What happens when we use the same English term to translate ideas from different Asian medical traditions? Conflating concepts coming from different medical and cultural contexts can lead to confusion that severely compromises our understanding and appreciation of the differences between medical systems.

One pernicious example of this is how common it is even among seasoned Chinese medicine practitioners in the West to say that their theory is based on the “five elements.” This phrase is using a term from the European cultural context to fundamentally misrepresent the basic worldview of Chinese medicine.

Let’s pick this apart together in order to see why this mistranslation matters. . .

Our starting point is to understand that, in the ancient period, traditions of medicine originated in relative isolation from one another on opposite sides of the Eurasian landmass. Historical texts dating from the last few centuries BCE show us that the Chinese medical tradition that had taken form at one end and the Indo-European medical tradition at the other were based on fundamentally different ideas.

On the eastern side, foundational medical texts written in Chinese such as the Inner Canon of the Yellow Emperor (Huangdi neijing 黃帝內經) talked about Wood, Fire, Earth, Metal, Water being “five phases” (wuxing 五行). The key character 行 is based on a pictogram that originally depicted a crossroads or footsteps, and its core meaning is the noun “steps” or the verb “to walk.” It is associated with movement, directionality, and change over time.

On the other side of Eurasia, the Ancient Greek Hippocratic corpus that formed the basis of Greek and Roman medicine named Earth, Water, Air, and Fire the “four elements” (στοιχεῖα, stoicheia). Philosophers often added Void (αἰθήρ, aithḗr) to this list when signifying the absence of the other elements. There are also descriptions of these same elements (in India called mahābhūta) in Buddhist texts, such as the Great Elephant Footprint Simile (Maha-hatthipadopama-sutta), orally transmitted in the Pāli language since the last centuries BCE. They also appear in Sanskrit medical texts, such as the Āyurvedic classics Caraka’s Compendium and Śusruta’s Compendium (Caraka-saṃhitā and Śusruta-saṃhitā), that can be dated to roughly the same period. Whether these elements originated in India or Greece has been debated, but the fact that the elemental schema was shared between Europe and India is not disputed.^⁠1

In most schools of early Indo-European thought, the material elements of Earth, Water, Fire, and Wind are considered to be ontologically real substances that arise within the Void. They are the four fundamental building blocks of all material reality. This stands in marked contrast to Chinese cosmology, where everything that exists (i.e., the ”ten thousand things,” wanwu 萬物) are composed of the unitary substance of qi. In Chinese thought, the five phases thus are not separate ontologically existing things, but rather processes, patterns of change and transformation in how qi manifests in time.^⁠2

These philosophical and cosmological distinctions provide different starting points for East Asian and Indo-European forms of medicine. In Chinese medicine, where the human body, like all physical material, is composed of qi, the default state of the human being is one of wholeness, health, and harmony. It is only through error, or deviating from the Dao, that one deteriorates into sickness. Indo-European texts, in positing four primordial building blocks instead of one, present a less harmonious picture. The elements are not only distinct, they are often mutually incompatible, which is a persistent source of suffering for humans. Buddhist discourses on the body, for example, say that the relationship between the elements is like four venomous snakes trapped in the same basket. Their mutual antagonisms and perturbations cause disease, and inevitably in old age, they finally fall apart completely.^⁠3

If these differences between the Chinese phases and the Indo-European elements are so clear, then why do we find slippage between them today? Western-language translations equating phases and elements can be traced as far back as Matteo Ricci (1552-1610), the Jesuit envoy to the Chinese empire who first translated between European and Chinese philosophical and religious ideas. Ricci and other writers of his time were cognizant of the differences between elements and phases, defining the elements as “structural” (ti 體, yuan 源) and the phases as “processual” (yong 用, liu 流).^⁠4 Nevertheless, Ricci’s decision to translate the Greco-Roman elements as “the four phases” (sixing 四行) allowed later practitioners to elide these important distinctions and make simplistic equations between elements and phases.

Fast forward to the 1970s, when a modern style of practice called “Five Element Acupuncture” became central to the popularization of Chinese medicine in the English-speaking world. This system was primarily developed and promoted by the British physiotherapist and acupuncturist J.R. Worsley (1923–2003), and many acupuncture practitioners active in Europe and North America today trace their lineage to him.

Ricci’s and Worsley’s equation of phases and elements promoted the widespread misunderstanding that the wuxing can be thought of as ontologically existent “things,” but they are not. The phases should be understood as qualities rather than essences. They are adverbs or adjectives rather than nouns. Rather than thinking in terms of Wood, Fire, Earth, Metal, Water per se, we should think in terms of Wood-like, Fire-like, Earth-like, Metal-like, or Water-like qi. The noun is always qi because in Chinese thought that’s the only substance there ever is.

Clarifying these concepts has clinical implications, but is also important because of how metaphors structure our experience of ourselves and the world we inhabit.^⁠5 It’s one thing to live in a fractured body in a universe where competing substances vie for primacy. It quite another to be embedded in a unified whole where body and cosmos are composed of the same primordial stuff. It’s one thing for one’s idea of health and illness to be organized around the inevitability of disintegration, and quite another for it to be based on an assumption of harmonious oneness.

The stakes of this mistranslation extend far beyond academic pedantry. When we impose the language of “elements” onto Chinese medical concepts, we inadvertently import a Western metaphysical framework that is fundamentally at odds with the Chinese worldview. We lose sight of the dynamic, processual nature of the phases and replace it with an ontology that belongs to a different tradition entirely. Better historical understanding helps us to resist the temptation of false equivalences and to preserve the conceptual integrity of the traditions we study.

¹ Filliozat, J. (1964). The Classical Doctrine of Indian Medicine: Its Origins and Its Greek Parallels. Delhi: Munshiram Manoharlal; McEvilley, T. (2002). The Shape of Ancient Thought: Comparative Studies in Greek and Indian Philosophies. New York: Allworth Press, 300–309.

² Jones, CB. (2016). Creation and Causality in Chinese-Jesuit Polemical Literature. Philosophy East and West 66(4), 1251-1272. https://dx.doi.org/10.1353/pew.2016.0090.

³ Salguero, CP. (2018). “This Fathom-Long Body”: Bodily Materiality & Ascetic Ideology in Medieval Chinese Buddhist Scriptures, Bulletin of the History of Medicine 92.2: 237–60. https://muse.jhu.edu/pub/1/article/698172.

⁴ Hsu KT. (1997). “The Transmission of Western Four Elements Theory in Late Ming China.” Tsing Hua Journal of Chinese Studies n.s. 27.3: 347-380. https://thjcs.site.nthu.edu.tw/p/406-1452-41461,r2974.php

⁵ Lakoff, G, and M Johnson. (2003 [1980]). Metaphors We Live By. Chicago: University of Chicago Press.

I first traveled to Southeast Asia in 1990 to serve as a Peace Corps volunteer in Thailand. While studying Traditional Thai Massage or Nuad Boran at Wat Po Temple in Bangkok, I saw the Reusi Dat Ton (Traditional Thai Yoga) statues on the two Rishis’ Mountains on the temple grounds and became fascinated with this practice. I have now been a student of Thai Reusi Dat Ton and Indian Hatha Yoga for over 30 years.

During that time, I have traveled throughout Thailand, mainland Southeast Asia, and South Asia researching and studying yoga with dozens of teachers at various temples, ashrams, schools and institutes. In addition, I have visited numerous universities, libraries, museums, temples, caves and ancient archaeological sites on a quest for historical evidence of yoga poses in traditional texts, iconography, and artwork across Southeast Asia. In this article, I will share with you the best of what I have discovered.

Early Yoga Poses in SEA Art & Architecture

The earliest artistic depiction of a yoga pose I have found to date is at Sambor Prei Kuk in Kampong Thom, Cambodia, dated to about 600 AD. Sambor Prei Kuk was a capital city of the pre-Angkorian Chenla Empire and is one of the oldest surviving temple complexes in Cambodia. On an outside wall of the Yogi’s Tower or Prasat Asram in Sambor Prei Kuk, one can still discern a yogi in what is known in India as sopāśrayāsana pose, i.e., squatting while tying the back and the two legs with a piece of cloth. I found similar figures at Yasodharapura, an early capital of the Khmer Empire, in Roluos, Cambodia. Here, yogis in sopāśrayāsana pose can also be seen on the outside walls of the Lolei Temple, dated to about 893.

During my journeys across Southeast Asia, I have found images of yogis and gods in various yoga poses carved into stone at several ancient temples dedicated to Siva. In Southern Laos, in Champasak Province at the base of Lingaparvata Mountain, is the vast Vat Phu temple complex, dated to about 500-1100. Also known as the “Mountain Temple,” Vat Phu has traditionally been a special site for asceticism since ancient times. It was originally occupied by the Chams, then the Chenla and finally the Khmer who all continued the traditional worship of Siva at the site (Albanese p 283).

Outside and behind the central shrine carved into a rock face at the base of a cliff are the three gods of the Hindu trimurti, one of whom is performing a seated twisting pose similar to techniques practiced today in Reusi Dat Ton. In addition, numerous yogis in squatting poses, including sopāśrayāsana, are carved into stone on the base colonettes of doorways of numerous buildings throughout the Vat Phu temple complex.

In Northeast Thailand, in Buriram Province, atop an extinct volcano sits Prasat Phanom Rung “Big Mountain Temple,” constructed around 1100. Prasat Phanom Rung is a classical Khmer Temple that represents Siva’s home on Mount Kailasa. The temple is dedicated to the Pasupata sect of Hinduism and its concept of “formless yoga” (Srisuchat, 148). At base of the Principal Tower at Prasat Phanom Rung, carved into two stone colonettes at the bases of doorways are images of yogis practicing poses including utkutikasana, “the tight squatting pose” (Srisuchat, 154). These poses are also similar to techniques still practiced today in Thai Reusi Dat Ton.

Last but not least, I include a statue from Vietnam. While I found this one in a museum, not a temple, it’s one of my favorite early images of yogic postures because of how well it is preserved. The Museum of Cham Sculpture in Danang, Vietnam, houses a fabulous collection of stone sculptures recovered from various ancient Cham archaeological sites in southern and central Vietnam. One of the highlights of the museums collection is a sculpture of an apsara, a mythological celestial dancer in the “graceful three-bends posture (tribhanga)” (Museum of Cham Sculpture in Danang, Vietnam). This pose is nearly identical to a technique in Reusi Dat Ton known as “Gazing at the Stars.” This statue, dated around 1000, was originally from Tra Kieu, Simhapura, the first capital of the Hindu Cham Kingdom.

Nineteenth Century Examples

While the earliest artistic depictions of yoga techniques I was able to find in mainland Southeast Asia are primarily squatting, in later centuries, there appear a increasing number of more complex poses. This trend culminates in the 19th century with a sudden and vast proliferation in the sculpture and murals depicting yogic poses and exercises closely related to the Thai practice of Ruesi Dat Ton. In this section, I will give you some of my favorite examples from this era.

Advanced yoga practitioners are said to be able to develop various supernatural powers known as siddhi in Sanskrit and iddhi in Pāli. Among these powers are laghima, the ability to become weightless and fly. An example of artwork depicting this can be seen in Siam Reap, Cambodia, at the Buddhist Temple, Wat Bo. Inside the central shrine room high up on the inside walls are murals painted approximately 1800, depicting scenes from the Indian epic the Ramayana, known in Cambodia as the Reamker. One scene depicts four Yogis flying thru the sky. The abbot of the temple told me that the pose these Yogis are using is a special pose specifically used for flying. Indeed, during my travels throughout South and Southeast Asia, when I saw flying beings depicted in traditional artwork, they were almost invariably in an identical or very similar pose. This pose also appears in Ruesi Dat Ton practice.

