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- Why Study Chinese Medicine? - October 19, 2019
- An Old Problem in Indian Medical History Revised - September 2, 2019
This is a syndicated post reproduced here with the author’s permission. It first appeared at http://www.joshuajayintoh.com/3611361936323623363336053636360936233604365236073618-nuad-thai-history.html
Thai Massage is becoming more and more well known in today’s world. I will be offering some information that may very well conflict with what’s out there in the main stream. I am not a master of Thai Massage. I am just a silly ignorant man on the road, telling stories about experiences and adventures in distant lands.
Perhaps the difference, along with the chutzpa to frankly express what I am, is because I have just been lucky to meet and practice with Thai doctors from many aspects of the Thai Medical field: doctors from Wat Po to the Ministry of Public Health, ฤๅษี Reusi, Thai monks, rural ‘witch-doctors’, โยคี yogis, and people ‘in the know’ with Thai Medicine, all while using the Thai language as the medium.
My experiences are tainted and biased. At least, I am aware of that. Aren’t anybody’s? My intention here is that I’m not going to hold back information from you. This is not a place to mince words. You can decide if you want to further research in what I will be bringing up here. Such research is whole-heartedly welcome.
SAME SAME, BUT DIFFERENT
There is a lot of debate on ‘What is Thai Massage?’. What is the difference between ‘Traditional’ Thai Massage compared to Thai Massage? Here is some information covering the basic background and history to นวดไทย Nuad Thai. I believe it is an essential component to understanding Nuad Thai. Hope you enjoy!
Traditionally, Thai Bodywork views the body in terms of the 6 elemental components based on the BuddhaDharma of Lord Gautama Buddha. Thailand has been influenced by many many cultures and beliefs. Rural medicine is different than royal medicine, and even that differs from doctor to doctor. All of these are within the boundaries of what is now known as the Kingdom of Thailand. So you see how it is difficult to exactly specify in one phrase the fundamental theory and principles of this modality of medicine. However what one could say predominates Thailand and the largest partitioning body of traditional medicine in Thailand is Buddhism. And the medical system of Buddhism can be found in the Tripiṭaka, or Buddhist Canon of scriptures.
Getting back to the six elements, they are:
Each element has a function, and purpose, which is but one sixth of a greater whole. Coming for the BuddhaDharma base of śūnyatā, we will start from there, from space.
1. The experience of space is un-obstructedness and is the container/field for the four other elements to “exist” in
2. The experience of wind is movement, so all that moves has the element of wind
3. The experience of fire is heat / transformation / ripening, so all that has this experience has the element of fire; etc.
4. The experience of water is malleability / aqueousness, so all that has this experience has the element of water
5. The experience of earth is solidity, so all that is solid or cannot be passed through has the element of earth
These are the building blocks that Traditional Thai Medicine considers to compose the body. The Traditional Thai medical system utilizes a variety of techniques that uniquely treat these different elements and – should they be in imbalance – realign them into a harmonious balance. Typically a traditional doctor would employ various diagnostic tools to see how the elements either are, or are not, in balance Such diagnostic methods include:
1. Visual: quality of the patient’s eyes; the doctor would also observe the patient’s appearance, body language & structure, countenance, etc.
2. Smell / Olfactory: quality of the patient’s body odor; *old school doctors would smell the patient’s urine and excrement.
3. Taste: taste patterns – if applicable – to the patient’s palate & saliva; though not utilized as much today doctors would often taste the patient’s blood, saliva, sweat, and urine.
4. Sound: the doctor would listen to the patient and take in their condition / symptoms; they would also listen to what is the quality and quantity of the patient’s voice.
5. Touch: pulse diagnosis, and palpation of the patient.
As you may have already noticed, these diagnostic tools correlate to the Ṣaḍāyatana, the six major sense bases human beings possess. They are the sense organs and their objects: eye – sight, nose – smell, tongue – taste, ear – sound, skin – touch, mind – thoughts. A good doctor would also check the quality of the patient’s mind and spiritual practice, as this also directly and indirectly affects one’s health.
