Article
Colleen Ryan *Boonyong Keiwkarnka **
Manirul Islam Khan ***
* Tulane University, School of Public Health and Tropical Medicine, USA
** Director, ASEAN Institute for Health Development, Mahidol University, Thailand
*** Foreign Lecturer, ASEAN Institute for Health Development, Mahidol University, Thailand
Abstract
Traditional Thai medicine is an integral part of the culture of Thailand and more importantly the healthcare
system. Until recently traditional healthcare had lost its popularity due to the introduction of Western therapies,
but fortunately once again is seeing a revival of interest among Thai people. By prescribing traditional Thai
medicines in conjunction with Western medicines there is a wider variety of treatment options for the practitio-
ner thereby, optimizing patient health. One powerful, yet misunderstood, therapy is traditional Thai massage.
Very obvious and reproducible health benefits are known by patients and practitioners of Traditional Thai
massage, yet still there are very few scientific studies to back these claims. This paper focuses on the history,
theories, treatment, and health benefits of traditional Thai massage in order to foster a better understanding of
this ancient therapy.
Scientists of western medicine do not tend to study and treat the human body holistically as
traditional
healers do, but rather as diseased parts. Little is known about the causal relationship between traditional
treatments and the health benefits largely due to lack of scientific research. However the benefits are quite
obvious and reproducible. More research about Traditional Thai Massage needs to be undertaken to demystify
and to legitimize this powerful therapy.
INTRODUCTION
Thai traditional massage is an ancient form of heal-
ing that has been practiced in conjunction with other
traditional medicines in Thailand for thousands of years.
Unfortunately, there are many misconceptions about
traditional Thai massage. In the last century the validity
of traditional Thai massage has been questioned due to the
number of illegitimate Thai massage parlors operating
throughout Thailand. The tarnished reputation of Thai
massage hascaused the validity of the practice and its health
benefits to be questioned (3).
Traditional Thai Massage is an important aspect of
the Primary Health Care system in Thailand. The founda-
tion of Primary Health Care System emphasizes the role
of the individual and his responsibility for his health. By
utilizing Traditional Thai Massage as a means of
preventive and curative care the Thai community can
inexpensively and actively take responsibility for their own
health.Traditional Thai Medicine is an effective
treatment for many different ailments used in conjunction
with other treatments and also alone. This paper focuses
on the history, theories, treatment, and health benefits of
traditional Thai massage in order to foster a better
understanding of the therapy.
Theoretical Foundation of Thai Massage
Western medical doctors and scientists still
are baffled by the apparent relief of pain and cure of
diseases brought on by the eastern methods of energy
manipulation, including traditional Thai massage.
This concept of an energetic life-force is not unique to
Thailand and is found in many other eastern countries (3).
In traditional Thai massage the Indian influence is
unmistakable because the concept clearly originates from
Yoga philosophy. Theoretically, traditional Thai
Massage focuses on an invisible energy body that
surrounds the physical body. Yoga philosophy contends that
this energy body is the energy that sustains life. The energy
of life is absorbed through the air breathed and the food
eaten by the individual. Traditional Thai massage is
based on this concept of an invisible energy body
surrounding every individual being (ibid).
An individual’s energy body may be comprised of
over 72,000 individual energy lines. The individual’s ฃ
energy body is divided into ten main energy lines called
Sen that supply the organs with vital energy, the life force.
Traditional Thai Massage focuses on manipulating the
energy on the 10 main Sen Lines, which are similar to
the meridians of the Japanese and Chinese. Because the
energy body is an invisible extension of the physical body,
it can not be verified by sight and the energy lines also
can not be seen (ibid). Anatomically, the Sen lines do
not correspond with the paths of the blood vessels or the
lymph vessels. Though several Thai traditional medical
theories feature many parallels with India’s Ayurvedic
healing tradition and Chinese medicine’s accupressure, in
practice, Thai diagnostic and therapeutic techniques may
differ to some degree. (5).
Traditional Thai massage is known by several
different names, Ancient Massage, Passive Yoga, and
Yoga Massage Therapy.The latter names are more
descriptive and illustrative of an actual Thai traditional
massage. Thai traditional massage is a compilation of
Hatha Yoga postures and energy work (3).
