An Acupuncture Nerd in Thailand

The Chao Phraya River, which cuts through the center of Bangkok

As many of you may know, I am now in Thailand, in Krung Thep (Bangkok), the City of Angels! Actually the name for this city in Thai is the longest place name in the world (courtesy “Web of Linguistic Fun“). The following should be all one word:

Krungthepmahanakon…- (the land of angels, the great city of)

bowornratanakosin- (immortality, various of divine gems)

mahintarayudyayamahadilopop- (the great angelic land unconquerable)

noparatanarajthaniburirom– (land of nine noble gems, the royal city, the pleasant capital)

udomrajniwesmahasatarn– (place of the grand royal palace)

amornpimarnavatarsatit– (forever land of angels and reincarnated spirits)

sakattiyavisanukamphrasit– (predestined and created by the highest devas). 

The translation here is pretty much the unabridged history of the city rather than a word.

I’m visiting this beautiful and exciting country partially for personal reasons and partially for work. Half of my family lives here, and I have benefited from their amazing generosity in the past and present, as they have taken time to show me around the temples and marketplaces of Bangkok, Chiang Mai, Hua Hin, and many other villages around Thailand. This is the first time that I have a purpose in coming here other than pure touristing. I am here to work with Yanhee Hospital in their Natural Medicine Department, to learn Thai Massage, and to learn as much as I can about Thai Herbalism and Acupuncture’s role in the hospital system here.

The green blur is the sign for Yanhee Hospital, which I can see from my balcony

Now before you google Yanhee and start making assumptions, no I am not getting plastic surgery or undergoing a sex reassignment surgery, although about 80% of Yanhee’s patients have medical procedures in those categories. Yanhee has a large natural medicine department, which is where I am spending my time.

Lots of cosmetic surgery options here.

This is more like it:

Physiotherapy will be my jam (not pictured)

A happy coincidence allowed me to begin working with Yanhee Hospital, which is only a 20 minute walk from my house.  I will write a more detailed blog post about the actual hospital and the procedures that I’m involved in, but basically I am helping with rehabilitating patients who have had a stroke or who have cerebral palsy.

I ‘ll be treating mainly Thai stroke patients in the physiotherapy dept

Meanwhile, I will be learning Thai Massage next week, and currently I am doing an informal survey of acupuncture clinics in Bangkok. The ways that acupuncture is used here are very interesting, because acupuncture was only recently legalized in Thailand in the year 2000. Prior to that, you could receive acupuncture in Chinatown and at Chinese hospitals, but they were kind of unofficial or had to pay the police more than usual to stay in operation. Now Thailand is making strides towards popularizing this therapy and taking it out of the realm of purely a Chinese pursuit or a Spa treatment for westerners. Here is an example of a clinic that uses a more integrative approach-

I am actually really in love with this clinic (AcuMedic) and I recently had an herbal consultation with an elderly Chinese doctor of acupuncture. The AcuMedic clinic began in London, with a famous Chinese practitioner who spent his college years in Britain and has since treated Princess Di and other celebrities in Britain… this is their first branch in Asia and it seems they are doing an excellent job and working with amazing Chinese practitioners. I will provide a longer post exclusively about this clinic in the future, but for now all I have to say is, I’m so excited about this clinic!

The focus on health is very strong here in Bangkok. However, as I’m enjoying some of the tastiest and healthiest street food in the world, many Thai children are flocking to KFC and Mister Donut for their more ‘modern’ snacks. The same old story of increased levels of diabetes and hypertension in children is being played out in Bangkok, with the same attendant backlash against junk food, which is followed by a renewed interest in traditional medicine and ‘green’ or ‘natural’ products. In really great news, Thailand is also formalizing the teaching and accreditation of Traditional Thai Medicine.

DELICIOUS fresh pomegranate juice!

