Nutritional Care in Traditional Mongolian Medicine: Historical Foundations and Conceptual Framework Development—A Historical Study

ABSTRACT

Background and Aims

Nutritional care has long been a fundamental component of Traditional Mongolian Medicine (TMM), reflecting a holistic understanding of health, diet, and disease prevention. This study aimed to examine the historical and conceptual foundations of nutritional care in TMM and to develop a conceptual framework based on historical TMM texts.

Methods

Historical research was conducted using Berg's seven‐stage historical research framework and primary TMM texts dating from the sixth to the twentieth centuries. Recurrent concepts related to food, beverages, nutrition, and health maintenance were identified and analyzed through concept analysis. The resulting concepts were synthesized using concept mapping to develop a conceptual framework of nutritional care in TMM.

Results

Historical analysis revealed the progressive development and refinement of nutritional knowledge throughout the evolution of TMM. Five recurrent concepts were identified: cosmological foundations of nourishment, bodily balance and humoral regulation, dietary classification, contextualized nutritional assessment, and therapeutic nutritional care. These concepts were integrated into a conceptual framework structured around four interrelated domains: nutritional assessment, planning, intervention, and evaluation.

Conclusion

This study provides a systematic conceptualization of nutritional care grounded in TMM and proposes a framework that organizes its historical principles into a coherent model. The framework offers a foundation for future empirical studies examining the application and relevance of TMM–based nutritional care in contemporary healthcare contexts.

Abbreviations

MME

Mongolian medical education

TMM

Traditional Mongolian Medicine

1. Background

Foods has functioned not only as sustenance but also as a form of care, prevention, and therapy in many Indigenous medical systems [1, 2, 3]. In contemporary healthcare, understanding how nutrition is culturally conceptualized and practiced is essential for developing culturally sensitive and contextually appropriate approaches to health and well‐being [4, 5]. However, health science scholarship has largely focused on biomedical or Western‐derived nutritional models, leaving Indigenous and traditional medical systems under‐theorized, particularly regarding the conceptual foundations of nutritional care [3, 4, 5, 6, 7].

Mongolia represents a unique cultural and ecological context in which nutrition, health, and caregiving have been intertwined for millennia [8, 9, 10, 11]. Archaeological and historical evidence indicate that human populations have inhabited the Mongolian Plateau since the Stone Age [12, 13] with pastoral nomadic lifeways shaping dietary patterns for at least the past 5000 years [14, 15]. Early Mongolian populations incorporated dairy products, meat, blood‐based foods, cereal grains, and wild plants into their diets during different historical periods [16, 17, 18, 19, 20]. These food practices were not solely oriented toward survival but were embedded within broader cultural understandings of health maintenance, seasonal balance, and bodily regulation [11, 21].

Historical texts suggest that Mongolian food practices evolved into systematic dietary therapy approaches. As early as the 13th century, written sources have documented the use of fruits, berries, and wild plants for both nourishment and health‐related purposes [22, 23]. Importantly, one of the world's earliest known treatises on nutrition and dietary therapy, authored by Mongolian scholars continues to inform contemporary practices of food‐based healing and care [24, 25]. Unlike the imperial Chinese dietary systems [26, 27, 28], Mongolian nutritional thought emphasizes seasonal cycles, time of day, age, gender, physical constitution, and metabolic characteristics, reflecting a holistic and context‐sensitive approach to care [8, 29]. TMM emerged from this cultural and historical milieu, with roots extending approximately 4000 years into the past [30, 31, 32, 33].

During the Mongol Empire (13th–14th centuries), extensive cultural exchange across Eurasia contributed to the formation of a coherent theoretical medical system that integrated elements from Indian, Chinese, and later Tibetan and Arabic medical traditions [34, 35, 36]. By the 16th and 17th centuries, TMM had developed a systematic approach to diagnosis and therapy grounded in Ayurvedic principles while incorporating regional medical knowledge [35, 36, 37]. Within the TMM, caregiving—including nutritional care—was traditionally situated in the domestic sphere and carried out primarily by female family members [38, 39]. Although informal, these practices constituted an emic system of nutritional care and health maintenance centered on nourishment, balance, and daily care [3, 40]. Although not recognized as nursing in the modern professional sense, these traditions reflected forms of caregiving and health support that share important conceptual parallels with contemporary nursing approaches to nutrition and health maintenance [41, 42]. This raises the question of how such traditions have been understood and investigated within nursing scholarship. Modern nursing services in China emerged in the late 19th century, and formal nursing education began in the early 20th century [43, 44, 45]. In contrast, nurses practicing Mongolian medicine started working in the 1950s, while specialized educational institutions began training professionals in this field from the 1970s onward [46, 47, 48].

