Vietnamese traditional medicine (thuốc nam) in the life of the muong and the Thai people in mountainous area of Thanh Hoa province

Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 116 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 1 6 VIETNAMESE TRADITIONAL MEDICINE (THUỐC NAM) IN THE LIFE OF THE MUONG AND THE THAI PEOPLE IN MOUNTAINOUS AREA OF THANH HOA PROVINCE Mai Van Tung, Le Thi Thanh Thuy 1 Received: 20 April 2020/ Accepted: 1 September 2020/ Published: September 2020 Abstract: The article aims to examine key issue of Vietnamese traditional medicine (thuốc Nam) (based on medicinal herbs) in community healthcare from the view of ethnic minority groups living in mountainous area of Thanh Hoa Province. Our research shows that indigenous knowledge of ethnic people about traditional medicine in this area is rich and diverse in terms of the conception of sickness, disease, medicine, disease prevention and treatment, eating and drinking under the controlling of nutrition and healing by using the folk remedies. Currently, some ethnic groups in the mountainous area of Thanh Hoa still maintain various ways of distinguished traditional treatments. Although their knowledge and practices are quite traditional in the modern life, there are many ways of treatment that are very useful for community healthcare. Especially, these are very popular and important methods to cure disease for local people who are disadvantaged in terms of socio-economic development and lack of opportunities to access modern treatment methods. Thus, Vietnamese traditional medicine is an ethnic cultural heritage that needs to be preserved and promoted. Keywords: Vietnamese traditional medicine, medicinal herbs, ethnic groups, community healthcare, mountainous area, Thanh Hoa. 1. Introduction In recent years, promoting traditional medicine values as well as combining it with modern medicine in prevention and treatment has been noted for doing research and application in all corners of the World and in Vietnam particularly. In 1980, an anthropologist named- Arthur Kleinman introduced the sector model as a tool to understand the operation of health system. According to the author, there are three different parts of the sector model including professional sector, folk sector, and popular sector. The professional sector is comprised of medical professionals, fully trained as required, formally organized and legally recognized by the nation. Next, the folk section consists of healers, wizards, powwows and midwives, in which their treatments can be either mystical or folklore, or combination of both methods. The third part is the popular sector which belongs to people, making up the largest part of any health care systems, which activating the most health care activities. In Vietnam, professional sector is the most important part (both in political and social view), it also represents for national health Mai Van Tung, Le Thi Thanh Thuy Faculty of Social Sciences, Hong Duc University Email: maivantung@hdu.edu.vn () Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 117 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 1 7 care system. On the contrary, the practicing of the fork sector is somehow diminished and seen as superstition by massive people. However, it is worth to note that this sector is still plays an important role for the vast of ethnic minority population [9, pp.58-61]. Therefore, in this article, we mainly analyze Vietnamese traditional medicine in terms of the folk sector and popular sector and its role in taking healthcare of ethnic communities in mountainous area of Thanh Hoa, particularly for the Thai and the Muong peoples. 2. Common features in making Vietnamese medicinal herbs of the Thai and the Muong in mountainous areas of Thanh Hoa 2.1. In the western part of Thanh Hoa province Thanh Hoa is not only seen as an administrative unit simply, but also the land-named Xứ Thanh. This is an open, dynamic and transitional land locating between East- West, South- North of Viet Nam. The mountainous area of Thanh Hoa is very large with an area of 7,893 kilometer accounting for 3/4 of the whole province area. The northern system of Ma River consists rugged mountainous terrain that is an expansion of limestone mountain of Hoang Lien Son range and ending with Tam Diep mountain with the altitude decreasing gradually from 1,500 meters to 100 meters; the highest peak is Pù Luông (1.667m) lied between the boundary of Thanh Son commune (Ba Thuoc district) and Phu Xuan commune (Quan Hoa district). The southern system of Ma River consists of schist range, granite running from Muong Lat, Quan Hoa, Quan Son, Thuong Xuan to Nhu Xuan district with a height of about 1,000 meters; the highest peak is Bù Chó (1.122 m) in Xuan My commune (Thuong Xuan district). This is the living space of the Muong, Thai, Hmong, Tho, Yao and Khmu minorities, in which the Thai and Muong people account for the largest number of population approximately 