In 1836, the Thai king Rama III commissioned the creation of 80 statues depicting some of the techniques of Reusi Dat Ton. About 20 of the original statues have survived and can be seen on the two Hermit’s Mountains or Khao Mor, at Wat Phra Chetupon (“Wat Po”) in Bangkok. Inscriptions describe the statues as “postures of yogic exercise invented by siddhas for remedy of illness… due to the malfunctioning of internal air or wind” (Srisuchat, 172). Along with each statue, there was also an accompanying tablet upon which was etched a poem describing the technique and its therapeutic effect.

In the Southern Thai provincial capital of Songkhla, there is a temple known as Wat Machimawat. On the temple grounds is the Reusi Dat Ton Pavilion, Sala Reusi Dat Ton. High up on the inside walls of the pavilion are two murals originally painted in 1863, depicting 40 different Reusi Dat Ton techniques along with the accompanying poems that describe the therapeutic benefit of each technique. I had seen photos of this mural in an old book in the National Library in Bangkok. In the book, the mural looked to be considerably damaged and many of the images were fading. When I arrived at the temple, the abbot informed me that my timing was excellent as just the week before a team from the Thai Fine Arts Department had finished repairing and touching up sections of the murals. I was able to borrow a ladder and spent the next day photographing the two newly restored Reusi Dat Don murals.

In Reusi Dat Ton, there is a series of six poses based upon the temple guardians, known as yakshas. One of these poses, known as the “Giant Holding up the Roof” can be seen at the base of the Phra Suvarnachedi tower on the grounds of the Temple of the Emerald Buddha, Wat Phra Kaew, in Bangkok, Thailand. The temple was constructed circa 1783 and the guardian giants were added sometime during the Reign of King Rama V (1868-1919) A similar pose is also found in Indian Hatha Yoga where it is known as “the Goddess.”

References and Further Reading

Albanese, Marilia (Author,) A.B.A.-Milan (Translation.) 2006. Angkor, Splendors of The Khmer Civilization. Bangkok: Asia Books.

Bassoul, Aziz. 2006. Human and Divine: The Hindu and Buddhist Iconography of Southeast Asian Art from the Claire and Aziz Bassoul Collection. Beirut: Cedar of Lebanon Editions Publisher.

Bunker, Emma C. 2003. Tantric Hinduism in Khmer Culture. Asian Department, Denver Art Museum. Published in www.asianart.com/articles/bunker/index.html.

Chandler David P. 1983. A History of Cambodia. Boulder: Westview Press.

Conti, Pia Tantric Buddhism in Phimai: A New Reading of its Iconographic Message. https://angkordatabase.asia/publications/tantric-buddhism-in-phimai-a-new-reading-of-its-iconographic-message.

Griswold, A.B. 1965. The Rishis of Wat Po. In Felicitation Volumes of Southeast Asian Studies. Presented to His Highness Prince Dhaninivat Kromamun Bidyalabh Brindhyakorn. Bangkok: Siam Society.

Matics, Kathleen Isabelle. 1978. An Historical Analysis of the Fine Arts at Wat Phra Chetuphon: A Repository of Ratanakosin Artistic Heritage, PhD Dissertation, New York University, New York.

Matics, K.I. 1977. Medical Arts at Wat Pha Chetuphon: Various Rishi Statues. Journal of the Siam Society, 65:2: 2: 145-152.

Museum of Cham Sculpture, Visitor Information Display at The Museum of Cham Sculpture in Danang, Vietnam.

Powell, Seth. 2018. The Ancient Yoga Strap: A Brief History Of The Yogapatta. Published in TheLuminescent.blogspot.com16 June 2018 (v2).

Srisuchat, Amara. 2004. Yoga Philosophy in Secondary Thought: Tracing Back to Yoga in Thailand’s Past. PhD Dissertation, Department of Oriental Languages, Silpakorn University, Bangkok.

Suebsantiwongse, Saran. 2023. The Thai Body: Understanding the Principles of Medicine, Physiology, and the Massage Tradition through Inscriptions, Texts, and the Material Culture of Wat Phō. in Part 4 of The Rutledge Handbook of Religion and the Body. Edited by Yudit Kornberg Greenberg and George Pati. London: Taylor & Francis Publishing.

Trà̂n, Kỳ Phương, Văn Thắng Võ and Peter D. Sharrock. 2018. Vibrancy in Stone: Masterpieces of the Đà Nẵng Museum of Cham Sculpture. New York: River Books.

Wells, David. 2012. “Reusi Dat Ton: The Thai Hermit’s Exercises” Yoga Mimamsa, Volume 44, No. 1: 1-18.

Wells, David. 2016. Self-Massage and Joint Mobilization of Traditional Thai Yoga: Reusi Dat Ton Part 1 Handbook. North Charleston: CreateSpace Independent Publishing Platform.

David Wells, E-RYT500, YACEP, C-IAYT, CAS, works as a yoga therapist in an interdisciplinary pain management clinic and conducts continuing education workshops for yoga teachers, yoga therapists, and massage therapists. He received advanced yoga certifications from the Kaivalyadhama Yoga Institute, the Sivananda Yoga Center, and the Yoga Institute in Mumbai in India. He served three years in Peace Corps Thailand and received Thai Massage and Reusi Dat Ton certifications from the Wat Po School of Thai Traditional Medicine and the Thai Ministry of Education. He also studied with Reusi Tevijjo and the late Ajhan Pisit Benjamongkonwaree in Thailand. He is also a graduate of the California College of Ayurveda. Contact: david@wellsyoga.com and www.wellsyoga.com.

Even though there is room for more thorough adverse effect reporting in acupuncture trials and a need for more studies about acupuncture safety (Ng et al. 2016; Turner at al. 2011), there already exists evidence concerning the safety of acupuncture. Based on the studies (Witt et al. 2009; Kim et al. 2016; McCulloch et al. 2015; Park et al. 2014; Houzé et al. 2017), we can conclude that generally acupuncture can be seen as a relatively safe practice. The adverse effects from acupuncture are extremely rare compared to reported adverse effects from conventional medicine. The FDA Adverse Event Reporting System (FAERS) Public Dashboard reveals 906,773 serious side effect reports and 164,154 deaths from side effects or malpractice in 2017 alone. This is an unfair comparison as the patient base and seriousness of the conditions treated are often very different, but it gives us a perspective to the safety of acupuncture in comparison with many other medical treatments. And even the most serious side effects like pneumothorax from acupuncture seem to be preventable with sufficient training in acupuncture education (Kim et al. 2016).

In the acupuncture studies about patient safety, the subject has been approached from the point of safety of the treatment itself. There seems to be a lack of studies about the possibility of delayed medical treatment in cancer or other severe medical conditions due to the use of acupuncture. This essay approaches the subject with reflection on a patient case.

Case background

The author first met the patient in 2011. The patient had suffered from recurring, almost constant uveitis for 15 years. Known causes of uveitis had been previously excluded by medical doctors. The only treatment offered to the patient was ophthalmic steroids. Prolonged use of the steroids had increased her intraocular pressure causing glaucoma that threatened her diminishing vision. The ophthalmologist wanted to start a more robust and constant medication for glaucoma with a drug having the side effect of flaring of uveitis. The patient wanted to try acupuncture as an alternative.

After five sessions of acupuncture, the symptoms of uveitis had clearly decreased and she had reduced the use of corticosteroids. She had permission from the ophthalmologist to dose corticosteroids based on need. During the following months, she used them only twice when she felt any peculiar feelings in her eyes. Five months later she visited her ophthalmologist who could not see any signs of uveitis. Due to increased intraocular pressure, they had agreed for regular follow-ups. Beside one occasion in 2012, she has been without corticosteroids and free from uveitis.

In addition to uveitis, she had a medical history of back and joint pains, and Ménière's disease.

During her initial visits to author’s clinic, she expressed her growing frustration with medicine and how she felt like a test subject. The doctors could not give a reason for her symptoms, and to her it seemed illogical to use medication causing uveitis to treat problems caused by the medication for uveitis. She also felt that some doctors she had met had been unprofessional in their behaviour. Side effects and dissatisfaction to conventional health care are among common reasons for trying acupuncture (Jakes et al., 2014).

Radical change in patient's health

In 2015, the patient wanted to try acupuncture for fatigue. She had already visited a medical doctor through occupational health care who didn’t find anything alarming. The author performed acupuncture based partly on her previous background information and her current symptoms. Afterwards, she reported a slight initial improvement, but the exhaustion soon returned and was non-responsive to further attempts with acupuncture.

After a third acupuncture treatment she caught a flu and visited another doctor who took a chest X-ray that revealed a cancerous growth in her lungs. The patient was treated with surgical removal of the tumour. Because of inappropriate joking by the operating doctor just before the surgery, she felt mistreated again even though the surgery was successful. Soon after the surgery she contracted pneumonia. During follow-ups later on, her papers were not read properly leading to surgical marks visible in the X-ray to be mistaken as a sign of pulmonary embolism. Two months of unnecessary subcutaneous injections added to her mistrust of the whole medical profession even though the surgery itself had been successful.

During these events the patient contacted the author and told him about the correct diagnosis. She didn’t blame the author for misdiagnosis. But for the author this caused concerns and a need for reflection. How could something this serious be missed even when the cancer was advanced enough to cause serious fatigue? Could this be prevented from happening again?

Meeting in 2017

In 2017, the patient reserved time from the author because of vertigo caused by Ménière's disease. The prescribed medication was no longer effective. During the meeting she gave a detailed account of her experience with surgery and how she felt afterwards. She was angry and frustrated and said she had little faith left for the health care system even though she had been saved by the medical procedure. During the session she gave permission for using her case as a case study. After giving the permission, she was told that the treatments would be free of charge.

Meeting her after the incident produced conflicting thoughts. Because of her past, the current condition felt more alarming. Why did her medication suddenly stop working? Was the dizziness caused by Ménière's disease, a simple benign positional vertigo or was it something more severe? What if this was somehow connected to her previous condition? There was also curiosity and a need to ask questions about her previous health concerns that might shed some light to the author’s wrong diagnosis.

She had already seen her physician to screen out anything serious but still the situation stirred some insecurity in the author. During the discussion and diagnosis she revealed that she had recently lost her job and was now unemployed. So she was particularly happy to receive free treatments. Lack of money combined with free treatments might also increase the possibility of an already vulnerable patient to feel more dependent on the acupuncturist or it could produce a feeling of groundless gratitude. Having less money might also mean that she might be less willing to see a doctor in case the acupuncture treatment did not work, especially with her experiences with the public health care.

While describing her experiences and expressing her mistrust with the medical profession, she didn’t seem to consider the author to be part of the medical profession. In Finland, the author is a registered health care professional due to being a licensed masseur, but an acupuncturist is not an accepted health care professional nor is there any legal regulation about the profession. The professional associations are working to self-regulate the field, set educational criteria, enforce the following of ethical guidelines, and ensure that the professionals have proper insurances.

For the author, it was important to meet the patient face to face after making a wrong diagnosis. There were no signs of blaming or mistrust from the patient. Her patient records had been reviewed in 2015 and again before the appointment. There was no evidence of neglecting of symptoms, and she had already visited a medical doctor beforehand. It was crucial for the improvement of practice for the author to become more aware of possible consequences. It made the author question his own responsibilities and also the boundaries of his practice.

Analysing the case

During 2015, the author had failed to recognize lung cancer. The examination and questions asked during the visit could have been more thorough. Owing to the fact that the patient was previously known, there was a possibility of using information gathered during earlier visits. This combined with the shorter time reserved for returning patients might have made it harder to be cautious enough. The TCM diagnosis based on the discussion, pulse, and tongue during the visit revealed what is known in Chinese medicine as a deficiency of blood and a weakness of lung qi. Relying on the patient history while formulating a picture of the current situation might have affected the understanding of the real reason for exhaustion and how serious her case was. The medical expertise of the author did not enable him to recognise the underlying reason. A similar mistake was probably made by the medical doctor in occupational health care who failed to see cause for further tests. Given the patient's earlier bad experiences with health care, she probably might not easily go back for a second opinion. In this case, it was pure luck that the patient caught the flu and was sent to x-ray.

