







































 Humanities and Social Science Research; Vol. 8, No. 4; 2025 

ISSN 2576-3024   E-ISSN 2576-3032 

https://doi.org/10.30560/hssr.v8n4p137 

 137 Published by IDEAS SPREAD 

 

Pluralistic Therapy Choices for Neurological and Mental Disorders in 

Ethnic Minority Areas of Lijiang, China 

Yiming Liu1 

1 Nanjing Foreign Language School, China 

Correspondence: Yiming Liu, Nanjing Foreign Language School, Nanjing, Jiangsu, 210022, China. 

 

Received: July 29, 2025; Accepted: August 11, 2025; Published: August 12, 2025 

 

Abstract 

Lijiang’s medical pluralism blends biomedicine, TCM, and folk practices, yet local perceptions increasingly favor 

a binary divide ("Western" vs. "Traditional") that marginalizes ritual therapies as superstition. Based on the 

medical pluralism theory, this essay provides an overview of the current status of traditional medicine in Lijiang 

area based on individuals’ attitudes, analyzes the setbacks against its development, and explores possible solutions 

to breathe new life into Lijiang traditional medicine. Using the method of field study, researchers collected Lijiang 

people’s understanding towards ritual therapy and mental illness, and analyzed their therapy choice for mental 

illness (mental hospital, psychological counselling, or ritual therapy). The results included answers from multiple 

interviewees on four perspectives: perception of rituals, understanding of mental illness, attitudes toward modern 

medicine (mostly trust and priority), and support systems and self-help. The results also included a generalized 

therapy-choosing process for mental illness: modern medicine is prioritized, followed by psychotherapy, with 

traditional treatment (herbal and ritual practice) being a last choice. Preservation of traditional treatment requires 

integrating rituals into mental healthcare through scientific validation (e.g., stress-relief mechanisms) and cultural-

tourism initiatives (e.g., meditation experiences).  

Keywords: Lijiang, mental illness, ritual therapy, Chinese traditional medicine, medical pluralism  

1. Introduction 

With its diversified ethnic groups and a unique culture, Lijiang, a city located in Yunnan Province, southwest 

China, has long been a popular location of field investigation for scholars from around the world, famous examples 

of which include botanist Joseph Rock and the anthropologist Charles McKhann. Moreover, Lijiang was officially 

listed as a World Cultural Heritage Site in 1997, making it a popular tourist destination both at China and beyond. 

The local traditional culture was quickly swept into modernization and globalization. It can also be said that this 

area is the middle ground between tradition and modernity. 

 
Figure 1. Location of Lijiang in Yunnan Province, China. Lijiang city is highlighted with yellow 



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Home to diverse ethnic groups (e.g., Naxi, Bai, Tibetan, and Han) for thousands of years, Lijiang has developed a 

traditional medical culture combining herbal therapy with shamanic rituals [1][2]. Since the foundation of the 

People’s Republic of China in 1949, modern medical practices featuring hospitals and professional doctors have 

been promoted, while ritual therapy was classified as ‘superstition’ (míxìn 迷信) and not encouraged to be used 

[3]. Eventually, Lijiang residents accustomed to modern medical system, and though the conservation of Lijiang 

traditional culture has been promoted since 1980s (Lijiang Cultural Research Institute was founded in 1981), 

traditional ritual therapy remains marginalized due to its limited therapeutic timeliness in treating common 

ailments. 

During my fieldwork, I observed that local conceptions of illness—particularly mental health—diverged from 

biomedical frameworks in ways deeper than the word superstition conveys, and may hold therapeutic potential for 

mental illness treatment. Given that the therapeutic potential of Lijiang’s indigenous rituals remains 

understudied—particularly how they operate within the local pluralistic healthcare system, this study intends to 

provide an overview of how ritual therapies are understood and practiced within Lijiang’s pluralistic medical 

landscape. 

2. Materials and Methods  

In this section, the studying materials and fieldwork methods are presented. 

