Category Archives: Thai & SE Asian Medicines

A Thai Approach to Rounded Shoulders

First published in Jivaka Journal, by Jeffrey S. Thompson and Laura Hoge

“Every day we sit, stand, read, work and exercise in positions that are detrimental to our posture. Posture is an aspect of training that is often overlooked; however, improving your posture is just as important

to your regular fitness routine as proper nutrition, exercise and stress management. Improving your posture can help improve your health.”1

What is Rounded Shoulder?

Rounded Shoulder, or Protracted Shoulder Girdle, is a chronic condition which is defined as “an increase in the convex [curving or bulging outward] nature of the curve”2 of the upper back. A person suffering from this condition may take on a ‘hunched’ or anterior compressed posture, which, if left untreated will increase in severity with age. Currently, this disorder affects over two thirds of the population in the United States.3 As our increasingly sedentary society continues to ignore proper posture when behind the wheel, while watching television and/or working at a computer,4 and at the same time, continues to adopt exercise routines that over- focus pectoral muscles and neglect opposing muscle groups in the back, incidents of Rounded Shoulder will continue to increase over time.

Physiological Effects of Rounded Shoulder

The physiological effects that are often attributed to Rounded Shoulder vary in incidence and severity from person to person. Compressed nerves in the shoulder girdle are common and in some cases cause numbness, tingling or even pain which may radiate down the arm. Since the pectorals are in a continually contracted state “Rounded shoulders can restrict rib cage expansion”5 and as a result, may lead to difficult or labored breathing. Tight pectoral muscles can also pull the shoulder girdle forward, out of its anatomical plane of movement, and cause a decreased Range of Motion,6 discomfort or even pain. Continued contraction over an extended period of time will eventually lead to a shortening of the tight muscle, lengthening/weakening of the opposing muscle group in the back, and leave a person vulnerable to knots and/or permanent muscle damage.

Treating Rounded Shoulder – Western Style

The list of contributing factors for Rounded Shoulder is long. Because of this, there is no one set method of treatment, no silver bullet that will eradicate pain, pinpoint cause and erase existing muscle damage. That being said, an assessment of possible causative factors and a change in lifestyle can eliminate the suspected cause(s) of the disorder and stop its progression.

The aforementioned change in lifestyle often takes the form of a prescribed set of stretches and/or exercises that are specifically designed to elongate the pectoral muscles, release tension in the shoulder and allow the chest, shoulders and back to return to their anatomically correct position. Other exercises that are also suggested are those that strengthen the over-stretched and weakened back muscles to create a more stable operating environment for the free-floating shoulder girdle. Of course, the success of these stretches depends primarily on the determination of the client, so progress is reliant upon strict adherence to one’s prescribed stretching regimen.

How Thai Massage Can Help

When a client receives a diagnosis and calls upon a Thai Massage practitioner to help with recovery, the initial response must be to translate the patient’s needs from ‘Western’ concepts of disease into a traditional Thai approach. Since Thai massage works primarily with preserving and/or re-establishing energetic balance to the body, the most sensible place to begin treatment would be to first ascertain which of the sen line(s) (aka. energy lines, meridians, etc.) appear to be affected. Once this diagnosis is made, a course of treatment can be designed and put into practice.

According to Thai belief, Rounded Shoulder occurs as a result of energetic blockage in the Kalatharee sen:

Sen Kalathari starts at the navel, where it divides into four lines like an X that travels symmetrically on both sides of the body. The top two lines travel up to the armpits, passing above the nipples on the way. From there, they travel inside the middle of the arms to the wrists. At the wrists, Sen Kalathari splits into five branches, with each branch running to the tip of a finger. They then retrace themselves up the hands and arms, to the collarbones which they run under, up the sides of the front of the neck and face, overt the temples to the end of the eyebrows. From there, they run up over the sides of the head and then down the back sides of the neck. Just below the neck, they branch off to the armpits, where they merge with the aforementioned lines traveling inside the middle of the arms. The main trunks continue down the back to the ischial tuberosities (the bones at the bottom of the pelvis that bear the body’s weight when you are sitting down – commonly known as the “sit bones.”). From there, they go down the backs of the thighs to the backs of the knees. From the backs of the knees, they travel down the middle of the backs of the calves to the feet. At the feet, Sen Kalathari splits into five branches with each branch running to the tip of a toe. Sen Kalathari then retraces itself up the feet and then travels up the fronts of the lower legs to the knees. It goes through the knee joints and then travels up the fronts of the lower legs to the knees. It goes through the kene joints and then travels up the backs of the thighs to the ischal tuberosities. From there, it goes through the legs to the femoral pulses in the inner and upper thighs, where there is a pathway from one femoral pulse to the other, connecting the right and left lines. From the femoral pulses, Sen Kalathari returns to its starting place at the navel.7

Since Kalatharee travels through the shoulder girdle, manipulating it with acupressure, joint mobilization and yogic stretching can effectively locate the source of the blockage and encourage a more healthy flow of energy through the body. Salguero supports this theory and offers further advice in the treatment of Sen blockages in his book Encyclopedia of Thai Massage. He says that it is important to:

“Apply strong presses to the site of the blockage, and then to move along the sen away from the site, as if ‘flushing’ the blockage away” Travel all the way to the ends of the meridian or meridian segment, and finish by returning to the site. This encourages the disposal of stagnated energy, and then encourages the flow of fresh energy.” 8

In some cases, the client may be experiencing numbness, tingling and pain radiating down the arm. In such an instance, it is advisable that the practitioner begins treatment with this “flushing” at the point where the Kalatharee travels through the shoulder. This is most commonly the site of the blockage and the altered sensations in the arm are often referred pain brought on by the lack of proper energetic flow. It is also effective to apply heat, hot compresses and direct acupressure to the site of injury in order to break any energetic obstructions in the area that may be impeding proper flow of energy and, as a result, causing pain and impinging movement.

According to Thai medical theory, if the client’s shoulder girdle is anatomically misaligned, it is also believed to be a result of energetic blockage in the Kalatharee sen. Despite this similarity, the actual causes and site of the blockage are quite different. The location of the energetic blockage is often situated in the pectoral muscle itself, and as a result, the client frequently presents with difficulty breathing. When this occurs, administering pressure to the site of blockage is difficult as it is often uncomfortable for the client. Symptoms of the condition are best alleviated by treating the correlating Sumana sen which “runs from the navel to the base of the tongue.”10 This, combined with intentional acupressure and joint mobilization to the Kalatharee Sen will effectively treat Rounded Shoulder.

Specific Thai Yoga Massage Stretches for Rounded Shoulder

*Please note that the following stretches should only be performed by qualified Thai Massage Practitioners and should not be attempted otherwise. These exercises require knowledge of proper body alignment in order to reduce the risk of injury for both client and therapist.

WALKING BACK STRETCH

Have your client sit in front of you on the mat with legs straight or in a cross-legged position. Ask the client to reach both arms toward you with palms facing up and thumbs rotated towards each other. Reach forward and grab both forearms. Position your feet so that your toes are just beneath the client’s scapula. Your knees should be bent. From this position, use your body weight to pull back on the arms, rotating toward you slightly (medially). At the same time that you pull on the arms, apply a small amount of pressure with your feet while the client exhales. Hold for a breath or two before releasing. Repeat the stretch a few times, dropping your feet an inch or two with each adjustment. This stretch elongates the pectoral muscles and helps maintain and/or re-establish proper vertebral alignment. It also applies pressure to the rhomboids, which may be damaged, and/or have “knots.”

