During August break last year, I had the chance to travel to Mongolia, where I had the opportunity to meet with three practitioners of Mongolian Traditional Medicine. MTM can be loosely divided into three distinct styles, based on the type of practitioner: shamans, Buddhist monk-doctors, or “secular” physicians practising in the local, Western-(i.e. Russian-) style hospitals. The three types of practitioner seem to interact only rarely, if at all. The Buddhist monks and the western physicians seem most likely to exchange views and information; neither work with shamans without a certain degree of friction.
My first meeting was with Shagdarjav Sukhbat at the Mongolian shamanism “Golomt” Centre. An author of several books on shamanic medicine (none of which have been translated out of Mongolian), he has worked closely with several shaman still found in northwest Mongolia, among the reindeer herding peoples of Hovskol, as well as with Western and Japanese anthropologists. He was knowledgeable about current practices among the shaman, which are invariably influenced by the global transmission of other forms of east Asian medicine, and I was not always able to parse out how long certain practices have been used by the shaman in Mongolia. (Mongolian massage, for example, incorporates techniques from Chinese TuiNa, Shiatsu, and Northern Thai massage, and uses the thumb-point, palm, flat palm, and three finger techniques.) My meeting with him was brief but interesting.
Shamans, he explained to me, can be called for any illness. Their procedure is to take the pulse (of which Mongolians recognise 400 varieties, all similar to the Chinese pulse qualities), analyse the patient’s urine, examine the colour of the face and diagnose via the person’s shen. One can diagnose a child from the mother’s pulse and vice versa, and the pulse can even be used to divine important aspects of their relationship. For example, Shagdarjav told me once, when he was a child, he asked a monk-doctor when his mother would be returning from a journey and the monk determined the time and date from the boy’s pulse.
Urinalysis follows Tibetan practice, and colour, clarity, and smell are all assessed. Healthy urine is a clear, pale yellow, like the colour of butter. (Of course, Mongolia has incredibly fresh and undyed butter…) Diagnosing by facial colour follows the Chinese five element paradigm, with red hues indicative of the heart, yellow of the spleen, and so on. Diagnosing the shen involves looking at the eyes, teeth and tongue colour, the tip of the nose, and around the navel, and can include touch diagnosis. On infants, the ears are also examined.
Despite its similarities to TCM, Mongolian medicine has developed its own unique features due to several factors. The most frequently cited factors were climate and diet: China is a hot country of low elevation, where the people eat spicy food. Mongolia, in contrast, is high altitude, with variable and extreme weather (ranging from freezing temperatures at night to very high temperatures during the day), where the people eat lots of meat (mostly mutton) and are nomadic. Mongolian medicine therefore focuses more on lifestyle adjustments, and features a greater use of moxa, though the shamans seem to favour other modalities.
With its emphasis on climate, it was no surprise to be told that illness comes from three sources: the sky (Tengr), underground, and from the animal/ human world. Weakness in the body is caused by sleeping late (or general laziness), food (especially eating during 4am to noon, which negatively impacts the Stomach), and by sexual desires, which injure the heart when the mind is occupied by them constantly. These diseases are considered part of the human and animal world, and are treated by changing one’s lifestyle.
Those illnesses from the ground are viral in nature, stemming from dirty water that poisons the grasses animals feed on or which contains parasites which multiply in the water people and animals drink. 1, 616 types of illness come from this, of which 404 are genetic (it was not clear if they take advantage of a constitutional weakness or induce genetic changes or act as signal transducers triggering the appearance of illnesses latent in genes); 404 are “hidden,” or more accurately, transient due to a healthy lifestyle; 404 are treatable by a shaman’s soul journey or by mantras, but not by (herbal) pills; 404 can be treated by a shamanic pill. Just as in Tibetan medicine, so also in Mongolia it is said that 12 illnesses will appear in the future and be very dangerous. Sukhbat theorised that AIDS/ HIV, avian flu, and enterovirus could be among those 12 illnesses, but stressed this was just his own idea.
From the sky come the five different types of northern lights, embodying the five colours; these lights have their greatest effect from cock-crow (around 4am) to noon. Ironically, to live healthy, one should wake at 4am and go to bed at sunset – awake with the coming of the universe’s light. (From a TCM perspective, waking activates the wei qi, and thus opening one’s eyes before these lights arrive allows the body to defend itself more adequately, but this reasoning was not offered to me at the time.) Black northern lights signify a viral epidemic. Red indicates blood diseases (epistaxis, blood in stool, hematuria, etc) will appear, while green gives power to viruses in the grasses; after 5-12 years, illness arrives. Yellow light foretells jaundice, possibly with edema; or urine diseases (“gold water” was the phrase that was used, similar it seems to the jinye fluids, jade fluid); or bone diseases. Blue, which relates to the liver (“qing” — the colour related to the liver in TCM – is better translated as “cyan” rather than “green,” and is the colour grass appears from horseback, the colour of perennial herbs as they shoot up in the springtime; thus “blue” is meant in the sense of “qing”), is also the colour of water and good is for water; the blue light cleans and purifies the water, but harms the liver. For the shamans of Mongolia, blue is the colour of the world: grasses, lakes, and sky.
