Interview with Thai Traditional Medicine Master Sombat Traisri Silp

Thai Traditional Medicine (TTM) may be 1,000 – 12,000 years old, but is a science now…

For The Silk Road Kung Fu Friendship Tour Part 40, click here.

Mainland Southeast Asia in 1707 (excluding most of Myanmar and Malaysia). Author Nicolas Eynaud.

Thais are justifiably proud to be Thais, and the unique peacefulness of the culture, arts and so on provide all the substantiation for that needed. An obvious question is “Why are Thais so peaceful and reasonable?” Historically again and again they have proven to be willing to negotiate even in impossible situations, and somehow,more often than not, wrangle out a mutually beneficial solution without a fight and without being colonized. How exactly do they manage to keep doing that? Certainly, Buddhist philosophies of non-violence and extreme care to the preservation of all life have a lot to do with that.

Most modern Thai (T’ai) people emigrated from China to Thailand between the 8th and 10th centuries.  There are also substantial numbers of 2nd – 4th generation Chinese in Thailand, and a growing number of PRC immigrants since 2011. Those numbers receded during COVID-19 andincreased again in 2022.

At the same time, Thailand is as it always was, a crossroads from all directions and its medical systems most certainly included Traditional Chinese Medicine (TCM) just to the northeast, and Ayurveda medicine from India via the Ayutthaya Kingdom in what is now Southern Thailand, and just about every other major medical system previously known in history, combined with local knowledge and skills especially related to flora and fauna.

The relatively harmonious mosaics and blends of languages, cultures, and region-specific traditional food and medicines might have something to do with Thailand’s amazing reputation for being a neutral center for rest, relaxation,and TRADE for people from everywhere.A whole lot of bickering does not help trade and the livelihood of everyone involved, and so serenity rules at least this part of Thailand, almost always.One can only wonder at that. Interestingly, Thai massage and meditation appear prominently in most wholistic medical prescriptions in Thailand, forvery sound scientific reasons.

Brief Review of History of Medicine

The most famous of the ancient medical systems prior to the birth of Buddha Gautama (c. 500 CE) were Egyptian, Chinese, and Indian (Vedic). That these spread widely along the Silk Roads before 500 BCE is evidenced by concentric ripples of development during the “Three Ages,” Stone (a few million years to 4,000 - 2,000 BCE depending on region), Bronze (3300 to 1200 BCE) and Iron (starting in 1200 BCE in Asia, Europe and in the middle, the Fertile Crescent) outward from their origins and trading clusters.

Despite being a village until King Mangrai ordered a fortified city built in 1296, Chiang Mai, being along a major river, was “on the road” to progress across the continent in all directions from the most ancient times. Surrounded by hills – and in fact there is one right outside my window - it’s probably been a cozy spot for traveling primates for millions of years.

In 500 BCE in South Asia, the Burmans (including the Pye) were settling in northern Burma, pushing the Mon and Khmer peoples south and east. Iron was used for weapons and farming from south China in addition to various plant-based medicines.

1st Century BCE – 15th Century CE – Hindu and Buddhist Era in Southeast Asia

By 290 BCE Burma, Thailand, and the Malayan peninsula were on established Indian trade routes and visited by Hindu and Buddhist missionaries. The religions brought literacy (Sanskrit), art, architecture, and other influences.  Small Indian outposts and larger kingdoms began to appear along coastlines as bastions of Indian civilization.

From about the First Century BCE to the 15th Century CE was the Hindu-Buddhist Era in many coastal and inland areas of Southeast Asian kingdoms in Burma, Bhutan, Sri Lanka, Thailand, Indonesia, Malay Peninsula, Philippines, Cambodia and Champa. Political organizational structures, city states and confederacies were organized following Indian Hindu-Buddhist Mandala systems.

It is an excellent source of glycosides, tannins, and flavonoids. Cassia fistula is both the national tree and national flower of Thailand.In Thai language, it’s called ratchaphruek and the blossoms usually called dokkhun. Its yellow flowers symbolize Thai royalty.

Tribes may change but local flora and fauna remain the same. Simultaneously each major culture, ethnic, or language group has its own herbal and other medical treatments woven into the languages, song, legends, dances, and myths of its tribe. Even upon mass migrations there would be endless “leaks” from the old dominant inhabitants to the new regarding local flora and fauna and other resources via trade, intermarriage, slaves, etc. (Flora refers to all plant life and fauna refers to all animal life.)