Another way of viewing the body in the Thai system is through the different layers of the body. The fives layers include:
2. Muscle Tissues
3. Channels – Soft Connective Tissues – เส้น ‘Sen’ in Thai
Then the Maw Nuad must decide what will be her/his course of action for the treatment. In order for her/him to do that they need to have a deep, CLEAR understanding of the theory behind Traditional Thai Medicine; e.g. Elemental Theory, Constitution, Dhātus, Levels of the Body, ‘Sen‘ / Channels, Release Points, Access Points, Wind Gates, 108 Winds, Khwan, Breath, etc. If physical therapies are indeed the best treatment for the patient’s condition, then there are a number of techniques that s/he must be proficient and confident in executing. Such techniques include: ฤๅษีดัดตน Hermit Self-Stretching (the basis on which one gives a Nuad Thai Massage), Kneading, Point-pressing, Rubbing, Stretching, Range of Motion, Squeezing, Pressing, Plucking, Pulling, Beating, Rolling, Vibration, among many others. The Maw Nuad must also what is the aim/goal of the treatment. Is it to: balance the elements, create a state of calm, re-align the body’s physical structures, treat the channels, release blockages / stagnation, awaken the channels, balance / move the wind, clean the blood / lymph, clean the tissue, treat the organs.
You may now understand why it’s not just about intuition. There is a profoundly deep well of knowledge and theory one must be very intimate with – if not master – in order to be a very proficient and qualified Maw Nuad. Yet, as is common in Buddhist Medical lineages, before even being taught the medical theory, one is first taught how to cultivate virtue and quality of character. Initially, more important than one’s willingness to learn, is their willingness to work on themselves first. Something to the extent of “be the change you want to see in the world”, yet always reflecting and clarifying the motivation, the intention, so that it is altruistic and genuine.
These techniques were passed down from medical lineages in India and Southern China, which were then migrated to Southeast Asia and integrated into the preexisting indigenous modalities to the Southeast Asian region. What is commonly know in Thailand as Nuad Thai (aka ‘Thai Massage’, ‘Thai Yoga Massage’, ‘Thai Bodywork’) is an evolution of a variety of systems that holds its own sense of identity, and stems from its own modality of Traditional Medicine.
There are Thai people who firmly state and believe that their practice of Nuad Thai goes back to the time of the Lord Gautama Buddha. The only traditional medical system, including physical therapies i.e. massage, in the region of modern Thailand that I know of and that is said to not have been broken is that of Lanna in northern Thailand. Perhaps there are others, and they may indeed trace its lineage back to the time of Lord Buddha. In reality it is a difficult thing to track, because there are not consistent records of it over the past 2,500 years.
Lineage is a sensitive subject. In the early 20th century, King Vajiravudh Rama 6 of the Chakri Dynasty officially outlawed the practice and education of traditional – non- western – medicine throughout all of Thailand. Traditional medicine in Thailand took a huge blow. This resulted in an ‘official’ break in legal, capable and experienced massage doctors. ‘Old-school’ traditionalists stated that in order to have a lineage, you need to have three things: 1. Texts, Manuscripts, Manuals – time tested and proven to work; 2. Oral Transmission – the ‘how-to’ knowledge given from teacher to student; 3. Practitioners who are efficiently and proficiently practicing. In layman’s terms, if I want to cook, perhaps I can learn from a book. But it’s not the same as cooking with someone and having them show you the process, step by step.
Due to national identity, and fear of heresy or treason, a Thai would not in their own mind want to go against royal decree. What makes national identity? Love and devotion to the following three attributes are classically considered the essential factors in defining a person as Thai: 1. ประเทศชาติ Thailand as a nation and land; Nationalism, 2. พระราชา The nation’s royal heritage; The Royal Family, 3. พระศาสนา Buddhism; Religion.
