By Lena Lopez

Although the government in Vietnam intends to develop an identifiable Vietnamese Medical Science, traditional medicine has existed for generations. There are three medical traditions which have coexisted in Vietnam prior to the impact of Western Medicine: these are Thuoc Bac (Northern Medicine), Thuoc Nam (Southern Medicine), and Thuoc Tay (Western Medicine).

With Thuoc Bac or Northern Medicine only those Vietnamese capable of reading Chinese characters could diagnose and prescribe remedies. Northern medicine began with the belief that out of Yin-Yang force interactions and the eight trigrams, one could construct a model of the entire universe, valid on both material and moral planes. The human body was thus a microcosmic reproduction of the vast dynamic natural forces at work in the universe. The body was intimately and constantly linked to those external forces, so that good health depended in large part on tuning internal functions to the environment, as well as building defenses against disruptive changes. Disease was defined as impairment of the overall balance between external and internal, physical and moral forces. Many drugs and methods of treatment clearly emerged by trial and error, only later being incorporated by Chinese metaphysicians into medical ideology.

Vietnamese practitioners of Northern Medicine relied on the four-part clinical examinations: visual inspection, auditory perception, questioning the patient, and taking his pulses. Other techniques of examination would be listening to the patient cough to even tasting his urine. Significantly, asking a patient for his past medical history or questioning him in detail about symptoms often caused suspicion. Expectations were placed on a good physician to know what was wrong from outward signs, and not have to rely on the perceptions of a untutored patient.

A physician first decided whether the illness was ni thÜÖng that is to say, emanating mainly from within the body due to poor physical maintenance or emotional strain, or ngoåi cäm, the result of external forces (time of year, weather, humorous food, drink) disrupting the body's systemic harmony. After that he needed to determine whether the disease was still superficial in character (bieu), or already lodged deep in the major organs of the body (ly). The 'hot' and 'cold' components had to be delineated. Finally he reviewed all symptoms to judge whether some actually disguised the ultimate source of illness, rather than revealing them.

Particular drugs could be administered to produce sweating, expectoration, defecation, urination, vomiting, heat reduction or heat increase. Other ingredients who designed to excite or soothe particular organs. Still others might be added to offset harmful side-effects. If a first choice of prescription did not appear to work, three of four other prescriptions existed for the same complaint. Some Northern medicine ingredients were extremely rare and treatment could become very expensive for the patient, capable of ruining an entire family financially if the disease persisted for very long.

The second tradition available to Vietnamese was Thuoc Nam, or 'Southern Medicine'. It relies almost exclusively on tropical plants and animals native to Vietnam. It was a poor man's medicine, generally using ingredients readily available nearby and involving a minimum of processing. Most knowledge was passed unselfconsciously from one generation to the next. Thus every one understood that for a common cold one could eat rice gruel laced with onion, place one's head under a blanket for a herbal steam bath (xông), or to rub a coin hard across certain parts of the body (cåo gio). Headaches could be treated by pinching or pricking the forehead. Preheated bamboo tubes or small glass cups were applied to the skin to suck out perverse humors. Garlic or soapherry helped some in danger of fainting, ginger relieved stomach aches and a broth made from tangerine rind lessened nausea. Chewing fresh tea leaves or guava buds might halt diarrhea, apricot leaves might relieve dysentery.

The third Vietnamese medical tradition Thuoc Tay involved dealing with harmful spirits, preferably by preventing them from entering the body at all. Or failing that, by finding a way to exorcise them and hence regain physical and mental equilibrium. The spirits went by many names and techniques for dealing with them were innumerable.

Concern began during pregnancy, when mothers wore amulets to protect the fetus, and continued into childbirth, when a symbolic notice was hung outside the home to ward off visitors for fear that someone of 'bad corporal essence' (xÃu viá) would make the infant sick. For the first year the infant's real name was not mentioned, to lessen the chances of being noticed by demons. Until the age of twelve, magical formulas were available to ward against Con Ranh, a demon specializing in killing children.

When a family member became seriously ill, defensive prayers would probably be offered to the ancestors, and someone sent to a fortune teller to try to ascertain which particular spirit was causing the trouble, and where one might go to offer food and seek forgiveness. If that failed to work a variety of Buddhist monks, Taoist priests, sorceress, and mediums were available. Either the patient or his close relative could proceed to cleanse himself, abstain from eating meat, and sleep at a temple or pagoda in hope of experiencing a dream which revealed the source of the problem. It was even sometimes necessary to shift the grave of an ancestor or move one's own residence to a more favorable position.

It is important to ask how the three medical traditions related to each other. Both Northern and Southern Medicine were primarily secular and naturalistic in character, not religious or spiritual. A stomach ache or an abscessed tooth was treated with pharmaceuticals, or perhaps acupuncture. If these did not work another technique would be attempted, or the patient would go to a different practitioner. There were no incantations, no ghosts, no battles of hex and anti-hex as in Eastern medicine. Similar to Eastern physicians, Northern medical practitioners in Vietnam had no reservations about including magical components in their ingredients. One remedy for post-partum illness specified that a particular leaf had to be picked in utmost secrecy or it would lose its effectiveness. Another in the same text, after curing the symptoms of a bewitched person, prescribed the drinking of one bowl of warm blood from the neck of a freshly killed black dog in order to expel the poisons from the body.

Contrary to Northern Medicine beliefs, Eastern Medicine practitioners believed that humans possessed three 'souls' (hÒn), unlike animals with two, or plants with one. These could be attacked or lured out of the body. Death meant loss of all three souls, unconsciousness the loss of two, and various mental or physical disorders the loss of one.

In conclusion, since 1954, Vietnam had inevitably produced two very different health systems. In the South, the government extolled Northern medicine and tried repeatedly to restrict the role and status of traditional practitioners. In the North, building on practical experience obtained during the Anti-French Resistance, Ho Chi Minh urged all medical practitioners to study means of 'harmonizing' Eastern and Southern remedies. Meanwhile the advent of the Second Indochina War forced ordinary citizens in both regions to fall back on local initiatives and remedies.

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