Assuming previous presumptions are generally accurate, “Thai Traditional Medicine” is in fact thousands of years old, and a composite of truly indigenous “herbal” (leaf, flower, root, berry, stem and whole plant, moss, fungi, bone, you name it, etc.) teas, soups, salads and other foods, as well as massage and other branches of medicine from bone setting to meditation as of the past 25,000 years or so at least.But who knows? Meditation may be the natural state for humanity (and thus far old older than 25K years), and consciousness only filtered through the dichotomous (language/culture/ego-based) mind ensnared in “Maya” (Sanskrit “magic” or “illusion” from Hindu philosophy) and in “Nafs” (Arabic “ego” and animalistic desires) can so easily lead people astray.

Thai Massage

Other medical treatments for an enormous range of ailments include massage, and something akin to acupressure and creatively manipulated stretches to promote health, relieve tension, increase circulation, and in the hands of masters, medical treatment for a variety of more specific medical issues as we learn from the “Ajahn” (which means Master, professor, and Buddhist monk that maintained vows for 10+ years) in the interview below.

A guide to pressure points for use in 'Thai Yoga Massage' by Wellcome. Creative Commons Attribution 4.0.

“Knowledge of qi points and meridians, called Sen in Thai, and a variety of different ways to stimulate along those lines, is a licensed science and art in Thailand,”said Master of Thai Traditional Medicines Mr. Sombat Traisri Silp. Most people call him “Ajahn” at IDI Massage School, also known as Panyathai Thai Traditional Medicine Clinic. Selected parts of our interview are below.

Those indigenous traditional medical treatments over thousands of years borrowed occasionally from outside medical systems [like Mesopotamian, Egyptian, Chinese, Indian (Ayurvedic)] when they were found to be effective. Foreign medical knowledge and plants generally entered by ocean port and river cities and towns, large and small all around the land mass of Asia, west to Europe spreading around to more rural locals in between as a function of their geographic accessibility.

Greek doctors came much later in history and to a large extent sifted older systems adding their own indigenous medical arts and sciences to make something new.

Following that, the next series of great advancements in world medical knowledge came from Roman medicine, and after its collapse (“sacked” by the Visigoths in 410 CE; though some cite the year 476 CE), the Islamic Abbasid “Golden Age” (8th to 14th Century) and then again during the Renaissance in Western Europe beginning in the 16th Century.

Within each ethnicity and language tribe, there would always be the oldest and most knowledgeable medical person or persons who knew the most about the local flora and fauna. In ancient times they were revered. These days, masters can be found too, both in traditional medical clinics, and especially on farms.

https://www.ncbi.nlm.nih.gov/books/NBK92773/

https://www.ncbi.nlm.nih.gov/books/NBK350395/

https://www.who.int/initiatives/who-global-centre-for-traditional-medicine

The Reign of King Rama III (1782-1809): TTM knowledge and medicine formulas, diagrams of Nuad Thai (Thai massage) and Nuad pressure points were compiled and inscribed on marble tablets and placed on cloister’ walls of Wat Pho where people could visit and learn Thai traditional medicine. Wat Pho was therefore regarded as the first open university of Thailand the epigraphic archives of Wat Pho was registered by UNESCO as a "Memory of the World."

https://tpd.dtam.moph.go.th/images/oic/E-Book/TTM_PR_ENG_Final_resize.pdf

Also see: https://www.bangkokpost.com/thailand/general/780845/wat-pho-medical-wisdom-included-as-national-textbook, and

https://www.watpho.com/en/massage-school

Thai Traditional Medicine like most others has always been a unique blend of local indigenous wisdom/knowledge and learning from afar, however refinements on TTM picked up steam in the Sukhothai period (1238-1377 CE). Today…

“The practice of TTM can be divided into four main areas, i.e. Thai traditional medicine involving the diagnosis and treatment of diseases or symptoms based on TTM theories; Thai pharmacy involving the knowledge of herbal materials and its therapeutic value and the formulation and preparation of herbal medicines; Traditional Thai massage involving the therapy and treatment with therapeutic massage; and Traditional Midwifery involving prenatal care, assisting in childbirth, postnatal care, and newborn care.”

https://tpd.dtam.moph.go.th/images/oic/E-Book/TTM_PR_ENG_Final_resize.pdf

Interview with Master Sombat Traisri Silp (“Ajahn”)

Jan. 10, 2023 Panyathai Traditional and Alternative Medicine Center, Chiang Mai

Over the period of a couple of weeks I visited Panyathai Traditional and Alternative Medicine Clinic also called “IDI Thai Massage School,” several times and got to know and interview Master Sombat Traisri Silp, who is primarily a specialist in Thai Massage therapy and Thai Herbal medicines (root, bark, berry, branches, leaves, whole plants, mushrooms, mosses and so on). At the age of 70, he is still very active and enjoying excellent health.

