Traditional Vietnamese Medicine: Historical Perspective and Current Usage
For several thousand years, Vietnamese Traditional Medicine has evolved under the shadows of Chinese Traditional Medicine, culture, and rule. At this point in time, it is nearly impossible to separate out and delineate Traditional Vietnamese Medicine or Thuoc Nam (Southern Medicine) from Traditional Chinese Medicine or Thuoc Bac (Northern Medicine) because their developments were so inter-twined. This is a brief history of the development of Thuoc Nam and its influences particularly by Southern China.
What is generally considered classical Vietnamese culture started in the northern third of Vietnam. This area was very much connected to China and Chinese culture even before the 4th or 5th century B.C. During that time period, southern China, from the Yangtze River to the northern part of VN, was one large ecological region. There were a number of different ethnic groups living in this fertile region who were not considered Chinese by Northern Chinese. Among these groups was the ‘Yue,’ the Chinese word for Viet. Northern Vietnam and Southern China came under Chinese rule by the 4th century B.C.
Medical texts and instruments found in Northern Vietnam have been shown to predate Chinese conquest, suggesting that Vietnamese people already had a developed system of medicine. In addition, among Chinese medical texts from the 4th century B.C., references were given to the “Yue Prescriptions,” indicating that Thuoc Nam was an established discipline. Traditional Vietnamese and Chinese Medicine continued to evolve closely for the next millennium. As part of the conquest, the Chinese abstracted medicinal drugs, among other valuables, as tax and tribute. In so doing, folk medicine from Northern Vietnam was incorporated into Traditional Chinese Medicine. Likewise, Traditional Chinese Medicine and culture were introduced to Vietnam during the one thousand years of Chinese occupation. Their interrelationship can be observed by the influence of Chinese medical theories on traditional Vietnamese herbal practitioners, and likewise the empirical applications of local Vietnamese medicinals in Chinese medical texts. In practice, Traditional Vietnamese practitioners would use a more practical rather than theoretical explanations. In the 17th century, traditional Vietnamese, Chinese and practitioners from other ethnic groups began identifying their medicine as Eastern medicine or Dong Y (This is also referred to as Oriental Medicine) to distinguish their traditional medicine from Western Medicine (Tay Y). In this article, Dong Y is used to refer to both Chinese and Vietnamese traditional medicine.
Traditional Dong Y (Eastern Medicine) Theories
As described above, Traditional Chinese and Traditional Vietnamese Medicine differ in practice, yet they share the same theoretical foundation. The cornerstone of Dong Y theories is based on the observed effects of Qi (energy). Although there are as many different forms of Qi (Digestive, Immune, Mental state), they are all related to the original Source or Essence and Food Qi. The Essence is inherited from our parents, while Food Qi is extracted from food. So Qi represents both the potential or stored energy as well as the kinetic energy. It is both matter and energy. The counterpart of Qi is Blood. It is thought of as a nourishing substance that carries Qi to every part of the body. However, in practice Blood and Qi are just of one entity, like two faces of the same coin.
The functions of Qi can be summarized as 1) providing movement, 2) defending the body from pathological factors, and 3)supporting/promoting growth and development. The functions of Blood can be summarized as nourishment and moistening. Blood nourishes Qi and Qi moves Blood. As in physics, the concept of Qi is also universal - our energy and that of the universe is transferable. One can deplete one’s Qi by strenuous work, poor diet and lifestyle. It is believed that one can also harvest energy from the universe by maintaining optimal health and by exercises like Qi-gong and Tai-Chi.
Dong Y’s major theories are: Yin and Yang, Five Elements. These theories are often combined to explain a health condition. The following are brief summaries of these theories.
Yin and YangYin and Yang is probably the oldest and the most significant theory in Dong Y. It describes the existence of and the importance for balance between opposite states (cold and hot, inaction and action). Yin and Yang can be divided into three divisions: 1) Cold versus Hot; 2) Interior versus Exterior; and 3) Deficiency versus Excess.
Yin types of illnesses are typically manifested by symptoms of cold, interior, and deficiency states like malnutrition. On the other hand, Yang conditions are typically manifested by symptoms of heat, exterior, and excess.
Another major Dong Y’s theory is the Five elements. Major organs are grouped into the elements of, Water, Wood, Fire, Earth, and Metal. The flow of energy in our bodies are thought to follow the same principle from water nourishing wood, wood brings fire, fire forms ashes (earth), and earth solidify to form metal.
theory, health is viewed as balance between these five entities, each depending on as well as regulating one another similar to how our endocrine system functions. Observing these elements in nature, a Dong Y practitioner keenly relate these same concepts to our health. This simple model is expanded to encompass human physical, mental and spiritual health. Thus, a person with one weak element can lead to an excess of another element. For instance, a deficiency in water often leads deficient wood and excessive fire elements. A person of this profile is often thin physically, and with yin pattern conditions. Some Traditional Chinese Medicine schools base their entire approach on teaching the Five Elements theory.