634,489 people, around 94.6% over popumation of the Western part of Thanh Hoa. From the historical perspective, most of ethnic minorities in Thanh Hoa mountainous area has a long origin and strong native character, typically the Muong and the Thai people. Moreover, these two ethnic groups used to live together on the same land for a long time. Because of living symbiosis among ethnic groups for a long time, therefore, they exchange their culture and acculturation as well as have a deep mutual understanding and respect, helping each other during the lifetime. This has created a rich and diverse socio-culture picture, at the same time, preserves many cultural values of ethnic minorities. This is a favorable condition for the development of Vietnamese traditional medicine. From the ecological perspective, these mountainous areas of Thanh Hoa belong to the tropical rain forest area with a complex ecosystem and humid monsoon tropical climate, which is a favorable condition to create the best flora and fauna with rich and diverse species, with at least 3,500 species, most of which grow naturally. Due to the diversity of floristic composition, the fauna is quite diverse. As a result, there are many valuable and rare animals and endemic species [11]. This is a rich resource of pharmaceutical materials that is very valuable in medical treatment and public health care. Furthermore, some initial research results indicate that indigenous knowledge about traditional medicine of ethnic minorities here is extremely rich and diverse. This is reflected in some aspects such as the concept of illness, disease, medicine, prevention and treatment with traditional medicinal herbs, eating Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 118 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 1 8 and drinking from the perspective of nourishing and treatment, etc. As an important part of the intangible cultural heritage system, Vietnamese traditional medicine occupies an essential position in the daily life of people in the mountainous areas of Thanh Hoa in general and for the Thai and Muong people in particular. It plays a vital role of public healthcare, especially for a part of population who are suffering from socio-economic development and lack of opportunity to access to modern medicine. 2.2. The role of traditional healers (thầy lang) in the life of ethnic people Practitioners of Vietnamese traditional medicine are known as traditional healers (thầy lang) (curing disease based on medicinal herbs) generally perceived as medical practitioners specializing in treating diseases by using oriental medicine methods, usually mainly based on their experiences drawn from practicing in the treatment of everyday life. Form the Thai and the Muong‟s perspectives towards treatment, the medical practitioner must has a pure heart, good morality. They also have to love and respect to their patients. Besides, a traditional healer must always put their patients‟ life in the first priority. Although a good healer owns many good remedies, but without morality, he will not become a true healer and does not receive the respect from other in his community and his colleagues as well. Moreover, a true healer is made of two important parts: medical ethics and professional knowledge level. Thus, in the viewpoint of the Thai and the Muong (and perhaps to all ethnic groups in Thanh Hoa), a person has some kinds of characteristics such as calmness, perseverance, patience, prudence, eagerness to learn things, taking the patients‟ lives as prior duty is suitable to be a traditional healer. Most of mountainous districts in Thanh Hoa has good traditional healers. To put more details, Lang Chanh, Thuong Xuan, Ba Thuoc districts are several places having many famous medicinal herbs practitioners. By the end of the twentieth century, according to a wide range of field trips, there are 133 traditional healers of the Thai and Muong people using herbs for medical purposes [1]. To the Thai people only, the mass of population know popular folk remedies. According to Vu Truong Giang (2009), in the year 2006 - 2007, there were 14 traditional healers in Yen Khuong commune (Lang Chanh district). Specifically, there are 10 villages in 13 villages having traditional healers, in which regarding to gender there were 13 males and only a female [4]. In Ba Thuoc and Lang Chanh district, there are at least a few traditional healers using medicinal herbs in their treatment. Referring to some famous traditional healers in these areas, local people and people living in surrounding areas often mention to the healers named Pham Thi Yem and Mr Vi Cong Tam [6, pp.805-806]. From the above statistics, it indicates that traditional healers have a crucial role in life of ethnic groups, typically in the life of the Thai and the Muong. In other words, they hold important roles in healing and taking community healthcare. 