Traditional Thai Massage and Medicine Series

Welcome to this educational series! Being an immense subject that requires years of training to master, coverage will be brief.  My intention is to provide a taste of how this wonderful healing art developed and give a beginning insight to the theory behind the bodywork*.
Topics will include:

As comments and questions may arise, please feel free to call or email!
Phone: 503-481-6627

*DISCLAIMER: reading this information does not qualify someone to practice Thai Massage and/or Medicine, replace medical care by a trained physician, and is not medical advice. Always see a trained physician for your medical needs or a licensed massage therapist for your massage needs.

The Final Chapter


Remember how the condensation of elemental qualities through the layers of the physical body cause imbalance? By applying various physical therapies, the Thai massage practitioner dissipates those imbalances, bringing the body back into harmony.  As you learned, there are many techniques that fall under the umbrella of physical therapies and the approach taken depends on the layers affected, the element(s) involved, as well as other causative factors that may be present at the time.

In general, regardless of what is happening, the Thai massage therapist always works by beginning with the most superficial layer (skin) and ends with the deepest (organs).  The following are examples of how each layer could be treated as well as goal of treatment:

  1.  Skin ~ warming therapies such as rubbing, hot herbal compresses, gentle hand compression, applying balms/oils/linaments that have warming quality.  GOAL:  release pathogens through skin barrier, access tissue layer
  2. Tissue ~ massage, beating,  cupping, scraping, herbal applications.  GOAL: release spasms, adhesions, decrease pain, access sen layer
  3.  Sen (nerves, blood vessels, tendons, ligaments) ~ thumbing, compression, Tok Sen, point work, stretching.  GOAL: release blocked wind, increase blood and lymph circulation, release nerve impingement, access bone layer
  4.  Bone ~ range of motion, traction of joints.  GOAL: increase range of motion, release toxins, decrease inflammation, access organ layer
  5.  Organs ~ abdominal massage (working through the layers).  GOAL:  support function of processing toxins released from previous layers



As I mentioned above, the Thai massage therapist also takes into consideration the treatment of specific elements. Taking what you learned about them, how do you think you would care for the qualities of wind? fire? water? earth? Take a moment to write down your conclusions then read some answers below!







Please note:  the following examples are basic and do not fully encapsulate the extensive possibilities of treatment, nor are they intended for self diagnosis or self treatment; please consult a licensed professional for proper care.

WIND ~ needs warming. Use calming, balancing, rhythmic work.  Apply oil lubrication for dry skin




FIRE ~ needs cooling. Deep, strong, spot specific work at a slower pace, but not too slow. Cupping and scraping good for releasing heat.



WATER ~ needs warming. Approach with gentle, slow work accompanied with stretching and twisting. Apply balms and linaments that increase heat.



EARTH ~ potentially needs all of the above with some focus on increasing circulation (wind) and heat (fire).




Which treatment sounds best to you?  I wonder if this is based on your constitution or an imbalance?  What’s your guess!?!

This concludes the educational series “Thai Massage and Medicine”.  Thank you  for your curiosity, attention, and willingness to learn!  You are welcome to be in touch with any questions and/or comments.  I have thoroughly enjoyed sharing this tip of the iceberg and look forward to sharing more as my studies continue.  Again, I can not stress enough how important it is to understand that this series is not a replacement for professional expertise.  Always consult a licensed professional for your medical and bodywork needs.

♥Also, I want to express my deepest gratitude for my teacher Nephyr Jacobsen and the lineage of teachers in Thailand from which this knowledge comes, living and deceased, all the way back to the Buddha, Doctor Jivaka, and the Reusi.♥  If you would like to learn Thai Massage and Medicine,  I highly recommend taking a class with Nephyr.   Here is a link to her school the Naga Center.

Take care this winter, continue to play with the elements, and keep an eye out for the next educational series coming in January 2019 ~ Core Energetics Therapy Explained!



This explanation will be pretty brief as it is simple and straightforward, although not always in terms of symptoms and diagnosis.  There are two parts: WHAT are the physical layers and HOW disease or imbalance progresses through the layers.

  1. The Physical Layers

First of all, take a moment to consider the layers of your body.  Thinking about outer to inner, what is your best guess at what they are (hint: there are 5). No peeking!







How did you do?
Here are the answers:
a) Skin
b) Tissue (muscle, fascia, fat)
c) Sen (physical pathways along where movement happens; nerves, tendons and ligaments, blood vessels)
d) Bone
e) Organs

Surprised? Baffled? Fascinated?All of the above?