Recent studies have examined the historical development, theoretical foundations, materia medica, and therapeutic practices of TMM, including the relationship between food and medicine [21, 32, 49, 50]. Building on this literature, the present study focuses specifically on the historical development and conceptual organization of nutritional care within TMM. From the perspective of traditional medical knowledge, nutritional care in TMM can be understood as an emic system of culturally embedded health practices in which food functions simultaneously as nourishment, medicine, and a therapeutic modality [35, 51]. Conceptualizing this system is critical not only for preserving Indigenous health knowledge but also for advancing the theoretical understanding of culturally grounded approaches to nutrition, health maintenance, and well‐being in contemporary health sciences.

Therefore, this study aimed to explore and articulate a conceptual framework for nutritional care grounded in TMM. Specifically, this study addresses the following research questions: (1) How did historical TMM texts conceptualize nutrition in relation to caregiving, bodily regulation, and health maintenance? (2) What recurrent concepts relevant to nutritional care can be identified across historical TMM sources? (3) How can these concepts be integrated into a conceptual framework for nutritional care? We hypothesized that historical TMM texts would reveal recurrent and interrelated concepts of nutritional care that could be synthesized into a coherent conceptual framework.

2. Materials and Methods

This study combined historical research, Rodgers' evolutionary concept analysis, and concept mapping. Historical research followed Berg's seven‐stage framework: identification of the research question, literature review, refinement of the research question, data collection, source identification, verification of source authenticity, and narrative interpretation of the findings [52, 53].

Lincoln and Guba's criteria of credibility, transferability, dependability, and confirmability were applied to enhance methodological rigor [54, 55]. Credibility and confirmability were supported by the use of canonically published primary texts and by grounding interpretations in textual evidence; transferability by considering the socio‐cultural context in which the sources were preserved; and dependability by consistently applying the source‐selection and analytical procedures [56, 57].

The primary‐source corpus was drawn from the Ancient Classical Works of Mongolian Medicine series, officially published in Inner Mongolia in 2020. All 30 historical texts in the 25‐volume series were screened. Texts were included if they originated before the mid‐twentieth century, were preserved and published in Traditional Mongolian script, and contained information on food, beverages, dietary practices, or therapeutic nourishment. Sources in other scripts, contemporary scholarly works, and texts without relevant dietary content were excluded. Three texts containing no information on food or beverages were excluded, leaving 27 texts for analysis. Source authenticity and reliability were assessed from available information on authorship or origin, historical period, publication details, and textual context. Details of the included sources and their relevance are provided in Supporting Information S1: Appendix A.

The first author read all included texts, extracted relevant passages, and maintained analytical notes. The extracted material was coded and reviewed by three researchers. Related codes were compared across sources and historical periods and grouped into broader categories based on their recurrence, theoretical significance within TMM, and relevance to nutritional care. Differences in coding or categorization were discussed and resolved by consensus with the corresponding author. Rodgers' evolutionary concept analysis was then applied to examine the characteristics, contexts, historical continuity and change, and interrelationships of the categories [58, 59]. Through iterative comparison, recurrent concepts were identified and subsequently integrated through concept mapping [60, 61] into the proposed conceptual framework of nutritional care in TMM (Figure 1).

Figure 1.

Research process outline. The study addressed three research questions concerning [1] the historical conceptualization of nutrition in relation to caregiving, bodily regulation, and health maintenance [2]; recurrent concepts of nutritional care across historical TMM sources; and [3] the integration of these concepts into a conceptual framework. Historical research was used to examine the historical and theoretical foundations of TMM, Rodgers' evolutionary concept analysis to identify and refine recurrent concepts of nutritional care, and concept mapping to integrate these concepts into the proposed conceptual framework. Source: Created by the authors.

Secondary literature was used to contextualize the historical and conceptual analysis. PubMed, Google Scholar, and university library collections were searched during the study period using combinations of terms related to “Traditional Mongolian Medicine,” “Mongolian medicine,” “nutrition,” “diet,” “food,” “dietary therapy,” “nutritional care,” and “traditional medicine,” supplemented by reference‐list searching. Sources were included when relevant to the historical development, theoretical foundations, dietary practices, nutritional concepts, or therapeutic use of food in TMM and excluded when unrelated to these topics, focused solely on pharmacological or clinical outcomes without relevant historical or conceptual content, duplicated information represented by more relevant sources, or provided insufficient information for the study objectives. The search and initial selection were conducted by three authors, followed by research‐team review; disagreements regarding inclusion or interpretation were resolved by consensus.

The study was conducted between 2025 and 2026. As it relied exclusively on published historical and documentary sources and involved no human participants, IRB/ethical approval and informed consent were not required.