BACK STRETCH

Have your client sit cross-legged in front of you with both arms extended skyward and palms together in a prayer like fashion. From a standing position, take hold of your client’s forearms and place your knees just between his/her shoulder blades. Gently lift the client’s arms up and toward you, while at the same time, applying pressure to the upper back with your knees. This stretch will lengthen the pectoral muscles and open the chest to inspire deeper breathing and proper energetic flow along the Sumana sen.

COBRA

Have the client lie face down in a prone position. Situate yourself on top of the client with your knees just above the iliac crest. (This is important so as not to force extreme compression in the lumbar spine.) Hold the client’s forearms in the same manner as seen above in the Walking Back Stretch. Gently lean back with your body weight to lengthen the pectoral muscles and encourage the chest to open.

For clients that are suffering from more severe forms of Rounded Shoulder, Cobra pose may be difficult and/or too intense to perform. It can be supplemented by hooking your fingers under the client’s shoulders and manually drawing the scapulae together by leaning your body weight back. This will open up the chest and inspire proper energetic flow on both Sumana and Kalatharee sen.

SHOULDER MOBILIZATION

From a side-lying position, have your client bring the back of his/her hand to the sacrum, creating a 90 degree angle at the elbow. Using thumb presses, finger presses, and/or a bladed hand, apply gentle pressure just below the scapula. At the same time, use the other hand to pull the front of the shoulder, just lateral to the deltoid, toward you in a rotational motion. Repeat on the other side to lengthen the pectoral muscles. From this position, you can also address knots and/or energetic stagnation in the rhomboids with finger presses and/or thumb presses.

MODIFIED FISH POSE

Fish Pose may be too intense for clients with Rounded Shoulder, so this modification is more appropriate. Have your client sit with his/her legs extended forward. Place a bolster or firm folded blanket behind his/her hips. Support the head and thoracic spine as the client leans all the way back to lie flat. Sit behind the client’s head and from this position, gently hook your fingers underneath the skull at the occipital ridge. Lightly pull to lengthen and align the cervical vertebrae. You can also encourage further chest expansion by pulling the armpits open and out.

Endnote

While it is always important to address specific issues that a client brings to the mat, it is equally important to practice mindfulness for the well being of your client, to trust in the knowledge of the Father Doctor and to respect the lineage from which this energetic healing has been passed down through generations. “The true practice of the art of healing – be it nuad boran (Traditional Thai Massage) or any other type of medicine – is in the compassionate intent of the healer.”11

1 Vlach, Stephanie

2 McPeck, Christopher

3 Christman, John Ph.D (right rounded 73%, left rounded 66%)

4 International Chiropracters Association

5 Vlach, Stephanie

6 Vlach, Stephanie 7Apfelbaum, Ananda, pg 45

8 Salguero, C. Pierce

9 Salguero, C. Pierce

11Salguero, C. Pierce

Works Cited

Apfelbaum, Ananda. Thai Massage: Sacred Bodywork. New York: Penguin Group, Inc, 2004, pgs. 39-45.

Christman, John Ph.D. “The Prevention of Posture Related Problems in Orthodontists, Their Staff, and Their Patients.” Presentation at III Barcelona Orthodontic Meeting 13- 15 March 2003.

Gray, Henry F.R.S.. Gray’s Anatomy. New York: Barnes & Noble Books, 1995, pp. 222 – 226, 356 – 360.

International Chiropracters Association. “Perfect Posture Guide.” [online] Available http;//www.chiropractic.org/chiroinfo/posture.htm

Salguero, Pierce. Encyclopedia of Thai Massage. Scotland: Findhorn Press, 2004, pp.177 – 189

Vlach, Stephanie M.S.. “Stand up for Health.” [online] Available http://www.honoluluclub.com/pulse.php?ID=26

McPeck, Christopher. “The Cause of Internet and TV Addiction.” [online] Available http://www.causeof.org/posture.htm

Note: The information presented in this article is in no way intended to be used as a tool for diagnosis and or treatment. It is meant only to compare Eastern and Western approaches to a specific physical condition.

Adapting Thai Yoga Therapy for the Neurologically Involved Client

First published in Jivaka Journal, by Ann Airey

Neurologically involved clients (and their families) have been through an incredible trial physically, emotionally, mentally, and spiritually. Thai Yoga Therapy can be a medium for teaching clients to feel pleasure in their body again, and to show clients that they can still move their body in meaningful ways. When clients are taken passively through the stretches, they are able to relax and let go of the frustration caused by their body no longer moving like it used to. The gentle, rhythmic motions reduce tone and muscle tension, allowing clients to enjoy the therapeutic movement provided by this form of massage. Most clients find the sessions to be an oasis of calm in their tumultuous lives. Thai Yoga Therapy is often referred to as a “meditation of compassion,”1 and when done in the spirit of metta it is a beautiful dance between giver and receiver.

Case Study

In order to best illustrate the use of Thai Yoga Therapy as an adjunct treatment for neurological clients a case study is presented.

Patient History

The patient is a 72-year-old male with a history of cervical spinal stenosis (narrowing of the spinal canal causing compression on the spinal cord and spinal nerves). The patient underwent a cervical fusion in January 2003 with good initial results. After discharge from the hospital, however, the patient lost consciousness while getting up one night and fell to the floor. As a result of the fall the bony fusion became unstable. Additionally, the patient tore his left rotator cuff muscles (which had been surgically repaired two times previously), and he sustained a mild head injury.

Once medically stable the patient underwent a second surgery to have metal rods implanted along his vertebrae to stabilize the joints. After the second surgery the patient underwent intensive inpatient and outpatient rehabilitation to regain ROM, strength, balance, and functional mobility.

His recovery was complicated by many medical issues, including respiratory difficulties requiring supplemental oxygen, difficulty with bladder control requiring a catheter and eventually surgery, feeding problems that necessitated placement of an N-G Tube, increased tone and spasticity that impeded functional mobility, stiffness of the left shoulder due to the injury to the rotator cuff, loss of fine motor control in both hands, digestive difficulties, and loss of appetite. Additionally, the client experienced nearly constant pain, which prevented him from sleeping.

When I met the patient, he required assistance to stand up from a wheelchair, and he walked with a rolling walker. He required assistance to roll from one side to the other and to move side to side in bed. When seated, he could not reach outside his base of support without losing his balance, and he had fallen to the floor several times at home. The combination of tone, weakness, and joint stiffness caused him to walk with a rigid, shuffling gait. Because of pain in the left shoulder, stiffness in his joints, and muscle weakness, the patient had great difficulty transitioning from standing to tall kneeling or quadruped position. These factors initially made it difficult for the patient to get to the floor mat for sessions.

Treatment Modifications

I initially treated the patient in an outpatient rehabilitation setting in the hospital, where we were able to use a raised mat table to avoid the floor transfer. The client simply walked to the mat using his walker, sat down, and then came to supine. This technique is helpful for most neurological clients who have loss of balance and decreased functional mobility. It is also useful in working with clients with spinal cord injuries who may be unable to transfer to the floor—they can transfer directly from their wheelchair to the mat table. This is the safest and most comfortable way to adapt the Thai Yoga Therapy session for those clients who have difficulty getting to the floor.

In settings where a mat table is not available the therapist must adapt the floor transfer. Once this patient was discharged from therapy at the hospital I worked with him in his home. We were able to adapt the process of getting to the floor by having the patient first come from standing to tall kneel in front of a coffee table. Once he was steady in tall kneel I was able to help him transition to his elbows and knees; from there I assisted the patient into prone position, and then slowly to supine.