Not until the following reign of King Prajadhipok Rama 7 was traditional medicine officially allowed to be practiced again. Rama 7 reinstated แพทย์แผนโบราณ ‘Phaet Phaen Boran’ – Traditional Medicine – to the kingdom and decided to organize it further into four main categories:
1. เวชกรรม – Medical Theory & Therapeutics
2. เภสัชกรรม – Pharmacology, Herbology
3. ผดุงครรภ์ – Midwifery
4. นวดแผนโบราณ – Massage ( in 1998 A.D. this changed to นวดแผนไทย; in 2013 the Traditional Thai Medical Professions Act changed it again to นวดไทย ‘Nuad Thai’ )
Currently, these are the four major medical licenses that people aspiring to be traditional Thai doctors are able to receive and practice on the public. They are considered to be t!he four major branches that one can choose to focus on.
If the four categories listed above are the branches of the tree that constitutes Thai Medicine, is it enough to look at, or focus on, one alone? Perhaps even as separate to the others? Old world doctors greatly disagree with the view of disconnecting these s!ciences and focusing on them separately.
Here, we get to the core: Thai Massage cannot and should not be separated from Thai Medicine. Every branch needs a tree to be a branch on, as well as part of the roots which make up that tree. What then are the roots that feed and nourish this system? Traditionalists state that there are five major roots to Thai Medicine:
- Medical Science: pharmaceuticals, food, plants, minerals, animals, etc.
- Physical Therapies: massage, physical exercises
- Astrology or Divination: assessing what time or day is most beneficial for a specific action or medicine, what measures to take if a patient has a certain disease at a certain date of the year, etc.
- Sorcery Sciences: incantations, demonology, blessings, etc.
- BuddhaDharma: the teachings and practice for full-realization and the resulting liberation from Saṃsāra
A mentor of mine and I were discussing the five roots and he further described their importance:
“These fives roots make up the whole body and thus tree of Thai Medicine. You cannot say that you choose to focus on one or the other. You have to have knowledge of them all, as it is innately ingrained in the system of medicine itself. For example, even if you just focus on massage, you have to know about herbal compresses, which involves herbology. Also, if you use mantras or incantations, you thus have to know about the sorcery sciences.
If you want to learn the proper way, you have to learn all five roots. You limit yourself if you do not learn the system as a whole. With a good teacher, sometimes people learn them without even realizing they are learning them. The four branches are made up and standardized by licensure boards, so that people can have different licenses. But, for example, even a midwife needs to know about all five roots in order to practice fully and properly.
The reason they are called roots is because the whole tree comes from the roots, so you can’t say that in Thai Medicine you can choose one of the roots to focus on. As for the branches, that’s a different story. Then you can say that you’re going to specialize in one thing, but you still have the roots as the basis.”
Though there are widening variations currently expanding throughout Thailand on definitions of “What is Nuad Thai?”, there are some common threads. These elements are seen throughout the assorted schools and branches we currently see in Thai Massage – both in the west and also the east – and thus are noteworthy to chew over here.
First, homage and respect to the figure considered the “Father Doctor” and Official Head of Thai Medicine: Dr. Jīvaka KumarBhacca. There is much more information on Dr. Jīvaka on another part of this site so please feel free to visit there for more info on this amazing and incredible figure in the Buddhist Medical Lineage.
Second, mettā. The practice of ‘loving-kindness’ from the doctor to the patient. The daily cultivation, practice, and application of this powerful virtue and personality characteristic is essential to the foundation of a ‘Maw Nuad‘, Doctor of Nuad Thai. However it is just one fourth of a greater whole. The whole is called the Brahmaviharas, and should be viewed as one entity to be practiced and never forgotten.
Third, เส้น sen. No matter the pathways and how each doctor may view them slightly differently or converse over how they move throughout the body, nevertheless there is discussion and teachings regarding them and their existence. More information is given about the subject of ‘sen‘ on another section of this site. Please visit there for more info.
