TRADITIONAL THAI MEDICINE: HISTORY. HERBAL REMEDIES, DIAGNOSES, TREATMENTS

TRADITIONAL THAI MEDICINE

Thais often prefer locally prepared remedies, treatments by local healers and traditional massage therapy to hospitals and doctors. Massage is regarded by villagers as an important form therapy. Illness has traditionally been blamed on spiritual possession, fear, problems, and an imbalance of elements on the body. In the Northeast rituals such as bai sir sukwan (“tying” the soul back into a an ill or disturbed person) is an important form of healing.

Snuff, inhalants, gargling solutions, teas, infusions, tonics, alcoholic macerates, oral dosages, pills, capsules, tablets, poultices, ointments, essential oils, and suppositories - herbal remedies come in a vast variety of forms. Those taken orally are often classified by their taste - sweet, bitter, astringent, acrid, nutty, salty, and sour, which then correlate with their healing attributes. For example, an herb with a cooling flavor will be prescribed for someone suffering from an ailment caused by a fire element imbalance, or an acrid taste will restore the wind element to a balanced level.[Source: Thailand Foreign Office, The Government Public Relations Department]

Traditional herbalists, like Thai masseurs and masseuses, have a guardian spirit they pay homage to: Shivaga Komarpaj, the Ayurvedic practitioner who treated the Lord Buddha and is considered the father of Thai traditional medicine,. An important ritual among practitioners of Traditional Thai Medicine is the wai khru, or paying homage to Shivago and the unbroken lineage of masters who have kept the tradition alive. The devotee makes prayers and offerings (usually incense) at an altar, taking care never to turn his or her back on it after the ceremony. The wai khru which opens with the words Om namo Shivago, is performed in schools and massage facilities throughout the land.

Thai homeopaths also pay homage to Phra Mae Thorani, “Mother Earth,” and will chant a small prayer when they collect the plants. While certain districts and provinces are known for having superior species because of their climate and soil, there are also specific times that are best for collection; for example, the evening flower jasmine should be picked at night or just before sunrise. Furthermore, it is always best to collect plants during the full moon, when the elements are at their maximum power.

There are three basic ways to classify medicinal herbs: those taken internally, applied externally, and inhaled. Many, though, fall under two or even all three of these classifications. Herbal drugs can have from two to as many as 40 different ingredients, which are also classified by species and medicinal attributes. Then, there is Thai cuisine, which, while famous for its flavors, is also known for its healing properties. As the different dishes can kindle and arouse as well as soothe the senses, the different spices and ingredients are again included to achieve a harmony of the body’s elements, thus serving as a preventative or curative of different symptoms and ailments.

Philosophy and Reasoning Behind Thai Traditional Medicine

Earth, wind, fire, and water. No, not a band’s name, but the four elements that must be balanced for a person to be healthy. This is the basis for Thai traditional healing. As early as the third century BC, Indian Brahmins and Buddhist monks traveled to Thailand. As well as the introducing new religious beliefs, they brought with them a holistic approach to healing, Ayurveda, which is based on maintaining a balanced flow of energy through meridians in the body and includes massage and herbal remedies. As the region’s name, Indochina, so well implies, the Chinese also had a strong influence on Thai culture, bringing with them their treatments, particularly acupressure and acupuncture, as well as a cornucopia of animal and herbal concoctions.[Source: Thailand Foreign Office, The Government Public Relations Department]

While this theory has it roots in Indian Ayurvedic principles first introduced in Thailand during the second or third centuries BC, when Buddhist monks arrived to teach their new religion, Thais must have already been concocting herbal remedies, as it has always been the nature of man to discover better solutions for survival. Through trial and error and accident,the earliest people learned about the wild plants that grew around them, and when they settled and became farmers, they would plant gardens for their herbs and spices.

Thus, Thai healing evolved with the integration of these systems and ethno-practices being performed by local healers, shamans, and midwives. Based on a holistic approach that includes internal, external, and psycho-spiritual disciplines, or herbal potions, massage, and meditation, this medical philosophy focuses on four elements, earth (din), water (nam), wind (lom), and fire (fai), and achieving body and mind harmony.

History of Traditional Medicine in Thailand

Massage and herbal healing are presumably as old as the human race. After hunters returned to their caves with aching limbs, their mates probably tried to rub away the stiffness. Meanwhile,while foraging the forests, they would find wild plants and, after experimentation, discover that some had amazing medicinal properties. Over time, this knowledge was refined and passed down, first orally from generation to generation. Later, samut khoi, parchment texts, were produced. As trade and relations began to develop between villages, then city-states and finally kingdoms, this know-ledge was shared and adopted. [Source: Thailand Foreign Office, The Government Public Relations Department]

Legend ascribes the origin of Thai medicine to Shivago Komarpaj, a historical figure who served as physician to the Buddha's Sangha (community of monks and nuns). A minor personality in the scriptures, Shivago nevertheless attains near god-like status in Thai religion. He is revered throughout the country as the Father Doctor, and statues of him appear alongside the Buddha's. At the entrance to the Grand Palace, we see a statue of the divine physician overlooking the area.

The Ramkhamhaeng Stone Inscription is the earliest evidence of Thai ethno healing, as it describes the royal plant garden. Even before this, though, during the Khmer Empire that ruled the Northeast, it is recorded that King Jayavarman VII ordered the establishment of 102 arokaya sala, or traditional healing hospitals. Much later, in the 16th century, when King Narai ruled Siam from his seat of power in Ayutthaya, he had both hospitals and the herbal dispensaries opened. After the fall of Ayutthaya and the founding of Bangkok, King Rama III began to promote ethno healing, establishing a school at Wat Pho. However, interest waned as the Government and people turned their attention to, and put their trust in, Western medicine.