3. Historical Research

3.1. Historical Evolution of Nutritional Knowledge in TMM

The analysis focused on the theoretical foundations of nutritional practices in TMM, particularly the use of food and beverages for caregiving, health maintenance, disease prevention, and therapeutic purposes. Primary sources were examined within their historical contexts and arranged chronologically according to the historical periodization of Mongolian medical education (MME) [36]. The distribution of the 27 analyzed texts spanning the sixth to 20th centuries is presented in Table 1. Representative passages are presented below in English translation and interpreted in relation to relevant secondary historical literature.

Table 1.

Classification of sources aligned with the historical periodization of TMM.

MME historical periodization	Century	Nutritional knowledge characteristics	Relevant sources
MME of ancient states (3rd century BC‐10th century)	6th century	Cosmological and elemental understanding of body‐nutrition relations	Ashtanga Hridaya Samhita
	8th century		Four Medical Tantras
Influence of oriental MME (11th−16th century)	14th century		Proper Habits of Food and Drink
	16th century		Oral Instructions of the Ancestors
Manba Datsan (TMM core learning unit)–based MME (17th–early 20th century)	17th century		Blue Beryl
	17th century	Formalization of Nutritional Principles in TMM	Untieer of Vajra knot; Golden Subtitles; Teaching Title Light to Dispel the Darkness; Golden Vintage
	18th century		Four Medicinal Elixirs; The White Crystal Mirror; Subtitles of Lhantav; Precious Treasury of Healing; Moonlit Book of Healing
	19th century	Institutionalization of Caregiving Practices in TMM	The Treasury of All Precious Instruction; Four Keys to the Treasury of All Precious Instruction; Mthong ba dga' byed; Precious Collections of Selected Texts; Brief Beautiful Eye Ornament
	Early 20th century		A Garland of Arura; A Collection of Various Medicinal Formulas; A Treatise on Mongolian Medical Therapeutic Practices

TMM developed through sustained intercultural exchange rather than from a single medical tradition. Mongolian practical and folk knowledge, shaped by pastoral lifeways, local environments, and available food and medicinal resources, interacted with Indian, Tibetan, Chinese, Buddhist, and, later, Western medical traditions [35, 36, 62]. Indian elemental and humoral concepts were transmitted both directly and through Tibetan medical traditions, while Tibetan medicine became particularly influential in the systematization of medical theory, texts, and Manba Datsan–based education from the seventeenth century onward. Chinese medical concepts and therapeutic practices also contributed through regional exchange [35, 36, 62]. Thus, concepts such as elemental theory, humoral regulation, and therapeutic dietary principles should not be regarded as exclusively Mongolian in origin. In this study, “TMM nutritional knowledge” refers to historically transmitted knowledge that was preserved, adapted, and contextualized within TMM in relation to Mongolian dietary practices, ecological conditions, and ways of life [36, 63, 64].

None of the analyzed texts were specialized nursing treatises, consistent with the historical context in which nursing was not recognized as an independent discipline within the eight branches of Buddhist medicine [65]. Although the texts contain references to caregiving practices related to health, illness, and recovery [66], these were interpreted within their historical medical and cultural contexts rather than as evidence of modern nursing practice. References to food, beverages, dietary regulation, and support during illness were therefore treated as historical caregiving practices; their relationship to contemporary nutritional care was considered only during the subsequent concept analysis and framework development.

3.1.1. Cosmological Foundations of Nourishment (6th–Early 17th Centuries)

Historical analysis showed that early nutritional knowledge in TMM was grounded in cosmological understandings of the relationships among the body, environment, and food. Foundational texts influenced by Ayurvedic and Tibetan medical traditions conceptualized nourishment as a means of regulating bodily balance and health through elemental (shoroo or earth, us or water, gal or fire, khii or air, and ogtorgui or space) and humoral (khii, shar, and badgan) principles [67, 68, 69]. In TMM, khii, shar, and badgan constitute three interrelated regulatory principles: khii is associated primarily with movement, breathing, circulation, and physiological activity; shar with bodily heat and digestion; and badgan with bodily stability and fluid‐related functions. Health is understood as depending on their relative balance, whereas disruption contributes to disease [35, 70].

This relationship is illustrated in “Four Medical Tantras”, which states: “Sweet taste alleviates khii and shar. However, most sweet foods, except aged barley grown in dry regions and certain types of meat, tend to increase badgan. The meat of wild cattle, antelope, fish, and sheep, as well as honey, is beneficial in conditions associated with badgan. Sour taste alleviates badgan but increases shar [68]. This passage illustrates how food qualities were interpreted in relation to humoral regulation, consistent with secondary scholarship on the effects of the six tastes on the three humors and the therapeutic roles of food in the Four Medical Tantras [35, 71]. Texts from this period repeatedly emphasized moderation, seasonal adaptation, digestive regulation, and the relationship between food intake and bodily constitution [72]. Food and drink were increasingly understood as possessing distinct qualities, potencies, and effects capable of strengthening, weakening, balancing, or aggravating bodily processes [67, 68, 69]. Historical sources further suggested that dietary practices were closely connected to environmental conditions and lifeways, reflecting adaptation to people's ecological and climatic context [72, 73, 74, 75].