This story is partly recorded via video here.

The Thai Traditional Medicine Clinic/Massage school has a website, but its in Thai.Fortunately, one can paste the URL into Google and there is a “right-click option” to translate it into English. That procedure can introduce Panyathai’s general curriculum, medical and referral services, photos and videos.

Interview with translation assistance by Jitti Kongjitt

January 10, 2023: First impressions wheeling up on the south road border of Chiang Mai’s Old Town include “How picturesque,” and when I saw his clinic “This place is distinguished,” because indeed it is by its three stories of classic architecture, kept in perfect condition. In some ways walking inwas like entering any small neighborhood medical clinic, but in other ways distinctly different. Most powerful is the smell of medicinal herbs. They have an herbal medicine pharmacy on the first floor.Does it smell the same as Chinese herbal medicine pharmacies? Each herbal medicine pharmacy smells a bit different due to the use of local herbal medicines, and the purchasing manager’s decisions, but they all smell more or less the same. It smells good,like back to the Garden of Eden good.

I was escorted in by a man I thought in his early thirties, but later found out was in his early fifties. Speaking English quite well, his name was Jitti Kongjitt and commonly known as “Tu.”

The Master of Thai Traditional Medicines Mr. Sombat TraisriSilp, was referred to me by Professor Bannakij, MD, Dean of the faculty of Medicine at Chiang Mai University.

If one goes to Google and types in "Chiang Mai + Thai Traditional Medicine," one finds 1,730,000 results. Some might be ordinary Thai massage parlors, some might be extraordinary clinics, some are closed and so on. Clearly a referral was necessary.

Ajahn

I learned from Tu that he and most Thais refer to Master Sombat as “Ajahn,” Thai for “professor” or “Master.”

Upstairs I met Ajahn, and we went into a large elegant room with a dual use livingroom-like environment and maybe play space for kids on one side, Ajahn’s desk with a smaller collection of herbs than downstairs behind.

First, I found his clinic has been in operation since 2004. Curious about why he became interested in Thai Traditional Medicine (TTM), I asked, and he explained thatat the age of 44, he had a problem with his arm resulting from an injury at C-7 vertebrae. He tried one doctor after another and declined offers for surgical treatment.Then he tried massage therapy, specifically whole-body massage for two hours a day for five days. That helped.

He then spent 12 years studying different Thai massage styles and techniques. There were no written curricula at that time, but rather oral traditions passed down in each region. Since those days, there is now a Thai Traditional Medicine Council that has licensing requirements for certification as a Thai Traditional Massage Therapist, and Thai Traditional Massage Therapist Assistant, with seven schools in Chiang Mai licensed to provide the instruction necessary for that certification.

During that time, he has mastered other branches of TTM including what are called herbal medicines but includes roots, leaf-based (herbs), stems, bark, fruits and flowers and in some cases the whole plant.There are also certifications for Midwifery.

He said that this year,there were 14 students at his school applying for Certification in Thai Traditional Medicine. The training period for that is three years. TTM pharmacy requires a two-year study program, midwifery, one, and massage, two years.

Ajahn stressed the need for preventative medicine, including massage, and I could not agree with him more. They provide in-house massage training classes for certification at the Clinic.

Herbal Medicine

He also mentioned that the herbal medicines fit into categories labeled by the four elements: Earth, Water, Fire, and Wind. Individually and collectively they “give energy,” he said. He also mentioned his pharmacy has between 300-400 herbal medicines at any one time.

I asked him about the most common problems he has to deal with, and he mentioned:

1) Detox and for that he has a five-herb treatment called “Ya Tai Ka Sai.”

2) Sleep for which he has a formula called: Klom-Nung-Non

3) Gastric help and digestion

4) Overall circulatory

5) Cathartic described as “pull out, release pain of fever.”

Ajahn mentioned that such treatments are much more effective with massage and the massage should continue for health adding that 7 – 9 traditional herbs and massage combined are effective in improving sexual function. Incidentally, he is 70 and smiles quite easily.

Ajahn’s endorsement of massage as treatment for a very wide range of medical and psychological disorders is directly from his broad knowledge of and experience with it.

Science and Thai Massage

“Nuad Thai,” traditional Thai massage, inscribed in UNESCO’s Representative List of the Intangible Cultural Heritage of Humanity on 12 December 2019, is important local wisdom of Thailand (UNESCO, 2019).”