In my opinion, a bed is soft and yielding, so it is not an ideal surface for energy line work. It is, however, a safe option for those clients who are unable to get down on the floor safely. One session, after this patient underwent surgery, I treated him bedside with a modified session to decrease pain and to work specific acupressure points and energy lines for the bladder, kidneys, and prostate. The patient experienced almost immediate reduction of pain and anxiety from this session.

When working on the floor we made adaptations to accommodate the stiffness of the patient’s joints. The patient’s neck ROM was limited because of the cervical fusion. For comfort we used a pillow under his head to keep the spine in alignment. Once the patient was comfortable he was able to relax, and we started each session with gentle rocking motions of the trunk and extremities to reduce tone. This was followed by working the foot sen and marma points and kneading the feet with oil. Over the course of treatment the muscles in the patient’s feet relaxed, allowing the toes to extend and the arches to spread; as a result, the patient’s standing balance improved once more of the foot was in contact with the ground.

Once the feet were relaxed the inner and outer leg lines were worked to stimulate the balanced flow of energy to the spine and organs. The compression from palming along the lines also kneaded the tight muscles. Stretching postures for the lower extremities, hips, and low back were performed gently and slowly. Over time, the patient gained range of motion in the legs and spine, which increased functional mobility and decreased his back pain.

In Thai Yoga Therapy, the back of the body is worked with the client prone. Since the patient was unable to remain prone for any length of time because of the cervical spine fusion and pain/stiffness in the left shoulder, I worked the back sen and back muscles with the client in side- lying position with a pillow supporting his head. I also stretched the chest muscles and mobilized the scapula with the patient in side-lying position. Another alternative for clients with limited neck ROM is to use a “prone pillow,” which is a firm, spongy pillow with a cutout for the face, similar to a face rest on a massage table.

After the work done in prone (side-lying in this case) the middle arm line was worked with the client supine, followed by hand massage and wrist/finger stretches. Since this patient had a history of pneumonia and emphysema we worked on diaphragmatic breathing and abdominal massage in supine to free up the diaphragm. Abdominal reflex points for the organs were also worked during this section of the massage to stimulate digestion and peristalsis.

The sessions were concluded with massage to the upper back and neck muscles in supine position, followed by facial massage with essential oils. The client was visibly more relaxed, and his breathing was deeper and easier by the end of each session.

Results

This patient has attended a total of 13 sessions since November 2003. His overall level of health, vitality, and functional mobility has improved tremendously. The patient now transitions from standing to supine on the floor with only standby assistance. He turns from side to side and scoots up and down independently. He has regained a significant amount of active movement in his lower extremities and has regained some degree of fine motor control in both hands. He can balance in tall kneel and quadruped positions, withstanding minimal challenges to balance, and can reach six inches outside his base of support in sitting. He walks independently with a quad cane (four-pronged cane) and is able to get into and out of a car with standby guarding for safety. He can rise to standing position from a low surface independently and his posture is more upright. He can stand independently without his cane, maintaining his balance against minimal challenges (light nudges/pushes). He has regained some of the weight he lost over the course of events, and his skin tone and skin quality have improved. He enjoys the increased independence and mobility he has gained, which allow him to attend family events and resume a modified work schedule.

Conclusion

Thai Yoga Therapy is a powerful healing art suitable for the treatment of clients of all ages and ability levels. The skilled therapist, working with the client’s physician, can adapt sessions to meet each client’s needs. The results stated in this case study illustrate the complimentary effects of Eastern and Western healing. I encourage Western-trained physicians and therapists to go beyond treating the physical body to treat the patient as a whole. The most wonderful aspect of Thai Yoga Therapy is that it is healing for body, mind, and spirit for both the practitioner and the client, providing a space for healing in the midst of our chaotic lives.

References

1 Raye, op cit.

Resources

O’ Sullivan, S., and T. Schmitz. Physical Rehabilitation: Assessment and Treatment. 3d ed. Philadelphia: F. A. Davis Company, 1994, pp. 491-508.

Umphred, D. Neurological Rehabilitation. 3d ed. Baltimore: Mosby-Year Book, 1995, pp. 375- 420.

Adams, R., and M. Victor. Principles of Neurology. 5th ed. New York: McGraw-Hill, 1993, pp. 749-775.

Taber’s Cyclopedic Medical Dictionary. 17th ed. Philadelphia: F. A. Davis Company, 1993.

Thai Massage and the Grieving Client

From Jivaka Journal, 2006, by Laura Hoge

When a person loses a loved one, s/he embodies a host of physical, emotional, spiritual and psychological symptoms of distress. Often times, the weight of the loss is compounded by months of anticipatory caretaking, an exhausting process that can deplete a person’s energy to the point of illness. Some emotional symptoms of this depletion may include, but are not limited to, restlessness, emotional numbness, nightmares, cognitive impairment and lack of motivation. Physical symptoms may also impede function. Some of these include, but are not limited to, suppressed immunity, weight loss, muscular tightness, joint pain, digestive distress and/or an exacerbation of preexisting physical conditions.

Using traditional Thai massage to treat grief related energy depletion, practitioners can effectively help their clients to release emotions and alleviate physical symptoms. This is accomplished through a combination of knowledgeable soft tissue manipulation and compassionate intention. In the following case study, a client’s overall grieving process was addressed.

Case Study

In order to illustrate the effectiveness of addressing the energetic imbalance caused by grief with Thai Massage, the following case study is presented.

Patient History

The client is a 42-year-old female with a history of stress induced gastrointestinal disorders and sciatica. Her husband had recently died of an inoperable Glioblastoma (brain tumor). The length of his illness was more or less four months from time of diagnosis to time of death. The deceased underwent an ineffective protocol of both radiation and chemotherapy and was unconscious for the last week of life.

Shortly following funeral arrangements, the client became increasingly irritable, had isolated herself to the point of depression and was undergoing cognitive therapy and meditation instruction by a Zen influenced psychologist. She had begun a course of anti- depressant therapy (Prozac and Klonopin as needed) approximately one week prior to receiving Traditional Thai Massage Therapy.

For two months following funeral services, the client felt increasingly fatigued and cut back on the amount of exercise she was doing. She would have liked to have decreased the dosage of her medication, but found it effective in relieving symptoms of anxiety. She was plagued by the mental picture of her sick husband and was often irritated by the fact that she “couldn’t remember him when he was well.” She was also upset that her friends could not understand what she was going through and “never said the right thing to make her feel better.” When they tried to reach out and socialize, she became unavailable, emotional and exhausted. This upset her very much.

When I met the client, she presented as being very nervous and in digestive distress. She complained of lack of sleep and asked if it would be okay if she got up from the mat every so often to use the restroom. She complained of hip/low back and radiating sciatic pain and appeared weepy. The client was also having trouble staying asleep at night and found herself sluggish and cognitively “foggy” during the day as a result.

Treatment Modifications

I initially treated the client on the floor of her living room, though I would have preferred a smaller space to create a more nurturing environment. The living room was adjacent to a restroom though, which was necessary, as she often had to run to relieve herself. Chronic diarrhea was a problem for her, so I propped her torso up and increased the angle at the hips, which seemed to relieve her abdominal discomfort.

The prone position was not an option because of her gastrointestinal issues, so instead I used pillows to prop her on her side while manipulating the energy lines of the back.