When Burmese enemies sacked the old Siamese capital of Ayutthaya in 1767, they also destroyed most records of medicine. Years later when Rama I became king of Siam, he moved the seat of government to Bangkok and initiated a cultural renaissance with the intent to reclaim the kingdom's old glory. He and his descendants ordered the collection and preservation of the arts and sciences, renovated temples, and built schools. All surviving medical knowledge was committed into writing; in the process it was codified and organized into a system that closely follows Indian Ayurveda.

During the reign of King Rama VII, in 1929, the two medical approaches were separated, which was very detrimental to Thai indigenous medicine. It wasn’t until the World Health Organization began promoting the preservation of ethnoheritage in 1927 that the Ministry of Health turned its attention to a revival of indigenous treatments, which has been supported more and more by national economic and social development plans. This led to the establishment of the Foundation for the Promotion of Thai Traditional Medicine and other related organizations and agencies.

But, in 1938, a project was initiated in the northern province of Chiang Mai to cultivate the herb cinchona to produce quinine, but it was not economically viable. With World War II and a lack of sufficient quantities of drugs, the Government again turned its attention to herbal remedies. They even engaged a German expert, to establish an experimental medicinal garden in the eastern province of Chanthaburi. After a short time, the doctor produced a report in English and Thai listing as many as 400 indigenous plants, their characteristics, and medicinal values.

After the World Health Organization began to promote national traditional heritage in 1977, the Thai government added ethno medicine to its five-year national economic and social development plans. The Foundation for the Promotion of Thai Traditional Medicine was established and, over the years, the interest in and importance of herbal healing has continued to grow.

Two Traditions of Thai Medicine: Royal Tradition and Folk Tradition

According to thaimedicineguide.com: “Scholars differentiate between two forms of Traditional Thai Medicine, namely the Royal or literate tradition espoused by medical schools and supported by the Thai government, and the unregulated Folk practices which are passed orally from generation to generaton by individual healers. As official policy strives to centralize and unify TTM and raise medical practice standards, the Royal Tradition is growing increasingly dominant. [Source: Thai Medicine Guide thaimedicineguide.com ]

Tourists and travelers who study in a Thai medicine school encounter a standarized healing system that is heavily dependent on Ayurvedic, Yogic ane Western influences. This organized body of teachings presented in literature and school curricula is generally known as the Royal Tradition or Elite Tradition. So-called perhaps because it was developed under the command of Thai kings in a cultural revival dating from the late 18th century. Why the ayurvedic model was chosen as the standard is not clear, nor is there a way to tell how strong the Indian influence on Thai medicine was before then. What is obvious is modern Traditional Thai Medicine looks to Ayurveda to explain and systemize its doctrine. In addition, TTM also depends on Western, Chinese and other influences.

The Royal Tradition is a formal medical discipline learned in universities. Aspiring professionals need take up only herbal medicine and massage, but they must be licensed to practice. Courses run from 3-4 years. Shorter classes are also available and popular among tourists. It is this form of traditional medicine that is taught in schools throughout the kingdom, and it is what's represented in the vast majority of literature on the subject.

If one never looks beyond the knowledge offered by one's school, or perhaps a book, one would think that the Royal Tradition was the only form of native Thai medicine that existed. Yet such is not the case. Various healing arts exist outside of the literate tradition. Known collectively (for lack of a better term) as the Folk or Rural Tradition, these are an assortment of informal practices that are passed down from teacher to student and which vary from place to place.

The Folk Tradition consists of diverse practices that have survived in spite of its elite counterpart - native massage, herbal medicine, tatooing, astrology, amulet-making, mediumship, exorcism, etc. These are employed by folk healers who are neither licensed nor regulated. Such healers learn orally and experientially and a background in scientific theory is often lacking. Healers of the Rural Tradition may seem more like shamans and witch doctors than real physicians to a modern observer. Yet tempting as it is to dismiss it all as mere superstition or even as "quack" medicine, many Thai people still consult folk healers even in urbanized areas.

Unfortunately for outsiders, a lot of secrecy surrounds Thai folk healing. Healers guard their arts jealously and transmit them orally directly to their heirs. Furthermore, these practices are neither endorsed nor sanctioned by the government, which is eager to promote the Royal Tradition as the legitimate form of TTM. The Rural Tradition is not formally taught in Thai medical schools, so it is difficult to study especially by foreigners.

One key difference between the two traditions is the way they view health, illness and treatment. Like Ayurveda, the Royal Tradition sees disease as an inner battle between harmony and chaos in the body. Balancing the strength of the elements and the flow of vital energy is key to health and longevity. Thai folk healing, on the other hand, is permeated by a strong belief in spirits and their power to affect human welfare. Disease and misfortune are often seen as attacks from malevolent beings such as angry ghosts and displaced spirits. Charms, prayers, tatoos, amulets and rituals are used to thwart these attacks.

Thai Massage and the Four Branches of Thai Medicine

According to thaimedicineguide.com: “Traditional medical practice in Thailand consisted of four branches: 1) medicine, 1) midwifery, 3) orthopedic and 4) massage. The traditional doctor had to master all four disciplines. He studied for many years under a teacher before becoming a full-fledged physician. Another way to classify these disciplines is by which part of the human being they tend to: physical body, energy system or the mind/heart. Herbal medicine and midwifery, for example, deal with physical conditions. Massage and yoga address the energy or sen lines. Spiritual healing or religion purifies the mind and heart. It is not a coincidence that the Shivago Komarpaj Hospital in Chiang Mai is divided into three sections: a massage clinic in the west, a herbal facility in the east, and a shrine in the middle-- representing the three levels of healing. [Source: Thai Medicine Guide thaimedicineguide.com ]

Thai massage or nuad boran is oil-free bodywork that combines body massage, acupressure and stretching. It is done on a mat on the floor with the client comfortably dressed. Besides the hands and fingers, the massage therapist uses other parts of his or her body such as the elbows, knees and feet to manuever the client into various positions. Body weight is used to apply pressure. Going through the motions of a Thai massage routine has often been described as " someone else doing yoga on you" or "doing yoga the lazy way." In reality, Thai massage is not yoga even though some of the postures resemble yoga asanas.