The 14th‐century text Proper Habits of Food and Drink represented a further stage in the intercultural development of nutritional knowledge, providing more systematic descriptions of dietary regulation, preventive nourishment, and food‐based therapeutic practices [35, 36]. It states: “By carefully adjusting one's diet to the four seasons, maintaining a balanced intake of food and drink, following an orderly way of life, and nourishing the five solid organs and six hollow organs with the five tastes, the organs become balanced and function harmoniously. As a result, wind and blood are nourished and strengthened, vitality and vigor flourish, and the mind becomes calm and composed. In this state, harmful influences cannot easily afflict the body” [76]. This passage directly links dietary regulation with bodily balance and health maintenance.

Together, these sources indicate a gradual elaboration of earlier cosmological principles into more explicit preventive and therapeutic dietary knowledge, including dietary regulation related to longevity, organ protection, and disease prevention [76], consistent with secondary historical scholarship on the development of dietary therapy in Mongolian medicine [77].

3.1.2. Systematization of Therapeutic Dietary Knowledge (17th–18th Centuries)

Historical texts from the seventeenth and eighteenth centuries reveal the formalization and expansion of nutritional knowledge within TMM, coinciding with the development of Manba Datsan–based medical education [36, 78]. During this period, dietary knowledge became increasingly systematized through the classification of foods and beverages according to flavor, qualities, potency, digestibility, and their effects on bodily balance [79, 80, 81, 82, 83]. Historical sources emphasized that dietary practices should be adapted to individual constitution, age, season, environment, digestive capacity, and disease conditions [84, 85, 86].

A notable development was the integration of nutrition into therapeutic and caregiving practices [35, 36, 64]. Texts distinguished between appropriate, supportive, and restricted foods and described dietary regulation before, during, and after treatment [81, 87]. Direct textual evidence for this therapeutic role is provided in “Moonlit book of healing”, which states: “When shar us (pathological fluid) spreads to the skin, it causes itching, dark spots on the nails, loss of hair and eyebrows, and dark bluish discoloration of the skin. The dietary treatment involves avoiding mutton, spoiled, decomposed, aged, or raw meat, as well as decayed vegetables, strong alcoholic beverages, and pungent and sour foods. Cooked flour‐based foods should be consumed in small quantities, salt intake should be restricted, and fresh foods and drinks with a pleasant taste should be provided” [84]. This passage demonstrates that dietary decisions were linked to the individual's condition and stage of treatment rather than being treated as general dietary advice. Food and beverages were employed not only for nourishment but also as therapeutic agents and, in some cases, as external applications to support healing [87, 88, 89]. Secondary historical studies similarly describe the increasing systematization of dietary and therapeutic principles within TMM during this period [90]. These sources indicate the emergence of individualized dietary care in which nutritional decisions were guided by the patient's bodily condition, strength, imbalance, and recovery status, reflecting an early form of nutritional assessment and intervention within TMM.

3.1.3. Emergence of Caregiving‐Oriented Nutritional Practice (19th–Early 20th Centuries)

Texts from the 19th and early 20th centuries increasingly emphasized nutritional support within therapeutic and caregiving contexts. Although classical TMM did not conceptualize nursing as an independent professional discipline, historical sources contained repeated references to dietary care for illness recovery, chronic disease management, bodily weakness, and supportive treatment [91, 92]. Dietary regulation was described according to disease progression and treatment stages, including nutritional support during the initial, intermediate, and recovery phases of illness [93, 94]. For example, “Mthong ba dga' byed” states: “Initially, light foods of low nutritional value should be given. As the condition improves, restrictions on fresh and nourishing foods may gradually be relaxed. Mild cases treated in this manner will generally recover without difficulty. Alternatively, khambil may be boiled down to prepare a concentrated broth, to which powdered jugаn, raisins, and pomegranate are added and mixed. During bouts of coughing, a single sip of this preparation should be administered; it is said to relieve severe, persistent coughing” [93]. This passage illustrates the use of nourishment as part of supportive care during illness and recovery. Similar relationships between dietary regulation, bodily strength, and recovery have also been identified in TMM [35]. Food and beverages were presented not only as sources of nourishment but also as therapeutic agents capable of restoring strength, regulating bodily imbalance, and supporting recovery [95].

Across these later sources, caregiving principles increasingly emphasized moderation, preservation of digestive function, restoration of vitality, and adaptation to weakened bodily states [96]. Nutritional support was closely linked to disease prevention and recovery, suggesting that food functioned simultaneously as nourishment, therapy, and caregiving intervention [93, 95, 96]. Some twentieth‐century texts further compared food and beverages with medicinal therapies and highlighted their shared therapeutic properties [97, 98], reflecting a growing specialization of dietary knowledge. Overall, TMM nutritional knowledge evolved from cosmological understandings of body–food relationships into increasingly systematized forms of therapeutic and caregiving dietary practice, in which food served as a culturally embedded modality of prevention, recovery, and care.