Treatment Notes

Once the client was comfortable, I began the first few treatments with some light foot manipulation and joint mobilization at the ankle. The client was hypersensitive to pressure initially so most of the points on the foot were done lightly with a steady focus on metta. When it came to joint mobilization, (i.e. rotating and stretching the ankle joint) she found it difficult to release the full weight of her leg. This was eventually achieved with light shaking and prompted inhalations and exhalations of breath. I ended up spending over fifteen minutes on the feet at the start of the first few sessions because it gave her room to transition into the massage without me being physically invasive. It also enabled her body to become accustomed to the feel of manual support. At the start of our sessions, she would occasionally experience cramping in the internal arch of her foot. This stopped after the third or fourth treatment.

During treatment, I manipulated all 10 major meridians of the body and then concentrated specifically on Kalatharee and Sahatsarangsi-Tawaree Sen to address the emotional aspects of her grief as well as the physical manifestations of it in the form of gastrointestinal problems and sciatica. Eventually, light abdominal manipulation was incorporated to inspire proper digestion. Though I did incorporate some of the yoga stretches into the massage (i.e. lateral hip stretches, abduction and adduction of the hip joint, quadriceps and iliopsoas stretches), my main focus was in helping the client to release energetic blockages by means of acupressure (jap sen) along the aforementioned meridians. I also addressed digestive distress with hot herbal compresses on the abdomen and treated her sciatic pain with jap sen along the sacroiliac joint and outer thigh.

Sessions were concluded with a 20-minute head and neck massage with a primary focus on jap sen to the third eye point with the hope that it would relieve some of her problems staying asleep. I also used many of the points associated with Itha Pingala Sen and incorporated gentle neck mobilization into the massage to open up Kalatharee just above the axilla. The client often said that she felt her hands “tingling” while I mobilized her neck. Since Kalatharee runs down the arms and out each fingertip and thumb, this led me to believe that it had a positive effect on that specific energy line.

During sessions where her trapezius muscles were noticeably tense, I placed herbal compresses in that area while I focused on other parts of the body. This loosened the muscles and helped me to deliver deeper acupressure to the region toward the end of treatment.

Results

The patient received a total of 12 massages and during that time there was a noticeable improvement in her ability to sleep through the night without interruption. Though her digestion is still affected greatly by her mood, it has definitely improved to a point where it no longer interrupts the massage sessions. In the past month, she has begun to make appointments to see friends and socialize. She says that her sciatica only bothers her when she is in the car for a length of time and no longer keeps her up at night. She rarely experiences neck pain and attributes this to the constant use of herbal compresses and application of heat. I have recently segued this client out of weekly massages and into a steady yoga and meditation practice. This is complimented with consistent visits to her psychologist and she is attending a bereavement support group.

Conclusion

Though this particular client received Thai Massage in conjunction with western pharmacological and psychological therapies, she believed that her weekly massage sessions were effective in addressing both the physical and emotional complications of her grief. I would not recommend the use of Traditional Thai Massage as a sole treatment for those who have just lost a loved one, but I do believe that with a compassionate and trusting relationship between client and practitioner, a client can more effectively navigate the storm of emotions and physical symptoms that normally occur during this time. I encourage family members, psychologists, psychopharmacologists, etc. to incorporate this or a similar type of energy work into the protocol for addressing grief and grief related complications. I believe that it helps to expedite the processing of overwhelming feelings as well as encourages re-identifying one’s self in what can be a shocking and changed world for the client.

Reviving the Traditional Medicine of the Karen

First published in Jivaka Journal 

In this report, I would like to share what I have learned about an indigenous ethnic minority group, the Karen people of Burma, focusing primarily on the condition of their traditional herbal medicine. By drawing information from my experiences in the refugee camps and from conversations I’ve had with people about life inside Karen State, I will conclude with what I know about the current work being done to preserve the herbal traditions of the Karen; specifically the courageous and visionary efforts of the Karen Environmental Social Action Network (KESAN).

As a result of the long-term refugee situation of the Burmese Karen population, I have seen an overall loss of herbal traditions combined with an unsustainable reliance upon modern medicine distributed in camp.

History and Introduction

The Karen are an ethnic minority living in Burma (now Myanmar) and Thailand. They trace their ancestry to Mongolia and Tibet, and claim to have been the first inhabitants of what is now Myanmar, arriving sometime in the 5th century B.C. Not long afterwards, the more aggressive Burman ethnic group moved into the central plains and pushed the Karen up into the mountains of what is now Karen State. They assumed control of the country, established great kingdoms and subjugated the ‘lesser’ hill tribe Karen. Thus the seeds of the current conflict were sown centuries ago.

In the early 1800s, British colonialism took place and the Karen fared quite well; they were thankful to see the Burman conquered by the British and so were quite loyal to the crown. Missionaries, especially American Baptists, were popular among the Karen. Along with conversions to Christianity, these missionaries brought education and literacy to the Karen.

As a result, an improved and sophisticated determination to stand up to the Burman began to grow. In 1949, the country gained independence, leaving the Burman ethnic group in control and the Karen began fighting a revolution that continues to this day.

The present military regime in Burma, the State Peace and Development Council (SPDC), perpetrates abuse on a mass-scale against their people — including ethnic Burmans.
However, they have a particular hatred for the Karen and their 56 year old revolution. In the 1970’s, after two decades of unsuccessful fighting against the guerilla warfare of the Karen, the military regime began specifically targeting civilians. Since then, many have sought refuge in neighboring Thailand. Despite this continuous movement, though, the majority of the Karen struggle to live in their homeland, the Karen State of Burma, along the Thai border.

The Kingdom of Thailand has responded to the plight of the Karen by establishing camps along its border, but Thai Authorities severely limit the actions and movements of both the refugees and the International Non Governmental Organizations (INGOs) that support them. The first official camp was founded in 1980, and over the years, numerous others have been established, consolidated, and relocated. Currently there are 7 Karen camps offering safety to over 100,000 legally registered refugees. The largest camp has over 40,000 inhabitants. The Karen are safe here, have access to clean water, shelter, food, and basic medical services. However, they now face a new psychological struggle as they have been trapped in camps for years with little hope of going home.

There are also Karen villages in Thailand. Many of these Karen are Thai citizens, either being born in the Kingdom or having lived there long enough to obtain papers. These villages serve as accurate models of what Karen villages might be like in Burma when there is peace and freedom. An herbal medical tradition still exists, but the rapid growth of Thailand’s economy is severely threatening its survival. In the meantime, many have attempted to study this traditional medicine, but little has been translated into English.

My experience in the last two years has primarily been with the refugee population. My wife and I spent almost one year living with the refugees in a remote camp. I taught English classes, trained local English teachers, and participated in a variety of other developmental activities. Through my experience with my students and day to day life in the camp, I learned a lot about refugee life and the Karen in general.

The transformation that the refugees have undergone during their time in camp is enormous. Most notably, I observed an unhealthy dependency on INGOs. These INGOs provide emergency food rations, basic necessities like mosquito nets and clothes, and education in the form of teacher subsidies, textbooks, notebooks, pens and pencils. In addition, several medical INGOs offer basic health care and training.

In my opinion, the refugees’ reliance on camp healthcare has become the most threatening impedance to the survival of the Karen in the future, especially after repatriation. For example, at any indication of not feeling well, a “para” is prescribed. This is the status quo throughout the community. Paracetemol (called acetaminophen in the U.S.) is the cure-all, handed out like candy by the INGOs in camp. I had no idea how widespread this treatment was until another English teacher told me that the clinic has been nicknamed the “paracetemol hospital.” He mentioned that every illness is treated similarly.