2.1 Ritual Therapies’ Underlying Cultural Logics 

2.1.1 “Hui” conception in Naxi Culture 

Naxi is one of thedominant ethnic groups in Lijiang, making Naxi medicine an important component of the Lijiang 

medical culture. Dongba are Naxi ethnic elites who integrate multiple domains including pictographic writing, 

traditional medicine, historiography, and ritual dance. Traditionally in Dongba culture, illness is believed to be 

caused by秽(Hui), or impurity, which encompasses ghosts, spirits, and other supernatural contaminants that need 

to be “driven away” by rituals in order for health to be restored.  

 

Figure 2. Dongba pictographic script 

     
Figure 3. Dongba painting, sculptures of gods, wooden boards for ritual use 



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In Naxi language, Dongba originally referred to a group of religious and cultural leaders who combined their 

knowledge of rituals and medicinal practices to serve the community. Currently, there are around 200 Dongba, 

and only ten percent of whom have the knowledge of traditional rituals and medicine. 

As time go by, the term “Dongba” now stands for a culture featuring Dongba pictographic script, Dongba 

traditional ceremonies, Dongba medicine usage and other related subjects. In Dongba culture, it is generally 

believed that humans each have nine spirits evenly distributed in human body and that whenever some of these 

spirits become unstable, people get sick. The instability and distortion of spirits is caused by Hui, an important 

symbol in Dongba culture that stands for denoting impurities encompassing ghosts, spirits, and other supernatural 

contaminants, which usually floats around in natural environment. Hui may be brought into individuals’ bodies 

due to two traits: excessive desire and inherent vulnerability. Excessive desire is believed to cause the excessive 

exploitation of natural resources, which infuriates Hui and brings illness. One of the Dongba scriptures The Origin 

and Treatment of Phobia reflects such a belief, recording how tribe members acquire phobia, a disease under 

which people experience sudden and unreasonable episodes of extreme fear, because of their greedy behaviors of 

exploiting natural resources. 

      

Figure 4. The Origin and Treatment of Phobia, P2-4 

 

The belief that excessive desire and exploitation of nature causes mental illness shows a binary view of good and 

evil and a moral view that those who harm the nature receive punishment, showcasing a worship towards nature 

resulting from the animist perspectivism, which has been proven by ecological anthropological researches on Naxi 

people’s worship towards nature [4]. 

Inherent vulnerability, on the other hand, shows that individual differences may increase the likelihood for a person 

to be affected by Hui and become mentally unstable, acknowledges that psychological problems are influenced by 

both environmental factors and personal traits. 

In conclusion, Dongba traditionally understand mental illness as mainly the result of Hui attaching to patients’ 

bodies and spirits, while admitting the influence of external environment on humans’ health, especially when it 

comes to physical diseases that can be treated by herbal therapies. They address the restoration of internal stability 

and calmness as key for curing mental illness.  

2.1.2 Bai ethnic group and “Mama” 

The Bai is another large ethnic group in Lijiang. In its traditional communities, there is a female role: Mama. 

Mama are elderly females who are capable of treating diseases and conducting ceremonies, and hold the belief 

that mental illness is caused by impure beings like ghosts, and the spirits of the dead can occupy people’s bodies, 

causing mental instability. In this situation, Mama is required to help drive those spirits away. 

“Mama jiao” has worn off since the last century and related records are limited. Nowadays, Mama usually refers 

to devout elderly women who gather in Lianchi Hui, a belief-based organization. Though no longer serving a 

psychic and healing function as traditional Mama religion did, Lianchi Hui has an inherited relationship with the 

Bai nationality's maternal culture, including procreation worship, Benzhu culture, and Kwan-yin worship, 

reflecting core ideas in traditional Mama healing methods. In conclusion, Mama religion understands mental 

illness as caused by drifting ghosts and deaths’ spirits and worship supernatural powers, which bless certain women 

with the ability to communicate with spirits and ghosts and make them leave. As a minority group well adapted to 

Han culture, Bai people have doctors of traditional Chinese medicine despite Mama, so Mama serves more as a 

psychic healer than a medical one. 

In conclusion, Mama Religion centers on kin-nature-spirit interdependence, with healers (often elderly women 

referred to as Mama) restoring health by negotiating with ancestral ghosts and natural forces.  