Thai massage operates based in the concept of energy lines called sen that nourish the body with vital force. This energy is called lom in Thai and prana in Sanskrit. There are ten major sen lines, each with its own function and benefit. Depending on the client's condition, the masage therapist treats specific lines to improve health. A full Thai massage routine can last from one hour to several hours. This type of massage is very polite, respectful and caring, in keeping with Thai culture and the Buddhist concept of metta.

The origin of Thai massage is unknown, but experts see the influence of Chinese and Indian medicine. Today, Thai massage is by far the most popular branch of Traditional Thai Medicine in the world. It is widely practiced in Thailand in health clinics and spas. More and more professionals in Europe and North America are adopting this massage modality and a few Thai massage schools/classes have cropped up as well.

Thai Medicine Diagnosis and Treatment

The process of diagnosis and treatment by a "medicine doctor" (herbalist) follows the Ayurvedic model: the cause of the disease as well as the elemental makeup of the patient is analyzed. All things in the world and in the human being is made up of the four elements: fire, water, air and earth. Each element rules specific body parts and functions, and an imbalance of an element manifests as a disese of the areas it is concerned with. For example: 1) A disharmony of the earth element may manifest as a disease of the organs, bones or muscles. 2) A disharmony of the water element may show symptoms such as urniary trouble, blood or lymph disease. 3) A disharmony of the air element may show as respiratory problems like bronchitis, dizziness, stiffness, arhtiritis. 4) A disharmony of the fire element may cause heart problems. [Source: Thai Medicine Guide thaimedicineguide.com ]

The imbalance can be either a lack or an excess of that element, and often more than one is involvred. Thai herbalists develop skills to recognize the malfunctioning element(s) as well as the elemental balance (humor) of the patient. A healer may also resort to other methods such as pulse diagnosis (used by Ayurvedic and TCM practitioners too).

Living in harmony with nature is key to health and longevity in ancient healing systems including Traditional Thai Medicine. Imbalance in one's internal energies, a failure to adjust to natural cycles and a poor diet and habits can all cause disease. In TTM theory, any one of the factors below can make a person sick: 1) Imbalance of the four elements (either a surplus or a lack); 2) Seasonal changes; 3) Growth and aging (life cycles); 4) Diurnal and nocturnal cycles; 5) Climate changes; 6) Unhealthy lifestyle or habits.

Health can be restored through lifestyle changes, massage, herbal treatment and/or exercise. The different branches of Traditional Thai Medicine cover all these aspects in one holistic system. Treatment consists of dietary adjustments and herbal medicine. Each herb affects the elements differently - some increase an element while others decrease it. Also, each herb is classified by its action, say expectorant, purgative, anti-inflammatory, etc. The exact prescription depends on the illness and the patient's makeup, so two people suffering from the same sickness may receive different treatments. However Thai herbalists today don't always use the doshas (humors) as much as ayurvedic physicians do.

Masters transmitted knowledge orally to their heirs. As in other traditional Asian societies, the relationship between teacher and student was considered sacred, and the teachings rarely shared with outsiders. A striking example of this is the reverent attitude shown toward herbal recipes. As Simon de la Loubere testifies in The Kingdom of Siam: They trouble not themselves to have any principle of Medicine, but only a number of Receipts, which they have learnt from their Ancestors, and in which they never alter any thing. For more on Thai herbalism including herbal recipes, see C. Pierce Salguero's bookA Thai Herbal.

Thai Midwifery

Delivering a newborn child has a dedicated art in TTM. On Thai midwifery, we read inThai Massage the Thai Way: Midwifery was a part of traditional Thai medicine which combined a mix of natural practices combined with folk beliefs, ritual and tradition. After delivery, the umbilical cord was severed using a small-sharp bamboo blade. In quite a few cases, new-born infants developed tetanus from this traditional practice and many died . Eventually, the importance of sanitary techniques and sterile medical instruments was emphasized and traditional midwives were trained to apply these practices. The development and regulation of public health care has helped to reduce the death rate of Thai newborns. [Source: Thai Medicine Guide thaimedicineguide.com ]

In accordance with tradition, the mother and newborn had to remain inside the birth room for one month, a practice called "Yu Fai" (heat therapy). During this month, Thai mothers received herbal therapy which included massage with an herbal compress known in Thai as "Luuk Prakrop", abdominal salt herbal massage, heating the birth canal area by sitting over a herbal hot charcoal seat, and herbal sauna. Today, the Yu Fai tradition is still practiced by women In Thailand's rural countryside. A recent phenomenon with the renewed interest in traditional Thai medicine as a natural alternative to modern western-based medicine sees pregnant women in urban areas beginning to use an adapted version of Yu Fai to suit a modern return to traditional practices by new-generation mothers.

Unknown to many, Thailand has its own version of yoga-like stretches known as ruesri dat ton or "the hermit's streching." These exercises are similar to Hatha Yoga,and a link between the two is obvious. A number of schools in the country stil teach this little-known gem of Traditional Thai Medicine even though many locals themselves are unfamiliar with it. A master of Thai Yoga, called a ruesri or rishi was traditionally the same as an ascetic, hermit, seer, etc. who practiced meditation and developed occult powers on the path to spiritual realization. A ruesri is depicted as a hermit wearing a tiger's skin, symbolic of his accomplishments and mastery. Some have suggested that Thai massage originated in individual yoga practice such as Ruesri Dat Ton and Hatha Yoga. Some massage positions do resemble yoga poses.