2.3. General conception of medical occupation and occupation transfer General conception of medical occupation The Thai, Muong and other ethnic groups in the mountainous areas of Thanh Hoa believe that the most important thing to a traditional healer is a pure mind, good morality, kindness, love and respect for other. A medical practitioner must save patients‟ lives as their Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 119 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 1 9 first prior duty. It is a common outlook that because it is the simplest and least expensive method for individual and community. The prevention of disease is manifested in areas of eating, drinking foods that has good effects on curing; particularly hygienic eating and drinking with high nutrition, pure living environment, keeping body clean and hygienic, etc. it practically would help prevent disease. The motto: “disease prevention is better than treatment” is also manifested through taboo and ritual prevention and healing for individual and community. This type of prevention and treatment is not only found in the Thai and the Muong but also found in all ethnic groups in Vietnam. Additionally, the professional level of the traditional medicinal practitioners is manifested through understanding the various types of medicinal plants, preparing medicines and fair preservation as well as the use of each medicinal plant and the combination of many herbs for folk remedies. Furthermore, to understand the status of patients‟ health, the healers need to ask their patients for more information to examine the time of their illness, degree of pain and observe the patient‟s injury and examine directly by hand. Based on all of these, the healers can diagnose the disease and offer their patients specific and appropriate treatment. General conception of medical occupation transfer In Vietnam, the experience of making medicine of ethnic minorities is often passed from one generation to another [5, pp.11-12]. Almost the Thai and the Muong adults simply know how to use some herbal remedies to prevent and treat some common diseases such as flu, stopping the bleeding wounds, bellyache... In case of complicated and serious diseases, they need help from traditional healers with “synthetic” remedies. The method of traditional medical occupation transfer for common remedies is very simple, mainly through oral tradition by practicing it in daily life. If someone gets sick, they will be cured by their relatives or neighbors. They will guide patient how to recognize medicinal plants, the way to collect, ration of each herbs to make a folk remedy witness some taboo if there are any... This is a popular form of medical occupation transfer among ethnic groups containing profound human values inside. To learn traditional medical occupation, each disciple has to experience traditional rituals. In traditional healers‟ opinion, besides ethical standards, those who are transferred the occupation must has some characteristics like gentle, calm, patient, carefulness and eager to learn things. In fact, learning medical occupation (based on medicinal herbs) is a long-term learning process to accumulate healing experience by the time. However, it is noted that traditional healers only share some common folk remedies not valuable remedies (such as curing snake bites or visceral diseases) for community. This can be explained that traditional healers want to keep inheriting secrets of their family and due to some superstition factors. Therefore, the valuable folk remedies do not widely spread to public. 2.4. General conception of disease and causes of disease The conception of disease and causes of disease are part of health system and cultural system as well. According to the traditional conception of ethnic minorities in Vietnam in general and ethnic groups in mountainous areas of Thanh Hoa in particular, the causes of disease are explained in following different ways [2, 3, 5, 12]. Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 120 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 2 0 Firstly, local people believe that sickness is generated by the imbalance between human body and living environment. In Northern Vietnam, the four-season climate has different properties, then it causes many different seasonal diseases. Secondly, diet and hard working conditions and sufficient abstinence are also the causes of disease. Thirdly, due to casual accidents happening at the work place or the lack of care during their work, people are more likely vulnerable or ill. Fourthly, insects or vectors can also be transmitted animals caused human disease. Although these are new knowledge that local people gained through a wide range of national campaigns and propaganda from modern medical practitioner at commune, they have been aware of this and applied it in their daily life before, this would help contributes to prevent some diseases. More importantly, the cause of sickness from locals‟ viewpoint is explained from spiritual perspectives