Mongolian traditional medicine

1. Introduction

Version followed: Mongolian traditional medicine (TMM, Mongolian уламжлалт анагаах ухаан) as state-supported and practised in Mongolia since the 1990 revival, a member of the Sowa Rigpa (Tibetan-derived) family of medical systems. The larger, more industrialised Mongolian medicine of Inner Mongolia (China) is noted only for contrast. Theory is given from Sowa Rigpa sources where Mongolia-specific textbooks could not be consulted [uncertain: not verified against a Mongolian national textbook].

TMM is a codified medical system with its own university training, state licensing, hospitals, pharmacopoeia and medicine industry. It is not a psychotherapy, and a psychotherapist does not practise it. Its practitioners are physicians called emchi (эмч), trained at university or private colleges and licensed through the Ministry of Health. This guide describes the system as its institutions and scholars publish it, then sets out the psychotherapist's own culturally responsive work alongside it. [source: Kloos; Hoffmann 2020]

Core idea of change, as the system holds it: health is a balance among three bodily principles, khii (хий, wind), shar (шар, bile) and badgan (бадган, phlegm), and between the body and its environment. Illness is their excess, depletion or disturbance; treatment restores balance through diet, behaviour, medicines and external therapies. The tradition links this to Buddhist teaching, and in Sowa Rigpa mental and emotional suffering is chiefly attributed to disturbed wind. [source: Hoffmann 2020; Shi et al. 2025; Nidup (Faculty of Traditional Medicine, Bhutan); Polish Journal of the Arts and Culture 2015]

2. Framework

This section has two layers: (A) the system as its institutions publish it, which the therapist needs to understand; (B) the therapist's own course of work alongside it.

A. The system: history, authority, theory, diagnosis, therapies, safety

History. Tibetan medicine was Mongolia's "sole professional health resource since the seventeenth century"; between 1662 and 1937 over 100 monastic medical schools (manba datsan) were founded in Inner and Outer Mongolia. In 1937 the ruling party framed traditional medicine as a potential weapon "in the lamas' hands"; the 1937–1938 purges followed and the sale of Tibetan medicine was banned in April 1938. Some lama doctors practised and taught in secret. A state pharmacology laboratory founded in 1959 under Tsend Haidav became the basis of a modern "Mongolian medicine" identity. Practitioners resumed open practice in 1990. [source: Kloos] Anthropologists describe the post-1990 revival as a return to a traditional understanding of health after decades of biomedical dominance. [source: Hoffmann 2020]

Who holds authority (Mongolia).

Ministry of Health: oversees licensing and medical education through its Center for Health Development. [source: Kloos] The state has a national policy on developing Mongolian traditional medicine, with six aims: wider access at sub-district, district and general care levels; protecting and studying the textual heritage; new methods for conditions hard to treat with modern medicine; training and retraining practitioners; safe new medicines and foods from natural ingredients; and sustainable use of medicinal plants, animals and minerals. Its adoption date is [uncertain: not verified]. [source: UNEP LEAP record]
Universities and colleges: a Traditional Medicine Department opened at the Health Sciences University in 1990 and is now the International School of Mongolian Medicine of the Mongolian National University of Medical Sciences (MNUMS). Private colleges include Manba Datsan (college founded 1991, with an 80-bed hospital and factory) and Otoch Manramba (1991). The first 24 professionals graduated in 1993; a standard curriculum introduced in 2012 is roughly 60% biomedical. [source: Kloos] A trial traditional-medicine class at an MNUMS-affiliated general school opened in the 2026–2027 school year as the first step of a planned tiered pathway. [source: iKon.mn 2026]
Professional body: the Association of TMM Doctors and Researchers (1999). [source: Kloos]
Service delivery: TMM clinics in state hospitals (e.g. Ulaanbaatar Central Hospital No. 1), TMM units in second- and third-level hospitals (described as weakly implemented), and around 175 hospitals and clinics offering only TMM (2014). TMM's share of health care is described as stagnating at about 3%. [source: Kloos]
Medicines regulation: safety requirements from 2002 test for "bacteria, fungi, and heavy metals"; a 2014 law required producers to register their drugs; a 2017 pharmacopoeia covered 80 single and 80 compound medicines. Seven official producers coexist with up to 50 unofficial manufacturers. [source: Kloos]
Abroad: about 200 TMM doctors practise outside Mongolia, the large majority in Poland. [source: Kloos] Registration rules for TMM practitioners in Poland, the UK, the US, Korea or elsewhere are [uncertain: not verified]; do not assume a foreign title is regulated where the client lives.