3.2. Recurrent Concepts of Nutritional Care in TMM

While historical research focuses on interpreting source materials and analyzing them within their historical and semantic contexts, concept analysis further deepens and enriches these findings by organizing the information at the level of classification and systematization in order to clarify the structure of concepts. This section transitions from historical description to conceptual interpretation by identifying recurrent concepts consistently embedded across primary historical texts. Through comparative analysis of the historical sources, several interrelated conceptual patterns emerged as the theoretical foundations of nutritional care in TMM. Five recurrent concepts emerged [1]: bodily balance and humoral regulation [2], elemental classification of nourishment [3], individualized and contextualized nutrition [4], therapeutic and caregiving functions of food, and [5] prevention through dietary moderation.

3.2.1. Bodily Balance and Humoral Regulation

The most consistently recurring concept across the historical sources was the regulation of the three humoral principles: khii, shar, and badgan [68, 69, 80]. These humoral elements were regarded as the primary determinants of bodily functioning and health. Disease was generally understood as the result of an imbalance among these principles, whereas health reflected their relative equilibrium [87, 88]. Food and drink were repeatedly described as factors capable of influencing humoral balance [73]. Nutritional care therefore functioned not merely as nourishment but as a means of regulating bodily equilibrium [72]. Historical texts consistently emphasized that dietary substances could either restore or disrupt humoral balance depending on their qualities, potency, and patterns of use [79, 81, 93]. This concept suggests that assessment of bodily balance constitutes the central rationale for nutritional care within TMM (Figure 2).

Figure 2.

Humoral regulation and bodily balance in traditional Mongolian medicine. The figure illustrates the dynamic relationship among khii, shar, and badgan, the three interrelated regulatory principles of bodily function in TMM. Khii is associated primarily with movement and physiological activity, shar with heat, digestion, and metabolic transformation, and badgan with bodily stability, structure, and fluid regulation. Their relative balance is understood within TMM as being influenced by food and drink, season, lifestyle, and environmental conditions. Nutritional care is therefore directed toward maintaining or restoring this balance through the appropriate use of food and beverages in relation to individual and contextual conditions. Source: Created by the authors.

3.2.2. Elemental Classification of Nourishment

A second recurring concept concerned the classification of food according to cosmological principles. Historical texts described food and beverages through the theory of the five great elements and the six flavors [68, 80]. Rather than focusing on nutritional composition, dietary substances were categorized according to their elemental origins, sensory qualities, potency, and effects on the humoral system [82, 83, 84, 89, 96]. The six flavors, understood as manifestations of the five great elements, were repeatedly linked to specific effects in regulating the balance of khii, shar, and badgan [68, 80]. Consequently, food selection was understood as a deliberate process of matching dietary qualities to individual bodily conditions. This classification system (Table 2) provided the theoretical basis for selecting appropriate foods and restricting unsuitable dietary substances.

Table 2.

Relationships between flavors, elements, and humoral effects in TMM.

Flavor	Elemental composition	Humorial effects
Sweet	Earth and water	to reduce khii and shar
Bitter	Water and air	to reduce shar and increase badgan, khii
Sour	Fire and earth	to reduce badgan and khii
Salty	Water and fire	to reduce khii, badgan and increase shar
Astringent	Earth and air	to reduce shar
Pungent	Fire and air	to reduce khii, badgan and increase shar, excessive use may increase khii

Note: Although space is recognized as one of the five elements, it is generally excluded from the elemental origins of the six flavors because it is understood to emerge from the interaction of the other four elements rather than functioning as an independent source.

3.2.3. Individualized and Contextualized Nutrition

Another recurrent concept was the importance of adapting food and drink to the individual's constitution and circumstances. Historical texts frequently referred to age, bodily characteristics, digestive capacity, season, climate, geographical environment, and lifestyle as factors influencing dietary appropriateness [81, 87, 88, 93, 95]. This indicates that nutritional care in TMM was fundamentally individualized rather than standardized. Appropriate nourishment was determined through the interaction between personal constitution and contextual conditions [82, 83, 84, 85, 86]. This concept corresponds to culturally and individually tailored care.

3.2.4. Therapeutic and Caregiving Functions of Nutrition

As demonstrated by the historical evidence presented above, across all historical periods, food was described not only as sustenance but also as a therapeutic and caregiving resource [99, 100]. Historical sources referred to appropriate, supportive, and restricted foods used before, during, and after treatment [81, 87, 94]. Nutritional support was particularly emphasized for weakened individuals, older adults, and people recovering from illness [76, 82, 83]. In several texts, food and medicinal substances were discussed together because they shared similar qualities, potency, and therapeutic effects [72, 79, 97, 98]. Consequently, nourishment occupied an intermediate position between everyday consumption and medical treatment. This concept reveals the caregiving dimension of nutritional practice and demonstrates how food functioned as a practical intervention within TMM.