that illness is caused by their ancestors or ghosts. Almost all ethnic groups believe that healthy people are partly supported and protected by their ancestors. This is why local people deeply respect their ancestors. They fear making their ancestors angry because they believe that if their ancestors get angry they will no longer protecting alive people and make everyone in the family get sick. Thus, indigenous people practice many abstinences to not make any mistakes with their ancestors. This is also a common spiritual views among other ethnic minorities in Vietnam. Besides, sickness is generated by the lack of several „vía’ (a part of souls or spirits when people alive and it gone when people die) because it is taken away by the devils. If the of the vía wanders somewhere or it is taken away by the ghosts, the corresponding parts of the body would hurt. And if the vía does not come back to the body, people will die. Thus, vía is one of five reasons that caused human sickness, suffering, pain and even death. 2.5. Common characteristics of collecting, processing and preserving traditional medicinal herbs of the Thai and the Muong in mountainous areas of Thanh Hoa The herbal remedies of the Thai and the Muong as well as in other ethnic groups are mainly exploited in nature. Abundance of herbal plants is recognized by the Thai as valuable medicine resources is available surrounding us “Hắng mạy lí xi ná khánh” (good medicine is stuck in the legs). One of the famous writing with many good remedies is in the book titled Medicinal Book of the Muong (Sách thuốc Mường1), compiled by Le Xuan Ky - district Chief in Lang Chanh (the time under French domination). This book is a precious collection of valuable medicinal plants and traditional remedies of the Muong and the Thai in Lang Chanh district. In the preface of the book, the author has written: “In the old days, Vietnamese people used to take leaves or plants to make medicine while suffering from diseases, it seems that Vietnamese traditional medicine is valuable and effective to cure diseases. Later on, practicing the Chinese and Western medicine was introduced and became more popular, so few people pay attention to national medicine as before. Moreover, people are often selfish, if anyone knows valuable remedies, they only keep it jealously or pass it on to their grandchildren not for others in community, as a result, some unfortunate families who suffering from illness are not 1The document was stored and provided by Mr Ha Chi Can in Lang Chanh district. The author would like to thank him sincerely for providing such precious document Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 121 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 2 1 cured and die and valuable remedies also gone with those who know it Vietnamese traditional medicine (thuốc Nam) is not life-threatening; in case of skin treatment, if medicine (herb) is not appropriate, it will make the skin red, warmer or even hurt more, when some diagnose happen, people know that medicine is inappropriate, they only need to take warm water to wash it away and alternate by other remedies; medicine is suitable when the skin get cool, smooth and comfortable. The same goes for oral medications, nothing is harmful to one’s life-threatening. Most of medicinal plants is in the forest, many herbs do not have Vietnamese names (Vietic), because these plants are not available in China; so many of them only have the name in the Thai and Muong lingoes ...” [6, pp.775, 776]. Briefly, the folk remedies in Medicinal Book of the Muong collected by Le Xuan Ky are precious documents in terms of traditional medicine, carefully introduced and noted by the author in terms of the name and the use of medicinal plants by bio-languages: the Thai and the Muong for convenient searching. This shows the author‟s ethical responsibility as well as his deeply understanding of Muong and Thai folk medicines in the mountainous areas of Thanh Hoa. The herb- doctors have lots of experience in finding, collecting plants, writing out a prescription and making it up. Depending on types of disease based on healer‟s knowledge and experience, they will pick the suitable herbs to treat disease fo patients. Towards collecting herbal plants, each ethnic group has certain rules and taboo that healers must follow. That is an explanation why local people believe that the taboo is crucial to the success or failure of the healing process. For the Thai and Muong people, specifically, before going to the forest collecting herbal plants, traditional healers have to make offerings and put it on the altar to pray their ancestors for finding good herbs, when disease are cured, they have to give offerings on the alter again to show their gratitude towards their ancestors. There is a common outlook of herb- doctors of ethnic minorities in the mountainous areas of Thanh Hoa that it is better to collect medicinal plants in the morning than in the