Review: Traditional Thai Medicine (2016)

Salguero, C. Pierce. Traditional Thai Medicine. Buddhism, Animism, Yoga, Ayurveda, Revised Edition. Bangkok: White Lotus, 2016. 120 pp.

   This book offers a very good introduction to the historical and cultural backgrounds of what the author calls "the Thai medical marketplace". Indeed, one of the strong theses of this book is that the peculiarity of Thai medicinal practice lies in its diversity. This diversity, the author claims, is not simply a plurality of suppliers, but a plurality that represents the changing and conditioned needs of the average Thai healthcare client. Contemporary efforts toward standardization, therefore, may prove fatal to the very essence of the system that it intends to regulate. The author claims that Traditional Thai Medicine (TTM), despite its many influences, or precisely because of its many influences, is unique and therefore cannot be simply described as an amalgam of foreign influences. I personally find the quest for origins and originality a non-problem, especially when it comes to national culture (whatever nation and culture are). There seems to be a need to prove that countries are, on the one hand, culturally indebted to other countries and, at the same time, they are unique, that is to say original. For instance, when we define Ayurveda (one of the influences of TTM) as "Indian", it is not totally clear to me what the qualifier "Indian" refers to. Does it refer to the modern republic of India? Or to the ancient civilisation? And if so, which ancient civilisation? Insofar as Indian civilisation is defined by (among other characteristics), the practice of Ayurveda, the argument becomes circular: the presence of Ayurveda in Thailand would indicate that Thailand belongs to the great Indian civilisation. But I understand this book is not the place to discuss such problems (or non-problems). Salguero's book gives a very broad perspective on TTM. Perhaps the uninitiated (like myself) will be surprised at the variety of human practices that are usually not considered part of medicine in the West, but are nevertheless recognised as therapeutic practices conductive to human well-being. The book is concise and well structured. It discusses different areas of TTM, from Ayurveda to incantations (mantras). I did not expect to find such a significant influence from Pali sources. In page 5 we learn that medical manuscripts are often revered as suttas, or even conferred higher authority. Medical books, mostly recipe collections, are worshipped as religious books. The Buddhist monastery is the place where medical instruments (medical technology) is to be found. A very good example of this, perhaps the medical temple par excellence, is Wat Pho in Bangkok. This monastery is well known to tourism, but it was initially built for the centralisation, propagation and revival of old medical traditions, including the yoga of the local ruesis (from Skt. ṛṣis, "sages"). In page 15 we learn that the idea of Rama III, the king who sponsored Wat Pho, was to make medical knowledge accessible to all. In other words, Wat Pho became a medical canon, its murals could be copied by any physician of the kingdom, free of charge. From the reign of Rama IV, King Mongkut (1851-1858) traditional and modern (Western) medicine follow different tracks. The reason that traditional techniques are not so well documented seems to be the reluctance of practitioners to reveal their recipes and techniques. This knowledge is transmitted orally, often secretly, in a teacher-disciple lineage.
   Chapter 2 surveys the diverse historical influence. The role of Theravada and the Pali canon is (surprisingly to me) very prominent, giving the "mythological" background for the discipline in the society. The narrative of Jivaka in the Vinaya takes the role of a foundational myth of medicine as a social institution (at least in the Buddhist world). Not only monasteries were medical centres, but also the Pali canon provides some of the earliest concepts in TTM such as the four mahābhūtas "great elements" (earth, water, fire, wind and, optionally, space), and also the concept of dosas (Skt. doṣas) "defects", that is to say imbalance of the humours (wind, phlegm, bile). Salguero reminds us that in the Pali texts medicine is labelled as "base and wrong means of livelihood". Perhaps this reference can lead to misunderstanding, because what is really wrong in a monk practising medicine is not the practice itself, but charging money for it. There is nothing ethically wrong with laypeople doing that for money, and nothing wrong with monks assisting someone free of charge. Therefore one should not consider monks practising medicine a breach of the Vinaya, unless they charge money for it. Another historical source of TTM is, as the title of the book says, Ayurveda. Ayurveda and the Pali canon share many concepts, the Pali being the oldest attestation. Another cardinal influence is tantra and yoga or Hatha Yoga. Anachronisms are difficult to avoid here: the earliest texts cited seem to be not older than 13th c. Interestingly massage and yoga are connected, as if massage is yoga done by another onto oneself, or yoga is a massage done by oneself. The principles and techniques are virtually the same. Tantra influence allegedly comes from the Khmer civilisation, where Shaiva Tantra and Mahayana were prominent traditions. Part of the old Khmer Empire is today territory of Eastern Thailand. Chinese and Western influence are also described in this chapter. Salguero points out that before the mid. 20th century, traditional medicine did not enjoy much respect from local authorities. In post-colonial time, however, with the rise of Asian nationalism, tradition received government support again.
   Chapter 3 is dedicated to Jivaka Kumarabhacca, the phyisician of the Buddha, well known by all Pali scholars. Indeed this personage is considered the father of Thai Medicine. Salguero himself opens his book with the salutation "Om namo Jivaka Kumarabhacca Pujaya" (p. iv). The figure of Jivaka, even if it is simply a myth, plays a very effective and specific role: it legitimises the practice of medicine as part of Buddhism and it works as a vanishing point for the origin of all medical traditions, thus giving unity to the diversity.
   Chapter 4 deals with TTM Theory, that is to say, with the principles and basic concepts of the different elements, dosas, different types of food according to their tastes that the ailments they cure, etc. Here we find concepts that are familiar to anyone familiar with Indian medicine. Comparative tables with Ayurveda are provided. 