2.  Condensation and Dissipation:  the progression of imbalance through the layers
Going back to the elements, remember how they progress from lightest to heaviest? Here we apply the formation of the elements through condensation and dissipation. Here’s how:
Condensation of the elements: From space (nothingness) came movement (wind), from movement came friction causing heat (fire), from heat came moisture (water), and from moisture came solidity (earth).
Dissipation of the elements: Solid melts into liquid, liquid evaporates into heat, heat vapors into wind, and wind dissipates into space.

When applying this concept to the layers of the body, we see qualities of an element condense through the initial barrier (skin)  all the way to the organs.  It is the doctor’s job to dissipate the imbalance, hopefully before it reaches the organ!  Here is an example:

Someone has excess fire due to a burn.  The skin is red, wrinkled, and blistering.  The soft tissue is red accompanied with a burning sensation and muscle spasms.  They are experiencing severe pain and can not move (sen layer).  Their joints are aching (bone), and they are feeling nauseous (organ).

Can you think of a time when an element moved through your body in this way?  Consider any time you have had a cold, injury, surgery, organ related problems ~ is there a connection to how it began from the outer layer?


Thank you for reading ~ I told you it was brief!  Next up:  How Thai Massage fits into all of this!



(scroll down for parts one and two)

Elemental theory is based on the understanding that EVERYTHING is made out of earth, water, fire, and wind.  When applying this understanding to medical practices,  the physical, mental, emotional, and spiritual states are all viewed as manifestations of the qualities of these elements and as an extension, diagnosis and treatment is made based on the way in which the elements are currently presenting.  There is a fifth element, space, which is seen as all pervasive and not necessarily prone to imbalance.

Now take a moment to consider each element.
What is the quality?  Is it hard or soft? Light or heavy? Dry or wet? Still or moving? Hollow or solid? Hot or cold? Smooth or rough?
How do you experience it?  A good way to get a sense of this is by sitting with the element and embodying it through meditation.  My teacher had us do a meditation with each element and I found it to be very informative.
In what way does it provide function?  It’s interesting to ponder how these qualities and experiences apply to their job!
In a nutshell (or a human shell in this case), earth provides structure and is made up of the solid stuff such as hair, teeth, bones, nerves, blood vessels, organs and so on.  Water provides fluidity (think lubrication) and makes up all of our fluids ~ some examples are mucus, urine, tears, sweat, and saliva.  Fire provides heat and is responsible for the transformative part of digestion, ageing, fever, and general warmth.  Wind provides mobility, dryness where needed, and is always moving.   Not only does wind give us the ability to run, skip, climb, walk, dance etc., it  is the force required for our blood to move (circulation), to burp, vomit, breathe, for peristalsis; imagine our bodies without wind to move everything along!  Finally, what about space? It is expansive and provides the “playing field” for all the other elements. Fascinated yet!?!

These elemental qualities also manifest in specific physical, mental, and emotional characteristics.  I wonder if you can think of some for each one?  How would a watery person appear physically? How would they express themselves emotionally?  What would their mental attributes look like?  A windy person? A fiery or earthy person?  We are born with a core constitution which can be used as a baseline of “normal” when figuring out current imbalances, however, the most important thing is what is happening today.  With what element do you present first and foremost?

Here are some guidelines:
EARTHLY CHARACTERISTICS: heavy bone structure, square like shape, deep and resonant voice, abundant body hair, loyal, stable, trustworthy, stays in one place long time rather than moving a lot, doesn’t change much, challenging to learn new things, dependable
WATERY CHARACTERISTICS: large~round~”sweet” eyes, fleshy/hydrated skin, large/heavy body, abundance of hair (softer than earth), takes longer to learn new things and once learned it sticks, slow to change and to want to change, emotional, prone to depression, kind and loving disposition, intuitive intelligence
FIERY CHARACTERISTICS: average sized body with naturally athletic/muscular frame, reddish skin, body hair is soft, bright eyes, strong body odor, highly motivated and goal oriented, tend to be leaders, prone to anger/frustration, can be bullies, don’t get sick often
WINDY CHARACTERISTICS: extra tall or extra short with smaller-light skeleton, small-dark eyes, dry skin, thin, lots of ideas and not a lot of follow through, intellectually quick, artistically or spiritually inclined, prone to anxiety and restlessness, “flighty”
Furthermore, the different seasons, age ranges, and times of the day are also viewed elementally.  All of these factors are examined when a doctor is assessing someone’s state of health, which brings us to the next order of business ~ elements out of balance.


