From Regulatory Approval to Subsidized Patient Access in the Asia-Pacific Region: A Comparison of Systems Across Australia, China, Japan, Korea, New Zealand, Taiwan, and Thailand.

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From Regulatory Approval to Subsidized Patient Access in the Asia-Pacific Region: A Comparison of Systems Across Australia, China, Japan, Korea, New Zealand, Taiwan, and Thailand.

Value Health Reg Issues. 2015 May;6:40-45

Authors: Cook G, Kim H

OBJECTIVES: To compare processes and timings of regulatory and subsidized access systems for medicines across seven jurisdictions within the Asia-Pacific region.
METHODS: A questionnaire was developed focusing on regulatory and health technology assessment-based subsidized access processes and timings in each of the seven surveyant’s jurisdictions.
RESULTS: Australia and Thailand are the only two jurisdictions that formally allow the subsidized access evaluation process to be conducted in parallel with the regulatory evaluation process. Australian, Japanese, Korean, New Zealand, and Taiwanese systems afford broad coverage, whereas Chinese and Thai systems provide limited coverage for medicines under patent. Subsidized access systems for all jurisdictions except Thailand have an associated patient co-payment for each medicine/prescription. The biggest disparity across the study group relates to time from regulatory submission to subsidized access of patented medicines-ranging from just over 1 year (Japan) to a minimum of 5 years (China).
CONCLUSIONS: There is consistency across the seven jurisdictions studied in relation to regulatory and subsidized patient access processes-that is, regulatory approval is required before subsidized access review; subsidized access coverage is broad; and the cost of medicine subsidization is offset, in part, by patient co-payments. Although local differences will always exist in relation to budget and pricing negotiation, there may be efficiencies that can be applied across systems to improve time to subsidized access. Closer understanding of regulatory and subsidized access systems can lead to best-practice sharing and, ultimately, timely access and better health outcomes for patients.

PMID: 29698191 [PubMed]

Can therapeutic Thai massage improve upper limb muscle strength in Parkinson’s disease? An objective randomized-controlled trial.

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Can therapeutic Thai massage improve upper limb muscle strength in Parkinson’s disease? An objective randomized-controlled trial.

J Tradit Complement Med. 2018 Apr;8(2):261-266

Authors: Miyahara Y, Jitkritsadakul O, Sringean J, Aungkab N, Khongprasert S, Bhidayasiri R

Muscle weakness is a frequent complaint amongst Parkinson’s disease (PD) patients. However, evidence-based therapeutic options for this symptom are limited. We objectively measure the efficacy of therapeutic Thai massage (TTM) on upper limb muscle strength, using an isokinetic dynamometer. A total of 60 PD patients with muscle weakness that is not related to their ‘off’ periods or other neurological causes were equally randomized to TTM intervention (n = 30), consisting of six TTM sessions over a 3-week period, or standard medical care (no intervention, n = 30). Primary outcomes included peak extension and flexion torques. Scale-based outcomes, including Unified Parkinson’s Disease Rating Scale (UPDRS) and visual analogue scale for pain (VAS) were also performed. From baseline to end of treatment, patients in the intervention group showed significant improvement on primary objective outcomes, including peak flexion torque (F = 30.613, p < .001) and peak extension torque (F = 35.569, p < .001) and time to maximal flexion speed (F = 14.216, p = .001). Scale-based assessments mirrored improvements in the objective outcomes with a significant improvement from baseline to end of treatment of the UPDRS-bradykinesia of a more affected upper limb (F = 9.239, p = .005), and VAS (F = 69.864, p < .001) following the TTM intervention, compared to the control group. No patients reported adverse events in association with TTM. Our findings provide objective evidence that TTM used in combination with standard medical therapies is effective in improving upper limb muscle strength in patients with PD. Further studies are needed to determine the efficacy of TTM on other motor and non-motor symptoms in PD.

PMID: 29736380 [PubMed]

Antipsoriatic Effects of Wannachawee Recipe on Imiquimod-Induced Psoriasis-Like Dermatitis in BALB/c Mice.

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Antipsoriatic Effects of Wannachawee Recipe on Imiquimod-Induced Psoriasis-Like Dermatitis in BALB/c Mice.