Also mentioned in this context was an offhand comment that white flowers occur in the summer, and they have the greatest impact on the Lungs.
The diseases which come from the sky can be treated in one of five ways, first and foremost by mantras. Either the shaman will prescribe a mantra meditation or the shaman, who has recited a specific mantra 100,000 times, can take a cup of vodka or water, circle it in front of him or herself, blow on it three times, take a mouthful, and blow it as a spray on the patient at Ren 6, GV4, and PC8, using a separate mouthful of liquid for each point. The body is like light, when there are holes, illness – especially those originating from the sky or northern lights – can enter. The vodka spray helps close those holes.
The other methods of treatment are by shamanic soul journey; by magical herbs made into pills; by massage; and by pure water from its source. (Think of the Bach flower remedy, “rock water.”)
Ultimately, from a shamanic point of view, to live healthily, the sky must be clear, the ground (and its water) be clean, and the food pure. These three elements were present in his prescription for losing weight: every day, early in the morning (around 4 or 5am), wake and drink cold water with honey; at sunset drink fresh yogurt.
Buddhist doctors are called “Otoch” in Mongolian, and for my second interview I was taken to the Otoch Manramba Institute of Traditional Mongolian Medicine, which functions as both a Buddhist temple, clinic, and college. At the gate of the college is a small pagoda of prayer wheels, and one of the first images that greets the visitor (or patient) walking into the clinic is a huge icon of the Future (Maidara) Buddha; below that icon were statues and thangkas of the Medicine Buddha, more prayer wheels, oil lamps, and (if I recall) also a statue of Tara, the Bodhisattva of compassion. Off to the side of the main hall were two low desks, on which were arranged quills, paper, patient records, herbal powders and a few religious implements. Behind each desk were two colourfully robed Otoch, and in front of them sat several patients, waiting to have their pulses read and medicine dispensed.
Upstairs, I passed by a sunlight, glassed in hall, where piles of wild-harvested herbs were being dried, each in its own carefully labeled pile. In the back offices, which overlook the main hall of the temple, I spoke to one of the directors of the College.
The director explained to me that Tibetan and Mongolian traditional medicine have their roots in Indian Buddhist medicine. She was very careful to emphasise that those roots are not in Ayurveda, which is Hindu, but in the Buddhist medicine of South Asia. Unique features of Mongolian Buddhist medicine include the ingredients in patent medicines, which are wild-harvested from the untouched Mongolian countryside (the Mongolians all seemed to be very proud of the pristine nature of their land), massage, and a number of other differences “too many to enumerate.”
Moxa is an important aspect of Mongolian Medicine, since Mongolia has a very cold climate; I recalled that the Su Wen notes moxibustion therapy originating in the North. Instead of mugwort, edelweiss forms the primary herb, although additional herbs (including woods, metals, wool, and oils) might be added to alter its therapeutic uses. (Edelweiss was also used as firestarter or kindling in the countryside.) Moxa is an ideal medium to treat the most commonly seen diseases in Mongolia, which include cold in the Kidneys, Heart, and Stomach.
Acupuncture is also used, primarily based on Chinese models, although certain extra points are also included – but when I asked to be shown an extra point, I was told we were not in a class.
The college itself currently enrolls 216 students for 6 years of study. 70% are women, and only 5 of the total student body are monks. Ordinarily, monks study only Buddhist philosophy and chanting, and doctors study only the Buddhist medical tradition; but a few study both – in this case, only five. All students begin the day with the meditation to Medicine Buddha, which is very similar to the sutra recited in Traditional Tibetan Medicine.
