Professional Documents
Culture Documents
original article
Abstract thus demonstrate the distinct nature do como un término paraguas para Author Affiliations
Department of
Background: Traditional Chinese of Uyghur, Tibetan, and Mongolian las prácticas médicas tradicionales Biochemistry and Cellular
med icine, as it is understood and medical systems. procedentes de las regiones internas and Maolecular Biology,
adopted by those with a growing y limítrofes a la República Popular Georgetown University
Medical Center
interest in complementary and alter- China. Sin embargo, hay muchas
Washington, DC.
native practices to biomedicine, is 摘要 tradiciones médicas distintas en
often used as an umbrella term for 背景:传统中药为越来越多的人 China, incluidas las de los uygures, Correspondence
traditional medical practices from 们所理解,并将其作为生物医学 tibetanos y mongoles. Hakima Amri, PhD
amrih@georgetown.edu
regions within and bordering the 的补充和替代医疗,它通常涵盖 Objetivo: Es importante reconocer Elaine Yu, MS
People’s Republic of China. However, 中华人民共和国境内各地区的传 las semejanzas y diferencias de estos ey80@georgetown.edu
there are multiple distinct medical 统医疗实践。然而,中国有许多 sistemas únicos de medicina que
traditions in China, including that of 独特的医学传统,其中包括维吾 practican tres culturas diferentes Citation
Global Adv Health Med.
the Uyghurs, Tibetans, and 尔族、藏族和蒙古族。 entre las fronteras de China. 2016;5(1):79-86. DOI:
Mongolians. 目的:了解中国境内三种不同文 Métodos: Mediante un análisis en 10.7453/gahmj.2015.116
Objective: It is important to recognize 化践行的独特医疗体系之共性与 profundidad de las creencias y teo-
Key Words
the commonalities and differences of 差异非常重要。 rías de los individuos que forman la
Uyghur medicine,
these unique systems of medicine 方法:我们通过深度分析形成各 base de cada sistema, realizamos un Tibetan medicine,
practiced by the 3 different cultures 个体系之基础的各种信念与理 seguimiento de los orígenes de los Mongolian medicine,
among China’s borders. 论,追踪了融入维吾尔族、藏族 conceptos que se sintetizaron en los traditional Chinese
medicine, humoral
Methods: Through an in-depth anal- 和蒙古族医疗体系的概念之根 sistema médicos uygures, tibetanos medicine.
ysis of the individual beliefs and theo- 源。此外,我们比较了这三种体 y mongoles. Además, comparamos
ries that form the foundation of each 系之间的诊断技术和对照治疗模 técnicas diagnósticas y contrasta- Disclosures
The authors completed
system, we trace the origins of the 式。 mos modalidades de tratamiento
the ICMJE Form for
concepts that were synthesized into 讨论:我们讨论了体液学说、体 entre los tres sistemas. Disclosure of Potential
the Uyghur, Tibetan, and Mongolian 质学说、元素学说、器官学说和 Debate: Estudiamos la teoría de los Conflicts of Interest and
medical systems. Furthermore, we 阴阳学说。我们发现,失衡是疾 humores, la teoría de la constitución, had no conflicts
to disclose.
compare diagnostic techniques and 病的常见病因,但在维吾尔族、 la teoría elemental, la teoría de órga-
contrast treatment modalities among 藏族和蒙古族体系中,解释此类 nos y la teoría del yin y el yang.
the 3 systems. 失衡的条件和外部因素不尽相 Averiguamos que el desequilibrio es
Discussion: We discuss humoral the- 同。通过这些比较,我们力求突 la causa más común de enfermedad o
ory, constitution theory, elemental 出这些文化使用的独特信念、实 trastorno, pero las condiciones y los
theory, organ theory, and yin and 践和治疗。 factores externos que explican dichos
yang theory. We find that imbalance 结论:这些特点与属性尽管并非 desequilibrios difieren entre los siste-
is the common cause of disease or ill- 每个人群所专属,但却独特地融 mas uygur, tibetano y mongol.