We can do everything right; eat well, exercise, brush our teeth, get plenty of sleep and so on, and still imbalances will happen; it is inevitable.  The shifting of balance is a natural occurrence so don’t think you are fundamentally flawed when your elements go ary.  Beginning with the state of balance, water, fire, and wind are susceptible to being agitated, depleted, distorted, broken, or totally lost (this means dying).  Earth can also be affected, however, less so since it is the heaviest of all the elements and apart from a direct injury, slowest to change.  Here are some examples of elemental imbalances:

Agitated fire ~ inflammation in the joints or skin rash
Depleted water ~ constipation or dehydration
Distorted wind ~ fluctuating blood pressure
Broken earth ~ torn ligament or broken bones
Lost wind ~ heart attack or lost fire ~ hypothermia
Can you think of a time when you experienced fire, water, wind, or earth out of balance?
How are they right now?


When an element is beginning to go into imbalance, your body will crave whatever will bring it back into balance.  This is the time when you first notice you are feeling a little off.  It is a crucial to take action because if ignored, the imbalance will progress and your body will begin to crave that which feeds it, ensuring it to worsen.  There is still hope at this stage and if treated appropriately, will go no further.  Otherwise, the imbalance will continue to progress and you will truly feel ill.


That concludes part three ~ Elemental Theory. I leave you with my thanks for reading and an invitation to turn your attention to how the elements exist within you and the external environment as you move through your day. It’s a whole new world to look through the lens of earth, water, fire, wind, and space! Please be in touch with any comments and/or questions; I would love to hear about your experience and curiosities!





PART TWO ~ The Branches of Thai Medicine
(if you missed Part One, please scroll down)

You may be surprised to learn that Thai Massage is only one working part of the larger system of Traditional Thai Medicine (TTM). Massage doctors in Thailand learn about all the different branches and while working in their specialty will utilize other areas of medicine, for example herbalism or Buddhist practices, to treat their patient, and vice versa. The focus on bodywork is mostly a result of the significant increase of tourism in Thailand in the late 1970’s; Western people were traveling there wanting to receive and learn Thai Massage. The combination of the tourist having very little time to learn the traditional medical theory, not speaking the language, being unable to commit to a long-term teacher-student relationship, and the willingness of the Thai people to cater to Western desires, Thai Massage and its dramatic stretches was extracted from TTM as a whole, infused with Western practices, and has been taught in other countries without the understanding of WHY and HOW it works. In fact, this lack of knowledge has been filled in with Ayurvedic and Chinese theory which was familiar to Westerners and already quite popular. However, this watering down of native practices began long before with the arrival of American Missionaries in the 1820’s (there was a resurgence during the Vietnam War in the 60’s), followed by the very first medical school (Bangkok 1890) eliminating traditional medicine in favor of western practices by the year 1915. In more recent history when interest in TTM reappeared, the government developed an official 4 year degree program in an effort to preserve tradition while continuing to lean more into Western anatomy and practices.

Today there are four categories of Thai Medicine:
1. Traditional Thai Medicine (TTM) ~ as mentioned above, this is the most recent evolution in the form of a 4 year degree program promoted by the Minsitry of Public Health
2. Traditional Medicine of Thailand (TMofT) ~ this varies from region to region, with practitioner, and which medical texts are used for reference. It is based on texts from the 1800’s and is written in both Thai and Khmer script.
3. Local or Indigenous Medicine ~ these are the village doctors and are based on local practices throughout the country, local texts, and local teachings. This type of medicine predates both TTM and TMofT.
4. Lanna Medicine ~ originating in the most northern part of Thailand, Lanna medicine dates back to the 13th century and is considered the oldest and most well-preserved tradition as well as being the indigenous medicine of the northern region. The texts and teachings are in Lanna script.