3.2.5. Prevention Through Dietary Moderation

The final recurring concept concerned prevention and moderation. Historical sources repeatedly emphasized balanced consumption, avoidance of excess, and adherence to dietary restrictions [89, 91, 92, 93, 94]. Improper eating and drinking practices were frequently described as causes of humoral imbalance and disease [76, 80, 81, 88]. Accordingly, nutritional care was directed not only toward restoring health but also toward preventing illness and maintaining vitality. Prevention was achieved through continuous dietary regulation rather than episodic intervention [76, 80, 88, 93]. This preventive orientation reflects a central philosophical principle underlying nutritional care in TMM. Taken together, these recurrent concepts indicate that nutritional care in TMM is grounded in a culturally embedded understanding of bodily balance, individualized care, and therapeutic nourishment. Food functions simultaneously as a source of sustenance, a regulatory mechanism, and a caregiving intervention.

3.3. Development of the Conceptual Framework of Nutritional Care in TMM

Although the conceptual foundations of TMM evolved through a long historical process. In the present study, these historically derived concepts were synthesized to clarify their interrelationships and organize them within a conceptual framework of nutritional care. The present framework addresses this gap by organizing historically derived nutritional concepts into an integrated model grounded in the theoretical foundations of TMM.

As demonstrated in the preceding analyses, five recurrent concepts were identified across the historical sources and refined through concept analysis. These concepts were subsequently synthesized through concept mapping to construct the conceptual framework of nutritional care in TMM. Table 3 summarizes the relationship between the historical evidence, conceptual categories, and framework components.

Table 3.

Derivation of the conceptual framework of nutritional care in TMM from historical sources.

Framework component	Recurrent concepts identified through concept analysis	Historical evidence identified across primary sources	Representative sources
Cosmological foundations of nourishment	Five elements; six flavors	Food and beverages are explained through elemental composition and sensory qualities that influence bodily functioning and health	Ashtanga Hridaya Samhita; Four Medical Tantras; Golden Subtitles; Four Medicinal Elixirs
Contextual influences	Season; environment; lifestyle; bodily constitution	Appropriate nutrition varies according to season, geographical environment, age, lifestyle, and individual characteristics	White Crystal Mirror; Teaching Title Light to Dispel the Darkness; Precious Collections of Selected Texts
Humoral balance and imbalance	Khii; shar; badgan; equilibrium; dysregulation	Food and beverages influence the balance or imbalance of the three humoral principles and thereby affect health and disease	Four Medical Tantras; Blue Beryl; Four Medicinal Elixirs
Dietary planning	Properties; effects; qualities; potency	Selection of food and drink is guided by humoral condition, constitution, disease status, and contextual circumstances	Golden Subtitles; Subtitles of Lhantav; Treasury of All Precious Instruction
Therapeutic nutritional care	Supportive nourishment; restorative care; therapeutic use of food and drink	Food and beverages are used before, during, and after treatment to support recovery and strengthen bodily functions	Golden Vintage; Precious Treasury of Healing; Treatise on Mongolian Medical Therapeutic Practices
Evaluation	Recovery; adaptation; bodily functioning; elimination of waste products	Nutritional care is evaluated through restoration of balance, improvement of bodily function, adaptation, and recovery	Treatise on Mongolian Medical Therapeutic Practices; A Garland of Arura

The framework was developed by analytically organizing the historically derived concepts according to the contemporary processes of assessment, planning, intervention, and evaluation. These categories represent the authors' conceptual synthesis and should not be interpreted as evidence that historical TMM practitioners explicitly used a modern nursing process [101]. Nutritional assessment considers constitutional characteristics, dietary habits, and contextual factors such as season, environment, and lifestyle, which together influence humoral balance. Based on this assessment, dietary planning involves selecting foods and beverages according to their qualities, potency, and expected effects on bodily regulation. Nutritional intervention includes dietary regulation, restorative nourishment, and the therapeutic use of food and beverages, while evaluation focuses on changes in bodily balance and responses to dietary care. The relationships among these components are illustrated in Figure 3.

Figure 3.

Conceptual framework of nutritional care in traditional Mongolian medicine. The framework organizes historically derived concepts of nutritional care into the interconnected processes of assessment, planning, intervention, and evaluation. Assessment considers constitutional bodily factors, dietary intake and habits, contextual influences, and imbalance among khii, shar, and badgan, the three regulatory principles of bodily function in TMM. Dietary planning guides the selection of appropriate foods and restriction of incompatible dietary substances according to their properties, qualities, potency, and expected effects on bodily balance. Intervention includes dietary regulation, restorative nourishment, and therapeutic food use, followed by evaluation of balance, recovery, and adaptation. The framework represents the authors' conceptual synthesis of the historical evidence and should not be interpreted as a historical clinical protocol. Source: Created by the authors.