Theory (Sowa Rigpa family). Five elements (earth, water, fire, air, space) combine into the three principles: wind governs movement (including nervous-system and breathing functions), bile governs digestion and heat, phlegm governs structure and lubrication. Seven bodily constituents (from plasma to reproductive tissue) and three wastes (urine, faeces, sweat) complete the model; wind and phlegm are classed as cold, bile as hot. Disease arises from excess, deficiency or toxins. [source: Nidup (Bhutan); Shi et al. 2025] Mongolian scholars also stress holism, harmony with nature and constitution types with distinct disease tendencies. [source: Shi et al. 2025] Classical Mongolian texts include an 18th-century work proposing "Six Basic Diseases". [source: Shi et al. 2025]

Diagnosis. Sowa Rigpa names observation, palpation and questioning as the core skills. [source: Nidup (Bhutan)] Pulse reading has been central to Mongolian diagnosis since the Mongol empire. [source: Wikipedia, Traditional Mongolian medicine (secondary)] Urine examination as practised in Mongolia today [uncertain: not verified].

Therapies. Medicines are mostly herbal, with mineral and animal ingredients; 60–70% of non-endemic ingredients are imported. Hospital TMM units may offer acupuncture, electrical, light, water, oil and mud therapies, massage, bloodletting, moxibustion, cupping and physical exercise. [source: Kloos] Bloodletting is described as "one of the most important treatments" in TMM and follows a preparation stage, the procedure itself, and a recuperation stage with dietary and activity restrictions. [source: Kim & Jung 2013] Medicinal springs (arshaan) and their sanatoria are a major healing setting. [source: Turk 2017] Hereditary lay bone-setters (bariach) worked by manipulation alone; the practice is reported to be declining and unstudied. [source: Wikipedia (secondary), citing Lane 2006; Turk 2017 lists bariach among massage practitioners] Household remedies (dom) are a separate folk layer. [source: Wikipedia (secondary)]

Mental-health concepts (attributed). In Sowa Rigpa, mental problems are understood as an imbalance of subtle wind (rlung, Mongolian khii), linked with emotional lability, anxiety, panic, depression and bipolar presentations, and treated through diet and lifestyle, compound medicines, external therapies (e.g. massage, moxa) and Buddhist spiritual practice. [source: Polish Journal of the Arts and Culture 2015] A Bhutanese teaching text lists epilepsy and other mental disorders under wind disorders and links mental disorders to past karma and habitual mental patterns. [source: Nidup (Bhutan)] Mongolian-specific everyday idioms built on khii (e.g. a "heart wind" complaint) [uncertain: not verified]. Alongside TMM, many Mongolians also consult lamas, shamans (böö, udgan), astrologers and energy healers; anthropological fieldwork describes illness attributed to the displeasure of earth and mountain masters among families who moved to Ulaanbaatar, and patients and healers who freely mix biomedical, Buddhist and spiritual approaches. [source: Turk 2017] Shamanic healing is a separate tradition with its own authorities and is not part of codified TMM.

Evidence status. No independent systematic review of TMM clinical effectiveness was located [uncertain]. The main recent review of Mongolian materia medica is pharmacological and largely preclinical. [source: Shi et al. 2025] No TMM practice should be presented as a treatment for mental disorder or physical disease.