And from here, lets start considering various ways we can look at and categorize Nuad Thai!
CATEGORIZING NUAD THAI
Let’s talk about the ‘Massage’ branch of Thai Medicine. There are a few ways one could break down Thai Massage for explaining it to those who are not familiar with it. This is one way. To make clear distinctions within this sub-category, we can separate the branch of Nuad Thai into two parts or limbs. These are two paths that a Maw Nuad can apply Thai Medical Theory to a treatment with a patient:
1. นวดรักษา – ‘Nuad Raksaa’ – Therapy, Medical Massage; also sometimes referred to as นวดบําบัด ‘Nuat Bambat’ and นวดแก้อาการ ‘Nuat Gae Ahgaan’
2. นวดคล้ายเส้น – ‘Nuad Klaai Sen’ – Relaxation Massage
MASSAGE FOR RELAXATION
Relaxation Massage is akin to a typical spa-style treatment for the whole body. It is the most common style of massage offered in parlors and spas around the world, often dubbed “Thai Yoga Massage”. I believe this style serves a great purpose, though it is more general and surface oriented. It is a great entry way for people getting started with the practice. In Thailand, massage is considered preventative care; one reason why it is so wide-spread and common. The effects are immediate, tangible, and lasting.
General relaxation style focuses more on the body as a whole rather than spending more time on a specific area. Though, should someone have a part of their body that they are nurturing this style can also be a good option, as that area would become a focal point of the session while still considering the body as a whole. This style is ideal for those new to Thai Bodywork.
THAI MEDICAL MASSAGE THERAPY
The therapeutic style is ideal for those more comfortable and experienced with Thai Massage, as well as deeper bodywork. It focuses on specific areas of the body that one is nurturing or having trouble with. This style is typically deeper and doesn’t hold any ‘fluffiness’. Each doctor approaches how they execute this style of Thai Bodywork in their own way, according to their lineage, tradition, and view. It is not always ‘comfortable’, though to the effect of it being therapeutic and beneficial.
Medical Thai Massage incorporates a variety of physical therapy techniques to treat specific ailments. Some of the common techniques include:
1. Acupressure – นวดกดจุด ‘Nuat Goht Joot’
2. ‘Sen’ Vein / Artery and Meridian Realignment – นวดจับเส้น ‘Nuat Jap Sen’, or นวดเขี่ยเส้น ‘Nuat “Clear” Sen’
3. ‘Sen’ Tapping – ตอกเส้น ‘Dtok Sen’
4. Bone-Setting – จัดกระดุก ‘Jad Gra-duk’
5. Cupping – นวดป้อง ‘Nuat Bpong’
6. Bleeding (Needle / Knife; Systemic / Local)
7. Compresses (Cold, Hot, Dry, Wet)
8. Saunas (Dry, Wet)
Then there are the more obscure external therapies:
1. Scrapping (Gua-sa)
2. Burning (with or without herbs)
3. Liniments / Balms (Heating, Cooling, Neutral)
4. Poultice (Dry, Wet)
5. Yam Kahng – “Stepping on Hot Iron”
6. Chet Haek เช็ดแหก – “Whipe & Scrape”
7. Jawp Khai – “Rubbing Egg”
8. Bpao เป่า – “Blowing”
RURAL VS ROYAL NUAD THAI
1. ราชสำนัก Royal Thai Massage
2. ชาวบ้าน Country / Rural Massage
It should be said that there are influences and similarities that interweave between the two styles. Both are Thai Massage in the end, and so the question is then, “what’s the difference?”