Overall, the framework conceptualizes food as a means of maintaining balance, supporting recovery, and promoting health within a culturally grounded system of care. By organizing historical nutritional knowledge into a coherent conceptual structure, the framework provides a foundation for future research on TMM and contributes to the broader understanding of Indigenous approaches to nutritional care.

4. Discussion

This study suggests that nutrition within TMM extends beyond dietary intake and represents a culturally and historically embedded approach to caregiving. Across the analyzed sources, food and beverages were described as means of maintaining bodily balance, preventing illness, supporting recovery, and adapting to individual, seasonal, and environmental conditions. These concepts should not, however, be regarded as exclusively Mongolian in origin. Rather, TMM nutritional knowledge reflects the historical transmission and adaptation of Indian, Tibetan, Chinese, and Buddhist medical concepts within Mongolian ecological conditions, dietary practices, and approaches to health and healing [66, 102, 103, 104, 105].

This interpretation should be considered in light of the source selection. Because the primary corpus was limited to texts preserved and published in Traditional Mongolian script, relevant Tibetan‐, Chinese‐, and Cyrillic Mongolian‐language sources were not included. The historical patterns identified therefore represent the selected Mongolian‐script corpus rather than a comprehensive reconstruction of all textual traditions that contributed to TMM. Sources in other languages may provide additional or differing evidence regarding the origins, transmission, and development of nutritional concepts.

The findings can be situated within broader perspectives on nutritional care, traditional and Indigenous knowledge, and transcultural care. Contemporary nutritional care extends beyond nutrient provision to include assessment, individualized decision‐making, intervention, and evaluation within clinical and social contexts [106, 107, 108], while traditional and Indigenous knowledge systems situate health and healing within culturally transmitted understandings of the body, environment, food, and ways of life [109]. Similarly, Leininger's Culture Care Theory emphasizes culturally congruent care grounded in culturally embedded values, beliefs, worldviews, and practices [66]. The present framework is consistent with these perspectives in recognizing nutritional care as culturally and contextually situated, but it does not equate historical TMM caregiving with modern professional nursing. Rather, assessment, planning, intervention, and evaluation provide a contemporary analytical structure for organizing historically derived concepts of bodily balance, the five elements, three humors, six flavors, individualized nutrition, therapeutic nourishment, and dietary moderation [21, 57, 62]. The framework should therefore be understood as the authors' conceptual synthesis rather than as evidence that historical TMM practitioners explicitly followed a modern healthcare or nursing process.

Through concept analysis and concept mapping, these concepts were synthesized into an integrated framework consisting of nutritional assessment, dietary planning, intervention, and evaluation. In this framework, food is positioned not merely as an adjunct to treatment but as a central modality for maintaining balance, supporting recovery, and promoting health. This interpretation is consistent with perspectives that recognize health‐related practices as culturally situated and shaped by broader systems of knowledge and belief [40, 110, 111]. The framework therefore provides a conceptual bridge between Indigenous medical knowledge and contemporary health science scholarship. Within TMM, nutritional care is guided by theoretical principles concerning balance, digestion, metabolism, and harmony between the human body and the natural environment [112, 113, 114]. To facilitate conceptual organization, these historically derived principles were structured according to the sequential processes of assessment, planning, intervention, and evaluation commonly used in healthcare and nursing.

The findings further indicate that nutritional care in TMM constitutes a coherent and context‐sensitive system of health maintenance and recovery. Food selection, preparation, timing, and quantity are traditionally determined by season, age, gender, physical constitution, and metabolic characteristics [21, 115]. These principles reflect a contextualized approach to nutritional care in which dietary practices are adapted to individual and environmental conditions. However, increasing disconnection from traditional knowledge systems has transformed many of these practices, highlighting the importance of preserving, documenting, and reinterpreting culturally grounded nutritional knowledge within contemporary healthcare contexts [10, 116, 117]. Accordingly, the proposed framework should be regarded as a conceptual basis for further research rather than an established clinical model. Because it was developed from historical texts and conceptual analysis and has not been empirically tested in contemporary clinical practice, its clinical applicability, feasibility, and effectiveness remain to be established before its use in clinical decision‐making or practice can be recommended.

Previous studies have described the historical development and theoretical foundations of TMM, including the three roots, five elements, six flavors, medicinal properties, and principles of materia medica [35, 57], while more recent reviews have examined its transition toward modern scientific research and developments in materia medica, pharmacology, quality control, and standardization [28, 64]. Research has also examined medicine–food relationships within individual Mongolian medical texts, demonstrating the close relationship between dietary substances and therapeutic practice [118].