 



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2.2 Fieldwork Method 

The fieldwork concerning Lijiang traditional medicine was conducted based on local folklores and recordings, 

conversations with local experts, and interview with non-expert individuals. The interviewees investigated in the 

field study are all residents around Lijiang area, yet their cultural background, ethnic identity, ages, professions, 

and genders vary. 

The current status of Lijiang traditional medicine was analyzed based on the theory of medical pluralism, Lijiang 

traditional medical practitioners’ narration, and individuals’ attitudes.  

The locations where field study was conducted are shown in the figure below. 

 

Figure 5. Filed Investigation Locations 

3. Results 

3.1 Participant Demographics 

The demographic information of participants interviewed in the fieldwork are presented in Table 1. 

 

Table 1. Interviewee Demographics. Original data were obtained with authorization from Dr. Zhao and used in 

government follow-up records. To ensure privacy protection, all personally identifiable information has been 

anonymized, with the pseudonym correspondence list retained solely by the research team. 

Personal Information Interviewer Gender Ethnic 

Identity 

Profession 

He 1 Male Naxi Dongba 

He 2 Male Naxi Director of Lijiang Cultural Research 

Institute 

Liu Male Naxi President of Lijiang Traditional Medicine 

Association 

Zhao Female Bai Village Health Station Doctor 

Wang 1 Male Han Chinese Medicine Doctor 

Wang 2 Male Bai Chinese Medicine Doctor and Herbalist 

Randomly chosen pationents at health 

station 

/ / / 

Chen Female Han Manager of Lijiang Traditional Medicine 

Association 

 



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3.2 Interview Content and Case Study 

The interview content reflects a structural characteristic of medical pluralism, where cosmopolitan medical 

practices compromise with local medical cultures [5]. Specifically, the plural medical practices in Lijiang and its 

surroundings include: cosmopolitan medical practices provided by hospitals and local clinics, folk traditional 

Chinese medicine (TCM) practices provided by doctors, traditional Naxi/Dongba medical practices provided by 

Dongba, and self-healing medical practices such as purchasing herbal market goods or self-learning psychological 

consulting.  

In a case provided by Dongba He, we can understand how mental problems are traditionally diagnosed, treated 

and attributed to: 

“A hostess, known to be easily frightened, fell ill with headaches and diarrhea after meeting my cousin, 

whose grandfather had died tragically in the 1966 earthquake and was believed to have become part of Hui 

as a ghost. We performed a ritual, chanting scriptures and burning herbs to cleanse Hui and stabilize her 

spirits. She slept and awoke recovered.” 

This case illustrates how mental illness in Lijiang is often interpreted through spiritual and emotional lenses rather 

than strictly physical or psychological terms. The blending of physical symptoms with supernatural causes, like 

spirit possession or disturbed souls, reflects a worldview that diverges significantly from modern medical 

perspectives. The healing process, reliant on rituals and herbal remedies, emphasizes calming the patient’s spirit 

and removing external influences, which aligns with broader themes in traditional medicine that focus on holistic 

healing. 

It’s also notable that the treatment emphasizes the role of the healer as a mediator between the human and spiritual 

worlds, unlike modern therapies that focus on psychological methods or pharmacological treatments.  

Junping Wang, a Bai doctor, gave the following example which shows Bai people’s understanding of the relation 

between physical conditions and mental well-being: 

“When I was living in a Bai village as a kid, one of my neighbors was a “crazy” woman. She talked to 

herself and might hurt others unintentionally. However, instead of attributing her “craziness” to ghosts or 

the dead’s spirits, villagers claimed that her disease developed from pregnancy. They said pregnant women 

undergo changes in their bodies which, if not treated properly, could eventually influence their brains and 

cause emotional or even insane behaviors.” 

This story took place around 30 years ago during a period when traditional beliefs about ghosts and the holiness 

of Mama were gradually replaced by rational and logical reasoning, as promoted by modern medicine. This 

transition aligns with the broader trends in rural China, where exposure to modern medicine was reshaping long-

held beliefs about mental health, even as elements of traditional practices remained intertwined. More specifically, 

barefoot doctor systems that lasted from 1960s to 1980s and ‘science popularization’ campaigns (科普运动) in 

the 1990s actively classified ‘ghost narratives’ as superstition, encouraging villagers to receive biomedical 

treatment in rural clinics. Such policies created medical hybridity, as presented in the example above: while a 

relation between physiological and structural change and illness is acknowledged, understanding of mental illness 

is still restrained to generalized expressions such as insanity.  

