\u0026ndash;ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7326/M18-0850\u003c/span\u003e\u003cspan address=\"10.7326/M18-0850\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/XEB.0000000000000050\u003c/span\u003e\u003cspan address=\"10.1097/XEB.0000000000000050\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrachulski J, Silva AA, Floriani N. For\u0026ccedil;a da floresta, sa\u0026uacute;de e doen\u0026ccedil;a: o uso da flora medicinal pelos Parintintin do Amazonas. Rev Cerrados. 2021;19(1):329\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.46551/rc24482692202114\u003c/span\u003e\u003cspan address=\"10.46551/rc24482692202114\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatax\u0026oacute; H\u0026atilde;h\u0026atilde;h\u0026atilde;i H, Rodrigues L. Participatory ethnobotany in Indigenous health: study conducted among the Patax\u0026oacute; H\u0026atilde;h\u0026atilde;h\u0026atilde;i and discussion about ethnomedicine among his people, Brazil. J Ethnobiol Ethnomed. 2025;21:34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13002-025-00706-0\u003c/span\u003e\u003cspan address=\"10.1186/s13002-025-00706-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos CAG, Cunha HFA, Cunha AC, Hellenkamp S, et al. Protecting Amazon\u0026rsquo;s Indigenous lands: a multidisciplinary approach. Front Ecol Environ. 2024;22(7):e2796. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/fee.2796\u003c/span\u003e\u003cspan address=\"10.1002/fee.2796\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLal R, Baeraiya B, Thakur R, Gautam RK, Narayan S, et al. Traditional knowledge in drug development and the rights of Indigenous peoples: a legal and ethical perspective. J Drug Alcohol Res. 2023;1(1):99\u0026ndash;106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4303/JDAR/236889\u003c/span\u003e\u003cspan address=\"10.4303/JDAR/236889\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOliveira KF. Sustentabilidade e usos de plantas medicinais em uma vis\u0026atilde;o decolonial: saberes tradicionais ind\u0026iacute;genas e pr\u0026aacute;ticas de sa\u0026uacute;de na Aldeia Ind\u0026iacute;gena. Disserta\u0026ccedil;\u0026atilde;o (Mestrado em Educa\u0026ccedil;\u0026atilde;o). Universidade Federal Rural do Rio de Janeiro; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePonte VS, Aquino MJS. A\u0026ccedil;\u0026atilde;o local, territ\u0026oacute;rio e servi\u0026ccedil;o p\u0026uacute;blico de sa\u0026uacute;de: os Tenetehar\u0026ndash;Temb\u0026eacute; entre a diferencia\u0026ccedil;\u0026atilde;o e a universaliza\u0026ccedil;\u0026atilde;o. Rev P\u0026oacute;s Ci Soc. 2014;11(21):185\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePonte VS, Ribeiro BESS. Terra Ind\u0026iacute;gena Alto Rio Guam\u0026aacute;: da unifica\u0026ccedil;\u0026atilde;o \u0026agrave; ruptura. Rev GeoAmaz\u0026ocirc;nia. 2019;7(14):75\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePonte VS, Ribeiro BESS, Bentes LV, Santos JS. Tudo a gente depende da floresta: (des)constru\u0026ccedil;\u0026otilde;es de saberes tradicionais e territorialidade (Terra Ind\u0026iacute;gena Alto Rio Guam\u0026aacute;, Par\u0026aacute;, Brasil). Investiga\u0026ccedil;\u0026atilde;o Cient\u0026iacute;fica Fibra Farm\u0026aacute;cia. 2021;1:05\u0026ndash;115.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSouza Temb\u0026eacute; BR, Putira Sacuena ER, Lima NCS, Mesquita DS, Parente AT, Castro NJCC. Child care among the Temb\u0026eacute; in growth and development follow\u0026ndash;up: a reflection study. Esc Anna Nery. 2023;27:e20220422. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/2177-9465-EAN-2022-0422en\u003c/span\u003e\u003cspan address=\"10.1590/2177-9465-EAN-2022-0422en\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRibeiro BESS, Ponte VS. A nossa briga mesmo \u0026eacute; a terra, priorit\u0026aacute;ria: saberes tradicionais em sa\u0026uacute;de e territorialidade Tenetehar\u0026ndash;Temb\u0026eacute;. Anthropol\u0026oacute;gicas. 2020;31(1):105\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Indigenous peoples, traditional knowledge, medicinal plants, intermedicality, territory, biodiversity, Brazilian Amazon, Tenetehara Tembé","lastPublishedDoi":"10.21203/rs.3.rs-8399552/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8399552/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Indigenous knowledge systems are deeply entangled with territorial stewardship and everyday health practices in the Amazon, yet this evidence is scattered across disciplines and often poorly indexed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: We conducted a scoping review. A primary database search (SciELO, LILACS, BDTD, CAPES Portal, PubMed, Scopus and the ISA repository; August–September 2025) combined controlled and free‑text terms for Indigenous peoples, traditional knowledge, health/care, medicinal plants and biodiversity/territory. To address sensitivity and known indexing gaps, we added supplementary targeted searches for the Tenetehara Tembé / Alto Rio Guamá Indigenous Territory and performed backward citation tracking (December 2025).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: The primary search retrieved 80 records; 5 evidence sources met the inclusion criteria. Supplementary searches added 5 additional eligible sources, totaling 10 included sources. Evidence converges on (i) intermedicality and medicinal‑plant use as part of biocultural identity, (ii) territory and forest integrity as determinants of Indigenous health, and (iii) legal‑ethical imperatives for equitable benefit‑sharing and Indigenous authorship in knowledge-based interventions. Evidence specific to the Alto Rio Guamá territory exists but remains limited and concentrated in the social sciences and nursing, signaling a disciplinary and indexing gap rather than an absolute absence of research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: Integrating Indigenous knowledge into public health and biodiversity policies requires intercultural governance, protection of land rights, and research designs led with Indigenous participation. For the Tenetehara Tembé, priority research needs include community‑defined health outcomes, participatory ethnobotany, and environmental‑health monitoring aligned with local territorial projects.\u003c/p\u003e","manuscriptTitle":"Indigenous traditional knowledge in health care and biodiversity stewardship in the Brazilian Amazon: a scoping review with a focus on the Tenetehara Tembé (Alto Rio Guamá Indigenous Territory, Pará, Brazil)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-29 11:28:48","doi":"10.21203/rs.3.rs-8399552/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-29T08:01:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-24T04:05:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-24T04:04:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-12-19T01:13:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"02ef2d75-02c8-4cfc-ae4b-be813d014304","owner":[],"postedDate":"December 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T07:55:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-29 11:28:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8399552","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8399552","identity":"rs-8399552","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}