The seriousness of the situation also raises other concerns. What if the patient had gotten better results from the acupuncture treatment? In that case, could the better results have delayed a proper diagnosis and medical treatment? And what role does the therapeutic relationship play in a possible delay of proper treatment?

There exists some evidence that acupuncture is effective in treating cancer-related fatigue (Duong et al. 2017; Zhang et al. 2018; Zick et al. 2016). These studies focus on fatigue in connection with conventional cancer treatments, but acupuncture might also diminish the fatigue caused by cancer itself. Definite scientific evidence for the effectiveness of acupuncture for cancer pain is still lacking (Wu et al. 2015), but there is reason to believe that acupuncture might provide some relief from cancer pain (Hu et al. 2016; Chiu et al. 2017). So there is a possibility that acupuncture might prolong the time before the patient goes to see a doctor. An acupuncturist might see diminished fatigue and/or pain as evidence of successful treatment, which might in reality delay proper medical treatment. However, in case of pain, the same could easily happen with self-administered and commonly available pain killers. The fatigue might also diminish with energy drinks (Warnock et al. 2017), but the effects wouldn’t probably last for long. However, it could also be possible that by visiting an acupuncturist frequently, the acupuncturist could notice if there was no response to treatment or that the results were not as long-lasting as they should be. At least the acupuncturist would notice if the condition of the patient seemed to deteriorate despite the treatments. This could easily alarm a professional acupuncturist so, in this way, the acupuncturist would provide an extra pair of eyes watching for the patient's health. In Finland, the acupuncture associations require the signing of ethical conduct which states that all acupuncturists refer cases to medical doctors when medical treatment is needed.

A study by Shorofi and Arbon (2017) offered some reasons why patients are opting to use CAM therapies instead of medical therapies. In the study, in all the people opting for CAM therapies, the most relevant reasons for this case study were that the problem was not seen serious enough to see a doctor (21.4%), a belief that these alternative treatments have fewer side effects than conventional ones (16.9%), and dissatisfaction with conventional treatments (6.8%). Combining these percentages with those of people who felt that CAM therapies were more fitting to their personal lifestyle or philosophy (37.7%), there is some evidence of a group of people who might not prefer to see a medical doctor in the first place. The study was done among hospitalised patients in Australia, but the author is in agreement over these patient groups and confirms similar numbers based on his own patient records and experience.

In serious diseases, like cancer in this case, medical diagnosis and intervention as early as possible is paramount. The symptoms, however, can begin with only minor health complaints. The 21.4% of population who use complementary modalities consider their problems not serious enough (Shorofi and Arbon 2017), but they might still find their way to the acupuncturist who, with adequate training, could be able to recognise the severity of the symptoms and could advise the patient to see a doctor.

The example patient in this essay had a medical diagnosis from her ophthalmologist for her previous condition. But in Finnish acupuncture clinics, it is very common to meet patients with medically unexplained physical symptoms (MUPS). These patients do not have a diagnosis and often feel that in conventional medical care they are misunderstood and their symptoms are not always taken seriously (Lipsitt et al. 2015). This same patient group generally obtains poor clinical outcomes from medical practice (Lipsitt et al. 2015), which might lead them to further avoid medical doctors. Some of these patients might feel more understood by CAM practitioners in general. Depending on the type of therapy, this could partly be due to the duration of initial interview and time used during the treatment, or more cosy clinical settings. It might be the CAM practitioner who first notices that their symptoms start to change or become worse, signalling that there might be a need to see a doctor. However, if the CAM therapist fails to see the alarming signs, the patient might get non-optimal treatment and believe that he gets all the treatment he needs. This could be preventable with proper education and further cooperation with medical doctors.

An even more alarming group than the MUPS patients who often burden health care with their constant visits (Lipsitt et al. 2015), are those who feel very dissatisfied with their medical care and are avoiding seeing doctors. This group is easily left without treatment by their own choice. Some of these patients might still be willing to see an acupuncturist. In that case, more serious and easily recognised problems might become apparent and they could be referred to health care, if they can be persuaded to make an appointment. Within these patient groups, there are people who feel vulnerable and, sometimes, they do not know where they should go and which symptoms they should tell their doctors. In their case, even one bad experience with a medical doctor can lead to further aversion of medical procedures and tests. For them an acupuncturist might be seen as a neutral bridge for communication to conventional health care.

CAM modalities are also often selected because of recommendations or wanting self-control over an illness (Shorofi and Arbon 2017). Many patients from the group who feel CAM therapies are more fitting to their personal way of life may not easily visit a doctor for any minor complaints. Based on the author’s experience, the people from these groups are generally willing to see a doctor when faced with any serious conditions or when told so by an acupuncturist. The problem for these patients is to recognise what is relevant and what is serious enough. Those seeing an acupuncturist with at least a basic education of medicine, could then be told by the acupuncturist to see a doctor if needed.

Conclusions

The failure to recognise lung cancer by the author and by a medical doctor in occupational health care was a human error. The proper acupuncture studies in Finland include a minimum of 14 to 30 ECTS of medicine, depending on the year of graduation, and lung cancer is one of the most difficult forms of cancer to diagnose even for general practitioners (Rankin et al. 2017). Mistakes can happen for any medical professional and CAM practitioner alike, but delays in treatment can lead to disease progression and missed opportunities for cure in a significant subset of patients (Rankin et al. 2017). In conventional care, it is customary to refer the patient to a specialist for diagnosis in case the general practitioner suspects cancer or another more serious disease. A similar attitude is crucial for patient safety among all CAM modalities. Wide cooperation with medical doctors would ensure patient safety and could also encourage some vulnerable patient groups to visit a doctor in time. It might also provide a bridge for communication to patients with MUPS or other patient groups who may feel more understood by CAM practitioners.

Based on these reflections, the author claims that there exists a possibility for certain groups of people to be left without early recognition of serious diseases in conventional health care and in clinics offering CAM modalities. In developed Western countries, most patients already go to a medical doctor in case they suspect anything serious. Those coming to see an acupuncturist or another CAM practitioner have often already visited a medical doctor (Eisenberg et al., 2001). Those who have considered their problems too minor for needing a doctor may still try acupuncture. In case the acupuncturists suspect any more serious health concerns, the professional acupuncturists always ask the patient to visit a doctor. In Chinese medicine education, it is necessary to teach acupuncturists to become aware of their own limitations. In acupuncture education, the students need to be taught to communicate with the patients honestly, if they cannot understand the symptoms or they have any suspicions.

The ability of an acupuncturist to recognise important clues about serious health issues depends on education and clinical experience. Even though Chinese medicine courses are not meant to produce medical doctors or to teach how to make a conventional medical diagnosis, they aim at providing enough understanding when it is necessary to refer the patient to medical care. As the popularity and acceptance of acupuncture is growing fast and more and more research about its effectiveness is emerging, the acupuncturists will receive more and more patients seeking alternatives. With growing public awareness of acupuncture, there will be more and more patients coming with grave illnesses that require conventional medical treatments. The need for basic medical education and continuous education for acupuncturists cannot therefore be stressed enough.

It is also crucial for acupuncturists, and other CAM practitioners, to network themselves with medical doctors whom they can refer the patients to or ask for an opinion. Awareness of these critical situations can also be improved with open discussion and sharing experiences with other acupuncturists or practitioners of other CAM modalities.

Some patients have withheld information from their doctors about their nutraceuticals recommended by their nutritional therapists or herbs recommended by CAM practitioners. In the study by Eisenberg et al. (2001), three fifths of CAM therapy used was not disclosed to doctors. The common reason is that the doctor didn’t ask and some patients were also afraid that the doctors would not agree or understand (Eisenberg et al., 2001). This can be very dangerous considering the potential interactions (Salminen, 2018) with drugs used in cancer treatment, for example. The possibility that the patient uses some CAM modality is ever increasing. According to Eardley et al. (2012) “the prevalence of CAM use varied widely within and across the EU countries” and could be even as high as 86% of the population in some countries. The most commonly used modality is herbal medicines. If the patients sense a strong dichotomy between CAM practitioners and medical professionals, it can cause the patients to withhold vital information. It is important that acupuncturists also recognize these dangers and are able to inform their patients and form patient relationships based on trust. They need to tell their patients to inform their doctors or practitioners of other CAM modalities about any treatments they give, especially if they prescribe any medicinal herbs or products.

The acupuncturists and Chinese medicine practitioners might also hear about the use of falsified medicines that can endanger the patients (Hamilton et al. 2016) or other unregulated and possibly harmful products. The acupuncturists can report these potentially harmful products to local authorities and inform their patients about possible dangers in their use. The author believes that information about the use of unregulated or falsified medicines might be left out during visit to a doctor just as easily as the patients withheld information, such as using CAM modalities, and an acupuncturist can instruct their patients to disclose this information.

With patients having any previous dissatisfaction with medical care, extra caution should be taken. In case of any suspicious symptoms, the patients should be instructed to see a doctor, if they have not already done so, to avoid a late diagnosis of serious medical conditions. Making patients agree to see a doctor probably requires building a good therapeutic relationship. The practitioner of any CAM modality also needs to be aware in his therapeutic relationships that a patient might also easily get a wrong idea of the effectiveness. The patient in this case reserved time to check if acupuncture could help with Ménière's disease when medicine failed. She had already had made the assumption that vertigo was because of Ménière’s disease and that acupuncture might help. Currently, there is preliminary evidence that acupuncture might work for Ménière’s disease (He et al. 2016) but her expectations were high because of the previous success with uveitis. It is sometimes almost impossible to avoid giving false hope by just agreeing to treat any less commonly treated symptoms. Not treating or overly explaining that the treatment might not work might harm the therapeutic relationship and even prevent the referral to a doctor in case it is needed.

Reflecting upon therapeutic relationships and clinical skills after this incident, the author became more aware of possible consequences of his therapeutic practice. It would be unrealistic to think that these mistakes couldn’t ever happen in the future, but there are always ways to improve the practice. He will now reserve extra time for returning patients if a few years have passed from the last session. With this he tries to ensure that he has enough time to collect information. Even in cases of seemingly minor complaints that do not respond to acupuncture treatments, the patients will from now on be routinely encouraged to see a doctor upon termination of the course of treatment. Before, the patients have already been asked to see doctor if there have been any alarming symptoms, but minor health concerns might have been previously overlooked. The author himself sees the work of an acupuncturist very tightly interwoven with the medical profession and sees further cooperation between different medical modalities as a requirement for patient safety. The author also concludes that it is unlikely that offering acupuncture would generally cause delays in diagnosis and treatment of a serious disease like cancer, but there is definitely a lack of proper studies in this area.

References

Chiu, HY., Hsieh, YJ. and Tsai, PS. (2017) Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. European Journal of Cancer Care. 2017 Mar;26(2).

Duong, N., Davis, H., Robinson, PD., Oberoi, S. Et al. (2017). Mind and body practices for fatigue reduction in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis. Critical Reviews in Oncology/Hematology. 2017 Dec;120:210-216.

Eardley, Susan., Bishop, a Felicity L., Prescott, Philip. Et al. (2012) A Systematic Literature Review of Complementary and Alternative Medicine Prevalence in EU. Forsch Komplementmed 2012;19(suppl 2):18–28

Eisenberg, David M., Kessler, Ronald C., Van Rompay, Maria I. Et al. (2001). Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey. Annals of Internal Medicine. 2001 Sep 4;135(5):344-51.

Hamilton WL., Doyle C., Halliwell-Ewen M., Lambert G. (2016) Public health interventions to protect against falsified medicines: a systematic review of international, national and local policies. Health Policy Plan. 2016 Dec;31(10):1448-1466.

He, Jiaojun., Jiang, Liyuan., Peng, Tianqiang. et al. (2016). Acupuncture Points Stimulation for Meniere's Disease/Syndrome: A Promising Therapeutic Approach. Evidence-Based Complementary and Alternative Medicine. 2016. Article ID 6404197

Houzé B., El-Khatib H., Arbour C. (2017) Efficacy, tolerability, and safety of non-pharmacological therapies for chronic pain: An umbrella review on various CAM approaches. Progress in Neuropsychopharmacology & Biological Psychiatry. 2017 Oct 3;79(Pt B):192-205.

