Outside of Thailand, Thai massage is perhaps the most widely known and practiced aspect of Traditional Thai Medicine (TTM). However, this relatively small component of the TTM system is often misunderstood or misrepresented. Unaware of the full scope of practice TTM offers and the medical theory in which Thai massage is based, many Thai massage practitioners are limited in making the most effective treatment choices for their patients.
Stemming from issues of geography to timing and language barriers to changing political priorities, there are many reasons TTM as a complete system is not as globally well known or practiced as some other traditional medical systems, such as Ayurveda and Traditional Chinese Medicine. Like other medical systems, Thai Medicine continues to remain a living tradition while it adapts as information is transmitted from teacher to student and as human environments and our global landscape change. In fact, the essential theories of Thai Medicine are based on the knowledge that everything is constantly shifting. And while human lives and maladies may appear very different in our modern time than for those living thousands of years ago, Thai medicine has remained applicable in diagnosis and treatment because fundamentally, wind continues to move, fire continues to transform, water still holds things together and earth still provides structure.
History and Context
Traditional Thai Medicine comes from Thailand. Despite popular belief, TTM theories and practices have not been transplanted from China or India or Taiwan; rather, TTM comes from the land that is Thailand and from the people living there, and their ancestors before them. While it is true that some of these ancestors interacted with and exchanged ideas with the early peoples of both India and China—particularly India, as medicine from the Buddhist tradition came to Thailand from India along with Buddhism—these influences were from the systems that would become Ayurveda and Traditional Chinese Medicine (TCM), as they are respectively known today, and were integrated into what would become Traditional Thai Medicine as it is known today. Though these three individual systems may share some similar ideas and concepts, it cannot be stressed enough that they are in no way interchangeable and one cannot simply exchange Ayurvedic or TCM theory for TTM theory. Each system is unique in its theory and in application and part of what makes each medical system unique is the geography, plants, and climate in which the system developed as well as the needs of the peoples developing medicinal knowledge in that region. The primary early peoples moving into and inhabiting the region known today as Thailand were the Malay in the South, the Khmer in the East and the Mon in the North. Later, the T’ai people moved into Central Thailand from Southern China and Northeast Vietnam. Together, with other early peoples already inhabiting the land, these groups connected and clashed, bringing various influences into a common knowledge and system that continues to be codified into Traditional Thai Medicine of today.
Historically, much of the traditional medical practices of Thailand have been preserved locally, with some variation in information and focus based on region and lineage. The Thailand Ministry of Public Health has been collecting the multiple streams of textual knowledge from these various lineages in order to create a singular system, which is presented in a four-year traditional medicine program offering government licensure in one of four areas: Traditional Pharmacist, Traditional Doctor, Traditional Midwife and, most recently, Traditional Massage.1While all practitioners, regardless of the level of previous training and experience, are encouraged to complete the degree program to earn licensure to practice, there are still doctors practicing within their individual lineages and systems of knowledge that exist locally and regionally across Thailand. While there is overlap and common theory among these various local systems, each lineage is considered whole unto itself.
Lanna medicine is an example of a localized traditional medical system that overlaps with TTM in theory and practice, but is considered a separate system from a separate culture. Lanna medicine is the traditional medicine of the Lanna people inhabiting Northern Thailand and is perhaps the oldest and best preserved indigenous medical system of Thailand. Lanna medical texts, written in Lanna script, date back to at least the 13th century, but are likely even older.2
Today, the population of Thailand is more than 90% Buddhist. Though the most common form of Buddhism practiced is Theravada Buddhism, many Animistic practices are still observed and have been blended with Buddhist practices. With such an overwhelming majority of practitioners in the population, it is not hard to imagine that this unique form of Buddhism permeates and informs nearly every aspect of daily life in Thailand, including traditional medicine. In fact, Traditional Thai Medicine is a form of Buddhist Medicine and Buddhism is an entire root of knowledge in TTM. This will be discussed further later, however, it is important to note that for practitioners of TTM, Buddhist concepts and practices both guide conduct in and outside of the treatment room and provide support in caring for patients, community and self.