Safety as sources state. Classical Mongolian pharmacology grades medicines from acutely to micro-toxic; toxicity depends on processing, combination, administration, material quality and excess dosage (aconite species are a cited example); some plant compounds raise concern with chronic use; and herb–drug interactions with conventional medicines may increase side effects. [source: Shi et al. 2025] Sowa Rigpa "precious pills" may contain processed mercury (mainly mercuric sulfide); a small cross-sectional study found little evidence of toxicity but its authors warn this is not proof of safety, and sampling studies have found Asian traditional medicines exceeding international metal limits. [source: Sallon et al. 2017] The scale of unofficial manufacture in Mongolia raises quality concerns. [source: Kloos] Injuries from bloodletting, cupping, moxibustion and bone-setting in Mongolia have no Mongolia-specific data in the sources used [uncertain: not verified].

B. The psychotherapist's course of work alongside TMM [synthesis]

Phase	Goals	Typical format	Move on when
1. Engagement and cultural assessment	Hear the problem in the client's terms; map TMM, lama, shaman and biomedical help already sought	1–3 sessions; core CFI plus relevant modules; interpreter if needed	Client's explanatory model and current healers and remedies are documented
2. Shared formulation and safety review	Hold the TMM account (e.g. disturbed khii) beside the psychological formulation; screen risk; flag remedy and procedure safety to the prescriber	1–2 sessions	Client agrees a plan that names both systems; prescriber informed with consent
3. Treatment with collaboration	Deliver the agreed psychotherapy; liaise with the licensed emchi when the client wishes	Usual course for the presenting problem	Goals are progressing; no unresolved safety concern
4. Integration and review	Help the client integrate TMM advice, spring stays or religious practice; revisit modules as life changes	Review every 4–6 sessions and at transitions	Ending or step-down agreed

3. Guiding principles

TMM is a licensed medical system, not a therapy you deliver. Never give TMM diagnoses, pulse readings, diet prescriptions or remedies; refer to licensed practitioners. [source: Kloos; synthesis]
Authority sits with the Ministry of Health, MNUMS and licensed emchi. Ask where a practitioner trained and whether they hold a Mongolian licence; titles abroad may be unregulated. [source: Kloos; synthesis]
Attribute, do not adjudicate. Describe khii, shar and badgan, karma or spirit causes as the client and tradition hold them, neither as fact nor as error. [synthesis]
Plurality is normal. Expect clients to combine TMM, biomedicine, Buddhist and shamanic help; ask about all of them without ranking. [source: Turk 2017]
History shapes trust. Decades of suppression (1937–1990) and later revival mean TMM can carry national identity and family memory; dismissing it may feel like a repeat of that suppression. [source: Kloos; Hoffmann 2020]
Never advise on medicines. Do not suggest starting, stopping or combining TMM or prescribed medicines; route every concern to the prescriber and, with consent, the emchi. [synthesis]
Safety first for products and procedures. Unregistered products, heavy-metal content and invasive procedures are medical questions for medical colleagues. [source: Kloos; Sallon et al. 2017; Shi et al. 2025]
Consent and confidentiality govern collaboration. Contact a healer only with the client's explicit, specific consent. [synthesis]
Do not pathologise or miss illness. Wind-language and spirit explanations are idioms, not symptoms; psychosis, mania, suicidality and medical illness still need standard assessment. [source: APA DSM-5-TR Section III; synthesis]
Self-examination. Notice your own assumptions about Asian medicines, Buddhism and post-socialist societies before they shape the formulation. [synthesis]

4. Intervention inventory

These are the psychotherapist's own interventions. TMM diagnosis and treatment belong to licensed emchi and are not listed as therapist techniques. [source: Kloos; synthesis]

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with Mongolian clients or anyone using TMM, to stop personal assumptions about "herbal", "Buddhist" or "post-Soviet" care from steering the formulation. [synthesis]
Steps: (1) Note your own beliefs about traditional medicine, Buddhism and shamanism. (2) Learn the basic history: monastic medicine, the 1937–1938 purges and the 1938 ban, the 1990 revival. [source: Kloos] (3) Ask the client to teach you their terms rather than importing textbook ones. (4) Seek supervision or consultation when you notice judgement or fascination. [synthesis]
Example language (illustrative): "I know only a little about Mongolian medicine, so please correct me when I get it wrong."
Watch for: exoticising (treating the client as a cultural specimen) or quiet dismissal; the client simplifying or hiding their healing choices. Working when the client volunteers more about TMM and other healers over time.