Principles of Traditional Thai Medicine; Aggregates, Essences and Sen Lines

The principles of Traditional Thai Medicine are rooted in an ancient view of health that views the human being as a composite of body, energy and spirit (mind/heart). It is vital that all components exist in harmony and receive equal care. Some of the key concepts of TTM are: 1) The threefold division into essences of a human being. 2) The theory of the four elements and their relationship with the human body, herbs and tastes. 3) The theory of the sen lines energy system, similar to meridians in Chinese medicine. 4) The faith in a lineage of teachers and their ability to transmit healing power to their heirs [Source: Thai Medicine Guide thaimedicineguide.com ]

Aggregates. Thai medicine adopts the Buddhist view that man is a composite of five parts or aggregates called panca khanda in Thai. These five aggregates are namely: matter, senses, cognition, will and consciousness. These five components are dependent on one another and together they form the illusory ego or "I." There is no such thing as reincarnation in Buddhism. The ego is dissolved upon death; it is only the karma of that past life that continues and generates a new life and body for the next one. It is like a riverbed where the same water never flows twice. The idea of an impermanent self or "no-self" is extremely difficult for people to understand, let alone accept. Nevertheless, it is a cornerstone of all true Buddhist practice and study.

The Essences. While the doctrine of the five aggregates is a major tenet of Buddhist philosophy, it isn't as important in TTM. A more useful division of the human being is that of the three essences: body, energy and mind/heart. Each branch of traditional medicine focuses on one of these essences, at least in principle. In reality, their goals and effects overlap. For example, Thai massage has benefits for both the physical body and the sen energy system; herbs and diet not only heal the body, they also help purify the mind.

Chitta or the mind/heart of a person is the domain of religious practice, chiefly Buddhism and secondly, native folk beliefs that have persisted in spite of the mainstream religion. Lom or energy is the purview of Thai massage and Thai yoga, whose movements are designed to harmonize the flow of vital force in the body. The physical body made up of the four elements can be healed and cared for through diet, exercise and herbs, as is done in Thai herbalism.

One school in Chiang Mai, Shivago Komarpaj, mirrors the essences in the threefold division of the school itself. C. Pierce Salguero testifies that on one wing lies the massage area, on the other is the herbal facility and in the middle of the two is the altar dedicated to the Buddha, Shivago and the lineage of teachers. This is symbolic of the fact tha that spirituality is central to the ancient Thai health care system.

Sen Lines. The theory of sen lines is extremely important to TTM, especially Thai massage. Sen lines are a network of channels in the body that carry vital force, called lom pran in Thai and prana in Sanskrit. There are said to be 72,000 sen lines, but only ten are important in practice. All sen lines begin two thumb lengths below the surface of the navel, but each line has a unique terminal point. Some lines are in pairs, mirroring each other. Further, the sen have sensitive points that respond to massage and yoga. Vital energy or "wind" travels through the sen to feed the body. If a pathway is blocked, illness results. Massage and yoga manipulate the sen lines to restore them to health.

Experts cite three major sources for the sen lines including the Wat Po marble tablets. Each gives a slightly different version of the sen pathways. For a detailed comparison of these texts, see Thai Massage the Thai Way. List of Sen Lines and their Terminal Point: 1) Itha line, left nostril; 2) Pingkala line, right nostril; 3) Susamana line, tongue; 4) Galataree line (or Kanlataree), fingers and toes; 5) Sahutsarungsri line( or Sahadsarangsri), left eye; 6) Tawaree line, right eye; 7) Jantapusank line (or Lawusank), left ear; 8) Ulanga line (or Ruchum), right ear; 9) Tawatharee line (or Sukumung), anus; 10) Sikinee line, genitals.

Elements and Tastes in Thai Medicine

Men and women have long conceived of the existence of primordial substances from which the whole universe is made. This is the doctrine of the four elements. According to this teaching, everything in the manifested universe including the human body is made up of four elements: fire, water, air and earth. The principle of vacancy or the void is called ether, the fifth element.

Each of the four elements governs specific body parts and bodily functions. The earth element rules 20 organs, the water element governs 12 types of fluids, the air element produces 6 types of wind, and the fire element creates 4 kinds of heat. he following table is based on information found inThai Massage the Thai Way and A Thai Herbal. Elemental Rulerships of the Human Body Element Body Parts/Functions: 1) Earth ORGANS: brain, stomach, spleen, liver, heart, kidneys, lungs, intestine, colon, muscles, tendons, ligaments, bones, bone marrow, rectum, hair, body hair, skin, teeth, nails. 2) Water FLUIDS: blood, lymph, sweat, tears, mucus, bile, saliva, nasal mucus, urine, joint lubrication, liquid and solid fats. 3) Air WINDS/MOVEMENT: higher to lower wind, lower to higher wind, wind in the belly, wind in the digestive system (digestion), wind in the blood and wind in the breath (respiration). 4) Fire HEAT: heat near the lungs that generates warmth, heat near the heart that stirs circulation, heat that helps with digestion in the abdomen, and the lowest heat that causes metabolism

The Tastes. Traditional Thai Medicine recognizes nine tastes plus bland, which are tied to the elements. Taste is a primary consideration in Thai herbalism because it is by taste that the healing properties of herbs are determined. Depending on its taste, an herb can increase a particular element and decrease others. List of Tastes, Treatments , Health Problems: 1) Astringent, diarrhea, digestion, wounds, liver; 2) Sweet, Fatigue, low immunity or energy; 3) Toxic/Nauseating, anti-toxic, for parasites, wounds, tetanus; 4) Bitter Tonic, parasites, infections, blood or bile disease; 5) Hot, colds, gas, indigestion, sinusitis; 6) Nutty, skin disease; stiff joints, tendons or muscles; 7) Fragrant, stimulates the heart, for blood, depression; 8) Salty, skin problems, constipation, gas; 9) Sour, expectorant, for fever, blood, lung infections; Bland, poisoning, thirst.