In TTM, the Buddha is regarded as the ultimate healer and TTM practitioners pay homage to both the Buddha and his physician, Jivaka Kumarabhacca, known to many as The Father Doctor, each day by performing a Wai Khru ceremony. In addition to the Buddha and Jivaka, practitioners of TTM also honor the Reusi tradition in their daily Wai Khru ceremony. Though the Reusi tradition continues in Thailand today, the Reusis of Old are honored for their contribution to the body of medical knowledge, including divination and spiritual practices. Reusis are spiritual ascetics or hermits studying the natural sciences through direct observation, interaction and experimentation in and with nature over time.
In Thai, Wai Khru means respect teacher and this ceremony is about honoring and respecting the practitioner’s lineage of knowledge and connection to all teachers in life. Without teachers, a practitioner would have no understanding, no skills and none of the knowledge needed to practice medicine. Remembering and developing a connection to one’s teachers and lineage means that one is never practicing alone, but rather with the support of all those who have practiced before. Practicing the Wai Khru also aids TTM practitioners in cultivating the Four Boundless States: Metta, Karuna, Mudita and Upekkha. Metta is universal goodwill, Karuna is compassion, Mudita is sympathetic joy and Upekkha is equanimity. From the TTM perspective, cultivating these qualities is a motivating factor in practicing as a doctor.
In addition to practices to cultivate the Four Boundless States, TTM practitioners receive ethical and conduct guidelines from Buddhism. These guidelines are based on the five Buddhist precepts: not killing, not stealing, not engaging in sexual misconduct, not engaging in false speech and not becoming intoxicated. These guidelines are observed for both ethical and practical reasons.
Element Theory and the Roots of Knowledge in Thai Medicine
Thai Element Theory is based on the fact that everything is a composition of earth, water, fire, wind and space. Together, these elements make up all things, animate and inanimate, from a fingernail to an ant to a pond. However, a fingernail and a pond appear and function quite differently because in an fingernail, Earth element is the most active, whereas in a pond, Water element is most active. Variation in all things is based on variations in the level of activity of the elements within each thing, including the body. Along these lines, each person has a unique core constitution, which becomes fixed early in life. This means that the balance of the elements in their mind and body will always lean a certain way, with one element, possibly two, being a bit more prominent than the others, regardless of time of life, season, climate or other external factors. While knowing a patient’s core constitution is valuable, assessment and treatment will primarily focus on current imbalances.
The topic of Thai Element Theory could be discussed at great length and has been in other works. Here, the most basic concepts as related to the body will be presented. The first is that each element has a specific experience, a specific function and a list of specific qualities.
The experience of Earth is solid and its function is to provide resistance and support. The primary qualities of Earth are hard, stable, heavy. Twenty specific structures are enumerated in the texts, but all solid components of the body are Earth element.
The experience of Water is aqueousness and its function is cohesion and fluidity. The primary qualities of Water are moist, fluid, soft. The texts list 12 body parts for Water, however all fluids of the body are Water element.
The experience of Fire is heat and its function is transformation and ripening. The primary qualities of Fire are bright, reactive, sharp. There are four fires of the body listed in the texts. All metabolic processes, aging, decay and heat in the body are Fire element.
The experience of Wind is movement and its function is growth and vibration. The primary qualities of Wind are light (not heavy), mobile, dry. There are six primary winds of the body. Wind is all movement in the body, from thoughts to nerve impulses to muscular contraction.
The experience of Space is unobstructedness and its function is to provide nonresistance and a field upon which all the other elements can play out their activity. The primary qualities of Space are expansive and subtle. The nine orifices in men and 10 in women are associated with Space. Space is also all of the physical space in the body.
Along with Thai Element Theory and Buddhism, the five roots of knowledge form the basis of all medical practices within the Traditional Thai Medicine system. The Five Roots of Knowledge are: Medical Knowledge, Physical Therapies, Divination, Spirit Medicine and Buddhism.
Medical Knowledge is the understanding of how the body works. This root works with herbs, diet, lifestyle guidelines and other types of internal medicine to help balance the elements of the body.
Physical Therapies work primarily with the function and structures of the physical body, focusing on freeing pathways of movement. Therapies include bodywork/ massage, bone setting, cupping, scraping, tok sen and Reusi Da Ton (Thai Yoga), among many others.
Divination looks at a person’s predisposition to disease by gathering and considering information such as where and when a person was born, the season of birth and planetary influences. Methods of divination include astrology, palmistry, numerology and geomancy, among others.
