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Thai medicine, like most aspects of culture in Thailand, is based on indigenous tradition and a colorful blend of Indian, Chinese, and Khmer influences. The historical progenitor of Thai medicine, Jivaka Kumar Bhaccha (pronounced by Thais as "Shivago Komarpaj") is revered by almost all practitioners as the "Father Doctor" of Thai medicine. Jivaka was a historical figure, a contemporary of the Buddha, and personal physician to the Buddha's order of monks and nuns over 2,500 years ago. He was a renowned Ayurvedic doctor in his time, and is considered by Thais to be the original teacher of the Thai massage system as well as the source of Thailand's complex herb and mineral pharmacopoeia.

Herbal medicine starts with the food we eat... a fruit stand at Warorot Market, Chiang Mai.

The Father Doctor plays a central role in the spiritual beliefs of Thai healers to this day. Most herbalists, masseurs, and traditional doctors maintain a shrine which includes statuettes of the Buddha and the Father Doctor side-by-side, and prayers such as the one at the beginning of this book are chanted daily to invoke the spirit of the Father Doctor to assist in the healing of patients.

Legends aside, however, it is difficult to tell how much of the Thai medical traditions actually came from the Ayurvedic masters. Ayurvedic ideas are mentioned frequently in the herbal texts of Thailand. However, it is not exactly clear how pervasive this influence is, or at what point Indian ideas entered the Thai culture. According to Harald "Asokananda" Brust, the foremost Western writer on Thai massage, the historical origins of Thai Medicine are shrouded in mystery:

Despite what is known about Kumar Bhaccha, much of the origins of Thai massage and traditional Thai medicine still remain obscure. It is believed that the teachings of Kumar Bhaccha reached what is now Thailand at the same time as Buddhism—as early as the 3rd or 2nd century BC. It is unknown whether there was any indigenous form of [medicine] in the region before that time. Equally unknown is to what extent Chinese concepts of acupuncture and acupressure (as well as other aspects of traditional medicine) had any theoretical and practical influence.... Nowadays it is impossible to definitively answer such questions, since for centuries medical knowledge was transmitted almost entirely orally from teacher to student following a teaching traditional also common in India.

It is clear, however, that--regardless of the ultimate dating of its arrival in Thailand--the Indian medical system has for at least 500 years been used as an explanatory model by the Thais, has served as the core theory around which other indigenous ideas have been organized or explained, and has contributed greatly to several important Thai medical practices. Many parallels to Ayurveda can be found in the Thai tradition, and some Thai concepts (such as tridosha and nadis) even share the same names as their Ayurvedic counterparts. Therefore, at least a cursory glance at the Indian traditions is unavoidable in any work on Thai medicinal traditions.

Traditional rural-tradition medicines made from venomous animals!

Rural and Royal Traditions

Scholars of Thai medicine have distinguished between the rural and the royal traditions, treating these two as distinct medical systems. There is much overlap between the two, as they share some terminology and herbal recipes. However, it is only the royal tradition that developed a formal theory of disease, symptoms, and treatment.

The Rural and Hill-Tribe Traditions The rural and Hill-Tribe traditions tend to be informal, varying considerably from village to village, tribe to tribe, and indeed from practitioner to practitioner. The livelihood of the rural tradition lies in the hands of uneducated, local male practitioners, famous in small circles for their healing "powers." Rural Thai and Hill-Tribe healers rarely attain the high levels of education that are prerequisite in the royal tradition. The medical knowledge is handed down largely orally, and through secret herbal manuscripts handed down from teacher to pupil. Whereas the royal medical practices have, in the past centuries, emphasized formal scientific treatises, rural Thai medicine has remained to this day more unorganized than centralized, more artistic than dogmatic, and more spiritual than scientific.

Because of the lack of formalized instruction, the local differences in practice, the language barrier, and the aura of secrecy which surrounds the tradition, rural herbal knowledge is difficult to collect, and even more difficult to study comprehensively. True to their secretive tradition, the herbal masters are not likely to give direct answers to theoretical questions, and will sometimes intentionally mislead anthropologists looking to study their healing systems. While this may seem frustrating to the modern scientific mind, it is important to realize that some of the most important practices in the rural tradition are difficult or impossible to explain verbally. Much of the rural and Hill-Tribe practice remains shrouded in spiritual tradition, and is difficult to translate to a modern context. Many of these healers are more properly shamans, and utilize a broad range of shamanic techniques such as exorcisms, amulet charming, and incantations of magic formulas.