Next week I will begin my training at the Wat Pho school of massage. This is the place to go for any foreigner interested in learning Thai Massage. I am taking the general massage course, which is a prerequisite for their more intensive (and expensive) Thai Medical Massage course, which is 26 days, five days a week for a month, 9am to 4pm. I will take that course eventually, but for now I am starting from the beginning! Wat Pho itself is a beautiful temple with extensive grounds, housing the famous huge reclining Buddha and many other significant Buddhas and meditation halls such as this one:

Wat Pho is full of astounding sights

Not only is natural medicine gaining attention here, but also local and sustainable products are finding a bigger market. As part of the renewed interest in ‘green’ and natural products, the One Tambon, One Product program (tambon means village), aka OTOP, was instituted by former prime minister Thaksin Shinawatra in the early 2000s. OTOP promotes locally crafted items, many of which fall into the herbal or healing category.

The way it works is that representatives of the OTOP program visited the villages all over Thailand and helped them focus on creating one product for commercial production, rather than having a bunch of products in each village made with less efficiency. Basically they started to specialize and centralize this kind of production- one village would just focus on making brooms, another on herbal liniments, another on the best naturally dyed cotton, etc. The royal family then makes a wholesale purchase of village products from all over Thailand, and they then disburse the products at local market outlets and large conventions. This initiative, combined with other creative ways that former prime minister Thaksin helped pull Thailand out of the economic slump of 1997 onwards, has been dubbed Thaksinomics.

I enjoy visiting the huge OTOP conventions, since it’s a way to learn about the handcrafted products of all the regions of Thailand in a day or two. I always come away with a higher respect for the knowledge, expertise, and craftsmanship of the vendors and village representatives that I meet. Again, since this is kind of an overview/update post, I will be detailing the types of products that I got at the OTOP fair (including Thai herbal textbooks, eep!) in a future post. I have a lot of writing to do!

at the 6th day of the OTOP fair, the decorative flowers had seen better days

So in the next couple days I will be doing lots of writing and cataloging. The past two times I visited Thailand, I took notes but not nearly enough. I hope to use this blog as both a way for you to join me on my journey and also to document the places I go/ people I meet so I can remember them next time I am here! Meanwhile I will eat lots of longan fruit and goji berries to improve my memory 🙂

Even through the mists of time, in general Thailand is exactly as I remembered it. My perspective is different this time since I am focusing on working as well as sight-seeing, and this has opened my eyes greatly. Coming from the dark, rainy Pacific Northwest, I welcomed the sensory stimulus, heat, vibrance, and of course the delicious food of Bangkok! I am reminded why the energy drink was invented here – the sound level, pollution, and general feeling of pulsating life tend to inhibit the completion of a restful night’s sleep, and everyone works incessantly.

The best Pad Thai in Bangkok

Luckily I have no problem falling asleep on an accelerating airplane, in a tree, or on a public bus (to my chagrin), so I don’t need to worry about insomnia at this point. But I have noticed that since arriving, my quality of sleep has diminished and I don’t wake up as refreshed… hence the espresso, ginseng, red bull, 5-hour energy drink, or for some the aid of illegal uppers such as yaa baa, or “crazy medicine” (hello overly energetic taxi driver!).

2am tuk-tuk ride

As I’m writing this, it is only 11pm and the city is just as alive as it was at 11am, but without the songs blasted over loudspeakers at nearby schoolyards or yelling children running across backyards. In their place, other sounds fill the night: the cheering and whistles of a soccer game played in a neighborhood square; a howling street (“soi”) dog setting off a cacophony of yowls and yips, growing exponentially to the point of making me question whether a dog-riot is about to coalesce and get all Animal Farm on the humans; the murmur and rush of wind sweeping heavy clouds from the tips of skyscrapers; the stuttering yet constant beeps, honks, and grunts of traffic amplified, thickened by the darkness so that sounds bounce like pinballs from one bright street to the next, careening through my window from miles away.

Chao Phraya River at night

It’s difficult to describe the atmosphere here, but these impressions are one way to begin to BEGIN to get a handle on the culture and daily life of Bangkok.

Coming here has given me an interesting perspective on my own position in the US and internationally. I have continually returned to many questions in the past week since I have arrived in Bangkok. What does the schooling for acupuncture in the US actually accomplish? How prepared am I to treat severe conditions? How do I communicate my level of expertise properly? What is my worth? Why is the TCM educational system in the US so unstandardized? Why don’t acupuncturists (many of whom also learn herbalism, work in student clinic for over a year, and ultimately learn a complete and effective system of diagnosis and treatment) earn the title of Doctor, as do chiropractors and naturopathic physicians?

