Historically, most medicine wheels follow a similar pattern of a central circle or cluster of stones, surrounded by an outer ring of stones, along with "spokes" (lines of rocks) radiating from the center out to the surrounding ring. Often, but not always, the spokes may be aligned to the cardinal directions (East, South, West, and North). In other cases, some stones may be aligned with astronomical phenomena. These stone structures may be called "medicine wheels" by the Indigenous nation which built them, or by more specific names in that nation's language.
Physical medicine wheels made of stone have been constructed by a number of different Indigenous cultures in North America, notably many of the Plains nations. The structures are associated with Native American and Indigenous Canadian religious ceremonies.