Actually, there is a big difference. Royal Thai massage was made to cater to royalty. It will only use thumbing and palming. Unless specified the feet would be touched last, or not at all. Why? The feet are considered the lowest and dirtiest part of the body. If the masseur touched the feet first, they would be spreading that ‘dirtiness’ to the rest of the body. At all times throughout a Royal Thai Massage treatment, the masseur must remain one arms-length away from the receiver. That sounds ridiculous, yeah? Well, this is Thailand. This branch was designed for the royal family and court to be able to receive massage while still in line with the custom. The custom of worshipping the royal family and court as more than people, as demigods.
By the way, one of the panel tests a Royal Thai masseur has to pass in order to qualify is to be able to sit in half lotus and lift themselves off the floor using only their fingertips for a minimum of one minute.
In Thailand, there are still remnants of a caste-like system. Even today, when people first meet one another, common questions include “How much do you earn?” and “How old are you?” We may consider this rude at first, but for Thais it is a way for them to gage what word choice and level of politeness they will use with you to begin with. They are categorizing and positioning you into a social class for their social interaction and relationship with you.
Physical contact in public has been somewhat shunned over the centuries in Thai culture. The royal court was just as subject to sickness, disease, and death as the rest. Thai custom practiced that when royalty was to be treated or physically contacted, then there was to be a protocol. The treatment would generally start at a point just below where the tibialis anterior muscle attaches to the knee, on the muscle itself, and lateral of the tibial tuberosity. No touching of the head, unless absolutely necessary, as the head is considered the highest and most sacred part of the body. No one of a lower social class would dare touch the head of someone “above” them. Also, the receiver would never assume the ‘prone’ position – facedown – as this would considered inappropriate and render them too “prone”.
I have my own personal issues with this protocol, but it is a Thai custom, so that it that. However, I will not deny my feelings of the สมน้ำหน้า – “Serves you right!” – effect to this custom. Many times, members of the royal court would not be able to receive the fullest effects from the massage. They either could not be treated or would not recover from their minor ailments because the royal protocol would get in the way and limit the masseur’s ability to fully treat them.
The Country, or Villager, style of Thai Massage is considerably the most encompassing, therapeutic and beneficial style. It not only incorporates thumbing and palming but also elbows, forearms, butt, knees, and feet. Pretty much all appropriate parts of the body. The receiver can be in any position that is needed without too much worry about protocol though respect is always present. This branch is much more sabai sabai (relaxed). Country style has been around the longest, is the most widely utilized, and is where the most advancement in technique and therapeutics has come about.
Personally, it is my favorite style. Not only is it functional and therapy-driven, it has a more fun and open atmosphere. I have received some of the biggest healing sessions while receiving this branch of massage.
A CONFLICT REGULARLY DEBATED
The very word ‘traditional’ necessitates the existence and importance of a lineage. A lineage that has been successfully tested over time and has proven its practices to be viable, providing beneficial results. A practice that the ancients have compassionately passed down through the generations.
If we are going to study traditional Thai massage, we need to understand the word “tradition”. Here are some definitions:
the transmission of customs or beliefs from generation to generation, or the fact of being passed on in this way.
1. The transmission or passing down of elements of a culture -customs, beliefs, or skills- from generation to generation, especially by oral communication.
2.a. A mode of thought or behavior followed by a people continuously from generation to generation; a custom or usage.
2.b. A set of such customs and usages viewed as a coherent body of precedents influencing the present: followed family tradition in dress and manners.