The practitioner applies Yoga poses, asanas, and
simultaneously manipulates energy along the energy lines
of the patient. Several main accupressure points are found
along the Sen Lines. By working the accupressure points
located on these lines, manipulating the energy on these
lines, stagnated energy and energy blockages are released,
restoring balance and creating energetic harmony (6).
Diagnostic Approach of Thai Health Practitioners
The approach of traditional Thai Medical practitio-
ners towards an individual patient’s health is generally
more holistic than the more conventional ideology
subscribed to by western allopathic doctors. Western
science typically encourages diagnoses to be focused more
on the individual diseased parts of the body rather than the
whole patient – body, mind, and spirit. Similar to health
practitioners in the west, traditional Thai medical practitioners also perform the diagnoses of their patients
by evaluating the pulse, heartbeat, skin color and texture,
body temperature, abnormal physical symptoms and bodily
excretions. However, unlike their western counterparts
the approach of traditional Thai medical practitioners
towards their patient’s health encompasses internal,
external, and psycho-social conditions as well (5).
Due to the broader scope of patient healthcare
provided by Thai medical practitioners, a wider variety of
treatment options are available to them. They tend to use
a combination of indigenous medical treatments and
western allopathic treatments. Three broad treatment cat-
egories encompass the many different traditional healing
therapies. Once a patient is diagnosed, healing therapy
can be prescribed from any of the following categories of
traditional Thai medicine: traditional Thai massage,
herbal medicines and psycho-spiritual healing. Treatment
aspects from each of these categories often are used alone,
in conjunction with each other,or in conjunction with
Western technologies, depending on the diagnosis. Thereby,
the range of treatment options are increased (ibid).
Medical diagnoses made through traditional Thai
Medicine also reflect the deep-rooted beliefs in the
supernatural, astrology, and the principles of equilibrium
of the four basic elements—earth, water, wind and fire.
The four basic elements are generally found in the
teachings of Buddha (4). Medically, each of the four
elements refers to specific parts of the physical body. When
the internal elements are out of balance with each other
and with external environmental elements, disease and
injury of the physical body, mind and spirit can result (7).
Earth, din, refers to all solid parts of the physical body
including: skeleton, muscles, blood vessels, flesh,
tendons, organs, skin, and nails. Water, nam, refers to
fluids present in the physical body including: blood, tears,
perspiration, urine, and other bodily secretions. Fire, fai,
represents processes that warm the body including: diges-
tion system and the metabolic system. Air, lom, also
refers to invisible systems in the physical body including:
the respiratory system and the circulatory system. By using
a variety of techniques to release energy blockages, the
goal of Traditional Thai Massage, also known as nuad
phaen boran is equilibrium of the four elements leading to
optimal health (5, 7).
Treatment
The focus of traditional Thai massage is completely
different from a western style of massage, like the Swed-
ish massage. In traditional Thai massage the attention
given to the physical body is secondary; therefore, the
kneading and intense stroking characteristics of Western
massage are noticeably absent (3). In a traditional Thai
massage the main focus is on the energy body creating
harmony and balance.
Traditional Thai massage incorporates soothing
massage techniques, including gentle muscular stretches
of Hatha yoga, which is energizing, and thumbing tech-
niques similar to accupressure, which is stimulating.
Patterns of gentle rocking, thumbing, and rhythmic palm-
ing ease the body into a deeply relaxed meditative state
(6). However, it must be noted that the experience of
traditional Thai massage is not altogether pleasant, and it
can be quite painful.
By pressing various points along the Sen Lines, the
massage stimulates and restores the natural flow of energy
throughout the body. By manipulating the energy body,
energy blockages are removed balancing the essence of
life, earth, air, wind, and fire. As these elements of the
invisible energy body become balanced, pain, discomfort,
illness, and disease are reduced and eliminated (3,5,7).
In traditional Thai massage the practitioner uses
almost every part of his own body to achieve this
equilibrium in his patient. He uses his hands, feet, legs,
forearms, knees, thumbs, and elbows to apply the needed
pressure to release blockages that are impeding flow of
energy (6). The practitioner should ask the recipient of
any health problems or concerns before the massage is
given. This is important for several reasons. The practi-
tioner needs to tailor his massage to each recipient
according to his ailments and because some of the
positions in a traditional Thai massage have counter-
indications that could be detrimental to the health of the
patient.