Evid Based Complement Alternat Med. 2018;2018:7931031

Authors: Na Takuathung M, Wongnoppavich A, Panthong A, Khonsung P, Chiranthanut N, Soonthornchareonnon N, Sireeratawong S

Psoriasis is a common immune-mediated chronic inflammatory skin disease characterized by thick and erythema raised plaques with adherent silvery scales. T-cells are activated via the IL-23/Th17 axis which is involved in psoriasis pathogenesis. Conventional treatments of psoriasis have adverse events that influence patients’ adherence. Wannachawee Recipe (WCR) is Thai traditional medicine that is known to be effective for psoriasis patients; however, preclinical evidence is still lacking. This study investigated the therapeutic potential of WCR on antiproliferant activity using imiquimod- (IMQ-) induced psoriasis-like dermatitis in a mouse model. Psoriasis-like dermatitis was induced on the shaved dorsal skin and right ear pinna of BALB/c mice by topical application of IMQ for 15 consecutive days after which WCR was administered to the mice by oral gavage for 10 days. Phenotypical observations, histopathological examinations, and ELISA of skin and blood samples were conducted. WCR significantly ameliorated development of IMQ-induced psoriasis-like dermatitis and reduced levels of Th17 cytokines (IL-17A, IL-22, and IL-23) in both serum and dorsal skin. Histopathological findings showed a decrease in epidermal thickness and inflammatory T-cell infiltration in the WCR-treated groups. The WCR has pharmacological actions which regulate Th17 related cytokines suggesting that it is a potential alternative therapeutic strategy for psoriasis.

PMID: 29619073 [PubMed]

Z’ev Rosenberg on “The Seminal Suwen Chapters: A Blueprint for Human and Ecological Health”


Given the fact that I am really busy right now finishing up my forthcoming book Humming with Elephants: The Great Treatise on the Resonant Manifestations of Yīn and Yáng (a discussion of the Yellow Emperor’s Inner Classic, Plain Questions 5 黃帝內經素問:陰陽應象大論) and getting ready for a busy spring lecturing season, my esteemed colleague Z’ev Rosenberg, professor emeritus and former chair of the Department of Herbal Medicine at the Pacific College of Oriental Medicine in San Diego, has kindly offered to help out. Incidentally, Z’ev and I will be teaching a “medical classics study and herb expedition summer retreat” in Taos, New Mexico, in August of this year, which will incorporate material from both of our books. For more information on that, see here. To read more about Z’ev and his ongoing projects, visit his website here. In the guest blog below, he is providing a brief excerpt from his long awaited brand-new book Returning to the Source: Han Dynasty Medical Classics in Modern Clinical Practice, which has just been released by Singing Dragon and promises to be a real gem. Here is a little taste:

The essential first three chapters of the Huang di nei jing Su wen set the stage for the core principles of Chinese medicine. These opening chapters contain the compass of life and medicine; the text reveals the equations that allow us to see how far we’ve deviated from the principles of life. As Wang Bing explains in his commentary of Chapter 3 in the Su wen:

If one’s desires cannot fatigue one’s eyes, if the evil of lewdness cannot confuse one’s heart, if no recklessness causes fatigue, this is ‘clarity and purity.’ Because of one’s clarity and purity, the flesh and interstice [structures] are closed and the skin is sealed tightly. The true and proper qi guards the interior and no depletion evil intrudes… Those that are ‘clear and pure’ follow the order/sequence of the four seasons, …they do not cause fatigue through reckless behavior, and rising and resting follow certain rules. As a result, their generative qi is never exhausted and they are able to preserve their strength forever.

Many modern practitioners of Chinese medicine criticize the seminal first three chapters of the Su wen as ‘fantasy’, about a world that no longer exists, of sages living in perfect harmony with the way (dào 道). The Su wen describes it as an ideal, as a way of living that even at the time of the Huang Di nei jing was long past. In Chapter 1 of the Su wen Huang Di asked Qi Bo:

The people of high antiquity, in [the sequence of] spring and autumn, all exceeded one hundred years. But it their movements and activities there was no weakening. As for the people of today, after one half of a hundred years, the movements and activities of all of them weaken. Is this because the times are different? Or that the people have lost this [ability]?