First of all, I’d like to say that I am confident in both my knowledge base and my ability as an acupuncturist. However, the critical, pessimistic, analytical parts of my being must pick apart and reconstruct the experience of my schooling in order to clearly communicate my level of expertise with colleagues in other areas of medicine.

After being asked many times in Bangkok, “Are you a Doctor?” and being referred to as “Doctor Beth,” when nurses understand that I am an acupuncturist, I begin to seriously question whether I am a doctor, why I should care if I’m a doctor or not, and who creates the meaning of being a doctor- who gets to define this doctor idea. I’m sure I could find some amazing medical anthropology texts that dive straight to the bottom of this question (if you have any good ones, please send them my way!), but I’m not sure if anyone ever surfaces after taking that teleological plunge. The notion of doctor-hood digs at the roots of existence, of being, and of ethics, morality, and spirituality. But I am not concerned with going into that now- I would like a more practical approach.

To me, the question of ‘doctor-hood’ comes down to two things: diagnosis and treatment. Can you make an accurate diagnosis according to the guidelines of your diagnostic framework? Can you provide an effective treatment based on that diagnosis? Does the patient recover and experience a return to a state of health and autonomy?

In that regard, yes I am a doctor. Traditional Chinese Medicine (TCM) has given me a highly sophisticated diagnostic tool, after learning the basic principles of which I am prepared to treat any condition that comes my way. In my 1.5 years of practice (not to mention the whole 2,000 years of recorded clinical efficacy), this has been borne out in reality, as I have both the tools to successfully treat conditions that have been presented to me (using a combination of herbal prescription and acupuncture with its associated modalities), and the knowledge to identify when a referral is needed (to the E.R., to a specialist, etc.). Granted, I am no biochemist or surgeon, but I am not using pharmaceutical grade doses of substances nor am I intervening in critical conditions. Using a complex, inductive system of diagnosis, I and my colleagues have the skill to address many recalcitrant conditions for which allopathic medicine has been ineffective.

Yet with everything that Traditional Chinese Medicine (TCM) has to offer in terms of primary care and preventive care, TCM remains completely vague and ill-defined in the public eye and in our institutions in the US. Even the name itself is up for discussion, since we have to differentiate between Classical Chinese Medicine, Traditional Oriental Medicine, Traditional Chinese Medicine, Traditional East Asian Medicine, and I’m sure more names of which I am not aware. Nomenclature in itself presents a hurdle, so that doesn’t bode well for the organization of our profession in further details.

For example, herbalism is a key component of TCM, yet the national accreditation board (NCCAOM) does not require the passing of an herbal board exam. California is the only state that requires comprehensive herbal knowledge in order to be a licensed acupuncturist- all other states use the national accreditation standard, if that. In my opinion, this is frightening and leaves our medicine open to justified criticism regarding safety and competence.

Personally, I would love to see the institution of a Traditional East Asian Medicine first doctorate, with stringent herbal prescription standards and a more demanding clinical experience (higher hours and patient count). If this were to be instituted, the profession could launch a real publicity campaign with the infrastructure to support inquiry into the standards of the profession, and we would have a greater ability as a whole to collaborate with integrative medicine teams due to a higher confidence level in our expertise as a profession. Currently, it seems that acupuncturists rely on the popular culture conception of our profession for a sense of legitimacy and acceptance, and we neglect the pursuit of developing a more demanding and standardized base curriculum in our colleges.

All of these thoughts have become incessant over the past week as I have struggled to place myself in a medical hierarchy in a foreign country, when I realize that I am not totally sure of my place in the medical food chain in my own country.

If you have any comments about this line of thought, I would be very interested to hear them- both from acupuncturists and non-acupuncturists! I know that this should be a different post as well, but I just had to add it here… ok I’m getting off my soap box 🙂

Thank you for listening! Stay tuned for much much more!!!

serious blogging face! or is that 'recently-escaped-heat-stroke' face?