ness, but the conditions and external 入到每一个体系,因此展现出维 Mediante estas comparaciones, que-
factors that explain such imbalances 吾尔族、藏族和蒙古族医疗体系 remos destacar las creencias, prácti-
differ among the Uyghur, Tibetan, 的独特性质。 cas y tratamiento únicos que utilizan
and Mongolian systems. Through estas culturas.
these comparisons, we seek to high- Conclusión: Los rasgos y atributos,
light the unique beliefs, practices, and Sinopsis aunque no son exclusivos de cada
treatments utilized by these cultures. Antecedentes: La medicina tradicio- población, están, sin embargo, sin-
Conclusion: The features and attri- nal china, tal y como está entendida y tetizados en cada sistema y, por con-
butes, while not exclusive to each adoptada por un interés creciente en siguiente, muestran la distinta natu-
population, are nonetheless unique- prácticas complementarias y alterna- raleza de los sistemas médicos uygur,
ly synthesized by each system and tivas a la biomedicina, se usa a menu- tibetano y mongol.
Medical Traditions
Uyghur Tibetan Mongolian
in China
Early Medical
Bon Shamanism
Practices
Figure 2 Transmission of medical knowledge from ancient and global medical systems to the 3 types of medicines described (arrows
indicate influence).
the Chinese government, the most prominent are ductive ability, spirit refers to control over mental and
Uyghur, Tibetan, and Mongolian medicines. Although physical activities, and natural force manifests as regu-
other hospitals may provide traditional medical care, lation, enrichment, and control of other organs. The
the government recognizes 39 Uyghur, 70 Tibetan, and controlling organs directly affect the 6 dominant organs.
51 Mongolian medical hospitals. The National They in turn affect the remaining controlled organs. All
Qualification Examination for Doctors certifies physi- other organs are considered controlled organs.7,8 It is
cians of Uyghur, Tibetan, and Mongolian medicines important to note that Unani medicine, the origin of
separately.6 Each practitioner of Uyghur, Tibetan, or Uyghur medicine, was the first to report the brain as a
Mongolian medicine must be thoroughly trained in major controlling organ.3
the theories, treatments, and medications unique to In the same way the 4 temperaments correspond
each system. What follows is a description of each of to the 4 elements (fire, air, water, and earth), Uyghur
these 3 systems of medicine as it is practiced today. medicine’s 4 bodily fluids correspond to the 4 elements
(Table 2). This is described by teliti theory or body fluid
The Uyghur Medical Model theory. The 4 hilits (fluids)—bile (or yellow bile), blood,
The central concept in Uyghur Medicine is that of phlegm, and atrabiliary (or black bile)—are created by
mizagyi (derived from the Arabic and Urdu word mizaj) the liver and help the body maintain a balanced state of
or temperament. An individual’s mizagyi is expressed health. Each individual is born with an inherent bal-
in facial appearance, skin color, body shape, personali- ance of his or her hilits, and this balance can be affected
ty, habits, and mental state.7 Temperament is deter- by food, climate, season, and medication.8 Any change
mined by a balance between the 4 properties of heat, in quantity or quality of these hilits will contribute to a
moisture, coldness, and dryness that correspond to state of disease.
qualities of the tot mizaj (4 elements) of fire, air, water, Similar to Unani medicine, there exist 6 principles
and earth (or soil). Mizagyi follows the idea that these in Uyghur medicine that can aid an individual in main-
elements are in a constant struggle for dominance and taining health. These sayat (conditions) are as follows8:
are affected by climate, geographical location, heredity,
seasons, food, herbs, fluids, and air.8 The 4 tempera- 1. people struggle in order to live
ments can be combined into a total of 8 conditions: 2. foods that one eats should be taken in balance of
heat, coldness, moisture, dryness, dry heat, moist heat, quantity and quality
moist coldness, and dry coldness. When these proper-
ties are unbalanced with some in excess and others Table 1 Uyghur Medicine Organs and Temperaments
insufficient, people fall ill.7 Element Temperament Organs
Temperament can be used to characterize each
Fire Dry heat gallbladder
organ as well as the whole individual. The Uyghurs
subscribe to the notion that each organ has its particu- Air Moist heat liver, heart, muscle, lung, esophagus,
duodenum, small intestine
lar temperament that is related to its function (Table 1).