Qi Bo responded:

The people of high antiquity, those who knew the Way, they modeled [their behavior] on yin and yang…. [Their] eating and drinking was moderate. [Their] risings and resting had regularity. They did not tax [themselves]) with meaningless work. Hence, they were able to keep physical appearance and spirit together, and to exhaust the years [allotted by] heaven. Their life span exceeded one hundred years before they departed.

What many people don’t glean from the passage is that the Su wen presents the principles for the practice of ecological medicine, based on living in harmony with natural law and its influences on the intricacies of human health. This has been known since ancient times, first mentioned in the Mawangdui manuscripts, as nourishing life (yǎng shēng 養生). The ideal way of life attributed to the sages is based on the intrinsic harmony of heaven (sky) and earth, and the human being as an intermediary between these poles of existence. So right at the beginning of Chinese history, we are seeing that the human being has a profound influence on the world around us.

In modern times, the predominating dogma(s) in modern science, on the one hand, are that nature is unconscious, working according to Darwinian mechanisms that push survival and adaption forward. On the other hand, are the religious fundamentalists who believe that such phenomena as climate change are a hoax, and free-market evangelists who believe that energy companies should be deregulated and be allowed to despoil the environment in the name of economic need and job growth? Nowhere is this problem more acute than in mainland China, as we discussed above. The closest modern theory I could find from a scientist is James Lovelock and Lynn Margulis’ “Gaia Principle,” which states that the Earth is a living being that responds to our activities. One of the great sea changes of the scientific revolution in the West was the complete repudiation of what is called the vitalist principle, the concept of a life force in creation that animates all living and sentient beings, replaced by a more mechanistic view of life. In my opinion, this is the biggest rift between Western and Chinese medicine. And to the degree that Chinese medicine abandons so-called vitalism, it moves far from its Han dynasty sources.

According to the evidence, of course doctors should recommend acupuncture for pain

Last week, the BMJ published an invited head to head debate as to whether doctors should recommend acupuncture for the treatment of pain. Below is my rapid response:

What’s most interesting about this discussion of whether or not doctors should recommend acupuncture for pain is a total lack of discussion of the other available treatment options that doctors and patients decide amongst and how acupuncture compares in terms of efficacy, effectiveness, safety and cost-effectiveness. Surely this is the only reasonable starting point for any intelligent discussion about how healthcare resources should be utilized to best help this patient population.

If we continue for a moment to look at acupuncture in an artificial vacuum, as Ernst and Hrobjartsson have done here, there are a few things to note. First, the small effect size that they note of acupuncture over sham needling for pain, which given that the review in question discarded the most positive studies constitutes an underestimation,1 both demonstrates specific effects of acupuncture and at the same time, is a completely irrelevant comparison to determine ‘clinical effects.’2 Doctors and patients are not choosing between acupuncture and sham acupuncture needling control; they are choosing between acupuncture, paracetomol, NSAIDs, opioids, surgery, off-label, poorly tolerated, experimental medication in the case of migraines and fibromyalgia, and physiotherapy, all of which are limited in their ability to effectively treat pain whilst introducing considerable and measurable harm. Sham controlled acupuncture trials merely assess two different types of acupuncture needling. Both are often superior to conventional care in terms of pain reduction and improved quality of life, with the highest-quality evidence demonstrating a statistically significant benefit of acupuncture over sham needling, with an effect size greater than that of paracetomol compared to placebo for many types of pain.3

If we look at sham controlled studies of orthopedic surgery, we find not a small difference between surgery and the sham procedure but no difference at all.4 Clearly surgery and acupuncture have similar methodological challenges to being studied using the double-blind RCT study design held as the gold-standard for pharmaceuticals. If lack of practitioner blinding is such a powerful force as the authors suggest, surely this should have a much stronger effect in the case of surgery, which is more invasive and more expensive (factors that we’re told influence acupuncture outcomes), and yet there’s no difference between fake surgery and the real thing when it comes to reducing patients’ pain. It seems odd to argue against something with at least small specific effects and large non-specific effects (in other words, large proven clinical effects in helping patients reduce their pain) rather than something that’s ineffective, invasive and expensive to boot.