afternoon, especially never collect herbal plants at noon because the scorching sun will “release all good substance of herbs”, or refrain from collecting herbs on rainy days because the rain will “reduce good substance of herbs”, that lessens treatment process or even the treatment has no effect at all. This is also similar to some scholars‟ perspective on the impact of the time collecting medicinal plants [7, pp.59]. Moreover, the healers believe that when picking the first medicinal plant, it must be carefully considered, if they are not satisfied with the first plant, they must keep it or take it to home whether they use it or not. If they give the first medicinal plant away, it means that they refuse to receive the gift from their ancestors and the Gods given, then finding the next plants will be very difficult, even they are unable to find the medicinal plants that they need or they found it but it will no longer have healing effects. When the bulbs are taken or if the roots are not totally removed, the medicinal plants must be replanted in the same place [10]. This is the folk knowledge in using and protecting medicinal plants. This is also an action to protect and sustainably maintain the source of medicinal herbs in particular and forest resources in general of the Thai and the Muong. Regarding the process of making medicinal plants, most ethnic groups in mountainous areas of Thanh Hoa uses both fresh and dried plants. Fresh herbs are used immediately after picking up while dried herbs are used after preparing. From the realities of everyday practices it shows that using fresh herbs is better than dried one because substance of fresh herbs has Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 122 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 2 2 not been changed while dried herbs have lost good substances due to processing. However, for some vital herbs that if difficult to find out or must be transported long distances, it is processed into dried form for convenient use and storage. In fact, storing fresh herbs is difficult because “the vast majority of herbs are made up of plant cells with full of nutritional ingredients that also are suitable for the development of microorganisms, especially the mold. Therefore, when the humidity of the air low or high, the mold develops well and creates some toxins that are harmful for patients’ treatment” [10, pp.62]. In short, the traditional medicinal herbs of the Thai and the Muong ethnics in mountainous area of Thanh Hoa plays a crucial role in taking care of public health, especially it is important for the part of vulnerable population who have little chances to access modern healthcare system due to the difficult social - economic conditions. The results of some initial research show that indigenous knowledge about traditional medicine of the Thai and the Muong is very rich and diverse. This is reflected through practical experiences of local residents such as the concept of sickness, disease, medicine and medicinal occupation transfer, prevention and treatment, eating and drinking from the perspective of nourishment and healing. These experiences are passed on one generations to another and still valuable in the modern life, which contributes to take care of community health. 3. Current situation and conservation solutions promoting the values of Vietnamese traditional medicine From 1954 to present, provinces and districts in mountainous areas of Viet Nam have been strongly affected by the economic development policies of the Party and Nation. Natural resources in general and natural medicinal plant sources in mountainous districts of Thanh Hoa have faced four basic issues. Firstly, the emergence of the movement of agricultural cooperation and the emergence of forest enterprise for exploiting and processing wood; Secondly, the participation of residents who migrated from the plain or lowland to highland to settle down and boost up the national economy under the national socio-economic development policies; Thirdly, an increase of indigenous population and changes in society and population; Fourthly, the impact of the market- economy and some external factors from society. These four issues directly and indirectly impact on natural resources at different levels. Many research results have shown that biodiversity, cultural diversity and indigenous knowledge are always interrelated and interdependent. In modern context, in the period 1960 - 1980, many head forests in the mountainous areas of Thanh Hoa were exhausted, number of plants and animals was reduced dramatically that leads to reduce the quantity of traditional herbs. Accordingly, indigenous knowledge about traditional medicine fell into oblivion. Thus, the current situation of exploitation of medicinal materials of ethnic minorities in mountainous area of Thanh Hoa has raised many issues that need to be addressed. In recent decades, the excessive trading of a large amount of medicinal plants