Hu, Caiqiong., Zhang, Haibo.,Wu, Wanyin. Et al. (2016) Acupuncture for Pain Management in Cancer: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine. Volume 2016, Article ID 1720239.

Jakes, Dan., Kirk, Ray. and Muir, Lauretta. (2014). A Qualitative Systematic Review of Patients’ Experiences of Acupuncture. The Journal of Alternative and Complementary Medicine, 20(9):663–671

Kim, Me-Riong., Shin Joon-Shik, Lee Jinho Lee, Lee Yoon Jae et al. (2016). Safety of Acupuncture and Pharmacopuncture in 80,523 Musculoskeletal Disorder Patients: A Retrospective Review of Internal Safety Inspection and Electronic Medical Records. Medicine. 95(18):e3635, MAY 2016.

Lipsitt, Don R., Joseph, Robert. Meyer, Donald. and Notman, Malkah T. (2015) Medically Unexplained Symptoms: Barriers to Effective Treatment When Nothing Is the Matter. Harvard Review of Psychiatry. 2015 Nov-Dec;23(6):438-48

MacArtney, John I. and Wahlberg, Ayo. (2014). The Problem of Complementary and Alternative Medicine Use Today: Eyes Half Closed?. Qualitative Health Research 2014, Vol. 24(1) 114–123.

Mcculloch M., Nachat A., Schwartz J., Casella-Gordon V. and Cook J. (2015). Acupuncture safety in patients receiving anticoagulants: a systematic review. Permanente Journal. 2015 Winter;19(1):68-73.

Ng JY., Liang L. and Gagliardi AR. (2016) The quantity and quality of complementary and alternative medicine clinical practice guidelines on herbal medicines, acupuncture and spinal manipulation: systematic review and assessment using AGREE II. BMC Complementary and Alternative Medicine. 2016 Oct 29;16(1):425.

Park J., Sohn Y., White AR. and Lee H. (2014). The safety of acupuncture during pregnancy: a systematic review. Acupuncture in Medicine: Journal of the British Medical Acupuncture Society. 2014 Jun;32(3):257-66.

Potential Signals of Serious Risks/New Safety information identified from the FDA Adverse Event Reporting System. FDA Adverse Event Reporting System (FAERS) Public Dashboard. https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/ucm070093.htm (Last accessed 30.7.2018)

Rankin, Nicole M., York, Sarah., Stone, Emily. Et al. (2017). Pathways to Lung Cancer Diagnosis: A Qualitative Study of Patients and General Practitioners about Diagnostic and Pretreatment Intervals. Annals of the American Thoracic Society. 2017 May;14(5):742-753

Salminen, Kaisa. (2018) Potential metabolism-based drug interactions with isoquinoline alkaloids: an in vitro and in silico study. Publications of the University of Eastern Finland. Dissertations in Health Sciences., no 444.

Shorofi, Seyed Afshin., Arbon, Paul. (2017). Complementary and alternative medicine (CAM) among Australian hospital-based nurses: knowledge, attitude, personal and professional use, reasons for use, CAM referrals, and socio-demographic predictors of CAM users. Complementary Therapies in Clinical Practice. 2017 May;27:37-45.

Turner LA., Singh K., Garritty C., Tsertsvadze A. et al. (2011). An evaluation of the completeness of safety reporting in reports of complementary and alternative medicine trials. BMC Complementary and Alternative Medicine. 2011 Aug 22;11:67.

Warnock, Rory., Jeffries, Owen., Patterson, Stephen and Waldron, Mark. (2017) The Effects of Caffeine, Taurine, or Caffeine-Taurine Coingestion on Repeat-Sprint Cycling Performance and Physiological Responses 2017 Nov 1;12(10):1341-1347.

Witt C.M., Pach D., Brinkhaus B., Wruck K. et al. (2009). Safety of Acupuncture: Results of a Prospective Observational Study with 229,230 Patients and Introduction of a Medical Information and Consent Form. Forsch Komplementmed 2009;16:91–97.

Wu, Xinyin., Chung, Vincent CH., Hui, Edwin P. et al. (2015). Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Scientific Reports. 2015 Nov 26;5:16776.

Zhang, Y., Lin, L., Li, H. et al. (2018). Effects of acupuncture on cancer-related fatigue: a meta-analysis. Support Care Cancer. 2018 Feb;26(2):415-425.

Zick, Suzanna M., Sen, Ananda., Wyatt, Gwen K. et al. (2016). Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Clinical Trial. JAMA Oncology. 2016 Nov 1;2(11):1470-1476.

Abstract:

The concept of therapeutic alliance, i.e., the relationship between practitioner and patient, is identified as being historically rooted within the practice of traditional Chinese medicine. Within this context, this relationship is shown to serve the modern self — a recent construct favored in westernized industrial countries. While tracing the rise of the modern self, the value and limitations of this construct are evaluated.

In this essay both the acupuncture intake, comprised of ten questions, and the practice of the Chinese self-cultivation techniques are analyzed: the intake procedure as an effective therapy and practitioner self-cultivation as a source for patient inspiration. By re-appropriating archaic methods, Chinese medicine practitioners can guide patients in the formation of a valuable personal narrative to address a construct of modernity.

Key words:

acupuncture narrative, human potential, Yang Sheng self-cultivation.

An Archeological Discovery

Ancient Chinese culture may have eschewed the individual, but in the practice of Chinese medicine there has always been an emphasis on treating idiosyncratic pathologies, unique to each person. Elisabeth Hsu, in chapter 2 of Innovation of Chinese Medicine, describes twenty-five such medical case histories found in the biography of a Han doctor recorded in about 90 BC. Hsu asserts that illness was designated by the term bing rather than the term ji. Her investigation revealed that apart from other meanings, bing frequently referred to the emotional state of a distressed or aggrieved person, suggesting that bing referred to the mind-emotion-body complex.1 This concept of individualism, buried in Chinese medicine, functioned as a release valve for strictures in traditional Confucian culture, indicating a nod to the individual through pathology.

By using this strategy today, the modern acupuncture practitioner may covertly treat a wide range of disharmonies that effect the psychological or metaphysical through the medium of the physical body.

Evolution of the Modern Self

Once upon a time we were all part of a family, congregating within a community or tribe, bounded by rules and traditions that guided every aspect of our lives. But industrialization and other extraordinary successes of capitalism eventually managed to devastate these traditions and erode our connection with the past.

As now experienced, the concept of self is a unique and recent construct that has emerged in the past century, launching each individual on a quest for personal meaning that had been previously supplied by traditional communities. Add to that the Nietzschean demise of the creator, the startling new world of physics, and the material excess of capitalist production, there emerged from the divan of Sigmund Freud and other psychologists a new kind of self. In the BBC documentary, Century of the Self, Adam Curtis examines how we have moved from the ‘citizens with needs’ to ‘consumers with desire’. In this documentary, Curtis deconstructs how the Freudian concept of ‘unconscious’ desire was harnessed to the new business of marketing consumer goods, encouraging the emergence of a singular individual. This new self re-examined the constraints that had previously bound it to the precepts of religion and other dogma.

Jan Sloterdijk’s You Must Change Your Life describes our “withdrawal from this collective identity” as a directive demanding that all individuals must now stand beside themselves a priori, living their lives in front of the mirror, or function as actors of everyday life.2 He decrees that we were once part of a collective unity, bounded by religion, tradition, and family that functioned as additional immune system by guiding, signifying, and protecting us.2 Now, with only our self-created psyche to protect or direct us, humanity must face the numerous onslaughts of circumstance alone.

Christopher Macann states: “Ontological psychology ceases to be what Kant took it to be: a spurious deduction of the immortality of the soul from the principle of self-identity”3, and becomes instead what might be called a doctrine of self-actualization, a phrase made famous in Maslow’s Psychology of Being.”4 Maslow describes self-actualization as “….what a man can be, a man must be…It refers to the desire for self-fulfillment, namely, to the tendency for him to become actualized in what he is potentially. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.”5

Authoring the Self or How to Live a Meaningful Life

The self has now become a center for experimentation and authorship. For a meaningful life, experiences must be accumulated and curated, and the personal narrative becomes a centerpiece for communication. Individual stories serve as guideposts for inspiration and transcendence in much the same way as The Confessions of Saint Augustine did 1700 years ago.2 Self-involvement is not new to western history, but it was traditionally used to serve as an example at the demand of some greater authority. Augustine’s Confessions are an early version of a transformational life story that permeates Hollywood dramas and soaps.

For the multitudes, the self-portrait, particularly illustrated by Rembrandt’s more than 90 painted images of himself, is now the “selfie”—a self that is not under the control of some special aegis. It is especially unsettling to many social critics, who claim it is a short jump from selfie to selfish. Great moral opprobrium is attached to this concept of self. Critics see self-involvement as shedding important shared traditions that have served to organize people or, in a spiritual context, preferring the self to the creator or the originator of that self. But this new self, while, yes, prideful and actively undermining tradition, still requires tending and guidance.

Jumping forward to our new, service-oriented economy, many kinds of practitioners are now engaged in mapping the ontology for this new individual self through the medium of the personal narrative. This new self has spawned a huge service industry that caters to its development, refinement, and care. This is important because other cultural institutions that once cultivated, sheltered, and groomed this aspect of our psyche are in retreat.

The Chinese Medicine Intake: The Practitioner Helps the Patient Write a Narrative

In my own specialty, acupuncture, the patient is encouraged to build their personnel narrative based on the ten intake questions, which provides an organizational template for their story. As the patient describes their digestion, sleep patterns, urination, breathing, and any other subjective sensations they may wish to include, these ten questions serve as a type of somatic confessional, whereby the patient is able to transpose their psychological and metaphysical anxiety into simple and comprehensible evaluation of autonomic vegetative functions. Rather than the soul or psyche, these functions then become the object of transformation. By the simple principle of adjusting the flow, intake, and expulsion of fluids, gases, and solids, the individual can be tuned to perform at a higher level.

In a secular world there is the obvious benefit to only adjudicating somatic function. Many pejorative moral and psychological implications can thus be averted, while such vegetative functions are modified or streamlined to a superior level of performance.

This strategy of using Chinese medicine to treat the somatic body by addressing the psyche is oddly akin6 to the James-Lange Theory of Emotion. This theory was put forth in 19^th century initially by American psychologist and theosophist William James and later, separately, by Danish physician Carl Lange. In this theory, physiological changes actually precede emotions. The subjective emotion is experienced because of the underlying physiology: our autonomic nervous system generates the physiological events that we associate with an emotion such as heart rate, perspiration, dry mouth, muscular tension. This theory suggests that emotions are a result of physiology rather than the cause.6 The autonomic nervous system is primarily unconscious, associated with activating the flight or fight response. But new research also shows that the sympathetic nervous system is “part of a constant regulatory machinery that keeps body functions in a steady state equilibrium.”7

It has been recently demonstrated that the sympathetic nervous system and the hypo-pituitary axis are activated by antigenic activity. Local immune cells inform the central nervous system and vice versa; the door swings both ways. New research in bioelectronics suggests that inflammation can be suppressed by stimulating the vagus nerve with electrical impulses. The standard of care associated with inflammatory conditions, such as rheumatoid arthritis, Crohn’s disease, or other insidious autoimmune conditions, might very soon incorporate vagal stimulation. Increasing vagal tone can also be taught by using the biofeedback technique.8,9 Hence, research science is verifying that the underlying soma is an effective pathway to modulate the psyche and vice versa.

In a study (to be published) by Randy Gollub et al., a patient’s experience of pain relief was correlated to their perception of being cared for with empathetic understanding. Patients were asked to evaluate the level of interest shown by their practitioner. Results demonstrated that their pain relief was enhanced by practitioner empathy. 10

A trial designed by Ted Kaptchuk, presents the notion that the patient’s narrative about self is fundamental to their health. He discusses and demonstrates how a practitioner perceives a patient affects the outcome of their health.11 This study of patients with irritable bowel syndrome randomly divided them into three groups. Group one was put on a waiting list. Group two received placebo treatment from a disinterested clinician. The third group got the same placebo treatment from a clinician who asked them questions about symptoms, while describing the causes of irritable bowel and displaying optimism about them overcoming their condition. Not surprisingly, the health of those in the third group improved the most.