The shoulders, upper back, and neck also harbor
energy blockages leading to tension and stress. By stimu-
lating the flow of energy on either side of the spine along
the Sen Lines and through the gentle Yoga poses, Thai
massage has numerous effects on the back and shoulders.
Smooth energy flow in this area can strengthen and lengthen
the spine and alleviate lower back pain. Traditional Thai
massage and Yoga postures like the spinal twists help to
release blocked energy (6). The head and face massages
are generally administered lastly to the patient. Not only
does this feel exceptionally nice for the patient there are
many therapeutic powerful accupressure points are located
on the face and head. The entire body should be massaged
in order to experience the health benefits of massage.
Unfortunately, time restraints often do not allow each person
to receive the entire massage from head to toe. Should
this be the case, massages have to be modified.
Though there are certain conditions that must be consid-
ered, traditional Thai massage can be given to virtually
any patient. Initially, the masseuse must modify the
treatment depending on the patient’s health status making
it more or less intense depending on the patient’s age,
health status, and sex (6). Additionally, giving the same
massage to every patient could potentially be counter-
productive because every patient is different, each having
unique individual healing needs. Several variations of
almost every pose exist in traditional Thai massage with
some being more suitable than others for different people
(3). For example, some patients are extraordinarily
flexible and others (especially Westerners) are extremely
stiff. The practitioner must be able to adjust the intensity
of the massage to compensate for the different levels of
flexibility of the patients.
The Indian influence in Traditional Thai Massage is
evident in the various yoga stretches that are administered
to the patient during the massage (3). The practitioner
manipulates the energy field and muscular-skeletal
system of the patient passively into yoga positions (6).
Passive Yoga refers to the practitioner’s gentle stretches
where various muscles, joints, tendons, and ligaments are
stretched smoothly and not forcibly. They are not stretched
beyond their natural capacity; therefore, there is little
resistance to the natural passive stretching. The effect of
slowly, rhythmically stretching the body has a calming
effect on the nerves. Subsequently, as the nerves become
tranquil the emotions do too further alleviating stress and
tension (8). The stretching movements affect the entire
body. By releasing both superficial and deep tension, the
patient’s body is re-educated and ultimately the patient’s
posture improves(6).
Because balance of the four elements of water, earth,
air, and fire is the ultimate goal of traditional Thai
massage, neglecting certain parts of the body could lead
to imbalance in other areas possibly resulting in illness or
disease. Though there is no strict order to follow, most
traditional practitioners begin the massage with the patient’s
feet moving upward towards the head.
Beginning with the feet creates a meditative,
relaxed state for both patient and practitioner. The feet
have many accupressure points that affect other parts of
the body. Following the feet, the energy lines and thus
the corresponding accupressure points of the legs are
massaged with palm pressure and deep thumb pressure.
They are also passively stretched to their natural
resistance point with Hatha Yoga positions applied by he
practitioner. These single and double leg stretches in
coordination with the palming and thumbing increase
mobility and encourage the hips to open alleviating lower
back pain (6). Because many people harbor emotional
energy and tension in the abdomen in or near their internal
organs, which can negatively affect their functioning lead-
ing to illness like constipation or indigestion, an abdomen
massage is also performed. The next area massaged
is generally the chest followed by a massage of the arms
and hands. The chest is home to the heart chakra, which
is a large energy body that holds emotional energy
blockages. The hands have many accupressure points that
can have a positive impact on health, including elimina-
tion of symptoms associated with migraine headaches,
menstrualcramps, and insomnia (3).
Physiological Affects
Traditional Thai massage offers many physical and
mental health benefits. Traditional Thai massage stimu-
lates all organs of the body and balances all systems of
the body making it a powerful therapy for physical and
emotional problems (6). During a traditional Thai
massage gentle pressure is applied to the internal organs
of the abdomen with the different Yoga postures and
the abdomen-massage. Studies done on Hatha Yoga
positions have shown this stimulation to cause the
internal organs to begin functioning at their highest
capacity. This will cause an improvement in digestion,
nutrient absorption, waste elimination, and the circulation
of blood and lymph (9).
