Neuroscience Research Notes

ISSN: 2576-828X

OPEN ACCESS | MINI-REVIEW

Concussion treatment through baria zasal: An exploration of Traditional Mongolian Medicine

Orgilbayar Ganbat 1,2, Oyuntugs Byambasukh 3, Tserendagva Dalkh 1 and Byambasuren Dagvajantsan 4*

1 International School of Mongolian Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
2 School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar 13270, Mongolia.
3 Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia.
4 Department of Neurology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 13270, Mongolia.
* Correspondence: byambasuren@mnums.edu.mn; Tel.: +976 99011455

Received: 6 August 2021; Accepted: 24 September 2021; Published: 29 December 2021        
Edited by: Norshariza Nordin (Universiti Putra Malaysia, Malaysia)
Reviewed by: Naveed Muhammad (Nanjing Medical University, China); Jordan Kiefer O’Sullivan (Independent Researcher, USA); Anonymous (Iran)
https://doi.org/10.31117/neuroscirn.v4i4.112   

ABSTRACT

There is no specific treatment for concussion in modern medicine; existing treatments are limited to resting and restoring cognition. For Mongolians, seeking concussion treatment from a bariachi, an advanced practitioner of the baria zasal traditional massage therapy, is very common. The baria zasal technique has been passed down the generations for millions of years, keeping with the Mongolian nomadic culture and way of life. However, this Mongolian treatment is little known or researched internationally. Due to the lack of literature on this subject, conducting a meta-analysis or systematic review was impossible. We reviewed the literature published in Mongolian about this technique. We also searched articles published from 1 January 1921 to 20 June 2021 in PubMed using “concussion”, “baria zasal”, and “Bariachi” keywords. Although informal observation indicates this is a commonly sought treatment among patients, there are very few published scientific articles about the practice outside the realm of cultural anthropology. This may be due to a few reasons: the informal, semi-religious setting in which the treatment takes place makes it difficult to conduct scientific field research; concussion is a mild traumatic brain injury, making it impossible to identify changes in the brain as a result of the treatment using imaging methods and therefore difficult to verify; and lastly, baria zasal is generally uncontested as a treatment even by Mongolian medical professionals, therefore it has not been the subject of empirical debate. Moreover, it is not classified under a specific system, each bariachi having its technique. As bariachis do not receive formal training, their treatments often depend on instincts, natural talents, and personal abilities. Therefore, it is recommended to study the techniques of baria zasal of concussion to explain its enduring popularity in Mongolia and to ascertain how it interacts with standard western medical treatment.

Keywords: concussion; bariachi; baria zasal; Traditional Mongolian Medicine;

©2021 by Ganbat et al. for use and distribution according to the Creative Commons Attribution (CC BY-NC 4.0) license (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

1.0 INTRODUCTION

A concussion is a mild traumatic brain injury. It is impossible to diagnose by imaging diagnostic tools. At the cellular level, it induces diffuse axonal damage and the development of nerve fibre oedema (Li et al., 2010; Rose et al., 2015) although the symptoms of the concussion usually disappear in a few days (Eisenberg et al., 2014; Howell et al., 2016). There is no specific treatment for concussion in modern medicine; existing treatment is limited to resting and restoring cognition (Schneider et al., 2017). Nowadays, if the patients are experiencing any kinds of symptoms and even it lasts only for a short time, it means inhumane (Brown et al., 2014). Therefore, it is vital to research alternative methods of distress alleviation.

For centuries, Mongolians have used traditional methods (treatments), known as Traditional Mongolian Medicine (TMM) to treat a variety of diseases (Bold, 1989; Gerke, 2004; Sodnompilova & Bashkuev, 2015; Tsybikova et al., 2019) is well adapted to the nomadic lifestyle of Mongolian people, severe climatic conditions, and dietary conditions. In the context of a nomadic lifestyle, concussions and fractures are common due to falling from horses or colliding with livestock. Among TMM, a widely popular method is baria zasal: vernacular bone-setting and cranial massage, as practised by a traditional healer called a bariachi. The words baria (бариа) means both “to come into contact with” or “massage”. The other word element, zasal, is an inflection of zasah (засах) which means “fixing” as well as “correcting”. Baria zasal and related traditional Mongolian healing methods have attracted the attention of some non-Mongolian cultural anthropologists. However, there has been no overview of Mongolian medical- and scientific-research on the baria zasal, a knowledge gap that this article seeks to fill.

2.0 LITERATURE SEARCH

Traditional Mongolian medicine (TMM) has rarely been promoted around the world or written internationally. Unlike some other vernacular Asian medicine, traditional Mongolian medicine is rarely practised across Mongolian state borders. As such, it has attracted little attention from international scholars. Thus, the possibility of conducting this research according to the systematic review or meta-analysis methodology was limited. We overviewed the written books and articles published in Mongolian about this technique. We also searched articles in PubMed registered journals using the following keywords: “concussion”, “baria zasal” and “Bariachi“. The collected information was published in between 01 January 1921 and 20 June 2021.