Statues at Wat Pho, Bangkok. (Source)

Chapter 5 explores the theory behind traditional Thai massage. Thai massage is today well known all over the world. This chapter is very important because it underscores the medical principles behind, and not only the execution, of Thai massage. It dispels many misconceptions about this very old practice and helps understanding it beyond the vulgarisation of massage in present day. In massage theory, again, we find concepts such as nadīs "energy channels" (or I prefer to translate: "(life-)streams"), which are part of Tantra and Yoga philosophy. Salguero explains that among the community of practitioners, some do not resort to metaphysical explanations such as energy healing. Regardless of the theoretical frame, the result, in practice, seems to be the same. Practitioners who are more inclined to Western scientific explanations have recently found an experimental basis in the independent research by Thomas Myers

Chapter 6 examines the so-called Popular Healing Practices. Of course, the definition of "popular" is problematic, but here Salguero uses the term in the sense of non-official, i.e. outside government schools and examinations. The author, who has a long experience as a scholar and practitioner in Thailand, claims that these are the traditions that most common in Thailand today. The reader will perhaps be surprised that, among these medical practices, appeasement of ghosts, yantra, tatoos, magic amulets, incantations, and the tham khwan "calling of the soul" ritual are all included. The role of the Chinese community in the ritual of tham khwan is particularly interesting due to its sociological role. The approach to all these practices as medicine is certainly challenging if one comes from a modern European or Western mindset.
     In the last chapter, "Standardization vs. Diversity" Salguero elaborates on his vision of TTM as an inherently diversified medical marketplace that is capable of satisfying the equally varied medical needs of Thai society. The author observes that the tendency to remove superstition from traditional medicine may not lead to any significant change in real practice. A similar push for standardization promoted by Buddhist modernists has not been able to change the "popular" understanding and practice of Buddhism in Southeast Asia. Despite the attempt to separate Buddhism or Medicine from "local culture", it is very unlikely that this distinction will ever be accepted by the majority of the people, because if they are Buddhists, and if they believe in the most "scientific" side of traditional medicine, it is precisely because it is part of their local culture.  In this regard, I concur with Salguero's scepticism.
   The book ends with a Conclusion chapter that surveys the scholarship on Thai medicine. The book also contains a very useful annotated bibliography, apart from the general bibliography that also gives different reading options for those who would like to deepen on any of the many aspects of TTM.
   Despite its brevity, this is a very thoughtful and informative book on Thai Traditional Medicine. It puts many important issues on the table. It is not simply a history or survey of medical theories and practices, but an essay on the very limits of medicine and its fundamental nature, not in general, but in a particular human society with its particular needs. I am looking forward to reading other books by Pierce Salguero. I definitely recommend this book to anyone interested in the social dimension of Theravada Buddhism, in this case, medicine.