It is not my intention to focus on the village traditions in this work. To my knowledge, there are no schools in Thailand that offer courses in rural medicine, and it is exceedingly difficult for Westerners to study under individual practitioners. To this day, there has not been very much written on the subject by either Thai or Western researchers. Of the few that have been written, one eloquent and interesting study (Brun and Schumacher, Traditional Medicine in Northern Thailand) is mentioned in the bibliography at the end of this book as an excellent introduction to this complicated field.

The royal tradition is now the standard form of herbalism in Thailand... An herb vendor at Warorot Market.

The Wat Po School of "Royal Medicine" At the same time that more informal traditions persisted for centuries in the countryside, temples and hospitals under royal patronage were establishing a consistent system of medical theory and practice. The royal tradition was based on traditional rural lore, but became organized and codified with the introduction of Ayurvedic and Western concepts. Buddhism, and along with it many Indian ideas, arrived in the kingdom of Siam in several waves throughout antiquity. A constant flow of information came to the region along with Chinese, Arab, and Indian, merchants. European explorers arrived as early as 1504. The medical traditions picked up something from each of these groups as they came through.

According to Somchintana Ratarasarn, a traditional medicine researcher: "by about 1600 AD the secular medical system of the Thai people had been established, and had attained maturity as a coherent and highly effective system of health care. It was sustained by... the king, his appointed officials, and the intellectual elite."

The Wat Po temple was established in the late 1700s under the founder of the current Thai dynasty, Rama I. In 1836, Rama III ordered an extensive renovation of the grounds. At that time, 60 inscribed stone tablets bearing acupressure charts and 1100 herbal recipes were placed in the walls of the temple to preserve medical knowledge for future generations. Over 80 statues depicting massage techniques and yoga postures were erected throughout the grounds as well. These statues and stone tablets can still be seen by visitors to the temple today, and they still form the basis of the royal school of Thai medicine.

From 1895 to 1907, Wat Po's Traditional Medical School published several important herbal manuals to disseminate this valuable information throughout Thailand. These texts are a summary of the ancient traditional lore preserved at Wat Po, and are a useful font of information for Thai and Western scholars. Furthermore, these texts provide the basic curriculum for the school of traditional medicine that still operates on the grounds of the temple.

Unfortunately, to this day, the Wat Po manuals have not appeared in complete English translation. While tourists are able to take short courses on Thai massage in English, the herbalism classes are limited to the Thai language, and therefore remain relatively inaccessible to Westerners. However, enough information has become available to provide a clear picture of the medical practices of the royal school. The theories discussed in this book are based mainly in this royal tradition of Wat Po. Information that comes specifically from the Wat Po texts is noted, as is information that more properly pertains to the rural or Hill-Tribe traditions.

The Branches of Thai Medicine

Traditional medicine in Thailand is historically split into three disciplines: Spiritual healing, massage, and dietary regimens and herbal medicine.

Thai dancer in traditional peacock dress.

Thai Massage: Thai massage is considered to be a therapy of energy. Masseurs apply acupressure to sensitive points on the body in order to impede or increase the flow of energy through the nadis, or sen lines (Thai energy meridians) as necessary to relieve symptoms and stimulate healing. While Thai massage has enjoyed increasing popularity in the West as of late, it is a field that, in Thailand, remains intimately tied to the other branches of traditional medicine.

Dietary regimens and herbal medicine: Herbs and food affect the human organism by causing physiological changes in body chemistry. This is expressed in traditional Thai medicine, like in the Ayurvedic medicine of India, by the idea of Four Elements. The constant interaction of the Four Elements gives rise to the processes of the body, and therefore is the impetus behind life. The Elements can become unbalanced due to a variety of reasons, including environment, food intake, age, and mental state. During the normal course of one's life, the Elements go in and out of balance in a continuously changing state of health or disease. The primary goal of traditional Thai dietary regimens and herbalism is to maintain balance of the Four Elements for optimum health.

Thai Spiritual healing: Thai medicine emphasizes the spiritual well-being of the patient, and holds that many diseases flow from a troubled spirit. For this reason, even modern traditional Thai medicine is enveloped in a rich and intricate tradition of prayer, meditation, mantras, and mythology based around Buddhist and shamanic ideas, which are designed to heal the spirit in order to heal the body.

A Holistic Approach

In Thai philosophy, human life is holistically viewed as a combination of three essences: body, mind, and spirit. The three branches of medicine are each associated with one of these essences. The Thai medical tradition recognizes diseases caused by germs, allergies, environmental factors, heredity, and emotional or psychological imbalance. However, the root cause of any and all disease is the imbalance of the body, mind, and spirit. When the three essences are balanced, the human organism enjoys health and well-being. The imbalance of the three essences causes this natural health and immunity to break down, leaving the organism vulnerable to disease. Maintaining balance of the three essences is therefore the primary focus of traditional Thai medicine.