4.2 Core Cultural Formulation Interview (DSM-5-TR)

Purpose / when: at intake or when a cultural factor seems to affect diagnosis or engagement. The CFI has 16 questions in four domains: cultural definition of the problem; cultural perceptions of cause, context and support; cultural factors affecting self-coping and past help-seeking; cultural factors affecting current help-seeking. It informs clinical judgement and is not the sole basis for diagnosis. APA describes it as usable "by any clinician providing services to any individual in any care setting." [source: APA DSM-5-TR CFI; APA DSM-5-TR Section III]
Steps: (1) Use the official APA form; clinicians may reproduce it for use with their own patients, but translation or modification needs APA permission. [source: APA DSM-5-TR CFI] (2) Work through the four domains in order, paraphrasing to fit the conversation. (3) Under past help-seeking, ask explicitly about emchi, TMM hospitals, medicinal springs, lamas, shamans and biomedicine. (4) Record the client's own words for the problem (e.g. "my khii is disturbed"). (5) Summarise back and ask what you missed. Time needed: the APA forms give none; field-trial reports of about 15–20 minutes [uncertain]. [source: APA DSM-5-TR CFI; synthesis]
Example language (illustrative): "People describe problems in different ways. How would you describe what has been happening, and how would your family describe it?"
Watch for: answers given in biomedical terms the client thinks you want; reluctance to name traditional or spiritual help. Working when the client's own explanation and help-seeking map emerge without prompting.

4.3 CFI supplementary modules

Purpose / when: to deepen the core CFI. APA publishes 12 modules (Explanatory Model; Level of Functioning; Social Network; Psychosocial Stressors; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Patient–Clinician Relationship; School-Age Children and Adolescents; Older Adults; Immigrants and Refugees; Caregivers). They can be added at first evaluation, later, or repeatedly. An Informant Version (17 questions) is used with a family member or friend. [source: APA Supplementary Modules; APA Informant Version]
Steps: (1) Choose modules from the core CFI subtopics that need depth. For TMM users the most relevant are Explanatory Model, Spirituality, Religion and Moral Traditions (Buddhist practice, karma), Coping and Help-Seeking, Cultural Identity and, for migrants (e.g. students or workers in Korea or Poland), Immigrants and Refugees [synthesis]. (2) Use the Older Adults module where elders carry memories of suppression. (3) Use the Informant Version with relatives who manage remedies or healer visits. (4) Repeat modules at transitions (e.g. after a sanatorium stay). [source: APA Supplementary Modules; synthesis]
Example language (illustrative): "Does your faith or any teacher, lama or doctor of Mongolian medicine help you understand this?"
Watch for: turning modules into a checklist; family informants overriding the client. Working when the formulation names the client's spiritual, family and healer resources.

4.4 Explanatory-model inquiry (Kleinman)

Purpose / when: when the client frames distress in TMM terms (wind, heat and cold, constitution), karma or spirit causes. Kleinman, Eisenberg and Good (1978) proposed eight questions: what the client calls the problem; its cause; why it started when it did; what it does and how it works; how severe it is and how long it will last; what treatment the client thinks they should receive; the chief problems it causes; and what they fear most. [source: Tanenbaum handout; Dinos et al. 2017]
Steps: (1) Ask the eight questions in your own words. (2) Note where TMM and psychological explanations agree (e.g. both see stress, poor sleep and diet as relevant) and where they differ. (3) Frame treatment goals so both can sit together. (4) Never correct the TMM account; add the psychological account alongside. [synthesis]
Example language (illustrative): "Your emchi said your wind is disturbed. What does that mean for you, and what do you think would settle it?"
Watch for: the client expecting you to endorse or reject the emchi; fear that psychological help means the TMM view is wrong. Working when the client can hold both accounts and agrees goals in both languages.