The Golub and Kaptchuk studies demonstrate the value of practitioner involvement. In recording the patient’s subjective narrative, practitioner empathy becomes part of substrate that influences the acupuncture patient’s outcome.

Acupuncturists stress which foods to eat, the temperature of the food to be consumed, how much to drink, what to drink, when to sleep, when to rise, how to dress, how often to have sexual intercourse, or how to massage internal organs. For patients who have never observed their bodily functions, discovering that the shape of a stool or the color of urine or nose phlegm can be a window into the interior can have profound effect on self-reflection. In a secular world, Chinese medicine provides support and instruction similar in some ways to the dietary and lifestyle guidelines once administered by other belief systems.

The acupuncture intake and diagnosis that generates this personal narrative with its pastiche of authentic Taoist and Confucian phrases represents an antique system of healing. This also can function successfully today as an intact nonreligious construct for evaluating the pilgrim/patient’s transcendent progress on their journey with their self, stressing behavior over belief.

Evolution of Self-Cultivation

For Maslow, levels of self-actualization are the peak levels achieved by an individual. Often an evolved individual can by example pull the rest of humanity upward toward a higher level of proficiency or consciousness.

In his essay, The Neurology of Self-Awareness, Ramachandran suggests that mirror neurons have played a critical role in learning through imitation rather than trial and error, along with our strong ability to empathize. He proposes that extraordinary human progress, in which self-awareness is fundamental, is the result of the interplay of these mirror neurons.12 He also posits that because of mirror neurons, humans have the uncanny ability to imitate each other and understand each other’s feelings, “setting the stage for a complex Lamarckian or cultural inheritance that characterizes our species.”12

Rizzolatti discovered back in 1996 that mirror neurons are the pre-motor neurons that fire when a primate performs some object-directed actions, such as grasping, tearing, manipulating, or holding but also when the animal watches someone else perform the same actions.13

Additionally, it is not just the repetition of one but repetition of many, imitating and competing, that drives us forward. Take the simple example of the marathon: in 1921, best time was 3 hours and 18 minutes; in 2014, best time was 2 hours, 2 minutes and 57 seconds.14 This has been achieved over the span of many years, through the accumulated effort of many runners, competing against each other, and shaving the time, second by second, year by year. Each competed to be the best, inspired by and imitating the competitor whom they followed, and tended and coached by those who made running a practice.

This sort of consciousness-raising effort that pervades human behavior is described by Jan Sloterdijk in You Must Change Your Life. He lauds the Nietzschean doctrine of combining practice with cumulative knowledge or education and designates practicing and training as an original and uniquely human path, especially in seeking to transcend the self.2 Through Sloterdijk‘s lens, training, peak experiences, and performance crystallize the human experience, while conscious measurement, observation, and skill refinement are reflected in learning and practice.

Sloterdijk comments that such training and practice systems formed the core of Platonism, Brahmanic training, and Taoist alchemy and martial arts, guiding adepts up ‘the vertical wall of achievement’ in superhuman spiritual and athletic extremes that have shaped the image of what human potential can be.2

Chinese Practice and Self-Cultivation

In ancient China, Taoism embraced the belief that through breath and meditation they could transform their lives, by reaching for immortality. Joseph Needham describes how in ancient China the physiological alchemists believed they could “master their neuro-muscular coordination, and sexual activity as part of the Tao.”15 He describes such activities, listing how this was accomplished by employing respiratory exercises, counting heartbeats, experiencing the movement of inner qi, and using a myriad of other special techniques, which were designed prolong longevity or restore youth by internally transforming the practitioner.15 These early Taoists exercises evolved into complicated styles of self-cultivation.

During the early Han period, around 200-100 BC, medical understanding of the inner body was changing. By the time the Huang de Nei Jing was compiled, there was a formal system of channels known as the jing luo, which allowed different types of qi to circulate.1

Medical technology was also changing. Fine filament needles became the preferred method of treatment.16 The practitioner was guided by the Su Wen and Ling Shu on how to perform this new inner practice. He was encouraged to gather his qi, employing techniques of self-cultivation that acupuncture students are still taught to imitate today. Metaphors in the Su Wen, such as “use the hand as if holding a tiger” or “pouring over a deep abyss,” coach the practitioner on how to proceed in treatment.

Technique was conflated with rectitude and moral character, instructing the practitioner to influence the spirit of the patient or proceed to a deeper metaphysical exchange, using the needle as an instrument of transmutation.16 These special skills represented the fruits of self-cultivation for the practitioner.

By focusing on self-manipulation of qi and self-improvement in technique, acupuncturists have become default practitioners of Yang Sheng self-cultivation

skills.1 Modern Chinese medicine has become an odd mix of the esoteric internal practice methods combined with modern physiology. By simply reading through a list of continuing education courses or the advanced curriculum at institute of traditional Chinese medicine, this obsession with obscure Taoist practices can easily be verified.

Pursuing a practice under the guidance of a Chinese master, whose particular lineage defines their curriculum vitae, is the equivalent to pursuing a board certification in another profession. Even if personally refraining from a deliberate practice of self-cultivation, acupuncture students are exposed to such practices through curriculum requirements. It is inculcated in the rhythm of learning in a professional school, where either qi gong or tai chi are combined with esoteric poetry about nature.

It is normal to find a student of acupuncture involved in a deep meditative performance exercise such as tai chi. Mastery of practice-related performance is expected of these students. In this profession, self-cultivation and skill development go hand in hand; other medical professionals are not expected to harmonize their qi, learn mystical movements such as tai chi, or root their being, before interacting with their patient. The skills of self-cultivation as both a healing art and a moral virtue are embedded in Chinese medicine. This imbues the practitioner with leadership qualities that occur in other training modes such as sports, arts, or religion. The modern patient, typically lacking in ritual signifiers for lifestyle direction, can thus benefit from this personal example of their practitioner.

Conclusion

Western treatments based on statistical patterns and board declarations that direct standards of care often negate or ignore an individual’s metaphysical sense of being. In the context of eastern and western cultural norms, western culture employs treatment standards that are ironically more aligned with the statistical whole, whereas traditional Chinese medicine, aligned with a rigid Confucian social structure, embraces the individual. In this example of cultural syncretism, acupuncture offers the modern self the care and understanding that it currently lacks in the territory of western evidence-based treatment.

Despite being anchored in traditional principles of Taoist and Confucian philosophy, Chinese medicine is able to address the modern concept of self by creating a distinct diagnostic template for the treatment of each patient. This narrative template teaches individuals to observe and measure their soma in a practical, effective way against an intact system that encompasses philosophical underpinnings that reflect every aspect of patient behavior. It is composed of understandable natural metaphors that generally resonate well with the patient and can be transposed into simple behavioral modification.

As part of traditional culture, both the narrative and techniques of self-cultivation are able to furnish individual guidance and performance-activated behavior that are often lacking in both western therapy and modern cultural norms. When scientists try to evaluate the efficacy of the acupuncture treatment, they often fail to comprehend the value of these methods: the intake, which varnishes the diagnosis with a veneer of empathy, and examples of self-cultivation, which represent internal strength achieved through moral refinement. Together, these two essential components of an acupuncture treatment may contribute monumentally to a therapeutic alliance that successfully enhances the patient’s outcome.

References: 

1. Ed. by Elisabeth Hsu, Innovation in Chinese Medicine, Needham Research Institute, Cambridge University Press, 2001; p. 16.

2. Peter Sloterdijk, You Must change Your Life, Polity Press; 2013. pp. 211, 215, 322, 199.

3. Referring to the Cartesian Objective

4. Maccan, Being and Becoming: https://philosophy now.org/issues/61

5. A.H.Maslow (1943); A Theory of Human Motivation, Originally published in Psychological Review, 50, p.370-396. http;//psychclassics.yorku.ca/Maslow/motivation.ht

6. https:Wikipedia.org/wiki/James-Lange_theory

7. http://medscape.com; Medscape: Arthritis Research & Therapy; Georg Pongratz; Rainer H Straub; The Sympathetic Nervous Response in Inflammation.

8. http://www.newyorktimes.com: Michael Beharmay, Can the Nervous System Be Hacked?; Mar. 23, 2014.

9. Torres-Rosas R, Yehia G, Peña G, Mishra P, del Rocio M,  Ulloa L, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nature Medicine. 20, 291–295 (204) doi:10.1038/nm.3479

10. Mawla I, Gerber J, Delibero S, Oriz A, Protsenko E,  Gollub R. Oral Abstract, Therapeutic Alliance between Patient and Practitioner Is Associated with Acupuncture Analgesia in Chronic Low Back Pain, Society for Acupuncture Research, 2015 Conference program, Boston, MA, USA, 11/12-13, 2015 , #SAR2015.

11. T J Kaptchuk; Components of placebo effect: Randomised controlled trial in patients with irritable bowel syndrome; BMJ.April2008;336:999 doi:10.1136/bmj.39524.439618.25.

12. Ramachandran V. [1.1.09]; Conversation: (title) Mind; Self Awareness: The Last Frontier; E. edge.org.

13. Marco Iacoboni, Istvan Molnar-Szakacs, Vittorio Gallese, Giovanni Buccino, John C Mazziotta, and Giacomo Rizzolatti; Grasping the Intentions of Others with One's Own Mirror Neuron System; Published: February 22, 2005; DOI:10.1371/journal.pbio.0030079

14. https:/www.wikipedia.org/wiki/Marathon;_world_record_progression

15. Joseph Needam, Volume V, Science and Civilisation in China: Chemistry and Chemical Technology, Part 5, Spagyrical Discovery and Invention: Physiological Alchemy, Science and Civilisation in China, Volume V:5; Cambridge University Press,1985; p. XXVIII, Introduction., p. 29

16. Vivienne Lo, Spirit of Stone: Technical Considerations in the Treatment of the Jade Body; Bulletin of the School of Oriental and African Studies, University of London Vol. 65, No. 1 (2002), pp. 99-128, Published by: Cambridge University Press on behalf of School of Oriental and African Studies; Stable URL: http://www.jstor.org/stable/4145903

Ruesi Dat Ton and the Foundations of Thai Massage

Reusi Dat Ton is a little known aspect of traditional Thai healing and culture. It consists of breathing exercises, self-massage, acupressure, dynamic exercises, poses, mantras, visualization and meditation.

“Reusi” in Thai, from the Sanskrit Rishi, is an Ascetic Yogi or Hermit. “Dat” means to stretch, adjust or train. “Ton” is a classifier used for a Reusi and also means oneself. So “Reusi Dat Ton” means the Hermit’s or Yogi’s self-stretching or self-adjusting exercises. Reusis were also known as “Jatila,” Yogi,” and “Chee Prai.” The Reusis were custodians and practitioners of various ancient arts and sciences such as: tantra, yoga, natural medicine, alchemy, music, mathematics, astrology, palmistry, etc. They have counterparts in many ancient cultures, such as: the Siddhas of India, the Yogis of Nepal and Tibet, the Immortals of China, the Vijjadharas of Burma and the Cambodian Eysey (from the Pali word for Reusi, Isii).

There are different Reusi traditions within Thailand. There is a Southern Thai/Malay Tradition, a Northeastern Thai/Lao Tradition, a Central Thai/Khmer Tradition and a Northern Thai/Burmese/Tibetan Tradition. In Thailand, there are Reusis as far South as Kanchanaburi Province who follow the Northern Thai/Burmese/Tibetan Reusi Tradition.

A typical Reusi Dat Ton program would begin with breathing exercises and self-massage, followed by dynamic exercises and poses (some of which involve self acupressure) and finish with visualization, mantras and meditation. The exercises and poses of Reusi Dat Ton range from simple stretches which almost anyone could do, to very advanced poses which could take many years to master.