Influences on Traditional Thai Medicine: Buddhism, Ayurveda, Chinese Medicine and Yoga

If some of the above concepts seem familiar, it's because Thai medicine received various foreign influences throughout its history via trade, migration, war and diplomacy. Modern TTM today has adopted many ideas from Ayurveda, Yoga, Traditional Chinese Medicine and Western medicine. Nevertheless, TTM is a unique system in its own right and can be studied and applied independently of other systems.

Thailand lies at the heart of the Indochina region bordered by Cambodia, Laos, Vietnam and Burma/Myanmar. Throughout its history it was home to busy ports and roads frequented by Chinese, Muslim and Indian merchants and travelers. Its various kingdoms tolerated and assimilated much of the knowledge and culture of its neighbors. As a result, Traditional Thai Medicine has evolved into a complex system that bears the stamp of several foreign traditions, as well as indigenous beliefs and practices. [Source: http://www.thaimedicineguide.com/traditions.html

Buddhism, Theravada Buddhism is the dominant religion in Thailand. It is also the predominant faith of neighbors Sri Lanka, Myanmar/Burma, Laos and Vietnam. The word Theravada means "Teaching of the Elders" and it is believed to be the oldest surviving form of Buddhism. The Theravada school distinguishes itself by a conservative interpretation of Buddhist scriptures.

Thai people believe that their medical knowledge comes from a line of Buddhist hermits and monks that began with Shivago Komarpaj, the Buddha's own physician. A minor figure in the Pali Canon itself, Shivago or Jivaka assumes a much greater importance in Thai medicine. Adherents of both royal and folk traditions of Thai medicine exalt him as the "Father Doctor." Students and practitiones pay homage to him and the Buddha before every session. Of course, this legendary physician is not a god; rather he is the foremost teacher of Thai healers. Shivago's role here may be likened to the idea of "patron saints" of Catholicism.

Buddhism is a key unifying element in traditional Thai medicine with its many diverse practices and teachings. While folk healing arts may have resisted Ayurvedic doctrine, all seem to revere Shivago and the Buddha without exception. The Buddhist faith also assumes a more pragmatic role: its temples have become a repository of knowledge of traditional Thai medicine, notably Wat Po; and monks are trained and deployed throughout the land to provide health care to the people.

Chinese and Thai culture made frequent contact throughout history, so it is not surprising to see the influence of ancient Chinese health care in Thailand. Chinese immigrants have always enjoyed a strong position in the Thai medical industry. A French author testifies in 1691 that the Siamese king had Chinese doctors at his service along with Thai, Burmese and western physicians. Today one finds Chinese remedies sold and used everywhere by locals, and some can even be found in medical textbooks. Thai massage seems to have similarities with Chinese massage, perhaps more so than with Indian massage. The doctrine of sen lines (see above) is comparable not only to the yogic nadis, but also to the Chinese meridians. It should not be forgotten that the Tai people themselves are believed to have come from the China/Vietnam area. Quite possibly they acquired knowledge of Chinese medicine early on and brought that with them on their journey southward to Siam.

Influences on Traditional Thai Medicine: Ayurveda and Yoga

Ayurveda. Ayurveda or "the science of life" is one of the best-known Asian healing systems, equaled only in popularity by Traditional Chinese Medicine. Ayurvedic teaching centers on a doctrine of humors (doshas) and elements, which are identical to the classical Greek elements fire, earth, water and air. Disease is viewed as an imbalance of these factors in the human body. To be healthy again, one must restore harmony through proper diet, lifestyle and conduct.

The written or royal tradition of Traditional Thai Medicine that began in the Bangkok era relies heavily upon Ayurveda to explain its theories and practices. It is not clear how strong was the ayurvedic influence before then, but from that time on it has become the dominant foreign influence on the system. As in Ayurveda, diagnosis and treatment in Thai herbalism is based in knowledge of the elements. Author C. Pierce Salguero observes in his book Traditional Thai Medicine that Thai herbal recipes use substances that are identical or similar to what is used in Ayurveda.

Yet TTM is not a mere copycat of Ayurveda. As Salguero observes in The Encyclopedia of Thai Massage: That being said, it is also clear that the Indian and the Thai practices parted ways many centuries ago, and that the two disciplines of Thai massage and yoga are not interchangeable. Thai beliefs, meridian charts, and massage techniques differ markedly from Indian Ayurvedic traditions, and can not be understood without looking at them on their own terms.

Yoga. Yoga began as a system of meditation and contemplation practiced by Indian ascetics. Its goal was - and is - to conquer the mind and realize divinity in oneself. Originally Yoga consisted of eight steps that progressively led inward, from physical posture and breathing to quieting the mind. Later, yogis developed an elaborate system of physical culture called hatha yoga. Much of what passes for yoga today in the west is derived from this system. In Yoga, there are said to be channels of energy called nadis that send vital force or prana to the whole body. There is a parallel to this in Traditional Thai Medicine - the sen lines which carry the lom. The sen lines and Indian nadis have similar pathways and even similar names. Manipulating the sen lines is key in Thai massage. The influence of Yoga is also very clear in Thai yoga or ruesri dat ton, often translated as "ascetic stretching" or "hermit's twist."