A search by this writer of the National Library of Medicine’s database for “Thai Massage” yielded 191 article research results and the reports consistently find Thai Massages effective in treating a very wide range of medical problems, even compared with some standard medical treatments for healing, from Ibuprofen to the “Hermit Exercise” for spinal injuries (Boonruab J, et. al., 2021 and on YouTube) in addition to chronic pain and other common disorders. Other studies have demonstrated that Thai Massage enhances the immune system in the elderly by way of T helper cells sometimes called CD4+ cells or CD4-positive cells, that function in a remarkable number of ways in the adaptive immune system. A wider search for Thai Massage without the quotation marks yielded 998 results again with very positive results reported.

Evolution of Licensing Traditional and Alternative Medicines in Thailand

The Protection and Promotion of Thai Traditional Medicine Knowledge Act was passed in B.E. 2542 (1997).The Thai Traditional Medicine Act was promulgated in 1999. In 2011, the Department of Thai Traditional and Alternative Medicine was created, followed by the Thai Traditional Medicine Council Act.

For a free book on Thai Traditional Medicine including a more complete list of government actions enhancing the professionalism of the TTM industry leading to today’s increasingly popular reliance on Thai Traditional Medicine, see PDF:

https://tpd.dtam.moph.go.th/images/oic/E-Book/TTM_PR_ENG_Final_resize.pdf

Asked about his background in western medical science he responded he previously worked as a lecturer in biomedical sciences at Chiang Mai University, and had a Master’s Degree from Mahidol University.

On the subject of TTM he mentioned the zodiac and its relationship to the five elements, and the relevancy of temperature and season, age stage and even the time of day in regard to specific treatments.

“Treatment of every individual in Thai Medicine is very specific,” said Ajahn.

The research on health benefits derived from massage therapy is extensive. One review article summarized:

“…massage therapy has been shown to have beneficial effects on varying conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564319/

As for the superiority of local fruits and vegetables over those transported great distances, that may be because they are likely to be fresher and therefore in many cases of greater nutritional value than fruits and vegetables that experienced long-distance transport. But who knows?

Not surprisingly Ajahn is working on different research projects with a few universities, including one that is testing his clinics TTM COVID-Treatment mix of fiveplants; however, he mentioned funding for more research is never sufficient. I took photos of the glass jars with the four plants used in his COVID-19 treatment formula.

I checked out one at random on the National Library of Medicine online site. This is what I found:

Raihan SZ, Biswas P, Monir MM, Biswas SK, Chowdhury A, Rahman AK. Phytochemical investigation and in vitro antinociceptive activity of Clerodendrum indicum leaves. Pak J Biol Sci. 2012 Feb 1;15(3):152-5. doi: 10.3923/pjbs.2012.152.155. PMID: 22866546. https://pubmed.ncbi.nlm.nih.gov/22866546/

The jar above looks like dried stem, none-the-less conclusions of that study were that the leaves of the plant function as an effective antinociceptive agent, which means acted as an effective analgesic (pain killer) potentially without side effects such as sometimes found with NSAIDS, “justifying its folkloric use as analgesics and further research is necessary to isolate the principle phytochemical constituent(s) responsible for this activity.” So, it looks all good for Clerodendrum indicum leaves at least.

Ajahn’s belief that buying local fruits and vegetables at what are sometimes called “farmers’ markets” might have substantiation from psychology, via local community networks that appreciate those that buy local products. On the other hand, who knows? There could be subtler processes at work, like those proposed by Feng Shui.

Meditation

He also mentioned the importance of meditation for healing. A search on the National Library of Medicine site for “Meditation” yielded 9,200 results, with the results generally quite favorable in the treatment of a myriad of ailments.

Some key points about mindfulness

From: Tang et al, 2015

Key Points

It is proposed that the mechanism through which mindfulness meditation exerts its effects is a process of enhanced self-regulation, including attention control, emotion regulation and self-awareness.

Research on mindfulness meditation faces a number of important challenges in study design that limit the interpretation of existing studies.

A number of changes in brain structure have been related to mindfulness meditation.

Mindfulness practice enhances attention. The anterior cingulate cortex is the region associated with attention in which changes in activity and/or structure in response to mindfulness meditation are most consistently reported.

Mindfulness practice improves emotion regulation and reduces stress. Fronto-limbic networks involved in these processes show various patterns of engagement by mindfulness meditation.

Meditation practice has the potential to affect self-referential processing and improve present-moment awareness. The default mode networks — including the midline prefrontal cortex and posterior cingulate cortex, which support self-awareness — could be altered following mindfulness training.