4.5 Mapping the healing pathway

Purpose / when: early and at review, because Mongolian clients often use several systems at once. [source: Turk 2017]
Steps: (1) Draw a timeline of all help sought: emchi (state hospital, private clinic, college hospital), medicinal springs and sanatoria, bone-setters or massage practitioners, lamas, shamans, astrologers, energy healers, biomedicine. [source: Turk 2017; Kloos] (2) For each, note what was advised, what helped, costs and any harm. (3) Ask who in the family decides on care. (4) Record current remedies and procedures for the prescriber. [synthesis]
Example language (illustrative): "Many people see more than one kind of healer. Who else has been helping you with this?"
Watch for: costly or competing advice; delays to urgent care; a client exhausted by moving between healers. Working when the map is complete and the client chooses a coordinated plan.

4.6 Working with khii and other idioms of distress

Purpose / when: when a client uses wind-language or similar idioms. DSM-5-TR describes cultural concepts of distress as idioms, explanations or perceived causes, and syndromes, and lists examples such as ataque de nervios, dhat, hikikomori, khyâl cap, kufungisisa, maladi dyab, nervios, shenjing shuairuo, susto and taijin kyofusho. [source: APA DSM-5-TR Section III; UNMC DSM-5-TR slides] A Mongolian wind idiom is not among the listed DSM-5-TR concepts [uncertain: list taken from secondary slides].
Steps: (1) Treat khii language as a culturally meaningful explanation and idiom, not a diagnosis. (2) Ask what the client feels in the body and mind when khii is disturbed. (3) Screen separately for depression, anxiety, trauma, psychosis and suicide risk with standard tools. (4) Use the client's term in sessions where it helps engagement (e.g. naming a breathing or grounding exercise as calming, without claiming it treats wind). [synthesis]
Example language (illustrative): "When your wind is unsettled, what do you notice first, in your chest, your sleep, your thoughts?"
Watch for: reading the idiom as somatisation or as psychosis; claiming a psychological technique balances the humors. Working when the client uses the idiom freely and standard screening is also complete.

4.7 Distinguishing spiritual experiences from disorder

Purpose / when: when a client reports spirit causes, shamanic calling, troubled earth or mountain masters, or trance. [source: Turk 2017; Sodnompilova 2021] Among Turkic-Mongolian peoples, conditions such as visions or convulsions have been read as spirit communication or a sign of being chosen as a shaman (scholarly, outsider account). [source: Sodnompilova 2021]
Steps: (1) Ask whether the experience is recognised and accepted by the client's community and religious authorities. (2) Apply DSM-5-TR exclusions: dissociative trance and possession-form presentations are not diagnosed when they are a normal part of broadly accepted cultural or religious practice; ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary, unwanted and impairing. [source: DSM-5 wording via PMC9199574 (DSM-5-TR keeps it in substance [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]; exact DSM-5-TR wording [uncertain]); ICD-11 via findacode] (3) Consult a cultural broker or, with consent, a lama or other community authority the client trusts. (4) Assess for psychosis, mania or medical causes in parallel. (5) Do not direct the client to shamans or ceremonies; leave that to their own community pathways. [synthesis]
Example language (illustrative): "Is this something others in your family or community would recognise? How do they understand it?"
Watch for: pathologising an accepted spiritual role; missing a first episode of psychosis or mania. Working when the formulation separates the culturally accepted meaning from any disorder needing care.