Traditional Thai Medicines

In addition to treating various symptoms and ailments, many Thai medicinal herbs are used to spice up the various dishes. Thais love to combine very different flavors, hot, sour, sweet and bitter, which create culinary delights that are also curatives, as they balance the four elements: wind, water, earth, and fire. [Source: Thailand Foreign Office, The Government Public Relations Department]

1) Basil (Horapha): An anti-bacterial, it also relieves constipation and indigestion as well as cold symptoms. It also helps reduce body fat. 2) Betel (Phlu): A very mild stimulant. 3) Bitter Cucumber (Mara): Reduces blood in sugar and relieves different liver ailments. 5) Chili Pepper (Prik): Rich in vitamin C, it can help prevent colds. It also stimulates blood circulation and assists in digesting starchy food. 6 Clove (Kan Phlu): An aid in digestion, it also relieves cold symptoms and works as an antiseptic for toothaches. 7) Coriander (Phak Chi): A good diuretic and detoxicant, it also relievescold symptoms. Some believe it is an aphrodisiac as well. 8) Cumin (Yira): An efficient cure for flatulence, indigestion, and diarrhea. 9) Galangal (Kha): An excellent treatment for colds and respiratory problems.

10) Garlic (Krathiam): A great treatment for colds, coughs, and bronchitis. It also purifies the blood, reduces blood pressure and cholesterol, and controls acne. 11) Ginger (Khing): Improves circulation and digestion. Relieves coughs as well as nausea and flatulence. An excellent remedy for sea and car sickness. 12) Hibiscus (Krachiap Daeng); ) Reduces fat in the blood. 13) Kariyat (Fathalai Chon): An excellent treatment to reduce fever and relieve indigestion. 14 ) Wild Ginger (Krachai): A treatment for dysentery, diarrhea, and flatulence, it is also an antidote for certain local poisons. 15) Mint (Saranae): A mild stimulant, it relieves headaches and cold symptoms and reduces flatulence and indigestion. 16) Nightshade (Mawaengkhrua): Relieves cold symptoms and cough. 17) Nutmeg (Chanthet): Relieves digestive and liver disorders, as well as flatulence. It is also used as a natural stimulant and is thought by some to be an aphrodisiac. 18) Tumeric (Khamin): An excellent cure for liver problems and jaundice, particularly when taken in tonic form.

Fresh Fruit and Herbal Juices and Infusions: 1) Aloe Vera (Wan Hang Jorakhe): Relieves peptic ulcers and aids digestion. Also high in vitamin E, it accelerates healing and improves the complexion. 2) Banana (Kluai): Every part of the banana, from root to tree, leaf and flower, as well as the fruit has medicinal properties. The roots are a diuretic, the sap an astringent, and the leaves can even stop bleeding. While the unripe fruit is also an astringent, the ripe fruit is an excellent laxative. 3) Asiatic Pennywort (Bua Bok): Very bitter, it is rich in vitamin A and well known as a remedy for internal injuries and wounds. It is also applied to accelerate the healing of burns and eczema, as it helps to prevent scars. 4) Champak (Champi): Another favorite, sweet, fragrant night flower, it reduces body temperature and stimulates the heart. 5) Bael Fruit (Mathum): Unripe, it is an astringent and tonic; when ripe, it is a mild laxative. It also increases appetite while relieving thirst. Contains vitamin A, calcium, and phosphorus. 6) Chrysanthemum (Kek Huai): Drunk hot or cold, it eases heartburn and reduces body heat.

7) Coconut (Ma Phrao); ) Removes toxins, flushing the kidneys and bladder. High in phosphorus, calcium, and carbohydrates. 8) Lime (Manao): Dissolves phlegm and dislodges parasitic worms, and reduces fever and reduces thirst. High in vitamin A and C. 9) Ginger (Khing): Improves circulation and relieves nausea. 10) Mango (Mamuang): Like the banana, the entire tree has medicinal attributes. The bark cures dysentery; the dried leaves stop diarrhea; and the fruit itself helps digest proteins. It’s also high in the minerals calcium, magnesium and potassium. 11) Guava (Farang): Cures diarrhea and indigestion. High in vitamin A, B1, B2, B6, and C, and iron and calcium. 12) Mulberry (Mon): Reduces sugar in blood as it refreshes. Also relieves sore throat. 13) Lemon Grass (Takhrai): While the roots act as a diuretic and relieve diarrhea and gas, the plant is used to treat asthma, as it’s rich in menthol and camphor. It’s also high in vitamin A, calcium, and phosphoric acid. 14) Orange (Som): High in vitamin A, B, and C, calcium, iron, and phosphorus.

15) Pandan / Screw Pine (Toei Hom): A refreshing beverage on hot days can be produced from the leaves, which are also known for treating eczema. The plant itself is an excellent diuretic and the roots an; ) anti-diabetic. Also reduces swelling when applied as a compress. 16) Pomelo (Som O): High in vitamin C and potassium. 16) Papaya (Malako): The unripe fruit relieves peptic ulcers, and unripe or ripe, it aids digestion. It’s also high in vitamin A and C. 17) Roselle (Krachiap): Reduces fats in the blood and lowers body temperature. It works as a diuretic, reduces cholesterol, and destroys bile. And it’s high in vitamin A and C and citric acid. 18) Passion Fruit (Saowarot): High in vitamin C and natural sugars. 19) Safflower (Khamfoi): Reduces fats in the blood. 20) Pineapple (Sapparot): Aids digestion and improves menstruation. High in vitamin B and C, calcium, and magnesium. 21) Star Fruit / Carambola (Mafueng): Anti-diabetic, as it reduces sugarlevels. It is also a diuretic and relieves coughs. Refreshing in hot weather as well. 22) Sugar Cane (Oi); ) High in fructose, it boosts energy. Also relieves coughs and is a diuretic. 23) Sugar Palm (Tan); ) Relieves fever and thirst. High in vitamin C and phosphorus. 24) Tamarind (Makham): An excellent laxative, it relieves indigestion and coughs, reducing phlegm in the colon and throat. High in vitamin A and C. 25) Thai Copper Pod / Cassod (Khilek); ) A remedy for insomnia, it also relieves constipation.