Mindfulness meditation has potential for the treatment of clinical disorders and might facilitate the cultivation of a healthy mind and increased well-being.

Future research into mindfulness meditation should use randomized and actively controlled longitudinal studies with large sample sizes to validate previous findings.

The effects of mindfulness practice on neural structure and function need to be linked to behavioral performance, such as cognitive, affective and social functioning, in future research.

The complex mental state of mindfulness is likely to be supported by the large-scale brain networks; future work should take this into account rather than being restricted to activations in single brain areas.

Tang, YY., Hölzel, B. & Posner, M. The neuroscience of mindfulness meditation. Nat Rev Neurosci 16, 213–225 (2015). https://doi.org/10.1038/nrn3916

https://www.nature.com/articles/nrn3916

Further elaborating on the benefits of meditation he added that “the power of mind is the major part of the power of life” and “the mind can control the body.”

Regional variations in recommended TTM diet

Ajahn explained that diets are also very specific. “North and south diets are very different due to geography,” using as an example a northern Thai soup called Kaeng-Kae (that can be picked up in the wet market) and its usefulness particularly for those in the north.

He added that in northeast Thailand there is Kaeng Aom regional soup, stressing the importance of regional herbs. In the south he mentioned Kao Yum rice mixed with regional salad with chili and or shrimp paste.

His recommendation was that people in general benefit from consuming at least one meal a week of the local traditional medical foods such as mentioned above.

“Those seasonal meals should be supplemented with other foods including local regional fruit emphasizing that people ensure their food is free of pesticides, preservatives and artificial colors,” he added.

At least a few of the most prescribedTCM medicines I mentioned to Ajahn, he recognized and responded with the Thai name that was rather similar, like Chinese Gancao became Gangko. Other herbs we talked about included Gingko leaf, from what may be the oldest species of tree, and Guava leaf, with "Guava leaf" in parenthesis, yielding 104 results on the National Library of Medicine site as medical treatment for an amazing array of medical disorders. It is widely used around Asia and the Pacific. Cinnamon and ginger are probably two of the most used “practical” traditional medicines used here. Thai ginger is different from Chinese, and in markets one will mostly find the varieties from further northeast.

Prevention

At least three or four times during our interview Ajahn mentioned the primary importance of prevention as compared to treatment of medical and psychological disorders. His primary prevention treatment advice appeared to be regular massage and eating at least one meal of local TTM a week and more local and seasonal fruits and vegetables.

Nine classifications of tastes for a healthy diet

They are:

1. Faad – Wound healing (related to wound healing)

2. Sweet

3. Toxic

4. Bitter

5. Salt

6. Sour

7. Fragrant (like jasmine and rose, thyme and sage)

8. Spicy (hot with ginger as an example)

9. Non-saturated oils from grain, sesame, coconuts and so on

Research

Ajahn is working in conjunction with researchers at several different universities including Mae-Fah-Luang University, Maejo University, and Chiang Mai University on TTM.

He also gave me an excellent book titled Traditional Herbal Medicine in Northern Thailand by Viggo Brun and Trond Shumacher, first published California Press 1987 and later by White Lotus Co. Ltd. Their research was extensive, interviewing and using records from TTM practitioners all around the North, and among other things they made a “disease reference map,” with the largest groups being skin diseases, digestive and urinary systems, and respiratory systems. The List of Medicinal Plants collected in Chiang Mai is more than 50 pages long and includes the vernacular name, locality, medical use, part of plant used and preparation and administration. That is an outstanding achievement.

After that splendid interview I had a most delicious TTM lunch with Tu as Ajahn had other business to attend to. In Thai language: “delicious” is “ah roi.”

January 12, 10AM Small medical conference: “Ha-Rak”

On this morning there was a short one hour or so medical conference at the Panyathai Traditional and Alternative Medical Clinic attended primarily by researchers from Mae Fah Luang University. The topic was updates on various parts of the research project initiated by Ajahn on a combination of five plant substances in a herbal formula treatment for COVID-19 he calls Ha-Rak. “Ha” incidentally means “five” in Thai language. Though I used a translate APP to catch parts of the discussion, there was a bit I missed, and Tu filled in.

Having worked as a senior editor with many research teams before, I’ve found they usually divide up research into various parts, with one or two or more writing each of the Introduction, Methods, Results and Discussion sections, and then some small committee of faculty examining it, with the original writers defending their decisions.

Over the following months, I stopped there several times, usually to chat with Tu who is also involved in co-teaching a massage class preparing to take one of several license tests. One afternoon while waiting for a friend I looked around another clinic.