This will entail a great many lessons rolled up into one here..
First, a medicine bag is a very personal item and should never be touched by anyone but the Medicine Elder who Blessed it and by the one whom it belongs too.
A person should not just go up and grab a medicine bag around some ones neck and think it sooooo cool! or ask "Wow what is this? or "what is in it?" "Can I see?" "Can I look inside it?"
If a person is truly interested, a person should ask politely and respective to the wearer about the medicine bag.
It has just the same religious significance to the wearer, as does the cross of Jesus does to one of faith.
To begin with a leather pouch or article, they are only that, a leather pouch or an article to made into being a medicine bag. Until one has items of significance to the wearer in it, and it is then blessed, it is not a "Medicine Bag".
Some wearers start out with a small leather pouch and place an item that represents each of the four elements..
examples: The element of air could be a small bird feather. The element of water could be a rock found in a stream or a small shell from the ocean. The element of fire could be the end of a match head. And the last element would be that of Earth, which could be a pinch of dirt itself.
As was said these are only examples, and is not what everyone puts into them. It is up to each wearer what is important to them, and give them the spiritual protection against all negativity and evil. Drawing in only good spiritual influences to the one who wears it.
When a pouch, (plain or beaded) or a decorative items like: a small box turtle shell with the leather pouch inside.
It then becomes a very important part of that individual, not just a decoration.
How it should be decorated if one wishes is up to the individual of course, but to be authentic and traditional like the ones worn of ancestors past.. They should not be bright purple or red or black leather and have skulls all over them.
I was taught it should hang from the neck with a leather tie, and kept close to skin near the heart
A woman should always wear theirs inside their dress or blouses..never left outside.
A male because they go bear chested, can go either way.
To keep it "Spiritually Energised" once blessed.. should be worn at all times. The ancestors never took theirs off even for bathing in the rivers and such.
But, I will tell all of you what was told to me, "One does not have to have such to have good medicine, it is truly what is in ones heart that makes the medicine good."