It’s also helpful to note that studies of placebo, including Hrobjartsson’s own research, repeatedly and consistently demonstrate that placebos are ineffective and while they can bring short-term benefits for subjective outcome measures such as pain, they don’t work in the long-term at all.56 This is diametrically opposed to what we see in acupuncture research. Acupuncture brings meaningful reduction in pain symptoms that persists at 12 months,7 as Dr Cummings has pointed out. No placebo has been demonstrated to do this so I’m curious if the authors are arguing that acupuncture is a particularly special placebo unlike any other that has ever been studied before. Of course, this would be special pleading, which is an argument firmly rooted in the authors’ own bias rather than faithfully interpreting the evidence in a consistent and objective way in order to best help patients.

If the authors’ reading of the acupuncture mechanism literature stops at the gate control theory as they have stated, I’m confused as to why they feel qualified to comment as subject experts. Specific mechanisms for acupuncture in pain control are numerous and well-documented, involving but not limited to peripheral effects mediated by purinergic signalling and nitric oxide release, spinal reflexes, modulation of endogenous analgesic biochemicals (including endorphins i.e. endogenous morphine, very effective for pain relief!), improved functional connectivity in the brain, modulation of parasympathetic activity and modulation of inflammatory signaling.8

Of course, the ability to articulate how a treatment works has zero relevance for clinical effectiveness, which is what we’re actually discussing. On the other hand, a recent review in this journal that found that paracetamol is even more harmful than generally appreciated, notes that the ‘mechanism of paracetamol’s analgesic action remains largely unknown.’9

This comes after another recent review of paracetamol for spinal pain and osteoarthritis, also published in this journal, that finds that “paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis” 10. In short, paracetamol is widely used and prescribed, increases the risk heart attack, stroke, kidney damage, GI bleeding and death, and we don’t know how it works which is moot because it doesn’t work anyways. In that light, doesn’t it seem a bit silly to debate whether or not to recommend a treatment that is repeatedly demonstrated to be efficacious, effective, cost-effective, and safe, where the only question is exactly how much of its sizable clinical effect is down to the specific effects through analgesia induced through mechano-transduction and how much is due to the ambiance of the acupuncture clinic or the caring disposition of the clinician?

Another mainstay of pain treatment in the NHS are NSAIDs. This class of drugs suffers from a paucity of long-term clinical data but are frequently prescribed indefinitely, despite serious risks. A recent review looking at over 400,000 patients, also published in this journal, found that “All NSAIDs, including naproxen, were found to be associated with an increased risk of acute myocardial infarction” (which is fancy medical speak for ‘heart attack’) when taken for any time period, including as little as one week.11 A now out-dated and absurdly conservative estimate shows that the adverse effects of NSAIDs costs the NHS a median estimate of £251 million pounds a year.12 This figure is only based on the cost of treating GI perforation and doesn’t take into account any of the heart attacks and strokes caused by NSAIDs when taken as directed.

Of course, the harms caused by NSAID and paracetamol consumption pale in comparison to those of opioids, which are extremely addictive, frequently debilitating and often lethal (in the UK, deaths related to prescription opioids doubled between 2005 and 200913), which is why until a successful albeit illegal marketing campaign by their manufacturer in the 1990’s, oral opioids were only available as part of end-of life pain management for terminal cancer patients. In this light, it’s interesting to note that the first and only study ever performed on long-term effectiveness of opioids for pain-relief found that those taking opioids were actually in more pain than their non-opioid popping counter-parts.14 Talk about a poor benefit to harm ratio! While NICE guidelines for various pain conditions urge doctors to use these drugs sparingly and as a last resort, recommending against using acupuncture as a treatment for pain directly increases the usage of these drugs, which is clearly in no one’s best interest and makes the recommendations seem disingenuous.

As acupuncture has been repeatedly demonstrated to reduce the consumption of pain medication, including opioids and NSAIDs, surely a discussion of the cost of acupuncture should take this into account, given how much treating the harms of these drugs costs the NHS each year. Indeed, if we look at the cost-benefit ratio of what’s typically offered for pain, it would be more germane to discuss the cost to the NHS and harms to patients of not recommending acupuncture.