This is the foundation of azha (derived from the Arabic Water Moist minimum-unit (cell), body fat,
coldness stomach, brain, kidney, spinal marrow
word A’ada’) theory or organ theory. Organs are catego-
rized as controlling, dominant, and controlled accord- Earth Dry spleen, bone, hair, nail, cartilage,
coldness ligament, membrane, large
ing to their function. They are organized in a hierarchi- intestine, bladder
cal manner based on a system of control (Figure 3). The
Moderatea fingers, palm, back of hand, skin
3 controlling organs are the brain, heart, and liver,
which correspond to an individual’s vitality, spirit, and Adapted from Yu and Ren7 with modifications.
a No associated element.
natural force. Vitality manifests as survival and repro-
Figure 3 Uyghur medicine organ hierarchy as practiced today (arrows indicate control).
3. rest and activity must be kept in balance some cases, the calendar is consulted to determine the
4. a good mood is important to long life best day to apply the treatment or perform a treatment
5. the body must be kept clean ritual.10 Treatment rituals can involve prayers or read-
6. energetic characteristics of body fluid deserve spe- ings from the Quran. While most Uyghur are Muslim
cial tracking after age 60 and the Quran is used in many healing prayer rituals, it
is important to note that Uyghur medicine is not based
To diagnose illness, Uyghur physicians, called bele- on Islam the way Tibetan medicine and Mongolian
tibabets, use their senses of smell, sound, sight, and medicine were based on Buddhist teachings.
touch to examine a patient.9 Once they determine the
cause of illness, they will prescribe a combination of The Tibetan Medical Model
herbal medicines and treatments, such as massage, Balance is essential to Tibetan medicine, as a
hydrotherapy, the external application of animal prod- healthy individual is defined by a state of balance.
ucts, or smoking animal bones, hooves, and horns. In Imbalances are a result of either the ignorance of the
Fire Bile Dry heat Helps peristalsis in large intestine and stomach
(yellow bile) Aids in the digestion of fat
Causes growth and strength
mind, mental afflictions, or direct influences. In order 4). Root organs are responsible for absorbing nutrients
to determine the cause of disease, physicians diagnose and transforming them into the essential humor. Fruit
through questioning, visual observations, and palpa- organs use the humor to govern major bodily func-
tion. Once the disease state is known, the correct com- tions and flower organs are facial components that
bination of diet therapy, herbal products, and external reflect the state of the other organs. This is important
treatments can be applied to return the patient to the for diagnosis, where the face is often examined to
balanced state. determine the cause of disease. These are observations
Tibetan medicine considers a psychosomatic link that are extrapolated directly from nature and the sur-
in the body that regulates an individual’s processes, rounding environment.12
functions, and structures. According to theory, the indi- Another way of thinking about the humors is in
vidual is divided into the 3 nays (humors) of rLung terms of 3 channels on the body. Tibetan medical theory
(activity, wind), mKhrispa (vitality, bile), and Badken divides the body into 3 channels—u-ma (middle, black),
(stability, phlegm). Activity is regulated by the nervous ro-ma (right, red), and rkyang-ma (left, white). These
system and divided into vital-conscious, respiratory- tantric channels are thought to determine the natural
expressive, digestive-metabolic, excretory-reproductive, quality and quantity of the body’s 3 humors. The father
and motor-proprioceptive sub-activities. All of these contributes the white channel, which corresponds to
comprise rLung. Vitality is a result of the functions of the lymphatic and endocrine systems that regulate
the digestive system and metabolism; stability results Badken (stability). The mother contributes to the red
from the structure of connective tissues and the muscu- channel, which corresponds to the blood circulation
loskeletal system.11 These 3 humors make up the 3 of that distributes mKrispa (bile). Lastly, the black channel
the 7 total constitutions (Table 3), which determines an is thought to originate from past lives and karma; this
individual’s body type and personality. Tibetans believe channel controls the nervous system and consciousness
that the constitution is developed from the parents’ that distributes rLung (wind).12,13
constitutions as well as a past karmic blueprint. Diseases are broken down into 3 main causes. The
The 3 humors that comprise the body constitu- first, Ringu (distant cause), refers to the ignorance of the
tions are connected to 5 main organs that correspond mind, which manifests as an ego. It is this ego that gives
with the 5 elements of earth, water, fire, air, and space rise to the second cause, nye-gyu (near cause), or mental
(similar to 5 Ayurvedic elements). They and other poisons of attachment, hatred, and close-mindedness.