The slight pressure changes in the abdomen and
internal organs (stomach, colon, urinary bladder, etc.)
during Yoga poses result in a stimulation of the
visceroceptor cells, which are sensitive to stretching. These
receptor cells send sensory impulses to the autonomic
nervous system and bring about a stretch reflex. The stretch
reflex is initiated in the lower portion of the hypothalamus
and is involuntarily regulated through a proprioceptive
feedback mechanism. The higher mind is not being stimu-
lated and therefore is inactive. Due to the autonomic
effect, balance is achieved in this way and emotions are
unable to bring about their usual effect. Thus, emotional
balance is also established. The emotional activity of
the individual decreases and deep relaxation begins.
This has an important effect on health. Emotional imbal-
ance due to emotional conflicts, stress, fickleness and
instability is thereby corrected by the passive stretching
and gentle massage given to the patient (8).
The increased circulation and pressure changes
brought about in the pelvic region also promote and
preserve the health of the endocrine glands. When
common cold, abdominal pain, digestive disorders,
headache, stiff neck, shoulder pain, back pain, fever,
urinary tract problems, liver disease, diseases of the
gall bladder, hernia, leg and arm paralysis, knee pain,
jaundice, arthritis, shock, sinusitis, epilepsy,
cardio-respiratory centers are calmed down there is
no extra demand for energy and oxygen from the
muscles. With Traditional Thai massage there is no
undue stress on the cardiovascular, skeletal, respiratory
systems as there is in some western therapies. Because
of the restoration of the parasympathetic predominance
in the body instead of irritation, ego-inflation, and
tension the patient feels calm quiet, pleasant, exhila-
rated, euphoric, and relaxed. This can have long term
effects on the individual patient in stress reduction
(ibid).
The static and passive stretching of the spinal
column, the muscles and the ligaments increases
blood circulation around the joints in these parts of the
body. Due to the improvement in circulation, the body
receives better nourishment assisting the periosteum,
the covering at the end of the bone, in effective and easy
removal of toxic waste products of the joint (ibid).
A good massage after strenuous activity will help the
muscles rid themselves of these waste products reducing
stiffness and soreness. The blood has more oxygen
dissolved in it, bathing the internal organs in oxygen rich
blood, boosting the immune system, allowing the body to
fend off more disease (9). These applied exercises also
improve flexibility, joint mobility, elasticity of the spine,
and posture. The range of freedom of an individual and
the coordination are also improved (6).
Although traditional Thai massage has long-term
health effects, the patient may become aware of several
immediate reactions after the release of energy. Some
of the more common experiences following massage therapy
include bouts of depression, sleeplessness, exhaustion,
and extreme happiness. It is not uncommon for patients to
have more physical ailments as well like diarrhea or
nausea. Although some symptoms are uncomfortable, they
are actually necessary for balance, equilibrium, and
ultimately healing (3).
The following partial list reveals the wide variety of
ailments a traditional Thai massage could improve
upon: asthma, bronchitis, heart disease, angina, nausea,
nasal obstruction, eye problems, throat problems, shock, schizophrenia, ysteria, various mental disorders, manic
depression, diseases of the urogenital system, appendici-
tis, deafness, ear diseases, frequent urination, impotence,
precox ejaculation, irregular menstruation, uterine
bleeding,facial paralysis, hypothermia, and diarrhea (ibid).
CONCLUSION
More extensive research in the area of health benefits
of traditional Thai massage therapy is needed. Research
has not been conducted in the past for several
reasons. Western studies tend to study causal-
effect relationships with relation to morbidity and
mortality without due consideration to the effects of
mentality and spirituality on the body. Often scientists
who are not students, practitioners or patients of tradi-
tional Thai medicine do not know how to interpret their
findings. With traditional Thai massage, along with other
traditional therapies, the healing effects may not be as
immediate as witha pill . There is also the crucial
element of obtaining funds for a long research period which
could prove difficul or even impossible given the general
lack of interest in research in this area (8). Because
manytreatments are based on spirituality, scientists have
left this field of research virtually untouched. However,
the health benefits are quite obvious and are reproducible.
Still, little is known about the causal relationship
between traditional treatments and the health benefits
largely due to lack of scientific data and the ignorance of
the western scientist. Some reluctance and doubt exists
about the validity of traditional medicines. The health
benefits of traditional Thai medicine including traditional
Thai massage are numerous and it is unfortunate that
traditional medicines are not utilized to their fullest
capacity as an inexpensive tool for both preventive and
curative care.