3.0 CONCUSSION TREATMENT THROUGH BARIA ZASAL

Baria zasal has been passed down through generations for millions of years due to the Mongolian nomadic culture and way of life. When the time, TMM developed rapidly in the 7th, 12th, and 16th centuries, diagnosis and treatment of concussions (Bariachi and Baria zasal) were written in historical literature (Bold, 1989; Dagvatseren, 1989). In 1921, after the Mongolian People’s Republic was declared, relations with Russia (Soviet Union) intensified, leading to the introduction of modern medicine into the country. As western medicine spread, the use TMM decreased (Bold, 1989). After the transition to democracy in Mongolia in 1990, the practice of TMM was revived (Bernstein et al., 2002; Bold, 1989). The patient’s personal beliefs influence the decision made between TMM and Western medicine. Although western medicine  is preferred for some diseases, it has been proven that Baria zasal is preferred for concussions among Mongolians. Especially in the case of children under five years of age, parents often go to the bariachi to have concussions treated. The reason includes that the treatment is quick and easy, and patients report that the symptoms will immediately disappear after the treatment (Goldin, 2012).

No detailed study of therapeutic mechanisms through baria zasal in concussion treatment was found in PubMed indexed journals. Since concussion is a mild traumatic brain injury, we assume that it is difficult to determine the mechanisms of the baria zasal method at the cellular level, making results difficult to report. A study involving 94 people with concussion treated through baria zasal were tested before and after treatment via laboratory examinations (Dolgormaa, 1990). Before the treatment, the number of leukocytes and lymphocytes in the blood was elevated, and haemoglobin level was decreased. These values returned to normal after baria zasal. They also measured cerebrospinal fluid pressure before and after treatment; as expected, there was increased pressure in people with concussions whereasa significant decrease after using baria zasal treatment. Thus, a possible explanation for the therapeutic mechanisms of baria zasal in the treatment of concussion is an improved blood flow of the brain and the general body circulation.

Worldwide, there are several alternative treatments for concussion, such as massage. However, it is difficult to compare with any other methods because baria zasal cannot be constricted within a specific system and each bariachi uses a different method. It has retained its empirical characteristics and have never been adopted into neighbouring countries (Dagvatseren, 1989). Other scientists also conclude that baria zasal of concussion is the only treatment available in Mongolia (Bold, 1989; Dagvatseren, 1989; Dolgormaa, 1990; Sodnompilova & Bashkuev, 2015; Tsybikova et al., 2019). Scientists also found that the uniqueness of Mongolian baria zasal for concussion from other folk medicines. For instance, in Tibetan medicine, which is quite similar to TMM, practitioners use calm methods to treat concussion while Mongolians use a kind of vibration (shaking head) in combination with massage for the treatment (Bold, 1989; Sodnompilova & Bashkuev, 2015). In other words, some Bariachis believe that concussion can be treated by shaking the head forward and backwards. Finally, baria zasal is more complicated than other alternative methods used to treat concussions. Therefore, there is a need to study and profile the practitioners’ qualifications as well as their methods and techniques used in treating concussions.

4.0 CONCUSSION HEALERS (BARIACHI) AND THEIR METHODS

As mentioned above, Bariachi is an advanced practitioner of the baria zasal. Most Bariachis are not formally trained, and they practise baria zasal often based on their instincts, natural talents and abilities (Bold, 1989; Dagvatseren, 1989; Dolgormaa, 1990). Thus, some bariachis are not trained medically. However, not any TMM practitioner can perform baria zasal or treat concussions. Therefore, only a few TMM practitioners ended up becoming concussion healers. However, the reason for this has not yet been explained. Therefore, more research needs to be carried out to answer various pertinent questions such as what techniques are used in baria zasal that make them different from regular massage therapists?

As we mentioned above, each bariachi has their own techniques to heal concussions. In the literature, we found 13 most common concussion baria zasal techniques (Dagvatseren, 1989; Dolgormaa, 1990). Almost all types of baria zasal include massages (“baria”). But some baria zasal techniques combine with other elements, which is called dom zasal. Some bariachis treat concussions using only the dom zasal method (Bold, 1989). These dom zasal techniques make the baria zasal more empirical. While some dom zasal cannot be explained scientifically  others have scientifically-based explanations. For example, one dom zasal technique involves firing off a pistol during difficult labour. The sudden, startling sound induces relaxing of the cervix (Bold, 1989; Dagvatseren, 1989). One dom zasal method to treat concussion is for the patient to bite on a wooden chopstick while a ceramic bowl filled with millet rice and wrapped in cotton gauze is placed upside-down on top of the patient’s head. Next, either end of the chopstick in the mouth of the patient is tapped with another wooden chopstick. This is one example of a dom zasal/baria zasal method that might induce a placebo reaction in adults (Jagan et al., 2019). Due to the lack of empirical research into the TMM itself, their effectiveness might be explained in terms of the trust that the patients place on the practitioner or solely the placebo effect (Gerke, 2004). Furthermore, there is a solid religious affiliation in TMM, including baria zasal and dom zasal (Bold, 1989). However, a study found that the effectiveness of baria zasal concussion treatment was higher than that of placebo treatment (Ganbat et al., 2021). This supports that the baria zasal treatment needs to be investigated with science-based disciplines.