3. A time-honored practice or set of such practices.
1. Texts, Manuscripts, Manuals – time tested and proven to work
2. Oral Transmission – the ‘how-to’ knowledge given from teacher to student
3. Practitioners who are efficiently and proficiently practicingThe hard line to take is that most of the westerners teaching Thai Massage, do not speak Thai. Many have indeed studied with great Thai practitioners. But most, maybe 90% if not more, have not studied it using the native ‘traditional’ language – Thai – with multiple Thai masters. They have not learned the language to a degree where they can read the old manuscripts and texts and then study them under authentic masters, in Thai. On a very mundane and basic level, nor have these ‘western masters’ become legal practitioners of Thai Massage in accordance to Thai Law and standards set by the Ministry of Public Health in Thailand.And here’s the sad part: many of Thai people – whom many westerners go to Thailand and deem them ‘Masters’ – are not as in-depth and well-practiced as they can be either. Don’t quote me out of context. There are many true and amazing masters of Thai Massage in Thailand. Whom I am referring to are the commercial mainstreamers. They can be good, and many are trained in the system or possibly rebellious like Pichest Boonthume. The unfortunate point is that many of the old masters who have taught the farang – Thai word referring to a white european westerner and also a ‘guava’ fruit; the word comes from the Thai pronunciation of français – world, have past on. “Holy sh*t Josh! That’s a bold statment!” Yes, it is. Does that mean that the currently popular teachers are not good practitioners of bodywork? No, not at all. Do true masters of Thai Massage, in the old school way, still exist in Thailand? Yes, they do. There is the very paradox, though. What is Thai Massage?
Currently there are personalized popularized hybrids of Thai Massage mixed with something else. Examples of this include OsteoThai, Sunshine Network system (from founder Harald ‘Asonkananda’ Brust), Lotus Palm (Kam Thye Chow), Thai Circus, etc. These are blends of Thai Massage with other things. They are not traditional Thai massage. Does that make them evil? No. But they are neither ‘Traditional’ nor fully ‘Thai Massage’. Just because they are the most famous and prevalent forms taught and practiced in the western world doesn’t make them authentic. Try Thai food in the west, then try it in Thailand. But then again, how can there be authenticity when there is a broken lineage? Exactly, there can’t be. So what’s the standard?
The twist is that even some great Thai-national practitioners of massage have told me that it is important to study different methods and then combine them together with skill, safety, and wisdom. This speaks to the Thai-way and style. They are blenders. As we stated above, Thai massage itself has been heavily influenced by Indian Medical Science -that which predates modern Ayurveda – as well as the medical systems of the Khmer, Mon, Indigenous, and southern Chinese cultures. How do we know this? History. Plus, look to the royal courts when “Thai Medicine” was being codified by Rama 1 – Rama 5 of the Chakri dynasty (the current dynasty). There were doctors of Indian medicine, Chinese medicine, and European medicine in the royal court. These doctors influenced what went in the codification and what did not. There is heavy influence of these modalities in the codified Royal branch of Thai massage. We need to know this when taking “tradition” into consideration.
What is the standard of a good Thai Therapist or Thai Massage teacher? If someone is going to dare to call themselves a Thai Massage Therapist and claims to be qualified to teach others on how to be one as well, then “how can I tell they are the ‘genuine article'”? A ‘standard’ gaging device to dictate efficient training and competency in Thai Massage could be that they are a student of the Thai language, practice BuddhaDharma, meditate, continually cultivate the Brahmaviharas, steer clear of the 8 World Dharmas, and have both received initiation and studied under proficient qualified teachers (preferably in Thai) for great lengths of time. Using the Buddhist Suttas as guidelines for the ethical behavior of a traditional Buddhist doctor – including Maw Nuad – is probably the most surefire way to go in my view. A great place to start is on this article written by Lily de Silva. I recently found a ‘Buddhist Doctor’s Oath’ called the Vejjavatapada, that was recently composed by the monk Shravasti Dhammika. It is something to check out and see if one is in line with. In Thailand, you can obtain a license to practice massage at The Ministry of Public Health’s massage program – which currently has the best curriculum in Thailand for Thais – and that is only available through the Thai language, and take around 2 years.
This page should be taken with some salt; fish sauce, rather. Don’t believe me. And at the same time, know that this isn’t just coming from nowhere. For learning more about the ins-and-outs of Thai massage from a theoretical point of view, and for practical application, then just go follow your noble heart to finding a good teacher and start massaging. Please don’t let this information cause inertia within you and your path. I hope that it inspires a newfound understanding to make better and clearer decisions based on relevant and beneficial information.