In summary, the practice of Dong Y is guided by its theories, which are based on the concepts of Blood, Qi, Yin and Yang, and the Five Elements. The tasks of the practitioner are to identify and correct disharmonies.
Diagnosis & Treatments
Dong Y practitioners typically assess patient’s Qi and Blood by taking a medical history, observing the patient’s affects, and by feeling her pulses and examining the shape, size, and color of her tongue. By examining the pulses and tongue, a picture of disharmony between different elements within one’s body can be pieced together. For example, red spots on the tip of the tongue indicate that the person has a yang type of condition. Someone with poor digestion will tend to have a swollen tongue with multiple tooth marks. All disorders are described in terms of disharmonies between elements or between organs. For example, a patient with digestion problems may carry a diagnosis of Liver stagnation that impacts on the Pancreas’ function. Important comparisons in this area can be made between Eastern and Western approaches. In the East, diagnoses and treatments are more conceptual i.e. Wood overacting on Earth instead of stress or indigestion. However, behind this simplicity lie keen observations of ailment patterns (i.e. emotional stress often affect digestion). Dong Y practitioners mostly focus their therapies on correcting syndromes rather than individual complaints. It utilizes food, herbs, minerals, acupuncture, and exercises with the goal of providing long-lasting effects.
Since Dong Y’s concepts encompass a broader function than biomedical models of organs, difficulties can arise when patients describe their complaints using Dong Y analogies to practitioners who are only trained in the biomedical approach. Other times, patients who are not aware of the differences between Western medicine and Dong Y can also mistaken Dong Y diagnoses for Western pathologies. A common example is when a patient complains of a “weak kidney” insists that his kidneys be tested. When in reality this patient may have back or knee pain, urinary or sexual difficulties, coldness in the extremities, or early morning diarrhea etc. Another common complaint in the Vietnamese community is “hot liver.” In Dong Y, hot liver can refer to skin eruptions, itchiness, and emotional agitation, none of which directly relates to the anatomical liver itself.
A strong emphasis on dietetics is seen in Dong Y. In general, it is considered that people who are omnivorous are more prone to getting excessive “heat” accumulation. Many Dong Y therapies begin with changes to a patient’s diet, such as consumption of Congee or Cháo, a porridge consisting of rice, a small amount of meat or tofu, and green onion or cilantro. People suffering from chronic illnesses usually eat this soup because it is easy to digest and very nourishing.
Vietnamese commonly refer to food property as hot or cold, which does not necessarily refer to temperature or spiciness. Instead, they refer to the effects that the food has on the body. For example, eating a plate of French fries can cause a person to feel very thirsty. Due to this effect on the body, fried foods are considered a hot food. Dried, deep fried or very rich foods (high sugar/fat content foods) are considered hot food.
On the other hand, melon and root vegetables are considered cool foods. Symptoms of cold or cool effects on the body may include: frequent urination and loose stool. Fresh food, steamed or boiled vegetables are considered cool. Food preparation is just as important as the kind of food in determining whether it is hot or cool. For example, French fries are very hot compared to boiled potatoes. Food choices are often made based on their energetic qualities. Vietnamese regularly consumes squash in the summer for its cooling effects and more ginger in the winter for its warming effects.
The interpretation above also applies when Vietnamese people refer to medicine, particularly to the side effects of medicines. Medication that cause skin rash, itchiness, and thirst are considered hot, while medicines that cause loose stool would be considered cool. It is uncommon to find a Vietnamese patient taking less medication than prescribed dose because of the side effects perceived as being too hot or too cold. Unless this matter is approached with sensitivity, many would not tell their physicians about it; they believe that they are in the best position to judge their health needs or they just do not want to appear as disobeying authorities.
Chart 1: Yin and Yang
Chart 2: Five Elements Theory
Chart 3: Symptoms of hot and cold
|Signs and Symptoms of excessive heat||Thirst for cold drinks, fever, red face, red eyes, canker sores, irritibility, insomnia, constipation, yellow urine, and yellow or green discharge|
|Signs and Symptoms of excessive cold||Cold, pain, cramps, diarrhea|
Chart 4: Cooling food
|Fruit||Vegetable||Grains and Legumes||Others|
- Information on the development of Traditional Vietnamese Medicine was adapted from lecture by Michelle Thompson PhD, Associate Professor, Southern Connecticut State University. April 3, 2002.
- T.N. Dung, Pharm.D., and Gerard Bodeker, Ed.D. Tue Tinh: Founder of Vietnamese
- Traditional Medicine. Journal of Alternative and Complementary Medicine. Volume 7, No 5, 2001, pp. 401-403.
- Tyme, L.Ac., Student Manual on the Fundamentals of Traditional Oriental Medicine. 3rd Edition, 1997.
- Pitchford, Paul. Healing with Whole Foods, revised edition. North Atlantic Books, 1993.