The school’s curriculum devotes 70% of its time to traditional medicine and 30% to western medicine (morphology, pharmacology, physiology). The school year lasts from 1 September to 1 July, during the two month break, students practice herbal medicine, nursing, or assist doctors, especially students in their 2nd and 4th years. Classes begin at 8.30 and finish by 3.30 in the afternoon, but both students and teachers are in school until 8pm or longer, to continually review what they know and are learn through repetition. Courses include Latin language, English language, traditional Mongolian script, Tibetan language (Mongol doctors in the past wrote their books on meditation and medicine in the Tibetan language, which was the scholarly Buddhsit language at the time. Many of these works are only now being translated into Mongolian. As a side note, the largest collection of Buddhist scriptures is, in fact, in the National Library in Ulaan Baatar). Social medicine, medical ethics, medical philosophy, computers, Buddhist philosophy, Medical Astrology, Traditional Morphology, Western Morphology, traditional physiology, western physiology; febrile diseases, pediatrics, genetics, Chinese acupuncture, surgery, plant physiology, and pharmacology are among the other courses students are expected to master. Herbal medicine is learned by studying formulas only; the functions of single herbs are learned in context. Formulas are learned according to the diseases they treat; thus a course in febrile diseases or cold diseases would feature formulas from (if this were a Chinese formulary) the Warm Disease School or the Shang Han Lun.
The most important thing to know about Mongolian Buddhist medicine, however, is that one must do the meditation to the Medicine Buddha every day. Meditation on pulse diagnosis must also be done every day (exactly what this entails was not explained to me)., but traditional diagnosis is not only by theory and practice (as with the pulses), but also by meditation. (Although the pulse is very important, I was told.) Why is meditation so important? Because at its most basic level, disease is suffering. Suffering is from bad karma. Traditional doctors must have good karma and good energy and a good mentality if they are to treat disease. To achieve this state of purity, one must do meditation every day; otherwise, when the doctor sees the patients he (or she) won’t cure the disease. (Which might explain the failure of western medicine to heal some patients). The students at the college, the director exhorted me, go every morning and evening into the countryside to perform the meditation to the Medicine Buddha.
To interview a doctor practicing traditional secular medicine, I was taken to the acupuncture and massage therapy wing of the main Hospital in Ulaan Baatar. The woman I interviewed had first been an gastroenterologist (studying in Russia), then specialised in Pediatrics, and only later went into acupuncture and medical massage, which she has been doing for the past ten years.
The medicine practiced at the hospital is not connected at all with shamanism, but does share roots with the Buddhist medicine taught at the Otoch college, and like the other two, makes use of special Mongol techniques. However, whereas the Otoch rely first on the pulse and then on herbs; here the physicians do not work with herbs, since being part of a larger institution patients can be directed to other specialists. The focus therefore is first on acupuncture, second on cupping, third on moxa, then bloodletting, and finally on massage. Acupuncture is used to reconnect the qi when its flow has been interrupted for some reason, and 26 – 28 gauge needs seemed to be the normal size of the needles used. Mongolian cupping is different from current Chinese practice, (i.e. suction, which the Mongolian doctors believed was not as effective), and the doctors in Mongolia use full fire, lighting strips of newsprint and then putting the four-inch cup on the person with the flame still burning inside. Bloodletting is typically viewed as emergency medicine, although it is used to tonify qi.
I was able to participate in the intake of one patient, a man in his late 40s or early 50s, who recently had surgery on his right ear. Subsequently, he developed Bell’s palsy on the right side of his face. His left lower leg trembled constantly, and the skin on the left side of face appeared scarred from burns. His pulses were wiry and full on left, thin and deficient on the right. LU and SP positions were weakest. Patients bring their medical files with them, including x-rays, in a clear plastic folder, and we were able to also see which cervical vertebrae had also moved out of place. Treatment was cupping for 10 minutes on DaZhu, Shenshu, Feishu, Jianshu – three cups across at the level of DaZhu, bilaterally. This was followed by needling ST2, 3, 4, 5; LI 4, 11, 19 (or 20); GB14 or YuYao, GB2, 3; Ren 24, 19, xiyan, SP10, ST36, and SP9.
The pulse is taken more proximal and medial than the Chinese pulse; in fact, the first position is below where we take the third position, pushing up against the wrist flexor muscles. (The doctor actually moved my hand from the Japanese position to place it in the correct Mongolian position. I explained to her why I was taking the pulse so distally, and she then had to explain to the patient the discrepency in pulse taking styles.)
Two techniques are used in Mongolian acupuncture, the doctor told me. First, from the beginning the teacher teaches students point location exactly; then together, they check the patient and determine the appropriate points to needle. Points are named according to their Chinese names, which are left untranslated. Everything is taught altogether within one year. Although thick gauge needles are used, the patients do not make any noises of complaint, and the previously mentioned patient only flinched when LI20, and ST2 were needled. Needles are kept in test tubes, but only used once (imported from China and Korea).
Root treatments are done on the first three days, and then branch or local treatments subsequently. Point energetics rather than meridian therapy is used.
The most important thing in this style of medicine, I was told, is diagnosis. Proper diagnosis and then practice. (I was also informed that to become an excellent doctor one should study first in a European university.)