3.3 Mental Illness and Traditional Medicine: Their Understanding 

How residents of Lijiang understand mental illness and the related treatment methods reveals a combination of 

traditional beliefs and modern practices. Overall, their attitudes towards mental health and treatment options can 

be analyzed from the following four aspects: 

3.3.1 Perception of Rituals 

Many villagers categorize Dongba ceremonies and rituals as forms of superstition lacking efficacy in treating 

psychological issues, which can be proved in the following cases: 

 “We don’t really do that in our village. It’s a kind of superstition, I think.”  

(H.He, an 83-year-old male villager) 

 “Most of people around me in my village don’t believe in rituals or superstition. I think there is a gap in the 

succession of Dongba rituals, since the generation who used to believe in this have mostly passed away, and the 

current elderly people received orders to stay away from superstition such as Dongba ceremonies when they were 

young.”  

 (R.Mu, a 60-year-old female villager) 



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 “Only very few people in the village would let Dongba perform rituals to treat such mental illness-- actually, 

people think of this as superstition.” 

 (H. Zhao, a licensed doctor at Changshui Village health station) 

These statements reflect a general distrust towards ritual therapies among common villagers and residents, 

particularly for the generations influenced by modern medical practices. Conversely, some informants promote the 

combination of traditional rituals and contemporary mental health care. 

Z. He, a Dongba (as introduced before, Dongba are known for their roles of known for their role in performing 

rituals, providing traditional medical care and preserving ancient Naxi culture), suggests that the spiritual 

dimensions of these practices can be beneficial when dealing with mental distress: 

“In my opinion, the development of western science has somehow resulted in a fixed mindset, making people 

unable to accept concepts in traditional medicine. But in fact, many concepts in Dongba medicine culture are 

correspondent with concepts in modern days. psychological problems happen to people with an unstable mind 

state, and they need to express the worries that accumulate inside them through different ways. In my opinion, 

traditional ritual therapy can actually achieve this goal if done in a proper way, for the process of chanting 

scriptures gives the patients a sense of calm, helping them clear their inner worries, as if an uprising positive spirit 

rises in their bodies, making them feel complete and cheerful. Another way is to walk around in nature and shout 

out loud in open space so that their depressed feelings can be expressed. A third way is treating them with music. 

Traditionally, we believe five notes(do, re, mi, sol, la) correspond with five body organs(spleen, lungs, liver, heart, 

kidney); based on this theory, we use different kinds of music to help patients achieve a peaceful and stable inner 

state.”  

He, director of Lijiang Cultural Research Institute, believes that while Dongba rituals may not directly cure specific 

diseases, they provide valuable psychological support, particularly for Naxi people seeking connection to their 

cultural roots: 

“In my opinion, such rituals can serve as a mental consolation for those who cherish their Naxi identity, 

making them feel connected to their roots again. That’s one important way to make use of Dongba medicine 

in modern days, to satisfy Naxi people’s psychological needs and thus improve their mental and overall 

health.” 

3.3.2 Understanding of Mental Illness 

The villagers predominantly associate mental health issues, particularly depression and anxiety, with the pressures 

faced by students in today’s educational environment. J.He, a 58-year-old female villager, noted, “I’ve heard 

rumors about students jumping off buildings because of depression,” while Z.He, a 37-year-old female villager 

mentioned, “I’ve got a cousin who acquired depression in high school, mostly because of the misunderstanding 

between he and a teacher, as well as the pressure at high school... I feel like students get depression a lot, and 

some of them even attempt suicide. I’ve heard such rumors but it hasn’t happened to people around me,” both of 

which illustrate the alarming consequences of academic stress. Also, many villagers relate their knowledge of 

mental illnesses primarily to personal anecdotes or those of acquaintances, often lacking a deeper understanding 

of the complexities involved. 

Based on different people’s responses, there is a divided opinion about traditional medicine and rituals’ potential 

for treating diseases in modern times. People whose careers and lives are closely related to Dongba culture and 

Lijiang traditional medicine tend to view traditional medicine more positively, while ordinary villagers often know 

little about these practices and primarily rely on hospitals and modern professionals when it comes to mental illness. 