In addition to this unhealthy reliance on western medicine, the Karen continue to look at the British, or “white skinned” as their potential saviors; a direct effect of colonialism and missionary work from years ago. We have returned to the area in the form of development workers, teachers, doctors, and missionaries. Basically, in the eyes of the Karen, we offer hope for a better future. By adopting our ways, young Karen believe that they can potentially leave behind the nightmare that is their reality. Sadly, it is this type of extreme vulnerability in the refugee population that threatens their cultural identity and ultimate survival upon repatriation.

It saddens me to see the Karen in camps losing their rich herbal tradition. When I look at their future repatriation to the mountains of their homeland, I see a major obstacle in terms of healthcare. The INGOs will be gone, and there will not be any “para” available for free. At the moment, their knowledge of traditional herbal remedies remains stronger than their understanding of the pills that they are given. However, what they are unwilling to admit is that they will have to rely on these traditional remedies when they return home, and this knowledge is fading with time.

In contrast to life at camp, the Karen struggling to survive in Burma continue to practice a traditional livelihood out of necessity. They live off of their land by farming, hunting,

gathering wild plants, fishing, and then trading what they have grown and collected. They possess a working understanding of traditional medicine based on the rich biodiversity of the forests because they have no other options. This type of necessity for survival is nonexistent in the refugee camps because the INGOs continue to provide basic necessities, including western medicine.

The Refugee Population

As mentioned above, my main concern within the Karen refugee community is the unhealthy reliance on INGOs. Though I respect the services they are providing and understand the need for food rations and other basic necessities, as time passes, it saddens me to see the Karen unable to provide for themselves. I truly believe that it is the very nature of the long-term refugee situation that has produced this unhealthy reliance.

Years ago, refugee camps were created as a temporary relief from an emergency situation. The Karen arrived with no food or shelter. The INGO’s were successful in meeting the needs of the refugees and have continued to this day in the same capacity. Unfortunately, the Karen are still unable to return home. It has been more than 20 years since the establishment of these refugee camps. In my opinion, the emergency has stabilized, and the greater need has evolved into one of development. The refugees need skills to prepare themselves for successful reintegration in Burma.

In 1984, the BBC (Burmese Border Consortium) was set up to respond to the needs of the refugees. Currently they provide bamboo and wood posts for house construction, mosquito nets, sleeping mats, and food rations in the form of rice, chili peppers, salt, oil, yellow mung beans, and fish paste. They are also working to relieve the Karen of their heavy reliance on INGO’s by developing programs aimed at empowering the refugees with sustainable life skills. For example, efforts are being made to create more gardens, thus providing more nutrition while at the same time reinforcing self reliance skills which will prove necessary upon repatriation.

Malnutrition is not as large a problem as is often seen within refugee situations, but nutrition continues to concern the BBC because it supports an unhealthy reliance on and consumption of “para.” The ultimate issue is the lack of space for growing vegetables, especially leafy greens. There is little room to grow farm vegetables or herbs like garlic, onions, lemongrass, basil, or cilantro, and many families cannot afford to buy them elsewhere. Thus even the most basic preventative herbs are not being used.

I admire the volunteer doctors that travel to the camps and spend their time working for the refugees. Their hard work is certainly needed and well-received. However, it is my experience that many of the numerous medical INGOs seem to be “imperialistic” when it comes to their health care. There is no effort on their part to maintain the Karen’s traditional knowledge of medicine. Most symptoms are remedied with a good dose of “para,” even though there may be equally effective traditional remedies available in camp to cure and/or prevent illness. “Para” will often eradicate these symptoms of disease, but there is little education among the Karen about the effects of a daily regimen of these pills. In addition, those that rely on this medication believe that it is a “cure-all,” when in reality, the cause of illness is rarely found.

There is another aspect of the relationship between the Karen and modern pills that concerns me. In their minds, and their vocabulary, there is no difference between medication such as “para” and vitamin supplements that are often prescribed and provided for them. For example, many women are given iron to combat a fairly common anemic condition. Ironically, most are reluctant to take these vitamins because they believe that it is unhealthy to take “medicine” everyday. The irony is that they do not mind taking “para” when they feel dizzy or unwell, a condition that usually occurs as a result of not taking daily vitamins. The pills, both medication and vitamins, are provided free by the INGOs.

Unfortunately, Karen traditional medicine, along with most alternative treatment options, is overlooked and even frowned upon. One experienced Karen medic I spoke with told me that he knew some traditional remedies, but that his faith in them had diminished. There is little effort directed towards empowering the people to develop and pass on their traditional practices, all of which have the potential to be invaluable upon repatriation.

Many Karen refugees are now posing the question, “Where will the INGOs be when the Karen are once again living in the remote mountains of their homeland?” They have voiced their concerns regarding the lack of health and medical education in camp. They understand western medicine is necessary at present, but also know that it will not prepare them for when

they return to the mountains. Several Karen are passionate about reviving their herbal traditions and feel it is their best tool for survival after repatriation. They are also aware of the rich preservation of Thai herbal tradition, including massage, preventative herbs in the diet, and other more practical techniques practiced in remote villages, and hope to employ something similar within their own villages.

I would like to mention one incredible program in the camps, and elsewhere along the border, that has tapped into the rich herbal traditions of Burma. A drug rehabilitation and addiction education program called the Drug and Alcohol Recovery and Education (DARE) Network was created in the Mae Hong Son Province of Thailand. DARE utilizes a remarkable blend of traditional herbs to help in the detoxification treatment of patients. The treatment they have created involves the use of Burmese herbal traditional medicine, herbal sauna, traditional massage and acupuncture (darenetwork.com). They have had astounding success in detoxification treatments for dependencies on everything from alcohol to opium. Most of the herbs are obtained in the forest and mixed by local Burmese herbalists in one of the camps.

Karen Youth

Another primary limitation in the perpetuation of the practice of Karen traditional medicine can be found in the youth in the refugee camps. Since some families have been in camps for over 20 years, and most for around ten, there is now a substantial population of children born in camp. These children spend their days in crowded classrooms and continue to eat poor quality rice and rations. They know little of their parents’ lives back in the homeland and many have no idea where rice comes from, other than on trucks. Since the Karen were traditionally farmers, and their homeland remains undeveloped, it can be assumed that growing rice will be a necessary skill upon repatriation. Without the knowledge of how to live off of the land and provide for themselves, their future remains unclear.

Karen youth also grow up accustomed to going to the Out Patient Department (OPD) at the slightest feeling of illness for some sort of pill. Reliance upon herbal tradition has been neglected and the community members that practice this type of medicine are generally looked down upon as “less developed” than the medical INGOs.

On the other hand, there still remains a lingering interest in Karen traditional medicine within the youth population. Some understand the importance of this wisdom and are motivated to learn more about it. I would often speak of the positive effects of learning this type of healing modality as opinions in these matters carry far more weight when spoken by a foreigner than when taught by their own community members.

Although the youth deny it, and the elders exaggerate it, there is certainly a loss of respect towards elders as well as the Karen traditions. Students look to the outside world for education and miss out on the valuable wisdom that their elders possess. Unfortunately, most of this wisdom cannot be transferred through practical hands-on experience.