Compared to physiotherapy, acupuncture has a much stronger evidence base. As one point of reference, there are over 10,000 trials on Cochrane’s Central Register for acupuncture compared to under 7,000 for physio (ironically, this latter number includes studies of physios doing acupuncture). With this in mind, it’s interesting to note that physios frequently add acupuncture to their practice (the UK’s Acupuncture Association of Chartered Physios boasts over 6,000 members), often after very minimal training, contrary to World Health Organisation safety recommendations. It’s difficult to reconcile why physios would increasingly start using acupuncture if it didn’t work and their own tools that they learned in their training yielded satisfactory results in practice. Are you suggesting that physiotherapy techniques are so ineffective at treating pain that thousands of physios are offering a placebo to their patients instead?

Any discussion about which treatments should be recommended for pain that center on patients’ wellbeing and the allocation of precious healthcare resources should be based on a comparison of the benefits versus the harms of available treatments. This is self-evident. Such an approach, no matter how you slice the evidence-base, leaves acupuncture amongst first-line treatment options for pain, if not a clear winner. If Hrobjartsson and Ernst insist on banging the disproven placebo drum despite repeated demonstration of specific effects, clinical superiority over treatments that themselves are shown to be superior to placebo and despite the scientific community’s clear understanding of specific mechanisms of how acupuncture is able to achieve these results, then the discussion we should be having is not about the ethics of recommending placebos. Rather the discussion would need to be about the ethics of recommending treatments that fail to outperform or in some cases are inferior to a treatment that you claim is s placebo, all while exposing patients to considerable and avoidable harm. That’s the only logically consistent reading of your suggested interpretation. So let’s have a discussion about the ethics of that.

In the interest of patients and the responsible provision of healthcare resources, I sincerely invite the authors to explain: if not acupuncture for pain, then what do they recommend instead and based on what evidence? If they are unable to provide evidence of a more effective treatment, one with stronger evidence of positive effect, one that does not unacceptably harm patients, then perhaps a reconsideration of providing such a respectable platform for such outdated and un-evidenced opinions is appropriate, as it directly puts patients at risk while impeding access to a proven and effective treatment for a poorly treated affliction.

The post According to the evidence, of course doctors should recommend acupuncture for pain appeared first on A Better Way To Health.

Dada and the punjabi princess

Dada and the Punjabi Princess is an abstract figurative moving collage that celebrates the ways in which Asian women in diaspora draw on traditional body practices to recreate new identities. Her first experimental moving image work Dada and the Punjabi princess is a fourteen minute celebration of traditional Indian dance, kaleidoscopic landscapes, polemical text, and social and political media. Confrontational and celebratory, Dada and the Punjabi Princess is a fusion of Punk, Pop Art and Bollywood for the Digital Age.

Antioxidant capacities and total phenolic contents of 20 polyherbal remedies used as tonics by folk healers in Phatthalung and Songkhla provinces, Thailand.

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Antioxidant capacities and total phenolic contents of 20 polyherbal remedies used as tonics by folk healers in Phatthalung and Songkhla provinces, Thailand.

BMC Complement Altern Med. 2018 Feb 21;18(1):73

Authors: Chanthasri W, Puangkeaw N, Kunworarath N, Jaisamut P, Limsuwan S, Maneenoon K, Choochana P, Chusri S

BACKGROUND: Uses of polyherbal formulations have played a major role in traditional medicine. The present study is focused on the formulations used in traditional Thai folkloric medicine as tonics or bracers. Twenty documented polyherbal mixtures, used as nourishing tonics by the folk healers in Phatthalung and Songkhla provinces in southern Thailand, are targeted. Despite traditional health claims, there is no scientific evidence to support the utilization of polyherbal formulations.
METHODS: The phenolic and flavonoid contents of the polyherbal formulations and a series of antioxidant tests were applied to measure their capability as preventive or chain-breaking antioxidants. In addition, the cytotoxic activity of effective formulations was assayed in Vero cells.
RESULTS: Ninety-eight plant species belonging to 45 families were used to prepare the tested formulation. The preliminary results revealed that water extracts of THP-R016 and THP-R019 contain a high level of total phenolic and flavonoid contents and exhibit remarkable antioxidant activities, as tested by DPPH, ABTS, and FRAP assays. The extract of THP-R019 also showed the strongest metal chelating activities, whereas THP-R016 extract possessed notable superoxide anion and peroxyl radical scavenging abilities.
CONCLUSIONS: The data provide evidence that the water extracts of folkloric polyherbal formulations, particularly THP-R016, are a potential source of natural antioxidants, which will be valuable in the pharmaceutical and nutraceutical industries. The free radical scavenging of THP-R016 may be due to the contribution of phenolic and flavonoid contents. Useful characteristics for the consumer, such as the phytochemical profiles of active ingredients, cellular based antioxidant properties and beneficial effects in vivo, are under further investigation.