organs are described in a 3-part structure with a root, Attachment is the cause of wind disorders, hatred the
fruit, and flower that work together to transport and root of fire disorders, and close-mindedness prevents
distribute the 3 humors throughout the body (Figure the action of phlegm and leads to negative karma,
which leads to suffering. These mental poisons are
Table 3 Tibetan Medicine Body Constitutions stimulated by unwholesome diet, behavior, and psy-
rLung Thin Talkative chology to disturb the humors and produce disease.
(Wind) Dark, rough, dry skin Doesn’t sleep much Lastly, imbalances are attributed to the third cause,
Dark, small, sharp eyes Emotional kyenl (immediate cause), or direct threats such as cli-
Big joints Short lifespan
Dry hair
mate change, strong negative emotions, unwholesome
Fragile nails diet, and negative behavior. Imbalances can manifest in
one or a combination of organs, thus affecting the
mKhrispa Medium size Sharp memory
(Bile) Yellow, red skin Strong ego
humoral balance that is maintained by the flow of
Red, yellow, brown eyes Formal, diplomatic rLung, mKrispa, and Badken energies among them. In
Thin, oily hair Medium lifespan order to regain balance, the origin of the disorder must
Fast digestion
be determined.12
Sweaty, smelly
Diagnosis is accomplished in a series of 3 steps. The
Badken Large, tall Thinker first step is driwa (questioning), which is used to deter-
(Phlegm) Smooth, white, moist skin Heavy sleeper
Green, gray, blue, large eyes
mine which humor is responsible for the disorder. Next,
Black, straight, strong hair physicians conduct mig-gi-tawa (visual diagnosis) by
Slow digestion examining the tongue, ear veins, eye veins, urine, and
rLung-mKrispa Cold extremities Fearful, anxious
constitution or complexion. The tongue shows what
(Wind and Bile) specific part of the body is afflicted by a humoral imbal-
ance. By looking at the ear veins, a physician can deter-
rLung-Badken Cold sweats Confused mind
(Wind and Phlegm) Obesity mine which organ is afflicted. Through the eyes, an
individual’s flow of psychic energy can be isolated.
mKrispa-Badken Hot upper body Conflicted mind
(Bile and Phlegm) Cold lower body
Urine analysis is important to distinguish superficial
from hidden diseases. The constitution is considered
rLung-mKrispa- Well-balanced body Well-balanced since people of specific constitutions are prone to cer-
Badken (Wind, Bile state of mind
and Phlegm)
tain humoral disorders. Finally, physicians use tsa-la-
tak-pa (pulse diagnosis) to find information about the
Adapted from Arya12 with modifications.
state of the organs and energies.12
Figure 4 Tibetan medicine 3-part organ structure as practiced today (arrows indicate movement).
According to Tibetan medical theory, there is a medicine holds that arga and bilig imbalances are the
cure for each type of disorder. Treatment usually cause of illness.14,15
involves a combination of diet, herbs, and external Mongolian medicine practitioners diagnose imbal-
therapies. Diets restricting and recommending certain ances through observation, palpation, and questioning.
foods are prescribed according to which humor(s) are Observation is the first step of a diagnosis, and includes
imbalanced. Foods are linked to the 5 elements which examination of the tongue, complexion, sclera, demean-
give rise to the 3 humors. Therefore, avoiding or eating or, posture, skin tone, vocal strength, and emotional
certain foods is believed to help bring the humors back state. Often, urine is collected for analysis over time in a
into balance through control of the elements. Herbal separate laboratory, where its color, vapor, odor, and
remedies are divided into 2 types—pacifying and puri- sediments are recorded at the hot, cooling, and cold
fying—and are categorized by taste. Formulas of multi- time periods following collection. While such analysis
ple herbs are used to simultaneously treat disorders, can determine the hot or cold nature of disease, this is
restore balance, and control side effects. Pacifying thera- most easily found through pulse-taking.