5.0 CONCLUSIONS

We found that concussion treatment by baria zasal is not classified under a specific system. Individual bariachi deploys a wide range of techniques to treat concussions as they have not been formally trained, and practise based on their instincts, natural talents, and abilities. Therefore, it is recommended to study their techniques in further detail to draw up a scientifically based explanation for the apparent success of their treatment. It also needs to be studied in conjunction with other science-based disciplines, such as biophysics, biochemistry, psychology, and anthropology. For future research, more scientific approach to study concussions by using modern technology to investigate the effectiveness of bariachi healers should be performed.

Author Contributions

Ts.D. and B.D conceived the study; O.G, O.B, and B.D analyzed the data; O.G and O.B wrote the paper; Ts.D. and B.D revised and edited the paper.

Conflicts of Interest

The authors declare no conflict of interest.

References

Bernstein, J. A., Stibich, M. A., & LeBaron, S. (2002). Use of traditional medicine in Mongolia: a survey. Complementary Therapies in Medicine, 10(1), 42–45. https://doi.org/10.1054/CTIM.2002.0508

Bold, S. (1989). Brief history and development of traditional Mongolian medicine. ., (25), 5-16. Tibetan Medicine, 25, 5–16. https://www.wipo.int/

Brown, N. J., Mannix, R. C., O’Brien, M. J., Gostine, D., Collins, M. W., & Meehan, W. P. (2014). Effect of cognitive activity level on duration of post-concussion symptoms. Pediatrics, 133(2). https://doi.org/10.1542/PEDS.2013-2125

Dagvatseren, B. (1989). Treatment for concussion through "baria zasal" method. Scientific Journal of Mongolia, 1, 22–29.

Dolgormaa, K. (1990). Treatment of head and brain injury through "baria zasal" treatment. Scientific Journal of Mongolia, 2, 11–15.

Eisenberg, M. A., Meehan, W. P., & Mannix, R. (2014). Duration and course of post-concussive symptoms. Pediatrics, 133(6), 999–1006. https://doi.org/10.1542/PEDS.2014-0158

Ganbat, O., Dalkh, T., & Dagvajantsan, B. (2021). Concussion in children and Baria zasal of Mongolian traditional medicine. Mongolian Journal of Neurology, 1(12), 34–37.

Gerke, B. (2004). Tradition and modernity in Mongolian medicine. Journal of Alternative and Complementary Medicine (New York, N.Y.), 10(5), 743–749. https://doi.org/10.1089/ACM.2004.10.743

Goldin, A. S. (2012). Bariachi of Ulaanbaatar. In undefined. https://digitalcollections.sit.edu/isp_collection/1292/

Howell, D. R., O’Brien, M. J., Beasley, M. A., Mannix, R. C., & Meehan, W. P. (2016). Initial somatic symptoms are associated with prolonged symptom duration following concussion in adolescents. Acta Paediatrica (Oslo, Norway : 1992), 105(9), e426–e432. https://doi.org/10.1111/APA.13486

Jagan, S., Park, T., & Papathanassoglou, E. (2019). Effects of massage on outcomes of adult intensive care unit patients: a systematic review. Nursing in Critical Care, 24(6), 414–429. https://doi.org/10.1111/NICC.12417

Li, J., Li, X. Y., Feng, D. F., & Pan, D. C. (2010). Biomarkers associated with diffuse traumatic axonal injury: exploring pathogenesis, early diagnosis, and prognosis. The Journal of Trauma, 69(6), 1610–1618. https://doi.org/10.1097/TA.0B013E3181F5A9ED

Rose, S. C., Weber, K. D., Collen, J. B., & Heyer, G. L. (2015). The Diagnosis and Management of Concussion in Children and Adolescents. Pediatric Neurology, 53(2), 108–118. https://doi.org/10.1016/J.PEDIATRNEUROL.2015.04.003

Schneider, K. J., Leddy, J. J., Guskiewicz, K. M., Seifert, T., McCrea, M., Silverberg, N. D., Feddermann-Demont, N., Iverson, G. L., Hayden, A., & Makdissi, M. (2017). Rest and treatment/rehabilitation following sport-related concussion: a systematic review. British Journal of Sports Medicine, 51(12), 930–934. https://doi.org/10.1136/BJSPORTS-2016-097475

Sodnompilova, M., & Bashkuev, V. (2015). Diseases and their origins in the traditional worldview of Buryats : folk medicine methods. Études Mongoles Et Sibériennes, Centrasiatiques Et Tibétaines, 46, 1–23. https://doi.org/10.4000/EMSCAT.2510

Tsybikova, B., Dampilova, L., & Chimitdorzhieva, G. (2019). National methods of treatment of the Buryats in Inner Mongolia (the People’s Republic of China). The Bulletin of Irkutsk State University. «Geoarchaeology, Ethnology, and Anthropology Series», 27, 79–85.

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