4.8 Remedy and medicine safety conversation, routed to the prescriber

Purpose / when: whenever a client takes TMM medicines (pills, powders, decoctions) alongside prescribed medicines, or obtains products informally or from abroad. Sources report herb–drug interactions that may increase side effects, toxicity linked to processing, combination and dosage, mercury-containing Sowa Rigpa preparations, and unofficial manufacture in Mongolia. [source: Shi et al. 2025; Sallon et al. 2017; Kloos]
Steps: (1) Ask neutrally what the client takes, from whom, and whether it was prescribed by a licensed emchi. (2) Do not comment on whether any product is safe, effective or should be changed. (3) With consent, inform the prescriber (GP or psychiatrist) in writing, listing products by name as the client gives them. (4) Encourage the client to tell both their emchi and their prescriber about all medicines. (5) Flag new physical symptoms (e.g. tremor, gum problems, jaundice, unusual fatigue) to medical colleagues promptly rather than interpreting them. [synthesis]
Example language (illustrative): "I can't advise on medicines, but your doctor and your emchi should both know everything you take. Shall we write a list together for them?"
Watch for: the client stopping psychiatric medication in favour of TMM, or the reverse, without medical advice; products bought online or carried from Mongolia without labels. Working when the prescriber has a complete list and the client feels no need to hide either system.

4.9 Collaboration and referral with licensed TMM practitioners

Purpose / when: when the client wants their emchi involved or asks for a TMM referral. In Mongolia, licensing and medical education are overseen by the Ministry of Health, and practitioners train at the MNUMS International School of Mongolian Medicine or recognised private colleges. [source: Kloos]
Steps: (1) Confirm the client wants contact and what may be shared; get written consent. (2) Ask the practitioner's training institution and licensing status; outside Mongolia, check what (if any) local registration applies [uncertain: not verified for Poland, UK, US, Korea]. (3) Share only what is needed (e.g. risk concerns, coordination of appointments). (4) Agree who the client contacts in a crisis (always emergency and biomedical services). (5) Do not refer to unlicensed sellers, informal manufacturers or self-described healers outside recognised pathways. [synthesis]
Example language (illustrative): "Would it help if I spoke with your emchi so we aren't giving you conflicting advice? You decide what I share."
Watch for: the therapist becoming a broker of TMM treatments; confidentiality slipping in small diaspora communities. Working when advice is coordinated and the client reports less conflict between helpers.

4.10 Interpreters and cultural brokers

Purpose / when: when the client is more fluent in Mongolian, or when TMM, Buddhist or shamanic terms need explaining. [synthesis]
Steps: (1) Use a trained interpreter, not a family member, for assessment. (2) Brief them that terms such as khii, shar, badgan, emchi or arshaan should be kept and explained, not replaced by English medical words. (3) Check for community ties that could affect confidentiality in a small diaspora. (4) Use a cultural broker (e.g. a Mongolian clinician or community worker) for formulation questions, with consent. [synthesis]
Example language (illustrative): "Please keep the client's own words for the illness, and tell me if a term has no English equivalent."
Watch for: interpreters correcting or editorialising about traditional beliefs; client discomfort with a known community member. Working when the client's terms appear verbatim in notes.

4.11 Consent and safety around physical procedures

Purpose / when: when the client receives bloodletting, cupping, moxibustion, massage, bone-setting or spring and mud treatments. [source: Kloos; Kim & Jung 2013; Turk 2017] The therapist does not perform or advise on any of these.
Steps: (1) Ask what procedures are planned and who performs them. (2) Encourage medical clearance where the client has a bleeding, heart, skin or pregnancy-related condition, or takes anticoagulants [synthesis]. (3) Remind the client that they can refuse or stop any procedure, and that no procedure should involve sexual or genital touch; intimate areas should only be involved with clear clinical explanation and consent. (4) Ask after procedures about pain, bruising, burns, dizziness or infection signs and refer these to medical colleagues. (5) For trauma survivors, discuss in advance how touch or restraint-like positioning might affect them. [synthesis]
Example language (illustrative): "You can always say stop during any treatment. How did your body feel after the last session?"
Watch for: procedure injuries, fainting, anaemia symptoms, retraumatisation from touch; any sexual boundary violation (a safeguarding matter). Working when the client describes consent being sought and respected.

