The sacred pipe and ceremony are at the heart of native people's culture, as they travel the Red Road, the native road of balance in a good way, their way, our way, the way of Wakan-Tanka, the Creator, the way of Tunkashila, the living breath of the Great Spirit Mystery, and the way of the Helpers, the way of love and freedom, here on the back of our Earth Mother. Simply put, the smoke coming from the mouth symbolizes the truth being spoken, and the plumes of smoke provide a path for prayers to reach the Great Spirit, and for the Great Spirit to travel down to Mother Earth.
The sacred pipe is a spiritual artifact, a religious altar, always to be treated with respect and care, and used only in a sacred manner. When it is put together with the stem it is sacred.
The ceremony is really very simple. The pipe a pinch at a time is loaded with tobacco, or a tobacco mixed with sweet smelling herbs, barks and roots such as bayberry, bearberry, mugwort, lovage, red willow inner bark, wild cherry bark, white willow bark, birch bark, and many others indigenous to a local area. The cultivation of the tobacco and the mixture preparation were the sacred responsibility of the "Tobacco Society" of the tribe, and practices varied in each area.
The ceremonial tobacco is usually very strong, the tobacco used in North America is nicotiana rustica, and usually the smoke is not inhaled, but puffed into, then out of the mouth in each of the four directions, acknowledging Father Sky, Mother Earth, and the Great Spirit as the pipe is smoked and passed from one person to the next around the circle.