copyright Joshua Jayintoh 2015
First Steps of Thai:
Traditional Ethics in the Making of a Thai Massage Doctors
We have all heard of the modus operandi in the west where physicians swear upon some version of the Hippocratic Oath as the basis for offering medical assistance, as well as for ethical accountability. In the old days, a person’s ‘word’ was their bond. I feel it is safe to say that I am not the only one who has been treated by a doctor or therapist whom I thought could improve their bedside manner, not to mention pondered over whether or not they solely possessed financial motives while assisting me. As the commercial social paradigm perseveres in driving us towards its adjudged version of abundance and achievement, I see the counterweight quest for whole health is growing paramount. Whomever we consider ourselves to be, we are all susceptible to illness and death. In receiving good medicine from a good doctor, let us take a look as what traditional, moral qualifications a Thai Doctor was required to possess.
Ancient Buddhist medical practices passed down through the ages from its homeland in Northern India and migrated to other lands. One such place was Thailand. The influence of Buddhism, and thus Buddhist medical practices, on Thailand has impacted the people and land since before its recorded formation. The Thai term given to massage therapists in Thailand is หมอนวด ‘Maw Nuad’, literally translated “Doctor (of) Massage”, owing to the fact that Thais revere qualified masseurs as doctors and expect them to act as such. Traditionally, as well as in current accordance with the Thai Ministry of Public Health, นวดไทย ‘Thai Massage’ is seen as an integral sub-sect of แพทย์แผนไทยโบราณ ‘Traditional Thai Medicine’.
In the Buddhist medical tradition of old, aspiring doctors would spend upwards of seven years in training in order to become a qualified doctor of medicine. As a standard, the first few years were spent cultivating ethical behavior, until it became second-nature in their everyday life. They would not only study spiritual texts on moral conduct, such as Shantideva’s Bodhisattvacaryāvatāra, but become proficient at putting them into practice. Doctors-to-be would read through the scriptures of the Sanskrit or Pali Buddhist Canon every day. This proceeded in conjunction with putting medical manuscripts to memory; e.g. the rGyud-bzhi ‘Four Tantras’ if in the Tibetan tradition, the คัมภีร์เวชศึกษา ‘khampi-wetchasueksa’1 and แพทย์ศาสตร์สงเคราะห์ ‘phaet-saat-songkroh’ if in the Thai tradition. To help inspire, as well as remind the practitioners of their accountability to the tradition, many would receive some type of initiation upon which they would take up vows and moral practices. An example of practices would be to regularly hold and practices the following five disciplines, or training exercises, known as the pañca-sīlāni in Pali:
1. Refrain from killing any sentient being
2. Refrain from stealing
3. Refrain from sexual misconduct [e.g. adultery, those in chastity or underaged]
4. Refrain from lying [false, divisive, harsh, and gossip / idle chatter]
5. Refrain from becoming intoxicated; i.e. alcohol, drugs
As the Thai medical profession evolved surrounded by its social and political environment, what remained constant was the perfecting of the Brahmavihāras, also known as the ‘Four Immeasureables’. Masters considered the Brahmavihāras to be the pillars of one’s practice because should a practitioner genuinely follow them then they would automatically follow the rest of the established ethical code expected of Traditional Thai Doctors. A common thread in the modern Thai Massage world is the practice of Mettā-bhāvanā, the “spreading (or distribution) of loving-kindness”. This is but one quarter of the Brahmavihāras, a fact which aspiring Thai Masseurs ought to remember. The four Brahmavihāras are comprised of:
- Mettā: “Loving-kindness”; the wish that a person, or all sentient beings without exception, be happy and have the cause of happiness.
- Karuṇā: “Compassion”; the wish that a person’s suffering, or that of all sentient beings without exception, will diminish and they will be free from suffering and the cause of suffering.
- Muditā: “Empathetic Joy”; rejoicing in and encouraging the happiness, success and accomplishments of a person, or all sentient beings without exception; the genuine wish that a person or all sentient beings never be separated from happiness.
- Upekkhā: “Equanimity”, “Impartiality”, “Non-prejudice”; removing any partiality towards whom one practices the three previous Brahmavihāras with; remaining in equanimity (unaffectedness) to the Attha Loka Dhamma.
- Loss and Gain
- Fame and Censure
- Praise and Slander
- Sorrow and Happiness
What these eight factors do is to remind us of the true intention and purpose of the medical profession: to remove the sufferings of sentient beings. If we are good therapists or doctors, practice well, and train ourselves well then people will want to come to us because we are good at what we do and we have genuine hearts with our offerings. Word- of-mouth is activated and spread, cyberneticly and physically. These eight factors are not telling us that we have to be poor or meek. In fact, traditionally it is important for the client-patient to not just offer something of value in exchange for a doctor’s aid, but to give them their full trust. Without the offering, the exchange becomes unbalanced and unfair, to both parties. The grey area of ‘what is equal exchange?’ is where the exploitations take place.
For these reasons, students are required to learn and observe a set code of conduct. The following is a translation of ten regulations from Thai to contemporary English used by the famed ‘Wat Po’ Chetupon School of Traditional Medicine in Bangkok2:
- Possess Mettā towards all patients equally, refraining from selecting patients based upon their wealth, fame, and preference.
- Do not treat patients solely out of greed and desire for money.
- Speak the truth and remember humility.
- Be honest and confident about one’s capabilities and knowledge, but do not advertise or tell patients that one is better than other doctors.
- Do not brag, boast, or advertise about one’s knowledge and capability, either in order to get more patients nor especially to the point where patients lose faith in other doctors.
- Know your community and your limitations. Share your patients. Do not obstruct other doctors and or speak poorly of other doctor’s capabilities, most especially if they currently have more knowledge than oneself.
- Refrain from prejudice and bias. A good doctor has a heart geared towards helping alleviate the suffering of everyone. Thus, do not treat people out of:
- Chandāgati: treating patients one endears, or has partiality towards, with
extra care while showing carelessness and indifference with those one does
not have an affinity towards.
- Mohagati: delusion; believing one possesses extraordinary skill to the point
where one treats patients with overconfidence and carelessness.
- Dosagati: treating a patient with annoyance, frustration, or anger in one’s
heart to the point where one does not give ‘their all’ to their patient.
- Bhayāgati: unfounded fear or worry while giving a treatment; i.e. fear that
they will not be able to pay, or will be completely cured and never come
back, or that they will go elsewhere and prefer that doctor instead.
- Chandāgati: treating patients one endears, or has partiality towards, with
- Remain unaffected by and indifferent to the Attha Loka Dhamma.
- Possess refinement and subtly of character, with a healthy fear of bad deeds in
body, speech, and mind. A good doctor remains loyal and honest to their duty and
- Be cautious and thorough. Avoid carelessness, laziness, and “half-ass-ness”.
- Possess thoughtfulness, consideration, and methodology. Rationally and
meticulously analyze the causes and conditions of the patient’s suffering. A good doctor fully utilizes their intelligence, knowledge, capability, skills of reflection and experience when giving treatments.
- Remove oneself from all habitual behavior leading to ruin and corruption, i.e. laziness, adultery [womanizing / man-izing], binge drinking, outlandish nightlife activities, indulgence in entertainment, gambling, and keeping the company of those leading such lifestyles.
In service, Joshua Jayintoh
1 an english translation now exists of this text and is within the book: Jacobsen, N. Salguero, CP. Wells, T. Thai Herbal Medicine. Scotland: Findhorn Press, 2013. Second Edition.
2 I personally translated these ten codes while I was studying at the Chetupon School of Traditional Medicine in Bangkok.