The Life of Thai Massage
A Little Light on Thai Traditional Medicine
(Excerpt from THE ROLE OF THAI TRADITIONAL MEDICINE IN HEALTH PROMOTION
By Vichai Chokevivat, M.D., M.P.H. and Anchalee Chuthaputti, Ph.D.
Department for the Development of Thai Traditional and Alternative Medicine, Ministry of Public Health, Thailand, 7-11 August 2005 Bangkok, Thailand)
TTM is a holistic and natural approach of health care that is derived from Buddhist beliefs, the observation of and respect for nature, and the wisdom of Thai ancestors. In addition, traditional knowledge of TTM was also built through the processes of “selection”, “adoption”, “adaptation” and “utilization” of traditional medicine of some countries with which Thailand had contact in the past, e.g., India and China, to suit the Thai way of life.
According to the “Protection and Promotion of Thai Traditional Medicine Wisdom Act B.E. 2542” (1999), Thai traditional medicine is defined as “the medical processes dealing with the examination, diagnosis, therapy, treatment, or prevention of diseases, or promotion and rehabilitation of the health of humans or animals, midwifery, Thai massage, as well as the preparation, production of Thai traditional medicines and the making of devices and instruments for medical purposes. All of these are based on the knowledge or textbooks that were passed on and developed from generation to generation”.
The principles of Thai traditional medicine
The four elements (tard) of the body
According to TTM, the human body is composed of four elements (‘tard’ in the Thai language), i.e., earth, water, wind and fire. When the four elements of the body are in equilibrium, it will be healthy. In contrast, if an imbalance in these elements occurs, i.e., if there is a deficit, an excess, or disabilityin any of the four elements, a person will become ill. Moreover, the imbalance in the four internal elements and illness can also be due to an imbalance in the four external elements as well. “Tard-chao-ruan” or the dominant element of the body According to TTM, for each person there will be one element that is more dominant than others, one’s own dominant element is called “tard-chao-ruan”, which is basically determined by the date and month of one’s conception. The tard-chao-ruanof a person plays an important role with regard to one’s characteristics and appearance as well as the weak point in one’s health.
The causes of illness
According to TTM, human illness can be caused by the following factors:
1. Supernatural power, e.g., ancestor’s soul, powerful spirit of the forest, evil spirits, punishment from a heavenly spirit of those who misbehave.
2. Power of Nature, e.g., imbalance in the four elements of the body, imbalance of heat and cold, and imbalance of the body’s equilibrium.
3. Power of the universe, e.g., positive and negative influences from the sun, the moon and the stars on human health.
4. Kimijati, which may be considered the equivalent of microorganisms or parasites in modern medicine.
In addition to the above mentioned, human health is also influenced by:
1. The elements (tard). As indicated previously, an imbalance in the four basic elements of the body and the effect of external elements or the environment can affect human health.
2. The seasons. Heat and cold during different seasons clearly affects human health.
3. Age. Based on TTM, during different periods of life, people are more prone to get ill from the influence of different elements.
4. Geography. As the geographic location of where one life dictates the weather and the environment, it can play a role in affecting one’s health.
5. Time. Astrologically, the sun, the moon and the stars continuously move, thereby influencing human life and health differently during different times of the day.
6. Inappropriate behaviors that can be the causes of ailments according to TTM are as follows:
6.1 Inappropriate eating habits, e.g., eating too much or too little, eating food that has gone bad, or unfamiliar food, or food that is not suitable for one’s own dominant element or diseases.
6.2 Imbalanced postures while sitting, standing, walking, or sleeping can lead to disequilibrium of the body structure and needless worsening of health.
6.3 Exposure to extreme weather or polluted air.
6.4 Being deprived of food, water or sleep.
6.5 Delayed urination or defecation.
6.6 Overwork, over-exercise, or excessive sexual activity.
6.7 Deep sorrow or extreme exhilaration.
6.8 Extreme anger, lack of equanimity.
Reasons for the government’s revival of Thai traditional medicine
The main reasons why the Thai government reconsidered the value of traditional medicine and decided to revive TTM and integrate it into the national health system could be summarized as follows:
1. WHO policy on indigenous medicine and primary health care (PHC). In 1978, WHO/UNICEF issued the Alma-Ata Declaration urging member countries to formulate national policies, strategies and plans of actions to launch and sustain PHC as a part of comprehensive national health systems in order to attain the “Health for All by the Year 2000” target. This included the promotion of the maximum level of community involvement and individual self-reliance and participation and making the fullest use of local, national and other available resources, e.g., medicinal plants, indigenous medicine and appropriate technology.