Some of the Reusi Dat Ton techniques are similar to or nearly identical to some techniques in various Tibetan Yoga Systems, particularly “Yantra Yoga,” “Kum Nye” and the Tibetan Yoga Frescoes from the Lukhang Temple behind the Potala Palace in Lhasa Tibet. (See Norbu, Tulku and Baker) For example; some of the self massage techniques, exercises, poses, neuromuscular locks (bandhas in Sanskrit,) breathing patterns, ratios, visualizations and the way in which male and female practitioners would practice the same technique differently are almost identical. It is possible that Reusi Dat Ton and some of the Tibetan Yoga Systems are derived from a common source, which Rishis brought with them as they moved down the Himalayan foothills into Southeast Asia.

According to the Reusi Tevijo Yogi “The foundation and key to Traditional Thai massage is Reusi Dat Ton. Ancient Reusis, through their own experimentation and experience, developed their understanding of the various bodies (physical, energetic and psychic, etc.) They discovered the postures, channels, points, the winds and wind gates within themselves. Later it was realized that these techniques could be adapted and applied to others for their healing benefit, which is

how Thai massage was developed. So, in order to really understand Thai massage, as a practitioner, one should have a foundation in Reusi Dat Ton and be able to experience it within oneself and then apply it to others. It is not only the roots of Thai massage but it also unlocks the method for treating oneself and maintaining one's own health.” (Reusi Tevijo Yogi)

It is also interesting to note that there are many similarities between the Reusi Dat Ton “Joint Mobilization Exercises,” many Thai massage techniques and some of the Indian Hatha Yoga therapeutic warming up exercises (the Pawanmuktasana or wind liberating and energy freeing techniques.) There is even an advanced Hatha Yoga pose, Poorna Matsyendrasana, which compresses the femoral artery and produces the same effect as “opening the wind gate” in Reusi Dat Ton Self Massage and Traditional Thai massage. (Saraswati)

Reusi Dat Ton in Traditional Art

In Northeast Thailand, in Buriram province atop an extinct volcano sits the Ancient Khmer temple of Prasat Phnom Rung. Built between 900 and 1200AD, this temple is dedicated to the Hindu God Shiva. The pediment over the eastern doorway features a sculpture of an avatar of Shiva in the form of Yogadaksinamurti. According to the Department of Fine Arts “Yogadaksinamurti means Shiva in the form of the supreme ascetic, the one who gives and maintains wisdom, perception, concentration, asceticism, philosophy, music and the ability to heal disease with sacred chants.” Here “Shiva is dressed as a hermit with crowned headdress holding a rosary in his right hand, seated in the lalitasana position...surrounded by followers. There are figures below him that...represent the sick and wounded.” (Department of Fine Arts). All over the temple one can see additional carvings of Reusis engaged in various activities. In one carving of the “Five Yogis” (or Reusis) the central figure is the God Shiva in his incarnation as Nagulisa, the founder of the Pasupata sect of Shivaite Hinduism. The four yogis on his sides are followers of this Pasupata sect, which is still active today in Nepal.

In 1767, invading Burmese armies destroyed the old Thai capital of Ayutthaya. Soon after his coronation in 1782, the Thai King Rama I established a new capital in what is today Bangkok. He initiated a project to revive the Thai culture after the disaster of Ayutthaya. An old temple Wat Potharam, (popularly known as “Wat Po,”) was chosen to become the site of a new Royal temple

and formally renamed Wat Phra Chetuphon. Beginning in 1789, a renovation and expansion project was begun on the temple. King Rama I also initiated a program to restore and preserve all branches of ancient Thai arts and sciences including: medicine, astrology, religion and literature. As part of this project, medical texts from across the kingdom were collected and brought to be stored at Wat Po. The King also ordered the creation of a set of clay Reusi statues depicting various Reusi Dat Ton techniques.

This restoration project was continued by the Kings Rama II and Rama III. As part of this work, scholars compiled important texts on various ancient arts and sciences and created authoritative textbooks for each of these fields. In 1832, a project to etch the medical texts into marble tablets was begun. Medical theories regarding the origin and treatment of disease, massage charts and over 1000 herbal formulas were all recorded on the marble tablets. Gardens of medicinal herbs were also planted on the temple grounds. Thus, Wat Po was to become “a seat of learning for all classes of people in all walks of life” which would “expound all braches of traditional knowledge both religious and secular,” and serve as “an open university” of traditional Thai culture with a “library of stone.” (Griswold, 319-321)

By 1836, the clay Reusi Dat Ton statues created by order of King Rama I had deteriorated. To replace these, King Rama III commissioned the creation of 80 new Reusi Dat Ton statues. Each statue depicted a different Reusi performing a specific Reusi Dat Ton technique. For each statue there was a corresponding marble tablet upon which was etched a poem describing the technique and it’s curative effect. These poems were composed by various important personalities of the day. Princes, monks, government officials, physicians, poets, and even the King himself contributed verses. The original plan was to cast the statues with an alloy of zinc and tin, but unfortunately only the more perishable material stucco was used. The statues were then painted and housed in special pavilions. Over the years most of the original statues have been lost or destroyed. Today only about 20 remain and these are displayed upon two small “Hermit’s Mountains” near the Southern entrance of Wat Po. The marble tablets have been separated from their corresponding statues and are now stored in the pavilion Sala Rai.

Beginning in 2009, the casting of metal Reusi Dat Ton statues was begun. These new statues are gradually appearing in and around the Wat Po Massage School near the Eastern entrance of Wat Po. So now after almost 200 years, Wat Po will soon finally have it’s complete set of 80 metal Reusi Dat Ton statues as originally envisioned by King Rama III.

Textual Sources of Reusi Dat Ton

We may never know what, if any Ancient texts on Reusi Dat Ton may have existed and were lost when the invading Burmese armies destroyed the old Thai capital of Ayutthaya in 1767. Today, the closest thing to an original source text on Reusi Dat Ton is an 1838 manuscript commissioned by Rama III entitled The Book of Eighty Rishis Performing Posture Exercises to Cure Various Ailments. Like other manuscripts of the time, this text was printed on accordion like folded black paper, known in Thai as “Khoi.” This text, popularly known as the Samut Thai Kao features line drawings of the 80 Wat Po Reusi Dat Ton statues along with their accompanying poems. In the introduction, it states that Reusi Dat Ton is a “...system of posture exercises invented by experts to cure ailments and make them vanish away.” (Griswold, 321) This text is housed in the National Library in Bangkok. There are also other editions of this text housed in museums and private collections as well.

The Benefits of Reusi Dat Ton

In both the Samut Thai Kao and The Book of Medicine, the texts not only describe the techniques, but also ascribe a therapeutic benefit to each pose or exercise. Some poems describe specific ailments while others use Sanskrit Ayurvedic medical terminology.

Some of the ailments mentioned include; abdominal discomfort and pain, arm discomfort, back pain, bleeding, blurred vision, chest congestion, chest discomfort and pain, chin trouble, chronic disease, chronic muscular discomfort, congestion, convulsions, dizziness and vertigo, dyspepsia, facial paralysis, fainting, foot cramps, pain and numbness, gas pain, generalized weakness, generalized sharp pain, headache and migraine, hand discomfort, cramps and numbness, heel and ankle joint pain, hemorrhoids, hip joint problems, joint pain, knee pain and weakness, lack of alertness, leg discomfort, pain and weakness, lockjaw, low back pain, lumbar pain, muscular

cramps and stiffness, nasal bleeding, nausea, neck pain, numbness, pelvic pain, penis and urethra problems, scrotal distention, secretion in throat, shoulder and scapula discomfort and pain, stiff neck, thigh discomfort, throat problems, tongue trouble, uvula spasm, vertigo, waist trouble, wrist trouble, vomiting, and waist discomfort.

Some of the Ayurvedic disorders described in the texts include; Wata (Vata in Sanskrit) in the head causing problems in meditation, severe Wata disease, Wata in the hands and feet, Wata in the head, nose and shoulder, Wata in the thigh, Wata in the scrotum, Wata in the urethra, Wata causing knee, leg and chest spasms, Wata causing blurred vision, Sannipat (a very serious and difficult to treat condition due to the simultaneous imbalance of Water, Fire and Wind Elements which may also involve a toxic fever) an excess of Water Dhatu (possibly plasma or lymph fluids,) and “Wind” in the stomach. Other benefits described in the old texts include; increased longevity and opening all of the “Sen” (There are various types of “Sen” or channels in Traditional Thai Medicine. There are Gross Earth Physical “Sen” such as Blood Vessels. There are also more Subtle “Sen” such as channels of Bioenergy flow within the Subtle Body, known as “Nadis” in Sanskrit. In addition, there are also “Sen” as channels of the Mind.)

In recent years, the Thai Ministry of Public Health has published several books on Reusi Dat Ton. According these modern texts, some of the benefits of Reusi Dat Ton practice include; improved agility and muscle coordination, increased joint mobility, greater range of motion, better circulation, improved respiration improved digestion, assimilation and elimination, detoxification, stronger immunity, reduced stress and anxiety, greater relaxation, improved concentration and meditation, oxygen therapy to the cells, pain relief, slowing of degenerative disease and greater longevity. (Subcharoen, 5-7)

A recent study at Naresuan University in Phitsanulok, Thailand, found that after one month of regular Reusi Dat Ton practice there was an improvement in anaerobic exercise performance in sedentary females. (Weerapong et al, 205)

Thai Reusi Dat Ton and Indian Hatha Yoga

A survey of the traditional Indian Hatha Yoga text Jogapradipaka of Jayatarama from 1737AD identified the following 45 Indian asanas as having similar or identical counterparts in Thai Reusi Dat Ton; Svastikasana, Padmasana, Netiasana, Udaraasana, Purvasana, Pascimatanasana, Suryasana, Gorakhajaliasana, Anasuyasana, Machendrasana, Mahamudrasana, Jonimudrasana, Sivasana, Makadasana, Bhadragorakhasana, Cakriasana, Atamaramasana, Gohiasana, Bhindokasana, Andhasana, Vijogasana, Jonisana, Bhagasana, Rudrasana, Machindrasana (2nd variety), Vyasaasana, Dattadigambarasana, Carapatacaukasana, Gvalipauasana, Gopicandasana, Bharathariasana, Anjanasana, Savitriasana, Garudasana, Sukadevasana, Naradasana, Narasimghasana, Kapilasana, Yatiasana, Vrhaspatiasana, Parvatiasana, Siddhaharataliasana, Anilasana, Parasaramasana and Siddhasana. To date over 200 different Indian Hatha Yoga techniques have been identified which have similar or identical counterparts in Thai Reusi Dat Ton.

One unique feature of Reusi Dat Ton is the absence of Viparitakarani (Inversions) such as Shirshasana (Headstand), Sarvangasana (Shoulderstand.) Reusi Dat Ton also has no equivalents to Mayurasana (Peacock) or Bakasana (Crow). In Hatha Yoga both men and women use the left heel to press the perineum in Siddhasana (Adepts Pose), while in Reusi Dat Ton, men use the

right heel and women use the left. Reusi Dat Ton includes a series of “Joint Mobilization” exercises, many of which are very similar or identical to the Pawanmuktasana (Joint Loosening and Energy Freeing Exercises) taught by the Bihar School of Yoga in Northeast India. (Saraswati) Reusi Dat Ton also includes a system of self-massage, which is typically done prior to the exercises.

Both Hatha Yoga and Reusi Dat Ton practice forms of Surya and Chandra Bhedana Pranayama (Solar and Lunar Breathing.) However in Hatha Yoga men and women both use the right hand when practicing Pranayama (Breathing Exercises), while in Reusi Dat Ton men use the right hand and women use the left. Both use Ashwini Mudra (Anal Lock) and Jivha Bandha (Tongue Lock.) However, Reusi Dat Ton has no counterparts to Uddiyana Bandha (Abdominal Lock) or Jalandhara Bandha (Throat Lock.)

