By Perry Garfinkel
Originally published in Massage & Bodywork magazine, January/February 2008.
Of the many Asian modalities that have been passed from East to West, Thailand’s traditional medicine and massage are among the more recent to gain popularity.
Now, as the technique sometimes referred to as “the lazy man’s yoga” draws more devotees, an interesting cross-pollination is beginning to occur—but this time it’s from West to East. Western approaches to both medicine and marketing are beginning to influence how Thai massage and medicine are practiced, researched, taught, and promoted, resulting in unique blendings of applications and adaptations.
Take, for example, Bangkok physician Krisna Piravej, an associate professor in the department of rehabilitation medicine at Chulalongkorn University. Faced with an increasing incidence of autism in Thailand and frustratingly few successful treatments, she resorted to a treatment so common in Thailand that most Western-trained doctors, even Thais, overlooked it —Thai massage. But, though many generations of Thai patients could offer anecdotal stories of its effectiveness, she knew that in order to convince her colleagues and her patients to try it, she needed to prove it worked. So she conducted a study that would meet the rigorous demands now required throughout the world of medical practices.
In her soon-to-be-published 2006 study, Piravej evaluated the difference in benefits between two groups of children with autism, one group treated only with standard behavioral therapy (sensory motor stimulation and occupational therapy), the other adding Thailand’s traditional massage techniques. Though the sampling was small—a dozen children ages three to ten, treated one hour twice a week for eight weeks—the results were strong enough to conduct further studies. The most encouraging finding, she said, was that all the parents of the massaged children were so satisfied with their kids’ behavioral improvements that they asked if the massage could continue after the study ended.
But science was what the medical community needed. “As teachers in the university hospital, we have the obligation to prove empirically these methods work, not just through word of mouth,” Piravej says.
Hers is one of fourteen similar studies funded by the five-year-old Department for Development of Thai Traditional and Alternative Medicine (DTAM), under the government’s Ministry of Public Health. Other DTAM-funded projects researching the efficacy of Thai massage target migraine headaches, myofascial pain, range-of-motion problems, and osteoarthritis. Still others examine the effectiveness of Thai herbal treatments on functional dyspepsia, acne vulgaris, influenza, and fever.
The impetus for setting up the department followed a 1980 Association of Southeast Asian Nation (ASEAN) Health Ministers’ resolution advocating “health for all by the year 2000.” But in the intervening years, “We found that Western medicine alone cannot achieve this end,” said Dr. Vichai Chokevivat, director general of the DTAM. “Each country—Brunei, Indonesia, Malaysia, the Philippines, Singapore, and Thailand—knew it had in its medicine chest this age-old treatment, which we call traditional medicine. But now, in modern times, belief is not enough. We have to offer evidence it works.”
Modern times—and Western influence—presented Thailand in particular with another obstacle to overcome with regard to validating its traditional medicines. To many American military men who served in Southeast Asia in the 1960s and 1970s, the phrase Thai massage has seedy associations.
“Thai massage meant sex to soldiers coming to Bangkok on R&R from Vietnam forty years ago,” Chokevivat says. Now, he says, he hopes his department’s studies will give legitimacy to its traditional healing approaches, as well as help turn travelers from sex tourism to spa and health tourism, both lucrative overlapping trends for which Thailand has become known as a top international destination. Though the DTAM’s annual budget of 120 million baht (an estimated $3.81 million US) is the smallest piece—less than 1 percent—of the Ministry of Public Health’s annual budget, it may be the government’s best investment. Backed by the Tourism Authority of Thailand (TAT) promotional campaigns that cleverly connect DTAM findings to the burgeoning spa and health travel boom, those segments have grown significantly.
Before the establishment of the DTAM, for example, the spa sector grew 64 percent from 2000 to 2002 in Thailand, according to a study undertaken by Intelligent Spas, an independent analyst. The number of spas jumped from 230 in 2002 to an estimated 450 today. In 2004, spas generated 5.3 billion baht (an estimated $168.3 million US) in revenue, exceeding the original target by nearly 10 percent, according to TAT.
In 2004, Thailand embarked on a five-year strategic plan, spearheaded by the Ministry of Public Health, to establish Thailand as the “center of excellent health” of Asia.
“Thailand’s spas are the new churches, the new meditation centers, and the new health clinics all rolled up into one,” says Patrick Ghielmetti, regional vice president of all four Four Seasons Hotels in Thailand and general manager of the Bangkok property. The Four Seasons Chiang Mai is a perennial award winner; it’s Conde Nast Traveller
UK’s 2007 Reader’s Award for world’s best spa.
“For a long time here, the hotel spa was considered an amenity—now it’s a key business revenue stream,” he says. “It used to be an up-sell, but now it has become a decision-maker for guests who won’t come unless we have a high-end spa that offers signature traditional Thai medicinal herbal and massage treatments. One big reason is it’s now got more to do with health than self-indulgent pampering.”
On the island of Phuket, at the Trisara, a small luxury hotel where each of forty-two rooms is a private villa and each villa has its own private pool, 100 percent of the guests book at least one treatment at the luxury beachfront hotel’s spa.