The six branches of Thai Medicine are:
1. Internal Medicine: herbs and diet
2. External Medicine: massage and bodywork
3. Divinatory Sciences: the oracular sciences such as numerology, palmistry, astrology, geomancy
4. Spirit Medicine: includes Shamanistic and Animistic practices such as working with spirits and deities, amulets, incantations, magical tattooing, spiritual herbalism, funeral rites, and other metaphysical/animistic practices
5. Buddhism: mental health and harmonious living; Buddhism is infused in all other branches
6. Midwifery: prenatal and postpartum care and medical assistance during childbirth


The external branch encompasses many practices in which practitioners may specialize while utilizing them all.  Some of these you have heard me mention during our sessions or you may have experienced. Can you spot them!?!
* Compression
* Bone setting
* external application of herbs
* Cupping
* Scraping
* Point work
* Sen work (releasing blockages along physical pathways)
* Stretching
* Blood letting
* Tok Sen (percussive therapy using tools and spirit medicine)
* Range of Motion
* Abdominal work
* Beating (creating deep vibration)

Thanks again for reading and as always, please feel free to reach out with any questions or comments!
Phone: 503-481-6627



PART ONE ~ The 3 Figureheads of Thai Medicine

Let’s get started!
My teacher says that it’s important to first learn about the geography because the original source of medicine is the land. Indigenous cultures’ connection with the natural world is where the study and practice of medicine began. When you look carefully at the indigenous medical systems across the globe, you will see the connection. Elemental theory, one of the crucial threads to Traditional Thai Medicine (TTM), was born from this very real, close living relationship with the land. Where we are born has a major influence on the formation of our physical constitution. Land and environment are key players while providing the necessary medicine, in all its forms, to treat imbalances.

Shaped like an elephant’s head Thailand is nestled among multiple countries; Myanmar (formally Burma) to the north, Laos to the northeast, Cambodia to the southeast, and Malaysia to the south. Though of farther reach, Vietnam, India, China, and Bangladesh are close neighbors! As you can see, Thailand has potential for influence from all directions.

Beyond the land being the primary origin of medicine, the main sources of TM are prehistory indigenous medicine, Mon and Khmer practices (Burmese and Cambodian respectively), pre-Ayurvedic from India, and pre-Traditional Chinese Medicine (TCM) from China. Another fundamental thread weaving this all together is Buddhism. Even though Buddhism is the main religion in Thailand today, Animism was the spiritual practice of the indigenous population and it continues to show up in the culture of every day living, and in Spirit Medicine (a branch of TTM). Besides the fact that Buddhism is deeply rooted in Thai culture, the lens of the Thai medical system views a person’s well being with the belief that physical, mental, emotional, and spiritual health depend on each other to achieve and maintain balance. If someone has a chronic condition, for example, and treatment with herbs, diet, physical therapies etc have not helped, it may be considered as something of a spiritual nature in which case they may be directed to seek spiritual guidance. This is a very simple explanation; the holistic approach to healthy balance can be much more complex.
*Mon refers to Burmese peoples and Khmer to Cambodian peoples.

Now, who do we have to thank for mixing these ingredients and creating TTM?
There are 3 main figureheads to whom we can give our thanks!

1. Buddha
Seen as the Ultimate Healer, Buddha teaches by helping people to understand that there is suffering and that it is possible to alleviate suffering. These teachings are based on the Four Noble Truths:
1. The reality of suffering
2. Understanding the causes of suffering
3. The cessation of suffering
4. The path to the cessation of suffering

2. Doctor Jivaka
For seven years Jivaka Komarabaccha studied with a teacher named Atreya. At the end of his studies, Atreya asked him to go in search of something that was not medicine. Believing he had failed, Jivaka returned empty handed and announced that he could not find anything that was not medicine. In response, his teacher pronounced him a true physician and sent him on his way. Jivaka continued to practice medicine and according to a tale in the Pali Vinaya, was asked to treat Shakyamuni Goutama (The Buddha). Sweet promotion 😉
He then became a lay monk and supported the monastery by donating his medical services, beginning the infusion of Thai Medicine with Buddhism. It is important to note that Doctor Jivaka’s tale is not unique to Thailand. Various versions are told in Tibet and China demonstrating the geographical span of influence his medical knowledge and practice reached, particularly through the spread of Buddhism.

3. Reusi
……variations in appearance and practice it’s often hard to determine what a Reusi is or is not. It’s possible to summarize the term Reusi by saying, the Reusi are the holders of natural law and sciences which have been passed down through the millenia.” writes Nephyr Jacobsen in her book Seven Peppercorns.

The Reusi are an elusive bunch, living mostly solo. They study nature and the natural law under their initiated teacher. Scientists of both exoteric (mathematics etc) and esoteric (astrology for example) realms, they learn through direct experimentation, and direct communcation with deities, spirit helpers, and plants, while following Buddhist precepts and practices. Dr. Jivaka and the Buddha himself are believed to have been Reusi.

Thank you for reading! I hope you enjoyed learning a little about the origin of Thai Medicine.
Next Episode: the 6 branches of Thai Medicine
Coming September 1st