3.3.3 Trust and Priority for Modern Medicine 

Among those with some knowledge of mental health, there is a clear preference for seeking help from 

psychological doctors and hospitals. Z.He, a 37-year-old female villager, expressed, “I think it’s still normal for 

people to try ritual therapies, but it usually happens when no other way works out and superstition is kind of the 

last hope.” This reflects a pragmatic approach where modern medical solutions are prioritized, yet a recognition 

exists for traditional ritual methods when modern treatment fails. This attitude is evident in the modern medical 

treatment order: hospitals, professional doctors, and medications such as anti-depressants are the preferred choice, 

while traditional methods are often not utilized or are seen as a last resort when all hope seems to be gone. 



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As pointed out by R.Mu from Changshui village, this situation might result from the rapid modernization of Lijiang 

and the discouragement of traditional medicine and rituals over the last century, leading to a division between 

modern medicine (seen as science) and traditional medicine (seen as superstition). 

3.3.4 Support Systems and Self-Help 

There is an acknowledgment of the importance of family support and self-help strategies in managing mental 

health issues. Z. He highlights the importance of family support, remarking, “I know an elder male who felt useless 

and became depressed, but his children are very kind to him, always accompanying and caring for him, and little 

by little he got better. So, I think that while medical treatment is important, the care and understanding form one’s 

family also matter a lot.” W. He, a 36-year-old self-learned psychologist, shared her experience, stating, “When 

faced with psychological problems, first trying to heal by oneself is not a bad idea. But still, it’s important to see 

doctors too.” This highlights the dual approach of relying on personal efforts while still valuing professional 

medical intervention. 

In conclusion, the perspectives gathered from the villagers illustrate a comprehensive view of mental health 

treatment in Lijiang, characterized by a lack of understanding of traditional medicine and a trust in modern medical 

practices. Although many villagers still associate rituals with superstition, voices like Dongba He’s shed light on 

the potential value of integrating traditional practices into contemporary psychological treatment. 

This holistic understanding shows the necessity of bridging traditional and modern methods so that cultural 

heritage such as ritual therapy can be revived when applied to face current mental health challenges. 

From the insights gained, a general medical treatment order for mental health issues in the Lijiang area can be 

illustrated. 

Therapy choice, referring to the categories of medical practices that individuals choose when sick and the order of 

using them, reflects individuals’ understanding of illness and attitudes towards plural medical practices. For one, 

their therapy choices reflect their explanatory models of mental illness, whether attributed to biochemical 

imbalance (favoring biomedicine), sociocultural stress (favoring psychological consulting), or spiritual disorder 

caused by Impurity (Hui, 秽) (favoring ritual therapy) [6]. It is also worth noting that though Health Care System 

divides medical practices into three sectors, individuals actively “navigate multiple therapeutic options based on 

efficacy, accessibility, and cultural congruence” [7]. The order and paths of such navigation also reflect individuals’ 

multilayered understanding of mental illness as well as the perceived trustability levels of different medical 

practices. 

 

 

Figure 6. General therapy choice for mental illness 



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4. Discussion and Conclusion 

4.1 Plural Medical Practices in Lijiang: Between Sectors and Realities 

The diversified medical practices in Lijiang can be classified based on the concept of Health Care System, which 

categorizes health-related practices into popular sector, professional sector, and folk sector [8]. Based on how local 

people perceive these medical practices, they can also be classified into two main categories: the traditional 

(composing of TCM, Dongba medicine, herbal remedy and so on) and the western (composing of hospital and 

clinical medical practices). 

4.1.1 Professional Sector: State-mediated Biomedicine and TCM 

Professional sector denotes state-legitimated practices, which in Lijiang include hybrid TCM-biomedical therapies. 

Professional medical institutions listed in Lijiang City Gazetteer (1991–2010) include People’s Hospital of Lijiang, 

Township Health Centers, Village Medical Stations, and Medical Institutions of Enterprises, all of which work 

under national standardized protocols and medical insurance coverage. 