pies target specific disorders while purifying therapies According to Mongolian medicine, pulse-taking is
generally cleanse the body and organs. Physicians will considered the most sophisticated diagnostic tool and
also apply external therapies such as moxibustion, mas- also the primary method of determining a state of disor-
sage, and medicinal baths. In some disorders, behavioral der. Therefore, there is a very specific methodology that
treatment is also required in the form of yoga and medi- must be applied. Male patients should have the pulse of
tative techniques. It is the responsibility of the physi- their left hand taken with the physician’s right hand,
cian to educate the patient about adopting the proper and female patients will have their right hand pulse
lifestyle and mindset in order to prevent disease, espe- taken by the practitioner’s left hand. Pulses are taken on
cially if an individual’s constitution predisposes one to 3 levels—skin, meat (muscle), and bone—and the qual-
a certain type of disorder.11,12 ity of the pulse at each location is indicative of a differ-
ent heat or cold disorder.15
The Mongolian Medical Model When it comes to treatment, emphasis is placed on
Many of the basic theories in Mongolian medicine changing the patient’s diet and behavior. To supple-
are taken directly from Tibetan medicine. Health is ment the changes, a physician may also prescribe medi-
defined as a balance between the 3 life-sustaining prin- cations or external therapies. Medications come in the
ciples of hii (wind), sar (bile), and badgan (phlegm). In form of decoctions, powders, pills, and ointments made
addition to their relationship to the 5 elements, these 3 from natural plant, animal, and mineral products. The
principles are also given hot and cold attributes in taste of each ingredient serves important functions to
accordance with arga and bilig (yang/hot and yin/cold) cure the disease, support the main ingredient in its effi-
theory as practiced in TCM (Table 4). Arga and bilig play cacy, or manage side effects of other ingredients.
an important role in diagnosis and are often used inter- Usually, medicines are placed in 1 of 2 categories: reliev-
changeably with hot and cold. Since most diseases are ing or evacuating. Relieving medicines such as decoc-
described by excessive heat or coldness, Mongolian tions, pills, herbal extracts, precious elements, powders,
pastes, ash, alcohol, and herbs are more common. Less Table 4 Three Principles in Mongolian Medicine
commonly found oils, emetics, oral or anal purgatives,
Principle Elements Attribute Description
nasal inhalants, and suppositories are considered evacu-
ating medicines. It is important that certain medicines Hii Wind Body movement, speech,
are blessed according to the ritual of reciting mantras of (Wind) breathing
Table 5 Direct Comparison of Uyghur, Tibetan, and Mongolian Medicine (Empty boxes have no attributes)
Health Balance 4 properties (humors) Balance 3 humors Balance 3 humors and hot/cold
Elements Fire, air, water, earth Earth, water, fire, air, space
Causes of disease Food, climate, season, medication, Constitution, ignorance/ego, Diet, behavior, climate,
To view or download condition attachment, hatred, close-mindedness, external factors
the full-text article, visit: climate, emotions, diet, behavior
www.gahmj.com/doi/full/
10.7453/gahmj.2015.116 Diagnosis Smell Questioning Observation
Sound Observation Palpation
Sight Pulse-taking Questioning
Touch
Main organs Brain, heart, liver Heart, liver, kidney, spleen lungs
Secondary organs Kidney, lung, gallbladder, spleen, Bladder, gallbladder, stomach, small intestine, large intestine
nervous system, ovaries, and testicles
Tertiary organs Fat, spinal cord, stomach, muscle, Tongue, lips, eyes, nose, ears
esophagus, small intestine, duodenum,
intestine, bladder, large intestine,
bone, tendons, ligaments, hair
Unique external treat- Animal excrement, smoking Moxibustion, massage, medicinal Mud baths, moxibustion,
ments animal bones baths, diet therapy, herbal products blood-letting, bone-setting