2. The high cost of modern medicine and loss of self-reliance in health care. It was estimated that the inability of modern doctors to assess the cost-effectiveness of their treatments and the non-compliance with the essential drug policy could account for the waste of tens of billions of baht per year. Moreover, most of the health-care budget was spent on diagnosis and treatment rather than on health promotion and disease prevention, which cost less. The reliance on modern medicines even for the relief of common minor symptoms that in the past could easily have been healed with herbal medicines, made the country lose its ability to rely on domestic resources when it came to health care, or its ability to control national spending on health care, as seen from the increase in medical and health expenditures from 15,167.9 million baht in 1978 to 35,973.7 million baht in 1983 and 78,423.1 million baht in 1988.
3. Awareness of the limitations of modern medicine. Even though modern medicine can successfully treat many infectious and serious diseases and increase human life expectancy, it also has some limitations, i.e., serious side effects from certain groups of drugs, the high cost of medications and technology, and the inability to cure several lifestyle-related chronic diseases, e.g., hypertension, diabetes, or cancer. Therefore, traditional medicine might be able to serve as an alternative choice for the people.
4. Problems with the quality of the TTM health-care system. Although modern medicine is the mainstream health system, TTM services are still available for people in the rural as well as some urban areas of the country. However, owing to over 60 years of neglect, the overall quality of the TTM health-care system is seriously in need of major improvements to conserve local wisdom about health care and for consumer protection.
5. The potential of herbal products and the practice of Thai traditional medicine for the country’s economy. After the Dietary Supplement Health and Education Act (DSHEA) took effect in 1994 in the United States, the “health conscious” movement towards exercise, eating well and the use of dietary supplements for health promotion spread all over the world. This global trend led to the opening up and expansion of the botanical dietary supplement market in the West worth tens of billions of dollars. Hence, the government has fully supported research and development (R&D) of new herbal products by research institutes and the production of herbal products by industry in order to satisfy this global demand. In addition, the global boom in the spa and wellness business during the past 10 years has not only kept high the demand for herbal products, but it has also created new job opportunities for Thai people to learn Thai massage and work as massage therapists at home and abroad. Hence, the training of qualified Thai traditional masseurs/masseuses using the Ministry’s curricula are now conducted by many schools in order to meet the demands of the spa business.
6. The success of China and India concerning the integration of traditional medical knowledge with modern medicine in their national health systems serves as a good example of the benefit that countries and people could gain from traditional medicine. The success of these two countries has helped to boost the confidence of other countries to develop their own traditional medicines and promote their integration into mainstream health system.
The role of Thai traditional medicine in health promotion
Since the beginning of the revival of TTM in 1978, various aspects and practices of TTM have been promoted for the health promotion of the Thai people and/or integrated into the national health service system, namely:
-Medicinal plants and traditional medicines
-Thai massage or nuad thai
-Hot herbal compresses and herbal steam baths
-The Practice of dhammanamai which is composed of
-Kayanamai (healthy body), i.e.
Eat good food, especially indigenous nutritious fruits and vegetables that are compatible with one’s own tard or underlying disease, and take traditional medicines or food that can correct the imbalance of tard to maintain good health. It can be said that medicinal plants are a part of Thai daily life because local Thai foods in different regions of the country consist mainly of several kinds of spices, vegetables and fruits, some of which can also be regarded as medicinal plants owing to their medicinal value. Hence, Thai people regularly consume various types of medicinal herbs as food and spices.
Exercise, e.g., ruesi-dud-ton,or Thai traditional stretch exercise
-Jitanamai (healthy mind), i.e., practice of meditation
-Chevitanamai (healthy lifestyle), e.g., live one’s life in the “Middle Path” of Buddhism.