“The connection between the guest and the masseur has such healing power—and it’s often the most personal interaction he or she has with our staff—that we invest heavily in it because we know how desirable this whole signature Thai healing experience has become,” says general manager Anthony Lark, a native of Sydney, Australia, who has lived on Phuket and worked in its hospitality industry for nineteen years. On Trisara’s spa menu is traditional Thai massage (ninety minutes for $135), but to stay at the cutting edge the offerings also blend East and West, including Native American Indian-inspired Raindrop Therapy ($120 for one hour). Similarly nontraditional, the spa at the Four Seasons Resort Koh Samui, which opened in February 2007, offers treatments that complement the seasons and the elements. Its Space Nurture massage, available as a full moon approaches, uses lotions that blend warm mango butter, honey, and sweet orange oil, complemented with a scalp massage (3.5 hours for about $480).
A Deeply Rooted Tradition of Blending
As with much of Thailand’s history, the origins and evolution of the country’s traditional medical practices are a somewhat murky mishmash of various cultural influences and oral histories that freely intertwined fact and legend over thousands of years.
Nuad boran (meaning ancient massage), as it’s known by its Thai practitioners, is a two-thousand-year-old system said to have been brought to Siam by an Indian ayurvedic doctor named Jivaka Kumar Bhacca, revered as the father of Thai medicine, who was said to have treated the Buddha himself. A combination of other regional healing systems, it mostly draws on ayurveda from India and acupuncture from China.
In the simplest of terms, the theoretical basis for traditional Thai healing is rooted in the belief that all forms of life are sustained by a vital force (lom) carried along energy pathways (sen) that run through the body. It is believed that disease and dysfunction occur when these energy lines become blocked, much the same way cholesterol clogs arteries. Thai massage attempts to release the blockage and stimulate the natural flow of life force.
Though passed down orally among the common people, the principles and techniques were kept by the royal court in reference texts. When Burmese invaders destroyed the old capital of Ayuthaya in 1767, most of these texts were burned and lost. Remaining fragments of the texts, however, were commissioned to be redrawn as stone etchings by King Rama III in 1832. Today, more than sixty such epigraphs showing treatment points and energy lines are on public display at the famous Wat Pho temple complex in Bangkok, where the golden statue of the Reclining Buddha lies. In 1856, King Rama V appointed the royal doctors to also translate and edit Indian Pali and Sanskrit medical texts into a Thai version, called Medical Science Textbook, with another version known as Thai Massage Handbook.
Western medicine was introduced to Thailand in the middle of the nineteenth century, mainly by American missionaries, and traditional treatment approaches fell out of favor—another example of Western influence on Thailand. In 1962, as the story goes, the current King, Bhumibol Adulyadej, Rama IX, visited Wat Po and asked about Thai traditional medicine and particularly massage, which triggered renewed interest in it. A council of traditional medicine doctors was granted approval by the Ministry of Health to establish Wat Phra Chetuphon Thai Traditional Medicine Science School.
Since then, the so-called Wat Po style of massage evolved. One of the original teachers at that time, Ajahn Sintorn, eventually moved to Chiang Mai, where he started the Shivagakomarpaj Hospital, now called the Old Medicine Hospital. No longer serving as a hospital, it has become one of the best-known massage schools in the country.
The Double-Headed Dragon of East Meeting West
The attempts to corroborate Eastern approaches to healing by applying Western empirical testing is “a mixed blessing, a double-headed dragon,” says Pierce Salguero, perhaps the most knowledgeable Western authority on Thai traditional medicine. He has authored several books on the subject, studied it for five years in Thailand, and is currently completing his doctorate in the History of Medicine Department at the Johns Hopkins School of Medicine in Baltimore, Maryland.
“On the one hand, it breathes new life into traditions and practices, dramatically increasing their relevance and legitimacy on the world stage and making them marketable and exportable,” he says. “This awareness of and attention to them will preserve practices that could have been lost and forgotten altogether.
“On the other hand, the marketplace has forced a homogenization. What’s now called Thai traditional medicine is a standardized system that comes mainly from the top down, from Bangkok bureaucrats. We lose the regionally distinct knowledge practiced by ethnic minorities in the mountains of remote Thailand, for example, who use local plants and herbs. To a large extent, those village healers are the losers.”
Among the winners is the entire city of Chiang Mai, where Thai massage schools have become a growth industry.
“When I first came to Chiang Mai in 1997 to study, there were four or five schools,” Salguero recalls. “I was in a class with seven people.” Now there are some thirty schools, plus many other private teachers. Each class has between twenty and thirty students who sign up for five-day to two-week courses (average cost is about US $160).
Wasan Sintorn, the son of the Old Medicine School’s founder and now director, said twenty years ago about twenty non-Thai people took the course each year; last year he had four hundred. One of the reasons for the increase, he says, was good old marketing with a modern Western adaptation. “My father was a great doctor but not a good promoter,” he says. “When I took over, we made brochures, put up posters, and spread the word. But when we put up a website, things really took off. We got interest and inquiries from all over the world. Now the majority of our students are from the West.”
A former student, David Bliss, a twenty-eight-year-old New York massage practitioner who has lived in Thailand for seven years studying Thai traditional medicine and massage, says the techniques he has picked up are valuable assets to his body of knowledge as a health practitioner. But he remains ambivalent as to whether, even as a Westerner, accumulating data through the evidence-based medical model adds anything to his own knowledge of the body.
“Everyone here knows that massage and herbal treatments are good for you,” he says. “It’s the West that needs to validate it with science, because science is the religion of the West. This healing tradition is older than science. If anything, it’s science that should be questioned.”
Nonetheless, he conceded, if not for the interest from and influence of the West, Thai massage and medicine may well have become an all-but-forgotten healing relic, to be bronzed and displayed in some imaginary Museum of Endangered Healing Traditions. And that would have improved no one’s health.