4.12 Integrating TMM regimens into psychotherapy plans

Purpose / when: when an emchi has advised diet, daily routine, rest or spring stays, which Sowa Rigpa counts among its core treatments. [source: Nidup (Bhutan); Polish Journal of the Arts and Culture 2015] [synthesis for the integration]
Steps: (1) Ask the client to describe their regimen in their own words (do not set or alter it). (2) Where it overlaps with psychological goals (regular sleep, reduced alcohol, structured days), fit behavioural activation or sleep work around it. (3) If a regimen conflicts with psychological safety (e.g. isolation, food restriction worsening an eating disorder), raise it with the client and, with consent, the emchi and prescriber. (4) Help the client reflect on meaning after a sanatorium or spring stay. [synthesis]
Example language (illustrative): "Your emchi has asked you to keep regular meals and rest. Could our sleep work fit with that?"
Watch for: the therapist prescribing diet or lifestyle in TMM terms; regimen used to avoid feared situations. Working when goals in both systems reinforce each other.

4.13 Acknowledging historical suppression and intergenerational memory

Purpose / when: when TMM, Buddhism or lamas carry family history, or when the client distrusts state or Western services. Sources describe the 1937–1938 purges, the 1938 ban, decades of anti-TMM propaganda, and post-1990 revival as recovering national identity. [source: Kloos; Hoffmann 2020]
Steps: (1) Ask whether the family has stories about lamas, monasteries or healers in the socialist period. (2) Validate that choosing TMM may also be an act of identity. (3) Explore intergenerational loss or fear if present, using trauma-informed pacing. (4) Notice your own position as a representative of biomedical services. [synthesis]
Example language (illustrative): "Some families have long memories about the years when monasteries were closed. Is that part of your family's story?"
Watch for: reopening family trauma without consent or containment; romanticising the past. Working when the client experiences their choices as respected.

4.14 Working with families

Purpose / when: when relatives decide on healers, carry remedies, or disagree about TMM versus psychiatry. [synthesis]
Steps: (1) With consent, invite key relatives; use the CFI Informant Version or Caregivers module. [source: APA Informant Version; APA Supplementary Modules] (2) Map each person's explanatory model. (3) Look for shared goals (recovery, function, family harmony). (4) Agree a plan naming both biomedical and TMM roles, and crisis steps. [synthesis]
Example language (illustrative): "Everyone here wants her to get well. Can we look at what each of you thinks will help most?"
Watch for: family pressure to stop psychiatric treatment or to keep the client at a healer while unwell; elders' authority silencing the client. Working when the family agrees a coordinated plan.

4.15 Safeguarding and risk

Purpose / when: when a practice, product or delay of care risks harm: unlabelled or informally made products, signs of poisoning, invasive procedures by unqualified people, delayed treatment of psychosis, mania, suicidality or physical illness, or any abuse presented as healing. Minors need particular care: consent of parents and the child's assent for any procedure. [synthesis; source on informal manufacture: Kloos]
Steps: (1) Assess risk with standard suicide and self-harm practice. (2) Escalate medical concerns to physicians the same day where urgent. (3) Follow local safeguarding procedures for children and adults at risk; consult safeguarding leads. (4) Document what the client reported in their words. (5) Stay respectful of the system while acting on the specific harm. [synthesis]
Example language (illustrative): "I respect your medicine. My concern is this particular symptom, and I want a doctor to see you today."
Watch for: fear that reporting will shame the family or community; under-reaction out of cultural caution. Working when the risk is addressed and the client stays engaged.

4.16 Diaspora and transnational care

Purpose / when: for Mongolian students, workers and families abroad (TMM doctors work abroad, mainly in Poland), who may combine local services with practitioners at home or remedies sent from Mongolia. [source: Kloos] [synthesis for the steps]
Steps: (1) Ask whether the client consults practitioners in Mongolia by phone or on visits. (2) Note remedies imported or posted, and share with the prescriber. (3) Consider the Immigrants and Refugees CFI module. (4) Explore loneliness for homeland foods, landscapes and springs that anthropologists link to health and identity. [source: APA Supplementary Modules; Turk 2017]
Example language (illustrative): "Do you still see a doctor of Mongolian medicine back home, or receive medicine from there?"
Watch for: unregulated imports; homesickness expressed as bodily complaints. Working when the client feels both systems are reachable and coordinated.