Spirit Medicine primarily works with the unseen forces, such as ghosts, spirits, sorcery and incantations in relation to health. Spirit Medicine helps to alleviate health concerns when they arise and provides preventative care and protection against imbalance with practices such as Sak Yan (magical tattoos), working with amulets and the use of specific incantations.
Buddhism, as mentioned previously, influences all aspects of TTM. As a root of knowledge, Buddhism primarily addresses mental and emotional health, offering practices, such as meditation and other meritorious acts, to help a patient relieve stress and let go of suffering.
These Five Roots of Knowledge are the basis of all medical practices and specialties in Traditional Thai Medicine. All therapies found in TTM require knowledge of the Five Roots to perform correctly, safely a nd effectively.
Traditional Learning in Thai Medicine
To learn Thai Medicine, it is considered necessary to have three things: a body of knowledge; oral transmission and explanation; and experienced practitioners. A body of knowledge could exist in a physical book or manuscript, but could also be an oral text. This information has been developed, tested and proven over time through a lineage of traditional practitioners. The body of knowledge alone does not provide enough information to develop medical knowledge and practice medicine. Without an experienced teacher to provide explanation, texts can easily be misunderstood or seem incomplete. A teacher with sufficient experience as a practitioner is vital to developing medical knowledge, for that person has taken theoretical concepts into practical application and seen the results with a variety of patients. An experienced practitioner is considered to be someone who has received transmission of knowledge from a qualified teacher, has studied the body of knowledge or the texts and has practiced under the guidance of an experienced teacher for a period of time before beginning an individual practice.
Though there is now a Traditional Thai Medicine degree program offered through the Thai Ministry of Public Health, as mentioned earlier, traditionally, Thai Medicine has been learned and taught through apprenticeship starting at a young age. Sometimes, this apprenticeship happens within a family, but this is not always the case. Entering a student teacher relationship is a lifelong commitment on the part of both parties and therefore, in their lifetime, a teacher may only accept a few students as apprentices. When a teacher accepts a student, they are also accepting that student into their medical lineage, meaning that the knowledge can be traced to a source, practitioner to practitioner, and therefore each practitioner has the full support of the knowledge and experience of all those who have practiced before; this body of knowledge and transmission is the legacy of the lineage, is exceptionally powerful and is not to be taken lightly. To maintain and honor this connection, it is important to always offer gratitude and respect to teachers in a number of ways. This is a primary reason to practice the daily Wai Khru, discussed earlier.
Typically, an apprenticeship consists of copying the teacher’s medical texts, observing treatments, assisting the doctor, lessons, discussions and hands-on practice under the supervision of the teacher. The pace and rhythm of this transmission varies from teacher to teacher and student to student, and it is the teacher that decides when the student is ready to begin a practice. Traditionally, a student will practice under supervision for a period of time before beginning to practice independently. For students, an apprenticeship model is central to developing a relationship with the body of knowledge being transmitted, with the teacher offering the transmission and with the lineage of practitioners who tested, preserved and passed the knowledge generation to generation.
When learned as a complete system, the care available to patients through Traditional Thai Medicine is comprehensive and specific, working with the natural systems of the body in the context of nature to find balance. The traditional method of learning this system is also extremely valuable in that it requires practitioners to develop relationships with teachers and the knowledge they receive, providing true understanding and the support necessary to practice with kindness, compassion and confidence.
This paper has been written and presented with gratitude to my primary teachers Nephyr Jacobsen of The Naga Center, LLC and Tevijjo Yogi.
Haddad, Bob. 2013. Thai Massage & Thai Healing Arts: Practice, Culture and Spirituality. Forres, Scotland: Findhorn Press. Jacobsen, Nephyr. 2015. Seven Peppercorns: Traditional Thai Medical Theory For Bodyworkers. Forres, Scotland: Findhorn Press.
Jacobsen, Nephyr and Salguero, Pierce. 2014. Thai Herbal Medicine: Traditional Recipes for Health and Harmony. Forres, Scotland: Findhorn Press.
1. Over the past several hundred years or more, various efforts have been made, regionally and nationally, to collect, condense and preserve traditional medical knowledge.
2. Though it is important to note the regional and cultural differences between the local medical systems of Thailand, such as Lanna medicine, for ease of reference, use of the term Traditional Thai Medicine or TTM in this paper encompass all of the medical systems of Thailand, past and present.