Additionally, Thai law prohibits refugees from leaving the camps. In a few camps located in the remote mountains, it is possible for them to go into the forests to collect what is available, but this is a rare benefit. In fact, the refugee situation has tightened significantly in recent years. There are now barbed wire fences around the two largest camps and travel outside is almost completely forbidden. That being said, I was fortunate enough to be able to join a group of my students for an early rainy season forest vegetable collection. We collected several varieties of wild vegetables. Each contained a preventative or curative property that my students had learned from their parents and I was thoroughly impressed with their knowledge. Afterwards, I noticed more and more of these wild medicinal vegetables and fresh roots being carried and eaten throughout the camp.

Fortunately, the Karen that have migrated into smaller semi-secret villages in Thailand are more knowledgeable of the local medicinal herbs. One man I know cured his hepatitis with a traditional remedy, mostly containing a fresh green leaf translated as “horse hoof leaf,” which is quite common to the area. Similarly, these Karen use many other herbs for preventative and curative measures. Some are collected from the forests, but many are found along the road or trail. They have no access to the clinics in the refugee camps and so have employed their traditional medicine as a case of necessity. However, even here, the youth are not interested, especially since they have established contact with mainstream Thai culture which looks down on “hill tribes.”

Karen in Burma

If we look at the Karen in the refugee camps, we can see that their suffering is primarily psychological. However, the Karen in Burma face both extreme mental and physical suffering. Most are struggling to survive with little money, food, and almost no medicine. In addition to this, they continue to suffer under an abusive military regime that denies them basic human rights. Mandatory labor, forced relocation, extrajudicial killings, torture and rape are only a few of the injustices that the ethnic minorities face in Burma.

The Karen in Burma generally consist of two main groups, although throughout the year it is common for people to be a part of both. One group lives in villages, mostly high up in the remote mountains of Karen State. The other group is known as the Internally Displaced People (IDPs). It is estimated that there are over 2 million IDPs in Burma with almost one million hiding in the most remote mountains of Karen State. The SPDC regularly patrols the ethnic minority areas and continues to relocate remote villages in order to control them better. At the sight of the SPDC, villagers will flee into hiding and become IDPs. Some remain IDPs for a few days or weeks, but some live as IDPs for years, constantly moving from one hiding site to another.

A friend of mine from a village in Karen State explained to me the situation in his village. He said that there is little modern medicine, and even less money to buy it. As a result, they have an extensive working knowledge of traditional remedies. In many cases it is all they have. For example, malaria is quite common among his students and the villagers. To treat it, one must go into the forest to search for a specific tree to use its bark. According to my friend, the tree is rare and it takes a lot of time to collect the needed remedy, which is an effective treatment. This is a desperate use of the traditional knowledge, and according to my friend, they would prefer having modern medicine. He has asked foreign volunteers for medicine or money to purchase it.

IDPs

As mentioned above, the other group of Karen in Burma is the Internally Displaced People. Their lives are total desperation. They are homeless, in hiding, and barely surviving. They face the worst situation of all, surviving for months on what they can find in the jungle. Malaria and diarrhea, two easily curable conditions, are slowly killing IDPs because they have no access to treatment. They have some knowledge of forest medicine, but are limited to what is growing around them and/or in season. Even more problematic though, is that they do not have any food, clean water, or shelter.

There are organized groups of Karen medics braving the mountains to provide basic care to the IDPs, but they are severely limited to what they can carry on their backs. Their work is all modern, having received medical training in Thailand, so there is little effort to utilize the available resources in the jungle as medicine. The situation is entirely desperate, and most emergency help is overwhelmed by the need and the danger. Volunteers do their best to offer basic hygiene training to prevent disease, but their knowledge and/or use of available herbal remedies is almost nonexistent.

SDPC

Interestingly enough, the ruthless military regime in Burma encourages the use of traditional herbal medicine. Since the colonial era, the Burman have been obsessively anti-imperialistic. They continue to dismiss western medicine and embrace their own and Chinese medical traditions. They encourage the population to continue to use these traditional remedies both directly and indirectly by having one of the worst health care systems in the world. In 2000, the World Health Organization (WHO) ranked Burma’s overall health system 190th out of 191 countries.

The mentality of the Karen is to oppose just about everything about their oppressors, the Burman. In the past they accepted the British, mainly because they defeated the Burman, and assumed better leadership for Burma. Now they try to follow our western ways, whatever they are. In rejecting the Burman culture, traditional herbal prescriptions included, and embracing western concepts of medicine, the Karen are expanding the distance between themselves and their oppressors.

KESAN

A shining light that I have been lucky enough to see is the grassroots Karen Environmental Social Action Network (KESAN). In fact, I can say that my whole inspiration for this work has been from them. They are a highly motivated and dedicated group of young Karen working to educate their community and the world about the importance of re-establishing the link between the natural environment and their livelihood. They contribute their research to numerous international environmental groups to raise awareness on a global scale of the environmental destruction in Burma that is leading to loss of livelihood for countless people. In addition, they strongly believe in the local knowledge and empowerment of villagers to create their own futures. While the Karen struggle to protect their homeland from the ruthless military regime, KESAN works hard to reinforce sustainable community development.

One of their current projects involves educating the Karen in the importance of protecting their community forests. I participated in one of their trainings in the camp. It involved me facilitating a discussion about the role of traditional cultural medicine, especially in Karen State. The conclusion was that there were several reasons why it needs to be preserved and many ways in which it can be done. I have also explained to students the hazards of modern medicine and the terrific value of their traditional practices.

My students and colleagues have been quite open and genuinely interested in our classroom discussions about preserving traditional medicinal knowledge. Some in the camp have taken it to the next level by going to their elders and learning about their traditional medicine. There is an evident pride in these actions; a pride that I typically do not see among them. This is something that is culturally theirs; something to be passionate about during a time of insecurity and sadness where there is little or nothing to be proud of.

KESAN is now in the process of recording what traditional herbal knowledge remains, both in the camps and in Karen State. They understand the importance of traditional medical knowledge and they are dedicated to preserving it. Their plan is to create a reference book to distribute throughout communities both in the camp and in Karen State.

KESAN recently initiated another traditional medicine project in Karen State as well. Members of one local village came together to create and encourage traditional medical educational programs for their youth population. The project gained incredible momentum and has received support from the village authorities and local Karen leaders. They were allotted ten acres of protected forest area to use for identifying, collecting, and replanting medicinal plants. As a result, local herbalists are now able to teach and produce natural treatments for malaria, tuberculosis, acute respiratory disease and menstrual problems, all of which are common to the area. News of this project has spread to surrounding villages, along with a renewed interest in the preservation of traditional medicine and its practical applications.

KESAN is now seeking funds to build an herbal clinic and store-house for their growing number of supplies. They hope to attract villagers from surrounding areas with treatment and/or available training upon its completion. We hope to inspire a similar interest within the camps.

In conclusion, although the herbal traditions of the Karen are alive, especially in Burma, there are severe threats to the continuation of it. This is particularly true among the refugee population. Traditional herbal medical training and herbal reference books are perhaps the best means to facilitate the continuation of Karen herbal traditions, both in camp and in Karen State. In addition, the role of the “white-skinned” must not be underestimated. Visiting herbalists and/or volunteers must continue to emphasize the validity of traditional herbal medicine. We also have a financial responsibility to support and expand the efforts of KESAN and small village initiatives in their struggle to keep Karen traditional medical knowledge alive.

The accompanying photography is from Karen villages. Reproduced with permission from DARE network, www.darenetwork.com.