6.4 The practice of dhammanamai
Dhammanamai is the application of Buddhist teachings in TTM for holistic health care of the body, the mind, the society and the environment. The principle of dhammanamai was founded by Professor Dr. Ouay Ketusingh, the founder of applied TTM. The practice of dhammanamai corresponds with the principles of health promotion, as it will enable people to increase control over the determinants of health and thereby to improve their health in order to achieve a state of complete physical, mental and social well-being. The practice of dhammanamai can be divided into three areas, namely, kayanamai (healthy body), jitanamai (healthy mind) and chevitanamai (healthy lifestyle).
6.4.1 Kayanamai (healthy body)
According to TTM, the human body starts deteriorating after the age of 32. Therefore, in order to stay healthy for as long as possible and prevent diseases, one needs to take care of the body by exercise and eating right. Regarding exercise, ruesi dud ton is a Thai body exercise suitable for all ages because it is not a high-impact exercise and can help to adjust the balance of the body structure.
188.8.131.52 Ruesi dud ton or Thai traditional stretch exercise
Ruesi dud ton, or Thai traditional stretch exercise, is another manifestation of Thai traditional wisdom related to health care that can be used for health promotion, disease prevention and rehabilitation of some minor disorders. Ruesi means “hermit” and dud ton means “body stretch exercise”. The word ruesi dud ton is derived from the belief that in the past hermits who resided in the forest to seek enlightenment usually sat in one position for a long time while doing meditation. They then created and performed a series of stretch exercise to relieve the muscle fatigue and stiffness that occurred after long hours of meditation. While performing ruesi dud ton, one also practices breathing exercises and meditation by focusing on breathing rhythm. Hence, the health benefits of ruesi dud ton are increased body agility and muscle coordination, stimulated blood circulation and promotion of good concentration. To educate people about ruesi dud ton, in 1836 King Rama III ordered the building of 80 ruesi dud ton statues made of a mixture of zinc and tin in different postures. They were placed in Wat Po together with marble tablet inscriptions in poetic form describing the health benefits of each posture. These ruesi dud ton casts can still be found at Wat Po.
ITTM selected 15 basic ruesi datton postures, out of a total of 127 postures, as suitable for people of all ages. The selected postures cover the exercise of all parts of the body from head to foot to be promoted for health promotion and to help adjust the balance of the body structure. To educate the public about ruesi datton, ITTM publishes booklets and makes videos and CDs that can be used for training and self-study.
184.108.40.206 Eat right according to TTM
Our Thai ancestors integrated the knowledge of TTM into daily life using food and drink to balance the basic elements of the body and soul and to stay healthy. Based on the principles of TTM, changes in the weather or the external elements during different seasons can adversely affect the balance of the body’s elements and health. Medicinal plants, vegetables and fruits with different tastes, possessing different health benefits as well as affecting the body elements differently, are therefore suitable for people with different dominant basic elements and are suitable for consumption during different seasons. For example, vegetables and fruits that help reduce body heat during summer are those with a bitter or cool and bland taste, e.g., bitter melon, bitter cucumber, watermelon, morning glory tips, pumpkin, sweet potato, okra, eggplant, Chinese chive, horseradish-tree pod and young inflorescence of Siamese neem. On the contrary, spicy or greasy food is not suitable during summer because it will be a fire element in the body and generate more heat. Meanwhile, vegetables and fruits suitable for the rainy season and the dry season are those that are used as spices.
6.4.2 Jitanamai (healthy mind)
Jitanamai is the training and strengthening of the mind so that one will be able to focus and concentrate better by practicing meditation, studying and following Buddhist teachings or other religious beliefs based on one’s faith, which will eventually help to sharpen one’s mind and intellect. The health benefits of daily practice of meditation are:
Induce mental relaxation, inner peace and happiness,
Increase working efficiency owing to improved concentration, and
Relieve stress, enhance the immune system and help to prevent psychosomatic disorders.
A well-trained mind would then lead to good thoughts that help to guide a person to choose a healthful way of life and not easily give in to self-indulgence. In addition to meditation, the practice of jitanamai also includes saying prayers, behaving well with family members and others, and extending love and kindness to others, which all are a part of the religious practices of all faiths.
6.4.3 Chevitanamai (healthy life)
Chevitanamai is to lead one’s life by following the “Middle Path” of Buddhist teachings and to earn one’s living doing a good and honest job and always abiding by the law. In addition, chevitanamai also includes keeping one’s home and environment in good, clean and healthy condition, which will eventually lead to a peaceful mind and healthy life.