In Traditional Indian Hatha Yoga one will generally maintain an Asana for a few minutes. In contrast, Reusi Dat Ton tends to be more dynamic. Generally, one will inhale while going into the pose, hold the pose for several breaths, and then exhale when coming out of the pose. This is done to encourage the strong, healthy flow of Prana thru the Nadis (or Loam thru the Sen in Thai)

 Reusi Dat Ton Today

Today in Thailand, Reusi Dat Ton is being used in various ways. Some practice Reusi Dat Ton poses and exercises as a way to improve and maintain overall health, in much the same way as Hatha Yoga and Chi Gong are used today. Others such as Ajan Pisit Benjamongkonware of Pisit’s Massage School in Bangkok used Reusi Dat Ton in combination with traditional Thai Massage techniques as a system of therapy. They will use specific techniques for specific ailments, rather like an ancient system of rehabilitation similar to modern day Chiropractic and Physical Therapy. Others consider the energetic effects with the aim of facilitating the normal healthy flow of bioenergy through the “Sen” or energy channels of the subtle body. There are also a few remaining Reusis who still use Reusi Dat Ton in the traditional way as part of their personal meditation and spiritual practice.

The Institute of Thai Traditional Medicine at the Ministry of Public Health requires all their students of Thai Massage and Thai Traditional Medicine to attend Reusi Dat Ton classes as part of their curriculum. In these classes, students learn some of the self-massage techniques as well as 15 poses and exercises. While based on Reusi Dat Ton, these 15 techniques are actually newly created modifications thought to be safe and easily practiced by anyone. In Bangkok, The Wat Po School of Traditional Medicine offers a formal Reusi Dat Ton certification course in which students learn 18 of the poses and exercises. The Massage School Chiang Mai offers a formal Reusi Dat Ton certificate course, which is accredited by the Thai Ministry of Education. Their course is based on the same 15 poses and exercises as taught by the Ministry of Public Health. There are also a number of other places offering Reusi Dat Ton classes. Most of these programs teach either one or a combination of both of the two different programs, as taught by the Ministry of Public Health and Wat Po. There are also a number of commercially available Reusi Dat Ton books and videos.

Today in Thailand, there are a dwindling number of true Reusis and few young people are interested in learning the traditional arts and sciences in their authentic forms. Much of the traditional knowledge of the Reusi traditions is in danger of being lost. Nowadays, most modern day students and teachers of Reusi Dat Ton have learned from second or third hand sources such as commercially available books, videos and classes. They have not had access to primary sources such as actual Reusis or even the Samut Thai Kao. If this trend continues, there is a danger of Reusi Dat Ton becoming diluted and distorted like Hatha Yoga has become in today’s popular culture. Today we may well be seeing the last generation of teachers with an actual living link to the ancient traditions of the past and who are able to transmit the authentic teachings of Reusi Dat Ton. Serious students of Reusi Dat Ton would do well to seek out actual Reusis who have themselves learned from older Reusis who serve as a living link in the lineage of this ancient tradition.

Possible Future Research 

A possible research project would be to seek out Reusis and traditional healers across Thailand. One would then learn as much as possible about Reusi Dat Ton from them and compile it. This way the authentic teachings of this ancient tradition would not be lost in case these people die without being able to pass their knowledge on to the next generation. It could also be well worth investigating the many claims about the therapeutic effects attributed to Reusi Dat Ton practices in the old texts.

Bibliography of Readings about Ruesi Dat Ton

English Language 

• Baker, Ian A. and Thomas Laird. (2000). “The Dali Lama’s Secret Temple: Tantric Wall Paintings from Tibet.” Thames & Hudson Ltd., London, UK.

• Buhnemann, Gudrun. (2007). “Eighty-Four Asanas in Yoga: A Survey of Traditions.” (Contains the Jogapradipika of Jayatarama). D. K. Printworld, New Delhi, India.

• Chokevivat, Vichai and Chuthaputti, Anchalee. (2005). “The Role of Thai Traditional Medicine in Health Promotion.” Thai Ministry of Public Health, Nonthaburi, Thailand.

• Chuthaputti, Anchalee. (2007). “National Traditional System of Medicine Recognized by the Thai Government.” Thai Ministry of Public Health, Nonthaburi, Thailand.

• Covington, Laura. (2010). “Interview with a Reusi.” (Interview with Reusi Tevijjo Yogi). Bodhi Tree Learning Center. Richmond, USA.

• Department of Fine Arts. “Phnom Rung Historical Park Visitors Guide.” (And displays in the Phnom Rung Museum.) Department of Fine Arts, Buriram, Thailand.

• Evans-Wentz, W. Y. (2006). “Tibetan Yoga and Secret Doctrines.” Pilgrims Publishing, Varanasi, India. Gharote, M. L. (Editor). (2006). “Encyclopaedia of Traditional Asanas.” The Lonavala Yoga Institute. Lonavala, India.

• Ginsburg, Henry. (2000). “Thai Art and Culture: Historic Manuscripts from Western Collections.” University of Hawaii, Honolulu, USA.

• Griswold, A.B. (1965). “The Rishis of Wat Po.” In Felicitation Volumes of Southeast Asian Studies Presented to His Highness Prince Dhaninivat Kromamun Bidyalabh Brindhyakorn. The Siam Society, Bangkok, Thailand.

• H.H. Prince Dhani Nivat, “The Inscriptions of Wat Phra Jetubon,” Journal of the Siam Society. Vol. 26, Pt. 2. The Siam Society, Bangkok, Thailand.

• Hofbauer, Rudolf. “A Medical Retrospect of Thailand.” In Journal of the Thailand Research Society, 34: 183-200. Thailand Research Society, Bangkok, Thailand.

• Linrothe, Rob, (Editor). (2006). “Holy Madness: Portraits of Tantric Siddhas.” Rubin Museum of Art and Serindia Publications. New York and Chicago, USA.

• Miao, Yuan. (2002). “Dancing on Rooftops with Dragons: The Yoga of Joy.” The Philosophical Research Society, Los Angeles, USA.

• Massage School of Chiang Mai. (2006). Yogi Exercise “Lue Sri Dadton” Student Handbook. Massage School of Chiang Mai, Chiang Mai, Thailand.

• Matics, Kathleen Isabelle. (1978). An Historical Analysis of the Fine Arts at Wat Phra Chetuphon: A Repository of Ratanakosin Artistic Heritage, PhD Dissertation, New York University, New York, USA. Matics, K.I. (1977). “Medical Arts at Wat Pha Chetuphon: Various Rishi Statues.” In Journal of the Siam Society, 65:2: 2: 145-152. The Siam Society, Bangkok, Thailand.

• Norbu, Chogyal Namkhai. (2008). “Yantra Yoga: The Tibetan Yoga of Movement.” Snow Lion Publications, Ithaca, USA.

• Reusi Tevijo Yogi. Personal Communication. Bangkok and Chiang Mai, Thailand.

• Salguero, C. Pierce, (2007). “Traditional Thai Medicine: Buddhism, Animism and Ayurveda.” Hohm Press, Prescott, USA.

• Saraswati, Swami Satyananda. (2006). “Asana, Pranayama, Mudra, Bandha.” Bihar School of Yoga, Yoga Publications Trust, Munger, India.

• Schoeppl, Adolf. (1981). Textbook of Thai Traditional Manipulative Medicine, MPH Thesis, Mahidol University, Bangkok, Thailand.

• Sheposh, Joel. (2006). Reusi Dat Ton: Thai Style Exercises, Tao Mt., Charlottesville, USA.

• Subcharoen, Pennapa and Deewised Kunchana, (Editors). (1995). “The Hermits Art of Contorting: Thai Traditional Medicine.” The National Institute of Thai Traditional Medicine, Nontaburi, Thailand.

• Tulku, Tarthang. (1978). “Kum Nye Relaxation: Parts 1and 2.” Dharma Publishing, Berkeley, USA. Tulku, Tarthang. (2003). “Tibetan Relaxation: Kum Nye Massage and Movement.” Duncan Baird Publications, London, UK.

• Venerable Dhammasaro Bhikkhu. “Textbook of Basic Physical Training- Hermit Style (Rishi).” Wat Po. Bangkok, Thailand.

• Wat Po Thai Traditional Medical School, Ruesi Dat Ton; Student Handbook. Wat Po. Bangkok, Thailand. White, David Gordon. (1996). “The Alchemical Body: Siddha Traditions in Medieval India.” University of Chicago Press, Chicago, USA.

Thai Language 

• Ajan Pisit Benjamongkonware. (2007). “Twenty One Self Stretching Exercises (21 Ta Dat Ton).” Village Doctor Press, Bangkok, Thailand.

• Ajan Pisit Benjamongkonware. Personal Communication. Pisit’s Massage School, Bangkok, Thailand, Ajan Kong Kaew Veera Prajak (Professor of Ancient Languages). Personal Communication. The Ancient Manuscript and Inscription Department, National Library, Bangkok, Thailand.

• Chaya, Ooh E. (2006). “Thai Massage, Reusi Dat Ton: Therapy for Illness and Relaxation, (Nuat Thai, Reusi Dat Ton: Bam Bat Rok Pai Klie Klieat).” Pi Rim Press, Bangkok, Thailand.

• Karen Reusi. Personal Communication via Dr. Robert Steinmetz of Wildlife Fund Thailand. Thung Yai National Park in Kanchanaburi Province, Thailand,

• Mr. Kayat, (Editor). (1995). “Eighty Poses of Reusi Dat Ton, Wat Po (80 Ta Bat Reusi Dat Ton, Wat Po).” Pee Wa Tin Press, Bangkok, Thailand.

• Mulaniti Health Center. (1994). “41 Poses, The Art of Self Massage for Health, (41 Ta, Sinlaba Gan Nuat Don Eng Pua Sukapap).” Mulaniti Health Center, Bangkok, Thailand.

• Patanagit, Arun Rawee. (1994). “Body Exercise, Thai Style: Reusi Dat Ton, (Gan Brehan Rang Gie Bap Thai: Chut Reusi Dat Ton).” Petchkarat Press. Bangkok, Thailand.

• Saw Pai Noie. (2001). “Lang Neua Chop Lang Ya.” Sai Ton Press, Bangkok, Thailand.

• Sela Noie, Laeiat. (2000). “Amazing Thai Heritage: Reusi Dat Ton.” Dok Ya Press, Bangkok, Thailand. Subcharoen, Pennapa (Editor). (2004). “Handbook of Thai Style Exercise: 15 Basic Reusi Dat Ton Poses, (Ku Mu Gie Brehan Bap Thai Reusi Dat Ton 15 Ta).” Thai Traditional Medicine Development Foundation, Bangkok, Thailand.

• Subcharoen, Pennapa (Editor). (2006). “One Hundred Twenty Seven Thai Style Exercises, Reusi Dat Ton (127 Ta Gie Brehan Bap Thai, Reusi Dat Ton).” Thai Traditional Medicine Development Foundation, Bangkok, Thailand.

• Various authors commissioned by King Rama III. (1838). “The Book of Eighty Rishis Performing Posture Exercises to Cure Various Ailments (Samut Rup Reusi Dat Ton Kae Rok Tang Tang Baet Sip Rup).” (Also known as Samut Thai Kao) Housed in the National Library Bangkok, Thailand,

• Wat Po Thai Traditional Medicine School. (1990). “Reusi Dat Ton Handbook (Dam Ra Reusi Dat Ton Wat Po).” (Reproductions from the original Samut Thai Kao). Wat Po Press, Bangkok, Thailand.

• Wat Po Thai Traditional Medicine School. (1958). “The Book Of Medicine (Dam Ra Ya).” (Contains a Reusi Dat Ton section based on the same verses as the 1838 manuscript, Samut Thai Kao, but with completely different illustrations). Wat Po Press, Bangkok, Thailand.

• Weerapong Chidnok, Opor Weerapun, Chanchira Wasuntarawat, Parinya Lertsinthai and Ekawee Sripariwuth. (2007). “Effect of Ruesi-Dudton-Stretching-Exercise Training to Anaerobic Fitness in Healthy Sedentary Females.” Naresuan University Journal 2007; 15 (3) 205-214. Phittsanulok, Thailand.