Interview with Wit Sukhsamran

Jivaka journal of traditional thai medicine — issue 3, 2007

©2007 Nephyr Jacobsen and Wit Sukhsamran

In the past year I have had the enormous blessing of striking up a friendship Wit Sukhsamran. In addition to enriching my life with his friendship, my life as a Thai massage practitioner and teacher has been greatly affected by this relationship. Khun Wit, who lives in Bangkok, is without a doubt the most knowledgeable English speaking person I have ever encountered when it comes to the study and practice of Thai medicine. He is also a little shy, wishing as much as possible to stay out of the Western public eye. For these reasons, to name only a few, I am grateful to him for agreeing to this interview, and this chance to share some of his thoughts with you, my community of students, practitioners and teachers.

N: Wit, I’d like to start by asking you what led you to study Thai medicine.

W: At a young age I became a novice in a Buddhist temple. The monk who became my teacher had training in Traditional Thai Medicine and being his disciple, I learned that wisdom along with my other studies in Buddhism and so forth.

N: Western scholars of Thai Medicine often note a difference between a “royal” elite system of medicine and a folk, or “rural” system. Can you comment on this?

W: Well, these divisions of medicine in Thailand are created by scholars, as you mentioned, and for the most part, these scholars are not actually practicing the medicine. When it comes down to it, there is no clear distinction between the two divisions. The interaction between the two divisions has been a dynamic one. There are definitely influences of “folk” medicine on the “royal” tradition and vice versa. In Thailand the divisions are labeled as “Traditional Thai Medicine” and “Indigenous Thai Medicine”. So while it is recognized as two separate systems, the divide is not as distinct as Western scholars would have us believe. What is considered to be Traditional Thai Medicine is influenced by Indian Medicine and Chinese Medicine, but has its roots in Indigenous Medicine. As with many things in Thailand, it’s not black and white. It’s usually a case by case basis and each case has a varying degree of influence.

N: Would I be correct in understanding that when you speak of “Indigenous Medicine” you are speaking of medicine that is native to the geography of Thailand, and may even pre-date the arrival of the T’ai people?

W: Yes. That is correct. While the T’ai people arrived in the area now known as Thailand around 800 C.E. (A.D.), there were other inhabitants who had been living here for many centuries. Both the Mon and the Khmer empires ruled various parts of what is now known as Thailand. The Khmers even had hospitals in many parts of N.E. and Central Thailand, so we know there was medicine being practiced here long ago. The important thing to remember is that the medicine comes from the land. It is a result of the environment around the people. The medicine we use is indigenous to the area. The theory is based on the experiences we encounter on a daily basis. So as long as there were people, with organized civilizations inhabiting this land, there was Indigenous Medicine.

N: Most of the readers of this interview will be people who relate to Thai medicine through their experiences with Thai massage. Can you speak a bit about the role of Thai massage in Thai Medicine?

W: Thai Medicine, as taught in the regulated programs in Thailand, is composed of four separate but inter-related branches. These are; Massage, Medical Theory, Pharmacy, and Midwifery. So to answer your question, Massage is a huge part of Thai Medicine.

N: How would you say Thai Massage, as practiced traditionally in Thailand as medicine, differs from what westerners are being taught, and what we encounter when we go to get a Thai massage on the streets of Thailand?

W: Well, there are different levels of knowledge and practice. There are some people who practice Thai massage for the purpose of relaxation. There are some that practice for general health. And there are others that practice for the treatment of various conditions. In general, what most Westerners encounter in schools and in most massage shops is the first or second, or perhaps somewhere in the middle.

N: Most Western teachers of Thai massage, and Westerners writing about it, tend to teach the theory portion with a strong Ayurvedic slant. Would you say that this is an appropriate way of understanding Thai medicine in general and Thai massage in particular?

W: Absolutely not. Unfortunately, this seems to be the norm. For a while it was Traditional Chinese theory that was being used to substitute for the traditional Thai theory. I guess people found that Ayurveda was a better fit. However, it’s still not completely correct. The theory of Thai Massage, as many people know, is unique to itself, and is not merely a ‘branch’ of Ayurveda. Thai medicine has been influenced by its neighbors, namely India and China. However, because of the specifics of the region and the differences in the culture, the medicine that came to be is very different from that of India and China. Especially in comparison to what has been brought to the West. I can’t express it in any other way but to say that Thai medicine is its own method and has its own theory.

N: Should Thai Massage be considered energy work?

W: To consider Thai Massage to be exclusively “energetic” work is ridiculous. Some of the techniques utilized are comparable to those used by physical therapists and chiropractors. By this I mean, if done incorrectly it could be dangerous and lead to injury. So no, it does should not be classified as ‘energy’ work in the Western sense of the word. In fact, it is one of the most physical forms of massage that I know of. However, despite this, there is of course an ‘energetic’ component. The difference is that the concept of energy in the Thai medical theory is different from the idea of energy commonly held in the West. In Thai Massage theory we do not separate the energetic body from the physical body. As we see it, one cannot really exist without the other. Utilizing the techniques available to us in Thai Massage we are working on both levels and not one or the other.

N: What do you have to say about Thai Massage “routines” as they are taught to and by Westerners?

W: The routines are used primarily by those practicing relaxation massage and massage for general health. There are various routines which are taught by different schools. Some schools teach routines for specific ailments. The routine is a good way to work with the entire body and to treat, or at least “touch,” all of the sen lines. However, it is really more of a collection of techniques, a medley. For those practicing therapeutic techniques they will often break from the routine and use only those techniques which are needed for the treatment of that particular patient.

N: You’re speaking of the different component parts of a Thai Massage routine, each being able to be seen as a form of therapy unto themselves – without the whole of the combination. Is that correct?

W: That is correct. A skilled therapist can use and apply the various techniques to form his/her own specific treatment protocol for a given patient.

N: Some teachers focus on knowing and understanding the sen lines, while others seem to disregard them (I’m talking about teachers in Thailand). Can you speak to this?

W: It really depends on the level of the practitioner. I feel that in the beginning it’s good to learn them (Sen) and all the foundational training. One should understand which Sen is being worked on and how it relates to the treatment. However, in the end, like with any art or skill, it has to become a part of you. It’s not enough to simply follow what your teachers have taught you or what the texts say. When it comes down to it, we are treating people and no two people are the same. It’s necessary to listen, to work intelligently and intuitively. Some teachers are teaching their students how to do this. Others are teaching the foundation. Neither is the best way or the right way. They are just different steps.

N: It seems like learning to read. At first you have to look at each letter and really think about what it means. Then later you just absorb the words, and don’t think about the letters anymore. Like with Thai massage, at first you think “I’m working on outside leg line 3, which is sen Kalatharee, which means….” then later, you just don’t think about it.

W: Correct. It’s no different. People often get too caught up in it all because it’s so different from what they are used to doing or because it is exotic and mysterious. In fact, learning Thai massage is the same as learning to ride a bike or learning anything to do anything that requires us to be able to work from a point of true understanding and intuition.

N: Can you talk about how Thai Massage differs from other Asian forms of bodywork?

W: Well, the major difference is in the theory. The techniques don’t differ much from other methods because we have to remember that we are working with the same body. There are only so many ways in which a stretch, point press, etc., can be done. I’d say the major difference is the sen theory. The sen theory is what makes Thai Massage unique. Chinese meridians relate to elements and organs. They have specific pathways that they follow in accordance with their theory. The Indian nadis, I can’t comment on as I have no knowledge of their system, but I know that the nadis are based on a chakra system and this system of chakras is not a part of Thai medical theory.

N: Before we part, do you have any advice for Westerners studying, practicing and teaching Thai massage?