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7 responses to “An Acupuncture Nerd in Thailand

  1. Hi Beth 😉
    So good to read about your travels and your thoughts! In medical anthropology class we learned that the word doctor comes from the latin word docere which means teacher. It seems one who is qualified to treat and teach patients how to achieve and maintain health should be addressed as doctor. But what would we call people who are trained to treat just one of the symptoms of disease or are skilled in prescribing pharmaceuticals that mask a symptom while the diseases are still present?
    Yours truly,
    Teresa

  2. Hi there , all this sounds really awesome.
    I am a French acupuncture student, currently studying in Canada but graduating very soon.
    I have trained in China and am also really interested in working or learning more about acupuncture in Thailand.
    You blog is very interesting , please let me know waht you find out 😉
    Cheers

    Indiana

  3. Same here… I m French, and trained as an acupuncturist and herbalist in Toronto looking to work in Thailand. Husband out of job for more than a year, it s time to consider relocating… And thought thailand might be an option.
    Thanks for all the info!

  4. Hi Beth, and thanks for the opportunity to respond to some of your thoughts regarding the broad field of acupuncture and its related regimens of diet, message and traditional Chinese Medicine. I have been a patient of three different acupuncturists, each of whom used pins but in addition went into other modalities, – physical manipulation/massage, diet, and Chinese medicines/herbs (which I have been advised to avoid because of lack of understanding of the product and the lack of quality control of the Chinese produced product). All treatments were for the same condition – itching over entire body. The treatment regimen is confusing to the uniformed patient who is left with the question: “Does acupuncture alone really work?” There is much disparity in the practice. How do we determine what works?
    But still an advocate of acupuncture!

    • That is a good question, Neil. Currently the World Health Organization is embarking upon a project to standardize the language and diagnostic categories of Chinese medicine, which do vary widely while sharing a common underlying principle. See: https://sites.google.com/site/whoictm/home

      With many professionals collaborating internationally, I think we will be able to start standardizing our language in order to be able to create more effectively reproducible studies with larger volumes of patients. We are at an exciting point in the history of acupuncture, when we are starting to marshal the scientific resources of the “West” to apply to the great numbers of people being treated in hospitals in China, South Korea, Taiwan, and now the US, Germany, Sweden, UK, Australia, and more.

      As far as “does acupuncture alone really work?” – we still need to provide more high-volume, repeated studies in order to start answering that question in a scientific sense. But in the clinical sense, yes there are many acupuncturists that use acupuncture alone to great effect.

      Regarding why so many acupuncturists use additional modalities, basically we are trying to perform the role of 3 or 4 doctors in one. Acupuncture and massage can create a great immediate effect, while exercises and dietary recommendations can help you extend the treatment at home. Chinese herbs can also be used alone to address complex medical conditions, but often acupuncturists use herbalism in order to improve the symptoms more quickly and allow the patient to spend a longer time between visits (more cost-effective for the patient ultimately).

      In China, herbal medicine is actually considered more complex and ‘advanced’ than acupuncture (it’s combined with pharmaceutical education), but we don’t have enough of a demand in the US for pure Chinese herbalists, so acupuncturists find themselves playing both roles. This can be very difficult due to the amount of constant study required to be a highly effective herbalist as well as acupuncturist. Dietary changes are a part of the herbal medical aspect of Chinese medicine, while massage and physical therapy are considered complementary to acupuncture. It’s just convenient to include them into a session if the practitioner is skilled in these techniques as well.

      I am curious if any of the treatments you received provided you with any relief of your symptom yet? Skill and knowledge base vary widely among practitioners, so sometimes it can take a few tries before you find a really great acupuncturist and/or herbalist 🙂 My advice for Chinese herbal medicine (which can be incredibly effective for unresolved conditions) is to call as many local acupuncturists as you have the patience to call, and ask them who they refer their toughest cases to for herbal medicine. Hopefully their referrals will overlap to some degree and you will have the local expert herbalist, usually a teacher or someone with many years of experience.

      I wish you the best!

  5. Howdy

    Did you see the video on Bangkok Post about acupucnture and face liftiing?

    http://www.bangkokpost.com/multimedia/vdo/thailand/404894/rejuvenating-the-face-one-needle-at-a-time

    Any thought ion the efficacy of this method ?

    Thx

    Stavros (also in Bangkok)

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