4.1.2 Folk Sector 

Lijiang’s folk sector comprises of folk TCM practices and ethnic medical practices, with their healing knowledge 

circulating through oral or family transmission rather than institutional education and certification. Examples of 

medical practices under the folk sector include TCM practices such as bonesetting and acupuncture in rural family-

run clinics, Dongba medical practices such as herbal therapy and ritual performing, and other minority groups’ 

medical practices such as Bai ethnic group’s Mama medical practices.  

 

Figure 7. Visualized diagram showing plural medical practices in Lijiang, classified in popular, folk, and 

professional sectors, and divided into traditional and western medicine. Created in https://BioRender.com 

 

It is worth noticing that though part of the medical practices under the folk sector receive no medical licensing, 

the practitioners often understand basic or even professional biomedical knowledge, which may be incorporated 

in the folk medical practice, showing a fluidity between sectors. Doctor Wang practicing TCM at his village has 

self-learned professional medical knowledge and prepared for the medical licensing test. Though he eventually 

failed the test, his biomedical knowledge together with his effective TCM skills has raised villagers’ trust for him. 

Those with medical licenses may as well master folk/TCM medical practices. For example, Doctor Zhao working 

at township health center also runs a clinic at home, treating patients with acupuncture and bonesetting techniques, 

both of which are TCM practices. 



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4.1.3 Popular Sector (Herb-Derived Health Supplements) 

Lijiang’s popular sector thrives on self-determined health strategies such as treatment made from self-purchased 

herbal plants. A large proportion of goods sold on Lijiang markets are herbal plants, many of which freshly dug 

from the wild areas such as Yulong Snow Mountain. They are then purchased and made part of the home remedies, 

such as using cordyceps to maintain health, or boiling Fuzi (Aconite root, 附子) to get rid of ‘寒气’ (hánqì, cold 

pathogen), a TCM concept denoting invasive cold energy that disrupts bodily balance. 

In general, Lijiang’s popular sector features common people’s own methods to maintaining health, especially 

through herbal therapy, exercises, and other TCM-related practices that reflect long-held family beliefs. 

4.1.4 A Common Binary Perception: Western Medicine vs. Chinese Medicine 

Unlike Kleinman’s approach of dividing plural medical system into three sectors, most Lijiang people classify 

various medical practices in a binary way, perceiving them as either ‘西医’ (xīyī, Western medicine) or ‘中医’ 

(zhōngyī, Chinese traditional medicine). Under this context, western medicine refers to biomedicine of 

professional sector, while Chinese medicine refers to a wider range, covering the majority of folk sector and 

popular sector, and licensed TCM practice of professional sector.  

It is also worth noting that certain practices traditionally included in TCM, such as conducting rituals and using 

talisman, are not perceived as medical practices among most people. Rather, they are frequently referred to as 迷
信 (míxìn, superstition).  

Ritual therapies and other practices perceived as superstition don’t fall into the Health Care System, but they were 

in the past perceived as medical practices in Lijiang area, and may offer insight on mental illness treatment. 

In order to understand these practices, we must add on to Kleinman’s sectors and address the cultural logics 

underlying minority groups’ traditional medical practice that traditional healers themselves employ. 

4.2 Traditional Mental Illness Classification 

Traditionally in Lijiang, mental diseases have not been systematically classified. In most cases, they are referred 

to as “psychiatric abnormality”. Many symptoms are related to “psychiatric abnormality”, including the 

unwillingness to communicate, irrational or meaningless speeches, and behaviors that hurt others. Actually, such 

symptoms are common among today’s patients diagnosed with depression, bipolar diseases and schizophrenia, the 

only difference being that no clear boundaries have been set among psychiatric diseases traditionally.  

Not all diseases related to mind, brain or nervous system are categorized as psychiatric abnormality. 惊悸(Jīngjì, 

phobia), causing people to experience abrupt fear but behave normally most of the time, has long been recognized 

as an independent disease. In fact, it is similar to agoraphobia, an anxiety disorder that involves generalized fear. 