The present study differs from these studies in its analytical focus and methodological approach. Rather than providing a general historical overview of TMM, examining materia medica and pharmacological development, or analyzing food–medicine relationships within a single text, it traces nutritional care across historical TMM sources and examines recurrent concepts through historical research, evolutionary concept analysis, and concept mapping. Its contribution lies not in claiming that nutrition or the therapeutic use of food in TMM has not previously been studied, but in synthesizing historically recurring concepts of bodily balance, elemental properties of food, individualized and contextualized nutrition, therapeutic nourishment, and dietary moderation into a unified conceptual framework of nutritional care.

5. Limitations

This study has several limitations that may introduce potential sources of bias. First, retrospective interpretation of historical texts through the contemporary conceptual lens of nutritional care may introduce presentist or interpretive bias, whereby past concepts and practices are understood in terms of present‐day categories. Presentism is a recognized methodological concern in historical research [119, 120], and recent scholarship continues to emphasize interpreting historical evidence within its own temporal and conceptual context [121]. To reduce this risk, the texts were interpreted within their chronological and theoretical contexts, and the conceptual framework was developed only after the historical analysis.

Second, restricting the primary corpus to texts preserved in Traditional Mongolian script may have introduced selection and language bias because relevant Tibetan‐, Chinese‐, and Cyrillic Mongolian‐language sources were not included. Language restrictions may omit or underrepresent relevant evidence and affect the comprehensiveness and representativeness of a synthesis [122, 123], while recent empirical research demonstrates that such restrictions can influence the evidence included and, in some contexts, the resulting conclusions [124]. Accordingly, the historical reconstruction should be regarded as partial rather than exhaustive and as primarily representative of the Traditional Mongolian‐script corpus examined.

Third, translation and contextual interpretation of historical terminology may have introduced translation and interpretive bias, particularly where TMM concepts have no exact equivalents in contemporary English. Cross‐language interpretation may alter or narrow culturally embedded meanings [125, 126], and recent methodological literature continues to emphasize the influence of language and translation on qualitative interpretation [127]. This risk was addressed by grounding interpretations in the original textual context and applying consistent analytical procedures; nevertheless, some semantic nuance may have been lost in translation.

Finally, this study was based on historical and published documentary sources rather than empirical observation of contemporary healthcare practice. The proposed framework therefore should not be interpreted as evidence of current nutritional‐care practices or clinical effectiveness, and its clinical applicability, feasibility, and effectiveness remain to be empirically established. Future research should incorporate multilingual historical sources and evaluate the framework's relevance and applicability in contemporary healthcare settings.

6. Conclusion

This study aimed to examine the historical and conceptual foundations of nutritional care in TMM and to develop a conceptual framework based on historical TMM texts. We hypothesized that these texts would reveal recurrent and interrelated concepts of nutritional care that could be synthesized into a coherent conceptual framework. The findings supported this hypothesis: historical analysis identified recurring and interconnected principles of bodily balance and humoral regulation, elemental classification of nourishment, individualized and contextualized nutrition, therapeutic and caregiving functions of nutrition, and prevention through dietary moderation. These five concepts were subsequently synthesized into a conceptual framework organized around assessment, planning, intervention, and evaluation.

By conceptualizing nutrition as a culturally embedded system of health maintenance and recovery, the study contributes to theory development within the field of Indigenous medical knowledge and supports a more comprehensive understanding of traditional nutritional practices.

The framework highlights the role of food as a central element in maintaining bodily balance, preventing illness, and supporting recovery within TMM. As healthcare systems become increasingly diverse, such conceptualizations provide a foundation for further research into culturally grounded approaches to nutritional care and their relevance within contemporary health sciences.

Author Contributions

Sarina Sarina: writing – original draft, methodology, writing – review and editing, formal analysis, resources. Munguntuul Enkhbat: writing – original draft, investigation, writing – review and editing, visualization, formal analysis, software. Enkhtuguldur Myagmar‐Ochir: writing – original draft, methodology, validation, formal analysis, supervision. Oyungoo Badamdorj: writing – original draft, methodology, validation, formal analysis, supervision. Bai Yiping: data curation, formal analysis, funding acquisition, software, resources. Hong Yuguang: funding acquisition, software, formal analysis, data curation, resources. Buyandelger Batmunkh: conceptualization, writing – original draft, writing – review and editing, methodology, project administration, visualization, supervision.

Funding

The authors have nothing to report.

Ethics Statement

This study involved no human participants, animals, or identifiable personal data. Therefore, ethical approval and informed consent were not required.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The corresponding author Buyandelger Batmunkh affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Supporting information

Supporting File

Data Availability Statement

The authors have nothing to report.