An observational study of patients, practitioners and practice in clinical settings offering traditional Mongolian medicine in Mongolia

By John Donnegan

Abstract

This research is intended to provide a basic observation-based outline of traditional Mongolian medicine (TMM) as very little has been written about it in English.
In the absence of written sources, this information has been provided by field research in Mongolia, which involved speaking with practitioners, and observing clinical practice.

The research took place in early June 2011 after having organised a three week stay in Mongolia. During this period I was able to observe practice at the Manba Datsan, monastery hospital, and the Ulaanbaatar Suvilal (Ulaanbaatar traditional medicine sanatorium), to interview a number of practitioners and to supplement my written sources.

The main findings are that traditional medicine as practiced in traditional hospitals and sanatoriums is a pluralistic combination of a Mongolian adaptation of Tibetan medicine (which has its roots in Indian ayurveda), together with Traditional Chinese Medicine (TCM) acupuncture and moxibustion, and also elements of folk practice which preceded both. This is now incorporating Biomedicine into its framework, with patients observed bringing western medical records and diagnoses to consultations, and facilities being provided at TMM institutions for running western-style tests such as x-rays and blood tests.

Literature and interviews suggest that Mongolian adaptations to the traditional Tibetan medical (TTM) canon include the introduction of the concept of diseases caused by external conditions and the categorisation of many diseases into hot and cold (Bold, 2009, pp. 238-239). Extensive use is made of moxibustion for this purpose, although as I was there at the height of summer, it was the wrong time of year to observe this in practice.

There was a strong presence of Buddhism in all the traditional medical practices I observed. The Manba Datsan is both a monastery and a hospital. The Ulaanbaatar Suvilal is a state-run facility but displays prominent Buddhist iconography and symbology throughout, and numbers of the senior medical and academic staff are Buddhist monks.

The therapies practiced include TTM drug treatment, based on herbs and minerals, TCM acupuncture and moxibustion, bloodletting, bodywork (massage), pulse diagnosis and bloodletting.

Pulse taking is seen as both diagnostic tool and therapy. It shows strong similarities to Chinese-style pulse-taking in some respects, most notably in the use of three fingers on each wrist to take the pulse, and the association of each position with one of the organs. It differs most obviously in the fact that different wrist positions are used for the pulse measurement.

During the course of my observation, I was able to gain some insight into patient behaviour, and self-diagnosis. The most striking thing was the social nature of the consultation process, with patients typically bringing family with them into the treatment room and involving them in the consultation process. This contrasts with ‘typical’ clinical practice in the UK, where the emphasis on patient confidentiality means that except where children are being treated, friends and family are not usually involved in an individual’s consultation and treatment.

My investigations shed light on an ongoing debate on medical pluralism. Many authors, referring to different areas of study, such as China and Tibet, view this as having a detrimental effect on traditional medicine practice. However, my research demonstrates that in Mongolia, pluralism is nothing new, and Mongolia has been adopting, adapting and incorporating new medical ideas since very early times, and indeed pluralism seems 'traditional'. While there's been exhaustive debate in the social sciences about the impossibility of making definite positivistic assertions about social reality, making it impossible to talk in terms of a continuum from non-pluralistic to pluralistic or fully traditional to fully biomedical, and placing what I've seen on that continuum, my observations give an insight into the reality of plural medical practices in Mongolia.

Three weeks of observation added considerably to my understanding of traditional Mongolian medicine, but inevitably could only skim the surface of what is a deep, rich and ancient medical tradition, containing many individual areas that in themselves could be subjects for considerable detailed study.