PMID: 29466987 [PubMed – in process]

Antiviral activities of Clinacanthus nutans (Burm.f.) Lindau extract against Cyprinid herpesvirus 3 in koi (Cyprinus carpio koi).

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Antiviral activities of Clinacanthus nutans (Burm.f.) Lindau extract against Cyprinid herpesvirus 3 in koi (Cyprinus carpio koi).

J Fish Dis. 2018 Feb 22;:

Authors: Haetrakul T, Dunbar SG, Chansue N

Cyprinid herpesvirus 3 (CyHV-3) or koi herpesvirus (KHV) is a virulent viral infection in common carp and koi. The disease has caused global epizootic and economic loss in fish aquaculture and in the wild. Clinacanthus nutans (Burm. f.) Lindau is a well-known medicinal plant used in Thai traditional medicine. Virucidal effects of the plant extract against human herpes simplex virus have been reported. In this study, C. nutans crude extract was tested for antiviral activities against CyHV-3 in koi carp. Results showed effective antiviral activity against CyHV-3 pre- and post-infection. The 50% lethal concentration (LC50 ) of extract was higher than 5 mg/ml. The 50% effective dose (ED50 ) was 0.99 mg/ml, 0.78 mg/ml, 0.75 mg/ml and 0.71 mg/ml at 1, 2, 3 and 4 hr pre-infection, respectively. The ED50 from post-infection tests was 2.05 mg/ml and 2.34 mg/ml at 0 and 24 hr, respectively. These results demonstrated that crude extract expressed antiviral activity against CyHV-3 and can be applied as a therapeutic agent in common carp and koi aquaculture.

PMID: 29468849 [PubMed – as supplied by publisher]

Healing Experiences of Vipassanā Practitioners in Contemporary China, Case study 5

This is a case study that is part of a series of linked posts:
Introduction, case 1 | 2 | 3 | 4 | 5

Case 5: Candasaro

Before ordaining as a monk in Thailand, Candasaro had worked at a private factory as a production manager in Sichuan for over 30 years. In 2008 he started exploring Theravāda meditation by learning observing the breath[i] with Pa-Auk Sayadaw’s method at Jiju Mountain for about two months in Yunnan. He later gave up this practice as he could not see any sign[ii] emerged in his sitting. “My personality is quite fast-paced. It’s difficult to cultivate calmness.”[iii] In May 2011, he firstly learnt about the practice of dynamic movement at a ten-day retreat led by Luangpor Khamkhian Suvanno, from Thailand, in Hongzhou.[iv] During the retreat, he tasted a sense of joy[v], a positive outcome of meditation.

Candasaro found that dynamic movement suited him perfectly. He explained about the practice: “In the beginning [you] observe the movement of the body. Later [you can] observe the mind. All practices are similar. They firstly cultivate calmness by bringing awareness to one point. That is developing an ability of concentrating the mind. Without calmness, it is impossible to practice vipassanā. When you open the six sense doors, you hold one of them, like a monkey holding the main pillar. In dynamic movement, the main practice is moving the arms. In Mahāsi’s method, it is about the rising and falling of the abdomen. … I like observing the movement.”

He also practiced the dynamic movement at workplace. “While I was working at the control room, I managed the office work and communicated with my colleagues [when it was necessary]. The workload was not so heavy. There was only about one working our every day. It was relaxing.” Then in October 2011 Candasaro joined an organized trip to stay at WatPa Sukato[vi] for two months in South Thailand. This was the first time he travelled to Thailand. Located at Chaiyaphum Province, the temple covering an area of 185 acres, including a river and Phu Kong Mountain that was 470 meters above sea level. Sukato means ‘good’. Luang Phor Kham Khian Suwanno, the first abbot, shared his intention of building the temple, “Sukato is a place where people come and go for wellness, also for the beneficial impact of the environment, human being, river, forest and air. This is the wellness in coming, going and being. This wellness is born from earth, water, air and fire, not from one person alone. …There are shelter, food and friends who will teach, demonstrate, and give advice. Should one wish to stay here, his or her intention to practice dharma shall be fulfilled.”[vii]