This post appeared simultaneously on Patheos.com.

On Nov. 20, 2015, the Ottawa Sun reported that a free yoga class for students, organized by the University of Ottawa’s Centre for Students with Disabilities since 2008, had been discontinued due to student concerns about “cultural issues.” The decision to cancel the program—which was taught by a young Caucasian woman named Jennifer Scharfe—is reportedly the subject of continuing discussion within student government. In the meantime, the decision has inspired much news coverage and debate on social media.

The controversy comes at a sensitive time for institutions of higher education in North America. As many readers are no doubt aware, a wave of student protests demanding heightened attention to structural racism have been sweeping across campuses over the past several weeks. This is not the venue in which to debate the larger issue of racial justice vs. free speech on campus; however, I think that a historian’s perspective might add something to the conversation about yoga at the University of Ottawa, and on cultural appropriation more generally.

While I am not a historian of yoga per se, my academic research focuses on the crosscultural exchange of Buddhist ideas about health globally, and I specifically focus a great amount of attention on the many acts of appropriation that have accompanied this 2200-year-old historical process. (Full disclosure: in addition to my academic research, I am also a practitioner of several Asian traditions, including both Buddhism and yoga.) My approach to analyzing such instances in various historical periods, in a nutshell, is to try to make connections between broader sociopolitical contexts on the one hand, and the ways that individual people selectively deploy culture to make meaning in their daily lives on the other. The current controversy is a great case study for integrating these different levels of analysis.

The debate at Ottawa pits against one another two opposing interpretations of what yoga is all about. On the one hand, a spokesperson for the university’s Centre for Students with Disabilities framed the cancelled yoga classes as an example of neo-colonialism. A statement quoted in the Sun explains that since many cultures “have experienced oppression, cultural genocide and diasporas due to colonialism and western supremacy … we need to be mindful of this and how we express ourselves while practising yoga.” This perspective interprets the word “yoga” as referring to a cluster of beliefs, practices, and orientations associated with Indian religion. The evidence of yoga’s importance in contemporary Hinduism and in such ancient and medieval texts as the Bhagavad Gita, the Yoga Sutra of Patañjali, and the Yoga Upanishads (see Geoffrey Samuel‘s history of yoga) is incontrovertible.

When interpreted exclusively through this lens, the campus yoga class might indeed appear to be legitimizing neo-colonialism and therefore to be problematic. However, Scharfe’s responses to her critics clearly indicate that her interpretation of yoga has little to do with Hinduism. “I’m not pretending to be some enlightened yogi master, and the point (of the program) isn’t to educate people on the finer points of the ancient yogi scripture,” the Sun quotes her as saying. “The point is to get people to have higher physical awareness for their own physical health and enjoyment.” In an interview with the Washington Post a few days later, she disavowed any specific religion or spirituality altogether, saying, “I would never want anyone to think I was making some sort of spiritual claim other than the pure joy of being human that belongs to everyone free of religion.” Seeing the controversy exclusively from this second perspective, some commentators have written off the events in Ottawa as symptomatic of an overreaction, an “epidemic of censure” that prevents free speech and choice on campus and that stultifies contemporary college life.

So long as this debate is framed as a conflict between neo-colonialism and freedom of speech, mutual misunderstanding is guaranteed. Fortunately, examining the history of yoga can help us to better understand the two positions in this debate. Specifically, we need to ask the question: how has yoga gone from being a core part of Hindu religion to a secular physical practice on a North American campus?

Here, some recent books about the history of modern yoga can be quite helpful. The scholar of Indian religion David Gordon White has shown that during much of British colonial rule in India, yogis were ridiculed by British and elite Indians alike as superstitious and backwards, and feared as politically subversive. Recent books by Mark Singleton and Elizabeth De Michelis have demonstrated that the “modern postural yoga” that arose after this period of suppression was quite a different entity, with little connection to Tantric and religious precedents from the ancient and medieval periods. This modern yoga arose via late-19th- and early-20th-century interactions between the Theosophical Society, the YMCA, weight-lifters, swami-celebrities, and a host of Indian and European promoters. This yoga, they demonstrate, was explicitly designed for transnational consumption.

Although Hindu religious concepts were highlighted by some of these modern proponents—particularly by those that thought Orientalist images of the “mystical East” would appeal to Western adherents—modern postural yoga has since the late 19th century often been characterized by Indians and non-Indians alike as a secular fitness practice. It appears that it is this variety of yoga that was being taught at Ottawa. At least as far as we can judge from published quotes, for Scharfe, the word “yoga” refers not to a religious tradition but to one among many contemporary practices that can be pursued in the interests of wellbeing and happiness. In addition to yoga, this contemporary repertoire includes a range of other ostensibly Asian practices (such as tai-chi, martial arts, meditation, etc.), as well as countless others that are not particularly Asian in origin or connotation (counseling, life-coaching, jogging, art therapy, etc.).

To Scharfe and her students faced with this range of options for wellness, yoga may have seemed like a particularly attractive option. Indeed, one might argue that they have been coerced into thinking so. As Andrea Jain‘s recent book has highlighted, modern yoga has for decades been fully complicit in modern consumer culture. It is now a multi-billion-dollar industry with a powerful marketing machine. Its appeal has been enhanced by yoga’s increasing medicalization over the late 20th and 21st centuries—to the extent that there are now about 600 articles with “yoga” in their title listed in PubMed, a major online repository of scientific research. These health benefits have widely been touted in popular media such as Yoga Journal, and are now a part of the conventional self-help wisdom of mainstream North American popular culture. In fact, yoga is now practiced by 10% of the adult population in the US. From this perspective, their appearance at campus wellness centers such as at the University of Ottawa should be uncontroversial.

The history of modern yoga is too complex to get into any further detail here, and I highly recommend anyone interested in the current controversy to read Samuel, White, Singleton, De Michelis, and Jain’s books. My purpose in this post is not to try to settle the controversy definitively, but rather to point out the importance of analyzing the contending positions from a historical standpoint, and to encourage each reader to learn more about the history of yoga before they decide where they stand on the issue.

Is practicing modern yoga an objectionable form of cultural appropriation? The question is certainly more complicated than simple neo-colonialism vs. the freedom to choose a personal wellness practice. Neither a knee-jerk decision to cancel the class nor the casual dismissal of the critique is the right approach to take toward this issue—especially not on a university campus. Further research and analysis (in other words, an informed, sober, academic discussion) is what the students at the University of Ottawa should be engaged in as they move forward with their deliberations. This is also precisely the kind of thoughtfulness that each of us should bring to the table when we ourselves engage in yoga classes and other complex transnational aspects of our lived experience in the contemporary globalized world.

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.

Traditional Thai medicine is a holistic discipline involving extensive use of indigenous herbal and massage/pressure treatment combined with aspects of spirituality and mental wellbeing. Having been influenced by Indian and Chinese concepts of healing, traditional Thai medicine understands disease not as a physical matter alone, but also as an imbalance of the patient with his social and spiritual world.

Thai medical manuscripts written during the 19^th century give a broad overview of different methods of treatment and prevention, of the understanding and knowledge of the human body, mind/spirit and diseases. In 1831, King Rama III ordered the compilation of various medical treatises to be used as teaching materials for the newly established royal medical schools at Wat Phrachetuphon (Wat Pho) and Wat Ratcha-orot in Bangkok. Wat Phrachetuphon formally became the first Royal School of Medicine in 1889 and still runs a Thai Traditional Medical School today.

Medical manuals and handbooks (khamphi phaetsāt songkhro) describe the anatomy and physiology of the human body, diseases and their possible causes, and methods of diagnosis and treatment. Some of these books are finely illustrated with human figures and diagrams; sometimes the human figures themselves appear like diagrams, particularly in massage treatises (tamrā nūat). Other manuals contain knowledge in the field of midwifery and herbalist practices including recipes for the preparation and use of herbal medicines (tamrā yā samunphrai). Most of these manuals were based on the knowledge and texts used by the royal physicians at the Thai court. Thai traditional medicine can be traced back to the Dvaravati (6^th-13^th centuries) and Sukhothai (ca.1238-1438) kingdoms according to stone inscriptions and pharmaceutical artefacts. Under King Narai (1656-1688), the first Thai pharmacopeia known as ‘Tamra Phra Osot Phra Narai’ was compiled by royal physicians.

According to the medical treatises, the human body consists of 42 elements, belonging to four groups (earth, wind, water and fire). If one or several of these elements are in disorder, it causes disease. The traditional Thai physician would have to find out which elements were unbalanced and why, and then try to restore the balance between them. This could be achieved by various methods, which included treatment with herbal and other supporting natural remedies, pressure points massage and body or head massage, as well as physical exercise (Yoga), meditation and dieting – or a combination of several of these methods.

A massage manual from Bangkok (Or 13922, ff. 1-5)

This lavishly illustrated paper folding book (samut khoi) with black lacquered covers is a manual for pressure massage in Thai language and script. It describes the channels in the body terminating in pressure points and how pressure massage can be used to treat certain illnesses. It is believed that the book was produced at Wat Phrachetuphon, Bangkok, in the first half of the 19^th century as the text clearly relates to the medical inscriptions from that time on the walls of this royal temple, which is adjacent to the royal palace.

It begins with an unlabelled large gilded diagram of the human body (Or 13922, ff. 1-5, shown on the left). It gives an introductory overview of the network of channels within the body. The figure is shown wearing lavish gilt royal headgear and the main pressure points are also gilt, whereas the rest of the body has been drawn in black ink. The area around the navel is a central point where many channels start.

This manuscript can be viewed in full on our digitised manuscripts webpage.

The diagram below (Or 13922, f. 32) indicates the channels and main pressure areas of the body, stylistically represented by spiralling calligraphic lines. One channel known as pinkhalā, for instance, begins at the navel and proceeds past the base of the right leg to exit via the back. Another channel, the susumannā line proceeds from the navel into the chest, climbs through the body and exits through the tongue.

Or 13922, f. 32

In most of the diagrams, the pressure points are named and their functions are described in detail. The fleshy areas of the body are all neatly labelled as such, so that the book also gives insight into the Thai understanding of the human anatomy. Each illustration indicates the points of the body that can be treated with pressure massage, which diseases can be treated and how many times certain points have to be massaged.

Here the pressure point above the right eye is identified as the one for treating pains and infections of the eye as well as dizziness. In the middle of the forehead is a point for treating headaches, fevers and congestion of mucus and haemorrhage in the nasal passage. (Or 13922, f. 36)

Massage in traditional Thai society

Not only massage treatises, but also illustrated Buddhist manuscripts and literary texts provide evidence that massage treatments were very popular and frequently used at all levels of Thai society. Buddhist manuscripts, such as the first example above, often contain genre scenes from the everyday life of Buddhist monks and lay people.

Lively descriptions of situations where pressure massage was carried out can be found in one of the most notable Thai literary works, Khun Chang Khun Phaen, a lengthy narrative of love and death which began in a folk tradition of oral performance (sēphā), but was adopted by the royal court and transformed into written text in the early 19^th century. Quite often, it seems, pressure massage was the method of first choice in emergencies such as this (Chris Baker and Pasuk Phongpaichit (eds.),

The tale of Khun Chang Khun Phaen. Siam’s great folk epic of love and war. Chiang Mai, 2010, p. 236):

Her body was motionless. ‘Wanthong, oh Wanthong!’ No sound came in return. With body trembling, she shouted, ‘Servants! Come to help, quick!’ The servants all came up in a rush. They propped Wanthong up. They wept. They massaged both her legs. They pressed between her eyebrows to open her eyes. Siprajan cried out, ‘Softly, now! Why don’t you massage her jaw?’ She sat with a kaffir lime in her hand, staring vacantly. ‘Do everything you can, everything.’ Someone bit Wanthong’s big toe, and then she murmured.

Jana Igunma, Asia and African Studies

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