26) Fermented Liquor (Ya Dong): An ancient Thai remedy, some believe it is an elixir for longevity as well as sexual prowess. There are actually a number of concoctions, prepared by dicing and grinding different herbs before placing them in a earthen crock and soaking them in rice whiskey. The mixture should be stirred daily and should not be taken until it has soaked for one month. To speed up the process, put the crocks in water and boil. Then wait a week or two before drinking. Alcoholic macerates are prepared by placing the herbs in a muslin cloth before inserting into a jar with rice whiskey. It should be left for at least a week before drinking. Pregnant women and those suffering from high blood pressure, diabetes, heart disease, high fever, and allergies to alcohol should not take ya dong or alcoholic macerates.

Herbal Body Applications

1) Aloe Vera (Wan Hang Jorakhe): The gel extracted from the leaves is high in; ) vitamin E. It’s an excellent treatment for burns and sunburn, as well as dry, flaky skin. 2) Coconut (Maphrao): The oil softens and restores damaged hair. 3) Basil (Horapha): It works wonderfully to refresh the senses and relieve exhaustion. 4) Frangipani (Lanthom): A plant often found flowering in Buddhist temples, the sweet aroma creates a very serene ambiance. 5) Camphor (Kalabun): The leaves are used in steam baths, and a white powder can be extracted from the tree, which, because of its cool, refreshing scent, relieves cold symptoms. 6) Guava (Farang): After boiling the leaves, gargle to remove bad breath. 7) Cassumunar (Phlai): A ginger-like rhizome, it is ground and boiled and then applied as a compress to relieve pain and reduce swelling. The oil is also used as a scalp conditioner and in aromatherapy. 7) Gourd Leaf (Bai Buap): Used in a body wrap for its excellent moisturizing properties, it can also soothe skin irritations. 8) Kaffir (Makrut): The fruit juice is an excellent remedy for dandruff, while stimulating hair growth. After applying, rinse after three minutes with clean water. [Source: Thailand Foreign Office, The Government Public Relations Department]

9) Jasmine (Mali): The scented oil and aroma can be soothing in tea. 10) Menthol (Pimsen): Often used in herbal steams, with a fragrance much like camphor, it relieves coughs and cold symptoms. 11) Lemon Grass (Takhrai): After squeezing juice from stalks, apply to hair to treat dandruff and stimulate hair growth. 12) Mint (Saranae): In addition to being a refreshing tea, the oil is used to invigorate the senses in aromatherapy. 13) Lime (Manao): The juice treats acne and skin infections. 14) Papaya (Malako): Because of its AHA content, it is a popular ingredient in body wrap exfoliate and treatments. 15) Loofa / Dried Gourd (Buap): An excellent exfoliating sponge because of its thick fibers. 16) Pineapple (Sapparot): The fruit rubbed on the skin is a excellent facial cleanser. After rubbing it on, rinse with warm water. 17) Mangosteen (Mangkut):After boiling the peels in water, apply the water to the skin to treat infection and remove dark facial marks.

18) Red Lime (Nam Pun Sai): An excellent deodorant, it also relieves inflammation. 19) Tamarind (Makham): Applied as a paste, the fruit cleanses and nourishes the skin. 20) Rice (Khao): In addition to being the main staple of the Thai diet, it makes an excellent natural body scrub when it’s uncooked and dry. 21) Thai Copper Pod / Cassod (Khilek): Boil the leaves in water and then apply to hair as a shampoo to treat dandruff and leave hair soft and glossy. 21) Sea Salt (Kluea): Another very effective natural body scrub, usually mixed with essential oils. 22) Tumeric (Khamin): Grind and mix the powder in water to relieve rashes. 23) Sesame (Nga); 24) The oil is an excellent moisturizer, as it softens skin. White Turnip (Hua Phakkat); 25) Rub thin slices of the root on the face to remove freckles.

Alternative Medicine: Herbal Therapies, Hydrotherapy and Accupuncture

Alternative medicine is defined as the treatment of illness using remedies not considered part of mainstream, or Western, medicine. So, as the book has shown, Thai traditional massage and healing are forms of alternative medicine. Today, the Kingdom offers a much wider range of therapies than it did before, developed predominantly in Asia, but some from the West as well. And a degree program in alternative medicine has been established at Siriraj Hospital, one of Thailand’s leading medical facilities, in cooperation with Mahidol University. [Source: Thailand Foreign Office, The Government Public Relations Department]

Alternative medicine can be divided into three classifications: balancing body elements, alignment of the body structure, and balancing the relationship between the body and mind. The first category, balancing elements, includes such therapies as herbs, homeopathy, macrobiotics, megavitamins, and detoxification. The second category, balancing body alignment, includes massage, chiropractics, yoga, exercise, and hydrotherapy. And the last category, finding a balance between the mind and body, includes therapies such as acupuncture, reflexology, aromatherapy, and music therapy.

Herbal therapies. Homeopathy is actually a complementary disease treatment system in which a patient is given minute doses of natural drugs that in larger doses would produce symptoms of the disease itself. Thus, it operates on the same principle as vaccines. This therapy works to build up a person’s immunity, in order to alleviate specific symptoms. It is an excellent therapy for allergies and asthma. There have been many books expounding upon the virtues of macrobiotics, which entails a very strict vegan diet of organic grains, seeds, fruit, and vegetables. Many persons suffering from cancer as well as digestive illnesses have found this an excellent treatment, as the diet balances body systems according to the type of food consumed.