In this huge forest temple, there were around 30 monks and 30 lay people only. As there were plenty established huts, every resident could stay in one hut.[viii] Every morning, all residents woke up at 3 o’clock in the early morning to prepare for the chanting and dhamma talk at 4 o’clock. Around 6 am, Candasaro and other monks, dressed in yellow monastic robe, formally visited villages nearby carrying their alms bowls for their daily alms round. (See Fig. 3 and Fig. 4) In Chinese Buddhist communities in China, alms round practices have been faded out for many centuries. With bare feet, the monks lined up tidily first and started walking towards one of the target villages. After entering the village, they stopped in front of a household where donors were waiting with cooked rice and food. Whenever people from households offered food to monks one by one, they would line up before the householders and chant blessing words in Pāli. All the monks went back to the monastery with the received alms. At around 7.30 am, volunteers in the monastery kitchen finished preparing the foods so that the monks and all residents could have their first meal. For monks, this was also the only meal according to their precepts.

In August 2012, he stayed there again for a month. In 2013, he decided to quit his job and receive early retired pension. He decided to ordain as a bhikkhu and settled at WatPa Sukato. He enjoyed his monastic life very much, “I don’t need to spend any money by living at a monastery. I have been working in government and business sectors for many years. I am very tired of them. And my wife agreed to that [the separation] ….  After you practice diligently, awareness lead you to have a strong sense of renunciation from the mundane world. Firstly, [it’s] renunciation; secondly, you do not attach or crave something.” (See Fig. 5)

Although Candasaro could not speak English, he had learnt some basic Thai words to communicate with Thai people for his daily basic needs. Over the past four years, he went back to China a few times to attend retreats and also invited some friends to travel to WatPa Sukato. In 2017, he returned to China and settled in Fujian Province. He started teaching dynamic meditation and led alms round in the village.

[i] Ch. guanhuxi; P. ānāpānasati.

[ii] Ch. chanxiang; P. nimitta.

[iii] Ch. ding; P. samādhi.

[iv] Luangpor Khamkhian Suvanno was a disciple of Luangpor Teean.

[v] Ch. xi; P. piti.

[vi] See “Wa-Pa-Sukato,” Tourism Authority of Thailand,–3354

[vii] Ibid.

[viii] Ch. gudi; P. kuṭi

Healing Experiences of Vipassanā Practitioners in Contemporary China, Case study 4

This is a case study that is part of a series of linked posts:
Introduction, case 1 | 2 | 3 | 4 | 5

Case 4: Jiang Hailong

Since May in 2006, Jiang Hailong, a forty-six-year-old civil servant from Fujian Province, had started practicing vipassanā with Goenka’s method for ten years. He attended four ten-day retreats and five eight-day satipaṭṭhāna retreats. Jiang said: “Learning vipassanā can purify the mind and cultivate wisdom. After a car accident in October 2005, I started suffering from headaches all the time. They could not be cured, although I had tried various kinds of treatment in clinics by spending a lot of money.”

Finally, he started practicing vipassanā to help relieve his physical pain in his daily life. He shared with me in a grateful tone: “I practice mindfulness every moment. From my experience, I feel pain in my head if I don’t practice. Yet with moment-to-moment awareness, the headache can be released. I can see clearly the change in the mind and the body. The whole body is composed of waves and particles. They emerge and disappear. I can see the phenomenon clearly during sitting and in my daily life. There is no concept of my arms, legs and head. They are waves only, with the vibration of particles. They arise and fall like bubbles… many bubbles …arise and fall… very quickly.”

Jiang highly recommend the teaching of Goenka. He believes that the teaching can lead to liberation of life and death. “Without awareness, I feel so painful. It is suffering. With awareness, the pain is relieved. Previously I had hatred towards the pain. Progressively the pain and hatred have faded away. A pleasant feeling even sometimes arises. Yet [I remind myself] not to attach to it.”

Jiang highlighted meditators should report to meditation teachers, who would give instructions during interview. Jiang thought that he did not practice well. He said shyly and humbly, “I have never dared to share with anyone about my practice–the experience of impermanence and not-self. But when I report to teacher, he confirmed that he could see it [in a similar way].”