inside and outside Thanh Hoa are alarmed. Medicinal plants become the commodity product bought by intermediaries from the local people. Whether intentionally or unintentionally, medical plants exploiters and traders are both engaged in taking healthcare of local people and a mass of population across the country. That is the positive side of the issue. However, another face of the coin is that local people Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 123 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 2 3 themselves are joining in deforestation group. They are destroying forest and natural resources day by day. Consequently, it is harder to find some first vital plants for traditional remedies. Additionally, some ethnic groups still maintain their traditional treatment by using medicinal remedies. Witnessing some outdated opinion, backwards knowledge and old practices in treatment by using herbs based on experience, many contents in using medicinal plants are very useful until now. Besides using traditional remedies, ethnic minorities recently have combined them accordance with using modern medicine. Local people are aware of the advantages and disadvantages of oriental medicine and western medicine. They use both methods to treat diseases, then public health is improving accordingly. For instance, in Ba Thuoc district, some Thai and Muong healers use the tomography result of patient‟s bone fracture combined with using herbal leaves or traditional healers use ultrasound results combined with their professional experience to pick up suitable herbs to treat some diseases. For the above reasons, the authors would like to suggest some solutions to conserve and promote the value of local knowledge about herbal medicines as follow. Firstly, the traditional healers have to take advantages of using herbal remedies or some esoteric remedies to protect the public health. This obviously promotes medical ethics and contributes to the sustainable socio-economic development of the mountainous areas. Secondly, systematical studying about indigenous knowledge of traditional medicine and re-assessing the effectiveness of each remedy to apply it directly to taking care of public health are necessary. Also, the government should enact some policies to encourage and reward traditional medical practitioners who have made great contribution in taking care of public health. Last but not least, we should develop a plan to protect intellectual property rights for indigenous knowledge on folk medicine, in particular traditional medicine, in order to protect the spiritual rights of indigenous knowledge holders. The commercial exploitation of indigenous knowledge of herbal medicine will bring economic benefits not only for those who hold indigenous knowledge but also for the well-being of the whole community as well. 4. Conclusion In general, the issue of public health in Vietnam has been concerned for a long time. Specifically, the ethnic community of Thanh Hoa, typically the Thai and the Muong people, have gathered valuable treasures of folk medicine to take care community health. Their knowledge about traditional medicine is expressed through cultural and spiritual activities, the use of plants and medicinal herbs to make medicine. These are the experiences that anthropologists perceived as the way local people be aware of health and treatment. This sheds light on the mutual relation between socio-culture and ecology in each region and each ethnic group. However, recently, Vietnam has no specific regulations on community copyright, such as taking valuable remedies and knowledge of using the remedies from indigenous people must be returned for that community. Moreover, many precious medicinal plants of many ethnic groups do not have scientific names; the use of herbs is also based on local people‟s experience and their senses, the lack of scientific evidence. Nonetheless, folk knowledge about traditional remedies is a national cultural heritage that needs to be preserved and promoted. Therefore, promoting research and understanding the value of medicinal Hong Duc University Journal of Science, E6, Vol.11, P (116 - 124), 2020 124 F ac. o f G rad . S tu d ies, M ah id o l U n iv . M . M . (In tern atio n al H o sp itality M an ag em en t) / 1 2 4 plants, preserving and using knowledge of valuable medicinal plants will contribute to preserving the national cultural identity as well as traditional medicine and conserving natural resources is an urgent need of each nation. References [1] Le Dinh Bich (1990), An investigation on medicinal plants and folk remedies of the Muong in Lang Chanh district, Dissertation of Pharmacy, Hanoi University of Pharmacy. [2] Vu Truong Giang (2008), Indigenous knowledge of Vietnamese traditonal medicine of the Thai people in mountainous areas of Thanh Hoa (case study in Yen Khuong commune, Lang Chanh district), Journal of Ethnology (1). 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