We all know that vitamins and minerals are essential for good health. Still, critics of megavitamin therapy say that it only provides “added value” to one’s urine. This is often the case when the vitamins and food supplements are taken haphazardly and not as prescribed, but often they are excellent anti-oxidants. So, in order not to waste the vitamins and supplements you take, it is best to see a therapist who can prescribe the correct dosages. In weight reduction, vitamins A, D, and E have been found to be very beneficial in reducing body fat, while vitamin C will reduce body fluids. Today, many of the natural herbs collected in Thailand can be produced in tablet and capsule form. Vitamin C is plentiful in many green leaf vegetables, as is Vitamin A. The chapter on herbs also tells in detail which herbs provide which vitamins.

Hydrotherapy is a therapy that employs water. We have already discussed traditional steam, sauna, and immersions. Jacuzzis are another favored therapy tool for unwinding and massaging muscles, and they can be found at virtually every spa in Thailand. There also are also a number of water treatments that have been developed to cleanse impurities from the body. Having people walk and exercise in pools is another very successful technique for rebuilding muscle tone and strength after an accident or stroke.

Acupuncture has its roots in China. While ancient beliefs revolved around the balancing of yin and yang, today it has been found to be an excellent remedy for pain, neuromuscular diseases, gastrointestinal disorders, psycho-physiologic disorders, respiratory disorders, and allergies. Certain symptoms, such as cool or numb extremities, internal heat, chronic fatigue, and loss of libido are often treated with a combination of acupuncture and Chinese herbal medicines.

Music has always been a technique for soothing the mind or stirring excitement. The sounds seem to penetrate our spirit and have a direct effect on our emotions. Many of the spas play soft music or compositions that combine sweet serenades with natural sounds, like waves breaking on a beach, a whippoorwill singing its song, or the trickle of a mountain stream. Alternative medicine is an ever-expanding discipline, as we preserve and restore many of our ancient traditions and develop new techniques to treat the body and mind. Through a holistic approach, we can enjoy the healthiest and most satisfying life, as nature intended.

Alternative Medicine: Different Types of Massage

Often called an oil massage in Thailand, Swedish massage has been popular since the mid-twentieth century and comprises long strokes, kneading and friction, and a light rubbing along the surface of the skin with oil. Powder is sometimes used instead of oil, well, but it is not popular. Aromatic massage, as discussed earlier, is similar to the Swedish procedures, the principal difference being the selection of oil. With this form of aromatherapy, the client will choose a specific essential oil or mixture, which can treat specific symptoms, such as stiffness, aches and pains, congestion, stress, and depression. [Source: Thailand Foreign Office, The Government Public Relations Department]

Cellulite massage, the third technique, stimulates the lymph and circulatory systems, through deep compression, stroking, and percussion, which will dissolve cellulite pockets. While different spas and centers may have their own procedures, this treatment must be performed 20 to 30 minutes, two or three times a week for up to a month. At the same time, clients must follow a prescribed exercise routine and diet, refraining from coffee, tea, alcohol, and smoking, if they want to see positive results.

Compression massage, combined with other techniques, has been found to help disperse fat globules so they can be absorbed by lymph nodes. Just as importantly, the treatment improves a person’s disposition. Furthermore, as a person loses weight, he gains energy. Today, many of the spas employ different instruments and equipment, such as endermologie and ultrasound, to perform cellulite reduction treatments.

The word “shiatsu,” when broken down, can be translated as “shi,” fingertips, and “atsu,” deep compression. Its roots date back to 200 BC, and today it has evolved into a combination of Chinese healing doctrine and Western approaches. While Thai massage focuses on 10 meridians, shiatsu concentrates on twelve. Using deep acupressure on specific points, therapists release blocked meridians, so energy, or chi, is stimulated, and a balanced flow of yin and yang, or male and female energy, is once more achieved. Yin is also related to stillness, stiffness, and coldness, while yang is linked to movement, agility, and warmth. If these are not in balance, pain and illness result. Points directly on a meridian should be compressed for one minute, while those nearby should be pressed down for three minutes. After completing the massage, the client will feel relaxed but energized, while stiffness, aches, and pains will be reduced or completely removed.

Tui-na is an ancient Chinese massage therapy during which the meridians and muscles are rubbed and pressed. Some of the rubbing, or stroking, is similar to Western techniques, while the compressions are rooted in acupressure therapy.

The chiropractic medical system is based on the theory that disease and disorders are caused by a misalignment of the bones, especially in the spine, thus obstructing proper nerve functions. Practitioners must study in a program similar to one for conventional medicine, but it will focus much more on body structure and biomechanics. Medicines are not prescribed, but the doctors manipulate the body to realign it. They also prescribe exercises and diet to treat different illnesses.

A relaxed body means a relaxed mind, and vice versa. And so we find yoga becoming more and more popular every day. Many of the spa retreats in Thailand include yoga in their holistic approach to well-being. As explained in the introduction of this book, Thai traditional massage is based on yoga and includes postures, or asana, in the stretching procedures. The asana, or exercises, in hatha yoga have been developed to stretch the body, regulate glandular secretions, massage internal organs, and improve internal systems, such as the circulation, respiration, and digestion, to bring the body into balance and make it possible for the individual to sit in meditation comfortably for long periods of time. In addition to the yoga postures, there is the practice of breath control, or pranayana. These not only help to center the mind, but burn up mucus and other impurities in the body.

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Tourist Authority of Thailand, Thailand Foreign Office, The Government Public Relations Department, CIA World Factbook, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.

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© 2008 Jeffrey Hays

Last updated May 2014

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