When it comes to the causes of Jīngjì, though, Hui and the disruption of spirits are still considered as the leading 

factors, just like in the case of psychiatric abnormality. Epilepsy, on the other hand, is independent of both the 

name and the cause of psychiatric abnormality. With its apparent symptom of continuous seizures, epilepsy seems 

to have a more physically related cause than other mental illness, and is therefore distinguished from other 

neurological diseases in Lijiang traditional medicine conception. While modern medicine aims to neutralize 

abnormal electronic signals in the brain to treat epilepsy, Lijiang people used to believe in a whole different way: 

eating human brains. This treatment can be called primitive, but it indicates that Lijiang people have somehow 

identified the body part most directly related to epilepsy: the brain. As for anxiety disorders where people 

experience discomfort but do not exhibit abnormal behaviors, Lijiang traditional medicine does not treat them as 

a state of illness. 

 

Table 2. Similarities between symptoms of ‘psychiatric abnormality’ and contemporary mental diseases. This 

classification is supported by the modern diagnostic criteria outlined in the DSM-5 (2013) and ICD-11 (WHO, 

2022) 

Symptom Modern 

Classification 

Social 

Withdrawal 

Disorganized Speech Risky/Self-Harming 

Behaviors 

Depression Common Rare Possible 

Bipolar Disorder Possible Common (In Manic 

State) 

Common (In Manic State) 

Schizophrenia Common Common (In Manic 

State) 

Possible 

Autism Spectrum Disorder Common Possible Possible 



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4.3 Find a Way Out: A Combination of Culture and Medicine, Rituals and Stress-Relieving 

With its accuracy and continuous advancement, modern medical treatment is proved efficient for most physical 

diseases. The field of mental illness treatment, however, requires consistent innovation in its methods: for some 

mental illness, there is yet no efficient treating methods; for others, new auxiliary treatments are needed to improve 

the current methods’ effects. The use of ritual therapy in Lijiang traditional medicine reflects a concern for patients’ 

mental status, a feature that, if properly combined with modern psychology theories, might help Lijiang traditional 

medicine earn a place in mental illness treatment field. In fact, previous studies have found that rituals enhance 

mental well-being. To begin with, the hallucinogenic plants used in rituals might have positive mental effects, an 

example of which being ayahuasca, a traditional Amazonian decoction with psychoactive properties that was 

originally used by indigenous shamans in religious rituals across several South American countries and now 

proved to have antidepressant effects in patients with recurrent depression [9][10]. Moreover, Samuel Weber et.al 

have found that positive religious coping, community and support, and positive beliefs involved in ritual therapies 

can promote mental health [11]. Most importantly, Goncalves et.al assessed the impact of religious/spiritual 

interventions through randomized clinical trials and found that, in general, religious/spiritual interventions 

decreased stress, alcoholism and depression [12]. Based on these findings, it is possible to put traditional Lijiang 

ritual therapies into modern psychiatric treatment practice, providing a new way to conserve and promote Lijiang 

traditional medicine. 

Re-knowing and reembracing ritual therapies bring more than mental calm to Lijiang people; it also gives them a 

sense of belonging and confidence. This conclusion is drawn from the conversations with Dongba He and Director 

Liu, both of whom devote their time into the understanding, conservation and inheritance of Lijiang culture. In 

this process, they feel connected to their ancestors and their cultural roots, and therefore achieve a state of mental 

well-being. 

The marginalization and degradation of ritual therapy is a global trend. However, there is still possibility to 

conserve and promote Lijiang traditional medicine and its ritual components. It is worth noting that among 

Lijiang's multi-ethnic populations, growing consciousness of mental distress has paradoxically exposed the 

limitations of both clinical psychiatry and mainstream cultural scripts in accounting for the localized surge of 

psychiatric conditions. Facing this interpretive crisis, many residents are turning to indigenous epistemologies 

embodied in Naxi herbal therapies and shamanic ceremonies for both etiological understanding and therapeutic 

efficacy. Moreover, in Lijiang, efforts are made by Dongba and other Lijiang culture experts to preserve ritual 

therapies as part of their cultural heritage, and explaining ritual therapy in scientific language and combining it 

with contemporary people’s mental needs might be a way to prevent them from fading. Effects of improved forms 

of rituals (those that cast no harm on patients) used in folk medical practices can also be collected to provide further 

insight into the effectiveness of rituals and in what ways they can be improved to adapt to mental illness treatment. 

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