W: My advice would be to learn from more than one teacher. Try to get various interpretations of the method. There isn’t one person who knows it all. Also, take time to actually practice the work before moving on to the next teacher or teaching yourself for that matter. In Thailand we usually say that we start beginning to understand massage after at least five years of practice. Question and investigate, but do so from a practical understanding, not just a theoretical one.

 

Thai Massage: A Cross-Training for Dance

©2006 Scott Putman

Scott Putman is an Assistant Professor in dance and choreography at Virginia Commonwealth University. He is also a practicing and certified Thai massage practitioner. He believes that choreography is the art of shaping energy in space. This belief continues to inspire him in his research to find the most effective way to channel energy into expressive dance and movement techniques.

During my graduate studies at the University of California, Irvine I was forced to justify my belief in and ideas behind the dances I created as well as my passion for dance in general. A strong dedication to martial forms and dance continued to cultivate energy in my body and therefore made perfect sense to me, but academic and western justification were still necessary to articulate its importance to others. It was no longer enough for me to sense and feel the energy of my own body. I had to find a way to build a bridge of communication between what I knew to be true in my dancing soul and what society seemed to embrace in the world around me.

Since that time I have been inspired by parallel movements in modern art such as Fauvism, Cubism and Futurism as a means to embark upon a four-year project known as the Experiment in White Project. Not only has this endeavor proven to be a rich and rewarding source for work but it has also raised questions about how to train my dancers so that they might manifest their energy and technical abilities to perform in new and creative ways.

Dancers have been trained for some time with the idea that the pelvis is the anchor and initiator of all movement. I still find that this is the best way to get at the center of movement and the place for the greatest propulsion. However, I am now finding myself interested in weaving other ideas into this method of teaching and moving. I am curious about integrating the idea of gathering energy from the earth and translating that energy into kinetic energy. I believe that by stimulating the intrinsic musculature to move the dancing body, a similar and even more effective style of movement might be initiated.

For over two years now, I have been practicing Thai massage, and in that time I have witnessed amazing benefits in my own capacity to cultivate energy as well as the healing effects that it seems to offer both myself and my clients. As a result, I have drawn the conclusion that utilizing Thai massage as a cross training for dance can be physically and psychologically beneficial when combined with an avid dance practice and/or training program.

In order to access the technical demands of dance, as well as its depth of performance, a dancer must be able to blend a variety of techniques with a full embodiment of expression within each piece of choreography. In order to do this, my dancers often train in ballet and in modern dance five days a week for an hour and a half each. This adds up to 3 hours of technical training before the rehearsal process even begins; a demanding day for both body and mind.

Knowing how rigorous a dancer’s schedule can be, I propose that consistently receiving Thai massage can be utilized as a means of cross training. I believe that it addresses issues of balance, flexibility and strength through its inherent non-gravitational movement and does not create unnecessary physical strain and/or exhaustion on the body and mind; a byproduct sometimes created within the pressures of a gym environment. Though “cross training” is traditionally associated with working supplementary muscle groups to support a primary mode of training, a well organized dance class, regardless of style, will address multiple muscle groups and the majority of physical needs of its dancers. This type of class also helps to build a dancer’s stamina and strength on a muscular and aerobic level. The rehearsal process, when well directed, also promotes aerobic activity through its repetitive nature.

Taking into consideration the aforementioned demands that a dancer often places on his or her body in class and during rehearsals, it seems counterproductive to risk injury and/or exhaustion at a gym training on machines and in repetitive motions that do not serve the health and well being of body and spirit. By using Thai massage instead as a method of cross-training, a dancer’s physical body will not only feel revitalized, but the cultivation of spiritual focus that often takes place during traditional sessions will enable him or her to connect more deeply with body and mind, and ultimately inspire a more successful artistic expression on stage.

In my experience, it is often the case that dancers are unable to access correct alignment and placement of dance forms. They get “stuck” trying to create a picture or imitate movement while overworking the exterior musculature and inhibiting correct placement of the physical dance form and greater range of motion. Repeating this time and again exhausts the body and slows the growth and development of a dancer’s process. Working like this can also develop poor movement habits that take time to break and modify.

I believe that if regime dancers added Thai massage to their practice on a bi-monthly basis, the benefits to their technique, focus and energy would be well worth it. By allowing a practitioner to guide them through sensations of correct body alignment, they would be able to sense and feel without gravity the potential of what they can ultimately achieve with gravity. With repetition, the memories of these sensations will manifest while working at the barre or center practice. Instead of trying to “muscle everything,” the aforementioned sensory feelings achieved in a relaxed state during Thai massage will help the dancer find form and placement during practice. This will also occur utilizing

only the necessary intrinsic musculature rather than the exterior musculature that can potentially cause injury through over and misuse.

Another aspect of Thai massage that I find beneficial is its internal focus on breathing. A similar focus is necessary in dance. Rather than utilizing a manipulating and forcing technique, the internal guiding that one develops when receiving Thai massage offers dancers a way of communicating with their bodies while in movement and within the demands of a classroom experience.

The cultivation of energy that often occurs during Thai massage also offers great benefits to dancers as it encourages a sustainable flow of energy throughout the body. It inspires an accurate firing of musculature and management of energy in technical exercises and therefore addresses the issue of endurance in both practice and performance. Understanding how energy flows throughout the body and being able to manage it is a key factor in executing technique and performance qualities. An uninterrupted flow of energy along the sen lines will help to maintain a dancer’s physical health and allows his or her body to move more efficiently.

As the director of a dance company, choreographer and teacher, I am more interested in the health and longevity of my dancers than in a dancer who is removed, exhausted or lacks presence in his or her body. I believe that a healthy and happy dancer creates the foundation for masterful work. By cultivating those qualities in my dancers, a perfect creation and expression of art becomes manifest. This occurs within the choreography that is created, in the way that it is interpreted by the dancers and ultimately through how it is experienced by the audience during performance.

At present, these thoughts are a springboard for me to deepen my practice of Thai massage within the dance environment and quantify the effects it has on both a personal and performance level. I welcome others with a passion for both dance and Thai massage to join me on this journey to help communicate these ideas in an academic and western setting.

The Role of Thai Traditional Medicine in Health Promotion

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

The Kingdom of Thailand has its own system of traditional medicine called “Thai traditional medicine” (TTM). It originated during the Sukhothai period (1238-1377) and developed in parallel with the country as a means of national health care until the early 20th century.(1) The spread of modern medicine from the Western world to the East then led to a decline in the practice of traditional medicine in Thailand. As a result, modern medicine eventually replaced TTM and became Thailand’s mainstream health-care system while TTM was neglected for over 60 years until the revival of TTM began in the late 1970s.

This paper will cover the principles of TTM and how they can be applied for health promotion, the movement to revive and integrate TTM into the national health system and the lessons learned…

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Anonimity, ethics and validity: Multi-sited fieldwork into Thai integral healing

By Marco Roncarati, SOAS

The mainstay of my fieldwork, covering a one-year period until September 2000, revolved around the study of traditional healers and health care developments within the context of Thai Buddhism. This paper attempts to look at certain ‘challenges’ many anthropologists face when in the field and when ‘writing up’, particularly with regard to the identity of those studied, the validity of their experiences, and related ethical matters. With reference to a case study it is argued that, in order to enhance understanding, knowledge in its various forms needs to be contextualised, while consciousness is more usefully understood as capable of being developed to ‘higher’ levels beyond the ‘mental-rational’ level to more adequately reflect the reality of ‘supernatural’ phenomenon described by the anthropologist’s informants….

Read more here: http://www.anthropologymatters.com/index.php/anth_matters/article/view/141/268