5. Handling problems

The sources describe the system, not psychotherapy alongside it, so the guidance below is [synthesis] unless a source is given.

Client asks you to say whether TMM "really works". Do not rule on it. Say that TMM is a licensed medical system in Mongolia, that you are not trained in it, and that your role is the psychological side. Offer to coordinate with their emchi and doctor. Note that independent clinical evidence is limited [source: Shi et al. 2025 is largely preclinical]. [synthesis]
Client wants to stop psychiatric medication for TMM. Do not agree or disagree. Explore their reasons with the explanatory-model questions, then arrange an urgent conversation with the prescriber and, with consent, the emchi. Document the discussion. [synthesis]
Stuck: the client sees the problem only as disturbed khii and psychological work as irrelevant. Use their framework: ask what settles their wind (rest, routine, calm surroundings) and build psychological goals around those aims without claiming to treat wind. Revisit the Explanatory Model module after a few sessions. [synthesis; Sowa Rigpa link of wind and mind: Polish Journal of the Arts and Culture 2015]
Resistance born of distrust of state or Western services. Name the history of suppression openly if the client raises it [source: Kloos]; emphasise choice and collaboration; avoid pushing biomedical framing. [synthesis]
Concealment of remedies or healer visits. Normalise plural care [source: Turk 2017]; ask routinely and without judgement at every review; explain that the list goes to the prescriber for safety, not to judge. [synthesis]
Overwhelm from many competing helpers. Use the healing-pathway map (4.5) to see overlap; help the client choose a lead clinician for each domain (medical, TMM, psychological, spiritual). [synthesis]
Non-adherence to psychotherapy because the TMM regimen takes priority (e.g. a sanatorium stay). Treat it as a planned break; agree what the client will notice during the stay and review on return. [synthesis]
Rupture after the therapist seemed dismissive of TMM, Buddhism or shamanic beliefs. Acknowledge it directly, ask what felt dismissive, and restate that the client's framework is respected. Use the Patient–Clinician Relationship module if trust stays low [source: APA Supplementary Modules]. [synthesis]
Physical symptoms after medicines or procedures (tremor, gum disease, jaundice, burns, bruising, infection signs, faintness). Refer to medical colleagues the same day if urgent; do not interpret the cause. Mercury-containing Sowa Rigpa medicines and unofficial manufacture are documented concerns [source: Sallon et al. 2017; Kloos]. [synthesis]
Possible psychosis or mania explained as spirit illness or shamanic calling. Assess in parallel; consult a cultural broker; involve the family with consent; keep emergency pathways open. The diagnostic exclusions for culturally accepted trance apply only when the experience is part of broadly accepted practice and not involuntary, unwanted and impairing [source: DSM-5 wording via PMC9199574; ICD-11 via findacode]. [synthesis]
Client asks you to recommend a shaman, lama or ceremony. Decline to arrange it; these sit within the client's own religious and community pathways. You can explore what the client hopes for and how that fits treatment. [synthesis]
Unverifiable practitioner abroad. If a client sees someone using a TMM title outside Mongolia, ask about training and licensing; where local registration is unclear [uncertain: not verified], encourage the client to check with local health authorities and to keep their prescriber informed. [synthesis]
Confidentiality in a small diaspora. Ask before using community interpreters or brokers; offer telephone interpreting from outside the local community. [synthesis]
Children and adolescents. Ensure parental consent and the young person's assent for any shared plan; follow safeguarding procedures if a remedy, procedure or delay of care puts the child at risk; use the School-Age Children and Adolescents module [source: APA Supplementary Modules]. [synthesis]

Sources

Web sources

Books and articles cited:

Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251–258.
Lane GT (2006). Daily Life in the Mongol Empire. Greenwood (cited only as reported by Wikipedia) [uncertain].
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).

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